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Raidt J, Riepenhausen S, Pennekamp P, Olbrich H, Amirav I, Athanazio RA, Aviram M, Balinotti JE, Bar-On O, Bode SFN, Boon M, Borrelli M, Carr SB, Crowley S, Dehlink E, Diepenhorst S, Durdik P, Dworniczak B, Emiralioğlu N, Erdem E, Fonnesu R, Gracci S, Große-Onnebrink J, Gwozdziewicz K, Haarman EG, Hansen CR, Hogg C, Holgersen MG, Kerem E, Körner RW, Kötz K, Kouis P, Loebinger MR, Lorent N, Lucas JS, Maj D, Mall MA, Marthin JK, Martinu V, Mazurek H, Mitchison HM, Nöthe-Menchen T, Özçelik U, Pifferi M, Pogorzelski A, Ringshausen FC, Roehmel JF, Rovira-Amigo S, Rumman N, Schlegtendal A, Shoemark A, Sperstad Kennelly S, Staar BO, Sutharsan S, Thomas S, Ullmann N, Varghese J, von Hardenberg S, Walker WT, Wetzke M, Witt M, Yiallouros P, Zschocke A, Ziętkiewicz E, Nielsen KG, Omran H. Analyses of 1236 genotyped primary ciliary dyskinesia individuals identify regional clusters of distinct DNA variants and significant genotype-phenotype correlations. Eur Respir J 2024; 64:2301769. [PMID: 38871375 PMCID: PMC11306806 DOI: 10.1183/13993003.01769-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) represents a group of rare hereditary disorders characterised by deficient ciliary airway clearance that can be associated with laterality defects. We aimed to describe the underlying gene defects, geographical differences in genotypes and their relationship to diagnostic findings and clinical phenotypes. METHODS Genetic variants and clinical findings (age, sex, body mass index, laterality defects, forced expiratory volume in 1 s (FEV1)) were collected from 19 countries using the European Reference Network's ERN-LUNG international PCD Registry. Genetic data were evaluated according to American College of Medical Genetics and Genomics guidelines. We assessed regional distribution of implicated genes and genetic variants as well as genotype correlations with laterality defects and FEV1. RESULTS The study included 1236 individuals carrying 908 distinct pathogenic DNA variants in 46 PCD genes. We found considerable variation in the distribution of PCD genotypes across countries due to the presence of distinct founder variants. The prevalence of PCD genotypes associated with pathognomonic ultrastructural defects (mean 72%, range 47-100%) and laterality defects (mean 42%, range 28-69%) varied widely among countries. The prevalence of laterality defects was significantly lower in PCD individuals without pathognomonic ciliary ultrastructure defects (18%). The PCD cohort had a reduced median FEV1 z-score (-1.66). Median FEV1 z-scores were significantly lower in CCNO (-3.26), CCDC39 (-2.49) and CCDC40 (-2.96) variant groups, while the FEV1 z-score reductions were significantly milder in DNAH11 (-0.83) and ODAD1 (-0.85) variant groups compared to the whole PCD cohort. CONCLUSION This unprecedented multinational dataset of DNA variants and information on their distribution across countries facilitates interpretation of the genetic epidemiology of PCD and indicates that the genetic variant can predict diagnostic and phenotypic features such as the course of lung function.
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Affiliation(s)
- Johanna Raidt
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Sarah Riepenhausen
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Petra Pennekamp
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Heike Olbrich
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Israel Amirav
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Rodrigo A Athanazio
- Pulmonary Division - Heart Institute, Hospital das Clínicas da Faculdade de São Paulo, São Paulo, Brazil
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Juan E Balinotti
- Respiratory Center, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sebastian F N Bode
- Center for Pediatrics - Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Mieke Boon
- Department of Paediatrics, University Hospital, Leuven, Belgium
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy
| | - Siobhan B Carr
- Department of Paediatric Respiratory Medicine and Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Eleonora Dehlink
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Diepenhorst
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter Durdik
- Department of Paediatrics, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin, Slovakia
| | - Bernd Dworniczak
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Nagehan Emiralioğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ela Erdem
- Department of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Rossella Fonnesu
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | - Serena Gracci
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | - Jörg Große-Onnebrink
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Karolina Gwozdziewicz
- Department of Pneumology and Cystic Fibrosis, Institute of Tuberculosis and Lung Diseases, Rabka, Poland
| | - Eric G Haarman
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christine R Hansen
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden
- Section for Lung Medicine, Metabolism and Neurology, Pediatrics Clinic, Skane University Hospital, Lund, Sweden
| | - Claire Hogg
- Department of Paediatric Respiratory Medicine and Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Mathias G Holgersen
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eitan Kerem
- Department of Pediatrics and Pediatric Pulmonology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Robert W Körner
- Department of Pediatrics, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Karsten Kötz
- Department of Pediatrics, Queen Silvias Children Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department Chrometa, BREATHE Laboratory, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jane S Lucas
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Debora Maj
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - June K Marthin
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Vendula Martinu
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Henryk Mazurek
- Department of Pneumology and Cystic Fibrosis, Institute of Tuberculosis and Lung Diseases, Rabka, Poland
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Tabea Nöthe-Menchen
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Ugur Özçelik
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | - Andrzej Pogorzelski
- Department of Pneumology and Cystic Fibrosis, Institute of Tuberculosis and Lung Diseases, Rabka, Poland
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jobst F Roehmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Rovira-Amigo
