Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis

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3 Citations (Scopus)

Abstract

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. Objective: To identify associations between inflammatory endotypes and clinical presentations in CRS. Methods: We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-γ (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features. Results: The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes. Conclusions: Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.

Original languageEnglish (US)
Pages (from-to)2812-2820.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume7
Issue number8
DOIs
StatePublished - Nov 1 2019

Fingerprint

Inflammation
Suppuration
Smell
Galectin 2
Eosinophil Cationic Protein
Interleukin-17
Paranasal Sinuses
Interleukin-3
Mucins
Nose
Medical Records
Comorbidity
Phenotype
Therapeutics
Asthma and Nasal Polyps

Keywords

  • Chronic rhinosinusitis
  • Clinical presentation
  • Endotype-phenotype association
  • Inflammatory endotype

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

@article{880f66fd41cb4e03b398ba3fac49de9f,
title = "Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis",
abstract = "Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. Objective: To identify associations between inflammatory endotypes and clinical presentations in CRS. Methods: We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-γ (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features. Results: The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes. Conclusions: Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.",
keywords = "Chronic rhinosinusitis, Clinical presentation, Endotype-phenotype association, Inflammatory endotype",
author = "Whitney Stevens and Peters, {Anju Tripathi} and Tan, {Bruce Kuang-Huay} and Klingler, {Aiko I.} and Poposki, {Julie A.} and Hulse, {Kathryn E} and {Grammer III}, {Leslie C} and Welch, {Kevin Christian} and Smith, {Stephanie Shintani} and {Conley Jr}, {David B} and Kern, {Robert C} and Schleimer, {Robert P} and Atsushi Kato",
year = "2019",
month = "11",
day = "1",
doi = "10.1016/j.jaip.2019.05.009",
language = "English (US)",
volume = "7",
pages = "2812--2820.e3",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
issn = "2213-2198",
publisher = "Elsevier",
number = "8",

}

TY - JOUR

T1 - Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis

AU - Stevens, Whitney

AU - Peters, Anju Tripathi

AU - Tan, Bruce Kuang-Huay

AU - Klingler, Aiko I.

AU - Poposki, Julie A.

AU - Hulse, Kathryn E

AU - Grammer III, Leslie C

AU - Welch, Kevin Christian

AU - Smith, Stephanie Shintani

AU - Conley Jr, David B

AU - Kern, Robert C

AU - Schleimer, Robert P

AU - Kato, Atsushi

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. Objective: To identify associations between inflammatory endotypes and clinical presentations in CRS. Methods: We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-γ (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features. Results: The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes. Conclusions: Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.

AB - Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. Objective: To identify associations between inflammatory endotypes and clinical presentations in CRS. Methods: We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-γ (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features. Results: The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes. Conclusions: Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.

KW - Chronic rhinosinusitis

KW - Clinical presentation

KW - Endotype-phenotype association

KW - Inflammatory endotype

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U2 - 10.1016/j.jaip.2019.05.009

DO - 10.1016/j.jaip.2019.05.009

M3 - Article

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SP - 2812-2820.e3

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

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