Immunological features of different phenotypes in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a disease which manifests with inflammation of the upper respiratory tract. Two main phenotypes can be distinguished in CRS: a clinical form with polypous tissue, and a clinical variant without polyposis. With regard of increased cytokine concentrations, the inflammatory response in CRS can be divided into 3 endotypes: Th1 (IFNγ), Th2 (IL-4, IL-5, IL-13) and Th3 type (IL-17, IL-22). The pathogenesis of inflammation in CRS with nasal polyps and polyposis-free cases is quite different, and, according to current publications, the data on prevalence of different endotypes is very contradictory, thus confirming the need for further studies of CRS development. These important medical and social features of diseases affecting nasal mucosa and paranasal sinuses require further studies in pathogenesis of CRS. This review covers information about the immunological features and dysfunctions that lead to occurence of CRS with or without polyps. The purpose of this review article is to study the influence of the first-line immune defense, components of innate and acquired immunity on the pathogenesis of CRS.
The article provides a review of the worldwide research publications in the field. The authors conducted a search for different items of immune response related to development of CRS with and without polyps. We used keywords and filters in the PubMed and Google Scholar, as well as in Scopus and Web of Science databases.
So far, low efficiency of various treatment methods used may be due to heterogeneous immunopathology. The use of biological preparations, although approved, may be non-reliable, since these Th2-targeted drugs may be administered to patients with non-Th2 disease. The presence of eosinophils and pus may provide a basis for endotype extrapolation. However, the clinicians treating CRS do not have widespread access to laboratory tests in order to specify the CRS type and to administer a tailored drug management. Patients with any type of inflammation may suffer from latent infections caused by bacteria, fungi or viruses, thus making difficult a specific evaluation of polarized immune response. Further studies on the links of immunological pathogenesis in CRS will allow us to develop a personalized algorithm for the diagnosis and treatment of such patients.

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