Individual exposure of ambient particulate matters and eosinophilic chronic rhinosinusitis with nasal Polyps: Dose-Response, mediation effects and recurrence prediction

Characterizing air pollution exposure methodologies in rhinology: a scoping review

ABST RACTCharacterization of air pollution assessment methodologies in rhinologic disease research is lacking. A scoping review was thus conducted to survey exposure methods in studies examining common rhinologic conditions: allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Several medical databases were queried for variables relating to (1) adults with a diagnosis of CRS or AR and (2) air pollution exposure. Data was extracted for pollutants assessed, method of quantifying exposure, assessment of residential stability, inclusion of authors with expertise in environmental exposure assessment, and disease-related outcomes. Thirty-four articles were included for analysis - 16 for AR and 18 for CRS. Fifteen studies originated from East Asia, 10 from North America, and 6 from Europe. The most common pollutant studied was PM2.5 (28 studies), with most studies investigating multiple pollutants. Twenty-one studies used a nearby air monitor to quantify exposure, 9 studies reported whether subjects had residential stability for the period assessed, and 17 studies included authors with climate science background. Timeframes included both acute and chronic exposure. Current methods to quantify air pollution exposure in rhinology vary considerably and inconsistently employ expertise from environmental scientists. Future investigations may benefit from multidisciplinary collaboration, reporting of residential stability, and standardized reporting metrics.

Development and Validation of an Explainable Prediction Model for Postoperative Recurrence in Pediatric Chronic Rhinosinusitis

OBJECTIVE

This study aims to develop an interpretable machine learning (ML) predictive model to assess its efficacy in predicting postoperative recurrence in pediatric chronic rhinosinusitis (CRS).

STUDY DESIGN

A decision analysis was performed with retrospective clinical data.

SETTING

Recurrent group and nonrecurrent group.

METHODS

This retrospective study included 148 pediatric CRS treated with functional endoscopic sinus surgery from January 2015 to January 2022. We collected demographic characteristics and peripheral blood inflammatory indices, and calculated inflammation indices. Models were trained with 3 ML algorithms and compared their predictive performance using the area under the receiver operating characteristic (AUC) curve. Shapley Additive Explanations and Ceteris Paribus profiles were used for model interpretation. The final model was transformed into a web for interactive visualization.

RESULTS

Among the 3 ML models, the Random Forest (RF) model demonstrated the best discriminative ability (AUC = 0.728). After reducing features based on importance and tuning parameters, the final RF model, including 4 features (systemic immune inflammation index (SII), pan-immune-inflammation value (PIV) and percentage of eosinophils (E%) and lymphocytes (L%)), showed good predictive performance in internal validation (AUC = 0.779). Global interpretation of the model suggested that L% and E% substantially contribute to the overall model. Local interpretation revealed a nonlinear relationship between the included features and model predictions. To enhance its clinical utility, the model was converted into a web (https://juice153.shinyapps.io/CRSRecurrencePrediction/).

CONCLUSION

Our ML model demonstrated promising accuracy in predicting postoperative recurrence in pediatric CRS, revealing a complex nonlinear relationship between postoperative recurrence and the features SII, PIV, L%, and E%.

Thymic Stromal Lymphopoietin (TSLP): Evidence in Respiratory Epithelial-driven Diseases Including Chronic Rhinosinusitis with Nasal Polyps

PURPOSE OF THE REVIEW

Thymic stromal lymphopoietin (TSLP) is increasingly recognized for its pivotal role in the pathogenesis of various epithelial-driven chronic inflammatory diseases. This review navigates the existing evidence on TSLP, with a particular focus on asthma, before delving into the current understanding of its role in chronic rhinosinusitis with nasal polyps (CRSwNP). We explore the role of TSLP in the pathogenesis of asthma and CRSwNP, two conditions often interconnected and collectively referred to as"Global Airway Disease". Additionally, this review assesses the therapeutic potential of TSLP inhibition as a treatment option for both CRSwNP and asthma. A systematic literature search was conducted; selected publications were used to describe the biology of TSLP, including its expression and diverse effects on inflammation.

RECENT FINDINGS

The role of TSLP in asthma is well established and supported by the efficacy of tezepelumab, the first anti-TSLP monoclonal antibody approved for both type 2 (T2)-high and T2-low severe asthma. TSLP may be a key contributor to CRSwNP pathogenesis as evidenced by genetic and mechanistic studies in which TSLP has been shown to regulate T2 inflammation and influence non-T2 responses. Preliminary data from the NAVIGATOR trial indicate that tezepelumab may reduce CRSwNP symptoms in patients with comorbid asthma. While further research is required to clarify the extent of TSLP contribution in CRSwNP, this review highlights the potential of anti-TSLP therapies as a novel approach for managing severe, uncontrolled CRSwNP. If these preliminary findings are confirmed, targeting TSLP could become a promising strategy to treat CRSwNP with or without comorbid asthma.

The mucosal concept in chronic rhinosinusitis: Focus on the epithelial barrier

Chronic rhinosinusitis (CRS) is a common chronic nasal cavity and sinus disease affecting a growing number of individuals worldwide. Recent advances have shifted our understanding of CRS pathophysiology from a physical obstruction model of ventilation and drainage to a mucosal concept that recognizes the complexities of mucosal immunologic variations and cellular aberrations. A growing number of studies have demonstrated the alteration of the epithelial barrier during inflammatory states. Therefore, the current review has focused on the crucial role of epithelial cells within this mucosal framework in CRS, detailing the perturbed epithelial homeostasis, impaired epithelial cell barrier, dysregulated epithelial cell repair processes, and enhanced interactions between epithelial cells and immune cells. Notably, the utilization of novel technologies, such as single-cell transcriptomics, has revealed the novel functions of epithelial barriers, such as inflammatory memory and neuroendocrine functions. Therefore, this review also emphasizes the importance of epithelial inflammatory memory and the necessity of further investigations into neuroendocrine epithelial cells and neurogenic inflammation in CRS. We conclude by contemplating the prospective benefits of epithelial cell-oriented biological treatments, which are currently under investigation in rigorous randomized, double-blind clinical trials in patients with CRS with nasal polyps.

Targeting Epithelium Dysfunction and Impaired Nasal Biofilms to Treat Immunological, Functional, and Structural Abnormalities of Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) with (CRSwNP) or without (CRSsNP) nasal polyps is a prevalent and heterogeneous disorder existing as a spectrum of clinical conditions with complex underlying pathomechanisms. CRS comprises a broad syndrome characterized by multiple immunological features involving complex interactions between the genes, the microbiome, host- and microbiota-derived exosomes, the epithelial barrier, and environmental and micromilieu exposures. The main pathophysiological feature is an epithelial barrier disruption, accompanied by microbiome alterations and unpredictable and multifactorial immunologic overreactions. Extrinsic pathogens and irritants interact with multiple epithelial receptors, which show distinct expression patterns, activate numerous signaling pathways, and lead to diverse antipathogen responses. CRSsNP is mainly characterized by fibrosis and mild inflammation and is often associated with Th1 or Th17 immunological profiles. CRSwNP appears to be associated with moderate or severe type 2 (T2) or Th2 eosinophilic inflammation. The diagnosis is based on clinical, endoscopic, and imaging findings. Possible CRS biomarkers from the peripheral blood, nasal secretions, tissue biopsies, and nasally exhaled air are studied to subgroup different CRS endotypes. The primary goal of CRS management is to maintain clinical control by nasal douching with isotonic or hypertonic saline solutions, administration of nasal and systemic steroids, antibiotics, biologic agents, or, in persistent and more severe cases, appropriate surgical procedures.