Inflammatory Profile of Chronic Rhinosinusitis With Nasal Polyp Patients in Brazil: Multicenter Study

Fabrizio R Romano¹, Fabiana C P Valera², Marco A Fornazieri³, Natália M D Lopes⁴, Marcel M Miyake⁵, Ricardo L L Dolci⁶, Marcio Nakanishi⁷, Gustavo S M Freire⁸, Eulália Sakano⁹, Mariana D C Toro¹⁰, Eduardo M Kosugi¹¹, Luciano L Gregorio¹², Marco C J Dos Santos¹³, Juliana Murata¹⁴, Atilio M Fernandes¹⁵, Luis L Moras¹⁵, Melissa A G Avelino¹⁶, Leandro A Camargo¹⁷, Marcus M Lessa¹⁸, Laiana do C Almeida¹⁹, Renato Roithmann^{20

21}, Nicole Redeker²², Miguel S Tepedino²³, Pedro M Vianna²⁴, Otávio B Piltcher²⁵, Camila D Meotti²⁶, Thiago F P Bezerra²⁷, Richard L Voegels²⁸, Renata R de Mendonça Pilan²⁸, Adriana de A Batista Murashima²⁸, Lilian E C M da Silva²⁹, Eurico Arruda³⁰, Denny M Garcia²⁸, Edwin Tamashiro², Wilma Anselmo-Lima²⁹

Affiliations

¹ Department of Ophtalmology, Otorhinolaryngology and Head and Neck Surgery, University of Sao Paulo, FMRP-USP, São Paulo, Brazil.
² Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
³ Department of Otorhinolaryngology, State University of Londrina and PUC-Paraná, Paraná, Brazil.
⁴ Department of Otorhinolaryngology, Grupo de Excelência Médica, State University of Londrina and PUC-Paraná, Paraná, Brazil.
⁵ Department of Otorhinolaryngology at Santa Casa de Misericórdia Hospital of São Paulo, FMRP-USP, São Paulo, Brazil.
⁶ Department of Otorhinolaryngology at Santa Casa de Misericórdia Hospital of São Paulo, São Paulo, Brazil.
⁷ Medical School Graduate Program, University of Brasília, Brasília, Brazil.
⁸ Department of Otorhinolaryngology, Medical Sciences University of Brasilia, Brasilia, Brazil.
⁹ Department of Ophthalmology/Otorhinolaryngology of the Science Medical School of Sao Paulo State University, Sao Paulo, Brazil.
¹⁰ Department of Otolaryngology, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
¹¹ Department of Otorhinolaryngology, Head and Neck Surgery at Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil.
¹² Department of Otorhinolaryngology, Universidade Federal de São Paulo, São Paulo, Brazil.
¹³ Department of Otorhinolaryngology, Catholic University of Parana, Parana, Brazil.
¹⁴ Department of Otorhinolaryngology, Eco Medical Center, Curitiba, Parana, Brazil.
¹⁵ Department of Otorhinolaryngology and Head and Neck Surgery, Famerp, São José do Rio Preto, São Paulo, Brazil.
¹⁶ Department at Goiás Federal University, Goiás Federal University, Goiás, Brazil.
¹⁷ Department of Otolaryngology, Federal University of Goias, Goias, Brazil.
¹⁸ Department of Otorhinolaryngology, Otorhinolaryngology of the Federal University of Bahia Medical School, Salvador, Bahia, Brazil.
¹⁹ Department of Otorhinolaryngology, Medical Sciences Federal University of Bahia Medical School, Salvador, Bahia, Brazil.
²⁰ Otolaryngology Department of Otolaryngology-Head and Neck Surgery, Universidade Luterana do Brasil, Porto Alegre, Brazil.
²¹ Department of Otolaryngology-Head and Neck Surgery Mount Sinai Hospital, Toronto, Canada.
²² Department of Otolaryngology-Head and Neck Surgery, Universidade Luterana do Brazil, Rio Grande do Sul, Brazil.
²³ Division of Clinical Otorhinolaryngology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Policlínica de Botafogo, Rio de Janeiro, Brazil.
²⁴ Department of Otorhinolaryngology, Medical Residency Program of Otorhinolaryngology at Army Central Hospital-RJ, Rhinology and Skull Base Endoscopic Surgery Team at HUPE-UERJ, Rio de Janeiro, Brazil.
²⁵ Department of Otorhinolaryngology, School of Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
²⁶ Department of Otorhinolaryngology, Hospital de Clinicas de Porto Alegre, Surgical Sciences at Universidade Federal do Rio Grande do Sul, Rhinology at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
²⁷ Department of Otorhinolaryngology, Federal University of Pernambuco, Pernambuco, Brazil.
²⁸ Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil.
²⁹ Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
³⁰ Department of Cell and Molecular Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.

