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 ...

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