Chinese Expert Consensus on the Use of Biologics in Patients with Chronic Rhinosinusitis (2022, Zhuhai).

BACKGROUND: Chronic rhinosinusitis (CRS) is a common inflammatory disease in otolaryngology, mainly manifested as nasal congestion, nasal discharge, facial pain/pressure, and smell disorder. CRS with nasal polyps (CRSwNP), an important phenotype of CRS, has a high recurrence rate even after receiving corticosteroids and/or functional endoscopic sinus surgery. In recent years, clinicians have focused on the application of biological agents in CRSwNP. However, it has not reached a consensus on the timing and selection of biologics for the treatment of CRS so far. SUMMARY: We reviewed the previous studies of biologics in CRS and summarized the indications, contraindications, efficacy assessment, prognosis, and adverse effects of biologics. Also, we evaluated the treatment response and adverse reactions of dupilumab, omalizumab, and mepolizumab in the management of CRS and made recommendations. KEY MESSAGES: Dupilumab, omalizumab, and mepolizumab have been approved for the treatment of CRSwNP by the US Food and Drug Administration. Type 2 and eosinophilic inflammation, need for systemic steroids or contraindication to systemic steroids, significantly impaired quality of life, anosmia, and comorbid asthma are required for the use of biologics. Based on current evidence, dupilumab has the prominent advantage in improving quality of life and reducing the risk of comorbid asthma in CRSwNP among the approved monoclonal antibodies. Most patients tolerate biological agents well in general with few major or severe adverse effects. Biologics have provided more options for severe uncontrolled CRSwNP patients or patients who refuse to have surgery. In the future, more novel biologics will be assessed in high-quality clinical trials and applied clinically.

Circadian rhythm disruption exacerbates Th2-like immune response in murine allergic airway inflammation.

BACKGROUND: Chronic jet lag (CJL)-induced circadian rhythm disruption (CRD) is positively correlated with an increased risk of allergic diseases. However, little is known about the mechanism involved in allergic rhinitis (AR). METHODS: Aberrant light/dark cycles-induced CRD mice were randomly divided into negative control (NC) group, AR group, CRD+NC group, and CRD+AR group (n = 8/group). After ovalbumin (OVA) challenge, nasal symptom scores were recorded. The expression of Occludin and ZO-1 in both nasal mucosa and lung tissues was detected by reverse transcription-quantitative polymerase chain reaction (RT-PCR) and immunohistochemical staining. The level of OVA-specific immunoglobulin E (sIgE) and T-helper (Th)-related cytokines in the plasma was measured by enzyme-linked immunosorbent assay (ELISA), and the proportion of Th1, Th2, Th17, and regulatory T cell (Treg) in splenocytes was evaluated by flow cytometry. RESULTS: The nasal symptom score in the CRD+AR group was significantly higher than those in the AR group with respect to eosinophil infiltration, mast cell degranulation, and goblet cell hyperplasia. The expression of ZO-1 and Occludin in the nasal mucosa and lung tissues in the CRD+AR group were significantly lower than those in the AR group. Furthermore, Th2 and Th17 cell counts from splenocytes and OVA-sIgE, interleukin 4 (IL-4), IL-6, IL-13, and IL-17A levels in plasma were significantly increased in the CRD+AR group than in the AR group, whereas Th1 and Treg cell count and interferon γ (IFN-γ) level were significantly decreased in the CRD+AR group. CONCLUSION: CRD experimentally mimicked CJL in human activities, could exacerbate local and systemic allergic reactions in AR mice, partially through decreasing Occludin and ZO-1 level in the respiratory mucosa and increasing Th2-like immune response in splenocytes.

Livin in synergy with Ras induces and sustains corticosteroid resistance in the airway mucosa.

