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Liu C, Wang K, Liu W, Zhang J, Fan Y, Sun Y. ALOX15 + M2 macrophages contribute to epithelial remodeling in eosinophilic chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2024; 154:592-608. [PMID: 38705258 DOI: 10.1016/j.jaci.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Epithelial remodeling is a prominent feature of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP), and infiltration of M2 macrophages plays a pivotal role in the pathogenesis of eCRSwNP, but the underlying mechanisms remain undefined. OBJECTIVE We sought to investigate the role of ALOX15+ M2 macrophages in the epithelial remodeling of eCRSwNP. METHODS Digital spatial transcriptomics and single-cell sequencing analyses were used to characterize the epithelial remodeling and cellular infiltrate in eCRSwNP. Hematoxylin and eosin staining, immunohistochemical staining, and immunofluorescence staining were used to explore the relationship between ALOX15+ M2 (CD68+CD163+) macrophages and epithelial remodeling. A coculture system of primary human nasal epithelial cells (hNECs) and the macrophage cell line THP-1 was used to determine the underlying mechanisms. RESULTS Spatial transcriptomics analysis showed the upregulation of epithelial remodeling-related genes, such as Vimentin and matrix metalloproteinase 10, and enrichment of epithelial-mesenchymal transition (EMT)-related pathways, in the epithelial areas in eCRSwNP, with more abundance of epithelial basal, goblet, and glandular cells. Single-cell analysis identified that ALOX15+, rather than ALOX15-, M2 macrophages were specifically highly expressed in eCRSwNP. CRSwNP with high ALOX15+ M2THP-1-IL-4+IL-13 macrophages had more obvious epithelial remodeling features and increased genes associated with epithelial remodeling and integrity of epithelial morphology versus that with low ALOX15+ M2THP-1-IL-4+IL-13 macrophages. IL-4/IL-13-polarized M2THP-1-IL-4+IL-13 macrophages upregulated expressions of EMT-related genes in hNECs, including Vimentin, TWIST1, Snail, and ZEB1. ALOX15 inhibition in M2THP-1-IL-4+IL-13 macrophages resulted in reduction of the EMT-related transcripts in hNECs. Blocking chemokine (C-C motif) ligand 13 signaling inhibited M2THP-1-IL-4+IL-13 macrophage-induced EMT alteration in hNECs. CONCLUSIONS ALOX15+ M2 macrophages are specifically increased in eCRSwNP and may contribute to the pathogenesis of epithelial remodeling via production of chemokine (C-C motif) ligand 13.
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Affiliation(s)
- Chang Liu
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Kanghua Wang
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Wenqin Liu
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jinxiu Zhang
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yunping Fan
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
| | - Yueqi Sun
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
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Baird AM, Masliah J, Filip P, Talati V, Brown HJ, Owen G, Khalife S, Papagiannopoulos P, Gattuso P, Batra PS, Tajudeen BA. Histopathologic features of biologic therapy nonresponders in chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol 2024; 14:939-949. [PMID: 37792287 DOI: 10.1002/alr.23283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Biologics are effective for chronic rhinosinusitis with nasal polyposis (CRSwNP) by reducing type 2 inflammation. Nonresponders often require functional endoscopic sinus surgery (FESS) and represent a challenging population potentially due to non-type 2 pathophysiology. This study characterizes the histopathologic features of biologic nonresponders. METHODS A retrospective review of 257 CRSwNP patients undergoing FESS was conducted. The biologic nonresponder group included patients with prior biologic therapy who exhibited persistent symptoms and polyp burden. Those with CRSwNP not prescribed biologic therapy were selected as controls. Demographics, comorbidities, and structured histopathology consisting of 13 variables were collected. RESULTS Of 257 CRSwNP patients, 20 were on biologics prior to FESS. Fourteen patients (70.0%) received dupilumab, one (5.0%) received mepolizumab, one (5.0%) received omalizumab, and four (20.0%) tried multiple biologics. The mean age for the biologic nonresponder group was 45.8 years compared to 50.4 years for the controls. Nonresponders had a significantly increased incidence of reduced tissue eosinophilia, defined as <5 per high power field (55% vs. 31.2%, p = 0.044) and increased basement membrane thickening (100% vs. 78.1%, p = 0.019). The remaining 11 variables did not reach statistical significance. CONCLUSION Histopathologic analysis of biologic nonresponders demonstrates decreased eosinophilia and thickened basement membranes. These findings, particularly low tissue eosinophils, are consistent with a non-type 2 CRSwNP that may be recalcitrant to biologic therapies. Histopathologic analysis done in conjunction with FESS may aid clinicians in understanding response to biologic therapies in patients with CRSwNP who have persistent symptom burden necessitating FESS.
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Affiliation(s)
- Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Jamie Masliah
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vidit Talati
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant Owen
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Khalife
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Cui Y, Wang K, Shi J, Sun Y. Endotyping Difficult-to-Treat Chronic Rhinosinusitis with Nasal Polyps by Structured Histopathology. Int Arch Allergy Immunol 2023; 184:1036-1046. [PMID: 37331342 DOI: 10.1159/000530864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION This study aimed to identify the histopathologic characteristics associated with difficult-to-treat chronic rhinosinusitis with nasal polyps (CRSwNPs), enabling physicians to predict the risk of poor outcome after endoscopic sinus surgery (ESS). METHODS A prospective cohort study performed at the First Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2018 with CRSwNP patients who underwent ESS. Polyp specimens were collected during surgery and were subjected to structured histopathological evaluation. Difficult-to-treat CRSwNPs were determined at 12-15 months post-operation according to the European Position Paper. Multiple logistic regression model was used to assess the association between histopathological parameters and the difficult-to-treat CRSwNP. RESULTS Among 174 subjects included in the analysis, 49 (28.2%) were classified with difficult-to-treat CRSwNP, which had higher numbers of total inflammatory cells, tissue eosinophils, and percentages of eosinophil aggregates and Charcot-Leyden crystals (CLC) formation but a lower number of interstitial glands than the nondifficult-to-treat CRSwNP. Inflammatory cell infiltration (adjusted OR: 1.017), tissue eosinophilia (adjusted OR: 1.005), eosinophil aggregation (adjusted OR: 3.536), and CLC formation (adjusted OR: 6.972) were independently associated with the difficult-to-treat outcome. Furthermore, patients with tissue eosinophil aggregation and CLC formation had an increasingly higher likelihood of uncontrolled disease versus those with tissue eosinophilia. CONCLUSION The difficult-to-treat CRSwNP appears to be characterized by increased total inflammatory infiltrates, tissue eosinophilia, eosinophil aggregation, and CLC formation in structured histopathology.
