Downregulation of Orai1 expression in the airway alleviates murine allergic rhinitis

Orai1 is the key subunit of the Ca(2+)-release-activated Ca(2+) channel. Our previous report has demonstrated that Orai1 expression in the airway was upregulated in the ovalbumin (OVA)-induced allergic rhinitis (AR) mouse models. To observe whether inhibition of Orai1 expression in the airway could suppress symptoms in a murine model of AR and to assess the impacts of this inhibition on the responses of local and systemic immunocytes, we administered recombinant lentivirus vectors that encoded shRNA against ORAI1 (lenti-ORAI1) into the nostrils of OVA-sensitized mice before the challenges, and analyzed its effect on allergic responses, as compared with the unsensitized mice and untreated AR mice. Administration of lenti-ORAI1 into the nasal cavity successfully infected cells in the epithelial layer of the nasal mucosa, and significantly decreased the frequencies of sneezing and nasal rubbing of the mice. Protein levels of leukotriene C4, OVA-specific IgE, and IL-4 in the nasal lavage fluid and serum and eosinophil cation protein in the serum were also significantly reduced by lenti-ORAI1, as were the mRNA levels of these factors in the nasal mucosa and spleen. These data suggested that administration of lenti-ORAI1 into the nasal cavity effectively decreased Orai1 expression in the nasal mucosa, alleviated AR symptoms, and partially inhibited the hyperresponsiveness of the local and systemic immune cells including T cells, B cells, mast cells and eosinophils that are involved in the pathogenesis of AR.

Xylitol nasal irrigation in the treatment of chronic rhinosinusitis

OBJECTIVE

To evaluate the efficacy of xylitol nasal irrigation (XNI) treatment on chronic rhinosinusitis (CRS) and to investigate the effect of XNI on nasal nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA in maxillary sinus.

MATERIALS AND METHODS

Patients with CRS were enrolled and symptoms were assessed by Visual Analog Scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22). Nasal NO and iNOS mRNA in the right maxillary sinus were also examined. Then, they were treated with XNI (XNI group) or saline nasal irrigation (SNI, SNI group) for 30days, after which their symptoms were reassessed using VAS and SNOT-22, and nasal NO and iNOS mRNA in the right maxillary sinus were also reexamined.

RESULTS

Twenty-five out of 30 patients completed this study. The scores of VAS and SNOT-22 were all reduced significantly after XNI treatment, but not after SNI. The concentrations of nasal NO and iNOS mRNA in the right maxillary sinus were increased significantly in XNI group. However, significant changes were not found after SNI treatment. Furthermore, there were statistical differences in the assessments of VAS and SNOT-22 and the contents of nasal NO and iNOS mRNA in the right maxillary sinus between two groups.

CONCLUSIONS

XNI results in greater improvement of symptoms of CRS and greater enhancement of nasal NO and iNOS mRNA in maxillary sinus as compared to SNI.

Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis

BACKGROUND

Upper airway inflammation is one of the most commonly identified causes of chronic cough, although the underlying mechanism is not clear. This study compared normal saline solution nasal-pharyngeal irrigation (NSNPI) and fluticasone propionate nasal spray (FPNS) treatment for chronic cough associated with allergic rhinitis (AR).

METHODS

Patients with suspected AR to house-dust mite were enrolled, and the symptom of cough was assessed by a cough symptom score and the Leicester Cough Questionnaire, and cough response to capsaicin was evaluated. AR was assessed by using the visual analog scale (VAS) and the Mini Juniper Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Mediators, including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein from nasal lavage fluid (NLF) were examined. The patients were treated with NSNPI (the NSNPI group) or FPNS (the FPNS group) for 30 days, after which they were reassessed.

RESULTS

Forty-five of 50 patients completed this study. The scores of the cough symptom and the Leicester Cough Questionnaire, and the capsaicin cough threshold all improved statistically after NSNPI but did not change after FPNS. There were statistically significant changes in the evaluations of the MiniRQLQ and the mediators, including histamine and leukotriene C4, in the NLF in the NSNPI group. However, significant changes were found in the assessments of VAS, MiniRQLQ, and all above mediators including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein in the NLF of the FPNS group. Furthermore, the assessments of VAS and all the mediators were reduced more in the FPNS group compared with those in the NSNPI group.

CONCLUSION

The patients with suspected AR to house-dust mite reported a better relief of the cough symptom after 30 days of treatment with NSNPI compared with that after nasal corticosteroid.

Up-regulation of Orai1 in murine allergic rhinitis

Orai1 is an essential pore-forming subunit of the Ca(2+) release-activated Ca(2+) channels and plays a key role in the store-operated Ca(2+) entry. However, little is known about the function of this pathway in allergic airway diseases. In this study, we evaluated Orai1 expression in normal and allergic rhinitis (AR) mice airway and spleen. AR models were established by repetitive intraperitoneal sensitization followed by intranasal challenge with ovalbumin. Sneezing was counted, and eosinophils infiltration was analyzed through Luna stain. We performed the analysis of Orai1 protein in airway and spleen by immunohistochemical staining, Western blotting and enzyme-linked immunosorbent assay, and quantitatively examined Orai1 mRNA in the above tissues by real-time reverse transcription-polymerase chain reaction. Sneezes and eosinophil counts in the AR group were increased in comparison to those in the normal group. Orai1 protein was expressed in mucosal epithelium and submucosal glands epithelium of airway, and in immune cells of spleen. The immunostaining appeared stronger in AR mice than that in normal ones. Both the Orai1 protein and mRNA levels showed up-regulation in the AR group compared with those in the normal one. Our results indicate that Orai1 is up-regulated in the airway and spleen in allergic inflammation and may participate in the pathogenesis of allergic rhinitis.

Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps

OBJECTIVES

Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP.

MATERIALS AND METHODS

CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups.

RESULTS

One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4⁺ and CD8⁺ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4⁺ and CD8⁺ T cell subpopulations and concentrations of inflammatory substances.

CONCLUSION

These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.

5-Oxo-ETE from Nasal Epithelial Cells Upregulates Eosinophil Cation Protein by Eosinophils in Nasal Polyps in vitro

BACKGROUND

5-Oxo-6,8,11,14-eicosatetraenoic acid (5-oxo-ETE) is a potent eosinophil chemoattractant and activator that is synthesized not only in inflammatory cells but also in bronchial epithelial cells. The purpose of this study is to clarify whether 5-oxo-ETE can promote the production of eosinophil cation protein (ECP) by eosinophils in nasal polyps (NP) in vitro, and whether normal nasal epithelial cells can produce this lipid mediator in response to oxidative stress.

MATERIALS AND METHODS

Nasal biopsy samples were obtained from normal subjects or subjects with chronic rhinosinusitis with NP. The infiltration of eosinophil in NP was detected and cultured. After that, concentrations of ECP in eosinophil and NP cultures were evaluated after the treatment of 5-oxo-ETE or 5-oxo-ETE + its receptor (OXER) antagonist, pertussis toxin (PT). Then we studied the synthesis of 5-oxo-ETE after H2O2 stimulation by normal nasal epithelial cells and by epithelial cells of NP alone in the cultures, and also determined the OXER expression in NP.

RESULTS

The number of infiltrative eosinophils in NP was increased. The ECP levels in eosinophil and NP cultures were enhanced after the administration of 5-oxo-ETE, and decreased by the PT treatment. 5-Oxo-ETE was upregulated in the cultures of nasal epithelial cells in the presence of H2O2 and of NP epithelial cells alone. The OXER was expressed in inflammatory cells, and not in epithelial cells.

CONCLUSION

5-Oxo-ETE produced by nasal epithelial cells may play a role in the formation and development of NP.

2-Aminoethoxydiphenyl borate administration into the nostril alleviates murine allergic rhinitis

OBJECTIVE

Orai1 is the pore-forming subunit of the Ca(2+) release-activated Ca(2+) channels and plays a key role in the store-operated Ca(2+) entry. However, little is known about the function of this pathway in allergic rhinitis (AR). In this study, we examined whether the intervention of Orai1 pathway was capable of controlling IgE-mediated allergic reactions by using AR mice models.

MATERIALS AND METHODS

We used Western blotting and real-time reverse transcription polymerase chain reaction to evaluate Orai1 expression in nasal mucosa and nasal-associated lymphoid tissue (NALT) of normal, control, and 2-aminoethoxydiphenyl borate (2-APB)-treated mice. In addition, we analyzed concentrations of nasal lavage fluid leukotriene C4 (LTC4), eosinophil cation protein (ECP), ovalbumin-specific IgE, and interleukin-4 (IL-4) through enzyme-linked immunosorbent assay and measured messenger RNA (mRNA) levels of LTC4 synthase and ECP in nasal mucosa, and germline Cɛ transcription and IL-4 mRNA in NALT by using real-time reverse transcription polymerase chain reaction among groups.

RESULTS

2-Aminoethoxydiphenyl borate administration into the nostril reduced numbers of sneezing and nasal rubbing as well as counts of invasive eosinophils in treated mice compared with those in control ones. Furthermore, the administration suppressed Orai1 expression in nasal mucosa and NALT of treated mice compared with that of control ones. Similarly, 2-APB treatment restrained nasal lavage fluid LTC4, ECP, ovalbumin-specific IgE, and IL-4 and their corresponding mRNAs in the previously mentioned tissues of treated mice in comparison with those of control ones.

CONCLUSION

Our results indicate that 2-APB treatment effectively alleviates murine AR through pleiotropic activities.

