title: Chronic rhinosinusitis pathogenesis.
abstract: There are a variety of medical conditions associated with chronic sinonasal inflammation, including chronic rhinosinusitis (CRS) and cystic fibrosis. In particular, CRS can be divided into 2 major subgroups based on whether nasal polyps are present or absent. Unfortunately, clinical treatment strategies for patients with chronic sinonasal inflammation are limited, in part because the underlying mechanisms contributing to disease pathology are heterogeneous and not entirely known. It is hypothesized that alterations in mucociliary clearance, abnormalities in the sinonasal epithelial cell barrier, and tissue remodeling all contribute to the chronic inflammatory and tissue-deforming processes characteristic of CRS. Additionally, the host innate and adaptive immune responses are also significantly activated and might be involved in pathogenesis. Recent advancements in the understanding of CRS pathogenesis are highlighted in this review, with special focus placed on the roles of epithelial cells and the host immune response in patients with cystic fibrosis, CRS without nasal polyps, or CRS with nasal polyps.
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Whitney W
authors.initials: WW
authors.lastname: Stevens
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: rpschleimer@northwestern.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schleimer
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Philadelphia Veterans Affairs Medical Center, Surgical Service, Philadelphia, Pa; Monell Chemical Senses Center, Philadelphia, Pa.
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
mesh_terms: D000818:Animals; D002908:Chronic Disease; D006801:Humans; D018836:Inflammation Mediators / Q000276:immunology; D064307:Microbiota; D009079:Mucociliary Clearance; D010455:Peptides / Q000276:immunology; D012220:Rhinitis / Q000276:immunology* / Q000382:microbiology; D012852:Sinusitis / Q000276:immunology* / Q000382:microbiology
chemical_list: D018836:Inflammation Mediators; D010455:Peptides
keywords: Chronic rhinosinusitis; epithelial cells; inflammation; microbiome; mucociliary clearance; nasal polyps