Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: The one airway concept revisited

The role of macrophages in asthma-related fibrosis and remodelling

Airway remodelling significantly contributes to the progressive loss of lung function and heightened symptom severity in chronic asthma. Additionally, it often persists and demonstrates reduced responsiveness to the mainstay treatments. The excessive deposition of collagen and extracellular matrix proteins leads to subepithelial fibrosis and airway remodelling, resulting in increased stiffness and decreased elasticity in the airway. Studies have emphasized the crucial role of subepithelial fibrosis in the pathogenesis of asthma. Fibrotic processes eventually cause airway narrowing, reduced lung function, and exacerbation of asthma symptoms. Macrophages play a crucial role in this process by producing pro-fibrotic cytokines, growth factors, and enzymes such as matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). Additionally, identification of novel genetic markers has provided evidence for a strong genetic component in fibrosis within macrophage regulated fibrosis. Although macrophages contribute to the progression of airway remodelling and subepithelial fibrosis, interventions targeting macrophage-driven fibrotic changes have not yet been developed. This review synthesizes research on the intricate pathways through which macrophages contribute to subepithelial fibrosis in chronic asthma and its' pathological features. Understanding the interplay between macrophages, fibrosis, and asthma pathogenesis is essential for developing effective therapeutic strategies to manage severe asthma and improve patient outcomes.

Sustained Efficacy and Low Rate of Adverse Events of Dupilumab in Type-2 CRSwNP Over 48 Months

OBJECTIVE

Dupilumab is a fully humanized monoclonal antibody that interferes with the inflammatory cascade in type-2 Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Studies evaluating its safety and efficacy in the long term are still few. Our study analyzed outcomes and adverse events after 1, 3, 6, 12, 24, 36, and 48 months of dupilumab administration in patients affected by CRSwNP.

MATERIALS AND METHODS

A monocentric, retrospective study assessing blood eosinophil (BEC) and total IgE count, Sinonasal Outcome Test-22 (SNOT-22), Nasal Polyps Score (NPS), sniffin' sticks identification test (SSIT-16), and Lund-Mackay score (LMS) in patients receiving subcutaneous Dupilumab 300 mg/2 weeks for at least 1 year and up to 4 years.

RESULTS

Seventy patients were enrolled, of whom 70, 38, 25, and 12 completed a 12, 24-, 36-, and 48-month follow-up period, respectively. Patients showed a very rapid and long-lasting statistically significant improvement in their SNOT-22, NPS, and SSIT after 1 month, and this trend was kept in the following 48 months. The total IgE count has been constantly reducing over the study period. BEC increased in the first 6 months and then gradually decreased over time, reaching an even smaller value than baseline at 36 and 48 months. Four patients (5.9%) complained of severe adverse events within 6 months, with two interrupting treatment due to hypereosinophilia.

CONCLUSION

Dupilumab was safe and effective in extinguishing the symptomatologic burden of CRSwNP as early as 1 month and up to 48 months, with side events limited to the first 6 months of administration.

LEVEL OF EVIDENCE: 4

Cannabinoids and the Endocannabinoid System in the Treatment of Chronic Rhinosinusitis

OBJECTIVE

Recently, the endocannabinoid system (ECS) has emerged as a therapeutic target for various inflammatory diseases, including those of the respiratory tract. The objective of this scoping review is to explore the role of the ECS in the pathophysiology of CRS. Moreover, we sought to identify, appraise, and summarize the available evidence for cannabinoids as a potential treatment for CRS.

DATA SOURCES

Six databases and four clinical trial registries were searched from inception to February 2025.

REVIEW METHODS

All identified studies investigating the role of the ECS in sinonasal inflammatory disease were included for review.

RESULTS

A total of 1534 studies were identified in the initial search. Following screening and full-text analysis by three authors, five studies were included in the final scoping review. Four of the studies were preclinical and in vitro in nature, examining the effects of ECS modulation through CB1 and/or CB2 receptors. The findings of each study support a common conclusion that the ECS is implicated in regulating cellular inflammatory pathways potentially involved in sinonasal disease. The final study investigated the effect of marijuana smoking on subjective and objective measures of CRS severity. There were no clinical studies identified investigating the use of cannabinoids for the treatment of sinonasal inflammatory conditions.

CONCLUSION

Current literature examining the role of ECS in sinonasal inflammatory disease is highly limited, though it indicates ECS may play a role in the complex pathophysiology of sinonasal inflammatory disease. Further work is warranted to assess ECS as a potential therapeutic target for CRS.

Unveiling the prevalence and impact of silent rhinovirus infection in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNPs) involves persistent sinus inflammation, with emerging evidence suggesting a potential role of rhinovirus (RV) in its pathophysiology. However, whether RV exists in nasal tissues and affects the nasal mucosa after the resolution of infection symptoms remains unknown.

OBJECTIVE

To investigate the prevalence and impact of silent RV infection in nasal tissues.

METHODS

RV loads were detected in the nasal tissues of 47 controls and 101 patients with CRSwNP without respiratory infection. Participants were categorized into RV-positive (+), RV-negative (-), and the "gray zone" groups. Quantitative polymerase chain reaction, Western blotting, and immunofluorescence assays were used to analyze the impact of silent RV infection on the immune status of nasal tissues.

RESULTS

Silent RV infection was prevalent in both control (34%) and CRSwNP (30.7%) tissues, with higher viral loads observed in the nasal polyps. In controls, it was associated with high expression of types 1 and 2 interferon (IFN), type 2 inflammation, interleukin (IL)-17A, and IL-10. In patients with CRSwNP, silent RV infection was associated with lower levels of type 1 IFN, IL-17A, type 2 inflammation, and IL-10 but higher levels of type 2 IFN compared with those without RV infection. Meanwhile, RV (+) nasal polyps exhibited fewer tissue eosinophils and neutrophils than RV (-) nasal polyps.

CONCLUSION

Silent RV infection was prevalent in the nasal tissues, with a higher viral load detected in the nasal polyps. This silent RV infection is associated with distinct immune responses in healthy controls and patients with CRSwNP, involving differential modulation of IFNs, TH2 cytokines, IL-17A, IL-10, and eosinophil and neutrophil levels.

Biological therapy in chronic rhinosinusitis with nasal polyps

INTRODUCTION

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease. High proportions of patients with CRSwNP characterized by type 2 inflammation fail to gain adequate control with conventional treatment. The application of biologics in clinics and assessments of novel biologics in clinical trials are blooming in expectations to fulfill the unmet medical needs of patients with CRSwNP with type 2 inflammation.

AREAS COVERED

After an extensive search of PubMed, Medline, and EMBASE for the most recent evidence, we thoroughly summarize current advances in biological therapies for treating patients with CRSwNP.

EXPERT OPINION

In recent years, biological therapy has been in the spotlight in clinical studies on CRSwNP. Biologics have proven to be efficacious in reducing nasal polyp size, alleviating CRSwNP-related symptoms, improving quality of life, and reducing the need for systemic corticosteroids or endoscopic sinus surgery for nasal polyps. The considerable efficacy and safety profile of biologics has offered patients with refractory CRSwNP another treatment option. However, some concerns remain to be addressed. Aspects such as the position of biological therapy in the management of CRSwNP, traits of patients suitable for certain biologics, etc. necessitate efforts to elucidate these unknowns in order to provide patients with tailored therapy.

Shared genetic investigation of asthma and blood eosinophils in relation to chronic rhinosinusitis

BACKGROUND

An epidemiological association among asthma, blood eosinophil level and chronic rhinosinusitis (CRS) is well established, but whether consistent genetic relationships exist, and whether this reflects a shared genetic etiology between CRS and asthma or blood eosinophil level remains unclear.

METHODS

Data from CRS patients (N = 1,255) and healthy controls (N = 1,032) were reviewed retrospectively to investigate associations between clinical characteristics and CRS. Data from white blood cells in the UK biobank (N = 173,480), asthma in the Trans-National Asthma Genetic Consortium (127,669) and CRS (N = 272,922) or nasal polyps (N = 264,107) in the FinnGen consortium were used to conduct genetic study, including linkage disequilibrium score regression analysis to detect genetic associations between aforementioned variables, Mendelian randomization (MR) analysis to investigate causal relationships of asthma and blood eosinophil levels on CRS, and Bayesian co-localization to consolidate MR findings and to identify shared genetic signals.

RESULTS

We found that blood eosinophil count, blood eosinophil percentages and asthma shared positive and causal genetic correlations with CRS (all q < 0.0001) and CRS with nasal polyps (CRSwNP) (all q < 0.0001) in both our observational and genetic study. Through colocalization analysis, 4 loci are shared among asthma, CRS and CRSwNP, 7 loci are shared among blood eosinophil count, CRS and CRSwNP, 2 loci are unique to blood eosinophil count and CRS, and 3 loci are unique to blood eosinophil count and CRSwNP.

CONCLUSIONS

These findings contribute to understanding CRS etiology, and provide insights for intervention and treatment target for CRS comorbid with asthma or high blood eosinophil levels.

Network pharmacology integrated with experimental validation reveals the mechanism of Xanthii Fructus against allergic rhinitis via JAK2/STAT3/HIF-1α signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

As a natural medicine, Xanthii Fructus (XF) is widely used in traditional Chinese medicine (TCM) and Tibetan medicine. It has been demonstrated to alleviate allergic rhinitis (AR) in modern research. However, the specific molecular mechanism underlying its treatment of AR is still unclear.

AIM OF STUDY

To elucidate the effect and mechanism of XF in treating AR through network pharmacology and experimental validation.

