title: Staphylococcal exotoxins and nasal polyposis: analysis of systemic and local responses.
abstract: BACKGROUND
  Staphylococcal exotoxins have been implicated in the pathogenesis of several chronic inflammatory diseases including atopic dermatitis (AD), asthma, and, most recently, chronic rhinosinusitis with nasal polyposis (CRS/NP). In severe AD, these toxins act both as superantigens (SAg), triggering massive T-cell activation, and as conventional allergens, triggering toxin-specific immunoglobulin E (IgE) in the serum. In CRS/NP, evidence for both processes has been reported but it is unclear whether these processes are linked. The aim of this study was to correlate SAg activity as inferred by staphylococcal-specific T-cell receptor (TCR) V-beta expansion in the polyp and blood of CRS/NP patients with staphylococcal-specific anti-IgE antibodies in the serum.
  
  
  METHODS
  IgE antibodies to staphylococcal exotoxin A (SEA), staphylococcal exotoxin B (SEB), and toxic shock syndrome toxin (TSST) 1 were measured in the serum of 12 individuals with CRS/NP before functional endoscopic sinus surgery. Flow cytometry was used to analyze the SEA, SEB, and TSST-1-specific TCR V-beta domains on the T cells from the polyp and blood of these patients.
  
  
  RESULTS
  Serum SEA-, SEB-, and TSST-1-specific IgE antibodies were detected in 0/12 (0%), 6/12 (50.0%), and 9/12 (75%) of CRS/NP patients, respectively. Evidence of SAg effect in the polyp lymphocytes (TCR V-beta expansion in both CD4+ and CD8+ subsets) was noted in 7/12 (58.3%) patients. Five of 6 CRS/NP patients had overlapping evidence of a systemic IgE response and TCR V-beta expansion, suggestive of exposure to the same exotoxin. No patients had evidence a SAg effect in blood lymphocytes. Nine of 12 subjects also had coexistent asthma.
  
  
  CONCLUSIONS
  These results provide evidence for a local SAg effect in 7/12 (58.3%) polyp patients and establish a positive correlation of V-beta expansion with the presence of corresponding toxin-specific IgE in the serum.
authors.affiliation: Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Anju
authors.initials: A
authors.lastname: Tripathi
authors.forename: Robert
authors.initials: R
authors.lastname: Kern
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Kristin
authors.initials: K
authors.lastname: Seiberling
authors.forename: Julie C
authors.initials: JC
authors.lastname: Klemens
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Harris
authors.forename: Lydia
authors.initials: L
authors.lastname: Suh
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Grammer
mesh_terms: D000328:Adult; D000368:Aged; D004797:Enzyme-Linked Immunosorbent Assay; D005098:Exotoxins; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000276:immunology / Q000382:microbiology* / Q000503:physiopathology*; D010641:Phenotype; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000276:immunology; D012220:Rhinitis / Q000382:microbiology; D012852:Sinusitis / Q000382:microbiology; D013210:Staphylococcus / Q000276:immunology* / Q000472:pathogenicity*; D018089:Superantigens
chemical_list: D005098:Exotoxins; D016693:Receptors, Antigen, T-Cell, alpha-beta; D018089:Superantigens; D007073:Immunoglobulin E