Inflammatory Profile of CRSwNP Patients in Brazil: Multicenter Study

Monday, October 2, 2023

8:42 AM - 8:48 AM East Coast USA Time

Location: 103BC

Presenting Author(s)

Fabrizio R. Romano, MD, PhD

Prof
USP-RP
São Paulo, Sao Paulo, Brazil

Co-Author(s)

ET

Edwin Tamashiro, MD, PhD

Associate Professor
University of Sao Paulo - Ribeirao Preto Medical School
Ribeirao Preto, Sao Paulo, Brazil
FV

Fabiana C. P Valera, MD

Prof
USP-RP
Ribeirão Preto, Sao Paulo, Brazil

Senior Author(s)

Wilma A. Anselmo-Lima, MD, PhD

Full Professor
Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
Ribeirao Preto, Sao Paulo, Brazil

Disclosure(s):

Fabrizio R. Romano, MD, PhD: No relevant relationships to disclose.

Edwin Tamashiro, MD, PhD: No relevant relationships to disclose.

Introduction: Chronic rhinosinusitis (CRS) is a prevalent, multifactorial disease with distinct endotypical features. Different populations present different inflammatory patterns, due to environmental and ethnical influences. This is the first study to assess the predominant inflamattory pattern in CRSwNP patients of different regions of Brazil.

Methods: A multicenter prospective cross-sectional study identified concentration of the following: EGF, eotaxin, G-CSF, GM-CSF, IFNα2, IFNγ, IL-10, IL-12P40, IL-12P70, IL-13, IL-15, IL-17A, IL-1RA, IL-1α, IL-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IP-10, IL-25, MCP-1, MIP-1α, MIP-1β, RANTES, TNFα, TNFβ, VEGF,FGF-2, TGF-α, FIT-3L, Fractalkine, GRO, MCP-3, MDC, PDGF-AA, PDGF-AB/BB, sCD40L and IL-9 in 166 patients with CRSwNP and 80 controls, along with clinical history, Eosinophil tissue count, SNOT-22 and Lund-Mackay scores.

Results: Mean age 48,9 y with 54,1% female. 46,3% had asthma and 19,6% were aspirin-intolerant. Mean SNOT-22 was 53 for patients and 16 for controls, and Lund-Mackay score 9 and 0, respectively. 75,5 % of the patients had predomint eosinophilic inflammation. The following cytokines and chemokines were elevated (P < 0,05): TNF-alpha, IL-6, IL-33, IL-10, , TLSP, IL-5, CCL11/Eotaxin. CCL24/Eotaxin-2/MPIF-2, IL-17/IL-17A and CCL26/Eotaxin-3. There were 2 distinct clusters of patients based on the inflammatory profile, and a 3rd cluster of outliers. Cluster 1 had high inflammation, especially T2 interleukines, whereas cluster 2 had low inflammation and a more mixed (T1/T2/T17) profile. We found no difference between this 2 clusters regarding to severity of symptons or surgery recurrence, but cluster 1 had a higher incidence of asthma and aspirin-intolerance. There was no difference between the clusters regarding race or country region.

Conclusions: CRSwNP patients in Brazil are mostly eosinophilic, and can be divided based on the endotypes in 3 clusters (high T2 inflammation, low mixed-type inflammation and outliers). Identification of individual patients into one of these groups can lead to better management of the disease in these patients.