Characterization of Cytokines and Proliferation Marker Ki-67 in Chronic Rhinosinusitis with Recurring Nasal Polyps

The Role of KI67 in Predicting Post-ESS (Endoscopic Sinus Surgery) Outcomes in CRSwNP (Chronic Rhinosinusitis With Nasal Polyps)

Introduction Nasal and paranasal sinus inflammation, specifically chronic rhinosinusitis with nasal polyps (CRSwNP), is a prevalent condition often addressed through endoscopic sinus surgery (ESS). Despite the commonality of this surgical intervention, recurrence rates post-ESS remain significant. This study explores the relationship between the expression of KI67, a protein indicating cell proliferation, and the likelihood of recurrence in CRSwNP patients who have undergone ESS. Methods Thirty patients undergoing ESS for CRSwNP were enrolled in this prospective study conducted between January 2023 and December 2023. Nasal polyp tissue samples, obtained during the surgical procedure, were subjected to immunohistochemical analysis to determine KI67 expression levels. Post-surgical follow-up was conducted for a period of six months to monitor for recurrence, indicated by the reappearance of nasal polyps upon endoscopic examination. Results The average number of KI67-positive cells per high-powered field (HPF) was 63.7 (range, 21-82). Nasal polyp recurrence was observed in 9 patients (30%) within 6 months following ESS. A statistically significant difference in mean KI67 expression was found between patients experiencing recurrence and those who did not (74.3 ± 11.1 vs. 53.1 ± 11.6, p=0.003). Furthermore, a positive correlation emerged between KI67 expression and Sino-Nasal Outcome Test-22 (SNOT-22) scores (Pearson correlation coefficient, r=0.42, p=0.02). Conclusion The results of this study indicate that KI67 expression could potentially serve as a predictor of recurrence and disease severity in CRSwNP patients following ESS. Confirmation of these findings and determination of the clinical utility of KI67 as a prognostic marker will necessitate further investigation with an expanded sample size and extended follow-up period.

Expression of Proliferating Cell Nuclear Antigen (PCNA) in Nasal Polyp: A Systematic Review and Meta-analysis

Nasal polyp (NP) is a pathological benign mass that affects the nasal cavity and paranasal sinuses. This lesion is occasionally associated with chronic rhinosinusitis (CRS), which is named chronic rhinosinusitis with nasal polyps (CRSwNP). Proliferating cell nuclear antigen (PCNA) indicates abnormal cell proliferation which may help assess the nasopharyngeal lesions and upper airway cancers. This study aimed to examine the PCNA expression in NP tissue. This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A thorough search using relevant keywords was performed on the electronic database to identify studies examining the PCNA expression in NP. Meta-analysis on pooled single group proportion and means of PCNA expression was conducted by the metamean and metaprop functions in R software (version 4.4.0). Quality assessment was done according to the Joanna Briggs Institute (JBI) checklist. Ten articles were included in this study. The PCNA expression in NP was higher than in normal nasal mucosa (NNM), while its expression in NP was lower than in inverted papilloma (IP). The mean percentage of PCNA expression in NP was 15.73% (95%-CI[2.87-28.58]) with considerable heterogeneity (I 2  = 97%[96-98%],p-value < 0.01). Based on a cutoff staining (> 5%), 64% of NP samples were PCNA-positive (95%-CI[42-81%]) with high heterogeneity (I 2  = 76%[47-89%], p-value < 0.01). NP tissue has a relatively high expression of the PCNA oncoprotein based on the immunohistochemistry (IHC) staining. Although more than half of NP samples were positive for PCNA, still the mean expression of this marker in NP was lower than in IP tissue.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12070-024-05172-y.

Exploring the Link Between Resilience and Disease Severity in Chronic Rhinosinusitis With Nasal Polyps

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly affects patients' quality of life, impacting both physical and psychological well-being. This study investigated the potential role of resilience in coping with CRSwNP and its relationship to disease severity and cellular proliferation. Methodology Between July 1, 2021, and June 30, 2022, 30 patients diagnosed with CRSwNP were enrolled in a study at Cardiomed Hospital in Cluj-Napoca, Romania. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), while disease severity was evaluated through patient-reported outcomes (Sino-Nasal Outcome Test (SNOT-22)) and objective measures (Lund-Mackay score). Ki-67 expression was analyzed as a marker of cellular proliferation within nasal polyps. Results No significant correlation was observed between resilience and either SNOT-22 scores or Ki-67 expression. However, a strong positive correlation was found between SNOT-22 scores and Lund-Mackay scores, indicating that patients with more severe symptoms also exhibited greater objective disease burden. In addition, a moderate positive correlation was identified between Ki-67 expression and Lund-Mackay scores, suggesting a potential link between cellular proliferation and disease severity. Conclusion These findings suggest that resilience may not directly influence symptom severity or cellular proliferation in CRSwNP. Further research with larger sample sizes and longitudinal designs is needed to elucidate the complex interplay between resilience, disease pathophysiology, and patient outcomes in CRSwNP. This will ultimately inform the development of more targeted and effective interventions to improve the quality of life for individuals with this chronic condition.