- Paediatric Pulmonology Section, Department of Paediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Nisreen Rumman
- Department of Pediatrics, Faculty of Medicine, Makassed Hospital, Al-Quds University, East Jerusalem, Palestine
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Katholisches Klinikum Bochum, Bochum, Germany
| | - Amelia Shoemark
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Ben O Staar
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Simon Thomas
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK
- Human Genetics and Genomic Medicine, University of Southampton Faculty of Medicine, Southampton, UK
| | - Nicola Ullmann
- Pneumology and Cystic Fibrosis Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Julian Varghese
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | | | - Woolf T Walker
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Wetzke
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Airway Research Center North (ARCN) Lübeck, German Center for Lung Research (DZL), Lübeck, Germany
| | - Michal Witt
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Panayiotis Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Hospital "Archbishop Makarios III", Nicosia, Cyprus
| | - Anna Zschocke
- Department of Pediatric and Adolescent Medicine, Pediatrics III, Medical University, Innsbruck, Austria
| | - Ewa Ziętkiewicz
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Kim G Nielsen
- Danish Primary Ciliary Dyskinesia Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
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Wee WB, Gatt D, Seidl E, Santyr G, To T, Dell SD. Estimates of primary ciliary dyskinesia prevalence: a scoping review. ERJ Open Res 2024; 10:00989-2023. [PMID: 39104959 PMCID: PMC11299005 DOI: 10.1183/23120541.00989-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/31/2024] [Indexed: 08/07/2024] Open
Abstract
Background Primary ciliary dyskinesia (PCD) is a rare multisystem genetic disease caused by dysfunctional motile cilia. Despite PCD being the second most common inherited airway disease after cystic fibrosis, PCD continues to be under-recognised globally owing to nonspecific clinical features and the lack of a gold standard diagnostic test. Commonly repeated prevalence estimates range from one in 10 000 to one in 20 000, based on regional epidemiological studies with known limitations. The purpose of this scoping review was to appraise the PCD literature, to determine the best available global PCD prevalence estimate and to inform the reader about the potential unmet health service needs in PCD. The primary objective of the present study was to systematically review the literature about PCD prevalence estimates. Methods A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) methodology. Included studies estimated PCD prevalence and used cohort, clinical or genomic data. Case reports, conference abstracts, review articles, animal studies or non-English articles were excluded. Results A literature review identified 3484 unique abstracts; 34 underwent full-text review and eight met the inclusion/exclusion criteria. Seven articles were based on epidemiological studies of specific geographical regions and provided prevalence estimates that ranged from approximately one to 44.1 in 100 000. Only one study estimated global prevalence, using two large genomic databases, and calculated it to be ∼13.2 in 100 000 (based on pathogenic variants in 29 disease-causing genes). Conclusions A population-based genomic approach for estimating global prevalence has found that PCD is much more prevalent than previously cited in the literature. This highlights the potential unmet health service needs of people living with PCD.
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Affiliation(s)
- Wallace B. Wee
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, The Stollery Children's Hospital, Edmonton, AB, Canada
- Dalla Lana School of Public Health, University Toronto, Toronto, ON, Canada
| | - Dvir Gatt
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elias Seidl
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Giles Santyr
- Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University Toronto, Toronto, ON, Canada
| | - Sharon D. Dell
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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3
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Schreck LD, Pedersen ESL, Dexter K, Manion M, Massin N, Maitre B, Goutaki M, Kuehni CE. Infertility and pregnancy outcomes among adults with primary ciliary dyskinesia. Hum Reprod Open 2024; 2024:hoae039. [PMID: 38962571 PMCID: PMC11219480 DOI: 10.1093/hropen/hoae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/21/2024] [Indexed: 07/05/2024] Open
Abstract
STUDY QUESTION What is the prevalence of infertility and ectopic pregnancies among individuals with primary ciliary dyskinesia (PCD)? SUMMARY ANSWER We found that 39 of 50 men (78%) and 72 of 118 women (61%) with PCD were infertile and that women with PCD had an increased risk of ectopic pregnancies (7.6 per 100 pregnancies, 95% CI 4.7-12.2). WHAT IS KNOWN ALREADY PCD is a heterogeneous multiorgan disease caused by mutations in genes required for the function and structure of motile cilia. Previous studies identified a link between PCD and infertility, but original data on prevalence of infertility and risk of ectopic pregnancies, the use and efficacy of medically assisted reproduction (MAR), and the association of fertility with PCD genotype are extremely limited. STUDY DESIGN SIZE DURATION We performed a cross-sectional survey about fertility within the Living with PCD study (formerly COVID-PCD). Living with PCD is an international, online, participatory study that collects information directly from people with PCD. People with PCD of any age from anywhere in the world can participate in the study. At the time of the survey, 482 adults with PCD were registered within the Living with PCD study. PARTICIPANTS/MATERIALS SETTING METHODS We sent a questionnaire on fertility on 12 July 2022, to all participants older than 18 years enrolled in the Living with PCD study. Responses were collected until 8 March 2023. The fertility questionnaire covered topics related to pregnancy attempts, use of MAR, and pregnancy outcomes. Data were collected via the Research Electronic Data Capture (REDCap) platform. We defined infertility as failure to achieve a clinical pregnancy after 12 months or use of MAR for at least one pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE In total, 265 of 482 adult participants (55%) completed the fertility questionnaire. Among 168 adults who had tried to conceive, 39 of 50 men (78%) and 72 of 118 women (61%) were infertile. Of the infertile men, 28 had tried MAR, and 17 of them (61%) fathered a child with the help of MAR. Among infertile women, 59 had used MAR, and 41 of them (69%) became pregnant with the help of MAR. In our population, women with PCD showed a relatively high risk of ectopic pregnancies: 1 in 10 women who became pregnant had at least one ectopic pregnancy and 7.6% of pregnancies were ectopic (95% CI 4.7-12.2). We evaluated the association between fertility and affected PCD genes in 46 individuals (11 men, 35 women) with available genetic and fertility information, and found differences between genotypes, e.g. all five women with a mutation in CCDC40 were infertile and all five with DNAH11 were fertile. LIMITATIONS REASONS FOR CAUTION The study has limitations, including potential selection bias as people experiencing problems with fertility might be more likely to fill in the questionnaire, which may have influenced our prevalence estimates. We were unable to validate clinical data obtained from participant self-reports owing to the anonymous study design, which is likely to lead to recall bias. WIDER IMPLICATIONS OF THE FINDINGS The study underlines the need for addressing infertility in routine PCD care, with a focus on informing individuals with PCD about their increased risk. It emphasizes the utility and efficacy of MAR in PCD-related infertility. Additionally, women attempting conception should be made aware of the increased risk of ectopic pregnancies and seek systematic early consultation to confirm an intrauterine pregnancy. Fertility, efficacy of MAR, and risk for adverse pregnancy outcomes differ between people with PCD-depending on genotypes-and close monitoring and support might be needed from fertility specialists to increase chances of successful conception. STUDY FUNDING/COMPETING INTERESTS Our research was funded by the Swiss National Science Foundation, Switzerland (SNSF 320030B_192804), the Swiss Lung Association, Switzerland (2021-08_Pedersen), and we also received support from the PCD Foundation, USA; the Verein Kartagener Syndrom und Primäre Ciliäre Dyskinesie, Germany; the PCD Support UK, UK; and PCD Australia, Australia. M. Goutaki received funding from the Swiss National Science Foundation, Switzerland (PZ00P3_185923). B. Maitre participates in the RaDiCo-DCP funded by INSERM France. The study authors participate in the BEAT-PCD Clinical Research Collaboration supported by the European Respiratory Society. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID NCT04602481.
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Affiliation(s)
- Leonie D Schreck
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Nathalie Massin
- IVF Center, American Hospital of Paris, Neuilly-sur-Seine, France
| | - Bernard Maitre
- Institut National de la Santé et de la Recherche Médicale (INSERM), IMRB, Université Paris-Est Créteil, Créteil, France
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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Wee WB, Kinghorn B, Davis SD, Ferkol TW, Shapiro AJ. Primary Ciliary Dyskinesia. Pediatrics 2024; 153:e2023063064. [PMID: 38695103 PMCID: PMC11153322 DOI: 10.1542/peds.2023-063064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 06/02/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetic disease characterized by dysfunctional motile cilia and abnormal mucociliary clearance, resulting in chronic sino-oto-pulmonary disease, neonatal respiratory distress, subfertility, and organ laterality defects. Over the past 2 decades, research and international collaborations have led to an improved understanding of disease prevalence, classic and variable phenotypes, novel diagnostics, genotype-phenotype correlations, long term morbidity, and innovative therapeutics. However, PCD is often underrecognized in clinical settings and the recent analyses of genetic databases suggest that only a fraction of these patients are being accurately diagnosed. Knowledge of significant advancements, from pathophysiology to the expanded range of clinical manifestations, will have important clinical impacts. These may include increasing disease recognition, improving diagnostic testing and management, and establishing an adequate pool of affected patients to enroll in upcoming clinical therapeutic trials. The objective of this state-of-the-art review is for readers to gain a greater understanding of the clinical spectrum of motile ciliopathies, cutting-edge diagnostic practices, emerging genotype-phenotype associations, and currently accepted management of people with PCD.
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Affiliation(s)
- Wallace B. Wee
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - BreAnna Kinghorn
- University of Washington, School of Medicine, Pediatrics, Seattle, Washington
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Thomas W. Ferkol
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Adam J. Shapiro
- McGill University Health Centre Research Institute, Montreal Children’s Hospital, Montreal, Quebec, Canada
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Han RC, Taylor LJ, Martinez-Fernandez de la Camara C, Henderson RH, Thompson DA, Cehajic-Kapetanovic J, MacLaren RE. Is RPGR-related retinal dystrophy associated with systemic disease? A case series. Ophthalmic Genet 2023; 44:577-584. [PMID: 36602268 DOI: 10.1080/13816810.2022.2163405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ciliopathies responsible for retinitis pigmentosa can also cause systemic manifestations. RPGR is a ciliary gene and pathogenic variants in RPGR cause a retinal ciliopathy, the commonest cause of X-linked recessive retinitis pigmentosa. The RPGR protein interacts with numerous other ciliary proteins present in the transition zone of both motile and sensory cilia, and may play an important role in regulating ciliary protein transport. There has been a growing, putative association of RPGR variants with systemic ciliopathies: mainly sino-respiratory infections and primary ciliary dyskinesia. MATERIALS AND METHODS Retrospective case series of patients with RPGR-RP presenting to Oxford Eye Hospital with systemic disease. RESULTS We report three children with RPGR-related rod-cone dystrophy, all of whom have mutations in the N-terminus of RPGR. Two cases co-presented with confirmed diagnoses of primary ciliary dyskinesia and one case with multiple sino-respiratory symptoms strongly suggestive of primary ciliary dyskinesia. These and all previously reported RPGR co-pathologies relate to ciliopathies and have no other systemic associations. CONCLUSIONS The link between RPGR variants and a systemic ciliopathy remains plausible, but currently unproven.
