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Philippart A, Eloy P. Vitamin D and Chronic Rhinosinusitis with Nasal Polyps: A Narrative Review and Perspectives. J Clin Med 2025; 14:2467. [PMID: 40217916 PMCID: PMC11989858 DOI: 10.3390/jcm14072467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 03/29/2025] [Accepted: 04/01/2025] [Indexed: 04/14/2025] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a subtype of chronic rhinosinusitis (CRS) characterized by bilateral nasal polyps, primarily affecting adults. It is often associated with hyposmia and asthma and driven by persistent Th2 inflammation, particularly in Caucasian patients. The disease is recurrent and significantly impacts quality of life, yet its pathophysiology remains poorly understood. Management includes intranasal steroids, short courses of systemic corticosteroids, surgery for refractory cases, and biologics. However, despite these treatment options, disease control remains challenging. Low vitamin D levels have been associated with worse clinical outcomes, while supplementation studies show promise in improving symptoms in deficient patients. Emerging research suggests that vitamin D modulates immunity, fibroblast activity, and epithelial integrity, potentially contributing to CRSwNP pathogenesis, though the exact mechanisms remain unclear. This review synthesizes current research on vitamin D's role in systemic and local inflammation in CRSwNP. By highlighting its potential therapeutic implications, this work aims to guide future research and inform clinical practice. Additionally, it may serve as a foundation for understanding the broader impact of vitamin D deficiency in sinonasal diseases and other atopic conditions.
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Affiliation(s)
- Adrien Philippart
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Saint-Jean Clinics, Boulevard du Jardin Botanique 32, 1000 Brussels, Belgium
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Saint-Luc University Hospital, Catholic University of Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Philippe Eloy
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, CHU UCL Namur, Site de Godinne, Avenue Thérasse, 1, 5534 Yvoir, Belgium;
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Li D, Yu L, Zi J, Du X, Yan X, Chen H, Wang L, Zheng C, Wang G, Zhang J, Jiang Y. Signaling lymphocytic activation molecule family 8 disrupts epithelial barrier in chronic rhinosinusitis with nasal polyps through M1 macrophage polarization. Ann Allergy Asthma Immunol 2025; 134:431-441.e4. [PMID: 39870212 DOI: 10.1016/j.anai.2025.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 12/21/2024] [Accepted: 01/19/2025] [Indexed: 01/29/2025]
Abstract
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.
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Affiliation(s)
- Danyang Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Longgang Yu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Jiajia Zi
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xiaoyun Du
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xudong Yan
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Han Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Lin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Chunge Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Guangyi Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Jisheng Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
| | - Yan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
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Ozdemir I, Bayar Muluk N, Yazır M, Cingi C. How does asthma coexistence affect the strategic selection of biologic therapies in CRSwNP management? FRONTIERS IN ALLERGY 2025; 6:1579224. [PMID: 40230787 PMCID: PMC11994701 DOI: 10.3389/falgy.2025.1579224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 03/19/2025] [Indexed: 04/16/2025] Open
Abstract
Objectives We reviewed asthma coexistence and the selection of biologic therapies in CRSwNP Management. Methods The literature review utilized Google and Google Scholar, in addition to PubMed, EBSCO, and Proquest Central at Kırıkkale University. We searched for " CRSwNP", "asthma", "biologic therapies", "Anti-IL-4RA", "Dupilumab", "Anti-IgE", "Omalizumab", "Anti-IL-5", "mepolizumab" from 2024 to 2000. Results Patients with CRSwNP frequently have co-occurring lower airway illnesses, including asthma and AERD asthma, which have a shared pathogenesis. The inflammatory bases of CRSwNP and asthma might be heterogeneous, with a type 2 or, less frequently, a non-type two inflammatory history. Lower airway inflammation and asthma control are worse in patients with asthma who also have CRSwNP. Patients with CRSwNP can now access targeted biologic medicines, a novel therapy option. The US Food and Drug Administration (FDA) has authorized three medications for CRSwNP: dupilumab, omalizumab, and mepolizumab. To treat chronic rhinosinusitis with a biological agent, the 2020 European position paper on rhinosinusitis established clear indications. A patient is considered a biologic therapy candidate if they have either undergone FESS before or did not meet FESS criteria but met three of the five. A diagnosis of concomitant asthma, necessitating an inhaled glucocorticoid controller regularly, is one of the five requirements. Conclusion Biologic treatments have the potential to be used in certain patients where CRSwNP and asthma coexist. The recommended treatments include omalizumab, dupilumab, and mepolizumab.
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Affiliation(s)
- Imran Ozdemir
- Department of Pulmonology, Medical Faculty, Üsküdar University, Istanbul, Türkiye
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Türkiye
| | - Mustafa Yazır
- Department of Otorhinolaryngology, Yazir Private Otorhinolaryngology Clinic, Izmir, Türkiye
| | - Cemal Cingi
- Department of Otorhinolaryngology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
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Chen YC, Wang X, Pan YW, Teng YS, Pan HG. Distinct and Shared Molecular Mechanisms in Pediatric Antrochoanal Polyps and Chronic Rhinosinusitis with Nasal Polyps: A Proteomic and Metabolomic Integrative Analysis. J Inflamm Res 2025; 18:4435-4447. [PMID: 40166594 PMCID: PMC11955737 DOI: 10.2147/jir.s507475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 03/22/2025] [Indexed: 04/02/2025] Open
Abstract
Purpose The underlying mechanisms of pediatric antrochoanal polyps (ACP)and chronic rhinosinusitis with nasal polyps (CRSwNP) remain largely unexplored. This study investigates their proteomic and metabolomic profiles to uncover unique and overlapping pathways, shedding light on their underlying causes. Methods Specimens were collected from six children with ACP, six with CRSwNP, and six with normal inferior turbinate mucosa (CK) at Shenzhen Children's Hospital. Protein profiles were analyzed using data-independent acquisition (DIA) mass spectrometry, while metabolite profiles were assessed via non-targeted metabolomics (UPLC-MS/MS). Differences in proteins and metabolites were identified through statistical selection and bioinformatics, followed by integrated pathway analysis to explore their roles in disease processes. Results Proteomic analysis identified 1000 differentially expressed proteins (DEPs) in ACP and 880 in CRSwNP compared to controls. Key DEPs in ACP included PEX1 and LYPD2, while CRSwNP included PEX1, CFAP52, SPAG6 and DHRS9. Metabolomic analysis identified 129 differential metabolites in ACP and 11 in CRSwNP, with 5-HTP showing opposite regulation between the two conditions. Pathway analysis pointed to oxidative stress and lipid metabolism disruptions in ACP, and immune and ciliary dysfunction in CRSwNP. Both conditions shared inflammation and extracellular matrix remodeling, but tryptophan metabolism diverged, with 5-HTP reduced in ACP and elevated in CRSwNP. Conclusion This study highlights oxidative stress and lipid dysregulation as hallmarks of pediatric ACP, distinct from ciliary and immune dysfunction in CRSwNP, with inflammation and matrix remodeling as common features. The opposing regulation of 5-HTP reflects differences in tryptophan metabolism. Key molecules like PEX1, LYPD2, CFAP52, and 5-HTP emerge as potential biomarkers, offering promise for improved diagnosis and targeted therapies in nasal polyp-related conditions, but the small sample size and exploratory design require validation in larger cohorts to ensure clinical applicability.
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Affiliation(s)
- Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Yan-Wen Pan
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Hong-Guang Pan
- Department of Otorhinolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
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Cvancara DJ, Aboueisha MA, Sharma AA, Sharma D, Humphreys IM, Jafari A, Abuzeid WM. Sleep dysfunction in aspirin exacerbated respiratory disease: A prospective cohort study. World J Otorhinolaryngol Head Neck Surg 2025; 11:1-9. [PMID: 40070508 PMCID: PMC11891273 DOI: 10.1002/wjo2.177] [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: 12/06/2023] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 03/14/2025] Open
Abstract
Objective Studies have described sleep dysfunction (SD) in patients with chronic rhinosinusitis (CRS). However, there is a paucity of literature describing sleep dysfunction in the context of aspirin-exacerbated respiratory disease (AERD). The purpose of this study was to evaluate the prevalence and severity of SD in patients with AERD relative to CRS. Methods This study is a prospective cohort study. Patients diagnosed with CRS without polyposis (CRSsNP, n = 206), CRS with nasal polyposis (CRSwNP, n = 38), and AERD (n = 28) were recruited prospectively in academic center rhinology clinic. SD was assessed using the Neuro-QOL Short Form v1.0-Sleep Disturbance (sleep-QOL), for which severe SD is defined as a score >2.0 standard deviations from the normalized mean. Demographic and patient-reported outcome measures (including SNOT-22 and PHQ-2) were collected to adjust for sleep confounders. Comparisons were made between groups using univariate and multivariate analyses. Results The prevalence of severe SD was significantly higher in AERD (57.1%) than in CRSsNP (32.5%) or CRSwNP (34.2%), p = 0.038. After adjusting for sleep confounders, the risk of sleep dysfunction remained higher among patients with AERD (odds ratio [OR] = 2.72 vs. CRSsNP, 95% confidence interval [CI] = 1.18-6.27, p = 0.02; OR = 3.06 vs. CRSwNP, 95% CI = 1.06-8.82, p = 0.04). SNOT-22 total score and the sleep subdomain showed no correlation with sleep-QOL score. Conclusions The frequency and severity of SD are greater in AERD patients than in patients with CRS with or without nasal polyposis, independent of confounders of sleep quality. While the putative link between AERD and SD remains elusive, this study suggests that SD in AERD may be greater than previously recognized.
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Affiliation(s)
- David J. Cvancara
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Mohamed A. Aboueisha
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Ayush A. Sharma
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Dhruv Sharma
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Ian M. Humphreys
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Aria Jafari
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Waleed M. Abuzeid
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
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Toppila‐Salmi S, Lyly A, Simin J, Aakko J, Olsen HH, Lehtimäki L. Predictors of revision endoscopic sinus surgery in Finnish patients with chronic rhinosinusitis with nasal polyps. Clin Transl Allergy 2025; 15:e70032. [PMID: 39887945 PMCID: PMC11779534 DOI: 10.1002/clt2.70032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 12/10/2024] [Accepted: 01/06/2025] [Indexed: 02/01/2025] Open
Abstract
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.
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Affiliation(s)
- Sanna Toppila‐Salmi
- Department of OtorhinolaryngologyUniversity of Eastern FinlandKuopioFinland
- Department of OtorhinolaryngologyWellbeing Services County of Pohjois‐SavoKuopioFinland
- Department of AllergologyInflammation CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Annina Lyly
- AstraZeneca NordicsMedical AffairsEspooFinland
- AstraZeneca NordicsMedical and RegulatoryOsloNorway
| | | | | | | | - Lauri Lehtimäki
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Allergy CentreTampere University HospitalTampereFinland
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Sinha R, Abhinandan A, Mala M, Singh RK. Unveiling the Impact of Total Body Fluid Dynamics on Chronic Rhinosinusitis With Sinonasal Polyposis. Cureus 2025; 17:e78916. [PMID: 40092017 PMCID: PMC11909283 DOI: 10.7759/cureus.78916] [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] [Accepted: 02/12/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND This study investigated the role of total body fluid dynamics in developing polyposis in patients with chronic rhinosinusitis. There is a significant gap in our understanding of body fluid dynamics in the pathogenesis of sinonasal polyposis. This preliminary research will be sensitized to explore hidden facts in this field further. METHODS In this cross-sectional study at a tertiary care hospital, 60 participants were enrolled, comprising 30 patients diagnosed with sinonasal polyposis and 30 controls without polyps. The measured parameters included total body water, excess body water, serum osmolality, albumin, creatinine, sodium, eosinophil count, arterial pH, and hematocrit. The t-test/Mann-Whitney U test and chi-square test were used for continuous and categorical variable analysis, respectively. Univariate and multivariate logistic regression was done to identify potential predictors, and model performance was evaluated using the receiver operating characteristic (ROC) curves, with an optimal classification cut-off of 0.5 for the area under the curve (AUC). RESULTS The mean age of cases was 34.03 ± 12.76 years, and that of controls was 34.77 ± 12.06 years. Amongst cases, 60% were males and 40% were females, while the control group had an equal distribution of males and females. The mean total body water level in patients with sinonasal polyposis was slightly higher than in those without polyps (34.42 ± 5.26 l vs. 32.38 ± 5.86 l). Moreover, the likelihood of developing sinonasal polyposis was twice as high in patients with excess body water compared to those without, as suggested by an adjusted odds ratio (OR) of 2.08. However, this association was not statistically significant (95% CI: 0.83-5.19, p = 0.116). Patients with polyposis also showed higher serum creatinine levels (0.94 mg/dL) than controls (0.80 mg/dL, p = 0.002). Univariate logistic regression indicated that a 1 mg/dL increase in serum creatinine level was associated with a 2.4-fold increase in the likelihood of polyposis (OR = 2.42, 95% CI: 1.30-4.50, p = 0.005). Multivariate analysis confirmed the significance of serum creatinine level (adjusted OR = 3.36, 95% CI: 1.42-7.97, p = 0.006), with an AUC of 0.803, demonstrating good discriminative ability. The model's accuracy, sensitivity, and specificity were 66.7%, 73.3%, and 60%, respectively. CONCLUSIONS Significantly elevated serum creatinine levels in patients with sinonasal polyposis may suggest a potential link with renal function or fluid regulation, warranting further research in larger cohorts to clarify this relationship. The regression model indicated a positive correlation between excess body water and the development of polyposis, with a weaker trend observed for other parameters. However, due to insufficient evidence, further research involving larger sample sizes across diverse geographic regions is recommended to validate their roles in the pathogenesis of sinonasal polyps.
