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Background: Nasal epithelial cells are important regulators of barrier function and immune signaling; however, in allergic rhinitis (AR) these functions can be disrupted by inflammatory mediators. We aimed to better discern AR disease mechanisms using transcriptome data from nasal brushing samples from individuals with and without AR. Methods: Data were drawn from a feasibility study of individuals with and without AR to Timothy grass and from a clinical trial evaluating 16 weeks of treatment with the following: dupilumab, a monoclonal antibody that binds interleukin (IL)‐4Rα and inhibits type 2 inflammation by blocking signaling of both IL‐4/IL‐13; subcutaneous immunotherapy with Timothy grass (SCIT), which inhibits allergic responses through pleiotropic effects; SCIT + dupilumab; or placebo. Using nasal brushing samples from these studies, we defined distinct gene signatures in nasal tissue of AR disease and after nasal allergen challenge (NAC) and assessed how these signatures were modulated by study drug(s). Results: Treatment with dupilumab (normalized enrichment score [NES] = −1.73, p =.002) or SCIT + dupilumab (NES = −2.55, p <.001), but not SCIT alone (NES = +1.16, p =.107), significantly repressed the AR disease signature. Dupilumab (NES = −2.55, p <.001), SCIT (NES = −2.99, p <.001), and SCIT + dupilumab (NES = −3.15, p <.001) all repressed the NAC gene signature. Conclusion: These results demonstrate type 2 inflammation is an important contributor to the pathophysiology of AR disease and that inhibition of the type 2 pathway with dupilumab may normalize nasal tissue gene expression. [ABSTRACT FROM AUTHOR]

The article examines the impact of the IL-4-IL-4Rα axis on olfactory neuroimmune signaling and its role in inducing loss of smell. Through studies on mice and human translational data, the research reveals that IL-4 disrupts olfactory sensory neurons' responsiveness to odors, leading to neuroinflammation and immune responses in the olfactory epithelium. The findings suggest that IL-4-IL-4Rα signaling mediates neuroimmune crosstalk, driving olfactory dysfunction in conditions like chronic rhinosinusitis with nasal polyps. The study, conducted by researchers from Sanofi and Regeneron Pharmaceuticals, provides insights into potential therapeutic strategies for addressing olfactory dysfunction and related conditions. [Extracted from the article]