Comparison of B-cell lymphoma 2 (BCL-2) expression in disordered proliferative endometrium and simple endometrial hyperplasia

BACKGROUND AND OBJECTIVE

B-cell lymphoma-2 (BCL-2) is an anti-apoptotic protein that may play a role in disordered proliferative endometrium (DPE) and endometrial hyperplasia (EH). Several studies have investigated BCL-2 expression in normal, hyperplastic endometrium and endometrial adenocarcinoma, with conflicting results. Therefore, the present study aimed to compare the expression of BCL-2 in disordered proliferative endometrium and simple EH.

METHODS

In this cross-sectional study, 63 DPE and 67 SEH samples from patients referred to Mostafa Khomeini Hospital between 2017 and 2022 were immunohistochemically stained by BCL-2 antibody. BCL-2 expression in each sample was reported as negative, weak positive, and strong positive. The findings were analyzed using SPSS version 16 software.

RESULTS

Negative, weakly positive, and strongly positive BCL-2 expression was observed in 55.6%, 38.1%, and 6.3% of DPE samples, and 61.2%, 31.3%, and 7.5% of SEH samples, respectively, which does not show a statistically significant difference (p=0.718). There was no relationship between the age of patients and BCL-2 expression in any of the two groups of DPE and SEH (p=0.378 and p=0.178, respectively).

CONCLUSION

BCL-2 expression is observed with a relatively similar frequency in DPE and SEH samples, and it is probably under the control of oestrogen hormone as the main factor involved in the pathogenesis of these lesions.

Comparison of Proliferating Cell Nuclear Antigen (PCNA) Expression among Nasal Polyp and Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVE

Chronic rhinosinusitis is a common inflammatory disorder in sinonasal mucosa that could be developed with or without nasal polyps. Cellular proliferation is suggested as a possible mechanism of nasal polyp development. However, conducted studies in this context are limited. So, the present study's aim is the comparison of proliferating cell nuclear antigen (PCNA) expression in nasal polyps and chronic rhinosinusitis.

MATERIALS AND METHODS

In this cross-sectional study, 70 nasal polyp and 60 chronic rhinosinusitis samples from patients referred to Mostafa Khomeini Hospital, Tehran from 2017 to 2022 were immunohistochemically stained by PCNA marker. The percentage of PCNA nuclear expression was determined in two groups and its association with the type of pathological lesion and the patient's age and sex was analyzed by SPSS statistic software version 24 statistical software (IBM Statistics, USA).

RESULTS

The mean percentage expression of PCNA in nasal polyp and chronic rhinosinusitis samples was 16.55 ± 13.66 and 17.58 ± 12.68 respectively (ranging from 0 to 57 in both groups) however, there was no significant statistical difference between the two groups (p = 0.479). No relationship was found between PCNA expression with age and sex in none of the chronic rhinosinusitis and nasal polyp groups.

CONCLUSION

Proliferative activity of the nasal epithelial cell is similar in chronic rhinosinusitis with and without nasal polyps and it is considered that the increase of epithelial cell proliferative activity probably has no role in nasal polyp development in patients with chronic rhinosinusitis.

Endotypes of Chronic Rhinosinusitis with Primary and Recurring Nasal Polyps in the Latvian Population

Chronic rhinosinusitis (CRS) is a complex syndrome with various inflammatory mechanisms resulting in different patterns of inflammation that correlate with the clinical phenotypes of CRS. Our aim was to use detected IL-1, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12, Ki 67, HBD-2, HBD-3, and LL-37 to classify specific inflammatory endotypes in chronic rhinosinusitis with the tissue of nasal polyps (CRSwNP). Samples from 35 individuals with primary and recurrent CRSwNP were taken during surgery. The tissues were stained for the previously mentioned biomarkers immunohistochemically. A hierarchical cluster analysis was performed. The clinical parameters were compared between clusters. Five clusters had significantly different biomarkers between groups. There were no significant differences in the clinical parameters, except for the Lund-Mackay score, which was significantly higher in cluster 4 compared to that of cluster 1 (p = 0.024). Five endotypes of (CRSwNP) are characterized by different combinations of type 1, type 2, and type 3 tissue inflammation patterns. In the Latvian population, endotypes associated with neutrophilic inflammation or a combination of neutrophilic inflammation and type 2 inflammation are predominant. Increased proliferation marker Ki 67 values are not associated with more severe inflammation in the tissue samples of chronic rhinosinusitis with nasal polyps.