Department of Medicine, Baylor College of Medicine, Houston, Tex.
Department of Otolaryngology-Head and Neck Surgery, Konkuk University, Chungju Hospital, Chungbuk, Korea.
J Allergy Clin Immunol. 2014 Aug;134(2):325-31. doi: 10.1016/j.jaci.2014.04.028. Epub 2014 Jun 11.
Environmental fungi have been linked to TH2 cell-related airway inflammation and the TH2-associated chronic airway diseases asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown.
To determine the frequency of fungus isolation and fungus-specific immunity in patients with TH2-associated and non-TH2-associated airway disease.
Sinus lavage fluid and blood were collected from sinus surgery patients (n = 118) including patients with CRSwNP, patients with CRS without nasal polyps, patients with AFRS, and non-CRS/nonasthmatic control patients. Asthma status was determined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. PBMCs were restimulated with fungal antigens in an enzyme-linked immunocell spot assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared with fungus-specific IgE levels measured from plasma by ELISA.
Filamentous fungi were significantly more commonly cultured in patients with TH2-associated airway disease (asthma, CRSwNP, or AFRS: n = 68) than in control patients with non-TH2-associated disease (n = 31): 74% vs 16%, respectively (P < .001). Both fungus-specific IL-4 enzyme-linked immunocell spot (n = 48) and specific IgE (n = 70) data correlated with TH2-associated diseases (sensitivity 73% and specificity 100% vs 50% and 77%, respectively).
The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with TH2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients.
环境真菌与 TH2 细胞相关的气道炎症以及与 TH2 相关的慢性气道疾病（如哮喘、慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）和变应性真菌性鼻-鼻窦炎（AFRS））有关，但这些生物体是否直接或间接参与疾病发病机制尚不清楚。
确定与 TH2 相关和非 TH2 相关气道疾病患者中真菌分离和真菌特异性免疫的频率。
从鼻窦手术患者（n=118）中采集鼻窦灌洗液和血液，包括 CRSwNP 患者、无鼻息肉的 CRS 患者、AFRS 患者和非 CRS/非哮喘对照患者。哮喘状态由病史确定。对鼻窦灌洗液进行培养，并直接检查是否存在有活力的真菌。用酶联免疫斑点法检测真菌抗原刺激 PBMC 后总记忆真菌特异性 IL-4 分泌细胞。将这些数据与通过 ELISA 从血浆中测量的真菌特异性 IgE 水平进行比较。
在与 TH2 相关的气道疾病（哮喘、CRSwNP 或 AFRS：n=68）患者中，丝状真菌的培养明显更为常见，而非与 TH2 相关疾病（n=31）的对照患者：分别为 74%和 16%（P<.001）。真菌特异性 IL-4 酶联免疫斑点（n=48）和特异性 IgE（n=70）数据均与 TH2 相关疾病相关（敏感性分别为 73%和 100%，特异性分别为 50%和 77%）。
在与 TH2 相关的慢性气道疾病患者中，频繁分离出直接在气道内生长的真菌，并对这些生物体产生特异性免疫，这表明真菌直接参与了这些疾病的发病机制。应考虑在选定的患者中从气道中清除气道真菌。
