Precision medicine in chronic rhinosinusitis – using endotype and endotype-driven therapeutic options

ABSTRACT

Introduction

Chronic rhinosinusitis (CRS) is a heterogeneous disease, and its complex pathophysiological characteristics pose a challenge to its clinical treatment. CRS is distinguished not only by clinical phenotype but also by endotype characteristics, which are divided into type 2 CRS and non-type 2 CRS.

Areas covered

In this review, we summarize and discuss current studies that depict the mechanisms and endotypes of CRS. In particular, inflammatory cells and the microbiome play a role in the pathophysiology of CRS. We also listed some of the biomarkers described in recent studies that may serve as a theoretical foundation for additional investigations. We have summarized the advantages and disadvantages of existing treatments and listed the available biological treatments for CRS in detail.

Expert opinion

Endotype-driven therapeutic options face many challenges because of the complexity of the disease. Glucocorticoids, nasal endoscopic surgery, and biological therapy are the main treatments used in clinical practice, but they have limitations. This review provides advice on the clinical management and treatment options for patients with different endotypes, which will be more conducive to improving the quality of life and reducing the financial burden on patients.

KEYWORDS:

• biologics
• chronic rhinosinusitis
• endotype
• inflammatory cells
• microbiome

Article highlights

• Different endotypes (type 1, type 2, and type 3) are the key to studying CRS.

• The investigation of CRS endotypes covers the mechanisms of inflammatory cells, typical biomarkers, and the microbiome.

• Clinicians need to choose the appropriate treatments based on the patient’s endotype characteristics.

• Although there have been tremendous advancements in biological therapy for the treatment of CRSwNP, multidisciplinary decision-making is still necessary to choose which antibody type to use (anti-IgE, anti-IL-4/13 receptor, or anti-IL-5/IL-5 receptor).

• The application of these study findings to clinical treatment should be the focus of future investigations.

Declaration of interest

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

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by grants from the National Key R&D Program of China (2022YFC2504100), the Program for the Changjiang Scholars and Innovative Research Team (IRT13082), the National Natural Science Foundation of China (81970852, 82000962, and 82171110), the Beijing Natural Science Foundation (7222024), the CAMS Innovation Fund for Medical Sciences (2019-I2M-5-022), the Beijing Municipal Science & Technology Commission (Z211100002921057) and Capital’s Funds for Health Improvement and Research (2022-1-1091), the Beijing Bai-Qian-Wan talent project (2019A32), the Interdisciplinary cooperation project of Beijing Science and Technology Star (20220484226), Beijing Hospitals Authority Youth Programme (QML20230201), and the Public Welfare Development and Reform Pilot Project (2019-10).