Amelioration of Muc5b mucin hypersecretion is enhanced by IL-33 after 2-APB administration in a murine model of allergic rhinitis

We attempted to clarify whether hypersecretion of Muc5b mucin from mouse nasal submucosal glands that is enhanced by interleukin (IL)-33 under allergic conditions can be ameliorated by administration of 2-APB. Immunohistochemistry was used to examine both the distribution of T cells in the nasal mucosa of an allergic rhinitis mouse model and expressions of IL-33 receptor ST2 and Muc5b protein in mouse submucosal gland cells. The amounts of protein and mRNA of Orai1, Muc5b, IL-4, IL-5, IL-13 and IL-33 in mouse nasal lavage fluid (NLF) and nasal mucosa were determined using enzyme-linked immunosorbent assay and real-time reverse transcription-polymerase chain reaction. Expressions of Orai1, Muc5b, IL-4, IL-5, IL-13 and IL-33 were up-regulated in the allergic state and IL-33 increased the levels of Muc5b, IL-4, IL-5 and IL-13, but did not influence proliferation of T cells; however, ST2 was diminished in nasal submucosal gland cells. 2-APB reduced proliferation of T cells and the Orai1 level in the nasal mucosa. It also reduced the concentrations of IL-4, IL-5 and IL-13 in NLF and nasal mucosa, and hypersecretion of Muc5b from glandular cells that was enhanced by IL-33, but did not affect IL-33 production. 2-APB decreased Muc5b mucin hypersecretion from submucosal gland that was enhanced by IL-33 in allergic mice by limiting Ca(2+) release-activated Ca(2+) channel activity in which Orai1 plays a crucial role in the gland cells and/or by controlling channel activation in T cells and proliferation of these cells.

Influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro

BACKGROUND

Orai1 is crucial for store-operated Ca2(+) entry and Ca2(+) release-activated Ca2(+) channel activities. However, little is known about its function in allergic diseases.

OBJECTIVE

To assess the influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro.

METHODS

We used immunohistochemical staining, enzyme-linked immunosorbent assay, and real-time reverse transcription-polymerase chain reaction to evaluate Orai1 expression in nasal and tracheal mucosa epithelium of nonsensitized, control, and 2-aminoethoxydiphenyl borate (2-APB)-treated groups in vivo and in vitro. In addition, we analyzed concentrations of interleukin 1β, interleukin 6, macrophage inflammatory protein 2, and tumor necrosis factor α in nasal lavage fluid, bronchoalveolar lavage fluid, and culture supernatant and their messenger RNAs in nasal and tracheal mucosa and cultured nasal and tracheal epithelium.

RESULTS

Administration of 2-APB into the nostrils suppressed Orai1 expression in nasal and tracheal mucosa of treated mice compared with that in control mice and restrained the mediators in nasal lavage fluid, bronchoalveolar lavage fluid, and airway mucosa of treated groups compared with those in control groups. Similarly, the 2-APB intervention also alleviated Orai1 and the production of the mediators in culture supernatant and cultured airway epithelium under allergic conditions.

CONCLUSIONS

Our results indicate that 2-APB could effectively ameliorate reactions of upper and lower airway epithelial cells in mice in allergic states in vivo and in vitro.

CD4+ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s in a murine model of allergic rhinitis

OBJECTIVE

CD4⁺ T cells play an important role not only in the induction of allergy but also in allergic inflammation. Group 2 innate lymphoid cells (ILC2s) also mediate type 2 immune responses in allergic rhinitis (AR). However, the relationships between CD4⁺ T cells and ILC2s in allergic condition are currently not well defined. The study aimed to evaluate the potential influences of CD4⁺ T cells on ILC2s in the murine model of AR.

METHODS

A murine model of AR was established using ovalbumin (OVA), and OVA-induced ILC2s were sorted and purified from the mouse nasal-associated lymphoid tissue (NALT), and cultured in vitro. Then, the expression of major histocompatibility complex class II (MHCII) on ILC2s was examined. CD4⁺ T cells were separated from AR mice peripheral blood mononuclear cells (PBMCs). After that, productions of IL-5 and IL-13 on ILC2s cultures were assessed when CD4⁺ T cells or plus anti-MHCII antibody or anti-CD4 antibody were administered into the cultures. Finally, we adoptively transferred ILC2s alone or ILC2s plus anti-MHCII antibody to the murine model of AR to investigate their roles in the nasal allergic inflammation.

RESULTS

We showed that ILC2s could be induced by OVA in the mouse NALT. The number and percentage of ILC2s in AR mice were increased. MHCII was expressed on ILC2s, and its protein and mRNA were all enhanced in allergic condition. IL-5 and IL-13 proteins and mRNAs were elevated after CD4⁺ T cells administration, and were reduced after these cells plus anti-MHCII antibody or anti-CD4 antibody application. Numbers of sneezing and nasal rubbing as well as counts of eosinophils in nasal lavage fluid (NLF) were all enhanced after the adoptive transfer of ILC2s when compared to AR mice. IL-5 and IL-13 in the NLF of allergic mice were also increased in comparison with AR group. However, above parameters were all decreased after the transfer of ILC2s plus anti-MHCII antibody versus AR mice or ILC2s-treated ones.