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Affiliation(s)
- Yueming Cui
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kanghua Wang
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jianbo Shi
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yueqi Sun
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Treatment Strategy of Uncontrolled Chronic Rhinosinusitis with Nasal Polyps: A Review of Recent Evidence. Int J Mol Sci 2023; 24:ijms24055015. [PMID: 36902445 PMCID: PMC10002552 DOI: 10.3390/ijms24055015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is recognized as a heterogeneous disease with a wide range of clinical features, resulting in significant morbidity and cost to the healthcare system. While the phenotypic classification is determined by the presence or absence of nasal polyps and comorbidities, the endotype classification has been established based on molecular biomarkers or specific mechanisms. Research on CRS has now developed based on information based on three major endotypes: types 1, 2, and 3. Recently, biological therapies targeting type 2 inflammation have been clinically expanded and may be applied to other inflammatory endotypes in the future. The purpose of this review is to discuss the treatment options according to the type of CRS and summarize recent studies on new therapeutic approaches for patients with uncontrolled CRS with nasal polyps.
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Ceballos Cantu JC, Alobid I, Mullol J. Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps. Expert Rev Clin Immunol 2022; 18:1253-1263. [PMID: 36196875 DOI: 10.1080/1744666x.2022.2128767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION A clear understanding of the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) and its close association with other airway pathologies, especially asthma, helps to comprehend the concept of the united airway and the importance of a multidisciplinary approach and the actual roll of biologic therapy. AREAS COVERED This expert review is the synthesis of a working group on the current state of the art of the evaluation and management of CRSwNP. A thorough analysis of the literature has been conducted for the latest studies and results, specially the European (EPOS 2020) and American (ICAR-RS 2021) guidelines. EXPERT OPINION The roles of optimal medical treatment and indications for surgery are becoming clearer, but much research is still needed regarding the extent and radicality when surgery is indicated. The main objectives of this review were to provide a clear and updated description of treatments, their indication, follow-up, and response criteria. These steps are considering the broad spectrum of inflammation endophenotypes and the biologic therapy available. Understanding the role and limitations of each specialty is key for providing greatest benefit to the patient.
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Affiliation(s)
- Juan Carlos Ceballos Cantu
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelon, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelon, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Reaserch Networking Centers of Respiratiry Diseases (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy (IRCE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Reaserch Networking Centers of Respiratiry Diseases (CIBERES), Madrid, Spain
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Wang K, Ren Y, Ma L, Fan Y, Yang Z, Yang Q, Shi J, Sun Y. Deep Learning-Based Prediction of Treatment Prognosis from Nasal Polyp Histology Slides. Int Forum Allergy Rhinol 2022; 13:886-898. [PMID: 36066094 DOI: 10.1002/alr.23083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Histopathology of nasal polyps contains rich prognostic information, which is difficult to objectively extract. In the present study, we aimed to develop a prognostic indicator of patient outcomes by analyzing scanned conventional haematoxylin and eosin (H&E) -stained slides alone using deep learning. METHODS An interpretable supervised deep learning model was developed using 185 H&E-stained whole-slide images (WSIs) of nasal polyps, each from a patient randomly selected from the pool of 232 patients who underwent endoscopic sinus surgery at the First Affiliated Hospital of Sun Yat-sen University (internal cohort). We internally validated the model on a holdout dataset from the internal cohort (47 H&E-stained WSIs) and externally validated the model on 122 H&E-stained WSIs from the Seventh Affiliated Hospital of Sun Yat-sen University and the University of Hong Kong-Shenzhen Hospital (external cohort). A poor prognosis score (PPS) was established to evaluate patient outcomes, and then risk activation mapping was applied to visualize the histopathological features underlying PPS. RESULTS The model yielded a patient-level sensitivity of 79.5%, and specificity of 92.3%, with areas under the receiver operating characteristic curve of 0.943, on the multi-center external cohort. The predictive ability of PPS was superior to that of conventional tissue eosinophil number. Notably, eosinophil infiltration, goblet cell hyperplasia, glandular hyperplasia, squamous metaplasia, and fibrin deposition were identified as the main underlying features of PPS. CONCLUSIONS Our deep learning model is an effective method for decoding pathological images of nasal polyps, providing a valuable solution for disease prognosis prediction and precise patient treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kanghua Wang
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China.,Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Yong Ren
- Center for Digestive Disease, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China.,Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Ling Ma
- Department of Otorhinolaryngology, the University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Yunping Fan
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Zheng Yang
- Department of Pathology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianbo Shi
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Yueqi Sun
- Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518107, China.,Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
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7
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Kato A, Peters AT, Stevens WW, Schleimer RP, Tan BK, Kern RC. Endotypes of chronic rhinosinusitis: Relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches. Allergy 2022; 77:812-826. [PMID: 34473358 PMCID: PMC9148187 DOI: 10.1111/all.15074] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023]
Abstract
Chronic rhinosinusitis (CRS) is a common clinical syndrome that produces significant morbidity and costs to our health system. The study of CRS has progressed from an era focused on phenotype to include endotype-based information. Phenotypic classification has identified clinical heterogeneity in CRS based on endoscopically observed features such as presence of nasal polyps, presence of comorbid or systemic diseases, and timing of disease onset. More recently, laboratory-based findings have established CRS endotype based upon specific mechanisms or molecular biomarkers. Understanding the basis of widespread heterogeneity in the manifestations of CRS is advanced by findings that the three main endotypes, Type 1, 2, and 3, orchestrate the expression of three distinct large sets of genes. The development and use of improved methods of endotyping disease in the clinic are ushering in an expansion of the use of biological therapies targeting Type 2 inflammation now and perhaps other inflammatory endotypes in the near future. The purpose of this review is to discuss the phenotypic and endotypic heterogeneity of CRS from the perspective of advancing the understanding of the pathogenesis and improvement of treatment approaches and outcomes.
