Testing of Transport, Measurement of Ciliary Activity
The mucociliary transport rate can be measured in vivo using either the saccharine and/or color test or radioisotope transport testing as well as by measuring ciliary activity in vitro. Inborn disorders of the mucociliary transport as in primary ciliary d
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Mark Jorissen and Martine Jaspers
Keywords
Mucociliary transport • Mucociliary clearance • Saccharin • Radioisotope transport • Nasal nitric oxide • Cell culture
Core Messages
• The mucociliary transport (MCT) can be studied by recording MCT as well as by measuring ciliary activity, but none of these tests are reliable for the diagnosis of inherited abnormalities. • Most people with PCD have unusually low levels of nasal NO, but a low nNO measurement is notdiagnostic for PCD. Sequential monolayer-suspension cell culture with dedifferentiation and redifferentiation of the ciliated epithelium is the most reliable screening test for the diagnosis of PCD.
28.1
Introduction
particles, bacteria, and viruses are trapped in the mucus layer that covers the airways and are transported by the beat of the cilia to the nasopharynx, where they are either swallowed or coughed up. Inborn disorders of the mucociliary transport are due to ciliary dysfunction as in primary ciliary dyskinesia (PCD) or to increased viscosity of the respiratory secretions as in cystic fibrosis (CF). Also frequently mucociliary transport is impaired because of inflammation, infection, and exposure to ciliotoxic agents. Mucociliary transport (MCT) can be studied by recording MCT in vivo, as well as by measuring ciliary activity in vitro. Methods based on nasal ciliary motility for the diagnosis of primary ciliary dyskinesia (PCD) are often hampered by the presence of acquired abnormalities (secondary ciliary dyskinesia (SCD)).
Ciliary activity causes the transport of mucus in the airways, which is an essential defense mechanism of the respiratory tract. Inhaled
M. Jorissen, MD, PhD (*) • M. Jaspers, MSc ENT Department, University Hospitals Leuven, Herestraat 49, Leuven B-3000, Belgium e-mail: [email protected]; [email protected]
Mucociliary clearance can be evaluated by using the saccharine and/or the 99mTcalbumin colloid test as well as by measuring ciliary activity and is important in the diagnosis of primary ciliary dyskinesia.
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_28, © Springer-Verlag Berlin Heidelberg 2013
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M. Jorissen and M. Jaspers
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28.2
Testing of Transport
28.2.1.2 Nuclear Testing
28.2.1 Testing of Transport In Vivo The mucociliary transport rate can be measured in vivo either by using the saccharine test (Andersen et al. 1974; Andersen and Proctor 1983) or by using the radioisotope technique (De Boeck et al. 2005). If with one of these methods active mucociliary transport can be demonstrated, it is accepted that the diagnosis of PCD is excluded. An abnormal result can certainly not be considered as proof for the disease. It implicates only that further investigation is needed.
28.2.1.1 Saccharine Test With the saccharine test, a particle of saccharine (most frequently dipped in a blue color, such as indigo blue powder) is placed on the inferior turbinate and the time elapsed before the patient taste the saccharine is measured.
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