Inflammatory features and predictors for postsurgical outcomes in patients with nasal polyps stratified by local and systemic eosinophilia

Li, Pan; Liao, Bo; Guo, Chongfeng; Liu, Jinxin; Wang, Heng; Xiang, Long; Liu, Zheng

doi:10.1002/alr.22702

Cited by 26 publications

(17 citation statements)

References 51 publications

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“…A total of 1181 Chinese patients with bilateral CRSwNP was initially identified. Then patients with the following items were excluded: (1) Patients were treated with systemic corticosteroids within 3 months or internasal corticosteroids within 1 month before surgery and routine blood test, 17 by cross‐referencing patient's medication history with the electronic prescription record system. (2) Patients with fungal rhinosinusitis, cystic fibrosis, antrochoanal polyps, gastro‐esophageal reflux disease, or sinonasal tumors.…”

Section: Methodsmentioning

confidence: 99%

Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Shi

Wang

et al. 2022

Laryngoscope Investig Oto

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Background High tissue and blood eosinophils are linked to poor treatment outcome in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). However, the difference between the patients with different level of blood or tissue eosinophilia in relation to disease control is still lacking. Objectives This study aimed to characterize patients with CRSwNP with intensely high eosinophil level. Methods A retrospective study of CRSwNP patients underwent endoscopic sinus surgery was conducted. The patients were subdivided with various cut‐off values of blood and tissue eosinophils. Tissue eosinophils of ≥50% and 10%–20% were defined as intensely high tissue eosinophils (IH‐tissue‐eos) and high tissue eosinophils (H‐tissue‐eos), respectively. Blood eosinophils of ≥0.6 × 109/L and 0.2 × 109/L–0.3 × 109/L were defined as intensely high blood eosinophils (IH‐blood‐eos) and high blood eosinophils (H‐blood‐eos). Clinical characteristics, Lund‐Mackay score (LMS), and disease control status were compared between subgroups. Results A total of 302 patients were enrolled. There was a trend toward a higher rate of uncontrolled disease when the patients subdivided by blood eosinophil cut‐off values ranged from 0.1 × 109/L to 0.6 × 109/L. The controlled patients accounted for 27%, 36%, 22%, and 31%, and the uncontrolled patients 46%, 32%, 52%, and 31% of patients in IH‐tissue‐eos, H‐tissue‐eos, IH‐blood‐eos, and H‐blood‐eos subgroup, respectively. The percentages of patients in the three categories of control were not significantly different between IH‐tissue‐eos and H‐tissue‐eos subgroups. By contrast, the IH‐blood‐eos subgroup had higher percentages of current smoker and asthma, preoperative LMS and tissue eosinophil percentage, and showed a trend toward a higher rate of uncontrolled subjects compare with the H‐blood‐eos subgroup. Conclusion CRSwNP patients with IH‐blood‐eos (≥0.6 × 109/L) may be possibly associated with a poorer disease control than those with levels near the threshold of blood eosinophilia (0.2 × 109/L–0.3 × 109/L). Further larger, preferably prospective studies are needed to confirm this relationship. Level of Evidence: 4.

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Section: Methodsmentioning

confidence: 99%

Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Shi

Wang

et al. 2022

Laryngoscope Investig Oto

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“…190 Limited available data suggest that higher intensity of T1 and T3 inflammation also favors surgical failure. 188,191 It should be highlighted that many of these larger studies examining T2 biomarkers for predicting surgical outcomes have been conducted in Asia, especially China, where CRSwNP is more endotypically heterogeneous. Whether these same biomarkers will prove useful in Western populations where CRSwNP is more homogenously T2 remains an area of active investigation.…”

Section: Surgerymentioning

confidence: 99%

Endotypes of chronic rhinosinusitis: Relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches

Kato

Peters

Stevens

et al. 2021

Allergy

134

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Chronic rhinosinusitis (CRS) is a common clinical syndrome that produces significant morbidity and costs to our health system. The study of CRS has progressed from an era focused on phenotype to include endotype-based information. Phenotypic classification has identified clinical heterogeneity in CRS based on endoscopically observed features such as presence of nasal polyps, presence of comorbid or systemic diseases, and timing of disease onset. More recently, laboratory-based findings have established CRS endotype based upon specific mechanisms or molecular biomarkers.Understanding the basis of widespread heterogeneity in the manifestations of CRS is advanced by findings that the three main endotypes, Type 1, 2, and 3, orchestrate the expression of three distinct large sets of genes. The development and use of improved methods of endotyping disease in the clinic are ushering in an expansion of the use of biological therapies targeting Type 2 inflammation now and perhaps other inflammatory endotypes in the near future. The purpose of this review is to discuss the phenotypic and endotypic heterogeneity of CRS from the perspective of advancing the understanding of the pathogenesis and improvement of treatment approaches and outcomes.

