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Possible Implication in the Pathogenesis of Nasal Polyposis

Chia-Ming Liu, MD; Chi-Yuan Hong, BDS, DMSc; Chia-Tung Shun, MD; Tzu-Yu Hsiao, MD; Chih-Chiang Wang, MS; Juo-Song Wang, BDS, MS; Michael Hsiao, DVM, PhD; Sze-Kwan Lin, BDS, MS, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:945-951.

Background  Inflammation is believed to be related to the pathogenesis of nasal polyp (NP). Inducible cyclooxygenase (COX-2) and interleukin (IL) 6 are important mediators of inflammation. However, no information is available regarding the expression of these mediators in nasal polyp fibroblasts (NPFs). The inductive effects of proinflammatory cytokines (IL-1 or tumor necrosis factor ) alone or in combination with prostaglandin E₂ on IL-6 and COX-2 messenger RNA (mRNA) synthesis in NPFs were investigated.

Design  The expressions of IL-6 and COX-2 mRNAs in NPFs and in 34 surgical specimens of NP were detected by Northern blot and in situ hybridization.

Results  Significant amounts of constitutive IL-6 and COX-2 mRNAs were produced in NPFs. Cytokines induced IL-6 and COX-2 mRNA synthesis in NPFs. Meloxicam (a specific COX-2 inhibitor) suppressed the induction of cytokines on IL-6 mRNA levels, and these effects could be reversed by exogenous prostaglandin E₂. In situ hybridization revealed that IL-6 and COX-2 mRNAs were detected primarily in fibroblasts, macrophages, and plasma cells. Aggregation of plasma cells as well as collagen deposition in vicinity to IL-6 mRNA-producing fibroblasts was found. Rich vascularity around COX-2 mRNA⁺ fibroblasts was also identified.

Conclusions  The pathogenesis of nasal polyposis involves NPFs through synthesizing IL-6 to modulate the activation of immune responses (plasma cell formation) and synthesis of stroma. Inducible cyclooxygenase also contributes to NP development by promoting vasodilatation and modulating the cytokine-induced IL-6 gene expression in NPFs.

From the Departments of Otolaryngology (Drs Liu and Hsiao), Dentistry (Drs Hong, Wang, and Lin), and Forensic Medicine (Dr Shun), and the Graduate Institute of Clinical Medicine (Mr Wang), National Taiwan University Hospital, Taipei, Taiwan; and the Department of Medical Education and Research, Kaohsiung-Veterans General Hospital, Kaohsiung (Dr Hsiao).

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