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Xu Z, Li R, Wang L, Wu Y, Tian Y, Su Y, Ma Y, Li R, Wei Y, Zhang C, Han S, Duan S, Peng H, Xue J. Pathogenic role of different phenotypes of immune cells in airway allergic diseases: a study based on Mendelian randomization. Front Immunol 2024; 15:1349470. [PMID: 38812518 PMCID: PMC11133742 DOI: 10.3389/fimmu.2024.1349470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
Background Airway allergic disease (AAD) is a class of autoimmune diseases with predominantly Th2-type inflammation, mainly including allergic rhinitis (AR), allergic asthma (AS), and chronic sinusitis (CRS). There are very complex regulatory mechanisms between immune cells and AAD; however, previous reports found that the functions of the same immune cells in AAD are not identical. Objective The aim of this study was to explore the causal relationship between different phenotypic immune cells and their association with AAD. Method Utilizing the publicly available Genome-Wide Association Studies (GWAS) database, this study conducted a bidirectional Mendelian randomization (MR) to assess the causal relationship between immune cells of 731 different immunophenotypes and AAD. The primary assessment methods included inverse variance weighting, weighted median, and MR Egger. Additionally, sensitivity analyses such as MR-PRESSO, leave-one-out, and scatter plots were employed to eliminate the interference of heterogeneity and pleiotropy, ensuring the stability of the causal inference. Result A total of 38 immune cells with different immunophenotypes were found to be positively and causally associated with AR, of which 26 were protective factors and 12 were risk factors. Positive associations were found between 33 immune cells and AS, of which 14 were protective factors and 19 were risk factors, as well as between 39 immune cells and CRS, of which 22 were protective factors and 17 were risk factors. Finally, the results of all relevant immune cells for the three diseases were taken and intersected, and it was found that CD3 on CD39+-activated Treg (IVWAR = 0.001, IVWCRS = 0.043, IVWAS = 0.027) may be the key immune cell that inhibits the development of AAD (ORAR = 0.940, ORAS = 0.967, ORCRS = 0.976). Conclusion This study reveals that different immune phenotypes of immune cells are closely related to AAD at the genetic level, which provides a theoretical basis for future clinical studies.
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Affiliation(s)
- Zhihan Xu
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ren Li
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Leigang Wang
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yisha Wu
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuhe Tian
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yilin Su
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuqiang Ma
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ruiying Li
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yao Wei
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chen Zhang
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Shikai Han
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Siyu Duan
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Haiyi Peng
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinmei Xue
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Rapid Diagnosis and Precision Treatment of Airway Allergic Diseases, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Airway Inflammatory Diseases Neuroimmunity Laboratory, Head & Neck Surgery, Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Medical University, Taiyuan, Shanxi, China
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Zamaili AM, Kueh YC, Mohamad S, Abdullah B. The impact of middle meatal steroid-eluting implants on the postoperative outcomes of chronic rhinosinusitis: A systematic review and meta-analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00047-4. [PMID: 38521652 DOI: 10.1016/j.anorl.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024]
Abstract
Endoscopic sinus surgery (ESS) has become an established surgical option in refractory chronic rhinosinusitis (CRS). The goal of this review is to assess the impact of steroid-eluting middle meatal implants after ESS. Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PUBMED, and GOOGLE SCHOLAR were searched from inception to November 2022. All randomised controlled trials (RCTs) involving adult patients receiving ESS for CRS utilising a steroid-eluting middle meatal implants were eligible. The primary outcome was adhesion or synechiae. The secondary outcomes were mucosal inflammation, polyp reformation, the need for oral steroids and additional surgery, postoperative bleeding, sinus pain and discomfort, postoperative sinus-related infection, and change in intraocular pressure. Fourteen full articles were examined out of 496 potential abstracts. Seven RCTs satisfied the criteria. At 30days, steroid-eluting implants reduced adhesion (OR: 0.28, 95% CI: 0.14 to 0.56; P<0.001), mucosal inflammation (MD: -13.09, 95% CI: -18.22 to -7.97; P<0.001), polyp reformation (OR: 0.31; 95% CI: 0.22 to 0.44; P<0.001), and requirement of additional oral steroid (OR: 0.44; 95% CI: 0.25 to 0.78; P=0.005) or surgery (OR: 0.25; 95% CI: 0.12 to 0.50; P<0.001). While their use for adhesion (OR: 0.24; 95% CI: 0.11 to 0.54; P<0.001) and polyp reformation (OR: 0.24; 95% CI: 0.12 to 0.51; P<0.001) were favourable, there was no difference in mucosal inflammation (MD: -5.68, 95% CI: -12.39 to 1.03; P=0.100) or the need for surgery (OR: 0.96; 95% CI: 0.07 to 12.37; P=0.980) when evaluated after 30days. Overall, the findings suggest that steroid-eluting middle meatal implants improve ESS outcomes by lowering rates of adhesion formation, postoperative medical and surgical interventions, recurrent polyposis, and inflammation, while having no significant negative impact in the immediate postoperative period. More research is needed into the long-term impacts.
