Clinical features of cytotoxic CD8+ T-lymphocyte deficiency in chronic rhinosinusitis patients: a demographic and functional study

Authors

  • Nathalie Gabra,

    1. Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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    • N.G. and S.A. contributed equally to this work.

  • Saud Alromaih MD,

    1. Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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    • N.G. and S.A. contributed equally to this work.

  • Leandra Mfuna Endam MSc,

    1. Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
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  • Rose Marie Brito MSc,

    1. Centre Hospitalier Universitaire (CHU) Sainte-Justine, Research Center, Montreal, Quebec, Canada
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  • Françoise Larivière MD, FRCPC,

    1. Department of Biochemistry, Centre Hospitalier de l’Université de Montréal (CHUM)
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  • Sawsan Al-Mot MSc,

    1. Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
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  • Françoise LeDeist MD, PhD,

    1. Centre Hospitalier Universitaire (CHU) Sainte-Justine, Research Center, Montreal, Quebec, Canada
    2. Department of Microbiology, Infectiology, and Immunology, University of Montreal, Montreal, Quebec, Canada
    3. Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
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  • Martin Desrosiers MD, FRCSC

    Corresponding author
    1. Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
    2. Centre Hospitalier Universitaire (CHU) Sainte-Justine, Research Center, Montreal, Quebec, Canada
    3. Department of Microbiology, Infectiology, and Immunology, University of Montreal, Montreal, Quebec, Canada
    4. Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
    5. Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
    6. Department of Biochemistry, Centre Hospitalier de l’Université de Montréal (CHUM)
    • Correspondence to: Martin Desrosiers, MD, FRCSC, Centre Hospitalier de l’Université de Montréal, Hôtel-Dieu, Pavillon Marie-Morin, local 4-423, 3840 rue St Urbain, Montréal, Québec H2W 1T8, Canada; e-mail: desrosiers_martin@hotmail.com

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  • Potential conflict of interest: None provided.

Abstract

Background

Identification of Staphylococcus aureus intracellularly in chronic rhinosinusitis (CRS) suggests an underlying cellular immunodeficiency. Supporting this, we have previously reported low CD8+ (cytotoxic) T-lymphocyte levels in a subpopulation of CRS patients and identified polymorphisms in the CD8A gene associated with CRS. In order to better understand the role of low CD8+ in CRS, we wished to determine the phenotype for CRS/Low CD8+ in comparison to that of conventional CRS.

Methods

Sixty-seven low CD8+ CRS patients identified during investigation of CRS were compared for demographics, disease evolution, and bacteriology on endoscopic culture were compared with an existing population of 480 patients with CRS with nasal polyposis previously recruited for genetic association studies.

Results

Mean level of CD8+ in the CRS/Low CD8+ population was 0.15 × 109/L (range, 0.20–1.5 × 109/L). There was no difference between both groups in terms of history of allergy, asthma, eczema, acetylsalicylic acid (ASA) intolerance or smoking. The bacteriology was similar between both groups (S. aureus: CRS/Low CD8+: 35%; CRS 32%, p = 0.643). Evolution of disease was somewhat milder in CRS/Low CD8+, with fewer patients requiring surgery, and first surgery performed at a more advanced age. However, antibiotic use was higher in CRS/Low CD8+. Subgroup analysis restricted to CRS with nasal polyposis (CRSwNP)/Low CD8 or CRS without nasal polyposis (CRSsNP)/Low CD8 phenotypes did not substantially alter these results.

Conclusion

Low CD8+ levels are often identified in CRS patients; however, these patients have disease remarkably similar to those with conventional CRS. This suggests that immune deficiency, whether systemic or locally mediated, is well tolerated and may be present in other forms in CRS. CRS patients with low CD8+ levels may possibly require antibacterial therapies as part of ongoing management.

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