CONCLUSION

These findings show that CD4⁺ T cells induce productions of IL-5 and IL-13 through MHCII on ILC2s in AR mice models.

In Vitro Treatment with 2-APB Inhibits the Inflammation in Nasal Polyps

OBJECTIVE

Glucocorticoids are considered the main treatment option for chronic rhinosinusitis with nasal polyps (CRSwNP), but their effect rate ranges from 60.9% to 80%. Novel therapeutic means should be studied. The purpose of this study was to investigate the expression of Orai1 in nasal polyps (NPs) and the influence of intervention of Orai1 on NPs after in vitro treatment of 2-aminoethoxydiphenyl borate (2-APB).

STUDY DESIGN

Prospective cross-sectional study.

SETTING

University hospital.

SUBJECTS AND METHODS

Nasal biopsy samples were obtained from normal subjects or subjects with CRSwNP. We studied the localization of Orai1 protein in NPs by using immunohistochemistry. Then these tissues in cultures were maintained in the absence or presence of dexamethasone (DEX) or 2-APB. Orai1 was examined by Western blot, enzyme-linked immunosorbent assay (ELISA), and real-time reverse transcription-polymerase chain reaction (RT-PCR). Inflammatory mediators including interleukin (IL)-1β, IL-5, eosinophil cation protein (ECP), leukotriene (LT)C4, interferon (IFN)-γ, and dermatophagoides pteronyssinus (DP)-specific immunoglobulin E (sIgE) as well as mucins (MUCs) including MUC5B and MUC7 in cultures were analyzed with ELISA and real-time RT-PCR.

RESULTS

The expression of Orai1 was localized to cytoplasmic membrane of inflammatory cells and submucosal glandular cells and was upregulated in NPs compared with normal nasal mucosa. Orai1 was decreased in NPs after in vitro treatment of 2-APB but not after DEX intervention. The levels of inflammatory mediators and mucins were reduced more after 2-APB treatment when compared with those after DEX treatment.

CONCLUSION

Orai1 may play crucial roles in NP formation, and the intervention of Orai1 may inhibit NP development.

The Intervention of CRAC Channels Alleviates Inflammatory Responses in Nasal Polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with Th2-dominant inflammation. However, effective treatments for CRSwNP have not yet been found. This study aimed to investigate the expression of Orai1 in nasal polyps (NP) and the influence on them of the intervention of Ca2+ release-activated Ca2+ (CRAC) channels.

MATERIALS AND METHODS

Nasal samples were obtained from normal subjects or subjects with CRSwNP. We studied the distribution of Orai1 protein in NP and normal mucosa (normal group) using immunohistochemistry. These tissues in cultures were then maintained in the absence (control group) or presence of 2-aminoethoxydiphenyl borate (2-APB) for 24 h. Orai1 was examined by means of enzyme-linked immunosorbent assay (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR). The Ca2+ mean fluorescence intensity (MFI) was evaluated by flow cytometry, and the inflammatory mediators, including interleukin (IL)-4, IL-5, IL-13, Dermatophagoides pteronyssinus-specific IgE, leukotriene C4 and eosinophil cation protein in cultures, were analyzed with ELISA and real-time RT-PCR.

RESULTS

The expression of Orai1 was localized to the cytoplasmic membrane of inflammatory cells, and upregulated in NP compared to that in the normal group. However, Orai1 protein was decreased in polyp tissues after the 2-APB treatment. The levels of Ca2+ MFI and above inflammatory mediators were also elevated in NP, and reduced after the 2-APB administration compared to those in the control group.

CONCLUSIONS

Orai1 and CRAC channels may play a crucial role in NP formation and development, and the 2-APB intervention of Orai1 protein may alleviate inflammatory responses in NP.

Efficacy of Budesonide Nasal Spray on Neutrophilic Chronic Rhinosinusitis with Nasal Polyps: A Combined Clinical and Experimental Study

BACKGROUND

Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the efficacy of budesonide nasal spray on neutrophilic CRSwNP.

MATERIALS AND METHODS

Fifteen neutrophilic CRSwNP patients were included, and then they received budesonide nasal spray treatment for 3 months. Biopsies of nasal polyps (NPs) were obtained from these subjects. Their clinical indexes were scored using Visual Analog Scale (VAS), Sino-Nasal Outcome Test (SNOT)-22, and Endoscopic Appearances (EAs). Histological analyses were used to assess numbers of neutrophils, goblet cells, and submucosal gland cells in NPs. Percentages of CD8+ T cells and CD4+CD25+Foxp3+ regulatory T cells (Tregs) were evaluated using flow cytometry. Mucin 5AC (MUC5AC), MUC5B, myeloperoxidase (MPO), interferon (IFN)-γ, and interleukin (IL)-1β and their mRNAs were also examined. After that, we cultured NP tissues in vitro and evaluated the abovementioned inflammatory parameters before and after the administration of budesonide.

