1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Kaliniak S, Fiedoruk K, Spałek J, Piktel E, Durnaś B, Góźdź S, Bucki R, Okła S. Remodeling of Paranasal Sinuses Mucosa Functions in Response to Biofilm-Induced Inflammation. J Inflamm Res 2024; 17:1295-1323. [PMID: 38434581 PMCID: PMC10906676 DOI: 10.2147/jir.s443420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024] Open
Abstract
Rhinosinusitis (RS) is an acute (ARS) or chronic (CRS) inflammatory disease of the nasal and paranasal sinus mucosa. CRS is a heterogeneous condition characterized by distinct inflammatory patterns (endotypes) and phenotypes associated with the presence (CRSwNP) or absence (CRSsNP) of nasal polyps. Mucosal barrier and mucociliary clearance dysfunction, inflammatory cell infiltration, mucus hypersecretion, and tissue remodeling are the hallmarks of CRS. However, the underlying factors, their priority, and the mechanisms of inflammatory responses remain unclear. Several hypotheses have been proposed that link CRS etiology and pathogenesis with host (eg, "immune barrier") and exogenous factors (eg, bacterial/fungal pathogens, dysbiotic microbiota/biofilms, or staphylococcal superantigens). The abnormal interplay between these factors is likely central to the pathophysiology of CRS by triggering compensatory immune responses. Here, we discuss the role of the sinonasal microbiota in CRS and its biofilms in the context of mucosal zinc (Zn) deficiency, serving as a possible unifying link between five host and "bacterial" hypotheses of CRS that lead to sinus mucosa remodeling. To date, no clear correlation between sinonasal microbiota and CRS has been established. However, the predominance of Corynebacteria and Staphylococci and their interspecies relationships likely play a vital role in the formation of the CRS-associated microbiota. Zn-mediated "nutritional immunity", exerted via calprotectin, alongside the dysregulation of Zn-dependent cellular processes, could be a crucial microbiota-shaping factor in CRS. Similar to cystic fibrosis (CF), the role of SPLUNC1-mediated regulation of mucus volume and pH in CRS has been considered. We complement the biofilms' "mechanistic" and "mucin" hypotheses behind CRS pathogenesis with the "structural" one - associated with bacterial "corncob" structures. Finally, microbiota restoration approaches for CRS prevention and treatment are reviewed, including pre- and probiotics, as well as Nasal Microbiota Transplantation (NMT).
Collapse
Affiliation(s)
| | - Krzysztof Fiedoruk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Jakub Spałek
- Holy-Cross Cancer Center, Kielce, Poland
- Institute of Medical Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, 25-317, Poland
| | - Ewelina Piktel
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Bonita Durnaś
- Holy-Cross Cancer Center, Kielce, Poland
- Institute of Medical Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, 25-317, Poland
| | - Stanisław Góźdź
- Holy-Cross Cancer Center, Kielce, Poland
- Institute of Medical Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, 25-317, Poland
| | - Robert Bucki
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
- Institute of Medical Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, 25-317, Poland
| | - Sławomir Okła
- Holy-Cross Cancer Center, Kielce, Poland
- Institute of Medical Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, 25-317, Poland
| |
Collapse
|
3
|
Ríos-Deidán C, Reyes MS, Acosta-Castillo T, Escalante-Fiallos E, Villacrés-Silva D. Histological Characteristics of Chronic Allergic Rhinitis Versus Non-allergy: Is There a Difference in the Remodeling? Indian J Otolaryngol Head Neck Surg 2023; 75:3364-3372. [PMID: 37974791 PMCID: PMC10645690 DOI: 10.1007/s12070-023-03922-y] [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: 05/07/2023] [Accepted: 05/29/2023] [Indexed: 11/19/2023] Open
Abstract
Demonstrate the histological remodeling changes in the turbinates, identify the frequency of the two forms of rhinitis in the samples studied and determine the remodeling differences found in the two variants. Patients attended an otolaryngology service at the Social Security Hospital of city Sangolqui-Ecuador from February 2016 to June 2017. The allergic variant was determined when eosinophils were found by higher magnification field and non-allergic when they were not found in the submucosal segment. Epithelial, inflammatory, and stromal markers were analyzed. One hundred twenty histopathological samples were analyzed, 75% presented allergic rhinitis, the age averaged 36.2 years. When we compared between the allergic and non-allergic variants: epithelial and stromal markers we had significant differences, as well as between each of its components; except fibrosis. In relation to the inflammatory pattern, there were significant differences between the number of mast cells and stromal markers with eosinophils > 10 by field. The allergic type corresponded to 75% of patients with persistent severe rhinitis who underwent turbinectomy. Regarding remodeling, there was a statistically significant difference in favor of the allergic variant. Eosinophilia greater than 10 was directly related to mastocytosis and subepithelial edema.
