Chronic Rhinosinusitis with Nasal Polyps

WAYPOINT: Are we there yet for patients with nasal polyposis?

The WAYPOINT trial demonstrated that tezepelumab treatment for chronic sinusitis with nasal polyposis was associated with statistically significant and clinically meaningful reductions vs. placebo in both objective (nasal polyp score and rates of rescue steroids or surgery) and subjective (nasal congestion, loss of smell, and sinonasal outcomes test scores) measures of disease burden at 52 weeks.1.

Multi-omics integration and machine learning identify and validate neutrophil extracellular trap-associated gene signatures in chronic rhinosinusitis with nasal polyps

This study aimed to explore the molecular characteristics of neutrophil extracellular traps (NETs) in chronic rhinosinusitis with nasal polyps (CRSwNP). Differentially expressed gene analysis, weighted gene co-expression network analysis, and machine learning algorithms identified three core NETs-associated genes: CXCR4, CYBB, and PTAFR, which were significantly upregulated in CRSwNP patients. The diagnostic performance of these genes was evaluated using receiver operating characteristic (ROC) curves, and their clinical relevance was validated using multicenter data. Immune infiltration analysis showed strong correlations between these genes and neutrophil and immune cell infiltration. Single-cell RNA sequencing demonstrated that these genes were predominantly expressed in myeloid and immune cells and exhibited dynamic changes during disease progression. These genes may contribute to CRSwNP pathogenesis through IL-17 signaling and metabolism-related pathways. This study identifies novel biomarkers and therapeutic targets for precise diagnosis and personalized treatment of CRSwNP.

IL-13 May Could Enhance the Proliferation and Affect the Differentiation of Nasal Epithelium Basal Cells Through the mTOR/p70S6K1 Pathway in Chronic Rhinosinusitis With Nasal Polyps

Background: One of the hallmarks of Chronic rhinosinusitis with nasal polyps (CRSwNP) is the overexpression of IL-13, which may influence the proliferation and differentiation of nasal epithelial basal cells. However, the pathway is not clear enough, and the mTOR/p70S6K1 pathway is related to cell growth. This study was trying to explore if IL-13 could impact nasal epithelial basal cells through the mTOR/p70S6K1 pathway. Methods: PCR, western blot (WB), and immunohistochemistry (IHC) were used to compare the difference between IL-13 and the mTOR/p70S6K1 pathway-related molecules expression level between the healthy control (HC) and CRSwNP groups. WB, 5-ethynyl-2'-deoxyuridine staining, and Immunofluorescent (IF) were performed on human nasal epithelial progenitor cells (HNEPCs) to detect the proliferation ability under the effect of IL-13. In addition, qRT-PCR, WB, and IF were used to detect the differentiation ability with the stimulation of IL-13 in the air-liquid interface (ALI) system. Results: The expression of IL-13, mTOR/p70S6K1-related molecules, and proliferation-related molecules Ki67, CDK2, and cyclin E1 were upregulated in CRSwNP compared to HC. In HNEPCs, IL-13 could stimulate nasal epithelial cells proliferating through the mTOR/p70S6K1 pathway, and this phenomenon could be inhibited when mTOR (with rapamycin) and S6K1 (with PF-4708671) were blocked. In the ALI system, the effect of IL-13 added in the proliferation phase could persist in the proliferation and differentiation stage, affecting the nasal epithelial progenitor/stem cells' irregular differentiation. Conclusion: IL-13 may affect the proliferation and differentiation of nasal epithelial progenitor/stem cells through the mTOR/p70S6K1 pathway, which may affect the development of nasal polyps.

Lacrimal canaliculitis related to chronic rhinosinusitis with nasal polyps: Case report and literature review

This paper reports an unusual case of recurrent canaliculitis who had a long history of chronic rhinosinusitis with nasal polyps. A 74-year-old woman complained of recurrent redness, purulent discharge, and occasional tearing of the left eye for 1 year. She has a 40-year untreated sinusitis history, with recurrent mucopurulent rhinorrhea, nasal obstruction and hyposmia, and loss of smell for 2 years. The patient's various symptoms, such as epiphora, purulent discharge, rhinorrhea, nasal obstruction, and anosmia, poorly responded to antibiotics and canaliculotomy. However, relief came from the unintentional usage of systemic corticosteroids. Canaliculitis is a rare form of inflammation involving the proximal lacrimal drainage system. Unfortunately, it is often misdiagnosed, has frequent recurrences, and fails to respond to therapy. This case highlights the importance of medical history, lacrimal examinations, and regular therapy in managing recurrent canaliculitis. For those canaliculitis patients with nasal symptoms, simultaneous treatment of nasal-related disorders should be considered.

Classification of chronic rhinosinusitis in Taiwan: A comprehensive analysis based on European Position Paper on rhinosinusitis and nasal polyps (EPOS) 2020

BACKGROUND

Chronic rhinosinusitis (CRS) is characterized by heterogeneous clinical presentations and underlying pathophysiology. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 introduced a new classification system categorizing CRS, moving away from with (CRSwNP) and without polyps (CRSsNP). This study applies the EPOS 2020 framework to categorize CRS patients in Taiwan, focusing on eosinophilic CRS (eCRS) and its clinical implications in this population.

METHODS

A retrospective cross-sectional study analyzed medical records of CRS patients who underwent endoscopic sinus surgery at a Taiwanese medical center from January 1 to December 31, 2023. Patients were classified per EPOS 2020 criteria using clinical history, nasal endoscopy, and CT scans. Demographic data, symptom severity (Sino-Nasal Outcome Test, SNOT-22), olfactory function (Taiwan Smell Identification Test, TWSIT), and inflammatory markers (blood eosinophil count, IgE) were assessed.

RESULTS

Of the cohort (n = 335), 69.8 % were classified as primary CRS, with eCRS accounting for 33.4 % of cases. Among CRSwNP patients, eCRS prevalence was 56.2 %, compared to 19.0 % in CRSsNP patients. eCRS patients exhibited significantly higher eosinophil counts, CT Lund-Mackay scores, and worse olfactory function compared to non-eCRS counterparts (p < 0.01).

CONCLUSIONS

This study underscores the predominance of eCRS among CRS patients in Taiwan and its association with severe disease burden, particularly in CRSwNP. The findings support the utility of EPOS 2020 in characterizing CRS phenotypes and guiding personalized treatment strategies. This research contributes valuable insights into CRS epidemiology in Asia, advocating for further exploration into regional variations and therapeutic approaches.

Investigation of PDE5 effect on NOS in nasal polyp pathophysiology

PURPOSE

Nasal polyps are masses resulting from chronic mucosal inflammation. Nitric oxide (NO) has recently attracted attention in nasal polyps as it plays an important role in both acute and chronic inflammation. One of the important mechanisms controlling NO production is phosphodiesterase (PDE) enzymes. The enzyme phosphodiesterase type 5 (PDE5) is an important regulator of cyclic guanosine 3'-5'-monophosphate (cGMP) signalling. PDE5 inhibitors increase intracellular cGMP concentration by inhibiting cGMP degradation and prolong NO signalling. NO is thought to cause nasal congestion because it increases microvascular permeability and causes mucosal oedema. The aim of our study was to investigate the role of PDE5, inducible nitric oxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) in the pathophysiology of nasal polyps with mucosal oedema in histopathology.

METHODS

Nasal mucosal tissues were obtained from 25 patients with nasal polyps who underwent endoscopic sinus surgery as the study group and 25 patients who underwent rhinoplasty as the control group. eNOS, iNOS and PDE5 levels were measured in nasal mucosal tissues.

RESULTS

The mean age was 47.40 ± 16.33 years in the nasal polyp group and 35.44 ± 12.47 years in the normal group, and 64.0% (n = 16) of both groups were male. ELISA measurements showed that PDE5 levels were significantly decreased and iNOS and eNOS levels were significantly increased in the nasal polyp group compared with the control group. CONCLUSıON: This study suggest that iNOS, eNOS, and PDE5 may play important roles in the pathophysiology of nasal polyps.

Molecular mimicry-driven autoimmunity in chronic rhinosinusitis with nasal polyps

BACKGROUND

The pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remains a subject of discussion. Although both microbial infection and autoimmunity have been proposed as potential contributors to CRSwNP pathobiology, their respective roles and intricate interactions in disease progression remain unclear owing to the limited knowledge regarding dysregulated humoral immunity in CRSwNP.

OBJECTIVE

To deepen understanding of CRSwNP, we sought to identify the precise humoral antigens targeted by dominant B-cell clones within the disease environments.

METHODS

Immunoglobulin repertoire sequencing was performed to identify dominant B-cell clones in CRSwNP tissues. These immunoglobulin clones were reconstructed as antibodies, which were then used in immunoprecipitation and antigen array experiments for hypothesis-free global antigen profiling of autogenous and exogenous antigens.

RESULTS

From analysis of 13 patients with CRSwNP, 31 antibodies were reconstructed from dominant B-cell clones identified in 9 patients. Seven novel protein autoantigens were identified, 5 of which were nucleic acid-binding proteins, and all were associated with autoimmune diseases. Additionally, 9 microbial antigens, including various viruses, bacteria, and fungi, were discovered. Notably, 2 antibodies demonstrated dual reactivity, simultaneously recognizing both microbial and human proteins. For example, 1 antibody targeted cytomegalovirus, Clostridium tetani, and human PLEC, whereas another recognized Aspergillus niger and human DLAT, through molecular mimicry of shared amino acid homologies.

CONCLUSION

Our data indicate the possibility that the pathobiology of CRSwNP involves autoreactive humoral immunity, with a subset of cases potentially exhibiting molecular mimicry-driven autoimmune features triggered by microbial infections. Nevertheless, this hypothesis requires further investigation.

Correlation between peripheral blood basophils and chronic sinusitis with nasal polyps in different age groups

PURPOSE

Despite improved surgical and medical therapies, it remains a disease entity that is difficult to cure chronic rhinosinusitis with nasal polyps (CRSwNP), given a recently-reported incidence up to 4% of the population severely affects patients' quality of life. In this retrospective study, we attempted to assess the role of another important inflammatory cell, the blood basophil, in a large series of patients with CRSwNP (n = 316) across three different age groups.