Rationale: Corticosteroid resistance (CR) seriously affects the therapeutic effects of steroids on many chronic inflammatory disorders, including airway allergy. The mechanism of CR development is unclear. Recent research indicates that livin, an apoptosis inhibitor, is associated with the regulation in cell activities. This study investigates the role of livin in the inducing and sustaining CR in the airway mucosa. Methods: Nasal epithelial cells (NECs) were isolated from surgically removed nasal mucosal tissues of patients with allergic rhinitis (AR) and nasal polyps with or without CR. Differentially expressed genes in NECs were analyzed by the RNA sequencing. A CR mouse model was developed to test the role of livin in CR development. Results: The results showed that NECs of AR patients with CR expressed high levels of livin, that was positively correlated with the thymic stromal lymphopoietin (TSLP) expression and the high Ras activation status in NECs. Livin and Ras activation mutually potentiating each other in the inducing and sustaining the TSLP expression in NECs. TSLP induced eosinophils and neutrophils to express glucocorticoid receptor-ß (GRß). Eosinophils and neutrophils with high CRß expression were resistant to corticosteroids. Depletion of livin or inhibition of TSLP markedly attenuated CR and airway allergy. Conclusions: Livin facilitates CR development in the airways by promoting TSLP expression in epithelial cells and the GRß expression in eosinophils and neutrophils. Depletion of livin or inhibiting TSLP attenuates CR development and inhibits airway allergy, this has the translational potential to be used in the treatment of airway allergy.

Interaction between Ras and Bcl2L12 in B cells suppresses IL-10 expression.

The pathogenesis of recurrent tonsillitis is to be further investigated. B cell-derived interleukin (IL)-10 plays a critical role in immune regulation. Ras activation plays an important role in cancer and many immune disorders. This study aims to investigate the role of Ras activation in down regulating IL-10 expression in tonsillar B cells. Surgically removed tonsil tissues were collected from patients with recurrent acute tonsillar inflammation; B cells were isolated from the tonsillar tissues by flow cytometry sorting to be analyzed by the Ras-specific enzyme-linked immunosorbent assay and pertinent immunological approaches. We found that, compared to peripheral B cells (pBC), B cells isolated from the tonsillar tissues with recurrent inflammation (tBC) showed higher Ras activation, lower IL-10 expression and higher Bcl2L12 expression. Bcl2L12 formed a complex with GAP (GTPase activating protein) to prevent Ras from deactivating. The Ras activation triggered the MAPK/Sp1 pathway to promote the Bcl2L12 expression in B cells. Bcl2L12 prevented the IL-10 expression in tBCs, that was counteracted by inhibition of Ras or the Ras signal transduction pathway. In conclusion, Bcl2L12 interacts with Ras activation to compromise immune tolerance in the tonsils by inhibiting the IL-10 expression in tBCs. Inhibition of Bcl2L12 can restore the IL-10 expression in tBCs.

Role of FcγRI in Antigen-Dependent Eosinophil Activation in Patients With Allergic Rhinitis.

BACKGROUND: The eosinophil (Eo) activation is a crucial factor evoking allergic rhinitis (AR) attacks; factors; the mechanism of triggering Eo activation remains to be further investigated. The interaction of antigen (Ag) and antibody plays a critical role in evoking allergy attacks. This study aims to elucidate the role of FcγRI, the high affinity receptor of IgG, in the Ag-mediated Eo activation. METHODS: Nasal lavage fluids (NLF) were collected from AR patients and healthy control (HC) subjects. Eos were isolated by flow cytometry cell sorting and analyzed by pertinent immunological approaches. RESULTS: Eos composed more than 60% of the cellular components in AR NLF. Exposure to specific Ags (sAgs) in the culture triggered Eos to release inflammatory mediators. High levels of FcγRI were detected on the surface of AR NLF Eos. Exposure to lipopolysaccharide markedly increased the FcγRI expression in naive Eos, which could be bound by Ag-specific IgG (sIgG) to form complexes on the surface of Eos; this made Eos at the sensitized status. Eos bore with the sIgG/FcγRI complexes could be activated upon exposure to sIgG in the culture; these Eos can be designated as Ag-specific Eos. Passive transfer of Ag-specific Eos resulted in profound AR response in mice upon sAg challenge. Depletion of FcγRI on Eos efficiently abolished AR response in mice. CONCLUSIONS: AR Eos express high levels FcγRI, that can be bound by sIgG to make Eos sensitized. Re-exposure to specific Ags can activate the sensitized Eos.

