A sensitive high throughput ELISA for human eosinophil peroxidase: a specific assay to quantify eosinophil degranulation from patient-derived sources

Quantitative high throughput assays of eosinophil-mediated activities in fluid samples from patients in a clinical setting have been limited to ELISA assessments for the presence of the prominent granule ribonucleases, ECP and EDN. However, the demonstration that these ribonucleases are expressed by leukocytes other than eosinophils, as well as cells of non-hematopoietic origin, limits the usefulness of these assays. Two novel monoclonal antibodies recognizing eosinophil peroxidase (EPX) were used to develop an eosinophil-specific and sensitive sandwich ELISA. The sensitivity of this EPX-based ELISA was shown to be similar to that of the commercially available ELISA kits for ECP and EDN. More importantly, evidence is also presented confirming that among these granule protein detection options, EPX-based ELISA is the only eosinophil-specific assay. The utility of this high throughput assay to detect released EPX was shown in ex vivo degranulation studies with isolated human eosinophils. In addition, EPX-based ELISA was used to detect and quantify eosinophil degranulation in several in vivo patient settings, including bronchoalveolar lavage fluid obtained following segmental allergen challenge of subjects with allergic asthma, induced sputum derived from respiratory subjects following hypotonic saline inhalation, and nasal lavage of chronic rhinosinusitis patients. This unique EPX-based ELISA thus provides an eosinophil-specific assay that is sensitive, reproducible, and quantitative. In addition, this assay is adaptable to high throughput formats (e.g., automated assays utilizing microtiter plates) using the diverse patient fluid samples typically available in research and clinical settings.

Activation-induced cytidine deaminase (AID)-associated multigene signature to assess impact of AID in etiology of diseases with inflammatory component

Activation-induced cytidine deaminase (AID) is expressed in B cells within germinal centers and is critically involved in class switch recombination and somatic hypermutation of immunoglobulin loci. Functionally active AID can additionally be detected within ectopic follicular structures developed at sites of chronic inflammation. Furthermore, AID may target non-Ig genes in B- and non-B-cell background. Therefore, AID-associated effects are of increasing interest in disease areas such as allergy, inflammation, autoimmunity, and cancer.Pathway- or disease-relevant multigene signatures have attracted substantial attention for therapeutic target proposal, diagnostic tools, and monitoring of therapy response. To delineate the impact of AID in etiology of multifactorial diseases, we designed the AID-associated 25-gene signature. Chronic rhinosinusitis with nasal polyps was used as an inflammation-driven airway disease model; high levels of IgE have been previously shown to be present within polyp tissue. Expression levels of 16 genes were found to be modulated in polyps including AID, IgG and IgE mature transcripts which reflect AID activity; clustering algorithm revealed an AID-specific gene signature for the disease state with nasal polyp. Complementary, AID-positive ectopic lymphoid structures were detected within polyp tissues by in situ immunostaining. Our data demonstrate the class switch recombination and somatic hypermutation events likely taking place locally in the airways and in addition to the previously highlighted markers and/or targets as IL5 and IgE suggest novel candidate genes to be considered for treatment of nasal polyposis including among others IL13 and CD23. Thus, the algorithm presented herein including the multigene signature approach, analysis of co-regularities and creation of AID-associated functional network gives an integrated view of biological processes and might be further applied to assess role of altered AID expression in etiology of other diseases, in particular, aberrant immunity and cancer.

[The role of infection in the development of polypous rhinosinusitis in patients with bronchial asthma]

At present, many authors accept the many-factor theory of development of polypous rhinosinusitis associated with bronchial asthma according to which this condition should be regarded as an inflammatory syndrome in subjects predisposed to a specific tissue reaction. Inflammation induced by an infection is accompanied by the release of protease-inhibiting enzymes that turn inflammation into a chronic process thereby contributing to tissue disintegration, remodeling of mucous membranes, and development of polyps.

PAR-2 activation regulates IL-8 and GRO-alpha synthesis by NF-kappaB, but not RANTES, IL-6, eotaxin or TARC expression in nasal epithelium

BACKGROUND

The effects of protease-activated receptor-2 (PAR-2) stimulation on inflammation mechanisms of chronic rhinosinusitis (CRS) are still unknown.

METHODS

PAR-2 receptor expression was investigated by immunohistochemistry and Taqman mRNA analysis in the mucosa of different rhinosinusitis entities. In primary nasal epithelial cell cultures, the function of PAR-2 and its ability to produce CXC, CC chemokines, and IL-6 were measured by calcium mobilization and stimulation tests. Inhibition tests were performed using cortisone, serine protease inhibitors, cysteine protease inhibitors, Pertussis toxin (PTX) and nuclear transcription factor (NF-kappaB) inhibition (BAY 11-7085). Signal transduction pathways were analysed by electromobility shift assays (EMSA) and NF-kappaB binding studies.