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Affiliation(s)
- Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert P Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce K Tan
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert C Kern
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Brown HJ, Tajudeen BA, Kuhar HN, Gattuso P, Batra PS, Mahdavinia M. Defining the Allergic Endotype of Chronic Rhinosinusitis by Structured Histopathology and Clinical Variables. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3797-3804. [PMID: 34174492 PMCID: PMC8511331 DOI: 10.1016/j.jaip.2021.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atopy has a strong association with chronic rhinosinusitis (CRS). OBJECTIVE To understand whether patients with atopy and CRS can be defined by markers of tissue histopathology, systemic biomarkers, and clinical factors, which may guide their response to new pharmacologic agents. METHODS In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery, a structured histopathology report consisting of 12 variables, comorbid conditions, preoperative total serum IgE levels, and preoperative modified Lund-Kennedy endoscopic and sinonasal outcome test (SNOT-22) scores were compared between atopic CRS (aCRS) and non-aCRS control patients in a multivariable model. RESULTS A total of 380 CRS patients were enrolled, 286 of whom had comorbid atopy (aCRS). Compared with non-aCRS, aCRS patients had significantly higher preoperative total SNOT-22 scores (40.45 ± 22.68 vs 29.70 ± 20.68, P = .015) and symptom-specific SNOT-22 scores in all domains except psychological dysfunction. Relative to non-aCRS, aCRS patients had increased tissue eosinophilia (P < .0001), eosinophil aggregates (P < .0001), Charcot-Leyden crystals (P < .04), fibrosis (P < .02), total serum IgE levels (P < .04), polyploid disease (P < .001), and a prevalence of comorbid asthma (P < .0001) and aspirin exacerbated respiratory disease (AERD) (P < .003). Patients with aCRS demonstrated increased tissue eosinophilia compared with non-aCRS patients even after controlling for polypoid disease, asthma, and AERD. CONCLUSION In the context of CRS, atopy appears to be a specific predictor of CRS severity linked to specific histopathologic variables, including enhanced eosinophilic aggregates. Moving forward, allergic status may be a useful way to identify an atopic endotype of CRS patients. Furthermore, after surgery, patients are often maintained on intranasal corticosteroids. In patients whose disease is unresponsive to steroids, we may look to atopic status to identify another management therapy. Atopic CRS patients, irrespective of polyp and asthmatic status, could be optimal candidates for biologic agents such as T-helper cell, eosinophil, and/or IgE-targeted therapies.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Ill
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Hannah N Kuhar
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Ill
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill.
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Wang F, Yang Y, Chen H. Alteration of Histopathology in Recurrent Nasal Polyps. ORL J Otorhinolaryngol Relat Spec 2021; 84:255-261. [PMID: 34198296 DOI: 10.1159/000516430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the histopathologic changes in recurrent nasal polyps (NPs) in terms of tissue inflammatory cells infiltration and mucosal remodeling. METHODS Thirty-five patients with primary NPs requiring a revision surgery during follow-up and a matched control group of 35 primary NP patients without recurrence were retrospectively enrolled. Histopathologic examination was performed of tissue inflammatory cells, subepithelial edema, epithelial cell hyperplasia, basement membrane thickness, and fibrosis. RESULTS The mean eosinophil and neutrophil counts, proportions of eosinophil and neutrophil, as well as total inflammatory cell count were significantly higher in the recurrent group than those in the controls. Higher subepithelial edema was seen in the recurrent group. Within the recurrent group, the mean tissue eosinophil count and relative eosinophilia reduced from the first operation to revision surgery, whereas neutrophil count and proportion, and total inflammatory cell counts remained unchanged. Subepithelial edema and epithelial cell hyperplasia were significantly reduced after the first surgical procedure. CONCLUSION NP recurrence is associated with higher inflammatory grade (especially in eosinophilia and neutrophilia). Surgical and corticoid treatments may have an impact on mucosal histopathologic changes but need further certification.
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Affiliation(s)
- Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Yang
- Department of Otolaryngology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haihong Chen
- Department of Otolaryngology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Lee HY, Pyo JS, Kim SJ. Distinct Patterns of Tissue Remodeling and Their Prognostic Role in Chronic Rhinosinusitis. ORL J Otorhinolaryngol Relat Spec 2021; 83:457-463. [PMID: 33853075 DOI: 10.1159/000515005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tissue remodeling refers to structural changes that occur in damaged tissue and is associated with disease severity in asthma. However, the characteristics of tissue remodeling and its prognostic role in chronic rhinosinusitis (CRS) remain unclear. In this report, we evaluated the clinical implications of tissue remodeling in CRS. METHODS We performed a retrospective cohort study of adult patients who underwent endoscopic sinus surgery for bilateral CRS. The histopathology of sinus mucosa was determined by evaluating the inflammatory cell count and tissue remodeling markers (squamous metaplasia, subepithelial gland proliferation, basement membrane [BM] thickening, stromal edema, and fibrosis). Eosinophilic CRS (ECRS) was defined as an eosinophil count >15/high-power field in the biopsied tissue. Patient characteristics, allergy test grade, preoperative Lund-Mackay score (LMS), and pre- and postoperative Lund-Kennedy scores (LKSs) were analyzed. RESULTS Of the identified patients, 59.1% were classified as ECRS and the remaining 40.9% as non-ECRS. Regarding tissue remodeling markers, stromal edema was seen in 90.9%, BM thickening in 63.6%, and stromal fibrosis in 34.1% of patients. In cases with stromal edema and BM thickening, greater tissue eosinophilia was observed, while stromal fibrosis decreased tissue eosinophilia (p < 0.05). Prognostically, subepithelial gland proliferation alone was an independent risk factor for poor postoperative endoscopic findings (odds ratio: 8.250, 95% confidence interval: 1.128-60.319, p = 0.038). CONCLUSIONS Tissue eosinophilia was commonly associated with BM thickening and stromal edema. Subepithelial gland proliferation predicted a poor surgical prognosis in CRS. These findings imply that tissue remodeling provides additional information not only on the CRS endotype but also on the postsurgical prognosis.
