Clinical Characteristics And Transcriptome Analysis Of Patients With Chronic Rhinosinusitis With Nasal Polyps And Asthma

Objective:To explore the clinical and histological characteristics of CRSwNP complicated with asthma,and to study the differences in transcriptome expression between CRSwNP+AS and CRSwNP-AS by RNA-Seq,so as to better understand the mechanisms underlying the different pathogenesis.Methods:The clinical data of 201 patients who were diagnosed with CRSwNP in Peking Union Medical College Hospital from February 2016 to February 2018 were collected and divided into CRSwNP with asthma group(CRSwNP+AS)and CRSwNP without asthma group(CRSwNP-AS).Clinical data of two groups were statistically analyzed,and the clinical characteristics of patients with CRSwNP+AS were summarized.Nasal polyp tissues were collected for histopathological analysis and transcriptome profiles by RNA-Seq.Results:A total of 201 patients including155 patients in the CRSwNP-AS group and 46 patients in the CRSwNP+AS group were included.Compared with CRSwNP-AS,the proportion of eosinophilic CRSwNP,allergic rhinitis and aspirin intolerance,ethmoid sinus CT score and total CT score,as well as peripheral blood and tissue eosinophil count and percentage were significantly higher in the CRSwNP+AS group.RNA-Seq results showed that the CRSwNP+AS group had 694 differentially expressed genes when compared with the CRSwNP-AS group,of which 491 were up-regulated and 203 were down-regulated.The up-regulated genes were mainly related to type 2 inflammation and tissue remodeling,such as CLCA1,COL6A5,IGHE,CCL7,CCL24,CCL26,IL5,IL13,etc.The KEGG pathway analysis proved that the upregulated genes in the CRSwNP+AS group were mainly related to inflammation,such as cytokine-cytokine interaction,chemokine signaling pathway,white blood cell activation and migration,platelet activation,JAK-STAT pathway and down-regulated genes are mainly related to signaling pathways such as IL-17 and TNF.Conclusion:CRSwNP+AS have more severe clinical manifestations,higher eosinophil infiltration in nasal polyp tissue,and higher expression of type 2 immune response related genes.The study of the correlation between the clinical phenotypes and immunophenotypes of CRSwNP will help to better classify CRSwNP patients,so as to promote the precision medicine of CRSwNP patients.