RESULTS

The expression of PAR-2 was found to be increased in CRS specimens. The activation of PAR by trypsin or PAR-2-specific activating peptide (AP) caused an increase in cytosolic calcium, as well as the release of the CXC chemokines IL-8 and growth-related oncogene (GRO)-alpha, but not the release of CC chemokines or IL-6. AP-induced CXC chemokine was sensitive to PTX and activation of NF-kappaB was inhibited by BAY11-7085. Furthermore, a serine protease inhibitor significantly inhibited chemokine synthesis stimulated by trypsin and culture supernatants of staphylococci, whereas steroids and cysteine protease inhibitors had little effect.

CONCLUSION

PAR-2 plays a role in serine protease-mediated regulation - staphylococcal and non-staphylococcal origin - of IL-8 and GRO-alpha in nasal epithelial cells, but not in the regulation of CC chemokines. PAR-2 may therefore be involved in the pathophysiology of CRS and NP at different sites of activation, namely (i) proteases, (ii) the PAR-2 receptor itself or (iii) the application of novel agents that block NF-kappaB/IkappaB-alpha signalling.

Telomerase in nasal polyps

BACKGROUND

The aim of this study was to determine the presence and location of telomerase activities and the possible influence of elevated human telomerase reverse transcriptase (hTERT) mRNA levels on the outcome after surgical treatment in nasal polyposis.

METHODS

Telomerase activity in nasal polyps of 21 patients was quantified by measuring the hTERT mRNA contents with one-step real-time polymerase chain reaction. Inferior turbinates of 12 patients served as controls. Immunohistochemistry with specific antibodies was performed against hTERT. The number of hTERT marked cells was determined in 15 randomly selected fields. All patients were followed up after surgery for 60 months.

RESULTS

Elevated hTERT mRNA expression and number of hTERT+ cells was detected in nasal polyps in comparison with inferior turbinates (p < 0.001). hTERT+ cells were detected in the basal layer of the epithelia, the endothelia, and in some seromucous glands. During follow-up, it was discovered that tissue samples of five patients with recurrent polyposis did not have higher amounts of hTERT when compared with patients without relapse.

CONCLUSION

Telomerase activity is elevated in nasal polyps. Elevated hTERT expression does not predict the recurrence of nasal polyposis after surgical treatment.

Group II subfamily secretory phospholipase A2 enzymes: expression in chronic rhinosinusitis with and without nasal polyps

BACKGROUND

Group II subfamily secretory phospholipases A(2) (sPLA(2)s) are the enzymes that can play a major role in inflammation. However, the presence of group II subfamily sPLA(2)s in human sinonasal mucosa and their roles in chronic rhinosinusitis (CRS) are not well known. The purpose of this study was to investigate the expression of group II subfamily sPLA(2)s in human sinonasal mucosa from controls and CRS patients with and without nasal polyps (NPs) and the regulation of expression by proinflammatory cytokines.

METHODS

Surgical samples were investigated by means of reverse transcriptase polymerase chain reaction (RT-PCR) for evaluation of group II subfamily sPLA(2)s mRNA expression, and the presence and location of group II subfamily sPLA(2)s-positive cells were analyzed by means of immunohistochemistry. Furthermore, nasal explant culture and quantitative RT-PCR techniques were used to investigate the effect of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha on group II subfamily sPLA(2)s mRNA production in sinonasal mucosa.

RESULTS

Messenger RNA expression of sPLA(2)-IIA, -IID, and -IIE was significantly upregulated in tissues from CRS patients compared with control tissues. Among CRS patients, patients without NPs showed significantly stronger expression in sinonasal mucosa than patients with NPs of sPLA(2)-IIA mRNA, and weaker expression of sPLA(2)-IIE mRNA. Immunohistochemistry revealed enhanced protein expression of type II sPLA(2)s and specific type IIA sPLA(2) in epithelial cells and submucosal glands in samples from CRS patients. Stronger type IIA sPLA(2) protein expression was found in samples from CRS patients without NPs when compared with NPs. Nasal explant culture experiments demonstrated that mRNA expression of sPLA(2)-IIA, -IID, and -IIE was dramatically induced by IL-1beta and TNF-alpha.

CONCLUSIONS

The expression of some members of group II subfamily of sPLA(2)s is upregulated in CRS and it may result from IL-1beta and TNF-alpha overexpression. Different individual group II subfamily sPLA(2)s may play different roles in the pathogenesis of CRS with and without NPs.

Metalloproteinase function in chronic rhinosinusitis with nasal polyposis

OBJECTIVES

Chronic rhinosinusitis with nasal polyposis (CRSwNP) and asthma share characteristic inflammatory features and histopathologic findings of airway remodeling. Remodeling, which is controlled by matrix metalloproteinases (MMP), is a key event in the pathogenesis of asthma. The MMP functions have rarely been evaluated in CRSwNP.

STUDY DESIGN

Prospective and in vivo.

