B7-H4 Identified as Potential Biomarker for CRSwNP in New Study

This study investigated the potential for postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) as measured against B7-H4 expression.

Level of serum B7-H4 has potential use as a predictive biomarker for postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP), according to new study findings published in Journal of Inflammation Research.

Outcomes from 80 patients with CRSwNP (40 having primary symptoms, 40 with recurrent symptoms) were compared against 27 patients who had chronic rhinosinusitis without nasal polyps (CRSsNP) and 32 healthy controls through serum, nasal polyp, and middle turbinate tissue samples. Enzyme-linked immunosorbent assay, reverse transcription-polymerase chain reaction, and immunofluorescence were employed to detect B7-H4 expression.

The study authors noted their investigation is important because, “Considering that the disease has a higher rate of recurrence, there is an urgent need to explore biomarkers for early prediction of nasal polyp recurrence, which may contribute to developing treatment strategies, adjusting follow-up protocols, and achieving precision treatment.”

Their analysis findings show associations between higher tissue B7-H4 levels in the CRSwNP group compared with the healthy controls (P < .001), among study participants with recurrent CRSwNP vs those with primary CRSwNP (P < .001), and with postoperative recurrence among all patients with CRSwNP (P < .05).

Overall, elevated B7-H4 levels positively correlated with tissue eosinophil count and percentage (P < .001). In addition, the prevalence of allergic rhinitis and peripheral eosinophil count and percentage were elevated among the patients with CRSwNP compared with those who had CRSsNP and the healthy control cohort (P < .05).

When comparing the patients with primary CRSwNP and recurrent CRSwNP, peripheral eosinophil counts were identical (P = .379), but peripheral eosinophil percentage (P = .187), tissue eosinophil count (P =.003), tissue eosinophil percentage (P = .016), visual analogue score (P = .209), and serum and tissue B7-H4 levels (both P < .001) were elevated among those with recurrent disease.

All of the patients in the study presented for treatment at the Department of Pathology, Xiangya Hospital of Central South University, People’s Republic of China between October 2020 and June 2021, and none had treatment history of glucocorticoids, immunomodulatory agents, or antibiotics in the 4 weeks before enrollment.

An additional binary logistic regression analysis showed serum B7-H4 and tissue B7-H4 levels were associated with a 6 times higher chance (odds ratio [OR], 6.837; 95% CI, 2.808-16.649; P < .001) and an almost 7 times higher chance (OR, 7.674; 95% CI, 2.794-21.078), respectively, of postoperative recurrence of CRSwNP.

When highlighting the clinical importance of their findings, the study authors note that recent study findings demonstrate significant increases of M2 macrophages among persons who have CRSwNP; B7-H4 is an important cell surface marker of M2 macrophages, they add, and its presence may indicate potential for chronic inflammatory disease development.

They also state that despite improved quality of life following endoscopic sinus surgery and pharmaceutical treatment, there is still a high rate of recurrence among many patients who have CRSwNP and therefore an urgent need to explore risk factors that enable the prediction of disease recurrence.

“Our results indicated that B7-H4 level was clearly enhanced in CRSwNP patients and associated with postoperative recurrence,” the authors concluded. “Serum B7-H4 might serve as a simple and convenient biomarker for early predicting postoperative recurrence in CRSwNP patients.”


Wang F, Chu W, Deng Z, Jing Q, Xie B. A potential role of B7-H4 expression in predicting the recurrence of chronic rhinosinusitis with nasal polyps. J Imflamma Res. 2022;15:3421-3431. doi:10.2147/JIR.S361868

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