Name: high-speed video microscopy analysis for first-line diagnosis of primary ciliary dyskinesia
Uploaded: 2022-01-19T14:00:00
Description: Watch this Scientific Journal Video about High-speed Video Microscopy Analysis for First-line Diagnosis of Primary Ciliary Dyskinesia at JoVE.com

We wish to express special thanks to the pediatric nurse Mrs. Johanna Juvankoski for her excellent help with the brushings. We would also like to express special gratitude to Professor Heymut Omran (University Clinic M&#252;nster, UKM) for granting permission to use the schematic figure of normal ciliary motion from their website. Finally, we would like to thank Mr. Alan Brown BA (Hons), PGCE, for proofreading the manuscript.

Ethics Statement:
This study was approved by the local ethics committee (69/2017) and was conducted in compliance with the declaration of Helsinki.
1. Collection and transport of respiratory epithelial cells
<ol>
	<li>Brushing
	<ol>
		<li>Before brushing, administer a two-week course of oral amoxicillin-clavulanic acid to the patient to eradicate biofilms interfering with cilia function. Ensure the antibiotic is terminated 2 days before the proced...

<ol>
	<li>Werner, C., Onnebrink, J. G., Omran, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+management+of+primary+ciliary+dyskinesia.">Diagnosis and management of primary ciliary dyskinesia.</a> Cilia. 4 (1), 2 (2015).</li><li>Mirra, V., Werner, C., Santamaria, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+ciliary+dyskinesia:+An+update+on+clinical+aspects,+genetics,+diagnosis+and+future+treatment+strategies.">Primary ciliary dyskinesia: An update on clinical aspects, genetics, diagnosis and future treatment strategies.</a> Frontiers in Pediatrics. 5, 135 (2017).</li><li>Schultz, R., Elenius, V., Lukkarinen, H., Saarela, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two+novel+mutations+in+the+DNAH11+gene+in+primary+ciliary+dyskinesia+(CILD7)+with+considerable+variety+in+the+clinical+and+beating+cilia+phenotype.">Two novel mutations in the DNAH11 gene in primary ciliary dyskinesia (CILD7) with considerable variety in the clinical and beating cilia phenotype.</a> BMC Medical Genetics. 21 (1), 237 (2020).</li><li>Knowles, M. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mutations+of+DNAH11+in+patients+with+primary+ciliary+dyskinesia+with+normal+ciliary+ultrastructure.">Mutations of DNAH11 in patients with primary ciliary dyskinesia with normal ciliary ultrastructure.</a> Thorax. 67 (5), 433-441 (2012).</li><li>Boon, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+ciliary+dyskinesia:+critical+evaluation+of+clinical+symptoms+and+diagnosis+in+patients+with+normal+and+abnormal+ultrastructure.">Primary ciliary dyskinesia: critical evaluation of clinical symptoms and diagnosis in patients with normal and abnormal ultrastructure.</a> Orphanet Journal of Rare Diseases. 9, 11 (2014).</li><li>Kouis, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+primary+ciliary+dyskinesia+in+consecutive+referrals+of+suspected+cases+and+the+transmission+electron+microscopy+detection+rate:+a+systematic+review+and+meta-analysis.">Prevalence of primary ciliary dyskinesia in consecutive referrals of suspected cases and the transmission electron microscopy detection rate: a systematic review and meta-analysis.</a> Pediatric Research. 81 (3), 398-405 (2017).</li><li>Marthin, J. K., Nielsen, K. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Choice+of+nasal+nitric+oxide+technique+as+first-line+test+for+primary+ciliary+dyskinesia.">Choice of nasal nitric oxide technique as first-line test for primary ciliary dyskinesia.</a> European Respiratory Journal. 37 (3), 559-565 (2011).</li><li>Jackson, C. L., Behan, L., Collins, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+diagnostic+testing+in+primary+ciliary+dyskinesia.">Accuracy of diagnostic testing in primary ciliary dyskinesia.</a> European Respiratory Journal. 47 (3), 837-848 (2016).</li><li>Lucas, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Respiratory+Society+guidelines+for+the+diagnosis+of+primary+ciliary+dyskinesia.">European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia.</a> European Respiratory Journal. 49 (1), 1601090 (2017).</li><li>Shoemark, A., Dell, S., Shapiro, A., Lucas, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ERS+and+ATS+diagnostic+guidelines+for+primary+ciliary+dyskinesia:+similarities+and+differences+in+approach+to+diagnosis.">ERS and ATS diagnostic guidelines for primary ciliary dyskinesia: similarities and differences in approach to diagnosis.</a> European Respiratory Journal. 54 (3), 1901066 (2019).</li><li>Kouis, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost-effectiveness+analysis+of+three+algorithms+for+diagnosing+primary+ciliary+dyskinesia:+a+simulation+study.">Cost-effectiveness analysis of three algorithms for diagnosing primary ciliary dyskinesia: a simulation study.</a> Orphanet Journal of Rare Diseases. 14 (1), 142 (2019).