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Affiliation(s)
- Richi Sinha
- Otolaryngology - Head and Neck Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Amit Abhinandan
- Otolaryngology - Head and Neck Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Mani Mala
- Otolaryngology - Head and Neck Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rakesh K Singh
- Otolaryngology - Head and Neck Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND
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De Corso E, Hellings PW, Fokkens WJ, Klimek L, Peters AT, Scadding GK, Desrosiers M, Lee SE, Mullol J. Thymic Stromal Lymphopoietin (TSLP): Evidence in Respiratory Epithelial-driven Diseases Including Chronic Rhinosinusitis with Nasal Polyps. Curr Allergy Asthma Rep 2024; 25:7. [PMID: 39636450 DOI: 10.1007/s11882-024-01186-2] [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] [Accepted: 11/04/2024] [Indexed: 12/07/2024]
Abstract
PURPOSE OF THE REVIEW Thymic stromal lymphopoietin (TSLP) is increasingly recognized for its pivotal role in the pathogenesis of various epithelial-driven chronic inflammatory diseases. This review navigates the existing evidence on TSLP, with a particular focus on asthma, before delving into the current understanding of its role in chronic rhinosinusitis with nasal polyps (CRSwNP). We explore the role of TSLP in the pathogenesis of asthma and CRSwNP, two conditions often interconnected and collectively referred to as"Global Airway Disease". Additionally, this review assesses the therapeutic potential of TSLP inhibition as a treatment option for both CRSwNP and asthma. A systematic literature search was conducted; selected publications were used to describe the biology of TSLP, including its expression and diverse effects on inflammation. RECENT FINDINGS The role of TSLP in asthma is well established and supported by the efficacy of tezepelumab, the first anti-TSLP monoclonal antibody approved for both type 2 (T2)-high and T2-low severe asthma. TSLP may be a key contributor to CRSwNP pathogenesis as evidenced by genetic and mechanistic studies in which TSLP has been shown to regulate T2 inflammation and influence non-T2 responses. Preliminary data from the NAVIGATOR trial indicate that tezepelumab may reduce CRSwNP symptoms in patients with comorbid asthma. While further research is required to clarify the extent of TSLP contribution in CRSwNP, this review highlights the potential of anti-TSLP therapies as a novel approach for managing severe, uncontrolled CRSwNP. If these preliminary findings are confirmed, targeting TSLP could become a promising strategy to treat CRSwNP with or without comorbid asthma.
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Affiliation(s)
- Eugenio De Corso
- UOC Otorinolaringoiatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F.Vito 1, Roma, Italy.
| | - Peter W Hellings
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
- Laboratory of Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, Louvain, Belgium
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, 2HNO-University Clinic Charité, Berlin, Germany
| | - Anju T Peters
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Glenis K Scadding
- Department of Allergy and Rhinology, Royal National ENT Hospital, London, UK
| | | | - Stella E Lee
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, FRCB- IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain
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Costanzo G, Marchetti M, Ledda AG, Sambugaro G, Bullita M, Paoletti G, Heffler E, Firinu D, Costanzo GAML. Mast Cells in Allergic and Non-Allergic Upper Airways Diseases: Sentinel in the Watchtower. Int J Mol Sci 2024; 25:12615. [PMID: 39684326 DOI: 10.3390/ijms252312615] [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: 10/01/2024] [Revised: 11/18/2024] [Accepted: 11/21/2024] [Indexed: 12/18/2024] Open
Abstract
Mast cells are immune system cells with the most disparate functions, but are also among the least understood. Mast cells are implicated in several known pathological processes, tissue homeostasis, and wound repair. However, they owe their notoriety to allergic diseases, of which they represent the effector cell par excellence. In both allergic and not upper airway pathologies, mast cells play a key role. Exploring the mechanisms through which these cells carry out their physiological and pathological function may help us give a new perspective on existing therapies and identify new ones. A focus will be placed on non-allergic rhinitis, a poorly recognized and often neglected condition with complex management, where the role of the mast cell is crucial in the pathogenetic, clinical, and prognostic aspects.
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Affiliation(s)
- Giovanni Costanzo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Marta Marchetti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Andrea Giovanni Ledda
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Monserrato, Italy
| | - Giada Sambugaro
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Monserrato, Italy
| | - Martina Bullita
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Monserrato, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Monserrato, Italy
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Li Y. The expression of MUC5AC in patients with rhinosinusitis: A systematic review and meta-analysis. Clin Transl Allergy 2024; 14:e70003. [PMID: 39482799 PMCID: PMC11527733 DOI: 10.1002/clt2.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/25/2024] [Accepted: 10/05/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND To understand the connection between Muc5AC expression and the likelihood of rhinosinusitis, with the goal of providing insights into its prospective use as a biomarker. METHODS We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for studies up to November 2023 to conduct a literature review. After screening and quality assessment, eligible studies meeting the criteria were included. Muc5AC expression and rhinosinusitis association was analyzed by STATA 14.0. RESULTS Including weighted mean difference and 95% confidence interval, were reported. The meta-analysis included 16 studies with 1448 rhinosinusitis patients. MUC5AC expression was significantly up-regulated in both chronic rhinosinusitis with nasal polyps (CRSwNP; WMD: 0.52; 95% CI: 0.41-0.63) and chronic rhinosinusitis without nasal polyps (CRSsNP; WMD: 0.42; 95% CI: 0.28-0.56) patients compared to controls. IHC positive area analysis corroborated these findings, with elevated MUC5AC levels in CRSwNP (WMD: 25.61; 95% CI: 22.41-28.81) and CRSsNP (WMD: 39.74; 95% CI: 25.6-53.88) patients. Subgroup analysis based on tissue type (nasal tissue fluid and sinus mucosa) consistently supported the overall results. CONCLUSION Our meta-analysis robustly demonstrates a significant association between elevated MUC5AC expression and rhinosinusitis risk. This finding underscores the potential of MUC5AC as a molecular marker, providing valuable insights for future research and potential therapeutic interventions in rhinosinusitis management. SYSTEMATIC REVIEW REGISTRATION CRD42024518932.
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Affiliation(s)
- Yitao Li
- Department of Otolaryngology Head and Neck SurgeryFirst Hospital of Hainan Medical CollegeHaikouChina
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11
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Wang H, Xu X, Lu H, Zheng Y, Shao L, Lu Z, Zhang Y, Song X. Identification of Potential Feature Genes in CRSwNP Using Bioinformatics Analysis and Machine Learning Strategies. J Inflamm Res 2024; 17:7573-7590. [PMID: 39464338 PMCID: PMC11512703 DOI: 10.2147/jir.s484914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 10/17/2024] [Indexed: 10/29/2024] Open
Abstract
Purpose The pathogenesis of CRSwNP is complex and not yet fully explored, so we aimed to identify the pivotal hub genes and associated pathways of CRSwNP, to facilitate the detection of novel diagnostic or therapeutic targets. Methods Utilizing two CRSwNP sequencing datasets from GEO, differential expression gene analysis, WGCNA, and three machine learning methods (LASSO, RF and SVM-RFE) were applied to screen for hub genes. A diagnostic model was then formulated utilizing hub genes, and the AUC was generated to evaluate the performance of the prognostic model and candidate genes. Hub genes were validated through the validation set and qPCR performed on normal mice and CRSwNP mouse model. Lastly, the ssGSEA algorithm was employed to assess the differences in immune infiltration levels. Results A total of 239 DEGs were identified, with 170 upregulated and 69 downregulated in CRSwNP. Enrichment analysis revealed that these DEGs were primarily enriched in pathways related to nucleocytoplasmic transport and HIF-1 signaling pathway. Data yielded by WGCNA analysis contained 183 DEGs. The application of three machine learning algorithms identified 11 hub genes. Following concurrent validation analysis with the validation set and qPCR performed after establishing the mouse model confirmed the overexpression of BTBD10, ERAP1, GIPC1, and PEX6 in CRSwNP. The examination of immune cell infiltration suggested that the infiltration rate of type 2 T helper cell and memory B cell experienced a decline in the CRSwNP group. Conversely, the infiltration rates of Immature dendritic cell and Effector memory CD8 T cell were positive correlation. Conclusion This study successfully identified and validated BTBD10, ERAP1, GIPC1, and PEX6 as potential novel diagnostic or therapeutic targets for CRSwNP, which offers a fresh perspective and a theoretical foundation for the diagnostic prediction and therapeutic approach to CRSwNP.
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Affiliation(s)
- Huikang Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, QingdaoUniversity, Yantai, People’s Republic of China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Xinjun Xu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, QingdaoUniversity, Yantai, People’s Republic of China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Haoran Lu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, QingdaoUniversity, Yantai, People’s Republic of China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Yang Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, QingdaoUniversity, Yantai, People’s Republic of China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Liting Shao
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, QingdaoUniversity, Yantai, People’s Republic of China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Zhaoyang Lu
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Second Clinical Medicine College, Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China
| | - Yu Zhang
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
| | - Xicheng Song
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai Yuhuangding Hospital, Yantai, People’s Republic of China
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12
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Enache I, Stepan AE, Anghelina F, Vîlcea ID, Stepan MD, Mogoantă CA, Osman A. Histopathological parameters and immunoexpression of CD45RO (CLA) and CD68 in chronic rhinosinusitis with nasal polyps. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:655-660. [PMID: 39957027 PMCID: PMC11924912 DOI: 10.47162/rjme.65.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 12/02/2024] [Indexed: 02/18/2025]
Abstract
Nasal polyps develop as a result of inflammation of the nasal and sinus mucosa. Allergies and nasal infections cause inflammation, and these are the main reasons why these symptoms appear in the first place. This study highlights the involvement of macrophages, as well as T- and B-lymphocytes, in the pathophysiology of nasal polyps. For the evaluation of lymphocyte activity, we analyzed the immunoexpression of cluster of differentiation 45RO [CD45RO; common leukocyte antigen (CLA)] and for macrophages we analyzed the immunoexpression of cluster of differentiation 68 (CD68). Our research, conducted on 110 sinonasal polyps harvested from chronic rhinosinusitis patients with nasal polyps, focused on analyzing both the epithelial and stromal compartments in relation to pre-established composite scores. Additionally, specific histopathological parameters were included in the study. We concluded that the inflammatory cells were more prevalent in the stromal compartment compared to the epithelial compartment. The statistical evaluation of CD45RO (CLA) and CD68 scores in the stromal compartment were also associated with high histological composite scores.
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Affiliation(s)
- Irina Enache
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania;
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13
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Molokomme T, Maharaj S, Motakef S. A Descriptive Analysis of Nasal Polyposis in HIV Positive Versus HIV Negative Patients. Indian J Otolaryngol Head Neck Surg 2024; 76:3289-3297. [PMID: 39130228 PMCID: PMC11306855 DOI: 10.1007/s12070-024-04674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/28/2024] [Indexed: 08/13/2024] Open
Abstract
Nasal polyposis (NP) represents a benign proliferation of soft tissue tumors within the nasal cavity and paranasal sinuses, characterized by chronic inflammation of the sinonasal mucosa. This phenomenon, attributed to various environmental and physiological factors, presents clinically as semi-transparent masses with variable morphology, often obstructing nasal passages and causing respiratory compromise, olfactory dysfunction, and recurrent infections. Predominantly associated with chronic rhinosinusitis (CRS), NP poses significant challenges in diagnosis and management, particularly in the context of comorbid conditions such as human immunodeficiency virus (HIV) infection. HIV infection, known for its debilitating effects on the immune system, is theorized to exacerbate NP development and manifestation through mechanisms involving CD4 cell depletion and dysregulation of immune responses. Despite extensive research, elucidating potential pathways linking HIV infection to NP, comprehensive understanding remains elusive. This study aims to address this knowledge gap by conducting a retrospective chart review of patients presenting with NP at Charlotte Maxeke Johannesburg Academic Hospital between January 2016 and December 2020. The primary objective is to investigate the influence of HIV status on the clinical, radiological, and histological features of NP. Data collection, encompassing patient demographics, HIV status, clinical presentations, radiological findings, and histopathological characteristics, will be conducted between March 2021 and August 2022. Preliminary analysis of collected data reveals a cohort of 41 patients meeting inclusion criteria, with notable exclusions based on undisclosed HIV status and incomplete documentation. Initial findings suggest a nuanced interplay between genetic predisposition, environmental factors, and HIV status in NP pathogenesis, underscoring the need for further research to validate these observations. In conclusion, this study underscores the importance of elucidating the complex relationship between HIV infection and NP to optimize diagnostic and therapeutic approaches, particularly in regions with a high HIV prevalence such as South Africa. By comprehensively assessing the clinical, radiological, and histological features of NP in HIV-positive and HIV-negative populations, this research endeavours to enhance our understanding of NP pathophysiology and improve patient outcomes.
