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Massa HM, Spann KM, Cripps AW. Innate Immunity in the Middle Ear Mucosa. Front Cell Infect Microbiol 2021; 11:764772. [PMID: 34778109 PMCID: PMC8586084 DOI: 10.3389/fcimb.2021.764772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/11/2021] [Indexed: 01/14/2023] Open
Abstract
Otitis media (OM) encompasses a spectrum of clinical presentations ranging from the readily identifiable Acute OM (AOM), which is characterised by otalgia and fever, to chronic otitis media with effusion (COME) where impaired hearing due to middle ear effusion may be the only clinical symptom. Chronic suppurative OM (CSOM) presents as a more severe form of OM, involving perforation of the tympanic membrane. The pathogenesis of OM in these varied clinical presentations is unclear but activation of the innate inflammatory responses to viral and/or bacterial infection of the upper respiratory tract performs an integral role. This localised inflammatory response can persist even after pathogens are cleared from the middle ear, eustachian tubes and, in the case of respiratory viruses, even the nasal compartment. Children prone to OM may experience an over exuberant inflammatory response that underlies the development of chronic forms of OM and their sequelae, including hearing impairment. Treatments for chronic effusive forms of OM are limited, with current therapeutic guidelines recommending a "watch and wait" strategy rather than active treatment with antibiotics, corticosteroids or other anti-inflammatory drugs. Overall, there is a clear need for more targeted and effective treatments that either prevent or reduce the hyper-inflammatory response associated with chronic forms of OM. Improved treatment options rely upon an in-depth understanding of OM pathogenesis, particularly the role of the host innate immune response during acute OM. In this paper, we review the current literature regarding the innate immune response within the middle ear to bacterial and viral otopathogens alone, and as co-infections. This is an important consideration, as the role of respiratory viruses as primary pathogens in OM is not yet fully understood. Furthermore, increased reporting from PCR-based diagnostics, indicates that viral/bacterial co-infections in the middle ear are more common than bacterial infections alone. Increasingly, the mechanisms by which viral/bacterial co-infections may drive or maintain complex innate immune responses and inflammation during OM as a chronic response require investigation. Improved understanding of the pathogenesis of chronic OM, including host innate immune response within the middle ear is vital for development of improved diagnostic and treatment options for our children.
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Affiliation(s)
- Helen M Massa
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Kirsten M Spann
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Allan W Cripps
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast, QLD, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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Živković M, Kolić I, Jesić S, Jotić A, Stanković A. The Allele 2 of the VNTR Polymorphism in the Gene That Encodes a Natural Inhibitor of IL-1β, IL-1RA Is Favorably Associated With Chronic Otitis Media. Clin Exp Otorhinolaryngol 2018; 11:118-123. [PMID: 29433161 PMCID: PMC5951068 DOI: 10.21053/ceo.2017.01060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives Chronic otitis media (COM) is followed by irreversible tissue damage and destruction of the middle ear structures, with the possibility of complications under the maintenance of inflammation. Inflammatory mediators such as cytokines play a crucial role in the initial stage of inflammation. The aim of this study was to evaluate the association of the polymorphisms in two innate immunity/inflammation cascade genes from interleukin-1 (IL-1) gene cluster with COM with regard to cholesteatoma. Methods In the cross-sectional case-control study, DNA samples were collected from 189 patients with COM and 119 controls from a population of Serbia. The +3953 C/T (rs1143634), TaqI polymorphism in interleukin-1 beta (IL-1β) gene and 86 bp variable number tandem repeat (VNTR, rs2234663) polymorphism in the IL-1 receptor antagonist (IL-1RA) gene were analyzed by polymerase chain reaction. Results The IL-1β TaqI polymorphism was not significantly different in patients compared with the control group. The significant difference between patients and controls was observed for both, genotype and allele frequencies of IL-1RA VNTR polymorphism (chi-square P<0.01). We found that carriers of IL-1RA allele 2 (odds ratio, 0.47; 95% confidence interval, 0.29 to 0.76; P=0.004) have a favorable association with COM, using multivariate logistic analysis that included both polymorphisms, age and sex. The IL-1RA allele frequency distribution was significantly different with regard to cholesteatoma. Conclusion The carriers of allele 2 of VNTR IL-1RA polymorphism had a decreased odds ratio for COM, which is in agreement with findings in other inflammatory disease and its previous association with higher IL-1RA levels. Possible down-regulation of IL-1 mediated proinflammatory signaling pathways via IL-1RA in COM as well as results of our study should be further investigated and replicated.
