Pathophysiologie der chronischen Rhinosinusitis, konservative Therapieoptionen

Zusammenfassung

Die immunologische Forschung hat in den letzten 2 Jahrzehnten enorme Fortschritte gemacht, die auch für die oberen Atemwege von großer Bedeutung sind. Unser Verständnis zur Pathophysiologie der chronischen Rhinosinusitis hat sich damit von eher mechanistischen Betrachtungen bzgl. Engstellen und mukoziliärem Transport zu einer neuen sehr komplexen immunologischen Sichtweise entwickelt. Wir differenzieren heute mehrerer Entzündungsformen, wir beginnen komplexe Netzwerke aus immunologischen Faktoren und die Gründe einer Fehlregulation zu verstehen, und haben daraus bereits erste innovative Therapieansätze entwickelt, die v. a. den am schwersten betroffenen Patienten zugutekommen können. Durch die neuen Erkenntnisse zu Entzündungsformen und Gewebeumbau und vor allem die Identifikation der Schlüsselfaktoren ergeben sich Konsequenzen für die Diagnostik und die Therapie der chronischen Rhinosinusitis; die Einteilung in Endotypen entsprechend den die Erkrankung treibenden Entzündungsmediatoren ist unabdingbar für einen sinnvollen Einsatz der innovativen Arzneimittel, meist in Form von humanisierten monoklonalen Antikörpern. Mehrere hundert solcher Antikörper sind derzeit in verschiedenen Indikationen bereits im Einsatz oder in Entwicklung und werden unser Fach ebenso wie z. B. die Pneumologie entscheidend beeinflussen.

Abstract

Research in immunology has brought great progress in knowledge of inflammatory processes in the last 2 decades, which also has an impact on the upper airways. Our understanding of the pathophysiology of chronic rhinosinusitis developed from a rather mechanistic point of view with a focus on narrow clefts and mucociliary clearance to the appreciation of a complex network of immunological pathways forming the basis of disease. We today differentiate various forms of inflammation, we start to understand complex immune-regulatory networks and the reasons for their failure, and have already developed innovative approaches for therapy for the most severely ill subjects. Due to this new knowledge in inflammation and remodeling processes within mucosal tissue, specifically on the key driving factors, new diagnostic tools and therapeutic approaches for chronic rhinosinusitis have developed; the differentiation of endotypes based on pathophysiological principles will be crucial for the use of innovative therapies, mostly humanized monoclonal antibodies. Several hundred of those antibodies are currently developed for various indications and will impact our speciality as well as pneumology to a great extent.

Schlüsselwörter

Chronische Rhinosinusitis - Pathophysiologie - Klusteranalyse - Phänotypen - Endotypen - Staphylococcus aureus - Biologika

Key words

Chronic rhinosinusitis - pathophysiology - cluster analysis - phenotypes - endotypes - Staphylococcus aureus - biologics

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