2. Academic Validation
  3. Prognostic Significance of Eosinophil Extracellular Traps in Chronic Rhinosinusitis and Innovative Nanosheets-Based Clearance Therapy

Prognostic Significance of Eosinophil Extracellular Traps in Chronic Rhinosinusitis and Innovative Nanosheets-Based Clearance Therapy

  • Clin Exp Allergy. 2026 Jun;56(6):650-664. doi: 10.1111/cea.70235.
Changhui Chen 1 2 3 4,  Hang Li 1 2 3 4,  Yilin Hou 1 2 3 5,  Yihui Wen 1 2 3,  Jian Li 1 2 3 6,  Hua Zhong 1 2 3,  Tong Lu 1 2 3,  Zhengqi Li 1 2 3,  Lin Sun 1 2 3,  Shimin Lai 1 2 3,  Yan Yan 7,  Jieying Yan 1 2 3,  Zihan Qiu 7,  Nan Zhang 1 8 9,  Claus Bachert 1 5 8 9,  Zhaoxu Tu 7,  Weiping Wen 1 2 3 7,  Yi Wei 1 2 3
Affiliations

Affiliations

  • 1 Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
  • 2 Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China.
  • 3 Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
  • 4 Department of Allergy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
  • 5 Department of Otolaryngology, Peking University Shenzhen Hospital, Shenzhen Peking University-the Hong Kong University of Science and Technology Medical Center, Shenzhen, China.
  • 6 Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Nanning, Guangxi, China.
  • 7 Department of Otolaryngology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
  • 8 Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, Münster, Germany.
  • 9 Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Germany.
PMID: 41679737 DOI: 10.1111/cea.70235
Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) can be classified into Eosinophilic CRSwNP (ECRSwNP) and non-Eosinophilic CRSwNP (nECRSwNP) based on eosinophilic infiltration in nasal polyps. However, no consensus criteria exist for eosinophilic infiltration in nasal polyps, including different cutoffs for eosinophil (EOS) counts or different EOS proportions among inflammatory cells.

Methods: Inferior turbinate (IT) tissues from controls (n = 27) and nasal polyp (NP) tissues from ECRSwNPs (n = 50) were collected. ECRSwNPs (n = 38) underwent 2-year post-FESS follow-up. Clinical assessments (SNOT-22, Lund-Mackay, Lund-Kennedy scores), eosinophil indicators (polyp/blood EOS counts, EETs area), and Th2 cytokines pre/post-FESS were recorded for correlation analysis and prognostic model building. Subsequently, functional nanosheets TLPGA targeting EETs were synthesized and tested for EETs clearance in human EOS, epithelial cell models, and NP models.

Results: Our findings demonstrated positive correlations between EETs area and ECRSwNP severity, including Lund-Mackay CT scores (r = 0.72, p < 0.001), Lund-Kennedy Endoscopic score (r = 0.57, p < 0.001), IL-4 (r = 0.50, p < 0.001), IL-5 (r = 0.50, p < 0.001), IL-13 (r = 0.39, p < 0.01), and Periostin (r = 0.34, p < 0.05). And we first demonstrated that increased preoperative EETs area predicts both impaired mucosal recovery and elevated nasal polyp uncontrolled risk within 2 years post-FESS. Furthermore, we developed novel nanosheets TLPGA and demonstrated that TLPGA effectively scavenges EETs and alleviates the type 2 inflammatory cascade in human nasal polyp tissues and epithelial cell model.

Conclusion: These findings highlight the potential of EETs and EOS morphology in assessing preoperative ECRSwNP severity and predicting postoperative prognosis. Moreover, this also supports TLPGA as a promising therapeutic approach for managing ECRSwNP with high EETs levels.

Keywords

ECRSwNP; EETs; eosinophil; nanosheets; prognostic prediction.

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