Characterizing endotypes in chronic rhinosinusitis: emerging research and clinical applications

Area of Science:

• Rhinology and Immunology
• Precision Medicine in Respiratory Diseases

Background:

• Endotyping, organizing inflammation by immunology, is now clinically relevant for chronic rhinosinusitis (CRS).
• Targeted biologic therapies have advanced the clinical application of endotyping.
• This review addresses progress and implementation challenges in endotype-based CRS care.

Purpose of the Study:

• To review the timeliness and relevance of endotyping in CRS.
• To highlight recent advancements in CRS endotyping.
• To discuss challenges in integrating endotype-based care into clinical practice.

Main Methods:

• Literature review of recent advancements in CRS endotyping.
• Analysis of different endotyping approaches: cellular, single-biomarker, and multibiomarker assays.
• Examination of machine-learning applications in endotype classification.

Main Results:

• Patients are classified into endotypes like Type 2, Type 1/3, pauci-inflammation, and mixed profiles.
• Endotypes correlate with clinical features, surgical outcomes, and treatment response.
• Histology-based, single-biomarker, and multibiomarker assays are key endotyping strategies.

Conclusions:

• Validated endotypes are essential for selecting appropriate precision biologics in CRS.
• Standardization, cost-effective testing, and clinical validation are critical for widespread adoption.
• Each endotyping method has unique strengths and limitations requiring careful consideration.