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Affiliation(s)
- A M Zamaili
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Y C Kueh
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - S Mohamad
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - B Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Norelli F, Schiappoli M, Senna G, Pinter P, Olivieri B, Ottaviano G, De Corso E, Caminati M. Adherence to Intranasal Steroids in Chronic Rhinosinusitis with Nasal Polyposis Prior to and during Biologic Therapy: A Neglected Matter. J Clin Med 2024; 13:1066. [PMID: 38398379 PMCID: PMC10889709 DOI: 10.3390/jcm13041066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Adherence to treatment is essential in chronic rhinosinusitis with nasal polyposis (CRSwNP). Intranasal corticosteroids (INCS) are the first-line therapy, followed by systemic corticosteroids and surgery if needed. In cases of refractory disease, biologics are added to conventional treatment, making adherence to INCS crucial in assessing eligibility for these targeted therapies. The purpose of this review is to examine INCS adherence assessment and rate, before starting and during biologic therapy. We conducted a comprehensive literature review focusing on INCS adherence in CRSwNP treated with biologics, including randomized controlled trials and real-life studies. The search extended to studies on allergic and non-allergic rhinitis to provide broader insights into tools to assess the INCS adherence. The result was that adherence to INCS in CRSwNP is underexplored, with only a few studies addressing it directly. Various tools for adherence assessment have been identified, but none are universally accepted as standard. The review also highlights the complexity of factors influencing adherence rates. Effective CRSwNP management requires a paradigm shift to prioritize adherence in treatment guidelines and clinical practice. The review advocates for improved adherence assessment tools, a deeper understanding of influencing factors, and the integration of personalized medicine approaches, especially for biologic therapies.
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Affiliation(s)
- Francesca Norelli
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Patrick Pinter
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, Verona University Hospital, University of Verona, 37129 Verona, Italy;
| | - Bianca Olivieri
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Giancarlo Ottaviano
- Otolaryngology Section, Department of Neurosciences, University of Padova, 35122 Padova, Italy;
| | - Eugenio De Corso
- Otorhinolaryngology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy;
| | - Marco Caminati
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
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Porfire (Irimia) IM, Berindan-Neagoe I, Budisan L, Leucuta DC, Gata A, Minoiu AC, Georgescu BA, Covaliu BF, Albu S. Tissue Interleukin-33: A Novel Potential Regulator of Innate Immunity and Biomarker of Disease Severity in Chronic Rhinosinusitis with Nasal Polyps. J Clin Med 2023; 12:7537. [PMID: 38137606 PMCID: PMC10743505 DOI: 10.3390/jcm12247537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease of real interest for researchers due to its heterogenicity and complex pathophysiological mechanisms. Identification of the factors that ensure success after treatment represents one of the main challenges in CRSwNP research. No consensus in this direction has been reached so far. Biomarkers for poor outcomes have been noted, but nonetheless, their prognostic value has not been extensively investigated, and needs to be sought. We aimed to evaluate the correlation between potential prognostic predictors for recalcitrant disease in patients with CRSwNP. METHODS The study group consisted of CRSwNP patients who underwent surgical treatment and nasal polyp (NP) tissue sampling. The preoperative workup included Lund-Mackay assessment, nasal endoscopy, eosinophil blood count, asthma, and environmental allergy questionnaire. Postoperatively, in subjects with poor outcomes, imagistic osteitis severity was evaluated, and IL-33 expression was measured. RESULTS IL-33 expression in NP was positively and significantly correlated with postoperative osteitis on CT scans (p = 0.01). Furthermore, high osteitis CT scores were related to high blood eosinophilia (p = 0.01). A positive strong correlation was found between postoperative osteitis and the Lund-Mackay preoperative score (p = 0.01), as well as the nasal endoscopy score (p = 0.01). CONCLUSIONS Our research analyzed the levels of polyp IL-33, relative to blood eosinophilia, overall disease severity score, and osteitis severity, in patients with CRSwNP. These variables are prognostic predictors for poor outcomes and recalcitrant disease. Considering the importance of bone involvement in CRSwNP, this research aims to provide a better insight into the correlations of osteitis with clinical and biological factors.
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Affiliation(s)
- Ioana Maria Porfire (Irimia)
- IInd Department of Otorhinolaryngology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.B.-N.); (L.B.)
| | - Livia Budisan
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (I.B.-N.); (L.B.)
| | - Daniel-Corneliu Leucuta
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400349 Cluj-Napoca, Romania;
| | - Anda Gata
- IInd Department of Otorhinolaryngology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Aurelian Costin Minoiu
- Diagnostical and Interventional Radiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - Bogdan Florin Covaliu
- IVth Department of Community Medicine, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Silviu Albu
- IInd Department of Otorhinolaryngology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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