The Journal of Allergy and Clinical Immunology
Volume 124, Issue 3 , Pages 478-484.e2, September 2009

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

  • Ping-Ping Cao, MD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • ,
  • Hua-Bin Li, MD, PhD

      Affiliations

    • Otolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    • ,
  • Bao-Feng Wang, MD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Nanjing Tongren Hospital, Nanjing, China
    • ,
  • Shui-Bin Wang, MD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • ,
  • Xue-Jun You, MD, PhD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • ,
  • Yong-Hua Cui, MD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • ,
  • De-Yun Wang, MD, PhD

      Affiliations

    • Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
    • ,
  • Martin Desrosiers, MD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Université de Montreal, Montreal, Quebec, Canada
    • Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
    • ,
  • Zheng Liu, MD, PhD

      Affiliations

    • Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    • Corresponding Author InformationReprint requests: Zheng Liu, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, P.R.China.

Received 21 January 2009; received in revised form 1 April 2009; accepted 5 May 2009. published online 22 June 2009.

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 TH1/TH2/TH17 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 TH2/TH17 reaction and Vα24 expression were found in eosinophilic CRSwNP.

Conclusion

Both Chinese CRSsNP and CRSwNP patients demonstrate impaired regulatory T cell function and enhanced TH1/TH2/TH17 responses. CRSsNP is confirmed to be a predominant TH1 milieu, whereas TH2 skewed inflammation with predominant TH17 reactions, and infiltration of natural killer T cells can be demonstrated only in eosinophilic CRSwNP, but not in noneosinophilic CRSwNP.

Key words: Chronic rhinosinusitis, nasal polyps, eosinophils, TH1, TH2, TH17, regulatory T cells, natural killer T cells

Abbreviations used: CRS, Chronic rhinosinusitis, CRSsNP, Chronic rhinosinusitis without nasal polyps, CRSwNP, Chronic rhinosinusitis with nasal polyps, DC-LAMP, Dendritic cell lysosome-associated membrane protein, FOXP3, Forkhead box P3, HE, Hematoxylin-eosin, NKT, Natural killer T, HP, High power, LP, Lamina propria, NP, Nasal polyp, PAS, Periodic acid-Schiff, RORC, Retinoic acid–related orphan receptor C, T-bet, T-box transcription factor, Treg, Regulatory T

 

 Supported by National Nature Science Foundation of China grants 30500557 and 30872847, the Scientific Research Foundation for Returned Overseas Chinese Scholars of State Education Ministry grant [2006]331, a grant for New Century Excellent Talents in University from State Education Ministry (NCET-07-0326) to Z.L., and National Nature Science Foundation of China grant 30700935 to H.-B.L.

 Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00793-3

doi:10.1016/j.jaci.2009.05.017

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 3 , Pages 478-484.e2, September 2009

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