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Affiliation(s)
- Thobile Molokomme
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shivesh Maharaj
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shahpar Motakef
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Luo C, Zhu Y, Zhang S, Zhou J, Mao S, Tang R, Gu Y, Tan S, Lin H, Li Z, Zhang W. Increased SERPINB2 potentiates 15LO1 expression via STAT6 signalling in epithelial cells in eosinophilic chronic rhinosinusitis with nasal polyps. Clin Exp Allergy 2024; 54:412-424. [PMID: 38639267 DOI: 10.1111/cea.14484] [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] [Received: 12/20/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND SERPINB2, a biomarker of Type-2 (T2) inflammatory processes, has been described in the context of asthma. Chronic rhinosinusitis with nasal polyps (CRSwNP) is also correlated with T2 inflammation and elevated 15LO1 induced by IL-4/13 in nasal epithelial cells. The aim of this study was to evaluate the expression and location of SERPINB2 in nasal epithelial cells (NECs) and determine whether SERPINB2 regulates 15LO1 and downstream T2 markers in NECs via STAT6 signalling. METHODS SERPINB2 gene expression in bulk and single-cell RNAseq database was analysed by bioinformatics analysis. SERPINB2, 15LO1 and other T2 markers were evaluated from CRSwNP and HCs NECs. The colocalization of SERPINB2 and 15LO1 was evaluated by immunofluorescence. Fresh NECs were cultured at an air-liquid interface with or without IL-13, SERPINB2 Dicer-substrate short interfering RNAs (DsiRNAs) transfection, exogenous SERPINB2, 15-HETE recombinant protein and pSTAT6 inhibitors. 15LO1, 15-HETE and downstream T2 markers were analysed by qRT-PCR, western blot and ELISA. RESULTS SERPINB2 expression was increased in eosinophilic nasal polyps compared with that in noneosinophilic nasal polyps and control tissues and positively correlated with 15LO1 and other downstream T2 markers. SERPINB2 was predominantly expressed by epithelial cells in NP tissue and was colocalized with 15LO1. In primary NECs in vitro, SERPINB2 expression was induced by IL-13. Knockdown or overexpression SERPINB2 decreased or enhanced expression of 15LO1 and 15-HETE in NECs, respectively, in a STAT6-dependent manner. SERPINB2 siRNA also inhibited the expression of the 15LO1 downstream genes, such as CCL26, POSTN and NOS2. STAT6 inhibition similarly decreased SERPINB2-induced 15LO1. CONCLUSIONS SERPINB2 is increased in NP epithelial cells of eosinophilic CRSwNP (eCRSwNP) and contributes to T2 inflammation via STAT6 signalling. SERPINB2 could be considered a novel therapeutic target for eCRSwNP.
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Affiliation(s)
- Chunyu Luo
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Ying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shiyao Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jiayao Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Song Mao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Ru Tang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yuelong Gu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shaolin Tan
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
- Postgraduate Training Base of Shanghai Sixth People's Hospital, Jinzhou Medical University, Shanghai, China
| | - Hai Lin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Zhipeng Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Weitian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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15
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M Yusoff NNF, Ahmad S, Wan Abdul Rahman WF, Mohamud R, C Boer J, Plebanski M, Abdullah B, Chen X, Tengku Din TADAA. CD4+ Foxp3+ Regulatory T-cells in Modulating Inflammatory Microenvironment in Chronic Rhinosinusitis with Nasal Polyps: Progress and Future Prospect. Cytokine 2024; 178:156557. [PMID: 38452440 DOI: 10.1016/j.cyto.2024.156557] [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: 11/15/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a subtype of chronic rhinosinusitis (CRS) characterized by the presence of nasal polyps (NP) in the paranasal mucosa. Despite the complex etiology, NP is believed to result from chronic inflammation. The long-term aftermath of the type 2 response is responsible for symptoms seen in NP patients, i.e. rhinorrhea, hyposmia, and nasal obstruction. Immune cellular tolerogenic mechanisms, particularly CD4 + Foxp3 + regulatory T cells (Tregs), are crucial to curtail inflammatory responses. Current evidence suggests impaired Treg activity is the main reason underlying the compromise of self-tolerance, contributing to the onset of CRSwNP. There is compelling evidence that tumor necrosis factor 2 (TNFR2) is preferentially expressed by Tregs, and TNFR2 is able to identify the most potent suppressive subset of Tregs. Tumor necrosis factor (TNF)-TNFR2 interaction plays a decisive role in the activation and expansion of Tregs. This review summarizes current understanding of Tregs biology, focusing on the discussion of the recent advances in the study of TNF-TNFR2 axis in the upregulation of Treg function as a negative feedback mechanism in the control of chronic inflammation. The role of dysregulation of Tregs in the immunopathogenesis of CRSwNP will be analyzed. The future perspective on the harnessing Tregs-mediated self-tolerant mechanism in the management of CRSwNP will be introduced.
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Affiliation(s)
- Nur Najwa Farahin M Yusoff
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Rohimah Mohamud
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Jennifer C Boer
- Translational Immunology and Nanotechnology Unit, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
| | - Magdalena Plebanski
- Translational Immunology and Nanotechnology Unit, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
| | - Xin Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, China
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16
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Giombi F, Pace GM, Nappi E, Giunta G, Muci G, Pirola F, Ferreli F, Heffler E, Paoletti G, Giannitto C, Mercante G, Francone M, Spriano G, Canonica GW, Malvezzi L. Radiological Versus Clinical 1-Year Outcomes of Dupilumab in Refractory CRSwNP: A Real-Life Study. Laryngoscope 2024; 134:2626-2633. [PMID: 38126613 DOI: 10.1002/lary.31238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To provide real-life evidence on long-term radiological changes in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with dupilumab, and to assess possible differences between radiological and clinical results in terms of endoscopic findings and Patient-Reported-Outcomes (PROs). METHODS Consecutive patients treated with dupilumab for recalcitrant CRSwNP were required to undergo CT scan at baseline (T0) and after 12 (T1) since first administration. A group of patients also performed CT scan at 52 weeks (T2) to assess long-term outcomes. At each timepoint, patients underwent nasal endoscopy, assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analogue-Scales (VAS) for sinonasal symptoms. RESULTS In fifty-three included patients, from T0 to T1 we detected a significant reduction in mean Lund-Mackay score (LM), PROs (SNOT-22, VAS) and endoscopic (NPS, LKS) scores (p < 0.05). In the subset of patients that reached T2 (n = 30), compared to T1, we observed a further significant decrease in mean LM, SNOT-22, VAS, and NPS scores, but not in LKS (p = 0.420). At T1, the highest improvement was observed in PROs (SNOT-22: 56.26%), and polyp size (NPS: 49.83%). Conversely, between T1 and T2, sinus opacification was shown to be the most improved outcome (LM: 36.86%). CONCLUSIONS Our experience showed that poorly controlled CRSwNP patients treated with dupilumab experienced significant improvement in radiologic, endoscopic and clinical disease severity. While in the initial 3 months, PROs garnered attention for showing earlier effectiveness, radiological outcomes revealed sustained and gradual efficacy in a longer term. LEVEL OF EVIDENCE Level 4. According to the Oxford Center for Evidence-Based Medicine 2011 level of evidence guidelines, this non-randomized retrospective cohort study is classified as level 4 evidence Laryngoscope, 134:2626-2633, 2024.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuele Nappi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanna Muci
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca Pirola
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
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17
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Baird AM, Masliah J, Filip P, Talati V, Brown HJ, Owen G, Khalife S, Papagiannopoulos P, Gattuso P, Batra PS, Tajudeen BA. Histopathologic features of biologic therapy nonresponders in chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol 2024; 14:939-949. [PMID: 37792287 DOI: 10.1002/alr.23283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Biologics are effective for chronic rhinosinusitis with nasal polyposis (CRSwNP) by reducing type 2 inflammation. Nonresponders often require functional endoscopic sinus surgery (FESS) and represent a challenging population potentially due to non-type 2 pathophysiology. This study characterizes the histopathologic features of biologic nonresponders. METHODS A retrospective review of 257 CRSwNP patients undergoing FESS was conducted. The biologic nonresponder group included patients with prior biologic therapy who exhibited persistent symptoms and polyp burden. Those with CRSwNP not prescribed biologic therapy were selected as controls. Demographics, comorbidities, and structured histopathology consisting of 13 variables were collected. RESULTS Of 257 CRSwNP patients, 20 were on biologics prior to FESS. Fourteen patients (70.0%) received dupilumab, one (5.0%) received mepolizumab, one (5.0%) received omalizumab, and four (20.0%) tried multiple biologics. The mean age for the biologic nonresponder group was 45.8 years compared to 50.4 years for the controls. Nonresponders had a significantly increased incidence of reduced tissue eosinophilia, defined as <5 per high power field (55% vs. 31.2%, p = 0.044) and increased basement membrane thickening (100% vs. 78.1%, p = 0.019). The remaining 11 variables did not reach statistical significance. CONCLUSION Histopathologic analysis of biologic nonresponders demonstrates decreased eosinophilia and thickened basement membranes. These findings, particularly low tissue eosinophils, are consistent with a non-type 2 CRSwNP that may be recalcitrant to biologic therapies. Histopathologic analysis done in conjunction with FESS may aid clinicians in understanding response to biologic therapies in patients with CRSwNP who have persistent symptom burden necessitating FESS.
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Affiliation(s)
- Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Jamie Masliah
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vidit Talati
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant Owen
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Khalife
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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18
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AlBloushi S, Al-Ahmad M. Exploring the immunopathology of type 2 inflammatory airway diseases. Front Immunol 2024; 15:1285598. [PMID: 38680486 PMCID: PMC11045947 DOI: 10.3389/fimmu.2024.1285598] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Significant advancements have been achieved in understanding the roles of different immune cells, as well as cytokines and chemokines, in the pathogenesis of eosinophilic airway conditions. This review examines the pathogenesis of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), marked by complex immune dysregulation, with major contributions from type 2 inflammation and dysfunctional airway epithelium. The presence of eosinophils and the role of T-cell subsets, particularly an imbalance between Treg and Th17 cells, are crucial to the disease's pathogenesis. The review also investigates the pathogenesis of eosinophilic asthma, a unique asthma subtype. It is characterized by inflammation and high eosinophil levels, with eosinophils playing a pivotal role in triggering type 2 inflammation. The immune response involves Th2 cells, eosinophils, and IgE, among others, all activated by genetic and environmental factors. The intricate interplay among these elements, chemokines, and innate lymphoid cells results in airway inflammation and hyper-responsiveness, contributing to the pathogenesis of eosinophilic asthma. Another scope of this review is the pathogenesis of Eosinophilic Granulomatosis with Polyangiitis (EGPA); a complex inflammatory disease that commonly affects the respiratory tract and small to medium-sized blood vessels. It is characterized by elevated eosinophil levels in blood and tissues. The pathogenesis involves the activation of adaptive immune responses by antigens leading to T and B cell activation and eosinophil stimulation, which causes tissue and vessel damage. On the other hand, Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitive response that occurs when the airways become colonized by aspergillus fungus, with the pathogenesis involving activation of Th2 immune responses, production of IgE antibodies, and eosinophilic action leading to bronchial inflammation and subsequent lung damage. This analysis scrutinizes how an imbalanced immune system contributes to these eosinophilic diseases. The understanding derived from this assessment can steer researchers toward designing new potential therapeutic targets for efficient control of these disorders.
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Affiliation(s)
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
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19
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Hopkins C, Mullol J, Khan AH, Lee SE, Wagenmann M, Hellings P, Fokkens W, Msihid J, Nair R, Kamat S, Nash S, Radwan A, Jacob-Nara JA, Deniz Y, Rowe PJ. Impact of Dupilumab on Sinonasal Symptoms and Outcomes in Severe Chronic Rhinosinusitis With Nasal Polyps. Otolaryngol Head Neck Surg 2024; 170:1173-1182. [PMID: 38156522 DOI: 10.1002/ohn.627] [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: 03/24/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES To assess the severity of the top 5 22-item Sino-Nasal Outcome Test (SNOT-22) items ranked most important by patients with chronic rhinosinusitis with nasal polyps (CRSwNP), the effect of dupilumab on these items, and their association with objective disease measures. STUDY DESIGN Post hoc analysis of the SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) clinical trials. SETTING Multinational, multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. METHODS Patients ranked the SNOT-22 items most affecting their health at baseline. Item symptom severity (0-5 scale) was assessed at baseline, Week 24 (W24), and Week 52 (W52). Changes in nasal polyps score (NPS) and Lund-Mackay (LMK) scores were assessed in patients with/without SNOT-22 items improvements of at least 1 severity group point at W24 and W52. RESULTS The SNOT-22 items ranked most important at baseline were "decreased sense of smell/taste" (87% of patients), followed by "nasal blockage" (82%), "postnasal discharge" (40%), "thick nasal discharge" (37%), and "wake up at night" (26%); 82%, 61%, 32%, 40%, and 26% of patients reported severe symptoms (score 4 or 5) for these items, respectively. Dupilumab improved score severity for all top 5 items versus placebo at W24 and W52. Improvements in NPS and LMK scores were numerically greater in patients with improvements in the SNOT-22 top 5 items. CONCLUSION Loss of smell/taste was ranked as the most important symptom by patients with CRSwNP. Dupilumab reduced the severity of the top 5 most important SNOT-22 items versus placebo, in parallel with improvements in objective disease measures. CLINICAL TRIAL REGISTRATION SINUS-24 and SINUS-52 clinical trials were registered with ClinicalTrials.gov, identifiers NCT02912468 and NCT02898454, respectively.
