Immunological mechanisms and treatable traits of chronic rhinosinusitis in Asia: A narrative review

Abstract

Objectives: To review the current literature on immunological mechanisms and treatable traits of chronic rhinosinusitis (CRS) in Asia.Design: This is a narrative review of published data on the immunological mechanisms and treatable traits of CRS in Asia. Published English literature on CRS in Asian and Western countries was reviewed. Where available, the data extracted included epidemiology, immunology, bacterium, phenotype, endotype and treatment. Results and Conclusion: CRS is a heterogeneous disease characterised by persistent locoregional mucosal inflammation of the paranasal sinuses. The inflammatory signatures of CRS vary across patients with distinct racial and ethnic backgrounds and geographic areas. Compared to CRS patients in Western countries, Asian CRS patients display less eosinophilic and Type 2 inflammation, which is associated with lower asthma and allergic rhinitis comorbidities. In contrast, Asian patients with CRS have more prominent non-eosinophilic inflammation than those in Western countries. In addition, Asian CRS patients may have different bacterial colonisation than patients in Western countries. Our review suggests that the distinct immunological mechanisms between Asian and Western CRS patients may influence the clinical phenotype, responses to treatment and outcomes. The treatable trait is a new strategy and therapeutic target identified by phenotype or endotype and has been proposed as a new paradigm for the management of diseases. Improved understanding of CRS phenotypic and endotypic heterogeneity and incorporation of treatable traits into clinical care pathways may facilitate more effective selections of therapeutic interventions, including surgery and biologics.

Biologics for Chronic Rhinosinusitis—A Modern Option for Therapy

“…Type 2 endotype is predominantly displayed in patients with CRSwNP in Western countries, whereas a mixed type 2 endotype is predominantly displayed on the Asian continent [4]. In addition to distinct immunological mechanisms between Asian and Western CRSwNP patients, different bacterial colonization was noticed [5]. Another way to endotype CRS is to use histopathology: paucigranulocytic, eosinophilic, neutrophilic and mixed granulocytic [6].…”

Comprehensive analysis of mitophagy-related genes in diagnosis and heterogeneous endothelial cells in chronic rhinosinusitis: based on bulk and single-cell RNA sequencing data

“…CRS is a common inflammatory condition affecting the paranasal sinuses and nasal mucosa, with a complex pathophysiology involving microbial, immunological, and inflammatory responses (Yao et al, 2023). Despite extensive Frontiers in Genetics frontiersin.org research, the exact etiology of CRS remains unclear, presenting significant challenges in the diagnosis and management of the condition (Kato et al, 2022).…”

Treatable traits models of care

“…Advantages of this label free approach are that the diagnosis does not need to be clearly established to commence the patient on the best treatments, as this is guided by the individuals' identified traits 1,20 . It also means that this approach is adaptable to different health care settings, 17,34 and as we have seen, to other patient populations with respiratory disease 2,3,5,35,36 …”

“…1,20 It also means that this approach is adaptable to different health care settings, 17,34 and as we have seen, to other patient populations with respiratory disease. 2,3,5,35,36 The first RCT of a comprehensive treatable traits model of care was in a tertiary care population of adults with severe asthma. 26 Traits were identified using a multidimensional assessment, a multidisciplinary care plan targeting the traits was developed and implemented using a shared decision approach (described later).…”