The Mucosal Immune Response to Laryngopharyngeal Reflux

Abstract

Rationale: Laryngopharyngeal reflux (LPR) affects up to 20% of Western populations. Although individual morbidity is usually moderate, treatment costs are high and there are associations with other diseases, including laryngeal cancer. To date, there have been no studies of the mucosal immune response to this common inflammatory disease. Objectives: To determine the mucosal immune response to LPR. Methods: We performed a prospective immunologic study of laryngeal biopsies from patients with LPR and control subjects (n 5 12 and 11, respectively), and of primary laryngeal epithelial cells in vitro. Measurements and Main Results: Quantitative multiple-color immunofluorescence, using antibodies for lymphocytes (CD4, CD8, CD3, CD79, CD161), granulocytes (CD68, EMBP), monocytic cells (CD68, major histocompatibility complex [MHC] class II), and classical and nonclassical MHC (I, II, b 2 -microglobulin, CD1d). Univariate and multivariate analysis and colocalization measurements were applied. There was an increase in percentage area of mucosal CD8 1 cells in the epithelium (P , 0.005), whereas other leukocyte and granulocyte antigens were unchanged. Although epithelial MHC class I and II expression was unchanged by reflux, expression of the nonclassical MHC molecule CD1d increased (P , 0.05, luminal layers). In vitro, laryngeal epithelial cells constitutively expressed CD1d. CD1d and MHC I expression were inversely related in all subjects, in a pattern which appears to be unique to the upper airway. Colocalization of natural killer T (NKT) cells with CD1d increased in patients (P , 0.01). Conclusions: These data indicate a role for the CD1d-NKT cell axis in response to LPR in humans. This represents a useful target for novel diagnostics and treatments in this common condition.

The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation

“…Since the effects of proteolytic enzymes, which are components of gastric juice, can persist for several hours, autolysis or delayed wound healing can occur, especially in the presence of local injuries that can be caused when a prosthesis is cleaned or replaced. In these cases, damage can be a direct result of acid-induced or pepsin-induced autolysis of the mucosa or can occur as a result of alterations in intercellular junctional complexes at the molecular level or as a result of abnormalities and abacterial inflammatory reactions at the immunological level [3,9,12,17,32,34,39,43,45].…”

What role do mucins have in the development of laryngeal squamous cell carcinoma? A systematic review

“…In reality, this is diYcult to achieve, as for example, it is unethical to biopsy the vibrating edge of normal vocal cords from a healthy living person, as this can cause permanent dysphonia. One possibility is to use nearby, non-vibrating edge, sites, such as posterior glottis and false vocal fold [2]. It is also possible to use specimens from cadavers but the eVect of delays in retrieval and/or long-term eVect of preservative on the tissue before collection is unknown [47].…”

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Laryngopharyngealer Reflux und kehlkopfassoziierte Beschwerden

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