Sinusitis, Chronic
Conditions
Brief summary
To characterize inflammatory cells in the nose of patients with Chronic Rhinosinusitis (CRS) before and after sinus surgery.
Detailed description
Rhinosinusitis (RS) is a heterogenous disease, with variable etiologies, manifestations, and progression. Generally, RS can be divided into acute, subacute, and chronic RS, depending on the symptoms and duration of the disease. Most commonly, acute RS is caused by a viral infection (viral RS), which starts in the nasal passages and progresses to inflammation of the sinuses. When this inflammation of the paranasal sinuses does not resolve and lasts for at least 12 weeks, the disorder is broadly defined as chronic RS (CRS), which is usually accompanied by bacterial infections. This inflammatory disease pathophysiology is further subdivided into CRS with (CRSwNP) and without (CRSsNP) nasal polyps. Recently, several studies aimed at phenotyping the diverse pathophysiology among patients suffering from CRS characterized subgroups based on the presence of inflammatory clusters. CRSsNP is marked by pro-inflammatory neutrophilic inflammation of the nasal mucosa and a nasal cytokine profile that is characterized by increased levels of TGFβ1 and IFNγ and low or undetectable levels of IL-5. In contrast, patients with CRSwNP demonstrate eosinophilic inflammation of the nasal mucosa, low levels of TGFβ1, but high levels of Th2/Th17-type cytokines such as IL-17 and IL-5, higher levels of eosinophil cationic protein (ECP) and mast cell tryptase, and lower levels of IL-10. Currently biomarkers associated with physician diagnosed disease severity and patient-perceived quality of life impairments are lacking. Analysis of markers of inflammation in the nasal mucosa and peripheral blood leukocytes in combination with quality of life symptom scoring will enable us to identify biomarkers associated with CRS disease severity. This study will determine if biomarkers identified in the nasal mucosa and peripheral blood leukocytes correlate with physician diagnosed and patient-perceived disease severity.
Interventions
PROCEDURESinus surgery
Standard Clinical Sinus Surgery
Sponsors
Flight Attendant Medical Research Institute
University of North Carolina, Chapel Hill
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
No
Inclusion criteria
* Physician diagnosed CRS with surgical requirement for treatment
Exclusion criteria
* Subjects with physician-diagnosed: * cystic fibrosis, * vasculitis, * any type of nasal tumor * receiving ongoing immunosuppressant therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Inflammatory mediators in the nasal mucosa | Baseline (Pre-surgery), Post-surgery (approximately 12 weeks after surgery) | Detection and analysis of inflammatory mediators previously characterized in CRS subgroups, including but not limited to Transforming growth factor beta 1 (TGFβ1), Interferon gamma (IFNγ), Interleukin 5 (IL-5), Interleukin 17 (IL-17), eosinophil cationic protein (ECP), mast cell tryptase, and Interleukin (IL-10) from the nasal mucosa. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Inflammatory mediators in the peripheral blood | Baseline (Pre-surgery), Post-surgery (approximately 12 weeks after surgery) | Detection and analysis of inflammatory mediators previously characterized in CRS subgroups, including but not limited to TGFβ1, IFNγ, IL-5, IL-17, ECP, mast cell tryptase, and IL-10 from the peripheral blood. |
| Change in Rhinosinusitis Disability Index (RSDI) Scores | Baseline (Pre-surgery), Post-surgery (approximately 12 weeks after surgery) | The RSDI is a disease-specific health-related quality of life instrument with 3 domains (physical, functional, and emotional impacts of rhinosinusitis) using a 5-point Likert scale ranging from 0 to 4 where 0 is never and 4 is always a problem. Higher scores indicate more significant impact on quality of life. |
| Change in gene expression profile | Baseline (Pre-surgery), Post-surgery (approximately 12 weeks after surgery) | Analyze cells for gene expression of inflammatory mediators including but not limited to TGFβ1, IFNγ, IL-5, IL-17, ECP, mast cell tryptase, and IL-10 |
| Change in Nasal lavage fluid cell count | Baseline (Pre-surgery), Post-surgery (approximately 12 weeks after surgery) | Count cell types present in nasal lavage fluid cells. |
Countries
United States
Outcome results
None listed