Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China,
Department of Gynecology and Obstetrics, Huashan Hospital North of Fudan University, Shanghai, China.
Int Arch Allergy Immunol. 2020;181(7):551-562. doi: 10.1159/000507395. Epub 2020 May 5.
Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the efficacy of budesonide nasal spray on neutrophilic CRSwNP.
Fifteen neutrophilic CRSwNP patients were included, and then they received budesonide nasal spray treatment for 3 months. Biopsies of nasal polyps (NPs) were obtained from these subjects. Their clinical indexes were scored using Visual Analog Scale (VAS), Sino-Nasal Outcome Test (SNOT)-22, and Endoscopic Appearances (EAs). Histological analyses were used to assess numbers of neutrophils, goblet cells, and submucosal gland cells in NPs. Percentages of CD8+ T cells and CD4+CD25+Foxp3+ regulatory T cells (Tregs) were evaluated using flow cytometry. Mucin 5AC (MUC5AC), MUC5B, myeloperoxidase (MPO), interferon (IFN)-γ, and interleukin (IL)-1β and their mRNAs were also examined. After that, we cultured NP tissues in vitro and evaluated the abovementioned inflammatory parameters before and after the administration of budesonide.
Budesonide nasal spray did not improve clinical evaluations including VAS, SNOT-22, and EA scores. Numbers of neutrophils and goblet cells, the score of submucosal gland cells, percentages of CD8+ T cells and Tregs, MUC5AC, MUC5B, MPO, IFN-γ, and IL-1β and their mRNAs were not decreased in NPs after the budesonide treatment. Furthermore, the administration of budesonide into NP cultures also did not reduce their levels in comparison with those before the treatment.
These findings demonstrate that budesonide treatment may not alleviate the inflammatory condition in neutrophilic CRSwNP.
伴有鼻息肉的中性粒细胞性慢性鼻-鼻窦炎（CRSwNP）主要发生在亚洲人群中。对于这种表型，尚未阐明适当的治疗方法。本研究旨在评估布地奈德鼻喷雾剂对中性粒细胞性 CRSwNP 的疗效。
纳入 15 例中性粒细胞性 CRSwNP 患者，接受布地奈德鼻喷雾剂治疗 3 个月。从这些患者中获取鼻息肉（NP）活检标本。使用视觉模拟量表（VAS）、鼻-鼻窦炎生活质量量表 22 项（SNOT-22）和内镜表现（EAs）对他们的临床指标进行评分。使用组织学分析评估 NP 中中性粒细胞、杯状细胞和黏膜下腺细胞的数量。使用流式细胞术评估 CD8+T 细胞和 CD4+CD25+Foxp3+调节性 T 细胞（Tregs）的百分比。还检测了黏蛋白 5AC（MUC5AC）、黏蛋白 5B、髓过氧化物酶（MPO）、干扰素（IFN）-γ和白细胞介素（IL）-1β及其 mRNA。然后，我们在体外培养 NP 组织，并在给予布地奈德前后评估上述炎症参数。
布地奈德鼻喷雾剂治疗并未改善 VAS、SNOT-22 和 EA 评分等临床评估。NP 中中性粒细胞和杯状细胞的数量、黏膜下腺细胞的评分、CD8+T 细胞和 Tregs 的百分比、MUC5AC、MUC5B、MPO、IFN-γ和 IL-1β及其 mRNA 水平在布地奈德治疗后并未降低。此外，与治疗前相比，NP 培养物中给予布地奈德也未降低其水平。
这些发现表明，布地奈德治疗可能无法缓解中性粒细胞性 CRSwNP 的炎症状态。
