Endotype of eosinophilic nasal polyposis according to the presence of atopy

Background and Objectives We evaluated differences in the pathophysiology of atopic and non-atopic eosinophilic nasal polyps and investigated their distinct inflammatory profiles. Subjects and Method A total of 36 patients were recruited: 10 controls (Group C), 14 with chronic rhinosinusitis with eosinophilic nasal polyps with atopy (Group A), and 12 without atopy (Group NA). Results Serum eosinophil counts, total immunoglobulin E, eosinophil cationic protein levels, and tissue eosinophil counts were elevated in Groups A and NA vs. Group C. Real-time polymerase chain reaction results showed increased GATA-3, interleukin (IL)-4, IL-33 levels, but decreased levels of retinoic acid-related orphan receptor gamma t, IL-17 in Groups A and NA. Related to the regulatory T (T-reg) cell response, forkhead box P3 (Foxp3+) (A: p<0.001, NA: p<0.001) and IL-10 (A: p<0.001, NA: p<0.001) levels were elevated and transforming growth factor-β levels (A: p<0.001, NA: p<0.001) were decreased in Group A and Group NA in comparison to those in Group C. The Foxp3+ (p=0.001) and IL-10 (p<0.001) were significantly higher in Group A than in Group NA. Conclusion T-reg cells and IL-10 may be major factors differentiating the pathophysiology of atopic and non-atopic eosinophilic nasal polyps, and the T helper (Th) 2/Th17/T-reg imbalance might be important in the development of eosinophilic nasal polyposis.