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Goulioumis AK, Kourelis K, Gkorpa M, Danielides V. Pathogenesis of Nasal Polyposis: Current Trends. Indian J Otolaryngol Head Neck Surg 2023; 75:733-741. [PMID: 37206761 PMCID: PMC10188681 DOI: 10.1007/s12070-022-03247-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/13/2022] [Indexed: 12/07/2022] Open
Abstract
Chronic Rhinosinusitis (CRS) is characterized by edema of the sub-epithelial layers, but, only specific types of CRS are developing polyps. Nasal polyposis may develop under different pathogenetic mechanisms rendering the typical macroscopic classification of CRS, with or without nasal polyps, rather deficient. Currently, we approach nasal polyposis, in terms of diagnosis and treatment, according to its endotype, which means that we focus on the specific cells and cytokines that are participating in its pathogenesis. It appears that the molecular procedures that contribute to polyp formation, initiating with a Th-2 response of the adaptive immune system, are local phenomena occurring in the sub-epithelial layers of the mucosa. Several hypotheses are trying to approach the etiology that drives the immune response towards Th-2 type. Extrinsic factors, like fungi, Staphylococcus superantigens, biofilms, and altered microbiome can contribute to a modified and intense local reaction of the immune system. Some hypotheses based on intrinsic factors like the elimination of Treg lymphocytes, low local vitamin-D levels, high levels of leukotrienes, epithelial to mesenchymal transition (EMT) induced by hypoxia, and altered levels of NO, add pieces to the puzzle of the pathogenesis of nasal polyposis. Currently, the most complete theory is that of epithelial immune barrier dysfunction. Intrinsic and extrinsic conditions can damage the epithelial barrier rendering sub-epithelial layers more vulnerable to invasion by pathogens that trigger a Th-2 response of the adaptive immune system. Th2 cytokines, subsequently, induce the accumulation of eosinophils and IgE together with the remodeling of the stroma in the sub-epithelial layers leading, eventually, to the formation of nasal polyps.
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Affiliation(s)
- Anastasios K. Goulioumis
- Department of Otorhinolaryngology, “Karamandanion” Pediatric Hospital of Patras, Erythrou Stavrou 40, 26331 Patras, Greece
- Anatomy Department, School of Medicine of the University of Patras, Patras, Greece
| | - Konstantinos Kourelis
- Department of Otorhinolaryngology, “Karamandanion” Pediatric Hospital of Patras, Erythrou Stavrou 40, 26331 Patras, Greece
| | | | - Vasilios Danielides
- Department of Otorhinolaryngology, University Hospital of Patras, Patras, Greece
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Relationship between the Severity of Inflammatory Changes in Chronic Sinusitis and the Level of Vitamin D before and after the FESS Procedure. J Clin Med 2021; 10:jcm10132836. [PMID: 34198970 PMCID: PMC8269335 DOI: 10.3390/jcm10132836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 12/21/2022] Open
Abstract
