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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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Rodriguez Mier N, Jaspers M, Van Hoof E, Jorissen M, Lorent N, Proesmans M, Vermeulen F, Breckpot J, Boon M. Genetic Spectrum and Clinical Characteristics of Patients with Primary Ciliary Dyskinesia: a Belgian Single Center Study. Lung 2024; 202:291-298. [PMID: 38602513 DOI: 10.1007/s00408-024-00696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE We aimed to examine the correlation between clinical characteristics and the pathogenic gene variants in patients with Primary Ciliary Dyskinesia (PCD). METHODS We conducted a retrospective single-center study in patients with PCD followed at the University Hospitals Leuven. We included patients with genetically confirmed PCD and described their genotype, data from ultrastructural ciliary evaluation and clinical characteristics. Genotype/phenotype correlations were studied in patients with the most frequently involved genes. RESULTS We enrolled 74 patients with a median age of 25.58 years. The most frequently involved genes were DNAH11 (n = 23) and DNAH5 (n = 19). The most frequent types of pathogenic variants were missense (n = 42) and frameshift variants (n = 36) and most patients had compound heterozygous variants (n = 44). Ciliary ultrastructure (p < 0.001), situs (p = 0.015) and age at diagnosis (median 9.50 vs 4.71 years, p = 0.037) differed between DNAH11 and DNAH5. When correcting for situs this difference in age at diagnosis was no longer significant (p = 0.973). Patients with situs inversus were diagnosed earlier (p = 0.031). Respiratory tract microbiology (p = 0.161), lung function (cross-sectional, p = 0.829 and longitudinal, p = 0.329) and chest CT abnormalities (p = 0.202) were not significantly different between DNAH11 and DNAH5 variants. CONCLUSION This study suggests a genotype-phenotype correlation for some of the evaluated clinical characteristics of the two most frequently involved genes in this study, namely DNAH11 and DNAH5.
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Affiliation(s)
- Noelia Rodriguez Mier
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Martine Jaspers
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology, KU Leuven, Leuven, Belgium
| | - Evelien Van Hoof
- Center for Human Genetics, University Hospital of Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology, KU Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, University Hospital of Leuven, Leuven, Belgium
| | - Natalie Lorent
- Department of Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - François Vermeulen
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospital of Leuven, Leuven, Belgium
| | - Mieke Boon
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium
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Shen C, Shen Y, Huang W, Zhang A, Zou T, Guo D, Wang H, Wu J, Hu H, Xiang M, Ye B. A novel homozygous RSPH4A variant in a family with primary ciliary dyskinesia and literature review. Front Genet 2024; 15:1364476. [PMID: 38818043 PMCID: PMC11137616 DOI: 10.3389/fgene.2024.1364476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction: Primary ciliary dyskinesia (PCD) is a rare heterogeneous disease caused by abnormalities in motile cilia. In this case report, we first analyzed the clinical and genetic data of a proband who was suspected of having PCD on the basis of her clinical and radiological findings. Methods: Whole-exome sequencing was performed, and a variant in the RSPH4A gene was identified in the proband. Sanger sequencing was used for validation of RSPH4A variants in the proband, her sister, her daughter and her parents. Finally, the phenotypic features of the patient were analyzed, and the current literature was reviewed to better understand the gene variants in PCD related to hearing loss and the clinical manifestations of the RSPH4A variant in PCD. Results: The chief clinical symptoms of this proband included gradual mixed hearing loss, otitis media, anosmia, sinusitis, recurrent cough and infertility. Her DNA sequencing revealed a novel homozygous T to C transition at position 1321 within exon 3 of RSPH4A according to genetic testing results. This variant had never been reported before. The homozygous variant resulted in an amino acid substitution of tryptophan by arginine at position 441 (p.Trp441Arg). The same variant was also found in the proband's sister, and a heterozygous pathogenic variant was identified among immediate family members, including the proband's daughter and parents. Discussion: A literature review showed that 16 pathogenic variants in RSPH4A have been reported. Hearing loss had only been observed in patients with the RSPH4A (c.921+3_6delAAGT) splice site mutation, and the specific type of hearing loss was not described.
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Affiliation(s)
- Chenling Shen
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Shen
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Huang
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Tianyuan Zou
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongye Guo
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jichang Wu
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haixia Hu
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingliang Xiang
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Ye
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Audiology and Speech-Language Pathology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ringshausen FC, Shapiro AJ, Nielsen KG, Mazurek H, Pifferi M, Donn KH, van der Eerden MM, Loebinger MR, Zariwala MA, Leigh MW, Knowles MR, Ferkol TW. Safety and efficacy of the epithelial sodium channel blocker idrevloride in people with primary ciliary dyskinesia (CLEAN-PCD): a multinational, phase 2, randomised, double-blind, placebo-controlled crossover trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:21-33. [PMID: 37660715 DOI: 10.1016/s2213-2600(23)00226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Mucociliary clearance is dysfunctional in people with primary ciliary dyskinesia, resulting in the accumulation of dehydrated mucus in the airways that is difficult to clear. We undertook a study to assess the benefit on lung function of treatment with a nebulised epithelial sodium channel (ENaC) blocker, idrevloride, with or without hypertonic saline, in people with primary ciliary dyskinesia. METHODS The CLEAN-PCD trial was a phase 2, randomised, double-blind, placebo-controlled crossover trial conducted at 32 tertiary adult and paediatric care centres and university hospitals in Canada, Denmark, Germany, Italy, the Netherlands, Poland, the UK, and the USA. People with a confirmed diagnosis of primary ciliary dyskinesia, aged 12 years or older, with a percentage of predicted FEV1 (ppFEV1) in the range of 40% to <90%, were randomly assigned in a 2:2:1:1 ratio (block size=6), stratified by ppFEV1 at screening, to one of four sequences: (1) idrevloride in hypertonic saline in treatment period 1 then hypertonic saline in treatment period 2; (2) hypertonic saline in treatment period 1 then idrevloride in hypertonic saline in treatment period 2; (3) idrevloride in treatment period 1 then placebo in treatment period 2; and (4) placebo in treatment period 1 then idrevloride in treatment period 2. The idrevloride dose was 85 μg and hypertonic saline was 4·2% NaCl. 3 mL of each study treatment was nebulised twice daily for 28 days in treatment periods 1 and 2; the two 28-day treatment periods were separated by a 28-day washout period. The primary endpoint was absolute change from baseline in ppFEV1 after 28 days. Safety assessments and reports of adverse events were made at clinic visits during each treatment period and by a follow-up telephone call 28 days after the last dose of study drug. Additionally, adverse events could be reported at a follow-up telephone call 3 days after the start of dosing and as they arose. Participants who received at least one dose of study drug were included in the safety analyses (safety set), and those who also had spirometry data were included in the efficacy analyses (full analysis set). The completed study is registered (EudraCT 2015-004917-26; ClinicalTrials.govNCT02871778). FINDINGS Between Sep 14, 2016, and May 31, 2018, 216 patients were screened and 123 were randomly assigned to one of four crossover sequences. Across the two treatment periods, treatment with idrevloride in hypertonic saline was initiated in 80 patients and completed in 78 patients (all 78 had data available and were included in the analysis); hypertonic saline initiated in 81 patients and completed in 76 patients (75 had data available and were included in the analysis); idrevloride initiated in 37 patients and completed in 35 patients (34 had data available and were included in the analysis); and placebo initiated in 36 patients and completed in 34 patients (all 34 had data available and were included in the analysis). Greater absolute increases in ppFEV1 from baseline to 28 days of treatment were seen with idrevloride in hypertonic saline (least-squares mean absolute change from baseline 1·0 percentage points, 95% CI -0·4 to 2·4) than with hypertonic saline alone (least-squares mean absolute change from baseline of -0·5 percentage points, -2·0 to 0·9; difference 1·5 percentage points, 95% CI <0·1 to 3·0; p=0·044). There was no significant difference in ppFEV1 for the parallel comparison of idrevloride in hypertonic saline compared with placebo or the crossover comparison of idrevloride with placebo. Adverse events were similar across treatments (57 to 65% of patients). Cough occurred in a greater proportion of participants during treatments that contained idrevloride or hypertonic saline compared with placebo, and oropharyngeal pain occurred in a greater proportion of participants during idrevloride treatments than during treatment with hypertonic saline alone or placebo, whereas chest discomfort was more common during treatments that included hypertonic saline. INTERPRETATION In this phase 2 crossover study, idrevloride in hypertonic saline was safe and associated with improved lung function over a 28-day period in people with primary ciliary dyskinesia compared with hypertonic saline alone. Larger, longer clinical studies are warranted to explore the potential benefits of idrevloride in combination with hypertonic saline in people with primary ciliary dyskinesia. FUNDING Parion Sciences, under agreement with Vertex Pharmaceuticals.
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Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, German Center for Lung Research and European Reference Network for Rare and Complex Lung Diseases, Hannover Medical School, Hannover, Germany.
| | - Adam J Shapiro
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Kim G Nielsen
- Danish Primary Ciliary Dyskinesia Centre, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Disorders, Rabka-Zdroj, Poland
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | | | | | - Michael R Loebinger
- Host Defence Unit and National Heart and Lung Institute, Royal Brompton Hospital and Imperial College London, London, UK
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Ferkol
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Keicho N, Hijikata M, Miyabayashi A, Wakabayashi K, Yamada H, Ito M, Morimoto K. Impact of primary ciliary dyskinesia: Beyond sinobronchial syndrome in Japan. Respir Investig 2024; 62:179-186. [PMID: 38154292 DOI: 10.1016/j.resinv.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by impaired motile cilia function, particularly in the upper and lower airways. To date, more than 50 causative genes related to the movement, development, and maintenance of cilia have been identified. PCD mostly follows an autosomal recessive inheritance pattern, in which PCD symptoms manifest only in the presence of pathogenic variants in both alleles. Several genes causing PCD have been recently identified that neither lead to situs inversus nor cause definitive abnormalities in ciliary ultrastructure. Importantly, the distribution of disease-causing genes and pathogenic variants varies depending on ethnicity. In Japan, homozygosity for a ∼27.7-kb deletion of DRC1 is estimated to be the most common cause of PCD, presumably as a founder mutation. The clinical picture of PCD is similar to that of sinobronchial syndrome, thus making its differentiation from diffuse panbronchiolitis and other related disorders difficult. Given the diagnostic challenges, many cases remain undiagnosed or misdiagnosed, particularly in adults. While no fundamental cure is currently available, lifelong medical subsidies are provided in Japan, and proper respiratory management, along with continued prevention and treatment of infections, is believed to mitigate the decline in respiratory function. Timely action will be necessary when specific treatments for PCD become available in the future. This narrative review focuses on variations in the disease status of PCD in a non-Western country.
