Host-microbial interactions in patients with chronic rhinosinusitis

• Published in: Journal of allergy and clinical immunology Vol. 133; no. 3; pp. 640 - 653.e4
• Main Author: Hamilos, Daniel L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2014; Elsevier; Elsevier Limited; American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc
• Subjects: Allergy and Immunology; antimicrobial; Asthma; Bacteria; biofilm; Biofilms; Biological and medical sciences; Chronic Disease; Chronic rhinosinusitis; Cytokines; Epithelium - physiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; host; Host-Pathogen Interactions; Humans; immunity; Immunity, Innate; Immunopathology; Infections - complications; innate; Ligands; Medical sciences; microbial; Mucociliary Clearance; Non tumoral diseases; Otorhinolaryngology. Stomatology; Proteins; Pseudomonas aeruginosa; Rhinitis - etiology; Rhinitis - immunology; Rhinitis - microbiology; Rodents; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sinuses; Sinusitis - etiology; Sinusitis - immunology; Sinusitis - microbiology; Streptococcus infections; Studies; Th2 Cells - immunology; Toll-Like Receptors - physiology; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Viral infections; Viruses; Cp110; antimicrobial; NO; NP; Chronic rhinosinusitis; CRS; PLUNC; IESA; CRSwNP; IBD; immunity; CRSsNP; DMBT1; MBL; biofilm; host; LBP; TLR; CD; NOD; innate; hBD; microbial; EMCRS; CSLM; PCD; SEB; SP-D; SLPI; SP-A; AFRS; FISH; PNEC; BPI; SEM; HC; IL-22R; TEM; Confocal scanning laser microscopy; Human β-defensin; Chronic rhinosinusitis with nasal polyposis; Primary ciliary dyskinesia; Cultured primary nasal epithelial cell; Fluorescence in situ hybridization; Toll-like receptor; Bactericidal/permeability-increasing protein; Scanning electron microscopy; Inflammatory bowel disease; Crohn disease; Nitric oxide; Deleted in malignant brain tumor 1; Intraepithelial Staphylococcus aureus; LPS-binding protein; Nasal polyp; IL-22 receptor; Allergic fungal rhinosinusitis; Mannose-binding lectin; Healthy control subject; Secretory leukocyte proteinase inhibitor; Eosinophilic mucin chronic rhinosinusitis; Centrosomal protein 110; Palate lung and nasal epithelium clone; Surfactant protein A; Chronic rhinosinusitis without nasal polyps; Surfactant protein D; Transmission electron microscopy; Nucleotide-binding oligomerization domain; Staphylococcal enterotoxin B; Human; Immunopathology; Nose disease; Rhinitis; Immunity; Antimicrobial agent; Sinusitis; Chronic; Immunology; Biofilm; ENT disease; Paranasal sinus disease
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2013.06.049

There has been considerable investigation of host-microbial interactions in patients with chronic rhinosinusitis (CRS) in hopes of elucidating mechanisms of disease and better treatment. Most attention has been paid to bacterial infection and potential underlying defects in innate immunity. Bacterial biofilm is present in most patients with CRS undergoing surgical intervention, and its presence is associated with more severe disease and worse surgical outcomes. A role for viral or fungal infection in patients with CRS is less clear. There is no evidence for a primary defect in mucociliary clearance in most patients with CRS. Decreased levels of certain antimicrobial proteins, most notably lactoferrin, have been found in sinus secretions, whereas levels of other antimicrobial proteins have been found to be normal. No primary defects in Toll-like receptors have been found in patients with CRS, although a 50% reduced expression of Toll-like receptor 9 was reported in patients with recalcitrant nasal polyps. A polymorphism in a bitter taste receptor was recently associated with refractory CRS and persistent Pseudomonas aeruginosa infection. A downregulation of innate immunity by maladaptive TH2 tissue inflammation has also been described in patients with recalcitrant nasal polyps, suggesting a link to persistent infection. To date, an effective means of restoring host-microbial balance and mitigating disease in patients with CRS remains elusive.