Pathophysiology and management of Staphylococcus aureus in nasal polyp disease

ABSTRACT

Introduction

Staphylococcus aureus (S. aureus) is a common pathogen that frequently colonizes the sinonasal cavity. Recent studies demonstrated the essential role of Staphylococcus aureus in the pathophysiology of uncontrolled severe chronic rhinosinusitis with nasal polyps (NP) by initiating an immune response to the germ and its products, resulting in type 2 inflammation.

Areas covered

This review aims to summarize the evidence for the role of S. aureus in the development of NP disease including S. aureus-related virulence factors, the pathophysiologic mechanisms used by S. aureus, and the synergistic effects of S. aureus and other pathogens. It also describes the current management of S. aureus associated with NPs as well as potential therapeutic strategies that are used in clinical practice.

Expert opinion

S. aureus is able to damage the nasal mucosal epithelial barrier, impair the clearance of the host immune system, and trigger adaptive and innate immune reactions which lead to the formation of inflammation and nasal polyp growth. Further studies should focus on the development of novel therapeutic strategies, such as biologics, bacteriophages, probiotics, and nanomedicine, which could be used to treat S. aureus and its immunological consequences in the future.

KEYWORDS:

• Chronic rhinosinusitis
• biologics
• nasal polyps
• Staphylococcus aureus
• pathophysiology

Article highlights

• Staphylococcus aureus plays an essential role in the pathophysiology of uncontrolled severe chronic rhinosinusitis with nasal polyps.

• With multiple virulence factors, S. aureus can break the nasal mucosal epithelial barrier, impair the clearance of the host immune system, and trigger adaptive and innate immune reactions.

• Type 2 targeted biologics have the potential to inhibit S. aureus-induced inflammation and, consequently, colonization.

• Novel therapeutic strategies are urgently needed.

Declaration of interest

C Bachert: Advisory Board member and speaker for Novartis, GSK, Astra-Zeneca, Sanofi, ALK, and Mylan. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One peer reviewer has received payment for lectures on Sinupret, a herbal product used to treat patients with rhinosinusitis. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contribution

NZ, CB conceptualized and supervised the study. ZX, JY searched the literature and drafted the manuscript. WW, NZ, CB reviewed and revised the important intellectual content. All authors approved the final manuscript for publication.

Additional information

Funding

This manuscript was supported by grants from the National Natural Science Foundation of China (8201001110). This study was also supported by grants from the National Natural Science Foundation of China (8201001110) and grants from Guangzhou Municipal Science and Technology Bureau (2023A04J2201).