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Affiliation(s)
- Claire Hopkins
- Department of Otorhinolaryngology, King's College London, London, UK
| | - Joaquim Mullol
- Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France
| | - Stella E Lee
- Harvard Medical School, Brigham and Women's Hospital, Division of Otolaryngology-Head & Neck Surgery, Boston, Massachusetts, USA
| | - Martin Wagenmann
- Department of Otorhinolaryngology, Düsseldorf University Hospital (UKD), Düsseldorf, Germany
| | - Peter Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wytske Fokkens
- Department of Otorhinolaryngology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jérôme Msihid
- Health Economics and Value Assessment, Sanofi, Gentilly, France
| | - Radhika Nair
- Health Economics and Value Assessment, Sanofi, Cambridge, Massachusetts, USA
| | - Siddhesh Kamat
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Amr Radwan
- Global Medical Affairs, Regeneron Pharmaceuticals Inc., Uxbridge, UK
| | | | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Paul J Rowe
- Global Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
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20
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Li YT, Huang SS, Ma JH, Hsieh BH, Tsou YA, Lin CD, Tai CJ, Shih LC. Bacteriology of Different Phenotypes of Chronic Rhinosinusitis. Laryngoscope 2024; 134:1071-1076. [PMID: 37477266 DOI: 10.1002/lary.30905] [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] [Received: 04/16/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) reduces the health-related quality of life and subsequently causes a tremendous socio-economic impact. Although many studies have been conducted, few have identified a relationship between bacteriological characteristics and different phenotypes or endotypes. Therefore, this study aimed to elucidate the recent trends in bacterial cultures from different types of CRS in the Asian population. METHODS This retrospective case-control study recruited patients diagnosed with CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into those with chronic rhinosinusitis with nasal polyps (CRSwNP)/chronic rhinosinusitis without nasal polyps (CRSsNP), eosinophilic chronic rhinosinusitis (eCRS)/non-eosinophilic chronic rhinosinusitis (NECRS), and central compartment atopic disease (CCAD)/lateral-dominant nasal polyp (LDNP) groups. The demographic data and bacteriological characteristics of the groups were analyzed. RESULTS We included 503 patients, identifying no significant difference between CRSwNP and CRSsNP for several common bacteria in CRS. The number of Staphylococcus epidermidis isolates in culture was significantly higher in the NECRS group (50.46% vs. 32.56%, p = 0.0003) than that in the eCRS group. The number of methicillin-resistant Staphylococcus aureus (MRSA; 8.51% vs. 2.35%, p = 0.0221) positive isolates was significantly higher in the CCAD group than that in the LDNP group. CONCLUSIONS This was the first study in Asia to analyze the relationship between bacteriological characteristics and CCAD. MRSA is significantly higher in the CCAD group than that in the LDNP group. Recognizing the unique microbiology of CRSwNP, eCRS, and CCAD is crucial when selecting antimicrobial therapy to lessen the socio-economic impact. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1071-1076, 2024.
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Affiliation(s)
- Yu-Ting Li
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shuang-Shuang Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jia-Hung Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Bing-Han Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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21
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Zhang K, Wang L, Qi F, Meng T. Hypotensive Levels on Endoscopic Sinus Surgery Visibility: A Randomized Non-Inferiority Trial. Laryngoscope 2024; 134:569-576. [PMID: 37449719 DOI: 10.1002/lary.30867] [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] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Optimization of endoscopic sinus surgery (ESS) conditions is a common focus of interest for otolaryngologists and anesthesiologists. Relying on hypotension alone to achieve a bloodless field may not without risks. We sought to determine whether ESS is feasible in the context of moderate hypotension. METHODS This randomized non-inferiority trial enrolled 96 adult patients who were to undergo ESS. The patients were divided into two groups: Controlled hypotension group (n = 48, MAP reduction to 55-65 mmHg, minimum of 60% of baseline blood pressure) or Individualized hypotension group (n = 48, MAP reduction to 75-80% of baseline blood pressure). All participants were placed in 10° reverse Trendelenburg position during ESS, and cottonoid patties dammed with epinephrine was recommended to clear the operative field of bleeding. The two groups were compared according to Boezaart grading scale (BS) score, estimated blood loss, blood loss rate, arterial lactate level and postoperative recovery. RESULTS Both levels of intraoperative hypotension (62.2 ± 2.3 mmHg vs. 74.0 ± 2.8 mmHg) provided acceptable surgical conditions with no difference in mean BS scores [2.00 (1.88-2.33) vs. 2.00 (1.85-2.45), p = 0.926]. The 95% CI for median value differences in mean BS scores is lower than the preset non-inferiority margin. There were no differences in blood loss rate and estimated blood loss between two groups (p > 0.05) Postoperative arterial lactate and Ramsay sedation scores were significantly different between the two groups (p < 0.05). CONCLUSIONS In ESS, both levels of intraoperative hypotension, combined with position adjustment and low-concentration adrenaline to constrict nasal mucosal blood vessels, provided acceptable surgical conditions. LEVEL OF EVIDENCE 2 Laryngoscope, 134:569-576, 2024.
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Affiliation(s)
- Kangda Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Lichun Wang
- Department of Pain Management, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Feng Qi
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Tao Meng
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
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Wang Y, Song X, Jin M, Lu J. Characterization of the Immune Microenvironment and Identification of Biomarkers in Chronic Rhinosinusitis with Nasal Polyps Using Single-Cell RNA Sequencing and Transcriptome Analysis. J Inflamm Res 2024; 17:253-277. [PMID: 38229690 PMCID: PMC10790669 DOI: 10.2147/jir.s440409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose Chronic rhinosinusitis is a prevalent condition in the field of otorhinolaryngology; however, its pathogenesis remains to be elucidated. The immunological defense of the nasal mucosa is significantly influenced by dendritic cells (DCs). We identified specific biological indicators linked to DCs and explored their significance in cases of chronic rhinosinusitis with nasal polyps (CRSwNP). Patients and Methods We categorized cells using single-cell RNA (scRNA) sequencing, and combined transcriptome sequencing was used to identify potential candidate genes for CRSwNP. We selected three biomarkers based on two algorithms and performed enrichment and immune correlation analyses. Biomarkers were verified using training and validation sets, receiver operating characteristic curves, immunohistochemistry, and quantitative real-time reverse-transcription PCR (qRT-PCR). Variations in biomarker expression were validated using pseudotime analysis. The networks of competing transcription factor (TF)-mRNA and competing endogenous RNA (ceRNA) were established, and the protein drugs associated with these biomarkers were predicted. Results Both scRNA-seq and transcriptome data showed that DCs immune infiltration was higher in the CRSwNP group than in the control group. Three DC-related biomarkers (NR4A1, CLEC4G, and CD163) were identified. In CRSwNP, NR4A1 expression decreased, whereas CLEC4G and CD163 expression increased. All biomarkers were shown to be involved in immunological and metabolic pathways by enrichment analysis. These biomarkers were associated with γδ T cells, effector memory CD4 + T cells, regulatory T cells, and immature DCs. According to pseudotime analysis, NR4A1 and CD163 expression decreased from high to low, whereas CLEC4G expression remained low. Conclusion We screened and identified potential DC-associated biomarkers of CRSwNP progression by integrating scRNA-seq with whole transcriptome sequencing. We analyzed the biological pathways in which they were involved, explored their molecular regulatory mechanisms and related drugs, and constructed ceRNA, TF-mRNA, and biomarker-drug networks to identify new CRSwNP treatment targets, laying the groundwork for the clinical management of CRSwNP.
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Affiliation(s)
- Yakun Wang
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Xinyu Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Jun Lu
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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23
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Paçacı Çetin G, Arslan B, Yılmaz İ. Doxycycline may be more clinically effective in type 2 chronic rhinosinusitis nasal polyp comorbid with asthma. J Asthma 2024; 61:20-26. [PMID: 37437223 DOI: 10.1080/02770903.2023.2236696] [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: 02/19/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis with nasal polyp (CRSwNP) is one of the major phenotypes of chronic rhinosinusitis (CRS) with a high symptom burden. Doxycycline can be used as add-on therapy in CRSwNP. We aimed to evaluate short-term efficacy of oral doxycycline on visual analog scale (VAS) and SNOT-22 (Sino-nasal outcome test) score for CRSwNP. METHODS Visual analog score (VAS) for nasal symptoms and total SNOT-22 scores of 28 patients who applied with the diagnosis of CRSwNP and received 100 mg doxycycline for 21 days were analyzed in this retrospective cohort study. Doxycycline efficacy was also evaluated in subgroups determined according to asthma, presence of atopy, total IgE and eosinophil levels. RESULTS After 21-day doxycycline treatment, there was a significant improvement in VAS score for post-nasal drip, nasal discharge, nasal congestion, and sneeze, and total SNOT-22 score (p = 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). No significant improvement was observed in VAS score for the loss of smell (p = 0.18). In the asthmatic subgroup, there were significant improvements in all VAS scores and total SNOT-22 score after doxycycline. In the non-asthmatic subgroup, there was no significant change in any of the VAS scores, but total SNOT-22 score was significantly improved (42 [21-78] vs. 18 [9-33]; p = 0.043). Improvement in VAS score for loss of smell is significant in only some subgroups like asthmatic patients, non-atopic patients, and patients with eosinophil >300 cell/µL. CONCLUSIONS Doxycycline can be considered as an add-on treatment for symptom control in patients especially with CRSwNP comorbid with asthma.
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Affiliation(s)
- Gülden Paçacı Çetin
- Department of Chest Disease, Division of Immunology and Allergy, Erciyes University School of Medicine, Kayseri, Türkiye
| | - Bahar Arslan
- Department of Chest Disease, Division of Immunology and Allergy, Erciyes University School of Medicine, Kayseri, Türkiye
| | - İnsu Yılmaz
- Department of Chest Disease, Division of Immunology and Allergy, Erciyes University School of Medicine, Kayseri, Türkiye
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24
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Bachert C, Laidlaw TM, Cho SH, Mullol J, Swanson BN, Naimi S, Classe M, Harel S, Jagerschmidt A, Laws E, Ruddy M, Praestgaard A, Amin N, Mannent LP. Effect of Dupilumab on Type 2 Biomarkers in Chronic Rhinosinusitis With Nasal Polyps: SINUS-52 Study Results. Ann Otol Rhinol Laryngol 2023; 132:1649-1661. [PMID: 37322842 PMCID: PMC10571440 DOI: 10.1177/00034894231176334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) are frequent coexisting conditions and share type 2 inflammatory pathophysiology, with interleukin (IL)-4 and IL-13 as key cytokines. Dupilumab is a monoclonal antibody that blocks the shared receptor for IL-4 and IL-13. The objective of this analysis was to evaluate dupilumab's effect on type 2 inflammation biomarkers in patients with CRSwNP with/without coexisting asthma or NSAID-ERD from the SINUS-52 (NCT02898454) study. METHODS Patients received treatment with dupilumab or placebo for 52 weeks. Blood and urinary biomarkers were evaluated through 52 weeks, and nasal secretions and mucosa brushings through 24 weeks. RESULTS Of 447 patients, 60% had coexisting asthma and 27% had coexisting NSAID-ERD. At baseline, blood eotaxin-3, eosinophils, and periostin, nasal secretion eotaxin-3, and urinary leukotriene E4 were significantly higher in patients with coexisting NSAID-ERD than without. Dupilumab reduced eotaxin-3, thymus and activation-regulated chemokine, periostin, and total immunoglobulin E in blood, eotaxin-3, periostin, IL-5, and eosinophil cationic protein in nasal secretions, and leukotriene E4 in urine. Reductions were generally similar or greater in the subgroups with asthma and NSAID-ERD than without. Dupilumab also reduced MUC5AC and mast cell counts in nasal mucosa brushings. CONCLUSION Dupilumab reduced local and systemic type 2 inflammatory biomarkers in patients with CRSwNP, including mast cells in nasal mucosa and cysteinyl leukotrienes in urine. These findings provide insight into the processes driving CRSwNP and the mechanisms of dupilumab's therapeutic effects. CLINICAL TRIAL REGISTRY NAME SINUS-52 https://www.clinicaltrials.gov/ct2/show/NCT02898454. CLINICALTRIALS.GOV IDENTIFIER NCT02898454.