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Affiliation(s)
- Maja Živković
- Vinca Institute of Nuclear Sciences, Laboratory for Radiobiology and Molecular Genetics, University of Belgrade, Belgrade, Serbia
| | - Ivana Kolić
- Vinca Institute of Nuclear Sciences, Laboratory for Radiobiology and Molecular Genetics, University of Belgrade, Belgrade, Serbia
| | - Snežana Jesić
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ana Jotić
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Aleksandra Stanković
- Vinca Institute of Nuclear Sciences, Laboratory for Radiobiology and Molecular Genetics, University of Belgrade, Belgrade, Serbia
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Acute Otitis Media and Acute Coalescent Mastoiditis. MIDDLE EAR DISEASES 2018. [PMCID: PMC7122426 DOI: 10.1007/978-3-319-72962-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute otitis media is a frequent manifestation of otitis media, mainly during the early childhood. The multifactorial pathogenesis and risk factors are exposed along with its most microbiological agents. The clinical manifestations and their differential diagnoses are presented. General concepts and different actual guidelines of the treatment are described, also the efficient preventive measures are proposed. The second main issue of this chapter is to deal with the complications of acute otitis media, especially the acute coalescent mastoiditis, that is the most common suppurative complication of AOM. The pathogenesis of coalescent acute mastoiditis, its epidemiology, risk factors and the microbiological agents are presented. The clinical features and differential diagnosis are described, as the specific imaging findings. Complications of acute coalescent mastoiditis are typically the subperiosteal abscess, due to the cortical bony necrosis of the mastoid and its septa, or the intracranial spread of the infection (meningitis, intracranial abscesses and venous sinus thrombosis). The general concept of management is exposed, with emphasis on the antimicrobial treatment and the different surgical options.
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Gestro M, Condemi V, Bardi L, Fantino C, Solimene U. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1749-1764. [PMID: 28466414 DOI: 10.1007/s00484-017-1356-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
AbstractOtitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0-18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose-response models (DLNM-final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0-3, CI 1.11-1.88 (lag time 0-1 days) and RR 1.43, CI 1.05-1.94 (lag time 0-3 days). The hourly model confirms a specific dose-response effect for T with RR 1.20, CI 1.04-1.38 (lag time range from 0 to 11 to 0-15 h) and for NO2 with RR 1.03, CI 1.01-1.05 (lag time range from 0 to 8 to 0-15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.
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Affiliation(s)
- Massimo Gestro
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
| | - Vincenzo Condemi
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy.
| | - Luisella Bardi
- Cuneo Department, Environmental Protection Agency of Piedmont, Turin, Italy
| | - Claudio Fantino
- S. Croce and Carle Hospital of Cuneo, SOC ORL Unit, Cuneo, Italy
| | - Umberto Solimene
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
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Preciado D, Granath A, Lin J, Val S, Kurabi A, Johnston N, Vijayasekaran S, Valdez T, Depireux D, Hermansson A. Panel 8: Report on Recent Advances in Molecular and Cellular Biochemistry. Otolaryngol Head Neck Surg 2017; 156:S106-S113. [PMID: 28372528 DOI: 10.1177/0194599816658290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To update the medical literature on recent cellular and molecular advances in otitis media disease models with a principal focus on developments in the past 5 years. We also aim to explain recent translational advances in cellular and molecular biology that have influenced our understanding and management of otitis media. Data Sources PubMed-indexed peer-reviewed articles. Review Methods A comprehensive review of the literature was conducted with the term otitis media and the following search terms: molecular biology, cell biology, innate immunity, oxidative stress, mucins, molecular diagnostics. Included articles were published in the English language from January 1, 2010, to July 31, 2015. Implications for Practice The molecular understanding of otitis media disease progression has rapidly advanced over the last 5 years. The roles of inflammation, mucins, and cell signaling mechanisms have been elucidated and defined. Advances in the field provide a plethora of opportunities for innovative molecular targeting in the development of novel therapeutic strategies for otitis media.
