Nasal microbiota shows promise as a predictor of polyps

A study of the nasal microbiome has helped researchers predict recurrent polyps in chronic disease. rhinosinusitis patients with over 90% accuracy, based on data from 85 people.

Chronic rhinosinusitis with nasal polyps (CRSwNP) has a significant impact on patients’ quality of life, but the underlying disease mechanism has not been well studied and treatment options remain limited, Yan Zhao wrote, MD, Capital Medical University, Beijing, China, and study co-authors.

Previous research has shown that the composition of the nasal microbiome differs in patients with and without asthma, and some studies suggest that changes in the microbiota may contribute to CRSwNP, the authors wrote. The researchers questioned whether characteristics of the nasal microbiome could predict the recurrence of nasal polyps after endoscopic sinus surgery and serve as a potential treatment target.

In a study in Allergy, researchers examined nasal swab samples from 85 adults with CRSwNP who underwent endoscopic sinus surgery between August 2014 and March 2016 at a single center in China. The researchers performed bacterial analysis and gene sequencing on all samples.

The patients ranged in age from 18 to 73, with an average age of 46, and included 64 men and 21 women. The primary endpoint was polyp recurrence. Of the total, 39 people had a recurrence and 46 did not.

When the researchers compared the microbiota of swab samples from recurrent and non-recurrent patients, they found compositional differences based on the abundance of the bacterial genus. “Campylobacter, Bdellovibrioand Aggregatibacteramong others, were more abundant in swabs from CRSwNP recurrence specimens, whereas Actinobacillus, Gemellaand Moraxella were more abundant in non-recurring samples,” they wrote.

The researchers then tested their theory that a distinct nasal microbiota could be a predictive marker of future risk. nasal polyp recurrence. They used a training set of 48 samples and built models from nasal microbiota alone, clinical features alone, and both together.

The identified regression model Porphyromonas, Bacteroides, Moryella, Aggregatibacter, Butyrivibrio, Shewanella, Pseudoxanthomonas, Friedmanniella, Limnobacterand Curvibacter as the most important taxon that distinguishes recurrence from non-recurrence in specimens. When the model was validated, the area under the curve was 0.914, yielding a predictor of nasal polyp recurrence with 91.4% accuracy.

“It is very likely that proteins, nucleic acids, and other small molecules produced by the nasal microbiota are associated with the progression of CRSwNP,” the researchers noted in their discussion of the findings. “In addition, the nasal microbiota could maintain a stable community environment through the secretion of various chemical compounds and/or inflammatory factors, thus playing a central role in the development of CRSwNP.”

The results of the study were limited by several factors, including the analysis of nasal flora only at the genus level in the screening phase, the use of only bioinformatics analysis for the prediction of recurrence and the inclusion of only subjects from a single center, the researchers noted. Future studies should combine predictors to increase accuracy and include more extensive sequencing, they said. However, the results support data from previous studies and suggest a strategy to address the need for predictors of recurrence in CRSwNP, they concluded.

“There is a critical need to understand the role of the upper respiratory tract microbiome in different CRS phenotypes,” said Emily K. Cope, PhD, associate director of the Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, in an interview. “This was one of the first studies to assess the predictive power of the microbiome in the recurrence of a common CRS phenotype, CRS with nasal polyps,” she said. “Importantly, the researchers were able to predict polyp recurrence prior to disease manifestation.,” she noted.

“Given the nascent state of current upper respiratory microbiome research, I was surprised that they were able to predict polyp recurrence before disease manifestation,” Cope said. “It’s exciting, and I can imagine a future where we use microbiome data to understand disease risk.”

What is the take home message for clinicians? Although the immediate clinical implications are limited, Cope expressed enthusiasm for further research. “At this point, there is not much we can do without validation studies, but this study is promising. Hopefully we can understand the mechanism by which an altered microbiome could lead to (or be the result of) polyposis,” she said.

The study was supported by National Natural Science Foundation of China, Program for Scholars and Innovative Research Team of Changjiang, Bai-Qian-Wan Talent Project of Beijing, Pilot Project of Development and public welfare reform, the national science and technology major project. , and the CAMS Innovation Fund for Medical Sciences. The researchers revealed no financial conflicts. Cope disclosed no financial disputes.

Allergy. 2022;77:540–549. do I: 10.1111/all.15168. Item.

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