Cellular phenotyping of chronic rhinosinusitis with nasal polyps

Lou, Hongfei; Meng, Y.; Piao, Yingshi; Zhang, N.; Bachert, C.; Wang, C.; Zhang, L.

doi:10.4193/rhin15.271

Cited by 77 publications

(75 citation statements)

References 17 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…74 More recent studies evaluating the molecular signature of the Th2 genes 23 or using unsupervised hierarchical clustering of gene expression profiles in asthma 75 reinforce the reality of non-eosinophilic asthma. In CRS with NP unsupervised cluster analysis showed a distinct cluster characterized by neutrophilic inflammation 76 and Th1/Th17 polarization was described for NP sampled from Asian patients. 77 Agerelated decline in neutrophil inflammation was related to better postoperative results in elderly patients with non-eosinophilic NP.…”

Section: Type 2 Immune Response Driven Complex Endotypementioning

confidence: 99%

Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine

Agache

Akdiş

2016

Allergology International

158

130

View full text Add to dashboard Cite

Discoveries from basic science research in the last decade have brought significant progress in knowledge of pathophysiologic processes of allergic diseases, with a compelling impact on understanding of the natural history, risk prediction, treatment selection or mechanism-specific prevention strategies. The view of the pathophysiology of allergic diseases developed from a mechanistic approach, with a focus on symptoms and organ function, to the recognition of a complex network of immunological pathways. Several subtypes of inflammation and complex immune-regulatory networks and the reasons for their failure are now described, that open the way for the development of new diagnostic tools and innovative targeted-treatments. An endotype is a subtype of a disease condition, which is defined by a distinct pathophysiological mechanism, whereas a disease phenotype defines any observable characteristic of a disease without any implication of a mechanism. Another key word linked to disease endotyping is biomarker that is measured and evaluated to examine any biological or pathogenic processes, including response to a therapeutic intervention. These three keywords will be discussed more and more in the future with the upcoming efforts to revolutionize patient care in the direction of precision medicine and precision health. The understanding of disease endotypes based on pathophysiological principles and their validation across clinically meaningful outcomes in asthma, allergic rhinitis, chronic rhinosinusitis, atopic dermatitis and food allergy will be crucial for the success of precision medicine as a new approach to patient management.

show abstract

Section: Type 2 Immune Response Driven Complex Endotypementioning

confidence: 99%

Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine

Agache

Akdiş

2016

Allergology International

158

130

View full text Add to dashboard Cite

show abstract

“…From a cytological point of view, recent studies have shown that CRSwNP is highly associated with an immune- inflammatory state, characterised by eosinophils and mast cells, sometimes associated, albeit more rarely, with neutrophils 22 . From a clinical point of view, it is well known that CRSwNP is commonly associated with other comorbidities (allergy, asthma, ASA-intolerance) that are able to influence the course of NP 23 24 .…”

