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Eren E, İşlek A, Bakiş YB, Altay S. Multivariate analysis of clinical and radiological risk factors for revision endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: can phenotype predict recurrence? J Laryngol Otol 2024; 138:527-534. [PMID: 37997646 DOI: 10.1017/s0022215123001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. METHOD Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively. RESULTS The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2). CONCLUSION Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.
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Affiliation(s)
- Erdem Eren
- Department of Otolaryngology - Head and Neck Surgery, İzmir Atatürk Research and Education Hospital, İzmir, Turkey and Izmir University of Economics, Faculty of Medicine, Medical Point Hospital, İzmir, Turkey
| | - Akif İşlek
- Otolaryngology - Head and Neck Surgery Clinic, Acıbadem Eskişehir Hospital, Eskişehir, Turkey
| | - Yaşar Batuhan Bakiş
- Department of Otolaryngology - Head and Neck Surgery, İzmir Atatürk Research and Education Hospital, İzmir, Turkey and Izmir University of Economics, Faculty of Medicine, Medical Point Hospital, İzmir, Turkey
| | - Sedat Altay
- Radiology Clinic, İzmir Atatürk Research and Education Hospital, İzmir, Turkey
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Anselmo-Lima WT, Romano FR, Tamashiro E, Roithmann R, Dinarte VRP, Piltcher OB, Miyake MM, Fornazieri MA, Nakanishi M, Bezerra TFP, Dolci RLL, Mello JF, Lessa MM, Voegels RL, Kosugi EM, Sakano E, Valera FCP. Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update. Braz J Otorhinolaryngol 2024; 90:101394. [PMID: 38367543 PMCID: PMC10879704 DOI: 10.1016/j.bjorl.2024.101394] [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: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. OBJECTIVES The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. RESULTS We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. CONCLUSIONS This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
| | - Fabrizio R Romano
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | | | | | - Otavio B Piltcher
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (FAMED-UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil; Santa Casa de Misericórdia, Hospital de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco A Fornazieri
- Universidade Estatual de Londrina, Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUCPR), Câmpus Londrina, Londrina, PR, Brazil
| | - Marcio Nakanishi
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação, Brasilia, DF, Brazil
| | | | | | - João F Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus M Lessa
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Richard L Voegels
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo M Kosugi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual Paulista, Faculdade de Ciências Médicas, Departamento de Oftalmologia/Otorrinolaringologia, Campinas, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Dobrican-Băruța CT, Deleanu DM, Muntean IA, Nedelea I, Bălan RG, Filip GA, Procopciuc LM. The Alarmin Triad-IL-25, IL-33, and TSLP-Serum Levels and Their Clinical Implications in Chronic Spontaneous Urticaria. Int J Mol Sci 2024; 25:2026. [PMID: 38396704 PMCID: PMC10889490 DOI: 10.3390/ijms25042026] [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: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
This study delves into the critical role of alarmins in chronic spontaneous urticaria (CSU), focusing on their impact on disease severity and the quality of life (QoL) of patients. We investigated the alterations in alarmin levels in CSU patients and their correlations with the Urticaria Activity Score (UAS7) and the Dermatology Life Quality Index (DLQI). We analyzed serum levels of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) in 50 CSU patients, comparing these to 38 healthy controls. The study examined the relationship between alarmin levels and clinical outcomes, including disease severity and QoL. Elevated levels of IL-33 and TSLP in CSU patients (p < 0.0001) highlight their potential role in CSU pathogenesis. Although IL-25 showed higher levels in CSU patients, this did not reach statistical significance (p = 0.0823). Crucially, IL-33's correlation with both UAS7 and DLQI scores underscores its potential as a biomarker for CSU diagnosis and severity assessment. Of the alarmins analyzed, IL-33 emerges as particularly significant for further exploration as a diagnostic and prognostic biomarker in CSU. Its substantial correlation with disease severity and impact on QoL makes it a compelling candidate for future research, potentially serving as a target for therapeutic interventions. Given these findings, IL-33 deserves additional investigation to confirm its role and effectiveness as a biomarker and therapeutic target in CSU.