</li><li>Rubbo, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+high-speed+video+analysis+to+diagnose+primary+ciliary+dyskinesia.">Accuracy of high-speed video analysis to diagnose primary ciliary dyskinesia.</a> Chest. 155 (5), 1008-1017 (2019).</li><li>Friedman, N. R., Pachigolla, R., Deskin, R. W., Hawkins, H. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimal+technique+to+diagnose+primary+ciliary+dyskinesia.">Optimal technique to diagnose primary ciliary dyskinesia.</a> The Laryngoscope. 110 (9), 1548-1551 (2000).</li><li>Chilvers, M. A., Rutman, A., O&#180;Callaghan, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+analysis+of+cilia+and+ciliated+epithelial+ultrastructure+in+healthy+children+and+young+adults.">Functional analysis of cilia and ciliated epithelial ultrastructure in healthy children and young adults.</a> Thorax. 58 (4), 333-338 (2003).</li><li>Lucas, J. S., Paff, T., Goggin, P., Haarman, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+methods+in+primary+ciliary+dyskinesia.">Diagnostic methods in primary ciliary dyskinesia.</a> Paediatric Respiratory Reviews. 18, 8-17 (2016).</li><li>Ballenger, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+effect+of+cigarette+smoke+on+human+respiratory+cilia.">Experimental effect of cigarette smoke on human respiratory cilia.</a> New England Journal of Medicine. 263, 832-835 (1960).</li><li>Stanley, P. J., Wilson, R., Greenstone, M. A., Mac William, L., Cole, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+cigarette+smoking+on+nasal+mucociliary+clearance+and+ciliary+beat+frequency.">Effect of cigarette smoking on nasal mucociliary clearance and ciliary beat frequency.</a> Thorax. 41 (7), 519-523 (1986).</li><li>Kobbernagel, H. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+azithromycin+maintenance+therapy+in+primary+cilia+dyskinesia+(BESTCILIA):+a+multicentre,+double-blind,+randomised,+placebo-controlled+phase+3+trial.">Efficacy and safety of azithromycin maintenance therapy in primary cilia dyskinesia (BESTCILIA): a multicentre, double-blind, randomised, placebo-controlled phase 3 trial.</a> Lancet Respiratory Medicine. 8 (5), 493-505 (2020).</li><li>Takeyama, K., Tamaoki, J., Chiyotani, A., Tagaya, E., Konno, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+macrolide+antibiotics+on+ciliary+motility+in+rabbit+airway+epithelium+in-vitro.">Effect of macrolide antibiotics on ciliary motility in rabbit airway epithelium in-vitro.</a> Journal of Pharmacy and Pharmacology. 45 (8), 756-758 (1993).</li><li>Toskala, E., Haataja, J., Shirasaki, H., Rautliainen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Culture+of+cells+harvested+with+nasal+brushing:+a+method+for+evaluating+ciliary+function.">Culture of cells harvested with nasal brushing: a method for evaluating ciliary function.</a> Rhinology. 43 (2), 121-124 (2005).</li><li>Pifferi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simplified+cell+culture+method+for+the+diagnosis+of+atypical+primary+ciliary+dyskinesia.">Simplified cell culture method for the diagnosis of atypical primary ciliary dyskinesia.</a> Thorax. 64 (12), 1077-1081 (2009).</li><li>Hirst, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Culture+of+primary+ciliary+dyskinesia+epithelial+cells+at+air+liquid+interface+can+alter+ciliary+phenotype+but+remains+a+robust+and+informative,+diagnostic+aid.">Culture of primary ciliary dyskinesia epithelial cells at air liquid interface can alter ciliary phenotype but remains a robust and informative, diagnostic aid.</a> PLoS One. 9 (2), 89675 (2014).</li><li>Papon, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+analysis+of+ciliary+beating+in+primary+ciliary+dyskinesia:+a+pilot+study.">Quantitative analysis of ciliary beating in primary ciliary dyskinesia: a pilot study.</a> Orphanet Journal of Rare Diseases. 7 (10), 78 (2012).</li><li>Smith, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cilia+FA:+a+research+tool+for+automated,+high-throughput+measurement+of+ciliary+beat+frequency+using+freely+available+software.">Cilia FA: a research tool for automated, high-throughput measurement of ciliary beat frequency using freely available software.</a> Cilia. 1 (8), 14 (2012).</li><li>Sampaio, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ciliar+Move:+new+software+for+evaluating+ciliary+beat+frequency+helps+find+novel+mutations+by+a+Portuguese+multidisciplinary+team+on+primary+ciliary+dyskinesia.">Ciliar Move: new software for evaluating ciliary beat frequency helps find novel mutations by a Portuguese multidisciplinary team on primary ciliary dyskinesia.</a> European Respiratory Journal Open Research. 7 (1), 00792 (2021).</li><li>Mullowney, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+ciliary+dyskinesia+and+neonatal+respiratory+distress.">Primary ciliary dyskinesia and neonatal respiratory distress.</a> Pediatrics. 134 (6), 1160-1166 (2014).</li><li>Leigh, M. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Standardizing+nasal+nitric+oxide+measurement+as+a+test+for+primary+ciliary+dyskinesia.">Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia.</a> Annals of the American Thoracic Society. 10 (6), 574-581 (2013).</li></ol>

