Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese

• Published in: Journal of allergy and clinical immunology 2009-09, Vol.124 (3), p.478-484.e2
• Main Authors: Cao, Ping-Ping, MD, Li, Hua-Bin, MD, PhD, Wang, Bao-Feng, MD, Wang, Shui-Bin, MD, You, Xue-Jun, MD, PhD, Cui, Yong-Hua, MD, Wang, De-Yun, MD, PhD, Desrosiers, Martin, MD, Liu, Zheng, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Allergy and Immunology; Asthma; Biological and medical sciences; CD20 antigen; CD3 antigen; CD4 antigen; CD8 antigen; China - epidemiology; Chronic Disease; Chronic rhinosinusitis; Cytokines; Cytokines - immunology; Cytokines - metabolism; Dendritic cells; eosinophils; Eosinophils - immunology; Eosinophils - metabolism; Forkhead protein; Fundamental and applied biological sciences. Psychology; Fundamental immunology; g-Interferon; GATA-3 protein; Gene expression; Helper cells; Humans; Immunopathology; Immunoregulation; Inflammation; Interleukin 5; Leukocytes (eosinophilic); Lymphocytes T; Medical sciences; Membrane proteins; Mucosa; nasal polyps; Nasal Polyps - epidemiology; Nasal Polyps - immunology; Nasal Polyps - pathology; Natural killer cells; natural killer T cells; Natural Killer T-Cells - immunology; Natural Killer T-Cells - metabolism; Non tumoral diseases; Otorhinolaryngology. Stomatology; Pathogenesis; Peroxidase; Plasma cells; Polymerase chain reaction; Polyps; Population studies; regulatory T cells; Rhinitis - epidemiology; Rhinitis - immunology; Rhinitis - pathology; rhinosinusitis; Rodents; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sinuses; Sinusitis - epidemiology; Sinusitis - immunology; Sinusitis - pathology; Studies; Surgery; T H1; T H17; T H2; T-Lymphocytes, Helper-Inducer - immunology; T-Lymphocytes, Helper-Inducer - metabolism; T-Lymphocytes, Regulatory - immunology; T-Lymphocytes, Regulatory - metabolism; Transcription factors; Transcription Factors - immunology; Transcription Factors - metabolism; Transforming growth factor-b1; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2009.05.017

Background Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is reported to be different in inflammatory patterns of the sinonasal mucosa in white patients. Studies in nonwhite populations may further be helpful to understand the pathogenic mechanisms of CRS. Objective To investigate the immunopathologic profiles of CRSwNP and CRSsNP in adult Chinese. Methods Histologic characteristics of surgical samples were analyzed in 50 controls, 94 CRSsNP patients, and 151 CRSwNP patients. Tissue samples from 17 controls, 36 CRSsNP patients, and 45 CRSwNP patients were stained for CD3, CD4, CD8, CD20, CD68, myeloperoxidase, and dendritic cell lysosome-associated membrane protein. Expression profiles of transcription factors of T-cell subsets in relation to cytokines and a marker of natural killer T cell (Vα24) were examined by means of quantitative RT-PCR. Results Over half of CRSwNP patients presented noneosinophilic inflammation. CRSwNP had a higher number of eosinophils, plasma cells, and CD3+ , CD8+ , CD20+ , and CD68+ cells and a lower myeloperoxidase expression rate than CRSsNP. Expression levels of transcription factors and cytokines of TH 1/TH 2/TH 17 were increased, whereas the expression rate of Forkhead box p3 and TGF-β1 was decreased in both CRSsNP and CRSwNP compared with controls. Comparing CRSsNP and CRSwNP, CRSsNP had higher levels of IFN-γ expression, whereas only eosinophilic CRSwNP demonstrated an enhanced expression of GATA-3 and IL-5. Compared with noneosinophilic CRSwNP, an exaggerated TH 2/TH 17 reaction and Vα24 expression were found in eosinophilic CRSwNP. Conclusion Both Chinese CRSsNP and CRSwNP patients demonstrate impaired regulatory T cell function and enhanced TH 1/TH 2/TH 17 responses. CRSsNP is confirmed to be a predominant TH 1 milieu, whereas TH 2 skewed inflammation with predominant TH 17 reactions, and infiltration of natural killer T cells can be demonstrated only in eosinophilic CRSwNP, but not in noneosinophilic CRSwNP.