METHODS

In the present study, blood-entry components of XF were analyzed using UPLC-Orbitrap-HRMS. Then, we conducted pharmacodynamic studies in vitro and vivo. In vitro study, Human IL-4 was used to treat HNEpCs cells to establish a vitro model. Subsequently, HNEpCs cells were administrated with XF extracts (0.5, 1, 2 mg/ml). And ovalbumin (OVA) was employed to establish an allergic rhinitis model, and different doses of XF (8, 16, 32 mg/kg) were administered by gavage to BABL/c mice for in vivo experiments. Next, the Swiss Target Prediction database was employed to acquire blood-entry components targets. Meanwhile, from OMIM and GeneCards databases, AR-related targets were obtained. A protein-protein interaction (PPI) network was established through the STRING database, and potential pathways of XF were identified through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. In the end, the results of network pharmacology were experimental validation in vivo and vitro experiments.

RESULTS

Fifteen compounds were identified, most of which were phenolic acids. In pharmacodynamic studies, the vitro study revealed that XF-treated gave rise to a significant decline of iNOS and COX2 protein expression in inflammatory conditions, as evidenced by Western blot results, and there was a sharp decline in the mRNA levels of TNF-α, IL-1β and IL-6. Meanwhile, the vivo studies demonstrated that XF exhibited favorable therapeutic efficacy against AR, as evidenced by a decrease in IgE, TNF-α, IL-4, and IL-6 levels in mice serum, an improvement in nasal mucosal injury pathology. Based on these findings, through network pharmacology, we identified 14 core AR-related targets, including HIF-1α, STAT3, TLR4. Using KEGG pathway analysis, it has been revealed that XF can alleviate AR through JAK2/STAT3/HIF-1α signaling pathway. Therefore, further experiments were conducted to verify the molecular mechanism of the anti-AR effect of XF. A decline of the phosphorylation of JAK2, STAT3 and HIF-1α proteins was observed, which resulted in the suppression of JAK2/STAT3/HIF-1α signaling pathway. These findings were corroborated by the same results obtained through IF. The results were verified by RT-qPCR, which demonstrated that XF was capable of downregulating the mRNA levels of TSLP and CCL11. Then, the conclusions were further reinforced with the introduction of WP1066. It could be observed that XF inhibited the STAT3 nuclear translocation. Finally, a restoration of p-JAK2, p-STAT3, HIF-1α expression levels to normal levels in AR mice.

CONCLUSION

The combined findings led to the conclusion that XF play its therapeutic role in AR by suppressing the JAK2/STAT3/HIF-1α signaling pathway.

Nasal Mucus Cytokines Are Correlated with Spirometry Measures in CRS Patients with Comorbid Asthma

KEY POINTS

CRS patients with asthma show differential nasal mucus cytokine signatures based on endotype. IL-7 concentration is positively associated with higher %FEV1 and %FVC in CRS patients with asthma.

Association between allergic diseases and hypertension: Co-occurrence pattern analysis

Background: The hypertension risk in the co-occurrence of allergic diseases remains largely unknown. Objective: We aimed to investigate the association between allergic diseases co-occurrence pattern and hypertension morbidity and mortality, and to evaluate additive interaction effects between allergic diseases. Methods: A nationally representative population from the U.S. National Health Interview Survey 2012 was enrolled. Hypertension and five specific allergic diseases, including asthma, allergic rhinitis (AR), food allergy (FA), eczema, and other allergy (OA), were determined. Hypertension mortality was identified until December 31, 2019. We evaluated additive interaction effects between two allergic diseases on hypertension risk: relative excess risk due to interaction (RERI) and attributable proportion of joint effect due to interaction (AP) (shown as percentages) were calculated. For modifiable lifestyle factors with significant heterogeneity in the subgroups, we examined the effect modification. Results: Totally, 34,392 participants were enrolled. Four co-occurrence patterns of two allergic diseases were associated with an increased risk of hypertension, including AR + FA (odds ratio [OR] 2.25 [95% confidence interval {CI}, 1.52-3.35]), eczema + OA (OR 1.94 [95% CI, 1.14-3.30]), AR + eczema (OR 1.76 [95% CI, 1.18-2.64]), asthma + AR (OR 1.67 [95% CI, 1.33-2.08]). Five co-occurrence patterns of three allergic diseases were associated with increased risk of hypertension. Additive interactions were seen in AR + FA (RERI, 0.65; AP, 29%), eczema + OA (RERI, 0.43; AP, 22%), AR + eczema (RERI, 0.21; AP, 12%), and asthma + AR (RERI, 0.05; AP, 3%). The significant association between asthma + FA and hypertension was only seen among participants with a body mass index (BMI) ≥ 30 kg/m² (p = 0.021). With a median follow-up of 7.5 years, one co-occurrence pattern of asthma + FA showed a significant increased risk of hypertension mortality (hazard ratio 4.32, 95% CI: 1.52-12.23), with an additive interaction was observed (RERI, 2.33; AP, 52%). Conclusion: We identified several allergic diseases co-occurrence patterns with a significantly increased risk of hypertension morbidity and mortality. Potential biologic additive effect among allergic diseases and effect modification of BMI was found. Precision primary prevention of hypertension is necessary for patients with co-occurring allergic diseases.

Type 2 immunity in allergic diseases

Significant advancements have been made in understanding the cellular and molecular mechanisms of type 2 immunity in allergic diseases such as asthma, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis (EoE), food and drug allergies, and atopic dermatitis (AD). Type 2 immunity has evolved to protect against parasitic diseases and toxins, plays a role in the expulsion of parasites and larvae from inner tissues to the lumen and outside the body, maintains microbe-rich skin and mucosal epithelial barriers and counterbalances the type 1 immune response and its destructive effects. During the development of a type 2 immune response, an innate immune response initiates starting from epithelial cells and innate lymphoid cells (ILCs), including dendritic cells and macrophages, and translates to adaptive T and B-cell immunity, particularly IgE antibody production. Eosinophils, mast cells and basophils have effects on effector functions. Cytokines from ILC2s and CD4+ helper type 2 (Th2) cells, CD8 + T cells, and NK-T cells, along with myeloid cells, including IL-4, IL-5, IL-9, and IL-13, initiate and sustain allergic inflammation via T cell cells, eosinophils, and ILC2s; promote IgE class switching; and open the epithelial barrier. Epithelial cell activation, alarmin release and barrier dysfunction are key in the development of not only allergic diseases but also many other systemic diseases. Recent biologics targeting the pathways and effector functions of IL4/IL13, IL-5, and IgE have shown promising results for almost all ages, although some patients with severe allergic diseases do not respond to these therapies, highlighting the unmet need for a more detailed and personalized approach.

Development and validation of a Guinea pig model for concurrent allergic rhinitis and asthma using recombinant Der f 2

BACKGROUND

This study aimed to develop a guinea pig model of concurrent allergic rhinitis and asthma.

METHODS

Thirty-three guinea pigs were randomly divided into the control group and the experimental group. Guinea pigs in the experimental group were sensitized by intraperitoneal injection of recombinant wild-type Dermatophagoides farinae group 2 allergen (wt Der f 2) plus Al(OH)3 on day 1 and 8, followed by inhalation of an aerosol of wt Der f 2 on day 16 and 23. The sensitized guinea pigs were challenged with intranasal instillation of wt Der f 2 plus Al(OH)3 gel on day 19 and 26 for nasal symptoms scoring, and on day 30 for the active cutaneous anaphylaxis (ACA) test. Control group guinea pigs received normal saline (N.S.) plus Al(OH)3 in parallel. Cutaneous provocation tests were performed to exclude nonsensitized guinea pigs, and nasal symptom assessments were conducted to exclude non-allergic guinea pigs from the study. The allergic airway model was finally validated using the ACA test, Evans blue dye quantification with wt Der f2, histopathology evaluation, and immunohistochemistry analysis of MUC5AC expression in both nasal mucosa and lung tissue.

RESULTS

Two guinea pigs with negative cutaneous reactions and three with less than 5 points of the nasal symptom assessment were excluded from the experimental group. The ACA test showed enhanced allergic reactions in the experimental group, and the quantification of extravasated Evans blue dye demonstrated significantly higher absorbance in the wt Der f 2 spots compared to mu Der f 2. Histologic analyses illustrated pathologic features typical of allergic rhinitis and asthma. MUC5AC levels in the nasal mucosa and lung samples were significantly higher in the experimental group than in the control group.

CONCLUSION

We successfully established a guinea pig model of concurrent allergic rhinitis and asthma using a combination of sensitization, challenge, and validation methodologies with the allergen Der f 2, suitable for pathophysiological studies.

CLINICAL TRIAL NUMBER

Not applicable.

Efficacy of vidian neurectomy in treating chronic rhinosinusitis with nasal polyps combined with allergic rhinitis: A systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of additional vidian neurectomy or posterior nasal neurectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and allergic rhinitis (AR), compared to the outcomes of conventional endoscopic sinus surgery alone.

METHODS

Up to May 2024, six databases were systematically searched. We evaluated studies that compared the clinical improvement of chronic sinusitis-related symptoms and endoscopic findings between the neurectomy group (endoscopic sinus surgery plus vidian neurectomy or posterior nasal neurectomy) and the control group (endoscopic sinus surgery only).

RESULTS

The neurectomy group showed a significant reduction in the Lund-Kennedy endoscopic score (SMD = -1.3163 [-1.6519; -0.9807]; I² = 53.3 %). However, this treatment did not have a significant effect on the Quality-of-life score (SMD = -0.1222 [-0.3427; 0.0983]; I² = 27.5 %) or patient-reported nasal symptom-related VAS scores (SMD = -1.6690 [-3.7062; 0.3682]; I² = 96.3 %). In the subgroup analyses of these results according to time points of measurement, the Lund-Kennedy endoscopic score was statistically lower in the treatment group during treatment periods (postop 6months, 12months, and 24months). However, there were no statistically significant differences in Quality-of-life score and VAS between the treatment and control groups during all treatment periods. There was no significant difference in the recurrent rate of CRS during the following up periods (odds ratio=0.5263 [0.1518; 1.8254], I2 = NA) between two groups. Regarding the adverse effect of neurectomy, this additional procedure did not induce the postoperative bleeding (odds ratio=0.8886 [0.3411; 2.3150]; I2 = 0.0 %) and dry eye related discomfort (odds ratio=65.3560 [0.1044; 40,908.1619]; I2 = 88.9 %) significantly compared to control group.

