REVIEW article
Front. Allergy
Sec. Rhinology
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1599797
This article is part of the Research TopicStrategic Selection of Biologic Therapies in CRSwNP ManagementView all 3 articles
The advance on pathophysiological mechanisms of type 2 chronic rhinosinusitis with nasal polyposis
Provisionally accepted
- 1Department of Otorhinolaryngology, University of Electronic Science and Technology Hospital, Chengdu, China
- 2University of Electronic Science and Technology Hospital, Chengdu, Sichuan Province, China
- 3Department of Otolaryngology, Head and Neck Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
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Purpose This review aims to explore the pathophysiological mechanisms and emerging therapies for type 2 chronic rhinosinusitis with nasal polyps (CRSwNP), driven primarily by type 2 inflammation.Search Methods A comprehensive search of relevant literature was performed in databases including PubMed, Web of Science, and Scopus, using keywords such as "chronic rhinosinusitis with nasal polyps", "type 2 inflammation", "Th2 cells", "ILC2s", "epithelial barrier dysfunction", and "biologics". The search was limited to articles published from January 2010 to February 2025.Search Results .A total of 200 articles were initially retrieved. After screening based on relevance and quality, 163 articles were selected for this review. These included 109 basic research papers, 30 clinical studies, and 24 review articles.Conclusions Type 2 CRSwNP pathogenesis involves Th2/ILC2-IL-4/IL-13 synergy, driving eosinophilic inflammation and tissue remodeling via a self-amplifying loop. PD-1/PD-L1 dysregulation intensifies Th2 responses. Epithelial barrier defects (via disrupted junctions and ciliary defects) and epithelial-mesenchymal transition (EMT) facilitate pathogen invasion and stromal changes. M2 macrophages amplify inflammation via CCL-24 and Staphylococcus aureus synergy, sustaining biofilm persistence. Targeted biologics—dupilumab (IL-4Rα inhibitor) reduces polyp burden and restores smell, while mepolizumab (anti-IL-5) and omalizumab (anti-IgE) address specific endotypes. Despite therapeutic advances, biologics require real-world validation for long-term safety and cost-effectiveness.
Keywords: Chronic rhinosinusitis with nasal polyposis (CRSwNP), Type 2 T helper cells (Th2), Type 2 innate lymphoid cells (ILC2s), Epithelial barrier dysfunction, biologics
Received: 25 Mar 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Yang, Guo, Wang, Jiang, Chen and Gu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Cheng Yang, Department of Otorhinolaryngology, University of Electronic Science and Technology Hospital, Chengdu, China
Qingjia Gu, Department of Otolaryngology, Head and Neck Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
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