Clin Exp Otorhinolaryngol.  2013 Sep;6(3):152-160.

The Role of Platelet-Derived Growth Factor in the Pathogenesis of Sinonasal Polyps: Immunohistochemical Assessment in Epithelial, Subepithelial and Deep Layers of the Mucosa

• Bayar Muluk N
• Arikan OK
• Atasoy P
• Kilic R
• Yalcinozan ET

Abstract

OBJECTIVES
The aim of this study is to investigate the role of platelet-derived growth factor (PDGF) in the pathogenesis of sinonasal polyps.
METHODS
Study group (groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps and the control group consisted of inferior turbinate samples of patients without nasal polyp. In group 1, 14 specimens from ethmoid sinus; in group 2, 10 specimens from nasal cavity; in group 3, 10 specimens from maxillary sinus; and in group 4 (control), 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, the PDGF positivity index (PI) in mucosal layers and in the inflammatory cells were assessed at the epithelium (EP), subepithelial layer of lamina propria (SE), and deep paraglandular layer of the mucosa (D).
RESULTS
Polymorphonuclear cell (PMNC)-percentage (%) values of ethmoid and maxillary sinus, and the PDGF PI from all cells of ethmoid sinus and nasal cavity were significantly higher than those of the control group. As mononuclear cell-% (MNC-%) increased, the PDGF_EP_basal PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PMNC-PDGF PI increased, the PDGF_D_perivascular PI decreased and PDGF_D_endothelial PI increased. As PDGF-MNC PI increased, the PDGF_EP_apical PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PDGF-all cells (PMNCs, MNCs, and fibroblasts) PI increased, the PDGF_EP_basal PI and PDGF_D_endothelial PI decreased, and the PDGF_D_perivascular PI increased.
CONCLUSION
We concluded that the PDGF systems play important roles in polyp pathogenesis. Fibroblast-derived PDGF may be more important than MNC-derived PDGF in polyp developing process. Increased perivascular-PDGF-PI in deep layers of the mucosa may result in sinonasal polyp formation by causing an increase in vascular permeability and extracellular edema, and thus promoting migration of inflammatory cells to extracellular area. Tissue oxygenization may be important for the initiation of PDGF release system. Because of this reason, nasal obstruction should be medically treated earlier, and, if necessary, by surgical approaches.

Keyword

Sinonasal polyp; Pathogenesis; Platelet-derived growth factor; Perivascular; Endothelial

MeSH Terms

Capillary Permeability
Edema
Epithelium
Ethmoid Sinus
Humans
Maxillary Sinus
Mucous Membrane
Nasal Cavity
Nasal Obstruction
Nasal Polyps
Oxygen
Platelet-Derived Growth Factor
Polyps
Turbinates
Oxygen
Platelet-Derived Growth Factor

Figure

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  Fig. 1 Platelet-derived growth factor (PDGF) positivity index (PI) levels in mucosa of groups 1-4. EP, epithelium; SE, subepithelial layer of lamina propria; pv, perivascular; D, deep paraglandular layer of the mucosa.

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  Fig. 2 Distribution of Inflammatory cells in mucosa. PMNC, polymorphonuclear cell; MNC, mononuclear cell.

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  Fig. 3 Platelet-derived growth factor (PDGF) positivity indexs in inflammatory cells. MNC, mononuclear cell, PMNC, polymorphonuclear cell.

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  Fig. 4 Immunohistochemical staining for platelet-derived growth factor (PDGF) in polyp sample displaying decreases from epithelial apical to deep layers of lamina propria. Positive staining for PDGF was mainly observed in cytoplasms of mononuclear cells at epithelial apical and subepithelial layers; and fibroblasts at deep layers (×100).

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  Fig. 5 Immunohistochemical staining for polyp sample displaying platelet-derived growth factor (PDGF) positivity in perivascular cells; and intense infiltration of mononuclear cells showing PDGF positivity in perivascular region (×100).

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  Fig. 6 Immunohistochemical staining for platelet-derived growth factor (PDGF) in polyp sample shows that: (A) No-staining was observed in polymorphonuclear cells (PMNCs); and positive staining was observed in mononuclear cells and fibroblasts at subepithelial layer of lamina propria (×200). (B) The +3 PDGF positivity was detected in cytoplasms of plasma cells; and +2 PDGF positivity was detected in cytoplasms of fibroblasts. No positive staining for PDGF was observed in cytoplasms of PMNCs (×400).

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