Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis

Kuhar, Hannah N.; Tajudeen, Bobby A.; Mahdavinia, Mahboobeh; Gattuso, Paolo; Ghai, Ritu; Batra, Pete S.

doi:10.1002/alr.21943

Cited by 75 publications

(127 citation statements)

References 15 publications

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“…The airway remodeling was first described in the lower airway in asthma. Recently, a growing numbers of studies investigated tissue remodeling in CRS and found that CRS is also characterized by mucosa remodeling [3]. It was reported that mucosal hypertrophy, basement membrane thickening, fibrosis, subepithelial collagen deposition and angiogenesis are common forms of remodeling in CRS [3].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a growing numbers of studies investigated tissue remodeling in CRS and found that CRS is also characterized by mucosa remodeling [3]. It was reported that mucosal hypertrophy, basement membrane thickening, fibrosis, subepithelial collagen deposition and angiogenesis are common forms of remodeling in CRS [3]. These tissue remodeling changes in CRS could affect normal sinonasal physiology, increase duration of symptoms and enhance surgical difficulty [18].…”

Section: Discussionmentioning

confidence: 99%

“…It causes a significant socioeconomic burden on health care system and severely impacts patients’ quality of life [2]. CRS can be divided into two phenotypes, based on the presence or absence of nasal polyps, referred to as chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), respectively [3]. Different phenotypes of CRS have different immunological mechanisms and different remodeling features as well.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, evidence suggested a relationship between inflammation and remodeling [3, 11]. Lots of inflammatory mediators are reported to play important roles in both inflammation and remodeling processes [12, 13].…”

Section: Introductionmentioning

confidence: 99%

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Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps

Xiang

Zhang

et al. 2018

Eur Arch Otorhinolaryngol

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BackgroundAllergic rhinitis (AR) has been reported to be associated with chronic rhinosinusitis (CRS). The objective of this study was to investigate the effect of AR on nasal mucosa remodeling in CRS.MethodsPatients were enrolled and divided into the following groups: CRS with nasal polyps (NP) with allergic rhinitis (AR)(CRSwNPwAR; n = 20), CRS with NP without AR (CRSwNPsAR; n = 20), CRS without NP with AR (CRSsNPwAR; n = 20), CRS without NP without AR (CRSsNPsAR; n = 20), AR without CRS (AR; n = 20) and controls (n = 14). Eosinophil infiltration, mucus production, and collagen deposition were examined by hematoxylin and eosin, periodic acid schiff and masson’s trichrome staining, respectively. VEGF-A and microvessel density were detected by immunohistochemistry. The expression of remodeling markers, including TGF-β1, MMP-7, MMP-9 and TIMP-1 were measured by Western blot.ResultsThe expression of remodeling factors, including VEGF-A, CD31, CD34 and TIMP-1 were significantly increased in CRSwAR compared to CRSsAR. Goblet cell hyperplasia, as well as VEGF-A, CD31, CD34, and MMP-9 expression were significantly higher in CRSwNPwAR compared to CRSwNPsAR. However, the expression of collagen fibers, MMP-7 and TGF-β1 were significantly higher in CRSsNPwAR compared to CRSsNPsAR.ConclusionsAR could enhance the remodeling process in CRS. Moreover, AR had different effects on CRSwNP and CRSsNP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps

Xiang

Zhang

et al. 2018

Eur Arch Otorhinolaryngol

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“…As our knowledge of pathophysiology evolves, treatment protocols must be adjusted to address specific underlying disease processes. Therefore, there is a need to develop tools to assist clinical decision‐making based on objective evidence, such as histopathology . In routine practice today, histopathology on surgical samples offers limited information on the heterogeneous pathogenic mechanisms underlying different CRSwNP endotypes, but a potential role of structured histopathological profiling for CRSwNP has begun to attract attention .…”

