Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is generally associated with severe type 2 immune reactions in the white population. However, recent findings suggest an additional role for neutrophils in severe type 2 inflammation.

Objective

This study aimed to characterize the neutrophilic inflammation in CRSwNP and its relation to eosinophilic inflammation in severe type 2 immune reactions.

Methods

The presence and activation of neutrophils and eosinophils was analyzed in CRS without NP and CRSwNP by measuring cell and activation markers via immunohistochemistry, immunofluorescence, Luminex assay, ELISA, UniCAP, fluorescence-activated cell sorting, and PCR. Differential neutrophil migration was assessed via Boyden-chamber assay and neutrophil survival was analyzed via flow cytometry.

Results

Both CRS without NP and CRSwNP displayed variable degrees of eosinophilic and neutrophilic inflammation, with a profound neutrophilic infiltration and activation in type 2 CRSwNP, associated with eosinophil extracellular traps cell death and Charcot-Leyden crystals, but independent of IL-17. Neutrophil extracellular traps cell death in CRSwNP was associated with bacterial colonization, however, neutrophils were less prone to undergo neutrophil extracellular traps cell death in the tissue of patients with severe type 2 CRSwNP. Neutrophils did not show increased migration nor survival in the CRSwNP environment in vitro.

Conclusions

This study demonstrated a severe neutrophilic inflammation associated with severe eosinophilic type 2 inflammatory CRSwNP, the role of which needs further study.

中文翻译：

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严重的嗜中性粒细胞炎症，是伴有鼻息肉的严重2型慢性鼻-鼻窦炎的常规部分。

背景

患有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）通常与白人人群中的严重2型免疫反应有关。但是，最近的发现提示嗜中性粒细胞在严重的2型炎症中具有额外的作用。

目的

这项研究旨在表征严重2型免疫反应中CRSwNP中的嗜中性炎症及其与嗜酸性炎症的关系。

方法

在无NP和CRSwNP的CRS中，通过免疫组织化学，免疫荧光，Luminex分析，ELISA，UniCAP，荧光激活的细胞分选和PCR测量细胞和激活标记，分析了嗜中性粒细胞和嗜酸性粒细胞的存在和激活。通过博登室试验评估中性粒细胞的差异迁移，并通过流式细胞仪分析中性粒细胞的存活。

结果

没有NP和CRSwNP的CRS都显示出不同程度的嗜酸性和嗜中性粒细胞炎症，在2型CRSwNP中具有深层的嗜中性浸润和激活，与嗜酸性粒细胞外陷阱细胞死亡和夏科特莱登晶体有关，但独立于IL-17。CRSwNP中的中性粒细胞胞外陷阱细胞死亡与细菌定植有关，但是，重度2型CRSwNP患者组织中的中性粒细胞不易发生中性粒细胞胞外陷阱细胞死亡。在CRSwNP环境中嗜中性粒细胞没有表现出增加的迁移或存活。

结论

这项研究表明，严重的嗜中性粒细胞炎症与严重的嗜酸性2型炎性CRSwNP有关，其作用有待进一步研究。