Biomarkers in Chronic Rhinosinusitis with Nasal Polyp: Personalized Medicine Based on Endotype / 대한이비인후과학회지

ABSTRACT

Chronic rhinosinusitis (CRS) is divided into CRS with nasal polyp (CRSwNP) and CRS without nasal polyp (CRSsNP) according to the presence of a nasal polyp. Some of the CRSwNP patients are relatively well managed without recurrences while others are difficult due to recurrence and refractoriness after surgical or medical treatment. Thus CRSwNP is not a single disease but is rather considered as a disease that has a variety of disease spectrum. Various biomarkers have been proposed to distinguish endotypes of CRSwNP. CRSwNP with high tissue eosinophil infiltration with robust type 2 inflammation (e.g., IL-5) is usually associated with comorbid asthma and is likely to recur. This type of CRSwNP is relatively common in Western countries. However, in Asian countries, CRSwNP is often presented as a heterogeneous disease comprising a mixture of type 1 (e.g., IFN-γ), type 2 and type 3 (e.g., IL-17) inflammation. In Asians, up-regulation of IL-8, IFN-γ and associated neutrophilic inflammation is prone to have disease refractoriness. Different underlying inflammatory profile indicates different underlying pathogenesis. Therefore, in the era of precision medicine, treatment should be based upon according to endotype.