METHODS

The investigation concerned 316 consecutive patients undergoing endoscopic sinus surgery (ESS) for CRSwNP. We divided these patients into three groups according to age, of which, 46 consecutive geriatric patients ( ≧ 61y), 243 consecutive young adult CRSwNP patients (19-60y), and 27 pediatric patients (≤ 18y) were enrolled.

RESULTS

Compared between groups, WBC and eosinophil counts in peripheral blood were not statistically different among the three groups, while blood basophil (p = 0.016), lymphocyte (p < 0.001), monocyte (p = 0.031) counts and LM scores (p = 0.025) were statistically different between groups, all of which were significantly different between pediatric and adult groups, pediatric and elderly groups. Spearman correlation analysis revealed blood basophil counts were positively correlated with blood eosinophils, leukocytes, lymphocytes, monocyte counts, and LM scores overall in the sample as a whole (p < 0.001).

CONCLUSION

The heterogeneous role of blood basophils identified in different age sub-cohorts of CRSwNP supports the hypothesis that blood basophil count may reflect the severity of inflammation in CRSwNP patients. In addition, we should pay attention to the long-term follow-up of pediatric patients with CRSwNP.

Chinese Position Paper on Biologic Therapy for Chronic Rhinosinusitis With Nasal Polyps

Emerging biologics that selectively target key cytokines present a promising therapeutic alternative for patients suffering from severe, uncontrollable chronic rhinosinusitis with nasal polyps (CRSwNP). Despite the limited availability of registered biologics for CRSwNP treatment in China, the country is experiencing rapid development in this field. It is imperative to standardize the application of biologic agents in CRSwNP management in preparation for their future integration into the CRSwNP care pathway. The Rhinology Group, Chinese Society of Otorhinolaryngology-Head and Neck Surgery; the Rhinology Group, Chinese Medical Doctor Association of Otorhinolaryngology-Head and Neck Surgery; and the Nasal and Ocular Allergy Group, Chinese Society of Allergy have convened an expert panel consisting of principal investigators experienced in clinical trials of biologic treatment for CRSwNP. This expert panel was assembled to discuss the application of biologic agents in patients with CRSwNP in China. Additionally, the latest findings on the pathogenesis of CRSwNP, mechanisms of biologic agents, and efficacy and safety of biologic treatment in patients with CRSwNP were reviewed, with a special emphasis on research evidence from China. The expert panel reached a consensus on several critical issues, including criteria for the prescription, treatment course, and efficacy evaluation from a Chinese perspective. This position paper aims to guide Chinese physicians in the use of biologic agents for patients with CRSwNP. As our experience with biologic treatment continues to grow, this position paper will be further updated.

Tissue eosinophil level as a predictor of control, severity, and recurrence of Chronic Rhinosinusitis with Nasal Polyps

Introduction

The histopathologic study of nasal polyps establishes endotype features of chronic rhinosinusitis (CRS). A tissular eosinophil count greater than 10 per high power field (HPF) classifies this condition as type 2 inflammation. Blood and mucosal eosinophils are suggested as biomarkers of severity and control of CRS. Additionally, a tissular eosinophil count greater than 55 per HPF has been related to a high risk of recurrence in the Asian population. Our study aims to determine whether tissue eosinophil count is associated with the control, severity, and recurrence of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP).

Methods

An observational study of patients with CRSwNP who underwent nasal mucosa biopsy was conducted between June 2021 and November 2023. Histopathologic features, asthma control, CRSwNP control and severity according to the POLINA consensus, quality of life parameters, recurrence of CRSwNP, and laboratory markers were recorded and compared with the tissular eosinophil count.

Results

A total of 108 cases were included. The majority (70.4%) had concomitant asthma, with 31.5% of the cases having well-controlled disease. Most patients had uncontrolled (57.4%) and severe (62%) CRSwNP. Fifty-four cases underwent surgery and 43.5% experienced recurrence. More than half had a SNOT-22 score greater than 50 points. Eighty-one percent of patients had a tissular eosinophil count greater than 10 per HPF, and 60.2% had blood eosinophilia greater than 0.3 × 10 3 . Blood eosinophilia was related to CRSwNP severity and control. No significant differences were found between tissue eosinophil count and the severity, control, and recurrence of CRSwNP.

Conclusion

Tissue eosinophil levels were not a marker of control, severity, and recurrence of CRSwNP in our data. Blood eosinophil levels, however, were a marker of CRSwNP control and severity.

Long-term outcomes of functional endoscopic sinus surgery with selective vidian neurectomy for chronic rhinosinusitis with nasal polyps combined with allergic rhinitis and asthma

BACKGROUND

Patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS) with nasal polyps (ARwCRSwNP), and asthma often exhibit high recurrence rates after functional endoscopic sinus surgery (FESS), sometimes requiring revision surgery. This study evaluated the long-term outcomes of combining FESS with selective vidian neurectomy in patients with ARwCRSwNP and asthma.

METHODS

Fifty-six ARwCRSwNP patients, including 27 with asthma, were divided into two groups: one received FESS with selective vidian neurectomy (group A), and the other underwent FESS alone (group B or control). Disease severity, control, and outcomes were evaluated using the Visual Analog Scale (VAS), the 22-item Sino-Nasal Outcome Test (SNOT-22), and the Lund-Kennedy score for nasal endoscopy. To assess factors influencing disease severity and treatment outcomes, we recorded allergy assessments (for mites, mold, and pollens), preoperative blood eosinophilia, and tissue eosinophil levels from histopathological examination following endoscopic surgery.

RESULTS

After three years, patients from both groups showed significant improvements in symptoms and quality of life compared to the preoperative period (p < 0.01). CRS patients with high tissue eosinophilic inflammation exhibited reduced disease control compared to those with controlled or partly controlled disease (p < 0.05). Patients in group A had better outcomes for nasal itching and sneezing compared to group B. While overall CRS control was similar between the two groups, group A demonstrated better CRS control among asthma patients (p < 0.05).

CONCLUSION

Combining FESS with selective vidian neurectomy effectively improves nasal symptoms in ARwCRSwNP patients and represents a beneficial treatment option for those with comorbid asthma.

Diagnostic value of serum survivin, Ki-67 and thymidine kinase in dogs with nasal cavity disease

Background

The most common nasal cavity disease (ND) in dogs is the malignant nasal cavity tumor. Prognosis and survival after radiation therapy are reported to correlate with tumor size, and therefore indirectly with the time to diagnosis. Diagnosis of a nasal tumor requires imaging procedures under anesthesia. Thus, diagnostic serum markers are urgently needed for early detection and for therapeutic monitoring.

Materials and methods

This prospective, blinded study included dogs with nasal discharge that completed a comprehensive diagnostic workup for ND. Dogs were evaluated by blood testing and whole-body CT and those with concomitant diseases or with steroid pre-treatment were excluded. Serum survivin, Ki-67, and thymidine kinase 1 (TK1) concentrations were determined, and the survivin-lymphocyte ratio (SLR) calculated. Results were compared between groups of dogs with different NDs and to ten healthy controls.

Results

A total of 55 dogs were included, consisting of 25 with malignant ND (12 sarcomas, 13 carcinomas) and 30 with benign ND (7 benign tumors, 13 dogs with idiopathic rhinitis (IR), 10 others including dogs with dental diseases and sinonasal aspergillosis). Survivin and SLR were significantly increased in dogs with malignant ND and in subgroup comparison in sarcomas compared to controls. In addition, the SLR was significantly increased in carcinomas and IR compared to controls. In dogs with IR, no differences were observed in survivin concentrations or SLR based on microbiological or histopathological findings. Survivin concentrations or SLR in dogs with nasal tumors were not significantly different between T-categories. No significant differences were detected in TK1 concentrations among the groups, nor in Ki-67, except for significantly lower Ki-67 concentrations in benign tumors compared to carcinomas and the group others including, e.g., dental diseases.

Conclusion

Although not diagnostic for ND, increased survivin serum concentrations or SLR can be detected in dogs with malignant nasal tumors and IR. In malignant nasal tumors, survivin and SLR did not correlate with tumor size and therefore may be useful in the detection of even small nasal tumors. Therefore, in dogs with nasal tumors and IR, survivin and SLR could serve as a target for disease monitoring or as therapeutic target.

Signaling lymphocytic activation molecule family 8 disrupts epithelial barrier in chronic rhinosinusitis with nasal polyps through M1 macrophage polarization

BACKGROUND

Recent studies reveal that M1 macrophages accumulate predominantly in noneosinophilic chronic rhinosinusitis with nasal polyps (neCRSwNP). However, the precise mechanisms regulating M1 macrophages and their impact on the epithelial barrier remain unclear.

OBJECTIVE

To investigate the expression and regulatory role of signaling lymphocytic activation molecule family (SLAMF)8, a molecule exclusively expressed in myeloid cells, in M1 macrophage polarization and its potential contribution to neCRSwNP development.

METHODS

We evaluated SLAMF8 expression and its correlation with clinical variables using real-time quantitative polymerase chain reaction and Western blot in sinonasal mucosa samples from CRSwNP and control subjects. Immunofluorescence staining confirmed the co-expression of SLAMF8 with macrophages. After SLAMF8 knockdown, we explored the influence on macrophage M1 polarization and the effect on epithelial-mesenchymal transition (EMT) process and tight junction integrity in epithelial cells through an indirect co-culture system of M1 macrophages with human nasal epithelial cells.

RESULTS

SLAMF8 was highly expressed on M1 macrophages in polyp tissues, notably in neCRSwNP, and correlated with disease severity indices only in neCRSwNP. SLAMF8 knockdown in THP-1 cells reduced M1 macrophage markers (CD86, iNOS, and NLRP3) and decreased secretion of inflammatory cytokines (interleukin-1 beta, interleukin-6, and tumor necrosis factor alpha). Co-culture with M1 macrophage supernatant after SLAMF8 knockdown enhanced epithelial viability, reduced EMT and apoptosis, and up-regulated tight junction markers, occludin and claudin-4, in nasal epithelial cells.

