[Detection of the G551D mutation in a patient with nasal polyps]

Atypical forms of cystic fibrosis can be manifested by a mild affection of the airways in adult age. They are the phenotypic manifestation of less frequent mutations for CF. The authors present the case-history of a man who developed the first symptoms of respiratory disease at the age of 16 years. He had relapsing nasal polyps, sinusitis, bronchial asthma, intolerance of acetylsalicylic acid. Bacteriological examination revealed repeatedly Pseudomonas aeruginosa on the respiratory mucosal membranes. The levels of the chloride ion in sweat were normal, genetic examination revealed a mutation of the gene for cystic fibrosis, G 551 D.

Interleukin-8 gene expression in chronic sinusitis

PURPOSE

Interleukin-8 (IL-8), a monocyte-derived and macrophage-derived cytokine, displays potent chemotactic activating properties toward neutrophils and thus may contribute to the pathogenesis of chronic sinusitis. The object of this investigation was to show the expression of the IL-8 gene in chronic sinusitis by Northern blot analysis and a reverse transcription-polymerase chain reaction (RT-PCR).

MATERIALS AND METHODS

For Northern blot analysis, RNAs were extracted from maxillary mucosa and nasal polyps from two patients with chronic sinusitis, respectively, and from the inferior turbinate of a nasal allergy patient. For RT-PCR, RNAs were extracted from 11 patients with chronic sinusitis, 8 patients with allergic rhinitis, and 4 patients with hypertrophic rhinitis.

RESULTS

Whereas IL-8 mRNA was expressed in the maxillary mucosa, IL-8 transcript was not detected in the inferior turbinate by Northern blot analysis. IL-8 transcripts were detected in 45% of chronic sinusitis RNAs (5/11) and in 50% of allergic rhinitis RNAs (5/10) by RT-PCR.

CONCLUSION

These data suggest IL-8 may contribute to neutrophil involvement in chronic sinusitis.

Phenotypes of alpha-1-antitrypsin in intrinsic asthma and ASA-triad patients

The frequency of presence of various phenotypes of alpha 1-antitrypsin was studied in 31 patients with intrinsic asthma and 11 with ASA-Triad, and compared to a group of 200 people representative of the general population. The MZ and SZ phenotype is more frequent in intrinsic asthmatics (p < 0.00001) and MZ in ASA-Triad (p < 0.0005) than in the control group. No differences were found between the intrinsic asthmatics and ASA-Triad. All the patients were divided into groups according to their clinical characteristics and an increase of the MZ phenotype was observed (p < 0.001) in patients with: nasal polyposis, intolerance to non-steroidal anti-inflammatories, a family history of atopy and peripheral eosinophilia (p < 0.01). Alpha-1-antitrypsin deficiency could be important in the pathogenesis of inflammatory processes and in the clinical manifestations characteristic of patients with intrinsic asthma and ASA-Triad.

Numerical chromosome changes in a nasal polyp

The etiology of nasal polyposis is not fully understood. We found numerical chromosome changes in one out of five cytogenetically investigated nasal polyps. The histological picture of this case was characterized by the presence of histiocyte-like cells, which were absent in the remaining cytogenetically normal polyps.

Chronic hyperplastic sinusitis: association of tissue eosinophilia with mRNA expression of granulocyte-macrophage colony-stimulating factor and interleukin-3

BACKGROUND

We investigated the association among tissue eosinophilia, cellular infiltration, and cytokine mRNA expression in chronic hyperplastic sinusitis (CHS).

METHODS

Percutaneous biopsies of the maxillary sinuses and nasal polyps were performed in 12 adult patients (six men and six women) of whom seven were nonallergic and 11 were asthmatic. Tissues were compared with biopsy specimens from the inferior and middle turbinates of normal control subjects.