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Affiliation(s)
- Diego Preciado
- 1 Shiekh Zayed Institute for Pediatric Surgical Innovation, Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Anna Granath
- 2 Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Jizhen Lin
- 3 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stéphanie Val
- 1 Shiekh Zayed Institute for Pediatric Surgical Innovation, Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA
| | - Arwa Kurabi
- 4 Division of Otolaryngology, Department of Surgery, University of California, San Diego, California, USA
| | - Nikki Johnston
- 5 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shyan Vijayasekaran
- 6 Department of Surgery, Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Tulio Valdez
- 7 Division of Pediatric Otolaryngology, Connecticut Children's Hospital, Hartford, Connecticut, USA
| | - Didier Depireux
- 8 Institute for Systems Research, University of Maryland, College Park, Maryland, USA
| | - Ann Hermansson
- 9 Departments of Otolaryngology, Oral and Maxillofacial Surgery, and Pediatrics, Lund University, Lund, Sweden
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Miljanović O, Cikota-Aleksić B, Likić D, Vojvodić D, Jovićević O, Magić Z. Association of cytokine gene polymorphisms and risk factors with otitis media proneness in children. Eur J Pediatr 2016; 175:809-15. [PMID: 26957492 DOI: 10.1007/s00431-016-2711-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED In order to assess the association between gene polymorphisms and otitis media (OM) proneness, tumor necrosis factor alpha (TNFA) -308, interleukin (IL) 10-1082 and -3575, IL6 -597, IL2 -330, and CD14 -159 genotyping was performed in 58 OM-prone children and 85 controls who were exposed to similar number and frequency of environmental and host risk factors. The frequencies of genotypes (wild type vs. genotypes containing at least one polymorphic allele) were not significantly different between groups, except for IL10 -1082. Polymorphic genotypes IL10 -1082 GA and GG were more frequent in OM-prone children than in control group (RR 1.145, 95 % CI 1.011-1.298; p = 0.047). However, logistic regression did not confirm IL10 -1082 polymorphic genotypes as an independent risk factor for OM proneness. CONCLUSION The present study indicates that high-producing IL10 -1082 GA/GG genotypes may increase the risk for OM proneness in its carriers when exposed to other environmental/host risk factors (day care attendance, passive smoking, male sex, respiratory infections, and atopic manifestations). This study revealed no significant independent genetic association, but the lack of breastfeeding in infancy was found to be the only independent risk factor for development of OM-prone phenotype, implying that breastfeeding had a protective role in development of susceptibility to OM. WHAT IS KNOWN • The pathogenesis of OM is of multifactorial nature, dependent on infection, environmental factors, and immune response of the child. • Cytokines and CD14 play an important role in the presentation and clinical course of otitis media, but a clear link with otitis media proneness was not established. What is new: • This is the first clinical and genetic study on Montenegrin children with the otitis media-prone phenotype. • The study revealed that high-producing IL10 -1082 genotypes may influence otitis media proneness in children exposed to other environmental/host risk factors.
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Affiliation(s)
- Olivera Miljanović
- Center for medical genetic and immunology, Clinical Center of Montenegro, Str. Ljubljanska BB, 81 000, Podgorica, Montenegro. .,Clinical Center of Montenegro, Medical Faculty, University of Montenegro, Podgorica, Montenegro.
