Immunopathologic characteristics of Chinese pediatric patients with chronic rhinosinusitis

Abstract

Background:The histopathology of pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is rarely reported due to low prevalence or the unavailability of tissue samples. Hence, we aimed to characterize and compare the histologic features and protein expression of Th1/Th2/Th17-related cytokines in pediatric CRSsNP and CRSwNP. Methods:The histologic characteristics of 15 children with CRSsNP, 52 children with CRSwNP, and 12 control participants were analyzed using hematoxylin and eosin staining. The expression of Th1/Th2/Th17-related cytokines were examined using immunohistochemistry and the enzymelinked immunosorbent assay.Results: Pediatric subjects with CRSwNP had more intact epithelium and less submucosal mucous glands compared to those with CRSsNP. Tissue eosinophils were more prevalent in the younger CRSwNP group compared to the older CRSwNP or the CRSsNP groups. The protein concentrations of Th2 cytokines were significantly higher in the CRSwNP group than the CRSsNP group or the control group. Moreover, the protein concentrations of Th17 cytokines were significantly higher in the younger CRSwNP group than the older CRSwNP group or the CRSsNP and control groups. The protein concentrations of Th1 and Th17 cytokines were also significantly higher in the CRSsNP group than the control group. Compared with non-eosinophilic CRSwNP, eosinophilic CRSwNP presented with elevated protein concentrations of Th1 and Th17 cytokines. Conclusion:For the first time, we showed that pediatric CRSwNP presents as eosinophilic with Th2/Th17 inflammation, whereas CRSsNP presents as Th1/Th17 inflammation. Our study may provide a theoretical basis for the precise treatment of pediatric CRS in the future.

Clinical Characteristics of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps in Adolescents

“…37 However, Jiang et al revealed that tissue eosinophils were more abundant in the younger CRSwNP group than in the older CRSwNP or CRSsNP groups and showed that Chinese pediatric CRSwNP is eosinophilic with mixed type 2/type 3 inflammation. 2 Brown et al recently reported that most (57.8%) pediatric CRS cases have a lymphocyte-predominant inflammatory background; in contrast, most (66.5%) adult CRS have a lymphoplasmacyticpredominant inflammatory background. 38 Differences in the presence of polyps, age, disease severity, and environmental factors may contribute to different mechanisms and immunopathological features of CRSwNP in pediatric populations.…”

“…Based on the predominance of tissue inflammatory cell infiltration by eosinophils or neutrophils, CRS can be categorized into eosinophilic and neutrophilic entities. 2 Eosinophilic CRSwNP is frequently associated with comorbid asthma and/or aspirin intolerance and is clinically characterized by a greater extent of inflammation, more severe endoscopic and computed tomography (CT) scores, more severe clinical symptoms and olfactory dysfunction, poorer prognosis, and high recurrence rate after sinus surgery. 3,4 Thus, early identification of the endotypes in patients with CRS is important for determining prognosis and treatment strategies.…”

Tissue eosinophilia and computed tomography features in paediatric chronic rhinosinusitis with nasal polyps requiring revision surgery

“…The prevalence of chronic rhinosinusitis (CRS) in the paediatric population is lower than that in adults, with an estimated preva-lence of 2-4% (1) . However, paediatric CRS is a relevant disease in terms of quality of life, such as missed classes, poor concentration in school, impaired sleep quality, and impaired physical and emotional health (2) .…”