CONCLUSIONS

Additional neurectomy shows better efficacy in improving endoscopic findings and is safer in patients with CRSwNP combined with AR; however, more clinical studies are needed to evaluate its long-term symptomatic effects and disease recurrence.

Inhaling arsenic aggravates airway hyperreactivity by upregulating PNEC-sourced 5-HT in OVA-induced allergic asthma

Increasing epidemiological evidence has proved that early-life exposure to inorganic arsenic (As) elevates the risks of childhood asthma. The present research aimed to explore susceptibility of respiratory As exposure to allergic asthma in a mouse model. BALB/c mice on postnatal day (PND) 28 were exposed to ddH2O or NaAsO2 aerosol for 4 hours daily over 5 consecutive weeks via respiratory tract. Mice were sensitized by intraperitoneal injection of ovalbumin (OVA) combined with Alum Adjuvant on PND42 and PND56. Subsequently, mice were challenged with ddH2O or 1 %OVA through a nebulizer for 3 days starting from PND63. In As-exposed mice, OVA-sensitized goblet cell hyperplasia and airway mucosal secretion did not worsen. OVA-induced inflammatory cell infiltration and upregulation of Th2 cytokines, including IL-4, IL-5, and IL-13, were not aggravated in As-exposed mice. Interestingly, airway hyperreactivity was intensified in As-exposed asthmatic mice. Mechanistically, OVA-induced elevation of 5-hydroxytryptamine (5-HT), probably secreted by pulmonary neuroendocrine cells (PNECs), was exacerbated in As-exposed mice. OVA-induced upregulation of tryptophan hydroxylase (TPH)1 and TPH2, two 5-HT synthases, was aggravated in As-exposed mouse lungs. LX1032, a specific TPH inhibitor, suppressed As-induced elevation of pulmonary 5-HT content in asthmatic mice. Moreover, LX1032 alleviated As-evoked airway hyperreactivity in asthmatic mice. These results suggest that respiratory As exposure elevates airway hyperreactivity partially through upregulating PNEC-sourced 5-HT in OVA-induced allergic asthma, which provides significant insight about the hazards of environmental As exposure.

Airway Remodeling in Asthma: Mechanisms, Diagnosis, Treatment, and Future Directions

Airway remodeling (AR) with chronic inflammation, are key features in asthma pathogenesis. AR characterized by structural changes in the bronchial wall is associated with a specific asthma phenotype with poor clinical outcomes, impaired lung function and reduced treatment response. Most studies focus on the role of inflammation, while understanding the mechanisms driving AR is crucial for developing disease-modifying therapeutic strategies. This review paper summarizes current knowledge on the mechanisms underlying AR, diagnostic tools, and therapeutic approaches. Mechanisms explored include the role of the resident cells and the inflammatory cascade in AR. Diagnostic methods such as bronchial biopsy, lung function testing, imaging, and possible biomarkers are described. The effectiveness on AR of different treatments of asthma including corticosteroids, leukotriene modifiers, bronchodilators, macrolides, biologics, and bronchial thermoplasty is discussed, as well as other possible therapeutic options. AR poses a significant challenge in asthma management, contributing to disease severity and treatment resistance. Current therapeutic approaches target mostly airway inflammation rather than smooth muscle cell dysfunction and showed limited benefits on AR. Future research should focus more on investigating the mechanisms involved in AR to identify novel therapeutic targets and to develop new effective treatments able to prevent irreversible structural changes and improve long-term asthma outcomes.

Asthma as a risk factor and allergic rhinitis as a protective factor for COVID-19 severity: a case-control study

PURPOSE

The COVID-19 pandemic has resulted in significant global morbidity and mortality. The disease presents a broad clinical spectrum, significantly influenced by underlying comorbidities. While certain conditions are known to exacerbate COVID-19 outcomes, the role of chronic inflammatory airway diseases such as asthma and rhinitis in influencing disease severity remains controversial. This study investigates the association between asthma and allergic rhinitis and the severity of COVID-19 outcomes in a specific geographical region prior to widespread vaccine deployment.

METHODS

We conducted a case-control study with unvaccinated adult patients who had laboratory-confirmed COVID-19 by polymerase chain reaction (PCR). Cases were defined as severe or critical COVID-19 patients requiring intensive care unit (ICU) admission, and controls were non-severe patients without signs of viral pneumonia or hypoxia. We utilized the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to assess the presence of asthma and allergic rhinitis. The association between these chronic inflammatory airway diseases and the severity of COVID-19 was evaluated using multivariate logistic regression analysis.

RESULTS

A total of 122 patients were analyzed, with 61 in each group. The presence of asthma (9 patients) was associated with an increased likelihood of severe COVID-19 (OR = 13.0; 95% CI 1.27-133.74), while rhinitis (39 patients) was associated with a protective effect against severe outcomes (OR = 0.36; 95% CI 0.13-0.99). No significant association was found between the frequency of asthmatic episodes or the severity of rhinitis and the severity of COVID-19 outcomes.

CONCLUSION

This study underscores the divergent effects of chronic inflammatory airway diseases on COVID-19 severity, with asthma associated with a higher likelihood of severe outcomes and rhinitis potentially offering protective effects. These findings enhance our understanding of the complex interactions between respiratory allergies and COVID-19, emphasizing the importance of targeted clinical management and public health strategies.

Surface-engineered mesenchymal stem cell for refractory asthma therapy: Reversing airway remodeling

In the development of asthma, subepithelial fibrosis and vascular proliferation cause airway remodeling and narrowing, leading to disease deterioration and respiratory failure. In the clinic, the treatment of asthma was aimed at reducing the frequency of acute asthma attacks through inhaled corticosteroids (ICSs). However, ICSs cannot prevent the progression into refractory asthma due to the formation of airway remodeling mainly by subepithelial fibrosis and angiogenesis surrounding the tracheal lumen. Herein, we constructed surface-engineered mesenchymal stem cells (MSCs/PVLA) via the bioconjugation of MSCs and reactive oxygen species-responsive polymeric micelles loaded with vactosertib (VST) and linifanib (LFN) for treating refractory asthma through reversing airway remodeling. MSCs/PVLA migrated to the tracheal lumen due to the inflammation tropism of MSCs, and subsequently released VST and LFN could inhibit the formation of airway remodeling by preventing subepithelial fibrosis and angiogenesis. Meanwhile, MSCs reduced inflammatory cell infiltration and cytokine secretion to regulate the pathological microenvironment. Our results suggested that MSCs/PVLA could serve as a promising candidate to prevent disease exacerbations and treat refractory asthma.

Factors for predicting the outcome of surgery for non-eosinophilic chronic rhinosinusitis with nasal polyps

BACKGROUND

Despite the large patient base in Asia, the prognostic factors of patients with non-eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNPs) remain largely undetermined.

OBJECTIVE

To systematically investigate the predictive value of clinical and biological variables for non-eosinophilic CRSwNP.

METHODS

A total of 51 patients with non-eosinophilic CRSwNP who underwent functional endoscopic surgery were recruited. Clinical information and assessment were comprehensively collected before and after surgery. A broad spectrum of biomarkers was measured in tissue homogenates using multiple assays. A random forest algorithm and stepwise logistic regression were used to construct clinical, biological, and combined models.

RESULTS

A total of 41.2% patients with non-eosinophilic CRSwNP were uncontrolled more than 6 months after surgery. We identified 1 clinical variable (22-item Sino-Nasal Outcome Test score) and 4 biomarkers (programmed cell death ligand 1, platelet-derived growth factor subunit β [PDGF-β], macrophage inflammatory protein-3b, and PDGF-α) that were significantly predictive of the surgical outcome. The clinical, biological, and combined models had predictive ability with areas under the curve of 0.78, 0.83, and 0.89, respectively. PDGF-β and programmed cell death ligand 1 were identified as independent biomarkers for the prognosis of patients with CRSwNP without considerable eosinophilic infiltration.

CONCLUSION

This study reveals that clinical and biological factors, such as the 22-item Sino-Nasal Outcome Test score and PDGF-β, are predictive of the postfunctional endoscopic surgical prognosis of patients with non-eosinophilic CRSwNP.

Therapeutic potential of a novel hybrid protein: Mitigating allergy and airway remodeling in chronic asthma models induced by Dermatophagoides pteronyssinus

BACKGROUND

The house-dust mite Dermatophagoides pteronyssinus is a key trigger of allergic asthma. Therefore, it is essential to develop new vaccines that can alter inflammatory processes and airway remodeling. The goal of this study was to test the hypoallergenic and immunogenic characteristics of the hypoallergen rDer p 2231 in a murine model of chronic asthma induced by D. pteronyssinus.

METHODS

For this, we measured the levels of IgE, IgG1, IgG2a, and cytokines produced by mice receiving the rDer p 2231 protein. Histopathological parameters of the chronic inflammatory response were also investigated by assessing inflammation and airway remodeling.

RESULTS

rDer p 2231 given as a therapeutic vaccine, led to a reduction in the production of IgE, eosinophils, and neutrophils, a lower activity of eosinophilic peroxidase in the airways, and an increase in the production of IgG1 and IgG2a antibodies. IgG antibodies blocked IgE binding to parental allergens in sera from atopic patients. Splenocytes, BALF, and lung from mice treated with rDer p 2231 secreted higher levels of Th1 and regulatory cytokines, as well as reduced levels of Th2 cytokines. Histopathological investigation of the lower airways demonstrated reductions in the thickness of the bronchiolar smooth muscle layer, in the subepithelial fibrosis, and in the goblet cells hyperplasia.

CONCLUSIONS

Our preclinical studies suggest that rDer p 2231 is a promising candidate for the treatment of D. pteronyssinus allergy, as the hypoallergen has demonstrated the ability to reduce IgE production, induce specific blocking antibodies, restore and balance Th1/Th2 immune responses, and significantly reduce airway remodeling factors. However, additional clinical studies are needed to more accurately assess the efficacy and safety of rDer p 2231 as a vaccine against D. pteronyssinus-induced allergy.

