Role of inflammation in nasal polyposis

Dr T Balasubramanian

Introduction

Nasal polyp is not simple oedema of mucous membrane of lateral nasal wall

These are denovo inflammatory growth of nasal mucosa of the lateral nasal wall

Commonly involves mucosa over uncinate area and bulla

Features of Nasal poyp

Basal cell hyperplasia

Goblet cell hyperplasia

Squmaous metaplasia

Features shown by lamina propria include: oedema, lymphocytosis, eosinophils and degenerated cystic glands filled with mucin

Chromosomal role

Risk of nasal polypi resides ? In the short arm of chromosome 6

This area of chromosomes contains genes which play a role in inflammation

The HLA genes and proinflammatory genes are transmitted together from parent to offspring

Components of short arm of chromosome 6

HLA antigens

Complement

Heat shock protein

Pro inflammatory gene TNF alpha

Role played by S aureus exotoxins

They act as super antigens

They stimulate IgE response against them

In combination they trigger the nasal mucosa in to developing polyp

TNF alpha levels are 4 times more than normal individuals

TNF - alpha

This is a potent immuno mediator

It is a proinflammatory cytokine

Produced by macrophages and T cells

Its concentration in the nasal mucosa is 4 times higher

Attracts eosinophils and activates it

Known for its anti tumor cytotoxic activity

Evokes inflammation

Cytokines & nasal polyp

TNF alpha

IL1 beta

VCAM1

RANTES

Cotaxin

TNF-alpha & VCAM 1

TNF alpha upregulates VCAM 1 in fibroblasts present in the nasal mucosa

This upregulation intitiates the cascade of immune mechanism

TNF alpha also increases secretion of cotaxin and expression of RANTES

Role of eosinophils

Substances secreted by eosinophils include: Eosinophilic mediator, and major basic protein

They increase the permeability of nasal mucosa to water

Changes in sodium gate mechanism is responsible for the increase in permeability

Thank you

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