Skip to main content
Top
Published in: Diagnostic Pathology 1/2011

Open Access 01-12-2011 | Research

Ultrastructural pathology of primary ciliary dyskinesia: report about 125 cases in Germany

Authors: Dirk Theegarten, Michael Ebsen

Published in: Diagnostic Pathology | Issue 1/2011

Login to get access

Abstract

Background

Primary ciliary dyskinesia (PCD) is a rare genetically induced disorder of cilia inducing mainly respiratory diseases. Transmission electron microscopy (TEM) analysis of ciliary ultrastructure is classically used for diagnosis. We report our experience of TEM investigations in a large series of patients.

Methods

TEM analysis performed of 742 biopsies from patients with suspected PCD was reviewed retrospectively. Ultrastructural defects were analysized further in 125 cases with changes typical for PCD.

Results

In 18.1% of patients diagnosis of PCD was made because of morphological alterations, in 68.2% secondary changes were seen. In 13.7% material was not feasible for analysis. Mostly defects of dynein arms were detected in PCD (96.8%). In particular defects of the inner arms (51.2%) and combined dynein defects (37.6%) were found. Total loss of dynein arms was dominant. Only in 3.2% deficiencies of central structures were found alone. Associated situs inversus or dextracardia was reported clinically in 21.4%.

Conclusions

TEM analysis is possible in most patients and a useful tool for diagnosis of PCD. Functional and genetic analysis should be done additionally. Registers should be installed to collect all available informations and push further research.