The Expression Levels of Transforming Growth Factor β1 and Tumor Necrosis Factor Receptor Associated Factor 6 in Allergic Rhinitis Patients and Their Potential Relationship with Epithelial - Mesenchymal Transition: A Pilot Prospective Observational Study

Objective

To study the role of transforming growth factor beta 1 (TGF-β1) and tumor necrosis factor receptor related factor 6 (TRAF6) in the progression of epithelial mesenchymal transformation (EMT) in allergic rhinitis (AR).

Methods

A total of 30 patients underwent nasal endoscopic surgery at our Hospital were selected for 15 patients in each group based on their allergy status. Inferior turbinate mucosa tissue was obtained and analyzed using immunohistochemical (IHC) tests, real-time quantitative PCR (qRT-PCR) detection, and Western blotting (WB) tests to measure TGF-β1, TRAF6, E-cadherin, Vimentin, and α-Smooth Muscle Actin (α-SMA) expression levels.

Results

The expression levels of TGF-β1, TRAF6, Vimentin, and α-SMA were significantly higher in the AR group compared to the control group as shown by IHC, qRT-PCR, and WB (P < 0.05). E-cadherin expression was significantly lower group than in the control group (P < 0.05). Protein expression of TGF-β1 showed significantly positive correlations with TRAF6 (r = 0.8188, P = 0.0002), α-SMA (r = 0.8076, P = 0.0003), and Vimentin (r = 0.6917, P = 0.0043). There was a significantly negative correlation between protein expression of TGF-β1 and E-cadherin (r = -0.8032, P = 0.0003). Protein expression of TRAF6 showed a significantly negative correlation with E-cadherin (r = -0.6405, P = 0.0101) but positive correlations with α-SMA (r = 0.5809, P = 0.0231) and Vimentin (r = 0.555, P = 0.0318).

Conclusion

TGF-β1, TRAF6, and EMT-related markers (Vimentin, α-SMA) were highly expressed in the nasal mucosa of AR patients. TGF-β1 and TRAF6 may be involved in the epithelial-mesenchymal transition in allergic rhinitis.

Species-level, metagenomic and proteomic analysis of microbe-immune interactions in severe asthma

BACKGROUND

The airway microbiome in severe asthma has not been characterised at species-level by metagenomic sequencing, nor have the relationships between specific species and mucosal immune responses in 'type-2 low', neutrophilic asthma been defined. We performed an integrated species-level metagenomic data with inflammatory mediators to characterise prevalence of dominant potentially pathogenic organisms and host immune responses.

METHODS

Sputum and nasal lavage samples were analysed using long-read metagenomic sequencing with Nanopore and qPCR in two cross-sectional adult severe asthma cohorts, Wessex (n = 66) and Oxford (n = 30). We integrated species-level data with clinical parameters and 39 selected airway proteins measured by immunoassay and O-link.

RESULTS

The sputum microbiome in health and mild asthma displayed comparable microbial diversity. By contrast, 23% (19/81) of severe asthma microbiomes were dominated by a single respiratory pathogen, namely H. influenzae (n = 10), M. catarrhalis (n = 4), S. pneumoniae (n = 4) and P. aeruginosa (n = 1). Neutrophilic asthma was associated with H. influenzae, M. catarrhalis, S. pneumoniae and T. whipplei with elevated type-1 cytokines and proteases; eosinophilic asthma with higher M. catarrhalis, but lower H. influenzae, and S. pneumoniae abundance. H. influenzae load correlated with Eosinophil Cationic Protein, elastase and IL-10. R. mucilaginosa associated positively with IL-6 and negatively with FGF. Bayesian network analysis also revealed close and distinct relationships of H. influenzae and M. catarrhalis with type-1 airway inflammation. The microbiomes and cytokine milieu were distinct between upper and lower airways.

CONCLUSIONS

This species-level integrated analysis reveals central, but distinct associations between potentially pathogenic bacteria and airways inflammation in severe asthma.

Predictors for Development of Chronic Rhinosinusitis in Transplant Recipients

OBJECTIVES

Studies suggest that transplant patients are at a higher risk of developing chronic rhinosinusitis (CRS). However, there is a dearth of studies describing the factors that may be linked to the development of CRS in this population. Our objective is to identify the risk factors associated with the development of CRS in transplant recipients.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary care center.

METHODS

This cohort included 3347 transplant recipients seen between 2017 and 2022. Of these, 2128 patients met the inclusion criteria and were grouped according to whether they were diagnosed with CRS during the post-transplant period. The analysis included both univariate and multivariate analysis to ascertain the odds ratio (OR) and predictive factors.

RESULTS

Of the 2128 patients, 649/2128 (30.4%) had CRS. CRS patients had an increased prevalence of previous endoscopic sinus surgery, allergic rhinitis, and recurrent acute rhinosinusitis in the pre-transplant period compared to the non-CRS group. According to the multivariate analysis, patients with primary immunodeficiency and additional transplant were 1.9 and 3.1 times more likely to develop CRS during the posttransplant period (95% CI: 1.3-2.6, p < .0001), (95% CI: 1.3 -7.3, p = .01), respectively. Sirolimus use was also associated with the development of CRS (OR = 1.4, 95% CI: 1.1-1.9, p = .01).

CONCLUSION

This study is the largest cohort aimed at determining the predictive factors associated with the development of CRS. Patients with pretransplant rhinologic conditions, hematologic deficiencies, and the utilization of specific immunosuppressants were found to have a higher likelihood of developing CRS following transplantation.

CTPAD: an interactive web application for comprehensive transcriptomic profiling in allergic diseases

BACKGROUND

Allergic diseases are systemic chronic inflammatory diseases associated with multiorgan damage and complex pathogenesis. Several studies have revealed the association of gene expression abnormalities with the development of allergic diseases, but the biomedical field still lacks a public platform for comprehensive analysis and visualization of transcriptomic data of allergic diseases.

OBJECTIVE

The aim of the study is to provide a comprehensive web tool for multiple analysis in allergic diseases.

METHODS

We retrieved and downloaded human and mouse gene expression profile data associated with allergic diseases from the Gene Expression Omnibus (GEO) database and standardized the data uniformly. We used gene sets obtained from the MSigDB database for pathway enrichment analysis and multiple immune infiltration algorithms for the estimation of immune cell proportion. The basic construction of the web pages was based on the Shiny framework. Additionally, more convenient features were added to the server to improve the efficiency of the web pages, such as jQuery plugins and a comment box to collect user feedback.

RESULTS

We developed CTPAD, an interactive R Shiny application that integrates public databases and multiple algorithms to explore allergic disease-related datasets and implement rich transcriptomic visualization capabilities, including gene expression analysis, pathway enrichment analysis, immune infiltration analysis, correlation analysis, and single-cell RNA sequencing analysis. All functional modules offer customization options and can be downloaded in PDF format with high-resolution images.

CONCLUSIONS

CTPAD largely facilitates the work of researchers without bioinformatics background to enable them to better explore the transcriptomic features associated with allergic diseases. CTPAD is available at https://smuonco.shinyapps.io/CTPAD/ .

Efficacy and safety of dupilumab in the treatment of CRSwNP in the real-life setting: a review of the literature

INTRODUCTION

The recent approval of Dupilumab has profoundly revolutionized the management of patients affected by severe and recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). However, a review that summarizes the results of real-life studies and compares them to phase 3 studies SINUS-24 and 52 is still lacking.

MATERIALS AND METHODS

A search of all real-life studies published from 2019 to 2023 was performed. Patients characteristics at baseline and 6 and 12 months after starting Dupilumab were extracted and compared to those from phase 3 trials: age, sex, smoking habits, comorbid asthma and aspirin-exacerbated respiratory disease (AERD), previous endoscopic sinus surgery (ESS), hematic eosinophils and total IgE, NasalAQ2 Polyps Score (NPS), smell, SNOT-22, adverse events (AEs), and response to treatment.

RESULTS

15 papers were included with an overall number of 1658 patients. A higher rate of comorbidities and previous ESS was found in patients from real-life studies. In addition, they had worse smell and SNOT-22 at baseline compared to patients from SINUS-24 and 52. Comorbid and post-ESS patients tended to have a faster NPS and SNOT-22 improvement, although the absolute values were not clinically relevant. A more extensive surgery and a number of ESS ≥ 2 were related to worse olfactory outcomes, probably due to iatrogenic damage. No correlation was found between hematic eosinophils and outcomes. AEs were reported by 12.4% of patients and 2.2% had to discontinue dupilumab. Weight gain was an emergent AE (0.8%), probably related to the restored sense of smell and taste. Non-responders were 3.5% and they were switched to systemic steroid, ESS, or another biologic.

CONCLUSION

Despite some differences in prescription criteria between countries, dupilumab was demonstrated to be effective even in the real-life scenario. However, emerging AEs and possible unknown long-term AEs of a likely lifelong therapy should be considered.

Functions and Clinical Applications of Extracellular Vesicles in TH2 Cell-Mediated Airway Inflammatory Diseases: A Review

Type 2 airway inflammation (T2AI), driven by type 2 innate lymphoid and CD4+ T helper 2 cells, leads to various diseases and conditions, such as chronic rhinosinusitis with nasal polyps, allergic rhinitis, and asthma. Emerging evidence suggests the involvement of extracellular vesicles (EVs) in these diseases. In this review, we describe the immunological T2AI pathogenic mechanisms, outline EV characteristics, and highlight their applications in the diagnosis and treatment of T2AI. An extensive literature search was conducted using appropriate strategies to identify relevant articles from various online databases. EVs in various biological samples showed disease-specific characteristics for chronic rhinosinusitis with nasal polyps, allergic rhinitis, and asthma, with some demonstrating therapeutic effects against these conditions. However, most studies have been limited to in vitro and animal models, highlighting the need for further clinical research on the diagnostic and therapeutic applications of EVs.

Establishment and Verification of a Risk Prediction Model for Chronic Rhinosinusitis

Objective: Factors influencing chronic rhinosinusitis (CRS) are usually studied in terms of genetics and environment; however, clinical indicators have not been reported. This case-control study was conducted in Ningbo, China, to explore new independent risk factors for CRS. Methods: A total of 695 participants, including 440 healthy controls and 255 patients with CRS, were included in this study. Clinical data were retrieved from questionnaires and electronic medical record systems of hospitals. Independent risk factors were screened using logistic regression and 10-fold cross-validation combined with the least absolute shrinkage and selection operator. A CRS risk prediction model was established using logistic regression, and nomograms were visualized. The model was validated and evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: Ten independent risk factors, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, creatinine, triglyceride, total cholesterol, red blood cell count, hemoglobin, lymphocyte percentage, and monocyte percentage were screened. ROC analysis showed that the area under the curve of the training set was 0.890, indicating that the predictive model had excellent discriminant ability. The calibration curves showed that the fitting curves of the training set were close to the reference curves, indicating that the model had a good fit. The DCA showed that the threshold probability range of the training set was 1% to 89%. Conclusions: Independent risk factors for CRS were screened, and a prediction model was constructed, which is of significance for the prevention, control, and treatment of the disease.

Causal Effects of Asthma on Upper Airway Diseases and Allergic Diseases: A Two-Sample Mendelian Randomization

INTRODUCTION

Asthma is associated with upper airway diseases and allergic diseases; however, the causal effects need to be investigated further. Thus, we performed this two-sample Mendelian randomization (MR) analysis to explore and measure the causal effects of asthma on allergic rhinitis (AR), vasomotor rhinitis (VMR), allergic conjunctivitis (AC), atopic dermatitis (AD), and allergic urticaria (AU).

METHODS

The data for asthma, AR, VMR, AC, AD, and AU were obtained from large-scale genome-wide association studies summarized recently. We defined single-nucleotide polymorphisms satisfying the MR assumptions as instrumental variables. Inverse-variance weighted (IVW) approach under random-effects was applied as the dominant method for causal estimation. The weighted median approach, MR-Egger regression analysis, MR pleiotropy residual sum and outlier test, and leave-one-out sensitivity analysis were performed as sensitivity analysis. Horizontal pleiotropy was measured using MR-Egger regression analysis. Significant causal effects were attempted for replication and meta-analysis.

RESULTS

We revealed that asthma had causal effects on AR (IVW, odds ratio [OR] = 1.93; 95% confidence interval [CI], 1.74-2.14; p < 0.001), VMR (IVW, OR = 1.40; 95% CI, 1.15-1.71; p < 0.001), AC (IVW, OR = 1.65; 95% CI, 1.49-1.82; p < 0.001), and AD (IVW, OR = 2.13; 95% CI, 1.82-2.49; p < 0.001). No causal effect of asthma on AU was observed. Sensitivity analysis further assured the robustness of these results. The evaluation of the replication stage and meta-analysis further confirmed the causal effect of asthma on AR (IVW OR = 1.81, 95% CI 1.62-2.02, p < 0.001), AC (IVW OR = 1.44, 95% CI 1.11-1.87, p < 0.001), and AD (IVW OR = 1.85, 95% CI 1.42-2.41, p < 0.001).

CONCLUSIONS

We revealed and quantified the causal effects of asthma on AR, VMR, AC, and AD. These findings can provide powerful causal evidence of asthma on upper airway diseases and allergic diseases, suggesting that the treatment of asthma should be a preventive and therapeutic strategy for AR, VMR, AC, and AD.

The CORE syndrome: an overlap of severe asthma, obstructive sleep apnea, rhinosinusitis, and esophageal reflux

PURPOSE

Asthma, obstructive sleep apnea (OSA), rhinosinusitis, and esophageal reflux are conditions that may overlap, forming a syndrome known as CORE. Whenever clinical remission of severe asthma (SA) is not achieved, it is essential to investigate the presence of comorbidities, in particular the presence of OSA that may lead to the diagnosis of CORE syndrome.

METHODS

The study was conducted on naive patients with SA and concomitant rhinosinusitis and esophageal reflux, referred to our institute since 2018. Patients who did not experience clinical remission were investigated for OSA through a home sleep apnea test. Subsequently, for those diagnosed with OSA, continuous positive airway pressure (CPAP) was proposed and was re-evaluated after 12 months.

RESULTS

Six patients with CORE syndrome were enrolled. The mean apnea-hypopnea index (AHI) was 33.25 ± 20.13 events/h, oxygen desaturation index (ODI) was 28.95 ± 19.95 events/h, and time in bed with SaO2 < 90% (T90) was 26.40 ± 27.22% for which continuous positive airway pressure (CPAP) treatment was proposed but only 3 out of 6 patients accepted. After 12 months, all CPAP-treated patients manifested a significant reduction in daytime sleepiness (ESS score was 6.33 ± 3.8), an improvement in ACT score (+ 8 (+ 32%), + 9 (+ 36%), and + 14 (+ 56%) points), a discontinuation of oral corticosteroids (OCS), an absence of exacerbations, and an improvement of lung function leading to clinical remission of asthma.

CONCLUSION

Whenever facing SA patients, non-responders to therapy, it is important to suspect the presence of CORE syndrome; in particular, the detection and subsequent treatment of OSA would seem to improve the outcome of such patients.

The causal relationship between autoimmune diseases and rhinosinusitis, and the mediating role of inflammatory proteins: a Mendelian randomization study

Observational studies have linked autoimmune diseases (ADs) with rhinosinusitis (RS) manifestations. To establish a causal relationship between ADs and RS, and to explore the potential mediating role of inflammatory mediators between ADs and RS, we utilized Mendelian randomization (MR) analysis. Using a two-sample MR methodology, we examined the causality between multiple sclerosis (MS), rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis (PsO), type 1 diabetes (T1D), Sjogren's syndrome (SS), celiac disease (CeD), Crohn's disease (CD), hypothyroidism (HT), Graves' disease (GD), and Hashimoto's thyroiditis and their association with chronic and acute rhinosinusitis (CRS and ARS, respectively).To achieve this, we employed three distinct MR techniques: inverse variance weighting (IVW), MR-Egger, and the weighted median method. Our analysis also included a variety of sensitivity assessments, such as Cochran's Q test, leave-one-out analysis, MR-Egger intercept, and MR-PRESSO, to ensure the robustness of our findings. Additionally, the study explored the role of inflammation proteins as a mediator in these relationships through a comprehensive two-step MR analysis. Among the ADs, MS, RA, T1D, CeD, and HT were determined as risk factors for CRS. Only CeD exhibited a causal relationship with ARS. Subsequent analyses identified interleukin-10 (IL-10) as a potential mediator for the association of MS, RA and HT with CRS, respectively., while C-X-C motif chemokine 10 levels (CXCL10) and T-cell surface glycoprotein CD6 isoform levels (CD6) were found to influence HT's effect on CRS. Our findings demonstrate a causative link between specific autoimmune diseases and rhinosinusitis, highlighting IL-10, CXCL10, and CD6 as potential mediators in this association.

Deciphering the Interplay between the Epithelial Barrier, Immune Cells, and Metabolic Mediators in Allergic Disease

Chronic exposure to harmful pollutants, chemicals, and pathogens from the environment can lead to pathological changes in the epithelial barrier, which increase the risk of developing an allergy. During allergic inflammation, epithelial cells send proinflammatory signals to group 2 innate lymphoid cell (ILC2s) and eosinophils, which require energy and resources to mediate their activation, cytokine/chemokine secretion, and mobilization of other cells. This review aims to provide an overview of the metabolic regulation in allergic asthma, atopic dermatitis (AD), and allergic rhinitis (AR), highlighting its underlying mechanisms and phenotypes, and the potential metabolic regulatory roles of eosinophils and ILC2s. Eosinophils and ILC2s regulate allergic inflammation through lipid mediators, particularly cysteinyl leukotrienes (CysLTs) and prostaglandins (PGs). Arachidonic acid (AA)-derived metabolites and Sphinosine-1-phosphate (S1P) are significant metabolic markers that indicate immune dysfunction and epithelial barrier dysfunction in allergy. Notably, eosinophils are promoters of allergic symptoms and exhibit greater metabolic plasticity compared to ILC2s, directly involved in promoting allergic symptoms. Our findings suggest that metabolomic analysis provides insights into the complex interactions between immune cells, epithelial cells, and environmental factors. Potential therapeutic targets have been highlighted to further understand the metabolic regulation of eosinophils and ILC2s in allergy. Future research in metabolomics can facilitate the development of novel diagnostics and therapeutics for future application.

Proteomic and metabolomic proof of concept for unified airways in chronic rhinosinusitis and asthma

BACKGROUND

The pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) with comorbid asthma remains unclear.

OBJECTIVE

To assess upper and lower airway unity and identify a possible common pathogenesis in CRSwNP with asthma.

METHODS

This study analyzed the expression of proteins and metabolites in nasal lavage fluid cells (NLFCs) and induced sputum cells (ISCs). Differentially expressed proteins and their function-related metabolites in the upper and lower airways of patients having CRSwNP with or without asthma were identified; relevant signaling pathways were analyzed, and key pathway-related proteins were identified. Parallel reaction monitoring was used to verify these target proteins.

RESULTS

Protein or metabolite expression between NLFCs and ISCs was highly correlated and conservative on the basis of expression profiles and weighted gene coexpression network analysis. There were 17 differentially coexpressed proteins and their function-related 13 metabolites that were identified in the NLFCs and ISCs of CRSwNP, whereas 11 proteins and 11 metabolites were identified in CRSwNP with asthma. An asthma pathway was involved in the copathogenesis of upper and lower airways in whether CRSwNP or CRSwNP with asthma. The asthma pathway-related proteins proteoglycan 2 and eosinophil peroxidase, as the core of the protein-metabolism interaction networks between the upper and lower airways, were both highly coexpressed in NLFCs and ISCs in patients having either CRSwNP or CRSwNP with asthma by parallel reaction monitoring validation.

