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Primary ciliary dyskinesia (PCD) is characterized by chronic airway disease, male infertility, and randomization of the left/right body axis as a result of defects of motile cilia and sperm flagella. We identified loss-of-function mutations in the open-reading frame C11orf70 in PCD individuals from five distinct families. Transmission electron microscopy analyses and high-resolution immunofluorescence microscopy demonstrate that loss-of-function mutations in C11orf70 cause immotility of respiratory cilia and sperm flagella, respectively, as a result of the loss of axonemal outer (ODAs) and inner dynein arms (IDAs), indicating that C11orf70 is involved in cytoplasmic assembly of dynein arms. Expression analyses of C11orf70 showed that C11orf70 is expressed in ciliated respiratory cells and that the expression of C11orf70 is upregulated during ciliogenesis, similar to other previously described cytoplasmic dynein-arm assembly factors. Furthermore, C11orf70 shows an interaction with cytoplasmic ODA/IDA assembly factor DNAAF2, supporting our hypothesis that C11orf70 is a preassembly factor involved in the pathogenesis of PCD. The identification of additional genetic defects that cause PCD and male infertility is of great importance for the clinic as well as for genetic counselling.

Ultrastructural abnormalities of spermatozoa and respiratory cilia have been reported in a male patient with Kartagener's syndrome and infertility. In this patient both respiratory cilia and sperm tails showed defects in radial spokes and dynein arms. Such defects are heretofore undescribed in the same subject with immotile cilia syndrome. Absence of both inner and outer dynein arms and absence of the inner dynein arms only were detected in spermatozoa and in respiratory tract cilia, respectively. Moreover, total absence of axoneme was seen in several sperm tails from this patient. The possibility that the features described are of genetic origin is discussed.