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Affiliation(s)
- Carmen-Teodora Dobrican-Băruța
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Diana Mihaela Deleanu
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Ioana Adriana Muntean
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Irena Nedelea
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Radu-Gheorghe Bălan
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
| | - Gabriela Adriana Filip
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Lucia Maria Procopciuc
- Department of Biochemistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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Yang G, Zeng XH, Geng XR, Liu JQ, Mo LH, Luo XQ, Liu HZ, Zhang YY, Yang LT, Huang QM, Xiao XJ, Liu J, Xu LZ, Liu DB, Liu XY, Liu ZQ, Yang PC. The transcription factor XBP1 in dendritic cells promotes the T H2 cell response in airway allergy. Sci Signal 2023; 16:eabm9454. [PMID: 37368951 DOI: 10.1126/scisignal.abm9454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Dendritic cells (DCs) that express T cell immunoglobulin domain molecule-4 (TIM4), a cell surface receptor for phosphatidylserine, induce T helper 2 (TH2) cell responses and allergic reactions. We elucidated the role of the transcription factor X-box-binding protein-1 (XBP1) in the induction of the TH2 cell response through its role in generating TIM4+ DCs. We found that XBP1 was required for TIM4 mRNA and protein expression in airway DCs in response to the cytokine interleukin-2 (IL-2) and that this pathway was required for TIM4 expression on DCs in response to the allergens PM2.5 and Derf1. The IL-2-XBP1-TIM4 axis in DCs contributed to Derf1/PM2.5-induced, aberrant TH2 cell responses in vivo. An interaction between the guanine nucleotide exchange factor Son of sevenless-1 (SOS1) and the GTPase RAS promoted XBP1 and TIM4 production in DCs. Targeting the XBP1-TIM4 pathway in DCs prevented or alleviated experimental airway allergy. Together, these data suggest that XBP1 is required for TH2 cell responses by inducing the development of TIM4+ DCs, which depends on the IL-2-XBP1-SOS1 axis. This signaling pathway provides potential therapeutic targets for the treatment of TH2 cell-dependent inflammation or allergic diseases.
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Affiliation(s)
- Gui Yang
- Department of Otolaryngology, Head and Neck Surgery, Longgang Central Hospital, Shenzhen, China
| | - Xian-Hai Zeng
- Longgang ENT Hospital, Shenzhen, China
- Shenzhen ENT Institute, Shenzhen, China
| | - Xiao-Rui Geng
- Longgang ENT Hospital, Shenzhen, China
- Shenzhen ENT Institute, Shenzhen, China
| | - Jiang-Qi Liu
- Longgang ENT Hospital, Shenzhen, China
- Shenzhen ENT Institute, Shenzhen, China
| | - Li-Hua Mo
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiang-Qian Luo
- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Hua-Zhen Liu
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
| | - Yuan-Yi Zhang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
| | - Li-Teng Yang
- Department of General Practice Medicine and Respirology, Third Affiliated Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Qin-Miao Huang
- Department of General Practice Medicine and Respirology, Third Affiliated Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Xiao-Jun Xiao
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
| | - Jie Liu
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
| | - Ling-Zhi Xu
- Department of Immunology, Weifang Medical University, Weifang, China
| | - Da-Bo Liu
- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xiao-Yu Liu
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
| | - Zhi-Qiang Liu
- Longgang ENT Hospital, Shenzhen, China
- Shenzhen ENT Institute, Shenzhen, China
| | - Ping-Chang Yang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Shenzhen, China
- Institute of Allergy and Immunology, Shenzhen University School of Medicine and State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Shenzhen, China
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Feist J, Lipari M, Kale-Pradhan P. Tezepelumab in the Treatment of Uncontrolled Severe Asthma. Ann Pharmacother 2023; 57:62-70. [PMID: 35535458 DOI: 10.1177/10600280221095540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To review the pharmacology, efficacy, and safety of subcutaneous tezepelumab in the treatment of severe uncontrolled asthma. DATA SOURCES The PubMed database and ClinicalTrials.gov were searched using the following terms: tezepelumab, Tezspire, AMG157, and MEDI9929. STUDY SELECTION AND DATA EXTRACTION Articles published in English between January 2000 and March 2022 related to pharmacology, safety, and clinical trials were assessed. DATA SYNTHESIS In a phase 2 trial, tezepelumab at low, medium, and high doses reduced the annualized asthma exacerbation rate by 62%, 71%, and 66%, respectively, when compared with placebo (P < 0.001). In addition to significant reduction of asthma exacerbation rate in the overall treatment population, a phase 3 trial showed significant reduction of asthma exacerbation across all subgroups analyzed regardless of serum eosinophil count (EOS), fractionated exhaled nitric oxide (FeNO) level, or allergic status as determined by IgE sensitivity. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Tezepelumab is indicated to treat nonallergic and noneosinophilic severe uncontrolled asthma phenotypes in addition to type 2 inflammatory asthma. When selecting the most appropriate biologic agent, consider the risks, benefits, and costs. There is a paucity of data on the efficacy of tezepelumab in patients with comorbid conditions. In the case of a patient presenting with uncontrolled severe asthma with such comorbid conditions, it may be prudent to consider a biologic therapy that can target both. CONCLUSION Tezepelumab has shown clinical utility in severe uncontrolled asthma regardless of phenotype, fulfilling the need for treatment options in individuals with severe, uncontrolled, noneosinophilic, and nonallergic asthma.
