title: Nasal lavage levels of granulocyte-macrophage colony-stimulating factor and chronic nasal hypereosinophilia.
abstract: BACKGROUND
  The aim of the present study was to measure levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) in nasal lavage of patients affected by chronic eosinophilic sinonasal inflammation to clarify the relationship with eosinophilic tissue infiltration and clinical features.
  
  
  METHODS
  Between November 2012 and June 2013, we selected 70 patients with chronic eosinophilic inflammation (average age 41.8 years) who were classified into the following groups: persistent allergic rhinitis (group 1), noninfectious non-allergic rhinitis with eosinophilia syndrome (group 2) and chronic rhinosinusitis with polyps (group 3). Finally, we enrolled 20 healthy subjects as controls (group 4). All patients underwent symptoms score questionnaire based on a visual analogue scale, nasal endoscopy and/or computed tomography (CT) scan, and allergy testing. Nasal cytology by scraping of the mucosa and GM-CSF assays in nasal lavage were performed in all subjects.
  
  
  RESULTS
  Detectable levels of GM-CSF were found in 34 of 70 (48.57%) patients, with an average concentration of 2.67 ± 0.8 pg/mL, whereas in controls only 1 of 20 individuals showed detectable GM-CSF levels. Eosinophil infiltration was significantly higher in patients with detectable GM-CSF compared to those with undetectable levels (49.4% vs 39.2%, respectively; p < 0.05). Furthermore, significant weakly-moderate correlation was found between GM-CSF levels and percentage of eosinophil infiltration in tissue (p < 0.05). Correlation between symptom scores and GM-CSF levels was significant only in group 2, which showed higher average concentrations of GM-CSF compared to groups 1 and 3 (2.9 pg/mL vs 1.6 pg/mL and 1.8 pg/mL, respectively; p < 0.05).
  
  
  CONCLUSIONS
  Our data confirm that GM-CSF is more frequently detectable in nasal lavages of patients affected by chronic sinonasal eosinophilic inflammation than in controls. Statistical analyses revealed a significant weakly-moderate correlation between GM-CSF levels in nasal lavage of all patients and percentage of eosinophil infiltration of nasal mucosa.
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: De Corso
authors.affiliation: Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroni
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Lucidi
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Mariapina
authors.initials: M
authors.lastname: Battista
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Romanello
authors.affiliation: Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Autilio
authors.affiliation: Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Morelli
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Di Nardo
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Giulio Cesare
authors.initials: GC
authors.lastname: Passali
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sergi
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bussu
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Fetoni
authors.affiliation: Department of Diagnostic and Laboratory Medicine-Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zuppi
authors.affiliation: Department of Head and Neck Surgery-Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000378:metabolism*; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000378:metabolism* / Q000473:pathology; D007113:Immunity, Innate / Q000502:physiology; D008297:Male; D017817:Nasal Lavage Fluid; D009298:Nasal Polyps / Q000473:pathology; D012220:Rhinitis / Q000378:metabolism* / Q000473:pathology; D011795:Surveys and Questionnaires
chemical_list: D016178:Granulocyte-Macrophage Colony-Stimulating Factor
keywords: GM-CSF; eosinophilic rhinitis; granulocyte-macrophage colony-stimulating factor; hypereosinophilia; innate immunity; nasal polyposis; paranasal sinus diseases; polyposis; rhinosinusitis