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Wu AW, Tang DM, Hur K, Jafari A, Chen PG, Takashima M, Chang EE, Balzer B, Mathew A, Divatia M, Xu H, Robledo J, Amin L, Tam B, Cvancara DJ, Kinua AG, Syed TA, Paderin DL, Vasquez M, Ahmed OG. Endotype evaluation of Hispanic/Latinx-American patients with chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2024; 14:981-985. [PMID: 37933596 DOI: 10.1002/alr.23298] [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: 08/16/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
KEY POINTS Hispanic-American patients with chronic rhinosinusitis with nasal polyps have a comparable level of tissue eosinophilia compared to their Caucasian counterparts in the United States. Mixed inflammation involving both neutrophils and eosinophils is more common in this population compared to Caucasians. Findings from this study may indicate that Hispanic-American patients have a unique endotype or endotypes that deserves further investigation.
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Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kevin Hur
- Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Aria Jafari
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Philip G Chen
- Department of Otolaryngology-Head & Neck Surgery, University of Texas-San Antonio, San Antonio, Texas, USA
| | - Masayoshi Takashima
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Elena E Chang
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bonnie Balzer
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Anna Mathew
- Department of Pathology, University of Southern California, Los Angeles, California, USA
| | - Mukul Divatia
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
| | - Haodong Xu
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Juliana Robledo
- Department of Pathology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Luv Amin
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Benjamin Tam
- Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - David J Cvancara
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Amisheila G Kinua
- Department of Otolaryngology-Head & Neck Surgery, University of Texas-San Antonio, San Antonio, Texas, USA
| | - Tariq A Syed
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dominique L Paderin
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Missael Vasquez
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Omar G Ahmed
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Bai J, Tan BK, Kato A. Endotypic heterogeneity and pathogenesis in chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 2024; 24:1-8. [PMID: 37966157 PMCID: PMC10873077 DOI: 10.1097/aci.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide updates in realms of endotypic heterogeneity, pathogenesis at the molecular level, potential of biomarkers, and cutting-edge scope of biologics in CRS. RECENT FINDINGS High-dimensional analyses, such as transcriptomes, and machine learning, have significantly enhanced CRS endotyping, uncovering diverse pathogenetic mechanisms contributing to its heterogeneity. The dynamic process of epithelial remodeling in CRS pathogenesis has gained more clarity and support as exemplified by IL-13 and oncostatin M (OSM) that are shown intricately linked to epithelial barrier dysfunction. Moreover, anti-dsDNA autoantibody, BAFF, periostin, and cystatin SN show promise as potentials biomarkers, offering diagnostic and prognostic value for CRS. SUMMARY The identification of inflammatory molecules involved in endotype specific signaling pathways provides insights into the underlying mechanisms and verifiable biomarkers for diagnosis and prediction of disease severity. More comprehensive clinical studies should be conducted to facilitate biologics from bench to bedside in treating CRS.
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Affiliation(s)
- Junqin Bai
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Bruce K. Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Atsushi Kato
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Zhong B, Sun S, Tan KS, Ong HH, Du J, Liu F, Liu Y, Liu S, Ba L, Li J, Wang DY, Liu J. Hypoxia-inducible factor 1α activates the NLRP3 inflammasome to regulate epithelial differentiation in chronic rhinosinusitis. J Allergy Clin Immunol 2023; 152:1444-1459.e14. [PMID: 37777019 DOI: 10.1016/j.jaci.2023.09.020] [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: 02/26/2023] [Revised: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is an upper airway inflammation disease associated with hypoxia-mediated inflammation. The effect of hypoxia-inducible factor 1α (HIF-1α) on NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation in the pathogenesis of sinonasal mucosa is unclear. OBJECTIVE We investigated the effect and mechanism of HIF-1α on NLRP3 inflammasome activation in the primary human nasal epithelial cells (hNECs). METHODS We measured the expression levels of HIF-1α and the NLRP3 inflammasome in nasal biopsy samples and hNECs derived from negative controls (healthy) and patients with CRS with and without nasal polyps, then further analyzed the specific mechanism of HIF-1α regulation of the NLRP3 inflammasome and its effect on hNEC differentiation. RESULTS Increased mRNA and protein expression levels of HIF-1α and the NLRP3 inflammasome were found in all CRS biopsy samples. HIF-1α enhanced expression of phosphorylated NLRP3 (S295) in both HEK293T cells and hNECs; it also promoted recruitment of caspase-1 and apoptotic speck-like protein containing caspase recruitment domain (aka ASC) by NLRP3. HIF-1α also improved NLRP3's stability by preventing NLRP3 degradation caused by hypoxia-mediated inflammation. In addition, HIF-1α could also increase expression of Mucin5AC and decrease expression of α-tubulin by promoting activation of the NLRP3 inflammasome in hNECs. In addition, HIF-1α could also directly promote P63 expression in hNECs. CONCLUSION HIF-1α could potentially induce cilia loss and enhance the proliferation of goblet cells, possibly mediated by the regulation of NLRP3 phosphorylation in CRS inflammation.
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Affiliation(s)
- Bing Zhong
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Silu Sun
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management & Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Kai Sen Tan
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Department of Microbiology and Immunology, National University of Singapore, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore
| | - Hsiao Hui Ong
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jintao Du
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yafeng Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shixi Liu
- Upper Airways Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Luo Ba
- Department of Otolaryngology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Jing Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management & Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Jing Liu
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Brar T, Baheti S, Marino MJ, Kita H, Lal D. Genome-wide Epigenetic Study of Chronic Rhinosinusitis Tissues Reveals Dysregulated Inflammatory, Immunologic and Remodeling Pathways. Am J Rhinol Allergy 2023; 37:692-704. [PMID: 37584357 DOI: 10.1177/19458924231193526] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND Epigenetics studies mechanisms such as DNA methylation, histone modifications, non-coding RNAs, and alternative polyadenylation that can modify gene activity without changing the underlying DNA nucleotide base-pair structure. Because these changes are reversible, they have potential in developing novel therapeutics. Currently, seven pharmaceutical agents targeting epigenetic changes are FDA approved and commercially available for treatment of certain cancers. However, studies investigating epigenetics in chronic rhinosinusitis (CRS) have not been undertaken previously in the United States. OBJECTIVES The goal of this study was to investigate sinonasal DNA methylation patterns in CRS versus controls, to discern environmentally-induced epigenetic changes impacting CRS subjects. METHODS AND RESULTS Ethmoidal samples from CRS and inferior turbinate mucosal tissue samples from controls without CRS were studied. DNA methylation was studied by Reduced Representation Bisulfite Sequencing. RADMeth® biostatistical package was used to identify differentially methylated regions (DMRs) between CRS and controls. Ingenuity Pathway analysis of DMRs was performed to identify top upstream regulators and canonical pathways. Ninety-three samples from 64 CRS subjects (36 CRSwNP; 28 CRSsNP) and 29 controls were studied. CRS and control samples differed in 13 662 CpGs sites and 1381 DMRs. Top upstream regulators identified included: 1. CRS versus controls: TGFB1, TNF, TP53, DGCR8, and beta-estradiol. 2. CRSwNP versus controls: TGFB1, CTNNB1, lipopolysaccharide, ID2, and TCF7L2. 3. CRSsNP versus controls: MYOD1, acetone, ID2, ST8SIA4, and LEPR. CONCLUSIONS Differential patterns of methylation were identified between controls and CRS, CRSwNP, and CRSsNP. Epigenetic, environmentally-induced changes related to novel, inflammatory, immunologic, and remodeling pathways appear to affect epithelial integrity, cell proliferation, homeostasis, vascular permeability, and other yet uncharacterized pathways and genes.
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Affiliation(s)
- Tripti Brar
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Saurabh Baheti
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michael J Marino
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Hirohito Kita
- Department of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, USA
| | - Devyani Lal
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
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5
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Brar T, McCabe C, Miglani A, Marino M, Lal D. Tissue Eosinophilia is Superior to an Analysis by Polyp Status for the Chronic Rhinosinusitis Transcriptome: An RNA Study. Laryngoscope 2023; 133:2480-2489. [PMID: 36594502 DOI: 10.1002/lary.30544] [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: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE RNA sequencing (transcriptomics) is used to study biological pathways. However, the yield of data depends on comparing well-characterized cohorts. We compared tissue eosinophilia versus nasal polyp (NP) status as the metric to characterize transcriptomic mechanisms at play in eosinophilic and non-eosinophilic chronic rhinosinusitis (CRS) versus controls. METHODS RNA sequencing was conducted on sinonasal tissue samples of CRS and controls. Analyses were conducted based on polyp status [with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)] as well as tissue eosinophil levels per high power field (eos/hpf)[non-eosinophilic (<10 eos/hpf, neCRS) or eosinophilic (≥10 eos/hpf, eCRS)]. The yield of differentially expressed genes (DEGs) and biological pathways through Ingenuity Pathway Analysis (IPA) were compared. RESULTS CRS tissue differed from controls by 736 statistically significant DEGs. Both NP status and tissue eosinophilia were effective in differentiating CRS from controls and into two distinct subgroups. Statistically significant DEGs identified when comparing CRS by NP status were 60, whereas 110 DEGs were identified using eosinophil cutoff ≥10 and <10 eos/hpf. Additionally, heatmaps showed greater homogeneity within each CRS subgroup when analyzed by tissue eosinophilia versus NP status. On IPA, the IL-17 signaling pathway was significantly different only by tissue eosinophilia status, not NP status, being higher in CRS <10 eos/hpf. CONCLUSION Tissue eosinophilia is superior to an analysis by NP status for the study of CRS transcriptome by RNA sequencing in identifying DEGs. Classification of CRS samples by eosinophil counts agnostic of NP status may offer advantageous insights into CRS pathogenetic mechanisms. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2480-2489, 2023.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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6
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Cui N, Zhu X, Zhao C, Meng C, Sha J, Zhu D. A Decade of Pathogenesis Advances in Non-Type 2 Inflammatory Endotypes in Chronic Rhinosinusitis: 2012-2022. Int Arch Allergy Immunol 2023; 184:1237-1253. [PMID: 37722364 DOI: 10.1159/000532067] [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: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 09/20/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by localized inflammation of the upper airways. CRS includes two main phenotypes, namely, CRS with nasal polyps and CRS without nasal polyps. The phenotype-based classification method cannot reflect the pathological mechanism. The endotype-based classification method has been paid more and more attention by researchers. It is mainly divided into type 2 and non-type 2 endotypes. The mechanism driving the pathogenesis of non-type 2 inflammation is currently unknown. In this review, the PubMed and Web of Science databases were searched to conduct a critical analysis of representative literature works on the pathogenesis of non-type 2 inflammation in CRS published in the past decade. This review summarizes the latest evidence that may lead to the pathogenesis of non-type 2 inflammation. It is the main method that analyzing the pathogenesis from the perspective of immunology. Genomics and proteomics technique provide new approaches to the study of the pathogenesis. Due to differences in race, environment, geography, and living habits, there are differences in the occurrence of non-type 2 inflammation, which increase the difficulty of understanding the pathogenesis of non-type 2 inflammation in CRS. Studies have confirmed that non-type 2 endotype is more common in Asian patients. The emergence of overlap and unclassified endotypes has promoted the study of heterogeneity in CRS. In addition, as the source of inflammatory cells and the initiation site of the inflammatory response, microvessels and microlymphatic vessels in the nasal mucosal subepithelial tissue participate in the inflammatory response and tissue remodeling. It is uncertain whether CRS patients affect the risk of infection with SARS-CoV-2. In addition, the pathophysiological mechanism of non-type 2 CRS combined with COVID-19 remains to be further studied, and it is worth considering how to select the befitting biologics for CRS patients with non-type 2 inflammation.