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Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji University Hospital, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, National Medical Center, Seoul, Republic of Korea
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Yu J, Xian M, Piao Y, Zhang L, Wang C. Changes in Clinical and Histological Characteristics of Nasal Polyps in Northern China over the Past 2-3 Decades. Int Arch Allergy Immunol 2021; 182:615-624. [PMID: 33596581 DOI: 10.1159/000513312] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recent studies have shown that inflammatory patterns of nasal polyps from patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) in East Asia have changed over time. However, to date there is a marked lack of similar data for CRSwNP in Northern China. This study thus aimed to assess the changes in the clinical and histological characteristics of CRSwNP patients from Northern China over the past 2-3 decades. METHODS This was a retrospective study, which examined data from 2 groups of 150 CRSwNP patients each, who had undergone endoscopic sinus surgery in Beijing Tongren Hospital from 1993 to 1995 (group A) and from 2015 to 2019 (group B). All relevant data for demographic, clinical, and histological parameters were collected for each patient from the 2 groups and compared for overall changes between the 2 groups. RESULTS The comorbidity of CRSwNP and asthma increased over time and the cellular phenotype of CRSwNPchanged significantly; in particular, the proportion of eosinophil-dominant CRSwNP increased, lymphocyte-dominant and plasma-dominant CRSwNP decreased significantly, and the proportions of neutrophil-dominant and mixed CRSwNP were not altered. The rate of polyp recurrence increased in CRSwNP but did not in eosinophilic CRSwNP. Smoking and age did not significantly impact the inflammatory patterns of CRSwNP. CONCLUSIONS The inflammatory patterns of CRSwNP patients have changed and comorbidity of asthma significantly increased in CRSwNP patients in Northern China over the past 2-3 decades.
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Affiliation(s)
- Jiaqi Yu
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Mu Xian
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Yingshi Piao
- Department of Pathology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China, .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China, .,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China, .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China,
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
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12
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Suzuki M, Ramezanpour M, Cooksley C, Ogi K, Psaltis AJ, Nakamaru Y, Homma A, Wormald PJ, Vreugde S. Metallothionein-3 is a clinical biomarker for tissue zinc levels in nasal mucosa. Auris Nasus Larynx 2021; 48:890-897. [PMID: 33526321 DOI: 10.1016/j.anl.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/25/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recently, depleted tissue zinc levels were found in nasal mucosa from patients with chronic rhinosinusitis (CRS) in correlation with tissue eosinophilia, however, no clinical biomarkers for tissue zinc levels have been identified. Metallothionein-3 (MT3) is an intracellular zinc chelator and previous data showed MT3 mRNA levels to be reduced in CRS patients with nasal polyps (CRSwNP). In this study, we examined the correlation between MT3 expression and zinc levels in nasal mucosa and primary human nasal epithelial cells (HNECs) to investigate whether MT3 could be a clinical biomarker for tissue zinc levels. METHOD Tissue was harvested from 36 patients and mounted on tissue micro-array (TMA) slides. MT3 expression and tissue zinc fluorescence intensity were measured at different areas within the mucosa (surface epithelium and lamina propria) and compared between controls, CRSwNP and CRS without nasal polyps (CRSsNP) patients. MT3 mRNA and protein expression were examined in zinc-depleted HNECs by qPCR and immunofluorescence microscopy. RESULTS MT3 expression in CRSwNP was significantly decreased in both surface epithelium (p<0.001 to controls) and lamina propria (p = 0.0491 to controls). There was a significant positive correlation between tissue zinc levels and MT3 expression in nasal mucosa (r = 0.45, p = 0.007). In zinc-deplete HNECs, MT3 expression was significantly decreased at mRNA (p = 0.02) and protein level (p<0.01). There was a significant positive correlation between tissue zinc levels and MT3 expression within individual HNECs (r = 0.59, p<0.001). CONCLUSIONS MT3 expression reflects intramucosal zinc levels in both nasal mucosa and HNECs indicating MT3 could be used as a clinical biomarker for monitoring intracellular zinc levels in the nasal mucosa.
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Affiliation(s)
- Masanobu Suzuki
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia; Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Mahnaz Ramezanpour
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia
| | - Clare Cooksley
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia
| | - Kazuhiro Ogi
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia
| | - Alkis J Psaltis
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, the Queen Elizabeth Hospital, and the University of Adelaide, Adelaide, SA 5061, Australia.
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13
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Predictive significance of arachidonate 15-lipoxygenase for eosinophilic chronic rhinosinusitis with nasal polyps. Allergy Asthma Clin Immunol 2020; 16:82. [PMID: 32973910 PMCID: PMC7493848 DOI: 10.1186/s13223-020-00480-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP. Methods Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients’ baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictors for ECRSwNP. Results ALOX15 mRNA level was significantly higher in ECRSwNP patients than in nonECRSwNP patients (P < 0.001). ALOX15 mRNA was significantly correlated with tissue and blood eosinophil percentages (r = 0.565, P < 0.001 and r = 0.395, P = 0.006), olfaction scores (r = 0.400, P = 0.005), total visual analogue scale (VAS) symptom scores (r = 0.383, P = 0.007), ethmoid/maxillary sinus (E/M) ratio (r = 0.463, P = 0.001), and endoscopy scores (r = 0.409, P = 0.004). Logistic regression analysis showed ALOX15 mRNA level and percentage of blood eosinophils to be predictive factors for ECRSwNP (P = 0.004 and P = 0.036, respectively). ROC curve indicated ALOX15 to have high predictive accuracy for ECRSwNP (area under the curve (AUC) = 0.909), which was further improved by combination of ALOX15 with percentage of blood eosinophils (AUC = 0.933). Conclusions The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.
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14
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Roland LT, Smith TL, Schlosser RJ, Soler ZM, Peters AT, Laidlaw TM, Bleier BS, Ramakrishnan V, Toskala E, Kennedy DW, Luong AU. Guidance for contemporary use of biologics in management of chronic rhinosinusitis with nasal polyps: discussion from a National Institutes of Health-sponsored workshop. Int Forum Allergy Rhinol 2020; 10:1037-1042. [PMID: 32484603 PMCID: PMC10714717 DOI: 10.1002/alr.22633] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biologic medications are emerging as options for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Several questions remain regarding patient selection, indications, clinical efficacy, and cost effectiveness. METHODS In November 2019, a group of physicians and scientists gathered to consider strategies for future studies regarding biologics. During the discussion, gaps in knowledge highlighted a need for a consensus on the present day use of biologics in polyp patients. RESULTS The goal of this guideline is to propose recommendations for the current use of biologics in CRSwNP as new evidence continues to emerge and inform practice. CONCLUSION We suggest that physicians evaluate patients on an individual basis and closely monitor for improvement due to the high cost and unknown long-term effects of biologics.