RESULTS

Budesonide nasal spray did not improve clinical evaluations including VAS, SNOT-22, and EA scores. Numbers of neutrophils and goblet cells, the score of submucosal gland cells, percentages of CD8+ T cells and Tregs, MUC5AC, MUC5B, MPO, IFN-γ, and IL-1β and their mRNAs were not decreased in NPs after the budesonide treatment. Furthermore, the administration of budesonide into NP cultures also did not reduce their levels in comparison with those before the treatment.

CONCLUSION

These findings demonstrate that budesonide treatment may not alleviate the inflammatory condition in neutrophilic CRSwNP.

Intervention of Orai1 Influences the Response of Nuocytes From Allergic Rhinitis Mice to IL-33

OBJECTIVE

Nuocytes are essential in innate type-2 immunity and contribute to the exacerbation of allergic rhinitis (AR). This study aimed to evaluate the intervention of Orai1 on the response of nuocytes from AR mice to interleukin (IL)-33.

METHODS

We established a murine model of AR. Nuocytes were obtained from the mouse nasal-associated lymphoid tissue. Then, we assessed expressions of Orai1, Ca²⁺ mean fluorescence intensity (MFI) in nuocytes, and their cellular response to mouse recombinant (rm) IL-33. After that, we administered rmlentivirus vectors (lenti) that encoded small hairpin RNA (shRNA) against ORAI1 (lenti-ORAI1) into nuocytes cultures and again evaluated Orai1 and Ca²⁺ MFI in nuocytes and their response to rmIL-33. Finally, we adoptively transferred nuocytes alone or nuocytes transfected by lenti or lenti-ORAI1 to AR models to investigate their roles during allergic inflammation.

RESULTS

We showed that Orai1 and Ca²⁺ MFI were upregulated in AR mice nuocytes. These cells were induced to produce more IL-5 and IL-13 by rmIL-33. However, the intervention of Orai1 by lenti-ORAI1 in nuocytes decreased Orai1 and Ca²⁺ MFI and reduced productions of aforementioned cytokines even after the administration of rmIL-33. Numbers of sneezing, nasal rubbing, and counts of eosinophils were all enhanced after the adoptive transfer of nuocytes. Concentrations of IL-5, IL-13, and IL-33 in the nasal lavage fluid (NLF) of allergic mice were also increased. However, the adoptive transfer of nuocytes transfected by lenti-ORAI1 decreased aforementioned parameters.

CONCLUSION

These findings show that the intervention of Orai1 in nuocytes influences the response of nuocytes to rmIL-33.

Influences of CD8+ Tregs on Peripheral Blood Mononuclear Cells from Allergic Rhinitis Patients

OBJECTIVES

CD8⁺ (or CD4⁺ ) CD25⁺ fork-head box transcription factor (Foxp3)⁺ regulatory T cells (CD8⁺ or CD4⁺ Tregs) all play a significant role in immune homeostasis and tolerance. However, the role of CD8⁺ Tregs in allergic rhinitis (AR) have not been clearly elucidated. The present study was aimed to assess the influence of CD8⁺ Tregs on peripheral blood mononuclear cells (PBMCs) from AR patients.

STUDY DESIGN

Prospective cross-sectional study.

METHODS

Patients with AR were enrolled. PBMCs were obtained, and CD4⁺ and CD8⁺ Tregs were separated from PBMCs and cultured in vitro. We examined percentages of these Tregs in total CD4⁺ or CD8⁺ T cells, respectively. After that, we evaluated levels of interleukin (IL)-10 and transforming growth factor (TGF)-β in Tregs cultures. Finally, we administered CD4⁺ and CD8⁺ Tregs from AR patients into PBMCs cultures and examined contents of IL-4 and IL-5.

RESULTS

The percentages of CD4⁺ or CD8⁺ Tregs in the total CD4⁺ or CD8⁺ T cells from PBMCs in AR patients were reduced compared to normal subjects. However, IL-10 and TGF-β and their mRNAs were increased in CD4⁺ and CD8⁺ Tregs cultures from AR patients, and there were no significant differences in their levels between these two Tregs cultures. IL-4 and IL-5 were increased in AR subjects' PBMCs compared to normal ones and decreased after the AR CD4⁺ or CD8⁺ Tregs administration. However, there were no statistical differences in IL-4 and IL-5 concentrations between these two Tregs treatments.

CONCLUSIONS

The findings demonstrate that CD8⁺ Tregs may alleviate inflammatory responses in AR condition.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:E316-E323, 2021.

CD8+ Tregs ameliorate inflammatory reactions in a murine model of allergic rhinitis

BACKGROUND

CD8⁺CD25⁺fork-head box transcription factor (Foxp3)⁺ regulatory T cells (CD8⁺ Tregs) play a role in immune tolerance. However, the role of these cells in allergic rhinitis (AR) has not been elucidated. The study aimed to evaluate influences of CD8⁺ Tregs on inflammatory conditions in a murine model of AR.

