Mechanisms of barrier dysfunction and tissue hyperplasia in CRS

慢性鼻窦炎综合研究计划2（CRISP 2）是流行病学家的综合计划， 耳鼻喉科医生，过敏症专家和免疫学家，其中高度合作的研究，建议更好地 了解疾病异质性的分子和细胞机制，以及这些机制如何 转化为临床表型、自然史和长期结果。该计划侧重于CRS， 鼻息肉（CRSsNP），从目前的观点来看是一种高度流行但尚不清楚的表型， 认识CRISP 2的另一个重点是批判性地评估共病的机制和后果。 患者同时患有CRS和肺部疾病（如哮喘或支气管扩张）的情况。实现 为了实现这些目标，CRISP 2研究小组的研究人员创新了新的检测方法和切割方法， 发病机制和流行病学的边缘研究，最重要的是，合并了这两个学科， 与CRS的症状、严重程度、病史和结局相关的机制。上皮屏障功能障碍，诱导 损伤和炎症，可导致屏障丧失，从而激活上皮-间质转化（EMT） 在上皮修复过程中。项目1研究屏障功能障碍的机制及其在 CRS严重程度和结果。另一个主题是我们的发现，组织增生是由沉积的 交联纤维蛋白将屏障丧失和纤维蛋白沉积联系起来是初步数据，表明EMT和 纤维蛋白沉积由2型炎症驱动。项目1将是第一个研究增生的机制， 在新定义的CRS表型（CRSsNP-HP）中仅限于鼻窦的变化。屏障功能障碍， 纤维蛋白沉积与免疫内型及其对表型、共病和 评估结果。目标一的研究检验了屏障完整性和功能丧失被诱导的假设 通过制瘤素M（OSM）、甲状腺激素和表皮调节素（EREG），并与2型炎症相关。 上皮EMT将采用一种适用于大量鼻粘膜上皮细胞的新型微粒检测法进行监测。 来自NU（三级护理）和Geisinger（初级护理）患者队列的灌洗液。单细胞RNA-Seq研究 将评估CRS患者样本中的上皮分化和EMT。第二个目标是测试 2型炎症促进纤维蛋白沉积和增生组织形成的假设，基于 结果提示纤维蛋白溶解途径的丧失和纤维化介质水平的增加。我们预测 组织纤维蛋白的生化测量将与内型和增生组织变化（息肉> 增生性疾病>>非息肉样疾病），并将监测凝血系统、纤维蛋白溶解和纤维蛋白 在具有确定的内型的患者中沉积以测试该假设。第三个目标是检验假设， 自身免疫性抗磷脂抗体促进CRS中的纤维蛋白沉积。我们检测到了自身抗体 鼻息肉组织，包括促凝血抗磷脂抗体（阿帕）抗体。我们将评估阿帕 特异性以及阿帕抗体与CRSwNP和CRSsNP-HP中纤维蛋白沉积之间的关系。

The Chronic Rhinosinusitis Integrative Studies Program 2 (CRISP2) is an integrated program of epidemiologists, otolaryngologists, allergists and immunologists in which highly collaborative studies are proposed to better understand the molecular and cellular mechanisms of disease heterogeneity and how these mechanisms translate into clinical phenotypes, natural history and long term outcomes. The program focuses on CRS without nasal polyps (CRSsNP), a highly prevalent and yet obscure phenotype from the standpoint of current understanding. Another focus of CRISP2 is to critically evaluate the mechanisms and consequences of comorbid conditions in which patients have both CRS and lung disease such as asthma or bronchiectasis. To achieve these goals, the investigators on the CRISP2 study team have innovated new assays and approaches to cutting edge studies of pathogenesis and epidemiology and, most importantly, have merged these two disciplines to relate mechanisms to symptoms, severity, history and outcomes of CRS. Epithelial barrier dysfunction, induced by injury and inflammation, can lead to barrier loss, which activates epithelial-mesenchymal transition (EMT) during the epithelial repair process. Project 1 investigates the mechanisms of barrier dysfunction and its role in CRS severity and outcomes. Another topic follows our findings that tissue hyperplasia is driven by deposition of cross-linked fibrin. Linking barrier loss and fibrin deposition are preliminary data suggesting that both EMT and fibrin deposition are driven by type 2 inflammation. Project 1 will be the first to study mechanisms of hyperplastic changes confined to the sinuses in a newly defined phenotype of CRS (CRSsNP-HP). Barrier dysfunction and fibrin deposition will be related to immunological endotype and their influence on phenotype, comorbidity and outcomes assessed. Studies in aim one test the hypothesis that loss of barrier integrity and function is induced by oncostatin M (OSM), thyroid hormone and epiregulin (EREG), and associates with type 2 inflammation. Epithelial EMT will be monitored with a novel microparticle-based assay applicable to large numbers of nasal lavage fluids from patient cohorts at NU (tertiary care) and Geisinger (primary care). Single cell RNA-Seq studies will evaluate epithelial differentiation and EMT in samples from patients with CRS. The second aim tests the hypothesis that type 2 inflammation promotes fibrin deposition and formation of hyperplastic tissue, based on results implicating loss of fibrinolytic pathways and increased levels of fibrogenic mediators. We predict that biochemical measurement of tissue fibrin will correlate with endotype and hyperplastic tissue changes (polyps > hyperplastic disease >> non-polypoid disease) and will monitor the coagulation system, fibrinolysis and fibrin deposition in patients with defined endotypes to test this hypothesis. The third aim tests the hypothesis that autoimmune antiphospholipid antibodies promote fibrin deposition in CRS. We have detected autoantibodies in nasal polyp tissues, including procoagulant anti-phospholipid antibodies (APA) antibodies. We will evaluate APA specificity and the relationship between APA antibodies and fibrin deposition in CRSwNP and CRSsNP-HP.