Type 2 inflammation in chronic rhinosinusitis without nasal polyps: Another relevant endotype - 05/08/20
, Elien Gevaert, PhD a, ∗Abstract |
Background |
Chronic rhinosinusitis without nasal polyps (CRSsNP) is mainly considered a type 1 mediated disease. The role and clinical significance of type 2 immune responses in CRSsNP have not been addressed sufficiently; a recent cluster analysis for CRS described the existence of a subgroup of patients with CRSsNP with a type 2 inflammation.
Objective |
We aimed to characterize the underlying type 2 immune response and its clinical significance in patients with CRSsNP.
Methods |
A total of 240 patients with CRSsNP were endotyped and subdivided on the basis of expression of marker cytokines. Clinical data such as recurrence, comorbid asthma and allergy, and numbers of blood eosinophils and neutrophils were collected from all patients. A selection of 15 patients was further characterized for the presence of eosinophils, neutrophils, Charcot-Leyden crystals, and eosinophil extracellular traps in the mucosae.
Results |
A type 2 immune response with increased levels of IL-4, IL-5, eosinophil cationic protein, IgE, and Staphylococcus aureus enterotoxin–specific IgE was observed in 49% of patients with CRSsNP. Those patients showed increased numbers of blood and tissue eosinophils, and they displayed a considerable eosinophilic inflammation associated with eosinophil extracellular trap cell death and Charcot-Leyden crystals. A significantly increased prevalence of recurrence and asthma was observed in patients with type 2 CRSsNP compared with in patients with non–type 2 CRSsNP. However, only 4 of 117 patients with type 2 CRSsNP developed nasal polyps within 12 years.
Conclusion |
This study shows that type 2 immune responses in CRSsNP follow similar patterns but are less pronounced than in chronic rhinosinusitis with nasal polyps. Also CRSsNP with a moderate type 2 immune response showed a considerable eosinophilic inflammation with clinical impact.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Key words : CRSsNP, type 2 inflammation, eosinophils, recurrence, asthma
Abbreviations used : CLC, CRS, CRSsNP, CRSwNP, EETosis, FESS, SE-IgE, ECP, EET, NPV, PPV
Mappa
| E.G. was supported by a postdoctoral research fellowship from the Fonds Wetenschappelijk Onderzoek (FWO/DPO/108). C.B. and E.G. were supported by grants from FWO Flanders (1515516N, EOS project nr. GOG2318N) and the Interuniversity Attraction Poles Grant P7/30. |
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| Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
Vol 146 - N° 2
P. 337 - Agosto 2020 Ritorno al numero
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