title: A novel insight into the immunologic basis of chronic granulomatous invasive fungal rhinosinusitis.
abstract: BACKGROUND
  Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a rare disease. The underlying immune responses that drive the development of CGIFRS, as opposed to successful pathogen clearance and controlled inflammation, are not currently known.
  
  
  OBJECTIVE
  To characterize the immune responses associated with CGIFRS.
  
  
  METHODS
  In addition to a battery of basic investigations, more in-depth immunologic testing involves ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with interleukin (IL) 12, was undertaken to investigate cell-mediated immune responses associated with CGIFRS.
  
  
  RESULTS
  Ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with IL-12 identified reduced interferon gamma and increased IL-17A levels within the supernatant, which indicated increased in vivo T-helper (Th)17 responses and impaired Th1 responses compared with healthy controls.
  
  
  CONCLUSIONS
  These findings suggest that the development of CGIFRS may be associated with an abnormally exaggerated host Th17 response, which caused failure to clear the fungal pathogen with refractory fungal infection of mucosal membranes, resulting in chronic tissue inflammation.
authors.affiliation: Department of Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: William
authors.initials: W
authors.lastname: Rae
authors.forename: Rainer
authors.initials: R
authors.lastname: Doffinger
authors.forename: Fenella
authors.initials: F
authors.lastname: Shelton
authors.forename: Eleanor
authors.initials: E
authors.lastname: Sproson
authors.forename: Hasnaa
authors.initials: H
authors.lastname: Ismail-Koch
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lund
authors.forename: Philip G
authors.initials: PG
authors.lastname: Harries
authors.forename: Efrem
authors.initials: E
authors.lastname: Eren
authors.forename: Rami J
authors.initials: RJ
authors.lastname: Salib