Here, the diagnostic process for PCD using HSVMA is described and discussed in the light of first-line diagnostics. Despite being relatively easy to establish, cost-effective11, and a reliable method in experienced hands12, HSVMA is not a diagnostic measure without pitfalls. Abnormal CBF and CBP may be due to secondary infection, leading to inflammation of the broncho-respiratory epithelia15, and for the same reason, smoking individuals may have abno...

Primary ciliary dyskinesia (PCD) is a rare, hereditary genetic disorder, which causes disturbances in the movement of beating cilia. If undiagnosed, it leads to severe lung damage in later life due to severe impairment of MCC. In the past, its prevalence has been estimated to be in the range of 1:4,000 to 50,000. Due to steadily improving diagnostics and a growing awareness of the condition, updates on the prevalence of PCD suggest that it might be much more common and probably in the range of 1:4,000 to 20,000 instead1,2. However, patients with PCD are still underdiagnosed or diagnosed too late1,3. Therefore, infants with either congenital situs inversus and/or heterotaxy or perinatal rhinorrhea, neonatal respiratory distress, a blocked nose, and feeding difficulties should be suspects for PCD. In later life, chronic otitis, recurrent pneumonia, rhinosinusitis, and a chronic, typical wet cough due to impaired MCC are the hallmark symptoms of PCD, which in combination with bronchiectasis and impaired lung function, continue into adulthood2. 
Patients suspected of having PCD can be diagnosed by using different diagnostic tools. TEM has been considered the gold standard for first-line diagnostics in the past. However, up to 30% of PCD cases do not show abnormal ultrastructure1,3,4,5,6, demanding a different diagnostic approach. Therefore, a growing number of centers and the guidelines of the European Respiratory Society (ERS) suggest a combination of nasal nitric oxide (nNO) and HSVMA as first-line diagnostics1,7,9,10. HSVMA and nNO are also the most cost-effective options in identifying a patient with PCD11. However, even if genetic testing were included in the diagnostics, it must be kept in mind that there is currently no stand-alone test or combination of tests that can exclude PCD with 100% certainty8,9,10. 
Out of the available diagnostic options, HSVMA is the only test that focuses on living, cilia-coated respiratory cells and evaluates ciliary beat pattern (CBP) and ciliary beat frequency (CBF). In contrast to TEM, the results of HSVMA are available quickly, usually on the day of testing, whereas results of TEM might arrive months after the specimen has been taken. HSVMA can be applied for all age groups, whereas nNO demands a high degree of compliance; attempts to use it under the age of 5 years are usually unsuccessful10. In experienced hands, HSVMA has excellent sensitivity and specificity to diagnose PCD at 100% and 96%, respectively12.
This paper describes the step-by-step procedure to perform HSVMA, including the harvesting of cilia-coated respiratory cells from the inferior turbinate of the nose, the preservation of harvested cells in a cell-nourishing medium for transport to the site of investigation, and the process of microscopic video analysis to determine CBF and CBP. Additionally, some video clips from patients are shown, comparing normal CBPs and CBFs with abnormal cilia function (Video 3, Video 4, Video 5, Video 6, Video 7, and Video 8).

