Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA
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ORIGINAL ARTICLE
Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA Giacomo Contro 1 & Giuseppe Brescia 1 & Lara Alessandrini 2 & Umberto Barion 1 & Roberto Padoan 3 & Anna Chiara Frigo 4 & Franco Schiavon 3 & Gino Marioni 1 Received: 11 September 2020 / Revised: 12 October 2020 / Accepted: 18 October 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Introduction/objectives The histopathological study of inflammatory cells and their tendency to form aggregates in chronic rhinosinusitis with nasal polyps (CRSwNP) has shown promising results in determining the pathogenesis and predicting clinical outcome. Bilateral nasal polyps also occur in over 70% of patients with eosinophilic granulomatosis with polyangiitis (EGPA). The study aim was to investigate neutrophil infiltrates and eosinophil aggregates in CRSwNP and EGPA tissues of Caucasian patients. Method A histopathological study was performed on surgical specimens of nasal polyps from 144 adults (15 with allergic fungal rhinosinusitis; 19 with nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD); 16 with intrinsic asthma; 21 with extrinsic asthma; 21 with allergy; 22 with eosinophil CRSwNP (ECRSwNP); 17 with non-ECRSwNP; 13 with EGPA). Results Focusing on the presence of tissue eosinophil aggregates, NERD and ECRSwNP were the sub-cohorts with the highest rate. Neutrophil infiltrate rate was significantly higher in EGPA sub-cohort than in all CRSwNP sub-cohorts apart from nonECRSwNP. Conclusions Structured histopathology is increasingly identifying the different histotypes of CRSwNP. This analysis can be used to better understand CRSwNP endotypes and develop targeted therapies. The response to therapy and therefore control of CRSwNP relapses definitely depends on our ability to act on the underlying inflammatory pattern.
Key points • Systematic analysis of how neutrophil infiltrates and eosinophilic aggregates are distributed in the different phenotypes of CRSwNP and EGPA. • Neutrophil infiltrates and eosinophil aggregates are strong risk factors for nasal polyps’ refractoriness. • NERD and ECRSwNP are the sub-cohorts of CRSwNP with the highest rate of tissue eosinophil aggregates. • Neutrophil infiltrates are significantly higher in EGPA.
Keywords Chronic rhinosinusitis with nasal polyps . Eosinophil aggregates . Eosinophilic granulomatosis with polyangiitis . Neutrophil infiltrates . Structured histopathology
Introduction * Gino Marioni [email protected] 1
Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy
2
Department of Medicine-DIMED, Padova University, Padova, Italy
3
Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy
4
Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, Padova, Italy
Chronic rhinosinusitis (CRS) is a significant multifactorial airway disease affecting 5–12% of the general population with di
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