| | | | - Dragan Likić
- Department for Anesthesiology, Department for Otorhinolaryngology, Clinical Center of Montenegro, Institute for Children Diseases, Podgorica, Montenegro
| | - Danilo Vojvodić
- Military Medical Academy, Institute of Medical Research, Belgrade, Serbia
| | - Ognjen Jovićević
- Department for Anesthesiology, Department for Otorhinolaryngology, Clinical Center of Montenegro, Institute for Children Diseases, Podgorica, Montenegro
| | - Zvonko Magić
- Military Medical Academy, Institute of Medical Research, Belgrade, Serbia
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Ovnat Tamir S, Roth Y, Goldfarb A, Grotto I, Marom T. Severity of pneumococcal versus non-pneumococcal acute otitis media in children. Clin Otolaryngol 2016; 40:370-7. [PMID: 25644105 DOI: 10.1111/coa.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumococcal acute otitis media (AOM) has been previously considered as a more severe disease than that caused by other otopathogens, based on clinical and/or otologic scores. We sought to test this hypothesis in the pneumococcal conjugated vaccine (PCV) era. METHODS Children <6 years who presented with 'severe' AOM episodes with middle ear fluid (MEF) cultures during 2008-2013 were retrospectively identified. 'Severe' AOM episodes were considered if tympanocentesis was required or if spontaneous otorrhea was present. Data were extracted for demographics, clinical and laboratory tests. Children were categorised according to their PCV status as 'unimmunised' or 'PCV7/PCV13 immunised' and according to their MEF culture results into the 'pneumococcal' or the 'non-pneumococcal' group. Leukocytosis was defined as white blood cells (WBC) count >15 000/μL, and elevated C-reactive protein (CRP) level was considered as >50 mg/L. RESULTS Of 295 eligible AOM episodes, 106 (36%) were culture positive. Children in the pneumococcal group (65, 61%) had a significantly higher WBC counts and higher CRP levels, were more often <2 years old and were more prone to complicate with acute mastoiditis (AM), compared to children in the non-pneumococcal group, P = 0.03, P = 0.02, P = 0.04 and P = 0.03, respectively. In the pneumococcal group, unimmunised children had higher WBC counts when compared with PCV13-immunised children (P = 0.04), but there were no appreciable differences in CRP levels between unimmunised and PCV7/PCV13-immunised children. CONCLUSION Pneumococcal AOM is associated with higher leukocytosis and CRP levels than non-pneumococcal AOM. Circulating Streptococcus pneumoniae strains causing 'severe' AOM in PCV13-immunised children yielded lower inflammatory responses when compared with unimmunised children.
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Affiliation(s)
- S Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - Y Roth
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - A Goldfarb
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - I Grotto
- Public Health Services, Israel Ministry of Health, Jerusalem, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - T Marom
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
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McCormick DP, Jennings K, Ede LC, Alvarez-Fernandez P, Patel J, Chonmaitree T. Use of symptoms and risk factors to predict acute otitis media in infants. Int J Pediatr Otorhinolaryngol 2016; 81:55-9. [PMID: 26810291 PMCID: PMC4730910 DOI: 10.1016/j.ijporl.2015.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Infants and children with upper respiratory tract infection (URI) often have concurrent acute otitis media (AOM). Young infants have fewer specific symptoms than older children. The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants. METHODS Healthy infants, age less than four weeks, were enrolled and followed prospectively for up to age one year. Infants were scheduled for a research visit when their parents noted the onset of symptoms. At each URI visit, parents first reported the severity of symptoms. An investigator then diagnosed the presence or absence of concurrent AOM. Risk factors and symptom scores for infants with and without AOM were studied. RESULTS Infants (N=193, mean age at first URI 3.9±2.5 months) experienced 360 URI episodes and 63 AOM events. Symptoms consisting of fever, earache, poor feeding, restless sleep, and irritability together (ETG-5) were statistically associated with the prediction of AOM (P=0.006). A multiple variable statistical model (J-Score) that included day care attendance, age, severity of cough and earache best predicted AOM (P<0.001), with 95% specificity. Both ETG-5 and J-score yielded relatively low sensitivity for AOM prediction. CONCLUSIONS In infants with URI in the first year of life, severity of symptoms was significantly associated with concurrent AOM. Daycare attendance, presence and severity of earache and cough added to better correlation. These observations may have clinical application in identification of infants at risk for AOM.
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Affiliation(s)
- David P. McCormick
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Texas, USA
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, TX, USA.
| | - Linda C. Ede
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Texas, USA
| | | | - Janak Patel
- Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA.
| | - Tasnee Chonmaitree
- Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA; Department of Pathology, University of Texas Medical Branch at Galveston, TX, USA.
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Cutforth T, DeMille MM, Agalliu I, Agalliu D. CNS autoimmune disease after Streptococcus pyogenes infections: animal models, cellular mechanisms and genetic factors. FUTURE NEUROLOGY 2016; 11:63-76. [PMID: 27110222 DOI: 10.2217/fnl.16.4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Streptococcus pyogenes infections have been associated with two autoimmune diseases of the CNS: Sydenham's chorea (SC) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS). Despite the high frequency of pharyngeal streptococcus infections among children, only a small fraction develops SC or PANDAS. This suggests that several factors in combination are necessary to trigger autoimmune complications: specific S. pyogenes strains that induce a strong immune response toward the host nervous system; genetic susceptibility that predispose children toward an autoimmune response involving movement or tic symptoms; and multiple infections of the throat or tonsils that lead to a robust Th17 cellular and humoral immune response when untreated. In this review, we summarize the evidence for each factor and propose that all must be met for the requisite neurovascular pathology and behavioral deficits found in SC/PANDAS.