Period2 gene regulates diurnal changes of nasal symptoms in an allergic rhinitis mouse model.

BACKGROUND: Allergic rhinitis (AR) symptoms exhibit prominent 24-hour variations associated with the biological clock. Although endogenous glucocorticoids synchronize circadian oscillator in the nasal mucosa, the precise mechanism of AR remains unclear. Therefore, using a mouse model, we investigated the association between circadian-clock genes and AR symptoms at various time-points. METHODS: Based on the rhythmic secretion of corticosterone levels, we chose 2 time-points, ZT4 (10:00 AM) and ZT16 (10:00 PM), to observe dynamic changes of nasal symptoms, immunologic responses, and circadian-clock gene period (Per) expressions. RESULTS: In the AR group, nasal symptom scores at ZT4 were significantly higher than at ZT16, with a greater increase in eosinophils, mast cells, and total immunoglobulin E levels at ZT4. The scores had a negative correlation with fluctuation of corticosterone levels. T-helper 1 (Th1) cell counts and interferon-γ levels decreased significantly at ZT4 compared with ZT16 in the AR group, whereas Th2 cells; Th17 cells; and interleukin (IL)-4, -13, and -17A levels increased significantly at ZT4 compared with ZT16. Furthermore, Per2 gene expression levels were attenuated at ZT4 and elevated at ZT16, but correlated negatively with Th2 and Th17 responses associated with Gata3 and Rorγt expression levels that were enhanced at ZT4 and reduced at ZT16 in the AR group. CONCLUSION: Our results suggest that the Per2 gene may influence diurnal variations of AR symptom severity, partially through its possible anti-inflammatory effect on the circadian regulation of GATA3 and RORγt levels in immune cells. This further demonstrates the neural-immune-endocrinal mechanism of circadian rhythm in AR and sheds new light on chronotherapeutic approaches to AR.

Probiotic extracts ameliorate nasal allergy by inducing interleukin-35-producing dendritic cells in mice.

BACKGROUND: The therapeutic efficacy of allergic rhinitis (AR) needs to be improved. Probiotics have immunoregulatory functions. In this study we evaluated the effects of protein extracts of probiotics in the amelioration of AR. METHODS: Extracts of Bifidobacterium infantis (EBI) were prepared by lysing the live probiotics. AR mice were developed to be used to evaluate the therapeutic efficacy of EBI. RESULTS: The results show that EBI induced interleukin (IL)-10-producing dendritic cells (DCs) via increasing IL-35 and signal transducer and activator of transcription 3 (STAT3) phosphorylation. IL-10-expressing DCs induced IL-10-producing B cells (B10 cells), with the latter showing immunosuppressive functions. After challenge with specific antigens, AR mice showed sneezing, nasal itch, and increases in serum-specific immunoglobulin E (IgE) and mouse mast cell protease-1; higher levels of T helper 2 (Th2) cytokines (IL-4, 67.17 ± 10.66; IL-5, 62.83 ± 9.70; IL-13, 51.00 ± 6.69, before treatment) in nasal mucosal protein extracts, which were significantly suppressed (IL-4, 27.00 ± 6.66; IL-5, 23.86 ± 4.53; IL-13, 25.67 ± 4.93, after treatment (p < 0.001) by administration with EBI nasal drops. CONCLUSION: EBI can suppress AR via inducing B10 cells. Thus, after carrying out required preclinical experiments and tests, EBI has the translational potential to be used in the treatment of AR and other allergic diseases.

B cell lymphoma-2-like protein-12 association with T-helper 2 inflammation in chronic rhinosinusitis with allergy.