CONCLUSION

SLAMF8 elevation correlates with the EMT, epithelial tight junction, and disease severity in neCRSwNP. SLAMF8 up-regulation promotes M1 macrophage polarization, which facilitates EMT and impairs nasal epithelial barrier function. SLAMF8 may represent a novel therapeutic target for neCRSwNP.

The auxiliary effect of vitamin D in the treatment of chronic rhinosinusitis with nasal polyposis, a clinical trial

BACKGROUND

Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a prevalent chronic inflammatory disorder of the nasal cavity and paranasal sinus with benign polypoid masses. Recent evidence highlights the immunomodulatory role of Vitamin D (Vit D) in mitigating inflammation associated with CRSwNP.

AIMS

The aim of this study is to examine the effect of Vit D on the improvement of CRSwNP.

MATERIAL AND METHODS

This randomized, double-blind clinical trial was conducted on 59 patients with CRSwNP. All patients with Vit D deficiency (25OH Vit D level < 20 ng/mL) or insufficiency (<30 ng/mL) underwent endoscopic sinus surgery (ESS). The rate of changes in the patients' symptoms were recorded before and 8 weeks after the surgery.

RESULT

All patients showed a better postsurgical improvement in terms of Visual Analogue Scale(VAS), Lund-Kennedy (LK), and Questionnaire (SNOT-22) scores. The Vit D supplement group showed better postsurgical improvement in comparison to placebo in terms of VAS and LK scores (p = 0.02, p = 0.03 respectively).

CONCLUSIONS AND SIGNIFICANCE

The administration of Vit D after ESS is relatively effective in the improvement of CRSwNP symptoms. This finding highlights the possibility of developing an efficient, safe, and cost-effective therapy for patients with CRSwNP.

Unveiling the prevalence and impact of silent rhinovirus infection in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNPs) involves persistent sinus inflammation, with emerging evidence suggesting a potential role of rhinovirus (RV) in its pathophysiology. However, whether RV exists in nasal tissues and affects the nasal mucosa after the resolution of infection symptoms remains unknown.

OBJECTIVE

To investigate the prevalence and impact of silent RV infection in nasal tissues.

METHODS

RV loads were detected in the nasal tissues of 47 controls and 101 patients with CRSwNP without respiratory infection. Participants were categorized into RV-positive (+), RV-negative (-), and the "gray zone" groups. Quantitative polymerase chain reaction, Western blotting, and immunofluorescence assays were used to analyze the impact of silent RV infection on the immune status of nasal tissues.

RESULTS

Silent RV infection was prevalent in both control (34%) and CRSwNP (30.7%) tissues, with higher viral loads observed in the nasal polyps. In controls, it was associated with high expression of types 1 and 2 interferon (IFN), type 2 inflammation, interleukin (IL)-17A, and IL-10. In patients with CRSwNP, silent RV infection was associated with lower levels of type 1 IFN, IL-17A, type 2 inflammation, and IL-10 but higher levels of type 2 IFN compared with those without RV infection. Meanwhile, RV (+) nasal polyps exhibited fewer tissue eosinophils and neutrophils than RV (-) nasal polyps.

CONCLUSION

Silent RV infection was prevalent in the nasal tissues, with a higher viral load detected in the nasal polyps. This silent RV infection is associated with distinct immune responses in healthy controls and patients with CRSwNP, involving differential modulation of IFNs, TH2 cytokines, IL-17A, IL-10, and eosinophil and neutrophil levels.

Therapeutic potential of thymoquinone in regulating p63, claudin, and periostin in chronic rhinosinusitis with nasal polyps: An animal model study

High recurrence rate and the necessity for repeated surgical interventions contribute to the chronicity and treatment-resistant nature of chronic rhinosinusitis with nasal polyps (CRSwNP). Thymoquinone, known for its protective effects on epithelial integrity, has not been previously explored in CRSwNP. The aim of this study was to investigate the therapeutic potential of thymoquinone to restore epithelial integrity by assessing p63 transcription factor and claudin protein expressions, as well as periostin mRNA expression in an animal model. An in vivo study using post-test-only control group design was conducted in which male Wistar rats were randomly assigned to three groups, each consisting of 10 animals: healthy group, CRSwNP group, and thymoquinone-treated group for three weeks. Immunohistochemistry was used to analyze the p63 and claudin protein expressions, while periostin mRNA expression was quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR). This study found that thymoquinone significantly reduced p63 transcription factor expression compared to the untreated CRSwNP group (p = 0.009). Claudin protein expression was significantly higher in thymoquinone-treated group compared to CRSwNP group (p = 0.007), indicating improved epithelial barrier function. Periostin mRNA expression showed no significant difference between healthy and thymoquinone-treated groups (p = 0.564), but a significant decrease was observed in CRSwNP group compared to thymoquinone-treated group (p = 0.000) and between the healthy and CRSwNP groups (p = 0.002), suggesting attenuation of tissue remodeling and inflammation. In conclusion, thymoquinone could enhance sinonasal epithelial barrier integrity in CRSwNP by downregulating p63 transcription factor, upregulating claudin protein expression, and reducing periostin mRNA expression. These findings emphasize the potential of thymoquinone as a therapeutic agent to mitigate inflammation and tissue remodeling in CRSwNP, warranting further investigation as a novel treatment option.

The Role of the Environment and Occupational Exposures in Chronic Rhinosinusitis

PURPOSE OF REVIEW

The purpose of the review is to summarize the current literature and evaluate how different environmental exposures may contribute to the development and course of chronic rhinosinusitis (CRS). The review aims to explore the relationship between host factors and environmental exposures in the pathogenesis of CRS.

RECENT FINDINGS

Recent studies have helped establish the role of air pollutants, tobacco smoke, occupational exposures, and microplastics in the pathogenesis of CRS. These exposures have been shown to cause epithelial dysfunction and promote inflammation through different mechanisms and to different degrees. The pathogenesis of CRS is complex and multifactorial, with environmental exposures playing a key role in its onset and exacerbation. Research indicates that pollutants can damage the sinonasal epithelial barrier and disrupt the microbiome, leading to increased inflammation. A deeper understanding of the mechanisms behind this inflammatory process and its link to environmental exposures could enhance strategies for preventing and treating CRS.

Viral infection as an inciting event for development of chronic rhinosinusitis: A population-based study

KEY POINTS

Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes.

A Study to Compare the Relationship Between Tissue Eosinophilia and Radiological Findings in Nasal Polyposis

Nasal polyps are benign inflammatory growth of sinonasal mucosa, often associated with chronic rhinosinusitis. This condition prevalent among adults, significantly impacts the quality of life. Eosinophil plays a crucial role in the pathogenesis of nasal polyposis. Hence, this study was carried out to compare the relationship between tissue eosinophilia and radiological findings in nasal polyposis. This observational study was conducted at a tertiary care centre, involving 30 patients with nasal polyposis underwent endoscopic sinus surgery. All patients underwent pre operative CT scan and Lund MacKay score were calculated. Excised polyp tissues were examined, and eosinophil count was calculated per high power field (400 X). Eosinophil count was categorized as low (≤ 10 E/HPF) and high (> 10 E/HPF). The study population had a mean age of 41.65 ± 11.43 years, with a male predominance (80%). Hypertension was the most common comorbidity (26.67%). The mean Lund MacKay score was 18.03 ± 4.3 with the majority of patients (60%) had Lund-Mackay scores between 17-24, indicating significant sinus involvement. Patients with higher eosinophil counts (> 10 E/HPF) showed more severe disease, reflected by higher Lund-Mackay scores (p < 0.0001). A moderate positive correlation (r = 0.005) was observed between tissue eosinophil count and Lund-Mackay scores. This study found moderate positive correlation between the Lund Mackay score and tissue eosinophil count. The correlation between tissue eosinophil count and disease severity underscores its potential as a prognostic marker in nasal polyposis.

A real-life evaluation of SNOT-22 domains in a cohort of CRSwNP patients treated with biologic therapies for 12 months

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disorder associated with rhinorrhea, nasal obstruction, nasal congestion, hyposmia, anosmia, and facial pain or pressure for over 12 weeks. This study examines the Sino-Nasal Outcome Test 22 (SNOT-22) score and its relationship to nasal, otologyc, sleep and emotional domains in CRSwNP patients during the first year of biologics treatment, comparing the pre-biologics score to that at 1, 6, and 12 months in a cohort of 59 patients with CRSwNP.

METHODS

We included 59 patients with CRSwNP (with or without asthma) who received add on therapy with targeted monoclonal antibodies (mAbs). At each visit we administered the SNOT-22 questionnaire and both total score and single domains scores were recorded.

RESULTS

In this real-life, observational study, we found a significant SNOT-22 total score reduction for patients treated with anti-IgE after 1 month, but this significant difference was not maintained at 6 or 12 months compared with the baseline. The use of anti-interleukin 5/5R (IL5/5R) leads to a significant reduction of the SNOT-22 total score after 1 month, which is maintained after 6 months but not at 12 months compared with the baseline. The use of an anti-interleukin 13/4R (IL13/4R) leads to a statistically significant reduction of the SNOT-22 score after 1 month of therapy, which is maintained after 6 and 12 months compared with the baseline. When examining the single domains, we observed that patients who received anti-IL13/4R treatment demonstrated a significant reduction in each domain at each time point (T) compared to the baseline. Patients who received anti-IL5/5R treatment demonstrated an improvement in the nasal domain at each T compared to the baseline. However, the improvement in the otologyc domain was not sustained after 12 months. Similarly, the sleep domain remained unchanged, and the emotional domain only improved significantly after 12 months. Similarly, there was a reduction of the emotional domain in patients treated with anti-IgE.