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Affiliation(s)
- Tyler Cutforth
- Department of Neurology, Columbia University Medical Center, 650 West 168 Street, Room 310E, New York, NY 10032, USA
| | - Mellissa Mc DeMille
- Department of Pediatrics, Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, Suite S208, New Haven, CT 06519, USA
| | - Ilir Agalliu
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Room 1315-B, Bronx, NY 10461, USA
| | - Dritan Agalliu
- Department of Neurology, Columbia University Medical Center, 650 West 168 Street, Room 310E, New York, NY 10032, USA; Departments of Pathology & Cell Biology & Pharmacology, Columbia University Medical Center, 650 West 168 Street, Room 310E, New York, NY 10032, USA
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Esposito S, Marchisio P, Orenti A, Spena S, Bianchini S, Nazzari E, Rosazza C, Zampiero A, Biganzoli E, Principi N. Genetic Polymorphisms of Functional Candidate Genes and Recurrent Acute Otitis Media With or Without Tympanic Membrane Perforation. Medicine (Baltimore) 2015; 94:e1860. [PMID: 26496338 PMCID: PMC4620788 DOI: 10.1097/md.0000000000001860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Evaluation of the genetic contribution to the development of recurrent acute otitis media (rAOM) remains challenging. This study aimed to evaluate the potential association between single nucleotide polymorphisms (SNPs) in selected genes and rAOM and to analyze whether genetic variations might predispose to the development of complicated recurrent cases, such as those with tympanic membrane perforation (TMP).A total of 33 candidate genes and 47 SNPs were genotyped in 200 children with rAOM (116 with a history of TMP) and in 200 healthy controls.INFγ rs 12369470CT was significantly less common in the children with rAOM than in healthy controls (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.25-1, P = 0.04). Although not significant, interleukin (IL)-1β rs 1143627G and toll-like receptor (TLR)-4 rs2737191AG were less frequently detected in the children with rAOM than in controls. The opposite was true for IL-8 rs2227306CT, which was found more frequently in the children with rAOM than in healthy controls. The IL-10 rs1800896TC SNP and the IL-1α rs6746923A and AG SNPs were significantly more and less common, respectively, among children without a history of TMP than among those who suffered from this complication (OR 2.17, 95% CI 1.09-4.41, P = 0.02, and OR 0.42, 95% CI 0.21-0.84, P = 0.01).This study is the first report suggesting an association between variants in genes encoding for factors of innate or adaptive immunity and the occurrence of rAOM with or without TMP, which confirms the role of genetics in conditioning susceptibility to AOM.
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Affiliation(s)
- Susanna Esposito
- From the Pediatric High Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (SE, PM, SS, SB, EN, CR, AZ, NP); and Unit of Medical Statistics, Biometry and Bioinformatics "G.A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AO, EB)
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Mittal R, Robalino G, Gerring R, Chan B, Yan D, Grati M, Liu XZ. Immunity genes and susceptibility to otitis media: a comprehensive review. J Genet Genomics 2014; 41:567-81. [PMID: 25434680 DOI: 10.1016/j.jgg.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 11/15/2022]
Abstract
Otitis media (OM) is a middle ear infection associated with inflammation and pain. This disease frequently afflicts humans and is the major cause of hearing loss worldwide. OM continues to be one of the most challenging diseases in the medical field due to its diverse host targets and wide range of clinical manifestations. Substantial morbidity associated with OM is further exacerbated by high frequency of recurrent infections leading to chronic suppurative otitis media (CSOM). Children have greater susceptibility to, and thus, suffer most frequently from OM, which can cause significant deterioration in quality of life. Genetic factors have been demonstrated, in large part by twin and family studies, to be key determinants of OM susceptibility. In this review, we summarize the current knowledge on immunity genes and selected variants that have been associated with predisposition to OM. In particular, polymorphisms in innate immunity and cytokine genes have been strongly linked with the risk of developing OM. Future studies employing state-of-the-art technologies, including next-generation sequencing (NGS), will aid in the identification of novel genes associated with susceptibility to OM. This, in turn, will open up avenues for identifying high-risk individuals and designing novel therapeutic strategies based on precise targeting of these genes.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Giannina Robalino