Collapse
Affiliation(s)
- Carlos Ríos-Deidán
- Otorhinolaryngology Department of Medical Sciences Faculty, Central University of Ecuador, 170527 Quito, Ecuador
| | - Maria-Soledad Reyes
- Pathology Unit, Ecuadorian Institute of Social Security Sangolquí, Sangolquí, Ecuador
| | | | | | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
He Y, Fu Y, Wu Y, Zhu T, Li H. Pathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction. Front Med (Lausanne) 2023; 10:1139240. [PMID: 37138733 PMCID: PMC10149833 DOI: 10.3389/fmed.2023.1139240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) is a clinical syndrome primarily characterized by long-term mucosal inflammation of the nasal cavity and sinuses. The pathogenesis of CRS is still unclear due to its high heterogeneity. A number of studies have recently focused on the sinonasal epithelium. Thus, there has been a quantum leap in awareness of the role of the sinonasal epithelium, which is now understood as an active functional organ rather than simply an inert mechanical barrier. Undoubtedly, epithelial dysfunction plays a vital role in the onset and development of CRS. Objective In this article, we discuss the potential contribution of sinonasal epithelium dysfunction to CRS pathogenesis and explore a few current and developing therapeutic options targeting the sinonasal epithelium. Results Impaired mucociliary clearance (MCC) and an abnormal sinonasal epithelial barrier are usually considered to be the main causative factors in CRS. Epithelial-derived bioactive substances, such as cytokines, exosomes, and complements, play a vital role in the regulation of innate and adaptive immunity and contribute to the pathophysiological alterations of CRS. The phenomena of epithelial-mesenchymal transition (EMT), mucosal remodeling, and autophagy observed in CRS offer some novel insights into the pathogenesis of this disease. In addition, existing treatment options targeting disorder of sinonasal epithelium can help to relieve the main symptoms associated with CRS to some extent. Conclusion The presence of a normal epithelium is fundamental for maintaining homeostasis in the nasal and paranasal sinuses. Here, we describe various aspects of the sinonasal epithelium and highlight the contributions of epithelial dysfunction to CRS pathogenesis. Our review provides sound evidence of the need for in-depth study of the pathophysiological alterations of this disease and for the development of novel epithelium-targeting alternative treatments.
Collapse
Affiliation(s)
- Yuanqiong He
- School of Heath Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yijie Fu
- School of Preclinical Medicine, Chengdu University, Chengdu, China
| | - Yuqi Wu
- School of Heath Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tianmin Zhu
- School of Heath Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Li
- School of Preclinical Medicine, Chengdu University, Chengdu, China
- *Correspondence: Hui Li
| |
Collapse
|
6
|
Numano Y, Nomura K, Hemmi T, Ikeda R, Kakuta R, Sugawara M. The Factors Related to the Time for Sinus Debridement after Functional Endoscopic Sinus Surgery - A Retrospective Study. Ann Maxillofac Surg 2023; 13:49-52. [PMID: 37711532 PMCID: PMC10499281 DOI: 10.4103/ams.ams_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Post-operative care after functional endoscopic sinus surgery (FESS) is essential for managing the long-term success of chronic rhinosinusitis. Post-operative sinus debridement promotes proper wound healing, but the procedure can be accompanied by discomfort and pain. Hence, we analysed the clinical factors related to sinus debridement time after FESS. Materials and Methods We evaluated retrospectively the clinical factors affecting the time taken for post-operative sinus debridement on the first visit after the discharge. We reviewed 101 patients who underwent FESS at our hospital by the same surgeon and extracted patient information. The time for post-operative sinus debridement at the first outpatient clinic was measured. Results The days of putting the cotton ball in the operated nostril were negatively associated with sinus debridement time (coefficient - -16.4 ± 5.7 seconds/day, P = 0.005). In contrast, current or history of asthma, amount of bleeding during the surgery, number of opened sinuses by the operation or the number of eosinophils in resected tissues under a microscope at ×400 was not associated. Discussion We recommend the use of a cotton ball in the nostril after FESS because it shortens the sinus debridement time. Placing cotton balls in the nostril helps to maintain a humid wound environment and reduce crusting, leading to easier sinus debridement and better wound healing.
Collapse
Affiliation(s)
- Yuki Numano
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Tomotaka Hemmi
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University Hospital, Iwate, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| |
Collapse
|
7
|
Bao H, Li X, Lai X, Chen X, Li Y, Yao Z, Huang Z, Huang J, Chang L, Zhang G. Interleukin-19 upregulates fibronectin and collagen I expression via the NF-κB-Smad2/3 pathway in fibroblasts of patients with chronic rhinosinusitis. Inflamm Res 2023; 72:43-55. [PMID: 36316415 DOI: 10.1007/s00011-022-01634-7] [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: 04/28/2022] [Revised: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Tissue remodeling is a prominent characteristic of chronic rhinosinusitis (CRS). Excess deposition of fibronectin (FN) and collagen (Col) I by fibroblasts is crucial for the pathologic tissue remodeling in CRS without nasal polyps (CRSsNP). Increased interleukin (IL)-19 level in patients with CRS had been demonstrated in our previous studies. Here, we aimed to evaluate the role of IL-19 in mediating FN and Col I expression in CRS. METHODS Nasal mucosal tissue samples were collected from patients with CRS with nasal polyps (CRSwNP), CRSsNP, and controls. The expression of IL-19, vimentin, FN, and Col I were detected using immunohistochemistry and immunofluorescence. Primary human nasal fibroblasts were treated with IL-19, then the activation of Smad2/3, NF-κB and relevant pathways, and the expression of FN and Col I were measured. RESULTS Expression levels of vimentin, FN, and Col I were significantly increased in nasal tissues from patients with CRSsNP compared with CRSwNP and control subjects. Moreover, IL-19 co-localized with FN and Col Ι in nasal tissues. IL-19-treated fibroblasts had increased production of FN and Col I, which was associated with the activated Smad2/3 and NF-κB pathways. Moreover, Smad2/3 activation was mediated by the NF-κB pathway in IL-19-treated fibroblasts. CONCLUSIONS IL-19 promotes FN and Col I production via the activated NF-κB-Smad2/3 pathway in fibroblasts, leading to fibrosis and collagen deposition in patients with CRS.
