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2017 ; 5
(ä): 135
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Primary Ciliary Dyskinesia: An Update on Clinical Aspects, Genetics, Diagnosis,
and Future Treatment Strategies
#MMPMID28649564
Mirra V
; Werner C
; Santamaria F
Front Pediatr
2017[]; 5
(ä): 135
PMID28649564
show ga
Primary ciliary dyskinesia (PCD) is an orphan disease (MIM 244400), autosomal
recessive inherited, characterized by motile ciliary dysfunction. The estimated
prevalence of PCD is 1:10,000 to 1:20,000 live-born children, but true prevalence
could be even higher. PCD is characterized by chronic upper and lower respiratory
tract disease, infertility/ectopic pregnancy, and situs anomalies, that occur in
?50% of PCD patients (Kartagener syndrome), and these may be associated with
congenital heart abnormalities. Most patients report a daily year-round wet cough
or nose congestion starting in the first year of life. Daily wet cough,
associated with recurrent infections exacerbations, results in the development of
chronic suppurative lung disease, with localized-to-diffuse bronchiectasis. No
diagnostic test is perfect for confirming PCD. Diagnosis can be challenging and
relies on a combination of clinical data, nasal nitric oxide levels plus cilia
ultrastructure and function analysis. Adjunctive tests include genetic analysis
and repeated tests in ciliary culture specimens. There are currently 33 known
genes associated with PCD and correlations between genotype and ultrastructural
defects have been increasingly demonstrated. Comprehensive genetic testing may
hopefully screen young infants before symptoms occur, thus improving survival.
Recent surprising advances in PCD genetic designed a novel approach called "gene
editing" to restore gene function and normalize ciliary motility, opening up new
avenues for treating PCD. Currently, there are no data from randomized clinical
trials to support any specific treatment, thus, management strategies are usually
extrapolated from cystic fibrosis. The goal of treatment is to prevent
exacerbations, slowing the progression of lung disease. The therapeutic mainstay
includes airway clearance maneuvers mainly with nebulized hypertonic saline and
chest physiotherapy, and prompt and aggressive administration of antibiotics.
Standardized care at specialized centers using a multidisciplinary approach that
imposes surveillance of lung function and of airway biofilm composition likely
improves patients' outcome. Pediatricians, neonatologists, pulmonologists, and
ENT surgeons should maintain high awareness of PCD and refer patients to the
specialized center before sustained irreversible lung damage develops. The recent
creation of a network of PCD clinical centers, focusing on improving diagnosis
and treatment, will hopefully help to improve care and knowledge of PCD patients.