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Affiliation(s)
- Na Cui
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China,
| | - Xuewei Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chen Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Cuida Meng
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jichao Sha
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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7
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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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8
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Yao Y, Zhu HY, Zeng M, Liu Z. Immunological mechanisms and treatable traits of chronic rhinosinusitis in Asia: A narrative review. Clin Otolaryngol 2023; 48:363-370. [PMID: 36317525 DOI: 10.1111/coa.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/23/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review the current literature on immunological mechanisms and treatable traits of chronic rhinosinusitis (CRS) in Asia. DESIGN This is a narrative review of published data on the immunological mechanisms and treatable traits of CRS in Asia. Published English literature on CRS in Asian and Western countries was reviewed. Where available, the data extracted included epidemiology, immunology, bacterium, phenotype, endotype and treatment. RESULTS AND CONCLUSION CRS is a heterogeneous disease characterised by persistent locoregional mucosal inflammation of the paranasal sinuses. The inflammatory signatures of CRS vary across patients with distinct racial and ethnic backgrounds and geographic areas. Compared to CRS patients in Western countries, Asian CRS patients display less eosinophilic and Type 2 inflammation, which is associated with lower asthma and allergic rhinitis comorbidities. In contrast, Asian patients with CRS have more prominent non-eosinophilic inflammation than those in Western countries. In addition, Asian CRS patients may have different bacterial colonisation than patients in Western countries. Our review suggests that the distinct immunological mechanisms between Asian and Western CRS patients may influence the clinical phenotype, responses to treatment and outcomes. The treatable trait is a new strategy and therapeutic target identified by phenotype or endotype and has been proposed as a new paradigm for the management of diseases. Improved understanding of CRS phenotypic and endotypic heterogeneity and incorporation of treatable traits into clinical care pathways may facilitate more effective selections of therapeutic interventions, including surgery and biologics.
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Affiliation(s)
- Yin Yao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
| | - Hong-Yu Zhu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
| | - Zheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.,Hubei Clinical Research Center for Nasal Inflammatory Diseases, Wuhan, Hubei, People's Republic of China
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9
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Chen CC, Buchheit KM. Endotyping Chronic Rhinosinusitis with Nasal Polyps: Understanding Inflammation Beyond Phenotypes. Am J Rhinol Allergy 2023; 37:132-139. [PMID: 36848270 DOI: 10.1177/19458924221149003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogenous group of inflammatory conditions impacting the nose and paranasal sinuses. Our understanding of the underlying pathobiology of CRSwNP has substantially improved due to ongoing translational research efforts. Advances in treatment options, including targeted respiratory biologic therapy for CRSwNP, allow for more personalized approaches for CRSwNP patient care. Patients with CRSwNP are typically classified to one or more endotype based on the presence of type 1, type 2, and type 3 inflammation. This review will discuss recent advances in our understanding of CRSwNP and how this may impact current and future treatment approaches for patients with CRSwNP.
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Affiliation(s)
- Chongjia C Chen
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen M Buchheit
- Department of Medicine, Harvard Medical School, the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
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10
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Chee J, Pang KW, Low T, Wang DY, Subramaniam S. Epidemiology and aetiology of chronic rhinosinusitis in Asia-A narrative review. Clin Otolaryngol 2023; 48:305-312. [PMID: 35997660 DOI: 10.1111/coa.13971] [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: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite having a similar prevalence to Western populations, literature on chronic rhinosinusitis (CRS) in the Asian population is sparse. There is limited data on the epidemiology and aetiology of CRS in Asia. OBJECTIVES To review the current literature on the epidemiology and aetiology of CRS in Asia. METHODS This is a narrative review of published data on the epidemiology and aetiology of CRS. Studies on CRS in Asian countries, published in English and indexed on PubMed or Google Scholar were reviewed. Where available, data extracted included epidemiology, endotype and cytokine profiles and genetic profiles. RESULTS AND CONCLUSION The prevalence of CRS in Asia ranges widely from 2.1% to 28.4%. Type 2 inflammation has been reported in 5%-55% of Asian patients, with lower levels of Type 2 cytokines reported in head to head comparisons of Western versus Asian patients. Notably, there exists marked heterogeneity in criterion of the tissue eosinophilic infiltration for diagnosis of type 2 CRS. Our review suggests that differences in prevalence of CRS and proportion of eosinophilic CRS between Asia and Europe and the Americas requires further study. Large-scale Asian studies utilising standardised definitions are needed to bridge this gap. Head to head genetic and microbiomal analysis may also be useful in understanding differences in CRS between the Asian and Western populations.
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Affiliation(s)
- Jeremy Chee
- Department of Otolaryngology-Head & Neck Surgery, National University Health System, Singapore, Singapore
| | - Khang Wen Pang
- Department of Otolaryngology-Head & Neck Surgery, National University Health System, Singapore, Singapore
| | - Terese Low
- Department of Otolaryngology-Head & Neck Surgery, National University Health System, Singapore, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Somasundaram Subramaniam
- Department of Otolaryngology-Head & Neck Surgery, National University Health System, Singapore, Singapore
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11
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Lal D, Brar T, Ramkumar SP, Li J, Kato A, Zhang L. Genetics and epigenetics of chronic rhinosinusitis. J Allergy Clin Immunol 2023; 151:848-868. [PMID: 36797169 DOI: 10.1016/j.jaci.2023.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/16/2023]
Abstract
Discerning the genetics and epigenetics of chronic rhinosinusitis (CRS) may optimize outcomes through early diagnostics, personalized and novel therapeutics, and early prognostication. CRS associated with cystic fibrosis and primary ciliary dyskinesia has well-characterized genetic mutations. Most CRS subjects, however, do not exhibit identifiable monogenic alterations. Clustering in related individuals is seen in CRS with nasal polyps. Spouses of subjects with CRS without nasal polyps also may be at increased risk of the same disease. These observations generate questions on genetic and environmental influences in CRS. Genome-wide association studies have identified variations and polymorphisms between CRS and control subjects in genes related to innate and adaptive immunity. Candidate gene and transcriptomics studies have investigated and identified genetic variations related to immunity, inflammation, epithelial barrier function, stress-response, antigen processing, T-cell regulation, and cytokines in CRS. Epigenetic studies have identified mechanisms through which environmental factors may affect these gene functions. However, causality is not determined for most variations. Inferences drawn from these data must be measured because most investigations report unreplicated results from small study populations. Large, replicated studies in tight cohorts across diverse populations remain a pressing need in studying CRS genetics.
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Affiliation(s)
- Devyani Lal
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Ariz.
| | - Tripti Brar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Ariz
| | - Shreya Pusapadi Ramkumar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Ariz; Saint Louis University School of Medicine, St Louis, Mo
| | - Jingyun Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Laboratory of Allergic Diseases and 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
| | - Atsushi Kato
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Laboratory of Allergic Diseases and 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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Zhang L, Zhang R, Pang K, Liao J, Liao C, Tian L. Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis. Front Public Health 2023; 10:986026. [PMID: 36699933 PMCID: PMC9869174 DOI: 10.3389/fpubh.2022.986026] [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: 07/04/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) can be seen in people of all ages. CRS heavily affects the quality of a patient's daily life and also causes tremendous economic burdens on patients' families and society. The prevalence of CRS in different countries varies and no systematic review of the prevalence of CRS among Chinese has been published previously. The objective of this systematic review and meta-analysis is to determine the prevalence of CRS among Chinese and to explore the main risk factors of CRS among Chinese. Methods Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Google Scholar, Embase, Cochrane Library, Chinese National Knowledge of Infrastructure (CNKI), WANGFANG, VIP, and China Biomedical Literature database (CMB) were searched to obtain literature reporting the prevalence of and risk factors of CRS among Chinese which were clearly diagnosed with CRS from inception to 30 June 2022. The random/fixed effect model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. All analyses were performed by using the STATA version 16.0 software. The study was registered with PROSPERO, register number. CRD42022341877. Result A total of 12 relevant kinds of literature were qualified for the present systematic review, including 4,033 patients. The results showed that the overall prevalence of CRS among Chinese was 10% (95%CI: 0.06-0.13, I2 = 99.6%, P < 0.001). The prevalence of CRS among Chinese who lived in urban cities was 18% (95%CI: -0.07 to 0.43, I2 = 99.9%, P < 0.001), which was obviously lower than the prevalence of CRS among Chinese who lived in rural areas (27%, 95%CI: -0.14 to 0.68, I2 = 99.8%, P < 0.001). The prevalence of CRS among Chinese before 2010 was 23% (95%CI: -0.05 to 0.50, I2 = 99.8%, P < 0.001), which was remarkably higher than the prevalence of CRS among Chinese after 2010 (7%, 95%CI: 0.05-0.09, I2 = 99.0%, P < 0.001). The prevalence of CRS among Chinese who were divorced was 17% (95%CI: 0.12-0.22, I2 = 0.0%, P = 0.436), while the prevalence of CRS among Chinese who were married, widowed, and unmarried was 9% (95%CI: 0.06-0.11, I2 = 88.1%, P = 0.004), 9% (95%CI: 0.06-0.11, I2 = 0.0%, P = 0.863), and 9% (95%CI: 0.08-0.10, I2 = 0.0%, P = 0.658), respectively. The prevalence of CRS among Han and minority Chinese was 8% (95%CI: 0.07-0.10, I2 = 69.6%, P = 0.070) and 12% (95%CI: 0.10-0.15, I2 = 38.6%, P = 0.202), respectively. The prevalence of CRS among Chinese who was never exposed to moldy or damp environments was 8% (95%CI: 0.08-0.09, I2 = 0.0%, P = 0.351), the prevalence of CRS among Chinese who was occasionally exposed to moldy or damp environments was 16% (95%CI: 0.10-0.22, I2 = 78.9%, P = 0.030), and the prevalence of CRS among Chinese who was frequently or every day exposed to moldy or damp environments was up to 20% (95%CI: 0.15-0.24, I2 = 0.0%, P = 0.558). Conclusion This meta-analysis shows that the prevalence of CRS among Chinese is at a high level. People who have some risk factors, such as occasional or frequent or everyday exposure to moldy or damp environments, have a higher prevalence of CRS. We should attach more importance to the risk factors of CRS in clinical practice and disseminate scientific information and carry out education to lower the prevalence of CRS in China. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=341877, identifier: CRD42022341877.