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Affiliation(s)
- Jacqueline Feist
- Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USA
| | - Melissa Lipari
- Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences and Ascension St. John Hospital and Medical Center, Detroit, MI, USA
| | - Pramodini Kale-Pradhan
- Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences and Ascension St. John Hospital, Detroit, MI, USA
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Khan S, Chopra C, Mitchell A, Nakonechna A, Yong P, Karim MY. Resistant Chronic Spontaneous Urticaria - A Case Series Narrative Review of Treatment Options. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2022; 13:21526575221144951. [PMID: 36578314 PMCID: PMC9791268 DOI: 10.1177/21526575221144951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Chronic spontaneous urticaria (CSU) can be extremely debilitating to the patient and challenging for the treating clinician. The National Institute of Health and Clinical Excellence (NICE) in the United Kingdom (UK) recommendation of omalizumab for patients who fail to respond to high-dose anti-histamines has improved treatment options and quality of life. However, there is still lack of clear guidelines for treatment of patients resistant to standard and anti-IgE therapies. Methods We discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies. Results Patients with anti-histamine-resistant urticaria either remained on omalizumab or started on immunosuppressive drugs (dapsone or ciclosporin) when they stopped responding to omalizumab. We used clinical assessment, skin biopsies (when available) and previous published reports to consider dapsone (for predominantly neutrophilic infiltration), or ciclosporin at doses between 2 and 4 mg/kg/day. One patient with ciclosporin-resistant urticaria responded to mycophenolate mofetil. Two patients remain on long-term omalizumab due to its relative safety and efficacy including 1 patient with underlying antibody deficiency where omalizumab was preferred over risks of using immunosuppressive medications. Conclusions These case studies bring to light the real-world difficulties in managing patients with resistant CSU and the need for generating the evidence base on alternative therapeutic options such as synergistic use of biologics and immunosuppressive drugs.
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Affiliation(s)
- Sujoy Khan
- Department of Immunology & Allergy, Queen's Centre, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK,Sujoy Khan, Department of Immunology & Allergy, Queen's Centre, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham HU16 5JQ, UK.