Collapse
Affiliation(s)
- Hongwei Bao
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xia Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoping Lai
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yue Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhouzhou Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zizhen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiancong Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lihong Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Gehua Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
8
|
Borish L, Cohen NA, Chupp G, Hopkins C, Wagenmann M, Sousa AR, Smith SG, Silver J, Yang S, Mayer B, Yancey SW, Chan RH, Fokkens W. Evaluating enrollment and outcome criteria in trials of biologics for chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2022; 129:160-168. [PMID: 35398492 DOI: 10.1016/j.anai.2022.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) generally involves intranasal corticosteroids (INCS) and saline irrigation, followed by short courses of systemic corticosteroids (SCS) or surgery with postoperative medical therapy for patients who do not respond to INCS. However, both SCS use and surgery are associated with a range of adverse effects or complications, have a high recurrence rate, and are unsuitable for some patients. Biologics targeting the underlying pathophysiology are promising treatment alternatives for these patients. Dupilumab, omalizumab, and mepolizumab are approved for use in patients with severe, uncontrolled CRSwNP. However, the lack of a consistent definition of severe CRSwNP makes the decision to initiate biologic treatment particularly complex. Furthermore, the position of each biologic in the overall management of CRSwNP remains to be clarified. DATA SOURCES Publications reporting results of phase III trials of dupilumab, omalizumab, mepolizumab, and benralizumab in the treatment of CRSwNP. STUDY SELECTIONS Randomized, controlled phase III trials of biologics approved for CRSwNP. RESULTS These trials all used different enrollment criteria. We discuss the complexities of assessing CRSwNP disease severity and highlight how these impact comparisons of the populations and outcomes of the phase III biologic trials. CONCLUSION To position biologic agents appropriately within the existing CRSwNP treatment paradigm, future trials will need to include comparable patient populations and standardized outcome measures. Such trials will help to ensure that biologic treatment is targeted appropriately to support optimal clinical outcomes.
Collapse
Affiliation(s)
- Larry Borish
- Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia.
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Chupp
- Yale Center for Asthma and Airways Disease, Yale School of Medicine, New Haven, Connecticut
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK and King's College London, London, United Kingdom
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ana R Sousa
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Jared Silver
- US Value Evidence & Outcomes, US Medical Affairs-Respiratory, GSK, Research Triangle Park, North Carolina
| | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, Pennsylvania
| | - Bhabita Mayer
- Clinical Statistics, GSK, GSK House, Brentford, Middlesex, United Kingdom
| | - Steven W Yancey
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, North Carolina
| | - Robert H Chan
- Respiratory Clinical Sciences, R&D, GSK House, Brentford, Middlesex, United Kingdom
| | - Wytske Fokkens
- Department of Otolaryngology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Jiang L, Zeng Y, Huang Z, Tang Y, Zeng Q, Liu W, Shi J. Immunopathologic characteristics of Chinese pediatric patients with chronic rhinosinusitis. World Allergy Organ J 2021; 14:100616. [PMID: 34934474 PMCID: PMC8654981 DOI: 10.1016/j.waojou.2021.100616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background The histopathology of pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is rarely reported due to low prevalence or the unavailability of tissue samples. Hence, we aimed to characterize and compare the histologic features and protein expression of Th1/Th2/Th17-related cytokines in pediatric CRSsNP and CRSwNP. Methods The histologic characteristics of 15 children with CRSsNP, 52 children with CRSwNP, and 12 control participants were analyzed using hematoxylin and eosin staining. The expression of Th1/Th2/Th17-related cytokines were examined using immunohistochemistry and the enzyme-linked immunosorbent assay. Results Pediatric subjects with CRSwNP had more intact epithelium and less submucosal mucous glands compared to those with CRSsNP. Tissue eosinophils were more prevalent in the younger CRSwNP group compared to the older CRSwNP or the CRSsNP groups. The protein concentrations of Th2 cytokines were significantly higher in the CRSwNP group than the CRSsNP group or the control group. Moreover, the protein concentrations of Th17 cytokines were significantly higher in the younger CRSwNP group than the older CRSwNP group or the CRSsNP and control groups. The protein concentrations of Th1 and Th17 cytokines were also significantly higher in the CRSsNP group than the control group. Compared with non-eosinophilic CRSwNP, eosinophilic CRSwNP presented with elevated protein concentrations of Th1 and Th17 cytokines. Conclusion For the first time, we showed that pediatric CRSwNP presents as eosinophilic with Th2/Th17 inflammation, whereas CRSsNP presents as Th1/Th17 inflammation. Our study may provide a theoretical basis for the precise treatment of pediatric CRS in the future.