METHODS

MMP-7, MMP-8, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 concentrations were analyzed by enzyme-linked immunosorbent assay and their molecular forms by Western immunoblotting and gelatin zymography in 24 patients operated on for CRSwNP and in nasal lavages from 19 healthy controls. MMP function, protective or destructive, was evaluated by comparing MMP/TIMP-1 levels with the disease activity, estimated by tissue eosinophilia and a need for re-operations.

RESULTS

Significantly increased levels of MMP-8/TIMP-1 and MMP-9/TIMP-1 were found in patients without tissue eosinophilia relative to eosinophil-positive CRSwNP patients and controls, as well as in patients who did not require re-operation in comparison with re-operated patients. In eosinophil-positive and re-operated patients, these parameters were within the same range than in controls.

CONCLUSIONS

Proteolytic spectrum is different in eosinophilic and noneosinophilic CRSwNP, suggesting a new mechanism for eosinophil accumulation in the disease pathogenesis. Enhanced MMP-8 and MMP-9 expression was associated with a better prognosis/clinical outcome, and thus these results may represent a synergic, protective role of MMP-8 and MMP-9 in host response in CRSwNP. Because synthetic MMP inhibitors, capable of equilibrating the unfavorable MMP/TIMP-ratio, may be of potential therapeutic value in chronic respiratory tract diseases, the MMP functions in inflammatory conditions need to be carefully established.

Role of prostaglandin D2 and E2 terminal synthases in chronic rhinosinusitis

BACKGROUND

Prostaglandin (PG)D(2) and E(2), two major cyclooxygenase (COX) products, are generated by PGD(2) synthase (PGDS) and PGE(2) synthase (PGES), respectively, and appear to mediate airway inflammation.

OBJECTIVE

We sought to determine the role of PGDS and PGES in the pathophysiology of chronic rhinosinusitis (CRS).

METHODS

The study examined the expression of PGDS and PGES in nasal polyps of 22 CRS patients. As controls, uncinate process mucosae were obtained from 12 CRS patients not having nasal polyps and five subjects without sinusitis. Immunohistochemistry and quantitative real-time PCR were used to evaluate the expression.

RESULTS

Both PGDS and PGES were detected in nasal polyps by immunohistochemistry. Significantly greater levels of PGDS mRNA and lesser levels of PGES mRNA were observed in the nasal polyps as compared with uncinate process mucosae, and an inverse correlation between PGDS and PGES expression was observed. Levels of PGDS mRNA in nasal polyps were positively correlated with degree of infiltration by EG2+ eosinophils, whereas the levels of PGES were inversely correlated. Significantly increased levels of PGDS and conversely decreased levels of PGES were observed in asthmatics as compared with non-asthmatics. In addition, PGDS and PGES levels were positively and inversely correlated with the radiological severity of sinusitis, respectively.

CONCLUSIONS

These results suggest that PGDS and PGES display an opposite and important role in the pathophysiology of CRS such as polyp formation, and more specifically, a biased expression of these synthases might contribute to the development of CRS by affecting eosinophilic inflammation.

Increased expression of acidic mammalian chitinase in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chitin is an abundant polysaccharide found in fungi, insects, and parasitic nematodes. Innate immune host defense against chitin-containing pathogens include production of chitinases. In human lower airways, acidic mammalian chitinase (AMCase) is produced in epithelial cells via a Th2-specific, IL-13-dependent pathway, and may act as an inflammatory mediator in asthma. The role of AMCase in chronic rhinosinusitis (CRS) has not been studied previously.

METHODS

Eleven controls and 22 subjects with medically recalcitrant CRS were prospectively enrolled before undergoing endoscopic sinus surgery. RNA was extracted from surgically obtained ethmoid mucosa, and real-time PCR was used to determine expression of AMCase, eotaxin, and IL-13. Subjects were followed for at least 6 months postoperatively to assess for polyp recurrence. Based on the presence or absence of polyps, the subjects were classified as either recalcitrant or responsive to therapy.

RESULTS

AMCase mRNA was detected in the sinus mucosa of 72% of control subjects and in 72% of patients with eosinophilic CRS with nasal polyps (CRSwNP). The expression of AMCase was significantly greater in recalcitrant CRSwNP than it was in treatment-responsive CRSwNP. There was no significant difference in IL-13 expression between these two groups.

CONCLUSION

AMCase may be an important mediator in the pathogenesis of Th2 inflammatory diseases of the respiratory tract. Failure of medical and surgical therapy in CRSwNP is associated with significantly increased expression of AMCase, but not the Th2 cytokines IL-13 and eotaxin. Additional studies are needed to determine the potential of AMCase as a therapeutic target in CRSwNP.

Increased expression of matrix metalloproteinase-2 in nasal polyps

OBJECTIVE

The formation and growth of nasal polyps requires remodeling of the extracellular matrix. Matrix metalloproteinases (MMPs) are a family of endopeptidases that can collectively degrade almost all extracellular matrix components. The aim of this study was to investigate the role of MMPs in nasal polyps.

