Pathogenesis of Nasal Polyposis: Current Trends

Area of Science:

• Immunology
• Otolaryngology
• Pathogenesis of Nasal Polyps

Background:

• Chronic Rhinosinusitis (CRS) presents with sub-epithelial edema, but polyp development varies.
• Current classification of CRS is insufficient due to diverse pathogenetic mechanisms in nasal polyposis.
• Endotype-based diagnosis and treatment are now standard for nasal polyposis.

Purpose of the Study:

• To explore the pathogenesis of nasal polyposis.
• To elucidate the role of Th-2 immune responses and epithelial barrier dysfunction.
• To review intrinsic and extrinsic factors contributing to polyp formation.

Main Methods:

• Review of current hypotheses on nasal polyposis etiology.
• Focus on molecular mechanisms of polyp formation.
• Analysis of immune cell and cytokine involvement.

Main Results:

• Nasal polyp formation is linked to Th-2 immune responses in sub-epithelial layers.
• Both extrinsic factors (fungi, bacteria, microbiome) and intrinsic factors (Treg cells, vitamin D, leukotrienes, EMT, NO) contribute.
• Epithelial immune barrier dysfunction is a leading theory, where barrier damage allows pathogen invasion and triggers Th-2 responses.

Conclusions:

• Nasal polyposis pathogenesis is multifactorial, involving immune dysregulation and epithelial barrier defects.
• Th-2 cytokines drive eosinophil and IgE accumulation, leading to stromal remodeling and polyp development.
• Endotype-specific approaches are crucial for effective management of nasal polyposis.