METHODS

A murine model of AR was established. CD8⁺ Tregs were isolated from mice nasal mucosa and cultured in vitro. We examined interleukin (IL)-10 and transforming growth factor (TGF)-β in cell cultures. Then, we administered CD8⁺ Tregs into mice nasal mucosal cultures, and examined eosinophil cation protein (ECP), IL-4, IL-5 and IL-13 in these cultures. Finally, we adoptively transferred CD8⁺ Tregs into mice models, and evaluated percentages of CD8⁺ Tregs, numbers of sneezing and nasal rubbing, and counts of eosinophils and contents of ECP, IL-4, IL-5, IL-13, IL-10 and TGF-β in nasal lavage fluid (NLF) in mice.

RESULTS

The percentage of CD8⁺ Tregs from AR mice was reduced. IL-10 and TGF-β were increased in cell cultures from AR mice. ECP, IL-4, IL-5 and IL-13 were decreased after the AR mice CD8⁺ Tregs administration in mucosal cultures. However, their contents were not changed after normal CD8⁺ Tregs treatment. Additionally, the adoptive transfer of AR CD8⁺ Tregs enhanced the percentage of CD8⁺ Tregs and levels of IL-10 and TGF-β in NLF, reduced numbers of sneezing and nasal rubbing, and counts of eosinophils and concentrations of ECP, IL-4, IL-5 and IL-13 in NLF. However, normal CD8⁺ Tregs could not change above parameters.

CONCLUSION

These findings show that CD8⁺ Tregs may inhibit inflammatory responses in the AR condition.

Can Transcutaneous Laryngeal Ultrasonography Systematically Quantify Vocal Fold Movement?-A Feasibility Study

OBJECTIVES

Several studies have assessed adult vocal fold movement using transcutaneous laryngeal ultrasonography (TLUSG) during the perioperative period of thyroidectomy. However, the movement was not objectively quantified. This study aimed to provide a feasible and objective method for assessing vocal fold movement using TLUSG.

STUDY DESIGN

Feasibility study.

METHODS

TLUSG was performed during calm breathing and breath-holding in healthy adult volunteers. The morphology and anatomy of the larynx were observed and measured using an ultrasonic self-contained measurement function. At the end of the calm inspiratory and breath-holding phases, vocal fold angle, vocal fold length, distance from vocal process to the midline, distance from anterior vocal commissure to arytenoid cartilage, distance from false vocal fold to the midline, and distance from the anterior horn of thyroid cartilage to false vocal fold were measured. Data were analyzed using a t test (significance <0.05).

RESULTS

The ultrasonic images were satisfactory in all 40 healthy adult volunteers (age 19-35 years; body mass index 18.55-23.93 kg/m2; 20 men and 20 women). There were no significant differences in all laryngeal parameters between the left and right sides in both phases (P > 0.05). Moreover, all differences in laryngeal parameters between the end of the calm inspiratory phase and the breath-holding phase were statistically significant (P < 0.05), regardless of sex.

CONCLUSION

The relevant positional parameters of the vocal fold, arytenoid cartilage, and false vocal fold and their differences before and after vocal fold movement in healthy adult volunteers can be obtained objectively using TLUSG.

[The Orai1 antibody treatment for a mouse model of allergic rhinitis]

OBJECTIVE

The aim of the study was to investigate whether Orai1 antibody intraperitoneal injection could improve the condition of allergic rhinitis (AR) in mice.

METHODS

Twenty-four BALB/C mice (SPF grade) were classified into 4 groups (AR group, Control group, Experimental group 1 and experimental group 2) according to a random number table. A mouse model of AR was established (Control group was established by phosphate buffered solution), and experimental group 1 and Experimental group 2 were established through intraperitoneal injection of 100 μg and 150 μg Orai1 antibody respectively. The number of sneezing and rubbing and eosinophilia in mice were assessed after different doses of Orai1 antibody intraperitoneal injection were applied. Then Orai1 protein and its mRNA in nasal mucosa, histomine, eosionphil cation protein (ECP), interlukin (IL)-1β, IL-4, IL-5 and IL-6 and their mRNA in nasal lavage fluid (NLF) and nasal mucosa were evaluated using enzyme linked immunosorbent assay (ELISA) and real-time reverse transcription-polymerase chain reaction (real-time RT-PCR). Furthermore, Orai1 protein and its mRNA in Th2 cells in peripheral blood, IL-4 and IL-5 in peripheral serum and their mRNAs in Th2 cells were also examined through ELISA and real-time RT-PCR. The data were analyzed by a statistical software of Graph Pad Prism 5.

