Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
Institute of Allergy and Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Curr Allergy Asthma Rep. 2023 Dec;23(12):703-713. doi: 10.1007/s11882-023-01114-w. Epub 2023 Nov 21.
Three biologics targeting type 2 inflammation have been approved for the treatment of severe and uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Nevertheless, around 40-60% of patients do not respond well to these biological treatments. Selecting appropriate patients is crucial to improve treatment outcome of biologics. This review summarizes the literature data on type 2 biomarkers, with a specific focus on the indication to biologics for severe CRSwNP.
No consensus has been reached on how to define mucosal type 2 inflammation in CRSwNP. Clinical markers (e.g., 22-item Sino-nasal Outcome Test (SNOT-22) score, Lund-Mackay CT score (LMS), ethmoid/maxillary sinus CT score, and CT-radiomics), nasal secretion biomarkers (e.g., eosinophil cationic protein and interleukin-5), blood and nasal cytology eosinophil counts, and nasal swab eosinophil peroxidase activity have been reported to be associated with type 2 inflammation in CRSwNP. The time duration since the last surgery, SNOT-22 score at 1 week of treatment, and baseline serum osteoprotegerin levels might indicate the response to dupilumab. LMS and asthma control test scores were found to have moderate predictive value for acceptable improvement after 24-week treatment of omalizumab. High blood eosinophil levels at baseline were associated with treatment response to mepolizumab and benralizumab. Although several clinical and biological markers might be associated with type 2 inflammation and response to biologics in patients with CRSwNP, their validity requires further investigation. Identifying clinically applicable biomarkers for biologic treatment holds significant promise for advancing personalized approaches to biologics and optimizing treatment outcomes for patients with CRSwNP.
已有三种靶向 2 型炎症的生物制剂被批准用于治疗严重且控制不佳的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）。然而，约 40-60%的患者对这些生物治疗反应不佳。选择合适的患者对于改善生物制剂的治疗效果至关重要。本文综述了 2 型生物标志物的文献数据，特别关注生物制剂治疗严重 CRSwNP 的适应证。
目前尚未就如何定义 CRSwNP 中的黏膜 2 型炎症达成共识。临床标志物（如 22 项鼻-鼻窦结局测试（SNOT-22）评分、Lund-Mackay CT 评分（LMS）、筛窦/上颌窦 CT 评分和 CT 放射组学）、鼻分泌物生物标志物（如嗜酸性粒细胞阳离子蛋白和白细胞介素-5）、血液和鼻细胞学嗜酸性粒细胞计数以及鼻拭子过氧化物酶活性均与 CRSwNP 中的 2 型炎症相关。最后一次手术的时间间隔、治疗第 1 周的 SNOT-22 评分和基线血清护骨素水平可能提示对度普利尤单抗的反应。LMS 和哮喘控制测试评分对奥马珠单抗治疗 24 周后可接受的改善具有中等预测价值。基线时的高血嗜酸性粒细胞水平与美泊利单抗和贝那利珠单抗的治疗反应相关。尽管几种临床和生物学标志物可能与 CRSwNP 患者的 2 型炎症和对生物制剂的反应相关，但它们的有效性需要进一步研究。确定用于生物治疗的临床适用的生物标志物有望为推进生物制剂的个体化方法和优化 CRSwNP 患者的治疗结果提供重要支持。