Collapse
Affiliation(s)
- Lijie Jiang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yinhui Zeng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhaoqi Huang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yiquan Tang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qingxiang Zeng
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenlong Liu
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| |
Collapse
|
10
|
Shin JM, Park JH, Yang HW, Moon JW, Lee HM, Park IH. miR-29b Regulates TGF-β1-Induced Epithelial-Mesenchymal Transition by Inhibiting Heat Shock Protein 47 Expression in Airway Epithelial Cells. Int J Mol Sci 2021; 22:ijms222111535. [PMID: 34768968 PMCID: PMC8584188 DOI: 10.3390/ijms222111535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Tissue remodeling contributes to ongoing inflammation and refractoriness of chronic rhinosinusitis (CRS). During this process, epithelial-mesenchymal transition (EMT) plays an important role in dysregulated remodeling and both microRNA (miR)-29b and heat shock protein 47 (HSP47) may be engaged in the pathophysiology of CRS. This study aimed to determine the role of miR-29b and HSP47 in modulating transforming growth factor (TGF)-β1-induced EMT and migration in airway epithelial cells. Expression levels of miR-29b, HSP47, E-cadherin, α-smooth muscle actin (α-SMA), vimentin and fibronectin were assessed through real-time PCR, Western blotting, and immunofluorescence staining. Small interfering RNA (siRNA) targeted against miR-29b and HSP47 were transfected to regulate the expression of EMT-related markers. Cell migration was evaluated with wound scratch and transwell migration assay. miR-29b mimic significantly inhibited the expression of HSP47 and TGF-β1-induced EMT-related markers in A549 cells. However, the miR-29b inhibitor more greatly induced the expression of them. HSP47 knockout suppressed TGF-β1-induced EMT marker levels. Functional studies indicated that TGF-β1-induced EMT was regulated by miR-29b and HSP47 in A549 cells. These findings were further verified in primary nasal epithelial cells. miR-29b modulated TGF-β1-induced EMT-related markers and migration via HSP47 expression modulation in A549 and primary nasal epithelial cells. These results suggested the importance of miR-29b and HSP47 in pathologic tissue remodeling progression in CRS.
Collapse
Affiliation(s)
- Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul 08308, Korea; (J.-M.S.); (J.W.M.); (H.-M.L.)
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul 08308, Korea; (J.-H.P.); (H.-W.Y.)
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul 08308, Korea
| | - Joo-Hoo Park
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul 08308, Korea; (J.-H.P.); (H.-W.Y.)
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul 08308, Korea
| | - Hyun-Woo Yang
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul 08308, Korea; (J.-H.P.); (H.-W.Y.)
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul 08308, Korea
| | - Jee Won Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul 08308, Korea; (J.-M.S.); (J.W.M.); (H.-M.L.)
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul 08308, Korea; (J.-M.S.); (J.W.M.); (H.-M.L.)
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul 08308, Korea; (J.-H.P.); (H.-W.Y.)
| | - Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul 08308, Korea; (J.-M.S.); (J.W.M.); (H.-M.L.)
- Upper Airway Chronic Inflammatory Diseases Laboratory, Korea University College of Medicine, Seoul 08308, Korea; (J.-H.P.); (H.-W.Y.)
- Medical Device Usability Test Center, Korea University Guro Hospital, Seoul 08308, Korea
- Correspondence: ; Tel.: +82-2-2626-3188
| |
Collapse
|
11
|
Sinonasal Tissue Remodelling during Chronic Rhinosinusitis. Int J Otolaryngol 2021; 2021:7428955. [PMID: 34567126 PMCID: PMC8460364 DOI: 10.1155/2021/7428955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
The purpose of this review is to summarise contemporary knowledge of sinonasal tissue remodelling during chronic rhinosinusitis (CRS), a chronic disease involving long-term inflammation of the paranasal sinuses and nasal passage. The concept of tissue remodelling has significant clinical relevance because of its potential to cause irreversibility in chronic airway tissues. Recent studies have indicated that early surgical treatment of CRS may improve clinical outcome. Tissue remodelling has been described in the literature extensively with no consensus on how remodelling is defined. This review describes various factors implicated in establishing remodelling in sinonasal tissues with a special mention of asthma as a comorbid condition. Some of the main histological features of remodelling include basement membrane thickening and collagen modulation. This may be an avenue of research with regard to targeted therapy against remodelling in CRS.
Collapse
|
12
|
Radajewski K, Kalińczak-Górna P, Zdrenka M, Antosik P, Wierzchowska M, Grzanka D, Burduk P. Short Term Pre-Operative Oral Corticosteroids-Tissue Remodeling in Chronic Rhinosinusitis with Nasal Polyps. J Clin Med 2021; 10:jcm10153346. [PMID: 34362131 PMCID: PMC8347571 DOI: 10.3390/jcm10153346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022] Open
Abstract
Chronic rhinosinusitis is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps. The main histological features of tissue remodeling are changes in epithelial structure, oedema, degradation of ECM (extracellular matrix), angiogenesis, and subepithelial fibrosis. In this study, patients were divided into two groups: group 1—patients with CRSwNP (chronic rhinosinusitis with nasal polyps) taking a nasal steroid and an oral steroid in the preoperative period, and group 2—patients with CRSwNP taking only the nasal steroid in the preoperative period. All samples were subject to histopatologic evaluation. The aim of this study was to investigate the effect of oral corticosteroids and topical steroids on the tissue of paranasal sinuses. We have shown statistically significant decreases in tissue eosinophilia per 5HPF and decreased fibrosis in group 1. No significant differences were presented in the percentage of total tissue oedema, epithelium, neutrophils, basement membrane thickening and vessels. Using systemic administration of 40 mg of prednisone for seven days decreased the counts of eosinophils and decreased fibrosis in the nasal polyps tissue in CRSwNP.