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“…Using cluster analysis, Liao et al 8 detected two distinct clusters characterized by T2 response and eosinophil‐dominated endotype, and neutrophil‐dominated endotype with high IL‐8 levels. Consistently, studies in China and Korea have shown that only a small percentage of CRSwNP patients (4.4%–11.2%) exhibited both high eosinophilic and neutrophilic inflammation 39–41 . In contrast, recent studies indicate a positive interaction between eosinophilic and neutrophilic inflammation in CRSwNP patients in Western countries 42 .…”

Section: Distinct Characteristics Of Crs In Asian Patientsmentioning

confidence: 66%

“…Consistently, studies in China and Korea have shown that only a small percentage of CRSwNP patients (4.4%-11.2%) exhibited both high eosinophilic and neutrophilic inflammation. [39][40][41] In contrast, recent studies indicate a positive interaction between eosinophilic and neutrophilic inflammation in CRSwNP patients in Western countries. 42 CRSwNP patients with markedly eosinophilic inflammation exhibit substantial levels of neutrophil infiltration.…”

Section: Eosinophilic and Neutrophilic Inflammationmentioning

confidence: 93%

Revisiting Asian chronic rhinosinusitis in the era of type 2 biologics

Yao

Zeng

Liu

2021

Clin Experimental Allergy

Self Cite

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Chronic rhinosinusitis (CRS) is defined as the inflammation of the mucosa of the nose and paranasal sinuses over 12 weeks, occurring in 11%-12% of adults in Europe and the United States, 1 and approximately 8% of adults in China and Korea. 2,3 CRS frequently presents with other inflammatory airway conditions such as asthma and allergic rhinitis (AR), and imposes huge global health and economic burdens. 1,2 CRS is a highly heterogeneous disorder with diverse inflammatory profiles. [4][5][6] Based on endoscopic examination finding, CRS is clinically subclassified into CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). 4,5 Studies in Caucasian patients have shown that CRSwNP is characterized by type 2 (T2) [high interleukin (IL)-4, IL-5, IL-13 and IgE expression] and eosinophilic inflammation, whereas CRSsNP is primarily characterized by type 1 (T1) [high interferon (IFN)γ expression] and type 3 (T3) (high IL-17A expression) inflammation. 1,4,6 Conventional anti-inflammatory treatments of CRS include intranasal and systemic corticosteroids. 1,4 Endoscopic sinus surgery is considered when medical therapy fails. 1,4 However, it has been shown that approximately 20% of CRSsNP and 40% of CRSwNP patients relapse 1-2 years after surgery. [7][8][9] Eosinophilic inflammation and T2 immune response have been identified as important risk factors for disease relapse in CRS patients, 1,4,6,10,11 thus stimulating the study of T2 biologics in Caucasian patients with severe CRSwNP. Four multicentre and international phase 3 trials have demonstrated promising effect of omalizumab (anti-IgE), dupilumab (anti-IL-4Rα), mepolizumab (anti-IL-5) and benralizumab (anti-IL-5Rα) in reducing nasal polyp (NP) size and relieving symptoms in patients with refectory and severe CRSwNP. [12][13][14][15]

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Inflammatory features and predictors for postsurgical outcomes in patients with nasal polyps stratified by local and systemic eosinophilia

Cited by 26 publications

References 51 publications

Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Clinical characteristics of patients with CRSwNP with intensely high eosinophil level

Endotypes of chronic rhinosinusitis: Relationships to disease phenotypes, pathogenesis, clinical findings, and treatment approaches

Revisiting Asian chronic rhinosinusitis in the era of type 2 biologics

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