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Affiliation(s)
- Naoto Keicho
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.
| | - Minako Hijikata
- Department of Pathophysiology and Host Defense, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Akiko Miyabayashi
- Department of Pathophysiology and Host Defense, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Keiko Wakabayashi
- Department of Pathophysiology and Host Defense, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Hiroyuki Yamada
- Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Masashi Ito
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
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Pedersen ESL, Schreck LD, Goutaki M, Bellu S, Copeland F, Lucas JS, Zwahlen M, Kuehni CE. Incidence and Severity of SARS-CoV-2 Infections in People With Primary Ciliary Dyskinesia. Int J Public Health 2023; 68:1605561. [PMID: 37663372 PMCID: PMC10470037 DOI: 10.3389/ijph.2023.1605561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives: There is little data on SARS-CoV-2 in people with rare chronic diseases. We studied incidence and severity of SARS-CoV-2 and its risk factors in people with primary ciliary dyskinesia (PCD) from May 2020 to May 2022. Methods: We used self-reported questionnaire data from the COVID-PCD study at baseline or during weekly follow-ups. We studied factors associated with SARS-CoV-2 and symptoms using Poisson regression. Results: By May 2022, 728 people participated (40% male, median age 27 years; range 0-85). 87 (12%) reported SARS-CoV-2 at baseline or during follow-up and 62 people reported an incident SARS-CoV-2 infection during 716 person-years (incidence rate 9 per 100 person years). The strongest predictors for reporting SARS-CoV-2 were exposure during periods where Delta variant was dominant (IRR 4.52, 95% CI 1.92-10.6) and Omicron variants (IRR 13.3, 95% CI 5.2-33.8). Severity was mild; 12 (14%) were asymptomatic and 75 (86%) had symptoms among whom four were hospitalized. None needed intensive care and nobody died. Conclusion: The COVID-PCD study participants did not have a higher incidence of SARS-CoV-2 infections nor higher risk of severe COVID-19 disease than people from the general population.
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Affiliation(s)
- Eva S. L. Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leonie D. Schreck
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, 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
| | - Sara Bellu
- Associazione Italiana Discinesia Ciliare Primaria Sindrome di Kartagener Onlus, Onlus, Italy
| | | | - Jane S. Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- School of Clinical and Experimental Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, 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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Kinghorn B, Rosenfeld M, Sullivan E, Onchiri F, Ferkol TW, Sagel SD, Dell SD, Milla C, Shapiro AJ, Sullivan KM, Zariwala MA, Pittman JE, Mollica F, Tiddens HAWM, Kemner-van de Corput M, Knowles MR, Davis SD, Leigh MW. Airway Disease in Children with Primary Ciliary Dyskinesia: Impact of Ciliary Ultrastructure Defect and Genotype. Ann Am Thorac Soc 2023; 20:539-547. [PMID: 36442147 PMCID: PMC10112400 DOI: 10.1513/annalsats.202206-524oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
Rationale: Primary ciliary dyskinesia (PCD) is characterized by impaired mucociliary clearance, recurrent respiratory infections, progressive airway damage, and obstructive lung disease. Although the association of ciliary ultrastructure defect/genotype with the severity of airflow obstruction has been well characterized, their association with airway abnormalities on chest computed tomography (CT) has been minimally evaluated. Objectives: We sought to delineate the association of ciliary defect class/genotype with chest CT scores in children with PCD. Methods: Cross-sectional analysis of children with PCD (N = 146) enrolled in a prospective multicenter observational study, stratified by defect type: outer dynein arm (ODA), ODA/inner dynein arm (IDA), IDA/microtubular disorganization (MTD), and normal/near normal ultrastructure with associated genotypes. CTs were scored using the MERAGMA-PCD (Melbourne-Rotterdam Annotated Grid Morphometric Analysis for PCD), evaluating airway abnormalities in a hierarchical order: atelectasis, bronchiectasis, bronchial wall thickening, and mucus plugging/tree-in-bud opacities. The volume fraction of each component was expressed as the percentage of total lung volume. The percentage of disease was computed as the sum of all components. Regression analyses were used to describe the association between clinical predictors and CT scores. Results: Acceptable chest CTs were obtained in 141 children (71 male): 57 ODA, 20 ODA/IDA, 40 IDA/MTD, and 24 normal/near normal. The mean (standard deviation) age was 8.5 (4.6) years, forced expiratory volume in 1 second (FEV1) percent predicted was 82.4 (19.5), and %Disease was 4.6 (3.5). Children with IDA/MTD defects had a higher %Disease compared with children with ODA defects (2.71% higher [95% confidence interval (CI), 1.37-4.06; P < 0.001]), driven by higher %Mucus plugging (2.35% higher [1.43-3.26; P < 0.001]). Increasing age, lower body mass index, and lower FEV1 were associated with a higher %Disease (0.23%; 95% CI, 0.11-0.35; P < 0.001 and 0.03%; 95% CI, 0.01-0.04; P = 0.008 and 0.05%; 95% CI, 0.01-0.08; P = 0.011, respectively). Conclusions: Children with IDA/MTD defects had significantly greater airway disease on CT, primarily mucus plugging, compared with children with ODA defects.
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Affiliation(s)
- BreAnna Kinghorn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Research Institute, Seattle, Washington
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Research Institute, Seattle, Washington
| | - Erin Sullivan
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Research Institute, Seattle, Washington
| | - Frankline Onchiri
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Research Institute, Seattle, Washington
| | - Thomas W. Ferkol
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott D. Sagel
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Sharon D. Dell
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carlos Milla
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Adam J. Shapiro
- Department of Pediatrics, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | | | | | - Jessica E. Pittman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; and
| | - Federico Mollica
- Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, and
- Department of Pediatric Pulmonology and Allergology, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Harm A. W. M. Tiddens
- Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, and
- Department of Pediatric Pulmonology and Allergology, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariette Kemner-van de Corput
- Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, and
- Department of Pediatric Pulmonology and Allergology, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Margaret W. Leigh
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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8
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Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases. Pathogens 2023; 12:pathogens12030456. [PMID: 36986378 PMCID: PMC10058615 DOI: 10.3390/pathogens12030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
In medical mycology, the main context of disease is iatrogenic-based disease. However, historically, and occasionally, even today, fungal diseases affect humans with no obvious risk factors, sometimes in a spectacular fashion. The field of “inborn errors of immunity” (IEI) has deduced at least some of these previously enigmatic cases; accordingly, the discovery of single-gene disorders with penetrant clinical effects and their immunologic dissection have provided a framework with which to understand some of the key pathways mediating human susceptibility to mycoses. By extension, they have also enabled the identification of naturally occurring auto-antibodies to cytokines that phenocopy such susceptibility. This review provides a comprehensive update of IEI and autoantibodies that inherently predispose humans to various fungal diseases.
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Lung Function in Children with Primary Ciliary Dyskinesia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020290. [PMID: 36832419 PMCID: PMC9955480 DOI: 10.3390/children10020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is characterized by impaired mucociliary clearance that results in accumulation of mucus and bacteria in the airways. Lower respiratory tract infections lead to airway remodeling and lung function impairment. The aim of our narrative review is to discuss available data on lung function in PCD children, focusing on risk factors for lung function impairment. METHODS Relevant published studies searching MEDLINE/Pubmed are included in this narrative review, using these terms: "primary ciliary dyskinesia" and "pulmonary function test" or "spirometry" or "lung function". Filters were language (English) and age of study subjects (0-18 years). RESULTS AND CONCLUSIONS The majority of recent published studies showed normal spirometric values in PCD children, even if some authors described a pulmonary impairment. Together with spirometry, Lung Clearance Index has been applied for detecting peripheral airway disease, and it might have a role in early mild lung disease assessment. Studies on lung function trajectories after PCD diagnosis showed a significant heterogeneity, with some patients maintaining reasonably good lung function, whereas others showing a decline. Further studies are needed to analyze lung function prospectively from childhood into adulthood, and to evaluate whether lung function trajectories are affected by PCD clinical phenotype, ultrastructural ciliary defect or genetic background.
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Kouis P, Kakkoura MG, Elia SA, Ioannou P, Anagnostopoulou P, Potamiti L, Loizidou MA, Panayiotidis MI, Kyriacou K, Hadjisavvas A, Yiallouros PK. Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures. Multidiscip Respir Med 2022; 17:881. [PMID: 36636646 PMCID: PMC9830407 DOI: 10.4081/mrm.2022.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales. Methods Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU. Results Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R2= 0.419) and EQ5D (R2= 0.538) variability. Conclusions Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Shakolas Educational Center of Clinical Medicine, Palaios Dromos Lefkosias- Lemesou 215/6, 2029 Aglantzia, Cyprus. Tel.+357.99467521 - +357.22895396.
| | - Maria G. Kakkoura
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Stavria Artemis Elia
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Phivos Ioannou
- Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
| | - Pinelopi Anagnostopoulou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
| | - Louiza Potamiti
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Maria A. Loizidou
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Mihalis I. Panayiotidis
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriacos Kyriacou
- Department of Cancer Genetics, Therapeutics & Ultrastructural 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 Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Panayiotis K. Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
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Shoemark A, Griffin H, Wheway G, Hogg C, Lucas JS, Camps C, Taylor J, Carroll M, Loebinger MR, Chalmers JD, Morris-Rosendahl D, Mitchison HM, De Soyza A, Brown D, Ambrose JC, Arumugam P, Bevers R, Bleda M, Boardman-Pretty F, Boustred CR, Brittain H, Caulfield MJ, Chan GC, Fowler T, Giess A, Hamblin A, Henderson S, Hubbard TJP, Jackson R, Jones LJ, Kasperaviciute D, Kayikci M, Kousathanas A, Lahnstein L, Leigh SEA, Leong IUS, Lopez FJ, Maleady-Crowe F, McEntagart M, Minneci F, Moutsianas L, Mueller M, Murugaesu N, Need AC, O'Donovan P, Odhams CA, Patch C, Perez-Gil D, Pereira MB, Pullinger J, Rahim T, Rendon A, Rogers T, Savage K, Sawant K, Scott RH, Siddiq A, Sieghart A, Smith SC, Sosinsky A, Stuckey A, Tanguy M, Taylor Tavares AL, Thomas ERA, Thompson SR, Tucci A, Welland MJ, Williams E, Witkowska K, Wood SM. Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis. Eur Respir J 2022; 60:13993003.00176-2022. [PMID: 35728977 DOI: 10.1183/13993003.00176-2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.