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Affiliation(s)
- Claus Bachert
- Department of Otorhinolaryngology — Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
- Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong H. Cho
- Division of Allergy-Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - Brian N. Swanson
- College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
- Research and Development, Sanofi, Bridgewater, NJ, USA
| | - Souad Naimi
- Molecular and Digital Histopathology, Sanofi, Vitry-sur-Seine, France
| | - Marion Classe
- Pathology Department, Institut Gustave Roussy, Villejuif, France
- Translational Sciences, Sanofi, Chilly-Mazarin, France
| | - Sivan Harel
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Elizabeth Laws
- Immunology and Inflammation Global Development, Sanofi, Bridgewater, NJ, USA
| | - Marcella Ruddy
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Nikhil Amin
- Clinical Sciences Global Development, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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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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26
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Viksne RJ, Sumeraga G, Pilmane M. Antimicrobial and Defense Proteins in Chronic Rhinosinusitis with Nasal Polyps. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1259. [PMID: 37512070 PMCID: PMC10383322 DOI: 10.3390/medicina59071259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) presently remains a difficult disease to manage. Antimicrobial and defense proteins are important factors that could help characterize the role of microorganisms in CRSwNP pathogenesis, as the concept of microbial dysbiosis in CRS is still being considered. Our aim is to investigate the complex appearance, relative distribution and interlinks of human β defensin 2 (HBD-2), human β defensin 3 (HBD-3), human β defensin 4 (HBD-4), and cathelicidin LL 37 (LL 37) in chronic rhinosinusitis with nasal polyps (CRSwNP)-affected human nasal mucosa. Materials and Methods: The study group consisted of 48 samples from patients with CRSwNP. Samples were collected during functional endoscopic sinus surgery. The control group consisted of 17 normal healthy nasal mucosa samples gathered during routine septoplasty. β-defensin-2, β-defensin-3, β-defensin-4 and cathelicidin LL 37 in tissue were detected via immunohistochemical analysis. Results: HBD-2, HBD-3 and LL 37 were significantly decreased in epithelial cells in both primary and recurrent nasal polyp samples (p < 0.001) in comparison to control samples. HBD-2 was decreased in the subepithelial connective tissue of primary nasal polyp samples when compared to both recurrent polyp (p = 0.050) and control (p = 0.033) samples. In subepithelial connective tissue, significantly more HBD-3-positive structures were observed in primary nasal polyp samples (p = 0.049) than in control samples. In primary polyp samples, moderate correlations between connective tissue HBD-3 and connective (R = 0.584, p = 0.001) and epithelial tissue LL 37 (R = 0.556, p = 0.002) were observed. Conclusions: Decreased HBD-2, HBD-3 and LL 37 concentrations in the epithelium suggest a dysfunction of the epithelial barrier in patients with nasal polyps. Decreased subepithelial connective tissue HBD-2 suggests different responses to nasal microbiota in patients with primary nasal polyps compared to recurrent nasal polyps. Increased HBD-3 in subepithelial connective tissue suggests a possible role of this antimicrobial peptide in the pathogenesis of primary nasal polyps.
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Affiliation(s)
- Rudolfs Janis Viksne
- Department of Otorhinolaryngology, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia
- Daugavpils Regional Hospital, Vasarnicu Street 20, LV-5417 Daugavpils, Latvia
| | - Gunta Sumeraga
- Department of Otorhinolaryngology, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia
- Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Mara Pilmane
- Institute of Anatomy and Anthropology, Riga Stradins University, Kronvalda Boulevard 9, LV-1010 Riga, Latvia
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Huang ZQ, Ye J, Liu J, Sun LY, Ong HH, Wei YH, Fu SC, Hu XX, Xu Y, Wang DY. Predictive Significance of Claudin-3 for Epithelial Barrier Dysfunction in Chronic Rhinosinusitis With Nasal Polyps. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:512-525. [PMID: 37153980 PMCID: PMC10359644 DOI: 10.4168/aair.2023.15.4.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The abnormal expression of tight junction (TJ) plays a vital role in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, there is no appropriate tool to distinguish and diagnose epithelial barrier defects in clinical practice. This study aimed to evaluate the predictive value of claudin-3 for epithelial barrier dysfunction in CRSwNP. METHODS In this study, TJ protein levels were evaluated by real-time quantitative polymerase chain reaction, immunofluorescent, and immunohistochemistry staining in control subjects and CRSwNP patients. The receiver operating characteristic (ROC) curve was created to assess the predictive value of TJ breakdown in clinical outcomes. In vitro, human nasal epithelial cells were cultured at the air-liquid interface to analyze the transepithelial electrical resistance (TER) level. RESULTS The expression levels of occludin, tricellulin, claudin-3, and claudin-10 were decreased (all P < 0.05), and those of claudin-1 was increased (P < 0.05) in CRSwNP patients as compared to healthy subjects. Additionally, claudin-3 and occludin levels were negatively correlated with the computed tomography score in CRSwNP (all P < 0.05), and the ROC curve indicated that the claudin-3 level had the most predictive accuracy in evaluating epithelial barrier disruption (area under the curve = 0.791, P < 0.001). Finally, the time-series analysis showed the highest correlation coefficient between TER and claudin-3 (cross-correlation function = 0.75). CONCLUSION In this study, we suggest that claudin-3 could be a valuable biomarker for predicting nasal epithelial barrier defects and disease severity in CRSwNP.
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Affiliation(s)
- Zhi-Qun Huang
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jing Ye
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Liu
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Li-Ying Sun
- First School of Clinical Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hsiao Hui Ong
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Yong-Hao Wei
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Shu-Cai Fu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Xiao-Xun Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Yu Xu
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
| | - De-Yun Wang
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
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Yoshikawa M, Asaba K, Nakayama T. Prioritization of nasal polyp-associated genes by integrating GWAS and eQTL summary data. Front Genet 2023; 14:1195213. [PMID: 37424726 PMCID: PMC10326843 DOI: 10.3389/fgene.2023.1195213] [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: 03/28/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Nasal polyps (NP) are benign inflammatory growths of nasal and paranasal sinus mucosa that can substantially impair patients' quality of life by various symptoms such as nasal obstruction, insomnia, and anosmia. NP often relapse even after surgical treatment, and the curative therapy would be challenging without understanding the underlying mechanisms. Genome wide association studies (GWASs) on NP have been conducted; however, few genes that are causally associated with NP have been identified. Methods: We aimed to prioritize NP associated genes for functional follow-up studies using the summary data-based Mendelian Randomization (SMR) and Bayesian colocalization (COLOC) methods to integrate the summary-level data of the GWAS on NP and the expression quantitative trait locus (eQTL) study in blood. We utilized the GWAS data including 5,554 NP cases and 258,553 controls with 34 genome-wide significant loci from the FinnGen consortium (data freeze 8) and the eQTL data from 31,684 participants of predominantly European ancestry from the eQTLGen consortium. Results: The SMR analysis identified several genes including TNFRSF18, CTSK, and IRF1 that were associated with NP due to not linkage but pleiotropy or causality. The COLOC analysis strongly suggested that these genes and the trait of NP were affected by shared causal variants, and thus were colocalized. An enrichment analysis by Metascape suggested that these genes might be involved in the biological process of cellular response to cytokine stimulus. Conclusion: We could prioritize several NP associated genes including TNFRSF18, CTSK, and IRF1 for follow-up functional studies in future to elucidate the underlying disease mechanisms.
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Affiliation(s)
- Masahiro Yoshikawa
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
- Technology Development of Disease Proteomics Division, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kensuke Asaba
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
- Technology Development of Disease Proteomics Division, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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Pelaia C, Pelaia G, Maglio A, Tinello C, Gallelli L, Lombardo N, Terracciano R, Vatrella A. Pathobiology of Type 2 Inflammation in Asthma and Nasal Polyposis. J Clin Med 2023; 12:jcm12103371. [PMID: 37240477 DOI: 10.3390/jcm12103371] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Asthma and nasal polyposis often coexist and are frequently intertwined by tight pathogenic links, mainly consisting of the cellular and molecular pathways underpinning type 2 airway inflammation. The latter is characterized by a structural and functional impairment of the epithelial barrier, associated with the eosinophilic infiltration of both the lower and upper airways, which can be driven by either allergic or non-allergic mechanisms. Type 2 inflammatory changes are predominantly due to the biological actions exerted by interleukins 4 (IL-4), 13 (IL-13), and 5 (IL-5), produced by T helper 2 (Th2) lymphocytes and group 2 innate lymphoid cells (ILC2). In addition to the above cytokines, other proinflammatory mediators involved in the pathobiology of asthma and nasal polyposis include prostaglandin D2 and cysteinyl leukotrienes. Within this context of 'united airway diseases', nasal polyposis encompasses several nosological entities such as chronic rhinosinusitis with nasal polyps (CRSwNP) and aspirin-exacerbated respiratory disease (AERD). Because of the common pathogenic origins of asthma and nasal polyposis, it is not surprising that the more severe forms of both these disorders can be successfully treated by the same biologic drugs, targeting many molecular components (IgE, IL-5 and its receptor, IL-4/IL-13 receptors) of the type 2 inflammatory trait.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giulia Pelaia
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Caterina Tinello
- Pediatrics Unit, Provincial Outpatient Center of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Rosa Terracciano
- Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
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Rizzi A, Gammeri L, Cordiano R, Valentini M, Centrone M, Marrone S, Inchingolo R, Lohmeyer FM, Cavaliere C, Ria F, Cadoni G, Gangemi S, Nucera E. Therapeutic Strategies to Prevent the Recurrence of Nasal Polyps after Surgical Treatment: An Update and In Vitro Study on Growth Inhibition of Fibroblasts. J Clin Med 2023; 12:jcm12082841. [PMID: 37109177 PMCID: PMC10142691 DOI: 10.3390/jcm12082841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is the most bothersome phenotype of chronic rhinosinusitis, which is typically characterized by a Type 2 inflammatory reaction, comorbidities and high rates of nasal polyp recurrence, causing severe impact on quality of life. Nasal polyp recurrence rates, defined as the number of patients undergoing revision endoscopic sinus surgery, are 20% within a 5 year period after surgery. The cornerstone of CRSwNP management consists of anti-inflammatory treatment with local corticosteroids. We performed a literature review regarding the therapeutic strategies used to prevent nasal polyp recurrence after surgical treatment. Finally, we report an in vitro study evaluating the efficacy of lysine-acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (ketoprofen and diclofenac) on the proliferation of fibroblasts, obtained from nasal polyp tissue samples. Our study demonstrates that diclofenac, even more so than lysine-acetylsalicylic acid, significantly inhibits fibroblast proliferation and could be considered a valid therapeutic strategy in preventing CRSwNP recurrence.
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Affiliation(s)
- Angela Rizzi
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luca Gammeri
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Raffaele Cordiano
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Mariagrazia Valentini
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Michele Centrone
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Sabino Marrone
- Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University, 00185 Rome, Italy
| | - Francesco Ria
- Section of General Pathology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Department Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 1-8, 00168 Rome, Italy
| | - Gabriella Cadoni
- Otorhinolaryngology Unit, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Otolaryngology Institute, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Goulioumis AK, Kourelis K, Gkorpa M, Danielides V. Pathogenesis of Nasal Polyposis: Current Trends. Indian J Otolaryngol Head Neck Surg 2023; 75:733-741. [PMID: 37206761 PMCID: PMC10188681 DOI: 10.1007/s12070-022-03247-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/13/2022] [Indexed: 12/07/2022] Open
Abstract
Chronic Rhinosinusitis (CRS) is characterized by edema of the sub-epithelial layers, but, only specific types of CRS are developing polyps. Nasal polyposis may develop under different pathogenetic mechanisms rendering the typical macroscopic classification of CRS, with or without nasal polyps, rather deficient. Currently, we approach nasal polyposis, in terms of diagnosis and treatment, according to its endotype, which means that we focus on the specific cells and cytokines that are participating in its pathogenesis. It appears that the molecular procedures that contribute to polyp formation, initiating with a Th-2 response of the adaptive immune system, are local phenomena occurring in the sub-epithelial layers of the mucosa. Several hypotheses are trying to approach the etiology that drives the immune response towards Th-2 type. Extrinsic factors, like fungi, Staphylococcus superantigens, biofilms, and altered microbiome can contribute to a modified and intense local reaction of the immune system. Some hypotheses based on intrinsic factors like the elimination of Treg lymphocytes, low local vitamin-D levels, high levels of leukotrienes, epithelial to mesenchymal transition (EMT) induced by hypoxia, and altered levels of NO, add pieces to the puzzle of the pathogenesis of nasal polyposis. Currently, the most complete theory is that of epithelial immune barrier dysfunction. Intrinsic and extrinsic conditions can damage the epithelial barrier rendering sub-epithelial layers more vulnerable to invasion by pathogens that trigger a Th-2 response of the adaptive immune system. Th2 cytokines, subsequently, induce the accumulation of eosinophils and IgE together with the remodeling of the stroma in the sub-epithelial layers leading, eventually, to the formation of nasal polyps.
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Affiliation(s)
- Anastasios K. Goulioumis
- Department of Otorhinolaryngology, “Karamandanion” Pediatric Hospital of Patras, Erythrou Stavrou 40, 26331 Patras, Greece
- Anatomy Department, School of Medicine of the University of Patras, Patras, Greece
| | - Konstantinos Kourelis
- Department of Otorhinolaryngology, “Karamandanion” Pediatric Hospital of Patras, Erythrou Stavrou 40, 26331 Patras, Greece
| | | | - Vasilios Danielides
- Department of Otorhinolaryngology, University Hospital of Patras, Patras, Greece
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De Corso E, D'Amato M, Carpagnano GE, Pelaia G, Bonini M. The Comorbid Patient in the Spotlight: Efficacy of Benralizumab on Chronic Rhinosinusitis with Nasal Polyp Outcomes in Presence of Severe Asthma. Curr Allergy Asthma Rep 2023; 23:237-248. [PMID: 36995525 DOI: 10.1007/s11882-023-01074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW The present review aims to systematically assess published data to elucidate benralizumab efficacy on nasal outcomes in comorbid patients. RECENT FINDINGS Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease of the nasal cavity often associated with severe asthma (SA), contributing to a global disease burden in asthmatics. The two pathologies share common underlying mechanisms (e.g., type-2 inflammation), which sustain symptoms and poor comorbid patient quality of life. Therefore, it is of primary importance to identify the correct therapeutic option in order to achieve the optimal management of patients affected by both pathologies. Benralizumab is a humanized monoclonal antibody directed at the α subunit of the interleukin-5 receptor (IL-5Rα) approved for the treatment of severe eosinophilic asthma. Increasing body of literature provides data on its efficacy also on CRSwNP in the comorbid SA patient. Based on the data described in this review, when benralizumab is administered to comorbid patients, it does not only control severe asthma but also improves CRSwNP clinical outcomes, although we need further studies to add stronger evidence and to improve the correct pheno-endotyping of the comorbid patient.
