Characterizing endotypes in chronic rhinosinusitis: emerging research and clinical applications.

Abstract

Purpose of review: The purpose of this study is to describe why this review is timely and relevant. Endotyping, the organization of rhinologic inflammation around immunologic precepts, has evolved from a research subject to a clinically relevant tool with the advent of targeted biologics in chronic rhinosinusitis (CRS). This review highlights recent progress but also the challenges to implementing endotype-based care into routine clinical practice.

Recent findings: Describe the main themes in the literature covered by the article. Recent literature demonstrates organization of patients around multiple endotypes, most prominently Type 2, Type 1/3, pauci-inflammation, and mixed inflammatory profiles. Three principal approaches to endotyping have been widely utilized: cellular (histology-based) analysis, single-biomarker, and multibiomarkers assays. Emerging machine-learning models further enhance data-driven multibiomarkers classification. Importantly, developed endotypes demonstrate correlates with key clinical features, postoperative outcomes, and responsiveness to sinus surgery and biologic therapy.

Summary: Describe the implications of the findings for clinical practice or research. Increase use of precision biologics necessitates developing well validated endotypes to better select therapy for patients. Three major approaches - histology-based, single-biomarker, and multibiomarker strategies - are commonly employed, each with distinct advantages and limitations. Moving forward, standardization of methods, development of cost-effective testing, and rigorous clinical validation remain essential steps.