EOSINOPHILIC INFALMMATION
ACROSS INFLAMMATORY DISEASESCHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)
CHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)
WHAT IS CHRONIC RHINOSINUSITIS WITH NASAL POLYPS (CRSwNP)?
Chronic rhinosinusitis (CRS) is characterized by persistent, symptomatic
inflammation of the mucosa of the nose and paranasal sinuses.1
Nasal polyps (NP) are benign inflammatory masses arising from the
mucosa of the nose and paranasal sinuses.2
The estimated prevalence of CRSwNP is 1%-4%3,4
Approximately
1 in 20
people have CRS
(2007 US Survey)5
Up to 30%
of patients
with CRS have CRSwNP in the US6
~60 to 90%
of CRSwNP
patients have eosinophil-dominant infiltration
(Using the definition of >=5-10 eosinophils / field magnification X400)7-9
THE ROLE OF EOSINOPHILIC INFALMMATION IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS
Eosinophilic inflammation can potentially contributes to key pathological
mechanisms in chronic rhinosinusitis with nasal polyps.1,10-13
These eosinophil-derived substances result in the above effects in diseases, including nasal polyps. The above table summarizes the proposed effects in nasal polyps.10
ECP=eosinophil cationic protein; EDN=eosinophil-derived neurotoxin; EPX=eosinophil peroxidase; GM-CSF=granulocyte-macrophage colony-stimulating factor; MBP=major basic protein; MMP=matrix metalloproteinase; RANTES=regulated on activation, normal T cells expressed and secreted; TGF=transforming growth factor.
THE CLINICAL CONSEQUENCES OF CHRONIC
RHINOSINUSITIS WITH NASAL POLYPS
In patients with CRSwNP, elevated levels of eosinophils may accumulate in the upper respiratory tract and correlate with disease severity and progression.14 Patients with CRSwNP experience adverse effects on quality of life, including reduction in sense of smell, nasal obstruction and discharge, and sleep disturbance.15
Surgery to remove polyps may be required in patients whose symptoms are not controlled with
corticosteroids. However, rates of relapse and repeated intervention can be high.6,15
ASTRAZENECA IS COMMITTED TO UNCOVERING THE ROLE OF EOSINOPHILIC INFALMMATION IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS.
References: 1. Bachert C. Akdis CA. Phenotypes and emerging endotypes of chronic rhinosinusitis. J Allergy Clin Immunol Pract. 2016;4(4):621-628. 2. Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507-512. 3. Zhang Y, Gevaert E, Lou H, et al. Chronic rhinosinusitis in Asia. J Allergy Clin Immunol. 2017;140(5):1230-1239. 4. Beule A. Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden. GMS Curr Top Otorhinolaryngol Head Neck Sug. 2015;14:Doc11. 5. Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Ann Otol Rhinol Laryngol. 2011;120(7):423-427. 6. Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4(4):565-572. 7. Fujieda S, Imoto Y, Kato Y, et al. Eosinophilic chronic rhinosinusitis. Allergol Int. 2019;68(4)403-412. 8. Benjamin MR, Stevens WW, Li N, et al. Clinical characteristics of patients with chronic rhinosinusitis without nasal polyps in an academic setting. J Allergy Clin Immunol Pract. 2019;7(3):1010-1016. 9. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004;131(6 Suppl):S1-S62. 10. Kita H, Bochner BS. Biology of eosinophils. In: Middleton’s Allergy: Principles and Practice. 8th ed. 2014.1. 11. Schleimer RP. Immunopathogenesis of chronic rhinosinusitis and nasal polyposis. Annu Rev Pathol. 2017;12:331-357. 12. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:3-298. 13. Boita M, Garzaro M, Raimondo L, et al. Eosinophilic inflammation of chronic rhinosinusitis with nasal polyps is relation to OX40 ligand expression. Innate Immun. 2015;21(2):167-174. 14. Jacobsen EA, Jackson DJ, Heffler E, et al. Eosinophil knockout humans: uncovering the role of eosinophils through eosinophil-directed biological therapies. Ann Rev Immunol. 2021;39:719-757. 15. Hopkins C. Chronic rhinosinusitis with nasal polyps. N Engl J Med. 2019;381(1):55-63.