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Liu H, Shao S, Chen B, Yang S, Zhang X. Mendelian randomization analysis reveals causal relationship between tonsillectomy and irritable bowel syndrome. Front Surg 2025; 12:1436227. [PMID: 39936026 PMCID: PMC11811094 DOI: 10.3389/fsurg.2025.1436227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 01/10/2025] [Indexed: 02/13/2025] Open
Abstract
Objective This study used two sample Mendelian randomization (MR) method to evaluate the causal relationship between tonsillectomy and irritable bowel syndrome (IBS). Methods We selected tonsillectomy as the exposure factor and IBS as the outcome variable, using GWAS data from the IEU Open GWAS project. Instrumental variables (IVs) were SNPs strongly correlated and independent of tonsillectomy. MR-PRESSO was used for outlier removal. IVW was the primary MR analysis method, supplemented by MR-Egger regression, WM, WME, and simple mode. Cochran's Q tests assessed heterogeneity. MR-Egger intercept tested horizontal pleiotropy. Sensitivity analysis used a leave-one-out method. Results The IVW analysis indicated a positive association between genetically predicted tonsillectomy and IBS (OR = 1.682, 95% CI: 1.157-2.446, P = 0.006). Heterogeneity tests revealed the presence of heterogeneity at the SNPs (Cochran Q test, P = 3.13 × 10-5. The MR-Egger intercept test did not detect horizontal pleiotropy (egger_intercept = 0.000914, P = 0.789). Sensitivity analysis demonstrated the stability of the results. All F-statistics were greater than 10, indicating the absence of weak instrument bias. Conclusion Genetics predicts a positive causal relationship between tonsillectomy and IBS, suggesting that prevention of IBS in tonsillectomy patients should be enhanced.
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Affiliation(s)
- Huaiquan Liu
- College of Acumox and Tuina, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Shuoshuo Shao
- College of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Bo Chen
- College of Acumox and Tuina, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Shili Yang
- College of Acumox and Tuina, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xinyan Zhang
- College of Acumox and Tuina, Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Gu T, Zhang W, Tan L, Xiang R, Liu P, Huang J, Deng Q, Deng Y, Tao Z, Chen S, Xu Y. Intratonsillar Immunotherapy: A Convenient and Effective Alternative to Subcutaneous Immunotherapy for Allergic Rhinitis. RESEARCH (WASHINGTON, D.C.) 2025; 8:0573. [PMID: 39822282 PMCID: PMC11735709 DOI: 10.34133/research.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/02/2024] [Accepted: 12/16/2024] [Indexed: 01/19/2025]
Abstract
Allergen-specific immunotherapy (AIT) is the only treatment that addresses the root cause of immunoglobulin E (IgE)-mediated allergies, but conventional methods face challenges with treatment duration, patient compliance, and adverse effects. In this study, we propose intratonsillar immunotherapy (ITIT) as a new effective and safer route for AIT. Prior to clinical trials, we analyzed tonsil samples from human subjects to assess immune responses, measuring interleukin-4 (IL-4), IL-21, total IgE (tIgE), and allergen-specific IgE concentrations using ELISA and BioIC. Our results indicated that tonsils contained higher levels of allergen-specific IgE compared to peripheral blood. In the clinical phase, 120 allergic rhinitis (AR) patients were treated with either 3 intratonsillar allergen injections over 2 months or conventional subcutaneous immunotherapy (SCIT) over 1 year. ITIT demonstrated superior and faster symptom relief, especially in younger patients, while requiring markedly fewer doses and injections than SCIT. Immunological analysis revealed reduced eosinophil counts, increased regulatory T (Treg) and follicular regulatory T (TFR) cell levels, and a favorable shift in cytokine profiles. Adverse events were minimal, and the treatment showed high patient compliance. These findings suggest that ITIT could provide an effective, safer, and more convenient alternative to AIT.