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Affiliation(s)
- Ruofan Connie Han
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Laura J Taylor
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Robert H Henderson
- Department of Ophthalmology, Great Ormond Street Children's Hospital, London, UK
| | - Dorothy A Thompson
- Department of Ophthalmology, Great Ormond Street Children's Hospital, London, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Jasmina Cehajic-Kapetanovic
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robert E MacLaren
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Rumman N, Fassad MR, Driessens C, Goggin P, Abdelrahman N, Adwan A, Albakri M, Chopra J, Doherty R, Fashho B, Freke GM, Hasaballah A, Jackson CL, Mohamed MA, Abu Nema R, Patel MP, Pengelly RJ, Qaaqour A, Rubbo B, Thomas NS, Thompson J, Walker WT, Wheway G, Mitchison HM, Lucas JS. The Palestinian primary ciliary dyskinesia population: first results of the diagnostic and genetic spectrum. ERJ Open Res 2023; 9:00714-2022. [PMID: 37077557 PMCID: PMC10107064 DOI: 10.1183/23120541.00714-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/04/2023] [Indexed: 04/21/2023] Open
Abstract
Background Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. Methods Individuals with symptoms suggestive of PCD were opportunistically considered for diagnostic testing: nasal nitric oxide (nNO) measurement, transmission electron microscopy (TEM) and/or PCD genetic panel or whole-exome testing. Clinical characteristics of those with a positive diagnosis were collected close to testing including forced expiratory volume in 1 s (FEV1) Global Lung Index z-scores and body mass index z-scores. Results 68 individuals had a definite positive PCD diagnosis, 31 confirmed by genetic and TEM results, 23 by TEM results alone, and 14 by genetic variants alone. 45 individuals from 40 families had 17 clinically actionable variants and four had variants of unknown significance in 14 PCD genes. CCDC39, DNAH11 and DNAAF11 were the most commonly mutated genes. 100% of variants were homozygous. Patients had a median age of 10.0 years at diagnosis, were highly consanguineous (93%) and 100% were of Arabic descent. Clinical features included persistent wet cough (99%), neonatal respiratory distress (84%) and situs inversus (43%). Lung function at diagnosis was already impaired (FEV1 z-score median -1.90 (-5.0-1.32)) and growth was mostly within the normal range (z-score mean -0.36 (-3.03-2.57). 19% individuals had finger clubbing. Conclusions Despite limited local resources in Palestine, detailed geno- and phenotyping forms the basis of one of the largest national PCD populations globally. There was notable familial homozygosity within the context of significant population heterogeneity.
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Affiliation(s)
- Nisreen Rumman
- Pediatric Department, Makassed Hospital, East Jerusalem, Palestine
- Caritas Hospital, Bethlehem, Palestine
- Al-Quds University, School of Medicine, East Jerusalem, Palestine
- Joint first authors
| | - Mahmoud R. Fassad
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Joint first authors
| | - Corine Driessens
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
- Joint first authors
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Biomedical Imaging Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Joint first authors
| | - Nader Abdelrahman
- Internal Medicine Department, Makassed Hospital, East Jerusalem, Palestine
| | - Adel Adwan
- Al-Quds University, School of Medicine, East Jerusalem, Palestine
| | - Mutaz Albakri
- Internal Medicine Department, Makassed Hospital, East Jerusalem, Palestine
| | - Jagrati Chopra
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Regan Doherty
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Biomedical Imaging Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Grace M. Freke
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Claire L. Jackson
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mai A. Mohamed
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- Biochemistry Division, Chemistry Department, Faculty of Science, Zagazig University, Ash Sharqiyah, Egypt
| | | | - Mitali P. Patel
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Reuben J. Pengelly
- Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
| | - Ahmad Qaaqour
- Internal Medicine Department, Makassed Hospital, East Jerusalem, Palestine
| | - Bruna Rubbo
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N. Simon Thomas
- Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
| | - James Thompson
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Biomedical Imaging Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Woolf T. Walker
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gabrielle Wheway
- Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
| | - Hannah M. Mitchison
- Genetics and Genomic Medicine Research and Teaching Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- Joint senior authors
| | - Jane S. Lucas
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Joint senior authors
- Corresponding author: Jane S. Lucas ()
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7
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Characterization of a DRC1 null variant associated with primary ciliary dyskinesia and female infertility. J Assist Reprod Genet 2023; 40:765-778. [PMID: 36856967 DOI: 10.1007/s10815-023-02755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
PROPOSE We here present a female case with primary ciliary dyskinesia (PCD) and infertility. In this report, we also present the evaluation of the patient family, including her twin sister, also with PCD and infertility. METHODS Confirmation of the PCD clinical diagnosis was performed through assessment of cilia motility, by high-speed video microscopy (HSVM), axoneme ultrastructure, by transmission electron microscopy (TEM), and genetic characterization, by whole-exome sequence (WES). Gene expression studies used qPCR for mRNA expression and immunofluorescence to determine cell protein localization. RESULTS We identified a homozygous nonsense variant in the DRC1 gene (NM 145038.5:c.352C>T (p.Gln118Ter)) in the female patient with PCD and infertility that fit the model of autosomal recessive genetic transmission. This variant eventually results in a dyskinetic ciliary beat with a lower frequency and a partial lack of both dynein arms as revealed by TEM analysis. Moreover, this variant implies a decrease in the expression of DRC1 mRNA and protein. Additionally, expression analysis suggested that DRC1 may interact with other DRC elements. CONCLUSIONS Our findings suggest that the DRC1 null variant leads to PCD associated with infertility, likely caused by defects in axoneme from Fallopian tube cilia. Overall, our outcomes contribute to a better understanding of the genetic factors involved in the pathophysiology of PCD and infertility, and they highlight the interaction of different genes in the patient phenotype, which should be investigated further because it may explain the high heterogeneity observed in PCD patients.