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Affiliation(s)
- Lan Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rong Zhang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Kaiyun Pang
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Liao
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chao Liao
- Department of Otorhinolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li Tian
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,Department of Otorhinolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,*Correspondence: Li Tian ✉
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13
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Xu S, Vallei M, Hwang Siok Gek J, Tze Choong C, Wei Yang Teo N. Endotyping of nasal polyps in a multiracial Asian population. RHINOLOGY ONLINE 2022. [DOI: 10.4193/rhinol/22.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Chronic rhinosinusitis is a heterogenous disease with variation in the endotypes of nasal polyps, with type 2 inflammation being more prevalent in Caucasian populations whereas Chinese populations are more heterogenous. We aim to describe the variation in endotypes for patients with chronic rhinosinusitis with nasal polyposis in our unique multiracial population. Methodology: Demographic, clinical and structured histopathological data of 66 patients who underwent sinus surgery for nasal polyposis were evaluated retrospectively. Results: 54.6% had eosinophilic disease, and 45.4% had non-eosinophilic disease with no significant demographic differences between the 2 populations. There were significantly higher peripheral eosinophil levels in patients with eosinophil-predominant inflammation on tissue histology (mean absolute eosinophil count 0.59 ± 0.18 x 109) compared with non-eosinophilic disease (mean absolute eosinophil count 0.24 ± 0.11 x 109). Structured histopathological reporting revealed that patients with eosinophilic disease had higher degree of inflammation and eosinophil aggregates. Conclusions: Our population is shown to have a slight preponderance toward eosinophilic disease, however the Chinese majority tended to have non-eosinophilic disease. Serum eosinophilia and the presence of asthma seems to correlate well with tissue eosinophilia, which can potentially be utilised as markers of type 2 inflammatory disease.
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14
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De Corso E, Baroni S, Settimi S, Onori ME, Mastrapasqua RF, Troiani E, Moretti G, Lucchetti D, Corbò M, Montuori C, Cantiani A, Porru DP, Lo Verde S, Di Bella GA, Caruso C, Galli J. Sinonasal Biomarkers Defining Type 2-High and Type 2-Low Inflammation in Chronic Rhinosinusitis with Nasal Polyps. J Pers Med 2022; 12:jpm12081251. [PMID: 36013200 PMCID: PMC9410079 DOI: 10.3390/jpm12081251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The complex pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) generates a spectrum of phenotypes with a wide variety of inflammatory states. We enrolled 44 very-likely-to-be type 2 CRSwNP patients in order to evaluate the load of inflammation and to analyze human interleukins in nasal secretion. Clinical data were collected to evaluate the severity of the disease. High levels of IL-5, IL-4, IL-6, and IL-33 were detected in all type 2 CRSwNP patients. By analyzing type 2 cytokine profiles and local eosinophil count, we identified two coherent clusters: the first was characterized by high levels of IL-4, IL-5, IL-6, and a high-grade eosinophil count (type 2-high); the second had lower levels of cytokines and poor or absent eosinophilic inflammation (type-2 low). IL-5 levels were significantly higher within the type 2 cytokine and it was the most reliable biomarker for differentiating the two clusters. In type 2-high inflammatory profile clinical scores, the mean number of previous surgeries and need for systemic corticosteroids were significantly higher compared to type 2-low. Our research demonstrated the potential role of type 2 biomarkers, and in particular, of IL-5 in identifying patients with a more severe phenotype based on a high inflammatory load.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-0630154439
| | - Maria Elisabetta Onori
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Rodolfo Francesco Mastrapasqua
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Eliana Troiani
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Giacomo Moretti
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Alessandro Cantiani
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
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15
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Lee SN, Yoon JH. The Role of Proprotein Convertases in Upper Airway Remodeling. Mol Cells 2022; 45:353-361. [PMID: 35611689 PMCID: PMC9200660 DOI: 10.14348/molcells.2022.0019] [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: 02/02/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a multifactorial, heterogeneous disease characterized by persistent inflammation of the sinonasal mucosa and tissue remodeling, which can include basal/progenitor cell hyperplasia, goblet cell hyperplasia, squamous cell metaplasia, loss or dysfunction of ciliated cells, and increased matrix deposition. Repeated injuries can stimulate airway epithelial cells to produce inflammatory mediators that activate epithelial cells, immune cells, or the epithelial-mesenchymal trophic unit. This persistent inflammation can consequently induce aberrant tissue remodeling. However, the molecular mechanisms driving disease within the different molecular CRS subtypes remain inadequately characterized. Numerous secreted and cell surface proteins relevant to airway inflammation and remodeling are initially synthesized as inactive precursor proteins, including growth/differentiation factors and their associated receptors, enzymes, adhesion molecules, neuropeptides, and peptide hormones. Therefore, these precursor proteins require post-translational cleavage by proprotein convertases (PCs) to become fully functional. In this review, we summarize the roles of PCs in CRS-associated tissue remodeling and discuss the therapeutic potential of targeting PCs for CRS treatment.
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Affiliation(s)
- Sang-Nam Lee
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Joo-Heon Yoon
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea
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16
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Jiang L, Wang K, Lin T, Jiang Y, Gao W, Li C, Huang Z, Chen C, Nie Z, Zheng R, Sun Y, Shi J, Lai Y. A novel risk score for disease control prediction of Chronic rhinosinusitis. Clin Otolaryngol 2022; 47:568-576. [PMID: 35622459 PMCID: PMC9542583 DOI: 10.1111/coa.13949] [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: 01/06/2022] [Revised: 03/30/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
Objectives To assess the impact of risk factors on the disease control among chronic rhinosinusitis (CRS) patients, following 1 year of functional endoscopic sinus surgery (FESS), and combining the risk factors to formulate a convenient, visualised prediction model. Design A retrospective and nonconcurrent cohort study. Setting and Participants A total of 325 patients with CRS from June 2018 to July 2020 at the First Affiliated Hospital of Sun Yat‐sen University, the Third Affliated Hospital of Sun Yat‐sen University, the Seventh Affiliated Hospital of Sun Yat‐sen University. Main Outcomes Measures Outcomes were time to event measures: the disease control of CRS after surgery 1 year. The presence of nasal polyps, smoking habits, allergic rhinitis (AR), the ratio of tissue eosinophil (TER) and peripheral blood eosinophil count (PBEC) and asthma was assessed. The logistic regression models were used to conduct multivariate and univariate analyses. Asthma, TER, AR, PBEC were also included in the nomogram. The calibration curve and area under curve (AUC) were used to evaluate the forecast performance of the model. Results In univariate analyses, most of the covariates had significant associations with the endpoints, except for age, gender and smoking. The nomogram showed the highest accuracy with an AUC of 0.760 (95% CI, 0.688–0.830) in the training cohort. Conclusions In this cohort study that included the asthma, AR, TER, PBEC, which had significantly affected the disease control of CRS after surgery. The model provided relatively accurate prediction in the disease control of CRS after FESS and served as a visualised reference for daily diagnosis and treatment.
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Affiliation(s)
- Lijie Jiang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kanghua Wang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Otorhinolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University Shenzhen, China
| | - Tengjiao Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifeng Jiang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenxiang Gao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cong Li
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaoqi Huang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuxin Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Otorhinolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University Shenzhen, China
| | - Zhiyin Nie
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Otorhinolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University Shenzhen, China
| | - Rui Zheng
- Department of Otorhinolaryngology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yueqi Sun
- Department of Otorhinolaryngology, The Seventh Affiliated Hospital, Sun Yat-sen University Shenzhen, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinyan Lai
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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17
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Lee SH, Choi MR, Chung J, Choi SH, Park SK, Kim YM. Povidone iodine suppresses LPS-induced inflammation by inhibiting TLR4/MyD88 formation in airway epithelial cells. Sci Rep 2022; 12:3681. [PMID: 35256715 PMCID: PMC8901750 DOI: 10.1038/s41598-022-07803-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Povidone-iodine (PVP-I) is an antiseptic and a disinfectant with broad-spectrum antimicrobial activity against various pathogens. However, it is unclear whether PVP-I nasal instillation can suppress mucosal inflammation in non-eosinophilic chronic rhinosinusitis (CRS) mice. This study aimed to explore the anti-inflammatory effects and underlying molecular mechanism of PVP-I on lipopolysaccharide-stimulated airway epithelial cells and investigate whether nasal instillation of PVP-I can suppress mucosal inflammation in non-eosinophilic CRS mice. Inflammation-related molecules in the nasal epithelial cells and non-eosinophilic CRS mice were measured by enzyme-linked immunosorbent assay, western blotting, quantitative real-time polymerase chain reaction, immunoprecipitation, and histopathological analysis. PVP-I blocked expressions of various inflammation-related molecules, such as NLRP3, NF-κB-p65, caspase-1, and IL-1β. Translocation of NF-κB to the nucleus, and assembly of NLRP3/ASC complexes in the nasal epithelial cells and non-eosinophilic CRS mice were also restricted. Notably, PVP-I strongly blocked the receptor co-localization of TLR4 and MyD88 in the epithelial cells of nasal mucosa. We demonstrated that PVP-I significantly attenuated inflammatory molecules and cytokines via blocking the formation of TLR4 and MyD88 complexes during LPS-induced mucosal inflammation in non-eosinophilic CRS.
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Affiliation(s)
- Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Mi-Ra Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jaein Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung-Hyeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea. .,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, South Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, South Korea.
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18
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Nakayama T, Lee IT, Le W, Tsunemi Y, Borchard NA, Zarabanda D, Dholakia SS, Gall PA, Yang A, Kim D, Akutsu M, Kashiwagi T, Patel ZM, Hwang PH, Frank DN, Haruna SI, Ramakrishnan VR, Nolan GP, Jiang S, Nayak JV. Inflammatory molecular endotypes of nasal polyps derived from Caucasian and Japanese populations. J Allergy Clin Immunol 2021; 149:1296-1308.e6. [PMID: 34863854 DOI: 10.1016/j.jaci.2021.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emerging evidence suggests that chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly heterogeneous disease with disparate inflammatory characteristics between different racial groups and geographies. Little is known currently about possible distinguishing factors underlying these inflammatory differences. OBJECTIVE To interrogate for differences between Caucasian and Japanese CRSwNP disease using whole transcriptome and single-cell RNA gene expression profiling of nasal polyps (NPs). METHODS We performed whole transcriptome RNA sequencing (RNA-seq) with endotype stratification of NPs from 8 Caucasian (residing in USA) and 9 Japanese (residing in Japan) patients. Reproducibility was confirmed by qPCR in an independent validation set of 46 Caucasian and 31 Japanese patients. Single-cell RNA-seq stratified key cell types for contributory transcriptional signatures. RESULTS Unsupervised clustering analysis identified two major endotypes present within both NP cohorts, which have previously been reported at the cytokine level: 1) type 2 endotype and 2) non-type 2 endotype. Importantly, there was a statistically significant difference in the proportion of these endotypes between these geographically distinct NP subgroups (p = 0.03). Droplet-based single-cell RNA sequencing further identified prominent type 2 inflammatory transcript expression: C-C motif chemokine ligand 13 (CCL13) and CCL18 in M2 macrophages, as well as cystatin SN (CST1) and CCL26 in basal, suprabasal, and secretory epithelial cells. CONCLUSION NPs from both racial groups harbor the same two major endotypes, which we determine are present in differing ratios between each cohort with CRSwNP disease. Distinct inflammatory and epithelial cells contribute to the type 2 inflammatory profiles observed.