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Affiliation(s)
- Tian Gu
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Zhang
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Tan
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Xiang
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Peiqiang Liu
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyu Huang
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Deng
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuqin Deng
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Zezhang Tao
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiming Chen
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Xu
- Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center,
Renmin Hospital of Wuhan University, Wuhan 430060, China
- Research Institute of Otolaryngology-Head and Neck Surgery,
Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunity, Wuhan, China
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3
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Santos-Cortez RLP, Gomez HZ, Elling CL, Mayher L, Diala OR, Gardner C, Willford K, Zamora VC, Agyepong A, Lee NK, Green KK, Darr OA, Wine TM, Francom CR, Larson ED, Gitomer SA, Schell AE, Frank DN, Friedman NR, Herrmann BW. APOBR Is Downregulated in EBV+ Tonsils of Children with Obstructive Sleep-Disordered Breathing. Genes (Basel) 2024; 15:1324. [PMID: 39457448 PMCID: PMC11507010 DOI: 10.3390/genes15101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 10/10/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Obstructive sleep-disordered breathing (oSDB) is a heterogeneous phenotype that is increasing in prevalence worldwide and has many potential comorbidities that could severely affect quality of life. There is a need to identify biomarkers for oSDB and its comorbidities to improve clinical management, particularly in children. Methods: We performed bulk mRNA-sequencing, differential expression analysis, and qPCR replication of selected differentially expressed genes (DEGs) using RNA samples extracted from tonsils of children with oSDB. Two variables were used as classifier, namely, detection of Epstein-Barr virus (EBV) in tonsils and need for continuous positive airway pressure (CPAP) treatment. Standard statistical tests were used to determine associations across clinical, EBV, and DEG variables. Results: Nineteen genes were dysregulated in tonsils that are EBV+ or from children needing CPAP. Of these genes, APOBR was downregulated in both EBV+ and CPAP+ tonsils, and this downregulation was replicated by qPCR in an independent set of pediatric samples. In the tonsils of adult patients with oSDB, APOBR was positively correlated with age, and potentially with diastolic blood pressure. Conclusions: Taken together, APOBR and DEGs in tonsillar tissues may be useful as potential biomarkers of oSDB severity and comorbidity across the lifespan, with APOBR levels being dependent on latent EBV infection.
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Affiliation(s)
- Regie Lyn P. Santos-Cortez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Helen Z. Gomez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Christina L. Elling
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Landen Mayher
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Obinna R. Diala
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Colin Gardner
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Kiera Willford
- Pathways in Genomic Research for Undergraduate Experiences (PATH-GREU) Program, University of Colorado Denver|Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Valerie C. Zamora
- Colorado Research Experiences (CORE) Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (V.C.Z.); (A.A.)
| | - Ashley Agyepong
- Colorado Research Experiences (CORE) Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (V.C.Z.); (A.A.)
| | - Nam K. Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Katherine K. Green
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Owen A. Darr
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Todd M. Wine
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Christian R. Francom
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Eric D. Larson
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Basic and Translational Science, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sarah A. Gitomer
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Amy E. Schell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Norman R. Friedman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Brian W. Herrmann
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (H.Z.G.); (C.L.E.); (L.M.); (C.G.); (N.K.L.); (K.K.G.); (O.A.D.); (T.M.W.); (C.R.F.); (E.D.L.); (S.A.G.); (A.E.S.); (N.R.F.); (B.W.H.)
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
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4
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Chen H, Zhu G, Liu Y, Huang D, Zhang X, She L. Allergic Diseases and Chronic Adenotonsillar Diseases: A Mendelian Randomization Study. Laryngoscope 2024; 134:2653-2658. [PMID: 38193619 DOI: 10.1002/lary.31275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE The existing epidemiological evidence regarding the intricate relationship between allergic diseases and chronic adenotonsillar diseases (CATD) remains inconclusive. Herein, the objective of our study is to explore the causal association using Mendelian randomization (MR). METHODS Employing data from large genome-wide association studies, a comprehensive two-sample bidirectional MR study was conducted. The studied traits encompassed allergic rhinitis (cases n = 9707, controls n = 331173), allergic asthma (cases n = 8525, controls n = 193857), allergic conjunctivitis (cases n = 18321, controls n = 324178), atopic dermatitis (cases n = 11964, controls n = 306909), and CATD (cases n = 38983, controls n = 258553). All the patients were of European descent and participants in cohort studies. The primary analysis was executed using inverse-variance-weighted MR. Furthermore, six additional MR methods (MR-Egger, weighted median, simple mode, weighted mode, MR pleiotropy residual sum and outlier, MR robust adjusted profile score) were employed to ensure the reliability and detect potential horizontal pleiotropy within the results. The estimates obtained from the MR analysis were factored into the overall effect calculation. RESULTS Genetically anticipated outcomes demonstrated a significant association between CATD risk and allergic rhinitis (OR = 1.141, p = 6.30E-06), allergic asthma (OR = 1.115, p = 8.31E-05), allergic conjunctivitis (OR = 1.197, p = 8.69E-07), and a suggestive association with atopic dermatitis (OR = 1.053, p = 0.040). However, no substantial correlation was observed in the reverse direction. CONCLUSIONS Findings of our study provide evidence supporting a causal role of allergic diseases in the development of CATD, whereas the converse relationship does not appear to hold true. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2653-2658, 2024.
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Affiliation(s)
- Huihong Chen
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, People's Republic of China
| | - Gangcai Zhu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yong Liu
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, People's Republic of China
| | - Donghai Huang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, People's Republic of China
| | - Xin Zhang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, People's Republic of China
| | - Li She
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, People's Republic of China
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