Beyond the Present: Current and Future Perspectives on the Role of Infections in Pediatric PCD

Megan Frohlich ^1,2* Bernadette Prentice ^1,2 Louisa Owens ^1,2 Shafagh Al Nadaf Waters ^1,2,3,4 Lucy Morgan ^5,6

• ¹ Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
• ² Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
• ³ Molecular and Integrative Cystic Fibrosis Research Centre, University of New South Wales, Kensington, New South Wales, Australia
• ⁴ School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
• ⁵ Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
• ⁶ Faculty of Medicine, The University of Sydney, Darlington, New South Wales, Australia

Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder affecting motile cilia, leading to impaired mucociliary clearance and increased susceptibility to respiratory infections. These infections contribute to long-term complications such as bronchiectasis and lung function decline. Objectives: This review explores both the acute and long-term impact of respiratory infections in children with PCD, while highlighting the multiple contributors to infection susceptibility. The review also evaluates emerging personalized approaches such as gene and mRNA therapy that hold promise for restoring ciliary function and reducing the burden of acute infections in pediatric PCD. Key Findings and Conclusions: Acute respiratory infections have a significant impact on morbidity in pediatric PCD, driving progressive airway remodelling. While current treatment strategies focus on managing infections directly, emerging therapies targeting inflammation and genetic causes hold promise for reducing infection burden and improving long-term outcomes. Future advances in personalized medicine could further enhance therapeutic approaches in this population.