Section: Introductionmentioning

confidence: 99%

A classification of chronic rhinosinusitis with nasal polyps based on structured histopathology

et al. 2019

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Aims In chronic rhinosinusitis with nasal polyps (CRSwNP), tools based on objective evidence, such as histopathology, are needed to assist clinical decision‐making. The main aim of this exploratory investigation was to determine whether structured histopathology could be used to classify CRSwNP in homogeneous histological clusters. Methods and results A cohort of 135 CRSwNP patients was assessed, on the basis of clinicopathological features: allergic fungal rhinosinusitis (17 patients); non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (19 patients); intrinsic asthma (18 patients); extrinsic asthma (21 patients); allergy (21 patients); histologically eosinophilic (22 patients); and histologically non‐eosinophilic (17 patients). For structured histopathology, we considered: the degree of inflammation; eosinophil count; eosinophil aggregates; neutrophil infiltration; goblet cell hyperplasia; basement membrane thickening; fibrosis; hyperplastic/papillary changes; squamous metaplasia; mucosal ulceration; and subepithelial oedema. Cluster analysis identified four distinct sets of cases. On discriminant analysis, the global error rate was 1.48%, and the stratified error rates were 4.34%, 0%, 0%, and 0% for clusters 1, 2, 3 and 4, respectively. Cluster 1 was characterised by infrequent fibrosis (<4.5% of cases). Cluster 2 mainly featured neutrophil infiltration in 100% of cases, hyperplastic/papillary changes in 70% of cases, and fibrosis in 65% of cases. Cluster 3 showed fibrosis in 100% of cases. Cluster 4 showed hyperplastic/papillary changes in 100% of cases, and fibrosis in 92% of cases. Conclusions This study shows that cluster analysis can identify different histotypes among CRSwNP patients. The next step will be to investigate, in a larger series, the clinical (e.g. prognostic) implications of identifying such homogeneous clusters of patients with CRSwNP on the basis of their structured histopathology.

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Relative abundance of nasal microbiota in chronic rhinosinusitis by structured histopathology

Kuhar

Tajudeen

Mahdavinia

et al. 2018

Int Forum Allergy Rhinol

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Background: Chronic rhinosinusitis (CRS) is an inflammatory disease process with several different phenotypes. Recent data has shown that CRS phenotypes maintain distinct nasal microbiota that may predict surgical outcomes. Nasal microbiota and structured histopathologic reporting have the potential to further differentiate subtypes and provide additional insight into the pathophysiology of CRS. Methods:Sinus swabs collected during functional endoscopic sinus surgery (FESS) were studied by polymerase chain reaction analysis of 16S ribosomal RNA. A structured histopathology report of 13 variables was utilized to analyze sinus tissue removed during FESS. Histopathology variables and relative abundance of nasal microbiota were compared among CRS patients. Results: A total of 51 CRS patients who underwent FESS were included. Relative abundance of the Firmicutes phylum in nasal microbiota of CRS patients was associated with presence of neutrophilic infiltrate (27.47 ± 44.75 vs 9.21 ± 11.84, p < 0.029), presence of mucosal ulceration (47.67 ± 45.52 vs 13.27 ± 26.48, p < 0.041), presence of squamous metaplasia (5562.70 ± 2715.66 vs 3563.73 ± 2580.84, p < 0.035), and absence of Charcot-Leyden crystals (5423.00 ± 3320.57 vs 679.94 ± 1653.66, p < 0.001).Relative abundance of the Bacteroidetes phylum in nasal microbiota of CRS patients was associated with increased severity of inflammatory degree (p < 0.004) and presence of mucosal ulceration (p < 0.004). Conclusion: Distinct histopathologic features of CRS are associated with relative abundance of nasal microbiota phyla, specifically Firmicutes and Bacteroidetes. These findings contribute to the growing body of literature on microbiota in sinonasal disease and may have important implications for understanding pathophysiologic mechanisms of CRS subtypes and disease management. C 2018 ARS-AAOA, LLC. How to Cite this Article: Kuhar HN, Tajudeen BA, Mahdavinia M, et al. Relative abundance of nasal microbiota in chronic rhinosinusitis by structured histopathology. Int Forum Allergy Rhinol. 2018;8:1430-1437.

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Inflammatory infiltrate and mucosal remodeling in chronic rhinosinusitis with and without polyps: structured histopathologic analysis

Cited by 75 publications

References 15 publications

Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps

Different effects of allergic rhinitis on nasal mucosa remodeling in chronic rhinosinusitis with and without nasal polyps

A classification of chronic rhinosinusitis with nasal polyps based on structured histopathology

Relative abundance of nasal microbiota in chronic rhinosinusitis by structured histopathology

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