CONCLUSION

Proteomics and metabolomics reveal upper and lower airway unity. Asthma pathway-related proteins proteoglycan 2 and eosinophil peroxidase from the upper airway could be used to assess the potential risk of lower airway dysfunction in CRSwNP.

Risk factor analysis and nomogram for predicting poor symptom control in smoking asthmatics

BACKGROUND

Smoking induces and modifies the airway immune response, accelerating the decline of asthmatics' lung function and severely affecting asthma symptoms' control level. To assess the prognosis of asthmatics who smoke and to provide reasonable recommendations for treatment, we constructed a nomogram prediction model.

METHODS

General and clinical data were collected from April to September 2021 from smoking asthmatics aged ≥14 years attending the People's Hospital of Zhengzhou University. Patients were followed up regularly by telephone or outpatient visits, and their medication and follow-up visits were recorded during the 6-months follow-up visit, as well as their asthma control levels after 6 months (asthma control questionnaire-5, ACQ-5). The study employed R4.2.2 software to conduct univariate and multivariate logistic regression analyses to identify independent risk factors for 'poorly controlled asthma' (ACQ>0.75) as the outcome variable. Subsequently, a nomogram prediction model was constructed. Internal validation was used to test the reproducibility of the model. The model efficacy was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve.

RESULTS

Invitations were sent to 231 asthmatics who smoked. A total of 202 participants responded, resulting in a final total of 190 participants included in the model development. The nomogram established five independent risk factors (P<0.05): FEV1%pred, smoking index (100), comorbidities situations, medication regimen, and good or poor medication adherence. The area under curve (AUC) of the modeling set was 0.824(95%CI 0.765-0.884), suggesting that the nomogram has a high ability to distinguish poor asthma control in smoking asthmatics after 6 months. The calibration curve showed a C-index of 0.824 for the modeling set and a C-index of 0.792 for the self-validation set formed by 1000 bootstrap sampling, which means that the prediction probability of the model was consistent with reality. Decision curve analysis (DCA) of the nomogram revealed that the net benefit was higher when the risk threshold probability for poor asthma control was 4.5 - 93.9%.

CONCLUSIONS

FEV1%pred, smoking index (100), comorbidities situations, medication regimen, and medication adherence were identified as independent risk factors for poor asthma control after 6 months in smoking asthmatics. The nomogram established based on these findings can effectively predict relevant risk and provide clinicians with a reference to identify the poorly controlled population with smoking asthma as early as possible, and to select a better therapeutic regimen. Meanwhile, it can effectively improve the medication adherence and the degree of attention to complications in smoking asthma patients.

Updated epithelial barrier dysfunction in chronic rhinosinusitis: Targeting pathophysiology and treatment response of tight junctions

Tight junction (TJ) proteins establish a physical barrier between epithelial cells, playing a crucial role in maintaining tissue homeostasis by safeguarding host tissues against pathogens, allergens, antigens, irritants, etc. Recently, an increasing number of studies have demonstrated that abnormal expression of TJs plays an essential role in the development and progression of inflammatory airway diseases, including chronic obstructive pulmonary disease, asthma, allergic rhinitis, and chronic rhinosinusitis (CRS) with or without nasal polyps. Among them, CRS with nasal polyps is a prevalent chronic inflammatory disease that affects the nasal cavity and paranasal sinuses, leading to a poor prognosis and significantly impacting patients' quality of life. Its pathogenesis primarily involves dysfunction of the nasal epithelial barrier, impaired mucociliary clearance, disordered immune response, and excessive tissue remodeling. Numerous studies have elucidated the pivotal role of TJs in both the pathogenesis and response to traditional therapies in CRS. We therefore to review and discuss potential factors contributing to impair and repair of TJs in the nasal epithelium based on their structure, function, and formation process.

Matrix metalloproteinases in chronic rhinosinusitis

INTRODUCTION

Matrix metalloproteinases (MMPs) are a group of enzymes that are essential in maintaining extracellular matrix (ECM) homeostasis, regulating inflammation and tissue remodeling. In chronic rhinosinusitis (CRS), the overexpression of certain MMPs can contribute to chronic nasal tissue inflammation, ECM remodeling, and tissue repair.

AREAS COVERED

This review provides a comprehensive overview of the biological characteristics and functions of the MMP family, particularly focusing on the expression and activity of MMPs in patients with CRS, and delves into their role in the pathogenesis of CRS and their potential as therapeutic targets.

EXPERT OPINION

MMPs are important in tissue remodeling and have been implicated in the pathophysiology of CRS. Previous studies have shown that the expression of MMPs is upregulated in the nasal mucosa of patients with CRS and positively correlates with the severity of CRS. However, there is still a large gap in the research content of MMP in CRS, and the specific expression and pathogenic mechanism of MMP still need to be clarified. The significance and value of the ratio of MMP to tissue inhibitors of metalloproteinase (TIMP) in diseases still need to be demonstrated. Moreover, further studies are needed to assess the efficacy and safety of biologics that target MMPs in patients with CRS.

Galectin-10 in serum extracellular vesicles reflects asthma pathophysiology

BACKGROUND

Novel biomarkers (BMs) are urgently needed for bronchial asthma (BA) with various phenotypes and endotypes.

OBJECTIVE

We sought to identify novel BMs reflecting tissue pathology from serum extracellular vesicles (EVs).

METHODS

We performed data-independent acquisition of serum EVs from 4 healthy controls, 4 noneosinophilic asthma (NEA) patients, and 4 eosinophilic asthma (EA) patients to identify novel BMs for BA. We confirmed EA-specific BMs via data-independent acquisition validation in 61 BA patients and 23 controls. To further validate these findings, we performed data-independent acquisition for 6 patients with chronic rhinosinusitis without nasal polyps and 7 patients with chronic rhinosinusitis with nasal polyps.

RESULTS

We identified 3032 proteins, 23 of which exhibited differential expression in EA. Ingenuity pathway analysis revealed that protein signatures from each phenotype reflected disease characteristics. Validation revealed 5 EA-specific BMs, including galectin-10 (Gal10), eosinophil peroxidase, major basic protein, eosinophil-derived neurotoxin, and arachidonate 15-lipoxygenase. The potential of Gal10 in EVs was superior to that of eosinophils in terms of diagnostic capability and detection of airway obstruction. In rhinosinusitis patients, 1752 and 8413 proteins were identified from EVs and tissues, respectively. Among 11 BMs identified in EVs and tissues from patients with chronic rhinosinusitis with nasal polyps, 5 (including Gal10 and eosinophil peroxidase) showed significant correlations between EVs and tissues. Gal10 release from EVs was implicated in eosinophil extracellular trapped cell death in vitro and in vivo.

CONCLUSION

Novel BMs such as Gal10 from serum EVs reflect disease pathophysiology in BA and may represent a new target for liquid biopsy approaches.

Airborne indoor allergen serine proteases and their contribution to sensitisation and activation of innate immunity in allergic airway disease

Common airborne allergens (pollen, animal dander and those from fungi and insects) are the main triggers of type I allergic disorder in the respiratory system and are associated with allergic rhinitis, allergic asthma, as well as immunoglobulin E (IgE)-mediated allergic bronchopulmonary aspergillosis. These allergens promote IgE crosslinking, vasodilation, infiltration of inflammatory cells, mucosal barrier dysfunction, extracellular matrix deposition and smooth muscle spasm, which collectively cause remodelling of the airways. Fungus and insect (house dust mite and cockroaches) indoor allergens are particularly rich in proteases. Indeed, more than 40 different types of aeroallergen proteases, which have both IgE-neutralising and tissue-destructive activities, have been documented in the Allergen Nomenclature database. Of all the inhaled protease allergens, 85% are classed as serine protease activities and include trypsin-like, chymotrypsin-like and collagenolytic serine proteases. In this article, we review and compare the allergenicity and proteolytic effect of allergen serine proteases as listed in the Allergen Nomenclature and MEROPS databases and highlight their contribution to allergic sensitisation, disruption of the epithelial barrier and activation of innate immunity in allergic airways disease. The utility of small-molecule inhibitors of allergen serine proteases as a potential treatment strategy for allergic airways disease will also be discussed.

The cyclooxygenase-2 upregulation mediates production of PGE2 autacoid to positively regulate interleukin-6 secretion in chronic rhinosinusitis with nasal polyps and polyp-derived fibroblasts

Chronic rhinosinusitis (CRS) can be traditionally classified as CRSwNP [with nasal polyps (NPs)] and CRSsNP (without NPs) based on the clinical phenotypes but recently suggested to be classified by the endotypes. We have identified overexpression of the cyclooxygenase-2 (COX-2) gene in NP tissues of Taiwanese CRSwNP patients. Therefore, in this study, we sought to investigate its protein expression/location/distribution in NP specimens and explore its roles in nasal polyposis. The COX-2 protein and mRNA expression was found higher in NPs than that in the control and CRSsNP patients' nasal tissues, mainly located at the epithelium and subepithelial stroma. Consistently, the CRS-related peptidoglycan (PGN) and bradykinin provoked COX-2 mRNA and protein upregulation in the human NP-derived fibroblasts and caused PGE2, thromboxane A2 (TXA2), and interleukin (IL-6) secretion in culture medium. Further analysis revealed that the PI3K/Akt activation and COX-2 induction were necessarily required for PGN-induced IL-6 production/secretion and the induced PGE2, but not TXA2, was speculated to affect IL-6 protein trafficking and production. Finally, the IL-6 increase observed in vitro could also be detected in NP tissues. Collectively, we demonstrated here that COX-2 protein and IL-6 are overexpressed in human NP tissues. In response to PGN challenge, the PI3K/Akt activation and COX-2-mediated PGE2 autacoid correlates with extracellular IL-6 protein trafficking/production in NP-derived fibroblasts, which can additionally contribute to the production of Th17-related cytokines such as IL-17 and TNF-α. This study also suggests COX-2 as a special biomarker for CRSwNP endotyping and may highlight the importance of COX-2 inhibitors in treating CRSwNP.