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Affiliation(s)
- Tsuguhisa Nakayama
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Ivan T Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Wei Le
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Nicole A Borchard
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - David Zarabanda
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sachi S Dholakia
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Philip A Gall
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela Yang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dayoung Kim
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Makoto Akutsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takashi Kashiwagi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel N Frank
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
| | - Shin-Ichi Haruna
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Garry P Nolan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sizun Jiang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Otolaryngology-Head and Neck Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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19
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Huang Y, Zhang N, Xu Z, Zhang L, Bachert C. The development of the mucosal concept in chronic rhinosinusitis and its clinical implications. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:707-715. [PMID: 34742931 DOI: 10.1016/j.jaip.2021.10.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022]
Abstract
In the last 2 decades, an increasing understanding of pathophysiological mechanisms in chronic rhinosinusitis opened an avenue from phenotyping to endotyping, from eosinophilic inflammation to type 2 immunity, and from the "ventilation and drainage" paradigm to the mucosal concept for therapeutic considerations. With the advent of type 2 endotyping and targeted biomarkers, precise endotype-driven therapeutic options are possible including biologics and adapted surgical approaches. We here aim to focus on the complexity and heterogeneity of the features of chronic rhinosinusitis (CRS) endotypes, especially for those with nasal polyps, including its history, latest developments, clinical associations and endotype-driven solutions. In order to better manage uncontrolled severe CRS in clinical practice, medical decisions based on a profound understanding of the pathology and immunology of this heterogeneous disease, aiding a precision-medicine based approach for patient's treatment are pivotal.
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Affiliation(s)
- Yanran Huang
- Upper Airway Research Laboratory, Ghent University, Ghent, Belgium; Department of Allergy, Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
| | - Nan Zhang
- Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
| | - Zhaofeng Xu
- The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Department of Otorhinolaryngology, International Airway Research Center, Guangzhou, China
| | - Luo Zhang
- Department of Allergy, Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing key laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China.
| | - Claus Bachert
- Department of Allergy, Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Division of ENT diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden; The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Department of Otorhinolaryngology, International Airway Research Center, Guangzhou, China.
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20
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Feng T, Miao P, Liu B, Liu Y, Bao X, Xu J, Ren N, Li Y, Shi J, Cao W, Fang J, Li M, Liu Q, Li J. Sinus Microbiota in Patients With Eosinophilic and Non-Eosinophilic Chronic Rhinosinusitis With Nasal Polyps. Front Cell Infect Microbiol 2021; 11:672355. [PMID: 34368010 PMCID: PMC8346020 DOI: 10.3389/fcimb.2021.672355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2-skewed inflammation and increased colonization by Staphylococcus aureus. CRSwNP can be distinguished as eosinophilic (ECRSwNP) and non-eosinophilic (NECRSwNP) by the infiltration of eosinophils. The local microbiota plays an important role in the persistent inflammation of CRSwNP. To evaluate the bacterial community composition on the distinct types of CRSwNP patients, we collected nasal swabs from 16 ECRSwNP patients, 18 NECRSwNP patients, and 39 healthy control subjects. The microbiome structure for all the samples were analyzed by high-throughput 16S rRNA gene sequencing. Concentration of S. aureus was determined using TaqMan quantitative polymerase chain reaction (qPCR) targeting the nuclease (nuc) gene. The result showed significant differences in the sinus microbiome among healthy control subjects and CRSwNP patients. Microbiota community diversity was significantly lower in NECRSwNP samples compared to that of healthy control subjects. Interestingly, the abundance of several pathogenic bacteria was diverse between ECRSwNP and NECRSwNP patients. Although Staphylococcus prevailed in all groups, the abundance of Staphylococcus was significantly higher in the healthy control group than the ECRSwNP group. More importantly, the abundance of S. aureus was much higher in NECRSwNP patients. This study highlights that microbiota composition may contribute to the different clinical types of CRSwNP, inspiring new therapeutic strategies to resolve this chronic inflammation process.
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Affiliation(s)
- Tingting Feng
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Miao
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bin Liu
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yao Liu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ximing Bao
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ji Xu
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nana Ren
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ying Li
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiali Shi
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wanxin Cao
- Department of Otorhinolaryngology, Peking University Third Hospital, Peking University, Beijing, China
| | - Jianchen Fang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qian Liu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiping Li
- Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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21
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Lygeros S, Danielides G, Grafanaki K, Riga M. Matrix metalloproteinases and chronic rhinosinusitis with nasal polyposis. Unravelling a puzzle through a systematic review. Rhinology 2021; 59:245-257. [PMID: 33730750 DOI: 10.4193/rhin20.578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The expression of metalloproteinases (MMPs) in chronic rhinosinusitis with nasal polyposis (CRSwNP) was reviewed in order to investigate their possible use as therapeutical targets and/or biomarkers. METHODOLOGY The differences between CRSwNP and normal controls or CRS without NP, as well as the effects of various treatments on MMPs, tissue inhibitors of MMPs (TIMPs) and MMP/TIMP ratios were considered as primary outcomes. Additional factors reported to affect MMP expression levels were noted as secondary outcomes. Data regarding inflammatory subtypes, patients’ clinical characteristics, controls, laboratory method(s) and origin of samples were also pooled. Studies on 10 or fewer patients or on specimens other than nasal and serum were excluded. RESULTS Forty-three studies were included. Tissue sample origin, allergic rhinitis, smoking, infection, medication intake and primary or recurrent disease should be considered as confounding factors for MMP levels. MMP-1 and -7 were consistently found to be significantly higher in CRSwNP patients than controls. CRSwNP endotypes with distinctly different inflammation patterns seem to present similar MMP-related remodelling patterns. CONCLUSIONS The existing literature has revealed several population and methodology related confounding factors and remains inconclusive regarding the roles of MMPs in CRSwNP pathophysiology and their possible clinical usefulness as biomarkers and therapeutical targets.
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Affiliation(s)
- S Lygeros
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Patras, Medical School, Patras, Greece
| | - G Danielides
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Patras, Medical School, Patras, Greece
| | - K Grafanaki
- Department of Biochemistry and Department of Dermatology School of Medicine, University of Patras, Greece
| | - M Riga
- Department of Otorhinolaryngology-Head and Neck Surgery, Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia
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22
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Kim S, Ward LA, Butaric LN, Maddux SD. Ancestry-based variation in maxillary sinus anatomy: Implications for health disparities in sinonasal disease. Anat Rec (Hoboken) 2021; 305:18-36. [PMID: 33890723 DOI: 10.1002/ar.24644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/18/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Paranasal sinus drainage is mediated by mucociliary transport and gravity. However, human orthograde posture, along with the superior positioning of the maxillary sinus (MS) ostium, increases reliance on the mucociliary system. Previous research has thus suggested that differences in MS size and shape may impede mucociliary clearance, potentially contributing to disparities in sinusitis susceptibility. To further investigate this hypothesis, this study collected 29 three-dimensional (3D) coordinate landmarks and seven linear measurements of MS morphology from 167 computed tomography (CT) scans of crania of European, East Asian, or Equatorial African ancestry. MANOVA results reveal the Asian-derived individuals are characterized by both a significantly taller MS (F = 14.15, p < 0.0001) and a significantly greater distance from the MS floor to the ostium (F = 17.22, p < 0.0001) compared to those of European and African ancestry. A canonical variate (CV) analysis conducted on 3D landmark data provides corroborative results, distinguishing Asian-derived individuals predominantly on the basis of a relatively lower MS floor. As a greater distance between the MS floor and ostium may impede mucociliary clearance, our results suggest MS anatomy may be a more prominent factor in chronic sinusitis among individuals of Asian ancestry compared to those of European and African ancestries. This provides tentative evidence of an anatomical etiology for chronic sinusitis even in the absence of anatomical variants/abnormalities (e.g., nasal polyps, concha bullosa, Haller's cells, and Agger nasi cells). Further research into the relationship between MS anatomy and sinusitis, in addition to socioeconomic inequalities of healthcare, is warranted to continue evaluating possible contributions to health disparities.
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Affiliation(s)
- Suhhyun Kim
- Center for Anatomical Sciences, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Lyndee A Ward
- Center for Anatomical Sciences, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Lauren N Butaric
- Department of Anatomy, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, USA
| | - Scott D Maddux
- Center for Anatomical Sciences, Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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23
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朱 梦, 高 学, 朱 壮, 胡 晓, 刘 济, 周 慧. [The role of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyp]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:216-223. [PMID: 33794605 PMCID: PMC10128229 DOI: 10.13201/j.issn.2096-7993.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the roles of nasal nitric oxide(nNO) in diagnosis and endotypes of CRSwNP. Methods:Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP (Eos CRSwNP) and non-eosinophilic CRSwNP (non-Eos CRSwNP) endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic (ROC) curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP. Results:Eos CRSwNP patients(143.9±106.2) ×10-9 had lower nNO levels than non-Eos CRSwNP[(228.3±109.2) ×10-9, P=0.000 9) and healthy subjects(366.5±88.0) ×10-9, P<0.000 1). Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy(P<0.05). For Eos CRSwNP diagnosis, nNO had the highest predictive value(AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231×10-9, P<0.001). Furthermore, nNO levels were associated with CRSwNP endotypes(odds ratio: 1.010; 95% confidence interval: 1.003%, 1.016%; P=0.002). When the nNO concentration was 158 ×10-9, we could discriminate Eos CRSwNP from non-Eos CRSwNP(AUC=0.710, sensitivity: 76.92%; specificity, 60.47%, P=0.001). After it was combinated by nNO, periphera blood eosinophil count(PEAC) and VAS score, the AUC was increased to 0.894(95%CI=0.807 to 0.951, P<0.000 1, sensitivity: 76.74%, specificity: 89.74%). Conclusion:nNO may has potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be an ideal diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.
