1-Minute Summary: Predictive Significance of Charcot-Leyden Crystal Protein in Nasal Secretions in Recurrent Chronic Rhinosinusitis with Nasal Polyps

Expert Name
Dr D. Wu, Dr B. Yan, Dr Y. Wang , Dr L. Zhang, Dr C. Wang
Int Arch Allergy Immunology

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous, inflammatory disease with defects in the epithelial barrier [1-5]. After treatment with corticosteroids as first-line therapy and endoscopic sinus surgery (ESS) when first-line therapy fails, recurrence occurs in over 50% of patients [1,6-13].

To improve disease management, it is necessary to identify predictors of recurrence. Currently used biomarkers require tissue harvesting, which is considered an invasive procedure. Charcot-Leyden crystal (CLC) proteins are key features of CRSwNP and can be collected noninvasively by use of nasal secretions before ESS or during the postoperative follow-up [14-17]. The current study investigated the significance of CLC protein concentrations in nasal secretions in predicting recurrent CRSwNP.

In this single-centre, retrospective study, 108 patients were included with a mean age of 44.8 (range 18–69) [18]. Overall, 68/108 (63.0%) had polyp recurrence and were included in the recurrence group, whereas 40 (37.0%) were recurrence free. Patients in the recurrence group had a higher rate of comorbid asthma (P=0.002) and atopy (P=0.010), a higher E/M ratio (P=0.004), and a higher percentage of peripheral blood eosinophils (P<0.001), but no differences were found regarding sex, age, comorbid allergic rhinitis, or smoking history. Median CLC protein concentration in nasal secretions was higher in the recurrence group (74.1 ng/mL, IQR 50.2–129.4) compared with the recurrence-free group (4.1 ng/mL, IQR 0.3–28.5; P<0.001). Furthermore, CLC protein concentrations had a high predictive value for recurrence that was comparable with eosinophil percentages in polyp tissues. CLC protein concentrations positively correlated with eosinophils in both polyp tissue and peripheral blood.

To conclude, CLC protein concentrations in nasal secretions were higher in CRSwNP patients with recurrence compared with recurrence-free patients and positively correlated with the percentage of eosinophils in both polyp tissue and peripheral blood [18]. CLC protein can be collected and detected noninvasively, suggesting it to be an effective recurrence predictor.

Wu D, Yan B, Wang Y, Zhang L, Wang C. Predictive Significance of Charcot-Leyden Crystal Protein in Nasal Secretions in Recurrent Chronic Rhinosinusitis with Nasal Polyps. Int Arch Allergy Immunol. 2021;182(1):65-75. doi: 10.1159/000510120. Epub 2020 Sep 14. PMID: 32927462.

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