B7-H4 identified as a potential biomarker for CRSwNP in new study

This study evaluated the potential for postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) as measured by B7-H4 expression.

Serum B7-H4 levels have potential utility as a predictive biomarker of postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP), according to new study results published in . Journal of Inflammation Research.

The results of 80 patients with CRSwNP (40 with primary symptoms, 40 with recurrent symptoms) were compared with 27 patients with chronic rhinosinusitis without nasal polyps (CRSsNP) and 32 healthy controls using tissue samples of serum, nasal polyps and middle turbinate. Enzyme-linked immunosorbent assay, reverse transcription polymerase chain reaction, and immunofluorescence were used to detect B7-H4 expression.

The study authors noted that their investigation is important because “given that the disease has a higher rate of recurrence, there is an urgent need to explore biomarkers for the early prediction of nasal polyp recurrence, leading to the development of treatment strategies and Adjusting follow-up protocols and achieving precise treatment can help.”

Their analysis results show associations between higher tissue B7-H4 levels in the CRSwNP group compared to the healthy controls (P < 0.001), in subjects with recurrent CRSwNP compared to those with primary CRSwNP (P < 0.001) and with postoperative recurrence in all patients with CRSwNP (P < 0.05).

Overall, elevated B7-H4 levels were positively correlated with the number and percentage of tissue eosinophils (P < 0.001). In addition, the prevalence of allergic rhinitis and the number and percentage of peripheral eosinophils were increased in the patients with CRSwNP compared to those with CRSsNP and the healthy control cohort (P < 0.05).

Comparing patients with primary CRSwNP and recurrent CRSwNP, peripheral eosinophil counts were identical (P = 0.379), but peripheral eosinophil content (P = 0.187), tissue count of eosinophils (P =.003), tissue eosinophil fraction (P = .016), visual analog value (P = 0.209) and serum and tissue B7-H4 levels (both P < 0.001) were increased in patients with recurrent disease.

All patients in the study presented for treatment at the Department of Pathology, Xiangya Hospital, Central South University, P.R. China, between October 2020 and June 2021, and none had 4 weeks prior to enrollment.

An additional binary logistic regression analysis showed that serum B7-H4 and tissue B7-H4 levels were associated with a 6-fold higher probability (odds ratio). [OR], 6,837; 95% CI, 2.808-16.649; P < 0.001) and an almost 7-fold greater likelihood (OR, 7.674; 95% CI, 2.794-21.078) of postoperative CRSwNP recurrence.

In highlighting the clinical significance of their findings, the study authors note that recent study results show a significant increase in M2 macrophages in individuals with CRSwNP; B7-H4 is an important cell surface marker of M2 macrophages, they add, and its presence may indicate potential for the development of chronic inflammatory diseases.

They also state that despite improved quality of life after endoscopic sinus surgery and pharmaceutical treatment, many patients with CRSwNP still have a high recurrence rate and therefore urgently need to investigate risk factors that allow prediction of disease recurrence.

“Our results showed that B7-H4 levels were significantly elevated in CRSwNP patients and associated with postoperative recurrence,” the authors concluded. “Serum B7-H4 could serve as a simple and practical biomarker for early prediction of postoperative recurrence in CRSwNP patients.”


Wang F, Chu W, Deng Z, Jing Q, Xie B. A possible role of B7-H4 expression in predicting recurrence of chronic rhinosinusitis with nasal polyps. J Imflamma Res. 2022;15:3421-3431. doi:10.2147/JIR.S361868

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