Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy

• Published in: Journal of allergy and clinical immunology Vol. 129; no. 6; pp. 1522 - 1528.e5
• Main Authors: Wen, Weiping, PhD, Liu, Wenlong, MD, Zhang, Luo, PhD, Bai, Jing, MD, Fan, Yunping, PhD, Xia, Wentong, MD, Luo, Qing, PhD, Zheng, Jing, PhD, Wang, Hongtian, MD, Li, Zuwang, MD, Xia, Jiahong, PhD, Jiang, Hongyan, MD, Liu, Zheng, PhD, Shi, Jianbo, PhD, Li, Huabin, PhD, Xu, Geng, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Administration, Oral; Adult; Allergy and Immunology; Biological and medical sciences; Case-Control Studies; Corticoids; Cytokines; Cytokines - metabolism; Enzyme-linked immunosorbent assay; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Inflammation; Inflammation Mediators - metabolism; inflammatory response; Interleukin 4; Interleukin 5; Interleukin 8; IP-10 protein; Leukocytes (eosinophilic); Leukocytes (neutrophilic); Male; Medical sciences; Middle Aged; Nasal Polyps - drug therapy; Nasal Polyps - immunology; Nasal Polyps - pathology; Neutrophil Infiltration - immunology; Neutrophilia; Neutrophils - immunology; Nose; Otorhinolaryngology. Stomatology; Polymerase chain reaction; Polyps; Prednisone; Prednisone - therapeutic use; prognostic factor; response to therapy; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult; NP; Nasal polyp; prognostic factor; Major basic protein; Analysis of covariance; High-power field; inflammatory response; IQR; IP-10; response to therapy; MPO; Total nasal symptom score; ANCOVA; Ct; Human neutrophil elastase; Interferon-inducible protein 10; Nose; Interquartile range; Cycle threshold; Myeloperoxidase; MBP; TNSS; HNE; hpf; Corticosteroid; Immunopathology; Nose disease; Prognosis; Upper respiratory tract; Oral administration; Inflammation; Immunology; Treatment; ENT disease
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.01.079

Background Nasal polyps (NPs) are characterized by eosinophilic inflammation, which is generally considered sensitive to corticosteroid treatment. Objectives We evaluated levels of neutrophilia in NPs and investigated whether increased neutrophilia in polyp tissue affected the response to corticosteroid treatment. Methods We studied 3 independent cross-sectional groups of patients with NPs. Levels of infiltration by different types of inflammatory cells were determined by using immunohistochemical analyses and compared with those seen in control nasal tissues from subjects without NPs. Levels of inflammatory mediators were measured by using real-time PCR, ELISA, and FlowCytomix analyses. Patients with NPs received oral corticosteroid therapy (30 mg of prednisone once daily for 7 days); clinical parameters of efficacy were associated with NP phenotypes. Results Among patients with NPs, 76.5% had an eosinophilic phenotype, 46.0% had a neutrophilic phenotype, and 35.8% had a mixed phenotype (indicated by double staining). Overall, patients' symptoms improved after corticosteroid treatment; numbers of eosinophils and levels of their mediators (IL-4 and IL-5), but not numbers of neutrophils or levels of their mediators (IL-8 and interferon-inducible protein 10), were reduced ( P  < .05). After corticosteroid treatment, patients with the nonneutrophilic phenotype (neutrophil negative) had significantly greater reductions in bilateral polyp size scores, nasal congestion scores, total nasal symptom scores, and nasal resistance than patients with the neutrophilic phenotype (neutrophil positive, P  < .05). Conclusions There are different phenotypes of NPs based on the type of immune cell infiltrate and cytokines produced (eosinophilic or neutrophilic). Patients with the neutrophilic phenotype have less response to treatment with corticosteroids based on symptom scores.