Some immunological aspects of targeted therapy in polypous rhinosinusitis

Abstract

Over the past decade, targeted therapy with various monoclonal antibodies has become particularly relevant for the treatment of chronic polypous rhinosinusitis (PR). This is primarily due to the high incidence rate, polyetiological origin and pathogenetic features of polyposis development, low effectiveness of existing treatment approaches, the tendency for relapse, and comorbid conditions. The article provides a brief historical background concerning various predictors of the mucous membrane remodeling in the nasal cavity and paranasal sinuses at the stages of the polyposis formation thus justifying the need for implementation of monoclonal antibodies in the treatment schedules. Considering the leading role of Th2-inflammation in immunopathogenesis of developing polypous vegetations, the influence of targeted therapy upon treatment of chronic polypous rhinosinusitis is theoretically evaluated, and we highlight some important issues that should be further specified. Undoubtedly, inhibition of the synthesis of necessary interleukins leads to improvement in clinical symptoms and reduced size of polypous vegetations. At the same time, the real biochemical transformations of the nasal mucosa have been scarcely studied. E.g., an attempt to inhibit some cytokine may lead to indirect blockage of other pro-inflammatory cytokines. In future, it is necessary to study the pharmacodynamics of targeted drugs in order to clarify distinct contraindications to their use.