Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis.
BACKGROUND
During clinical practice, we noticed that some patients with both ulcerative colitis (UC) and chronic rhinosinusitis (CRS) showed amelioration of UC after treatment of CRS. This study was designed to identify a possible association between CRS and UC.


METHODS
Thirty-two patients with both CRS and UC received treatment with functional endoscopic sinus surgery (FESS) for CRS. Clinical symptom scores for CRS and UC, as well as serum levels of anti-Staphylococcal enterotoxin B (SEB) were evaluated at week 0 and week 12. Sinus wash fluid SEB content was measured with enzyme-linked immunosorbent assay (ELISA). The surgically removed tissues were cultured to identify growth of Staphylococcus. aureus (S. aureus). Immunohistochemistry was employed to identify anti-SEB positive cells in the colonic mucosa. Colonic biopsies were obtained and incubated with SEB. Mast cell activation in the colonic mucosa in response to incubation with SEB was observed with electron microscopy and immunoassay.


RESULTS
The clinical symptom scores of CRS and UC severe scores (UCSS) were significantly reduced in the UC-CRS patients after FESS. The number of cultured S. aureus colonies from the surgically removed sinus mucosa significantly correlated with the decrease in UCSS. High levels of SEB were detected in the sinus wash fluids of the patients with UC-CRS. Histamine and tryptase release was significantly higher in the culture supernate in the patients with UC-CRS than the patients with UC-only and normal controls. Anti-SEB positive cells were located in the colonic mucosa.


CONCLUSIONS
The pathogenesis of UC in some patients may be associated with their pre-existing CRS by a mechanism of swallowing sinusitis-derived SEB. We speculate that SEB initiates inappropriate immune reactions and inflammation in the colonic mucosa that further progresses to UC.
Yang
Ping-Chang
PC
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. yangp@mcmaster.ca
Liu
Tao
T
Wang
Bin-Quan
BQ
Zhang
Tao-Yuan
TY
An
Zi-Yuan
ZY
Zheng
Peng-Yuan
PY
Tian
Dao-Fa
DF
D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis; D016022:Case-Control Studies; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000209:etiology* / Q000378:metabolism; D004724:Endoscopy; D004768:Enterotoxins / Q000032:analysis / Q000276:immunology / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006636:Histamine Release; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000276:immunology / Q000378:metabolism / Q000382:microbiology; D020545:Respiratory Mucosa / Q000276:immunology / Q000378:metabolism / Q000382:microbiology; D012220:Rhinitis / Q000150:complications* / Q000378:metabolism*; D012697:Serine Endopeptidases / Q000378:metabolism; D012852:Sinusitis / Q000150:complications* / Q000378:metabolism* / Q000382:microbiology / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification; D007507:Therapeutic Irrigation; D053802:Tryptases
D000907:Antibodies, Bacterial; D004768:Enterotoxins; C031818:enterotoxin B, staphylococcal; D012697:Serine Endopeptidases; D053802:Tryptases