Collapse
Affiliation(s)
- Kamil Radajewski
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, 85-168 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-525-855-291
| | - Paulina Kalińczak-Górna
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (P.K.-G.); (M.W.); (P.B.)
| | - Marek Zdrenka
- Chair and Department of Clinical Pathomorphology, Collegium Medicum, Nicolaus Copernicus University, 85-009 Bydgoszcz, Poland; (M.Z.); (P.A.); (D.G.)
| | - Paulina Antosik
- Chair and Department of Clinical Pathomorphology, Collegium Medicum, Nicolaus Copernicus University, 85-009 Bydgoszcz, Poland; (M.Z.); (P.A.); (D.G.)
| | - Małgorzata Wierzchowska
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (P.K.-G.); (M.W.); (P.B.)
| | - Dariusz Grzanka
- Chair and Department of Clinical Pathomorphology, Collegium Medicum, Nicolaus Copernicus University, 85-009 Bydgoszcz, Poland; (M.Z.); (P.A.); (D.G.)
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (P.K.-G.); (M.W.); (P.B.)
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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: 413] [Impact Index Per Article: 137.7] [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.
Collapse
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
| |
Collapse
|
16
|
Hopkins C, Wagenmann M, Bachert C, Desrosiers M, Han JK, Hellings PW, Lee SE, Msihid J, Radwan A, Rowe P, Amin N, Deniz Y, Ortiz B, Mannent LP, Rout R. Efficacy of dupilumab in patients with a history of prior sinus surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2021; 11:1087-1101. [PMID: 33611847 PMCID: PMC8359289 DOI: 10.1002/alr.22780] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease treated with sinus surgery when refractory to medical intervention. However, recurrence postsurgery is common. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor for interleukin 4 (IL‐4) and IL‐13, key and central drivers of type 2 inflammation. We report the efficacy of dupilumab in patients with CRSwNP from the SINUS‐24/SINUS‐52 trials (NCT02912468/NCT02898454), by number of prior surgeries and time since last surgery. Methods Patients were randomized to placebo or dupilumab 300 mg every 2 weeks. Post hoc subgroup analyses were performed for patients with 0, ≥1, 1/2, or ≥3 prior surgeries, and for patients who had surgery within <3, 3 to <5, 5 to <10, or ≥10 years. Efficacy outcomes at 24 weeks included co‐primary endpoints nasal polyp score (NPS) and nasal congestion (NC), and Lund‐Mackay (LMK), 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and smell scores. Results Of 724 patients randomized, 459 (63.4%) had ≥1 prior surgery. Baseline sinus disease (NPS, NC, LMK) and olfactory dysfunction (University of Pennsylvania Smell Identification Test [UPSIT] and loss of smell) scores were worse for patients with ≥3 prior surgeries vs no surgery. Baseline NPS and LMK were worse in patients with <3 years since last surgery than in patients with ≥5 years since last surgery. Dupilumab significantly improved all outcome measures vs placebo in all subgroups by number of surgeries and by time since last surgery. Improvements in NPS and LMK were greater in patients with <3 years since last surgery than patients with ≥5 years. Safety results were consistent with the known dupilumab safety profile. Conclusion Dupilumab improved CRSwNP outcomes irrespective of surgery history, with greater improvements in endoscopic outcomes in patients with shorter duration since last surgery.
Collapse
Affiliation(s)
- Claire Hopkins
- ENT Department, Guy's and St Thomas' Hospitals, London, UK
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium.,Division of ENT diseases, Karolinska Institutet, Stockholm, Sweden.,First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Martin Desrosiers
- Department of Otorhinolaryngology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Joseph K Han
- Division of Allergy, Rhinology and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Peter W Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Stella E Lee
- Department of Otorhinolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Amr Radwan
- Regeneron Pharmaceuticals, Inc., Uxbridge, London, UK
| | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW This review highlights the expression and regulation of mucin in CRS and discusses its clinical implications. RECENT FINDINGS Chronic rhinosinusitis (CRS) is common chronic nasal disease; one of its main manifestations and important features is mucus overproduction. Mucin is the major component of mucus and plays a critical role in the pathophysiological changes in CRS. The phenotype of CRS affects the expression of various mucins, especially in nasal polyps (NP). Corticosteroids(CS), human neutrophil elastase (HNE), and transforming growth factor-β1 (TGF-β1) are closely related to the tissue remodeling of CRS and regulate mucin expression, mainly MUC1, MUC4, MUC5AC, and MUC5B. "It is expected that CS, HNE and TGF - β could be used to regulate the expression of mucin in CRS." However, at present, the research on mucin is mainly focused on mucin 5AC and mucin 5B, which is bad for finding new therapeutic targets. Investigating the expression and location of mucin in nasal mucosa and understanding the role of various inflammatory factors in mucin expression are helpful to figure out regulatory mechanisms of airway mucin hypersecretion. It is of great significance for the treatment of CRS.