Section: Discussionmentioning

confidence: 99%

Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach

Gelardi

Iannuzzi

Giosa

et al. 2017

Acta Otorhinolaryngol Ital

View full text Add to dashboard Cite

La rinosinusite cronica con polipi nasali (CRSwNP) è una malattia cronica nasosinusale, a eziologia infiammatoria, con significativo impatto negativo sulla qualità di vita dei pazienti. La CRSwNP rappresenta ancora oggi una sfida terapeutica per lo specialista ORL, sia per la comprensione della sua eziopatogenesi, sia per il suo controllo clinico ed è questo è testimoniato dalla alta incidenza di recidiva dopo trattamento. Abbiamo voluto verificare lipotesi che un approccio terapeutico nuovo, standardizzato, e individualizzato sul grading clinico-citologico (clinical-cytological grading CCG) consentisse un miglior controllo dei sintomi della malattia, e di ridurre la necessità di ricorrere alla chirurgia. Abbiamo pertanto reclutato 204 pazienti affetti da CRSwNP, di cui 145 hanno regolarmente assunto la terapia rispettando il protocollo proposto, e 59 pazienti, invece, che non hanno assunto la terapia in modo sistematico e sono stati quindi inclusi come controlli. Dopo 5 anni di trattamento standardizzato, abbiamo notato che 15 pazienti su 145 (10,3%) del gruppo con terapia standardizzata avevano avuto un miglioramento dello staging endoscopico, 61 su 145 (42%) si erano mantenuti costanti, mentre 69/145 (47,5%) erano andati incontro a un peggioramento. Nel gruppo di controllo, invece, i pazienti peggiorati erano ben 49 su 59 (83%), con un peggioramento significativo in termini di grading endoscopico di almeno due classi (p < 0,05). I pazienti e i controlli sono stati successivamente stratificati sulla base del CCG in 3 sottogruppi: pazienti con CCG lieve, moderata e grave. Dopo tale suddivisione in classi, è stato possibile evidenziare che nel gruppo con CCG lieve (n = 27), il 92% dei pazienti manteneva negli anni un trend costante, in assenza di peggioramenti e senza necessità di ricorrere alla chirurgia nei 5 anni di osservazione, mentre nel gruppo di controllo, 1 paziente su 59 (1,6%; p = <0,05) ricorreva a chirurgia. Nel gruppo con CCG moderato (n = 83), invece, il 44% dei pazienti standardizzati non aveva avuto un peggioramento di grading endoscopico, con un 3,6% di pazienti che aveva avuto necessità di ricorrere alla chirurgia, contro il 13,6% del gruppo controllo (p < 0,05). Nel gruppo dei pazienti con CCG grave (n = 35), anche se nessun paziente riusciva a ottenere un miglioramento del grading endoscopico, il 40% dei pazienti veniva comunque giudicato controllato da un punto di vista clinico. Nel gruppo dei pazienti con CCG grave, ben il 5,7% dei pazienti necessitava di trattamento chirurgico, ma anche in questo caso, la percentuale dei pazienti operati era significativamente maggiore (p = 0,0000) nel gruppo di controllo (49%). Infine, lanalisi statistica effettuata ha dimostrato chiaramente che, da un punto di vista obiettivo, le dimensioni dei polipi nasali tendevano ad aumentare a una velocità maggiore nel gruppo controllo che nel gruppo standardizzato, con incrementi proporzionali nelle tre classi di CCG (lieve, moderato e grave). Lo studio attuale fornisce le basi per lo sviluppo e ladozione di un nuovo approccio per la gestione della CRSwNP sulla base di uno score clinico e citologico (CCG) che permetta di stimare con accuratezza la gravità della CRSwNP e di adattarne il trattamento. Tale approccio limita luso degli steroidi sistemici alle sole classi CCG di entità moderata-grave con dosi di steroidi inferiori rispetto a quanto precedentemente suggerito in letteratura. Il nostro protocollo può migliorare pertanto laderenza terapeutica dei pazienti, il tasso di controllo della malattia e può ridurre il ricorso alla chirurgia nel corso degli anni.

show abstract

“…Unfortunately, less is known about the specific cellular and molecular mechanisms contributing to AERD pathogenesis in particular, especially at baseline when COX-1 inhibitors are not present. For example, the role of epithelial cells and the microbiome in AERD has not been as extensively characterized as it has in CRSwNP 40–42 . As a result, it is possible that specific functional and physical defects in sinonasal epithelial cells as well as alterations in the microbiome of the sinonasal cavity could distinguish AERD and CRSwNP clinical phenotypes.…”

Section: Disease Pathophysiologymentioning

confidence: 99%

Aspirin-Exacerbated Respiratory Disease as an Endotype of Chronic Rhinosinusitis

Stevens

Schleimer

2016

Immunology and Allergy Clinics of North America

View full text Add to dashboard Cite

Synopsis Aspirin-Exacerbated Respiratory Disease (AERD) and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) are both diseases characterized by the presence of chronic sinonasal inflammation and nasal polyps. Both diseases are associated with asthma; AERD by definition and CRSwNP by common comorbidity (~50%). Therefore, the most prominent clinical feature distinguishing patients with AERD from those with CRSwNP remains the development of an upper or lower respiratory tract reaction following the ingestion of a COX-1 inhibitor. However, even in the absence of COX-1 inhibitors, there are other notable clinical and pathophysiological differences between AERD and CRSwNP patients. Patients with AERD on average have worse upper respiratory disease with increased sinonasal symptoms, mucosal inflammation and requirements for revision sinus surgery when compared to patients with CRSwNP. While no single genetic factor has been identified in either CRSwNP or AERD pathogenesis to date, many studies have evaluated whether there are differences in the underlying cellular and molecular mechanisms that account for the observed clinical variations. Studies from several laboratories have discovered important differences in the metabolism of arachidonic acid, including increased activity of the 5-lipoxygenase pathway and decreased levels of the anti-inflammatory prostanoid PGE2. Clear evidence for activation of platelets in AERD also distinguishes it from CRSwNP. Nasal polyp tissues from both AERD and CRSwNP are characterized by type-2 inflammation but there are significantly increased levels of eosinophil and mast cell degranulation products in AERD sinonasal tissue, and recent evidence suggesting that spontaneous activation of eosinophils, basophils and mast cells occurs.

show abstract

Cellular phenotyping of chronic rhinosinusitis with nasal polyps

Abstract: Chinese CRSwNP patients may be classified into five phenotypes with different polyp recurrence rates, based on the presence of predominantly plasma cells, lymphocytes, neutrophils, eosinophils or mixed inflammatory cells in polyps.

Cited by 77 publications

References 17 publications

Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine

Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine

Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach

Aspirin-Exacerbated Respiratory Disease as an Endotype of Chronic Rhinosinusitis

Contact Info

Product

Resources

About