PMID: 39087780
DOI: 10.1002/ohn.904

Multicenter Study

Inflammatory Profile of Chronic Rhinosinusitis With Nasal Polyp Patients in Brazil: Multicenter Study

Fabrizio R Romano et al. Otolaryngol Head Neck Surg. 2024 Nov.

. 2024 Nov;171(5):1552-1561.

doi: 10.1002/ohn.904. Epub 2024 Aug 1.

Authors

Affiliations

¹ Department of Ophtalmology, Otorhinolaryngology and Head and Neck Surgery, University of Sao Paulo, FMRP-USP, São Paulo, Brazil.
² Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
³ Department of Otorhinolaryngology, State University of Londrina and PUC-Paraná, Paraná, Brazil.
⁴ Department of Otorhinolaryngology, Grupo de Excelência Médica, State University of Londrina and PUC-Paraná, Paraná, Brazil.
⁵ Department of Otorhinolaryngology at Santa Casa de Misericórdia Hospital of São Paulo, FMRP-USP, São Paulo, Brazil.
⁶ Department of Otorhinolaryngology at Santa Casa de Misericórdia Hospital of São Paulo, São Paulo, Brazil.
⁷ Medical School Graduate Program, University of Brasília, Brasília, Brazil.
⁸ Department of Otorhinolaryngology, Medical Sciences University of Brasilia, Brasilia, Brazil.
⁹ Department of Ophthalmology/Otorhinolaryngology of the Science Medical School of Sao Paulo State University, Sao Paulo, Brazil.
¹⁰ Department of Otolaryngology, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
¹¹ Department of Otorhinolaryngology, Head and Neck Surgery at Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil.
¹² Department of Otorhinolaryngology, Universidade Federal de São Paulo, São Paulo, Brazil.
¹³ Department of Otorhinolaryngology, Catholic University of Parana, Parana, Brazil.
¹⁴ Department of Otorhinolaryngology, Eco Medical Center, Curitiba, Parana, Brazil.
¹⁵ Department of Otorhinolaryngology and Head and Neck Surgery, Famerp, São José do Rio Preto, São Paulo, Brazil.
¹⁶ Department at Goiás Federal University, Goiás Federal University, Goiás, Brazil.
¹⁷ Department of Otolaryngology, Federal University of Goias, Goias, Brazil.
¹⁸ Department of Otorhinolaryngology, Otorhinolaryngology of the Federal University of Bahia Medical School, Salvador, Bahia, Brazil.
¹⁹ Department of Otorhinolaryngology, Medical Sciences Federal University of Bahia Medical School, Salvador, Bahia, Brazil.
²⁰ Otolaryngology Department of Otolaryngology-Head and Neck Surgery, Universidade Luterana do Brasil, Porto Alegre, Brazil.
²¹ Department of Otolaryngology-Head and Neck Surgery Mount Sinai Hospital, Toronto, Canada.
²² Department of Otolaryngology-Head and Neck Surgery, Universidade Luterana do Brazil, Rio Grande do Sul, Brazil.
²³ Division of Clinical Otorhinolaryngology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Policlínica de Botafogo, Rio de Janeiro, Brazil.
²⁴ Department of Otorhinolaryngology, Medical Residency Program of Otorhinolaryngology at Army Central Hospital-RJ, Rhinology and Skull Base Endoscopic Surgery Team at HUPE-UERJ, Rio de Janeiro, Brazil.
²⁵ Department of Otorhinolaryngology, School of Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
²⁶ Department of Otorhinolaryngology, Hospital de Clinicas de Porto Alegre, Surgical Sciences at Universidade Federal do Rio Grande do Sul, Rhinology at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
²⁷ Department of Otorhinolaryngology, Federal University of Pernambuco, Pernambuco, Brazil.
²⁸ Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil.
²⁹ Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil.
³⁰ Department of Cell and Molecular Biology, Virology Research Center, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.