There have been a few reports confirming that vitamin D (VD3) deficiency increases inflammation in the paranasal sinuses. The work brings new information that, despite the presence of inflammation before surgery, patients with higher vitamin D levels had less inflammation, and this has been proven on three levels. We show that vitamin D levels clearly correlate with the severity of the disease in chronic sinusitis. These results have been confirmed in imaging studies (Lund MacKay scale), endoscopy (Lund-Kennedy scale) and in the SNOT 20 questionnaire. 40 patients suffering from chronic sinusitis were divided into two equal groups: group 1: with less severe radiological changes (10 or less points on the Lund-Mackay scale), group 2: with a more advanced form (>10 points). The relationship between VD3 and the severity of the disease (clinical and nasal endoscopy) was assessed. The mean VD3 level in patients in group 2 before surgery was lower (23.01 ng/mL) than in group 1 (28.02 ng/mL) (p < 0.05). They presented a higher degree of advanced changes in all the above scales, i.e., before the SNOT 20 procedure, the mean was: group 1: 30.33, group 2: 31.80 (p < NS); Lund-Kennedy: group 1: 3.21, group 2: 6.30 (p < 0.05). After surgery an increase in VD3 levels was observed in both study groups: in group 1 to the value of 37.98 ng/mL (p < 0.002) and in group 2 to 27.67 ng/mL (p < 0.004). Lower VD3 levels were found in patients with a higher stage of the disease. Reduction of inflammation increases the level of VD3 and reduces subjective and objective symptoms of chronic inflammation.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Ma SW, Ende JA, Alvarado R, Christensen JM, Kalish L, Sacks R, Campbell R, Rimmer J, Harvey R. Topical Vitamin D May Modulate Human Sinonasal Mucosal Responses to House Dust Mite Antigen. Am J Rhinol Allergy 2020; 34:471-481. [PMID: 32046501 DOI: 10.1177/1945892420905432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Respiratory epithelium is a key defense against inhaled pathogens. Vitamin D3 (VD) has been suggested to modulate airway inflammation; however, its effect on innate airway defenses, the physical barrier, mucociliary apparatus, and cytokine release remains unclear. OBJECTIVE To investigate the outcomes of VD application prior to challenge in an in vitro model of human sinonasal epithelium, through assessment of epithelial transepithelial resistance (TER), cilia beat frequency (CBF), and interleukin (IL)-6 release, and secondarily to determine whether topical VD is beneficial to patients with inflammatory sinonasal pathology. METHODS Primary human sinonasal epithelial cells from patients with eosinophilic chronic rhinosinusitis (eCRS) and healthy controls were cultured in air-liquid interface (ALI). Well-differentiated cultures from each patient were pretreated for 24 hours with 4 different VD doses. Toxicity was quantified at 24 hours in unchallenged ALI by lactate dehydrogenase (LDH) assay. Innate responses were assessed by measuring TER and CBF before and up to 24 hours after house dust mite Dermatophagoides pteronyssinus challenge. IL-6 release was evaluated 24-hour postchallenge. RESULTS Fifteen patients (53 ± 13.5 years, 60% females, 53% eCRS) representing 120 ALI wells were assessed. VD (0, 25, 50, 150 IU/mL) released less LDH than vehicle, indicating noncytotoxicity (0.15 ± 0.02; 0.15 ± 0.00; 0.14 ± 0.02; 0.11 ± 0.01 vs 0.17 ± 0.03, P = .004). VD increased TER for eCRS wells at 5 minutes (50 IU/mL: Δ6.76 ± 3.93 vs Δ3.87 ± 2.46, P = .04) and 24 hours (50 IU/mL: Δ0.88 ± 0.49 vs Δ0.40 ± 0.42, P = .02; 150 IU/mL: Δ1.06 ± 0.58 vs Δ0.47 ± 0.46, P = .01). CBF increased at 1 hour for eCRS wells (50 IU/mL: Δ0.62 ± 0.14 vs Δ0.41 ± 0.13, P = .001; 150 IU/ml: Δ0.60 ± 0.13 vs Δ0.38 ± 0.11, P < .001). IL-6 release was similar between normal and eCRS wells. CONCLUSION Topical VD supplementation in eCRS patients may be beneficial for innate epithelial defenses. VD is noncytotoxic and does not adversely affect the physical barrier, mucociliary apparatus, or IL-6 release. Further studies should clarify its potential as a therapeutic agent.
