EPOS/EUFOREA update on indication and evaluation of Biologics in Chronic Rhinosinusitis with Nasal Polyps 2023.

Severe chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating disease with a significant impact on the quality of life (QoL). It is typically characterized by a type 2 inflammatory reaction and by comorbidities such as asthma, allergies and NSAID-Exacerbated Respiratory Disease (N-ERD). Here, the European Forum for Research and Education in Allergy and Airway diseases discusses practical guidelines for patients on biologic treatment. Criteria for the selection of patients who would benefit from biologics were updated. Guidelines are proposed concerning the monitoring of the drug effects that provide recognition of responders to the therapy and, subsequently, the decision about continuation, switching or discontinuation of a biologic. Furthermore, gaps in the current knowledge and unmet needs were discussed.

Structural requirements for B2-agonists with improved degradation stability.

Studies on bradykinin (BK) have been impeded by the fact that this peptide is rapidly degraded by various kininases. Modifications enacted to stabilize the BK sequence have usually resulted in a loss of agonistic activity. In this study, new structural modifications were investigated with the aim to identify degradation-resistant agonists on the bradykinin B2-receptor. The efficacy and degradation stability of several potentially agonistic derivatives were examined using a B2-receptor model (FURA-stained rat fibroblasts) and rat serum kininases. Modifications of the investigated BK analogues included amino-terminal (D-Arg) or carboxy-terminal (Ile-Tyr) prolongation, various substitutions at positions 2, 5, 7, 8 (tetrahydroisoquinoline-3-carboxylic acid, octahydroindole-2-carboxylic acid, hydroxy-proline, beta-2-thienylalanine, 2,3-dehydro-phenylalanine, erythro-beta-phenylserine, erythro-alpha-amino-beta-phenyl-butyric acid, N-methyl-phenylalanine), or intramolecular cyclization via lactam bridges. Kinin inactivation was investigated in rat serum, where the activities of angiotensin I-converting enzyme (ACE), carboxypeptidase N (CPN), aminopeptidase P (APP) and aminopeptidase M (APM) could be differentiated by selective inhibitors. Analogues derived from phyllokinin (BK-Ile-Tyr-SO4) and cyclic peptides had no receptor affinity. Useful modifications compatible with agonistic activity included D-Arg0 (protects against APP), D-N-methyl-Phe7 and dehydro-Phe5 (protect against ACE), and erythro-phenylserine or erythro-amino-phenyl-butyric acid at position 8 (protect against ACE and CPN). Finally, the kinin derivatives D-Arg0-[Hyp3, Thi5, epsilonSer(betaPh)8]-BK and D-Arg0-[Hyp3, Thi5, epsilonAbu(betaPh)8]-BK proved to be potent B2-agonists with extensive stability against rat serum kininases.

Pathways of bradykinin degradation in blood and plasma of normotensive and hypertensive rats.

Kinins are vasoactive peptide hormones that can confer protection against the development of hypertension. Because their efficacy is greatly influenced by the rate of enzymatic degradation, the activities of various kininases in plasma and blood of spontaneously hypertensive rats (SHR) were compared with those in normotensive Wistar-Kyoto rats (WKY) to identify pathogenic alterations. Either plasma or whole blood was incubated with bradykinin (10 microM). Bradykinin and kinin metabolites were measured by high-performance liquid chromatography. Kininase activities were determined by cumulative inhibition of angiotensin I-converting enzyme (ACE), carboxypeptidase N (CPN), and aminopeptidase P (APP), using selective inhibitors. Plasma of WKY rats degraded bradykinin at a rate of 13.3 +/- 0.94 micromol x min(-1) x l(-1). The enzymes ACE, APP, and CPN represented 92% of this kininase activity, with relative contributions of 52, 25, and 16%, respectively. Inclusion of blood cells at physiological concentrations did not extend the activities of these plasma kininases further. No differences of kinin degradation were found between WKY and SHR. The identical conditions of kinin degradation in WKY and SHR suggest no pathogenic role of kininases in the SHR model of genetic hypertension.