The role of mucosal immunity in fungus ball of the paranasal sinuses

Predicting the Probability of the Incidence of Maxillary Sinus Fungus Ball in Patients Using Nomogram Models

Maxillary sinus fungal ball (MSFB) is the most common type of non-invasive fungal rhinosinusitis. Since MSFB requires a unique treatment strategy and is associated with potentially severe complications, timely and precise diagnosis is crucial. Computed tomography (CT) is the first-line imaging tool for evaluating chronic rhinosinusitis. Accordingly, we aimed to investigate the clinical and CT imaging characteristics of MSFB. We retrospectively enrolled 97 patients with unilateral MSFB and 158 with unilateral non-fungal maxillary rhinosinusitis. The clinical characteristics, laboratory data, and CT imaging features of participants were evaluated. Older age, female sex, lower white blood cell and neutrophil counts, and CT imaging features (including an irregular surface, erosion of the medial sinus wall, sclerosis of the lateral sinus wall, and intralesional hyperdensity) were significantly associated with MSFB. The presence of adjacent maxillary odontogenic pathology was associated with a decreased likelihood of the incidence of MSFB in unilateral maxillary rhinosinusitis. Separate nomograms were created for patients, without and with the use of CT scan, to predict the probabilities of MSFB in patients with unilateral maxillary rhinosinusitis. We proposed two nomograms based on the clinical and CT characteristics of patients with MSFB. These could serve as evaluation tools to assist clinicians in determining the need for undergoing CT and facilitate the accurate and timely diagnosis of MSFB.

Analysis of metabolites of fungal balls in the paranasal sinuses

Fungal ball sinusitis is characterized by complex fungus infections with non-invasive inflammation. But no research reported fungal ball composition and metabolic-related product types currently. 12 patients with chronic rhinosinusitis who underwent surgery and 9 healthy control were enrolled in this study. Samples from both groups were analyzed for high-throughput metabolites by UPLC-MS. OsiriX software was applied to perform imaging measurements on sinus CT. 2138 and 394 metabolites were screened from cationic and anionic modes. There was a significant difference in the abundance of glycerophospholipid metabolism and sphingolipid metabolism between the two groups, with the experimental group showing an increased trend related to the sphingolipid metabolic pathway, including sphingosine 1-phosphate (S1P) and related products, diacylglycerol, sphingomyelin (SM), suggesting that its metabolites are associated with mucosal and bony inflammation. Imaging measurements showed a median sinus CT value (median (P25, P75) of 351(261.4, 385.8) HU and a median sinus wall thickness (median (P25, P75) of 2.31(1.695, 3.718) mm, which correlated with the levels of glycerophospholipid metabolites and sphingolipid metabolites (P < 0.03). Dysfunctional glycerophospholipid and sphingolipid metabolism is present in the lesion of fungal ball sinusitis. Glycerophospholipid and sphingolipid metabolism plays a significant role in the progression of mucosal and osteitis produced by fungal ball sinusitis.

Concurrent Monoclonal Gammopathy of Undetermined Significance in a Patient With Maxillary Sinus Fungus Ball

Fungus ball is a common disease encountered in rhinology departments. As it usually affects immunocompetent patients, other systemic diseases occurring concurrently with fungus ball have not been reported often. Recently, we encountered a patient who was diagnosed with fungus ball in the maxillary sinus and underwent endoscopic sinus surgery. During the surgery, fungus ball-like materials were sucked out and a maxillary sinus mucosal biopsy was performed. The post-operative pathologic report demonstrated that there were many plasma cells; the patient underwent several additional tests in our hematologic department. Finally, he was diagnosed with monoclonal gammopathy of undetermined significance (MGUS). In the present report, we summarize our experience with this patient and share the lessons that we have learned from this case.

The immune response to airway mycosis

The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T_H2 and T_H17 cell predominant immune responses, the production of IgE antibody, and a typical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection, recognized as an essential driving factor in at least severe subsets of allergic airway diseases. In this review, we consider recent progress made in understanding the immune mechanisms that drive airway mycosis-related diseases, improvements in immune-based diagnostic strategies, and therapeutic approaches that target key immune pathways.

