@article {772, title = {Cytoplasmic "ciliary inclusions" in isolation are not sufficient for the diagnosis of primary ciliary dyskinesia.}, journal = {Pediatr Pulmonol}, volume = {55}, year = {2020}, month = {2020 01}, pages = {130-135}, abstract = {

BACKGROUND: The diagnosis of primary ciliary dyskinesia (PCD) is difficult and requires a combination of clinical features, nasal nitric oxide testing, cilia ultrastructural analysis by electron microscopy (EM), and genetics. A recently described cytoplasmic ultrastructural change termed "ciliary inclusions" was reported to be diagnostic of PCD; however, no supporting evidence of PCD was provided. In this study, we sought to confirm, or refute, the diagnosis of PCD in subjects with "ciliary inclusions" on EM.

METHODS: Six subjects from five families with previous lab reports of "ciliary inclusions" on EMs of ciliated cells were identified and evaluated at a Genetic Disorders of Mucociliary Clearance Consortium site. We performed a detailed clinical history, nasal nitric oxide measurement, genetic testing including whole-exome sequencing (WES), and when possible, repeat ciliary EM study.

RESULTS: Only one of six subjects had multiple and persistent clinical features congruent with PCD. No subject had situs inversus. Only one of six subjects had a very low nasal nitric oxide level. No "ciliary inclusions" were found in three subjects who had a repeat ciliary EM, and ciliary axonemal ultrastructures were normal. Genetic testing, including WES, was negative for PCD-causing genes, and for pathogenic variants in gene pathways that might cause "ciliary inclusions," such as ciliary biogenesis.

CONCLUSION: "Ciliary Inclusions", in isolation, are not sufficient to diagnosis PCD. If seen, additional studies should be done to pursue an accurate diagnosis.

}, keywords = {Child, Preschool, Cilia, Ciliary Motility Disorders, Female, Genetic Testing, Humans, Infant, Male, Nasal Mucosa, Nitric Oxide, Whole Exome Sequencing}, issn = {1099-0496}, doi = {10.1002/ppul.24528}, author = {Vece, Timothy J and Sagel, Scott D and Zariwala, Maimoona A and Sullivan, Kelli M and Burns, Kimberlie A and Dutcher, Susan K and Yusupov, Roman and Leigh, Margaret W and Knowles, Michael R} } @article {608, title = {Primary Ciliary Dyskinesia: Longitudinal Study of Lung Disease by Ultrastructure Defect and Genotype.}, journal = {Am J Respir Crit Care Med}, volume = {199}, year = {2019}, month = {2019 01 15}, pages = {190-198}, abstract = {

RATIONALE: In primary ciliary dyskinesia, factors leading to disease heterogeneity are poorly understood.

OBJECTIVES: To describe early lung disease progression in primary ciliary dyskinesia and identify associations between ultrastructural defects and genotypes with clinical phenotype.

METHODS: This was a prospective, longitudinal (5 yr), multicenter, observational study. Inclusion criteria were less than 19 years at enrollment and greater than or equal to two annual study visits. Linear mixed effects models including random slope and random intercept were used to evaluate longitudinal associations between the ciliary defect group (or genotype group) and clinical features (percent predicted FEV and weight and height z-scores).

MEASUREMENTS AND MAIN RESULTS: A total of 137 participants completed 732 visits. The group with absent inner dynein arm, central apparatus defects, and microtubular disorganization (IDA/CA/MTD) (n = 41) were significantly younger at diagnosis and in mixed effects models had significantly lower percent predicted FEV and weight and height z-scores than the isolated outer dynein arm defect (n = 55) group. Participants with CCDC39 or CCDC40 mutations (n = 34) had lower percent predicted FEV and weight and height z-scores than those with DNAH5 mutations (n = 36). For the entire cohort, percent predicted FEV decline was heterogeneous with a mean (SE) decline of 0.57 (0.25) percent predicted/yr. Rate of decline was different from zero only in the IDA/MTD/CA group (mean [SE], -1.11 [0.48] percent predicted/yr; P = 0.02).

CONCLUSIONS: Participants with IDA/MTD/CA defects, which included individuals with CCDC39 or CCDC40 mutations, had worse lung function and growth indices compared with those with outer dynein arm defects and DNAH5 mutations, respectively. The only group with a significant lung function decline over time were participants with IDA/MTD/CA defects.

}, keywords = {Child, Cilia, Cohort Studies, Female, Genotype, Humans, Kartagener Syndrome, Longitudinal Studies, Lung, Male, Mutation, Phenotype, Prospective Studies, Respiratory Function Tests}, issn = {1535-4970}, doi = {10.1164/rccm.201803-0548OC}, author = {Davis, Stephanie D and Rosenfeld, Margaret and Lee, Hye-Seung and Ferkol, Thomas W and Sagel, Scott D and Dell, Sharon D and Milla, Carlos and Pittman, Jessica E and Shapiro, Adam J and Sullivan, Kelli M and Nykamp, Keith R and Krischer, Jeffrey P and Zariwala, Maimoona A and Knowles, Michael R and Leigh, Margaret W} }