International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Neutralizing anti-GM-CSF autoantibodies as a risk factor of orbital extension and blindness in chronic invasive Aspergillus rhinosinusitis: A retrospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Zhu Rong-Sheng, Huang Jun-Tian, Chen Te-Chang, Zhou Ling-Hong, Qiu Wen-Jia, Jiang Ying-Kui, Tang Hui, Zhao Hua-Zhen, Zhu Si-Qi, Jia Xin-Ming, Chen Zhong-Qing, Zhu Li-Ping
Аннотация
OBJECTIVES: To investigate the role of antigranulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies in Aspergillus infections.
METHODS: A retrospective study (2017-2025) was conducted to determine the prevalence and clinical significance of neutralizing anti-GM-CSF autoantibodies in adult patients with chronic invasive Aspergillus rhinosinusitis (CIARS) and chronic pulmonary aspergillosis (CPA). Neutralizing capacity of anti-GM-CSF autoantibodies was confirmed via STAT5 phosphorylation inhibition assays. Firth's penalized likelihood logistic regression was used to identify independent risk factors for blindness in CIARS.
RESULTS: High-titer neutralizing autoantibodies were detected in 6.0% (8/133) of patients with CIARS, significantly higher than in patients with CPA (1.3% [3/224]; P = 0.022) and healthy controls (0%; P = 0.023). Most patients with autoantibodies were phenotypically immunocompetent. In the CIARS cohort, autoantibody positivity was strongly associated with orbital involvement (87.5% vs 36.8%; P = 0.007) and blindness (50.0% vs 15.2%; P = 0.030). Multivariable Firth regression identified anti-GM-CSF autoantibody positivity as an independent driver of blindness (adjusted OR 6.55, 95% CI: 1.37-31.32; P = 0.019), distinct from the risk posed by sphenoid sinus involvement.
CONCLUSIONS: Neutralizing anti-GM-CSF autoantibodies define a specific, high-risk immunologic endotype in CIARS, characterized by aggressive orbital extension in otherwise immunocompetent hosts. Routine screening for anti-GM-CSF autoantibodies in invasive Aspergillus rhinosinusitis could facilitate early risk stratification and prompt aggressive intervention to preserve vision.
METHODS: A retrospective study (2017-2025) was conducted to determine the prevalence and clinical significance of neutralizing anti-GM-CSF autoantibodies in adult patients with chronic invasive Aspergillus rhinosinusitis (CIARS) and chronic pulmonary aspergillosis (CPA). Neutralizing capacity of anti-GM-CSF autoantibodies was confirmed via STAT5 phosphorylation inhibition assays. Firth's penalized likelihood logistic regression was used to identify independent risk factors for blindness in CIARS.
RESULTS: High-titer neutralizing autoantibodies were detected in 6.0% (8/133) of patients with CIARS, significantly higher than in patients with CPA (1.3% [3/224]; P = 0.022) and healthy controls (0%; P = 0.023). Most patients with autoantibodies were phenotypically immunocompetent. In the CIARS cohort, autoantibody positivity was strongly associated with orbital involvement (87.5% vs 36.8%; P = 0.007) and blindness (50.0% vs 15.2%; P = 0.030). Multivariable Firth regression identified anti-GM-CSF autoantibody positivity as an independent driver of blindness (adjusted OR 6.55, 95% CI: 1.37-31.32; P = 0.019), distinct from the risk posed by sphenoid sinus involvement.
CONCLUSIONS: Neutralizing anti-GM-CSF autoantibodies define a specific, high-risk immunologic endotype in CIARS, characterized by aggressive orbital extension in otherwise immunocompetent hosts. Routine screening for anti-GM-CSF autoantibodies in invasive Aspergillus rhinosinusitis could facilitate early risk stratification and prompt aggressive intervention to preserve vision.