Preservation of adaptive immunity is associated with survival in invasive fungal sinusitis

Invasive Fungal Sinusitis (IFS) is a deadly and morbid disease of the paranasal sinuses. Immunocompromised patients are at risk of developing IFS, and survival at 6 months is approximately 50%. Previously studied treatments such as granulocyte stimulating factor have not improved survival. Thus, the immune cells responsible for survival in this vulnerable population are not well defined.

The goal of this study was to immunophenotype cells associated with IFS survival.

Blood samples from consenting patients were collected at the time of surgery for IFS between April 2022 and December 2023. Peripheral blood mononuclear cells (PBMCs) were evaluated for major lymphoid and myeloid subsets using mass Cytometry by Time of Flight (CyTOF) between IFS survivors and non-survivors, defined by vital status 6 months after the time of diagnosis. Data were analyzed using the dimensionality reduction algorithm optimized t-distributed stochastic neighbor embedding (opt-SNE).

Seven patients had PBMCs viable for analysis (3 survivors and 4 non-survivors). Total white blood cell counts were lower in non-survivors. Total T cell and B cell counts were decreased in non-survivors as compared to survivors, but there were no differences in other immune cell populations, such as NK cells or monocytes. Percentage differences were identified as deficiencies in CD4 T cells, particularly memory cells, in the IFS non-survivors.

Future work includes the investigation of CD4 T cells as a biomarker for IFS survival and the study of T cell manipulation or stimulation in IFS patients.