CONCLUSION

Our real-life study describes the kinetics over the first year of treatment with mAbs in CRSwNP, showing different patterns in reducing symptoms and improving Health Related Quality of Life (HRQoL). SNOT-22 with the factorial division in 4 domains can help distinguish fast responders from low or non-responders to a mAb based on clinical response after 1 month and more accurately assign the right mAb to the right patient.

Type 2 inflammation: a Portuguese consensus using Web-Delphi and decision conferencing (INFLAT2-PT)

OBJECTIVES

Atopic/allergic diseases impose a growing burden on public health, affecting millions of patients worldwide. The main objective of this study was to develop a national expert consensus on relevant clinical questions related to type 2 inflammation.

METHODS

We conducted: a comprehensive literature review with a qualitative analysis to identify the most repeated themes on the overlap of conditions; a modified 3-round Web-Delphi (or e-Delphi); and a final online decision conference.

RESULTS

We included 51 studies. Following three Web-Delphi rounds, we ended up with 30 statements with a 76% overall full agreement rate, 16% agreement, 2% disagreement, and 0% full disagreement. The decision conference enabled adjustments, and the expert panel agreed unanimously on the final set of statements. The consensus used evidence synthesis, Web-Delphi, and decision conference to produce 30 statements on type 2 inflammation as a driver for multimorbidity in asthma, certain rhinitis phenotypes, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis grouped under five domains in underlying pathophysiology, multimorbidity, diagnosis and management, multidisciplinary management, and impact on mental health.

CONCLUSION

We expect the first Portuguese expert consensus INFLAT2-PT to promote understanding of type 2 inflammation diseases, multidisciplinary care, integrated care pathways, future research, and inform health authorities.

Psychometric validation of the Standard Tests for Asthma, Allergic Rhinitis, and Chronic Rhinosinusitis in the United States

BACKGROUND

Chronic rhinosinusitis with nasal polyposis is an inflammatory disease associated with type 2 inflammation, which is present in lower airway disease (asthma). Current tools used to track symptoms and quality-of-life burden of disease, such as the 22-item Sinonasal Outcome Test (SNOT-22), lack specificity in the symptoms evaluated.

OBJECTIVE

To combat this shortcoming, we validated a new survey, Standard Tests for Asthma, Allergic Rhinitis, and Chronic Rhinosinusitis (STARR-15), in a population of US patients with chronic rhinosinusitis with nasal polyposis.

METHODS

In this project, STARR-15 was tested in a population of patients with chronic rhinosinusitis with nasal polyposis at a single tertiary care center in the United States. The survey was also compared with a corresponding population of patients with chronic rhinosinusitis without nasal polyps from the same institution.

RESULTS

The survey was assessed within the population of patients with chronic rhinosinusitis with nasal polyposis and found to demonstrate good test-retest reliability with an intraclass correlation coefficient of 0.93. The survey was internally valid, with Cronbach alpha of 0.85. Furthermore, the survey was assessed for external validity by comparing it with the SNOT-22. STARR-15 correlated positively with the SNOT-22, with a Pearson coefficient of 0.77.

CONCLUSION

This work has implications in helping follow patient symptoms over time for patients who have not only chronic rhinosinusitis with nasal polyps but also other inflammatory conditions of the lower airways. It also has potential to be used as a screening tool for patients with chronic rhinosinusitis, asthma, and allergic rhinitis.

Pilot Study on the Efficacy of a Novel Questionnaire for Assessing Psychological Health in Patients with Chronic Rhinosinusitis with Nasal Polyps Treated with Biologics

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a debilitating disease with significant morbidity and decreased quality of life (QoL). The introduction of biologics in its management has allowed new therapeutic options, and Dupilumab represents the first approved biologic. This study aims to evaluate a possible relationship between the clinical response to biological therapy and mental health in patients with severe CRSwNP. Methods: This is a multicenter study conducted at the Otolaryngology departments of three major Italian health institutions. Participants were patients with CRSwNP treated with Dupilumab. Patients were assessed at baseline and during treatment by submitting them to a survey consisting of a dedicated questionnaire focused on psychological health and two patient-reported outcome measures (PROMs): the 22-item Sino-Nasal Outcome Test (SNOT-22) and a Visual Analogue Scale (VAS) for nasal symptoms. Results: 86 patients were included in the study (58 males and 28 females; mean age: 58.2 years). There was a significant improvement in both symptoms and QoL, with an enhanced psychological state observed in patients after the first administration and within the first months of therapy. Conclusions: This study evaluated the possible correlations between Dupilumab treatment and improvements in mental health in patients with CRSwNP, as assessed through a survey, and clinical conditions, assessed through SNOT-22 and VAS. Our findings showed that Dupilumab not only improved clinical symptoms but also had a positive impact on patients' mental health, with benefits observed already after the first administration and the first months of therapy. This survey highlights the relevance of psychological well-being and its implications for patients with chronic diseases such as CRSwNP.

The Impact and Burden of Chronic Rhinosinusitis with Nasal Polyps on Patients and Their Family Caregivers: A Nationally Representative Survey

Background: Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a chronic inflammatory disease associated with frustrating symptoms, particularly nasal obstruction and loss of smell. We conducted a patient survey on the significant burden of the disease, with a specific focus on conditions that affect health, sleep quality, absenteeism, and presenteeism, including the caregivers' perspectives. Methods: An online questionnaire was sent to 4230 randomly selected recipients, and 200 matched the inclusion criteria for self-reported CRSwNPs symptoms. A total of 100 participants not matching the inclusion criteria for CRSwNPs were recruited as a control group. The study also collected the perspectives of 50 caregivers. Results: Patients with CRSwNPs experienced very bothersome symptoms, such as nasal congestion, headache, and rhinorrhoea, with a profound impact on their health-related quality of life (HRQoL). The patients and their caregivers showed significantly lower quality of sleep, experiencing a poor night's sleep on average 72.1 and 51.7 days per year, respectively. Smell and taste impairments significantly impacted patients' social and working lives, with 39.5% feeling in danger because of hyposmia and 34.5% because of limited taste. Out-of-pocket costs were up to EUR 40/month for 68.5% of patients. CRSwNPs alone was responsible for an average of 24.7 days of absenteeism and 25.1 days of presenteeism. Conclusions: Our results highlight how CRSwNPs has a negative impact on patients' and caregivers' HRQoL. Most bothersome and health-conditioning symptoms involve nose symptoms and poor sleep quality, resulting in patient absenteeism and presenteeism with a strong burden on cognitive and emotional functioning for both patients and their caregivers.

Advances in Biologic Therapies for Allergic Diseases: Current Trends, Emerging Agents, and Future Perspectives

Biologic therapies have revolutionized the treatment of severe allergic diseases, including asthma, atopic dermatitis (AD), chronic spontaneous urticaria (CSU), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic gastrointestinal diseases (EGIDs), and allergic rhinitis (AR). These molecularly targeted agents provide significant benefits for patients unresponsive to conventional treatments by addressing underlying immune mechanisms, particularly type 2 inflammation driven by cytokines such as IL-4, IL-5, and IL-13. Recent advancements include biologics targeting alarmins like thymic stromal lymphopoietin (TSLP) and IL-33, which may address both type 2 and non-type 2 inflammation, broadening their therapeutic scope. Despite their effectiveness, biologics remain expensive, posing socioeconomic challenges, and there are concerns regarding long-term safety and inter-individual variability in responses. Promising innovations such as bispecific antibodies and ultra-long-acting agents are under investigation, alongside digital health tools like remote biomarker monitoring and AI-driven decision support systems, which aim to enhance personalized care. However, disparities in access, particularly for underserved populations, underscore the need for policy reforms and affordable biosimilars. This review synthesizes recent findings and emerging trends, highlighting the evolving role of biologics in transforming allergic disease management and offering insights into future research directions.

Proposal of a New Composite Score (DAMADECO) to Simultaneously Evaluate Asthma and CRSwNP Severity in Comorbid Patients

Background: Asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are chronic respiratory conditions that frequently coexist. However, an integrated assessment tool for both conditions is currently lacking. This study aimed to develop and preliminarily evaluate a composite score capable of simultaneously assessing asthma and CRSwNP in comorbid patients. Methods: An expert panel comprising three pulmonologists, one allergist/clinical immunologist, and four ear, nose and throat (ENT) specialists developed a tool to capture asthma and CRSwNP severity. The tool (D'Amato-De Corso score, or DAMADECO score) incorporates eight parameters, four specific to asthma and four specific to CRSwNP, to assign individual scores for each condition. A composite score is then calculated to reflect the overall disease burden (ranging from -8: poor control and +8: optimal control). A retrospective pilot study was conducted to evaluate the tool. Results: The DAMADECO composite score was applied to 21 comorbid patients. The mean partial scores for asthma and CRSwNP were -1.57 and -1.67, respectively, with a mean total composite score of -3.24. A total of 13 out of 21 patients had uncontrolled domains in both diseases, while fewer patients had only uncontrolled domains in asthma (1/21) or CRSwNP (6/21). The DAMADECO score also allows researchers to track disease progression and monitor treatment effectiveness. Conclusions: The preliminary results suggest that the DAMADECO score is a promising tool for simultaneously assessing asthma and CRSwNP, addressing the unmet need for an integrated approach to comorbid respiratory diseases. Further validation studies are needed to validate the tool in larger patient populations.

Identification of Transforming Growth Factor-β1 in the nasal polyp tissue of chronic rhinosinusitis: a comprehensive analysis

BACKGROUND

Chronic Transforming Growth Factor Beta 1 (TGF-β1) plays a critical role in tissue remodelling and immunological modulation, which may contribute to the severity and recurrence of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Despite extensive research on CRSwNP, the exact role and pathological significance of TGF-β1 in CRSwNP remain poorly understood due to inconsistencies in study methodologies and findings.

AIMS/OBJECTIVES

To resolve discrepancies in the literature, this systematic review compares the levels of TGF-β1 in CRSwNP tissue to controls and Chronic Rhinosinusitis without Nasal Polyps (CRSsNP).

