Integration of Approaches to Studying the Microbiota in Chronic Rhinosinusitis: The Path Toward Etiological Therapy

Chronic rhinosinusitis (CRS) is a complex, heterogeneous inflammatory disease in which dysregulated interactions between the host immune system and local microbiota play a central pathogenic role. The aim of this review is to shift the scientific paradigm from the traditional concept of simple bacterial infection toward the dysbiosis hypothesis – an ecological imbalance characterized by loss of microbial diversity, disruption of protective commensal networks, and dominance of pathogenic microorganisms. We discuss in detail the role of key pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa, their capacity to form biofilms, and the association between microbiota composition and distinct immune endotypes of the disease (T2-mediated eosinophilic and non-T2 neutrophilic inflammation). Material and methods. We critically evaluate current methodological approaches to studying the sinus microbiome, including a comparison of conventional culture-based techniques and 16S rRNA gene sequencing technologies. Particular attention is paid to the challenges of standardizing sample collection and the need to implement functional methods such as metatranscriptomics to distinguish metabolically active microorganisms from extracellular DNA. A significant portion of the review is devoted to microbial interactions that perpetuate chronic inflammation. We describe the role of anaerobic bacteria (genera Peptoniphilus, Prevotella) in mucin fermentation and production of short-chain fatty acids, which may serve as nutritional substrates promoting pathogen growth. Results on analysis of preclinical in vivo models, we justify the potential of rabbit models for microbiota research due to their anatomical similarity to humans, in contrast to mouse models, which have significant limitations. Conclusion. In the final section, we outline future therapeutic strategies aimed at restoring a stable sinus ecosystem, including the use of probiotics, microbial metabolites, and nasal microbiota transplantation — paving the way toward personalized medicine in CRS.
Keywords: microbiota, chronic rhinosinusitis, comprehensive studies, respiratory tract, cultivation of microbial communities
Conflict of interest. The authors declare that there is no conflict of interest.
Financing. The study was supported by a grant from the Russian Science
Foundation, No. 24-75-10028, dated July 31, 2024. https://rscf.ru/project/24-75-10028.