Different levels of mucus inflammatory mediators in nasal polyposis with and without aeroallergen sensitivity

Abstract

Objectives: Biomarker levels in nasal secretions can reflect the inflammatory status of nasal mucosa and evolution of sinus disease. The aim of this study was to evaluate the relationship between local inflammatory mediator production and clinical characteristics of patients with nasal polyposis (NP).

Methods: Thirty-one nonaeroallergen sensitized patients with NP (NANP), 29 aeroallergen sensitized patients with NP (ANP), and 30 subjects without inflammation of nasal mucosa as controls (C) entered this prospective, cross-sectional study. Clinical parameters (symptoms, endoscopic, and radiological findings) were assessed. The concentrations of heat shock protein 70 (HSP70), eosinophil cationic protein (ECP), tryptase, substance P and Clara cell protein 16 (CC16) were measured in the nasal secretion samples of all participants by ELISA method.

Results: Our results showed higher concentrations of HSP70, ECP, and tryptase in ANP than in NANP and C (p < .001 for all markers). On the other hand, levels of CC16 were significantly higher in C than in NANP and ANP groups (p < .001; p < .001, respectively). We found positive correlations between HSP70, ECP, tryptase, and substance P levels and nasal symptom score in patients with NP. Also, HSP70, ECP, tryptase, and substance P showed different levels of positive correlation among themselves, with HSP70 showing highest positive correlation with ECP. Finally, relatively strong negative correlations were found between the levels of CC16 and nasal symptoms, as well as between the CC16 levels and levels of other four mediators in nasal fluid.

Conclusion: HSP70, ECP, tryptase, and substance P might play a role in the pathogenesis of NP. The results suggest that chronic inflammation in NP involves a self-sustaining local release of HSP70, ECP, and tryptase, independent of aeroallergen stimulation of the mucosal layer, although the production of these mediators is higher in aeroallergen sensitized NP patients.

Keywords: Tryptases; eosinophil cationic protein; heat‐shock proteins; inflammation; nasal polyps; substance P.

FIGURE 1

Comparison of different clinical parameter scores between participant groups. TNSS was compared between all three groups, while ES and LMS were only assessed in patients with nasal polyps. Statistical difference was only shown for TNSS, which was significantly higher both in NANP and ANP groups, when compared with patients from the control group. Results are represented as medians with 25th and 75th percentiles. *** p value of <.001. ANP, Aeroallergen sensitized patients with nasal polyposis; ES, endoscopic score; LMS, Lund‐Mackay score; NANP, non‐aeroallergen sensitized patients with nasal polyposis; TNSS, Total Nasal Symptom Score

FIGURE 2

Comparison of different inflammatory mediators between groups. (A) CC16 was significantly higher in control patient group when compared to patients with nasal polyps. In addition, CC16 was higher in NANP than in ANP patient group. (B) HSP70 values were significantly lower in control group when compared to patients with nasal polyps, while NANP patients had lower values than patients from ANP group. (C) ECP showed lower values in control patient group and significantly lower values in NANP group than in ANP group. (D) Tryptase levels were also lower in control and NANP patients' groups than in patients from ANP group. (E) Significantly lower levels of Substance P were only discovered in control patient group, while no significant difference was detected between NANP and ANP groups. ***p value of <.001 and statistical significance between control and NANP/ANP groups. **p value of <.01 and statistical significance between control and NANP/ANP groups. ###p value of <.001 and statistical significance between NANP and ANP groups. Results are represented as medians with 25th and 75th percentiles. ##p value of <.01 and statistical significance between NANP and ANP groups. ANP, aeroallergen sensitized patients with nasal polyposis; NANP, nonaeroallergen sensitized patients with nasal polyposis

FIGURE 3

Heatmap of correlation between inflammatory mediators and clinical parameters. Colors in the heatmap correspond to the strength and direction of correlation, where red color denotes a positive correlation, blue color denotes a negative correlation, and white color denotes a correlation coefficient of 0. Values in the heatmap boxes represent the Spearman's correlation coefficient