Patients with nasal polyposis (NP)—another name for chronic rhinosinusitis with nasal polyps (CRSwNP)—could soon see advancements in disease severity determination, according to the results of a new study that evaluated the neuropeptides bradykinin (BK) level and substance P for their utility as biomarkers in NP. The study findings show that among these patients who do and do not have concomitant aspirin-exacerbated respiratory disease (AERD), BK concentration has potential for use as an indicator of disease severity.

The 42-patient cross-sectional study cohort was equally divided into 3 groups: NP as part of AERD with mild persistent asthma (CRSwNP-AERD), NP without aspirin sensitivity (CRSwNP), and no nasal inflammation (controls). All received care from January 2019 to December 2021 at the Department of Otorhinolaryngology and Institute for Clinical and Experimental Immunology of the Military Medical Academy, Belgrade, Serbia. They also self-scored each of 5 symptoms—nasal obstruction, sneezing, itching, hyposmia, and rhinorrhea—on a scale of 0 to 3 (no symptom to severe), and their sinus CT scans were rated via Lund-Mackay scores.

The authors published their findings in Laryngoscope Investigative Otolaryngology, noting, “Although the role of neurogenic inflammation in allergic and nonallergic noninfectious rhinitis is relatively well documented, very little is known about neurogenic inflammation in NP. Unlike cytokines and chemokines in nasal secretion samples, which have been found to be able to correlate with clinical disease parameters, it is unclear whether this also applies to neuropeptides.”

Mean (SD) nasal symptom, nasal endoscopic, and Lund-Mackay CT scores were highest in the CRSwNP-AERD group (57% male; mean [SD] age, 41.4 [11.2] years) and lowest among the controls:

• Nasal symptom score:
  • CRSwNP-AERD cohort: 12.8 (3.0)
  • CRSwNP cohort: 10.6 (2.5)
  • Controls: 3.9 (1.4)
• Nasal endoscopic score:
  • CRSwNP-AERD cohort: 5.0 (1.1)
  • CRSwNP cohort: 4.6 (1.2)
• Lund-Mackay CT score:
  • CRSwNP-AERD cohort: 20.1 (5.5)
  • CRSwNP cohort: 15.5 (6.7)

In addition, compared with the control group, substance P and BK levels were significantly higher in the 2 patient groups with CRSwNP:

• BK (P < . 0001):
  • CRSwNP-AERD cohort: 153.8 (11.9) ng/mL
  • CRSwNP cohort: 47.6 (8.8) ng/mL
  • Controls: 15.5 (18.2) ng/mL
• Substance P (P = .022):
  • CRSwNP-AERD cohort: 127.5 (88.9) ng/mL
  • CRSwNP cohort: 68.4 (29.3) ng/mL
  • Controls: 8.8 (10.2) ng/mL

The authors highlighted that among the patients with CRSwNP, with and without AERD, there was a high positive correlation between nasal secretion BK level and Lund-Mackay CT score and that their data on the higher levels of both neuropeptides seen among the CRSwNP-AERD cohort could indicate greater neurogenic inflammation vs persons not sensitive to aspirin.

“The fact that the concentration of BK in nasal secretions in both groups of patients with NP strongly correlates with the Lund–Mackay CT score, the only objective clinical indicator of the extent of sinus disease, suggests that in addition to SP, BK also plays a significant role in pathogenesis of NP,” they concluded. “Thus, the concentration of BK in nasal secretions could serve as a reliable biomarker for assessing the radiological findings suggesting the extent of paranasal sinus disease.”

Reference

Perić A, Matković S, Barać A, Vukadinobvić T, Čvorović L, Vojvodić D. Evaluation of substance P and bradykinin levels in nasal secretions of patients with nasal polyposis with and without sensitivity to non-steroidal anti-inflammatory drugs. Laryngoscope Investig Otolaryngol. 2022;7(4):928-934. doi:10.1002/lio2.851