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Affiliation(s)
- Eugenio De Corso
- Otolaryngology Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy.
| | - Maria D'Amato
- UOSD Malattie Respiratorie "Federico II", Ospedale Monaldi, AO Dei Colli, Naples, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
| | - Girolamo Pelaia
- Dipartimento Di Scienze Della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
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Maspero JF, Bachert C, Martinez FJ, Hanania NA, Ortiz B, Patel N, Mannent LP, Praestgaard A, Pandit-Abid N, Siddiqui S, Hardin M. Clinical Efficacy among Patients with Chronic Rhinosinusitis with Nasal Polyps and Clinical Features of Obstructive Lung Disease: Post Hoc Analysis of the Phase III SINUS-24 and SINUS-52 Studies. J Asthma Allergy 2023; 16:333-342. [PMID: 37026112 PMCID: PMC10072142 DOI: 10.2147/jaa.s357393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/17/2022] [Indexed: 04/03/2023] Open
Abstract
Purpose To provide a descriptive summary of clinical efficacy and health-related quality of life (HRQoL) measures in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and clinical features of obstructive lung disease in the Phase III dupilumab studies SINUS-24 and SINUS-52 (NCT02912468, NCT02898454). Patients and Methods Patients met a "broad" definition of having clinical features of obstructive lung disease with any of 3 criteria: (i) pre-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70 and smoking history; (ii) patient-reported medical history of chronic obstructive pulmonary disease (COPD); or (iii) asthma with >10 pack-years' smoking history. A "narrow" definition including criteria (i) or (ii) was also analyzed. CRSwNP and HRQoL measures were evaluated in all patients and lung function (FEV1; FEV1/FVC ratio) was captured and analyzed only in those patients who had a self-reported history of asthma. Results Across both studies, 131 patients met the "broad" definition, of whom 90 also had asthma, and 115 patients met the "narrow" definition, of whom 74 had asthma. CRSwNP outcomes and HRQoL were improved with dupilumab vs placebo in both the broad and narrow subgroups. Among the 90 patients who met the broad definition and had asthma, dupilumab improved pre-bronchodilator FEV1 and FEV1/FVC ratio at Week 16 (least squares mean differences vs placebo: 0.38 L [95% confidence interval: 0.17, 0.59; p = 0.0004] and 4.8% [1.7%, 7.9%; p = 0.0024], respectively) sustained through Week 24. Similar results were seen in the "narrow" subgroup with asthma. Conclusion In a population of patients with CRSwNP and clinical features of obstructive lung disease, dupilumab improved CRSwNP and HRQoL outcomes, and, among those with a history of asthma, also improved lung function. These results support further analyses of dupilumab in patients with evidence of type 2 inflammation and obstructive lung disease such as COPD.
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Affiliation(s)
- Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
- Correspondence: Jorge F Maspero, Allergy and Respiratory Research Unit, Fundación CIDEA, Paraguay 2035, Buenos Aires, C1121ABE, Argentina, Tel +54 91141837294, Email
| | - Claus Bachert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin Ortiz
- Immunology and Allergy Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Naimish Patel
- Immunology and Inflammation, Sanofi, Cambridge, MA, USA
| | - Leda P Mannent
- Global Clinical Development, Sanofi, Chilly-Mazarin, France
| | | | | | - Shahid Siddiqui
- Immunology and Allergy Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Megan Hardin
- Immunology and Inflammation, Sanofi, Cambridge, MA, USA
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Seah JJ, Thong M, Wang DY. The Diagnostic and Prognostic Role of Biomarkers in Chronic Rhinosinusitis. Diagnostics (Basel) 2023; 13:diagnostics13040715. [PMID: 36832203 PMCID: PMC9955000 DOI: 10.3390/diagnostics13040715] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Chronic rhinosinusitis (CRS) refers to an inflammatory disease of the sinonasal mucosa, with a significant economic burden and impact on quality of life. The diagnosis of CRS is conventionally made on careful history and physical examination, including nasoendoscopic assessment which requires technical expertise. There has been increasing interest in using biomarkers in the non-invasive diagnosis and prognostication of CRS, tailored to the disease inflammatory endotype. Potential biomarkers currently being studied can be isolated from peripheral blood, exhaled nasal gases or nasal secretions, as well as sinonasal tissue. In particular, various biomarkers have revolutionized the way in which CRS is managed, revealing new inflammatory pathways where novel therapeutic drugs are employed to curb the inflammatory process, which may be different from one patient to the next. Biomarkers that have been extensively studied in CRS, such as eosinophil count, IgE, and IL-5, have been associated with a TH2 inflammatory endotype which correlates with an eosinophilic CRSwNP phenotype that predicts a poorer prognosis, tends to recur after conventional surgical treatment, but responds to glucocorticoid treatment. Newer biomarkers that demonstrate potential, such as nasal nitric oxide, can support a diagnosis of CRS with or without nasal polyps, especially when invasive tests such as nasoendoscopy are unavailable. Other biomarkers such as periostin can be used to monitor disease course after treatment of CRS. With a personalized treatment plan, the management of CRS can be individualized, optimizing treatment efficiency and reducing adverse outcomes. As such, this review aims to compile and summarize the existing literature regarding the utility of biomarkers in CRS in terms of diagnosis and prognostication, and also makes recommendations for further studies to fill current knowledge gaps.
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Affiliation(s)
- Jun Jie Seah
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Mark Thong
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Correspondence:
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Mitchell MB, Workman AD, Lee SE. Clinically meaningful changes in efficacy outcomes in chronic rhinosinusitis with nasal polyposis. Curr Opin Allergy Clin Immunol 2023; 23:9-13. [PMID: 36539378 DOI: 10.1097/aci.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) carries a high disease burden, and many studies have been done investigating the efficacy of various medical and surgical therapies. However, outcome metrics have varied across these studies, making it difficult to compare therapeutic efficacy on a large scale. In this article, we discuss various outcome metrics used across prior studies as well as the relationship between these measures. RECENT FINDINGS Outcome metrics in CRSwNP studies include both clinically assessed and patient-reported outcome measures (PROMs). The former includes olfaction testing, scoring systems based on imaging and endoscopic evaluation, and histopathological and immunohistochemical evaluation of sinus tissue, and the latter includes quality-of-life instruments, symptom severity scales, and disease-control instruments. Recent studies evaluating the efficacy of new biologics have used a combination of both types of metrics. SUMMARY Both clinical metrics and patient-reported outcomes provide utility in evaluating disease severity and control in patients with CRSwNP, although there are nuances when comparing therapies in this population as patients with CRSwNP are heterogeneous and may have symptoms across several domains. However, PROMs in conjunction with clinical metrics provide useful information to assess patient symptoms and response to interventions.
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Affiliation(s)
- Margaret B Mitchell
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alan D Workman
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stella E Lee
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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36
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Jin P, Zhao Q, Zang Y, Zhang Q, Shen C, Zhang H, Zhang H, Zhi L. A Google Trends analysis revealed global public interest and awareness of nasal polyps. Eur Arch Otorhinolaryngol 2023; 280:2831-2839. [PMID: 36642736 PMCID: PMC9840878 DOI: 10.1007/s00405-022-07814-9] [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: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Nasal polyps (NPs) is a common upper airway inflammatory disorder with a huge negative burden on both the quality of life and costs to patients. However, NPs patients remain undiagnosed and untreated in a timely, which may be due to a lack of disease-related awareness. Google Trends (GT) is an online and open tool, which can provide real-world data on health informatics worldwide. OBJECTIVES This study aimed to explore global public interest and awareness in nasal polyps (NPs) by performing a GT analysis. METHODS Data on relative search volume (RSV) for NPs globally were collected by the public website Google Trends from January 2007 to December 2021. Top-related topics, rising-related topics, and regions were extracted for further analysis. Seasonal variation analysis, the latitude difference analysis, and the rising-related topics between the developed countries and the developing countries were analyzed. A P value less than 0.05 was considered statistically significant. RESULTS The average searching strength showed an overall increasing trend, although with slight fluctuation. The public interest of NPs focuses on the symptoms and treatment for NPs and changes with time. For seasonal variation countries, the peak for the RSV occurred in winter and the bottom in summer. A region in higher latitudes may yield more RSV than that in lower latitudes. The rising-related topics in the recent 5 years reflected the significant differences in treatment and public interest of NPs between the developed and developing countries. CONCLUSIONS Google Trends analysis revealed global public interest and awareness of the evolution of trends and related topics in nasal polyps over time. Geographic distribution and seasonal variation may be potential trigger factors for NPs, and the public's interest in treatment especially biologics is rising.
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Affiliation(s)
- Peng Jin
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Qiuliang Zhao
- grid.410638.80000 0000 8910 6733Department of Otolaryngology, The Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yiran Zang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Qinqin Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Chaofan Shen
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Hongyang Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Hongping Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Lili Zhi
- grid.452422.70000 0004 0604 7301Department of Allergy, Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250013 Shandong China
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Lin L, Cheng L. Current and Emerging Treatment Options in Sinus and Nasal Diseases: A Promising Future in the Appropriate Therapies. J Clin Med 2022; 11:7398. [PMID: 36556014 PMCID: PMC9788022 DOI: 10.3390/jcm11247398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is an inflammatory condition of the nose and paranasal sinuses defined by clinical symptoms, including two or more symptoms, one of which should be either nasal blockage or nasal discharge with or without facial pain/pressure or reduction in/loss of sense of smell [...].
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Affiliation(s)
- Lin Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
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A decreased prevalence of group 2 innate lymphoid cells in blood is associated with good postoperative outcomes in patients with chronic rhinosinusitis. Auris Nasus Larynx 2022:S0385-8146(22)00224-3. [DOI: 10.1016/j.anl.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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Chang GH, Yang PR, Cheng YC, Hsu KH, Wu CY, Yang YH, Lin YS, Hsu CM, Tsai MS, Tsai YT, Chang PJ. Nasal irrigation with licorice extract (Glycyrrhiza glabra) in treating nasal polyps by reducing fibroblast differentiation and extracellular matrix production in TGF-β1-stimulated nasal polyp-derived fibroblasts by inhibiting the MAPK/ERK-1/2 pathway - an in vitro and in clinic study. BMC Complement Med Ther 2022; 22:313. [PMID: 36447209 PMCID: PMC9706886 DOI: 10.1186/s12906-022-03791-y] [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: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To date, treating nasal polyps (NPs) is still a medical challenge. However, we have developed an innovative therapy using licorice extract (LE: Glycyrrhiza glabra) to treat rhinitis and sinusitis via nasal irrigation and have discovered that it significantly affects treatment of NPs. HYPOTHESIS/PURPOSE This study investigated the mechanism of LE on NPs. STUDY DESIGN NPs were collected from three patients using tissue biopsies before and 2 weeks after nasal irrigation with licorice for histopathological analysis. Additionally, NPs from two patients were collected, and nasal polyp-derived fibroblasts (NPDF) were isolated and cultured. METHODS The TGF-β1-stimulated NPDF model was used to examine the effect of LE on fibroblast differentiation (biomarker: α-SMA), the consequent production of extracellular matrix (ECM; biomarkers: fibronectin, FBN), and the functional signaling pathway. RESULTS Immunohistochemistry (IHC) revealed that the number of eosinophils and the expression of α-SMA and interstitial collagen of polyps after licorice treatment significantly decreased. Additionally, RT-PCR, western blotting, and immunofluorescence (IF) showed that α-SMA and FBN expressions were significantly increased in the NPDF, which was stimulated by TGF-β1, and LE dose-dependently could effectively reduce this effect. Furthermore, western blotting showed that LE could attenuate α-SMA and FBN expressions by preventing the signaling pathway of MAPK/ERK-1/2, which IHC and IF further confirmed. In addition, LE effectively suppressed the cell migration of NPDF, which is related to polyp expansion. CONCLUSION LE is clinically used to treat sinusitis with NPs through nasal irrigation, which significantly reduces the size of NPs. This effect could attenuate fibroblast differentiation, ECM production and cell migration, and one of the functional mechanisms may be through inhibition of the MAPK/ERK-1/2 signaling pathway. TRIAL REGISTRATION ISRCTN (No. 51425529) registered on 17/04/2020 (retrospectively registered) - http://www.isrctn.com/ISRCTN51425529.