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Affiliation(s)
- Lauren T Roland
- Department of Otolaryngology, University of California, San Francisco, CA
| | - Timothy L Smith
- Department of Otolaryngology, Oregon Health and Science University, Portland, OR
| | - Rodney J Schlosser
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Anju T Peters
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tanya M Laidlaw
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Elina Toskala
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA
| | - David W Kennedy
- Department of Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amber U Luong
- Department of Otolaryngology, Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
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15
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Donnell NJ, Marino MJ, Zarka MA, Lal D. Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients. Laryngoscope Investig Otolaryngol 2020; 5:5-10. [PMID: 32128424 PMCID: PMC7042647 DOI: 10.1002/lio2.358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The histopathological characteristics of primary vs recurrent nasal polyps in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have not been studied comprehensively. Identification of these features may be helpful for prognostication, postoperative management, and consideration of novel eosinophil-targeting biologic therapy. This study investigates the histopathological differences in primary vs recurrent CRSwNP tissue. METHODS Patients undergoing endoscopic sinus surgery for CRSwNP were included if all 13 histopathological and mucin characteristics on a standardized report were available. Histopathology parameters were compared in surgical tissue and mucin from primary vs recurrent CRSwNP. RESULTS Complete structured histopathology reports were available for 96 patients (39 primary polyps and 57 recurrent polyps). Compared to primary polyp tissue, recurrent CRSwNP mucin was significantly more likely to feature eosinophil aggregates (57.9% vs 35.9%; P = .047). Tissue eosinophilia (using a threshold >10 per high power field [HPF]) was not significantly different in primary and recurrent CRSwNP tissue. Other histopathologic parameters and clinical characteristics were similar. CONCLUSION Eosinophil aggregates on histopathology are significantly more likely to be present in recurrent CRSwNP. In the limited series, tissue eosinophilia (>10 per HPF) was not significantly different in primary and recurrent CRSwNP. Therefore, in addition to the study of tissue eosinophilia levels, Rhinologic surgeons should also direct attention to CRSwNP mucin. Mucin eosinophilic aggregates are an independent marker of severe inflammation that is associated more likely with recurrent vs primary polyposis. Further study of this marker may help determine its role of choice of postoperative medical therapies, including anti-eosinophilic biologics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Michael J. Marino
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryMayo ClinicPhoenixArizona
| | | | - Devyani Lal
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryMayo ClinicPhoenixArizona
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16
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Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT. Current and Future Treatments of Rhinitis and Sinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1522-1531. [PMID: 32004747 DOI: 10.1016/j.jaip.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Advances in understanding the pathogenic mechanisms of both rhinitis and chronic rhinosinusitis have resulted in new treatment options, especially for chronic rhinosinusitis. A review of relevant medical and surgical clinical studies shows that intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis. Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps. Omalizumab, mepolizumab, and benralizumab may have a future role in the treatment of chronic rhinosinusitis. Novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids. Surgical management tailored to the underlying disease process improves clinical outcomes in chronic rhinosinusitis with or without nasal polyposis. Advances in the understanding of the heterogeneous nature of rhinitis and rhinosinusitis have resulted in more precise treatments. Improving the understanding of different endotypes should provide better knowledge to determine appropriate current and new therapies to treat these diseases.
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Affiliation(s)
- Gayatri B Patel
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Park Hae-Sim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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17
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Wang F, Yang Y, You Q, Chen H. Prognostic Significance of Serum Complement Component 3 in Chronic Rhinosinusitis with Nasal Polyps. ORL J Otorhinolaryngol Relat Spec 2020; 82:67-73. [PMID: 31935724 DOI: 10.1159/000504195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between serum complement component 3 (C3) levels and disease recurrences in patients with chronic rhinosinusitis with nasal polyps (NPs). METHODS Ninety-seven patients with NPs and 30 controls were recruited. Clinical features were collected. Serum concentrations of C3 and C4 were measured before and after endoscopic sinus surgery. RESULTS Compared to the controls, increased C3 levels were found in patients with NPs. Patients with polyp recurrences had higher pre- and postoperative serum C3 levels than patients without polyp recurrences. Serum C3 levels dropped after surgery. After polyp regrowth, the mean C3 level in the recurrent group elevated again to the degree similar to that before surgery. When patients were stratified by tissue eosinophilia, no significant difference was seen in pre-/postoperative, absolute change after surgery, and post-recurrent C3 levels between patients without and with eosinophilic NPs in the group with disease recurrences. CONCLUSION Serum C3 may be involved in the pathogenesis of NPs. Higher serum C3 levels may pinpoint patients at high risk of recurrence as an independent factor. Furthermore, the change in C3 levels after surgery may have the potential to serve as a predictor for polyp progression. Adding serum C3 measurement to the routine walk-up in the clinical management of NPs is worth further investigation and may help physicians make a more rational diagnostic and/or therapeutic decision regarding this disease.