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Affiliation(s)
- 梦迪 朱
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 学欢 高
- 复旦大学公共卫生学院Department of Environmental Health, School of Public Health, Fudan University
| | - 壮 朱
- 苏州大学附属第一医院骨科Department of Orthopaedics, the First Affiliated Hospital of Soochow University
| | - 晓清 胡
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 济生 刘
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 慧 周
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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24
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Lin YT, Lin CF, Liao CK, Chiang BL, Yeh TH. Clinical characteristics and cytokine profiles of central-compartment-type chronic rhinosinusitis. Int Forum Allergy Rhinol 2021; 11:1064-1073. [PMID: 33529479 DOI: 10.1002/alr.22759] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The clinical characteristics of central-compartment-type chronic rhinosinusitis (CRS) in East Asian individuals are not clear. We sought to investigate the clinical features and the cytokine profiles of central-compartment-type CRS in our patient group. METHODS Adult patients diagnosed with bilateral CRS were recruited, and patients who had previously undergone sinus surgery and pansinusitis (Lund-Mackay scores >23) were excluded. Central-compartment-type CRS was defined by both endoscopic and radiological features. The symptoms, inhalant allergen sensitization status, endoscopic findings, and radiological assessments were recorded and compared between patients with central-compartment-type CRS and other types of CRS. We also examined the extent of tissue eosinophilia and specific cytokine protein levels (eosinophil cationic protein [ECP], myeloperoxidase [MPO], immunoglobulin E [IgE], interleukin [IL]-4, IL-5, and IL-13) in the sinonasal tissues. RESULTS Central-compartment-type CRS was found in 16 (23.9%) patients, and non-central-compartment-type CRS was found in 51 (76.1%) patients. Hyposmia or anosmia as the major symptom was more common in the central-compartment-type CRS group. The numbers of eosinophils in tissue and serum were significantly higher in the central-compartment-type CRS patients. The presence of allergen sensitization was not significantly different between groups. The levels of IL-5 and IL-13 were increased in middle turbinate tissues of patients with central-compartment-type CRS. CONCLUSION Central-compartment-type CRS was associated with hyposmia or anosmia, eosinophilic subtypes, and elevated levels of IL-5 and IL-13 in middle turbinate tissues but not necessarily correlated with allergic disease in our patients.
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Affiliation(s)
- Yi-Tsen Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Feng Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Kang Liao
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Luen Chiang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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25
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Eosinophils in the Field of Nasal Polyposis: Towards a Better Understanding of Biologic Therapies. Clin Rev Allergy Immunol 2021; 62:90-102. [DOI: 10.1007/s12016-021-08844-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
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Bochner BS, Stevens WW. Biology and Function of Eosinophils in Chronic Rhinosinusitis With or Without Nasal Polyps. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:8-22. [PMID: 33191674 PMCID: PMC7680832 DOI: 10.4168/aair.2021.13.1.8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022]
Abstract
Chronic rhinosinusitis (CRS) with or without nasal polyposis is a complex medical condition characterized by varying patterns of chronic innate and adaptive mucosal inflammation. Treatment of CRS has been traditionally limited to corticosteroids and sinus surgery; however, novel biologics have more recently been evaluated as steroid- and surgery-sparing options. While it is clear that there are different subtypes or endotypes of CRS, perhaps the most frequent presentation involves the features of type 2 inflammation, including a prominent tissue eosinophilia component. The purpose of this review is to provide an update on eosinophil biology as well as on the potential contribution of eosinophils and their mediators to the pathophysiology of CRS, drawing mechanistic conclusions mainly from studies of human sinus mucosal tissues, nasal secretions, and benefits (or lack thereof) from the use of various pharmacotherapies. The unavoidable conclusion derived from this approach is that eosinophils themselves cannot fully explain the underlying pathophysiology of this complex disorder.
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Affiliation(s)
- Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, 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
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Formation of nasal polyps: The roles of innate type 2 inflammation and deposition of fibrin. J Allergy Clin Immunol 2020; 145:740-750. [PMID: 32145873 DOI: 10.1016/j.jaci.2020.01.027] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/28/2022]
Abstract
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases worldwide. It is a heterogeneous disease, and geographical or ethnic differences in inflammatory pattern in nasal mucosa are major issues. Tissue eosinophilia in CRS is highly associated with extensive sinus disease, recalcitrance, and a higher nasal polyp (NP) recurrence rate after surgery. The prevalence of eosinophilic CRS (ECRS) is increasing in Asian countries within the last 2 decades, and this trend appears to be occurring across the world. International consensus criteria for ECRS are required for the accurate understanding of disease pathology and precision medicine. In a multicenter large-scale epidemiological survey, the "Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis study," ECRS was definitively defined when the eosinophil count in nasal mucosa is greater than or equal to 70 eosinophils/hpf (magnification, ×400), and this study proposed an algorithm that classifies CRS into 4 groups according to disease severity. The main therapeutic goal with ECRS is to eliminate or diminish the bulk of NP tissue. NPs are unique abnormal lesions that grow from the lining of the nasal and paranasal sinuses, and type 2 inflammation plays a critical role in NP development in patients with ECRS. An imbalance between protease and endogenous protease inhibitors might play a pivotal role in the initiation and exacerbation of type 2 inflammation in ECRS. Intraepithelial mast cells in NPs, showing a tryptase+, chymase- phenotype, may also enhance type 2 inflammation. Intense edema and reduced fibrosis are important histological features of eosinophilic NPs. Mucosal edema mainly consists of exuded plasma protein, and excessive fibrin deposition would be expected to contribute to the retention of proteins from capillaries and thereby perpetuate mucosal edema that may play an etiological role in NPs. Upregulation of the coagulation cascade and downregulation of fibrinolysis strongly induce abnormal fibrin deposition in nasal mucosa, and type 2 inflammation plays a central role in the imbalance of coagulation and fibrinolysis.
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28
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Blaiss MS. Chronic rhinosinusitis with nasal polyps management in the age of biologics. Allergy Asthma Proc 2020; 41:413-419. [PMID: 33109306 DOI: 10.2500/aap.2020.41.200069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Chronic rhinosinusitis is one of the most common medical conditions seen in the U.S. population. Chronic rhinosinusitis with nasal polyps (CRSwNP) in adults has predominately a type 2 inflammatory endotype that usually is treated with medical management that consists of inhaled corticosteroids, saline solution irrigation, oral corticosteroid bursts, and, at times, leukotriene antagonists and antibiotics. If medical management fails, then surgical intervention is usually recommended. Various biologics that target type 2 inflammation are now available, which have been or will be approved for use in these patients. Objective: To determine where biologics that affect the type 2 pathway fit into the algorithm of treatment for CRSwNP. Methods: A review of the literature on standard-of-care measures and surgical interventions in CRSwNP and an analysis of recent studies on the efficacy and safety of biologics in this condition. Results: Standard of care with medication and surgical interventions fail in some patients with CRSwNP. Biologics that affect the type 2 inflammatory pathway led to a decrease in nasal polyp size, improved nasal congestion, and improved quality of life both in patients who had surgery and those who had not had surgery for CRSwNP. Also, they showed efficacy and safety in patients whether or not they had comorbid asthma. These agents do not cure the patient with CRSwNP, and will be required chronically for control. Conclusion: Shared decision-making should be used in determining the use of certain medications, surgical management, and biologics in patients with CRSwNP. In patients for whom surgery has already failed and in patients with moderate-to-severe CRSwNP who have other type 2 comorbidities, e.g., asthma, a trial of biologics is a rational course.
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Affiliation(s)
- Michael S. Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia
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29
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Contro G, Brescia G, Alessandrini L, Barion U, Padoan R, Frigo AC, Schiavon F, Marioni G. Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA. Clin Rheumatol 2020; 40:1949-1957. [PMID: 33094393 DOI: 10.1007/s10067-020-05474-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVES The histopathological study of inflammatory cells and their tendency to form aggregates in chronic rhinosinusitis with nasal polyps (CRSwNP) has shown promising results in determining the pathogenesis and predicting clinical outcome. Bilateral nasal polyps also occur in over 70% of patients with eosinophilic granulomatosis with polyangiitis (EGPA). The study aim was to investigate neutrophil infiltrates and eosinophil aggregates in CRSwNP and EGPA tissues of Caucasian patients. METHOD A histopathological study was performed on surgical specimens of nasal polyps from 144 adults (15 with allergic fungal rhinosinusitis; 19 with nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD); 16 with intrinsic asthma; 21 with extrinsic asthma; 21 with allergy; 22 with eosinophil CRSwNP (ECRSwNP); 17 with non-ECRSwNP; 13 with EGPA). RESULTS Focusing on the presence of tissue eosinophil aggregates, NERD and ECRSwNP were the sub-cohorts with the highest rate. Neutrophil infiltrate rate was significantly higher in EGPA sub-cohort than in all CRSwNP sub-cohorts apart from non-ECRSwNP. CONCLUSIONS Structured histopathology is increasingly identifying the different histotypes of CRSwNP. This analysis can be used to better understand CRSwNP endotypes and develop targeted therapies. The response to therapy and therefore control of CRSwNP relapses definitely depends on our ability to act on the underlying inflammatory pattern. Key points • Systematic analysis of how neutrophil infiltrates and eosinophilic aggregates are distributed in the different phenotypes of CRSwNP and EGPA. • Neutrophil infiltrates and eosinophil aggregates are strong risk factors for nasal polyps' refractoriness. • NERD and ECRSwNP are the sub-cohorts of CRSwNP with the highest rate of tissue eosinophil aggregates. • Neutrophil infiltrates are significantly higher in EGPA.
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Affiliation(s)
- Giacomo Contro
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | - Giuseppe Brescia
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | | | - Umberto Barion
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Padoan
- Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, Padova, Italy
| | - Franco Schiavon
- Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy.
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30
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Zhu M, Gao X, Zhu Z, Hu X, Zhou H, Liu J. The roles of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyps. J Otolaryngol Head Neck Surg 2020; 49:68. [PMID: 32962755 PMCID: PMC7507626 DOI: 10.1186/s40463-020-00465-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023] Open
Abstract
Background Chronic rhinosinusitis with polyps (CRSwNP) is a global health concern. Nasal nitric oxide (nNO), a clinical biomarker, have been studied to assess the presence of airway mucosal inflammation. This study aimed to clarify the roles of nNO in diagnosis and endotypes of CRSwNP. Methods Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP (Eos CRSwNP) and non⁃eosinophilic CRSwNP (Non-Eos CRSwNP) endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic (ROC) curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP. Results Eos CRSwNP patients(143.9 ± 106.2, ppb) had lower nNO levels than Non-Eos CRSwNP(228.3 ± 109.2, ppb, p = 0.013) and healthy subjects(366.5 ± 88, ppb, p < 0.0001). Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy (p < 0.05). For Eos CRSwNP diagnosis, nNO had high predictive value for Eos CRSwNP (AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231 ppb, p < 0.001). Furthermore, nNO levels were associated with CRSwNP endotypes (odds ratio: 1.010; 95% confidence interval: 1.003, 1.016%; p = 0.002). When the nNO concentration was 158 ppb, we could discriminate Eos CRSwNP from Non-Eos CRSwNP (AUC = 0.710, sensitivity: 76.92%; specificity, 60.47%, P = 0.001). After it was combinated by nNO, peripheral blood eosinophil count (PEAC) and VAS score, the AUC was increased to 0.894 (95%CI = 0.807 to 0.951, p < 0.0001, sensitivity:76.74%, specificity: 89.74%). Conclusions nNO may have potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be a good diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.
