Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Ma, Ling; Shi, Jianbo; Wang, Kanghua; Sun, Yueqi; Xu, Rui

doi:10.1002/lio2.758

Cited by 11 publications

(3 citation statements)

References 33 publications

(68 reference statements)

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“…Although tissue eosinophilia is known to be a risk factor for poor treatment outcome in patients with CRSwNP, the relationship between the patients with different level of tissue eosinophilia and treatment outcome is still unclear. In our another published study [34], we chose various cut-off values for tissue eosinophilia, ranging from 10% to 50%, to subdivide a cohort of 302 patients with CRSwNP, and found that patients with different tissue eosinophil cut-off values displayed similar rates of uncontrolled disease, suggesting that tissue eosinophils would not further increase risks for poor disease control when they reach the threshold value of 10%. This may partially, if not completely, explain why tissue neutrophils did not add additional risk for poor outcome in current study, although tissue neutrophil numbers correlated to tissue eosinophil levels.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Eosinophilic and Neutrophilic Inflammation in Chinese Chronic Rhinosinusitis with Nasal Polyps

Ma¹,

Deng²,

Wang³

et al. 2023

Int Arch Allergy Immunol

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Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNPs) in China is characterized by a mixed eosinophilic-neutrophilic inflammation, linking to a more heterogeneous clinical phenotype. However, the relationship between eosinophilic and neutrophilic inflammation in Chinese patients with CRSwNP remains largely unknown. We aimed to further characterize the correlation between neutrophils with eosinophils in relation to clinical characters and disease control status after endoscopic sinus surgery (ESS). Methods: A total of 242 patients were recruited and stratified based on tissue (≥10%) eosinophilia and (≥20/per high-power field) neutrophilia. Clinical characteristics and disease control status were compared between subgroups. Associations between tissue eosinophils and neutrophils were analyzed. Results: The uncontrolled patients accounted for 41.3%, 41.3%, 17.1%, and 22.2% in subjects with concomitant tissue eosinophilia and neutrophilia (EN-high), isolated eosinophilia (E-high), isolated neutrophilia (N-high), and no eosinophilia and neutrophilia (EN-low), respectively. Positive correlations between tissue eosinophils and neutrophils were observed in patients with CRSwNP as well as in EN-high and N-high subgroups but not in E-high and EN-low subgroups. The EN-high subgroup had higher tissue eosinophil numbers than the other three subgroups. Both EN-high and E-high subgroups had higher rates of uncontrolled subjects than the N-high and EN-low subgroups; however, there was no difference in the rate of uncontrolled subjects between EN-high and E-high subgroups and between N-high and EN-low subgroups. Conclusion: Tissue neutrophils might have a potential interaction and mutual promotion effect with eosinophils in CRSwNP. However, tissue neutrophilia would not pose significant risk for poor disease control after ESS. Further larger, prospective studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Relationship between Eosinophilic and Neutrophilic Inflammation in Chinese Chronic Rhinosinusitis with Nasal Polyps

Ma¹,

Deng²,

Wang³

et al. 2023

Int Arch Allergy Immunol

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“…CRSwNP in Western populations has a broadly similar T2 endotype [1 ▪ ]. Eosinophilia predicts more severe and recurrent disease severity [2]. By such association, a causal role for eosinophils as a key cell in the pathogenesis and maintenance of disease in CRSwNP has been assumed.…”

Section: Introductionmentioning

confidence: 99%

Chronic rhinosinusitis with nasal polyps: eosinophils versus B lymphocytes in disease pathogenesis

Kariyawasam,

James

2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review To highlight the current evidence that supports the view that eosinophils may not drive disease in chronic rhinosinusitis with nasal polyps (CRSwNP) and the emerging evidence for B cells as an important player in this disease. Recent findings Eosinophil depletion studies in CRSwNP do not fully support a critical role for eosinophils in CRSwNP. Almost complete eosinophil depletion with dexpramipexole had no impact on polyp size reduction or clinical improvement. Anti-interleukin (IL)-5 and IL-5Rα inhibition were more effective though with less clinical impact when compared to anti-immunoglobulin E (IgE) or IL-4Rα inhibition strategies. As IL-5Rα is also expressed on CRSwNP derived IgE+ and IgG4+ plasma cells to the same extent as eosinophils, improvements in CRSwNP with IL-5 inhibition may suggest a role for B cells over eosinophils in CRSwNP. We review both eosinophils and B cells in the context of CRSwNP and highlight the current evidence that supports an emerging role for B cells. Summary Despite many aspects of immunopathology in CRSwNP explainable by B cell dysfunction, B cells have so far been ignored in CRSwNP. Further work is needed, as targeting B cells may offer an exciting new therapeutic option in the future.