MATERIAL AND METHODS

A comprehensive literature search was conducted across databases such as PubMed, ScienceDirect, and Cochrane Library. Studies assessing TGF-β1 levels in the tissue through various methods were systematically reviewed. Data were extracted on TGF-β1 levels, methodological approaches, and clinical correlations.

RESULTS

The review indicates that TGF-β1 levels were highly variable in controls, elevated in CRSsNP, and broadly ranged in CRSwNP with generally lower levels compared to CRSsNP, placing controls between CRSwNP and CRSsNP.

CONCLUSIONS AND SIGNIFICANCE

Elevated TGF-β1 in CRSsNP points to its significant role in fibrosis and tissue remodeling, which could inform targeted therapeutic approaches and improve management strategies for chronic rhinosinusitis.

Risk of swallowing disorders in patients with chronic rhinosinusitis and nasal polyposis in comparison to healthy controls: a Survey of 50 cases

PURPOSE

To investigate the risk of swallowing disorders and the frequency and intensity of vocal tract symptoms in patients with chronic rhinosinusitis and nasal polyposis (CRSwNP).

METHODS

Adult patients diagnosed with CRSwNP presenting to the rhinology clinic of a tertiary referral center between March 2023 and March 2024, were recruited. Patients with acute or recent history of respiratory tract infections, tonsillitis, pharyngitis or otitis, were excluded. The frequency and severity of nasal symptoms and their impact on quality of life was assessed using the Sinonasal Outcome Test (SNOT-22). The Eating Assessment Tool (EAT-10) was used to evaluate the risk of swallowing disorders, and the Vocal Tract Discomfort Scale (VTDS) was used to evaluate the frequency and intensity of vocal tract symptoms.

RESULTS

Twenty-five patients with CRSwNP and 25 controls were recruited for this study. There was a statistically significant difference in the mean EAT-10 score between the study group and control group (3.52 ± 4.68 vs.0.88 ± 1.83; p = 0.013). There was also a statistically significant difference in the mean VTDS score between the study group and control group (12.56 ± 7.9 vs. 4 ± 4.64; p < 0.001). There was a positive moderate correlation between the VTDS score and the SNOT-22 score (r = 0.595; p < 0.001).

CONCLUSION

The study indicates that patients with CRSwNP have a higher risk for swallowing disorders and are more likely to experience vocal tract symptoms than healthy controls.

Predictors of revision endoscopic sinus surgery in Finnish patients with chronic rhinosinusitis with nasal polyps

BACKGROUND

Although patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may benefit from endoscopic sinus surgery (ESS), some patients will experience polyp recurrence, adding to the overall disease burden of CRSwNP. We aimed to investigate predictors of revision ESS in patients with CRSwNP.

METHODS

A nationwide population-based study including all adults diagnosed with CRSwNP who had surgical procedure codes for ESS (N = 3506), followed up between January 2012 and December 2019. Logistic regression models provided adjusted odds ratios (OR) with 95% confidence intervals (CIs) for the odds of revision surgery within one and 3 years post-index surgery.

RESULTS

559 (15.9%) of the patients had at least one revision surgery during the follow-up. Median time to revision of ESS was 425 days (interquartile range: 213-898). Baseline asthma (OR = 1.58, 95% CI 1.17-2.12) and antibiotic use (OR = 1.61, 95% CI 1.27-2.04) were associated with higher odds of revision ESS, particularly within 3 years post-index surgery, whereas Increasing age was inversely associated with the odds of ESS revision (OR = 0.82, 95% CI 0.76-0.88). The highest odds of revision ESS were observed within 3 years post-index surgery in patients who had undergone extensive surgery at index (OR = 14.13, 95% CI 3.41-95.64) compared with those who had undergone limited surgery. OCS use was frequent among CRSwNP patients, with a higher cumulative dose in patients undergoing multiple ESS revisions (63%, n = 97, median daily dose 3.29 mg, IQR: 1.64-3.70) compared with patients without revisions (49%, n = 1361 and 1.64 mg, IQR: 1.64-3.29, respectively. p-value <0.001).

CONCLUSIONS

A small proportion of CRSwNP patients require revision ESS with associated high cumulative OCS doses, highlighting the need for additional therapies to achieve disease control and reduce the corticosteroid burden. A few simple baseline characteristics can predict the need for recurrent surgery among the patients with CRSwNP.

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis

OBJECTIVE

To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS).

METHODS

The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS.

RESULTS

All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%-13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%-19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%-15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%-10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%-7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%-4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%-11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%-22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%-19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%-12.17%, p = 0.005).

CONCLUSION

Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:593-601, 2025.

The IL-4-IL-4Rα axis modulates olfactory neuroimmune signaling to induce loss of smell

IL-4 and IL-13 have non-redundant effects in olfaction, with loss of smell in mice evoked only by intranasal administration of IL-4, but not IL-13. IL-4-evoked pathophysiological effects on olfaction is independent of compromised structural integrity of the olfactory neuroepithelium. IL-4-IL-4Rα signaling modulates neuronal crosstalk with immune cells, suggesting a functional link between olfactory impairment and neuroinflammation. Abbreviations: IL, interleukin; KO, knock-out; wk, week; WT, wild-type.

Patient-centered outcomes for clinical trials in chronic rhinosinusitis with or without nasal polyps and allergic fungal rhinosinusitis

BACKGROUND

Chronic rhinosinusitis (inclusive of subtypes with nasal polyps [CRSwNP], without nasal polyps [CRSsNP], and allergic fungal rhinosinusitis [AFRS]) causes inflammation of the nose mucosa and paranasal sinuses. Unfortunately, evidence supporting use of clinical outcome assessments (COAs) in regulated clinical trials to assess key measurement concepts of these conditions is limited.

OBJECTIVE

To identify key disease-related symptoms and impacts, potential outcomes of interest for new treatments, and COAs available to measure those outcomes among adult and adolescent individuals living with CRSwNP, CRSsNP, and AFRS.

METHODS

Literature, clinical trial, and product label reviews were conducted to identify symptoms, impacts, and COAs used to assess CRSwNP, CRSsNP, and AFRS patient experiences in clinical trials. The disease related concepts identified in the literature were mapped to selected COAs to determine conceptual coverage of each COA.

RESULTS

Twenty-five articles, twenty-five clinical trial records, and four product labels were included in the review. Across conditions, nasal obstruction, nasal discharge, and altered smell were the most frequently identified symptoms. The most frequently identified impacts of CRSwNP and CRSsNP were on emotional functioning and sleep, and adopting new behaviors for AFRS. Findings for key symptoms and impacts in adolescents were limited. More than 20 COAs used in these conditions were identified, and 14 COAs (e.g., Sinonasal Outcome Test [SNOT-22]) were evaluated for conceptual coverage of the concepts identified in the literature.

CONCLUSION

Results specify several symptom and impact outcomes, that if improved, would reflect treatment benefit for patients living with CRSwNP, CRSsNP, and/or AFRS. Several COAs demonstrated coverage of key measurement concepts and warrant further evaluation for use in clinical trials.

Eosinophilic Granulomatosis With Polyangiitis: A Real-World Study of Biologics and Sinus Surgery Use for Managing Nasal Polyposis

BACKGROUND/AIM

Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease associated with nasal polyposis. Multiple biologics are used for managing EGPA, including some approved for nasal polyps (NP). This study investigated real-world biologic prescription patterns for EGPA and their impact on NP and endoscopic sinus surgery (ESS) use.

METHODS

EGPA patients with NP treated with a biologic at any Mayo Clinic site (January 2010 to January 2024) were identified by querying the unified electronic medical record. Patterns of biologic therapy, clinical course, impact on NP, and performance of ESS were studied.

RESULTS

Eighty patients were identified. Overall, 71 of 80 (88.75%) patients underwent ESS, with 62 of 80 (77.5%) undergoing 131 ESS procedures prior to biologic therapy. ESS for recalcitrant NP (47 episodes) was performed on 38 of 80 (47.5%) patients on biologics. Biologic monotherapy was used in 90% (72) of patients; mepolizumab (81.9%) was the most common, followed by rituximab (23.6%), benralizumab (18.1%), and dupilumab (12.5%). Switching of biologics was observed in 28 of 80 patients. Concurrent dual-biologic therapy was used in eight (10%) patients. For patients on single-agent biologic therapy, ESS was performed on 52.5% of patients on mepolizumab, 23.5% on rituximab, 42.8% on benralizumab, and 22.2% on dupilumab.

CONCLUSIONS

Multidisciplinary multi-modality treatment with biologics and ESS appeared to be the mainstay of controlling NP in EGPA. Mepolizumab was the most frequently used biologic. Dual biologic therapy was necessary in 10% of patients. Overall, 71 of 80 (88.75%) patients had ESS, with almost half the study population (47.5%) undergoing ESS after initiating biologic treatment.

Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphism in Chronic Rhinosinusitis with Nasal Polyps

Objective

Inflammatory processes play a role in the etiopathogenesis of chronic rhinosinusitis. Many gene polymorphisms have been associated with inflammation. In this study, we aimed to examine the relationship between angiotensin-converting enzyme insertion/deletion gene polymorphism and chronic rhinosinusitis.

Methods

Fifty-two cases with nasal polyps and 139 control patients were included in the study. Angiotensin-converting enzyme insertion/deletion gene polymorphisms, genotype, and allele distributions were determined. Results were statistically compared between groups.

Results

Statistically significant differences were found between the chronic rhinosinusitis with nasal polyps group and the control group in terms of genotype and allele distribution (p=0.015, 0.003, respectively). There were no significant differences in genotype distribution in the chronic rhinosinusitis with nasal polyps group in terms of non-steroidal anti-inflammatory drug (NSAID) allergy, asthma, and NSAID-exacerbated respiratory disease (p=0.645, 0.660, 0.095, respectively).