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Affiliation(s)
- Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, Hangzhou, China,
| | - Yang Yang
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, Hangzhou, China
| | - Qihan You
- Department of Pathology, The First Affiliated Hospital, School of Medicine, ZheJiang University, Hangzhou, China
| | - Haihong Chen
- Department of Otolaryngology, The First Affiliated Hospital, School of Medicine, ZheJiang University, Hangzhou, China
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18
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Ganti A, Kuhar HN, Eggerstedt M, Mahdavinia M, Gattuso P, Batra PS, Tajudeen BA. The Association of Serum Eosinophilia with Structured Histopathology in Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2019; 129:512-516. [DOI: 10.1177/0003489419898200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Prior studies have demonstrated associations between serum eosinophilia and chronic rhinosinusitis (CRS) pathogenesis. However, the association of serum eosinophilia with histopathology profiling in CRS has not been fully delineated and may help better characterize CRS disease burden prior to surgery. Methods: A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during functional endoscopic sinus surgery (FESS). Complete blood count (CBC) with differential was drawn within 4 weeks prior to FESS. Serum eosinophilia was defined as >6.0% (>0.60 th/μL). Histopathology variables were compared among patients. Results: A total of 177 CRS patients (37 with serum eosinophilia and 140 with normal serum eosinophilia) were analyzed. Compared to CRS patients with normal serum eosinophil counts, CRS patients with serum eosinophilia demonstrated increased polypoid disease (67.6% vs 35.0%, P < .001), eosinophil aggregates (45.9% vs 20.7%, P = .003), and eosinophils per high-power field (>5/HPF) (67.6% vs 40.7%, P = .003). Conclusion: CRS patients with serum eosinophilia demonstrated severe disease burden on histopathology with high levels of polypoid disease and tissue eosinophilia. However, a considerable number of patients without serum eosinophilia demonstrated eosinophilic disease on histopathology, indicating that preoperative serum eosinophilia alone could not be reliably used to predict eosinophilic CRS. Level of evidence: 4
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Affiliation(s)
- Ashwin Ganti
- Rush Medical College, Rush University, Chicago, IL, USA
| | | | - Michael Eggerstedt
- Department of Otorhinolaryngology—Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Division of Allergy/Immunology, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Pete S. Batra
- Department of Otorhinolaryngology—Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A. Tajudeen
- Department of Otorhinolaryngology—Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
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19
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Marino MJ, Garcia JO, Zarka M, Lal D. A structured histopathology-based analysis of surgical outcomes in chronic rhinosinusitis with and without nasal polyps. Laryngoscope Investig Otolaryngol 2019; 4:497-503. [PMID: 31637292 PMCID: PMC6793607 DOI: 10.1002/lio2.303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives Structured histopathology reporting has been recently described for detailing immunopathological characteristics of chronic rhinosinusitis (CRS), and can be utilized for subtyping CRS and personalizing management. This study scrutinized elements of structured histopathology to identify characteristics that prognosticate outcomes following endoscopic sinus surgery (ESS) for CRS patients with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). Methods Outcomes following ESS were measured using the patient‐reported 22‐item sinonasal outcome test (SNOT‐22). Changes in total SNOT‐22 scores at 6 and 12 months postoperatively were analyzed. Thirteen parameters reported in structured histopathology of sinus surgical tissue were studied for association with outcomes postsurgery. The overall cohort of all CRS patients was studied, along with subgroup analyses of CRSwNP and CRSsNP patients. Results In the entire CRS cohort (n = 171), eosinophil count >10 per high power field (HPF) was associated with greater improvement in SNOT‐22 scores at 6 months post‐ESS (P = .039). At 12 months follow‐up, no histopathological characteristic was associated with change in total SNOT‐22 score. In the CRSwNP (n = 66) subgroup, the presence of fibrosis (P = .006) and eosinophil count ≤10 per HPF (P = .025) were associated with less favorable changes in SNOT‐22 scores at 12 months follow‐up. Fibrosis remained statistically significant in multivariable analysis (P = .007). Conclusions At 6 months post‐ESS, tissue eosinophilia is associated with significantly higher improvement in SNOT‐22 scores, but this difference is diluted by 12 months. Fibrosis was associated with less favorable outcomes in SNOT‐22 scores for CRSwNP patients at 12 months and may be a prognosticator for poorer long‐term outcomes. Level of Evidence 4
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
| | - J Omar Garcia
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
| | - Matthew Zarka
- Division of Laboratory Medicine Mayo Clinic Phoenix Arizona U.S.A
| | - Devyani Lal
- Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona U.S.A
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20
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Wang F, Yang Y, Wu Q, Chen H. Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes. Am J Otolaryngol 2019; 40:423-426. [PMID: 30926262 DOI: 10.1016/j.amjoto.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis. SETTING Hospital of Zhejiang University. STUDY DESIGN Retrospective analysis of collected data. SUBJECTS AND METHODS One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively. RESULTS Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively. CONCLUSIONS Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.
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21
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Brescia G, Alessandrini L, Zanotti C, Parrino D, Tealdo G, Torsello M, Zybine V, Giacomelli L, Barion U, Marioni G. Histopathological and hematological changes in recurrent nasal polyposis. Int Forum Allergy Rhinol 2019; 9:813-820. [DOI: 10.1002/alr.22314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Brescia
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | | | - Claudia Zanotti
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | - Daniela Parrino
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | - Giulia Tealdo
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | - Miriam Torsello
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | - Vladislav Zybine
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | | | - Umberto Barion
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
| | - Gino Marioni
- Otolaryngology Section, Department of Neuroscience (DNS); Padova University; Padova Italy
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22
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Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2019; 27:20-24. [DOI: 10.1097/moo.0000000000000510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Ryu G, Kim DK, Dhong HJ, Eun KM, Lee KE, Kong IG, Kim H, Chung SK, Kim DY, Rhee CS, Cho SH, Hong SD, Kim DW. Immunological Characteristics in Refractory Chronic Rhinosinusitis with Nasal Polyps Undergoing Revision Surgeries. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:664-676. [PMID: 31332978 PMCID: PMC6658403 DOI: 10.4168/aair.2019.11.5.664] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 12/19/2022]
Abstract
Purpose Despite medical and surgical treatments, some cases of nasal polyps (NP) exhibit recidivism. However, the endotype of refractory chronic rhinosinusitis with NP (CRSwNP) remains unclear. Therefore, the objective of this study was to characterize the immunological profile of refractory CRSwNP. Methods The control (n =23), primary NP group (pNP, n =70) and refractory NP group (rNP, n =86) were enrolled in this study. Patients who underwent revision surgeries due to failed maximal medical treatment after primary surgery were defined as the rNP group. A total of 18 inflammatory markers were investigated in nasal tissues using multiplex cytokine assay or enzyme-linked immunosorbent assay. Results The clinical characteristics of rNP included more extensive disease and worse clinical course after surgery. Additionally, rNP subjects showed higher infection rate (mucopurulence and culture-positive rate), more frequent use of antibiotics and suffered from symptomatic bacterial infection, increased asthma morbidity compared to pNP. Cytokine profile analysis showed that levels of Th17-associated mediators (myeloperoxidase, interleukin (IL)-8, IL-17A and IL-23), B-cell activating factor (BAFF) and Th1 cytokine (interferon-γ) were up-regulated in rNP compared to controls and pNP. Human neutrophil elastase-positive cells were also enhanced in rNP compared with pNP. Upregulation of Th17/Th1mediators and BAFF were observed in rNP, regardless of tissue eosinophilia or asthmatic comorbidity. Interestingly, eosinophilic markers, such as eosinophil cationic protein and C-C motif chemokine ligand 24, were up-regulated in asthmatic rNP compared to pNP and controls. Levels of anti-dsDNA immunoglobulin (Ig) G and IgA were up-regulated in rNP and highest in asthmatic eosinophilic rNP among subtypes of rNP. Conclusions Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP.