Virtual Slides

The virtual slide(s) for this article can be found here: http://​www.​diagnosticpathol​ogy.​diagnomx.​eu/​vs/​1629267757580889​.
Appendix
Available only for authorised users
Literature
1.
go back to reference Badano JL, Mitsuma N, Beales PL, Katsanis N: The ciliopathies: an emerging class of human genetic disorders. Annu Rev Genomics Hum Genet. 2006, 7: 125-148. 10.1146/annurev.genom.7.080505.115610.CrossRefPubMed Badano JL, Mitsuma N, Beales PL, Katsanis N: The ciliopathies: an emerging class of human genetic disorders. Annu Rev Genomics Hum Genet. 2006, 7: 125-148. 10.1146/annurev.genom.7.080505.115610.CrossRefPubMed
2.
go back to reference Afzelius BA: A human syndrome caused by immotile cilia. Science. 1976, 193 (4250): 317-319. 10.1126/science.1084576.CrossRefPubMed Afzelius BA: A human syndrome caused by immotile cilia. Science. 1976, 193 (4250): 317-319. 10.1126/science.1084576.CrossRefPubMed
3.
go back to reference Ferkol T, Mitchison HM, O'Callaghan C, Leigh M, Carson J, Lie H, Rosenbluth D, Brody SL: Current issues in the basis mechanisms, pathophysiology, diagnosis and management of primary ciliary dyskinesia. Eur Respir Mon. 2006, 37: 291-313. Ferkol T, Mitchison HM, O'Callaghan C, Leigh M, Carson J, Lie H, Rosenbluth D, Brody SL: Current issues in the basis mechanisms, pathophysiology, diagnosis and management of primary ciliary dyskinesia. Eur Respir Mon. 2006, 37: 291-313.
4.
go back to reference Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MP, Bush A: Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J. 2009, 34: 1264-1276. 10.1183/09031936.00176608.CrossRefPubMed Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MP, Bush A: Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J. 2009, 34: 1264-1276. 10.1183/09031936.00176608.CrossRefPubMed
5.
go back to reference Bush A, Cole P, Hariri M, Mackay I, Phillips G, O'Callaghan C, Wilson R, Warner JO: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J. 1998, 12: 982-988. 10.1183/09031936.98.12040982.CrossRefPubMed Bush A, Cole P, Hariri M, Mackay I, Phillips G, O'Callaghan C, Wilson R, Warner JO: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J. 1998, 12: 982-988. 10.1183/09031936.98.12040982.CrossRefPubMed
6.
go back to reference Coren ME, Meeks M, Morrison I, Buchdahl RM, Bush A: Primary ciliary dyskinesia: age at diagnosis and symptom history. Acta Paediatr. 2002, 91: 667-669. 10.1111/j.1651-2227.2002.tb03299.x.CrossRefPubMed Coren ME, Meeks M, Morrison I, Buchdahl RM, Bush A: Primary ciliary dyskinesia: age at diagnosis and symptom history. Acta Paediatr. 2002, 91: 667-669. 10.1111/j.1651-2227.2002.tb03299.x.CrossRefPubMed
7.
go back to reference Bush A, Chodhari R, Collins N, Copeland F, Hall P, Harcourt J, Hariri M, Hogg C, Lucas J, Mitchison HM, O'Callaghan C, Phillips G: Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007, 92: 1136-1140. 10.1136/adc.2006.096958.PubMedCentralCrossRefPubMed Bush A, Chodhari R, Collins N, Copeland F, Hall P, Harcourt J, Hariri M, Hogg C, Lucas J, Mitchison HM, O'Callaghan C, Phillips G: Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007, 92: 1136-1140. 10.1136/adc.2006.096958.PubMedCentralCrossRefPubMed
8.
go back to reference Lesic I, Maurer E, Strippoli MP, Kuehni CE, Barbato A, Frischer T: Primäre Ziliendyskinesie in Österreich. Wien Klin Wochenschr. 2009, 121: 616-622. 10.1007/s00508-009-1197-4.CrossRefPubMed Lesic I, Maurer E, Strippoli MP, Kuehni CE, Barbato A, Frischer T: Primäre Ziliendyskinesie in Österreich. Wien Klin Wochenschr. 2009, 121: 616-622. 10.1007/s00508-009-1197-4.CrossRefPubMed
9.
go back to reference Popper H, Jakse R: Diagnose und Aspekte der Pathogenese des Kartagener-Syndromes an Hand von Nasenschleimhautbiopsien. Wien Klin Wochenschr. 1982, 94: 370-372.PubMed Popper H, Jakse R: Diagnose und Aspekte der Pathogenese des Kartagener-Syndromes an Hand von Nasenschleimhautbiopsien. Wien Klin Wochenschr. 1982, 94: 370-372.PubMed
10.
go back to reference Milara J, Armengot M, Mata M, Morcillo EJ, Cortijo J: Role of adenylate kinase type 7 expression on cilia motility: possible link in primary ciliary dyskinesia. Am J Rhinol Allergy. 2010, 24: 181-185. 10.2500/ajra.2010.24.3468.CrossRefPubMed Milara J, Armengot M, Mata M, Morcillo EJ, Cortijo J: Role of adenylate kinase type 7 expression on cilia motility: possible link in primary ciliary dyskinesia. Am J Rhinol Allergy. 2010, 24: 181-185. 10.2500/ajra.2010.24.3468.CrossRefPubMed