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Affiliation(s)
- Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Helen Griffin
- Primary Immunodeficiency Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gabrielle Wheway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Claire Hogg
- Royal Brompton Hospital and NHLI, Imperial College London, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Carme Camps
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Jenny Taylor
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office, John Radcliffe Hospital, Oxford, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and NHLI, Imperial College London, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
- These authors contributed equally to this manuscript
| | - Anthony De Soyza
- Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle upon Tyne, UK
- These authors contributed equally to this manuscript
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12
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Al-Mutairi DA, Alsabah BH, Alkhaledi BA, Pennekamp P, Omran H. Identification of a novel founder variant in DNAI2 cause primary ciliary dyskinesia in five consanguineous families derived from a single tribe descendant of Arabian Peninsula. Front Genet 2022; 13:1017280. [PMID: 36303540 PMCID: PMC9596166 DOI: 10.3389/fgene.2022.1017280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Primary ciliary dyskinesia (PCD) is caused by dysfunction of motile cilia resulting in insufficient mucociliary clearance of the lungs. The overall aim of this study is to identify disease causing genetic variants for PCD patients in the Kuwaiti population. Methods: A cohort of multiple consanguineous PCD families was identified from Kuwaiti patients and genomic DNA from the family members was analysed for variant screening. Transmission electron microscopy (TEM) and immunofluorescent (IF) analyses were performed on nasal brushings to detect specific structural abnormalities within ciliated cells. Results: All the patients inherited the same founder variant in DNAI2 and exhibited PCD symptoms. TEM analysis demonstrated lack of outer dynein arms (ODA) in all analysed samples. IF analysis confirmed absence of DNAI1, DNAI2, and DNAH5 from the ciliary axoneme. Whole exome sequencing, autozygosity mapping and segregation analysis confirmed that seven patients carry the same homozygous missense variant (DNAI2:c.740G>A; p.Arg247Gln; rs755060592). Conclusion:DNAI2:c.740G>A is the founder variant causing PCD in patients belonging to a particular Arabian tribe which practices consanguineous marriages.
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Affiliation(s)
- Dalal A. Al-Mutairi
- Department of Pathology, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
- *Correspondence: Dalal A. Al-Mutairi,
| | | | | | - Petra Pennekamp
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
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Abo M, Takeuchi K, Ikejiri M, Ueno T, Yoneda T, Hara J, Ohkura N, Watanabe S, Kasahara K, Yano S. Primary ciliary dyskinesia with CCDC39 variants displaying specific ciliary ultrastructure and movement concordant with the genotype: A case report. Respir Investig 2022; 60:725-728. [PMID: 35817681 DOI: 10.1016/j.resinv.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a genetic disease with chronic airway infection and inflammation caused by ciliary ultrastructural defects and impairment in ciliary function. We present an adult case of PCD with compound heterozygous nonsense variants in CCDC39. The ciliary ultrastructure findings using electron microscopy and ciliary movement using high-speed video analysis matched the genotype. This is the first case report of PCD with CCDC39 variants in Japan demonstrating specific ciliary ultrastructure and movement related to the genotype.
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Affiliation(s)
- Miki Abo
- Kanazawa University Health Service Center, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan; Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Makoto Ikejiri
- Department of Clinical Laboratory, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takayoshi Ueno
- Department of Otorhinolaryngology, Head & Neck Surgery, Graduate School of Medical Science Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoaki Yoneda
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Seiji Yano
- Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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14
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Berra TZ, Ramos ACV, Arroyo LH, Delpino FM, de Almeida Crispim J, Alves YM, dos Santos FL, da Costa FBP, dos Santos MS, Alves LS, Fiorati RC, Monroe AA, Gomes D, Arcêncio RA. Risk-prone territories for spreading tuberculosis, temporal trends and their determinants in a high burden city from São Paulo State, Brazil. BMC Infect Dis 2022; 22:515. [PMID: 35655177 PMCID: PMC9161466 DOI: 10.1186/s12879-022-07500-5] [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: 05/31/2021] [Accepted: 05/25/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives To identify risk-prone areas for the spread of tuberculosis, analyze spatial variation and temporal trends of the disease in these areas and identify their determinants in a high burden city. Methods An ecological study was carried out in Ribeirão Preto, São Paulo, Brazil. The population was composed of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 and 2017. Seasonal Trend Decomposition using the Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were applied to identify risk areas. Spatial Variation in Temporal Trends (SVTT) was used to detect risk-prone territories with changes in the temporal trend. Finally, Pearson's Chi-square test was performed to identify factors associated with the epidemiological situation in the municipality. Results Between 2006 and 2017, 1760 cases of pulmonary tuberculosis were reported in the municipality. With spatial scanning, four groups of clusters were identified with relative risks (RR) from 0.19 to 0.52, 1.73, 2.07, and 2.68 to 2.72. With the space–time scan, four clusters were also identified with RR of 0.13 (2008–2013), 1.94 (2010–2015), 2.34 (2006 to 2011), and 2.84 (2014–2017). With the SVTT, a cluster was identified with RR 0.11, an internal time trend of growth (+ 0.09%/year), and an external time trend of decrease (− 0.06%/year). Finally, three risk factors and three protective factors that are associated with the epidemiological situation in the municipality were identified, being: race/brown color (OR: 1.26), without education (OR: 1.71), retired (OR: 1.35), 15 years or more of study (OR: 0.73), not having HIV (OR: 0.55) and not having diabetes (OR: 0.35). Conclusion The importance of using spatial analysis tools in identifying areas that should be prioritized for TB control is highlighted, and greater attention is necessary for individuals who fit the profile indicated as “at risk” for the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07500-5.
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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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Kos R, Israëls J, Gogh CDL, Altenburg J, Diepenhorst S, Paff T, Boon EMJ, Micha D, Pals G, Neerincx AH, Maitland‐van der Zee AH, Haarman EG. Primary ciliary dyskinesia in Volendam: Diagnostic and phenotypic features in patients with a
CCDC114
mutation. AMERICAN JOURNAL OF MEDICAL GENETICS PART C: SEMINARS IN MEDICAL GENETICS 2022; 190:89-101. [PMID: 35343062 PMCID: PMC9314105 DOI: 10.1002/ajmg.c.31968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 11/20/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a heterogeneous disease, with impaired mucociliary clearance causing respiratory tract infections. A founding CCDC114 mutation has led to a relatively homogeneous and large Dutch PCD population in Volendam. Our aim was to describe their phenotype. Therefore, all Volendam PCD patients seen at the Amsterdam UMC were included in this study. Data were collected on lung function, microbiology, radiology, and ear‐nose‐throat (ENT) symptoms. A mixed effects model estimated lung function decline in %point per year (95% confidence interval [CI]). Thirty‐three (60%) out of approximately 56 Volendam PCD patients were treated at our center and included in this study. Only 30% of patients had situs inversus. FEV1 declined in children (−1.43%/year, CI: −1.80/−1.05), but not in adults (0.01%/year, CI: −0.36/0.38). Pseudomonas aeruginosa was cultured in 21% of children and 60% of adults, respectively. Patients who have been infected at some point with P. aeruginosa had a steeper decline in FEV1 as compared to patients that have never been infected. Neonatal symptoms (79%) and ENT problems (94%) were common; fertility issues however, were not (11%) common. Compared to other PCD cohorts, the Volendam/CCDC114 patients have a moderately severe phenotype with lung function decline predominantly occurring in childhood.
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Affiliation(s)
- Renate Kos
- Department of Respiratory Medicine Amsterdam University Medical Centers – locatie AMC Amsterdam The Netherlands
| | - Joël Israëls
- Department of Pediatric Respiratory Medicine and Allergy Emma Children's Hospital, Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Christine D. L. Gogh
- Department of Otolaryngology, Head and Neck Surgery Amsterdam University Medical Centers – locatie VUmc Amsterdam The Netherlands
| | - Josje Altenburg
- Department of Respiratory Medicine Amsterdam University Medical Centers – locatie AMC Amsterdam The Netherlands
| | - Sandra Diepenhorst
- Department of Pediatric Respiratory Medicine and Allergy Emma Children's Hospital, Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Tamara Paff
- Department of Pediatric Respiratory Medicine and Allergy Emma Children's Hospital, Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Elles M. J. Boon
- Department of Human Genetics Amsterdam University Medical Centers – locatie VUmc Amsterdam The Netherlands
| | - Dimitra Micha
- Department of Human Genetics Amsterdam University Medical Centers – locatie VUmc Amsterdam The Netherlands
| | - Gerard Pals
- Department of Human Genetics Amsterdam University Medical Centers – locatie VUmc Amsterdam The Netherlands
| | - Anne H. Neerincx
- Department of Respiratory Medicine Amsterdam University Medical Centers – locatie AMC Amsterdam The Netherlands
| | - Anke H. Maitland‐van der Zee
- Department of Respiratory Medicine Amsterdam University Medical Centers – locatie AMC Amsterdam The Netherlands
- Department of Pediatric Respiratory Medicine and Allergy Emma Children's Hospital, Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Eric G. Haarman
- Department of Pediatric Respiratory Medicine and Allergy Emma Children's Hospital, Amsterdam University Medical Centers Amsterdam The Netherlands
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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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Shah A, Laguna TA. Primary Ciliary Dyskinesia: A Rare and Often Underdiagnosed Disease. Pediatr Ann 2022; 51:e82-e85. [PMID: 35156887 DOI: 10.3928/19382359-20220119-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disease with clinical features of ear, sinus, and pulmonary infections that overlap with common respiratory illnesses of childhood. It is a progressive disorder that has significant influence on quality of life, lung function, and survival. Given the considerable overlap of symptoms between common illnesses and PCD, a high index of suspicion by primary care providers is needed to consider the diagnosis. There is not a single "gold standard" diagnostic test for PCD and multiple diagnostic methods coupled with specialized expertise is often needed to make the diagnosis. Patients with PCD also have comorbidities requiring a multidisciplinary approach for optimal clinical management. It is important for primary care physicians to recognize the PCD clinical phenotype and have a diagnostic framework for these patients. [Pediatr Ann. 2022;51(2):e82-e85.].
