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Cysteinyl Leukotriene Receptors Are Expressed by Tonsillar T Cells of Children With Obstructive Sleep Apnea^*

^* From the Sleep Disorders Laboratory (Drs. Kaditis, Chaidas, Alexopoulos, and Gourgoulianis) and Departments of Pathology (Dr. Ioannou and Koukoulis) and Otorhinolaryngology (Dr. Apostolidou and Apostolidis), University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.

Correspondence to: Athanasios Kaditis, MD, Sleep Disorders Laboratory, Larissa University Hospital, PO Box 1425, Larissa 41110, Greece; e-mail: KADITIA{at}hotmail.com

Abstract

Background: Increased expression of cysteinyl leukotriene receptors (cysteinyl leukotriene receptor-1 [LT1-R]; cysteinyl leukotriene receptor-2 [LT2-R]) has been detected in adenotonsillar tissue from children with sleep-disordered breathing (SDB) compared to control subjects. LT1-R has been localized in myeloperoxidase-positive cells. This phenomenon possibly contributes to lymphoid tissue enlargement and may be related to systemic inflammation.

Objective: To characterize cells expressing LT1-R and LT2-R in tonsillar tissue and assess serum C-reactive protein (CRP) levels in children with and without SDB.

Methods: Immunohistochemistry with LT1-R and LT2-R antibodies was used to examine tonsils from children who had tonsillectomy (with or without adenoidectomy) for SDB and from control subjects operated for recurrent tonsillitis/otitis. All participants underwent preoperative polysomnography and measurement of morning serum CRP.

Results: Fifteen children with SDB (mean age ± SD, 6.4 ± 2.1 years; apnea-hypopnea index, 9.6 ± 5.6 episodes per hour) and 11 control subjects (age, 7.5 ± 2.8 years; apnea-hypopnea index, 7 ± 0.3/h) were examined. Immunoreactivity for LT1-R and LT2-R was detected in tonsillar extrafollicular areas of all subjects with SDB but not of control subjects. Cells expressing leukotriene receptors were CD3+ lymphocytes. Children with SDB and control subjects were similar regarding CRP levels: 0.11 ± 0.15 mg/dL vs 0.09 ± 0.15 mg/dL, respectively (p > 0.05).

Conclusions: Tonsils of children with SDB but not of control subjects have enhanced expression of cysteinyl leukotriene receptors in T lymphocytes without an associated increase in serum CRP concentration. Up-regulation of LT1-R and LT2-R could potentially promote tonsillar enlargement in children with obstructive sleep apnea.

Key Words: adenoidal hypertrophy • adenotonsillectomy • montelukast • obstructive sleep-disordered breathing