Collapse
Affiliation(s)
- Jiaxin Tong
- Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provinicial People's Hospital & Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China
| | - Qingjia Gu
- Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provinicial People's Hospital & Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China.
| |
Collapse
|
18
|
Fungal ball of the maxillary sinus and the risk of persistent sinus dysfunction after simple antrostomy. Am J Otolaryngol 2020; 41:102541. [PMID: 32466983 DOI: 10.1016/j.amjoto.2020.102541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maxillary sinus fungal ball is a common cause of unilateral maxillary sinusitis. Fungal balls or mycetomas are primarily treated with surgery to remove the fungus. However, this assumes the pre-fungal ball sinus cavity was normal and post-surgery patients may suffer from mucostasis in the sinus cavity with persistent symptoms. It is proposed that fungal balls are potentially a feature of impaired mucus clearance as they are a pathology in their own right. METHODS A case series of consecutive patients undergoing antrostomy for maxillary sinus fungal ball was performed. Patient factors including age, gender, smoking status, comorbidities (allergy, asthma, and reflux), disease specific factors including duration of symptoms, microbiology (bacterial co-infection, Gram-positive and/or Gram-negative) and preoperative radiologic findings (extent of sinus development, and neo-osteogenesis/bone thickness) were collected. The primary outcome was sinus function defined by evidence of a normal functioning maxillary sinus, with the absence of mucostasis or pooling, on endoscopic exam at three months, six months and last follow-up. Endoscopic evaluation of inflammation was also collected. RESULTS 28 patients (age 58.5 ± 15.5 years, 64.3% female) were assessed. Mucostasis was present at three months in 39.3%, at six months in 32.1%, and 17.9% at last follow-up. There was no comorbidity or radiologic finding that was associated with failure to normalize. Those patients with mucostasis had a higher modified Lund-Mackay endoscopic score at last follow-up (5.0 ± 0.7 v 0.2 ± 0.6, p < 0.01). CONCLUSIONS Long term post-operative mucostasis occurred in 17.9% of patients following an adequate maxillary antrostomy for treatment of a fungal ball. Patients with mucostasis had persistent mucosal inflammation and a greater need for further surgery (modified medial maxillectomy).
Collapse
|
19
|
TGF-β1 Activates Nasal Fibroblasts through the Induction of Endoplasmic Reticulum Stress. Biomolecules 2020; 10:biom10060942. [PMID: 32580467 PMCID: PMC7355919 DOI: 10.3390/biom10060942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Tissue remodeling and extracellular matrix (ECM) accumulation contribute to the development of chronic inflammatory diseases of the upper airway. Endoplasmic reticulum (ER) stress is considered to be the key signal for triggering tissue remodeling in pathological conditions. The present study aimed to investigate the role of ER-stress in TGF-β1-stimulated nasal fibroblasts and inferior turbinate organ cultures; (2) Methods: Fibroblasts and organ cultures were pretreated with 4-phenylbutyric acid (PBA) and stimulated with TGF-β1 or thapsigargin (TG). Expression of ER-stress markers, myofibroblast marker, and ECM components was measured by Western blotting and real-time PCR. Reactive oxygen species (ROS) were quantified using 2',7'-dichlorofluorescein diacetate. Cell migration was evaluated using Transwell assays. Contractile activity was measured by collagen contraction assay; (3) Results: 4-PBA inhibited TGF-β1 or TG-induced ER-stress marker expression, phenotypic changes, and ECM. Pre-treatment with ROS scavengers inhibited the expression of TGF-β1-induced ER-stress markers. Migration and collagen contraction of TGF-β1 or TG-stimulated fibroblasts were ameliorated by 4-PBA treatment. These findings were confirmed in ex vivo organ cultures; (4) Conclusions: 4-PBA downregulates TGF-β1-induced ER-stress marker expression, migration, and collagen contraction via ROS in fibroblasts and organ cultures. These results suggest that ER-stress may play an important role in progression of chronic upper airway inflammatory diseases by aiding pathological tissue remodeling.
Collapse
|
20
|
Epperson MV, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Predictors of efficacy for combination oral and topical corticosteroids to treat patients with chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2019; 9:1436-1442. [PMID: 31609091 DOI: 10.1002/alr.22431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND A short-course oral corticosteroid taper and topical intranasal corticosteroids may be used to maximize the success of medical management for chronic rhinosinusitis with nasal polyps (CRSwNP). In this study, we sought to identify characteristics that would be predictive of efficacy for this combination regimen. METHODS Sixty-four patients with CRS, bilateral polyps, a polyp score of at least 3, and a 22-item Sino-Nasal Outcome Test (SNOT-22) score ≥20 were prospectively enrolled and uniformly treated with a 15-day prednisone taper and twice daily dilute budesonide irrigations. Participants were assessed at enrollment and at follow up, 2 to 5 months later. Clinical and demographic characteristics were assessed at enrollment. At both time points, CRS symptoms were assessed with SNOT-22, and polyp score (range, 0 to 6) was assessed endoscopically. Associations were determined with regression. RESULTS Pretreatment SNOT-22 score (adjusted β = -0.83; 95% CI, -1.08 to -0.58; p < 0.001) and comorbid asthma (adjusted β = 15.75; 95% CI, 4.74 to 26.75; p = 0.007) were associated with a change in SNOT-22 experienced over the study period. Achieving a greater-than-1 minimal clinically important difference (MCID) improvement in SNOT-22 score was also associated with pretreatment SNOT-22 score (adjusted OR = 1.09; 95% CI, 1.04 to 1.14; p < 0.001) and comorbid asthma (adjusted OR = 0.13; 95% CI, 0.03 to 0.72; p = 0.019). SNOT-22 score ≥47 had 81.5% sensitivity and 78.4% specificity to detect patients experiencing 1 MCID improvement. Pretreatment polyp score was not associated with any outcome metric. CONCLUSION In treatment of CRSwNP with prednisone and budesonide irrigations, pretreatment endoscopy was not informative of treatment response. Pretreatment SNOT-22 and comorbid asthma may be more predictive.