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Pembridge T, Chalmers JD. Precision medicine in bronchiectasis. Breathe (Sheff) 2022; 17:210119. [PMID: 35035573 PMCID: PMC8753699 DOI: 10.1183/20734735.0119-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022] Open
Abstract
Bronchiectasis, due to its highly heterogenous nature, requires an individualised approach to therapy. Patients experience symptoms and exacerbations driven by a combination of impaired mucociliary clearance, airway inflammation and airway infection. Treatment of bronchiectasis aims to enhance airway clearance and to address the underlying causes of inflammation and infection susceptibility. Bronchiectasis has multiple causes and so the pathophysiology leading to individual symptoms and exacerbations are different between individuals. Standardised investigations are recommended by international guidelines to identify the underlying causes of bronchiectasis. The process of identifying the underlying biology within an individual is called “endotyping” and is an emerging concept across chronic diseases. Endotypes that have a specific treatment are referred to as “treatable traits” and a treatable traits approach to managing patients with bronchiectasis in a holistic and evidence-based manner is the key to improved outcomes. Bronchiectasis is an area of intense research. Endotyping allows identification of subsets of patients to allow medicines to be tested differently in the future where trials, rather than trying to achieve a “one size fits all” solution, can test efficacy in subsets of patients where the treatment is most likely to be efficacious. Bronchiectasis, due to its highly heterogenous nature, requires an individualised approach to therapy. Treatment targets symptoms and exacerbations by aiming to improve mucociliary clearance and to reduce airway inflammation and airway infection.https://bit.ly/3ite4B2
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Affiliation(s)
- Thomas Pembridge
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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21
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Guan Y, Zhang X, Yang H, Xu H, Zhao S. Long-Term Azithromycin Treatment in Pediatric Primary Ciliary Dyskinesia: A Retrospective Study. Front Pediatr 2022; 10:905253. [PMID: 35757125 PMCID: PMC9226474 DOI: 10.3389/fped.2022.905253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/18/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Primary ciliary dyskinesia (PCD) is a rare genetic disease mainly involved in lung dysfunction. PCD patient outcomes after azithromycin (AZM) treatment have rarely been reported. This study was aimed to assess AZM treatment effects on disease progression of pediatric PCD patients. STUDY DESIGN This retrospective follow-up study involved PCD patients diagnosed from 2009 to 2021. Changes of clinical outcomes, pulmonary function, and chest computed tomography findings were compared between untreated and AZM-treated patients. RESULTS Of 71 enrolled patients (median follow-up duration of 3.1 years), 34 received AZM (AZM-treated group) and 37 received no AZM (AZM-untreated group). At diagnosis, no significant intergroup differences in age, sex, height, weight, number of respiratory exacerbations, and FEV1% and FVC% predicted values were found, although FEF25-75% predicted was lower in AZM-treated group. Between treatment initiation and follow-up, patients in AZM-treated group had less respiratory exacerbations than that of AZM-untreated group (mean ± SD, 1.4 ± 0.8 vs. 3.0 ± 2.1, times/year P = 0.001) and fewer AZM-treated group patients exhibited exercise intolerance. Increases above baseline of AZM-treated FEV1% and FVC% predicted values exceeded that of AZM-untreated group, but intergroup differences were insignificant (FEV1% predicted: (median, IQR) 5.3 [-13.4, 9.4] vs. 1.8 [-12.1, 9.5], P = 0.477; FVC% predicted: (median, IQR) 6.7 [-7.6, 18.8] vs. 1.6 [-5.6, 7.6], P = 0.328). CONCLUSION Long-term AZM treatment can reduce respiratory infection frequency and may maintain pulmonary diseases stable in pediatric PCD patients with worse lung function.
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Affiliation(s)
- Yuhong Guan
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiang Zhang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Haiming Yang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shunying Zhao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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22
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Feng G, Xu Y, Saso S, Sasano H, Kondoh S, Itani H, Gotoh S, Nagao M, Ikejiri M, Tanabe M, Takeuchi K. A Novel Homozygous Variant in GAS2L2 in Two Sisters with Primary Ciliary Dyskinesia. Intern Med 2022; 61:2765-2769. [PMID: 36104176 PMCID: PMC9556235 DOI: 10.2169/internalmedicine.8884-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare hereditary disease. We herein report two sisters in their 20s with suspected PCD. They were both born at full term and did not have situs inversus. Chest computed tomography showed similar signs of bronchiectasis in both siblings. Genetic examinations of the family confirmed that the sisters both harbored a homozygous variant in the growth-arrest-specific 2-like 2 (GAS2L2) gene. This is the third report of a family with PCD caused by a GAS2L2 variant.
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Affiliation(s)
- Guofei Feng
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Japan
| | - Yifei Xu
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Japan
| | - Shun Saso
- Faculty of Medicine, Mie University, Japan
| | - Hajime Sasano
- Department of Respiratory Medicine, Japan Red Cross Ise Hospital, Japan
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
| | - Shigeto Kondoh
- Department of Respiratory Medicine, Japan Red Cross Ise Hospital, Japan
| | - Hidetoshi Itani
- Department of Respiratory Medicine, Japan Red Cross Ise Hospital, Japan
| | - Shimpei Gotoh
- Department of Drug Discovery for Lung Diseases, Graduate School of Medicine, Kyoto University, Japan
| | - Mizuho Nagao
- Institute for Clinical Research, National Hospital Organization Mie National Hospital, Japan
| | - Makoto Ikejiri
- Department of Clinical Laboratory, Mie University Hospital, Japan
| | - Masaki Tanabe
- Department of Clinical Laboratory, Mie University Hospital, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Japan
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23
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Gahleitner F, Thompson J, Jackson CL, Hueppe JF, Behan L, Dehlink E, Goutaki M, Halbeisen F, Queiroz APL, Thouvenin G, Kuehni CE, Latzin P, Lucas JS, Rubbo B. Lower airway clinical outcome measures for use in primary ciliary dyskinesia research: a scoping review. ERJ Open Res 2021; 7:00320-2021. [PMID: 34853782 PMCID: PMC8628193 DOI: 10.1183/23120541.00320-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Disease-specific, well-defined and validated clinical outcome measures are essential in designing research studies. Poorly defined outcome measures hamper pooling of data and comparisons between studies. We aimed to identify and describe pulmonary outcome measures that could be used for follow-up of patients with primary ciliary dyskinesia (PCD). Methods We conducted a scoping review by systematically searching MEDLINE, Embase and the Cochrane Database of Systematic Reviews online databases for studies published from 1996 to 2020 that included ≥10 PCD adult and/or paediatric patients. Results We included 102 studies (7289 patients). 83 studies reported on spirometry, 11 on body plethysmography, 15 on multiple-breath washout, 36 on high-resolution computed tomography (HRCT), 57 on microbiology and 17 on health-related quality of life. Measurement and reporting of outcomes varied considerably between studies (e.g. different scoring systems for chest HRCT scans). Additionally, definitions of outcome measures varied (e.g. definition of chronic colonisation by respiratory pathogen), impeding direct comparisons of results. Conclusions This review highlights the need for standardisation of measurements and reporting of outcome measures to enable comparisons between studies. Defining a core set of clinical outcome measures is necessary to ensure reproducibility of results and for use in future trials and prospective cohorts.
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Affiliation(s)
- Florian Gahleitner
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Respiratory Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Claire L Jackson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Jana F Hueppe
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Eleonora Dehlink
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - 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
| | - Florian Halbeisen
- 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.,Basel Institute for Clinical Epidemiology and Biostatistics, Dept of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ana Paula L Queiroz
- School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Guillaume Thouvenin
- AP-HP, Pneumologic Unit, Trousseau Hospital, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - 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
| | - Philipp Latzin
- 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
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Faculty of Medicine, Southampton, UK.,School of Health Sciences, University of Southampton, Faculty of Environmental and Life Sciences, Southampton, UK
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24
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Longitudinal Lung Volume Changes by Ultrastructure and Genotype in Primary Ciliary Dyskinesia. Ann Am Thorac Soc 2021; 18:963-970. [PMID: 33760720 DOI: 10.1513/annalsats.202007-816oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Genotype-phenotype relationships are emerging in primary ciliary dyskinesia (PCD), but little is known about lung volume changes over time. Objectives: To investigate the evolution of static lung volumes with ultrastructural defects, gene mutations, body mass index, and specific infections in PCD. Methods: Prospective, longitudinal, single-center study in children and adults evaluated twice yearly for up to 10 years. Linear mixed-effects models were used to assess associations between ciliary morphology, genetic mutations, and clinical features. Results: A total of 122 patients had 1,096 visits. At enrollment, almost all spirometric and, especially in adults, plethysmographic parameters were significantly worse in absent inner dynein arms (IDAs), central apparatus (CA) defects, and microtubular disorganization (MTD) (IDA/CA/MTD) compared with patients with normal electron microscopy (EM) results. The mean trend increase with time for residual volume (RV) was significantly higher in IDA/CA/MTD group compared with groups with outer dynein arm defect and normal EM results. The mean trend of RV/total lung capacity in the IDA/CA/MTD group was significantly worse than in all other groups. The steepest rise in lung volumes was in CCDC39 and CCDC40, whereas hyperinflation increased less in DNAH5 and DNAH11 groups. RV/total lung capacity showed a significantly steeper rise in patients with Pseudomonas aeruginosa compared with patients with other infections or patients without infection. Conclusions: Patients with IDA/CA/MTD defects or CCDC39 and CCDC40 mutations had the greatest increase in hyperinflation, whereas those with outer dynein arm defect and normal EM results or DNAH11 and DNAH5 mutations had less severe changes. We have robustly confirmed the worse prognosis for some genetic and ultrastructural defects, which association hitherto rested solely on spirometry.
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25
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Goutaki M, Pedersen ESL. Phenotype-genotype associations in primary ciliary dyskinesia: where do we stand? Eur Respir J 2021; 58:58/2/2100392. [PMID: 34353866 DOI: 10.1183/13993003.00392-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 11/05/2022]
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
| | - Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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26
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Shoemark A, Rubbo B, Legendre M, Fassad MR, Haarman EG, Best S, Bon ICM, Brandsma J, Burgel PR, Carlsson G, Carr SB, Carroll M, Edwards M, Escudier E, Honoré I, Hunt D, Jouvion G, Loebinger MR, Maitre B, Morris-Rosendahl D, Papon JF, Parsons CM, Patel MP, Thomas NS, Thouvenin G, Walker WT, Wilson R, Hogg C, Mitchison HM, Lucas JS. Topological data analysis reveals genotype-phenotype relationships in primary ciliary dyskinesia. Eur Respir J 2021; 58:13993003.02359-2020. [PMID: 33479112 DOI: 10.1183/13993003.02359-2020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a heterogeneous inherited disorder caused by mutations in approximately 50 cilia-related genes. PCD genotype-phenotype relationships have mostly arisen from small case series because existing statistical approaches to investigating relationships have been unsuitable for rare diseases. METHODS We applied a topological data analysis (TDA) approach to investigate genotype-phenotype relationships in PCD. Data from separate training and validation cohorts included 396 genetically defined individuals carrying pathogenic variants in PCD genes. To develop the TDA models, 12 clinical and diagnostic variables were included. TDA-driven hypotheses were subsequently tested using traditional statistics. RESULTS Disease severity at diagnosis, measured by forced expiratory volume in 1 s (FEV1) z-score, was significantly worse in individuals with CCDC39 mutations (compared to other gene mutations) and better in those with DNAH11 mutations; the latter also reported less neonatal respiratory distress. Patients without neonatal respiratory distress had better preserved FEV1 at diagnosis. Individuals with DNAH5 mutations were phenotypically diverse. Cilia ultrastructure and beat pattern defects correlated closely to specific causative gene groups, confirming these tests can be used to support a genetic diagnosis. CONCLUSIONS This large scale, multi-national study presents PCD as a syndrome with overlapping symptoms and variations in phenotype according to genotype. TDA modelling confirmed genotype-phenotype relationships reported by smaller studies (e.g. FEV1 worse with CCDC39 mutation) and identified new relationships, including FEV1 preservation with DNAH11 mutations and diversity of severity with DNAH5 mutations.