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Affiliation(s)
- Mengdi Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China
| | - Xuehuan Gao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Zhuang Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqing Hu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China
| | - Hui Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China.
| | - Jisheng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China.
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Nasta MS, Chatzinakis VA, Georgalas CC. Updates on current evidence for biologics in chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2020; 28:18-24. [PMID: 31789925 DOI: 10.1097/moo.0000000000000594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present the most important recent developments concerning biologics as a therapeutic option for chronic rhinosinusitis (CRS). RECENT FINDINGS mAb anti-IL-4 receptor α (Dupilumab) was recently approved by Food and Drug Administration (FDA) for patients with CRSwNP and four other biologics are under investigation, with promising preliminary results. SUMMARY CRS is a disease associated with a significant symptom burden and high-indirect costs. Despite recent advances in combined approaches, persistent symptoms or recurrences are not uncommon. Monoclonal antibodies, used mainly to treat asthma, have recently been shown to have a positive impact on controlling the symptoms of CRS and reducing the need for endoscopic sinus surgery. Dupilumab, mepolizumab, reslizumab, benralizumab and omalizumab are discussed and their mechanism of action, risk and current evidence on efficacy are presented. Preliminary studies show encouraging results with relatively few side effects. Once the high cost of such therapies is addressed, they could prove an important adjuvant therapy for patients with CRS. Large-scale clinical trials designed to evaluate them are called for.
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Affiliation(s)
- Melina S Nasta
- Department of Otorhinolaryngology - Head and Neck Surgery, Hellenic Red Cross Hospital 'Korgialeneio-Benakeio', Athens, Greece
| | - Vasileios A Chatzinakis
- Department of Otorhinolaryngology - Head and Neck Surgery, Hellenic Red Cross Hospital 'Korgialeneio-Benakeio', Athens, Greece
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Maniu AA, Perde-Schrepler MI, Tatomir CB, Tănase MI, Dindelegan MG, Budu VA, Rădeanu GD, Cosgarea M, Mogoantă CA. Latest advances in chronic rhinosinusitis with nasal polyps endotyping and biomarkers, and their significance for daily practice. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:309-320. [PMID: 33544783 PMCID: PMC7864319 DOI: 10.47162/rjme.61.2.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
The term chronic rhinosinusitis (CRS) comprises of an assortment of diseases that share a common feature: inflammation of the sinonasal mucosa. The phenotype classification of CRS, based on the presence of polyps, has failed to offer a curative treatment for the disease, particularly in refractory cases. Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging entity. Researchers have made efforts trying to characterize subtypes of the disease according to the endotypes, which are delineated by different immunological pathways, using biomarkers. Even if the inflammatory processes controlling CRSwNP are not fully understood, data suggested that the disease associated with a type 2 inflammatory mechanisms can be also linked to the type 1 or type 3 pathomechanism, being highly heterogeneous. Biomarkers for CRSwNP are proposed, such as: eosinophil count, cytokines, metalloproteinases, bitter and sweet taste receptors, and the nasal microbiome. For endotyping to be clinically applicable and simply determined, biomarkers referring to the intrinsic biomolecular mechanism still need to be found. Precision medicine is becoming the new standard of care, but innovative therapies such as biologics may be rather challenging for the clinicians in their daily practice. This new approach to CRSwNP implies patient selection and a simple algorithm for deciding the right treatment, easy to implement and adjust. Our review points out the ongoing new research on the pathophysiology of CRSwNP, biomarkers and treatment opportunities. It allows clinicians to keep abreast of current evidence-based knowledge and to individualize the management of CRSwNP, especially in refractory cases.
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Affiliation(s)
- Alma Aurelia Maniu
- Department of ENT, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Ida Perde-Schrepler
- Department of Radiobiology and Tumor Biology, Prof. Dr. Ion Chiricuţă Oncology Institute, Cluj-Napoca, Romania
| | - Corina-Bianca Tatomir
- Department of Radiobiology and Tumor Biology, Prof. Dr. Ion Chiricuţă Oncology Institute, Cluj-Napoca, Romania
| | - Mihai Ionuţ Tănase
- Department of ENT, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of ENT, Emergency County Hospital, Cluj-Napoca, Romania
| | | | - Vlad Andrei Budu
- Department of ENT, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gheorghe Doinel Rădeanu
- Department of ENT, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Department of ENT, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Liu Z, Chen J, Cheng L, Li H, Liu S, Lou H, Shi J, Sun Y, Wang D, Wang C, Wang X, Wei Y, Wen W, Yang P, Yang Q, Zhang G, Zhang Y, Zhao C, Zhu D, Zhu L, Chen F, Dong Y, Fu Q, Li J, Li Y, Liu C, Liu F, Lu M, Meng Y, Sha J, She W, Shi L, Wang K, Xue J, Yang L, Yin M, Zhang L, Zheng M, Zhou B, Zhang L. Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:176-237. [PMID: 32009319 PMCID: PMC6997287 DOI: 10.4168/aair.2020.12.2.176] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023]
Abstract
The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines-with a focus on China-will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
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Affiliation(s)
- Zheng Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Cheng
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Huabin Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shixi Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongfei Lou
- 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
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dehui Wang
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, 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
| | - Xiangdong Wang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Hospital, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pingchang Yang
- Research Center of Allergy & Immunology, Shenzhen University School of Medicine, Shenzhen, China
| | - Qintai Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gehua Zhang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuan 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
| | - Changqing Zhao
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Dongdong Zhu
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li Zhu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Qingling Fu
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyun Li
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yanqing Li
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chengyao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feng Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Meiping Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yifan Meng
- 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
| | - Jichao Sha
- Department of Otolaryngology Head and Neck Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wenyu She
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lili Shi
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kuiji 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
| | - Jinmei Xue
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital, Shanxi Medical University, Taiyuan, China
| | - Luoying Yang
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Yin
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
| | - Lichuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Zheng
- 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
| | - Bing Zhou
- 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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Licari A, Castagnoli R, De Filippo M, Foiadelli T, Tosca MA, Marseglia GL, Ciprandi G. Current and emerging biologic therapies for allergic rhinitis and chronic rhinosinusitis. Expert Opin Biol Ther 2020; 20:609-619. [PMID: 32053391 DOI: 10.1080/14712598.2020.1729350] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Allergic rhinitis and chronic rhinosinusitis, with and without nasal polyps, are the most common chronic inflammatory diseases of the upper airways. They both cause relevant respiratory symptoms and a substantial detriment to patients' quality of life, mainly in uncontrolled and severe patients.Areas covered: This review aims to present the most recent evidence on current and emerging biologic therapies for allergic rhinitis and chronic rhinosinusitis and discuss their potential implementation in clinical practice. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed database, using terms 'biologics OR biological agents', 'allergic rhinitis' and 'chronic rhinosinusitis'. The literature review was performed for publication years 2009-2019, restricting the articles to humans and English language publications.Expert opinion: Biological therapies represent a potential step forward in providing individualized care for all patients with uncontrolled severe upper airway diseases. Biologics recently showed promising results for the treatment of severe uncontrolled allergic rhinitis and chronic rhinosinusitis with nasal polyps with or without associated asthma. Endotyping inflammatory pathways and identifying related biomarkers remain the major challenge for positioning biologics in the care pathway of chronic respiratory diseases.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Thomas Foiadelli
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Wu Q, Chen J, Deng H, Ren Y, Sun Y, Wang W, Yuan L, Hong H, Zheng R, Kong W, Huang X, Huang G, Wang L, Zhang Y, Han L, Yang Q. Expert-level diagnosis of nasal polyps using deep learning on whole-slide imaging. J Allergy Clin Immunol 2020; 145:698-701.e6. [DOI: 10.1016/j.jaci.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
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Staudacher AG, Peters AT, Kato A, Stevens WW. Use of endotypes, phenotypes, and inflammatory markers to guide treatment decisions in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2020; 124:318-325. [PMID: 32007571 DOI: 10.1016/j.anai.2020.01.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE With the advent of new treatment options for Chronic Rhinosinusitis (CRS) comes the ability for physicians to provide more individualized patient care. Physicians are now tasked with identifying who may be the best candidate for a particular therapy. In this review, existing biomarkers and potentially new methods that could guide treatment choices in CRS patients will be discussed. DATA SOURCES Published literature obtained through PubMed searches. STUDY SELECTION Studies relevant to inflammatory endotypes, phenotypes, and biomarkers in CRS were included. RESULTS Currently, there are no clinically validated tools that determine the best therapeutic modality for CRS patients with or without nasal polyps (CRSwNP or CRSsNP). Patients with CRS can be classified into three endotypes based on the presence of type 1, type 2, or type 3 inflammation. CRS endotypes can be influenced by age and geographic location. Clinical application however may be limited since endotyping current requires basic research laboratory support. Clinical symptoms may also predict inflammatory endotypes with smell loss being indicative of type 2 inflammation. Numbers of tissue and/or peripheral eosinophils as well as levels of IgE may predict disease severity in CRSwNP but not necessarily treatment responses. Unique clinical phenotypes or biomarkers are especially lacking that predict type 1 or type 3 inflammation in CRSwNP or type 1, type 2, or type 3 inflammation in CRSsNP. CONCLUSION While significant progress has been made in characterizing endotypes, phenotypes, and biomarkers in CRS, additional studies are needed to determine if and how these factors could assist physicians in providing more individualized clinical care.
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Affiliation(s)
- Anna G Staudacher
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Atsushi Kato
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Lin L, Lan J, Dai F, Wei J, Chen Z, Sun G. Efficacy of Budesonide Nasal Spray on Neutrophilic Chronic Rhinosinusitis with Nasal Polyps: A Combined Clinical and Experimental Study. Int Arch Allergy Immunol 2020; 181:551-562. [PMID: 32369807 DOI: 10.1159/000507395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the efficacy of budesonide nasal spray on neutrophilic CRSwNP. MATERIALS AND METHODS Fifteen neutrophilic CRSwNP patients were included, and then they received budesonide nasal spray treatment for 3 months. Biopsies of nasal polyps (NPs) were obtained from these subjects. Their clinical indexes were scored using Visual Analog Scale (VAS), Sino-Nasal Outcome Test (SNOT)-22, and Endoscopic Appearances (EAs). Histological analyses were used to assess numbers of neutrophils, goblet cells, and submucosal gland cells in NPs. Percentages of CD8+ T cells and CD4+CD25+Foxp3+ regulatory T cells (Tregs) were evaluated using flow cytometry. Mucin 5AC (MUC5AC), MUC5B, myeloperoxidase (MPO), interferon (IFN)-γ, and interleukin (IL)-1β and their mRNAs were also examined. After that, we cultured NP tissues in vitro and evaluated the abovementioned inflammatory parameters before and after the administration of budesonide. RESULTS Budesonide nasal spray did not improve clinical evaluations including VAS, SNOT-22, and EA scores. Numbers of neutrophils and goblet cells, the score of submucosal gland cells, percentages of CD8+ T cells and Tregs, MUC5AC, MUC5B, MPO, IFN-γ, and IL-1β and their mRNAs were not decreased in NPs after the budesonide treatment. Furthermore, the administration of budesonide into NP cultures also did not reduce their levels in comparison with those before the treatment. CONCLUSION These findings demonstrate that budesonide treatment may not alleviate the inflammatory condition in neutrophilic CRSwNP.