BACKGROUND: T-helper 2 (Th2) polarization plays a critical role in the pathogenesis of chronic rhinosinusitis (CRS) with accompanying nasal allergy. Recent studies indicate that B cell lymphoma-2-like protein-12 (Bcl2L12) is associated with immune dysregulation. The purpose of this study was to elucidate the role of Bcl2L12 in the pathogenesis of Th2 polarization of CRS patients. METHODS: CRS patients with nasal allergy (CRSa) and without nasal allergy (CRSna) were recruited into this study. CD4+ T cells were isolated from the blood samples of human subjects. A variety of immunologic molecular strategies were used to assess Th2 polarization and Bcl2L12 expression. RESULTS: Twenty CRSa patients, 20 CRSna patients, and 20 healthy subjects were recruited into this study. High levels of immunoglobulin E (IgE), interleukin 4 (IL-4), IL-5, IL-13, and Bcl2L12 were detected in nasal extracts of CRSa patients, but not in CRSna patients. The levels of Bcl2L12 were positively correlated with Th2 cytokines. CD4+ T cells from CRSa patients were prone to differentiate into Th2 cells, in which Bcl2L12 was required. CONCLUSION: Bcl2L12 is positively correlated with Th2 cytokine levels in the nasal mucosa of CRSa patients. Bcl2L12 contributes to the Th2 polarization, which may be a novel therapeutic target in the treatment of CRSa.

The 3-methyl-4-nitrophenol (PNMC) compromises airway epithelial barrier function.

BACKGROUND AND AIMS: It is recognized that the air pollution is associated with the pathogenesis of airway diseases. This study aims to elucidate the role of the 3-methyl-4-nitrophenol (PNMC), one of the components of diesel-exhaust particles, in compromising the airway epithelial barrier integrity. METHODS: A549 cells, an airway epithelial cell line, were cultured to monolayers to be used as an in vitro epithelial barrier model. BALB/c mice were treated with nasal drops containing PNMC to test the effects of PNMC on alternating the airway epithelial barrier functions. RESULTS: Exposure of mice to PNMC induced nasal epithelial cell apoptosis and increased the permeability of the nasal epithelial barrier. PNMC increased casp8 and casp3 activities in nasal epithelial cells. Exposure to PNMC up regulated Fas and FasL expression in airway epithelial cells. Inhibition of caspase abolished the PNMC-induced airway epithelial barrier dysfunction. CONCLUSION: Exposure of airway mucosa to PNMC induces epithelial cell apoptosis and compromises the epithelial barrier function, which can be prevented by the inhibition of caspases.

[Preliminary study on Aspergillus fumigatus-induced IKKα controlled maspin protein expression in respiratory epithelial cells of rats].

OBJECTIVE: To study if the expression of maspin protein in respiratory epithelial cells was downregulated through IκB kinase-α (IKKα)-controlled mechanism in an Aspergillus fumigatus-induced model in rat. METHODS: Inactivated Aspergillus fumigatus hyphae (AFH) suspension was used to induce respiratory epithelial cells (REC) cultured in vitro in rat, with PBS buffer as control. By RT-PCR, the mRNA expression of maspin was quantified, and by immunocytochemistry, the expression of maspin and IKKα in REC was observed. Furthermore AFH (from level 1 to level 3) suspension was prepared to induce REC. Then Western blot hybridization technique was used to detect the expression of maspin and IKKα protein. All data were processed by analysis of variance and two-variable correlation analysis. RESULTS: By RT-PCR, a statistically significant (t = 2.463, P < 0.05) expression of maspin mRNA was found (0.128 ± 0.059 in AFH group, 2.972 ± 0.353 in control group). By Immunocytochemistry, the difference of maspin protein color in different groups was shown statistically significant in integrated scoring (t = 3.721, P < 0.05, weak positive in AFH group, moderately positive in control group). While in IKKα color study, the difference between the two groups was also statistically significant (t = 6.825, P < 0.05) in integrated scoring, with a moderate positive in AFH group and weak positive in control group. By Western Blot hybridization, grayscale ratio of maspin and ß-actin was 0.912 ± 0.023 in control group, 0.607 ± 0.030, 0.476 ± 0.019, 0.416 ± 0.017 in AFH 1-3 groups, respectively, with a statistically significant difference within the four groups (F = 281.91, P < 0.05); While grayscale ratio of IKKα and ß-actin was 0.624 ± 0.012 in control group, 0.739 ± 0.020, 0.778 ± 0.010, 0.927 ± 0.017, respectively, in AFH 1-3 groups; with a statistically significant difference within the four groups(F = 200.91, P < 0.05). Moreover, the difference between any two groups from both AFH group (including subgroup 1, 2 and 3) and control group was statistically significant. Two-variable correlation analysis indicated a negative correlation between expression of maspin and IKKα (r = -0.911, P < 0.05). CONCLUSIONS: Induced by Aspergillus fumigatus, the rat respiratory epithelia might upregulate the expression of IKKα with a downregulated expression of maspin protein.

