Appropriate Medical Therapy Primarily Modifies Type 2 and Severity Biomarkers in Chronic Rhinosinusitis

Area of Science:

• Immunology
• Otolaryngology
• Biomarker Research

Background:

• Chronic rhinosinusitis (CRS) is commonly treated with appropriate medical therapy (AMT).
• Understanding the inflammatory landscape and treatment effects in CRS is crucial for optimizing patient care.
• This study investigates inflammatory structures, treatment-induced changes, and biomarker associations in AMT-managed CRS patients.

Purpose of the Study:

• To evaluate inflammatory profiles and treatment-induced changes in CRS patients undergoing AMT.
• To identify associations between specific biomarkers and clinical outcomes following AMT.
• To determine which inflammatory axes are most responsive to AMT in CRS.

Main Methods:

• Fifty-one CRS patients were assessed before and after AMT (oral antibiotics, oral/intranasal steroids).
• Data collected included SNOT-22, CRS-PRO, BSIT, CT scans (Lund-Mackay Score), and endoscopy (Modified Lund-Kennedy Score).
• Middle-meatal mucus was analyzed for cytokines (IL-1b, IL-5, IL-13, IFN-g, MIP1a); Principal Components Analysis (PCA) identified biomarker axes.

Main Results:

• PCA identified two key inflammatory components: PC-1 (inflammation severity) and PC-2 (endotype axis) characterized by T2 (IL-5, IL-13) and T1/3 (IFN-g, IL-1b) biomarkers.
• AMT significantly reduced inflammatory severity and T2 biomarker levels (IL-5, IL-13, ECP, MIP1a; p < 0.01), with no change in T1/3 biomarkers.
• Clinical outcomes (MLK, SNOT-22, CRS-PRO, BSIT) improved, correlating more strongly with T2 than T1/3 biomarkers.

Conclusions:

• AMT for CRS reduces key biomarkers associated with inflammation severity and the T2 endotype.
• T2-driven inflammation appears to be the primary AMT-responsive pathway in this CRS cohort.
• These findings correlate with significant improvements in endoscopic, patient-reported, and nasal airflow outcomes.