Remodeling of the nasal mucosa

Persistent, chronic (often allergic) inflammation of the nasal mucosa can lead to a remodelling of the mucosa with hyperplasia of the mucus-forming glandular cells, the muscles, a thickening of the basal membrane and irreversible subepithelial fibrosis, a biological phenomenon known as "remodeling".

An important trigger for this faulty reconstruction is apparently chronic persistent inflammatory processes in the nasal mucosa. Remodeling is also understood as the result of a misdirected repair process. In the nasal lavage of patients, the cytokine levels of interleukin-4, interleukin-5 and interleukin-13 were significantly increased in comparison to healthy subjects. Furthermore, an increase of eosinophilic granulocytes in the subkmucosa was detectable. Furthermore, in chronic inflammatory nasal mucosa of allergic persons increased expression of proteoglycans such as lumikan and biglycan. Fibronectin and the matrix metalloproteinase MMP 9 were also found to be increased, as was lymphangiogenesis measured by the number and density of lymph capillaries.

It has been shown that developmentally relevant signaling pathways, such as the Wnt signaling pathway, are activated in the chronically inflammatory nasal mucosa, but that this does not lead to successful repair.

Remarkable are therapy approaches that aim at a so-called "reverse remodeling".

Remodeling is a central disease mechanism that plays a role in almost all chronic lung diseases (COPD, pulmonary fibrosis, cystic fibrosis, pulmonary hypertension).

Barham HP et al(20159 Remodeling changes of the upper airway with chronic rhinosinusitis. Int Forum Allergy Rhinol 5:565 572.

Bassiouni A et al (2013) Mucosal remodeling and reversibility in chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 13:4-12.

Eifan AO et al. (2015) Severe Persistent Allergic Rhinitis. Inflammation but No Histologic Features of Structural Upper Airway Remodeling. At J Respir Crit Care Med 192:1431-1439.

Hirshoren N et al (2013) Extra domain-A fibronectin is necessary for the development of nasal remodeling in chronic allergen-induced rhinitis. Ann Allergy Asthma Immunol 110:322-327.