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Dysfunctional mucociliary clearance in asthma and airway remodeling – New insights into an old topicJesenak, Milos; Durdik, Peter; Oppova, Dasa; Franova, Sona; Diamant, Zuzana; Golebski, Kornel; Banovcin, Peter; Vojtkova, Jarmila; Novakova, Elena
Respiratory medicine, 11/2023, Volume: 218Journal Article
Bronchial asthma is a heterogeneous respiratory condition characterized by chronic airway inflammation, airway hyperresponsiveness and airway structural changes (known as remodeling). The clinical symptoms can be evoked by (non)specific triggers, and their intensity varies over time. In the past, treatment was mainly focusing on symptoms’ alleviation; in contrast modern treatment strategies target the underlying inflammation, even during asymptomatic periods. Components of airway remodeling include epithelial cell shedding and dysfunction, goblet cell hyperplasia, subepithelial matrix protein deposition, fibrosis, neoangiogenesis, airway smooth muscle cell hypertrophy and hyperplasia. Among the other important, and frequently forgotten aspects of airway remodeling, also loss of epithelial barrier integrity, immune defects in anti-infectious defence and mucociliary clearance (MCC) dysfunction should be pointed out. Mucociliary clearance represents one of the most important defence airway mechanisms. Several studied in asthmatics demonstrated various dysfunction in MCC – e.g., ciliated cells displaying intracellular disorientation, abnormal cilia and cytoplasmic blebs. Moreover, excessive mucus production and persistent cough are one of the well-recognized features of severe asthma and are also associated with defects in MCC. Damaged airway epithelium and impaired function of the ciliary cells leads to MCC dysfunction resulting in higher susceptibility to infection and inflammation. Therefore, new strategies aimed on restoring the remodeling changes and MCC dysfunction could present a new therapeutic approach for the management of asthma and other chronic respiratory diseases. Display omitted •Bronchial asthma is a complex multi-facetted disease which develops as a consequence of the interplay between genes and factors or triggers from the external and internal environment.•Immune defects, epithelial barrier dysfunction and mucociliary clearance dysfunction are important features of bronchial asthma and should be considered in the context of airway remodeling.•So far, only selected molecules used in asthma treatment showed some capacity to affect and modify remodeling process, but more studies are needed.•New therapeutic options for allergies and bronchial asthma should be aimed at the restoration of the mucociliary clearance and epithelial barrier function.•Therapeutic modulation of associated immune deficiencies could decrease the susceptibility of asthma patients to respiratory infections and thus help to prevent exacerbations.
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