Predictive Significance of Arachidonate 15-Lipoxygenase for Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

Abstract Background Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP. Methods Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients’ baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictors for ECRSwNP. Results ALOX15 mRNA level was significantly higher in ECRSwNP patients than in nonECRSwNP patients ( P < 0.001). ALOX15 mRNA was significantly correlated with tissue and blood eosinophil percentages ( r = 0.565, P < 0.001 and r = 0.395, P = 0.006), olfaction scores ( r = 0.400, P = 0.005), total visual analogue scale (VAS) symptom scores ( r = 0.383, P = 0.007), ethmoid/maxillary sinus (E/M) ratio ( r = 0.463, P = 0.001), and endoscopy scores ( r = 0.409, P = 0.004). Logistic regression analysis showed ALOX15 mRNA level and percentage of blood eosinophils to be predictive factors for ECRSwNP ( P = 0.004 and P = 0.036, respectively). ROC curve indicated ALOX15 to have high predictive accuracy for ECRSwNP (area under the curve (AUC) = 0.909), which was further improved by combination of ALOX15 with percentage of blood eosinophils (AUC = 0.933). Conclusions The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.

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Predictive significance of arachidonate 15-lipoxygenase for eosinophilic chronic rhinosinusitis with nasal polyps

10.21203/rs.3.rs-32525/v2 ◽

2020 ◽

Author(s):

Zhuoping Liang ◽

Bing Yan ◽

Chang Liu ◽

Ruyu Tan ◽

Chengshuo Wang ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Roc Curve ◽

Nasal Polyps ◽

Predictive Accuracy ◽

Mrna Level ◽

Treatment Strategies ◽

Area Under The Curve ◽

Blood Eosinophil ◽

Eosinophilic Chronic Rhinosinusitis ◽

Blood Eosinophils

Abstract Background: Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP. Methods: Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients’ baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictors for ECRSwNP.Results: ALOX15 mRNA level was significantly higher in ECRSwNP patients than in nonECRSwNP patients (P < 0.001). ALOX15 mRNA was significantly correlated with tissue and blood eosinophil percentages (r = 0.565, P < 0.001 and r = 0.395, P = 0.006), olfaction scores (r = 0.400, P = 0.005), total visual analogue scale (VAS) symptom scores (r = 0.383, P = 0.007), ethmoid/maxillary sinus (E/M) ratio (r = 0.463, P = 0.001), and endoscopy scores (r = 0.409, P = 0.004). Logistic regression analysis showed ALOX15 mRNA level and percentage of blood eosinophils to be predictive factors for ECRSwNP (P = 0.004 and P = 0.036, respectively). ROC curve indicated ALOX15 to have high predictive accuracy for ECRSwNP (area under the curve (AUC) = 0.909), which was further improved by combination of ALOX15 with percentage of blood eosinophils (AUC = 0.933). Conclusions: The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.

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Predictive significance of arachidonate 15-lipoxygenase for eosinophilic chronic rhinosinusitis with nasal polyps

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-020-00480-8 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Zhuoping Liang ◽

Bing Yan ◽

Chang Liu ◽

Ruyu Tan ◽

Chengshuo Wang ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Roc Curve ◽

Nasal Polyps ◽

Predictive Accuracy ◽

Mrna Level ◽

Treatment Strategies ◽

Area Under The Curve ◽

Blood Eosinophil ◽

Eosinophilic Chronic Rhinosinusitis ◽

Blood Eosinophils

Abstract Background Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP. Methods Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients’ baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictors for ECRSwNP. Results ALOX15 mRNA level was significantly higher in ECRSwNP patients than in nonECRSwNP patients (P < 0.001). ALOX15 mRNA was significantly correlated with tissue and blood eosinophil percentages (r = 0.565, P < 0.001 and r = 0.395, P = 0.006), olfaction scores (r = 0.400, P = 0.005), total visual analogue scale (VAS) symptom scores (r = 0.383, P = 0.007), ethmoid/maxillary sinus (E/M) ratio (r = 0.463, P = 0.001), and endoscopy scores (r = 0.409, P = 0.004). Logistic regression analysis showed ALOX15 mRNA level and percentage of blood eosinophils to be predictive factors for ECRSwNP (P = 0.004 and P = 0.036, respectively). ROC curve indicated ALOX15 to have high predictive accuracy for ECRSwNP (area under the curve (AUC) = 0.909), which was further improved by combination of ALOX15 with percentage of blood eosinophils (AUC = 0.933). Conclusions The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.

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Predictive Significance of Charcot–Leyden Crystals for Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

American Journal of Rhinology and Allergy ◽

10.1177/1945892419860646 ◽

2019 ◽

Vol 33 (6) ◽

pp. 671-680 ◽

Cited By ~ 2

Author(s):

Chang Liu ◽

Bing Yan ◽

Sihan Qi ◽

Yunyun Zhang ◽

Luo Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Chronic Rhinosinusitis ◽

Predictive Value ◽

Nasal Polyps ◽

Mrna Level ◽

Blood Eosinophil ◽

Mrna Levels ◽

Qrt Pcr ◽

Eosinophilic Chronic Rhinosinusitis

Background Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is a distinct phenotype of chronic rhinosinusitis with nasal polyps (CRSwNP), with many significantly different clinical features from non-eosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP). Thus, identification of subtypes is crucial for precise treatment. Immunohistology is a reliable way to present the subtypes; however, the results mainly depend on the observation of pathologist, and the method with automatic readout and the corresponding biomarkers is lacking. Objective The purpose of our research was to explore the predictive value of quantitative reverse transcription polymerase chain reaction (qRT-PCR) as an alternative method and messenger RNA (mRNA) expression of Charcot–Leyden crystals (CLC) as a corresponding target for ECRSwNP, which may benefit the automatized judgment. Method CLC mRNA levels in tissue samples from 48 CRSwNP patients and 10 controls were evaluated by quantitative real-time PCR. Hematoxylin and eosin staining was performed for histological assessment of CRSwNP and subtyping as ECRSwNP and non-ECRSwNP. Factors associated with ECRSwNP were determined with logistic regression analysis, the predictive value was presented by a receiver operating characteristic (ROC) curve, and optimal cutoff points of the predictors were identified as the Youden index. Results mRNA level of CLC in ECRSwNP was significantly elevated compared to either non-ECRSwNP group or control group, with no significant difference between non-ECRSwNP patients and controls. CLC mRNA levels were positively correlated with percentages of tissue eosinophil and peripheral blood eosinophil ( P < .001, r = .683; P = .003, r = .420, respectively). Logistic regression analysis revealed CLC mRNA level and blood eosinophil percentages were prediagnosis factors ( P = .007, P = .045, respectively) for ECRSwNP. ROC curves analysis indicated the area under the curve (AUC) of CLC mRNA level was 0.948 which was superior to the blood eosinophil percentage (AUC = 0.797; P = .044) as an optimal biomarker to predict ECRSwNP. Conclusions CLC mRNA levels based on the qRT-PCR may serve as a reliable and alternative method for the identification of ECRSwNP.

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Systemic Predictors of Eosinophilic Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.1177/1945892418779451 ◽

2018 ◽

Vol 32 (4) ◽

pp. 252-257 ◽

Cited By ~ 28

Author(s):

Jacqueline Ho ◽

Aneeza W. Hamizan ◽

Raquel Alvarado ◽

Janet Rimmer ◽

William A. Sewell ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Predictive Value ◽

Nasal Polyps ◽

Immunoglobulin E ◽

Sinus Surgery ◽

Full Blood Count ◽

Blood Eosinophil ◽

Markers Of Inflammation ◽

Eosinophilic Chronic Rhinosinusitis ◽

Blood Eosinophils

Background Eosinophilic chronic rhinosinusitis (eCRS) is linked with skewed T-helper 2 or immunoglobulin E (IgE)-mediated allergic responses, with differing diagnosis, prognosis, and management to non-eCRS. Objective The association between biomarkers and eCRS was investigated to assess the predictors of eCRS. Methods A cross-sectional study of adult patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery was conducted. eCRS was defined by histopathological assessment showing >10 eosinophils/high-power field on sinus mucosal biopsy. Blood tests were performed preoperatively and assessed for a full blood count including eosinophils and a white cell count (WCC) as well as biochemical markers of inflammation and atopy including Immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ImmunoCAP testing for serum-specific IgE. Comparisons between eCRS and non-eCRS patients were performed. Results 345 patients (48.1% female, age 48.72 ± 15.06 years) were recruited, with 206 (59.7%) identified as eCRS, 41% with asthma and 47% CRS with nasal polyps. eCRS patients were more likely to have asthma ( P < .01) and nasal polyps ( P < .01). Blood eosinophils were significantly elevated in eCRS (0.42±0.34 vs 0.17±0.13 × 109/L, P < .01) as were eosinophils as a ratio of WCC (6.21 ± 4.48 vs 2.55 ± 1.84, P < .01). ESR was decreased when compared with non-eCRS (8.1±7.87 vs 10.65±11.91, P = .03). Receiver operating characteristic curve analysis predicted high tissue eosinophilia at blood eosinophil levels above 0.24 × 109/L (sensitivity 70.9%, specificity 78.4%, area under the curve [AUC]: 0.792, P < .01). eCRS was predicted at eosinophil above 4.27% of total WCC (sensitivity 64.1%, specificity 88.5%, AUC 0.797; P < .01; positive predictive value 89.2%, negative predictive value 62.4%, positive likelihood ratio 5.57, and diagnostic odds ratio 13.71). There was no significant association among WCC, CRP, IgE, or ImmunoCAP testing. Conclusion eCRS is associated with elevated blood eosinophils (>0.24 × 109/L), eosinophil ratio (>4.27% of total WCC), and lower ESR when compared with non-eCRS.

