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Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA

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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 non-ECRSwNP.

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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

The authors thank Alison Garside for correcting the English version of this paper.

Funding

This study was partly supported by grant no. DOR2090593/20 (G. Marioni) from the University of Padova, Italy.

Author information

Authors and Affiliations

  1. Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy

    Giacomo Contro, Giuseppe Brescia, Umberto Barion & Gino Marioni

  2. Department of Medicine-DIMED, Padova University, Padova, Italy

    Lara Alessandrini

  3. Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy

    Roberto Padoan & Franco Schiavon

  4. Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, Padova, Italy

    Anna Chiara Frigo

Authors
  1. Giacomo Contro
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  2. Giuseppe Brescia
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  3. Lara Alessandrini
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  4. Umberto Barion
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  5. Roberto Padoan
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  6. Anna Chiara Frigo
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  7. Franco Schiavon
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  8. Gino Marioni
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Contributions

GC: conceptualization, investigation, writing – review and editing; GB: conceptualization, investigation, writing – review and editing, supervision ENT topics; LA: investigation, writing – review and editing, supervision pathological topics; UB: review and editing, supervision ENT topics; RP: review and editing, supervision rheumatologic topics; ACF: statistical analysis, writing – review and editing; FS: review and editing, supervision rheumatologic topics; GM: conceptualization, investigation, writing – review and editing, supervision ENT topics, funding acquisition.

Corresponding author

Correspondence to Gino Marioni.

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Ethics approval

The study was conducted in accordance with the principles of the Helsinki Declaration. Data were examined in agreement with the Italian privacy and sensitive data laws and internal rules of Padova University’s Otolaryngology section.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Contro, G., Brescia, G., Alessandrini, L. et al. Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA. Clin Rheumatol 40, 1949–1957 (2021). https://doi.org/10.1007/s10067-020-05474-w

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  • DOI: https://doi.org/10.1007/s10067-020-05474-w

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