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Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis

PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system...

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Autores principales: Kim, Dong-Kyu, Kang, Seong Il, Kong, Il Gyu, Cho, Young Hoon, Song, Seul Ki, Hyun, Se Jin, Cho, Sung Dong, Han, Sang-Yoon, Cho, Seong-Ho, Kim, Dae Woo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082823/
https://www.ncbi.nlm.nih.gov/pubmed/30088369
http://dx.doi.org/10.4168/aair.2018.10.5.490
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author Kim, Dong-Kyu
Kang, Seong Il
Kong, Il Gyu
Cho, Young Hoon
Song, Seul Ki
Hyun, Se Jin
Cho, Sung Dong
Han, Sang-Yoon
Cho, Seong-Ho
Kim, Dae Woo
author_facet Kim, Dong-Kyu
Kang, Seong Il
Kong, Il Gyu
Cho, Young Hoon
Song, Seul Ki
Hyun, Se Jin
Cho, Sung Dong
Han, Sang-Yoon
Cho, Seong-Ho
Kim, Dae Woo
author_sort Kim, Dong-Kyu
collection PubMed
description PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option.
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spelling pubmed-60828232018-09-01 Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis Kim, Dong-Kyu Kang, Seong Il Kong, Il Gyu Cho, Young Hoon Song, Seul Ki Hyun, Se Jin Cho, Sung Dong Han, Sang-Yoon Cho, Seong-Ho Kim, Dae Woo Allergy Asthma Immunol Res Original Article PURPOSE: The previously reported Japanese clinical scoring study (JESREC) suggests that chronic rhinosinusitis (CRS) can be divided into 4 subtypes according to the degree of eosinophilic CRS (ECRS) and offers the information regarding the prognosis of CRS to clinicians. However, this scoring system has not yet been validated by an immunological study and needs to provide treatment guidelines based on underlying immunologic profiles. We investigated the immunologic profile of each CRS subgroup according to the JESREC classification and suggest its clinical application. METHODS: A total of 140 CRS patients and 20 control subjects were enrolled. All patients were classified into 4 groups according to the JESREC (non-, mild, moderate and severe ECRS). Nasal tissues were analyzed for mRNA expression of major cytokines (IL-5, IL-10, IL-13, IL-17A, IL-22, IL-23p19, IFN-γ, periostin, thymic stromal lymphopoietin [TSLP] and ST2), major chemokines (CCL11, CCL24, CXCL1 and CXCL2), transcription factors (T-bet, GATA3, RORC and FOXP3) and COL1A1 for type I collagen. Protein levels of 3 major cytokines (IL-5, IL-17A and IFN-γ) were also measured by multiplex immunoassay. Principal component analysis (PCA) was conducted to investigate the overall profile of multiple mediators. RESULTS: The moderate/severe ECRS showed up-regulation of type 2-related mediators (IL-5, IL-13, periostin, TSLP and ST-2), whereas INF-γ (type 1 cytokine) and CXCL1 (neutrophil chemokine) expressions were increased in non-/mild ECRS compared with moderate/severe ECRS. The JESREC classification reflected an immunological endotype. In PCA data, PCA1 indicates a relative type 2 profile, whereas PCA2 represents a type 1/type 17-related profile. In this analysis, mild ECRS was indistinguishable from non-ECRS, whereas moderate to severe ECRS showed a distinct distribution compared with non-ECRS. The JESREC classification could be divided into 2 categories, non-/mild vs. moderate/severe ECRS based on underlying immunological analyses. CONCLUSIONS: The CRS clinical scoring system from the JESREC study reflects an inflammatory endotype. However, the immunologic profile of mild ECRS was similar to that of non-ECRS. Therefore, we propose type 2-targeted medical treatment for moderate to severe ECRS and type 1/type 17-targeted for non-ECRS and mild ECRS as the first treatment option. The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease 2018-09 2018-06-15 /pmc/articles/PMC6082823/ /pubmed/30088369 http://dx.doi.org/10.4168/aair.2018.10.5.490 Text en Copyright © 2018 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Dong-Kyu
Kang, Seong Il
Kong, Il Gyu
Cho, Young Hoon
Song, Seul Ki
Hyun, Se Jin
Cho, Sung Dong
Han, Sang-Yoon
Cho, Seong-Ho
Kim, Dae Woo
Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title_full Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title_fullStr Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title_full_unstemmed Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title_short Two-Track Medical Treatment Strategy According to the Clinical Scoring System for Chronic Rhinosinusitis
title_sort two-track medical treatment strategy according to the clinical scoring system for chronic rhinosinusitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082823/
https://www.ncbi.nlm.nih.gov/pubmed/30088369
http://dx.doi.org/10.4168/aair.2018.10.5.490
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