MATERIAL AND METHODS

The expression of MMP-2 and -9 was investigated in the nasal polyps of 20 patients undergoing endonasal sinus surgery and compared with that in control nasal mucosal samples obtained from 20 non-allergic hypertrophic rhinitis patients. Tissue samples were either homogenized for reverse transcriptase polymerase chain reaction analysis or frozen for immunohistochemistry.

RESULTS

MMP-2 mRNA expression was observed only in the nasal polyp samples and not in the control tissues. MMP-9 mRNA was not expressed in either type of tissue. Similarly, MMP-2 expression was observed in the nasal polyps of chronic sinusitis patients but not in the inferior turbinate mucosa of the control subjects. MMP-2 positivity was present in basal cells in the surface epithelium and in infiltrating cells in subepithelial tissues. MMP-9-positive cells were not observed in either nasal polyps or inferior turbinates. These results suggest that MMP-2 expression is characteristic of nasal polyps.

CONCLUSION

MMP-2 may play a role in the remodeling of nasal polyps.

Lysozyme levels in the nasal secretions of patients with perennial allergic rhinitis and recurrent sinusitis

BACKGROUND

The association of perennial allergic rhinitis (PAR) with recurrent sinusitis (RS) is well recognized. Anatomic abnormalities at the osteomeatal complex or ciliary dysfunction may play a significant role in some patients. However, for most patients with allergy, the determinants of RS are unknown.

OBJECTIVE

To determine whether altered concentrations of antimicrobial peptides and proteins, such as lysozyme, lactoferrin, human beta-defensin-2 (HBD-2), and human neutrophil peptides 1 to 3 (HNP-1 to 3), contribute to the development of RS in patients with PAR.

METHODS

Nasal secretions were collected by vacuum aspiration from 15 individuals with PAR+RS, 16 with PAR alone, and 16 controls. Lysozyme and lactoferrin levels were determined in nasal secretions by using quantitative enzyme-linked immunosorbent assay, and HBD-2 and HNP-1 to 3 levels were determined in nasal secretions by using semiquantitative Western blot analysis. Eosinophil-derived neurotoxin (EDN) levels were measured by using enzyme-linked immunosorbent assay as a marker of nasal eosinophilia in all 3 groups.

RESULTS

Levels of EDN were elevated significantly in patients with PAR+RS compared with controls. Lysozyme levels were decreased significantly in patients with PAR+RS compared with PAR alone or controls. Mean lysozyme levels were significantly lower in patients with EDN levels greater than 1,000 ng/mL vs those with levels of 1,000 ng/mL or less in the PAR+RS group. There were no statistically significant differences in lactoferrin, HBD-2, and HNP-1 to 3 levels among the 3 groups.

CONCLUSIONS

The presence of eosinophils and their products and reduced lysozyme concentrations may be critical factors that predispose the airways of patients with PAR to RS.

[Expression of inducible nitric oxide synthase in allergic fungal rhinosinusitis]

OBJECTIVE

To investigate the expression of inducible nitric oxide synthase(iNOS) in the mucus involved in allergic fungal rhinosinusitis(AFRS) and chronic sinusitis(CRS).

METHOD

The iNOS expression was examined using immunohistochemistry in cases of AFRS as well as CRS.

RESULT

The expression rate of iNOS in AFRS was significantly higher than in CRS.

CONCLUSION

The increased expression of iNOS may involve in AFRS pathogenesis. Statistical difference between AFRS and CRS groups may indicate two groups may be distinct diseases entity.

[Evaluation of microorganisms ability to beta-lactamase production in exacerbation of chronic sinusitis treated with beta-lactam antibiotics]

In our study the ability of the isolated microorganisms to produce beta-lactamase was determined. These microorganisms were isolated from sinus punctures of 115 patients before (evaluation I) and after the treatment finished (evaluation III). During first evaluation 93 microorganisms with potential ability to beta-lactamase production were isolated. 24 of them (25.81%) produced beta-lactamase, 69 (74.19%) didn't do it. 57 patients were qualified for amixycillin with potassium clavulanate treatment (subgroup A) and 58 patients for cefuroxime axetil treatment (subgroup B). After the treatment (evaluation III) in the group of 21 isolated microorganisms 6 produced beta-lactamase. The microorganisms producing beta-lactamase were isolated only from the patients where the amoxycillin with potassium clavulanate was administered.

Hydrocephalus, situs inversus, chronic sinusitis, and male infertility in DNA polymerase lambda-deficient mice: possible implication for the pathogenesis of immotile cilia syndrome