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Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China,
| | - Jing Lan
- Department of Gynecology and Obstetrics, Huashan Hospital North of Fudan University, Shanghai, China
| | - Fei Dai
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Jinjin Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Zheng Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China
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Lin L, Dai F, Ren G, Wei J, Chen Z, Tang X. Efficacy of lianhuaqingwen granules in the management of chronic rhinosinusitis without nasal polyps. Am J Otolaryngol 2020; 41:102311. [PMID: 31732300 DOI: 10.1016/j.amjoto.2019.102311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a complicated disease with clinical symptoms that are impacted by the absence or presence of nasal polyps (CRSsNP or CRSwNP). Understanding of the different treatments of CRS is very significant in selecting appropriate therapies and preventing exacerbation relevant to this chronic inflammation. This study was aimed to evaluate the effect of Chinese traditional medicine lianhuaqingwen granules on CRSsNP. MATERIALS AND METHODS CRSsNP patients were enrolled and randomized into placebo or lianhuaqingwen (LHQW) granules treatment group (placebo or LHQW group). Their clinical symptoms were scored using Visual Analog Scale (VAS) and Sino-Nasal Outcome Test (SNOT)-22. Nitric oxide (NO) from nasal cavity and sinus and nasal resistance were also examined. Then, nasal biopsy samples and nasal lavage fluid (NLF) were obtained from these patients, and histologic characteristics of nasal mucosa and T cell subpopulations patterns in the NLF were evaluated. Finally, inflammatory mediators in the NLF were assessed in both groups. RESULTS One hundred and forty patients with CRSsNP finished this one-month study. VAS and SNOT-22 scores and nasal resistance were all decreased distinctly after the treatment of LHQW, but not after placebo. However, the nasal NO concentration was increased in LHQW administration group in comparison with placebo group. There were significant differences in above parameters between these two treatments. Histologic changes in nasal mucosa were improved only in LHQW group. CD4+ and CD8+ T cells were all downregulated in the LHQW treatment group, but not in placebo group. Inflammatory mediators from the NLF were decreased in LHQW treatment group compared to placebo group. Furthermore, there were significant changes between these two groups in CD4+ and CD8+ T cell subpopulations and concentrations of inflammatory substances. CONCLUSION These findings demonstrate that LHQW granules treatment may control the inflammation in nasal mucosa and result in the improvement of CRSsNP. This Chinese medicine might become a promising therapy in the management of this disease.
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Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China.
| | - Fei Dai
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Guoqiang Ren
- Department of Pathology, Huashan Hospital North of Fudan University, Shanghai, China
| | - Jinjin Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Zheng Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
| | - Xinyue Tang
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University, Shanghai, China
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蒋 子, 孟 娟. [Advances in the endotypes of chronic rhinosinusitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:13-18. [PMID: 32086890 PMCID: PMC10128580 DOI: 10.13201/j.issn.1001-1781.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 11/12/2022]
Abstract
The pathogenesis of chronic rhinosinusitis(CRS) is complex. There are differences in the clinical manifestations and therapeutic effects of CRS dominated by different causes. At present, there is a lack of uniform classification standards in clinical practice. In this paper, the research progress in the endotype of CRS in recent years was discussed.
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Affiliation(s)
- 子涵 蒋
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)
| | - 娟 孟
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)
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Wang K, Deng J, Yang M, Chen Y, Chen F, Gao WX, Lai Y, Shi J, Sun Y. Concordant systemic and local eosinophilia relates to poorer disease control in patients with nasal polyps. World Allergy Organ J 2019; 12:100052. [PMID: 31452832 PMCID: PMC6704051 DOI: 10.1016/j.waojou.2019.100052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background Eosinophilic inflammation is a major phenotype associated with poorly controlled disease in nasal polyp patients. The difference between systemic and local eosinophilia in relation to disease control is poorly understood. Objective To explore whether blood and polyp tissue eosinophil numbers are independent risk factors for poor disease control in patients with nasal polyp. Methods By using the electronic medical records database and manual evaluation, 183 nasal polyp patients who had undergone endoscopic sinus surgery at least one year prior to the study with complete data of tissue specimens, baseline blood routine test, nasal endoscopy and sinus computed tomography, were identified and recruited to assess disease control based on the criteria of a European position paper on rhinosinusitis and nasal polyps 2012 (EPOS 2012). Multiple logistic regression model was used to determine the association between blood and tissue eosinophil numbers and risk of poor disease control by adjusting for demographics and comorbidities. Results We broke down the cohort into 4 groups according to blood (0.3 × 109/L) and tissue (10%) eosinophils. The patients without eosinophilic inflammation represented the largest group (41.5%). The group with concordant blood and tissue eosinophilia represented the second largest (31.2%), and the patients with isolated tissue (15.3%) or blood (12.0%) eosinophilia were relatively rare. Multiple logistic regression models found blood eosinophil count and tissue eosinophil percentage were independently associated with increased risk for poor disease control after adjustments for covariates related to poor treatment outcome. Furthermore, subjects with concordant blood and tissue eosinophilia had a higher risk for poor disease control than those with isolated blood or tissue eosinophilia. Conclusion Concordant blood and tissue eosinophilia relates to a higher likelihood of poor disease control than isolated blood or tissue eosinophilia after adjustment of potential confounders in nasal polyp patients.
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Affiliation(s)
- Kanghua Wang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Jie Deng
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Meng Yang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yang Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Wen-Xiang Gao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Yinyan Lai
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Jianbo Shi
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
| | - Yueqi Sun
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, China
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Kesici GG, Kargın Kaytez S, Özdaş T, Özdaş S. Association of Toll-Like Receptor Polymorphisms With Nasal Polyposis. EAR, NOSE & THROAT JOURNAL 2019; 100:NP26-NP32. [PMID: 31304782 DOI: 10.1177/0145561319859305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nasal polyposis is a disease characterized with chronic inflammation of the nasal mucosa. Toll-like receptors (TLRs) are defined as essential receptors of the innate immune system and may play in the development of nasal polyposis. A total of 71 patients with nasal polyposis and 74 healthy controls were included in this study. Three single-nucleotide polymorphisms (SNPs); TLR2 (2258 A>G), TLR4 (896 A>G), and TLR4 (1196 C>T) were analyzed in all patients. The degree of pair-wise linkage disequilibrium and the genotype and haplotype analyses were conducted using regression in this logistic model and the Multifactor Dimensionality Reduction (MDR) software package was used to construct all possible interactions among different genotype variants belonging to the TLR gene. There was significant difference in genotype and allele frequencies of the TLR4 (1196 C>T) polymorphism between the nasal polyposis and control groups (0.017). Also, it was observed that the probability of nasal polyposis was 62.7% in the presence of TLR4 (1196 C>T) polymorphism with asthma (P = .007). As a conclusion, this study showed that TLR4 and TLR2 polymorphisms were predisposing factors for nasal polyposis. Further functional studies investigating the consequences of loss of TLR function are needed.
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Affiliation(s)
- Gülin Gökçen Kesici
- Department of ENT, 64082Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Selda Kargın Kaytez
- Department of ENT, 64082Ankara Education and Research Hospital, Ankara, Turkey
| | - Talih Özdaş
- Department of ENT, 64130Adana City Education and Research Hospital, Adana, Turkey
| | - Sibel Özdaş
- Department of Bioengineering, Engineering Faculty, 365074Adana Science and Technology University, Adana, Turkey
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Codispoti CD, Mahdavinia M. A call for cost-effectiveness analysis for biologic therapies in chronic rhinosinusitis with nasal polyps. Ann Allergy Asthma Immunol 2019; 123:232-239. [PMID: 31295554 DOI: 10.1016/j.anai.2019.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify the need for cost-effectiveness analysis of biologic therapies in the treatment of chronic rhinosinusitis (CRS). DATA SOURCES Clinical trials of monoclonal antibodies (omalizumab, benralizumab, mepolizumab and dupilumab) for nasal polyposis or chronic rhinosinusitis published on PubMed. STUDY SELECTIONS Clinical trials of biologic therapies in CRS and nasal polyposis. RESULTS No cost-effectiveness analyses of biologic therapies in CRS have been performed. CONCLUSION As more clinical trials of biologic therapies for CRS are conducted, there is a need for cost-effectiveness analysis. Future analyses should consider these therapies as part of medical therapeutic options compared with surgery. To increase generalizability, analyses should include samples from allergy and primary care clinics rather than only otolaryngology clinics.
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Huriyati E, Darwin E, Yanwirasti Y, Wahid I. Association of Inflammation Mediator in Mucosal and Tissue of Chronic Rhinosinusitis with Recurrent Nasal Polyp. Open Access Maced J Med Sci 2019; 7:1635-1640. [PMID: 31210814 PMCID: PMC6560307 DOI: 10.3889/oamjms.2019.327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis with polyps (CRSwNP) have a high risk of recurrence and patients often experience repeated surgery. There are several types of inflammatory patterns in CRSwNP, such as Th2 inflammation (eosinophilic) and Th1/Th17 inflammation (neutrophilic). AIM This study aims to determine the expression of IL-5, IL-8, IL-17A and TGF-β in recurrent CRSwNP using the most convenient and non-invasive examination tool such as brushing the mucosal polyp and find out its correlation with polyp tissues. MATERIAL AND METHODS A cross-sectional comparative study was carried out on 15 samples of mucosal brushing and polyp tissue. Expressions of IL-5, IL-8, IL-17A and TGF-β on mucosa were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) examination and tissues using Immunohistochemical (IHC) examination. RESULT The result showed that Only IL-5 has a significant relationship between mucosa and tissue with moderate positive correlation (p < 0.05; r = 0.527). CONCLUSION This study concluded that mucosa brushing could be used as a simple and non-invasive examination to observe the expression of IL-5 in recurrent CRSwNP. IL-5 is one of the cytokines that mark the Th2 (eosinophilic) inflammatory pattern where eosinophilic polyps are closely related to recurrence.
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Affiliation(s)
- Effy Huriyati
- Postgraduate Biomedical Science, Faculty of Medicine, Andalas University, Padang, Indonesia
| | - Eryati Darwin
- Department of Histology, Faculty of Medicine, Andalas University, Padang Indonesia
| | | | - Irza Wahid
- Department of Internal Medicine, Faculty of Medicine, Andalas University, General Hospital of Dr M. Djamil, Padang, Indonesia
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Qu J, Mei Q, Niu R. Oxidative CaMKII as a potential target for inflammatory disease (Review). Mol Med Rep 2019; 20:863-870. [PMID: 31173191 DOI: 10.3892/mmr.2019.10309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 05/22/2019] [Indexed: 11/06/2022] Open
Abstract
CaMKII is a calcium‑activated kinase, proved to be modulated by oxidation. Currently, the oxidative activation of CaMKII exists in several models of asthma, chronic rhinosinusitis with nasal polyps, cardiovascular disease, diabetes mellitus, acute ischemic stroke and cancer. Oxidized CaMKII (ox‑CaMKII) may be important in several of these diseases. The present review examines the mechanism underlying the oxidative activation of CaMKII and summarizes the current findings associated with the function of ox‑CaMKII in inflammatory diseases. Taken together, the findings of this review aim to improve current understanding of the function of ox‑CaMKII and provide novel insights for future research.