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8
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Raidt J, Maitre B, Pennekamp P, Altenburg J, Anagnostopoulou P, Armengot M, Bloemsma LD, Boon M, Borrelli M, Brinkmann F, Carr SB, Carroll MP, Castillo-Corullón S, Coste A, Cutrera R, Dehlink E, Destouches DMS, Di Cicco ME, Dixon L, Emiralioglu N, Erdem Eralp E, Haarman EG, Hogg C, Karadag B, Kobbernagel HE, Lorent N, Mall MA, Marthin JK, Martinu V, Narayanan M, Ozcelik U, Peckham D, Pifferi M, Pohunek P, Polverino E, Range S, Ringshausen FC, Robson E, Roehmel J, Rovira-Amigo S, Santamaria F, Schlegtendal A, Szépfalusi Z, Tempels P, Thouvenin G, Ullmann N, Walker WT, Wetzke M, Yiallouros P, Omran H, Nielsen KG. The disease-specific clinical trial network for Primary Ciliary Dyskinesia (PCD-CTN). ERJ Open Res 2022; 8:00139-2022. [PMID: 35983540 PMCID: PMC9379353 DOI: 10.1183/23120541.00139-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients. The disease-specific clinical trial network for primary ciliary dyskinesia (PCD-CTN) was built under the framework of the European Reference Network (ERN)-LUNG PCD Core, and operates to establish evidence-based and new personalised treatment for PCDhttps://bit.ly/3sLtC8o
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9
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Nielsen KG, Holgersen MG, Crowley S, Marthin JK. Chronic airway disease in primary ciliary dyskinesia—spiced with geno–phenotype associations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C: SEMINARS IN MEDICAL GENETICS 2022; 190:20-35. [PMID: 35352480 PMCID: PMC9314966 DOI: 10.1002/ajmg.c.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2022]
Abstract
Primary ciliary dyskinesia (PCD) can be defined as a multiorgan ciliopathy with a dominant element of chronic airway disease affecting the nose, sinuses, middle ear, and in particular, the lower airways. Although most patients with PCD are diagnosed during preschool years, it is obvious that the chronic lung disease starts its course already from birth. The many faces of the clinical picture change, as does lung function, structural lung damage, the burden of infection, and of treatment throughout life. A markedly severe neutrophil inflammation in the respiratory tract seems pervasive and is only to a minimal extent ameliorated by a treatment strategy, which is predominantly aimed at bacterial infections. An ever‐increasing understanding of the different aspects, their interrelationships, and possible different age courses conditioned by the underlying genotype is the focus of much attention. The future is likely to offer personalized medicine in the form of mRNA therapy, but to that end, it is of utmost importance that all patients with PCD be carefully characterized and given a genetic diagnosis. In this narrative review, we have concentrated on lower airways and summarized the current understanding of the chronic airway disease in this motile ciliopathy. In addition, we highlight the challenges, gaps, and opportunities in PCD lung disease research.
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Affiliation(s)
- Kim G Nielsen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mathias G Holgersen
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases Oslo University Hospital, Rikshospitalet Oslo Norway
| | - June K Marthin
- Department of Paediatrics and Adolescent Medicine Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited Copenhagen Denmark
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10
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Goutaki M, Hüsler L, Lam YT, Koppe HM, Jung A, Lazor R, Müller L, Pedersen ESL, Kuehni CE. Respiratory symptoms of Swiss people with Primary Ciliary Dyskinesia. ERJ Open Res 2022; 8:00673-2021. [PMID: 35415187 PMCID: PMC8995537 DOI: 10.1183/23120541.00673-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 11/08/2022] Open
Abstract
Background Mostly derived from chart reviews, where symptoms are recorded in a nonstandardised manner, clinical data about primary ciliary dyskinesia (PCD) are inconsistent, which leads to missing and unreliable information. We assessed the prevalence and frequency of respiratory and ear symptoms and studied differences by age and sex among an unselected population of Swiss people with PCD. Methods We sent a questionnaire that included items from the FOLLOW-PCD standardised questionnaire to all Swiss PCD registry participants. Results We received questionnaires from 74 (86%) out of 86 invited persons or their caregivers (median age 23 years, range 3–73 years), including 68% adults (≥18 years) and 51% females. Among participants, 70 (94%) reported chronic nasal symptoms; most frequently runny nose (65%), blocked nose (55%) or anosmia (38%). Ear pain and hearing problems were reported by 58% of the participants. Almost all (99%) reported cough and sputum production. The most common chronic cough complications were gastro-oesophageal reflux (n=11; 15%), vomiting (n=8; 11%) and urinary incontinence (n=6; 8%). Only nine (12%) participants reported frequent wheeze, which occurred mainly during infection or exercise, while 49 (66%) reported shortness of breath, and 9% even at rest or during daily activities. Older patients reported more frequent nasal symptoms and shortness of breath. We found no difference by sex or ultrastructural ciliary defect. Conclusion This is the first study to describe patient-reported PCD symptoms. The consistent collection of standardised clinical data will allow us to better characterise the phenotypic variability of the disease and study disease course and prognosis. Detailed information about patient-reported PCD symptoms will help characterise the phenotypic variability of the disease and could inform the development of individualised treatment strategies for patientshttps://bit.ly/363Zb4T
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11
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Hyland RM, Brody SL. Impact of Motile Ciliopathies on Human Development and Clinical Consequences in the Newborn. Cells 2021; 11:125. [PMID: 35011687 PMCID: PMC8750550 DOI: 10.3390/cells11010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Motile cilia are hairlike organelles that project outward from a tissue-restricted subset of cells to direct fluid flow. During human development motile cilia guide determination of the left-right axis in the embryo, and in the fetal and neonatal periods they have essential roles in airway clearance in the respiratory tract and regulating cerebral spinal fluid flow in the brain. Dysregulation of motile cilia is best understood through the lens of the genetic disorder primary ciliary dyskinesia (PCD). PCD encompasses all genetic motile ciliopathies resulting from over 60 known genetic mutations and has a unique but often underrecognized neonatal presentation. Neonatal respiratory distress is now known to occur in the majority of patients with PCD, laterality defects are common, and very rarely brain ventricle enlargement occurs. The developmental function of motile cilia and the effect and pathophysiology of motile ciliopathies are incompletely understood in humans. In this review, we will examine the current understanding of the role of motile cilia in human development and clinical considerations when assessing the newborn for suspected motile ciliopathies.
