Abstract
BackgroundInnate and adaptive immune responses change with increasing age and affect the course of diseases. Previous study investigated immunologic alteration in Western nasal polyps (NP) which is mostly eosinophilic. However, there are no reports regarding age-related immune changes of non-eosinophilic NP (NE-NP) which is a predominant subtype in Asian population.MethodsA total of 153 subjects, including 20 with control, 63 with chronic rhinosinusitis (CRS) without NP (CRSsNP), and 70 with CRS with NP were enrolled. Age-related changes in computed tomography (CT), cytokines and clinical information were investigated. Tissue samples were analyzed for protein levels of IL-5, IL-17A, IL-23, interferon (IFN)-γ, CCL-11, and CXCL-8, using Luminex immunoassay and for mRNA expression levels of interleukin (IL)-5, IL-17A, IL-23p19, IFN-γ, CCL-11, CXCL-1, CXCL-2, CXCL-8, and CXCR2 by quantitative RT-PCR. Immunohistochemistry (IHC) was performed for the number of inflammatory cells.ResultsWe observed that Lund-Mackay CT scores decreased with age in NE-NP. The number of human neutrophil elastase-positive cells and myeloperoxidase gene expression decreased in older patients with NE-NP, but not in control subjects, CRSsNP, and E-NP. Neutrophil-associated cytokines including IL-17A and IL-23, were negatively correlated with age in NE-NP at the protein and mRNA levels. Additionally, the expression of CXCR2, a receptor for CXCL-1 and CXCL-2, was decreased with age in NE-NP. However, there were no age-related changes in blood neutrophil count, and neutrophil-recruiting chemokines such as CXCL-1, CXCL-2, and CXCL-8. Elderly NE-NP patients showed better endoscopic scores at 12 months after surgery compared with the non-elderly.ConclusionAge-related decline in neutrophil inflammation may favorably affect postoperative results in elderly patients with NE-NP.
Highlights
Recent research using both animal models and human subjects suggests that there are several important changes in the innate and adaptive immune responses with increasing age [1]
We observed that Lund-Mackay computed tomography (CT) scores decreased with age in NE-nasal polyps (NP)
The number of human neutrophil elastase-positive cells and myeloperoxidase gene expression decreased in older patients with non-eosinophilic NP (NE-NP), but not in control subjects, chronic rhinosinusitis (CRS) without NP (CRSsNP), and eosinophilic NP (E-NP)
Summary
Recent research using both animal models and human subjects suggests that there are several important changes in the innate and adaptive immune responses with increasing age [1]. There was a significant age-related decline of eosinophilic inflammation and innate immune barrier function in patients with chronic rhinisinusitis with NP (CRSwNP) Altered barrier function such as decreased S100A8/9 and increased soluble gp130 may be associated with disease extent or asthma comorbidity in eosinophilic NP (E-NP). Several studies have shown that the inflammatory response in NP removed during surgery is usually eosinophilic in the US and Europe, the incidence of E-NP is likely overestimated since the population of these study is based on tertiary referral hospital, while NP removed from patients in Asian countries (including China, Korea and Japan) and even from 2nd generation Asians in the US, have inflammation that is much more often noneosinophilic [5,6,7] These two subtypes of NP show different levels of inflammatory cell accumulation and remodeling pattern. There are no reports regarding age-related immune changes of non-eosinophilic NP (NE-NP) which is a predominant subtype in Asian population
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