11.
go back to reference de Iongh RU, Rutland J: Ciliary defects in healthy subjects, bronchiectasis, and primary ciliary dyskinesia. Am J Respir Crit Care Med. 1995, 151: 1559-1567.CrossRefPubMed de Iongh RU, Rutland J: Ciliary defects in healthy subjects, bronchiectasis, and primary ciliary dyskinesia. Am J Respir Crit Care Med. 1995, 151: 1559-1567.CrossRefPubMed
12.
go back to reference Santamaria F, de Santi MM, Grillo G, Sarnelli P, Caterino M, Greco L: Ciliary motility at light microscopy: a screening technique for ciliary defects. Acta Paediatr. 1999, 88: 853-857. 10.1111/j.1651-2227.1999.tb00061.x.CrossRefPubMed Santamaria F, de Santi MM, Grillo G, Sarnelli P, Caterino M, Greco L: Ciliary motility at light microscopy: a screening technique for ciliary defects. Acta Paediatr. 1999, 88: 853-857. 10.1111/j.1651-2227.1999.tb00061.x.CrossRefPubMed
13.
go back to reference Felix H, Holzmann D: Function and ultrastructure of cilia in primary ciliary dyskinesia. Schweiz Med Wochenschr. 2000, 130: 699-704.PubMed Felix H, Holzmann D: Function and ultrastructure of cilia in primary ciliary dyskinesia. Schweiz Med Wochenschr. 2000, 130: 699-704.PubMed
14.
go back to reference Noone PG, Leigh MW, Sannuti A, Minnix SL, Carson JL, Hazucha M, Zariwala MA, Knowles MR: Primary ciliary dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med. 2004, 169: 459-467.CrossRefPubMed Noone PG, Leigh MW, Sannuti A, Minnix SL, Carson JL, Hazucha M, Zariwala MA, Knowles MR: Primary ciliary dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med. 2004, 169: 459-467.CrossRefPubMed
15.
go back to reference Carlén B, Stenram U: Primary ciliary dyskinesia: a review. Ultrastruct Pathol. 2005, 29: 217-220. 10.1080/01913120590951220.CrossRefPubMed Carlén B, Stenram U: Primary ciliary dyskinesia: a review. Ultrastruct Pathol. 2005, 29: 217-220. 10.1080/01913120590951220.CrossRefPubMed
16.
go back to reference Plesec TP, Ruiz A, McMahon JT, Prayson RA: Ultrastructural abnormalities of respiratory cilia: a 25-year experience. Arch Pathol Lab Med. 2008, 132: 1786-1791.PubMed Plesec TP, Ruiz A, McMahon JT, Prayson RA: Ultrastructural abnormalities of respiratory cilia: a 25-year experience. Arch Pathol Lab Med. 2008, 132: 1786-1791.PubMed
17.
go back to reference Stannard WA, Chilvers MA, Rutman AR, Williams CD, O'Callaghan C: Diagnostic testing of patients suspected of primary ciliary dyskinesia. Am J Respir Crit Care Med. 2010, 181: 307-314. 10.1164/rccm.200903-0459OC.CrossRefPubMed Stannard WA, Chilvers MA, Rutman AR, Williams CD, O'Callaghan C: Diagnostic testing of patients suspected of primary ciliary dyskinesia. Am J Respir Crit Care Med. 2010, 181: 307-314. 10.1164/rccm.200903-0459OC.CrossRefPubMed
18.
go back to reference Papon JF, Coste A, Roudot-Thoraval F, Boucherat M, Roger G, Tamalet A, Vojtek AM, Amselem S, Escudier E: A 20-year experience of electron microscopy in the diagnosis of primary ciliary dyskinesia. Eur Respir J. 2010, 35: 1057-1063. 10.1183/09031936.00046209.CrossRefPubMed Papon JF, Coste A, Roudot-Thoraval F, Boucherat M, Roger G, Tamalet A, Vojtek AM, Amselem S, Escudier E: A 20-year experience of electron microscopy in the diagnosis of primary ciliary dyskinesia. Eur Respir J. 2010, 35: 1057-1063. 10.1183/09031936.00046209.CrossRefPubMed
19.
go back to reference Markmann HU, Matthus J: Das primäre ziliare Dyskinesiesyndrom. Ultrastrukturelle Beobachtungen bei einem Zwillingspaar. Pathologe. 1990, 11: 80-84.PubMed Markmann HU, Matthus J: Das primäre ziliare Dyskinesiesyndrom. Ultrastrukturelle Beobachtungen bei einem Zwillingspaar. Pathologe. 1990, 11: 80-84.PubMed
20.
go back to reference Theegarten D, Anhenn O, Hotzel H, Wagner M, Marra A, Stamatis G, Mogilevski G, Sachse K: A comparative ultrastructural and molecular biological study on Chlamydia psittaci infection in alpha-1 antitrypsin deficiency and non-alpha-1 antitrypsin deficiency emphysema versus lung tissue of patients with hamartochondroma. BMC Infect Dis. 2004, 4: 38-10.1186/1471-2334-4-38.PubMedCentralCrossRefPubMed Theegarten D, Anhenn O, Hotzel H, Wagner M, Marra A, Stamatis G, Mogilevski G, Sachse K: A comparative ultrastructural and molecular biological study on Chlamydia psittaci infection in alpha-1 antitrypsin deficiency and non-alpha-1 antitrypsin deficiency emphysema versus lung tissue of patients with hamartochondroma. BMC Infect Dis. 2004, 4: 38-10.1186/1471-2334-4-38.PubMedCentralCrossRefPubMed