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Affiliation(s)
- Rachael M. Hyland
- Department of Pediatrics, Division of Newborn Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO 63110,USA;
| | - Steven L. Brody
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO 63110, USA
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12
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Holgersen MG, Marthin JK, Johansen HK, Nielsen KG. A retrospective review of Achromobacter species and antibiotic treatments in patients with primary ciliary dyskinesia. Chron Respir Dis 2021; 18:14799731211061600. [PMID: 34854775 PMCID: PMC8646779 DOI: 10.1177/14799731211061600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Primary ciliary dyskinesia (PCD) is a rare congenital disease with defective mucociliary clearance causing frequent and often persistent pulmonary infections. Achromobacter species are opportunistic pathogens renowned for the difficulty of effective treatments and deteriorating effects on lung function. We aimed to describe the occurrence, treatment, and rate of successful eradication of Achromobacter species in patients with PCD. Methods: We retrospectively reviewed 18 years of historical microbiological samples and 10 years of electronic health records for PCD patients in Denmark. Results: We included 136 patients. Twenty-six patients had isolates of Achromobacter species. On average, 5% of the cohort had at least one annual isolate. Infections became persistent in 38% with a median length of 6.6 years leading to a significant number of antibiotic treatments. Resistance toward tobramycin and ciprofloxacin was prevalent. Overall, successful eradication was achieved in 62% of patients. We found the course of lung function significantly worse during persistent Achromobacter species infection than during the two preceding years, but not different to the course in unaffected age-matched controls. Conclusion The prevalence of Achromobacter species in patients with PCD is in line with what has been reported in cystic fibrosis and can occur transiently, intermittently, or develop into a serious persistent lung infection associated with long-term antibiotic treatment.
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Affiliation(s)
- Mathias G Holgersen
- Danish Paediatric Pulmonary Service, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
| | - June K Marthin
- Danish Paediatric Pulmonary Service, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
| | - Helle K Johansen
- Department of Clinical Microbiology, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Kim G Nielsen
- Danish Paediatric Pulmonary Service, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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13
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Paff T, Omran H, Nielsen KG, Haarman EG. Current and Future Treatments in Primary Ciliary Dyskinesia. Int J Mol Sci 2021; 22:9834. [PMID: 34575997 PMCID: PMC8470068 DOI: 10.3390/ijms22189834] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic ciliopathy in which mucociliary clearance is disturbed by the abnormal motion of cilia or there is a severe reduction in the generation of multiple motile cilia. Lung damage ensues due to recurrent airway infections, sometimes even resulting in respiratory failure. So far, no causative treatment is available and treatment efforts are primarily aimed at improving mucociliary clearance and early treatment of bacterial airway infections. Treatment guidelines are largely based on cystic fibrosis (CF) guidelines, as few studies have been performed on PCD. In this review, we give a detailed overview of the clinical studies performed investigating PCD to date, including three trials and several case reports. In addition, we explore precision medicine approaches in PCD, including gene therapy, mRNA transcript and read-through therapy.
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Affiliation(s)
- Tamara Paff
- Department of Paediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Heymut Omran
- Department of General Pediatrics, University Childrens’s Hospital Muenster, 48149 Muenster, Germany;
| | - Kim G. Nielsen
- Danish PCD Centre, Danish Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Righospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Eric G. Haarman
- Department of Paediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
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14
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Müller L, Savas ST, Tschanz SA, Stokes A, Escher A, Nussbaumer M, Bullo M, Kuehni CE, Blanchon S, Jung A, Regamey N, Haenni B, Schneiter M, Ingold J, Kieninger E, Casaulta C, Latzin P. A Comprehensive Approach for the Diagnosis of Primary Ciliary Dyskinesia-Experiences from the First 100 Patients of the PCD-UNIBE Diagnostic Center. Diagnostics (Basel) 2021; 11:1540. [PMID: 34573882 PMCID: PMC8466881 DOI: 10.3390/diagnostics11091540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disease characterized by dyskinetic cilia. Respiratory symptoms usually start at birth. The lack of diagnostic gold standard tests is challenging, as PCD diagnostics requires different methods with high expertise. We founded PCD-UNIBE as the first comprehensive PCD diagnostic center in Switzerland. Our diagnostic approach includes nasal brushing and cell culture with analysis of ciliary motility via high-speed-videomicroscopy (HSVM) and immunofluorescence labeling (IF) of structural proteins. Selected patients undergo electron microscopy (TEM) of ciliary ultrastructure and genetics. We report here on the first 100 patients assessed by PCD-UNIBE. All patients received HSVM fresh, IF, and cell culture (success rate of 90%). We repeated the HSVM with cell cultures and conducted TEM in 30 patients and genetics in 31 patients. Results from cell cultures were much clearer compared to fresh samples. For 80 patients, we found no evidence of PCD, 17 were diagnosed with PCD, two remained inconclusive, and one case is ongoing. HSVM was diagnostic in 12, IF in 14, TEM in five and genetics in 11 cases. None of the methods was able to diagnose all 17 PCD cases, highlighting that a comprehensive approach is essential for an accurate diagnosis of PCD.
