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) . 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 . 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.
- Fokkens WJ, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. 2012 Mar; 50(1): 1–12.
- Kennedy JL, et al. Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis. Ann Allergy Asthma Immunol. 2013 Oct; 111(4): 246–51.e2.
- Lou H, et al. Cellular phenotyping of chronic rhinosinusitis with nasal polyps. 2016 Jun; 54(2): 150–9.
- Steinke JW, Borish L. Chronic rhinosinusitis phenotypes. Ann Allergy Asthma Immunol. 2016 Sep; 117(3): 234–40.
- Cao PP, et al. Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes. Ann Allergy Asthma Immunol. 2019 Jan; 122(1): 33–40.
- Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. 2004 May; 114(5):811–3.
- Matsuwaki Y, et al. Chronic rhinosinusitis: risk factors for the recurrence of chronic rhinosinusitis based on 5-year follow-up after endoscopic sinus surgery. Int Arch Allergy Immunol. 2008; 146(Suppl 1):77–81.
- Tosun F, et al. Relationship between postoperative recurrence rate and eosinophil density of nasal polyps. Ann Otol Rhinol Laryngol. 2010 Jul; 119(7): 455–9.
- Grgic MV, et al. Surgical treatment for nasal polyposis: predictors of outcome. Eur Arch Otorhinolaryngol. 2015 Dec; 272(12): 3735–43.
- DeConde AS, et al. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. 2017 Mar; 127(3): 550–5.
- Lin L, et al. Efficacy of budesonide nasal spray on neutrophilic chronic rhinosinusitis with nasal polyps: a combined clinical and experimental study. Int Arch Allergy Immunol. 2020; 181(7): 551–62.
- Lou H, et al. Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population. Am J Rhinol Allergy. 2015 Sep-Oct; 29(5): 350–6.
- Zhang L, et al. Long-term outcomes of different endoscopic sinus surgery in recurrent chronic rhinosinusitis with nasal polyps and asthma. 2020 Apr 1; 58(2): 126–35.
- Chua JC, et al. Galectin-10, a potential biomarker of eosinophilic airway inflammation. PLoS One. 2012; 7(8): e42549.
- Negrete-Garcia MC, et al. Galectin-10 is released in the nasal lavage fluid of patients with aspirin-sensitive respiratory disease. 2012; 2012: 474020.
- She W, et al. Diagnostic value of nasal cytology in chronic rhinosinusitis assessed by a liquid-based cytological technique. Am J Rhinol Allergy. 2018 May; 32(3): 181–7.
- Persson EK, et al. Protein crystallization promotes type 2 immunity and is reversible by antibody treatment. 2019 May 24; 364(6442): eaaw4295.
- Wu D, et al. 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.