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Robert Gerring
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Brandon Chan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Denise Yan
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - M'hamed Grati
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Xue-Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Biochemistry, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Nokso-Koivisto J, Chonmaitree T, Jennings K, Matalon R, Block S, Patel JA. Polymorphisms of immunity genes and susceptibility to otitis media in children. PLoS One 2014; 9:e93930. [PMID: 24718616 PMCID: PMC3981756 DOI: 10.1371/journal.pone.0093930] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute otitis media (OM) is a common disease which often develops through complex interactions between the host, the pathogen and environmental factors. We studied single nucleotide polymorphisms (SNPs) of genes involved in innate and adaptive immunity, and other host and environmental factors for their role in OM. METHODS Using Sequenom Massarray platform, 21 SNPs were studied in 653 children from prospective (n = 202) and retrospective (n = 451) cohorts. Data were analyzed for the relationship between SNPs and upper respiratory infection (URI) frequency, risk of acute OM during URI episodes, and proneness to recurrent OM. RESULTS Increased risk for OM proneness was associated with CX3CR1 (Thr280Met) SNP and with a jointly interactive group of IL-10 (-1082) SNP, IL-1β (-511) wild type genotype and white race. Family history of OM proneness independently increased the risk for frequent URIs, OM occurrence during URI, and OM proneness. Additionally, IL-1β (-31) SNP was associated with increased risk for frequent URIs, but IL-10 (-592), IL-1β (-511), IL-5 (-746) and IL-8 (-251) SNPs were associated with decreased risk of URI. CONCLUSION IL-1β (-31), CX3CR1 (Thr280Met), IL-10 (-1082) and IL-1β (-511) SNPs were associated with increased risk for frequent URIs or OM proneness.
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Affiliation(s)
- Johanna Nokso-Koivisto
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Tasnee Chonmaitree
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Reuben Matalon
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Stan Block
- Kentucky Pediatric Research, Inc., Bardstown, Kentucky, United States of America
| | - Janak A. Patel
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, United States of America
- * E-mail:
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Kurabi A, Lee J, Wong C, Pak K, Hoffman HM, Ryan AF, Wasserman SI. The inflammasome adaptor ASC contributes to multiple innate immune processes in the resolution of otitis media. Innate Immun 2014; 21:203-14. [PMID: 24652041 DOI: 10.1177/1753425914526074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study was designed to understand the contribution of the inflammasome and IL-1β activation in otitis media (OM). We examined the middle ear (ME) response to non-typeable Haemophilus influenzae (NTHi) in wild type (WT) mice using gene microarrays and a murine model of acute OM. Expression of members of the NOD domain-like receptor family of inflammasome genes was significantly up-regulated early in NTHi infection of the ME, potentially activating specific downstream regulatory cascades that contribute to the proliferative inflammatory response observed during OM. Expression of the pro-forms of the inflammasome targets IL-1β and IL-18 were also up-regulated. To evaluate the role of inflammasome-mediated cytokine maturation, NTHi-induced OM was examined in Asc(-/-)-deficient mice and compared with that seen in WT mice. Mice lacking the Asc gene showed near absence of IL-1β maturation in the ME and a reduction in leukocyte recruitment and infiltration to the cavity, and their macrophages exhibited reduced phagocytosis of NTHi. These inflammatory defects were linked to an increase in the degree and duration of mucosal epithelial hyperplasia in the ME of Asc(-/-) mice, as well as a delay in bacterial clearance from their MEs. These data demonstrate an important role for the inflammasome and cytokine processing in the course and resolution of OM.
