The Role of IL5 in Epithelial Cell Integrity

Study Overview
=================
Brief Summary
-----------------
The goal of this laboratory study is the examine the effect of mepolizumab drug on the health and function of the cells lining the human nasal airways in vitro cell culture derived from patients with chronic rhinosinusitis with nasal polyposis. The main questions the study aims to study are: To see what mepolizumab does to suppress inflammation of the human cells. To see what mepolizumab does to maintain barrier integrity of epithelial cells

Detailed Description
-----------------
The investigators hypothesize that anti-IL5 treatment will promote epithelial cell function by inhibition of Type 1 and innate immune mediated inflammation and epithelial-mesenchymal transition resulting from IL5 induction. Aim 1. To test the hypothesis that anti-IL5 therapy results in inhibition of epithelial cell dysfunction including epithelial derived inflammatory responses and barrier dysfunction, the investigators will examine the effect of in vitro anti-IL5 mepolizumab exposure of human primary nasal epithelial cells from chronic rhinosinusitis with nasal polyposis on Type 1, Type 2 and innate immune inflammatory markers, and markers of epithelial cell barrier function. Aim 2. To examine the effect of mepolizumab to broadly modulate the expression of Type 2, Type 1, Type 3, and innate immune inflammatory gene responses in human nasal airway epithelial cells, the investigators will perform high throughput RNA sequencing on IL5 primed differentiated human primary nasal epithelial cells exposed to the presence and absence of mepolizumab in vitro cell culture which are derived from patients with chronic rhinosinusitis with nasal polyposis. These studies will provide an unbiased approach to identification of biomarkers resulting from anti-IL5 treatment.

Official Title
-----------------
The Role of IL5 in Epithelial Cell Integrity

Conditions
-----------------
Chronic Rhinosinusitis With Nasal Polyps, Chronic Rhinosinusitis (Diagnosis)

Intervention / Treatment
-----------------
* Drug: Mepolizumab


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: (1) sinonasal inflammation for greater than 12 weeks which include at least 2 of the following symptoms: nasal obstruction/congestion, nasal discharge (anterior or posterior), facial pressure/pain, reduction of sense of smell. (2) confirmation of the clinical symptoms by: (2a) CT scan evidence of paranasal sinus mucosal inflammation, and/or (2b) endoscopic exam evidence of purulence from the sinuses or ostiomeatal complex; and (3) presence of nasal polyps seen on endoscopic exam or sinus CT scan. Exclusion Criteria: 1. Children under the age of 18 will be excluded due to: possible confounding diagnosis of cystic fibrosis and other non-Type 2 inflammatory etiologies that commonly presents with nasal polyps in the pediatric population. lack of complete pneumatization of the majority of paranasal sinuses 2. pregnant or lactating females, 3. prisoners, 4. mentally disabled 5. persons unable to give informed consent will be contemplated for inclusion. 6. disease secondary to a clearly defined anatomic process, such as facial trauma, and obstruction due to sinonasal neoplasm. 7. exposure to oral or systemic IV glucocorticoids within 2 weeks of surgery 8. exposure to immunomodulatory biologics will be excluded. These include, but are not limited to systemic treatment with biologics omalizumab, dupilumab, mepolizumab, benralizumab, reslizumab, or rituximab.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Nasal epithelial cells will be exposed to defined doses of mepolizumab in vitro culture (Arm 1) or control media without mepolizumab (Arm 2)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mepolizumab treatment arm<br>Nasal epithelial cells will be exposed in vitro to mepolizumab in culture. | Drug: Mepolizumab<br>* In vitro exposure of human nasal epithelial cells to mepolizumab<br>* Other names: Nucala;|
| No Intervention: Control arm<br>Nasal epithelial cells will be exposed in vitro to media without mepolizumab in culture | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Type 1 inflammatory markers (ng/mL) | IL8 cytokine mRNA and protein expression | 0 to 48 hours | 
| Change in Type 2 inflammatory markers (ng/mL) | IL5 and thymic stromal lymphopoietin cytokine mRNA and protein expression | 0 to 48 hours | 
| Change in Innate immune inflammatory markers (ng/mL) | IL1 receptor mRNA and protein expression | 0 to 48 hours | 
| Change in epithelial barrier function protein expression (ng/mL) | E-cadherin | 0 to 48 hours | 
| Change in epithelial integrity markers (staining intensity units) | alpha-smooth muscle actin protein expression | 0 to 48 hours |