Significance of IgG4-positive cells in severe eosinophilic chronic rhinosinusitis |
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Authors: | Takahisa Koyama Shin Kariya Yasuharu Sato Yuka Gion Takaya Higaki Takenori Haruna Tazuko Fujiwara Akira Minoura Soshi Takao Yorihisa Orita Kengo Kanai Masami Taniguchi Kazunori Nishizaki Mitsuhiro Okano |
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Affiliation: | 1. Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;2. Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;3. Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;4. Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan;5. Department of Public Health, Showa University School of Medicine, Tokyo, Japan;6. Department of Otolaryngology-Head and Neck Surgery, Kumamoto University, Kumamoto, Japan;g. Department of Otorhinolaryngology-Head & Neck Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan;h. Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan;i. Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan |
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Abstract: | BackgroundIgG4 production is regulated by type 2 (IL-4 and IL-13) and regulatory (IL-10) cytokines involved in the pathophysiology of chronic rhinosinusitis (CRS). We sought to determine the pathophysiological characteristics of IgG4-positive cells in sinonasal tissues in CRS, especially eosinophilic CRS (ECRS).MethodsIgG4-positive cells in uncinate tissues (UT) and nasal polyps (NP) were examined by immunohistochemistry. Associations between the number of IgG4-positive cells and clinicopathological factors were analyzed. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of IgG4-positive cells in tissue that can predict the post-operative course.ResultsIgG4 was mainly expressed in infiltrating plasma and plasmacytoid cells, and the number of IgG4-positive cells was significantly higher in NP, especially those from severe ECRS patients, than in UT. In CRS patients, the number of IgG4-positive cells significantly and positively correlated with blood and tissue eosinophilia, radiological severity, and serum level of total IgE. The number of infiltrating IgG4-positive cells was significantly higher in patients with a poor post-operative course (sustained sinus shadow 6 months after surgery) than in those with a good one. The number of IgG4-positive cells in NP could discriminate patients with a good or a poor post-operative course (area under the curve: 0.769). Also, 73.3% sensitivity and 82.5% specificity were achieved when the cut-off value was set at 17 cells/high-power field.ConclusionsOur results suggest that the local expression of IgG4 on cells may be used as a biomarker that reflects the pathophysiology of CRS, including the post-operative course. |
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Keywords: | Chronic rhinosinusitis Eosinophils IgG4 Nasal polyps Severity CRS chronic rhinosinusitis CRSsNP chronic rhinosinusitis without nasal polyps CRSwNP chronic rhinosinusitis with nasal polyps ECRS eosinophilic chronic rhinosinusitis 1-s forced expiratory volume/forced vital capacity HPF high power field IgG4-RD IgG4-related disease JESREC Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis NP nasal polyps SEB staphylococcal enterotoxin B UT uncinate tissues |
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