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Affiliation(s)
- Arwa Kurabi
- School of Medicine, Department of Surgery, Division of Otolaryngology, University of California San Diego, La Jolla, CA, USA
| | - Jasmine Lee
- Department of Biology, University of California La Jolla, La Jolla, CA, USA
| | - Chelsea Wong
- Department of Biology, University of California La Jolla, La Jolla, CA, USA
| | - Kwang Pak
- School of Medicine, Department of Surgery, Division of Otolaryngology, University of California San Diego, La Jolla, CA, USA San Diego Veterans Administration Healthcare System, San Diego, CA, USA
| | - Hal M Hoffman
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA, USA Ludwig Institute of Cancer Research, San Diego Branch, La Jolla, CA, USA
| | - Allen F Ryan
- School of Medicine, Department of Surgery, Division of Otolaryngology, University of California San Diego, La Jolla, CA, USA San Diego Veterans Administration Healthcare System, San Diego, CA, USA
| | - Stephen I Wasserman
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
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MacArthur CJ, Wilmot B, Wang L, Schuller M, Lighthall J, Trune D. Genetic susceptibility to chronic otitis media with effusion: candidate gene single nucleotide polymorphisms. Laryngoscope 2013; 124:1229-35. [PMID: 23929584 DOI: 10.1002/lary.24349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS The genetic factors leading to a predisposition to otitis media are not well understood. The objective of the current study was to develop a tag-single nucleotide polymorphism (SNP) panel to determine if there is an association between candidate gene polymorphisms and the development of chronic otitis media with effusion. STUDY DESIGN A 1:1 case/control design of 100 cases and 100 controls was used. The study was limited to the chronic otitis media with effusion phenotype to increase the population homogeneity. METHODS A panel of 192 tag-SNPs was selected. Saliva for DNA extraction was collected from 100 chronic otitis media with effusion cases and 100 controls. After quality control, 100 case and 79 control samples were available for hybridization. Genomic DNA from each subject was hybridized to the SNP probes, and genotypes were generated. Quality control across all samples and SNPs reduced the final SNPs used for analysis to 170. Each SNP was then analyzed for statistical association with chronic otitis media with effusion. RESULTS Eight SNPs from four genes had an unadjusted P value of <.05 for association with the chronic otitis media with effusion phenotype (TLR4, MUC5B, SMAD2, SMAD4); five of these polymorphisms were in the TLR4 gene. CONCLUSIONS Even though these results need to be replicated in a novel population, the presence of five SNPs in the TLR4 gene having association with chronic otitis media with effusion in our study population lends evidence for the possible role of this gene in the susceptibility to otitis media.
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Affiliation(s)
- Carol J MacArthur
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A; Oregon Hearing Research Center, Oregon Health and Science University, Portland, Oregon, U.S.A
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Hoffman HJ, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L. Panel 1: Epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg 2013; 148:E1-E25. [PMID: 23536527 DOI: 10.1177/0194599812460984] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The First International Symposium on Recent Advances in Otitis Media (OM) with Effusion was held in Columbus, Ohio, in 1975. The symposium has been organized in the United States every 4 years since, followed by a research conference to (a) assess major research accomplishments, (b) identify important research questions and opportunities, (c) develop consensus on definitions and terminology, and (d) establish priorities with short- and long-term research goals. One of the principal areas reviewed quadrennially is Epidemiology, Natural History, and Risk Factors. OBJECTIVE To provide a review of recent literature on the epidemiology, natural history, and risk factors for OM. DATA SOURCES AND REVIEW METHODS A search of OM articles in English published July 2007 to June 2011 was conducted using PubMed and related databases. Those with findings judged of importance for epidemiology, public health, and/or statistical methods were reviewed. RESULTS The literature has continued to expand, increasing understanding of the worldwide burden of OM in childhood, complications from treatment failures, and comorbidities. Novel risk factors, including genetic factors, have been examined for OM susceptibility. Population-based studies in Canada, the United States, and other countries confirmed reductions in OM prevalence. Although most studies concentrated on acute OM (AOM) or OM with effusion (OME), a few examined severe chronic suppurative OM (CSOM), a major public health problem in developing countries and for certain indigenous populations around the world. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Recent publications have reinforced earlier epidemiological findings, while extending our knowledge in human population groups with high burden of OM.
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Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, Maryland 20892, USA.
