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Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis

Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis
Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis

Background Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60–80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. Methods This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. Results Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5–10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. Conclusions PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

0903-1936
Shoemark, Amelia
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Griffin, Helen
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Wheway, Gabrielle
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Hogg, Claire
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Lucas, Jane
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Camps, C
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Taylor, Jenny
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Carroll, Mary
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Loebinger, Michael R.
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Chalmers, James D
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Morris-Rosendahl, Deborah
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Mitchison, Hannah
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De Souza, Anthony
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Shoemark, Amelia
6197d7b4-f36b-47bf-b138-373e1aa4b63b
Griffin, Helen
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Wheway, Gabrielle
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Hogg, Claire
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Lucas, Jane
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Camps, C
01c641ac-698c-484b-b50a-03b94421ae11
Taylor, Jenny
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Carroll, Mary
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Loebinger, Michael R.
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Chalmers, James D
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Morris-Rosendahl, Deborah
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Mitchison, Hannah
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De Souza, Anthony
735a82ea-79ef-44a3-a7cf-48f3f5d29766

Shoemark, Amelia, Griffin, Helen, Wheway, Gabrielle, Hogg, Claire, Lucas, Jane, Camps, C, Taylor, Jenny, Carroll, Mary, Loebinger, Michael R., Chalmers, James D, Morris-Rosendahl, Deborah, Mitchison, Hannah and De Souza, Anthony (2022) Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis. European Respiratory Journal, 60 (5), [2200176]. (doi:10.1183/13993003.00176-2022).

Record type: Article

Abstract

Background Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60–80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. Methods This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. Results Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5–10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. Conclusions PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

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Accepted/In Press date: 12 May 2022
e-pub ahead of print date: 21 June 2022
Published date: 17 November 2022
Additional Information: Funding Information: Conflict of interest: A. Shoemark has received grants from AstraZeneca. G. Wheway is currently employed by Illumina Inc. M.R. Loebinger has received consultancy or speaker fees from Insmed, AstraZeneca, Parion, Grifols and Armata. J.D. Chalmers has received grants or contracts from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Novartis and Insmed; and received consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis and Zambon. J.S. Lucas reports grants from NHS England, NIHR and AIR Charity. H.M. Mitchison is a Trustee of Ciliopathy Alliance. A. De Soyza reports grants from AstraZeneca, GlaxoSmithKline and Pfizer; consulting fees and lecture honoraria from Gilead, GlaxoSmithKline, AstraZeneca, LifeArc and 30T; participation on advisory board at Bayer; receipt of equipment from GlaxoSmithKline. All other authors have nothing to disclose. Funding Information: Acknowledgements: Study authors participate in the Bronch UK Consortium (www.bronch.ac.uk) who developed the inclusion groups within bronchiectasis for the 100,000 Genomes Project. Study authors and data contributors participate in the BEAT-PCD clinical research collaboration, supported by the European Respiratory Society. We acknowledge the BEAT-PCD Workpackage 2 team, for gene list input (WP2 Leads, Marie Legendre, Sorbonne Université, Paris, France and Suzanne Crowley, Oslo University Hospital, Oslo, Norway). Study authors participate in the EMBARC clinical research collaboration supported by the European Respiratory Society. This research was made possible through access to the data and findings generated by the 100,000 Genomes Project. The 100,000 Genomes Project is managed by Genomics England Limited (a wholly owned company of the Department of Health and Social Care). The 100,000 Genomes Project is funded by the National Institute for Health Research and NHS England. The Wellcome Trust, Cancer Research UK and the Medical Research Council have also funded research infrastructure. The 100,000 Genomes Project uses data provided by patients and collected by the National Health Service as part of their care and support. The British Thoracic Society Audit 2017 data was provided by the British Thoracic Society (BTS). The contribution of all centres contributing to the BTS audit is gratefully acknowledged. This publication makes use of data provided by the British Thoracic Society Clinical Audit Programme which has no responsibility or liability for the accuracy, currency or correctness of this publication. Funding Information: Support statement: H.M. Mitchison acknowledges funding from the NIHR Biomedical Research Centre at Great Ormond Street Hospital and the Ministry of Higher Education in Egypt. The National PCD Service is commissioned and funded by NHS England; PCD research in Southampton is supported by NIHR Southampton Biomedical Research Centre, NIHR Clinical Research Facility, National Institute for Health Research (RfPB PB-PG-1215-20014; and 200470) and The AAIR Charity (registration number 1129698). Publisher Copyright: Copyright © The authors 2022.

Identifiers

Local EPrints ID: 457399
URI: http://eprints.soton.ac.uk/id/eprint/457399
ISSN: 0903-1936
PURE UUID: 417ab15b-40cd-47fc-b780-3df99ca3399c
ORCID for Gabrielle Wheway: ORCID iD orcid.org/0000-0002-0494-0783
ORCID for Jane Lucas: ORCID iD orcid.org/0000-0001-8701-9975

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Date deposited: 07 Jun 2022 16:36
Last modified: 17 Mar 2024 07:19

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Contributors

Author: Amelia Shoemark
Author: Helen Griffin
Author: Claire Hogg
Author: Jane Lucas ORCID iD
Author: C Camps
Author: Jenny Taylor
Author: Mary Carroll
Author: Michael R. Loebinger
Author: James D Chalmers
Author: Deborah Morris-Rosendahl
Author: Hannah Mitchison
Author: Anthony De Souza

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