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2017 ; 12
(ä): 331-357
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Immunopathogenesis of Chronic Rhinosinusitis and Nasal Polyposis
#MMPMID27959637
Schleimer RP
Annu Rev Pathol
2017[Jan]; 12
(ä): 331-357
PMID27959637
show ga
Chronic rhinosinusitis (CRS) is a troublesome, chronic inflammatory disease that
affects over 10% of the adult population, causing decreased quality of life, lost
productivity, and lost time at work and leading to more than a million surgical
interventions annually worldwide. The nose, paranasal sinuses, and associated
lymphoid tissues play important roles in homeostasis and immunity, and CRS
significantly impairs these normal functions. Pathogenic mechanisms of CRS have
recently become the focus of intense investigations worldwide, and significant
progress has been made. The two main forms of CRS that have been long recognized,
with and without nasal polyps, are each now known to be heterogeneous, based on
underlying mechanism, geographical location, and race. Loss of the immune
barrier, including increased permeability of mucosal epithelium and reduced
production of important antimicrobial substances and responses, is a common
feature of many forms of CRS. One form of CRS with polyps found worldwide is
driven by the cytokines IL-5 and IL-13 coming from Th2 cells, type 2 innate
lymphoid cells, and probably mast cells. Type 2 cytokines activate inflammatory
cells that are implicated in the pathogenic mechanism, including mast cells,
basophils, and eosinophils. New classes of biological drugs that block the
production or action of these cytokines are making important inroads toward new
treatment paradigms in polypoid CRS.