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Affiliation(s)
- Geng-He Chang
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.454212.40000 0004 1756 1410Head and Neck Infection Treatment Center, Chang Gung memorial Hospital, Chiayi, Taiwan
| | - Pei-Rung Yang
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Cheng
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ke-Hsin Hsu
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Yuan Wu
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shih Lin
- grid.454212.40000 0004 1756 1410Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pey-Jium Chang
- grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Gevaert P, Han JK, Smith SG, Sousa AR, Howarth PH, Yancey SW, Chan R, Bachert C. The roles of eosinophils and interleukin-5 in the pathophysiology of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2022; 12:1413-1423. [PMID: 35243803 PMCID: PMC9790271 DOI: 10.1002/alr.22994] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 12/30/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is generally associated with eosinophilic tissue infiltration linked to type 2 inflammation and characterized by elevated levels of interleukin (IL)-5 and other type 2 inflammatory mediators. Although distinct and overlapping contributions of eosinophils and IL-5 to CRSwNP pathology are still being explored, they are both known to play an important role in NP inflammation. Eosinophils secrete numerous type 2 inflammatory mediators including granule proteins, enzymes, cytokines, chemokines, growth factors, lipids, and oxidative products. IL-5 is critical for the differentiation, migration, activation, and survival of eosinophils but is also implicated in the biological functions of mast cells, basophils, innate lymphoid cells, B cells, and epithelial cells. Results from clinical trials of therapeutics that target type 2 inflammatory mediators (including but not limited to anti-IL-5, anti-immunoglobulin-E, and anti-IL-4/13) may provide further evidence of how eosinophils and IL-5 contribute to CRSwNP. Finally, the association between eosinophilia/elevated IL-5 and greater rates of NP recurrence after endoscopic sinus surgery (ESS) suggests that these mediators may have utility as biomarkers of NP recurrence in diagnosing and assessing the severity of CRSwNP. This review provides an overview of eosinophil and IL-5 biology and explores the literature regarding the role of these mediators in CRSwNP pathogenesis and NP recurrence following ESS. Based on current published evidence, we suggest that although eosinophils play a key role in CRSwNP pathophysiology, IL-5, a cytokine that activates these cells, also represents a pertinent and effective treatment target in patients with CRSwNP.
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Affiliation(s)
- Philippe Gevaert
- Upper Airway Research LaboratoryDepartment of OtorhinolaryngologyGhent University HospitalGhentBelgium
| | | | - Steven G. Smith
- Respiratory Medical Franchise, GSKResearch Triangle ParkNorth CarolinaUSA
| | - Ana R. Sousa
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Peter H. Howarth
- Clinical and Experimental SciencesFaculty of Medicine, University of Southampton and NIHR Respiratory Biomedical Research UnitSouthampton General HospitalSouthamptonUK,Global Respiratory Franchise, GSKBrentfordMiddlesexUK
| | - Steven W. Yancey
- Respiratory Medical Franchise, GSKResearch Triangle ParkNorth CarolinaUSA
| | - Robert Chan
- Clinical Sciences, Respiratory, GSKBrentfordMiddlesexUK
| | - Claus Bachert
- Upper Airway Research LaboratoryDepartment of OtorhinolaryngologyGhent University HospitalGhentBelgium,Division of ENT DiseasesCLINTECKarolinska InstituteStockholmSweden
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41
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Pavlov VE, Pervakova MY, Kuznetsova DA, Blinova TV, Surkova EA, Lapin SV, Polushin YS. Effect of Dexamethasone and Lidocaine on the Cytokine Profile and Bleeding during Endoscopic Rhinosinus Surgery. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-5-40-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective: to evaluate the feasibility of using dexamethasone and lidocaine to potentiate the effect of anesthesia in patients with chronic polypous rhinosinusitis during functional endoscopic sinus surgery (FESS) interventions.Subjects and Methods. Clinical data, blood serum samples were collected prospectively from 52 patients who underwent FESS intervention. The patients were divided into 3 groups: Control Group ‒ C (n = 26), anti-inflammatory drugs were not administered; Dexamethasone Group ‒ D (n = 13), dexamethasone was administered (0.10‒0.15 mg/kg); and Lidocaine Group ‒ L (n = 13), a 1% solution of lidocaine was administered intravenously. The following parameters were studied: IL-6, IL-10, IL-18, alpha1-antitrypsin, and ferritin.Results. An increase of IL-6, IL-6/IL-10 was observed in Group C. An increase of IL-10 and a decrease of IL-6, IL-6/IL-10 were noted in Group D. In Group L, IL-6, IL-6/IL-10 did not change significantly. The intensity of bleeding was lower in Groups L (p < 0.001) and D (p < 0.05) versus Group C. Relative changes in the concentration of biomarkers within the normal range were detected in all groups.Conclusions. Changes in the cytokine profile are insignificant in patients with chronic polyposis rhinosinusitis during FESS performed under combined anesthesia.No convincing data on the need for intraoperative use of dexamethasone or intravenous lidocaine have been received.
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Affiliation(s)
- V. E. Pavlov
- Pavlov First Saint Petersburg State Medical University
| | | | | | - T. V. Blinova
- Pavlov First Saint Petersburg State Medical University
| | - E. A. Surkova
- Pavlov First Saint Petersburg State Medical University
| | - S. V. Lapin
- Pavlov First Saint Petersburg State Medical University
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Yin X, Bose D, Kwon A, Hanks SC, Jackson AU, Stringham HM, Welch R, Oravilahti A, Fernandes Silva L, Locke AE, Fuchsberger C, Service SK, Erdos MR, Bonnycastle LL, Kuusisto J, Stitziel NO, Hall IM, Morrison J, Ripatti S, Palotie A, Freimer NB, Collins FS, Mohlke KL, Scott LJ, Fauman EB, Burant C, Boehnke M, Laakso M, Wen X. Integrating transcriptomics, metabolomics, and GWAS helps reveal molecular mechanisms for metabolite levels and disease risk. Am J Hum Genet 2022; 109:1727-1741. [PMID: 36055244 PMCID: PMC9606383 DOI: 10.1016/j.ajhg.2022.08.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2023] Open
Abstract
Transcriptomics data have been integrated with genome-wide association studies (GWASs) to help understand disease/trait molecular mechanisms. The utility of metabolomics, integrated with transcriptomics and disease GWASs, to understand molecular mechanisms for metabolite levels or diseases has not been thoroughly evaluated. We performed probabilistic transcriptome-wide association and locus-level colocalization analyses to integrate transcriptomics results for 49 tissues in 706 individuals from the GTEx project, metabolomics results for 1,391 plasma metabolites in 6,136 Finnish men from the METSIM study, and GWAS results for 2,861 disease traits in 260,405 Finnish individuals from the FinnGen study. We found that genetic variants that regulate metabolite levels were more likely to influence gene expression and disease risk compared to the ones that do not. Integrating transcriptomics with metabolomics results prioritized 397 genes for 521 metabolites, including 496 previously identified gene-metabolite pairs with strong functional connections and suggested 33.3% of such gene-metabolite pairs shared the same causal variants with genetic associations of gene expression. Integrating transcriptomics and metabolomics individually with FinnGen GWAS results identified 1,597 genes for 790 disease traits. Integrating transcriptomics and metabolomics jointly with FinnGen GWAS results helped pinpoint metabolic pathways from genes to diseases. We identified putative causal effects of UGT1A1/UGT1A4 expression on gallbladder disorders through regulating plasma (E,E)-bilirubin levels, of SLC22A5 expression on nasal polyps and plasma carnitine levels through distinct pathways, and of LIPC expression on age-related macular degeneration through glycerophospholipid metabolic pathways. Our study highlights the power of integrating multiple sets of molecular traits and GWAS results to deepen understanding of disease pathophysiology.
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Affiliation(s)
- Xianyong Yin
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Debraj Bose
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Annie Kwon
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Sarah C Hanks
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Anne U Jackson
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Heather M Stringham
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Ryan Welch
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Anniina Oravilahti
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio 70210, Finland
| | - Lilian Fernandes Silva
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio 70210, Finland
| | - Adam E Locke
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO 63108, USA
| | - Christian Fuchsberger
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Institute for Biomedicine, Eurac Research, Bolzano 39100, Italy
| | - Susan K Service
- Center for Neurobehavioral Genetics, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Michael R Erdos
- Molecular Genetics Section, Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lori L Bonnycastle
- Molecular Genetics Section, Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio 70210, Finland; Center for Medicine and Clinical Research, Kuopio University Hospital, Kuopio 70210, Finland
| | - Nathan O Stitziel
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO 63108, USA; Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA; Department of Genetics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Ira M Hall
- Center for Genomic Health, Department of Genetics, Yale University, New Haven, CT 06510, USA
| | - Jean Morrison
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki 00290, Finland; Department of Public Health, University of Helsinki, Helsinki 00014, Finland; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki 00290, Finland; Department of Public Health, University of Helsinki, Helsinki 00014, Finland; Analytic and Translational Genetics Unit, Department of Medicine, Department of Neurology, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nelson B Freimer
- Center for Neurobehavioral Genetics, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Francis S Collins
- Molecular Genetics Section, Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura J Scott
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Eric B Fauman
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development and Medical, Cambridge, MA 02139, USA
| | - Charles Burant
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio 70210, Finland.
| | - Xiaoquan Wen
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
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Toppila‐Salmi S, Hällfors J, Aakko J, Mannerström B, Nieminen K, Telg G, Lehtimäki L. The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland. Clin Transl Allergy 2022; 12:e12200. [PMID: 36246729 PMCID: PMC9549071 DOI: 10.1002/clt2.12200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is commonly associated with asthma. Treatment of CRSwNP includes intranasal and systemic corticosteroids, with non-responsive patients commonly considered for endoscopic sinus surgery (ESS). This nationwide register-based study evaluated the incidence, prevalence, and treatment burden of CRSwNP in Finland, and their association with the presence and severity of comorbid asthma. Methods Electronic health records of patients diagnosed with CRSwNP between 1.1.2012 and 31.12.2018 in Finnish specialty and primary care were included in the study. The patients were divided into subgroups based on presence, severity, and control of asthma: no asthma, mild to moderate asthma, severe controlled asthma, and severe uncontrolled asthma. A mean cumulative count of ESS was calculated over time per subgroup. Results The prevalence of CRSwNP increased from 602.2 to 856.7 patients per 100,000 population between years 2012 and 2019 (p < 0.001). A total of 18,563 patients (59.9% male) had incident CRSwNP between 2012 and 2019, with 27% having asthma, 6% having severe asthma, and 1.5% having severe uncontrolled asthma. In the no asthma, severe controlled asthma, and severe uncontrolled asthma subgroups, systemic corticosteroids were used by 54.1%, 94.9% and 99.3% (p < 0.001), respectively, while the ESS count 3 years post diagnosis was 0.49, 0.68 and 0.80, respectively. Conclusions The prevalence of CRSwNP showed a significant increase in the recent decade in Finland. Comorbid asthma, and in particular severe asthma, increased the probability of receiving systemic corticosteroids and undergoing ESS. Thus, improved management of CRSwNP in patients with comorbid asthma is urgently needed.
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Affiliation(s)
- Sanna Toppila‐Salmi
- Department of AllergologyDepartment of Pulmonary Medicine, Heart and Lung CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | | | | | | | | | - Lauri Lehtimäki
- Faculty of Medicine and Health TechnologyTampere University Respiratory Research GroupTampere UniversityTampereFinland
- Allergy CentreTampere University HospitalTampereFinland
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Nordström A, Jangard M, Svedberg M, Ryott M, Kumlin M. Levels of eicosanoids in nasal secretions associated with nasal polyp severity in chronic rhinosinusitis. Prostaglandins Leukot Essent Fatty Acids 2022; 184:102474. [PMID: 35917595 DOI: 10.1016/j.plefa.2022.102474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 12/29/2022]
Abstract
Severe nasal polyposis and mucosal inflammation, in patients with chronic rhinosinusitis (CRS) may include a dysregulated eicosanoid profile, but a clinical role for eicosanoids in CRS with nasal polyps (NP; CRSwNP) remains to be elucidated. This study focused on assessing levels and clinical implications of inflammatory mediators in nasal secretions and urine from patients with different NP severity or Aspirin Exacerbated Respiratory Disease (AERD). Levels of leukotrienes E4 and B4, prostaglandins D2 and E2 as well as 15(S)-hydroxyeicosatetraenoic acid were measured with enzyme immunoassays and cytokines with magnetic bead immunoassays. Patients with CRSwNP were subdivided based on NP score; CRSwNP-low (NP score ≤ 4, n = 11) or CRSwNP-high (NP score ≥ 5, n = 32) and compared to CRS without polyps (CRSsNP, n = 12), CRSwNP-AERD (n = 11) and individuals without CRS (n = 25). Smell test score, fractional exhaled nitric oxide (FeNO), blood eosinophils and Sinonasal outcome test-22 were assessed as clinical markers. Leukotriene E4, prostaglandin D2 and 15(S)-hydroxyeicosatetraenoic acid in nasal secretions correlated with NP score. Nasal leukotriene E4 also correlated with FeNO and smell test score, with highest levels found in CRSwNP-AERD. Levels of prostaglandin D2 in nasal secretion as well as urinary levels of the prostaglandin D2 metabolite 11β-prostaglandin F2α differed between CRSNP-high and CRSwNP-low. Urinary 11β-prostaglandin F2α was associated with asthma comorbidity whereas a similar association with prostaglandin D2 in nasal secretions was not observed. In conclusion, subdividing patients based on NP severity in combination with analysis of eicosanoids in non-invasively collected nasal secretions, may have clinical implications when assessing CRS disease severity.