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Affiliation(s)
- Sophia W Ma
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jesse A Ende
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jenna M Christensen
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,ENT Department, Concord General Repatriation Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Raymond Sacks
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,ENT Department, Concord General Repatriation Hospital, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Raewyn Campbell
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Ear, Nose and Throat Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Sydney, Australia.,Department of Thoracic Medicine, St Vincent's Hospital, Sydney, Australia
| | - Richard Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Grammatopoulou V, Praveena CV, Sunkaraneni VS. Optimising Medical Management in CRS. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wang F, Yang Y, Chen H. Vitamin D deficiency are associated with subjective disease severity in Chinese patients with chronic rhinosinusitis with nasal polyps. Am J Otolaryngol 2019; 40:36-39. [PMID: 30322743 DOI: 10.1016/j.amjoto.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the serum vitamin D level in patients with chronic rhinosinusitis with nasal polyps and its correlation with the disease severity. SETTING Hospital of Zhejiang University. STUDY DESIGN Retrospective analysis of collected data. SUBJECTS AND METHODS Patients with chronic rhinosinusitis with or without nasal polyps who underwent endoscopic sinus surgery were recruited. Demographic information including age, gender, body mass index, smoke history, atopic status and asthma was collected. Disease severity was measured by the Lund-Mackay CT score and Sino-Nasal Outcome Test-22 score. Serum 25-hydroxyvitamin D3 was measured by enzyme-linked immunosorbent assay preoperatively. RESULTS Serum 25-hydroxyvitamin D3 levels were significantly lower in patients with nasal polyps (CRSwNP, 38.2 ± 9.1 nmol/L; CRSsNP, 48.94 ± 12.1 nmol/L; control, 54.1 ± 17.1 nmol/L. p < 0.001), and the levels were significantly associated with the preoperative Sino-Nasal Outcome Test-22 score (p = 0.013), but not with the Lund-Mackay score (p = 0.126). Furthermore, serum 25-hydroxyvitamin D3 levels were associated with the subjective improvement six months postoperatively (p < 0.001), CONCLUSION: Serum 25-hydroxyvitamin D3 levels are lower in Chinese CRSwNP patients. These 25-hydroxyvitamin D3 levels are associated with SNOT-22 score. Preoperative 25-hydroxyvitamin D3 level may impact on the symptom improvement after surgery.
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Affiliation(s)
- Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, 79 Qingchun Road, Hangzhou 310003, China
| | - Yang Yang
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, 79 Qingchun Road, Hangzhou 310003, China
| | - Haihong Chen
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, 79 Qingchun Road, Hangzhou 310003, China.
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Tomaszewska M, Sarnowska E, Rusetska N, Kowalik K, Sierdzinski J, Siedlecki JA, Badmaev V, Stohs SJ, Popko M. Role of Vitamin D and Its Receptors in the Pathophysiology of Chronic Rhinosinusitis. J Am Coll Nutr 2018; 38:108-118. [PMID: 30388935 DOI: 10.1080/07315724.2018.1503102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a disease that represents a challenging therapeutic problem. Vitamin D and its receptors (VDR) are involved in the regulation of the immune system and may play role in CRS. Objectives of this study were to assess the relationships between the total concentration of vitamin D (25VD3) in sera, vitamin D receptor (VDR) expression, 1α-hydroxylase expression, and clinical data, including age, gender, Sino-Nasal Outcome Test (SNOT-22), computerized tomography (CT) scan, allergy status, and vitamin D supplementation in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP), and in a control group. METHODS The studied group comprised 52 patients with CRS without nasal polyps (sNP), 55 with CRS with nasal polyps (wNP), and 59 in the control group. The endpoints were determined by appropriate methods. We conducted immunohistochemical staining of gathered tissue from the ostiomeatal complex for determination of VDR and 1α-hydroxylase. Analytical results were compared with clinical data as already noted. RESULTS A decrease in VDR nuclear staining occurred in CRS patients as compared to controls. Insignificant differences were observed in 1α-hydroxylase, expression in all studied groups, while VDR and cytochrome CYP27B1 protein expression (1α-hydroxylase) correlated with clinical data. CONCLUSIONS The data provide evidence that indicates that vitamin D and its receptor and enzymes may play a role in CRS.
