Vitamin D3 Deficiency Increases Sinus Mucosa Dendritic Cells in Pediatric Chronic Rhinosinusitis with Nasal Polyps

Abstract

Objective Dendritic cells are professional antigen presenting cells, capable of initiating Th1 or Th2 responses, and have been implicated in the pathogenesis of a number of diseases, including sinusitis. Vitamin D3 is a steroid hormone that acts on dendritic cells in a manner similar to corticosteroids. Investigators examined whether children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were vitamin D3 deficient and the relationship of vitamin D3 deficiency to dendritic cell infiltrate in the sinus mucosa. Setting Tertiary care university hospital. Study Design Retrospective, controlled study using samples collected from pediatric patients seen from August 2009 to July 2011. Subjects and Methods Plasma levels of 25-hydroxy vitamin D3 were measured by enzyme-linked immunosorbent assay in children (≤18 years old) with AFRS, CRSwNP, or CRS without nasal polyposis (CRSsNP) and in controls undergoing surgery for adenotonsillar hypertrophy. Vitamin D3 levels were confirmed using clinical diagnostic methods for those with CRSwNP or AFRS. Tissue samples were immunohistochemically stained for the dendritic cell marker CD209 and the costimulatory molecules CD80 and CD86. Results There was no difference in mean vitamin D3 levels between control and CRSsNP, whereas mean CRSwNP and AFRS levels were both well below the minimum recommended level of 30 ng/mL and significantly lower than control and CRSsNP levels. CD209+ dendritic cells inversely correlated with vitamin D3 but not costimulatory molecule expression. Conclusions These studies identify that children with CRSwNP or AFRS are vitamin D3 deficient, which may be linked to increased dendritic cell infiltrate. These results suggest a role for vitamin D3 as a key player in the immunopathology of pediatric CRSwNP.