Staphylococcal enterotoxin B-derived haptens promote sensitization.

T helper 2 (Th2) polarization is a major pathological feature in allergic diseases; its etiology is not fully understood. This study aims to elucidate the adjuvant effect of the microbial product-derived small peptides in the initiation of antigen-specific Th2 polarization. In this study, a clinical survey of patients with chronic rhinosinusitis (CRS) and food allergy (FA) was carried out. The Staphylococcal enterotoxin B (SEB)-derived small peptides (Ssps) were examined in the human stool extracts. The formation of Ssp/antigen adducts was tested in a protein-protein combination assay. The bone marrow-derived dendritic cells (BMDCs) were employed to test the role of Ssp/ovalbumin (OVA) adducts in the dendritic cell (DC) maturation. A mouse model was developed to test the role of Ssp/OVA adducts in the initiation of Th2 polarization in the intestine. The results showed that 54 (18.2%) patients with FA were diagnosed among 296 patients with SEB(+) CRS; only eight (2.9%) FA patients were identified among 272 patients with SEB(-) CRS. Ssps were detected in the stool protein extracts from FA patients with SEB(+) CRS, but not in those with SEB(-) CRS. Ssp/OVA adducts induced DC maturation, speeded up DC migration, activated CD4(+) T cells in the regional lymph nodes and induced skewed Th2 polarization in the local tissue. We conclude that patients with SEB(+) CRS are prone to suffering from FA. SEB can be degraded to Ssps in the gastrointestinal tract. The Ssps can bind macromolecular antigens to form adducts to promote the antigenicity of the antigens and induction of the antigen-specific Th2 polarization and inflammation in the local tissue.

Ubiquitin E3 ligase A20 facilitates processing microbial product in nasal epithelial cells.

Microbial products play a role in the pathogenesis of allergic diseases; ubiquitin E3 ligase A20 (A20) is an important molecule in regulating inflammation in the body. The present study aims to elucidate the role of A20 in processing the absorbed microbial products in nasal epithelial cells. Human nasal mucosal specimens were collected from patients with or without chronic rhinitis and analyzed by immunohistochemistry. Human nasal epithelial cell line, RPMI2650 cell, was employed to assess the role of A20 in processing the absorbed staphylococcal enterotoxin B (SEB). The RPMI2650 cells absorbed SEB in the culture. The increase in A20 was observed in RPMI2650 cells in parallel to the absorption of SEB. A20 is a critical molecule in the degradation of SEB in the nasal epithelial cells by promoting the tethering of endosomes and lysosomes. A20 plays a critical role in processing of the absorbed SEB in nasal epithelial cells.

[Effects of sulphur dioxide inhalation on allergic rhinitis in mice].

OBJECTIVE: To observe the effect of sulphur dioxide (SO2) inhalation on the pathogenesis of allergic rhinitis (AR) in mice, and investigate the toxic effect of SO2 on respiratory tract mucosa. METHODS: Fifty male Kunming strain mice were randomly allocated to five groups, i. e., control group, AR group and AR plus different concentrations of SO2 group (three sub-groups). Nasal cavity irrigating solution was gathered from nasal cavity, and blood from the orbital venous sinus after anesthesia The concentrations of IL-5 and IL-13 in the peripheral serum and nasal cavity irrigating solution were measured by ELISA. The number of eosinophils (EOS) per square millimeter in sinus mucosa was calculated by hematoxylin-eosin. The expression of SP-D in nasal mucosa was analyzed by immunohistochemistry technique. RESULTS: With increasing concentrations of SO2, the levels of IL-5 and IL-13 in the peripheral serum, and the density of Eos in sinus mucosa increased simultaneously. A positive correlation existed between the concentration of inhaled SO2 and the elevation of both IL-5, IL-13 and Eos infiltration in nasal mucosa. The coefficient correlation relatively were 0.894, 0.874, 0.894, 0.891 and 0.870 (P <0.01). The expression of SP-D in 56 mg/m3 and 112 mg/m3 SO2 groups was higher, while it was lower in 168 mg/m3 SO2 group (P < 0. 001). CONCLUSIONS: The study showed that sulphur dioxide inhalation facilitates the onset of allergic rhinitis in mice. SO2-related Th2-derived cytokines as well as the infiltration of EOS in nasal mucosa help to aggravate the development of allergic rhinitis.

