title: Fibroblast levels are increased in chronic rhinosinusitis with nasal polyps and are associated with worse subjective disease severity.
abstract: BACKGROUND
  Fibroblasts are implicated in tissue remodeling and recruitment of inflammatory cells in chronic rhinosinusitis (CRS). Populations of fibroblasts remain unquantified in CRS subtypes. The objectives of this study were to measure fibroblast populations in subtypes of CRS, and to investigate the association between fibroblasts and disease severity.
  
  
  METHODS
  Patients undergoing endoscopic sinus surgery (ESS) for CRS were prospectively enrolled from January 2011 to December 2014. Control subjects included patients undergoing endoscopic surgery for non-inflammatory conditions such as cerebrospinal fluid leak repair or non-hormone-secreting pituitary tumors. Patients completed 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires prior to surgery. Blood and tissue biopsies were taken during surgery. Percent of sinonasal fibroblasts was determined via flow cytometry by selecting fibroblast-specific protein (FSP)-positive and Mucin 1 (MUC1)-negative cells.
  
  
  RESULTS
  A total of 69 patients were enrolled: control (n = 24), CRS without nasal polyps (CRSsNP) (n = 13), CRS with nasal polyps (CRSwNP) (n = 22), and allergic fungal rhinosinusitis (AFRS) (n = 10). Patients with CRSwNP had significantly more fibroblasts than both control (p < 0.001) and CRSsNP (p < 0.01). Patients with AFRS had the most fibroblasts when compared to control (p < 0.0001), CRSsNP (p < 0.0001), and CRSwNP (p < 0.05). Atopy and asthma were not associated with increased fibroblasts in CRSwNP (p = 0.21, p = 0.26, respectively). Increased fibroblasts correlated with subjective disease severity as measured by SNOT-22 for CRSwNP (p = 0.003) and AFRS (p = 0.048).
  
  
  CONCLUSIONS
  Sinonasal fibroblasts are increased in CRSwNP and AFRS compared to control and CRSsNP. Increased fibroblasts correlated with worse quality of life in CRSwNP and AFRS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: William W
authors.initials: WW
authors.lastname: Carroll
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: O'Connell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.|Ralph H. Johnson VA Medical Center, Charleston, SC.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: David A
authors.initials: DA
authors.lastname: Gudis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Tom T
authors.initials: TT
authors.lastname: Karnezis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Lawrence
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.|Ralph H. Johnson VA Medical Center, Charleston, SC.|Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Mulligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002135:Calcium-Binding Proteins / Q000378:metabolism; D002469:Cell Separation; D002648:Child; D002908:Chronic Disease; D018450:Disease Progression; D004724:Endoscopy; D005260:Female; D005347:Fibroblasts / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis* / Q000473:pathology; D011788:Quality of Life; D012220:Rhinitis / Q000175:diagnosis* / Q000473:pathology; D000071999:S100 Calcium-Binding Protein A4; D012852:Sinusitis / Q000175:diagnosis* / Q000473:pathology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D002135:Calcium-Binding Proteins; D000071999:S100 Calcium-Binding Protein A4; C077591:S100A4 protein, human
keywords: SNOT-22; chronic rhinosinusitis; endoscopic sinus surgery; quality of life; sinusitis