Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries

Gwanghui Ryu; Dong Kyu Kim; Hun Jong Dhong; Kyoung Mi Eun; Kyung Eun Lee; Il Gyu Kong; Hyo Yeol Kim; Seung Kyu Chung; Dong Young Kim; Chae Seo Rhee; Seong Ho Cho; Sang Duk Hong; Dae Woo Kim

doi:10.4168/aair.2019.11.5.664

Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries

Gwanghui Ryu
, Dong Kyu Kim
, Hun Jong Dhong
, Kyoung Mi Eun
, Kyung Eun Lee
, Il Gyu Kong
, Hyo Yeol Kim
, Seung Kyu Chung
, Dong Young Kim
, Chae Seo Rhee
, Seong Ho Cho
, Sang Duk Hong
, Dae Woo Kim

Research output: Contribution to journal › Article › peer-review

44 Scopus citations

Abstract

Purpose: Despite medical and surgical treatments, some cases of nasal polyps (NP) exhibit recidivism. However, the endotype of refractory chronic rhinosinusitis with NP (CRSwNP) remains unclear. Therefore, the objective of this study was to characterize the immunological profile of refractory CRSwNP. Methods: The control (n =23), primary NP group (pNP, n =70) and refractory NP group (rNP, n =86) were enrolled in this study. Patients who underwent revision surgeries due to failed maximal medical treatment after primary surgery were defined as the rNP group. A total of 18 inflammatory markers were investigated in nasal tissues using multiplex cytokine assay or enzyme-linked immunosorbent assay. Results: The clinical characteristics of rNP included more extensive disease and worse clinical course after surgery. Additionally, rNP subjects showed higher infection rate (mucopurulence and culture-positive rate), more frequent use of antibiotics and suffered from symptomatic bacterial infection, increased asthma morbidity compared to pNP. Cytokine profile analysis showed that levels of Th17-associated mediators (myeloperoxidase, interleukin (IL)-8, IL-17A and IL-23), B-cell activating factor (BAFF) and Th1 cytokine (interferon-γ) were up-regulated in rNP compared to controls and pNP. Human neutrophil elastase-positive cells were also enhanced in rNP compared with pNP. Upregulation of Th17/Th1mediators and BAFF were observed in rNP, regardless of tissue eosinophilia or asthmatic comorbidity. Interestingly, eosinophilic markers, such as eosinophil cationic protein and C-C motif chemokine ligand 24, were up-regulated in asthmatic rNP compared to pNP and controls. Levels of anti-dsDNA immunoglobulin (Ig) G and IgA were up-regulated in rNP and highest in asthmatic eosinophilic rNP among subtypes of rNP. Conclusions: Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP.

Original language	English
Pages (from-to)	664-676
Number of pages	13
Journal	Allergy, Asthma and Immunology Research
Volume	11
Issue number	5
DOIs	https://doi.org/10.4168/aair.2019.11.5.664
State	Published - 1 Sep 2019
Externally published	Yes

Keywords

B cell activating factor
Nasal polyps
Neutrophil
Refractory
Sinusitis
Th17 cells

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.4168/aair.2019.11.5.664

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Ryu, G., Kim, D. K., Dhong, H. J., Eun, K. M., Lee, K. E., Kong, I. G., Kim, H. Y., Chung, S. K., Kim, D. Y., Rhee, C. S., Cho, S. H., Hong, S. D., & Kim, D. W. (2019). Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries. Allergy, Asthma and Immunology Research, 11(5), 664-676. https://doi.org/10.4168/aair.2019.11.5.664

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title = "Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries",

abstract = "Purpose: Despite medical and surgical treatments, some cases of nasal polyps (NP) exhibit recidivism. However, the endotype of refractory chronic rhinosinusitis with NP (CRSwNP) remains unclear. Therefore, the objective of this study was to characterize the immunological profile of refractory CRSwNP. Methods: The control (n =23), primary NP group (pNP, n =70) and refractory NP group (rNP, n =86) were enrolled in this study. Patients who underwent revision surgeries due to failed maximal medical treatment after primary surgery were defined as the rNP group. A total of 18 inflammatory markers were investigated in nasal tissues using multiplex cytokine assay or enzyme-linked immunosorbent assay. Results: The clinical characteristics of rNP included more extensive disease and worse clinical course after surgery. Additionally, rNP subjects showed higher infection rate (mucopurulence and culture-positive rate), more frequent use of antibiotics and suffered from symptomatic bacterial infection, increased asthma morbidity compared to pNP. Cytokine profile analysis showed that levels of Th17-associated mediators (myeloperoxidase, interleukin (IL)-8, IL-17A and IL-23), B-cell activating factor (BAFF) and Th1 cytokine (interferon-γ) were up-regulated in rNP compared to controls and pNP. Human neutrophil elastase-positive cells were also enhanced in rNP compared with pNP. Upregulation of Th17/Th1mediators and BAFF were observed in rNP, regardless of tissue eosinophilia or asthmatic comorbidity. Interestingly, eosinophilic markers, such as eosinophil cationic protein and C-C motif chemokine ligand 24, were up-regulated in asthmatic rNP compared to pNP and controls. Levels of anti-dsDNA immunoglobulin (Ig) G and IgA were up-regulated in rNP and highest in asthmatic eosinophilic rNP among subtypes of rNP. Conclusions: Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP.",

keywords = "B cell activating factor, Nasal polyps, Neutrophil, Refractory, Sinusitis, Th17 cells",