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Amoxiciline-clavulanic acid</td>
			<td>Orion Oyj</td>
			<td></td>
			<td>40 mg/kg divided in 2 doses/day, for adults 875/125 mg 1 tablet x2/day</td>
		</tr>
		<tr>
			<td>Camera Software</td>
			<td>Hamamatsu</td>
			<td></td>
			<td>HCI Image</td>
		</tr>
		<tr>
			<td>Cold pack</td>
			<td>any</td>
			<td></td>
			<td>for preservation and transport</td>
		</tr>
		<tr>
			<td>Differential interference microscope</td>
			<td>Carl Zeiss</td>
			<td></td>
			<td>Inverted, cell observer microscope</td>
		</tr>
		<tr>
			<td>Digitial High Speed Video Camera</td>
			<td>Hamamatsu</td>
			<td></td>
			<td>Orca Flash 4.0, digital camera type C11440</td>
		</tr>
		<tr>
			<td>Dulbecco&#180;s Modified Eagle Medium</td>
			<td>Thermo Fisher</td>
			<td>10565018</td>
			<td>basal cell culture medium</td>
		</tr>
		<tr>
			<td>Eppendorf tube</td>
			<td>Eppendorf</td>
			<td>30120086</td>
			<td>1.5 mL tube</td>
		</tr>
		<tr>
			<td>Glass-bottom microwell dish</td>
			<td>MatTek</td>
			<td>P35G-1.5-14-C</td>
			<td>cuvette for microscopy</td>
		</tr>
		<tr>
			<td>Heating Unit</td>
			<td>Carl Zeiss/PeCon</td>
			<td>810-450001</td>
			<td>Carl Zeiss incubation elements with PeCon TempModule S1 temperature control</td>
		</tr>
		<tr>
			<td>Interdental brush 0.6 mm</td>
			<td>Doft</td>
			<td>872267</td>
			<td>Interdental brush on a long wire with a reusable handle and cap in zipbag</td>
		</tr>
		<tr>
			<td>Objective</td>
			<td>Carl Zeiss</td>
			<td></td>
			<td>100x/1.46, &#945; Plan-Apochromat DIC objective</td>
		</tr>
		<tr>
			<td>Small polystyrene box with lid</td>
			<td>any</td>
			<td></td>
			<td>for transport</td>
		</tr>
	</tbody>
</table>

high-speed video microscopy analysis for first-line diagnosis of primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) is a congenital disorder predominantly inherited in an autosomal recessive trait. The disorder causes disturbance in the motion of cilia, leading to severe impairment of mucociliary clearance (MCC). If undiagnosed or diagnosed too late, the condition leads to the development of bronchiectasis and serious damage to the lungs in later life. Most of the methods for diagnosing PCD are time-consuming and demand extensive economic resources to establish them. High-speed video microscopy analysis (HSVMA) is the only diagnostic tool to visualize and analyze living respiratory cells with beating cilia in vitro. It is fast, cost-effective, and, in experienced hands, very reliable as a diagnostic tool for PCD. In addition, classical diagnostic measures such as transmission electron microscopy (TEM) are not applicable for some mutations as morphological changes are absent. 
This paper describes the process of collecting respiratory epithelial cells, the further preparation of the specimen, and the process of HSVMA. We also describe how brushed cells can be successfully kept unharmed and beating by keeping them in a nourishing medium for storage and transport to the investigation site in cases where a clinic does not possess the equipment to perform HSVMA. Also shown are videos with pathologic beating patterns from patients with a mutation in the dynein arm heavy chain 11 gene (DNAH11), which cannot be diagnosed with TEM; the result of an inconclusive HSVMA due to infection of the upper airways, as well as an unsuccessful brushing with superimposition of red blood cells. With this article, we would like to encourage every unit dealing with pulmonology patients and rare lung diseases to perform HSVMA as part of their daily routine diagnostics for PCD or send the specimens over to a center specializing in performing HSVMA.

Video 1 and Video 2 show a normal control where CBF and CBP are in the normal range (see Figure 1). Video 3, Video 4, Video 5, and Video 6 represent two cases of PCD patients with a homozygous mutation in the DNAH11 gene (c.2341G &#62; A; p. Glu781Lys)3. These representative videos were chosen because phenotypes of mutations in the DNAH11...

Watch this Scientific Journal Video about High-speed Video Microscopy Analysis for First-line Diagnosis of Primary Ciliary Dyskinesia at JoVE.com

High-speed Video Microscopy Analysis for First-line Diagnosis of Primary Ciliary Dyskinesia

High-speed video microscopy analysis is a relatively easy-to-perform, fast, cost-effective, and, in experienced hands, a considerably reliable tool for first-line diagnostics of primary ciliary dyskinesia, which should be available in every center involved in diagnostics and the treatment of severe lung diseases.

Primary ciliary dyskinesia (PCD) is a congenital disorder predominantly inherited in an autosomal recessive trait. The disorder causes disturbance in the ...