21.
go back to reference Armengot M, Milara J, Mata M, Carda C, Cortijo J: Cilia motility and structure in primary and secondary ciliary dyskinesia. Am J Rhinol Allergy. 2010, 24: 175-180. 10.2500/ajra.2010.24.3448.CrossRefPubMed Armengot M, Milara J, Mata M, Carda C, Cortijo J: Cilia motility and structure in primary and secondary ciliary dyskinesia. Am J Rhinol Allergy. 2010, 24: 175-180. 10.2500/ajra.2010.24.3448.CrossRefPubMed
22.
go back to reference Sirvanci S, Seda Uyan Z, Ercan F, Karadag B, Ersu R, Karakoc F, Dagli E, San T: Quantitative analysis of ciliary ultrastructure in patients with primary ciliary dyskinesia. Acta Histochem. 2008, 110: 34-41. 10.1016/j.acthis.2007.05.006.CrossRefPubMed Sirvanci S, Seda Uyan Z, Ercan F, Karadag B, Ersu R, Karakoc F, Dagli E, San T: Quantitative analysis of ciliary ultrastructure in patients with primary ciliary dyskinesia. Acta Histochem. 2008, 110: 34-41. 10.1016/j.acthis.2007.05.006.CrossRefPubMed
23.
go back to reference Rayner CF, Rutman A, Dewar A, Greenstone MA, Cole PJ, Wilson R: Ciliary disorientation alone as a cause of primary ciliary dyskinesia syndrome. Am J Respir Crit Care Med. 1996, 153: 1123-1129.CrossRefPubMed Rayner CF, Rutman A, Dewar A, Greenstone MA, Cole PJ, Wilson R: Ciliary disorientation alone as a cause of primary ciliary dyskinesia syndrome. Am J Respir Crit Care Med. 1996, 153: 1123-1129.CrossRefPubMed
24.
go back to reference Jorissen M, Willems T: The secondary nature of ciliary (dis)orientation in secondary and primary ciliary dyskinesia. Acta Otolaryngol. 2004, 124: 527-531. 10.1080/00016480410016270.CrossRefPubMed Jorissen M, Willems T: The secondary nature of ciliary (dis)orientation in secondary and primary ciliary dyskinesia. Acta Otolaryngol. 2004, 124: 527-531. 10.1080/00016480410016270.CrossRefPubMed
25.
go back to reference Jorissen M, Willems T, Van der Schueren B, Verbeken E, De Boeck K: Ultrastructural expression of primary ciliary dyskinesia after ciliogenesis in culture. Acta Otorhinolaryngol Belg. 2000, 54: 343-356.PubMed Jorissen M, Willems T, Van der Schueren B, Verbeken E, De Boeck K: Ultrastructural expression of primary ciliary dyskinesia after ciliogenesis in culture. Acta Otorhinolaryngol Belg. 2000, 54: 343-356.PubMed
26.
go back to reference Escudier E, Couprie M, Duriez B, Roudot-Thoraval F, Millepied MC, Prulière-Escabasse V, Labatte L, Coste A: Computer-assisted analysis helps detect inner dynein arm abnormalities. Am J Respir Crit Care Med. 2002, 166: 1257-1262. 10.1164/rccm.2111070.CrossRefPubMed Escudier E, Couprie M, Duriez B, Roudot-Thoraval F, Millepied MC, Prulière-Escabasse V, Labatte L, Coste A: Computer-assisted analysis helps detect inner dynein arm abnormalities. Am J Respir Crit Care Med. 2002, 166: 1257-1262. 10.1164/rccm.2111070.CrossRefPubMed
27.
go back to reference Chilvers MA, Rutman A, O'Callaghan C: Ciliary beat pattern is associated with specific ultrastructural defects in primary ciliary dyskinesia. J Allergy Clin Immunol. 2003, 112: 518-524. 10.1016/S0091-6749(03)01799-8.CrossRefPubMed Chilvers MA, Rutman A, O'Callaghan C: Ciliary beat pattern is associated with specific ultrastructural defects in primary ciliary dyskinesia. J Allergy Clin Immunol. 2003, 112: 518-524. 10.1016/S0091-6749(03)01799-8.CrossRefPubMed
28.
go back to reference O'Callaghan C, Rutman A, Williams GM, Hirst RA: Inner dynein arm defects causing Primary Ciliary Dyskinesia: Repeat testing required. Eur Respir J. 2011, 38: 603-607. 10.1183/09031936.00108410.CrossRefPubMed O'Callaghan C, Rutman A, Williams GM, Hirst RA: Inner dynein arm defects causing Primary Ciliary Dyskinesia: Repeat testing required. Eur Respir J. 2011, 38: 603-607. 10.1183/09031936.00108410.CrossRefPubMed
Metadata
Title
Ultrastructural pathology of primary ciliary dyskinesia: report about 125 cases in Germany
Authors
Dirk Theegarten
Michael Ebsen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Diagnostic Pathology / Issue 1/2011
Electronic ISSN: 1746-1596
DOI
https://doi.org/10.1186/1746-1596-6-115

Other articles of this Issue 1/2011

Diagnostic Pathology 1/2011 Go to the issue