A growing number of DNA polymerases have been identified, although their physiological function and relation to human disease remain mostly unknown. DNA polymerase lambda (Pol lambda; also known as Pol beta2) has recently been identified as a member of the X family of DNA polymerases and shares 32% amino acid sequence identity with DNA Pol beta within the polymerase domain. With the use of homologous recombination, we generated Pol lambda(-/-) mice. Pol lambda(-/-) mice develop hydrocephalus with marked dilation of the lateral ventricles and exhibit a high rate of mortality after birth, although embryonic development appears normal. Pol lambda(-/-) mice also show situs inversus totalis and chronic suppurative sinusitis. The surviving male, but not female, Pol lambda(-/-) mice are sterile as a result of spermatozoal immobility. Microinjection of sperm from male Pol lambda(-/-) mice into oocytes gives rise to normal offspring, suggesting that the meiotic process is not impaired. Ultrastructural analysis reveals that inner dynein arms of cilia from both the ependymal cell layer and respiratory epithelium are defective, which may underlie the pathogenesis of hydrocephalus, situs inversus totalis, chronic sinusitis, and male infertility. Sensitivity of Pol lambda(-/-) cells to various kinds of DNA damage is indistinguishable from that of Pol lambda(+/+) cells. Collectively, Pol lambda(-/-) mice may provide a useful model for clarifying the pathogenesis of immotile cilia syndrome.

[Study of the enzyme peptidyl peptidase IV in nasal mucosa]

INTRODUCTION

The endothelial serine protease dipeptidyl peptidase IV (DPP IV) cleaves the tyrosin-prolin dipeptide of several inflammatory mediators and neuropeptides, including neuropeptide Y (NPY), yielding the endogenous Y2-receptor agonist NPY (3-36) which modulates sensory and parasympathetic nerve activity. The aims of the study were to investigate the localisation of DPP IV in human nasal mucosa and to measure in vitro activity of DPP IV in nasal mucosa biopsies from patients suffering from chronic rhinosinusitis.

PATIENTS AND METHODS

Using immunohistochemistry we have studied the localisation of DPP IV in human nasal biopsies. The activity of DPP IV was measured in vitro in nasal mucosa samples obtained from 45 patients suffering from chronic rhinosinusitis and compared with the density of inflammatory cell infiltration.

RESULTS

Positive immunoreactivity for DPP IV was observed in the human nasal mucosa. Low activity of DPP IV was associated with high density of inflammatory cells in the mucosa of patients suffering from chronic rhinosinusitis. The regressive correlation was statistically significant (p < 0.001).

CONCLUSION

Low level DPP IV activity is associated with inflammation of the nasal mucosa. This enzyme may be involved in the pathophysiological mechanism of nasal hyperreactivity and chronic rhinosinusitis.

Urokinase-type plasminogen activator and plasminogen activator inhibitor antigen in tissue extracts of paranasal sinus mucous membranes affected by chronic sinusitis and antrochoanal polyps

We examined the effect of pH on the extraction of urokinase-type plasminogen activator (u-PA) and plasminogen activator inhibitor-1 (PAI-1) from paranasal sinus mucous membrane associated with chronic sinusitis and antrochoanal polyps. The specific activity of u-PA extracted with buffer at pH 7.4 was stronger than that extracted with buffer at pH 4.2. The antigen level of u-PA extracted with the acidic buffer was significantly higher than that extracted with the neutral buffer. In contrast, the difference in antigen levels of PAI-1 extracted with the acidic buffer and neutral buffer was not significant. Based on these results, we inferred that the u-PA-PAI-1 complex was extracted by the acidic buffer and the activity of u-PA was therefore decreased.

IgG antibody levels in the sinus, ear, and airway in a rabbit model of sinusitis with Bacteroides

OBJECTIVE

To evaluate distribution of IgG antibodies (Ab) in the airway, ear, and sinuses in association with inflammatory changes in a rabbit sinusitis model.

DESIGN

We measured IgG Ab and lactate dehydrogenase levels in solutions from sinus, airway, and middle ear lavage and in serum, and determined interferon y messenger RNA expression in sinus and ear mucosa at 1, 2, 3, and 4 weeks after inoculation with Bacteroides fragilis.

SUBJECTS

Six rabbits at each time point; controls were untreated (n=5) and sham-operated rabbits at 2 and 4 weeks (n=4-5).

INTERVENTION

Bacteroides fragilis was inoculated into the left maxillary sinus with ostium closed.

RESULTS

IgG Ab was undetectable in all controls. IgG Ab (>50 microg/g protein) was present at 2, 3, and 4 weeks in most bilateral sinus lavage samples and in 2 of 6, 5 of 6, and 6 of 10 ear lavage samples at 2, 3, and 4 weeks, respectively, following inoculation. Inflammatory changes (histological and lactate dehydrogenase) were much greater in the inflamed sinus. IgG Ab (>50 microg/g protein) was also detected in most bronchoalveolar lavage samples after 2 weeks. Interferon gamma mRNA was undetectable in all untreated and most sham-operated controls but was detected in the bilateral sinus mucosa at 1 to 2 weeks, and remained detectable up to 4 weeks in most rabbits. Serum IgG Ab levels positively correlated with those in lavage samples, with highest correlation with right sinus lavage IgG Ab levels (r=0.56, P<.001).

CONCLUSION

IgG Ab levels in the upper airway mucosa likely increase within 2 weeks following bacterial inoculation as a part of mucosal immune responses independent of tissue necrosis.

