Letters to the Editor-in-Chief
Published: 2022-05-16
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Immune system elements - a puzzle in CRS

ENT-Department, Hospital in Sanok, Sanok, Poland
Department of Experimental Immunotherapy, Maria Sklodowska-Curie National Research Institute of Oncology , Warsaw, Poland
Institute of Biochemistry and Biophysics Polish Academy of Sciences, Warsaw, Poland
ENT-Department, Czerniakowski Hospital, Warsaw, Poland
chronic rhinosinusitis SWI/SNF complex T cell exhaustion

 

Dear Editor,

We read with great interest and appreciated the comments by Gelardi et al. to our paper entitled “The SWI/SNF complex in eosinophilic and non-eosinophilic chronic rhinosinusitis” 1. In their Letter “Should the role of mast cells in chronic rhinosinusitis with nasal polyps be revaluated?”, Gelardi et al. 2 pointed out a very important issue related to chronic rhinosinusitis (CRS), namely the role of mast cells (MCs) in chronic rhinosinusitis with nasal polyps (CRSwNP). Mast cells have been reported in the pathophysiology of diseases like asthma, allergy, skin diseases, gastrointestinal disorders and various malignancies as well as cardiovascular disease 1. MCs associated with eosinophils play a complex role, sometimes distinct and sometimes complementary, depending on the context 2. Interestingly, mast cells can present antigens and modulate T cell response 3, and tumour-associated mast cells have immunosuppressive function in the tumour microenvironment. Apart from the broad repertoire of diseases involving their action, MCs, when activated, may promote eosinophilic inflammation in chronic rhinosinusitis with nasal polyps. Thus, we fully agree with Gelardi et al. that scientific attention in CRS should be given to the role of MCs. We additionally postulate that the role of other immune cells like macrophages, NK, dendritic, and T and B cells 4 should be evaluated more carefully in CRS, although the current EPOS 2020 guidelines sub-classify CRS based on the eosinophil infiltration as non-eosinophilic (neCRS) or eosinophilic (eCRS) 5. In our paper, we followed the classification and found a negative correlation between SWI/SNF subunit abundance in the epithelium and eosinophil count, thus supporting the role of SWI/SNF in eCRS 6. We are, however, fully aware of the fact that our study represents only a part of a broader picture of changes characteristic for CRS.

It has been described that epithelial to mesenchymal transition (EMT) is associated with CRSwNP. Moreover, the Wnt signaling pathway is involved in nasal polyp pathogenesis via EMT 7. SWI/SNF impairment, namely the loss of SMARCB1/INI1, a core SWI/SNF complex subunit, has been linked with activation of the Wnt signaling pathway 8. The SWI/SNF complex is involved in epigenetic control of gene expression and plays an important role in the response of upper airway epithelial cells to infections. Deficiency of the SMARCA4/BRG1 central ATPase subunit disrupts function of the SWI/SNF complex and triggers a hybrid epithelial/mesenchymal state which may lead to tissue remodeling upon RSV infection 9. The SWI/SNF complex is also involved in inflammation and immune response. Furthermore, we recently found that SWI/SNF chromatin remodeling complex plays a crucial role in CD4+ T cell exhaustion mediated by cancer cells 10. T cell exhaustion is well documented in chronic infections and leads to T cell dysfunction. Therefore, in view of our unpublished data and currently available knowledge, we postulate that in precision medicine of CRSwNP not only the role of eosinophils should be assessed, but also other types of immune cells need to be taken into the consideration.

In our opinion, the substantially broader picture of CRS will be constructed only if potential links between SWI/SNF alterations and the role of other immune cells will be evaluated. The extent of the SWI/SNF complex should likely be tested in both nasal epithelium and immune cells. Thus, in agreement with Gelardi et al. suggestions, we highlight the following potential directions which should be taken into consideration in further study of CRS: i) investigation of the extent of T cell exhaustion in CRS; ii) assessment of the role of mast cells and other immune cells in CRS-associated immune response and inflammation; iii) correlation of the SWI/SNF aberrations with epithelial cells and mucosa tissue remodeling observed in CRS. Last, but not least, since the SWI/SNF complex plays an important role in the eviction of the Polycomb Repressive Complex 2, another epigenetic machinery involved in the control of gene expression, evaluation of the potential role of EZH2 (central PRC2 subunit) in CRS seems to be vital because it may open the possibility of the use of epidrugs in CRSwNP treatment.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

All authors contributed equally.

Figures and tables

Figure 1.The role of SWI/SNF in immune cell function.

References

  1. Kowalik K, Waniewska-Leczycka M, Sarnowska E. The SWI/SNF complex in eosinophilic and non eosinophilic chronic rhinosinusitis. Acta Otorhinolaryngol Ital. 2021; 41:159-167. DOI
  2. Gelardi M, Giancaspro R, Cassano M. Should the role of mast cells in chronic rhinosinusitis with nasal polyps be revaluated?. Acta Otorhinolaryngol Ital. 2021; 41:576-577. DOI
  3. Galdiero MR, Varricchi G, Seaf M. Bidirectional mast cell-eosinophil interactions in inflammatory disorders and cancer. Front Med. 2017; 4:103. DOI
  4. Bulfone-Paus S, Bahri R. Mast cells as regulators of T cell responses. Front Immunol. 2015; 6:394. DOI
  5. Kaczmarek M, Wasicka K, Tin-Tsen Chou J. NK cells in patients with chronic rhinosinusitis show decreased maturity and limited expression of functional receptors. Immunobiology. 2020; 225:151890. DOI
  6. Fokkens WJ, Lund VJ, Hopkins C. European Position Paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020; 58:1-464. DOI
  7. Bae JS, Ryu G, Kim JH. Effects of Wnt signaling on epithelial to mesenchymal transition in chronic rhinosinusitis with nasal polyp. Thorax. 2020; 75:982-993. DOI
  8. Wanior M, Krämer A, Knapp S. Exploiting vulnerabilities of SWI/SNF chromatin remodelling complexes for cancer therapy. Oncogene. 2021; 40:3637-3654. DOI
  9. Xu X, Qiao D, Dong C. The SWI/SNF-related, matrix associated, actin-dependent regulator of chromatin A4 core complex represses respiratory syncytial virus-induced syncytia formation and subepithelial myofibroblast transition. Front Immunol. 2021; 12:633654. DOI
  10. Jancewicz I, Szarkowska J, Konopinski R. PD-L1 Overexpression, SWI/SNF complex deregulation, and profound transcriptomic changes characterize cancer-dependent exhaustion of persistently activated CD4(+) T cells. Cancers (Basel). 2021; 13:4148. DOI

Affiliations

Katarzyna Kowalik

ENT-Department, Hospital in Sanok, Sanok, Poland

Elżbieta Sarnowska

Department of Experimental Immunotherapy, Maria Sklodowska-Curie National Research Institute of Oncology , Warsaw, Poland

Tomasz J. Sarnowski

Institute of Biochemistry and Biophysics Polish Academy of Sciences, Warsaw, Poland

Mariola Popko-Zagor

ENT-Department, Czerniakowski Hospital, Warsaw, Poland

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2022

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