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OBJECTIVE: The objectives of this study were to characterize the endotypes of different chronic rhinosinusitis without nasal polyps (CRSsNP) samples, to investigate the effects of certain anti-inflammatory drugs on these endotypes, and to investigate the effect of the same drugs on recently identified CRSsNP marker proteins. PATIENTS AND METHODS: Initially, ethmoid tissues (ETs) from CRSsNP patients (n=12) were dissected into sections and incubated with the addition of mometasone, verapamil, cenicriviroc, and dupilumab. Cell culture media were collected after 24 hours, and the contents of the secreted proteins interferon-gamma (IFN-γ), interleukin (IL)-5, IL-17A, macrophage inflammatory protein-1 beta (MIP-1β), resistin and platelet (P)-selectin were measured using enzyme-linked immunosorbent assay (ELISA). The endotypes were characterized using the unstimulated samples. The fold changes of protein secretion caused by the analyzed substances were calculated. For each protein, the samples of the distinct endotypes were compared with the remaining samples. RESULTS: Both single and mixed endotypes were identified within the CRSsNP samples, whereas none of the typical endotype-defining cytokines were elevated in a significant portion of the samples. All of the incubated medicaments greatly reduced the tissue secretions of IFN-γ and IL-5 in type 1 CRS while causing a lower secretion of IL-17A in all endotypes compared to the remaining samples. Among the analyzed CRSsNP marker proteins, the distinct endotypes revealed different reactions to the drugs. Dupilumab induced more effects among the examined cytokines than the marker proteins but did not stand out from the other substances overall. CONCLUSIONS: Medications used to treat CRS may have different effects on distinct CRS endotypes. [ABSTRACT FROM AUTHOR]

Background: The fibrinolysis pathway has been previously implicated in the etiopathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). Objective: The purpose of this study was (1) to explore protein derangements of selected protease inhibitors of the serpin superfamily in CRSwNP and (2) to correlate the protease inhibitor derangements of the fibrinolysis pathway in tissue with exosomal samples to evaluate the potential of an exosomal noninvasive "liquid biopsy" for CRSwNP. Methods: Institutional review board approved study in which matched tissue and mucus exosomal proteins (SerpinB2, SerpinF2, SerpinG1, and SerpinE1) were compared between control and CRSwNP patients using Western Blot analysis (n = 6/group) and immunohistochemistry (IHC). Transcriptome analysis (n = 10/group) on the same proteins was performed using whole transcriptome sequencing. Semiquantitative analysis of the Western Blots was performed using the Whitney–Mann U test. Results: The transcriptomic data set showed multiple differentially expressed genes including SerpinB2 (fold changes [FC] 7.38), SerpinE1 (FC 1.42), SerpinF2 (FC 2.03), and SerpinG1 (FC 0.72). Western Blot and IHC analysis showed an overexpression of the Serpin protease inhibitors in tissue (SerpinB2, P <.01; SerpinE1, P <.01; SerpinF2, P <.01; and SerpinG1, P <.01) indicating a downregulation of the fibrinolysis cascade. The mucus exosomal serpin proteins exhibited similar findings. Conclusion: Our analysis supported that protease inhibitors of the fibrinolysis pathway, especially SerpinB2, SerpinF2, and SerpinG1, are highly deranged in patients with CRSwNP. These findings suggest a downregulation of the fibrinolysis pathway via proteolytic cascade imbalance leading to excessive polyp fibrin deposition. Our data further supported our hypothesis that exosomal proteomic analyses may be used as noninvasive "liquid biopsy" for CRSwNP and a novel method to study chronic sinonasal inflammation. [ABSTRACT FROM AUTHOR]

