The role of innate immunity in the development of chronic rhinosinusitis and perspectives of its conservative management

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Abstract

Chronic rhinosinusitis (CRS) is a heterogeneous, multifactorial disease of unknown etiology, with an underlying deficient immune response to infectious and other triggers, leading to their incomplete elimination and persistence of inflammation. Development of CRS is made possible by a deficient response of the innate immunity of nasal and paranasal sinus mucosa. The main factors of non-specific defense system of nasal and paranasal mucosa are the function of cell junctions between epithelial cells, mucociliary clearance, pattern recognition receptors (PRRs), antigen presenting cells, and phagocytosis. The multirowed ciliate epithelium of nasal and paranasal sinus mucosa is covered by a thick layer of mucus containing more than 200 proteins. Changes in the qualitative composition of the nasal mucus in CRS manifests in overexpression of the main mucins MUC5AC and MUC5B and decreased synthesis of lactoferrin and lyzocin. Ciliary dyskinesia or abnormalities in their microstructure lead to decreased efficacy of mucociliary clearance. Diminished expression of proteins of tight junctions (TJ) ZO-1 and occluding results in decreased density of intercellular contacts and increased permeability of epithelial barrier. In addition, CRS is characterized by deficient Tolllike receptors (TLR) 9, 2 and 4, as well as increased counts of M2 macrophages in the mucosa. This results in suppressed phagocytosis and antimicrobial mucosal defense. Lower levels of STAT3 protein causes an imbalanced reaction of innate and adaptive immune response and disordered reparation processes. With abnormal functioning of all the above mentioned mechanisms, no immune elimination of infectious agents can take place, with increased susceptibility to viral and bacterial infections of the upper respiratory tract. This opens the door to development of CRS, including that with polyps. Investigation of the innate immunity factors would allow for predicting of inflammation in a given patient, as well as for development of new approaches to its conservative management.

About the authors

V. I. Egorov

Moscow Regional Research and Clinical Institute (MONIKI), Moscow

Email: fake@neicon.ru

Egorov Viktor I. - MD, PhD, Head of Department of Otorhinolaryngology; Head of Chair of Otorhinolaryngology, Postgraduate Training Faculty

Russian Federation

E. L. Savlevich

Central State Medical Academy of Department for Presidential Affairs of the Russian Federation, Moscow

Author for correspondence.
Email: savllena@gmail.com

Savlevich Elena L. - MD, PhD, Associate Professor, Chair of Otorhinolaryngology.

19-1А Marshala Timoshenko ul., Moscow, 121359, Russian Federation. Tel.: +7 (985) 145 27 45. E-mail: savllena@gmail.com Russian Federation

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Copyright (c) 2016 Egorov V.I., Savlevich E.L.

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