[Immunoglobulin domain and mucin domain-1 in helper T lymphocytes in allergic rhinitis].

OBJECTIVE: To investigate the significance of T cell immunoglobulin domain and mucin domain-1 (TIM-1) expression in helper T lymphocyte in allergic rhinitis (AR) patients. METHODS: Peripheral blood samples were collected from 20 AR patients, 9 males and 11 females, aged 31.4 (20-54), and 20 healthy persons, 12 males and 8 females, aged 38, 6 (18-60). Peripheral blood mononuclear cells (PBMNs) were isolated and magnetic cell sorting technique was used to purify the CD4+ T cells and CD4 + CD45RA + T cells. Immunofluorescence staining and flow cytometry were used to detect the percentage of CD4 + CD45RA + T cells positive in TIM-1, a helper T lymphocyte marker. Phytohemagglutinin (PHA) was added into the culture media to stimulate the TIM-1 positive helper T lymphocytes. Dendritic cells (DCs) thus induced and differentiated were conditioned by standardized allergen from dust mite (Dermatophagoides pteronyssinus) or lipopolysaccharide (LPS), and then co-cultured with CD4 T cells. The percentage of TIM-1 positive CD4 + CD45RA + T cells was counted. ELISA was used to detect the IL-4 and interferon (IFN)-gamma levels in the supernatants of the culture media of the dust mite and LPS groups. RESULTS: The percentage of TIM-1 positive CD4+ T cells of the AR patients was (9.48 +/- 1.51)%, significantly higher than that of the healthy controls [(3.12 +/- 0.32)%, P < 0.05], and the percentage of TIM-1 positive CD4 + T cells after PHA stimulation of the AR patients was (47.05 +/- 4.35)%, significantly higher than that of the healthy controls [(29.92 +/- 3.36)%, P < 0.05]. The percentage of TIM-1 positive CD4 + CD45RA + T cells of the AR patients was (26.34 +/- 4.0)%, significantly higher than that of the healthy controls [(18.4 +/- 8.1)%, P < 0.05], and the percentage of TIM-1 positive CD4 + CD45RA + T cells after PHA stimulation of the AR patients was (65.3 +/- 7.4)%, significantly higher than that of the healthy controls [(36.3 +/- 6.8)%, P < 0.05]. The percentage of TIM-1 positive CD4 + CD45RA + T cells co-cultured with the DCs conditioned by dust mite of the AR patients was (10.81 +/- 1.48)%, significantly higher than that of the LPS group [(6.08 +/- 1.45)%] and the blank control group [(1.56 +/- 2.30)%, both P < 0.05]. The IL-4 level of the DCs conditioned by dust mite allergen was (74.61 +/- 13.82) pg/ml, significantly higher than those of the LPS group and blank control group [(28.57 +/- 3.36) and (1.40 +/- 0.99) ng/ml respectively, both P < 0.05]. The IFN-gamma level of the DCs conditioned by dust mite allergen was (25.31 +/- 7.23) pg/ml, significantly lower than that of the LPS group [(163.41 +/- 82.37) pg/ml, P < 0.05], however, significantly higher than that of the blank control group [(1.58 +/- 0.53) pg/ml, P < 0.05]. CONCLUSION: The percentage of TIM-1 positive helper T lymphocytes of the AR patients are abnormally high. After stimulation of allergen The DCs increase the number of TIM-1 expressing naïve Th cells and promote them to differentiate into Th2 cells. Promoting naïve Th cells to differentiate into Th2 cells, TIM-1 expression induces Th2 cytokine-based immune responses.