RESULTS

There were significant differences in sneezing, nasal rubbing and local invading eosinophils in nasal mucosa after the treatment (t100 μg=7.88, t100 μg=9.92, t100 μg=4.30, respectively; t150 μg=16.43, t150 μg=16.31, t150 μg=9.35, respectively, all P-values<0.01). The Orai1 antibody intervention decreased contents of Orai1 in nasal mucosa, histomine, ECP, IL-1β, IL-4, IL-5 and IL-6. The contents of experimental group 1 were (0.186±0.015) μg/ml, (6.618±0.180) ng/ml, (2.555±0.031) ng/ml, (85.26±2.94) pg/ml, (55.12±1.21) pg/ml, (58.45±2.11) pg/ml and (77.12±2.13) pg/ml, respectively. The contents of experimental group 2 were (0.089±0.003) μg/ml, (4.501±0.310) ng/ml, (1.260±0.017) ng/ml, (48.49±2.12) pg/ml, (33.15±0.87) pg/ml, (38.24±0.95) pg/ml and (51.72±0.81) pg/ml, respectively. The differences were siginificant between group 1, group 2 and AR group(t value was 3.29, 10.44, 9.45, 17.53, 74.53, 87.06, 3.98; 8.54, 13.32, 23.00, 20.89, 80.73, 103.70, 13.34, all P<0.01). However, there were no significant differences in Orai1 protein and its mRNA in peripheral Th2 cells, IL-4 and IL-5 in peripheral serum and their mRNAs in Th2 cells (all P-values>0.05). In addition, the effect of 150 μg Orai1 antibody treatment was better than 100 μg one (all P-values<0.05).

CONCLUSION

Orai1 antibody intraperitoneal injection can improve the symptoms of AR mice, and alleviate the condition of allergic inflammation. Orai1 may become a novel aim in the AR study.

Age-related morphological change in bony segment and cartilage segment of Eustachian tube

Background

Eustachian tube dysfunction (ETD) is the predominant cause of otitis media with effusion in children and adults. Balloon dilatation of the Eustachian tube (BDET) provides a new method for restoring the ventilatory function of Eustachian tube (ET). However, the differences in age-related morphological changes in the dimensions and positions of ET in children and adults are unclear.

Purpose

This study aimed to examine age-related morphological changes in bony and cartilage segments of the ET in a three-dimensional space in normal population.

Methods

A total of 71 randomly selected computed tomography (CT) images of the temporal bones of 46 people were retrospectively studied in four age groups: A (0-3 years old); B (4-8 years old), C (9-18 years old), and D (19-65 years old). Space analytic geometry was assessed to calculate the dimensions and positions of ET.

Results

The bony segment of ET lengthened from infancy to adulthood with age in groups A, B and C (r = 0.562**/0.000). The cartilage segment of ET mostly extended with age from infancy to 8 years old in children (r = 0.633**/0.000), but with bending close to the sagittal plane and away from the horizontal plane with age in groups A, B and C (P < .05), and with a constant angle to the coronal plane among the four groups (P > .05).

Conclusion

The bony and cartilaginous segments of ET exhibit distinct morphological changes in space with age. The bony segment of ET extends in a constant position from infancy to adulthood. In contrast, the cartilaginous segment of the ET indicates multidimensional positional changes until adulthood, in addition to the elongation from infancy to children. This may provide an accurate morphological basis for comparing the differences in ETD pathogenesis and surgical treatment between children and adults.

Activations of group 2 innate lymphoid cells depend on endotypes of chronic rhinosinusitis

OBJECTIVE

Chronic rhinosinusitis (CRS) is a complicated disease with several variants caused by different cellular and molecular mechanisms. The characterization of this heterogeneity supports the definition that the disease consists of many endotypes, such as eosinophilic and neutrophilic CRS, and so on. This study aimed to explore group 2 innate lymphoid cells (ILC2s) in neutrophilic CRS without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP), and evaluate ILC2s across characteristics of the disease.

METHODS

Nasal biopsy samples were obtained from normal subjects or subjects with CRSsNP or CRSwNP during surgery. ILC2s were sorted and purified as CD45⁺Lin^-CD127⁺CD4^-CD8^-CRTH2⁺CD161⁺ cells through flow cytometry, and were compared among three groups of subjects. Then, these samples were cultured in vitro, and inflammatory factors were assessed in tissue cultures. After that, human recombinant (rm) interleukin (IL)-33 or IL-17 were administered into the cultures, and we again examined relevant inflammatory substances.

RESULTS

ILC2s were upregulated in neutrophilic CRSsNP and CRSwNP patients, and there were no statistical differences between them. Eosinophil cation protein (ECP), myeloperoxidase (MPO), IL-25, IL-33, IL-5, IL-13, interferon (IFN)-γ and IL-17 were increased in the cultures, however, only concentrations of MPO, IFN-γ and IL-17 were enhanced in CRSwNP tissues compared to CRSsNP ones. After administration of rmIL-33, ECP, IL-5 and IL-13 were all increased in tissues from CRSsNP and CRSwNP patients, however, there were no significant differences between them. Finally, we evaluated concentrations of several above inflammatory factors after the treatment of rmIL-17, and found that MPO and IFN-γ were enhanced in these two phenotypes of patients, and were elevated significantly in CRSwNP tissue cultures.

CONCLUSION

These findings show that ILC2s might be inactivated in neutrophilic CRSsNP and CRSwNP based on this pilot study.

