Calprotectin in nasal secretion: a new biomarker of non-type 2 inflammation in CRSwNP

Abstract

Objective. We analysed calprotectin in sinonasal secretions of different chronic rhinosinusitis with nasal polyps (CRSwNP) endotypes to assess its role as a biomarker of non-type 2 inflammation. Methods. We included primary diffuse CRSwNP patients (n = 41) and three different control groups [non-allergic rhinitis (NAR) (n = 13), non-allergic eosinophilic syndrome (NARES) (n = 10) and healthy subjects (n = 12)]. Calprotectin levels were detected in nasal secretions using a chemiluminescent immunoassay (CLIA). Results. Calprotectin levels in nasal secretions were significantly higher in all non-type 2 endotypes of CRSwNP compared to healthy controls (p < 0.05). In contrast, in type-2 CRSwNP calprotectin was significantly lower compared to controls (p < 0.05). A significant correlation between calprotectin levels and neutrophilic count/HPF was found in CRSwNP (p < 0.01). Clinically, mean levels of calprotectin and neutrophilia were significantly higher in patients who previously underwent 3 or more endoscopic sinus surgeries (p < 0.05). Conclusions. Calprotectin in nasal secretions may be a biomarker of non-type 2 inflammation. Low levels of calprotectin are indicative of a type-2 immune response in both CRSwNP and non-allergic rhinitis. We observed that calprotectin levels significantly increased based on the number of previous surgeries.

Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights

“…In Sweden, a comprehensive work-up of patients with recurrent CRSwNP with previous surgery is recommended only when their disease is advanced enough to warrant biological treatment; 44 Defined by EPOS 2020 as a temporary aggravation of symptoms, 1 acute exacerbations typically occur after treatment with systemic corticosteroids and/or antibiotics. 46 Acute CRSwNP exacerbations have been associated with an average 7.83-point increase in SNOT-22 47 and pose a considerable burden on patients' daily lives as well as the healthcare systems. 46 Exacerbations in CRSwNP are triggered by viral or bacterial infections, but the clinical backdrop is often more complex.…”

EUFOREA/EPOS2020 statement on the clinical considerations for chronic rhinosinusitis with nasal polyps care

“…In the shared decision-making process, clinicians and patients must consider symptomatology, goals of the revision surgery, impact of the surgery on the patient (including the potential for an increased risk of intra-operative complications), post-operative compliance to anti-inflammatory treatment and the chronicity of the disease. 24,41 Revision ESS can be more challenging than the primary surgery due to scarring and altered anatomy from previous procedures 42 resulting in a higher risk of complications, 43 and one can consider referring to a rhinologist or more experienced sinus surgeon. The surgeon must carefully assess the extent of inflammation, the extent of the surgery performed earlier, the presence of fibrosis and chronic osteitis and the potential impact on adjacent structures and include the higher complication risk in the decision process.…”

“…12,22 In routine clinical practice, there is a significant heterogeneity in prescribing systemic steroids by clinicians in terms of type, dosage and treatment duration, partially explained by the lack of universally accepted modes of prescribing of systemic steroids over the years. 8,20,23,24…”

Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients

“…According to the sensorineural hypothesis, the chronic inflammation of the neuroepithelium and the edema on the olfactory mucosa contribute to decreasing the transmission of synaptic olfactory impulses. However, the conductive hypothesis states that the change in the airflow due to the presence of nasal polyps or edematous mucosal tissue could be responsible for the olfactory impairment (13). Indeed, smell loss is also feasible in patients without obstruction or altered airflow and, on the other side, in many patients, the removal of nasal polyps does not improve the olfactory function (14).…”