| | - Charu Chopra
- Department of Clinical Immunology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Alla Nakonechna
- Department of Immunology & Allergy, Queen's Centre, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK,University of Liverpool, Liverpool, UK
| | - Patrick Yong
- Department of Immunology & Allergy, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
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Li M, Wen Ma Z, Jun Deng S, Oliver BG, Wang T, Ping Zhang H, Wang L, McDonald VM, Wang J, Liu D, Gibson PG, Ming Luo F, Min Li W, Jing Wan H, Wang G. Development and validation of a noninvasive prediction model for identifying eosinophilic asthma. Respir Med 2022; 201:106935. [DOI: 10.1016/j.rmed.2022.106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
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Increased miR-124-3p alleviates type 2 inflammatory response in allergic rhinitis via IL-4Rα. Inflamm Res 2022; 71:1271-1282. [PMID: 35922673 PMCID: PMC9616750 DOI: 10.1007/s00011-022-01614-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/02/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objectives miRNAs play a crucial role in regulating immune responses. However, the effect of miR-124-3p on type 2 inflammation in allergic rhinitis (AR) is unclear. We aimed to study the immune regulation of miR-124-3p in AR and the mechanisms involved. Methods The direct interaction between miR-124-3p and IL-4Rα was confirmed through a dual-luciferase reporter assay. In vitro splenic lymphocytes from mice and peripheral blood mononuclear cells (PBMCs) from healthy individuals were cultured and treated with miR-124-3p mimic/inhibitor. Twenty-four female C57BL/C mice were divided into four groups: control, AR model, miR-124-3p agomir, and miR-124-3p antagomir groups (n = 6 per group). The allergic responses were evaluated based on the number of sneezing and nasal scratching, the serum HDM-specific IgE (sIgE) levels, and the degree of nasal mucosa eosinophil infiltration. The expression of IL-4Rα, p-STAT6, and type 2 inflammatory cytokines (IL-4, IL-5 and IL-13) in lymphocytes or nasal mucosa was determined by qPCR, western blotting, flow cytometry, immunohistochemistry and immunofluorescence. Results miR-124-3p directly targets the 3'UTR of IL-4Rα. The miR-124-3p mimic lowered the IL-4Rα, p-STAT6, IL-4, IL-5, and IL-13 expression levels in both mouse splenic lymphocytes and human PBMCs in vitro, and the miR-124-3p inhibitor rescued these changes. Furthermore, the miR-124-3p agomir decreased the levels of IL-4Rα and IL-4 in nasal mucosa, Th2 differentiation in spleen, and allergic response in AR mice. Moreover, the miR-124-3p antagonist increased the IL-4Rα and IL-4 levels and further aggravated the allergic responses. Conclusions miR-124-3p might attenuate type 2 inflammation in AR by regulating IL-4Rα signaling, and miR-124-3p may be a promising new target in AR treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00011-022-01614-x.
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Dawson D, Patterson M, Patel A, Vickery C. Where does Allergy Management Fit in Obstructive Sleep Apnea? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Morandini P, Laino ME, Paoletti G, Carlucci A, Tommasini T, Angelotti G, Pepys J, Canonica GW, Heffler E, Savevski V, Puggioni F. Artificial intelligence processing electronic health records to identify commonalities and comorbidities cluster at Immuno Center Humanitas. Clin Transl Allergy 2022; 12:e12144. [PMID: 35702725 PMCID: PMC9175261 DOI: 10.1002/clt2.12144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Comorbidities are common in chronic inflammatory conditions, requiring multidisciplinary treatment approach. Understanding the link between a single disease and its comorbidities is important for appropriate treatment and management. We evaluate the ability of an NLP-based process for knowledge discovery to detect information about pathologies, patients' phenotype, doctors' prescriptions and commonalities in electronic medical records, by extracting information from free narrative text written by clinicians during medical visits, resulting in the extraction of valuable information and enriching real world evidence data from a multidisciplinary setting. Methods We collected clinical notes from the Allergy Department of Humanitas Research Hospital written in the last 3 years and used it to look for diseases that cluster together as comorbidities associated to the main pathology of our patients, and for the extent of prescription of systemic corticosteroids, thus evaluating the ability of NLP-based tools for knowledge discovery to extract structured information from free text. Results We found that the 3 most frequent comorbidities to appear in our clusters were asthma, rhinitis, and urticaria, and that 991 (of 2057) patients suffered from at least one of these comorbidities. The clusters which co-occur particularly often are oral allergy syndrome and urticaria (131 patients), angioedema and urticaria (105 patients), rhinitis and asthma (227 patients). With regards to systemic corticosteroid prescription volume by our clinicians, we found it was lower when compared to the therapy the patients followed before coming to our attention, with the exception of two diseases: Chronic obstructive pulmonary disease and Angioedema. Conclusions This analysis seems to be valid and is confirmed by the data from the literature. This means that NLP tools could have significant role in many other research fields of medicine, as it may help identify other important, and possibly previously neglected clusters of patients with comorbidities and commonalities. Another potential benefit of this approach lies in its potential ability to foster a multidisciplinary approach, using the same drugs to treat pathologies normally treated by physicians in different branches of medicine, thus saving resources and improving the pharmacological management of patients.
