Role of staphylococcal superantigens in upper airway disease.
OBJECTIVE
Chronic rhinosinusitis with nasal polyps often represents a chronic severe inflammatory disease of the upper airways and may serve as a model for lower airway diseases such as late-onset intrinsic asthma. Enterotoxins derived from Staphylococcus aureus have been implicated in the pathophysiology of nasal polyps as disease-modifying factors; recent findings using therapeutic proof-of-concept approaches support this hypothesis.


RESULTS
Nasal polyps (chronic rhinosinusitis with nasal polyps) are characterized by a T-helper-2 dominated cytokine pattern that includes interleukin-5 and formation of immunoglobulin E. This is in contrast to chronic rhinosinusitis without polyps, which exhibits T-helper-1 biased cytokine release. It is now evident that the cytokine environment is decisive regarding the impact of S. aureus derived enterotoxins, which function as superantigens. S. aureus enterotoxin B further shifts the cytokine pattern in nasal polyps toward T-helper-2 cytokines (increases greater than twofold for interleukin-2, interleukin-4 and interleukin-5), but it disfavours the T-regulatory cytokines interleukin-10 and transforming growth factor-beta1. Furthermore, S. aureus derived enterotoxins influence local immunoglobulin synthesis and induce polyclonal immunoglobulin E production, which may contribute to severe inflammation via activation of mast cells.


CONCLUSIONS
From this new understanding of chronic rhinosinusitis with nasal polyps, new therapeutic approaches emerge such as anti-interleukin-5, anti-immunoglobulin E, and antibiotic treatment. These may enlarge the nonsurgical armentarium.
Bachert
Claus
C
Upper Airway Research Laboratory, Ear Nose and Throat Department, University Hospital Ghent, Ghent, Belgium. claus.bachert@ugent.be
Zhang
Nan
N
Patou
Joke
J
van Zele
Thibaut
T
Gevaert
Philippe
P
D001427:Bacterial Toxins / Q000276:immunology; D002908:Chronic Disease; D004768:Enterotoxins / Q000276:immunology; D006801:Humans; D018928:Immunity, Mucosal; D007073:Immunoglobulin E / Q000276:immunology; D015848:Interleukin-5 / Q000276:immunology; D009298:Nasal Polyps / Q000276:immunology / Q000378:metabolism / Q000382:microbiology* / Q000503:physiopathology; D012852:Sinusitis / Q000276:immunology / Q000378:metabolism / Q000382:microbiology* / Q000503:physiopathology; D013203:Staphylococcal Infections / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D013211:Staphylococcus aureus; D018089:Superantigens / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology
D001427:Bacterial Toxins; D004768:Enterotoxins; D015848:Interleukin-5; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal; D007073:Immunoglobulin E; C031818:enterotoxin B, staphylococcal