Lam Kent, Kern Robert C, Luong Amber
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at, The University of Texas Health Science Center at Houston, Houston, TX.
Int Forum Allergy Rhinol. 2016 Sep;6(9):935-42. doi: 10.1002/alr.21780. Epub 2016 Apr 22.
Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory condition of the sinonasal mucosa consisting of poorly defined subtypes and characterized by variable clinical manifestations, responses to therapy, and underlying pathophysiologies. In the related disorder of asthma, progress has been made in defining disease subtypes on both clinical and pathophysiologic levels, facilitating the development of targeted biologic pharmacotherapy. The potential role of these drugs for the management of CRS will be reviewed. The objective of this work is to highlight the emerging therapeutic targets in CRS in light of evolving treatment options for asthma and enhanced understandings of the clinical manifestations and pathophysiology of CRS.
This article is a review of recent studies regarding current and future advances in biomarker-directed therapies in the medical treatment of CRS.
Various biologic therapies used in the management of asthma have demonstrated clinical promise for CRS, particularly within the CRS with nasal polyposis (CRSwNP) phenotype. Several randomized, double-blind, placebo-controlled studies increasingly support the targeting of immunoglobulin E (IgE) and interleukin (IL)-5 pathways to improve outcome measures in CRSwNP patients. The IL-4/IL-13 pathway and other type 2 inflammatory pathways have also shown potential as targets for CRSwNP, but all pathways require further investigation.
Recalcitrant CRS in the United States and Europe is most commonly associated with nasal polyposis and a type 2 cytokine skewing in the tissue, resulting in tissue infiltration of eosinophils, mast cells, and basophils. Targeting biomarkers of the associated type 2 pathways may be a practical treatment option for recalcitrant CRSwNP in the future.
慢性鼻-鼻窦炎（CRS）是一种鼻窦黏膜的异质性炎症性疾病，其亚型定义不明确，临床表现、对治疗的反应及潜在病理生理学各不相同。在相关的哮喘疾病中，在临床和病理生理学层面定义疾病亚型方面已取得进展，这促进了靶向生物药物治疗的发展。将对这些药物在CRS治疗中的潜在作用进行综述。这项工作的目的是鉴于哮喘治疗选择的不断发展以及对CRS临床表现和病理生理学的深入理解，突出CRS中新兴的治疗靶点。
本文是对近期关于CRS药物治疗中生物标志物导向治疗的现状和未来进展的研究综述。
用于哮喘治疗的各种生物疗法已显示出对CRS具有临床应用前景，特别是在伴有鼻息肉的CRS（CRSwNP）表型中。多项随机、双盲、安慰剂对照研究越来越支持针对免疫球蛋白E（IgE）和白细胞介素（IL）-5通路，以改善CRSwNP患者的疗效指标。IL-4/IL-13通路和其他2型炎症通路也显示出作为CRSwNP治疗靶点的潜力，但所有通路都需要进一步研究。
在美国和欧洲，难治性CRS最常与鼻息肉及组织中2型细胞因子失衡有关，导致嗜酸性粒细胞、肥大细胞和嗜碱性粒细胞浸润组织。针对相关2型通路的生物标志物可能是未来难治性CRSwNP的一种实用治疗选择。