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Affiliation(s)
| | - Maria Elena Laino
- Artificial Intelligence CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Giovanni Paoletti
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Personalized Medicine, Asthma and AllergyIRCCS Humanitas Research HospitalMilanItaly
| | | | - Tobia Tommasini
- Artificial Intelligence CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Giovanni Angelotti
- Artificial Intelligence CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Jack Pepys
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Giorgio Walter Canonica
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Personalized Medicine, Asthma and AllergyIRCCS Humanitas Research HospitalMilanItaly
| | - Enrico Heffler
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Personalized Medicine, Asthma and AllergyIRCCS Humanitas Research HospitalMilanItaly
| | - Victor Savevski
- Artificial Intelligence CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Francesca Puggioni
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Personalized Medicine, Asthma and AllergyIRCCS Humanitas Research HospitalMilanItaly
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Abstract
PURPOSE OF REVIEW In recent years, therapeutic advances in eosinophilic granulomatosis with polyangiitis (EGPA) have changed our treatment paradigm. This review will summarize and discuss updates in management of EGPA, with a particular focus on biologic therapies. RECENT FINDINGS The anti-interleukin (IL)-5 agent mepolizumab (the first FDA-approved drug specifically for EGPA) is effective in induction and maintenance of remission particularly in patients with predominantly asthma and allergic manifestations, though efficacy in ANCA-positive, vasculitic disease is unclear; additional anti-IL-5 agents are under study. Rituximab is currently recommended for remission induction in severe disease, particularly in ANCA-positive patients with vasculitic manifestations, though the supportive evidence is mostly observational. Evidence supporting use of traditional DMARDs and other biologic agents such as omalizumab remains limited and observational. SUMMARY Although management of this heterogeneous disease remains challenging and unanswered questions remain, advances in biologics (particularly anti-IL-5 agents and an evolving interest in rituximab) have expanded our treatment armamentarium in EGPA.
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Riva G, Pecorari G. Commentary to the Letter to the Editor on "Long-term evaluation of nasal polyposis recurrence: A focus on multiple relapses and nasal cytology". Am J Otolaryngol 2022; 43:103449. [PMID: 35428532 DOI: 10.1016/j.amjoto.2022.103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Riva
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Via Genova 3, Turin, Italy.
| | - Giancarlo Pecorari
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Via Genova 3, Turin, Italy
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Sex, Allergic Diseases and Omalizumab. Biomedicines 2022; 10:biomedicines10020328. [PMID: 35203537 PMCID: PMC8869622 DOI: 10.3390/biomedicines10020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Gender differences are increasingly emerging in every area of medicine including drug therapy; however, specific gender-targeted studies are infrequent. Sex is a fundamental variable, which cannot be neglected. When optimizing therapies, gender pharmacology must always be considered in order to improve the effectiveness and safety of the use of drugs. Knowledge of gender differences promotes appropriate use of therapies and greater health protection for both genders. Further development of gender research would make it possible to report on differences in the assimilation and response of the female organism as compared to the male, in order to identify potential risks and benefits that can be found between genders. Furthermore, a better understanding of sex/gender-related influences, with regard to pharmacological activity, would allow the development of personalized “tailor-made” medicines. Here, we summarize the state of knowledge on the role of sex in several allergic diseases and their treatment with omalizumab, the first biologic drug authorized for use in the field of allergology.