Characteristics of Sinus Fungus Ball: A Unique Form of Rhinosinusitis

Objective:

The purpose of this study was to investigate the characteristics of this unique form of rhinosinusitis.

Methods:

Ninety-one patients with sinus fungus balls were evaluated for clinical characteristics. Nasal tissues obtained from 38 patients with sinus fungus ball, along with 26 controls were used for histopathological, cytokines/chemokines, western blotting, and genetic analyses.

Results:

Patients with fungus balls had significantly more females and their age was older. The presentation of fungus ball was predominantly unilateral (97.8%). Thirty-three patients (36.3%) had risk factors for fungal infection. Macrophage and neutrophil dominated cellular infiltration was found in nasal tissues of fungus ball patients. A tendency of reduced tight junction staining (e-cadherin) and protein expression was found. Interleukin 8 (IL8) and granulocyte colony stimulating factor (G-CSF) significantly increased in sinus fungus ball tissue homogenates when compared with those from controls. Higher prevalence of a single single nucleotide polymorphism (SNP) with E-cadherin was found in the patients with fungus ball.

Conclusions:

We found that patients with sinus fungus ball had robust immune responses, allowing recruitment and activation of macrophages and neutrophils. However, patients with sinus fungus ball could have genetic or acquired weakness in immunity. The fungal hyphae were localized and accumulated within single sinus instead of being eradicated by host.

Possible Role of Fungus Ball in Acute Exacerbation of Headache: Spontaneous Migration

This unusual patient highlights the need for careful clinical and radiological follow-up, in patients with asymptomatic fungus ball of nasal cavity and paranasal sinuses. In addition, although the predictive value may be limited, we must keep in mind that acute severe headache may be an alarming feature that predicts the change of fungus ball.

Toll like receptor 3 & 4 responses of human turbinate derived mesenchymal stem cells: stimulation by double stranded RNA and lipopolysaccharide

Background and objectives

Multipotent mesenchymal stromal cells (MSCs) represent a promising cell-based therapy for a number of inflammatory or autoimmune diseases. Herein, Toll like receptor (TLR) expression by MSCs and their immune regulatory roles are investigated. In this study, we investigated the influence of TLR on the immune response, proliferation, and differentiation potential of human turbinated MSC (hTMSC) cultures in vitro.

Subjects and Methods

After isolating hTMSCs from discarded inferior turbinate tissue, FACS analysis was used to assess the expression of TLRs such as TLR2, TLR3, TLR4, and TLR5 in hTMSCs and cell proliferation was assessed using a cell counting kit (CCK)-8. Cytokine and chemokine secretions were analyzed with multiplex immunoassays for IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, IP-10 (CXCL10), RANTES (CCL5), TNF-a, GM-CSF, and IFN-γ. The differentiation potential of hTMSCs was evaluated in the osteogenic, chondogenic, and adipogeinc media and analyzed by histology and gene expression related to differentiation.

Results

FACS analysis revealed that TLR3 and TLR4 expression consisted of a relatively high percentage of the surface proteins expressed by hTMSCs. The proliferation of hTMSCs was influenced and significantly increased by the presence of TLR4 agonists. In particular, hTMSCs produced a set of cytokines and chemokines and the expression of IL-6, IL-8, IL-12, IP-10 (CXCL10), RANTES (CCL5), TNF-α, and GM-CSF were up-regulated in response to the TLR4 agonist LPS. The osteogenic and adipogeinc differentiation potential of hTMSCs was not affected by TLR agonists.

Conclusions

We conclude that TLR4 stimulation affects TLR expression, proliferation, and the immunomodulation potential of hTMSCs. Understanding the mechanism behind TLR's influence on hTMSCs and their immunomodulating properties would be useful for providing a novel target to exploit in the improvement of stem cell-based therapeutic strategies.