[Justification of a personalized approach to the treatment of patients with recurrent chronic rhinosinusitis with nasal polyps based on cytokine-induced Th2 inflammation (interleukin-4, interleukin-13)].

OBJECTIVE

To investigate the features of cytokine-induced Th2 inflammation (IL-4 and IL-13) in patients with recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) in order to improve therapeutic effectiveness.

MATERIAL AND

METHODS

A total of 74 patients with recurrent CRSwNP and 30 healthy individuals (control group) were examined. Based on the characteristics of sinonasal mucus, patients were divided into two groups: Group I - with liquid mucus (n=39) and Group II - with dense mucus (n=35). Dense mucus was associated with tissue remodeling within the inflammatory focus, an increased risk of intraoperative complications, frequent recurrences, and resistance to standard therapy. Concentrations of IL-4 and IL-13 in lavage fluids were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

Patients with dense mucus exhibited significantly higher concentrations of IL-4 and IL-13 than those with liquid mucus (p<0.05). Elevated IL-13 levels were pathogenetically significant and correlated with the severity of clinical manifestations (p<0.05). High clinical efficacy was observed with dupilumab, a monoclonal antibody that blocks the shared α-subunit of the IL-4 and IL-13 receptor (IL-4Rα) (p = 0.0077).

CONCLUSION

Assessment of key Th2-related cytokines (IL-4 and IL-13) demonstrated their pathogenetic relevance in patients with recurrent CRSwNP and dense mucus. Elevated IL-13 levels were associated with more severe clinical manifestations and mucus densification. Dupilumab therapy showed significant clinical efficacy. Thus, dense mucus may be considered a clinical marker of IL-13-driven pathology and a potential criterion for a personalized approach to targeted biologic therapy.