鼻息肉
免疫学
医学
嗜酸性粒细胞
嗜酸性阳离子蛋白
免疫系统
免疫球蛋白E
主要碱性蛋白
嗜酸性
过敏
炎症
内型
鼻窦炎
哮喘
病理
抗体
作者
Tim Delemarre,Gabriële Holtappels,Natalie De Ruyck,Nan Zhang,Hans Nauwynck,Claus Bachert,Elien Gevaert
标识
DOI:10.1016/j.jaci.2020.04.040
摘要
Background
Chronic rhinosinusitis without nasal polyps (CRSsNP) is mainly considered a type 1 mediated disease. The role and clinical significance of type 2 immune responses in CRSsNP have not been addressed sufficiently; a recent cluster analysis for CRS described the existence of a subgroup of patients with CRSsNP with a type 2 inflammation. Objective
We aimed to characterize the underlying type 2 immune response and its clinical significance in patients with CRSsNP. Methods
A total of 240 patients with CRSsNP were endotyped and subdivided on the basis of expression of marker cytokines. Clinical data such as recurrence, comorbid asthma and allergy, and numbers of blood eosinophils and neutrophils were collected from all patients. A selection of 15 patients was further characterized for the presence of eosinophils, neutrophils, Charcot-Leyden crystals, and eosinophil extracellular traps in the mucosae. Results
A type 2 immune response with increased levels of IL-4, IL-5, eosinophil cationic protein, IgE, and Staphylococcus aureus enterotoxin–specific IgE was observed in 49% of patients with CRSsNP. Those patients showed increased numbers of blood and tissue eosinophils, and they displayed a considerable eosinophilic inflammation associated with eosinophil extracellular trap cell death and Charcot-Leyden crystals. A significantly increased prevalence of recurrence and asthma was observed in patients with type 2 CRSsNP compared with in patients with non–type 2 CRSsNP. However, only 4 of 117 patients with type 2 CRSsNP developed nasal polyps within 12 years. Conclusion
This study shows that type 2 immune responses in CRSsNP follow similar patterns but are less pronounced than in chronic rhinosinusitis with nasal polyps. Also CRSsNP with a moderate type 2 immune response showed a considerable eosinophilic inflammation with clinical impact.
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