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The Palestinian primary ciliary dyskinesia population: first results of the diagnostic, and genetic spectrum

The Palestinian primary ciliary dyskinesia population: first results of the diagnostic, and genetic spectrum
The Palestinian primary ciliary dyskinesia population: first results of the diagnostic, and genetic spectrum

Background Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. Methods Individuals with symptoms suggestive of PCD were opportunistically considered for diagnostic testing: nasal nitric oxide (nNO) measurement, transmission electron microscopy (TEM) and/or PCD genetic panel or whole-exome testing. Clinical characteristics of those with a positive diagnosis were collected close to testing including forced expiratory volume in 1 s (FEV 1) Global Lung Index z-scores and body mass index z-scores. Results 68 individuals had a definite positive PCD diagnosis, 31 confirmed by genetic and TEM results, 23 by TEM results alone, and 14 by genetic variants alone. 45 individuals from 40 families had 17 clinically actionable variants and four had variants of unknown significance in 14 PCD genes. CCDC39, DNAH11 and DNAAF11 were the most commonly mutated genes. 100% of variants were homozygous. Patients had a median age of 10.0 years at diagnosis, were highly consanguineous (93%) and 100% were of Arabic descent. Clinical features included persistent wet cough (99%), neonatal respiratory distress (84%) and situs inversus (43%). Lung function at diagnosis was already impaired (FEV 1 z-score median −1.90 (−5.0–1.32)) and growth was mostly within the normal range (z-score mean −0.36 (−3.03–2.57). 19% individuals had finger clubbing. Conclusions Despite limited local resources in Palestine, detailed geno-and phenotyping forms the basis of one of the largest national PCD populations globally. There was notable familial homozygosity within the context of significant population heterogeneity.

2312-0541
Rumman, Nisreen
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Fassad, Mahmoud R.
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Driessens, Corine
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Goggin, Patricia M.
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Abdelrahman, Nader
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Adwan, Adel
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Albakri, Mutaz
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Chopra, Jagrati
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Doherty, Regan
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Fashho, Bishara
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Freke, Grace
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Hasaballah, Abdallah
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Jackson, Claire
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Mohamed, Mai
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Nema, Reda Abu
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Patel, Mitali
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Pengelly, Reuben
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Qaaqour, Ahmad
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Rubbo, Bruna
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Thomas, N. Simon
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Thompson, James
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Walker, Woolf T.
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Wheway, Gabrielle
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Mitchison, Hannah
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Lucas, Jane
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Rumman, Nisreen
2fa983a0-2b5d-44cb-bbb4-79b1eb0a632c
Fassad, Mahmoud R.
8de9f7df-4d23-4546-9bcb-3064adf16345
Driessens, Corine
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Goggin, Patricia M.
44bfa939-e14e-48da-b91b-e74c5c747143
Abdelrahman, Nader
2345abb4-af63-4827-b52d-f96e5030d396
Adwan, Adel
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Albakri, Mutaz
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Chopra, Jagrati
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Doherty, Regan
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Fashho, Bishara
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Freke, Grace
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Hasaballah, Abdallah
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Jackson, Claire
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Mohamed, Mai
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Nema, Reda Abu
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Patel, Mitali
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Pengelly, Reuben
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Qaaqour, Ahmad
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Rubbo, Bruna
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Thomas, N. Simon
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Thompson, James
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Walker, Woolf T.
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Wheway, Gabrielle
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Mitchison, Hannah
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Lucas, Jane
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Rumman, Nisreen, Fassad, Mahmoud R., Driessens, Corine, Goggin, Patricia M., Abdelrahman, Nader, Adwan, Adel, Albakri, Mutaz, Chopra, Jagrati, Doherty, Regan, Fashho, Bishara, Freke, Grace, Hasaballah, Abdallah, Jackson, Claire, Mohamed, Mai, Nema, Reda Abu, Patel, Mitali, Pengelly, Reuben, Qaaqour, Ahmad, Rubbo, Bruna, Thomas, N. Simon, Thompson, James, Walker, Woolf T., Wheway, Gabrielle, Mitchison, Hannah and Lucas, Jane (2023) The Palestinian primary ciliary dyskinesia population: first results of the diagnostic, and genetic spectrum. ERJ Open Research, 9 (2), [00714-2022]. (doi:10.1183/23120541.00714-2022).