Expression of cyclo-oxygenase 1 and 2 proteins in upper respiratory mucosa

BACKGROUND

Cyclo-oxygenases 1 (Cox-1) and 2 (Cox-2) catalyse the conversion of arachidonic acid to prostaglandin endoperoxides, leading to the formation of prostaglandin and thromboxane mediators of inflammation. The involvement of these enzymes in inflammatory disorders such as sinusitis and nasal polyps is unknown although this may be relevant to their pathophysiology.

METHODS

We studied Cox-1 and Cox-2 immunoreactivities in nasal polyp, maxillary sinus, and turbinate biopsies obtained from eight patients with chronic allergic rhinitis and sinusitis and/or nasal polyps, 15 patients with chronic non-allergic rhinitis and sinusitis and/or nasal polyps and five control subjects (patients requiring nose surgery not related to sinusitis or nasal polyps).

RESULTS

Both Cox- and Cox-2 were mainly expressed in the epithelium (basal, ciliated) and were found in 16/28 and 25/28 subjects for Cox-1 and Cox-2 respectively. We did not find any differences between the patient populations. There were no correlations between any of the clinical parameters studied nor the pathological patterns and the presence and characteristics of the Cox immunoreactivities.

CONCLUSION

Both cyclo-oxygenase enzymes are expressed in normal human upper respiratory epithelium and are not upregulated in chronic sinusitis nor in nasal polyposis, possibly suggesting that Cox products do not have an important role as mediators of the chronic upper airway inflammation.

Myeloperoxidase and interleukin-8 levels in chronic sinusitis

We have recently phenotyped inflammation in non-infectious allergic and non-allergic chronic maxillary sinusitis using sinus biopsies and lavage fluids. In this first paper, we have concentrated our work on the eosinophil, T cell, mast cell and macrophage infiltrates. However, many unresolved questions remain and particularly the role of neutrophils needed to be addressed. In the present study, we focused on the neutrophilic inflammation: myeloperoxidase (MPO) and interleukin-8 (IL-8) were measured by immunoassays and neutrophils were enumerated by conventional staining in the sinus lavage fluids of 16 patients with chronic sinusitis and six control subjects. Both MPO and IL-8 levels were significantly higher in patients than in controls (P < 0.01 and 0.005, respectively). There was a significant correlation between MPO levels and neutrophil numbers, and between MPO and IL-8 levels in the sinus lavage fluid (P < 0.0001, Spearman rank correlation). The presence of high levels of IL-8 in the lavage fluids of patients suffering from chronic sinusitis, levels which correlate with those of MPO, suggests that this cytokine may activate neutrophils in this chronic disease.

Neutrophil elastase and its complex with alpha 1-antitrypsin in soluble and insoluble fractions of nasal secretions of chronic sinusitis

Immunoreactive neutrophil elastase (NE) and its complex with alpha 1-antitrypsin (AT) was measured by double antibody enzyme linked immunosorbent assay (ELISA) in nasal secretions of chronic sinusitis (CS). Nasal secretions were separated into two fractions: PBS-soluble and insoluble fractions. Elastolytic activity was also examined. Mean value of total NE level was 31.0 micrograms/ml in the soluble fraction, which was significantly lower than that in the insoluble fraction (71.9 micrograms/ml, p less than 0.01). On the other hand, the percentage of complexed NE in total NE in the soluble fraction (33.7%) was significantly higher than that in the insoluble fraction (12.1%, p less than 0.01). Elastolytic activity in the soluble fraction (23.4 RFU) was significantly lower than that in the insoluble fraction (170.5 RFU, p less than 0.01). NE with elastolytic activity exists in nasal secretions of CS, and active-free NE in the insoluble fraction could be a major source of enhancement and continuation of mucosal inflammation.

ELISA for determination of immunoreactive free elastase and elastase in complex with alpha 1-antitrypsin in nasal secretions with sinusitis

Sensitive double antibody sandwich ELISA methods was developed in order to quantify immunoreactive neutrophil elastase (NE) levels in nasal secretions with chronic sinusitis (CS). Microwell plate as a solid phase was coated with anti-NE antibody. Two different horseradish peroxidase (HRP) labelled antibodies used as the second antibody were anti-NE-HRP for measuring total (free + complexed) NE level and anti-alpha 1-antitrypsin (AT)-HRP for complexed NE level. Mean value of total NE was 31.0 +/- 20.7 micrograms/ml in nasal secretions from adult patients with CS, and the percentage of complexed NE in total NE was 33.7 +/- 21.4%. This sandwich ELISA is a useful method for measuring both total and complexed NE levels in nasal secretions.

Na/K-ATPase in rabbit paranasal sinus mucosa during induced sinusitis

Sinusitis was produced in rabbits, after which animals were separated into three groups: allergic sinusitis, induced purulent sinusitis, and spontaneous purulent sinusitis. Mucosal specimens were taken from these animals and normal controls. Na/K-ATPase was localized cytochemically and its activity studied in order to define the energy metabolism of secretion. The Na/K-ATPase reaction was unable to be clearly distinguished in either the allergic sinusitis specimens or the normal mucosa. In both purulent sinusitis groups, an intensive reaction was observed in the subepithelial glands and a weak reaction was found in the goblet cells. The Na/K-ATPase activity in the purulent sinusitis groups was significantly higher than that in the normal control group. The increased Na/K-ATPase activity may be an affect of hyperactivity of the secretory cells.

