Predictive and Diagnostic Value of Nasal Nitric Oxide in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

2020 ◽  
Vol 181 (11) ◽  
pp. 853-861
Author(s):  
Hao Lv ◽  
Pei-Qiang Liu ◽  
Rong Xiang ◽  
Wei Zhang ◽  
Shi-Ming Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Upper Airway ◽  
Central China ◽  
Clinical Parameters ◽  
Total Ige ◽  
Nasal Nitric Oxide ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Plasma Cytokines

<b><i>Background:</i></b> A hallmark of eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is mucosal eosinophil-predominant inflammation. Nasal nitric oxide (nNO) is a known biomarker of eosinophilic inflammation in the upper airway. However, the utility of nNO measurement in the upper airway remains controversial. The present study aimed to compare the use of other clinical parameters with nNO to prediagnose patients with eCRSwNP from Central China. <b><i>Methods:</i></b> From June 2019 to December 2019, 70 patients with CRSwNP undergoing endoscopic sinus surgery and 30 healthy subjects were enrolled. nNO measurements were performed in all of these subjects. Computed tomography scans, full blood count with differential analysis, and determination of total immunoglobulin E (total IgE) and plasma cytokines were performed before surgery. Receiver operating characteristic curves and logistic regression analysis were used to assess the predictive potential of the clinical parameters. <b><i>Results:</i></b> We recruited 24 patients with eCRSwNP and 46 with noneosinophilic CRSwNP (non-eCRSwNP). In patients with eCRSwNP, nNO levels were significantly higher than those in patients with non-eCRSwNP (<i>p</i> &#x3c; 0.0001). Blood eosinophil percentages and counts, total IgE, and CT-derived ethmoid sinus and maxillary sinus ratio (E/M ratio) were all significantly higher compared with those in patients with non-eCRSwNP (<i>p</i> &#x3c; 0.05). To diagnose eCRSwNP, the highest area under the curve (0.803) was determined for nNO. At a cutoff of &#x3e;329 parts per billion (ppb), the sensitivity was 83.30% and the specificity was 71.70%. However, the levels of plasma cytokines Th1/Th2 were not significantly different between the histological types of CRSwNP (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Measurement of nNO is useful for the early diagnosis of eCRSwNP.

scholarly journals Reduced nasal nitric oxide levels in patients with eosinophilic chronic rhinosinusitis

2019 ◽  
Vol 68 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Kanako Yoshida ◽  
Tetsuji Takabayashi ◽  
Yoshimasa Imoto ◽  
Masafumi Sakashita ◽  
Norihiko Narita ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Nasal Nitric Oxide ◽  
Eosinophilic Chronic Rhinosinusitis

scholarly journals Nasal Nitric Oxide in Chronic Rhinosinusitis with or without Nasal Polyps: A Systematic Review with Meta-Analysis

2020 ◽  
Vol 9 (1) ◽  
pp. 200 ◽  
Author(s):  
Pasquale Ambrosino ◽  
Antonio Molino ◽  
Giorgio Alfredo Spedicato ◽  
Paolo Parrella ◽  
Roberto Formisano ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Regression Models ◽  
Nasal Polyps ◽  
Meta Analysis ◽  
Final Analysis ◽  
Healthy Controls ◽  
Intranasal Corticosteroids ◽  
Nasal Nitric Oxide ◽  
And Control

Background and Aims: There has been a recent growing interest in the role of nasal nitric oxide (nNO) as a biomarker for osteomeatal complex obstruction in paranasal sinus diseases. By using meta-analysis, we systematically reviewed the literature to establish the possible link between nNO concentration and chronic rhinosinusitis with nasal polyps (CRSwNP) or without (CRSsNP). Methods: We systematically searched the EMBASE, PubMed, Scopus, and Web of Science databases for related studies. Differences between controls and cases were reported as standardized mean difference (SMD), with 95% confidence intervals (95% CI), using the random-effects method. Results: We selected 23 articles for the final analysis: 15 with data on 461 CRSwNP patients and 384 healthy controls, 10 with data on 183 CRSsNP patients and 260 controls, and 14 studies on 372 CRSwNP and 297 CRSsNP patients. CRSwNP patients showed significantly lower nNO values when compared to both healthy controls (SMD: −1.495; 95% CI: −2.135, −0.854; p < 0.0001) and CRSsNP patients (SMD: −1.448; 95% CI: −2.046, −0.850; p < 0.0001). Sensitivity and subgroup analyses confirmed the results, which were further refined by regression models. They showed that an increasing aspiration flow is related to a greater difference in nNO levels between cases and control subjects. We also documented lower nNO levels in CRSsNP patients with respect to controls (SMD: −0.696; 95% CI: −1.189, −0.202; p = 0.006), being this result no longer significant when excluding patients in therapy with intranasal corticosteroids. As shown by regression models, the increased Lund–Mackay score indicates a high effect size. Conclusions: nNO levels are significantly lower in CRSwNP, especially when using higher aspiration flows. Additional studies are needed to define one single standardized method and normal reference values for nNO.

