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Chronic rhinosinusitis: Endotypes, biomarkers, and treatment response

内型 医学 美波利祖马布 重症监护医学 精密医学 哮喘 苯拉唑马布 微生物群 鉴定(生物学) 机制(生物学) 生物信息学 免疫学 嗜酸性粒细胞 病理 生物 植物 哲学 认识论
作者
José Gurrola,Larry Borish
出处
期刊:The Journal of Allergy and Clinical Immunology [Elsevier BV]
卷期号:140 (6): 1499-1508 被引量:108
标识
DOI:10.1016/j.jaci.2017.10.006
摘要

It is increasingly recognized that chronic rhinosinusitis (CRS) comprises a spectrum of different diseases with distinct clinical presentations and pathogenic mechanisms. Defining the distinct phenotypes and endotypes of CRS affects prognosis and, most importantly, is necessary as the basis for making therapeutic decisions. The need for individualized definitions of pathogenic mechanisms before initiating therapy extends to virtually all therapeutic considerations. This is clearly crucial with antibiotics, where, barring an influence from their off-target anti-inflammatory pharmacologic effects, an understanding of the role of the individual biome predicts likelihood of therapeutic benefit. However, this need for identifying individual phenotypes and endotypes also extends to the agent that is currently considered the mainstay of treatment of CRS, specifically glucocorticoids. As with asthma, it is recognized that a large minority of patients with CRS have a steroid-resistant phenotype, identification of which will preclude use of these agents with their potential side effects. Identification of endotypes is also becoming increasingly imperative because targeted biotherapeutic agents, such as anti-IgE and anti-cytokine antibodies, are becoming available. These agents are likely to benefit patients in whom the targeted mediator is not only expressed but demonstrably driving a central mechanism in that patient. In summary, the treatment of CRS is at an exciting crossroad. On the positive side, numerous therapeutics are in development that seem likely to have a positive effect in our patients with this condition. The challenge is that these therapies will require targeted individualized treatments based on identifying subjects with the relevant endotype.
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