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Affiliation(s)
- Gwanghui Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Dong Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hun Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Mi Eun
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Gyu Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Pyongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - HyoYeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chae Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong Ho Cho
- Division of Allergy-Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Dae Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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24
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Yan B, Wang Y, Li Y, Wang C, Zhang L. Inhibition of arachidonate 15-lipoxygenase reduces the epithelial-mesenchymal transition in eosinophilic chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2018; 9:270-280. [PMID: 30452122 DOI: 10.1002/alr.22243] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Bing Yan
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
| | - Yang Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
| | - Ying Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Nasal Diseases; Beijing Institute of Otolaryngology; Beijing China
- Department of Allergy, Beijing TongRen Hospital; Capital Medical University; Beijing China
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25
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Hong HY, Chen FH, Sun YQ, Hu XT, Wei Y, Fan YP, Zhang J, Wang DH, Xu R, Li HB, Shi JB. Local IL-25 contributes to Th2-biased inflammatory profiles in nasal polyps. Allergy 2018; 73:459-469. [PMID: 28771767 DOI: 10.1111/all.13267] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND IL-25 has been proposed to play a key role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to evaluate the association of IL-25 with the Th2-biased inflammatory profiles in CRSwNP. METHODS Nasal polyp (NP) tissues and control uncinate process tissues were collected from 92 patients with CRSwNP, 20 patients with chronic rhinosinusitis without nasal polyps (CRSsNP), and 16 normal control subjects. IL-25 expression was examined using immunohistochemistry and immunofluorescence staining, flow cytometry, RT-qPCR, and ELISA. The inflammatory profiles and clinical characteristics of 2 NP subtypes (IL-25high and IL-25low ) were evaluated, and the effects of IL-25 on Th2 cytokine production in cultured dispersed polyp cells were examined in vitro. RESULTS The mRNA and protein levels of IL-25 were significantly increased in the polyp tissues compared with the control uncinate process tissues. The IL-25high subtype showed greater computed tomography scores, endoscopic scores, and Th2 response. Exposure to IL-25 activated type 2 innate lymphoid cells and Th2 cells in NP simultaneously which further increased Th2 cytokine production in vitro. CONCLUSIONS Local IL-25 plays a crucial role in promoting Th2-biased inflammatory profiles in NP and may serve as a promising therapeutic target in CRSwNP patients.
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Affiliation(s)
- H.-Y. Hong
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
- Department of Otolaryngology; The Fifth Affiliated Hospital of Sun Yat-sen University; Zhuhai China
| | - F.-H. Chen
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Y.-Q. Sun
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - X.-T. Hu
- Department of Otolaryngology, Head and Neck Surgery; Affiliated Eye, Ear, Nose and Throat Hospital; Fudan University; Shanghai China
| | - Y. Wei
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Y.-P. Fan
- Department of Otolaryngology; The Fifth Affiliated Hospital of Sun Yat-sen University; Zhuhai China
| | - J. Zhang
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - D.-H. Wang
- Department of Otolaryngology, Head and Neck Surgery; Affiliated Eye, Ear, Nose and Throat Hospital; Fudan University; Shanghai China
| | - R. Xu
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - H.-B. Li
- Department of Otolaryngology, Head and Neck Surgery; Affiliated Eye, Ear, Nose and Throat Hospital; Fudan University; Shanghai China
- Department of Otolaryngology; The First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - J.-B. Shi
- Allergy Center; Otorhinolaryngology Hospital; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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26
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Du J, Ba L, Zhou J, Yu L, Liu R, Zhang J, Liu F, Xian J, Liu S, Liu Y. The role of cysteinyl leukotrienes and their receptors in refractory nasal polyps. Prostaglandins Leukot Essent Fatty Acids 2017; 126:39-48. [PMID: 29031394 DOI: 10.1016/j.plefa.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/12/2017] [Accepted: 09/12/2017] [Indexed: 02/05/2023]
Abstract
Leukotriene signaling is essential in many diseases, including asthma, allergic rhinitis, atherosclerosis and inflammatory bowel disease. Nevertheless, the expression of cysteinyl leukotrienes (CysLTs) and its receptors (CYSLTRs) in different types of nasal polyps (NPs), and the role of their antagonist in the treatment of refractory chronic rhinosinusitis with nasal polyps (CRSwNP) are not well understood. The following study investigates the expression of CysLTs and CYSLTRs in different types of NPs, as well as the role of leukotriene receptor antagonist (montelukast) in refractory NPs. Our data showed that CysLTs and CYSLTRs were significantly elevated in CRSwNP group (p < 0.05), particularly in IL-5+NP patients, compared to patients with chronic rhinosinusitis but without NPs (CRSsNP) and the control group. Furthermore, montelukast have shown the ability to inhibit the expression of MUC5AC, TSLP, IL-4, IL-5, IL-13, and TGF-β in NP explants after treatment with Staphylococcal Enterotoxins B (SEB). In addition, the patients treated by additional montelukast have better outcomes compared to those with INCS only. To conclude, our results demonstrate that the inhibition of CysLTs signaling by montelukast decreases the expression of cytokines and mucin in polyp explants, and in turn promotes the recovery in patients with refractory CRSwNP.