scholarly journals Exhaled and nasal nitric oxide in chronic rhinosinusitis patients with nasal polyps in primary care

2018 ◽  
Vol 56 (1) ◽  
pp. 59-64 ◽  
Author(s):  
M. Frendo ◽  
K. Hakansson ◽  
S. Schwer ◽  
A.T. Ravn ◽  
H. Meteran ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Primary Care ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Nasal Nitric Oxide

scholarly journals Arginase Isoform Expression in Chronic Rhinosinusitis

2019 ◽  
Vol 8 (11) ◽  
pp. 1809 ◽  
Author(s):  
Diana Vlad ◽  
Silviu Albu
Keyword(s):  
Nitric Oxide ◽  
Chronic Rhinosinusitis ◽  
Defense Mechanisms ◽  
Upper Airway ◽  
Control Group ◽  
Mrna Levels ◽  
Tissue Samples ◽  
Endoscopic View ◽  
Important Regulator ◽  
Arginase I

Nitric oxide (NO) has emerged as an important regulator of upper airway inflammation, mainly as part of the local naso-sinusal defense mechanisms. Increased arginase activity can reduce NO levels by decreasing the availability of its precursor, L-arginine. Chronic rhinosinusitis (CRS) has been associated with low levels of nasal nitric oxide (nNO). Thus, the present study investigates the activity of arginase I (ARG1) and II (ARG2) in CRS and its possible involvement in the pathogenesis of this disease. Under endoscopic view, tissue samples of pathologic (n = 36) and normal (n = 29) rhinosinusal mucosa were collected. Arginase I and II mRNA levels were measured using real-time PCR. Our results showed low arginase I activity in all samples. The levels of ARG2 were significantly higher in patients with chronic rhinosinusitis compared to the control group (fold regulation (FR) 2.22 ± 0.42 vs. 1.31 ± 0.21, p = 0.016). Increased ARG2 expression was found in patients with CRS without nasal polyposis (FR 3.14 ± 1.16 vs. 1.31 ± 0.21, p = 0.0175), in non-allergic CRS (FR 2.55 ± 0.52 vs. 1.31 ± 0.21, p = 0.005), and non-asthmatic CRS (FR 2.42 ± 0.57 vs. 1.31 ± 0.21, p = 0.028). These findings suggest that the upregulation of ARG2 may play a role in the pathology of a distinctive phenotype of CRS.

scholarly journals A Global Analysis of Tandem 3′UTRs in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps

PLoS ONE ◽  
2012 ◽  
Vol 7 (11) ◽  
pp. e48997 ◽  
Author(s):  
Peng Tian ◽  
Yu Sun ◽  
Yuxin Li ◽  
Xiang Liu ◽  
Liang Wan ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Global Analysis ◽  
Eosinophilic Chronic Rhinosinusitis

scholarly journals Relationships between IL-17A and Macrophages or MUC5AC in Eosinophilic Chronic Rhinosinusitis and Proposed Pathological Significance

2012 ◽  
Vol 3 (2) ◽  
pp. ar.2012.3.0030 ◽  
Author(s):  
Noritsugu Ono ◽  
Takeshi Kusunoki ◽  
Katsuhisa Ikeda
Keyword(s):  
Airway Inflammation ◽  
Chronic Rhinosinusitis ◽  
Neutrophil Elastase ◽  
Nasal Polyps ◽  
Mucus Hypersecretion ◽  
Promotive Factors ◽  
Chemotactic Protein ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Semithin Sections ◽  
The Mean

Recently, some researchers have reported that macrophages and neutrophils were related to severe asthma. Mucus hypersecretion and persistent airway inflammation result from increased expression of mucin gene (MUC5AC). Eosinophilic chronic rhinosinusitis (ECRS) is considered as intractable rhinosinusitis. From the viewpoint of “one way one disease,” we examined whether ECRS is associated with infiltrating macrophages, neutrophils, their promotive factors, and MUC5AC. We examined 21 nasal polyps with CRS. Each specimen was fixed in 10% phosphate-buffered formalin, embedded in paraffin, processed routinely, and then prepared as semithin sections (3.5 μm). We immunohistochemically observed the macrophages by using CD68, neutrophils by using neutrophil elastase and the promotive factors, monocyte chemotactic protein (MCP) 1, IL-17A, and IL-8, in both ECRS and non-ECRS. The number of macrophages (CD68+ cells), IL-17A, and MUC5AC+ cells in ECRS were significantly greater than in non-ECRS. The mean number of MCP-1+ cells in ECRS was greater than that in non-ECRS, but not significantly. There was a significant correlation in all cases between IL-17A and macrophages or MUC5AC+ cells. Neither the numbers of neutrophils (positive cells for neutrophil elastase) nor the IL-8+ cells showed any significant differences between ECRS and non-ECRS. Our study suggested that infiltrating macrophages, IL-17A and MUC5AC, as well as eosinophils could have roles in the development of ECRS.

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