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by type 2 helper T-cell-skewed immune profiles, but the state of the neutrophil activation signaling pathway in CRSwNP is unknown. The purpose of this study was to examine neutrophil activation pathways in the pathogenesis of CRSwNP. Methods Institutional review board approved the study in which tissue proteomes were compared between control (inferior turbinate) and CRSwNP (nasal polyps) (n = 10/group) using an aptamer-based proteomic array and confirmed by whole transcriptomic analysis. Protein expression was analyzed using Student’s t test and Benjamini–Hochberg procedures followed by the application of Ingenuity Pathway, MetaCore, and Genemania bioinformatics analyses. Results All the patients with CRSwNP (n = 10) had eosinophilic nasal polyps. Compared with controls, proteins associated with the triggering receptor expressed on myeloid cells 1 (TREM-1) neutrophil activation signaling pathway such as Calcineurin B, zeta chain-associated protein kinase of 70 kD (ZAP70), 14-3-3 protein theta, 14-3-3 protein zeta/delta, protein kinase C delta type (PKC-D), Interleukin (IL)-17B, IL-17B receptor, IL-23, and IL-1B were significantly decreased in CRSwNP (fold change [FC] = −1.60, P = .003; FC = −1.85, P = .040; FC = −1.26, P < .001; FC = −1.05, P = .008; and FC = −1.31, P = .004; FC = −1.22, P < .001; FC = −1.09, P = .022; FC = −1.25, P < .001; and FC = −1.31, P = .014; respectively). In contrast, tissue eosinophil count (P < .001) and eosinophil-associated proteins such as C-C motif chemokine 17, periostin, and galectin 10 were all significantly increased in CRSwNP (FC = 1.56, P = .009; FC = 3.95, P < .001; and FC = 2.44, P < .001; respectively). Furthermore, the FC of the studied proteins’ expression significantly and positively correlated with FC of their mRNA expression (P = .001, r = .75). Conclusions TREM-1-associated neutrophilic signaling pathway proteins are significantly suppressed in eosinophilic CRSwNP. [ABSTRACT FROM AUTHOR]

Background Dysfunctional innervation might contribute to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but the state of the axonal outgrowth signaling in CRSwNP is unknown. The purpose of this study was to explore the axonal outgrowth pathway-related protein expression in CRSwNP. Methods Institutional review board approved study in which tissue proteomes were compared between control and CRSwNP patients (n = 10/group) using an aptamer-based proteomic array and confirmed by whole transcriptomic analysis. Results Compared with controls, proteins associated with axonal guidance signaling pathway such as beta-nerve growth factor, semaphorin 3A, Ras-related C3 botulinum toxin substrate 1, Bcl-2, protein kinase C delta type, and Fyn were significantly decreased in patients with CRSwNP (fold change [FC] = −1.17, P = .002; FC = −1.09, P < .001; FC = −1.33, P < .001; FC = −1.31, P < .001; FC = −1.31, P = .004; and FC = −1.20, P = 0.012, respectively). In contrast, reticulon-4 receptor, an inhibitory factor, was significantly increased in patients with CRSwNP (FC = 1.25, P < .001). Furthermore, neuronal growth-associated proteins such as ciliary neurotrophic factor receptor subunit alpha, neuronal growth regulator 1, neuronal cell adhesion molecule, neural cell adhesion molecule L1, platelet-derived growth factor subunit A, and netrin-4 were all significantly decreased in patients with CRSwNP (FC = −1.25, P < .001; FC = −1.27, P = .002; FC = −1.65, P = .013; FC = −4.20, P < .001; FC = −1.28, P < .001; and FC = −2.31, P < .001, respectively). In contrast, tissue eosinophil count (P < .001) and allergic inflammation factors such as IgE, periostin, and galectin-10 were all significantly increased in patients with CRSwNP (FC = 12.28, P < .001; FC = 3.95, P < .001; and FC = 2.44, P < .001, respectively). Furthermore, the log FC of the studied proteins expression significantly and positively correlated with log FC of their mRNA expression (P < .001, r = .88). Conclusions Axonal guidance signaling and neural growth factors pathways proteins are significantly suppressed in eosinophilic CRSwNP. [ABSTRACT FROM AUTHOR]