Uncovering Type 2 inflammatory profiles in severe eosinophilic asthma with nasal polyps: the role of transcript-protein ratios and Staphylococcus aureus enterotoxin B-specific IgE

Abstract

Background: Severe eosinophilic asthma with nasal polyps (SEAwNP) is a clinical phenotype characterized by elevated peripheral eosinophil counts and heightened type 2 (T2) inflammation. Objective: In this study, we aimed to compare the transcript/protein expression ratios of factor XIII-A (F13A), B-cell activating factor (BAFF), interleukin-5 (IL-5), and thymus- and activation-regulated chemokine (TARC), as well as serum Staphylococcus aureus Enterotoxin B-Specific IgE (SEB-IgE) levels, among patients with SEAwNP, SEA without nasal polyps (NP), NP without asthma, and healthy controls groups. Material and Methods: A total of 73 participants were enrolled and stratified into four groups: SEAwNP (n=20), SEA without NP (n=18), NP without asthma (n=15), and healthy controls (n=20). Peripheral blood samples were analyzed using real-time quantitative PCR and protein levels using ELISA for periostin, F13A, BAFF, IL-5, and TARC. Serum SEB-IgE levels were also assessed. Results: SEAwNP patients exhibited significantly elevated transcript/protein expression ratios of periostin, F13A, BAFF, and IL-5 compared to SEA without NP (p=0.007, p=0.001, p=0.019, and p=0.017, respectively). Furthermore, periostin, F13A, BAFF, IL-5, and TARC transcript/protein ratios were significantly higher in SEAwNP patients compared to healthy controls (p=0.0001, p=0.001, p=0.003, p=0.014, and p=0.02, respectively). SEB-IgE positivity rates were 45% in SEAwNP, 38% in SEA without NP, 13% in NP without asthma, and 0% in healthy controls. Conclusion: SEAwNP is associated with elevated transcript/protein expression ratio of key T2 inflammatory mediators and increased SEB-IgE positivity, supporting their potential role in the immunopathogenesis of this phenotype. These findings underscore the importance of biomarker profiling in distinguishing endotypes within the spectrum of eosinophilic airway diseases.