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

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 D-3 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 D-3 deficient and the relationship of vitamin D-3 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 D-3 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 D-3 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 D-3 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 D-3 but not costimulatory molecule expression. Conclusions. These studies identify that children with CRSwNP or AFRS are vitamin D-3 deficient, which may be linked to increased dendritic cell infiltrate. These results suggest a role for vitamin D-3 as a key player in the immunopathology of pediatric CRSwNP.