Conclusion

We observed that the risk of chronic rhinosinusitis is higher in individuals with the deletion-deletion genotype and D allele of the angiotensin-converting enzyme insertion/deletion gene polymorphism. We believe that these results could be related to the high angiotensin-converting enzyme levels in these patients.

Olfactory impairment in Italian patients with chronic rhinosinusitis with nasal polyps: a patient-centered survey

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition characterized by persistent nasal obstruction, discharge, facial pressure, and olfactory dysfunction. CRSwNP significantly impairs quality of life (QoL), with olfactory loss being a particularly distressing symptom that affects food enjoyment, personal safety, and social interactions.

Methods

This study investigated the experiences of Italian patients with CRSwNP. A cross-sectional quantitative and qualitative survey (Google Forms questionnaire), collecting data on diagnosis, symptomatology, QoL impact, and treatment experiences was developed and distributed.

Results

There were 155 respondents, with over half diagnosed with CRSwNP for more than a decade. Nasal obstruction was the primary symptom leading to medical consultation. Corticosteroid therapy and surgery showed limited and variable effectiveness in olfactory restoration. Biologic therapy, particularly dupilumab, demonstrated promising results, with approximately half of the patients reporting complete smell restoration.

Conclusions

CRSwNP significantly affected patients' QoL, with olfactory dysfunction being a common and impactful symptom. While current treatments provide symptom relief, they do not always result in sustained olfactory improvement. Biologic therapy emerged as a promising option for olfactory restoration, underscoring the importance of personalized treatment strategies. Further research is warranted to explore the mechanisms of olfactory recovery and to optimize treatment protocols for CRSwNP.

Unveiling and validating biomarkers related to the IL-10 family in chronic sinusitis with nasal polyps: insights from transcriptomics and single-cell RNA sequencing analysis

Introduction

Extensive efforts have been made to explore members of the IL-10 family as potential therapeutic strategies for various diseases; however, their biological role in chronic rhinosinusitis with nasal polyps (CRSwNP) remains underexplored.

Methods

Gene expression datasets GSE136825, GSE179265, and GSE196169 were retrieved from the Gene Expression Omnibus (GEO) for analysis. Candidate genes were identified by intersecting differentially expressed genes (DEGs) between the CRSwNP and control groups (DEGsall) with those between the high- and low-score groups within the CRSwNP cohort (DEGsNP). Biomarker selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine Recursive Feature Elimination (SVM-RFE), and the Boruta algorithm. Further refinement of biomarkers was carried out using receiver operating characteristic (ROC) analysis, with genes demonstrating an area under the curve (AUC) greater than 0.7 being considered significant. Genes exhibiting consistent expression trends and significant differences across both GSE136825 and GSE179265 were selected as potential biomarkers. Cell-type annotation was performed on GSE196169, and the expression profiles of the biomarkers across various cell types were analyzed. A competing endogenous RNA (ceRNA) network and a biomarker-drug interaction network were also established. Additionally, the mRNALocater database was utilized to determine the cellular localization of the identified biomarkers.

Results

The intersection of 1817 DEGsall and 24 DEGsNP yielded 15 candidate genes. Further filtering through LASSO, SVM-RFE, and Boruta led to the identification of seven candidate biomarkers: PRB3, KRT16, MUC6, SPAG4, FGFBP1, NR4A1, and GSTA2. Six of these genes demonstrated strong diagnostic performance in GSE179265, while four biomarkers, showing both significant differences and consistent expression trends, were validated in both GSE179265 and GSE136825. Single-cell sequencing analysis of GSE196169 revealed seven distinct cell types, including endothelial cells, with the biomarkers predominantly expressed in epithelial cells. The ceRNA network comprised nine nodes and eleven edges, with only FGFBP1 exhibiting a complete lncRNA-miRNA-mRNA interaction.

Discussion

This study identifies several novel biomarkers and their associated drugs for CRSwNP therapy, as well as potential therapeutic targets, such as spiperone and arnenous acid, identified through molecular docking. Ultimately, this work underscores the identification of four IL-10 family-related biomarkers, providing a theoretical foundation for future clinical research in CRSwNP.

[Immunotherapy in the treatment of chronic polypous rhinosinusitis with comorbid bronchial asthma]

The leading factors in the pathogenesis of chronic polyposis rhinosinusitis (CRSwNP) are dysfunction of the epithelial barrier of the nasal and sinus mucosa and dysregulation of the immune system, both at the systemic and local levels. A Th2-mediated immune response plays a central role in the development of disease in patients with CRSwNP CRPS, and CRSwNP is often associated with bronchial asthma (BA). At the present time, for the conservative treatment of patients with CRSwNP+BA, preference is given to drug therapy aimed at the correction of mucosal immunity. The use of interferon α2β (IFN α2β) and the dipeptide γ-D-glutamyl-L-tryptophan may reduce the severity of the long-term local inflammatory process. However, the clinical efficacy of these drugs in the context of chronic polyposis has not been studied. The aim of this study was to compare the efficacy of topical application of recombinant IFN α2β, recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan and IL-4Rα receptor inhibitor in the treatment of patients with CRSwNP+BA. The patients were divided into three groups. In the first group (31 people), 1 million units of interferon alpha2b were injected into the polyposis tissue for five days. In the second group (31 people), interferon alpha2b at a dose of 1 million units and gamma-D-glutamyl-L-tryptophan at a dose of 0.1 mg were injected into the polypous tissue for five days. To assess the dynamics of clinical symptoms in the reference group (31 people), a drug with a known mechanism of action and efficacy - a genetically engineered IL-4Rα receptor inhibitor - was used. This drug was used 300 mg once every 2 weeks subcutaneously for 1 year. The obtained results showed that recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan are pathogenetically appropriate preparations for conservative treatment of patients with the following initial indicators: severity of the polyposis process - 2.2+0.2 points, swelling - 2.8+0.4 points, and amount of discharge - 2.9+0.3 points. A single 5-day course of the above-mentioned preparations had a positive therapeutic effect, which was accompanied by a pronounced reduction in the clinical symptoms of the disease: the volume of polyposis tissue, nasal breathing difficulties and swelling of the nasal mucosa after one month and was maintained for one year. At the same time, the results of our study indicate the necessity of a longer period of application of recombinant IFN α2β in combination with γ-D-glutamyl-L-tryptophan in patients with CRSwNP+BA. The data obtained were comparable to the corresponding indicators when using the IL-4Ra inhibitor. In our opinion, the mechanism of action of the preparations is associated with a decrease in the activity of inflammatory and proliferative processes in the nasal and sinus mucosa.

Global Incidence and Prevalence of Chronic Rhinosinusitis: A Systematic Review

OBJECTIVE

Data on the global prevalence of chronic rhinosinusitis (CRS) is significantly varied and limited across countries and over time. Therefore, we aimed to conduct a comprehensive investigation into the global, regional, and national burden of CRS from the years 1980 to 2021, as well as identify those factors that influence levels of such burden.

DESIGN

We conducted a systematic review and meta-analysis of general population-based observational studies focusing on CRS. We calculated pooled estimates of CRS prevalence and incidence with 95% confidence intervals (CIs). Subgroup analyses were conducted stratifying by sex, age cohorts, geographic regions, smoking status, obesity, and comorbid conditions.

DATA SOURCES

PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, and Cochrane databases.

ELIGIBILITY CRITERIA FOR SELECTION

We included general population-based observational studies on CRS published from database inception through October 20, 2023.

RESULTS

A total of 28 eligible studies, encompassing more than 237 million participants and 11,342,923 patients with CRS from 20 countries across four continents, were included in the analysis. Global pooled prevalence of CRS and CRS with nasal polyps (CRSwNP) was found to be 8.71% (95% CI, 6.69-11.33; number of studies, 20) and 0.65% (95% CI, 0.56-0.75; number of studies, 4), respectively. The prevalence of CRS was greater in Europe compared with North America, South America, and Asia; adults compared with children; smokers compared with never-smoker; those with obesity compared with normal weight; and those with comorbidities such as asthma, diabetes mellitus, eczema, and nasal septal deviation. Pooled prevalence of CRS increased from 1980 to 2020 (1980-2000: 4.72%; 95% CI, 2.12-10.49; 2014-2020: 19.40%; 95% CI, 12.12-31.07). Similar patterns were observed in CRS incidence.

CONCLUSIONS

Our study provides valuable insights into CRS prevalence and incidence across diverse demographic and clinical factors, highlighting its increasing global burden. The reported prevalence of CRS varies internationally, and may be increasing over time. To enhance data quality and comparability, standardization of reporting methodologies is imperative.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (registration no. CRD42024527805).

Chronic rhinosinusitis with nasal polyps: Key considerations in the multidisciplinary team approach

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a recurrent inflammatory disease associated with several comorbidities and a significant disease burden for patients. Treatments include corticosteroids and sinonasal surgery, but these can be associated with the risk of adverse events and nasal polyp recurrence. Biologic treatments such as mepolizumab can be used as an add-on treatment and are effective at reducing surgery and corticosteroid use.

MAIN TEXT

Patients with CRSwNP may be seen by a specialist in one of several different areas and often experience delayed diagnosis due to the need to see multiple physicians, as well as misdiagnosis resulting from lack of sufficient expertise within any one speciality. Multidisciplinary team (MDT) approaches have been shown to be effective in optimising the treatment and clinical management of other respiratory diseases, such as aspirin-exacerbated respiratory disease and severe asthma. In CRSwNP, an MDT approach may reduce diagnostic delays, mitigate secondary disease burden, and reduce overprescription of corticosteroids and antibiotics.

CONCLUSION

This article provides an overview of the patient perspective of MDTs, existing approaches and barriers to adoption, lessons learnt from allied and rare diseases, how to address under-recognised aspects of CRSwNP, and other key considerations for developing an MDT approach.

Practice Patterns of Biologics Prescriptions and Surgery in Chronic Rhinosinusitis With Nasal Polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging to manage effectively, with high symptom recurrence rates and significant impacts on quality of life, prompting a need to evaluate the real-world use of biologics and optimize treatment strategies.

