PURPOSE:Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease in which eosinophil (Eos) infiltration into polyp tissues is associated with disease prognosis. Our previous study found that linoleic acid is an important differential metabolite. However, lipid metabolism in nasal polyps has been insufficiently investigated. This study aimed to explore the characteristics of lipid metabolism in CRSwNP tissue. METHODS:This study employed a multi-omics approach by integrating lipidomics and single-cell transcriptomics. The lipidomics analysis was performed using nasal mucosal tissues obtained from 32 patients with nasal polyps and 20 healthy controls. The sequencing findings were validated by using immunofluorescence staining and Western blotting. RESULTS:Phosphatidylethanolamine and phosphatidylcholine were the most abundant lipids expressed in the sinus mucosa, and lysophosphatidylinositol (LPI) was significantly increased in the eosinophilic CRSwNP group compared to the noneosinophilic CRSwNP and the control groups. The LPI levels showed significant positive correlations with the Eos counts and percentages in nasal polyp tissue. The expressions of membrane-bound O-acyltransferase 7 and receptor G-protein coupled receptor 55 in the LPI metabolic pathway were significantly elevated in eosinophilic nasal polyps, and their expression was mainly localized to Eos in polyp tissues. CONCLUSIONS:There are differences in the lipidomic patterns between healthy individuals and patients with CRSwNP. The LPI metabolic axis may be associated with Eos activation in polyp tissue. These findings could provide new insights into the pathogenesis and endotyping of CRSwNP.
PURPOSE:Specialist cough clinics operate in various countries to address the complex needs of patients with chronic cough. Despite their increasing recognition and the recent establishment of an international consensus, such as the European Respiratory Society NEUROCOUGH initiative, no formal agreement on the goals and standards of chronic cough clinics has been established in South Korea. To address this gap, the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) and its Chronic Cough Working Group initiated a Delphi study to develop an expert consensus on the objectives, roles, and standards of chronic cough clinics tailored to the Korean healthcare context. METHODS:A Task Force endorsed by KAAACI and composed of members of the Chronic Cough Working Group conducted a 2-round Delphi survey involving 113 clinicians with relevant clinical or research expertise. The panel evaluated 12 statements and 17 diagnostic items. A consensus was defined as > 70% agreement and < 20% disagreement. RESULTS:Consensus was achieved for all 12 statements (agreement rates, 93.9%-99%), covering clinical care, research, and education. The key agreements were the provision of evidence-based care to improve the quality of life and reduce disease burden; comprehensive assessment of cough characteristics and treatable traits; careful use of neuromodulators or opioid antitussives; appropriate referral to other specialists; and active participation in research and education. A minimum diagnostic test panel, comprising chest radiography, spirometry, paranasal sinus X-ray, and fractional exhaled nitric oxide measurement/blood eosinophil count, was also established. CONCLUSIONS:This study presents the first national consensus to define the goals and standards of chronic cough clinics in South Korea. The recommendations reflect a balance between internationally suggested approaches and local healthcare realities. This consensus is expected to provide updates to national guidelines, facilitate standardized care, and support future research and educational initiatives in chronic cough.
Topical Streptococcus postbiotic emollient (Strain CX) has shown efficacy for mild-to-moderate atopic dermatitis (AD) in a previous study; however, treatment responses according to allergic comorbidity status have not yet been explored. We conducted a post hoc analysis to evaluate the differential therapeutic effects of Strain CX in patients with AD stratified by the presence or absence of allergic comorbidities. This post hoc analysis was derived from a randomized, double-blind, vehicle-controlled trial (Clinical Research Information Service of South Korea, KCT0007876). A total of 98 patients with mild-to-moderate AD were stratified into placebo (n = 33), AD without allergic comorbidities (n = 29), and AD with allergic comorbidities (n = 36) groups. The primary outcomes were the Investigator's Global Assessment (IGA) score and the proportions of participants achieving 25% or 50% improvement in the Eczema Area and Severity Index (EASI), assessed at weeks 4 and 8. The secondary outcomes included a range of skin-related clinical and molecular measures, along with additional evaluations of serum inflammatory and allergic biomarkers as laboratory measures in the per-protocol analysis set. At week 8, 55.2% (16/29) of participants in the AD without allergic comorbidities group achieved an IGA score of 0 or 1 with ≥ 1 point reduction, compared to 30.6% (11/36) in the AD with allergic comorbidities group (P = 0.0272). Both Strain CX intervention groups showed significant improvements in skin parameters, including EASI, skin moisture, and transepidermal water loss. Notably, the AD with allergic comorbidities group solely exhibited significant reductions in systemic inflammatory markers, including sIL-2R (mean, -231.19; 95% confidence interval [CI], -378.82 to -83.57 pg/mL), CCL17 (-127.05; 95% CI, -251.80 to -2.31 pg/mL), and CCL22 (-578.40; 95% CI, -939.31 to -217.49 pg/mL). Clinical skin responses improved more in patients with AD without allergic comorbidities, while immunomodulatory benefits were observed in those with allergic comorbidities. These findings support patient stratification based on allergic comorbidity status for personalized Strain CX treatment strategies. Trial Registration: Clinical Research Information Service Identifier: KCT0007876.
Periostin is a matricellular protein that binds to its receptors, which include several integrin molecules but mainly αvβ3 integrin on cell surfaces, thereby transducing its signals into cells. Almost 20 years have passed since we found that periostin is involved in the pathogenesis of asthma, which marked the first evidence of its involvement in allergic diseases. Over the past 2 decades, cumulative evidence has demonstrated that periostin plays important roles in the onset or progress of many allergic diseases such as chronic rhinitis with nasal polyp, atopic dermatitis (AD), allergic conjunctivitis, eosinophilic esophagitis, eosinophilic otitis media, allergic rhinitis, and eosinophilic granulomatosis with polyangiitis. Starting from the observation of highly expressed periostin in the lesions of these diseases, periostin studies have expanded to include how periostin contributes to the generation of allergic phenotypes, how measurement of periostin is useful as a biomarker for allergic diseases, and recently how periostin inhibitors can improve allergic diseases. Periostin contributes to the generation of allergic phenotypes by acting as a matricellular protein on many cells, including both non-immune and immune cells. Based on the characteristics of periostin as a surrogate biomarker of interleukin-13, a signature cytokine of type 2 inflammation, serum periostin has been used as a biomarker for stratifying endotypes, estimating disease severity, predicting or monitoring the efficacy of therapeutic drugs, and predicting disease relapse or recurrence. Moreover, a lot of attention is now being paid to periostin in body fluids such as tears and sputum as a biomarker directly reflecting type 2 inflammation. Since it has been shown that periostin evokes itch in AD, we hope to see the development of a novel therapeutic agent for AD targeting periostin/αvβ3 integrin. Here we summarize the discovery and characteristics of periostin, as well as questions and/or problems regarding periostin that remain to be resolved.