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Affiliation(s)
- Jintao Du
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Luo Ba
- Department of Otolaryngology, People's Hospital of the Tibet Autonomous Region, Lasha, China
| | - Jiao Zhou
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lingyu Yu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ruowu Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie Zhang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Junming Xian
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shixi Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Yafeng Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
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27
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Zhao YC, Bassiouni A, Tanjararak K, Vreugde S, Wormald PJ, Psaltis AJ. Role of fungi in chronic rhinosinusitis through ITS sequencing. Laryngoscope 2017; 128:16-22. [DOI: 10.1002/lary.26702] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/04/2017] [Accepted: 04/28/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Yi Chen Zhao
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Ahmed Bassiouni
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Kangsadarn Tanjararak
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
| | - Alkis James Psaltis
- Department of Surgery-Otorhinolaryngology; Head and Neck Surgery, University of Adelaide; Adelaide Australia
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28
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Oue S, Ramezanpour M, Paramasivan S, Miljkovic D, Cooksley CM, Bassiouni A, Ou J, Psaltis AJ, Wormald PJ, Vreugde S. Increased IL-13 expression is independently associated with neo-osteogenesis in patients with chronic rhinosinusitis. J Allergy Clin Immunol 2017; 140:1444-1448.e11. [PMID: 28601687 DOI: 10.1016/j.jaci.2017.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sakiko Oue
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Mahnaz Ramezanpour
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Sathish Paramasivan
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Dijana Miljkovic
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Clare M Cooksley
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Ahmed Bassiouni
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Judy Ou
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Alkis J Psaltis
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- From the Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
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29
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Kuhar HN, Tajudeen BA, Mahdavinia M, Gattuso P, Ghai R, Batra PS. Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis. Int Forum Allergy Rhinol 2017; 7:679-689. [PMID: 28521083 DOI: 10.1002/alr.21943] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/20/2017] [Accepted: 03/21/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is commonly classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Structured histopathologic reporting has the potential to identify salient histologic markers to differentiate subtypes and provide insights into pathophysiologic mechanisms in CRS. METHODS A structured histopathology report of 13 variables was prospectively employed to analyze ethmoid sinus tissue removed during endoscopic sinus surgery for 99 patients, including 43 CRSsNP and 56 CRSwNP. These variables were compared in association with presence of nasal polyps, radiographic computed tomography scores (Lund-Mackay Score [LMS]), subjective symptoms scores (SNOT-22), duration of CRS, comorbid asthma, and atopy. RESULTS Overall inflammation did not differentiate between CRSsNP and CRSwNP (p < 0.26). Compared to CRSsNP, CRSwNP had statistically significant increase in basement membrane thickening (76.8% vs 48.8%, p < 0.004), subepithelial edema (19.6% vs 2.3%, p < 0.01), fibrosis (58.9% vs 27.9%, p < 0.002), hyperplastic/papillary changes (12.5% vs 0.0%, p < 0.016), eosinophilia (41.1% vs 18.6%, p < 0.047), and eosinophilic aggregates (30.4% vs 11.6%, p < 0.022). Higher LMS was associated with increased eosinophilia (p < 0.001), eosinophil aggregates (p < 0.000), inflammation (p < 0.023), basement membrane thickening (p < 0.037), hyperplastic/papillary changes (p < 0.040) and fibrosis (p < 0.000). SNOT-22 scores were not associated with any histologic parameters. CONCLUSION Significant histopathologic differences were evident in patients with CRSwNP and CRSsNP. No single feature reliably differentiated between the 2 subtypes, underscoring the heterogeneity of CRS and limitation of this phenotypic classification system. Eosinophilic aggregates were associated with significantly worse disease, possibly signifying a unique subtype. Further studies are needed to understand the relationship of histopathologic features to disease outcome.
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Affiliation(s)
- Hannah N Kuhar
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, IL
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
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30
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Ou J, Drilling A, Singhal D, Tan NCW, Wallis-Hill D, Vreugde S, Psaltis AJ, Wormald PJ. Association of intracellularStaphylococcus aureuswith prognosis in chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:792-9. [DOI: 10.1002/alr.21758] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Judy Ou
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Amanda Drilling
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Deepti Singhal
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Neil C.-W. Tan
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Deanna Wallis-Hill
- Anatomical Pathology Department; Adelaide Pathology Partner; Adelaide Australia
| | - Sarah Vreugde
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Alkis J. Psaltis
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
| | - Peter-John Wormald
- Department of Surgery, Otorhinolaryngology Head and Neck Surgery; The University of Adelaide; Adelaide Australia
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31
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Ramezanpour M, Moraitis S, Smith JLP, Wormald PJ, Vreugde S. Th17 Cytokines Disrupt the Airway Mucosal Barrier in Chronic Rhinosinusitis. Mediators Inflamm 2016; 2016:9798206. [PMID: 26903715 PMCID: PMC4745600 DOI: 10.1155/2016/9798206] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 12/27/2015] [Indexed: 01/26/2023] Open
Abstract
Cytokine mediated changes in paracellular permeability contribute to a multitude of pathological conditions including chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of interferons and of Th1, Th2, and Th17 cytokines on respiratory epithelium barrier function. Cytokines and interferons were applied to the basolateral side of air-liquid interface (ALI) cultures of primary human nasal epithelial cells (HNECs) from CRS with nasal polyp patients. Transepithelial electrical resistance (TEER) and permeability of FITC-conjugated dextrans were measured over time. Additionally, the expression of the tight junction protein Zona Occludens-1 (ZO-1) was examined via immunofluorescence. Data was analysed using ANOVA, followed by Tukey HSD post hoc test. Our results showed that application of interferons and of Th1 or Th2 cytokines did not affect the mucosal barrier function. In contrast, the Th17 cytokines IL-17, IL-22, and IL-26 showed a significant disruption of the epithelial barrier, evidenced by a loss of TEER, increased paracellular permeability of FITC-dextrans, and discontinuous ZO-1 immunolocalisation. These results indicate that Th17 cytokines may contribute to the development of CRSwNP by promoting a leaky mucosal barrier.
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Affiliation(s)
- Mahnaz Ramezanpour
- Department of Surgery (Otorhinolaryngology Head and Neck Surgery), The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, SA 5011, Australia
| | - Sophia Moraitis
- Department of Surgery (Otorhinolaryngology Head and Neck Surgery), The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, SA 5011, Australia
| | - Jason L. P. Smith
- School of Biology, Faculty of Science and Engineering, Flinders University of South Australia, Adelaide, SA 5042, Australia
| | - P. J. Wormald
- Department of Surgery (Otorhinolaryngology Head and Neck Surgery), The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, SA 5011, Australia
| | - Sarah Vreugde
- Department of Surgery (Otorhinolaryngology Head and Neck Surgery), The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, SA 5011, Australia
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