OBJECTIVE

To assess the real-world application and perspectives of American Rhinologic Society (ARS) members on biologic treatments and surgical interventions for CRSwNP, focusing on clinical practice patterns, adoption of biologics, and their impact on surgical practices.

METHODS

A standardized questionnaire evaluated clinical practice patterns of biologics prescriptions and surgery in treating CRSwNP between July 2022 and August 2023. Data collected from 162 ARS members were analyzed.

RESULTS

Of 162 participants, a substantial majority (95.06%, n = 154) reported prescribing biologics in their practice. Notably, 45.45% (n = 70) found biologics easily accessible, although accessibility challenges remained for some. The impact of biologics on surgical practices was significant, with 36.36% (n = 56) observing a marked reduction in revision sinus surgeries. Among the participants, 47.16% (n = 71) agreed that aspirin-exacerbated respiratory disease (AERD) was the highest phenotype that tended to increase the possibility of biological treatment by more than 20%. Adopting Patient-Reported Outcome Measures (PROMs) was prevalent, with 57.79% (n = 89) utilizing them in patient management.

CONCLUSION

The study highlights the evolving landscape in managing CRSwNP, with a marked trend toward integrating biological treatments into clinical practice. It underscores the necessity for continued research, updates to clinical guidelines, and enhanced practitioner education to optimize treatment outcomes for CRSwNP patients.

Correlation of sino-nasal outcome test and nasal polyp score in dupilumab-treated chronic rhinosinusitis with nasal polyps

BACKGROUND

The alignment between objective scores and patient-reported outcome measures (PROMs) is underexplored. This study aimed to assess changes in Nasal Polyp Score (NPS) and Sino-Nasal Outcome Test (SNOT) scores in chronic rhinosinusitis with nasal polyps (CRSwNP) patients undergoing dupilumab treatment and explore correlations between these scores.

METHODS

CRSwNP patients received dupilumab therapy for six months. SNOT-20 German Adapted Version (GAV)/SNOT-22 scores were assessed weekly, and NPS was measured at baseline and after one, three, and six months. Correlations were analyzed using Spearman's rank correlation and regression analysis.

RESULTS

69 patients were included. After one, three and six months of dupilumab therapy, SNOT and NPS scores improved significantly. Correlation analysis of SNOT and NPS showed significant correlations only within the nasal subscores, along with a weak trend for SNOT-20. Absolute changes over time lacked significance. However, correlation analysis revealed significant associations between relative changes in SNOT score and NPS, irrespective of timing, and when stratified by baseline NPS of 8, 6, and 4 (r = -0.54, p = 0.01; r = -0.44, p < 0.001; r = -0.7, p < 0.001). This was supported by linear regression modeling, suggesting potential predictive capability of NPS reduction on relative SNOT score improvement.

CONCLUSION

Dupilumab therapy significantly improved subjective and objective CRSwNP scores, exhibiting weak correlations in absolute values for nasal subscores. Furthermore, evidence indicated a correlation between relative changes in SNOT score and NPS, substantiated by predictive capability. This might be due to subjective perception variability, highlighting the suitability of relative change correlation analysis.

Soluble Guanylate Cyclase Dysfunction and Nitric Oxide Pathway in Chronic Rhinosinusitis With Nasal Polyps: Predictive Markers for Postoperative Recurrence

BACKGROUND

Elevated nitric oxide (NO) levels have been linked to a heightened risk of recurrence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the precise influence of NO on CRSwNP recurrence remains unclear.

OBJECTIVE

This study seeks to elucidate the relationship between NO levels and the risk of CRSwNP recurrence.

METHODS

A protein chip array analysis was conducted to identify differentially expressed inflammatory mediators in the nasal tissues between patients with CRSwNP and healthy controls (HC). Differentially expressed proteins were analyzed, and bioinformatics analysis was used to predict the potential functions and pathways of these proteins. Western blotting (WB) and immunohistochemistry were employed to validate the candidate proteins in 2 independent cohorts. Receiver-operating characteristic (ROC) curves were employed to assess the abilities of target proteins for predicting the postoperative recurrence of CRSwNP.

RESULTS

Twelve differentially expressed proteins were identified between the CRSwNP and HC groups. Notably, differentially expressed proteins exhibited high expression of the biological process term "positive regulation of nitric oxide-mediated signal transduction" (P < .05). WB and immunohistochemistry results demonstrated that guanylate cyclase 1 soluble subunit alpha 1 (GUCY1A1), GUCY1A2, nitric oxide synthase 1 adaptor protein, epidermal growth factor receptor, and insulin were found to be upregulated in the CRSwNP group compared to the HC group (P < .05). Moreover, elevated levels of GUCY1A2 and GUCY1A1 were observed to be associated with an increased risk of CRSwNP recurrence (P < .05), and ROC curve analysis confirmed their effectiveness as predictors for postoperative recurrence (P < .05).

CONCLUSION

Our findings revealed that CRSwNP exhibited a distinct tissue protein profile, with soluble guanylate cyclase dysfunction and the nitric oxide pathway implicated in the underlying pathological mechanisms. The discovery-validation results suggested that GUCY1A1 and GUCY1A2 were promising predictors for postoperative recurrence in patients with CRSwNP.

Adverse events of mepolizumab in the treatment of nasal polyps: A FDA database evaluation

BACKGROUND

Mepolizumab has shown significant efficacy in managing eosinophil-associated disorders such as eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Despite the advancements in treatment options for CRSwNP, traditional therapies often fail to prevent polyp recurrence and come with substantial side effects, emphasizing the need for ongoing evaluation of new therapeutic approaches and their safety profiles.

OBJECTIVES

Utilize the FDA Adverse Event Reporting System to identify and evaluate adverse effects related to the use of mepolizumab in treating CRSwNP.

METHODS

From Q12021 until Q12023, the FDA Adverse Event Reporting System database was queried to identify mepolizumab adverse reactions (MARs), which were compared between the two treatment groups of interest, CRSwNP and asthma. Individual MARs (iMARs) were modeled using zero-truncated Poisson regression, while serious MARs and outcomes were modeled using logistic regression.

RESULTS

For the CRSwNP-tx group, there were 80 MARs (16 serious MARs, 19 serious outcomes, 0 deaths). For the asthma-tx group, there were 4779 MARs (4308 serious MARs, 2334 serious outcomes, 124 deaths). 68,479 iMARs were observed, with 1198 iMARS in the CRSwNP-tx group. Common CRSwNP-tx iMARs were pulmonary (27.1 %), generalized (10.9 %), neurologic (9.9 %), and hematologic (9.0 %). Age < 50, RR 1.63 [1.41, 1.90], and asthma, RR 5.73 [4.29, 7.66], were significant predictive factors for total iMAR, while sex, RR 1.00 [0.86, 1.16], was not. Within the CRSwNP-tx group, concurrent asthma treatment increased the odds of having a serious MAR by 11.77 [3.02, 53.74] and serious outcome by 26.58 [3.23, 605.81].

CONCLUSION

Mepolizumab treatment of CRSwNP is associated with fewer individual adverse reactions. Pulmonary reactions were, by far, the most common type of adverse reaction. Concurrent asthma treatment in CRSwNP-only-tx increases the number of reactions, and the seriousness of reactions and outcomes.

Fungal nasal polyposis - A rare case report

Aspergillus peyronelii is an emerging and rare pathogen causing chronic rhinosinusitis with fungal nasal polyposis among immunocompetent individuals. Usual fungal aetiologies are Aspergillus spp, Mucor spp and Cladosporium spp, among which Aspergillus flavus being the most common in India. We present a case of 28-year-old woman with unilateral nasal obstruction with 15 years history of allergy, diagnosed as nasal polyposis, uncovered an uncommon pathogen A.peyronelii. Being a saprophytic and endophytic fungus, meticulously diagnostic approaches were employed for the precise identification. Further researches are needed to optimize diagnostic strategies and therapeutic intervention of this species.

Matrix metalloproteinase-12 by M2 macrophages induced epithelial to mesenchymal transition in chronic rhinosinusitis with nasal polyps

Th2 inflammation and epithelial-mesenchymal transition (EMT) play crucial roles in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to investigate the hypothesis that MMP-12, produced by M2 macrophages, induces EMT in nasal epithelial cells, thereby contributing to airway inflammation and remodeling in CRSwNP. The expression levels of MMP-12 were measured by RT-PCR in CRS nasal mucosa and THP-1 cells. mRNA and protein levels of E-cadherin, vimentin, α-SMA, and fibronectin were determined using RT-PCR, western blotting, and immunofluorescence staining in primary nasal epithelial cells and air-liquid interface culture. The expression of MMP-12 was significantly increased in CRSwNP and M2-like THP-1 cells. In co-culture with primary nasal epithelial cells and M2-like THP-1 cells, E-cadherin expression was inhibited, and fibronectin, vimentin, and α-SMA expression were increased. MMP-12 decreased E-cadherin but induced fibronectin, vimentin, and α-SMA mRNA and protein expression in primary nasal epithelial cells and air-liquid interface culture. MMP408, an MMP-12 inhibitor, inhibited EMT-related factors. These findings suggest that MMP-12 expression in M2 macrophages induces EMT in nasal epithelial cells and may contribute to the pathogenesis of CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) symptom verbal response scales: content validity testing for use in adults with CRSwNP

BACKGROUND

PRO measures of symptoms in clinical trials have historically utilized visual and numerical scales but verbal descriptors may make it easier for patients to clearly differentiate between response options. This study assessed content validity and meaningful change in five verbal response scales (VRSs) used to assess chronic rhinosinusitis with nasal polyp (CRSwNP) symptom severity.

METHODOLOGY

This qualitative, semi-structured interview study recruited adults from the US, Germany, and China with confirmed moderate-to-severe CRSwNP. Interviews included a concept elicitation section, where participants were asked about their experience of living with CRSwNP including symptoms and health-related quality-of-life impacts, and a cognitive debriefing section, where participants were debriefed and participant understanding and real-life relevance of the CRSwNP symptom VRS content were assessed. Interview transcripts were qualitatively analyzed using thematic analysis methods.