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Affiliation(s)
- Malgorzata Tomaszewska
- a Department of Otorhinolaryngology , Faculty of Medicine and Dentistry, Medical University of Warsaw , Poland
| | - Elzbieta Sarnowska
- b Department of Molecular and Translational Oncology , Maria Sklodowska-Curie-Institute Oncology Center , Warsaw , Poland
| | - Natalia Rusetska
- b Department of Molecular and Translational Oncology , Maria Sklodowska-Curie-Institute Oncology Center , Warsaw , Poland
| | - Katarzyna Kowalik
- a Department of Otorhinolaryngology , Faculty of Medicine and Dentistry, Medical University of Warsaw , Poland
| | - Janusz Sierdzinski
- c Department of Medical Informatics and Telemedicine , Medical University of Warsaw , Warsaw , Poland
| | - Janusz A Siedlecki
- b Department of Molecular and Translational Oncology , Maria Sklodowska-Curie-Institute Oncology Center , Warsaw , Poland
| | - Vladimir Badmaev
- d American Medical Holdings Inc , Staten Island , New York , USA
| | - Sidney J Stohs
- e School of Pharmacy and Health Professions , Creighton University , Omaha , Nebraska , USA
| | - Mariola Popko
- a Department of Otorhinolaryngology , Faculty of Medicine and Dentistry, Medical University of Warsaw , Poland
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Bikle DD, Patzek S, Wang Y. Physiologic and pathophysiologic roles of extra renal CYP27b1: Case report and review. Bone Rep 2018; 8:255-267. [PMID: 29963603 PMCID: PMC6021194 DOI: 10.1016/j.bonr.2018.02.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 01/13/2023] Open
Abstract
Although the kidney was initially thought to be the sole organ responsible for the production of 1,25(OH)2D via the enzyme CYP27b1, it is now appreciated that the expression of CYP27b1 in tissues other than the kidney is wide spread. However, the kidney is the major source for circulating 1,25(OH)2D. Only in certain granulomatous diseases such as sarcoidosis does the extra renal tissue produce sufficient 1,25(OH)2D to contribute to the circulating levels, generally associated with hypercalcemia, as illustrated by the case report preceding the review. Therefore the expression of CYP27b1 outside the kidney under normal circumstances begs the question why, and in particular whether the extra renal production of 1,25(OH)2D has physiologic importance. In this chapter this question will be discussed. First we discuss the sites for extra renal 1,25(OH)2D production. This is followed by a discussion of the regulation of CYP27b1 expression and activity in extra renal tissues, pointing out that such regulation is tissue specific and different from that of CYP27b1 in the kidney. Finally the physiologic significance of extra renal 1,25(OH)2D3 production is examined, with special focus on the role of CYP27b1 in regulation of cellular proliferation and differentiation, hormone secretion, and immune function. At this point the data do not clearly demonstrate an essential role for CYP27b1 expression in any tissue outside the kidney, but several examples pointing in this direction are provided. With the availability of the mouse enabling tissue specific deletion of CYP27b1, the role of extra renal CYP27b1 expression in normal and pathologic states can now be addressed definitively.
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Affiliation(s)
- Daniel D Bikle
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
| | - Sophie Patzek
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
| | - Yongmei Wang
- Department of Medicine, Endocrine Research Unit, Veterans Affairs Medical Center, University of California San Francisco, United States
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Stokes PJ, Rimmer J. The relationship between serum vitamin D and chronic rhinosinusitis: A systematic review. Am J Rhinol Allergy 2016; 30:23-8. [PMID: 26867526 DOI: 10.2500/ajra.2016.30.4267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An exciting development in upper respiratory tract disease is the pathophysiology of vitamin D (VD3). There now is substantial literature to indicate that VD3 acts as an immunomodulator of adaptive and innate immunity locally within the respiratory epithelium. Chronic rhinosinusitis (CRS) places a relatively large socioeconomic burden on developed nations, yet remains a difficult disease to treat. VD3, therefore, has become an area of clinical interest because it may provide an adjunctive drug therapy option in CRS, thereby potentially improving the quality of life of these patients. OBJECTIVE A systematic review of the relationship among serum VD3 levels, CRS phenotype, and disease severity by using outcome assessments. METHODS A systematic search was performed by using the PubMed, MEDLINE, and EMBASE databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured serum VD3 levels and correlated the measurements to any subtype of CRS (with or without nasal polyps) were included for qualitative analysis. RESULTS Seven articles were included (four prospective and three retrospective studies), with a total of 539 patients. There were significantly lower VD3 levels in the polypoid phenotypes of CRS compared with controls. Low VD3 levels were often associated with an increased degree of inflammation. CONCLUSION The available evidence indicated that there is a significant relationship between low VD3 levels and polypoid CRS phenotypes. The association between VD3 levels and disease severity and VD3 potential for drug therapy remains unclear, which warrants further research in the area.