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Affiliation(s)
- Amelia Shoemark
- PCD Diagnostic Centre and Dept of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.,Equal first author contribution
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,Equal first author contribution
| | - Marie Legendre
- Département de Génétique Médicale, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) U933, Hôpital Trousseau, Paris, France
| | - Mahmoud R Fassad
- Genetics and Genomic Medicine Dept, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,Dept of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eric G Haarman
- Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sunayna Best
- Genetics and Genomic Medicine Dept, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Irma C M Bon
- Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joost Brandsma
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Pierre-Regis Burgel
- Service de Pneumologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) U1016, Institut Cochin, Paris, France
| | | | - Siobhan B Carr
- PCD Diagnostic Centre and Dept of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Matt Edwards
- Clinical Genetics and Genomics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Estelle Escudier
- Département de Génétique Médicale, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) U933, Hôpital Trousseau, Paris, France
| | - Isabelle Honoré
- Service de Pneumologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - David Hunt
- Wessex Clinical Genetics Service, University Hospitals Southampton, Princess Anne Hospital, Southampton, UK
| | - Gregory Jouvion
- Département de Génétique Médicale, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) U933, Hôpital Trousseau, Paris, France
| | - Michel R Loebinger
- Host Defence Unit, Dept of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute (NHLI), Imperial College, London, UK
| | - Bernard Maitre
- Service de Pneumologie, DHU A-TVB, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France.,Université Paris Est, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | | | - Jean-Francois Papon
- Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Kremlin-Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France.,Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Centre national de la recherche scientifique (CNRS) ERL 7240, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Créteil, France
| | - Camille M Parsons
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mitali P Patel
- Genetics and Genomic Medicine Dept, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - N 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
| | - Guillaume Thouvenin
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,Service de Pneumologie Pédiatrique, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Centre de Recherche Saint-Antoine, Paris, France
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Robert Wilson
- Host Defence Unit, Dept of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Claire Hogg
- PCD Diagnostic Centre and Dept of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Dept, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre, London, UK.,H.M. Mitchison and J.S. Lucas contributed equally to this article as lead authors and supervised the work
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.,H.M. Mitchison and J.S. Lucas contributed equally to this article as lead authors and supervised the work
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27
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Marthin JK, Lucas JS, Boon M, Casaulta C, Crowley S, Destouches DMS, Eber E, Escribano A, Haarman E, Hogg C, Maitre B, Marsh G, Martinu V, Moreno-Galdó A, Mussaffi H, Omran H, Pohunek P, Rindlisbacher B, Robinson P, Snijders D, Walker WT, Yiallouros P, Johansen HK, Nielsen KG. International BEAT-PCD consensus statement for infection prevention and control for primary ciliary dyskinesia in collaboration with ERN-LUNG PCD Core Network and patient representatives. ERJ Open Res 2021; 7:00301-2021. [PMID: 34350277 PMCID: PMC8326680 DOI: 10.1183/23120541.00301-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction In primary ciliary dyskinesia (PCD) impaired mucociliary clearance leads to recurrent airway infections and progressive lung destruction, and concern over chronic airway infection and patient-to-patient transmission is considerable. So far, there has been no defined consensus on how to control infection across centres caring for patients with PCD. Within the BEAT-PCD network, COST Action and ERS CRC together with the ERN-Lung PCD core a first initiative has now been taken towards creating such a consensus statement. Methods A multidisciplinary international PCD expert panel was set up to create a consensus statement for infection prevention and control (IP&C) for PCD, covering diagnostic microbiology, infection prevention for specific pathogens considered indicated for treatment and segregation aspects. Using a modified Delphi process, consensus to a statement demanded at least 80% agreement within the PCD expert panel group. Patient organisation representatives were involved throughout the process. Results We present a consensus statement on 20 IP&C statements for PCD including suggested actions for microbiological identification, indications for treatment of Pseudomonas aeruginosa, Burkholderia cepacia and nontuberculous mycobacteria and suggested segregation aspects aimed to minimise patient-to-patient transmission of infections whether in-hospital, in PCD clinics or wards, or out of hospital at meetings between people with PCD. The statement also includes segregation aspects adapted to the current coronavirus disease 2019 (COVID-19) pandemic. Conclusion The first ever international consensus statement on IP&C intended specifically for PCD is presented and is targeted at clinicians managing paediatric and adult patients with PCD, microbiologists, patient organisations and not least the patients and their families. For the first time ever, an international consensus statement for infection prevention and control in PCD is presented. A total of 20 statements were developed in a collaboration of BEAT-PCD, COST Action, ERS CRC and ERN-LUNG PCD Core Network.https://bit.ly/3yuahKt
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Affiliation(s)
- June K Marthin
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, Clinical and Experimental Science, University of Southampton, Southampton, UK
| | - Mieke Boon
- Dept of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine, University Children's Hospital, Bern, Switzerland
| | - Suzanne Crowley
- Paediatric Dept of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Damien M S Destouches
- Association des Patients Ayant une Dyskinésie Ciliaire Primitive, Limeil-Brevannes, France.,Patient representative
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Amparo Escribano
- Pediatric Pulmonology Unit, Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Eric Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Claire Hogg
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Bernard Maitre
- Pulmonary Service, Centre constitutif Respirare, Centre Hospitalier intercommunal de Créteil, Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Gemma Marsh
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Vendula Martinu
- Paediatric Pulmonology, Paediatric Dept, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Antonio Moreno-Galdó
- Dept of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Huda Mussaffi
- Schneider Children's Medical Center of Israel, Petach-Tikva, Sackler School of Medicine, Tel-Aviv, Israel
| | - Heymut Omran
- Dept of General Paediatrics and Adolescent Medicine, University Hospital Muenster, Muenster, Germany
| | - Petr Pohunek
- Paediatric Pulmonology, Paediatric Dept, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Bernhard Rindlisbacher
- Kartagener Syndrom und Primäre Ciliäre Dyskinesie, Steffisburg, Switzerland.,Patient representative
| | - Phil Robinson
- Dept of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia.,Dept of Paediatrics, University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Deborah Snijders
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padua, Italy
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, Clinical and Experimental Science, University of Southampton, Southampton, UK
| | | | - Helle Krogh Johansen
- Dept of Clinical Microbiology, University Hospital Rigshospitalet, Copenhagen, Denmark.,Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim G Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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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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29
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Abstract
Bronchiectasis is a complex, heterogeneous disorder defined by both a radiological abnormality of permanent bronchial dilatation and a clinical syndrome. There are multiple underlying causes including severe infections, mycobacterial disease, autoimmune conditions, hypersensitivity disorders, and genetic conditions. The pathophysiology of disease is understood in terms of interdependent concepts of chronic infection, inflammation, impaired mucociliary clearance, and structural lung damage. Neutrophilic inflammation is characteristic of the disease, with elevated levels of harmful proteases such as neutrophil elastase associated with worse outcomes. Recent data show that neutrophil extracellular trap formation may be the key mechanism leading to protease release and severe bronchiectasis. Despite the dominant of neutrophilic disease, eosinophilic subtypes are recognized and may require specific treatments. Neutrophilic inflammation is associated with elevated bacterial loads and chronic infection with organisms such as Pseudomonas aeruginosa. Loss of diversity of the normal lung microbiota and dominance of proteobacteria such as Pseudomonas and Haemophilus are features of severe bronchiectasis and link to poor outcomes. Ciliary dysfunction is also a key feature, exemplified by the rare genetic syndrome of primary ciliary dyskinesia. Mucus symptoms arise through goblet cell hyperplasia and metaplasia and reduced ciliary function through dyskinesia and loss of ciliated cells. The contribution of chronic inflammation, infection, and mucus obstruction leads to progressive structural lung damage. The heterogeneity of the disease is the most challenging aspect of management. An understanding of the pathophysiology of disease and their biomarkers can help to guide personalized medicine approaches utilizing the concept of "treatable traits."
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Affiliation(s)
- Holly R Keir
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, United Kingdom
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30
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Rademacher J, Dettmer S, Fuge J, Vogel-Claussen J, Shin HO, Shah A, Pedro PI, Wilson R, Welte T, Wacker F, Loebinger MR, Ringshausen FC. The Primary Ciliary Dyskinesia Computed Tomography Score in Adults with Bronchiectasis: A Derivation und Validation Study. Respiration 2021; 100:499-509. [PMID: 33895745 PMCID: PMC8220914 DOI: 10.1159/000514927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disorder which requires a complex diagnostic workup. Thus, an easy and widely available screening method would be helpful to identify patients who need a further diagnostic workup for PCD. OBJECTIVES The aim of the study was to develop and validate a computed tomography (CT) score for PCD to facilitate etiological diagnosis in adults with bronchiectasis. METHOD Chest CTs from 121 adults with bronchiectasis were scored for bronchiectasis morphology, distribution, and associated findings. Patients with and without the etiological diagnosis of PCD (46 and 75, respectively) were compared. Significantly, different imaging findings (p < 0.05) in univariate analysis were considered for multivariate analysis. Distinct findings were used to build the score. Based on this score, receiver operating characteristic (ROC) curve analysis was performed. The score was validated with 2 independent cohorts, another cohort from the same institution with 56 patients (28 with PCD) and an external cohort from another referral center with 172 patients (86 with PCD). RESULTS The following parameters predicted PCD in adults with bronchiectasis and were included in the score with weighting according to their regression coefficients: 2 points were given for predominance in the middle/lower lobe, 2 points for tree-in-bud pattern, 2 points for atelectasis or prior resection of a middle/lower lobe, and 3 points for absence of emphysema and fibrosis. Situs inversus was only observed in subjects with PCD (Kartagener syndrome) and, thus, was not used in the primary ciliary dyskinesia computed tomography (PCD-CT) score as group comparisons could not be performed. ROC curve analysis revealed an area under the curve (AUC) of 0.90 (95% CI 0.85-0.96). Youden index was the highest at a threshold of >6 with a sensitivity of 83% and a specificity of 83%. In the validation cohorts, ROC curve analysis confirmed the performance of the score with an AUC of 0.83 (95% CI 0.72-0.94) in the first validation cohort and 0.79 (95% CI 0.73-0.86) in the external validation cohort. CONCLUSIONS The PCD-CT score provides the first validated CT score for PCD and helps physicians in identifying adult bronchiectasis patients who require further diagnostic workup. Key message: The PCD-CT score provides the first validated CT score to assist physicians in identifying adult bronchiectasis patients who require a further diagnostic workup for PCD. It potentially improves earlier recognition of this rare and underdiagnosed disease.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Sabine Dettmer
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany,*Sabine Dettmer,
| | - Jan Fuge
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Hoen-oh Shin
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Anand Shah
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paula Inês Pedro
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Rob Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Michael R. Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Felix C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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31
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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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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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Clofent D, Álvarez A, Traversi L, Culebras M, Loor K, Polverino E. Comorbidities and mortality risk factors for patients with bronchiectasis. Expert Rev Respir Med 2021; 15:623-634. [PMID: 33583300 DOI: 10.1080/17476348.2021.1886084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause-effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.
