Processes involved in the repair of injured airway epithelia

Recent studies have uncovered many aspects of the repair processes that follow airway epithelial injury. Although the repair process has common elements among various epithelia, such as the ones lining the airways, skin, and gut, there are differences based on their diverse functions. Whenever possible, similarities are pointed out that could help researchers further investigate their application to airway epithelia, although it would be beyond the scope of this review to cover the processes that may occur during the repair of all types of epithelia. In general, five major steps are involved in the recovery of airway epithelia from injury: 1) epithelial cells migrate to cover denuded areas within minutes, and certain proteins, such as the trefoil factor family proteins, are crucial to this process; 2) epithelial cells start to proliferate in order to replace injured cells and to differentiate to establish squamous or mucous cell metaplasia; 3) because more epithelial cells are present after proliferation, some of the cells must be discarded to restore the epithelium to the original condition; 4) once the cell numbers have been reduced to those found in unexposed individuals, the normal proportions of cell types are restored; 5) finally, studies from exposures of rats to ozone show that epithelial cells can adapt and develop a memory of the chronic exposure to which they were exposed. This adaptation allows the epithelium to respond quickly, thus minimizing further injury. Although the molecular mechanisms involved in these major steps of the recovery process are largely unknown, disruption of these steps clearly causes the permanent changes observed in diseases such as asthma, chronic bronchitis, and cancer; therefore, extensive research of these mechanisms may provide ideas for novel therapies.