High speed Video microscopy analysis is a reliable tool for first line diagnostic of primary ciliary dyskinesia. This technique is relative easy to perform, fast, cost effective, and in experienced hands else a very reliable tool. And it is applicable for patients of all age groups.Video microscopy also reveals secondary ciliary function. Like, for instance, due to bacterial or viral infections. But it has been mainly used to diagnose primary ciliary dyskinesia.Scientists use this method also to visualize intracellular processes or biological functions in living cells. Assisting me in this procedure will be Mrs. Tina Peromaa, our laboratory technician.Before collecting the respiratory epithelial cells, ask the patient to blow their nose thoroughly. When the patient is ready, keep the head of the patient fixed with one hand and use an interdental brush of 0.6 millimeter size in the other hand to brush the inferior turbinate of the nostril to collect sufficient epithelial cell strips. Drop the harvested cell strips into a 1.5 milliliter microcentrifuge tube containing the cell nourished DMEM.After closing the lid of the microcentrifuge tube hold the tube against the light source and shake the tube to discover harvested cell strips and conglomerates. Later, place the microcentrifuge tubes with the lids properly closed in a polystyrene box. Before closing the box tightly ensure the tubes are fixed inside the box.Then add a cold pack to the box while avoiding freezing the specimen. After removing the micro centrifuge tubes containing the samples from the polystyrene box, place one tube under a hood of the microscope heating unit to warm up to 37 degrees celsius for the high speed video microscopy analysis or HSVMA. Next, start the camera and the software of the video unit on the computer.Use a pipette to take a small sample and place two drops of the sample into a cuvette. Cover the cuvette with a lid before placing it under the microscope. Use an oil immersion lens with a 100x magnification and put a drop of immersion oil onto the surface of the optic.While approaching the bottom of the dish with the microscope lens, search for the cell clusters without red blood cells and with low mucus content. After finding a representative region of interest, or ROI, focus on one group of the beating cilia with the largest cilia movements and record a video sequence. Record the cells with beating cilia side wise and from above.The representative analysis shows normal cilia motions seen side wise and from above. The sample of a primary ciliary dyskinesia, or PCD patient, with a mutation in the DNAH11 gene demonstrated the classic stiff minimally moving pattern of ciliary beat. When viewed from the side and above.In another PCD patient with the same mutation, a different hyperkinetic but inefficient pattern of the beating cilia was observed. A pathological ciliary beat pattern and ciliary beat frequency were also seen in a patient having recurrent upper airway infections. If the brushing procedure is carried out rigorously HSVMA analysis could not be performed as ciliated epithelial cells were covered with a coating of red blood cells.The most important step in the procedure is to get sufficient respiratory cells from the brushings and to keep this material well preserved for the video analysis. Remaining material can be used to perform electron microscopy or immunoflourescense microscopy to detect possible structural defects in cilia or to reveal defects and the synthesis of ciliary proteins.

high-speed-video-microscopy-analysis-for-first-line-diagnosis-primary

Research

JoVE Journal

Medicine

FISH for Pre-implantation Genetic Diagnosis

Pre-implantation genetic diagnosis (PGD) is an established alternative to pre-natal diagnosis, and involves selecting pre-implantation embryos from a cohort generated by assisted reproduction technology (ART). This selection may be required because of familial monogenic disease (e.g. cystic fibrosis), or because one partner carries a chromosome rearrangement (e.g. a two-way reciprocal translocation). PGD is available for couples who have had previous affected children, and/or in the case of chromosome rearrangements, recurrent miscarriages, or infertility. Oocytes aspirated following ovarian stimulation are fertilized by in vitro immersion in semen (IVF) or by intracytoplasmic injection of an individual spermatozoon (ICSI). Pre-implantation cleavage-stage embryos are biopsied, usually by the removal of a single cell on day 3 post-fertilization, and the biopsied cell is tested to establish the genetic status of the embryo. Fluorescence in situ hybridization (FISH) on the fixed nuclei of biopsied cells with target-specific DNA probes is the technique of choice to detect chromosome imbalance associated with chromosome rearrangements, and to select female embryos in families with X-linked disease for which there is no mutation-specific test. FISH has also been used to screen embryos for spontaneous chromosome aneuploidy (also known as PGS or PGD-AS) in order to try and improve the efficiency of assisted reproduction; however, the predictive value of this test using the spreading and FISH technique described here is likely to be unacceptably low in most people's hands and it is not recommended for routine clinical use. We describe the selection of suitable probes for single-cell FISH, spreading techniques for blastomere nuclei, and in situ hybridization and signal scoring, applied to PGD in a clinical setting.

This article describes the selection of suitable probes for single-cell FISH, spreading techniques for blastomere nuclei, and in situ hybridization and signal scoring, applied to pre-implantation genetic diagnosis (PGD) in a clinical setting.

Pre-implantation genetic diagnosis (PGD) is an established alternative to pre-natal diagnosis, and involves selecting pre-implantation embryos from a ...

