Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria.

Morse JC, Li P, Ely KA, Shilts MH, Wannemuehler TJ, Huang LC, Sheng Q, Chowdhury NI, Chandra RK, Das SR, Turner JH
J Allergy Clin Immunol. 2019 143 (3): 990-1002.e6

PMID: 30468775 · PMCID: PMC6408962 · DOI:10.1016/j.jaci.2018.10.056

BACKGROUND - Potential effects of aging on chronic rhinosinusitis (CRS) pathophysiology have not been well defined but might have important ramifications given a rapidly aging US and world population.

OBJECTIVE - The goal of the current study was to determine whether advanced age is associated with specific inflammatory CRS endotypes or immune signatures.

METHODS - Levels of 17 mucus cytokines and inflammatory mediators were measured in 147 patients with CRS. Hierarchical cluster analysis was used to identify and characterize inflammatory CRS endotypes, as well as to determine whether age was associated with specific immune signatures.

RESULTS - A CRS endotype with a proinflammatory neutrophilic immune signature was enriched in older patients. In the overall cohort patients 60 years and older had increased mucus levels of IL-1β, IL-6, IL-8, and TNF-α when compared with their younger counterparts. Increases in levels of proinflammatory cytokines were associated with both tissue neutrophilia and symptomatic bacterial infection/colonization in aged patients.

CONCLUSIONS - Aged patients with CRS have a unique inflammatory signature that corresponds to a neutrophilic proinflammatory response. Neutrophil-driven inflammation in aged patients with CRS might be less likely to respond to corticosteroids and might be closely linked to chronic microbial infection or colonization.

Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

MeSH Terms (17)

Adult Aged Bacteria Bacterial Infections Chronic Disease Cluster Analysis Cytokines Female Humans Male Middle Aged Mucus Nasal Polyps Neutrophils Paranasal Sinuses Rhinitis Sinusitis

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