Subpopulation and functional activity of regulatory T-lymphocytes in patients with chronic polyposis rhinosinusitis

   Overcoming therapeutic resistance in chronic polypous rhinosinusitis (CRS) is directly linked to the recognition of its immunological heterogeneity. The modern paradigm views CRS as a spectrum of distinct endotypes (Th1, Th2, Th17), each requiring a specific targeted approach, making detailed immune profiling the cornerstone of personalized treatment strategies.

   Objective. To study the numerical composition and functional activity of T-regulatory lymphocytes at different stages of differentiation depending on the immune response type in patients with chronic polypous rhinosinusitis.

   Materials and Methods. The study included 44 patients suffering from chronic polypous rhinosinusitis. The control group consisted of 20 patients without chronic rhinosinusitis and concomitant pathology who underwent septoplasty. Using cluster analysis (k-means), all patients were divided into three clusters: 1^st – patients with T helper 1 type immune response, 2^nd – T helper 2 type, 3^rd – T helper 17 type immune response. The content of Treg cells with the CD4+CD25hiCD127low phenotype in the venous blood of the subjects and the levels of cytokines (IL-2, IL-6, IL-10, TGF-β1, TNF-α) in blood serum and tissue homogenates were studied using the multiplex analysis system "Human Essential Immune Response Panel" by Biolegend (USA).

   Results. The total number of Treg was increased in Th-2 and Th-1 immune responses, while it was minimal in the Th-17 response. The pool of naive Treg was preserved only in the Th-2 immune response. A progressive decrease in memory Treg was observed from the Th-1/Th-2 to the Th-17 response. Systemic disturbances in cytokine balance have been identified, explaining various mechanisms of pathogenesis of nasal polyps formation with different types of immune response.

   Conclusion. Differences in the state of the immune regulatory system were established in patients with various immune endotypes of chronic polypous rhinosinusitis, manifested both at the level of cellular composition and the functional activity of T regulatory lymphocytes, which have a divergent nature depending on the CRS immune endotype. The concordance of changes in the cellular and cytokine profiles in peripheral blood and polyp tissue confirms the systemic nature of immunopathological disorders in CRS.

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