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves' Muntjac Deer

Reeves' muntjac deer (Muntiacus reevesi) are a small cervid species native to southeast Asia, and are currently being investigated as a potential model of prion disease transmission and pathogenesis. Vertical transmission is an area of interest among researchers studying infectious diseases, including prion disease, and these investigations require efficient methods for evaluating the effects of maternal infection on reproductive performance. Ultrasonographic examination is a well-established tool for diagnosing pregnancy and assessing fetal health in many animal species1-7, including several species of farmed cervids8-19, however this technique has not been described in Reeves' muntjac deer. Here we describe the application of transabdominal ultrasound to detect pregnancy in muntjac does and to evaluate fetal growth and development throughout the gestational period. Using this procedure, pregnant animals were identified as early as 35 days following doe-buck pairing and this was an effective means to safely monitor the pregnancy at regular intervals. Future goals of this work will include establishing normal fetal measurement references for estimation of gestational age, determining sensitivity and specificity of the technique for diagnosing pregnancy at various stages of gestation, and identifying variations in fetal growth and development under different experimental conditions.

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves&#039; Muntjac Deer

Transabdominal ultrasound is described as an effective, noninvasive means for assessing reproductive status in Reeves' muntjac deer. These methods can be used to achieve early pregnancy diagnosis and to evaluate fetal viability. Future applications of this technique include estimation of gestational age and effects of maternal disease on fetal development.

Reeves' muntjac deer (Muntiacus reevesi) are a small cervid species native to southeast Asia, and are currently being investigated as a potential model of ...

Intravital Video Microscopy Measurements of Retinal Blood Flow in Mice

Alterations in retinal blood flow can contribute to, or be a consequence of, ocular disease and visual dysfunction. Therefore, quantitation of altered perfusion can aid research into the mechanisms of retinal pathologies. Intravital video microscopy of fluorescent tracers can be used to measure vascular diameters and bloodstream velocities of the retinal vasculature, specifically the arterioles branching from the central retinal artery and of the venules leading into the central retinal vein. Blood flow rates can be calculated from the diameters and velocities, with the summation of arteriolar flow, and separately venular flow, providing values of total retinal blood flow. This paper and associated video describe the methods for applying this technique to mice, which includes 1) the preparation of the eye for intravital microscopy of the anesthetized animal, 2) the intravenous infusion of fluorescent microspheres to measure bloodstream velocity, 3) the intravenous infusion of a high molecular weight fluorescent dextran, to aid the microscopic visualization of the retinal microvasculature, 4) the use of a digital microscope camera to obtain videos of the perfused retina, and 5) the use of image processing software to analyze the video. The same techniques can be used for measuring retinal blood flow rates in rats.

Intravital microscopy can be used in animals to visualize and measure retinal vascular diameters, bloodstream velocities, and total retinal blood flow.

Alterations in retinal blood flow can contribute to, or be a consequence of, ocular disease and visual dysfunction. Therefore, quantitation of altered ...

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20&#176; of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20&#176; flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Isolated Musculus gastrocnemius tightness is a common cause for foot and ankle pathologies. Currently no standardized examination procedure exists. This manuscript demonstrates that 20 degree of knee flexion eliminates the restraining effect of the M. gastrocnemius on ankle dorsiflexion and presents a video description of a standardized examination protocol.

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described ...

Evaluation of Vascular Control Mechanisms Utilizing Video Microscopy of Isolated Resistance Arteries of Rats

This protocol describes the use of in vitro television microscopy to evaluate vascular function in isolated cerebral resistance arteries (and other vessels), and describes techniques for evaluating tissue perfusion using Laser Doppler Flowmetry (LDF) and microvessel density utilizing fluorescently labeled Griffonia simplicifolia (GS1) lectin. Current methods for studying isolated resistance arteries at transmural pressures encountered in vivo and in the absence of parenchymal cell influences provide a critical link between in vivo studies and information gained from molecular reductionist approaches that provide limited insight into integrative responses at the whole animal level. LDF and techniques to selectively identify arterioles and capillaries with fluorescently-labeled GS1 lectin provide practical solutions to enable investigators to extend the knowledge gained from studies of isolated resistance arteries. This paper describes the application of these techniques to gain fundamental knowledge of vascular physiology and pathology in the rat as a general experimental model, and in a variety of specialized genetically engineered &#34;designer&#34; rat strains that can provide important insight into the influence of specific genes on important vascular phenotypes. Utilizing these valuable experimental approaches in rat strains developed by selective breeding strategies and new technologies for producing gene knockout models in the rat, will expand the rigor of scientific premises developed in knockout mouse models and extend that knowledge to a more relevant animal model, with a well understood physiological background and suitability for physiological studies because of its larger size.

