Tumor necrosis factor-α receptor expression correlates with mucosal changes and biofilm presence in chronic rhinosinusitis with nasal polyposis.
OBJECTIVE
Biofilms might play a potential role in the pathogenesis and high recurrence rate of chronic rhinosinusitis with nasal polyposis (CRSwNP). Biofilm persistence has been thought to correlate with epithelial damage, subepithelial inflammatory cell infiltration, and tumor necrosis factor-α receptor (TNFR) expression in CRSwNP.


METHODS
Case-control experimental study.


METHODS
A total of 36 patients with CRSwNP undergoing endoscopic sinus surgery were analyzed. The negative control group consisted of eight patients undergoing septoplasty for nasal obstruction without CRSwNP. The nasal polyps and inferior turbinate mucosa samples applied as negative controls were processed by hematoxylin-eosin (HE) and Gram staining and TNFR-I and TNFR-II-specific immunofluorescent assay.


RESULTS
Biofilm was detected in 29 of 36 patients with CRSwNP and in none of the eight negative controls. Staining by HE showed strong correlation with the results of Gram staining protocol. In the biofilm-positive cases, TNFR-I and TNFR-II displayed homogeneous pattern of significantly increased epithelial expression compared to the biofilm-negative nasal polyps. In cases of biofilm absence, the expression pattern of TNF-α receptors was characterized by increased TNFR-II-specific immunoreaction. It was found that biofilm detectability corresponded to the integrity of nasal epithelium and to the dominant inflammatory cell type of the subepithelial layer.


CONCLUSIONS
Persisting biofilms might increase the epithelial sensitivity against TNF-α that result in epithelium destruction. Coexistence of biofilms and increased TNFR expression might explain the inflammatory mucosal changes, functional disorders, and therapy resistance featuring CRSwNP.
Department of Otolaryngology and Head and Neck Surgery, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary. karositamas@gmail.com
Tamás
T
Karosi
Péter
P
Csomor
István
I
Sziklai
D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification*; D018441:Biofilms; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism / Q000382:microbiology* / Q000473:pathology; D009298:Nasal Polyps / Q000150:complications / Q000378:metabolism* / Q000382:microbiology; D010256:Paranasal Sinuses / Q000382:microbiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000378:metabolism* / Q000382:microbiology; D012852:Sinusitis / Q000150:complications / Q000378:metabolism* / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis*
D014409:Tumor Necrosis Factor-alpha