RESULTS

Histologically, an eosinophil-predominant inflammatory infiltrate was seen in 10 of 12 patients, whereas a mild to moderate neutrophilic infiltrate was seen in 4 of 12 patients. As determined by immunocytochemistry, diseased tissues and normal control tissues differed significantly in terms of the number of activated (EG2+) eosinophils (p = 0.005) but not in terms of CD3+ or CD4+ T lymphocytes, elastase-positive neutrophils or CD68+ macrophages. The number of eosinophils did not correlate with that of any other cell type. By in situ hybridization, CHS tissues showed significantly higher numbers of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin (IL)-3 mRNA-positive cells than normal control tissues (p = 0.002 and 0.0005, respectively) per high-powered field. There was a significant correlation between the number of infiltrating EG2+ eosinophils and cells that expressed mRNA for GM-CSF (r = 0.60, p = 0.041) or IL-3 (r = 0.69, p = 0.013). Furthermore, epithelial cells did not show detectable mRNA expression for GM-CSF or IL-3. No significant correlation was found between IL-5 mRNA expression and infiltrating EG2+ eosinophils in diseased tissues. However, the IL-5 density was significantly higher in the five patients with CHS who had positive allergy skin test results than in the seven patients with negative skin test results (p = 0.017) or in normal control subjects.

CONCLUSIONS

Our data support a role for GM-CSF and IL-3 in the eosinophilia characteristic of CHS and show that IL-5 mRNA expression is not a prominent feature of nonallergic inflammation. The cellular sources of GM-CSF and IL-3 in CHS remain to be definitely determined.

Analysis of CFTR transcripts in nasal epithelial cells and lymphoblasts of a cystic fibrosis patient with 621 + 1G-->T and 711 + 1G-->T mutations

We have analyzed the CFTR mRNA populations in a cystic fibrosis patient heterozygous for the 621 + 1G-->T and 711 + 1G-->T mutations. Total RNA isolated from the nasal epithelial cells and Epstein-Barr virus-transformed lymphoblasts derived from this patient was reversely transcribed and a region extending from exon 3 to exon 7 of the gene was amplified by the polymerase chain reaction and analyzed. Three abnormal products were identified, suggesting the presence of three aberrant transcripts, and their profiles were identical in both cell types. Two of the products were found to be missing either exon 4 or exon 5 as anticipated from the transcripts from the 621 + 1G-->T or 711 + 1G-->T alleles, respectively. The third product was apparently derived from an alternatively spliced mRNA species in the absence of the nominal splice site (in 621 + 1G-->T) through the use of a cryptic splice donor sequence (TT528/GTGAGG) within exon 4. Although reading frames appeared to be preserved in all three putative transcripts, significant portions of the presumed first and second transmembrane spans as well as the immediately following cytoplasmic domain would be deleted from the mutant CFTR polypeptides, if made. These observations are consistent with a loss of CFTR function in this cystic fibrosis patient.

Nasal polyps in identical twins

Nasal polyps are multifactorial in aetiology but are associated with respiratory diseases, particularly late onset asthma. Several members of a family may be affected with nasal polyps but there is little evidence for a genetic basis for this. Some evidence to support a genetic predisposition comes from the development of polyps in identical twins.

Nasal polyposis: in search of a viral etiology using DNA hybridization

The etiology of nasal polyps is unknown. Numerous theories have been proposed, with allergic and infectious causes predominant. A viral theory was postulated almost 40 years ago. In a pilot project, we studied 15 subjects comprising six controls and nine patients with nasal polyps. No known viruses were cultured from the nasal polyp tissue or nasal mucosal biopsies from the control subjects. DNA Hybridization for Epstein-Barr Virus, Herpes simplex virus, adenovirus type V, and Chlamydia trachomatis were also negative for all tissue studied. The use of molecular biological techniques is not widespread in otolaryngology and this is the first report, to the best of our knowledge, of the application of these techniques for the investigation of the viral etiology of nasal polyps.