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Hafrén L, Kentala E, Einarsdottir E, Kere J, Mattila PS. Current knowledge of the genetics of otitis media. Curr Allergy Asthma Rep 2013; 12:582-9. [PMID: 22886440 DOI: 10.1007/s11882-012-0292-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Otitis media is one of the most common childhood infections leading to doctor's visits and a leading cause of antibiotic prescriptions in children. Twin and family studies have confirmed that the predisposition of developing a bacterial middle ear infection is genetically determined. Several case-control studies have been performed to analyze genes involved in inflammatory processes in search of potential associations. Modern genome-wide association approaches that require no prior assumptions of the involvement of a given gene locus in the risk of otitis media are currently being used to identify otitis media genes, and will hopefully give more detailed information on the pathogenesis of childhood otitis media. That information could be used in finding the high-risk patient, in the prevention of the disease, and in the design of new treatments.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology, Helsinki University Central Hospital, University of Helsinki, P.O. Box 220, 00029, HUS, Finland.
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Abstract
Cytokines are a group of diverse molecules that influence the function of every organ system. They are most well studied in their effects on the immune system and their integral role in mediating inflammation. The common cold and otitis media are two such disease states, and much has been learned about the various effects of cytokines in each disease. Most often the viruses isolated include rhinovirus (RV), respiratory syncytial virus (RSV), adenovirus, coronavirus, and picornavirus. Otitis media, sinusitis, bronchiolitis, pneumonia, and asthma exacerbation are commonly accepted as complications of viral upper respiratory tract infections. Furthermore, otitis media and upper respiratory infections are inextricably linked in that the majority (>70 %) of cases of acute otitis media occur as complications of the common cold. Cytokine polymorphisms have been associated with the severity of colds as well as the frequency of otitis media. This article attempts to update the reader on various studies that have recently been published regarding the role of cytokines in these two disease entities.
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Affiliation(s)
- Todd M Wine
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Human milk provides infants with antimicrobial, anti-inflammatory, and immunomodulatory agents that contribute to optimal immune system function. The act of breastfeeding allows important bacterial and hormonal interactions between the mother and baby and impacts the mouth, tongue, swallow, and eustachian tubes. Previous meta-analyses have shown that lack of breastfeeding and less intensive patterns of breastfeeding are associated with increased risk of acute otitis media, one of the most common infections of childhood. A review of epidemiologic studies indicates that the introduction of infant formula in the first 6 months of life is associated with increased incidence of acute otitis media in early-childhood. More recent research raises the issues of how long this increased risk persists, and whether lack of breastfeeding is associated with diagnosis of otitis media with effusion. However, many studies suffer from lack of study of younger populations and imprecise definitions of infant feeding patterns. These findings suggest that measures of the association between breastfeeding history and otitis media risk are sensitive to the definition of breastfeeding used; future research is needed with more precise and consistent definitions of feeding, with attention to distinctions between direct breastfeeding and human milk feeding by bottle.
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Rye MS, Blackwell JM, Jamieson SE. Genetic susceptibility to otitis media in childhood. Laryngoscope 2012; 122:665-75. [DOI: 10.1002/lary.22506] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/03/2011] [Accepted: 11/28/2011] [Indexed: 11/07/2022]
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Abstract
Tumour necrosis factor (TNF), an important proinflammatory cytokine, plays a role in the regulation of cell differentiation, proliferation and death, as well as in inflammation, innate and adaptive immune responses, and also implicated in a wide variety of human diseases. The presence of DNA sequence variations in regulatory region might interfere with transcription of TNF gene, influencing the circulating level of TNF and thus increases the susceptibility to human diseases (infectious, cancer, autoimmune, neurodegenerative and other diseases). In this review, we have comprehensively analysed various published case-control studies of different types of human diseases, in which TNF gene polymorphism played a role, and computationally predicted several single nucleotide polymorphisms (SNPs) lie in transcription factor-binding sites (TFBS) of transcription factors (TFs). It has been observed that TNF enhancer polymorphism is implicated in several diseases, and TNF rs1800629 and rs361525 SNPs are the most important in human disease susceptibility as these might influence the transcription of TNF gene. Thirty-two SNPs lies in TFBS of 20 TFs have been detected in the TNF upstream region. It has been found that TNF enhancer polymorphism influences the serum level of TNF in different human diseases and thus affects the susceptibility to diseases. The presence of DNA sequence variation in TNF gene causes the modification of transcriptional regulation and thus responsible for association of susceptibility/resistance with human diseases.
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Affiliation(s)
- T Qidwai
- Metabolic and Structural Biology Department, Central Institute of Medicinal and Aromatic Plants, Council of Scientific and Industrial Research, Lucknow, Uttar Pradesh, India
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