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Affiliation(s)
- David Clofent
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Antonio Álvarez
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese, Italy
| | - Mario Culebras
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Karina Loor
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Eva Polverino
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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Singer F, Schlegtendal A, Nyilas S, Vermeulen F, Boon M, Koerner-Rettberg C. Lung clearance index predicts pulmonary exacerbations in individuals with primary ciliary dyskinesia: a multicentre cohort study. Thorax 2021; 76:681-688. [PMID: 33504569 DOI: 10.1136/thoraxjnl-2020-215504] [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: 06/09/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lung clearance index (LCI) is a promising lung function outcome in individuals with primary ciliary dyskinesia (PCD). The impact of events clinically important for individuals with PCD, such as pulmonary exacerbations, on LCI is unknown. METHODS We conducted an international, multicentre, observational cohort study to assess the association of LCI and risk of pulmonary exacerbation, specific changes in LCI during pulmonary exacerbation and global variability of LCI across four visits every 4 months. Ninety individuals with PCD, aged 3-41 years, underwent nitrogen multiple-breath washout (MBW) and spirometry measurements. The association of LCI and pulmonary exacerbations was assessed by Cox proportional hazards and random-effects regression models. RESULTS We obtained 430 MBW and 427 spirometry measurements. In total, 379 person-years at risk contributed to the analysis. Per one unit increase (deterioration) in LCI, the risk of future pulmonary exacerbation increased by 13%: HR (95% CI), 1.13 (1.04 to 1.23). If LCI changed from a range of values considered normal to abnormal, the risk of future pulmonary exacerbations increased by 87%: 1.87 (1.08 to 3.23). During pulmonary exacerbations, LCI increased by 1.22 units (14.5%). After pulmonary exacerbations, LCI tended to decline. Estimates of variability in LCI suggested lower variation within individuals compared with variation between individuals. Findings were comparable for forced expiratory volume in 1 s. CONCLUSION On a visit-to-visit basis, LCI measurement may add to the prediction of pulmonary exacerbations, the assessment of lung function decline and the potential lung function response to treatment of pulmonary exacerbations.
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Affiliation(s)
- Florian Singer
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Schlegtendal
- Department of Paediatric Pulmonology, University Children's Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany
| | - Sylvia Nyilas
- Department of Diagnostic, Interventional, and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - François Vermeulen
- Paediatric Pulmonology, Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Mieke Boon
- Paediatric Pulmonology, Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cordula Koerner-Rettberg
- Department of Paediatric Pulmonology, University Children's Hospital of Ruhr University Bochum at St. Josef-Hospital, Bochum, Germany .,Children's Hospital, Research Institute, Marien Hospital Wesel, Wesel, Germany
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35
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Nikolaizik W, Hahn J, Bauck M, Weber S. Comparison of ciliary beat frequencies at different temperatures in young adults. ERJ Open Res 2020; 6:00477-2020. [PMID: 33263055 PMCID: PMC7682707 DOI: 10.1183/23120541.00477-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022] Open
Abstract
Rationale Direct visualisation of ciliary beat pattern (CBP) and ciliary beat frequency (CBF) has been recommended as the first-line diagnostic test in patients suspected of having primary ciliary dyskinesia (PCD). However, the test procedure is not yet completely standardised, and centres measure the CBF at different temperatures. Objectives It was the aim of the study to compare CBF at different temperatures, to establish normative values, to check for age dependency and to measure the temperature on the nasal mucosa of the participants. Methods High-speed video-microscopy analysis with a Sisson-Ammons Video Analysis (SAVA) system was used to determine CBP and CBF in the participants. Measurements Nasal brushings were taken and CBF was measured in randomised order at three temperatures: 25°C, 32°C and 37°C. Main results In total, 100 healthy young adults (74 female, 26 male), aged 20.2–31.9 years, were included in the study. We found a highly significant difference among the groups: the median CBF was 7.0 Hz at 25°C, 7.6 Hz at 32°C and 8.0 Hz at 37°C. The maximum time period ex vivo was 65 min and did not differ significantly. However, CBF was significantly higher when the cilia were kept at a higher temperature before the measurements were made. We found no correlation between CBF and the age of the participants. The median nasal mucosal temperature in our study participants was 30.2°C (range 24.7–35.8°C) comparable to the 30.2–34.4°C described in the literature. Conclusions The most appropriate temperature at which to measure CBF is 32°C. In our study, with 95% confidence for this temperature the CBF was between 6.3 and 9.0 Hz. Equivalent to the nasal mucosa, the most appropriate temperature to measure ciliary beat frequency is 32°Chttps://bit.ly/2GCr2fP
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Affiliation(s)
- Wilfried Nikolaizik
- Dept of Pediatric Chest Medicine, Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Jana Hahn
- Dept of Pediatric Chest Medicine, Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Monika Bauck
- Dept of Pediatric Chest Medicine, Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Stefanie Weber
- Dept of Pediatric Chest Medicine, Children's Hospital, Philipps-University Marburg, Marburg, Germany
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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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37
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Late Diagnosis of Infants with PCD and Neonatal Respiratory Distress. J Clin Med 2020; 9:jcm9092871. [PMID: 32899853 PMCID: PMC7563976 DOI: 10.3390/jcm9092871] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023] Open
Abstract
Neonatal respiratory distress (NRD) is common among infants with primary ciliary dyskinesia (PCD), but we do not know whether affected neonates receive a timely diagnosis. We used data from the international PCD cohort and assessed the proportion of patients with PCD who had a history of NRD and their age at diagnosis, stratifying by presence of laterality defects. First we analyzed data from all participants diagnosed after 2000, followed by individuals from a subgroup diagnosed using stricter criteria. Among the 1375 patients in the study, 45% had a history of NRD and 42% had laterality defects. Out of the 476 children with definite PCD diagnosis, 55% had a history of NRD and 50% had laterality defects. Overall, 30% of children with PCD were diagnosed during the first 12 months of life. This varied from 13% in those with situs solitus and no NRD, to 21% in those with situs solitus and NRD, 33% in those with situs anomalies but no NRD, and 52% in those with both situs anomalies and NRD. Our results suggest that we need to improve our knowledge of the neonatal presentation of infants with PCD and apply it so that these patients will receive appropriate care sooner.
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Pifferi M, Bush A, Mariani F, Piras M, Michelucci A, Cangiotti A, Di Cicco M, Caligo MA, Miccoli M, Boner AL, Peroni D. Lung Function Longitudinal Study by Phenotype and Genotype in Primary Ciliary Dyskinesia. Chest 2020; 158:117-120. [DOI: 10.1016/j.chest.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022] Open
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Efficacy and safety of azithromycin maintenance therapy in primary ciliary dyskinesia (BESTCILIA): a multicentre, double-blind, randomised, placebo-controlled phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2020; 8:493-505. [DOI: 10.1016/s2213-2600(20)30058-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022]
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40
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Piatti G, De Santi MM, Farolfi A, Zuccotti GV, D’Auria E, Patria MF, Torretta S, Consonni D, Ambrosetti U. Exacerbations and Pseudomonas aeruginosa colonization are associated with altered lung structure and function in primary ciliary dyskinesia. BMC Pediatr 2020; 20:158. [PMID: 32284045 PMCID: PMC7153224 DOI: 10.1186/s12887-020-02062-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/31/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recurrent bacterial infections of the respiratory tract are one of the major clinical features of the primary ciliary dyskinesia (PCD), a rare genetic disease due to malfunctioning of motile cilia. Chronic infections and persistent inflammation of the respiratory system result in progressive lung disease. Aim of the study was to highlight the main factors associated with clinical, functional and anatomical deterioration in PCD patients. METHODS We retrospectively analyzed data from 58 patients with PCD, 37 adults and 21 children. The demographic and clinical data, forced expiratory volume at 1 s (FEV1) and forced vital capacity (FVC), sputum microbiology and imaging results (chest CT scores-modified Bhalla) were recorded. Patients were stratified according to the number of exacerbations (< 2/year vs ≥ 2/year) and chronic Pseudomonas aeruginosa (PA) colonization. The possible correlations between lung function and chest CT scores were assessed; we also evaluated the correlation between these parameters and the severity scores for bronchiectasis (BSI, FACED and e-FACED). RESULTS Chest CT scores showed a significant correlation with FEV1 (p = 0.0002), age (p < 0.0001), BMI (p = 0.0002) and number of lung lobes involved (p < 0.0001). PA colonization had an overall prevalence of 32.6%: no significant difference in FEV1 between PA colonized and non-colonized patients was found (p = 0.70), while chest CT score was significantly worse in chronic PA colonized patients (p = 0.009). Patients with a high number of exacerbation (≥ 2/year) were older (p = 0.01), had lower FEV1 (p = 0.03), greater number of lobes involved (p < 0.001) and worse CT score than patients with low number of exacerbations (p = 0.001); they also had higher prevalence of PA chronic bronchial infection (33.3% versus 13.6%, p = 0.10). Multivariable linear regression analyses adjusted for gender, age and BMI showed positive associations between PA colonization and number of exacerbations with severity of disease (number of lobes involved, CT score, BSI, FACED, and e-FACED). CONCLUSIONS In our PCD population the number of exacerbations (≥ 2/year) and PA colonization were the two most relevant factors associated with severity of disease.