Current and Emerging Treatment Options in Sinus and Nasal Diseases: A Promising Future in the Appropriate Therapies

Chronic rhinosinusitis (CRS) is an inflammatory condition of the nose and paranasal sinuses defined by clinical symptoms, including two or more symptoms, one of which should be either nasal blockage or nasal discharge with or without facial pain/pressure or reduction in/loss of sense of smell [...].

[Treatment of allergic rhinitis with normal saline nasal irrigation at different temperature]

OBJECTIVE

To investigate the influence of normal saline nasal irrigation with different temperature on allergic rhinitis (AR) and to confirm the appropriate temperature of nasal irrigation.

METHODS

Sixty patients with AR were randomly divided into 3 groups (according to random number table) and received 15 °C, 25 °C or 40 °C normal saline nasal irrigation respectively, and 20 healthy controls received no treatment. Visual analogue scale ( VAS) was used to assess the symptoms among the control group and the various intervention groups and the enzyme linked immunosorbent assay (ELISA) was applied to detect the contents of histamine, leukotriene C4 (LTC4), house dust mite D1 specific IGE (sIGE) and eosinophil cationic protein (ECP) among the control group and the various intervention groups. GraphPad Prism 5 software was used to analyze the data.

RESULTS

There was no statistical difference between 15 °C normal saline nasal irrigation group and 25 °C normal saline nasal irrigation group. Pre-intervention and post intervention whether is VAS scores of rhinorrhea, sneezing, nasal obstruction and nasal pruritis or in contents of histamine, LTC4, sIgE and ECP showed no difference (all P > 0.05). However, the symptoms of (sneezing VAS score: 3.765 ± 0.291; nasal obstruction VAS score: 3.529 ± 0.365). The difference was significant (t = 4.678, P < 0.001; t = 3.901, P < 0.01). The contents of histamine [ (21.78 ± 0.62) ng/ml] and LTC4 (17.43 ± 0.67 ng/ml) were also decreased after intervention of 40 °C normal saline nasal irrigation [ histamine content: (18.82 ± 0.52) ng/ml; LTC4 content: (13.14 ± 0.59) ng/ml ]. The difference was significant (t = 3.632, P < 0.01; t = 4.79, P < 0.001). Nonetheless, there were no statistical differences in VAS scores of rhinorrhea (t = 2.02, P = 0.051) and nasal pruritis (t = 1.984, P =0.056) and in contents of sIgE (t = 1.891, P = 0.066) and ECP (t = 2.021, P = 0.05). There were statistical differences between the 40 °C group and the 25 °C group normal saline nasal irrigation group in symptoms of sneezing (t = 2.060, P = 0.048) and nasal obstruction (t = 2.1053, P = 0.048). and inflammatory factors of histamine (t = 2.078, P = 0.045) and LTC4 (t = 2.149, P = 0.038). In symptoms of rhinorrhea and nasal pruritis and local production of sIgE and ECP, there was no statistical difference (all P > 0.05).

CONCLUSION

40 °C normal saline nasal irrigation can improve the symptoms of sneezing and nasal obstruction and can alleviate the local levels of inflammatory factors like histamine and LTC4 in AR patients, and is the appropriate irrigation temperature.

Allergic inflammation is exacerbated by allergen-induced type 2 innate lymphoid cells in a murine model of allergic rhinitis

BACKGROUND

Group 2 innate lymphoid cells (ILC2s) represent a new innate effector leukocyte population that mediates type-2 immune response. However, the contribution of ILC2s to allergic rhinitis (AR) is currently not well defined.

OBJECTIVE

To evaluate the potential existence and function of allergen-induced ILC2s in the experimental AR.

METHODS

We established a murine model of AR using ovalbumin (OVA) and aluminium hydroxide. The OVA-induced ILC2s were sorted and purified from the mouse nasal-associated lymphoid tissue (NALT). Then, we assessed ILC2s responses to mouse recombinant interleukin (rmIL)-25, anti-IL17RB antibody and CC chemokine ligand (CCL) 25 in the culture. After that, we adoptively transferred the NALT-derived ILC2s alone or plus rmIL-25 or anti-IL17RB antibody to the murine model of AR to investigate their role in the nasal allergic inflammation.

RESULTS

We showed that ILC2s could be induced by OVA in the NALT of AR model. They were induced to secrete IL-5 and IL-13 by rmIL-25, and blocking of IL17RB contributed to the decreased production of these cytokines in the culture. We found that CCL25 induced the NALT-derived ILC2s migration through CC chemokine receptor 9 on ILC2s in vitro. Numbers of sneezing and nasal rubbing as well as counts of invasive eosinophils were all enhanced after the adoptive transfer of cultured ILC2s in vitro. The expressions of IL-5, IL-13, IL-25 and CCL25 in the NLF of allergic mice were also increased.

CONCLUSION

These findings show that ILC2s play a proinflammatory role in the murine AR model, and also highlight ILC2s as a new target in the future AR therapy.