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Affiliation(s)
- Loretta Müller
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Sibel T. Savas
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Stefan A. Tschanz
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Andrea Stokes
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Anaïs Escher
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Mirjam Nussbaumer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Marina Bullo
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Claudia E. Kuehni
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Sylvain Blanchon
- Pediatric Pulmonology and Cystic Fibrosis Unit, Service of Pediatrics, Department Woman–Mother–Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Andreas Jung
- Division of Respiratory Medicine, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children’s Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Beat Haenni
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Martin Schneiter
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
- Institute of Applied Physics, University of Bern, 3012 Bern, Switzerland
| | - Jonas Ingold
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
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Abstract
Primary ciliary dyskinesia (PCD) is an inherited cause of bronchiectasis. The estimated PCD prevalence in children with bronchiectasis is up to 26% and in adults with bronchiectasis is 1 to 13%. Due to dysfunction of the multiple motile cilia of the respiratory tract patients suffer from poor mucociliary clearance. Clinical manifestations are heterogeneous; however, a typical patient presents with chronic productive cough and rhinosinusitis from early life. Other symptoms reflect the multiple roles of motile cilia in other organs and can include otitis media and hearing loss, infertility, situs inversus, complex congenital heart disease, and more rarely other syndromic features such as hydrocephalus and retinitis pigmentosa. Awareness, identification, and diagnosis of a patient with PCD are important for multidisciplinary care and genetic counseling. Diagnosis can be pursued through a multitest pathway which includes the measurement of nasal nitric oxide, sampling the nasal epithelium to assess ciliary function and structure, and genotyping. Diagnosis is confirmed by the identification of a hallmark ultrastructural defect or pathogenic mutations in one of > 45 PCD causing genes. When a diagnosis is established management is centered around improving mucociliary clearance through physiotherapy and treatment of infection with antibiotics. The first international randomized controlled trial in PCD has recently been conducted showing azithromycin is effective in reducing exacerbations. It is likely that evidence-based PCD-specific management guidelines and therapies will be developed in the near future. This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care.
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Affiliation(s)
- Amelia Shoemark
- Scottish Centre for Respiratory Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom.,PCD Diagnostic Service, Royal Brompton Hospital, London, United Kingdom
| | - Katharine Harman
- Department of Paediatrics and Child Health, King's College Hospital, London, United Kingdom
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16
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Yiallouros PK, Kouis P, Kyriacou K, Evriviadou A, Anagnostopoulou P, Matthaiou A, Tsiolakis I, Pirpa P, Michailidou K, Potamiti L, Loizidou MA, Hadjisavvas A. Implementation of multigene panel NGS diagnosis in the national primary ciliary dyskinesia cohort of Cyprus: An island with a high disease prevalence. Hum Mutat 2021; 42:e62-e77. [PMID: 33715250 DOI: 10.1002/humu.24196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
We aimed to determine a genetic diagnosis in the national primary ciliary dyskinesia (PCD) cohort of Cyprus, an island with a high disease prevalence. We used targeted next-generation sequencing (NGS) of 39 PCD genes in 48 patients of Greek-Cypriot and other ancestries. We achieved a molecular diagnosis in 74% of the unrelated families tested. We identified 24 different mutations in 11 genes, 12 of which are novel. Homozygosity was more common in Greek-Cypriot than non-Greek-Cypriot patients (88% vs. 46.2%, p = .016). Four mutations (DNAH11:c.5095-2A>G, CFAP300:c.95_103delGCCGGCTCC, TTC25:c.716G>A, RSPH9:c.670+2T>C) were found in 74% of the diagnosed Greek-Cypriot families. Patients with RSPH9 mutations demonstrated higher nasal nitric oxide (57 vs. 15 nl/min, p <.001), higher forced expiratory volume in 1 s (-0.89 vs. -2.37, p = .018) and forced vital capacity (-1.00 vs. -2.16, p = .029) z scores than the rest of the cohort. Targeted multigene-panel NGS is an efficient tool for early diagnosis of PCD, providing insight into genetic disease epidemiology and improved patient stratification.