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Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Ear Nose & Throat Journal ◽

10.1177/0145561320960357 ◽

2020 ◽

pp. 014556132096035

Author(s):

Gian Luca Fadda ◽

Andrea Galizia ◽

Giuseppe Galizia ◽

Paolo Castelnuovo ◽

Maurizio Bignami ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Predictive Biomarker ◽

Blood Eosinophil ◽

High Power Field ◽

Diverse Range ◽

Blood Eosinophilia ◽

Tissue Eosinophilia ◽

Eosinophilic Chronic Rhinosinusitis ◽

Clinical Records

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively.

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Diagnostic significance of blood eosinophil count in eosinophilic chronic rhinosinusitis with nasal polyps in Chinese adults

The Laryngoscope ◽

10.1002/lary.22507 ◽

2012 ◽

Vol 122 (3) ◽

pp. 498-503 ◽

Cited By ~ 64

Author(s):

Ying Hu ◽

Ping-Ping Cao ◽

Geng-Tian Liang ◽

Yong-Hua Cui ◽

Zheng Liu

Keyword(s):

Chronic Rhinosinusitis ◽

Eosinophil Count ◽

Nasal Polyps ◽

Blood Eosinophil ◽

Chinese Adults ◽

Diagnostic Significance ◽

Blood Eosinophil Count ◽

Eosinophilic Chronic Rhinosinusitis

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Non-Eosinophilic Chronic Rhinosinusitis With Nasal Polyps: Eosinophil, Basophil, and Neutrophil Blood Counts Before and After Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418818578 ◽

2018 ◽

Vol 128 (3) ◽

pp. 233-240

Author(s):

Daniela Parrino ◽

Giuseppe Brescia ◽

Claudia Zanotti ◽

Giulia Tealdo ◽

Luciano Giacomelli ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Significant Negative Correlation ◽

Sinus Surgery ◽

Blood Eosinophil ◽

Response Patterns ◽

Eosinophilic Chronic Rhinosinusitis ◽

Before And After ◽

Consequent Reduction ◽

Change In Mean

Objectives: Research selectively investigating non-eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is lacking. The inflammatory patterns seen in non-eosinophilic CRSwNP are still poorly understood. The present study is the first to compare blood eosinophil, basophil, and neutrophil counts before/after surgery in patients with non-eosinophilic CRSwNP stratified by their clinical features. Methods: The study concerned 107 consecutive patients with histologically confirmed non-eosinophilic CRSwNP who underwent endoscopic sinus surgery (ESS). Results: Statistical analysis ruled out any significant change in mean blood eosinophil, basophil, and neutrophil counts after ESS. A significant positive correlation emerged between blood eosinophil and basophil counts in both pre- and post-ESS laboratory tests. In the subcohort of allergic patients, a significant negative correlation was found after ESS between eosinophil and neutrophil levels and between basophil and neutrophil levels. Conclusions: In eosinophilic CRSwNP, ESS can clear polyps, remove inflammatory tissue, and reduce the inflammatory cytokines it generates, with a consequent reduction in blood eosinophil levels. The different results in non-eosinophilic CRSwNP support the conviction that the 2 types of CRSwNP are entities with distinct inflammatory response patterns.

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Rapid Effect of Benralizumab for Hypereosinophilia in a Case of Severe Asthma with Eosinophilic Chronic Rhinosinusitis

Medicina ◽

10.3390/medicina55070336 ◽

2019 ◽

Vol 55 (7) ◽

pp. 336 ◽

Cited By ~ 4

Author(s):

Tsurumaki ◽

Matsuyama ◽

Ezawa ◽

Koga ◽

Yatomi ◽

...

Keyword(s):

Lung Function ◽

Chronic Rhinosinusitis ◽

Severe Asthma ◽

Nasal Polyps ◽

Oral Corticosteroid ◽

Blood Eosinophil ◽

Blood Eosinophil Count ◽

Eosinophilic Chronic Rhinosinusitis ◽

Rapid Effect ◽

Rapid Treatment

A 56-year-old man with severe asthma underwent bronchial thermoplasty (BT). However, his asthma exacerbated and hypereosinophilia developed 2 months later, thus necessitating oral corticosteroid (OCS) therapy. Six months after BT, a diagnosis of severe asthma with eosinophilic chronic rhinosinusitis (ECRS) was made and benralizumab treatment was initiated; the blood eosinophil count subsequently decreased and lung function improved, thereby permitting OCS dose tapering. Surprisingly, benralizumab both reduced nasal polyps and ameliorated ECRS. Thus, benralizumab may be a useful drug for the rapid treatment of severe asthma with ECRS, especially in patients with hypereosinophilia.

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