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Affiliation(s)
- Patrick J Stokes
- Department of Surgery, South West Healthcare, Warrnambool, Australia
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10
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Evaluation of vitamin D levels in children with primary epistaxis. Int J Pediatr Otorhinolaryngol 2016; 89:97-101. [PMID: 27619037 DOI: 10.1016/j.ijporl.2016.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to investigate whether there is a relationship between 25-hydroxy vitamin D [25(OH)D 3] values and incidences of primary epistaxis among children. METHODS A total of 42 cases and 55 matched controls were included in our study. The study group and control group were well matched for age and gender. Age, gender, activated partial thromboplastin time (APTT) with reference to the international normalized ratio (INR), prothrombin time (PT), and 25(OH)D 3, parathormone (PTH), alkaline phosphatase (ALP), calcium (Ca), magnesium (Mg), and phosphorus (P) values were recorded for each participant. RESULTS Serum 25(OH) D values were found to be statistically significantly (P = 0.03) lower in children with primary epistaxis than in the healthy control group. Our study also revealed that 25(OH) D values were considerably (P < 0.001) lower in the group with primary epistaxis and upper respiratory tract infections (RTI) than in the group with primary epistaxis without upper RTI. Univariate logistic regression analyses demonstrated that 25(OH)D 3 < 20 ng/ml [odds ratio (OR) 1.117, 95% confidence interval (CI) (1.019-1.225); P = 0.019] and serum albumin level [OR 3.499, 95% CI (1072-11,426); P = 0.038] ratio were significantly related to primary epistaxis. Furthermore, multivariate logistic regression analyses revealed that 25(OH)D 3 < 20 ng/ml [OR 1.141, 95% CI (1047-1242); P = 0.003] and serum albumin level [OR 3.340, 95% CI (1068-10,446); P = 0.038] ratio were significantly related to primary epistaxis. CONCLUSIONS Many studies have revealed that vitamin D is a preventive and therapeutic agent for inflammation and infection, thereby providing benefits for children with primary epistaxis. In line with this, our study suggested that a patient's vitamin D status could also be important for the prevention of childhood primary epistaxis, although further studies are required to validate our findings.
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Abstract
BACKGROUND Protecting the upper airway from microbial infection is an important function of the immune system. Proper detection of these pathogens is paramount for sinonasal epithelial cells to be able to prepare a defensive response. Toll-like receptors and, more recently, bitter taste receptors and sweet taste receptors have been implicated as sensors able to detect the presence of these pathogens and certain compounds that they secrete. Activation of these receptors also triggers innate immune responses to prevent or counteract infection, including mucociliary clearance and the production and secretion of antimicrobial compounds (e.g., defensins). OBJECTIVE To provide an overview of the current knowledge of the role of innate immunity in the upper airway, the mechanisms by which it is carried out, and its clinical relevance. METHODS A literature review of the existing knowledge of the role of innate immunity in the human sinonasal cavity was performed. RESULTS Clinical and basic science studies have shown that the physical epithelial cell barrier, mucociliary clearance, and antimicrobial compound secretion play pivotal innate immune roles in defending the sinonasal cavity from infection. Clinical findings have also linked dysfunction of these defense mechanisms with diseases, such as chronic rhinosinusitis and cystic fibrosis. Recent discoveries have elucidated the significance of bitter and sweet taste receptors in modulating immune responses in the upper airway. CONCLUSION Numerous innate immune mechanisms seem to work in a concerted fashion to keep the sinonasal cavity free of infection. Understanding sinonasal innate immune function and dysfunction in health and disease has important implications for patients with respiratory ailments, such as chronic rhinosinusitis and cystic fibrosis.
