Tan Bruce K, Schleimer Robert P, Kern Robert C
Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):21-6. doi: 10.1097/MOO.0b013e3283350053.
This article reviews recent insights surrounding the etiology and pathogenesis of chronic rhinosinusitis. In particular, we highlight the increasing recognition of host-mediated mechanisms in driving mucosal inflammation.
Published differences between epithelium from patients with chronic rhinosinusitis and normal controls can be classified into several broad categories. Alterations are reported in the various components of the epithelial innate immune system including epithelial-expressed pattern-recognition receptors (PRRs) and the levels of antimicrobial innate immune effector molecules. Other studies demonstrate differences in the proteins involved in maintaining epithelial barrier integrity. Finally, recent studies show in chronic rhinosinusitis that epithelial-derived cytokines, chemokines and inducible surface proteins are involved in recruiting and activating cells of the adaptive immune system.
The sinonasal epithelium provides a mechanical and innate immune barrier to a diverse array of environmental agents. This barrier also plays a key role in regulating the acquired mucosal immune response in the nose. Recent studies suggest that defects in this barrier may foster development of chronic sinonasal inflammation in response to environmental agents, and pathogenic or commensal organisms. The ability to dissect and analyze defects in the inflammatory response in rhinosinusitis may help identify novel targets for drug development.
本文综述了有关慢性鼻-鼻窦炎病因和发病机制的最新见解。特别强调了宿主介导机制在驱动黏膜炎症方面日益受到重视。
已发表的慢性鼻-鼻窦炎患者上皮与正常对照上皮之间的差异可分为几大类。据报道，上皮固有免疫系统的各个组成部分存在改变，包括上皮表达的模式识别受体（PRR）和抗菌固有免疫效应分子的水平。其他研究表明，在维持上皮屏障完整性的相关蛋白方面存在差异。最后，最近的研究表明，在慢性鼻-鼻窦炎中，上皮衍生的细胞因子、趋化因子和诱导性表面蛋白参与了适应性免疫系统细胞的募集和激活。
鼻窦上皮为多种环境因素提供了机械和固有免疫屏障。该屏障在调节鼻腔获得性黏膜免疫反应中也起着关键作用。最近的研究表明，这一屏障的缺陷可能促使鼻腔对环境因素、致病或共生生物产生慢性炎症。剖析和分析鼻-鼻窦炎炎症反应中的缺陷，可能有助于确定药物研发的新靶点。
