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Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GM ‐ CSF signatures during symptomatic exacerbations
Author(s) -
Divekar R. D.,
Samant S.,
Rank M. A.,
Hagan J.,
Lal D.,
O'Brien E. K.,
Kita H.
Publication year - 2015
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.12463
Subject(s) - exacerbation , medicine , nasal polyps , eosinophil , immunology , immune system , sinusitis , pathogenesis , gastroenterology , univariate analysis , endotype , tryptase , asthma , multivariate analysis , mast cell
Summary Background The mechanisms and immune pathways associated with chronic rhinosinusitis ( CRS ) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease. Objective To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps ( CRS w NP ) compared to controls. Methods This was a non‐interventional prospective study of individuals with CRS w NP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post‐visit 2 weeks later. The sinonasal outcome test‐22 ( SNOT ‐22) scores and immunological parameters in the specimens were analysed using a novel, unsupervised learning method and by conventional univariate analysis. Results Both CRS w NP patients and control subjects showed a significant increase in SNOT ‐22 scores during acute exacerbation. Increased nasal levels of IL ‐6, IL ‐5, and eosinophil major basic protein were observed in CRS w NP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRS w NP but not with controls. In particular, systemic increases in VEGF and GM ‐ CSF levels were notable and were validated by a conventional analysis. Conclusions CRS w NP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM ‐ CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation.