Abstract
Chronic rhinosinusitis (CRS) is presently classified into two subgroups: CRS without and CRS with nasal polyps. A variety of inflammatory mediators, including cytokines and chemokines, as well as adhesion molecules and matrix metalloproteinases, are upregulated in both subgroups of CRS; remodeling is also observed in both. However, there are also characteristic differences. Whereas CRS without nasal polyps has more neutrophilic infiltration, in CRS with nasal polyps (especially when associated with allergy/asthma) eosinophil infiltration is strikingly increased. Although several features of remodeling (eg, squamous metaplasia, basement membrane thickening, collagen deposition, hyperplasia of mucous glands, and goblet cells) are features seen in both subgroups of CRS, epithelial shedding as observed in asthma is not seen in either subgroup. Furthermore, pseudocyst formation seen in CRS with nasal polyps is not seen in CRS without nasal polyps.
Similar content being viewed by others
References
Moss AJ, Parsons VL: Current estimates from the National Health Interview Survey. United States-1985. Hyattsville, MD: National Center for Health Statistics; 1986. [DHHS publication no. (PHS) 68-1588, Vital and Health Statistics, series 10, no. 160:66-72.]
Meltzer EO, Hamilos DL, Hadley JA, et al.: Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 2004, 114: 155–212. Describes the new classification of CRS.
Baraniuk JN: Physiology of sinusitis. In Sinusitis: Pathophysiology and Treatment. Edited by Druce HM. New York: Marcel Dekker; 1994: 19–39.
Van Cauwenberge P, Ingels K: Effects of viral and bacterial infection on nasal and sinus mucosa. Acta Otolaryngol (Stockh) 1996, 116: 316–321.
Calenoff E, McMahan JT, Herzon GD, et al.: Bacterial allergy in nasal polyposis. A new method for quantifying specific IgE. Arch Otolaryngol Head Neck Surg 1993, 119 (8): 830–836.
Holt PG, Sly PD: Interactions between respiratory tract infections and atopy in the aetiology of asthma. Eur Respir J 2002, 19: 538–545.
Corrado G, Luzzi I, Lucarelli S, et al.: Correlation between Helicobacter pylori infection and food allergy in chronic gastritis. Med Sci Monit 2000, 6: 530–538.
McCormick JK, Yarwood JM, Schlievert PM: Toxic shock syndrome and bacterial superantigens: an update. Annu Rev Microbiol 2001, 55: 77–104.
Llewelyn M, Cohen J: Superantigens: microbial agents that corrupt immunity. Lancet Infect Dis 2002, 2: 156–162.
Mempel M, Lina G, Hojka M, et al.: High prevalence of superantigens associated with the egc locus in Staphylococcus aureus isolates from patients with atopic eczema. Eur J Clin Microbiol Infect Dis 2003, 22: 306–309.
Schubert MS: A superantigen hypothesis for the pathogenesis of chronic hypertrophic rhinosinusitis, allergic fungal sinusitis, and related disorders. Ann Allergy Asthma Immunol 2001, 87: 181–188.
Bachert C, Gevaert P, Holtappels G, et al.: Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol 2001, 107: 607–614.
Rudack C, Stoll W, Bachert C: Cytokines in nasal polyposis, acute and chronic sinusitis. Am J Rhinol 1998, 12: 383–388.
Stierna P, Carlsoo B: Histopathological observations in chronic maxillary sinusitis. Acta Otolaryngol (Stockh) 1990, 10: 450–458.
Bachert C, Van Cauwenberge PB: Inflammatory mechanisms in chronic sinusitis. Acta Otorhinolaryngol Belg 1997, 51: 209–217.
Georgitis JW, Matthews BL, Stone B: Chronic sinusitis: characterization of cellular influx and inflammatory mediators in sinus lavage. Int Arch Allergy lmmunol 1995, 106: 416–421.
Lund VJ, Henderson B, Song Y: Involvement of cytokines and vascular adhesion molecules in the pathophysiology of fronto-ethmoidal mucoceles. Acta Otolaryngol (Stockh) 1993, 13: 540–546.
Suzuki H, Takahashi Y, Wataya H, et al.: Mechanism of neutrophil recruitment induced by IL-8 in chronic sinusitis. J Allergy Clin Immunol 1996, 98: 659–670.
Bazzoni F, Cassatella MA, Rossi F, et al.: Phagocytosing neutrophils produce and release high amounts of NAP-1/IL-8. J Exp Med 1991, 173: 771–774.
Dubravec DB, Spriggs DR, Mannick JA, Rodrick ML: Circulating human peripheral blood granulocytes synthesize and secrete tumor necrosis factor a. Proc Natl Acad Sci U S A 1990, 87: 6758–6761.
Hisamatsu K, Ganbo T, Nakazawa T, et al.: Cytotoxicity of human eosinophil granule major basic protein to human nasal sinus mucosa in vitro. J Allergy Clin Immunol 1990, 86: 52–63.
Lindemann A, Riedel D, Oster W, et al.: Granulocyte/macrophage colony-stimulating factor induces interleukin-1 production by human polymorphonuclear neutrophils. J Immunol 1988, 140: 837–839.
Harlin SL, Ansel DG, Lane SR, et al.: A clinical and pathologic study of chronic sinusitis: the role of the eosinophi1. J Allergy Clin Immunol 1988, 81: 867–875.
Tokushige E, Itoh K, Ushikai M, et al.: Localization of IL-1 beta mRNA and cell adhesion molecules in the maxillary sinus mucosa of patients with chronic sinusitis. Laryngoscope 1994, 104: 1245–1250.
Ten Brinke A, Grootendorst DC, Schmidt JT, et al.: Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol 2002, 109: 621–626.
Bresciani M, Paradis L, Des Roches A, et al.: Rhinosinusitis in severe asthma. J Allergy Clin Immunol 2001, 107: 73–80.
Min YG, Lee CH, Rhee CS, et al.: Increased expression of IL-4, IL-5, IFN-gamma, IL-6, IL-8, and TGF-beta mRNAs in maxillary mucosa of patients with chronic sinusitis. Am J Rhinol 1999, 13: 339–343.
Nonoyama T, Harada T, Shinogi J, et al.: Immuno-histochemical localization of cytokines and cell adhesion molecules in maxillary sinus mucosa in chronic sinusitis. Auris Nasus Larynx 2000, 27: 51–58.
Tokushige E, Itoh K, Ushikai M, et al.: Localization of IL-1beta mRNA and cell adhesion molecules in the maxillary sinus mucosa of patients with chronic sinusitis. Laryngoscope 1994, 104: 1245–1250.
Kennedy DW: Two cases of Aspergillus sinusitis with bone destruction. Auris Nasus Larynx 2003, 30(Suppl): S115–121.
Khalid AN, Hunt J, Perloff JR, Kennedy DW: The role of bone in chronic rhinosinusitis. Laryngoscope 2002, 112: 1951–1957.
Bolger WE, Leonard D, Dick EJ Jr, Stierna P: Gram negative sinusitis: a bacteriologic and histologic study in rabbits. Am J Rhinol 1997, 11: 15–25.
Pawankar R: Nasal polyposis: an update. Curr Opin Allergy Immunol 2003, 3: 1–6.
Hamilos DL, Leung DYM, Huston DP, et al.: GM-CSF, IL-5 and RANTES immunoreactivity and mRNA expression in chronic hyperplastic sinusitis with nasal polyposis (NP). Clin Exp Allergy 1998, 28: 1145–1152.
Hamilos DL, Leung DYM, Wood R, et al.: Evidence for distinct cytokine expression in allergic versus nonallergic chronic sinusitis. J Allergy Clin Immunol 1995, 96: 537–544.
Pawankar R: Mast cells as or orchestrates of the allergic reaction: the IgE-IgE mast cell network. Curr Opin Allergy Clin Immunol 2001, 1: 3–6.
Nonaka M, Pawankar R, Saji F, Yagi T: Distinct expression of RANTES and GM-CSF by lipopolysaccharide in human nasal fibroblasts but not in other airway fibroblasts. Int Arch Allergy Immunol 1999, 119: 314–321.
Di Lorenzo G, Drago A, Esposito Pellitteri M, et al.: Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis. Int Arch Allergy Immunol 2001, 125: 164–175.