[Preliminary investigation into the allergic rhinitis complicated with acute bacterial sinusitis in mice].

OBJECTIVE: To develop a mouse model of bacterial rhinosinusitis superposed on allergic rhinitis (AR), and to explore whether ongoing allergic rhinitis enhance the acute sinus infection and inflammation associated with Streptococcus pneumoniae (SP). METHODS: Fourty mice of C57BL6/J were randomly divided on average into 4 groups: A [ovalbumin (OVA) + SP], B [OVA + normal saline (NS)], C [phosphate buffered solution (PBS) + SP] and D (PBS + NS). (1) Group A and B were sensitized by intraperitoneal injection with 200 microl (10%) OVA on days 1 through 9, and exposed to OVA (6%) intranasally on days 10 through 17, to induce allergic inflammation. OVA was replaced with PBS in group C and D in the same way. (2) Subsequently, group A and C were inoculated with SP intranasally on day 13, and NS was used in group B and D. On the 6th day after inoculation, mice were killed. Blood was collected from the orbital venous sinus after anesthesia. The heads were embedded with paraffin and serial sections were followed and stained with hematoxylin-eosin and toluidine blue (0.5%) for histological analysis and inflammation cells count. The number of polymorphonuclear neutrophils (PMN) and eosinophils (EOS) per square millimeter of sinus mucosa were calculated by using a computer-aided special software under microscope. RESULTS: AR models were successfully established in 9 mice from group A and 8 from group B. Histologic examination of the sinus from group A and B revealed significant mucosal edema and dilated venules. The symptoms were mild in group C, and no symptom was observed in group D. PMN (x +/- s) in group A (139.3 +/- 26.5)/mm2 was significantly higher than that in group B (70.7 +/- 16.7)/mm2, C (63.0 +/- 14.7)/mm2 and D (40.2 +/- 14.1)/mm2 respectively (P < 0.01); EOS and serous IL-5 level in group A (134.6 +/- 25.5)/mm2, (48.2 +/- 13.9) pg/ml and B (116.2 +/- 25.2)/mm2, (40.8 +/- 7.8) pg/ml, were higher than that in group C (16.7 +/- 2.7)/mm2, (23.9 +/- 8.7) pg/ml (P < 0.05) and D (13.4 +/- 4.9)/mm2, (24.6 +/- 6.5) pg/ml (P < 0.05). CONCLUSIONS: The data demonstrate that an ongoing local allergic response augments bacterial infection in mice, and allergic sensitization alone without SP does not induce the sinus infection.

[Alteration of cytokines and mucin in lower respiratory tract in allergic rhinitis model in rats].

OBJECTIVE: To investigate the relationship between allergic rhinitis (AR) and asthma as well as the mechanisms related with it. METHODS: Sixty healthy rats were randomly divided into AR group and control group. AR model was established by intraperitoneal injection of ovalbumin (OVA) and nasal challenge with OVA. Nasal mucosa and lung tissue from both groups were stained with hematoxylin-eosin (HE), alcian-blue and periodic acid-schiff (AB-PAS), respectively. At the same time, the lung tissue was studied by transmission electron microscopy (TEM). Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry were used to examine the level of interleukin-4 (IL-4) in bronchial alveolus lavage fluid (BALF) and the expression of intercellular adhesion molecule-1 (ICAM-1) and MUC5AC in nasal and lung tissue, respectively. RESULTS: Infiltration of inflammatory cells in nasal mucosa and lung tissue of AR model in rat was evident. Cilia destruction of bronchial epithelial cells of AR model was found. The level of IL4 in BALF of AR group (58.10 +/- 7.92) pg/ml was significant higher compared with that in control group (24.66 +/- 2.07) pg/ml. The expression of ICAM-1 (0.66 +/- 0.24) and MUC5AC (0.71 +/- 0.10) in lung tissue were both significantly higher than that in control group (0.23 +/- 0.02, 0.29 +/- 0.03). CONCLUSIONS: Allergic inflammation in nasal mucosa not only leads to changes in both histopathology and immunology, but also initiates the inflammation in lower respiratory tract mainly causing the change of cytokines and mucin.