Lysosomal proteases and protease inhibitors in nasal allergy and non-atopic sinusitis

Patterns of protease activity and levels of protease inhibitors were analyzed in both nasal secretions and tissue extracts from patients with nasal allergy and non-atopic sinusitis to investigate the role of proteases in the inflammatory reaction. Protease activity was measured using specific methyl-coumaryl-7-amide substrates. The pattern of protease activity in the nasal secretions of chronic sinusitis patients was similar to that in neutrophil lysate and quite different from that in plasma. Both gluthatione activation testing and inhibition testing using synthetic inhibitors revealed that the majority of proteases in both secretions and tissues are lysosomal thiol proteases such as cathepsins B and L. Neutrophilic elastase is also a major protease in nasal secretions. In acute sinusitis, both protease activity and inhibitor levels were very high, suggesting an interaction between proteases and inhibitors. Cathepsin B and B-like thiol proteases appear to play a key role in prolonging chronic inflammation against the healing process, due to their resistance to plasma inhibitors and the shortage of thiol protease inhibitors. Protease activity in the secretions of nasal allergy patients was very weak, and the reaction between proteases and inhibitors appeared to be weak.

[A study on collagenase production of nasal polyp-derived fibroblasts stimulated by nasal secretions of chronic sinusitis]

The collagenase produced by mesenchymal cells has been thought to have a great importance in the pathophysiology of connective tissue metabolism and prolongation of chronic inflammation. The factors, such as IL-1 and PMN factor, released by inflammatory cells have been known to induce mesenchymal cells to produce collagenase. In the present study, the collagenase activity of the nasal secretions were estimated using FITC-labelled collagens as substrates. The factor, enhancing the fibroblasts to produce collagenase, was also isolated from nasal secretions and partially characterized. The fibroblasts used in the present study were cultured with explant of the sections of nasal polyp obtained from a patient with chronic sinusitis. The collagenase activity in nasal secretions from patients with chronic sinusitis was high, whereas that of allergic nasal secretions was extremely low. Furthermore, the collagenase productions of nasal polyp-derived fibroblasts were enhanced by the extracts of nasal secretions from patients with chronic sinusitis. Crude extracts of nasal secretions were fractionated by ammonium sulfate precipitation. The active materials precipitated by 50% to 80% ammonium sulfate were further purified by Sephadex G-75 gel chromatography. The molecular weight determination of the active fraction checked by HPLC utilizing for TSK 2,000 SW gel column indicates 20,000 daltons for the active materials. However, the collagenase production of human microvascular endothelial cells derived from nasal mucosa was not enhanced by this factor. Although either the origin or the nature was not confirmed, the factor was considered to relate to the prolongation of chronic inflammation in the nasal and paranasal sinus pathology. Analysis of these factors will expected to establish methods for new therapeutics in chronic inflammation.

A protease inhibitor from human allergic nasal secretions

Protease and antiprotease activities were estimated in nasal secretions from patients with chronic sinusitis and nasal allergy, using [3H]-casein as substrate. In the purulent nasal secretions, strong protease activity was measured, but there was less activity in the allergic nasal secretions. In contrast, trypsin inhibitory activity in allergic nasal secretions was much higher than in nasal secretions from the patients with chronic sinusitis. A protease inhibitor was partially isolated from nasal secretions of the nasal allergic patients by Sephadex G-150 gel chromatography and characterized. This protease inhibitor has an apparent molecular weight of 10,000 D, determined by SDS-polyacrylamidegel electrophoresis. It depresses the activities of bovine pancreatic trypsin, bovine pancreatic chymotrypsin and proteases in nasal purulent secretions, whereas it does not inhibit porcine pancreatic elastase, papain, or human plasmin.

Significance of lysosomal proteases; cathepsins B and H in maxillary mucosa and nasal polyp with non-atopic chronic inflammation

Tissue extracts from maxillary mucosa (MM) and nasal polyp (NP) with non-atopic chronic inflammation were applied to DEAE-Sepharose, and hydrolytic activity of lysosomal proteases (cathepsins B and H) was measured by the fluorometric assay. Hydrolytic activity of cathepsins B and H in MM, of which cathepsin B was a major one, was about 3.5 times as high as that in NP. Protein composition resembled in both extracts except for several apparent protein bands with high molecular weight observed in NP. These results suggest that in MM with chronic inflammation, mucosal destruction induced by excess lysosomal granuloproteases overwhelming protease inhibitors would occur, being much related to the formation of its irreversible lesion.