RESULTS

Among the 24 participants interviewed, the most frequently reported CRSwNP symptoms were nasal obstruction, runny nose, mucus in the throat, loss of smell and facial pain/pressure. Participants demonstrated good understanding of the CRSwNP symptom VRS instructions, items, recall period, and response options. The five CRSwNP symptom VRS items were relevant to the majority of participants' experience of CRSwNP. At the item level, a one-category within-person improvement was the level most frequently reported by participants to be a meaningful change.

CONCLUSION

The CRSwNP symptom VRSs assess relevant and bothersome symptoms experienced by patients with moderate-to-severe CRSwNP, supporting content validity of this measure. The findings of this study provided preliminary insights into meaningful change in the VRS. Further quantitative assessment of meaningful change is needed, and psychometric evaluation of the CRSwNP symptom VRSs will be required to evaluate their appropriateness for assessment of clinical trial endpoints in patients with CRSwNP.

Risk factors for postoperative relapse of chronic rhinosinusitis with nasal polyps and improvement in clinical treatment

OBJECTIVES

To identify the risk factors for postoperative relapse of chronic rhinosinusitis with nasal polyps (CRSwNP) using multivariate Logistic regression analysis and to explore potential improvements in clinical treatment measures.

METHODS

We selected 270 CRSwNP patients who underwent surgery at The First People's Hospital of Jiangxia District between January 2022 and July 2024. The patients were divided into two groups based on the presence or absence of postoperative relapse: 40 cases with relapse were designated as the relapse group, and the other 230 cases without relapse were designated as the non-relapse group. Serum samples were collected from both groups before surgery to measure eosinophilic cationic protein (ECP)/myeloperoxidase (MPO), immunoglobulin E (IgE), and C-C motif chemokine ligand 4 (CCL4). Receiver operating characteristic (ROC) curves were used to analyze the predictive value of these indices for postoperative relapse in CRSwNP patients. The correlation of these indices with postoperative relapse was analyzed using Spearman's correlation coefficients. Univariate and multivariate analyses were employed to identify factors influencing postoperative relapse of CRSwNP.

RESULTS

The relapse group showed markedly higher ECP/MPO, IgE, and CCL4 compared to the non-relapse group. The area under the curve (AUC) for predicting postoperative relapse of CRSwNP by each single indicator approximated 0.800, while the AUC of combined detection was above 0.900. ECP/MPO, IgE, and CCL4 all exhibited a significant positive correlation with postoperative relapse of CRSwNP. Univariate analysis revealed that the postoperative relapse of CRSwNP was significantly linked to the Davos score of nasal polyps, smoking history, postoperative infection, ECP/MPO, IgE, and CCL4. Multivariate analysis confirmed that ECP/MPO, IgE, and CCL4 were independent risk factors for postoperative recurrence of CRSwNP.

CONCLUSIONS

ECP/MPO, IgE, and CCL4 are reliable predictors of postoperative relapse in CRSwNP patients, and their combined detection can further enhance the predictive accuracy. These biomarkers are closely and positively correlated with postoperative relapse and serve as risk factors for postoperative recurrence. Given the elevated risk of postoperative recurrence in CRSwNP patients with high levels of ECP/MPO, IgE, and CCL4, it is recommended to optimize clinical treatment strategies for these patients to reduce the likelihood of recurrence.

M2 macrophage derived HMOX1 defines chronic rhinosinusitis with nasal polyps

BACKGROUND

Molecular signatures of chronic rhinosinusitis with nasal polyps (CRSwNP) related to macrophages remain unclear. This study aimed to develop a macrophage-associated diagnostic signature for CRSwNP.

METHODS

Transcriptome data from 54 patients with CRSwNP and 37 healthy controls across GSE136825, GSE36830, and GSE72713 were used to identify differentially expressed genes (DEGs) between two groups. Gene Set Enrichment Analysis and Weighted Gene Co-Expression Network Analysis pinpointed crucial pathways and gene clusters. A diagnostic model was created from these analyses and receiver operating characteristic curve (ROC), and further validated in our transcriptome data from 29 samples. Immune cell infiltration analysis was performed and linked those diagnostic genes to macrophages and verified by single-cell RNA sequencing data. Immunofluorescence co-staining of CD163 and HMOX1 was performed in nasal tissues. Mouse bone marrow-derived macrophage (BMDMs) cultures were used in functional experiments. Correlations between the expression of HMOX1 and eotaxin genes were investigated.

RESULTS

DEGs of CRSwNP versus control group were enriched in the INTERLEUKIN_4_AND_13_SIGNALING pathways. A four-gene diagnostic model (HMOX1, ALOX5, F13A1 and ITGB2) was developed and demonstrated high diagnostic precision with an area under ROC curve of 0.980 for training dataset and 0.895 for test dataset. M2 macrophage presence and HMOX1 expression significantly correlated with CRSwNP (p < 0.001). Single-cell RNA sequencing data underscored the altered cellular composition in CRSwNP, with HMOX1 notably expressed in M2 macrophages. Immunofluorescence staining highlighted the increased infiltration of CD163+ M2 macrophages in nasal mucosa samples of eosinophilic CRSwNP, which correlated with HMOX1 protein levels (p < 0.05). The HMOX1 inhibitor zinc protoporphyrin reduced the ratio of CD163 + HMOX1 + M2 macrophages in mouse BMDM cultures (p < 0.05). HMOX1 expression showed a strong positive correlation with the expression of eotaxin genes (CCL11, CCL24, and CCL26; p < 0.05 respectively).

CONCLUSION

M2 macrophage-derived HMOX1 can be used as an innovative diagnostic signature for CRSwNP, which might be a potential regulator of eosinophilic inflammation.

Dupilumab Versus Mepolizumab for Chronic Rhinosinusitis With Nasal Polyposis: An Indirect Treatment Comparison

BACKGROUND

Dupilumab and mepolizumab have shown efficacy and safety in treating chronic rhinosinusitis with nasal polyps (CRSwNP).

OBJECTIVE

Without available results from head-to-head randomized control trials (RCTs) comparing dupilumab with other biologics, we conducted an indirect treatment comparison (ITC) with mepolizumab.

METHODS

A systematic literature review identified RCTs of biologics in CRSwNP. A Bucher ITC was performed, including nasal polyp score (NPS; range 0-8), nasal congestion (NC; 0-3), loss of smell (LOS; 0-3), University of Pennsylvania Smell Identification Test (UPSIT; 0-40), visual analog score (VAS; 0-10), Sino-Nasal Outcome Test (SNOT-22; 0-110), systemic corticosteroid (SCS) use or surgery for nasal polyps (NPs), and binary responder analyses for NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively. Matching-adjusted indirect comparisons (MAICs) were conducted as supporting analyses.

RESULTS

SINUS-24/-52 (SYNAPSE-like subpopulation only) and SYNAPSE were identified for ITC. At 24 weeks, the change from baseline in NPS and the proportion of patients with a binary responder outcome of NPS improvement ≥1 were significantly (P < .05) greater in those receiving dupilumab than those receiving mepolizumab. At 52 weeks, improvements in NPS, NC, LOS, UPSIT, and VAS were significantly (P < .05) greater for dupilumab than mepolizumab. The proportion of patients achieving binary responder outcomes of NPS and SNOT-22 improvement by ≥1/≥2 and ≥8.9, respectively, was significantly (P < .05) higher, whereas SCS use was significantly (P < .05) reduced, for dupilumab versus mepolizumab. Surgery rate was numerically reduced with dupilumab versus mepolizumab. The MAIC analyses confirmed these results.

CONCLUSION

Dupilumab was associated with greater improvements in CRSwNP-related outcomes versus mepolizumab.

Efficacy of dupilumab on chronic rhinosinusitis with nasal polyps and concomitant asthma in biologic-naive and biologic-pretreated patients

OBJECTIVES

Dupilumab, an anti-IL-4 receptor monoclonal antibody (mAb), was recently approved for the treatment of severe chronic rhinosinusitis with nasal polyps (CRSwNP). The main objective of this study was to assess whether previous exposure to biological treatment affected the clinical outcomes in CRSwNP and asthma patients, treated with dupilumab over time. A collateral secondary objective was to analyse the effects over time of dupilumab in patients with and without aeroallergen sensitization.

METHODS

Single-centre retrospective observational study on severe CRSwNP patients treated with dupilumab. Nasal polyp score (NPS), visual analogue scale (VAS) symptom score, sinonasal outcome test (SNOT-22), aeroallergen sensitization, total serum IgE levels, and blood eosinophil counts were assessed at baseline and after 4, 6 and 12 months.

RESULTS

42 patients were included, 40 (95.2%) had asthma. Twenty-one (50%) patients received dupilumab without prior biological treatment (Group A: naive) and 50% switched to dupilumab from previous biological treatment (Group B: pre-treated). NPS, VAS symptoms, SNOT-22 improved significantly after 12 months treatment in both groups of patients (p < 0.001). After 12 months, VAS overall symptom score showed a significant reduction from 6 (IQR, 4.6-8.6) and 6 (IQR, 3.8-7.1) for Group A and Group B patients respectively, to 1.2 (IQR, 0.8-2.7) and 1.2 (IQR, 0.2-2.5); NPS from 6 (IQR, 4.0-7.0) and 5 (IQR, 3.5-6.0), respectively, to 1 (IQR, 0.0-2.0) and 0 (IQR, 0.0-3.0) and SNOT-22 from 64 (IQR, 56-78) and 71 (IQR, 47.5-76.0) respectively, to 5.5 (IQR, 4-21) and 6 (IQR, 4-15). IgE reduced from 57 to 22.1 and from 46.9 to 30.2 in Group A and Group B respectively (p < 0.001).

CONCLUSIONS

Dupilumab improves symptom severity, polyp size, and health-related quality of life, regardless of the presence or absence of comorbid aeroallergen sensitization and previous administration of biologic therapy.