Record type: Article

Abstract

Background Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. Methods Individuals with symptoms suggestive of PCD were opportunistically considered for diagnostic testing: nasal nitric oxide (nNO) measurement, transmission electron microscopy (TEM) and/or PCD genetic panel or whole-exome testing. Clinical characteristics of those with a positive diagnosis were collected close to testing including forced expiratory volume in 1 s (FEV 1) Global Lung Index z-scores and body mass index z-scores. Results 68 individuals had a definite positive PCD diagnosis, 31 confirmed by genetic and TEM results, 23 by TEM results alone, and 14 by genetic variants alone. 45 individuals from 40 families had 17 clinically actionable variants and four had variants of unknown significance in 14 PCD genes. CCDC39, DNAH11 and DNAAF11 were the most commonly mutated genes. 100% of variants were homozygous. Patients had a median age of 10.0 years at diagnosis, were highly consanguineous (93%) and 100% were of Arabic descent. Clinical features included persistent wet cough (99%), neonatal respiratory distress (84%) and situs inversus (43%). Lung function at diagnosis was already impaired (FEV 1 z-score median −1.90 (−5.0–1.32)) and growth was mostly within the normal range (z-score mean −0.36 (−3.03–2.57). 19% individuals had finger clubbing. Conclusions Despite limited local resources in Palestine, detailed geno-and phenotyping forms the basis of one of the largest national PCD populations globally. There was notable familial homozygosity within the context of significant population heterogeneity.

