The Journal of Allergy and Clinical Immunology
Volume 125, Issue 2 , Page 507, February 2010

Remodeling and inflammation in Chinese versus white patients with chronic rhinosinusitis

  • Nan Zhang, MD, PhD

      Affiliations

    • Upper Airway Research Laboratory, Department of ORL, University of Ghent, Belgium
    • Department of ORL, Zhongshan City People's Hospital, China
    • ,
  • Shixi Liu, MD, PhD

      Affiliations

    • Department of ORL, West China Hospital, Sichuan University, Chengdu, China
    • ,
  • Ping Lin, PhD

      Affiliations

    • Upper Airway Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
    • ,
  • Xiaoyuan Li, MD

      Affiliations

    • Department of ORL, West China Hospital, Sichuan University, Chengdu, China
    • ,
  • Nicholas van Bruaene, MD

      Affiliations

    • Upper Airway Research Laboratory, Department of ORL, University of Ghent, Belgium
    • ,
  • Jie Zhang, MBBS

      Affiliations

    • Upper Airway Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
    • ,
  • Thibaut van Zele, MD, PhD

      Affiliations

    • Upper Airway Research Laboratory, Department of ORL, University of Ghent, Belgium
    • ,
  • Claus Bachert, MD, PhD

      Affiliations

    • Upper Airway Research Laboratory, Department of ORL, University of Ghent, Belgium

published online 11 January 2010.

Article Outline

 

To the Editor:

The authors of the article entitled “Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese”1 claim to confirm our data2 on the deficit of forkhead box protein 3 (or T-regulatory cells) and a decreased production of TGF-β1 in Chinese patients with chronic rhinosinusitis with nasal polyps versus controls; they also claim that, in contrast with our findings in white patients,3, 4 mucosal samples of patients with chronic rhinosinusitis without nasal polyps (CRSsNP) in China would be characterized by a decrease in T-regulatory cells and TGF-β expression.

However, their data do not allow such conclusions, and we do have solid evidence from work in China that their conclusions concerning CRSsNP are incorrect and misleading.

Whereas we provided evidence for an upregulation of TGF-β1 on the mRNA and protein levels, of TGF-β2 protein concentrations, of TGF-β receptors RI and RIII mRNA expression, and of corresponding downstream events such as an increase in the number of TGF-β activated cells and total collagen amount in CRSsNP versus controls,3, 4 the conclusions in the article by Cao et al1 are based on TGF-β1 mRNA data only. Moreover, those data are presented as “proportions of patients having positive mRNA expression” and do not allow any quantitative conclusions, which needs explanation. We also wonder why Cao et al1 could not detect TGF-β1 mRNA in approximately 50% to 60% of their samples, and how these findings fit with their own “pathological classification,” (P480) showing a low edema score for CRSsNP.

In the same way, the data for forkhead box protein 3 expression in the article by Cao et al1 are given as “proportions of patients having positive mRNA expression,” whereas we provided quantitative mRNA and protein data (immunohistochemistry) for white patients with CRSsNP.3

Further concerns include the definition of “eosinophilic polyps” based on number of cells, because we have shown that eosinophils may be present but not activated2; the fact that the patients in the immunologic study are not identical with those from the histologic study; and the statistical evaluation of 5 groups in parallel (Fig 2) without necessary correction (eg, Bonferroni).

In contrast with their findings, we are able to show that the remodelling pattern in Chinese patients of Chengdu, a city in West China, does match our findings in white patients with CRSsNP, with a significant upregulation of TGF-β proteins and of downstream events such as the total collagen content versus controls. Furthermore, mucosal forkhead box protein 3 mRNA in Chinese subjects with CRSsNP is quantitatively measurable and also significantly increased versus controls (Li et al, Aug 2009).

In summary, in clear contrast with the unjustified conclusions of the article by Cao et al,1 mucosal remodelling patterns and forkhead box protein 3 expression in patients with CRSsNP and chronic rhinosinusitis with nasal polyps in China do resemble those in white patients, whereas the T-effector cell patterns and the types of inflammation do differ between Chinese and white subjects with chronic rhinosinusitis with nasal polyps, as published earlier.2 These findings are extremely helpful in clarifying pathomechanisms and phenotypes of upper airway inflammation and may affect therapeutic approaches to these diseases.

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References 

  1. Cao PP, Li HB, Wang BF, Wang SB, You XJ, Cui YH, et al. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese. J Allergy Clin Immunol. 2009;124:478–484
  2. Zhang N, Van Zele T, Perez-Novo C, Van Bruaene N, Holtappels G, DeRuyck N, et al. Different types of T effector cells orchestrate mucosal inflammation in chronic sinus disease. J Allergy Clin Immunol. 2008;122:961–968
  3. Van Bruaene N, Perez-Novo C, Basinski T, Van Zele T, Holtappels G, Schmidt-Weber C, et al. T cell regulation in chronic paranasal sinus disease. J Allergy Clin Immunol. 2008;121:1435–1441
  4. Van Bruaene N, Derycke L, Perez-Novo CA, Gevaert P, Holtappels G, De Ruyck N, et al TGF-beta protein and receptor expression, and intracellular signaling in chronic rhinosinusitis. J Allergy Clin Immunol. 2009;124:253–259

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

PII: S0091-6749(09)01542-5

doi:10.1016/j.jaci.2009.10.015

Refers to article:

  • Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese , 22 June 2009

    Ping-Ping Cao, Hua-Bin Li, Bao-Feng Wang, Shui-Bin Wang, Xue-Jun You, Yong-Hua Cui, De-Yun Wang, Martin Desrosiers, Zheng Liu
    The Journal of Allergy and Clinical Immunology September 2009 (Vol. 124, Issue 3, Pages 478-484.e2)

  • Different types of T-effector cells orchestrate mucosal inflammation in chronic sinus disease , 22 September 2008

    Nan Zhang, Thibaut Van Zele, Claudina Perez-Novo, Nicholas Van Bruaene, Gabriele Holtappels, Natalie DeRuyck, Paul Van Cauwenberge, Claus Bachert
    The Journal of Allergy and Clinical Immunology November 2008 (Vol. 122, Issue 5, Pages 961-968)

The Journal of Allergy and Clinical Immunology
Volume 125, Issue 2 , Page 507, February 2010

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