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Affiliation(s)
- G. Piatti
- Department of Pathophysiology and Transplantation, University of Milan and Unit of Bronchopneumology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35 -, 20122 Milan, Italy
| | - M. M. De Santi
- Department of Human Pathology and Oncology, University of Siena and Unit of Pathological Anatomy, Policlinico Le Scotte, Strada delle Scotte 6, Siena, Italy
| | - A. Farolfi
- Pediatric Pulmonology, Pediatric Department, Vittore Buzzi Children’s Hospital, University of Milan, via Castelvetro 32, 20154 Milan, Italy
| | - G. V. Zuccotti
- Pediatric Pulmonology, Pediatric Department, Vittore Buzzi Children’s Hospital, University of Milan, via Castelvetro 32, 20154 Milan, Italy
| | - E. D’Auria
- Pediatric Pulmonology, Pediatric Department, Vittore Buzzi Children’s Hospital, University of Milan, via Castelvetro 32, 20154 Milan, Italy
| | - M. F. Patria
- Department of Pathophysiology and Transplantation, University of Milan and Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - S. Torretta
- Department of Clinical Sciences and Community Health, University of Milan and Division of Otolaryngology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - D. Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - U. Ambrosetti
- Department of Clinical Sciences and Community Health, University of Milan and Audiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
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41
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Meerburg JJ, Veerman GDM, Aliberti S, Tiddens HAWM. Diagnosis and quantification of bronchiectasis using computed tomography or magnetic resonance imaging: A systematic review. Respir Med 2020; 170:105954. [PMID: 32843159 DOI: 10.1016/j.rmed.2020.105954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bronchiectasis is an irreversible dilatation of the airways caused by inflammation and infection. To diagnose bronchiectasis in clinical care and to use bronchiectasis as outcome parameter in clinical trials, a radiological definition with exact cut-off values along with image analysis methods to assess its severity are needed. The aim of this study was to review diagnostic criteria and quantification methods for bronchiectasis. METHODS A systematic literature search was performed using Embase, Medline Ovid, Web of Science, Cochrane and Google Scholar. English written, clinical studies that included bronchiectasis as outcome measure and used image quantification methods were selected. Criteria for bronchiectasis, quantification methods, patient demographics, and data on image acquisition were extracted. RESULTS We screened 4182 abstracts, selected 972 full texts, and included 122 studies. The most often used criterion for bronchiectasis was an inner airway-artery ratio ≥1.0 (42%), however no validation studies for this cut-off value were found. Importantly, studies showed that airway-artery ratios are influenced by age. To quantify bronchiectasis, 42 different scoring methods were described. CONCLUSION Different diagnostic criteria for bronchiectasis are being used, but no validation studies were found to support these criteria. To use bronchiectasis as outcome in future studies, validated and age-specific cut-off values are needed.
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Affiliation(s)
- Jennifer J Meerburg
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre -Sophia Children's Hospital, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Adult Cystic Fibrosis Center, Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre -Sophia Children's Hospital, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
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42
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Lucas JS, Davis SD, Omran H, Shoemark A. Primary ciliary dyskinesia in the genomics age. THE LANCET RESPIRATORY MEDICINE 2019; 8:202-216. [PMID: 31624012 DOI: 10.1016/s2213-2600(19)30374-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia is a genetically and clinically heterogeneous syndrome. Impaired function of motile cilia causes failure of mucociliary clearance. Patients typically present with neonatal respiratory distress of unknown cause and then continue to have a daily wet cough, recurrent chest infections, perennial rhinosinusitis, otitis media with effusion, and bronchiectasis. Approximately 50% of patients have situs inversus, and infertility is common. While understanding of the underlying genetics and disease mechanisms have substantially advanced in recent years, there remains a paucity of evidence for treatment. Next-generation sequencing has increased gene discovery, and mutations in more than 40 genes have been reported to cause primary ciliary dyskinesia, with many other genes likely to be discovered. Increased knowledge of cilia genes is challenging perceptions of the clinical phenotype, as some genes reported in the last 5 years are associated with mild respiratory disease. Developments in genomics and molecular medicine are rapidly improving diagnosis, and a genetic cause can be identified in approximately 70% of patients known to have primary ciliary dyskinesia. Groups are now investigating novel and personalised treatments, although gene therapies are unlikely to be available in the near future.
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Affiliation(s)
- 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.
| | - Stephanie D Davis
- Department of Pediatrics, Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK; Department of Paediatrics, Royal Brompton and Harefield NHS Trust, London, UK
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Kouis P, Goutaki M, Halbeisen FS, Gioti I, Middleton N, Amirav I, Barbato A, Behan L, Boon M, Emiralioglu N, Haarman EG, Karadag B, Koerner-Rettberg C, Lazor R, Loebinger MR, Maitre B, Mazurek H, Morgan L, Nielsen KG, Omran H, Özçelik U, Price M, Pogorzelski A, Snijders D, Thouvenin G, Werner C, Zivkovic Z, Kuehni CE, Yiallouros PK. Prevalence and course of disease after lung resection in primary ciliary dyskinesia: a cohort & nested case-control study. Respir Res 2019; 20:212. [PMID: 31533829 PMCID: PMC6751891 DOI: 10.1186/s12931-019-1183-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background Lung resection is a controversial and understudied therapeutic modality in Primary Ciliary Dyskinesia (PCD). We assessed the prevalence of lung resection in PCD across countries and compared disease course in lobectomised and non-lobectomised patients. Methods In the international iPCD cohort, we identified lobectomised and non-lobectomised age and sex-matched PCD patients and compared their characteristics, lung function and BMI cross-sectionally and longitudinally. Results Among 2896 patients in the iPCD cohort, 163 from 20 centers (15 countries) underwent lung resection (5.6%). Among adult patients, prevalence of lung resection was 8.9%, demonstrating wide variation among countries. Compared to the rest of the iPCD cohort, lobectomised patients were more often females, older at diagnosis, and more often had situs solitus. In about half of the cases (45.6%) lung resection was performed before presentation to specialized PCD centers for diagnostic work-up. Compared to controls (n = 197), lobectomised patients had lower FVC z-scores (− 2.41 vs − 1.35, p = 0.0001) and FEV1 z-scores (− 2.79 vs − 1.99, p = 0.003) at their first post-lung resection assessment. After surgery, lung function continued to decline at a faster rate in lobectomised patients compared to controls (FVC z-score slope: − 0.037/year Vs − 0.009/year, p = 0.047 and FEV1 z-score slope: − 0.052/year Vs − 0.033/year, p = 0.235), although difference did not reach statistical significance for FEV1. Within cases, females and patients with multiple lobe resections had lower lung function. Conclusions Prevalence of lung resection in PCD varies widely between countries, is often performed before PCD diagnosis and overall is more frequent in patients with delayed diagnosis. After lung resection, compared to controls most lobectomised patients have poorer and continuing decline of lung function despite lung resection. Further studies benefiting from prospective data collection are needed to confirm these findings.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ifigeneia Gioti
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Israel Amirav
- Department of Pediatrics University of Alberta Edmonton, Edmonton, Canada.,Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Angelo Barbato
- Primary Ciliary Dyskinesia Centre, Department of Women's and Children's Health (SDB), University of Padova, Padova, Italy
| | | | - Laura Behan
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton, NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Mieke Boon
- Department of Paediatrics & Paediatric Pulmonology, University Hospital Gasthuisberg Leuven, Leuven, Belgium
| | | | - Eric G Haarman
- Department of pediatric pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Cordula Koerner-Rettberg
- Department of Paediatric Pulmonology, University Children's Hospital of Ruhr University Bochum, Bochum, Germany
| | - Romain Lazor
- Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Lyon, France
| | | | - Michael R Loebinger
- Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Bernard Maitre
- Hopital intercommunal de Créteil, Service de Pneumologie, DHU ATVB, Université Paris Est Créteil, Paris, France
| | | | - Henryk Mazurek
- Klinika Pneumonologii i Mukowiscydozy, Instytut Gruźlicy i ChoróbPłuc, Rabka, Poland
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Kim Gjerum Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heymut Omran
- Department of General Paediatrics and Adolescent Medicine, University Hospital Muenster, Muenster, Germany
| | - Ugur Özçelik
- Pediatric Pulmonology, Hacettepe University, Ankara, Turkey
| | - Mareike Price
- Clinic for Paediatric pulmonology, Allergiology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Andrzej Pogorzelski
- Klinika Pneumonologii i Mukowiscydozy, Instytut Gruźlicy i ChoróbPłuc, Rabka, Poland
| | - Deborah Snijders
- Primary Ciliary Dyskinesia Centre, Department of Women's and Children's Health (SDB), University of Padova, Padova, Italy
| | | | - Guillaume Thouvenin
- Service de pneumologie pédiatrique, Hôpital Trousseau, APHP, Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, Paris, France
| | | | - Claudius Werner
- Department of General Paediatrics and Adolescent Medicine, University Hospital Muenster, Muenster, Germany.,Department of Pediatrics, Helios Hospital Schwerin, Schwerin, Germany
| | - Zorica Zivkovic
- Children's Hospital for Lung Diseases and TB, Medical Centre "Dr Dragisa Misovic", Belgrade, Serbia.,Faculty of Pharmacy Novi Sad, Business Academy in Novi Sad, Novi Sad, Serbia
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus. .,Shakolas Educational Center of Clinical Medicine, Palaios Dromos Lefkosias-Lemesou 215/6,2029 Aglantzia, Nicosia, Cyprus.
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Pieters A, Bakker M, Hoek RAS, Altenburg J, van Westreenen M, Aerts JGJV, van der Eerden MM. Predicting factors for chronic colonization of Pseudomonas aeruginosa in bronchiectasis. Eur J Clin Microbiol Infect Dis 2019; 38:2299-2304. [PMID: 31471703 PMCID: PMC6858402 DOI: 10.1007/s10096-019-03675-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/08/2019] [Indexed: 12/01/2022]
Abstract
About 25% of the patients with bronchiectasis are likely to develop a chronic colonization with Pseudomonas aeruginosa. A better understanding of predictors of acquiring Pseudomonas within the patient population may facilitate future focused research. The aim of this retrospective observational study was to investigate predicting factors for P. aeruginosa colonization in patients with bronchiectasis. This was a single-center retrospective cohort study using a bronchiectasis database which consisted of 211 patients with bronchiectasis. Data were collected for demographic details, etiology, spirometry, microbiology data, maintenance medication use, exacerbation frequency, hospital admission rate, and FACED and Bronchiectasis Severity Index (BSI) score. Two hundred eleven patients were identified from our bronchiectasis database. Overall, 25% of the patients (n = 53) had a chronic colonization with P. aeruginosa. Seventeen patients (8%) died in a 5-year follow-up period of whom 7 (41%) had a chronic P. aeruginosa colonization (p > 0.05). After multiple regression analysis, P. aeruginosa-positive patients were significantly associated with an older age (> 55 years) (p = 0.004), the use of hypertonic saline (0.042), and inhalation antibiotics (< 0.001). Furthermore, the presence of PCD (p < 0.001) and post-infectious etiology (p < 0.001) as underlying causes were significantly associated with P. aeruginosa colonization. We observed that independent predictors for P. aeruginosa colonization were age > 55 years, hypertonic saline, and PCD, and post-infectious etiology as underlying causes of bronchiectasis. Since prevention of P. aeruginosa colonization is an important aim in the treatment of bronchiectasis, more attention could be directed to these groups at risk for Pseudomonas colonization.
