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T‐Helper 2 Lymphocyte Immunophenotype Is Associated With Iatrogenic Laryngotracheal Stenosis
Author(s) -
Hillel Alexander T.,
Ding Dacheng,
Samad Idris,
Murphy Michael K.,
Motz Kevin
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27321
Subject(s) - medicine , fibrosis , immunophenotyping , inflammation , pathology , lamina propria , flow cytometry , proinflammatory cytokine , cd3 , lymphocyte , cytokine , immune system , immunology , epithelium , cd8
Objective/Hypothesis This prospective controlled human and murine study assessed the presence of inflammatory cells and cytokines to test the hypothesis that immune cells are associated with fibroproliferation in iatrogenic laryngotracheal stenosis (iLTS). Methods Inflammation was assessed by histology and immunofluorescence (IF), quantitative real‐time polymerase chain reaction (qRT‐PCR), and flow cytometry of cricotracheal resections of iLTS patients compared to normal controls. An iLTS murine model assessed the temporal relationship between inflammation and fibrosis. Results iLTS specimens showed increased inflammation versus normal controls (159/high power field [hpf] vs. 119/hpf, P = 0.038), and increased CD3 + T‐cells, CD4 + cells, and CD3+/CD4 + T‐helper (T H ) cells (all P < 0.05). The inflammatory infiltrate was located immediately adjacent to the epithelial surface in the superficial aspect of the thickened lamina propria. Human flow cytometry and qRT‐PCR showed a significant increase in interleukin (IL)‐4 gene expression, indicating a T H 2 phenotype. Murine IF revealed a dense CD4 + T‐cell inflammatory infiltrate on day 4 to 7 postinjury, which preceded the development of fibrosis. Murine flow cytometry and qRT‐PCR studies mirrored the human ones, with increased T‐helper cells and IL‐4 in iLTS versus normal controls. Conclusion CD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a T H 2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS. Level of Evidence NA Laryngoscope , 129:177–186, 2019