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Affiliation(s)
- Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus.,Pediatric Pulmonology Unit, Hospital "Archbishop Makarios III", Nicosia, Cyprus
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Kyriacos Kyriacou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Aigli Evriviadou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Pinelopi Anagnostopoulou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus.,Pediatric Pulmonology Unit, Hospital "Archbishop Makarios III", Nicosia, Cyprus
| | - Andreas Matthaiou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ioannis Tsiolakis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Panayiota Pirpa
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriaki Michailidou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Louiza Potamiti
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Maria A Loizidou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Andreas Hadjisavvas
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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17
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Pedersen ESL, Collaud ENR, Mozun R, Ardura-Garcia C, Lam YT, Harris A, Lucas JS, Copeland F, Manion M, Rindlisbacher B, Silberschmidt H, Goutaki M, Kuehni CE. COVID-PCD: a participatory research study on the impact of COVID-19 in people with primary ciliary dyskinesia. ERJ Open Res 2021; 7:00843-2020. [PMID: 33778058 PMCID: PMC7983255 DOI: 10.1183/23120541.00843-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022] Open
Abstract
COVID-PCD is a participatory study initiated by people with primary ciliary dyskinesia (PCD) who have an essential vote in all stages of the research from the design of the study to the recruitment of participants, and interpretation and communication of the study results. COVID-PCD aims to collect epidemiological data in real-time from people with PCD throughout the pandemic to describe incidence of coronavirus disease 2019 (COVID-19), symptoms and course of disease; identify risk factors for prognosis; and assess experiences, wishes and needs. The study is advertised through patient support groups and participants register online on the study website (www.covid19pcd.ispm.ch). The study invites persons of any age from anywhere in the world with a suspected or confirmed PCD. A baseline questionnaire assesses details on PCD diagnosis, habitual symptoms and COVID-19 episodes that occurred before study entry. Afterwards, participants receive a weekly follow-up questionnaire with questions on incident severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, current symptoms, social contact behaviour and physical activity. Occasional thematic questionnaires are sent out focussing on emerging questions of interest chosen by people with PCD. In case of hospitalisation, patients or family members are asked to obtain a hospital report. Results are continuously analysed and summaries put online. The study started recruitment on April 30, 2020, and 556 people with PCD completed the baseline questionnaire by November 2, 2020. The COVID-PCD study is a participatory study that follows people with PCD during the COVID-19 pandemic, helps to empower affected persons, and serves as a platform for communication between patients, physicians and researchers.
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Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eugénie N R Collaud
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | | | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Fiona Copeland
- PCD Family Support Group, Ciliopathy Alliance, London, UK
| | | | | | - Hansruedi Silberschmidt
- Vorstand/Schriftführer des deutschen Vereins Kartagener Syndrom und Primäre Ciliäre Dyskinesie eV, PCD-betroffen, Wetzikon, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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18
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Goutaki M, Crowley S, Dehlink E, Gaupmann R, Horton KL, Kouis P, Lam YT, Loges NT, Lucas JS, Roehmel JF, Shoemark A. The BEAT-PCD (Better Experimental Approaches to Treat Primary Ciliary Dyskinesia) Clinical Research Collaboration. Eur Respir J 2021; 57:57/2/2004601. [PMID: 33541936 DOI: 10.1183/13993003.04601-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Suzanne Crowley
- Paediatric Dept of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Eleonora Dehlink
- Division of Pediatric Pulmonology, Allergology, and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - René Gaupmann
- Division of Pediatric Pulmonology, Allergology, and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katie L Horton
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Niki T Loges
- Dept of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Jane S Lucas
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jobst F Roehmel
- Dept of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin, Berlin, Germany
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19
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Holgersen MG, Marthin JK, Johansen HK, Nielsen KG. A retrospective review of Achromobacter species and antibiotic treatments in patients with primary ciliary dyskinesia. Chron Respir Dis 2021. [DOI: 10.1177/14799731211061600
expr 938379187 + 801163930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Objectives: Primary ciliary dyskinesia (PCD) is a rare congenital disease with defective mucociliary clearance causing frequent and often persistent pulmonary infections. Achromobacter species are opportunistic pathogens renowned for the difficulty of effective treatments and deteriorating effects on lung function. We aimed to describe the occurrence, treatment, and rate of successful eradication of Achromobacter species in patients with PCD. Methods: We retrospectively reviewed 18 years of historical microbiological samples and 10 years of electronic health records for PCD patients in Denmark. Results: We included 136 patients. Twenty-six patients had isolates of Achromobacter species. On average, 5% of the cohort had at least one annual isolate. Infections became persistent in 38% with a median length of 6.6 years leading to a significant number of antibiotic treatments. Resistance toward tobramycin and ciprofloxacin was prevalent. Overall, successful eradication was achieved in 62% of patients. We found the course of lung function significantly worse during persistent Achromobacter species infection than during the two preceding years, but not different to the course in unaffected age-matched controls. Conclusion The prevalence of Achromobacter species in patients with PCD is in line with what has been reported in cystic fibrosis and can occur transiently, intermittently, or develop into a serious persistent lung infection associated with long-term antibiotic treatment.
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Affiliation(s)
- Mathias G Holgersen
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
| | - June K Marthin
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
| | - Helle K Johansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Kim G Nielsen
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen E, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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20
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Abstract
Motile cilia are highly complex hair-like organelles of epithelial cells lining the surface of various organ systems. Genetic mutations (usually with autosomal recessive inheritance) that impair ciliary beating cause a variety of motile ciliopathies, a heterogeneous group of rare disorders. The pathogenetic mechanisms, clinical symptoms and severity of the disease depend on the specific affected genes and the tissues in which they are expressed. Defects in the ependymal cilia can result in hydrocephalus, defects in the cilia in the fallopian tubes or in sperm flagella can cause female and male subfertility, respectively, and malfunctional motile monocilia of the left-right organizer during early embryonic development can lead to laterality defects such as situs inversus and heterotaxy. If mucociliary clearance in the respiratory epithelium is severely impaired, the disorder is referred to as primary ciliary dyskinesia, the most common motile ciliopathy. No single test can confirm a diagnosis of motile ciliopathy, which is based on a combination of tests including nasal nitric oxide measurement, transmission electron microscopy, immunofluorescence and genetic analyses, and high-speed video microscopy. With the exception of azithromycin, there is no evidence-based treatment for primary ciliary dyskinesia; therapies aim at relieving symptoms and reducing the effects of reduced ciliary motility.
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