An Integrated Analysis of Inflammatory Endotypes and Clinical Characteristics in Chronic Rhinosinusitis with Nasal Polyps

Abstract

Objective Chronic rhinosinusitis with nasal polyps (CRSwNP) is mainly characterised by type 1 (T1), type 2 (T2) and type 3 (T3) inflammatory endotypes. However, correlations between inflammatory endotypes and clinical features in CRSwNP have not been demonstrated sufficiently. This study aimed to determine the endotype-phenotype associations in CRSwNP. Methods Clinical data of 31 control subjects and 106 CRSwNP patients were analysed. Interferon (IFN)-γ (T1), Charcot-Leyden crystal galectin (CLC) (T2) and Interleukin (IL)-17A (T3) were used as biomarkers to identify the inflammatory endotypes. Results The mRNA expression level of IFN-γ was positively correlated with IL-17A (r = 0.817; P < 0.0001). Headache/facial pain (P = 0.039) was associated with T1 endotype. Smell loss (P = 0.025) was associated with T2 endotype. Purulent rhinorrhea (P = 0.001) was associated with T3 endotype. Atopy (P = 0.030), asthma (P = 0.005) and recurrence (P = 0.022) were more frequent in T2 endotype. Total Symptom Scores (TSS) of T2 (P < 0.001) and T3 (P = 0.009) endotype were higher than non-T2 and non-T3, respectively. Sino Nasal Outcome Test-22 (SNOT-22) total scores of T3 (P = 0.054) endotype were higher than non-T3. Conclusion Identifications of endotype-phenotype associations are useful in clinical diagnoses and targeted therapies for patients with CRSwNP.

Role of Fibroblasts in Chronic Inflammatory Signalling in Chronic Rhinosinusitis with Nasal Polyps—A Systematic Review

“…Although endotyping has proven to be pivotal in the management of chronic inflammation of CRSwNP, the actual clinical presentation may comprise a spectrum with overlapped inflammatory responses. Indeed, Hao et al [72] found that IL-17A production correlated in turn with IFN-γ production, which highlights the existence of a synergistic effect between the T1 and T3 inflammatory response in the pathogenesis of certain patients with CRSwNP.…”

Lymphatic Vessels in Chronic Rhinosinusitis

“…13 However, recent findings in research point out that CRS may be a much more complex disease with many different factors contributing to its development. 14,15 Studies examining the contribution of the nasal microvasculature to CRS pathophysiology generally focus more on blood vessels than on LVs. 16 However, one study suggested that the occurrence of nasal polyps is connected to a lower lymphatic vessel density, 17 and currently there is also speculation about the participation of the micro lymphvasculature in non-type 2 inflammatory endotypes.…”