Effectiveness of dupilumab versus endoscopic sinus surgery for the treatment of type-2 chronic rhinosinusitis with nasal polyps: a preliminary report

PURPOSE

Historically managed with intranasal corticosteroids (INCS) and endoscopic sinus surgery (ESS), type-2 Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) treatment was revolutionized by the introduction of dupilumab but universally accepted guidelines are still lacking.

METHODS

Patients treated at our University Hospital for type-2 CRSwNP were enrolled. Demographic data were collected, as well as laboratory (eosinophils, total IgE), endoscopic [nasal polyps score (NPS), modified Lund-Kennedy score (mLKS)], radiological [Lund-Mackay score (LMS) at CT scan], SNOT-22, and olfactory [Sniffin' Sticks identification test (SSIT)] features. Patients were treated with dupilumab or ESS and re-evaluated after 3 and 12 months.

RESULTS

At 3 and 12 months, patients undergoing ESS achieved a higher reduction of NPS and mLKS, while patients receiving dupilumab experienced a higher improvement at SNOT-22 and SSIT with a greater positive variation in the prevalence of anosmia (- 57.7% vs - 42.9%) and normosmia (+ 37.8 vs + 28.5%). Mean mLKS and LMS were quite similar. Results were independent of clinical features known to contribute to CRSwNP severity, except for patients with ≥ 2 prior ESS who had a significantly lower smell improvement.

CONCLUSION

ESS and dupilumab were effective at reducing CRSwNP inflammatory burning. CRSwNP smell impairment cannot be attributed only to olfactory cleft obstruction and other mechanisms may be involved. Dupilumab acts systemically with poor correlation with NPS. As of today, dupilumab appears to be more suitable for elderly patients with anesthesiological contraindications and/or several previous surgeries, while ESS may represent the first-line choice in surgery-naive patients.

The role of ZEB1 in regulating tight junctions in antrochoanal polyp

Background

Antrochoanal polyp (ACP) is a benign nasal mass of unknown etiology. Tight junctions (TJs) are essential to the epithelial barrier that protects the body from external damage. However, the phenotype of tight junction in ACP is currently unclear.

Methods

The samples were collected from 20 controls, 37 patients with ACP and 45 patients with chronic rhinosinusitis with nasal polyp (CRSwNP). Quantitative Real-Time PCR (qRT-PCR) and immunofluorescence staining (IF) were performed to analyze the expressions of TJs markers (ZO-1, claudin-3 and occludin) and ZEB1. hNEpCs were transfected with ZEB1 small interfering RNA (si-ZEB1) or ZEB1 over-expression plasmid (OE-ZEB1). qRT-PCR and Western blotting were used to determine the levels of TJs-related markers. Primary human nasal epithelial cells (hNECs) were stimulated with IL-17A and si-ZEB1, and the expression of epithelial barrier markers were measured by qRT-PCR and Western blotting.

Results

Compared to the control group, ACP group showed a significant downregulation in both mRNA and protein levels of ZO-1, occludin, and claudin-3. Furthermore, disease severity correlates positively with the degree of disruption of tight junctions. In addition, higher expression levels of ZEB1, IL-17A, and IFN-γ were observed in the ACP group compared to controls. Overexpression of ZEB1 in hNEpCs led to impairments in the levels of ZO-1, occludin, and claudin-3, while silencing of ZEB1 expression was found to enhance the barrier function of epithelial cells. Finally, IL-17 stimulation of hNECs impaired the expression of TJs-associated molecules (ZO-1, occludin, and claudin-3), which was effectively reversed by the IL-17A + si-ZEB1 group.

Conclusions

The tight junctions in ACP were extremely damaged and were correlated with the severity of the disease. ZEB1 was involved in the pathogenesis of ACP mediated by IL-17A through regulating tight junctions.

Upper and lower airway interactions in children

PURPOSE OF REVIEW

The aim of the present review was to highlight the interactions between rhinitis, rhinosinusitis and asthma in children and to discuss the most relevant scientific progresses in the pathophysiology and treatment of these combined conditions.

RECENT FINDINGS

Advances in understanding the mechanisms underlying the relationship between upper and lower airways have provided valuable insights into the role of eosinophils in the pathophysiology of inflammatory events and have further delineated the concept of united airway disease. Studies addressed to evaluate the burden of sinonasal system on asthma outcomes showed a parallel severity of upper and lower airway diseases. Histopathology of sinonasal tissue in patients with chronic rhinosinusitis is different in adults and children. Targeted administration of biological agents represents an effective treatment in patients with severe uncontrolled asthma, but specific trials are awaited in children with chronic sinonasal disease.

SUMMARY

Allergic rhinitis and rhinosinusitis are important comorbidities in patients with asthma. Improved knowledge of pathogenic mechanisms of inflammation and remodelling in the sinonasal system and the lung has led to new therapeutic approaches in patients with united airway disease and opened interesting perspectives for personalized drug therapies.

Single-cell RNA sequencing reveals the epithelial cell, fibroblast, and key gene alterations in chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal mucosa, and epithelial-mesenchymal transition (EMT) is thought to be an essential process in the pathogenesis of CRSwNP. However, the mechanisms of epithelial and fibroblastic changes at the single-cell level are unclear. In this study, we investigated the epithelial cell, fibroblast, and key gene alterations in the development of CRSwNP. We revealed major cell types involved in CRSwNP and nasal mucosal inflammation formation, then mapped epithelial and fibroblast subpopulations. We showed that the apical and glandular epithelial cells and the ADGRB3+ and POSTN+ fibroblasts were the key cell subtypes in the progression of CRSwNP. Pseudotime and cell cycle analysis identified dynamic changes between epithelial cells and fibroblasts during its development. WFDC2 and CCL26 were identified as the key marker genes involved in the development of CRSwNP and were validated by IHC staining, which may provide a potential novel target for future CRSwNP therapy. ScRNA-seq data provided insights into the cellular landscape and the relationship between epithelial cells and fibroblasts in the progression of CRSwNP. WFDC2 and CCL26 were identified as the key genes involved in the development of CRSwNP and may be the potential markers for gene therapy.

Modulation of the Immune Response to Allergies Using Alternative Functional Foods

Modulation of the allergic immune response through alternative therapies is a field of study that aims to address allergic reactions differently from traditional approaches. These therapies encompass the utilization of natural functional foods, which have been observed to exert an influence on the immune response, thus mitigating the severity of allergies. Indeed, some studies suggest that the incorporation of these nutraceuticals can regulate immune function, leading to a reduction in histamine release and subsequent alleviation of allergic symptoms. Moreover, certain herbs and dietary supplements, such as curcumin, are believed to possess anti-inflammatory properties, which may serve to moderate allergic responses. Although the results remain somewhat mixed and require further research, these alternative therapies exhibit the potential to impact the allergic immune response, thereby providing complementary options to conventional treatments. Therefore, in this review, we aim to provide an updated account of functional foods capable of modulating the immune response to allergies. In that sense, the review delves into functional foods sourced from plants (phytochemicals), animals, and marine algae. Emphasis is placed on their potential application in the treatment of allergic disorders. It also provides an overview of how these foods can be effectively utilized as functional foods. Additionally, it explores the molecular mechanisms and scientific validity of various bioactive natural compounds in the management of allergies.

Cigarette smoke aggravates asthma via altering airways inflammation phenotypes and remodelling

INTRODUCTION

Many asthmatic patients are exposed to cigarette smoke actively or passively, which contributes to asthma exacerbation and poor control. This study is to explore the effects of cigarette smoke on pathological changes in murine surrogate of asthma.

METHODS

C57BL/6 mice were sensitised and challenged with ovalbumin (OVA) to establish a surrogate of asthma and then administered with cigarette smoke extract (CSE). Airways hyperresponsiveness (AHR) was measured using the Flexivent system. Histological staining (haematoxylin-eosin [HE], periodic acid Schiff [PAS], Congo red and Masson's trichrome) was employed to measure pathological changes in sections of lung tissue of experimental mice. Enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of total and OVA-specific IgE, cytokines and chemokines (eotaxin-1, IL-13, IL-1β, TNF-α, IL-17A, IL-33) in the lung tissue homogenates. Immunoreactivity for vWF and α-SMA in lung tissue sections was detected by immunohistochemistry.

RESULTS

Exposure of the animals to CSE significantly reduced OVA-induced AHR, the number of eosinophils in bronchoalveolar lavage fluid (BALF) and eosinophils infiltrating into the lung tissue, as well as concentrations of some cytokines in lung homogenate. In contrast, it significantly enhanced the number of macrophages and M2 in BALF, as well as collagen deposition, smooth muscle thickness and alveolar destruction in lung tissue.

CONCLUSION

CSE inhibits OVA-induced AHR, changes inflammation 'phenotypes', while accelerates some aspects of airways remodelling, which might contribute to worse symptoms and be refractory to anti-inflammation therapies for asthmatics.

Loke zupa decoction attenuates bronchial EMT-mediated airway remodelling in chronic asthma through the PI3K-Akt/HIF-1α signaling pathway

CONTEXT

Loke zupa decoction (Lok) is a well-established classic Chinese folk remedy for asthma.

OBJECTIVE

We sought to investigate the effect and mechanism of Lok on asthma airway remodelling and provide novel insights for the prevention and treatment of asthma.