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Accepted/In Press date: 4 February 2023
Published date: 1 March 2023
Additional Information: Funding Information: Support statement: N. Rumman was the recipient of a European Respiratory Society (ERS) Fellowship (STRTF 2014-6816). AAIR Charity (charity number 1129698) funded the whole-exome sequencing and Circassia loaned two Niox Mino analysers for this study. The National PCD Diagnostic Service at University Hospital Southampton is commissioned and funded by NHS England. Some authors are participants of BEAT-PCD: Better Evidence to Advance Therapeutic options for PCD (COST Action BM 1407; ERS Clinical Research Collaboration). BEAT-PCD COST Action funded J.S. Lucas to visit N. Rumman to support the new PCD Service and development of this cohort in Palestine. N. Rumman was funded by an Academy of Medical Sciences Daniel Turnberg Travel Fellowship to visit H.M. Mitchison for completion of the genetic data. H.M. Mitchison acknowledges funding from Great Ormond Street Children’s Charity, NIHR Biomedical Research Centre at Great Ormond Street Hospital, the British Council Newton-Mosharafa Fund and Ministry of Higher Education in Egypt. Some authors participate in European Reference Network for Rare Respiratory Diseases (ERN-LUNG) project identifier number 739546. J.S. Lucas chaired the ERS Task Force for the development of a practice guideline for diagnosis of PCD (ERS TF-2014-04) and ERS Task Force for “Nasal nitric oxide measurement in children for the diagnosis of primary ciliary dyskinesis: a technical standard”. M.R. Fassad is supported by a Wellcome Trust Collaborative Award in Science (210585/Z/18/Z). Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Support statement: N. Rumman was the recipient of a European Respiratory Society (ERS) Fellowship (STRTF 2014-6816). AAIR Charity (charity number 1129698) funded the whole-exome sequencing and Circassia loaned two Niox Mino analysers for this study. The National PCD Diagnostic Service at University Hospital Southampton is commissioned and funded by NHS England. Some authors are participants of BEAT-PCD: Better Evidence to Advance Therapeutic options for PCD (COST Action BM 1407; ERS Clinical Research Collaboration). BEAT-PCD COST Action funded J.S. Lucas to visit N. Rumman to support the new PCD Service and development of this cohort in Palestine. N. Rumman was funded by an Academy of Medical Sciences Daniel Turnberg Travel Fellowship to visit H.M. Mitchison for completion of the genetic data. H.M. Mitchison acknowledges funding from Great Ormond Street Children’s Charity, NIHR Biomedical Research Centre at Great Ormond Street Hospital, the British Council Newton-Mosharafa Fund and Ministry of Higher Education in Egypt. Some authors participate in European Reference Network for Rare Respiratory Diseases (ERN-LUNG) project identifier number 739546. J.S. Lucas chaired the ERS Task Force for the development of a practice guideline for diagnosis of PCD (ERS TF-2014-04) and ERS Task Force for “Nasal nitric oxide measurement in children for the diagnosis of primary ciliary dyskinesis: a technical standard”. M.R. Fassad is supported by a Wellcome Trust Collaborative Award in Science (210585/Z/18/Z). Funding Information: Conflict of interest: N. Rumman received support for the present manuscript from two NIOX MINO devices from Circassia (previously called Aerocrine) to perform nasal nitric oxide testing and AAIR Charity funded whole-exome sequencing testing, and support for attending meetings and/or travel from the European Respiratory Society for a short term research training fellowship (3 months at Southampton University) (STRTF 2014-6816), outside the submitted work. M.R. Fassad received support for the present manuscript from a Wellcome Trust Collaborative Award in Science (210585/Z/18/Z). C. Driessens received support for the present manuscript from NHS England: work for this manuscript was performed while working for the National PCD Diagnostic Service at University Hospital Southampton; this service is commissioned and funded by NHS England. R. Pengelly received support for the present manuscript from Asthma Allergy and Inflammation Research. G. Wheway received support for the present manuscript from Asthma Allergy and Inflammation Research Trust; grants or contracts from UKRI COVID-19 Agile Response Fund, Wessex Medical Research/Rosetrees Trust PhD studentship, and Asthma Allergy and Inflammation Research Trust, outside the submitted work; stock or stock options for Illumina Inc., outside the submitted work; and receipt of equipment, materials, medical writing, gifts or other services from Synthego, outside the submitted work. H.M. Mitchison received support for the present manuscript from Great Ormond Street Children’s Charity, NIHR Biomedical Research Centre at Great Ormond Street Hospital, and British Council Newton-Mosharafa Fund and Ministry of Higher Education in Egypt. J.S. Lucas received grants or contracts from NIHR, AAIR Charity, and NHS England, outside the submitted work. The remaining authors have nothing to disclose. Publisher Copyright: © The authors 2023.

Identifiers

Local EPrints ID: 475215
URI: http://eprints.soton.ac.uk/id/eprint/475215
ISSN: 2312-0541
PURE UUID: 5df8d437-93a7-4c97-ade3-346d19ba58a8
ORCID for Corine Driessens: ORCID iD orcid.org/0000-0003-3767-7683
ORCID for Claire Jackson: ORCID iD orcid.org/0000-0002-1200-0935
ORCID for Reuben Pengelly: ORCID iD orcid.org/0000-0001-7022-645X
ORCID for James Thompson: ORCID iD orcid.org/0000-0002-9285-1317
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: 14 Mar 2023 17:43
Last modified: 17 Mar 2024 03:53

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Contributors

Author: Nisreen Rumman
Author: Mahmoud R. Fassad
Author: Corine Driessens ORCID iD
Author: Patricia M. Goggin
Author: Nader Abdelrahman
Author: Adel Adwan
Author: Mutaz Albakri
Author: Jagrati Chopra
Author: Regan Doherty
Author: Bishara Fashho
Author: Grace Freke
Author: Abdallah Hasaballah
Author: Claire Jackson ORCID iD
Author: Mai Mohamed
Author: Reda Abu Nema
Author: Mitali Patel
Author: Reuben Pengelly ORCID iD
Author: Ahmad Qaaqour
Author: Bruna Rubbo
Author: N. Simon Thomas
Author: James Thompson ORCID iD
Author: Woolf T. Walker
Author: Hannah Mitchison
Author: Jane Lucas ORCID iD

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