Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Ping-Ping Cao, Zhi-Chao Wang, Robert. P. Schleimer, Zheng Liu

ABSTRACT

Objective

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with distinct pathophysiologic mechanisms. Based on the transcription factor expression and cytokine production patterns in different types of innate lymphoid cells (ILCs), in parallel with those of adaptive CD4⁺ T helper (Th) cells and CD8⁺ cytotoxic T (Tc) cells, new perspectives on endotypes of patients are emerging around the immune response deviation into type 1 (orchestrated by ILC1s, Tc1 and Th1 cells), type 2 (characterized by ILC2s, Tc2 and Th2 cells), and type 3 (mediated by ILC3s, Tc17 and Th17 cells) responses. Additionally, cluster analysis has been applied to the endotyping of CRS in recent years, which has provided additional novel insights into the CRS pathogenesis. This article aims to review pathological mechanisms of CRS on the basis of type 1, type 2, and type 3 immune responses and how they inform us to begin to understand CRS endotypes. This article also reviews the recent cluster analysis studies of CRS endotypes. Finally, the impact of endotype on therapeutic management of CRS is summarized.

Data Sources

Review of published literature.

Study Selections

Relevant literature concerning CRS endotypes and the possible underlying mechanisms were obtained from a PubMed search and summarized here.

Results and Conclusion

Both CRSwNP and CRSsNP are comprised of distinct endotypes with distinct deviated immune responses, pathogenic mechanisms, and different responses to medical and surgical treatment. An endotype of CRS with prominent type 2 immune responses is the most well studied endotype, and generally can benefit from treatment with steroids and specific type 2 disrupting biologics.

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