Changes And Clincal Significance Of MDSCs And Tfh Cells In Chronic Rhinosinusitis With Nasal Polyps

Background:Chronic Sinusitis with Nasal Polyps(CRSw NP)is a common disease in otorhinolaryngology head and neck surgery.The most significant pathological feature is a chronic inflammation of the mucosa dominated by Th2 cells with massive infiltration of inflammatory cells(about 20% of the cells are eosinophils).The main treatment measures include topical or systemic glucocorticoids and functional endoscopic surgery.However,due to the lack of thorough research on the pathogenic mechanism of CRSw NP,the rate of symptom recurrence or n eed for repeated surgery after medical or surgical treatment is estimated to be as high as 30% to 50%.It can be said that the prevalence of CRSw NP is increasing year by year,and there are more and more refractory cases,and it has increasingly become an important factor that threatens the life and health of Chinese people.Through extensive literature reading,we found that myeloid-derived suppressor cells(MDSCs)and follicular helper T cells(Tfh)play a pathogenic role in upper airway inflammatory diseases such as asthma,According to th e inference of “same airway,same disease”,we speculate that MDSCs and Tfh cells may play a role in the pathogenic mechanism of CRSw NP.Purpose:The percentages,subtypes and related functional molecules of MDSCs and Tfh were observed in CRSw NP to explore the possible clinical significance and provide new ideas for th e study of the pathogenesis of CRSw NP and targeted therapy.Method:1.Using flow cytometry to detect 45 patients with CRSw NP who were admitted to the Department of Otolaryngology and Head and Neck Surgery,People’s Hospital Affiliated to Jiangsu University from May 2020 to October 2021,and 57 healthy subjects without CRSw NP were determined by plain thin-section CT scan of the sinuses.Among them,30 CRSw NP patients and 36 healthy controls underwent MDSCs-related research;15 CRSw NP patients and 21 healthy controls underwent Tfh cells-related research.The gender,age(no statistical difference),and preoperative Lund-Mackay CT score of the patients were counted,and perip heral blood was collected from all participants.2.Detect the percentage of total MDSCs,PMN-MDSCs,M-MDSCs and expression of functional molecule arginase 1(ARG-1)in peripheral blood of CRSw NP group and control group by flow cytometry.3.Using flow cytometry to detect the percentage of total Tfh,Tfh1,Tfh2 and Tfh17 in peripheral blood of CRSw NP group and control group.3.Using enzyme-linked immunosorbent assay(ELISA)to detect the concentrations of IL-6,IL-21 and Ig E in the plasma of CRSw NP group and control group.4.To analyze the correlation between IL-6,ARG-1 and MDSCs;the correlation between MDSCs,Tfh cells,IL-6,ARG-1,IL-21,Ig E and Lund-Mackay CT score.Result:1.Compared with the control group,the proportion of total MDSCs in peripheral blood of CRSw NP patients was significantly increased(P<0.01),and the proportion of PMN-MD SCs in the CRSw NP group was significantly increased(P<0.05),while the proportion of MMDSCs was decreased(P<0.05).The mean fluorescence intensity of ARG-1 in total MDS Cs in CRSw NP group increased(P<0.05).2.Compared with the control group,the total Tfh cells and Tfh1 cells in peripheral blood of CRSw NP patients had no significant changes(P>0.05),while the proportions of Tfh2 cells and Tfh17 cells decreased(P<0.05).3.Compared with the control group,the plasma levels of IL-6,IL-21 and Ig E in CRS w NP patients were significantly increased(P<0.05).4.In the MDSCs group,there was a significant negative correlation between the proportion of total MDSCs in the peripheral blood of CRSw NP patients and the Lund-Mackay score(P<0.05),and there was no significant correlation between PMN-MDSCs,M-MDSCs and the Lund-Mackay score(P>0.05).There was a significant positive correlation between the proportion of total MDSCs and IL-6 concentration(P<0.01),and there was a significant positive correlation between the proportion of PMN-MDSCs and IL-6 concentration(P<0.05).H owever,there was no correlation between M-MDSCs and IL-6 concentration(P>0.05).There was a significant positive correlation between total MDSCs and ARG-1(P<0.01),but there was no significant correlation between PMN-MDSCs,M-MDSCs and ARG-1(P>0.05).The re was a significant negative correlation between ARG-1 and Lund-Mackay score(P<0.01).There was a significant negative correlation between IL-6 concentration and Lund-Mackay s core(P<0.01).5.In the Tfh group,there was no significant correlation between the proportions of tota l Tfh,Tfh1,Tfh2 and Tfh17 in peripheral blood of CRSw NP patients and the Lund-Mackay score(P>0.05).There was a significant positive correlation between IL-21 and Lund-Mackay score(P<0.01),and there was a significant positive correlation between IgE and Lund-Ma ckay score(P<0.05).Conclusion:MDSCs and their related functional molecules ARG-1 and IL-6 in peripheral blood of CRSw NP patients were all increased,and the concentrations of Tfh-related cytokines IL-21 and Ig E were also significantly increased.And there is a significant correlation between the m and the severity of the disease,so it is speculated that MDSCs and Tfh cells may be closely related to the occurrence of CRSw NP.