Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by the accumulation of inflammatory cells; however, an eosinophil predominance is seen in white (Belgian), but not Asian (south Chinese), patients with polyps.

Objective

We sought to investigate the association of inflammatory cell predominance with regulatory T-cell and T-effector cell patterns.

Methods

Nasal mucosal tissue was obtained from 26 consecutive Belgian patients with CRSwNP and 21 Belgian control subjects and 29 south Chinese patients with CRSwNP and 29 south Chinese control subjects, who all underwent phenotyping, including nasal endoscopy and computed tomographic scanning. Tissues were investigated for granulocytes and their products and T-effector/regulatory T cells and related cytokines.

Results

Both CRSwNP groups were comparable in terms of symptoms, computed tomographic scan results, and nasal endoscopy results, but asthma comorbidity was significantly higher in white patients. Tissue from white patients with CRSwNP was characterized by eosinophilic inflammation (eosinophil cationic protein/myeloperoxidase ratio > 2), whereas samples from Asian patients were biased toward neutrophilic inflammation (eosinophil cationic protein/myeloperoxidase ratio = 0.25). Both CRSwNP groups demonstrated significant upregulation of the T-cell activation marker soluble IL-2 receptor α and significant downregulation of Foxp3 expression and TGF-β1 protein content versus their respective control groups. However, whereas white patients displayed a significant increase in T_H2 cytokine and related marker levels versus control subjects and versus Asian patients, the latter showed a T_H1/T_H17 cell pattern versus control tissue.

Conclusion

Nasal polyps (CRSwNP) from white and Asian patients are both characterized by T-cell activation and impaired regulatory T-cell function; however, T-effector cells in the samples from white patients were T_H2-biased, whereas samples from their Asian counterparts demonstrated a T_H1/T_H17 polarization.

Key words: Airway inflammation, chronic rhinosinusitis, nasal polyps, eosinophils, T_H2, T_H17, regulatory T cells, IL-17A, TGF-β1, Foxp3

Abbreviations used: Be NP, Nasal polyps from Belgian patients, Be CO, Control tissue from Belgian patients, CRSwNP, Chronic rhinosinusitis with nasal polyps, CT, Computed tomography, ECP, Eosinophil cationic protein, Foxp3, Forkhead box P3, MPO, Myeloperoxidase, NP, Nasal polyp, RORC, Retinoic acid–related orphan receptor C, S-Ch CO, Control tissue from south Chinese patients, S-Ch NP, Nasal polyps from south Chinese patients, STAT, Signal transducer and activator of transcription, T-bet, T-box transcription factor