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Affiliation(s)
- A Pieters
- Erasmus Medical Center, Rotterdam, The Netherlands.
| | - M Bakker
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - R A S Hoek
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Altenburg
- Erasmus Medical Center, Rotterdam, The Netherlands
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45
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Roden L, Görlich D, Omran H, Peters G, Große-Onnebrink J, Kahl BC. A retrospective analysis of the pathogens in the airways of patients with primary ciliary dyskinesia. Respir Med 2019; 156:69-77. [PMID: 31437650 DOI: 10.1016/j.rmed.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare genetically heterogeneous disorder of motile cilia, which leads to recurrent and chronic airway infections. Detailed information about infection causing pathogens is scarce. With this study, we aimed to determine the prevalence and susceptibility of the most common respiratory pathogens in PCD patients retrospectively in a cross-sectional and the dynamics of the microbiological diversity in a longitudinal study. METHODS Microbiological and clinical data of 106 patients between 2010 and 2016 were analysed cross-sectionally and of 28 patients longitudinally. Dynamics in microbiological diversity were assessed by calculating the mean rate of alteration (MRA). RESULTS Haemophilus influenzae was the most common pathogen (n = 41; 38.7%) followed by Staphylococcus aureus (n = 36; 34%), Moraxella catarrhalis (n = 18; 17%) and Pseudomonas aeruginosa (n = 16; 15.1%). Nontuberculous mycobacteria were cultured from two patients (1.9%). H. influenzae was the most prevalent pathogen in children (n = 31; 45.6%), S. aureus in adults (n = 15; 39%). Two patients were infected by methicillin-resistant S. aureus. P. aeruginosa was mostly susceptible to standard antibiotics with highest rates of resistance against fosfomycin (63.6%; 7/11). The culture of P. aeruginosa correlated negatively with age adjusted FEV1% predicted (p = 0.04), while the MRA was positively associated with age (rho 0.411, p = 0.032). DISCUSSION In PCD patients, the prevalence of pathogens differed in children and adults with H. influenzae and S. aureus being the most common pathogens in children, S. aureus and P. aeruginosa in adults, respectively. Unexpectedly, the MRA increased by age.
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Affiliation(s)
- Lukas Roden
- Institute of Medical Microbiology, University Hospital Münster, Germany.
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Germany.
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Münster, Germany.
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Germany.
| | | | - Barbara C Kahl
- Institute of Medical Microbiology, University Hospital Münster, Germany.
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Leigh MW, Horani A, Kinghorn B, O'Connor MG, Zariwala MA, Knowles MR. Primary Ciliary Dyskinesia (PCD): A genetic disorder of motile cilia. ACTA ACUST UNITED AC 2019; 4:51-75. [PMID: 31572664 DOI: 10.3233/trd-190036] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Margaret W Leigh
- Department of Pediatrics and Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - BreAnna Kinghorn
- Seattle Children's Hospital, Department of Pediatrics, University of Washington School of Medicine; Seattle, Washington
| | - Michael G O'Connor
- Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Maimoona A Zariwala
- Department of Pathology/Lab Medicine and Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael R Knowles
- Department of Medicine and Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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47
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Halbeisen FS, Jose A, de Jong C, Nyilas S, Latzin P, Kuehni CE, Goutaki M. Spirometric indices in primary ciliary dyskinesia: systematic review and meta-analysis. ERJ Open Res 2019; 5:00231-2018. [PMID: 31111042 PMCID: PMC6513038 DOI: 10.1183/23120541.00231-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/28/2019] [Indexed: 12/19/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a genetic, heterogeneous disease caused by dysfunction of cilia. Evidence is sparse and reports of lung function in PCD patients range from normal to severe impairment. This systematic review and meta-analysis of studies of lung function in PCD patients examines the spirometric indices of PCD patients and differences by age group and sex. We searched PubMed, Embase and Scopus for studies that described lung function in 10 or more patients with PCD. We performed meta-analyses and meta-regression to explain heterogeneity. We included 24 studies, ranging from 13 to 158 patients per study. The most commonly reported spirometric indices were forced expiratory volume in 1 s (FEV1) and forced vital capacity presented as mean and standard deviation of percent predicted values. We found considerable heterogeneity for both parameters (I2=94–96%). The heterogeneity remained when we stratified the analysis by age; however, FEV1 in adult patients was lower. Even after taking into account explanatory factors, the largest part of the between-studies variance remained unexplained. Heterogeneity could be explained by genetic differences between study populations, methodological factors related to the variability of study inclusion criteria or details on the performance and evaluation of lung function measurements that we could not account for. Prospective studies therefore need to use standardised protocols and international reference values. These results underline the possibility of distinct PCD phenotypes as in other chronic respiratory diseases. Detailed characterisation of these phenotypes and related genotypes is needed in order to better understand the natural history of PCD. Spirometric indices of PCD patients vary between published studies, which suggests not only the possibility of methodological differences between centres but also real differences in disease expression based on genotype–phenotype associationshttp://ow.ly/wopw30nYaJo
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Affiliation(s)
- Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anu Jose
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carmen de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sylvia Nyilas
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- 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
| | - 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
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48
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Nenna R, Hunt KA, Dassios T, Collins JJ, Rottier RJ, Liu NM, Rottier B, Goutaki M, Karadag B, Prayle A, Fernandes RM, Parisi G, Barben J, Rubbo B, Snijders D, Makrinioti H, Hall G, Pijnenburg MW, Grigg J. Key paediatric messages from the 2018 European Respiratory Society International Congress. ERJ Open Res 2019; 5:00241-2018. [PMID: 31044141 PMCID: PMC6487274 DOI: 10.1183/23120541.00241-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/23/2019] [Indexed: 11/29/2022] Open
Abstract
In this article, the Group Chairs and early career members of the European Respiratory Society (ERS) Paediatric Assembly highlight some of the most interesting findings in the field of paediatrics which were presented at the 2018 international ERS Congress.
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Affiliation(s)
- Raffaella Nenna
- Dept of Paediatrics, Sapienza University of Rome, Rome, Italy
- Asthma and Airway Disease Research Center, The University of Arizona, Tucson, AZ, USA
| | - Katie A. Hunt
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jennifer J.P. Collins
- Dept of Paediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Robbert J. Rottier
- Dept of Paediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Norrice M. Liu
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University London, London, UK
| | - Bart Rottier
- Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Bülent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Andrew Prayle
- Child Health, Obstetrics and Gynaecology, The University of Nottingham, Nottingham, UK
| | - Ricardo M. Fernandes
- Dept of Pediatrics, Santa Maria Hospital, Lisbon, Portugal
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Jürg Barben
- Division of Paediatric Pulmonology, Children's Hospitals of Eastern Switzerland, St. Gallen, Switzerland
| | - Bruna Rubbo
- 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 Science, Southampton, UK
| | - Deborah Snijders
- Dept of Women's and Children Health, University of Padova, Padova, Italy
| | | | - Graham Hall
- Telethon Kids Institute and Curtin University, Perth, Australia
| | - Mariëlle W. Pijnenburg
- Dept of Paediatrics, Division of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
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49
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Kobbernagel HE, Green K, Ring AM, Buchvald FF, Rosthøj S, Gustafsson PM, Nielsen KG. One-year evolution and variability in multiple-breath washout indices in children and young adults with primary ciliary dyskinesia. Eur Clin Respir J 2019; 6:1591841. [PMID: 30949311 PMCID: PMC6442098 DOI: 10.1080/20018525.2019.1591841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/27/2019] [Indexed: 11/27/2022] Open
Abstract
Background and objective: Cross-sectional and longer-term studies have demonstrated abnormal yet stable multiple-breath inert gas washout (MBW) indices in patients with primary ciliary dyskinesia (PCD). This study aimed to assess the intermediate term evolution and the between-occasion variability of MBW indices in PCD over 1 year. Methods: Children and young adults with a confirmed diagnosis of PCD were included in this single-centre, prospective, observational, longitudinal study. Over 1 year, nitrogen (N2) MBW and spirometry were performed at three occasions during ordinary scheduled outpatient visits. Trends and variability in lung clearance index (LCI), moment ratios, normalized N2 concentration at six lung volume turnovers, and regional ventilation inhomogeneity indices of the conducting and intra-acinar airways (Scond*VT and Sacin*VT) were analysed using linear mixed models. Results: Forty-two patients, aged 6–29 years (median: 15.4), performed 116 N2 MBW test occasions and 96.6% were technically acceptable. A minimal, although significant, increase in LCI over 1 year (mean: 0.51 units, 95% CI: 0.12–0.91, p = 0.01) was found; while, all other N2 MBW indices and FEV1 remained unchanged. A moderate correlation was observed between LCI and FEV1 (r = −0.47, p = 0.0001). The limits of agreement between tests 1 year apart were for LCI: −1.96 to 2.98; Scond*VT: ± 0.039; Sacin*VT: −0.108 to 0.128. Conclusions: Children and young adults with PCD managed at a specialist centre showed slightly, but significant, increasing LCI and otherwise unchanged ventilation inhomogeneity indices and dynamic volumes over the intermediate term of 1 year. Estimates of the variability of N2 MBW indices may inform sample size calculations of future randomized controlled trials.
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Affiliation(s)
- Helene Elgaard Kobbernagel
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kent Green
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederik Fouirnaies Buchvald
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Rosthøj
- Department of Biostatistics, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kim Gjerum Nielsen
- Danish PCD Centre, Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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50
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Accuracy of High-Speed Video Analysis to Diagnose Primary Ciliary Dyskinesia. Chest 2019; 155:1008-1017. [PMID: 30826306 DOI: 10.1016/j.chest.2019.01.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diagnosis of primary ciliary dyskinesia (PCD) relies on a combination of tests. High-speed video microscopy analysis (HSVA) is widely used to contribute to the diagnosis. It can be analyzed on the day of diagnostic consultation, but the qualitative analyses are subjective. Diagnostic accuracy and reliability of assessing ciliary function have not been robustly evaluated. We aimed to establish the accuracy of HSVA to diagnose PCD compared with a combination of tests, and to assess the interobserver reliability of HSVA analysis. METHODS We randomly selected and anonymized archived videos from 120 patients seen at three UK PCD centers. Three experienced scientists independently reviewed six videos per patient, using a standardized proforma, blinded to diagnostic and clinical data. We compared study outcomes with two references: (1) a combination of diagnostic tests in accordance with the European Respiratory Society PCD diagnostic guidelines and (2) original clinical outcome determined by all available diagnostic tests. RESULTS HSVA had excellent sensitivity and specificity to diagnose PCD: (1) 100% and 96%, respectively, compared with ERS guidelines, and (2) 96% and 91% compared with diagnostic outcomes. There was high interobserver agreement for "PCD-positive" outcomes (κ = 0.7). CONCLUSIONS Specialist scientists accurately diagnosed PCD using HSVA, with high interobserver agreement. HSVA can be reliably used to counsel patients and commence treatment on the day of testing while awaiting confirmatory investigations.
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