This manuscript describes in vitro video microscopy protocols for evaluating vascular function in rat cerebral resistance arteries. The manuscript also describes techniques for evaluating microvessel density with fluorescently labeled lectin and tissue perfusion using Laser Doppler Flowmetry.

This protocol describes the use of in vitro television microscopy to evaluate vascular function in isolated cerebral resistance arteries (and other ...

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect of different cardiovascular risk factors (e.g., diabetes, raised blood pressure, unhealthy diet, tobacco use, stress, etc.) that commonly coexist and act multiplicatively. Most CVDs can be prevented by an early identification of the highest risk factors and an appropriate treatment. The stratification of cardiovascular risk factors involves a wide range of parameters and tests that specialists use in their clinical practice. In addition to cardiovascular (CV) risk stratification, ambulatory blood pressure monitoring (ABPM) also provides relevant information for diagnostic and treatment purposes. This work presents a list of protocols based on the Hydra platform, a web-based system for clinical decision support which incorporates a set of functionalities and services that are required for complete cardiovascular analysis, risk assessment, early diagnosis, treatment and monitoring of patients over time. The program includes tools for inputting and managing comprehensive patient data, organized into different checkups to track the evolution over time. It also has a risk stratification tool to compute a CV risk factor based upon several risk stratification tables of reference. Additionally, the program includes a tool that incorporates ABPM analysis and allows the extraction of valuable information by monitoring blood pressure over a specific period of time. Finally, the reporting service summarizes the most relevant information in a set of reports that aid clinicians in their clinical decision-making process.

This article presents a protocol based on Hydra &#8212; a web-based system for clinical decision support that integrates a full and detailed set of functionalities and services required by physicians for complete cardiovascular analysis, risk assessment, early diagnosis, treatment, and monitoring over time.

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect ...

Immunofluorescence Labelling of Human and Murine Neutrophil Extracellular Traps in Paraffin-Embedded Tissue

Neutrophil granulocytes, also called polymorphonuclear leukocytes (PMN) due to their lobulated nucleus, are the most abundant type of leukocytes. They mature in the bone marrow and are released into the peripheral blood, where they circulate for about 6&#8722;8 h; however, in tissue, they can survive for days. By diapedesis through the endothelium, they leave the blood stream, enter tissues, and migrate towards the site of an infection following chemotactic gradients.&#160;Neutrophils can combat invading microorganisms by phagocytosis,&#160;degranulation, and generation of neutrophil extracellular traps (NETs). This protocol will help to detect NETs in paraffin-embedded tissue. NETs are the result of a process called NETosis, which leads to the release of nuclear, granular, and cytoplasmic components either from living (vital NETosis) or dying (suicidal NETosis) neutrophils. In vitro, NETs form cloud-like structures, which occupy a space several times larger than that of the cells from which they descended. The backbone of NETs is chromatin, to which a selection of proteins and peptides originating from granules and cytoplasm are bound. Thereby, a high local concentration of toxic compounds is maintained so that NETs can capture and inactivate a variety of pathogens including bacteria, fungi, viruses, and parasites, while diffusion of the highly active NET components leading to damage in neighboring tissue is limited. Nevertheless, in recent years it has become apparent that NETs, if generated in abundance or cleared insufficiently, do have pathological potential ranging from autoimmune diseases to cancer. Thus, detection of NETs in tissue samples may have diagnostic significance, and the detection of NETs in diseased tissue can influence the treatment of patients. Since paraffin-embedded tissue samples are the standard specimen used for pathological analysis, it was sought to establish a protocol for fluorescent staining of NET components in paraffin-embedded tissue using commercially available antibodies.

Neutrophil extracellular traps (NETs) are three-dimensional structures generated by stimulated neutrophil granulocytes. It has become clear in recent years that NETs are involved in a wide variety of diseases. Detection of NETs in tissue may have diagnostic relevance, so standardized protocols for labelling NET components are required.

Neutrophil granulocytes, also called polymorphonuclear leukocytes (PMN) due to their lobulated nucleus, are the most abundant type of leukocytes. They ...