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“…Patients with CRSwNP, who make up 25-30% of patients with CRS, exhibit more severe clinical symptoms and a lower quality of life than patients with CRSsNP, making CRSwNP research clinically valuable (7).…”

Section: Introductionmentioning

confidence: 99%

Immune Endotyping and Gene Expression Profile of Patients with Chronic Rhinosinusitis with Nasal Polyps in Aspirin-Exacerbated Respiratory Disease (AERD) and non-AERD Subgroups

Khoshmirsafa,

Nazari,

Shahba

et al. 2023

Preprint

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‌Background: Chronic Rhinosinusitis (CRS) is a paranasal sinus inflammatory disease and is divided into two subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays a T helper (Th)2 biased phenotype, and based on sensitivity or tolerance to aspirin or non-steroidal anti-inflammatory drugs (NSAID), are further subdivided into Aspirin-exacerbated respiratory disease (AERD) and non-AERD groups. Considering the challenge of diagnosis and treatment in patients with CRSwNP, particularly the AERD subtype, and the significance of endotyping in these patients, we examined the immune profile and endotyping based on gene expression analysis in AERD and non-AERD groups of patients with CRSwNP. Material and Method: In this study, 21 patients were enrolled and were categorized into AERD (N=10) and non-AERD (N=11) groups based on their sensitivity to aspirin. After the special washing period, nasal polyps were biopsied in both groups, and the infiltration of eosinophils, neutrophils, plasma cells, and lymphocytes was compared between the AERD and non-AERD groups. Also, gene expression levels of transcription factors including Tbet, GATA3, RoRγt, and FoxP3 and inflammatory cytokines including interleukin (IL)1β, IL1RAP (IL1 receptor accessory protein), IL2, IL4, IL5, IL10, IL13, IL17, TNFα, and IFNγ were investigated by quantitative Real-time PCR (qRT-PCR). Statistical analyses were performed using analytical tests including Kolmogorov–Smirnov, Mann-Whitney, and T-test. A P value less than 0.05 was considered statistically significant. Results: The mean±SD age of the studied groups was 37±8.7 years old (21-50) for AERD, and 40.4±7.7 years old (31-52) for non-AERD. LMS/EPOS/SNOT scores and pulmonary function tests showed no difference between the two groups. Serum IgE level was found to be higher in patients with AERD (p<0.05), however, the peripheral blood counts of eosinophils were comparable in the two groups. In the histopathologic analysis, the AERD group showed higher percentages of eosinophils (p=0.04), neutrophils (p=0.04), and plasma cells (p=0.04) than the non-AERD group. Additionally, the gene expression levels of GATA3 (p<0.01), IL4 (p<0.05), IL5 (p<0.05), and IL17 (p<0.05) were significantly higher in AERD than non-AERD groups. Conclusion: Higher levels of GATA3, IL4, IL5, and IL17 were observed in the AERD group compared with the non-AERD group. These findings point to distinct patterns of inflammation in patients with AERD, with a predominance of Th2 inflammation.

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Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Cited by 11 publications

References 33 publications

Relationship between Eosinophilic and Neutrophilic Inflammation in Chinese Chronic Rhinosinusitis with Nasal Polyps

Relationship between Eosinophilic and Neutrophilic Inflammation in Chinese Chronic Rhinosinusitis with Nasal Polyps

Chronic rhinosinusitis with nasal polyps: eosinophils versus B lymphocytes in disease pathogenesis

Immune Endotyping and Gene Expression Profile of Patients with Chronic Rhinosinusitis with Nasal Polyps in Aspirin-Exacerbated Respiratory Disease (AERD) and non-AERD Subgroups

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