Collapse
Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Tajudeen BA, Ganti A, Kuhar HN, Mahdavinia M, Heilingoetter A, Gattuso P, Ghai R, Batra PS. The presence of eosinophil aggregates correlates with increased postoperative prednisone requirement. Laryngoscope 2018; 129:794-799. [DOI: 10.1002/lary.27693] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Bobby A. Tajudeen
- Department of Otorhinolaryngology–Head and Neck Surgery Chicago Illinois
| | - Ashwin Ganti
- Rush Sinus ProgramRush Medical College Chicago Illinois
| | | | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Allergy/Immunology Section Chicago Illinois U.S.A
| | | | - Paolo Gattuso
- Department of PathologyRush University Medical Center Chicago Illinois U.S.A
| | - Ritu Ghai
- Department of PathologyRush University Medical Center Chicago Illinois U.S.A
| | - Pete S. Batra
- Department of Otorhinolaryngology–Head and Neck Surgery Chicago Illinois
| |
Collapse
|
23
|
Xiang R, Zhang QP, Zhang W, Kong YG, Tan L, Chen SM, Deng YQ, Tao ZZ, Xu Y. Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol 2018; 276:115-130. [PMID: 30446828 PMCID: PMC6338715 DOI: 10.1007/s00405-018-5195-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
Background Allergic rhinitis (AR) has been reported to be associated with chronic rhinosinusitis (CRS). The objective of this study was to investigate the effect of AR on nasal mucosa remodeling in CRS. Methods Patients were enrolled and divided into the following groups: CRS with nasal polyps (NP) with allergic rhinitis (AR)(CRSwNPwAR; n = 20), CRS with NP without AR (CRSwNPsAR; n = 20), CRS without NP with AR (CRSsNPwAR; n = 20), CRS without NP without AR (CRSsNPsAR; n = 20), AR without CRS (AR; n = 20) and controls (n = 14). Eosinophil infiltration, mucus production, and collagen deposition were examined by hematoxylin and eosin, periodic acid schiff and masson’s trichrome staining, respectively. VEGF-A and microvessel density were detected by immunohistochemistry. The expression of remodeling markers, including TGF-β1, MMP-7, MMP-9 and TIMP-1 were measured by Western blot. Results The expression of remodeling factors, including VEGF-A, CD31, CD34 and TIMP-1 were significantly increased in CRSwAR compared to CRSsAR. Goblet cell hyperplasia, as well as VEGF-A, CD31, CD34, and MMP-9 expression were significantly higher in CRSwNPwAR compared to CRSwNPsAR. However, the expression of collagen fibers, MMP-7 and TGF-β1 were significantly higher in CRSsNPwAR compared to CRSsNPsAR. Conclusions AR could enhance the remodeling process in CRS. Moreover, AR had different effects on CRSwNP and CRSsNP.
Collapse
Affiliation(s)
- Rong Xiang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Qing-Ping Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Suizhou Hospital, Hubei University of Medicine, 60 Longmen Rd, Suizhou, 441300, Hubei, People's Republic of China
| | - Wei Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yong-Gang Kong
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Lu Tan
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Shi-Ming Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yu-Qin Deng
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Ze-Zhang Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China
| | - Yu Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan, 430060, Hubei, People's Republic of China.
| |
Collapse
|
24
|
Alt JA, Orlandi RR, Mace JC, Soler ZM, Smith TL. Does Delaying Endoscopic Sinus Surgery Adversely Impact Quality-of-Life Outcomes? Laryngoscope 2018; 129:303-311. [PMID: 30208208 DOI: 10.1002/lary.27473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES There is little consensus regarding the prognostic value of symptom duration in predicting clinical disease severity or quality-of-life (QOL) outcomes in patients with chronic rhinosinusitis (CRS). Our objectives were to: 1) determine if patients with longer symptom duration have worse preoperative disease severity and/or QOL, and 2) determine if delayed surgical intervention influences outcomes of endoscopic sinus surgery (ESS). METHODS Patients diagnosed with CRS were prospectively enrolled into a multicenter cohort study and observed 14.7 (standard deviaton {SD} ± 4.8) months on average following primary ESS. Preoperative symptom duration was stratified into short-term (< 12 months), middle-term (12-60 months), and long-term (> 60 months). Disease severity was assessed using endoscopy and computed tomography. Disease-specific QOL was measured with the 22-item Sinonasal Outcome Test (SNOT-22) and Rhinosinusitis Disability Index. Adjusted bivariate and multivariate associations between symptom duration, disease severity, and QOL scores were evaluated. RESULTS One hundred and thirteen patients met inclusion criteria with 35 patients lost to postoperative follow-up. No significant differences in preoperative disease severity or QOL scores were reported between symptom duration subgroups. Participants in the long-term symptom subgroup reported significantly greater mean postoperative improvement on SNOT-22 total scores (n = 28; -36.3[± 22.2]) compared to both short-term (n = 27; -23.4[SD ± 11.3]; P = 0.039) and middle-term (n = 23; -23.5[SD ± 20.1]; P = 0.050) subgroups. Postoperative QOL improvements in the long-term symptom subgroup remained significantly greater (P ≤ 0.036) after multivariate adjustment. CONCLUSIONS Symptom duration was not associated with mean preoperative disease severity or QOL. Patients with long-term symptom duration reported the greatest mean postoperative QOL improvement, suggesting that delayed surgical intervention may not reduce QOL improvements following ESS. LEVEL OF EVIDENCE 2c Laryngoscope, 129:303-311, 2019.
