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Immunologie der Polyposis nasi als Grundlage für eine Therapie mit Biologicals

Immunology of chronic rhinosinusitis with nasal polyps as a basis for treatment with biologicals

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Zusammenfassung

Hintergrund

Die chronische Rhinosinusitis (CRS) ist eine heterogene und multifaktorielle entzündliche Erkrankung der nasalen und paranasalen Schleimhäute. Bis heute konnte keine international standardisierte einheitliche Klassifikation hierfür entwickelt werden.

Meist wird eine Phänotypklassifikation nach CRS mit (CRScNP) und ohne Polyposis (CRSsNP) vorgenommen. Durch eine Vielzahl von Studien konnte aber gezeigt werden, dass auch innerhalb dieser Phänotypen verschiedene Endotypen der CRS existieren, denen eine unterschiedliche entzündliche Pathophysiologie zugrunde liegt. In diesem Review sollen die wesentlichen immunologischen Vorgänge bei CRScNP dargestellt und hieraus abgeleitete moderne Therapiemöglichkeiten mit Biologika aufgezeigt werden.

Methoden

Das aktuelle Wissen zu den immunologischen und molekularen Prozessen der CRS, speziell der CRScNP, wurde mittels einer strukturierten Literaturanalyse durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library zusammengestellt.

Ergebnisse

Basierend auf der derzeitigen Literatur wurden die verschiedenen immunologischen Prozesse bei CRS und nasalen Polypen herausgearbeitet. Aktuelle Studien zur Therapie eosinophiler Erkrankungen wie Asthma und Polyposis werden vorgestellt und – falls bereits vorhanden – deren Ergebnisse diskutiert.

Schlussfolgerung

Das Verständnis über die immunologischen Grundlagen der CRScNP kann dazu beitragen, neue personalisierte Therapieansätze mittels Biologika zu entwickeln.

Abstract

Background

Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammation of the nasal and paranasal mucosa. Until now, no internationally standardized classification could be developed. In most cases, CRS is phenotypically classified according to chronic rhinosinusitis with (CRScNP) and without nasal polyps (CRSsNP). However, recent studies could show that there are numerous endotypes within these phenotypes based on different inflammatory mechanisms. This review describes the important immunological mechanisms of CRScNP and highlights modern treatment options with biologicals directly addressing particular immunological processes.

Methods

Current knowledge on immunological and molecular processes of CRS, particularly CRScNP, was extracted from Medline, PubMed, national and international study- and guideline-registers, and the Cochrane library by a systematic review of the literature.

Results

Based on current literature, various immunological mechanisms for CRS and CRScNP could be identified. Relevant studies for the treatment of eosinophilic conditions such as asthma or CRScNP are presented and, if available, results of these studies are discussed.

Conclusion

The growing insight into the underlying immunological mechanisms of CRScNP could pave the way for new personalized treatment options such as biologicals in the future.

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Authors and Affiliations

  1. Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183, Wiesbaden, Deutschland

    L. Klimek

  2. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Koennecke & B. Wollenberg

  3. Hals‑, Nasen‑, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland

    J. Hagemann & S. Becker

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Klimek, L., Koennecke, M., Hagemann, J. et al. Immunologie der Polyposis nasi als Grundlage für eine Therapie mit Biologicals. HNO 67, 15–26 (2019). https://doi.org/10.1007/s00106-018-0557-7

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