Expression And Significance Of TLR2 And TLR4 In Fungal Ball Rhinosinusitis

Background The incidence of sinus fungal infections is gradually increasing,and the pathogenesis is not fully understood.The clinical fungal ball type is as high as 95%-98% or more,which may be related to prolonged use of antibiotics,poor ventilation,dark and humid environment,and low immune function.When the immune system is damaged,fungal infections of the nasal cavity and sinuses are prone to occur.Therefore,the body's autoimmune and nasal defense functions are particularly important.Toll-like receptors(TLRs)have attracted much attention in the immune defense of nasal cavity and sinus mucosa.With continuous research on Toll-like receptors,it can be used as a new type of promising immunotherapy target.Objective To study the clinical and pathological features of fungal ball rhinosinusitis(fungal ball,FB)and chronic rhinosinusitis(CRS).And the expression characteristics of Toll-like receptor 2(TLR2)and Toll-like receptor 4(TLR4)in both and normal sinus mucosa.By studying the expression characteristics of TLR2 and TLR4 in fungal ball sinusitis,further elucidating its role in the pathogenesis,and providing a new type of immunotherapy possibility for the clinic.Methods Tissue specimens of surgical patients admitted from October 2017 to October 2019 were collected from 30 cases of fungal ball sinusitis and sinus mucosa,30 cases of chronic sinusitis and 20 cases of normal sinus mucosa.Patients with fungal ball sinusitis and chronic sinusitis were evaluated with SNOTT-22 score,Lund-Kennedy score, Lund-Mackey score,and the morphology of sinus mucosa was observed by HE staining.The expression levels of TLR2 and TLR4 in the sinus mucosa of the three groups were detected by immunohistochemistry and western blotting.Results1 Fungal ball sinusitis and chronic sinusitis patients with SNOTT-22 score,Lund-Kennedy score,Lund-Mackey score There were no significant differences in SNOTT-22 scores and Lund-Kennedy scores between fungal ball sinusitis and chronic sinusitis(P> 0.05),but there were statistically significant differences in Lund-Mackey scores(P <0.05).2 Sinus mucosal morphology of fungal ball sinusitis and chronic sinusitis Fungal ball sinusitis mucosal edema with a small amount of inflammatory cell infiltration.Chronic sinusitis mucosal inflammatory cell infiltration,goblet cells increase,epithelial hyperplasia.3 Results of immunohistochemical staining of TLR2 and TLR4 in sinus mucosa of three groups.TLR2 and TLR4 are expressed in fungal ball sinusitis,chronic sinusitis and normal sinus mucosa,and the differences between the three groups are statistically significant.Compared with the normal group,the expression of TLR2 decreased in fungal ball sinusitis(P <0.01),and increased in chronic sinusitis(P<0.05);compared with the normal group,the expression of TLR4 decreased in fungal ball sinusitis(P <0.05),increased expression in chronic sinusitis(P <0.05).4 TLR2 and TLR4 protein expression in sinus mucosa of three groups.TLR2 and TLR4 have protein expression in fungal ball sinusitis,chronic sinusitis,and normal tissues,and the differences between the three groups are statistically significant.Compared with the normal group,the relative protein expression of TLR2 was significantly reduced in fungal ball rhinosinusitis(P < 0.05),and the relative protein expression of TLR2 was increased in chronic rhinosinusitis(P<0.01).Compared with the normal group,TLR4 protein expression level was reduced in fungal ball rhinosinusitis(P<0.05),and TLR4 protein expression level was increased in chronic rhinosinusitis(P<0.05).conclusion1.TLR2 and TLR4 are expressed in fungal ball sinusitis,chronic sinusitis,and normal sinus mucosa;protein expression of TLR2 and TLR4 decreases in fungal ball sinusitis,and protein expression of TLR2 and TLR4 increases in chronic sinusitis.The expression of TLR2 and TLR4 in fungal ball sinusitis and chronic sinusitis tissues is different,suggesting that intervention of TLR2 and TLR4 expression has a therapeutic effect on fungal ball sinusitis and chronic sinusitis.2.Fungal ball sinusitis and chronic sinusitis are completely different in terms of clinical manifestations,pathological characteristics,and pathogenesis.In order to distinguish them from chronic sinusitis and to express them more accurately,it is more appropriate to call them "fungal sinusitis" clinically.