Cellular phenotyping of chronic rhinosinusitis with nasal polyps

Abstract

Background: Defining the phenotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) with prognosis may lead to delivery of personalized treatment. This study aimed to identify cellular phenotypes of CRSwNP using cluster analysis and define an algorithm for different clusters associated with polyp recurrence. Methods: Overall, 366 patients with CRSwNP were enrolled in this retrospective analysis. Eighteen variables, including clinical characteristics and tissue/peripheral inflammatory cells assessments, were selected for factor analysis. Unsupervised cluster analysis was performed after variables reduction and standardization and differences in polyp recurrence during follow-up for a minimum of 24 months were analysed among clusters. Discriminant analysis was further used to develop a clinically useful algorithm for predicting clustering. Results: Five phenotypic clusters were identified. Clusters 1 and 2 were plasma cell-dominant and lymphocyte-dominant phenotypes, respectively. Cluster 3 revealed a mixed inflammatory pattern. Cluster 4 was characterized by infiltration of predominantly neutrophils. Cluster 5 was characterized by a marked tissue eosinophilia and highest recurrence rate of 98.5%. The clinical algorithm predicted clustering with 93.7% accuracy. Conclusions: 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.

Respiratory Nasal Mucosa in Chronic Rhinosinusitis with Nasal Polyps versus COVID-19: Histopathology, Electron Microscopy Analysis and Assessing of Tissue Interleukin-33

“…CRSwNP is characterized by a predominant type 2 inflammatory response mediated by T helper 2 cells [21]. Based on the dominant inflammatory cell types infiltrating the stroma, structured histopathology has identified several histotypes of CRSwNP (phenotypic clusters): plasma cell-dominant, lymphocyte-dominant, a mixed inflammation phenotype (Figure 1C), eosinophil-dominant (Figure 1D) and neutrophil-dominant [22]. These CRSwNP histotypes (Figure 1C,D) were also identified in our study, except the neutrophil-dominant one.…”

Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

“…24 Lou et al revealed an eosinophil-dominant CRSwNP, in which tissue eosinophils was more than 54.5% of total inflammatory cells, had a polyp recurrence rate as high as 98.5%. 25 In another report with multivariate analysis, they identified a tissue eosinophil proportion over 27% and a tissue eosinophil count over 55 eosinophils/HPF as the strongest predictors of polyp recurrence after sinus surgery in the Chinese patients with CRSwNP. 26 However, the relationship between the patients with different level of tissue eosinophilia and disease control is still unclear.…”

“…For example, Tokunaga et al reported a multicenter retrospective study of 1716 patients showing that individuals with more than 70 eosinophils/HPF in mucosal tissues was characterized with a refractory nature of disease 24 . Lou et al revealed an eosinophil‐dominant CRSwNP, in which tissue eosinophils was more than 54.5% of total inflammatory cells, had a polyp recurrence rate as high as 98.5% 25 . In another report with multivariate analysis, they identified a tissue eosinophil proportion over 27% and a tissue eosinophil count over 55 eosinophils/HPF as the strongest predictors of polyp recurrence after sinus surgery in the Chinese patients with CRSwNP 26 .…”

Chinese Central Compartment Atopic Disease: The Clinical Characteristics and Cellular Endotypes Based on Whole-Slide Imaging

“… 12 , 13 Eosinophilia is related to higher polyp recurrence 14–16 and worse olfactory function. 17–19 Whereas neutrophilia is linked with corticosteroid sensitivity and more severe surgical outcomes. 20–22 Thus, it is critical to give a more detailed description of CCAD histopathology.…”