PMID: 39087780
DOI: 10.1002/ohn.904

Abstract

Objectives: To determine the inflammatory profile of CRSwNP in Brazil and characterize the subgroups of CRSwNP patients in this population through cluster analysis.

Study design: Multicenter cross-sectional study involving 15 centers representing different regions of Brazil.

Subjects and methods: Clinical data of 166 patients and 80 controls, aged 18 to 70 years old, number of surgeries for CRS, history of asthma and aspirin sensitivity, and Lund-Mackay scores on CT scans. During nasal endoscopy, we obtained the Lund-Kennedy scores and collected 2 samples of nasal polyps: one for eosinophil and neutrophil tissue counts and one to quantify different cytokines.

Results: 79.6% of our patients had 10 or more eosinophils/HPF. CRSwNP groups exhibited significantly lower concentrations of TNF-alpha and significantly higher concentrations of IFN-gamma, CCL11/Eotaxin, CCL24/Eotaxin-2/MPIF-2, and CCL26/Eotaxin-3 versus the control group (Kruskal-Wallis test). Comparison between CRSwNP groups (≥10 vs <10 eosinophils/HPF) showed no difference in cytokine concentration (Mann-Whitney test). Hierarchical clustering and PCA according to cytokine concentrations revealed 2 main Clusters, with a significantly higher concentration of all cytokines in Cluster 1 (n = 35) than in Cluster 2 (n = 121), except IL-6 and IL-33 (Mann-Whitney test). According to ROC curve analysis the best cut-off to differentiate the 2 clusters was 43 eosinophils/HPF. The group with ≥43 presented a higher prevalence of men and a higher Lund-Mackay score (Mann-Whitney test).

Conclusions: CRSwNP patients in Brazil present mixed inflammation, with 2 distinct groups (high and low inflammatory pattern) that can be distinguished by tissue eosinophilia of ≥43 eosinophils/HPF cut-off in nasal polyps.

Keywords: chronic rhinosinusitis; inflammation; phenotype.

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References

1. Ahern S, Cervin A. Inflammation and endotyping in chronic rhinosinusitis—a paradigm shift. Medicina. 2019;55(4):95.
1. Soler ZM, Hyer JM, Ramakrishnan V, et al. Identification of chronic rhinosinusitis phenotypes using cluster analysis. Int Forum Allergy Rhinol. 2015;5(5):399‐407.
1. Epub 2015 Feb 17 Erratum in: Int Forum Allergy Rhinol. 2017 Jan;7(1):106
1. Fokkens WJ, Lund VJ, Hopkins C, et al. Executive summary of EPOS 2020, including integrated care pathways. Rhinol J. 2020;58(2):82‐111.
1. Kato A, Schleimer RP, Bleier BS. Mechanisms and pathogenesis of chronic rhinosinusitis. J Allergy Clin Immunol. 2022;149(5):1491‐1503. doi:10.1016/j.jaci.2022.02.016

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Inflammatory Profile of Chronic Rhinosinusitis With Nasal Polyp Patients in Brazil: Multicenter Study

Affiliations

Inflammatory Profile of Chronic Rhinosinusitis With Nasal Polyp Patients in Brazil: Multicenter Study

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Medical