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

In about a quarter of patients with angina and non-obstructive coronary arteries, no epicardial spasm is noted on coronary arteriography during an angina attack. Since the pressure-rate product is almost identical at rest and the onset of attack in those patients, the decrease in coronary blood flow rather than increased myocardial oxygen consumption is likely to explain myocardial ischemia, indicating a substantial involvement with coronary microvascular spasm (MVS). Myocardial lactate production, which could be defined as a negative myocardial lactate extraction ratio (ratio of the coronary arterial-venous difference in lactate concentration to arterial concentration), is considered indicative of objective evidence to support the emerging myocardial ischemia. Thus, monitoring of the myocardial lactate production and the emergence of chest pain and ischemic electrocardiographic changes during acetylcholine (ACh) provocation testing is of significant value for detecting the entity of MVS. Practically, 1 min after incremental doses of ACh (20, 50, and 100 &#956;g) are administered into the left coronary artery (LCA), paired samples of 1 mL of blood are collected from the LCA ostium and coronary sinus for measurement of lactate concentration by a calibrated automatic lactate analyzer. Then, the development of MVS could be confirmed by negative myocardial lactate extraction ratio despite the absence of angiographically demonstrable epicardial coronary spasm or before its occurrence throughout ACh provocation testing. In conclusion, assessment of myocardial lactate production is essential and valuable for the diagnosis of MVS.

Myocardial lactate production (coronary arterial-venous difference in serum lactate level) during coronary spasm provocation testing is considered as a highly sensitive marker that reflects acetylcholine-induced myocardial ischemia due to microvascular spasm. This article presents the procedures to assess myocardial lactate production for the diagnosis of coronary microvascular spasm.

In about a quarter of patients with angina and non-obstructive coronary arteries, no epicardial spasm is noted on coronary arteriography during an angina ...

Basophil Activation Test for Allergy Diagnosis

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and specific IgE (sIgE) determination in the evaluation of IgE-mediated allergic reactions to food, insect venom, drugs, as well as some forms of chronic urticaria. However, the role of this technique in the diagnostic algorithms is highly variable and not well determined.
BAT is based on the determination of basophil response to allergen/drug cross-linking IgE activation through the measurement of activation markers (such as CD63, CD203c) by flow cytometry. This test can be a useful and complementary tool to avoid controlled challenge tests&#160;to confirm allergy diagnosis, especially in subjects experiencing severe life-threatening reactions. In general, the performance of BAT should be considered if i) the allergen/drug produces false positive results in ST; ii) there is no allergen/drug source to use for ST or sIgE determination; iii) there is discordance between patient history and ST or sIgE determination; iv) symptoms suggest that ST may result in systemic response; v) before considering a CCT to confirm the culprit allergen/drug. The main limitations of the test are related to non-optimal sensitivity, especially in drug allergy, the need to perform the test no longer than 24 h after sample extraction, and the lack of standardization between laboratories in terms of procedures, concentrations, and cell markers.

The basophil activation test is a complementary in vitro diagnostic test for the evaluation of IgE-mediated allergic reactions based on the detection of basophil activation in the presence of a specific stimulus through the measure of activation markers by flow cytometry.

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and ...

Collection, Expansion, and Differentiation of Primary Human Nasal Epithelial Cell Models for Quantification of Cilia Beat Frequency

Measurements of cilia function (beat frequency, pattern) have been established as diagnostic tools for respiratory diseases such as primary ciliary dyskinesia. However, the wider application of these techniques is limited by the extreme susceptibility of ciliary function to changes in environmental factors e.g., temperature, humidity, and pH. In the airway of patients with Cystic Fibrosis (CF), mucus accumulation impedes cilia beating. Cilia function has been investigated in primary airway cell models as an indicator of CF Transmembrane conductance Regulator (CFTR) channel activity. However, considerable patient-to-patient variability in cilia beating frequency has been found in response to CFTR-modulating drugs, even for patients with the same CFTR mutations. Furthermore, the impact of dysfunctional CFTR-regulated chloride secretion on ciliary function is poorly understood. There is currently no comprehensive protocol demonstrating sample preparation of in vitro airway models, image acquisition, and analysis of Cilia Beat Frequency (CBF). Standardized culture conditions and image acquisition performed in an environmentally controlled condition would enable consistent, reproducible quantification of CBF between individuals and in response to CFTR-modulating drugs. This protocol describes the quantification of CBF in three different airway epithelial cell model systems: 1) native epithelial sheets, 2) air-liquid interface models imaged on permeable support inserts, and 3) extracellular matrix-embedded three-dimensional organoids. The latter two replicate in vivo lung physiology, with beating cilia and production of mucus. The ciliary function is captured using a high-speed video camera in an environment-controlled chamber. Custom-built scripts are used for the analysis of CBF. Translation of CBF measurements to the clinic is envisioned to be an important clinical tool for predicting response to CFTR-modulating drugs on a per-patient basis.

This protocol describes nasal epithelial cell collection, expansion, and differentiation to organotypic airway epithelial cell models and quantification of cilia beat frequency via live-cell imaging and custom-built scripts.

Measurements of cilia function (beat frequency, pattern) have been established as diagnostic tools for respiratory diseases such as primary ciliary ...