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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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Brar T, McCabe C, Miglani A, Marino M, Lal D. Tissue Eosinophilia is Superior to an Analysis by Polyp Status for the Chronic Rhinosinusitis Transcriptome: An RNA Study. Laryngoscope 2023; 133:2480-2489. [PMID: 36594502 DOI: 10.1002/lary.30544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE RNA sequencing (transcriptomics) is used to study biological pathways. However, the yield of data depends on comparing well-characterized cohorts. We compared tissue eosinophilia versus nasal polyp (NP) status as the metric to characterize transcriptomic mechanisms at play in eosinophilic and non-eosinophilic chronic rhinosinusitis (CRS) versus controls. METHODS RNA sequencing was conducted on sinonasal tissue samples of CRS and controls. Analyses were conducted based on polyp status [with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)] as well as tissue eosinophil levels per high power field (eos/hpf)[non-eosinophilic (<10 eos/hpf, neCRS) or eosinophilic (≥10 eos/hpf, eCRS)]. The yield of differentially expressed genes (DEGs) and biological pathways through Ingenuity Pathway Analysis (IPA) were compared. RESULTS CRS tissue differed from controls by 736 statistically significant DEGs. Both NP status and tissue eosinophilia were effective in differentiating CRS from controls and into two distinct subgroups. Statistically significant DEGs identified when comparing CRS by NP status were 60, whereas 110 DEGs were identified using eosinophil cutoff ≥10 and <10 eos/hpf. Additionally, heatmaps showed greater homogeneity within each CRS subgroup when analyzed by tissue eosinophilia versus NP status. On IPA, the IL-17 signaling pathway was significantly different only by tissue eosinophilia status, not NP status, being higher in CRS <10 eos/hpf. CONCLUSION Tissue eosinophilia is superior to an analysis by NP status for the study of CRS transcriptome by RNA sequencing in identifying DEGs. Classification of CRS samples by eosinophil counts agnostic of NP status may offer advantageous insights into CRS pathogenetic mechanisms. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2480-2489, 2023.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Kallieri M, Zervas E, Fouka E, Porpodis K, Mitrova MH, Tzortzaki E, Makris M, Ntakoula M, Papaioannou AI, Lyberopoulos P, Dimakou K, Koukidou S, Ampelioti S, Papaporfyriou A, Katsoulis K, Kipourou M, Rovina N, Antoniou K, Vittorakis S, Bakakos P, Steiropoulos P, Markopoulou K, Avarlis P, Papanikolaou ΙC, Markatos M, Gaki E, Samitas K, Glynos K, Papiris SA, Papakosta D, Tzanakis N, Gaga M, Kostikas K, Loukides S. RELIght: A two-year REal-LIfe study of mepolizumab in patients with severe eosinophilic asTHma in Greece: Evaluating the multiple components of response. Allergy 2022; 77:2848-2852. [PMID: 35595723 DOI: 10.1111/all.15382] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Maria Kallieri
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Marija Hadji Mitrova
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Maria Ntakoula
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Panagiotis Lyberopoulos
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | - Sofia Koukidou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | | | | | | | - Maria Kipourou
- Pulmonary Department, 424 Army General Hospital, Thessaloniki, Greece
| | - Nikoletta Rovina
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Katerina Antoniou
- Respiratory Medicine School of Medicine, University of Crete, Heraklion, Greece
| | | | - Petros Bakakos
- 1st Respiratory Department, National and Kapodistrian University of Athens Medical School, "Sotiria" Chest Hospital, Athens, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, Alexandroupolis, Greece
| | - Katerina Markopoulou
- 1st Pulmonary Department, Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | - Spyros A Papiris
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Nikolaos Tzanakis
- Respiratory Medicine School of Medicine, University of Crete, Heraklion, Greece
| | - Mina Gaga
- 7th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
| | - Stelios Loukides
- 2nd Respiratory Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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