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Affiliation(s)
- Axel Nordström
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
| | - Mattias Jangard
- Department of Otorhinolaryngology, Sophiahemmet Hospital, Stockholm, Sweden
| | - Marie Svedberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Michael Ryott
- Department of Otorhinolaryngology, Sophiahemmet Hospital, Stockholm, Sweden
| | - Maria Kumlin
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
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Nasal Microbiota, Olfactory Health, Neurological Disorders and Aging—A Review. Microorganisms 2022; 10:microorganisms10071405. [PMID: 35889124 PMCID: PMC9320618 DOI: 10.3390/microorganisms10071405] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023] Open
Abstract
The nasal region is one of the distinct environments for the survival of various microbiota. The human microbial niche begins to inhabit the human body right from birth, and the microbiota survive as commensals or opportunistic pathogens throughout the life of humans in their bodies in various habitats. These microbial communities help to maintain a healthy microenvironment by preventing the attack of pathogens and being involved in immune regulation. Any dysbiosis of microbiota residing in the mucosal surfaces, such as the nasal passages, guts, and genital regions, causes immune modulation and severe infections. The coexistence of microorganisms in the mucosal layers of respiratory passage, resulting in infections due to their co-abundance and interactions, and the background molecular mechanisms responsible for such interactions, need to be considered for investigation. Additional clinical evaluations can explain the interactions among the nasal microbiota, nasal dysbiosis and neurodegenerative diseases (NDs). The respiratory airways usually act as a substratum place for the microbes and can act as the base for respiratory tract infections. The microbial metabolites and the microbes can cross the blood–brain barrier and may cause NDs, such as Parkinson’s disease (PD), Alzheimer’s disease (AD), and multiple sclerosis (MS). The scientific investigations on the potential role of the nasal microbiota in olfactory functions and the relationship between their dysfunction and neurological diseases are limited. Recently, the consequences of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) in patients with neurological diseases are under exploration. The crosstalk between the gut and the nasal microbiota is highly influential, because their mucosal regions are the prominent microbial niche and are connected to the olfaction, immune regulation, and homeostasis of the central nervous system. Diet is one of the major factors, which strongly influences the mucosal membranes of the airways, gut, and lung. Unhealthy diet practices cause dysbiosis in gut microbiota and the mucosal barrier. The current review summarizes the interrelationship between the nasal microbiota dysbiosis, resulting olfactory dysfunctions, and the progression of NDs during aging and the involvement of coronavirus disease 2019 in provoking the NDs.
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Maspero J, Adir Y, Al-Ahmad M, Celis-Preciado CA, Colodenco FD, Giavina-Bianchi P, Lababidi H, Ledanois O, Mahoub B, Perng DW, Vazquez JC, Yorgancioglu A. Type 2 inflammation in asthma and other airway diseases. ERJ Open Res 2022; 8:00576-2021. [PMID: 35923421 PMCID: PMC9339769 DOI: 10.1183/23120541.00576-2021] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/22/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic inflammatory airway diseases, including asthma, chronic rhinosinusitis, eosinophilic COPD and allergic rhinitis are a global health concern. Despite the coexistence of these diseases and their common pathophysiology, they are often managed independently, resulting in poor asthma control, continued symptoms and poor quality of life. Understanding disease pathophysiology is important for best treatment practice, reduced disease burden and improved patient outcomes. The pathophysiology of type 2 inflammation is driven by both the innate immune system triggered by pollutants, viral or fungal infections involving type 2 innate lymphoid cells (ILC2) and the adaptive immune system, triggered by contact with an allergen involving type 2 T-helper (Th2) cells. Both ILC2 and Th2 cells produce the type-2 cytokines (interleukin (IL)-4, IL-5 and IL-13), each with several roles in the inflammation cascade. IL-4 and IL-13 cause B-cell class switching and IgE production, release of pro-inflammatory mediators, barrier disruption and tissue remodelling. In addition, IL-13 causes goblet-cell hyperplasia and mucus production. All three interleukins are involved in trafficking eosinophils to tissues, producing clinical symptoms characteristic of chronic inflammatory airway diseases. Asthma is a heterogenous disease; therefore, identification of biomarkers and early targeted treatment is critical for patients inadequately managed by inhaled corticosteroids and long-acting β-agonists alone. The Global Initiative for Asthma guidelines recommend add-on biological (anti IgE, IL-5/5R, IL-4R) treatments for those not responding to standard of care. Targeted therapies, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab, were developed on current understanding of the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases.
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Affiliation(s)
- Jorge Maspero
- Fundacion CIDEA (Centro de Investigacion de Enfermedades Alergicas y Respiratorias), University of Buenos Aires, Buenos Aires, Argentina
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion, Institute of Technology, Haifa, Israel
| | - Mona Al-Ahmad
- Microbiology Dept, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Carlos A. Celis-Preciado
- Pulmonary Unit, Internal Medicine Department, Hospital Universitario San Ignacio, Bogota, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Federico D. Colodenco
- Pulmonology, Hospital De Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Bassam Mahoub
- Dept of Pulmonary Medicine and Allergy and Sleep Medicine, Rashid Hospital, Dubai, United Arab Emirates
- Dept of Medicine and Chest Disease, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Juan C. Vazquez
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Arzu Yorgancioglu
- Dept of Chest Diseases, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Wang F, Chu W, Deng Z, Jing Q, Xie B. A Potential Role of B7-H4 Expression in Predicting the Recurrence of Chronic Rhinosinusitis with Nasal Polyps. J Inflamm Res 2022; 15:3421-3431. [PMID: 35711239 PMCID: PMC9192352 DOI: 10.2147/jir.s361868] [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: 02/16/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic rhinosinusitis with polyps (CRSwNP) is a common chronic inflammatory disease of the nasal cavity and sinuses with a high rate of postoperative recurrence. In this study, we aim to investigate the expression of B7-H4 in CRSwNP and its association with postoperative recurrence. Methods A total of 80 CRSwNP patients, including 40 primary CRSwNP (pCRSwNP) patients and 40 recurrent CRSwNP (rCRSwNP) patients, 27 chronic rhinosinusitis without polyps (CRSsNP) and 32 healthy controls (HC) were enrolled in this study, and the serum, nasal polyps and middle turbinate tissue samples were collected. Peripheral and tissue B7-H4 expressions were detected by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) and immunofluorescence, and their clinical values in predicting postoperative recurrence of CRSwNP were evaluated. Results We identified significantly higher tissue B7-H4 mRNA levels in the CRSwNP group than in the HC group, and elevated B7-H4 levels were associated with tissue eosinophil count and percentage (r = 0.469, P < 0.001; r = 0.521, P < 0.001). B7-H4 mRNA and protein levels were significantly higher in the rCRSwNP group than the pCRSwP group. Multivariate analysis and receiver operating characteristic (ROC) curves showed that tissue B7-H4 levels were associated with postoperative recurrence in patients with CRSwNP (P < 0.05). In addition, serum B7-H4 levels were significantly increased in the CRSwNP group than the CRS and HC groups, especially in the rCRSwNP group (P < 0.05), and the ROC curve presented a predictive ability of serum B7-H4 in predicting postoperative recurrence. Conclusion Our results indicated that B7-H4 level was clearly enhanced in CRSwNP patients and associated with postoperative recurrence. Serum B7-H4 might serve as a simple and convenient biomarker for early predicting postoperative recurrence in CRwNP patients.
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Affiliation(s)
- Fengjun Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Wei Chu
- Department of Pathology, The People's Hospital of Shimen County, Changde, Hunan, People's Republic of China
| | - Zhenghao Deng
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, 410008, People's Republic of China.,Department of Pathology, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Qiancheng Jing
- The Affiliated Changsha Central Hospital, Department of Otolaryngology Head and Neck Surgery, Hengyang Medical School, University of South China, Changsha, Hunan, People's Republic of China
| | - Bin Xie
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, 410008, People's Republic of China.,Department of Pathology, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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Construction and analysis of a ceRNA network and patterns of immune infiltration in chronic rhinosinusitis with nasal polyps: based on data mining and experimental verification. Sci Rep 2022; 12:9735. [PMID: 35697826 PMCID: PMC9192587 DOI: 10.1038/s41598-022-13818-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Recent studies have revealed the significant role of the competing endogenous RNA (ceRNA) network in human diseases. However, systematic analysis of the ceRNA mechanism in chronic rhinosinusitis with nasal polyps (CRSwNP) is limited. In this study, we constructed a competitive endogenous RNA (ceRNA) network and identified a potential regulatory axis in CRSwNP based on bioinformatics analysis and experimental verification. We obtained lncRNA, miRNA, and mRNA expression profiles from the Gene Expression Omnibus. After analysis of CRSwNP patients and the control groups, we identified 565 DE-lncRNAs, 23 DE-miRNAs, and 1799 DE-mRNAs by the DESeq2 R package or limma R package. Enrichment analysis of 1799 DE-mRNAs showed that CRSwNP was associated with inflammation and immunity. Moreover, we identified 21 lncRNAs, 8 miRNAs and 8 mRNAs to construct the lncRNA-miRNA-mRNA ceRNA network. A potential MIAT/miR-125a/IRF4 axis was determined according to the degree and positive correlation between a lncRNA and its competitive endogenous mRNAs. The GSEA results suggested that IRF4 may be involved in immune cell infiltration. The validation of another dataset confirmed that MIAT and IRF4 were differentially expressed between the CRSwNP and control groups. The area under the ROC curve (AUC) of MIAT and IRF4 was 0.944. The CIBERSORT analysis revealed that eosinophils and M2 macrophages may be involved in the CRSwNP process. MIAT was correlated with dendritic cells and M2 macrophages, and IRF4 was correlated with dendritic cells. Finally, to validate the key genes, we performed in-silico validation using another dataset and experimental validation using immunohistochemistry, immunofluorescence, and Western blot. In summary, the constructed novel MIAT/miR-125a/IRF4 axis may play a critical role in the development and progression of CRSwNP. We believe that the ceRNA network and immune cell infiltration could offer further insight into novel molecular therapeutic targets for CRSwNP.
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Mullol J, Azar A, Buchheit KM, Hopkins C, Bernstein JA. Chronic Rhinosinusitis With Nasal Polyps: Quality of Life in the Biologics Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1434-1453.e9. [PMID: 35306180 DOI: 10.1016/j.jaip.2022.03.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Chronic rhinosinusitis (CRS) affects up to 12% of the general population and is traditionally divided into two main phenotypic subsets, based on the presence of nasal polyps (CRSwNP) or their absence. It is well-established that many patients with CRSwNP report poor quality of life (QoL), which is further compromised by comorbidities (eg, asthma, bronchiectasis, aspirin-exacerbated respiratory disease). Chronic rhinosinusitis CRS with nasal polyps is managed with a combination of medical therapy and surgical interventions, and biologics are emerging as a promising new treatment option for patients with inadequate response to the standard of care. A range of patient-reported outcome measures have been used to assess QoL for patients with CRSwNP in clinical trials, including disease-specific questionnaires (eg, Sino-Nasal Outcome Test-22) and generic ones (eg, Short Form-36). Significantly impaired QoL has been identified as a criterion for the indication to use biologics in patients with CRSwNP. This review summarizes clinical evidence (2010-2021) on QoL outcomes with currently available treatments for CRSwNP and assesses the improvement in QoL after biologic treatments, especially for patients with comorbidities reported in interventional studies (randomized controlled trials and real-world experience).
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Affiliation(s)
- Joaquim Mullol
- Clinical and Experimental Respiratory Immunoallergy, Hospital Clinic Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universidad de Barcelona, Centro Investigación Biomédica En Red Enfermedades Respiratorias, Barcelona, Spain.
| | - Antoine Azar
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Kathleen M Buchheit
- AERD Center, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Claire Hopkins
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Li K, Liu F. Analysis of competing endogenous RNA (ceRNA) crosstalk in eosinophilic chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2022; 12:1468-1479. [PMID: 35385217 PMCID: PMC10084371 DOI: 10.1002/alr.23008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the most common chronic inflammatory diseases, and has various phenotypes. Although its pathophysiology remains obscure, evidence has shown that dysregulation of noncoding RNAs (ncRNAs) is associated with CRSwNP. ncRNAs in the cytoplasm can act as competing endogenous RNAs (ceRNAs), which are involved in many inflammatory processes. However, the ceRNA crosstalk in CRSwNP is still unclear METHODS: We investigated expression profiles of messenger RNA (mRNA), microRNAs (miRNAs), and long noncoding RNAs (lncRNAs) in eosinophilic CRSwNP and constructed a global triple ceRNA network. RESULTS As a result, 964 differentially expressed mRNAs (DEmRs), 207 differentially expressed miRNAs (DEmiRs), and 15 differentially expressed lncRNAs (DElncRs) were identified, and a ceRNA network containing 598 miRNA-mRNA pairs and 70 lncRNA-miRNA pairs was finally constructed. Gene set enrichment analysis (GSEA) results indicated these DEmRs were mainly enriched in "cytokine-cytokine receptor interaction," "salivary secretion," "hematopoietic cell lineage," and "chemokine signaling pathway." Moreover, we also predicted the subcellular localization of the DElncRs identified in the network via bioinformatics approaches CONCLUSION: In summary, the present study provided the first comprehensive assessment of the ceRNA crosstalk in eosinophilic CRSwNP. These findings will be of interest to the understanding of the potential pathophysiology of this disease.
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Affiliation(s)
- Ke Li
- Department of Blood TransfusionTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fang‐Fang Liu
- Department of PathologyThe Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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