Expression of Toll-like receptor-9, CD28, and CD152 in chronic suppurative Otitis media evidence for innate-adaptive immune crosstalk in bacterial persistence

Document Type : Research Paper

Authors

1 Department of Microbiology, College of Medicine, University of Babylon, Hilla, Iraq.

2 Professor of Otolaryngology and Allergy, Department of Surgery, College of Medicine, University of Babylon, Hilla, Iraq.

Abstract

Objective
Chronic suppurative otitis media (CSOM) is a long-term inflammatory disease in the middle ear. This disease is associated with different factors. Some of these factors are persistent infection, tissue damage, and bacterial biofilm formation. This situation indicates that the immune status has changed. This condition allows bacteria to survive and continue to cause inflammation. One of the most important regulatory pathways is the CD28-CD152 (CTLA-4) axis. CD28 provides activating signals. These signals promote T-cell activation, proliferation, and cytokine production. On the other hand, CD152 is an inhibitory receptor. It suppresses T-cell responses through competing with CD28 for B7 ligands. Moreover, Toll-like receptor 9 (TLR-9) is also involved in innate immune responses. This receptor recognizes bacterial DNA and contributes to chronic inflammation. The aim of this study was to evaluate the serum levels of TLR-9, CD28, and CD152 in patients with CSOM and to examine their relationship with bacterial infection patterns.
Materials and methods
Fifty patients with CSOM and twenty-five healthy controls were used in this study. Individuals who had persistent ear discharge for more than three months and whose tympanic membrane rupture was confirmed by otoscopic and radiological examinations were considered to have CSOM. Ear swab samples were collected from patients. Then cultured for bacterial isolation. The VITEK 2 Compact system was used to identify bacteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of TLR-9, CD28, and CD152 in blood samples of all participants.
Results
The most common bacteria isolated in this study were Staphylococcus aureus (38%), Pseudomonas aeruginosa (26%), Proteus mirabilis (14%), Klebsiella pneumoniae (12%), and Escherichia coli (10%). Serum TLR-9 levels were significantly higher in CSOM patients compared with controls (1.62 ± 0.07 ng/mL vs 0.48 ± 0.05 ng/mL; P < 0.001). CD28 levels were significantly lower in patients than in controls (0.42 ± 0.09 ng/mL vs 1.18 ± 0.06 ng/mL; P < 0.001). In contrast, CD152 levels were significantly increased in CSOM patients (1.33 ± 0.11 ng/mL vs 0.26 ± 0.08 ng/mL; P < 0.001).
Conclusion
The results of this study showed that CSOM is associated with both increased expression of TLR-9 and CD152 and decreased levels of CD28. It can be concluded that this immune pattern may increase immune tolerance, bacterial persistence, and chronic inflammation in CSOM.

Keywords

References

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Agricultural Biotechnology Journal
Volume 18, Issue 2
February 2026
Pages 205-220

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