MATERIALS AND METHODS

For in vitro experiments, BEAS-2B cells were assigned into six groups: Control, TGF-β1 (10 μM), TGF-β1 + Lok-20, TGF-β1 + Lok-40, TGF-β1 + Lok-80 μg/mL and TGF-β1 + SB431542 (5 μM). CCK8 and wound healing assays were performed. For in vivo experiments, 60 female BALB/c mice were randomly divided into 5 groups: Control, model, Lok-4.55, Lok-9.1, and DEX group. Lok was administrated by gavage during the challenge stage for 8 consecutive weeks (4.55 and 9.1 g/kg/day). We investigated airway inflammation and airway remodelling in the lungs and verified the activation status of EMT-related markers and the PI3K-Akt/HIF-1α signalling pathway.

RESULTS

In vitro, Lok efficiently inhibited TGF-β1-induced BEAS-2B cell proliferation ability (cell viability 165% vs. 105%) and migration (migration areas 85% vs. 35%) without affecting their normal growth (IC50 274.2 µg/mL at 48 h). In vivo, Lok effectively protected mice from asthma, as evidenced by decreased histological damage and level of cytokines in BALF (IL-4, IL-13 and TGF-β1) by 17%-77%. Mechanistic research revealed that Lok reduced the levels of EMT-related molecules and significantly downregulated the PI3K-Akt/HIF-1α signalling pathway.

DISCUSSION AND CONCLUSIONS

Our findings provide novel insights into the protective effect of Lok on asthma and the underlying mechanisms, providing a theoretical basis and potential treatment possibilities for this patient population.

Association of serum CD14 level and functional polymorphism C-159T in the promoter region of CD14 gene with allergic rhinitis

Allergic rhinitis (AR) is an inflammatory disease of the upper respiratory tract affecting a significant number of the world's population. It occurs as an IgE-mediated immune response of the nasal mucosa to inhaled allergens. The human Cluster of Differentiation 14 (CD14) is a glycosyl-phosphatidylinositol-anchored molecule expressed on the surface of monocytes and macrophages and functions as a receptor to lipopolysaccharides and inhaled endotoxins that may stimulate interleukins production by antigen-presenting cells. Consequently, CD14 plays a substantial role in allergic diseases and may become one of their etiological causes. This study aimed to determine the association between C-159T polymorphism in the CD14 gene promoter region and serum CD14 levels and the risk of Allergic rhinitis Egyptian patients and to test the validity of serum CD14 level measurement in predicting AR. This case-control study included 45 patients with AR referred to Allergy and Immunology Unit, Zagazig University Hospital, Zagazig, Egypt, and 45 healthy subjects as controls. Serum CD14 levels were measured by ELISA. The polymerase chain reaction-restriction fragment length polymorphism technique was used to detect C-159T gene polymorphism in the CD14 promoter region. There was a significant association between CD14 serum levels and AR incidence (P < 0.001), with patients having higher serum CD14 levels than controls. In addition, a significant association (P < 0.001) was detected between serum CD14 levels and the severity of AR, as well as elevated serum CD14 levels in severe and the most severe cases. On the molecular level, there was a statistically significant relationship between patients and the control group regarding the CD14 genotype (P < 0.001), where CT and TT genotypes and T allele were primarily associated with the cases group, indicating that the risk of AR was significantly associated with the inheritance of the TT genotype. Additionally, a statistically significant association was found between the severity of AR and CD14 genotype (P < 0.001), where TT genotypes were mainly associated with severe and the most severe cases. In the studied groups, there was a statistically significant difference (P < 0.05) between the CD14 genotype and serum CD14 levels, with TT genotypes being associated with higher CD14 levels. The results obtained in this study revealed that serum CD14 level is a potential biomarker for the diagnosis of AR and, at the genetic level, a potential predictor of disease.

Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is an inflammatory disease of paranasal sinuses. This study is formulated to explore the roles of pro-inflammatory factors Chemerin and interleukin-17 (IL-17) in CRS. Patients suffering from CRS without/with nasal polyps (CRSsNP/CRSwNP), along with volunteers, were recruited. CRS rabbit models were constructed by Staphylococcus aureus infection and rabbits were injected with lentiviral vectors of short hairpin RNA-targeting Chemerin (shChemerin), followed by micro-computed tomography (CT) scan. Levels of Chemerin and IL-17 were determined, and histopathological lesions were observed in subjects and CRS rabbits. Correlations between Chemerin/IL-17 level and Lund-Mackay/Lund-Kennedy scores of subjects and the predictive value of Chemerin or IL-17 for CRS were analyzed. In CRS patients and rabbits, inflammatory degrees and the level of Chemerin/IL-17 were increased in pathological tissues or plasma, while Chemerin silencing alleviated CRS symptoms of CRS rabbits. Chemerin and IL-17 were mainly located in the immune cells of pathological tissues and presented the positive correlation with Lund-Mackay/Lund-Kennedy score of CRS patients. Also, they showed high predictive value for CRS. Micro-CT scan uncovered that CRS rabbits had increased bone remodeling, which was alleviated by Chemerin silencing. Collectively, Chemerin and IL-17 are potential predictors and Chemerin silencing alleviates inflammatory response and bone remodeling in chronic rhinosinusitis.

IL18R1-Related Molecules as Biomarkers for Asthma Severity and Prognostic Markers for Idiopathic Pulmonary Fibrosis

To determine the role of inflammation-related proteins in predicting asthma severity and outcome, 92 inflammation-related proteins were measured in the asthmatic serum using Olink analysis. Different bioinformatics algorithms were developed to cross analyze with the single-cell or transcriptome data sets from the Gene Expression Omnibus database to explore the role of IL18R1 and related genes in asthma and idiopathic pulmonary fibrosis (IPF). Olink identified 52 differentially expressed proteins in asthma. They were strongly linked to the cytokine-cytokine receptor interaction, TNF, and NF-κB signaling pathway. Seven proteins were found in both single-cell RNA and Olink analyses. Among them, IL18R1 was predominantly expressed in mast cells, and the results suggested enhanced communication between mast cells and CD 8+ T cells. IL18R1 was upregulated in serum and induced sputum and bronchoalveolar lavage fluid of patients with uncontrolled or severe asthma. IL18R1 was positively correlated with TNFSF1 and OSM and S100A12. The diagnostic efficacy of these serum IL18R1-related molecules for asthma ranged from 0.839 to 0.921. Moreover, high levels of IL18R1, TNFSF1, OSM, and S100A12 were significantly associated with shorter survival times and worse lung function. IL18R1-related molecules may serve as biomarkers for monitoring uncontrolled or severe asthma and as prognostic markers for IPF.

Eosinophils and tissue remodeling: Relevance to airway disease

The ability of human tissue to reorganize and restore its existing structure underlies tissue homeostasis in the healthy airways, but in disease can persist without normal resolution, leading to an altered airway structure. Eosinophils play a cardinal role in airway remodeling both in health and disease, driving epithelial homeostasis and extracellular matrix turnover. Physiological consequences associated with eosinophil-driven remodeling include impaired lung function and reduced bronchodilator reversibility in asthma, and obstructed airflow in chronic rhinosinusitis with nasal polyps. Given the contribution of airway remodeling to the development and persistence of symptoms in airways disease, targeting remodeling is an important therapeutic consideration. Indeed, there is early evidence that eosinophil attenuation may reduce remodeling and disease progression in asthma. This review provides an overview of tissue remodeling in both health and airway disease with a particular focus on eosinophilic asthma and chronic rhinosinusitis with nasal polyps, as well as the role of eosinophils in these processes and the implications for therapeutic interventions. Areas for future research are also noted, to help improve our understanding of the homeostatic and pathological roles of eosinophils in tissue remodeling, which should aid the development of targeted and effective treatments for eosinophilic diseases of the airways.

The interplay of inflammation and remodeling in the pathogenesis of chronic rhinosinusitis: current understanding and future directions

Chronic rhinosinusitis (CRS), a common clinical condition characterized by persistent mucosal inflammation and tissue remodeling, has a complex pathogenesis that is intricately linked to innate and adaptive immunity. A number of studies have demonstrated that a variety of immune cells and cytokines that play a vital role in mediating inflammation in CRS are also involved in remodeling of the nasal mucosa and the cells as well as different cytokines involved in remodeling in CRS are also able to exert some influence on inflammation, even though the exact relationship between inflammation and remodeling in CRS has not yet been fully elucidated. In this review, the potential role of immune cells and cytokines in regulating inflammation and remodeling of CRS mucosa has been described, starting with the immune cells and cytokines that act together in inflammation and remodeling. The goal is to aid researchers in understanding intimate connection between inflammation and remodeling of CRS and to offer novel ideas for future research.

Risk Factors for Acute Rhinosinusitis in Childhood Asthma

INTRODUCTION

Specific pathogen infections associated with acute rhinosinusitis (ARS) in infants are risk factors for allergic asthma in adolescents. However, the risk factors for ARS onset remain largely unknown in asthmatic children. In this study, we aim to investigate the risk factors for ARS in childhood asthma.

METHODS

This study retrospectively compared and analyzed the clinical characteristics of asthmatic children with (n = 194) or without ARS (n = 799). Univariate regression analyses were performed to identify ARS-associated risk factors in asthmatic children, and subsequent multivariate backward stepwise logistic regression analyses were performed to identify independent risk factors.

RESULTS

The onset age, values of blood eosinophils (EOS) (%), and total IgE were significantly lower in patients with ARS than in those without ARS. Moreover, the proportions of patients allergic to Dermatophagoides pteronyssinus (d1) and Dermatophagoides farinae (d2) were significantly smaller in children with ARS (all p values <0.05). Univariate analyses showed that an older onset age, a higher body mass index, a higher value of blood EOS (%) were protective factors, while a higher value of blood lymphocytes (%) and a higher degree of sensitization to d1 and d2 were risk factors for ARS. Further backward stepwise multivariate logistic regression analyses confirmed that a younger onset age and allergic sensitization to d1 were independent risk factors for ARS in childhood asthma.

CONCLUSION

Younger onset age and allergic sensitization to d1 are risk factors for the onset of ARS in childhood asthma, so allergen intervention should be performed as early as possible in asthmatic children.