Ann Lab Med.  2018 Mar;38(2):125-131. 10.3343/alm.2018.38.2.125.

Serum Cytokine Profile in Patients with Chronic Rhinosinusitis with Nasal Polyposis Infected by Aspergillus flavus

• Rai G
• Ansari MA
• Dar SA
• Datt S
• Gupta N
• Sharma S
• Haque S
• Ramachandran VG
• Mazumdar A
• Rudramurthy S
• Chakrabarti A
• Das S

• KMID: 2403357
• DOI: http://doi.org/10.3343/alm.2018.38.2.125

Abstract

BACKGROUND
Fungi, especially Aspergillus flavus, can cause chronic rhinosinusitis with nasal polyposis and modulate host innate immune components. The objective of this study was to examine the serum levels of T helper (Th) cell subset Th1, Th2, and Th17 cytokines and total IgE in patients having chronic rhinosinusitis with nasal polyposis and Aspergillus flavus infection.
METHODS
A case-control study including 40 patients with chronic rhinosinusitis with nasal polyposis and 20 healthy controls was conducted. Aspergillus flavus infection was confirmed by standard potassium hydroxide (KOH) testing, culture, and PCR. Serum samples of all patients and controls were analyzed for various cytokines (interleukins [IL]-1β, IL-2, IL-4, IL-6, IL-17, IL-21, IL-27, TGF-β) and total IgE by ELISA. Data from patients with Aspergillus flavus infection and healthy volunteers were compared using the independent t-test and non-parametric Mann-Whitney U test.
RESULTS
Aspergillus flavus infection was found in 31 (77.5%) patients with chronic rhinosinusitis with nasal polyposis. IL-1β, IL-17, IL-21, and TGF-β serum levels were significantly higher in these patients than in controls; however, IL-2, IL-4, IL-6, and IL-27 levels were lower. Compared with nine (22.5%) patients without Aspergillus flavus infection, IL-17 level was higher while IL-2 level was lower in patients with Aspergillus flavus infection. Total IgE was significantly higher in patients with Aspergillus flavus infection than in controls.
CONCLUSIONS
High levels of IL-17 and its regulatory cytokines in patients with chronic rhinosinusitis with nasal polyposis infected by Aspergillus flavus raise a concern about effective disease management and therapeutic recovery. Surgical removal of the nasal polyp being the chief management option, the choice of post-operative drugs may differ in eosinophilic vs. non-eosinophilic nasal polyposis. The prognosis is likely poor, warranting extended care.

Keyword

Nasal polyposis; Chronic rhinosinusitis; Aspergillus flavus; Cytokines

MeSH Terms

Aspergillus flavus*
Aspergillus*
Case-Control Studies
Cytokines
Disease Management
Enzyme-Linked Immunosorbent Assay
Eosinophils
Fungi
Healthy Volunteers
Humans
Immunoglobulin E
Interleukin-17
Interleukin-2
Interleukin-27
Interleukin-4
Interleukin-6
Nasal Polyps
Polymerase Chain Reaction
Potassium
Prognosis
Cytokines
Immunoglobulin E
Interleukin-17
Interleukin-2
Interleukin-4
Interleukin-6
Potassium

Figure

• 

  Fig. 1 Serum levels of various cytokines in healthy controls and patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and A. flavus infection. The bars in (A) show the levels of downregulated cytokines (IL-2, IL-4, IL-6, and IL-27), and those in (B) show the levels of upregulated cytokines (IL-17, IL-21, IL-1β, and TGF-β), compared with healthy controls. *P<0.05; **P<0.01; ***P<0.001.

• 

  Fig. 2 Serum IgE levels in healthy controls and patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and A. flavus infection.

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