author = "Gwanghui Ryu and Kim, \{Dong Kyu\} and Dhong, \{Hun Jong\} and Eun, \{Kyoung Mi\} and Lee, \{Kyung Eun\} and Kong, \{Il Gyu\} and Kim, \{Hyo Yeol\} and Chung, \{Seung Kyu\} and Kim, \{Dong Young\} and Rhee, \{Chae Seo\} and Cho, \{Seong Ho\} and Hong, \{Sang Duk\} and Kim, \{Dae Woo\}",

note = "Publisher Copyright: {\textcopyright} 2019 The Korean Academy of Asthma.",

year = "2019",

month = sep,

day = "1",

doi = "10.4168/aair.2019.11.5.664",

language = "English",

volume = "11",

pages = "664--676",

journal = "Allergy, Asthma and Immunology Research",

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number = "5",

}

TY - JOUR

T1 - Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries

AU - Ryu, Gwanghui

AU - Kim, Dong Kyu

AU - Dhong, Hun Jong

AU - Eun, Kyoung Mi

AU - Lee, Kyung Eun

AU - Kong, Il Gyu

AU - Kim, Hyo Yeol

AU - Chung, Seung Kyu

AU - Kim, Dong Young

AU - Rhee, Chae Seo

AU - Cho, Seong Ho

AU - Hong, Sang Duk

AU - Kim, Dae Woo

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose: Despite medical and surgical treatments, some cases of nasal polyps (NP) exhibit recidivism. However, the endotype of refractory chronic rhinosinusitis with NP (CRSwNP) remains unclear. Therefore, the objective of this study was to characterize the immunological profile of refractory CRSwNP. Methods: The control (n =23), primary NP group (pNP, n =70) and refractory NP group (rNP, n =86) were enrolled in this study. Patients who underwent revision surgeries due to failed maximal medical treatment after primary surgery were defined as the rNP group. A total of 18 inflammatory markers were investigated in nasal tissues using multiplex cytokine assay or enzyme-linked immunosorbent assay. Results: The clinical characteristics of rNP included more extensive disease and worse clinical course after surgery. Additionally, rNP subjects showed higher infection rate (mucopurulence and culture-positive rate), more frequent use of antibiotics and suffered from symptomatic bacterial infection, increased asthma morbidity compared to pNP. Cytokine profile analysis showed that levels of Th17-associated mediators (myeloperoxidase, interleukin (IL)-8, IL-17A and IL-23), B-cell activating factor (BAFF) and Th1 cytokine (interferon-γ) were up-regulated in rNP compared to controls and pNP. Human neutrophil elastase-positive cells were also enhanced in rNP compared with pNP. Upregulation of Th17/Th1mediators and BAFF were observed in rNP, regardless of tissue eosinophilia or asthmatic comorbidity. Interestingly, eosinophilic markers, such as eosinophil cationic protein and C-C motif chemokine ligand 24, were up-regulated in asthmatic rNP compared to pNP and controls. Levels of anti-dsDNA immunoglobulin (Ig) G and IgA were up-regulated in rNP and highest in asthmatic eosinophilic rNP among subtypes of rNP. Conclusions: Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP.

AB - Purpose: Despite medical and surgical treatments, some cases of nasal polyps (NP) exhibit recidivism. However, the endotype of refractory chronic rhinosinusitis with NP (CRSwNP) remains unclear. Therefore, the objective of this study was to characterize the immunological profile of refractory CRSwNP. Methods: The control (n =23), primary NP group (pNP, n =70) and refractory NP group (rNP, n =86) were enrolled in this study. Patients who underwent revision surgeries due to failed maximal medical treatment after primary surgery were defined as the rNP group. A total of 18 inflammatory markers were investigated in nasal tissues using multiplex cytokine assay or enzyme-linked immunosorbent assay. Results: The clinical characteristics of rNP included more extensive disease and worse clinical course after surgery. Additionally, rNP subjects showed higher infection rate (mucopurulence and culture-positive rate), more frequent use of antibiotics and suffered from symptomatic bacterial infection, increased asthma morbidity compared to pNP. Cytokine profile analysis showed that levels of Th17-associated mediators (myeloperoxidase, interleukin (IL)-8, IL-17A and IL-23), B-cell activating factor (BAFF) and Th1 cytokine (interferon-γ) were up-regulated in rNP compared to controls and pNP. Human neutrophil elastase-positive cells were also enhanced in rNP compared with pNP. Upregulation of Th17/Th1mediators and BAFF were observed in rNP, regardless of tissue eosinophilia or asthmatic comorbidity. Interestingly, eosinophilic markers, such as eosinophil cationic protein and C-C motif chemokine ligand 24, were up-regulated in asthmatic rNP compared to pNP and controls. Levels of anti-dsDNA immunoglobulin (Ig) G and IgA were up-regulated in rNP and highest in asthmatic eosinophilic rNP among subtypes of rNP. Conclusions: Our results suggest that Th17/Th1-associated mediators and BAFF may play a role and be a potential therapeutic target in refractory CRSwNP. Additionally, eosinophilic markers and autoantibodies may contribute to refractoriness in asthmatic rNP.

KW - B cell activating factor

KW - Nasal polyps

KW - Neutrophil

KW - Refractory

KW - Sinusitis

KW - Th17 cells

UR - https://www.scopus.com/pages/publications/85071918163

U2 - 10.4168/aair.2019.11.5.664

DO - 10.4168/aair.2019.11.5.664

M3 - Article

AN - SCOPUS:85071918163

SN - 2092-7355

VL - 11

SP - 664

EP - 676

JO - Allergy, Asthma and Immunology Research

JF - Allergy, Asthma and Immunology Research

IS - 5

ER -

Immunological characteristics in refractory chronic rhinosinusitis with nasal polyps undergoing revision surgeries

Abstract

Keywords

UN SDGs

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