Clinical features and endotypes in Chronic Rhinosinusitis: an exploratory study

Mira Pratas, Catarina (2021) Clinical features and endotypes in Chronic Rhinosinusitis: an exploratory study. Doctoral thesis, University of East Anglia.

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Chronic Rhinosinusitis (CRS) is a complex immune-mediated chronic condition of the upper respiratory system characterised by a variable clinical course and presentation. Clinically it is characterised into CRS with and without polyps (CRSwNP and CRSsNP, respectively). The work described within this thesis aimed to help further advance the understanding of the pathophysiology of CRS, with a focus on biomarkers that optimize patient and treatment selection, and predict therapeutic response. Studies were conducted to identify relevant biomarkers in CRS patients. The first study investigated the clinical features of CRS patients to assess whether there were factors associated with pre- and post-operative compliance. Secondly, biomarkers were identified through a literature search to determine which would be good candidates for this preliminary study. Finally, to determine if identified biomarkers had potential for future clinical application, we explored this set of biomarkers to be used in a clinical trial of CRS patients comparing medical and surgical treatment options. Concurrently, we examined the effects of clarithromycin on the in-vitro expression of selected biomarkers in CRS.

The first study demonstrated that duration of disease, nasal allergy and presence of comorbidities were related to pre- and post-compliance in CRS patients. A total of 36 biomarkers were identified by the literature search. These biomarkers were assessed for their ability to determine endotypes through cluster analysis. From this, CRS was divided into six clusters. Periostin and IL-31 were identified as cut-off points by tree analysis. Our in-vitro results suggested that clarithromycin may be of value in decreasing IL-8 at 4h. These results offer some preliminary data for further research.

In conclusion, these studies add evidence to support the hypothesis that endotypes provide insight into the pathophysiology of CRS, and enable researchers and clinicians to better characterise and select optimal treatment options in CRS patients.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 21 Jun 2022 07:13
Last Modified: 31 Dec 2023 01:38


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