RT Journal Article SR Electronic T1 Primary ciliary dyskinesia with normal ultrastructure: three-dimensional tomography detects absence of DNAH11 JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1701809 DO 10.1183/13993003.01809-2017 VO 51 IS 2 A1 Amelia Shoemark A1 Thomas Burgoyne A1 Robert Kwan A1 Mellisa Dixon A1 Mitali P. Patel A1 Andrew V. Rogers A1 Alexandros Onoufriadis A1 Juliet Scully A1 Farheen Daudvohra A1 Thomas Cullup A1 Michael R. Loebinger A1 Robert Wilson A1 Eddie M.K. Chung A1 Andrew Bush A1 Hannah M. Mitchison A1 Claire Hogg YR 2018 UL http://erj.ersjournals.com/content/51/2/1701809.abstract AB In primary ciliary dyskinesia (PCD), motile ciliary dysfunction arises from ciliary defects usually confirmed by transmission electron microscopy (TEM). In 30% of patients, such as those with DNAH11 mutations, apparently normal ultrastructure makes diagnosis difficult. Genetic analysis supports diagnosis, but may not identify definitive causal variants. Electron tomography, an extension of TEM, produces three-dimensional ultrastructural ciliary models with superior resolution to TEM. Our hypothesis is that tomography using existing patient samples will enable visualisation of DNAH11-associated ultrastructural defects. Dual axis tomograms from araldite-embedded nasal cilia were collected in 13 PCD patients with normal ultrastructure (DNAH11 n=7, HYDIN n=2, CCDC65 n=3 and DRC1 n=1) and six healthy controls, then analysed using IMOD and Chimera software.DNAH11 protein is localised to the proximal ciliary region. Within this region, electron tomography indicated a deficiency of >25% of proximal outer dynein arm volume in all patients with DNAH11 mutations (n=7) compared to other patients with PCD and normal ultrastructure (n=6) and healthy controls (n=6). DNAH11 mutations cause a shared abnormality in ciliary ultrastructure previously undetectable by TEM. Advantageously, electron tomography can be used on existing diagnostic samples and establishes a structural abnormality where ultrastructural studies were previously normal.3D electron tomography identifies a defect in the cilia of patients with PCD and “normal ultrastructure” http://ow.ly/lZqd30hdPXM