Collapse
Affiliation(s)
- Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard R Orlandi
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| |
Collapse
|
25
|
McHugh T, Snidvongs K, Xie M, Banglawala S, Sommer D. High tissue eosinophilia as a marker to predict recurrence for eosinophilic chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2018; 8:1421-1429. [DOI: 10.1002/alr.22194] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/15/2018] [Accepted: 07/09/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Tobial McHugh
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery; McMaster University; Hamilton ON Canada
| | - Kornkiat Snidvongs
- Division of Otolaryngology, Head and Neck Surgery; Chulalongkorn University; Bangkok Thailand
| | - Michael Xie
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery; McMaster University; Hamilton ON Canada
| | - Sarfaraz Banglawala
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery; McMaster University; Hamilton ON Canada
| | - Doron Sommer
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery; McMaster University; Hamilton ON Canada
| |
Collapse
|
26
|
Chitsuthipakorn W, Seresirikachorn K, Sommer DD, McHugh T, Snidvongs K. Endotypes of Chronic Rhinosinusitis Across Ancestry and Geographic Regions. Curr Allergy Asthma Rep 2018; 18:46. [PMID: 29995271 DOI: 10.1007/s11882-018-0800-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Preliminary studies have suggested differences in endotypes of chronic rhinosinusitis (CRS) across ancestry/ethnic groups. Eosinophilic CRS (ECRS) is the predominant subtype for Western/European ancestry CRS patients and non-eosinophilic CRS (nECRS) for Asian patients. This review aims to re-analyze CRS endotypes across ancestry populations using one consistent criteria to existing data. RECENT FINDINGS Although tissue eosinophilia is the most commonly used criterion for ECRS, various cut-off points are suggested. Surrogate markers have been extensively studied. Sixty-six cohorts with study criteria were included with a total of 8557 patients. Raw data from 11 studies 544 patients were re-analyzed using number of tissue eosinophils. At lower cut-off values of ≥ 5 and ≥ 10 cells/HPF, most patients of Asian and Western/European ancestry were classified as ECRS without difference. In contrast, at cut-off points of ≥ 70 and ≥ 120 cells/HPF, the majority of both groups became reclassified as nECRS. After applying one consistent criteria to existing data, differences across ancestry and geographic populations in endotypes of CRS were no longer evident.
Collapse
Affiliation(s)
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Prathumwan, Bangkok, 10330, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Tobial McHugh
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Prathumwan, Bangkok, 10330, Thailand. .,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| |
Collapse
|
27
|
Kennedy DW. IFAR AUGUST EDITORIAL. Int Forum Allergy Rhinol 2018; 6:781-2. [PMID: 27482703 DOI: 10.1002/alr.21830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Sivasubramaniam R, Harvey RJ. How to Assess, Control, and Manage Uncontrolled CRS/Nasal Polyp Patients. Curr Allergy Asthma Rep 2018; 17:58. [PMID: 28770480 DOI: 10.1007/s11882-017-0728-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a multidimensional inflammatory disorder of the nose and paranasal sinuses. We reviewed the recent literature to identify improved methods to assess, control, and manage these difficult to control patients. RECENT FINDINGS The role of endotyping in CRS has offered a better understanding of the underlying pathophysiology and allows for more targeted treatment. The understanding of systemic disorders and their role in CRS and the importance of topical treatment reaching the sinuses has also allowed for better control of these patients. We have provided some of the commonly identified causes for uncontrolled CRS and a sensible approach to assessing these patients. We have also focused on common areas of pitfalls in the surgery and choice of patients and the role for ongoing systemic treatment. The future of managing this difficult condition includes endotyping using inflammatory markers and individualizing the treatment to the patient by using specific monoclonal antibodies.
Collapse
Affiliation(s)
| | - Richard J Harvey
- Rhinology and Skull Base, Macquarie University, Sydney, Australia. .,Sydney ENT Clinic, 67 Burton Street, Darlinghurst, NSW, 2010, Australia.
| |
Collapse
|
29
|
Soler ZM, Jones R, Le P, Rudmik L, Mattos JL, Nguyen SA, Schlosser RJ. Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis. Laryngoscope 2017; 128:581-592. [PMID: 29164622 DOI: 10.1002/lary.27008] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature. METHODS A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression. RESULTS The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score. CONCLUSIONS Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 128:581-592, 2018.
Collapse
Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rabun Jones
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Phong Le
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| |
Collapse
|
30
|
Newton E, Janjua A, Lai E, Liu G, Crump T, Sutherland JM. The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:1156-1161. [DOI: 10.1002/alr.22018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/25/2017] [Accepted: 09/02/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Ethan Newton
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - Arif Janjua
- Rhinology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - Ernest Lai
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
| | - Trafford Crump
- Department of Surgery; University of Calgary; Calgary AB Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC Canada
| |
Collapse
|