title: The interaction between bacteria and mucosal immunity in chronic rhinosinusitis: a prospective cross-sectional analysis.
abstract: BACKGROUND
  We have detected intramucosal bacteria within the sinus mucosa of patients with chronic rhinosinusitis (CRS), but our attempts at characterizing these did not yield any discernible genotypic or phenotypic differences from surface bacteria. We hypothesized that the presence of intramucosal microcolonies reflected host mucosal immune dysfunction. This study characterizes the activation status of T cells, B cells, and macrophages in the sinus mucosa of patients with CRS and controls and determines the impact of bacteria on mucosal immunology.
  
  
  METHODS
  Swabs and mucosal biopsy specimens were taken from 27 patients with CRS undergoing sinus surgery and 9 patients with normal sinuses having transnasal pituitary surgery. Microcolonies were detected using Gram staining, and the immune cells were characterized by immunohistochemical techniques.
  
  
  RESULTS
  Swab culture rates for Staphylococcus aureus were similar between CRS and controls. However, there were significantly more intramucosal microcolonies in CRS (59% versus 11%) than in controls (p = 0.02). There were significantly more immune cells in CRS. Percentage of activated T and B cells were similar between CRS and controls, but there were significantly more CD163(+) M2 macrophages in patients with CRS (p = 0.0004). Furthermore, percentage of CD163(+) macrophages showed a positive correlation with disease severity. The presence of bacteria had no impact on immunology or disease severity.
  
  
  CONCLUSIONS
  Tolerance of intramucosal microcolonies in CRS may reflect altered macrophage function in the host mucosa. The clinical severity of CRS is also dependent on the host mucosa immune dysfunction, rather than the presence of intramucosal microcolonies.
authors.affiliation: Department of Surgery, The University of Auckland, New Zealand.
authors.forename: Raymond J T
authors.initials: RJ
authors.lastname: Kim
authors.forename: Tary
authors.initials: T
authors.lastname: Yin
authors.forename: Chun-Jen J
authors.initials: CJ
authors.lastname: Chen
authors.forename: Claudia Jabs
authors.initials: CJ
authors.lastname: Mansell
authors.forename: Andrew
authors.initials: A
authors.lastname: Wood
authors.forename: P Rod
authors.initials: PR
authors.lastname: Dunbar
authors.forename: Richard G
authors.initials: RG
authors.lastname: Douglas
mesh_terms: D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D001419:Bacteria / Q000302:isolation & purification*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006801:Humans; D018928:Immunity, Mucosal; D008264:Macrophages / Q000502:physiology; D009297:Nasal Mucosa / Q000382:microbiology*; D011446:Prospective Studies; D011956:Receptors, Cell Surface / Q000032:analysis; D012220:Rhinitis / Q000276:immunology* / Q000382:microbiology; D012852:Sinusitis / Q000276:immunology* / Q000382:microbiology; D000098902:CD163 Antigen
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D000098902:CD163 Antigen; D011956:Receptors, Cell Surface