Diversity of TH cytokine profiles in patients with chronic rhinosinusitis: A multicenter study in Europe, Asia, and Oceania

Background: To date, no study has evaluated the diversity of T-H cell cytokine patterns of patients with chronic rhinosinusitis (CRS) among centers in different continents using identical methods. Objective: We sought to assess T-H cytokine profiles in patients with CRS from Europe, Asia, and Australia. Methods: Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP; n 5 435) and control subjects (n 5 138) were recruited from centers in Adelaide, Benelux, Berlin, Beijing, Chengdu, and Tochigi. Nasal mucosal concentrations of T(H)2, T(H)17, and T(H)1 cytokines; eosinophilic cationic protein (ECP); myeloperoxidase (MPO); IL-8; and tissue total and Staphylococcus aureus enterotoxin (SE)-specific IgE were measured by using identical tools. Results: Combinations of T(H)1/T(H)2/T(H)17 cytokine profiles in patients with CRSwNP varied considerably between regions. CRSwNP tissues from patients from Benelux, Berlin, Adelaide, and Tochigi were T(H)2 biased, whereas those from Beijing mainly demonstrated T(H)2/T(H)1/T(H)17 mixed patterns, and patients from Chengdu showed an even lower T(H)2 expression. Concentrations of IL-8 and tissue total IgE in patients with CRSwNP were significantly higher than those in control subjects in all regions. More than 50% of patients with CRSwNP in Benelux, Berlin, Adelaide, and Tochigi showed a predominantly eosinophilic endotype compared with less than 30% of patients in Beijing and Chengdu. SE-specific IgE was found in significantly greater numbers in patients with CRSwNP from Benelux, Adelaide, and Tochigi and significantly lower numbers in patients from Beijing and Chengdu. Moreover, the T(H)1/T(H)2/T(H)17 cytokine profiles in patients with CRSsNP showed diversity among the 6 regions. Conclusion: T-H cytokine levels, eosinophilic/neutrophilic patterns, and SE-specific IgE expressions show extreme diversity among patients with CRS from Europe, Asia, and Oceania.