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Affiliation(s)
- Benjamin M. Hariri
- From the Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noam A. Cohen
- From the Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Surgical Services, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, and
- Monell Chemical Senses Center, Philadelphia, Pennsylvania
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12
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Stevens WW, Lee RJ, Schleimer RP, Cohen NA. Chronic rhinosinusitis pathogenesis. J Allergy Clin Immunol 2016; 136:1442-1453. [PMID: 26654193 DOI: 10.1016/j.jaci.2015.10.009] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023]
Abstract
There are a variety of medical conditions associated with chronic sinonasal inflammation, including chronic rhinosinusitis (CRS) and cystic fibrosis. In particular, CRS can be divided into 2 major subgroups based on whether nasal polyps are present or absent. Unfortunately, clinical treatment strategies for patients with chronic sinonasal inflammation are limited, in part because the underlying mechanisms contributing to disease pathology are heterogeneous and not entirely known. It is hypothesized that alterations in mucociliary clearance, abnormalities in the sinonasal epithelial cell barrier, and tissue remodeling all contribute to the chronic inflammatory and tissue-deforming processes characteristic of CRS. Additionally, the host innate and adaptive immune responses are also significantly activated and might be involved in pathogenesis. Recent advancements in the understanding of CRS pathogenesis are highlighted in this review, with special focus placed on the roles of epithelial cells and the host immune response in patients with cystic fibrosis, CRS without nasal polyps, or CRS with nasal polyps.
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Affiliation(s)
- Whitney W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Robert P Schleimer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Philadelphia Veterans Affairs Medical Center, Surgical Service, Philadelphia, Pa; Monell Chemical Senses Center, Philadelphia, Pa
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13
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
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- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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14
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Francis HW, Papel I, Lina I, Koch W, Tunkel D, Fuchs P, Lin S, Kennedy D, Ruben R, Linthicum F, Marsh B, Best S, Carey J, Lane A, Byrne P, Flint P, Eisele DW. Otolaryngology-head and neck surgery at Johns Hopkins: The first 100 years (1914-2014). Laryngoscope 2015; 125 Suppl 9:S1-35. [PMID: 26297867 PMCID: PMC4696071 DOI: 10.1002/lary.25490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Howard W Francis
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ira Papel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Fuchs
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Sandra Lin
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Kennedy
- the Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Ruben
- the Departments ofOtorhinolaryngology-Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine Montefiore Medical Center, New York, New York
| | - Fred Linthicum
- the Department of Otolaryngology-Head and Neck Surgery, University of California at Los Angeles, Los Angeles, California
| | - Bernard Marsh
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Simon Best
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - John Carey
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrew Lane
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Flint
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
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15
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Derjac-Aramă AI, Sarafoleanu C, Manea CM, Nicolescu MI, Vrapciu AD, Rusu MC. Regenerative potential of human schneiderian membrane: progenitor cells and epithelial-mesenchymal transition. Anat Rec (Hoboken) 2015; 298:2132-40. [PMID: 26414809 DOI: 10.1002/ar.23276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/17/2015] [Accepted: 08/19/2015] [Indexed: 12/13/2022]
Abstract
An innate osteogenic potential of the Schneiderian membrane (SM) is progressively assessed in studies ranging from non-human species to human subjects. It has relevance for endosteal placement and osseointegration. Nestin-expressing osteogenic progenitor cells are allegedly involved in bone formation and remodelling. Nestin phenotype was not assessed previously in human SM. We therefore aimed to fill that particular gap in the literature. Bioptic samples of human adult SM were obtained during surgery from eight adult patients, operated for non-malignant pathologies. Immunohistochemistry on paraffin-embedded tissue samples used primary antibodies against nestin, CD45, CD146, cytokeratin 7 (CK7), and alpha-smooth muscle actin (α-SMA). Nestin expression was consistently found in endothelial cells, and was scarcely encountered in pericytes, putative stromal stem/progenitor cells, as well as in glandular epithelial cells. Moreover, woven bone formation in the periosteal layer of the SM can also be regarded as evidence of the osteogenic potential of this membrane. Nestin and CD45 expression in cells of the primary bone supports the osteogenic potential of SM nestin-expressing cells and a possible involvement of hematopoietic stem cells in maxillary sinus floor remodeling. CD146, a known inducer of epithelial-mesenchymal transition (EMT), was expressed in epithelia, as was CK7. Isolated stromal cells were found expressing CD146, CK7 and α-SMA, suggesting that regenerative processes happening in the SM may also involve processes of EMT which generate stem/progenitor cells. This study provides additional evidence for the regenerative potential of the Schneiderian membrane and identifies potential roles for cells of its stem niche in osteogenesis.