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Ba G, Tang R, Mao S, Li Z, Ye H, Lin H, Zhang W. The Expression and Regulation of Na+-K+-ATPase in Nasal Epithelial Cells of Chronic Rhinosinusitis with Nasal Polyps. ORL J Otorhinolaryngol Relat Spec 2021; 84:139-146. [PMID: 34551419 DOI: 10.1159/000517101] [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: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Na+-K+-ATPase (NKA) is essential in maintaining cell permeability, reserving potential energy, and preventing cellular edema. Nevertheless, how NKA expression is altered and regulated in chronic rhinosinusitis with nasal polyps (CRSwNPs) remain uncertain. Therefore, the present study aimed to explore the expression and regulation of NKA in CRSwNP. METHODS NKA immunolabeling was assessed by the immunohistochemistry method, NKA protein levels were detected with the Western blotting method, and mRNA levels of NKA and aquaporin-5 (AQP5) were assayed by real-time PCR in nasal tissues from CRSwNP and control subjects. The co-localization of NKA with inflammatory cells was evaluated by immunofluorescence staining. In addition, human nasal epithelial cells (HNECs) were cultured and stimulated using various stimulators to evaluate the regulation of NKA. RESULTS We found significantly decreased NKA positive cells, NKA protein levels, and mRNA levels of NKA and AQP5 in nasal tissues from CRSwNP patients compared to control subjects, especially in eosinophilic CRSwNP. Furthermore, NKA mRNA levels in HNECs were downregulated by staphylococcal enterotoxin B (SEB), lipopolysaccharides (LPSs), inflammatory cytokine (IFN)-γ, IL-4, IL-13, and IL-1β. CONCLUSION NKA and AQP5 expressions were decreased in CRSwNP. NKA in HNECs could be suppressed by SEB, LPS, IFN-γ, IL-4, IL-13, and IL-1β. Impairment of NKA may contribute to the genesis and development of CRSwNP via inducing AQP5 downregulation and edema.
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Affiliation(s)
- Guangyi Ba
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 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 Jiao Tong University Affiliated Sixth People's Hospital, 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 Jiao Tong University Affiliated Sixth People's Hospital, 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 Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haibo Ye
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngological Institute, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Hai Lin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 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 Jiao Tong University Affiliated Sixth People's Hospital, 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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Choosing the Right Patient for Biologic Therapy in Chronic Rhinosinusitis with Nasal Polyposis: Endotypes, Patient Characteristics, and Defining Failures of Standard Therapy. Otolaryngol Clin North Am 2021; 54:701-708. [PMID: 34116843 DOI: 10.1016/j.otc.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are many phenotypes of chronic sinusitis and clinical variables that differ between patients. The ability to accurately diagnose, predict prognosis, and select the appropriate treatment depends on the understanding of disease endotypes. Chronic sinusitis is in the early stages of disease endotyping. The ability to identify endotypes is at the forefront of clinical research. Endotyping of chronic sinusitis uses clinical information, radiographic studies, and pathophysiologic data. Understanding of the full spectrum of chronic sinusitis is in its infancy. A personalized approach to treatment will consider standard medical therapies, sinus surgeries, and targeted use of biologic agents.
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Anselmo-Lima WT, Tamashiro E, Romano FR, Miyake MM, Roithmann R, Kosugi EM, Nakanishi M, Fornazieri MA, Bezerra TFP, Mello JF, Lessa MM, Voegels RL, Piltcher OB, Sakano E, Valera FCP. Guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps (CRSwNP) in Brazil. Braz J Otorhinolaryngol 2021; 88:471-480. [PMID: 33867274 PMCID: PMC9422446 DOI: 10.1016/j.bjorl.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
The use of immunobiologicals is an option for the management of patients with chronic rinosinusitis with nasal polyps (CRSwNP) refractory to conventional treatment. The guideline lists the main drugs currently available in Brazil, their indications, and recommendations for use.
Introduction Severe uncontrolled chronic rhinosinusitis with nasal polyps has a negative impact on an individual’s quality of life. Therefore, new biologics have emerged for use in specific phenotypes of chronic rhinosinusitis, changing the paradigms of its treatment. Objective To review the current status of biologic treatment indications in chronic rhinosinusitis. Methods The Brazilian Academy of Rhinology brought together different specialists to suggest a course of action, considering its particularities and aspects related to the national reality. Results Of particular interest for decision making will be the identification of subgroups of patients refractory to pre-existing treatment options and the construction of a strategy that improves their quality of life, with the best cost-benefit ratio. Conclusion The use of biologics is a valid option for treatment in more severe cases. This strategy must be better understood and improved in the future, with more studies and greater clinical experience.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil
| | - Fabrizio R Romano
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil; Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo M Kosugi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | - Márcio Nakanishi
- Universidade de Brasília (UnB), Faculdade de Medicina, Brasilia, DF, Brazil
| | - Marco A Fornazieri
- Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brazil
| | | | - João F Mello
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Marcus M Lessa
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brazil
| | - Richard L Voegels
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), São Paulo, SP, Brazil
| | - Otávio B Piltcher
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Porto Alegre, RS, Brazil
| | - Eulalia Sakano
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.
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