Granulocyte/macrophage colony-stimulating factor (GM-CSF) gene expression by eosinophils in nasal polyposis

Nasal polyposis is a chronic inflammatory condition of the upper airways characterized by infiltration of activated inflammatory cells, particularly eosinophils. Granulocyte/macrophage colony-stimulating factor (GM-CSF) is a cytokine with powerful biologic effects including the regulation of survival, proliferation, and activation of granulocytes as well as differentiation of hemopoietic cells. To examine the potential role of GM-CSF in the pathogenesis of this condition, we investigated gene expression and production of GM-CSF in nasal polyp tissues as well as in the normal nasal mucosa. Immunoreactive GM-CSF was detected by enzyme-linked immunosorbent assay in the 24-h supernatant of nasal polyp tissues placed in culture. By Northern blot analysis and Southern blot analysis following a reverse-transcription polymerase chain reaction using a human GM-CSF cDNA probe, we detected GM-CSF mRNA in nasal polyp tissues, as well as in the tissue from a patient with allergic rhinitis, but not in the normal nasal mucosa. By in situ hybridization using the same probe, cells expressing mRNA specific for GM-CSF were observed in nasal polyp tissues and in the allergic nasal mucosa. In addition, by the combination of in situ hybridization and counterstaining with chromotrope 2R, we demonstrated that approximately 30% of eosinophils infiltrating the polyp tissue express the GM-CSF gene. These results suggest a novel mechanism by which eosinophils may contribute to the pathogenesis of chronic inflammatory diseases such as nasal polyposis, allergic rhinitis, and, by implication, asthma.

[Alpha 1-antitrypsin phenotypes in healthy persons and patients with polypous rhinosinusitis]

The prevalence of various phenotypes of alpha 1-antitrypsin (alpha 1-AT) in the population was investigated and their contribution to the emergence of polypous rhinosinusitis was ascertained. We examined 1738 residents of the Kalinin district, aged 16 to 82 years, 1390 of which were essentially healthy people and 348 of which were patients with polypous rhinosinusitis. We found that among both groups the carriers of normal phenotype MM were in predominance: 96.34% and 94.5%, respectively. We detected infrequent occurrence of heterozygotic phenotypes in the two groups. We demonstrated that, as compared to the healthy population, phenotype MZ occurred more frequently among patients--heterozygotic carriers of alpha 1-AT deficiency gene: 3.16% versus 0.79%, respectively. Thus the risk of polypous rhinosinusitis in them was 4 times higher. We measured alpha 1-AT activity in healthy and affected people--carriers of the normal gene M (PIMM) and found a normal inhibitor concentration (2.2 +/- 0.1 g/l soybean inhibitor) while heterozygotic carriers of alpha 1-AT deficiency showed a moderate decline of the inhibitor concentration: 50% to 82% of the norm. These observations can be used in medicogenetic consultation, professional selection and individual therapy choice.

Two unrelated clonal chromosome rearrangements in a nasal papilloma

We have cytogenetically examined short-term cultures from a nasal papilloma, a tumor type in which chromosome aberrations have hitherto not been reported. Two pseudodiploid clones were detected, giving the tumor karyotype 46,XY,t(1;3)(p31;p12)/46,XY,t(11;?)(q25;?).

The nasal polyps as a tool for basic research in cystic fibrosis

Total RNA and mRNA were prepared from cystic fibrosis (CF) and control nasal polyps and nasal epithelial cells. Genomic clones from the chromosomal region of the CF locus were screened by northern blots. A representative cDNA library from nasal polyps was cloned in the vector lambda gt10. For the construction of a physical genomic map around the CF locus single gene markers were isolated from metaphase 1:7q2qter chromosomes by laser micro-dissection and subsequent microcloning. A linkage study with the polymorphic markers met-H, met-D, and pJ3.11 was performed in 53 German CF families with at least 2 children. No significant correlation of any haplotype on the CF chromosomes with the clinical severity of the course of the disease could be observed, which provides evidence that cystic fibrosis is genetically homogeneous.

[Recurrent deforming juvenile nasosinusal polyposis and latent mucoviscidosis]

Three children from a family of eight, had a cystic fibrosis diagnosed by Sweat test. Two of these had a nasal polyposis wigh widening of the nose, ethmoid and intercanthal distance. Every cases of this rare type of nasal polyposis in children observed since 1953 (Sweat test) and related in the litterature, had cystic fibrosis. It is concluded that cystic fibrosis may be the one only, cause of nasal polyposis with widening of the nose.