Diverse endotypes of chronic rhinosinusitis result in different clinical outcomes

Published: October 19, 2022

Chronic rhinosinusitis (CRS) can result in severe nasal obstruction, mucopurulent secretions, headache, and smell disorder, significantly affecting patients’ work and study. CRS is traditionally classified into two subgroups depending on whether they have nasal polyps. Therefore, there is a need to further subdivide these patients so that a specific therapeutic approach can be designed. Such an approach has divided CRS patients into Type 2 and non-type 2, depending on the underlying immunological mechanism. Since some medications can target type 2 cytokines, they are usually used in such patients. These classifications have not been examined thoroughly in the Chinese population.

In a study by Wang et al. published in The Journal of Allergy and Clinical Immunology (JACI), patients with CRS from northern China were classified into 5 subgroups by 11 inflammatory and 5 remodeling biomarkers. Using these markers, the following subpopulations were identified:

1. Clusters 1 and 2 showed non-type 2 signatures with low biomarker concentrations, except for IL-19 and IL-27.
2. Cluster 3 involved a low type 2 endotype with high neutrophil factors and remodeling factors.
3. Cluster 4 had moderate type 2 inflammation.
4. Cluster 5 had high type 2 inflammation associated with high eosinophils and moderate neutrophil and remodeling factors.
5. The proportion of CRS with nasal polyps, asthma, and recurrence increased from clusters 1 through 5.

Previous studies have focused on inflammatory factors in different endotypes of CRS; however, Wang et al. found that CRS showed diverse features in terms of the inflammatory and remodeling factors in different subgroups. Currently, most therapeutic options target type 2 factors, such as biologics, but not neutrophilic and remodeling factors. Therefore, this study reports a new mechanism combining inflammatory and remodeling factors, offering new treatment options in the future.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI and is the most-cited journal in the field of allergy and clinical immunology.

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