Recent advances in understanding chronic rhinosinusitis endotypes

Abstract

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease with an as-yet-undefined etiology. The management of CRS has historically been phenotypically driven, and the presence or absence of nasal polyps has frequently guided diagnosis, prognosis, and treatment algorithms. Research over the last decade has begun to question the role of this distinction in disease management, and renewed attention has been placed on molecular and cellular endotyping and a more personalized approach to care. Current research exploring immunologic mechanisms, inflammatory endotypes, and molecular biomarkers has the potential to more effectively delineate distinct and clinically relevant subgroups of CRS. The focus of this review will be to discuss and summarize the endotypic characterization of CRS and the potential diagnostic and therapeutic implications of this approach to disease management.

Longitudinal stability of chronic rhinosinusitis endotypes

“…Recent investigations have expanded understanding of CRS pathophysiology and biomarkers largely by improving CRS classification schemes and defining putative CRS endotypes . These methods have potential both in directing patients to optimal therapeutic approaches based on inflammatory profiles and in following response to treatment.…”

“…The identification and characterization of chronic rhinosinusitis (CRS) inflammatory endotypes have advanced the understanding of CRS pathophysiology with potentially important clinical implications. [1][2][3] Building upon these innovative studies, our group recently characterized CRS inflammatory endotypes in a North American population using cluster analysis of cytokines measured in sinonasal mucus. 4,5 Cluster analysis of 147 adults with medically refractory CRS revealed phenotypic and inflammatory signatures unique to the different groupings.…”

Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps

“…1 It is commonly divided into 2 major entities based on the presence or absence of nasal polyposis, chronic rhinosinusitis with nasal polyposis (CRSwNP), and chronic rhinosinusitis without nasal polyposis (CRSsNP). CRSwNP is of particular interest because within this broad category there are several different variants or clinically relevant phenotypes, 2 including allergic fungal rhinosinusitis (AFRS), aspirin-exacerbated respiratory disease (AERD), cystic fibrosis (CF), eosinophilic granulomatosis with polyangitis (formerly Churg-Strauss syndrome), CRSwNP not otherwise specified (CRSwNP NOS), and the more recently described central compartment atopic disease (CCAD). 3 An association between edematous/polypoid changes of the middle turbinate (MT) and positive allergy status was first described in 2014.…”

A classification of chronic rhinosinusitis with nasal polyps based on structured histopathology

“…Two asthmatic clusters, and four non‐asthmatic clusters emerged for CRSwNP. The number of clusters identified by such studies has varied, but the underlying characteristics of the clusters have been fairly consistent …”

“…The number of clusters identified by such studies has varied, but the underlying characteristics of the clusters have been fairly consistent. 21 The main strengths of the present study are methodologically homogeneous investigation and treatment of the patients described, because: (i) all surgical treatments were performed consecutively by the same team; (ii) all structured histopathological analyses were performed by a dedicated head and neck pathologist; (iii) postoperative medical treatments were mainly standardised; (iv) endoscopic follow-up after surgery was conducted by the same team; and (v) allergy tests were performed at the same laboratory. The main weaknesses of the study are its retrospective setting and the limited number of patients involved.…”