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Affiliation(s)
- Jingjing Qu
- Department of Lung Cancer and Gastroenterology, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, Hunan 410008, P.R. China
| | - Quanhui Mei
- Department of Intensive Care Unit, The First People's Hospital of Changde City, Changde, Hunan 410005, P.R. China
| | - Ruichao Niu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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The IFN-γ-p38, ERK kinase axis exacerbates neutrophilic chronic rhinosinusitis by inducing the epithelial-to-mesenchymal transition. Mucosal Immunol 2019; 12:601-611. [PMID: 30804419 DOI: 10.1038/s41385-019-0149-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 02/04/2023]
Abstract
Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammatory disease characterized by involvement of diverse types of inflammatory cells. Asian CRS patients frequently show infiltration of neutrophils and an elevated level of interferon (IFN)-γ; by contrast, western patients exhibit eosinophil infiltration and enhanced levels of Th2-related cytokines. Neutrophilia in tissues decreases sensitivity to corticosteroids, but the mechanisms underlying the progression of neutrophilic CRS are unclear. In this study, we investigated the role of IFN-γ in CRS patients with marked neutrophil infiltration. We report that the IFN-γ level is upregulated in the tissues of these patients, particularly those with non-eosinophilic nasal polyps. The level of IFN-γ was significantly correlated with markers of the epithelial-to-mesenchymal transition (EMT). We further demonstrated that IFN-γ induced the EMT via the p38 and extracellular signal-regulated kinase (ERK) pathways in a manner distinct from the hypoxia-inducible factor (HIF)-1α, SMAD, and NF-κB signaling pathways. In a murine nasal polyp (NP) model, blocking the p38 and ERK signaling pathways prevented NP formation and chemotactic cytokine secretion by neutrophils but not eosinophils. Taken together, our results suggest that IFN-γ can induce the EMT in nasal epithelial cells, and thus blocking the p38 and ERK pathways could be an effective therapeutic strategy against neutrophil-dominant CRS.
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46
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Lee J, Kim HS. The Role of Autophagy in Eosinophilic Airway Inflammation. Immune Netw 2019; 19:e5. [PMID: 30838160 PMCID: PMC6399092 DOI: 10.4110/in.2019.19.e5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
Abstract
Autophagy is a homeostatic mechanism that discards not only invading pathogens but also damaged organelles and denatured proteins via lysosomal degradation. Increasing evidence suggests a role for autophagy in inflammatory diseases, including infectious diseases, Crohn's disease, cystic fibrosis, and pulmonary hypertension. These studies suggest that modulating autophagy could be a novel therapeutic option for inflammatory diseases. Eosinophils are a major type of inflammatory cell that aggravates airway inflammatory diseases, particularly corticosteroid-resistant inflammation. The eosinophil count is a useful tool for assessing which patients may benefit from inhaled corticosteroid therapy. Recent studies demonstrate that autophagy plays a role in eosinophilic airway inflammatory diseases by promoting airway remodeling and loss of function. Genetic variant in the autophagy gene ATG5 is associated with asthma pathogenesis, and autophagy regulates apoptotic pathways in epithelial cells in individuals with chronic obstructive pulmonary disease. Moreover, autophagy dysfunction leads to severe inflammation, especially eosinophilic inflammation, in chronic rhinosinusitis. However, the mechanism underlying autophagy-mediated regulation of eosinophilic airway inflammation remains unclear. The aim of this review is to provide a general overview of the role of autophagy in eosinophilic airway inflammation. We also suggest that autophagy may be a new therapeutic target for airway inflammation, including that mediated by eosinophils.
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Affiliation(s)
- Jinju Lee
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Hun Sik Kim
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.,Department of Microbiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.,Stem Cell Immunomodulation Research Center (SCIRC), Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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47
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Group 2 innate lymphoid cells and eosinophilic chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 2019; 19:18-25. [DOI: 10.1097/aci.0000000000000496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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48
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Chronic Rhinosinusitis without Nasal Polyps in Asian Patients Shows Mixed Inflammatory Patterns and Neutrophil-Related Disease Severity. Mediators Inflamm 2019; 2019:7138643. [PMID: 30766447 PMCID: PMC6350559 DOI: 10.1155/2019/7138643] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
Chronic rhinosinusitis (CRS) shows heterogeneous immunologic features. Western studies revealed that CRS without nasal polyps (CRSsNP) showed a predominantly type 1 immune response and CRS with nasal polyps (CRSwNP) was characterized by type 2 immune response; however, the detailed immunologic profile of CRSsNP in Asian patients has not been thoroughly investigated. Therefore, we investigated the inflammatory endotypes of CRSsNP in Asian patients. Patients with CRSsNP (N = 57), patients with CRSwNP (N = 13), and a control group (N = 10), who underwent endoscopic sinus surgery, were enrolled; uncinate process (UP) tissues were harvested from all patients. Homogenates were prepared from the UP of each group, and immunologic profiles were analyzed, including major cytokines (32 inflammatory mediators). When comparing the UPs between groups, CRSsNP patients showed higher levels of Th2 cytokines (IL-4 and IL-13), eosinophilic chemokines (CCL-11 and CCL-24), ECP, and total IgE expression than control subjects. In addition, several neutrophilic markers (IL-1α, IL-6, IL-8, CXCL-1, CXCL-2, and MPO), IL-17A, IL-22, and TNF-α were dominant in CRSsNP patients. Among these inflammatory mediators, IL-17A showed higher expression levels in CRSsNP patients than in the control group and CRSwNP patients. However, IFN-γ expression was not significantly elevated in CRSsNP patients. The levels of neutrophil-associated cytokines were well correlated with each other; of which, CXCL2, IL-8, and MMP-9/TIMP-1 levels were significantly correlated with disease extent (r = 0.338, r = 0.317, and r = 0.424, respectively). However, the levels of eosinophil-associated cytokines showed little correlation with each other and were not correlated with disease extent. Our study revealed that Asian CRSsNP patients showed a mixed (types 2 and 17) immune response, but neutrophil-related markers were dominant and associated with disease extent. Knowledge of this immunologic feature may help clinicians make better individual treatment decisions for Asian CRSsNP patients.
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Kim DK, Eun KM, Kim MK, Cho D, Han SA, Han SY, Seo Y, Lee DH, Cho SH, Kim DW. Comparison Between Signature Cytokines of Nasal Tissues in Subtypes of Chronic Rhinosinusitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:201-211. [PMID: 30661312 PMCID: PMC6340796 DOI: 10.4168/aair.2019.11.2.201] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Endotype in chronic rhinosinusitis (CRS) has been established in the last decade. However, the exact immunologic profile of CRS still has controversy because it has a considerable immunologic heterogeneity. Therefore, we investigated various inflammatory mediators according to different nasal tissues in chronic rhinosinusitis and compared them within the same subject. METHODS We collected uncinate process mucosa (UP) and nasal polyp (NP) tissues from controls, CRS without NP (CRSsNP) and CRS with NP (CRSwNP). Expression levels of 28 inflammatory mediators including T helper (Th) 1, Th2, Th17, proinflammatory cytokines and remodeling markers were determined by multiplex immunoassay and were analyzed using paired tests as well as principal component analysis (PCA) to investigate endotype in each subtype of CRS. RESULTS Signature inflammatory mediators are interleukin (IL)-5, C-C motif chemokine ligand (CCL)-24, monocyte chemoattractant protein (MCP)-4, and vascular cell adhesion molecule (VCAM)-1 in eosinophilic NP, whereas IL-17A, IL-1β, and matrix metallopeptidase (MMP)-9 were detected as signature inflammatory markers in non-eosinophilic NP. Despite differences in inflammatory cytokine profile between eosinophilic and non-eosinophilic NP, the common upregulation of IL-5, CCL-11, IL-23, IL-2Rα, VCAM-1, MMP-3 and MMP-9 were shown in NP compared to UP within the same subject. In the PCA, we observed that Th2 immune response was helpful in discriminating between nasal tissues in subtypes of CRS and that there was a partial overlap between non-eosinophilic NP and eosinophilic NP in terms of Th2 mediators. CONCLUSIONS Commonly upregulated mediators in NP were Th2-associated, compared with UP regardless of CRS subtypes, whereas signature markers were distinct in each NP subtype. These findings imply that Th2 inflammatory responses may play a role in the development of NP regardless of CRSwNP subtypes.
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Affiliation(s)
- Dong Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital and Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.,Clinical Mucosal Immunology Study Group, Seoul, Korea
| | - Kyoung Mi Eun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Deuktae Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Yoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yuju Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Ho Cho
- Division of Allergy-Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Dae Woo Kim
- Clinical Mucosal Immunology Study Group, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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50
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Lou H, Zhang N, Bachert C, Zhang L. Highlights of eosinophilic chronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement. Int Forum Allergy Rhinol 2018; 8:1218-1225. [PMID: 30296011 PMCID: PMC6282610 DOI: 10.1002/alr.22214] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/26/2018] [Accepted: 09/01/2018] [Indexed: 12/29/2022]
Abstract
Background Tissue eosinophils are characteristic of inflammation in most but not all patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and may be useful for defining subgroups and making treatment choices. However, no consistent diagnostic criteria for CRSwNP with eosinophilic inflammation have been established. Methods Related literature review was performed and current developments in the diagnosis of eosinophilic CRSwNP were summarized. Details in histopathology, definition of tissue eosinophilia, eosinophil as an indicator of disease recurrence, eosinophilic shift, and related biomarkers in CRSwNP are included in this review article. Results Mucosal eosinophilia exhibits significant geographic and ethnic differences and may increase over time. Tissue eosinophilia can be defined using a cutoff value based on reference values from healthy mucosa, but typical disease‐specific values should also be employed to increase sensitivity and specificity for clinical use. Recent developments highlight the diagnostic criteria for eosinophilic CRSwNP based on cluster analysis, which were also associated with clinical outcomes. Additionally, some promising eosinophil‐relevant biomarkers, such as eosinophilic cation protein and interleukin 5 (IL‐5), may be clinically applied as diagnostic or predictive tools for CRSwNP in the future. Conclusion Sinonasal tissue eosinophilia is present in a majority of CRSwNP patients but is currently more common in the West than in the East. Cutoff values of eosinophils as the diagnostic criteria of eosinophilic CRSwNP are subject to change with geographic and ethnic differences over time. It will be important to identify validated eosinophil‐related biomarkers in different continents/countries for future research and for the introduction of precision medicine.
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Affiliation(s)
- Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Nan Zhang
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, PR China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
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