Van Zele T, Gevaert P, Watelet JB, et al.: Staphylococcus aureus colonization and IgE antibody formation to enterotoxins is increased in nasal polyposis. J Allergy Clin Immunol 2004, 114: 981–983.
Pérez-Novo CA, Watelet JB, Claeys C, et al.: Prostaglandin, leukotriene, and lipoxin balance in chronic rhinosinusitis with and without nasal polyposis. J Allergy Clin Immunol 2005, 115: 1189–1196.
Kirtsreesakul V, Naclerio RM: Role of allergy in rhinosinusitis. Curr Opin Allergy Clin Immunol 2004, 4: 17–23.
Montefort S, Roberts JA, Beasley R, et al.: The site of disruption of the bronchial epithelium in asthmatic and non-asthmatic subjects. Thorax 1992, 47: 499–503.
Ponikau JU, Sherris DA, Kephart GM, et al.: Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma? J Allergy Clin Immunol 2003, 112: 877–882.
Sobol SE, Fukakusa M, Christodoulopoulos P, et al.: Inflammation and remodeling of the sinus mucosa in children and adults with chronic sinusitis. Laryngoscope 2003, 113: 410–414.
Chetta A, Foresi A, Del Donno M, et al.: Airways remodeling is a distinctive feature of asthma and is related to severity of disease. Chest 1997, 111: 852–857.
Majima Y, Masuda S, Sakakura Y: Quantitative study of nasal secretory cells in normal subjects and patients with chronic sinusitis. Laryngoscope 1997, 107: 1515–1518.
Lee HM, Choi JH, Chae SW, et al.: Expression of epidermal growth factor receptor and its ligands in chronic sinusitis. Ann Otol Rhinol Laryngol 2003, 112: 132–138.
Ishibashi T, Tanaka T, Nibu K, et al.: Keratinocyte growth factor and its receptor messenger RNA expression in nasal mucosa and nasal polyps. Ann Otol Rhinol Laryngol 1998, 107: 885–890.
Guo Y, Majima Y, Hattori M, et al.: Effects of functional endoscopic sinus surgery on maxillary sinus mucosa. Arch Otolaryngol Head Neck Surg 1997, 123: 1097–1100.
Bachert C, Gevaert P, Holtappels G, et al.: Nasal polyposis: from cytokines to growth. Am J Rhinol 2000, 14: 279–290.
Dahlen B, Shute J, Howarth P: Immunohistochemical localisation of the matrix metalloproteinases MMP-3 and MMP-9 within the airways in asthma. Thorax 1999, 54: 590–596.
Belleguic C, Corbel M, Germain N, et al.: Increased release of matrix metalloproteinase- 9 in the plasma of acute severe asthmatic patients. Clin Exp Allergy 2002, 32: 217–223.
Lechapt-Zalcman E, Coste A, d’Ortho MP, et al.: Increased expression of matrix metalloproteinase-9 in nasal polyps. J Pathol 2001, 193: 233–241.
Watelet JB, Bachert C, Claeys C, Van Cauwenberge P: Matrix metalloproteinases MMP-7, MMP-9 and their tissue inhibitor TIMP-1: expression in chronic sinusitis vs nasal polyposis. Allergy 2004, 59: 54–60.
Wang QP, Escudier E, Roudot-Thoraval F, et al.: Myofi-broblast accumulation induced by transforming growth factor-beta is involved in the pathogenesis of nasal polyps. Laryngoscope 1997, 107: 926–931.
Brewster CE, Howarth PH, Djukanovic R, et al.: Myofibroblasts and subepithelial fibrosis in bronchial asthma. Am J Respir Cell Mol Biol 1990, 3: 507–511.
Nonaka M, Pawankar R, Fukumoto A, et al.: Induction of eotaxin production by interleukin-4, interleukin-13 and lipopolysaccharide by nasal fibroblasts. Clin Exp Allergy 2004, 34: 804–811.
Djukanovic R: Airway inflammation and repair in asthma. Allergol Int 2001, 50: 281–294.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pawankar, R., Nonaka, M. Inflammatory mechanisms and remodeling in chronic rhinosinusitis and nasal polyps. Curr Allergy Asthma Rep 7, 202–208 (2007). https://doi.org/10.1007/s11882-007-0073-4
Issue Date:
DOI: https://doi.org/10.1007/s11882-007-0073-4