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Affiliation(s)
- A I Derjac-Aramă
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - C Sarafoleanu
- Division of Otorhinolaryngology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - C M Manea
- Division of Otorhinolaryngology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M I Nicolescu
- Division of Histology and Cytology, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A D Vrapciu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M C Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,MEDCENTER - Center of Excellence in Laboratory Medicine and Pathology, Bucharest, Romania
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16
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Khalid AN, Ladha KS, Luong AU, Quraishi SA. Association of Vitamin D Status and Acute Rhinosinusitis: Results From the United States National Health and Nutrition Examination Survey 2001-2006. Medicine (Baltimore) 2015; 94:e1447. [PMID: 26447998 PMCID: PMC4616759 DOI: 10.1097/md.0000000000001447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although vitamin D status may be a modifiable risk factor for various respiratory ailments, limited data exists regarding its role in sinonasal infections. Our goal was to investigate the association of 25-hydroxyvitamin D (25OHD) levels with acute rhinosinusitis (ARS) in a large, nationally representative sample of non-institutionalized individuals from the United States. In this cross-sectional study of individuals ≥ 17 years from the National Health and Nutrition Examination Survey 2001-2006, we used multivariable regression analysis to investigate the association of 25OHD levels with ARS, while adjusting for season, demographics (age, sex, race, and poverty-to-income ratio), and clinical data (smoking, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and neutropenia). A total of 3921 individuals were included in our analyses. Median 25OHD level was 22 (interquartile range 16-28) ng/mL. Overall, 15.8% (95% confidence interval [CI] 14.4-17.7) of participants reported ARS within the 24 hours leading up to their survey participation. After adjusting for season, demographics, and clinical data, 25OHD levels were associated with ARS (odds ratio 0.88, 95% CI 0.78-0.99 per 10 ng/mL). When vitamin D status was dichotomized, 25OHD levels < 20 ng/mL were associated with 33% higher odds of ARS (odds ratio 1.33, 95% CI 1.03-1.72) compared with levels ≥ 20 ng/mL. Our analyses suggest that 25OHD levels are inversely associated with ARS. Randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of sinonasal infections.
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Affiliation(s)
- Ayesha N Khalid
- From the Department of Surgery (ANK), Division of Otolaryngology-Head and Neck Surgery, Cambridge Hospital, Cambridge, MA; Department of Laryngology and Otology (ANK), Harvard Medical School; Department of Otolaryngology-Head and Neck Surgery (ANK), Boston University Medical Center; Department of Anesthesia, Critical Care and Pain Medicine (KSL, SAQ), Massachusetts General Hospital; Department of Anaesthesia (KSL, SAQ), Harvard Medical School, Boston, MA; and Department of Otorhinolaryngology-Head and Neck Surgery (AUL), University of Texas Medical School at Houston, Houston, TX
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17
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Kennedy DW. Editorial. Int Forum Allergy Rhinol 2013. [DOI: 10.1002/alr.21144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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