[Clinical relevance of protease inhibitors in nasal secretions]

The normal human nasal mucous membrane is protected against negative effects of proteases by special inhibitors. This inhibitor pool consists of both secretory-specific and humoral inhibitors. A method is presented to determine the function of protease inhibitors in nasal secretion. Investigations have been carried out on secretions of healthy subjects, as well as patients suffering from sinusitis. The differences are illustrated. The results enable an evaluation of the degree of infection; the course of the disease can be documented. A possibility of producing synthetic inhibitors for therapy is discussed.

Antileukoprotease in patients with maxillary sinusitis

Antileukoprotease, an inhibitor of leukocyte elastase, was studied in paired sera from 12 patients with maxillary sinusitis. The serum concentration of antileukoprotease was increased at the day of admission to hospital, compared with the serum concentration in convalescence sera. In purulent maxillary sinus secretions antileukoprotease was found in complex with leukocyte elastase, as shown by gel filtration. The findings suggest a local protective function of antileukoprotease in maxillary sinus.

Purification and characterization of tissue-type plasminogen activator in maxillary mucosa with chronic inflammation

Tissue-type plasminogen activator (TPA) was purified from maxillary mucosa with chronic inflammation and compared with urokinase. Purification procedure consisted of the extraction from delipidated mucosa with 0.3M potassium acetate buffer (pH 4.2), 66% saturation of ammonium sulfate, zinc chelate-Sepharose, concanavalin A-Sepharose and Sephadex G-100 gel filtration chromatographies. The molecular weight of the TPA was approximately 58,000 +/- 3,000. Its activity was enhanced in the presence of fibrin and was quenched by placental urokinase inhibitor, but not quenched by anti-urokinase antibody. The TPA made no precipitin line against anti-urokinase antibody, while urokinase did. All these findings indicate that the TPA in maxillary mucosa with chronic inflammation is immunologically dissimilar to urokinase and in its affinity for fibrin.

The role of fibrinolytic enzymes in inflammation and paranasal mucous membrane

The distribution and role of tissue plasminogen activator (TA) and proactivator (PA) in various diseases of the nasal and paranasal cavity were investigated. The stronger the inflammatory and proliferative response of the paranasal mucous membrane, the weaker was the fibrinolytic activity of TA. The fibrinolytic activity of PA tended to be stronger than TA activity. It is considered that PA may play an important role in inflammatory enlargement and proliferation of the paranasal mucous membrane, but does not play an important role in carcinogenic enlargement and proliferation of the nasal and paranasal mucous membrane.

Granulocyte proteases in human maxillary sinus secretions

Retained maxillary sinus secretions from 10 consecutive patients suffering from maxillary sinusitis were studied with regard to proteolytic activity and its possible sources. All secretions were proteolytically active. In 3 purulent secretions the proteolytic activity was of the same magnitude as that of a standard with an excess of pancreatic trypsin. The enzymes responsible for the proteolytical activity were found to be mainly of granulocyte origin, neutrophil elastase, unspecific collagenase and chymotrypsin-like cationic protein (CCP).

Differentiation of proactivator from tissue plasminogen activator with low molecular weight in the paranasal mucous membrane

It has been shown that large amounts of fibrinolytic enzyme are contained in tissue extracts of the paranasal mucous membrane in patients with chronic sinusitis. However, the fibrinolytic enzyme in the tissue extracts has not yet been characterized by biochemical techniques. In the present study, proactivator was differentiated from tissue plasminogen activator with low molecular weight in extracts of the paranasal mucous membrane and the existence of the proactivator was thus demonstrated in tissue extracts. By analogy with the proactivator in antrochoanal polyps, this proactivator may play an important role in the proliferation and enlargement of the paranasal mucous membrane.

Pathogenesis of sinus empyema

The crucial event in the pathogenesis of sinus empyema is the ostial obstruction. On the basis of recent reports, some consequences of the obstruction on the local bacterial-host interrelationship have been outlined. The anaerobic gas environment of the empyema is one quality important to the selection of bacteria but probably also to the efficiency of the antibacterial activity of the granulocytes. Release of proteolytic enzymes from neutrophilic granulocytes in the sealed sinus may jeopardize the bacterial engulfment due to proteolytic degradation of opsonins. A longstanding exposure of the sinus mucosa to uninhibited proteolytic enzymes may explain the irreversible lesion of the mucosa in chronic sinusitis.

Prolidase deficiency: report of a second case with quantitation of the excessively excreted amino acids

The second documented case of prolidase deficiency is presented. Clinical manifestations include chronic otitis media and sinusitis, dermatitis, and splenomegaly. Prolidase is undetectable in the white blood cells of the patient and near or less than the lower range of normal in each parent. The peptide chromatographic pattern of the urine is similar to that of the previously reported patient with prolidase deficiency. The quantity of amino acids excreted in urine per 24 hours is at least three times that of the upper range of normal (of these same amino acids) for the patients age group. More than 80% of the total amino acids excreted are in peptide form. The proline-to-hydroxyproline ratio suggests that the dipeptides are the catabolic products of other proteins in addition to collagen.