title: Systemic monocyte-derived dendritic cells and associated Th2 skewing in chronic rhinosinusitis.
abstract: BACKGROUND
  Monocyte-derived dendritic cells (moDCs) are antigen-presenting cells capable of directing immune responses toward T-helper 1 (Th1) or T-helper 2 (Th2) phenotypes. The systemic profile of moDCs and their association with Th1/Th2 skewing in chronic rhinosinusitis (CRS) is unclear. The purpose of this study is to characterize circulating moDCs in controls, CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP) and correlate moDCs with Th1/Th2 skewing, mucosal inflammation on computed tomography (CT), and quality of life (QoL).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Blood was drawn from control (n = 12), CRSsNP (n = 18), and CRSwNP (n = 15) patients during endoscopic sinus surgery.
  
  
  METHODS
  Peripheral blood moDCs were analyzed with flow cytometry for expression of HLA-DR, CD209, and CD14. Th1 and Th2 cells were identified by CXCR3 and CCR8 expression, respectively. Lund-Mackay CT scores were assigned by blinded graders. Sino-Nasal Outcome Test 22 (SNOT-22) surveys were completed by patients before surgery.
  
  
  RESULTS
  CRSsNP and CRSwNP displayed elevations in systemic moDCs compared with controls. In CRSwNP, systemic Th2 skewing was observed and circulating CD4+ Th2 cells correlated with percent moDCs. MoDCs strongly correlated with higher Lund-Mackay CT scores in CRSsNP but not in CRSwNP. No relationship between moDCs and SNOT-22 scores was observed for either subset of CRS.
  
  
  CONCLUSIONS
  These data support that CRSwNP and CRSsNP display alterations in systemic immune profiles. CRSwNP is characterized by significant elevations in circulating moDCs, which is associated with systemic Th2-biased inflammation. Circulating moDCs are associated with mucosal inflammation on CT imaging in CRSsNP. No association between moDCs and QoL is evident in either CRS subset.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: O'Connell
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wentzel
authors.forename: Whitney
authors.initials: W
authors.lastname: Nagel
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Mulligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003713:Dendritic Cells / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012220:Rhinitis / Q000276:immunology*; D012852:Sinusitis / Q000276:immunology*; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology*; D055815:Young Adult
keywords: Th2 inflammation; chronic rhinosinusitis; dendritic cells; nasal polyposis; t-helper cells