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Original research
Effects of Wnt signaling on epithelial to mesenchymal transition in chronic rhinosinusitis with nasal polyp
  1. Jun-Sang Bae1,2,3,
  2. Gwanghui Ryu4,
  3. Ji Hye Kim1,2,
  4. Eun Hee Kim1,2,
  5. Yun Hee Rhee1,2,3,
  6. Young-Jun Chung1,2,3,
  7. Dae Woo Kim5,
  8. Suha Lim6,7,
  9. Phil-Sang Chung1,2,3,
  10. Hyun-Woo Shin6,7,8,9,
  11. Ji-Hun Mo1,2,3
  1. 1 Otorhinolaryngology, Dankook University College of Medicine, Cheonan, South Korea
  2. 2 Beckman Laser Institute Korea and Medical Laser Research Center, Dankook University College of Medicine, Cheonan, South Korea
  3. 3 Laser Translational Clinical Trial Center, Dankook University Hospital, Cheonan, South Korea
  4. 4 Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, South Korea
  5. 5 Otorhinolaryngology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
  6. 6 Obstructive Upper airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
  7. 7 Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
  8. 8 Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
  9. 9 Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
  1. Correspondence to Professor Ji-Hun Mo, Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, South Korea; jihunmo{at}; Professor Hyun-Woo Shin, Pharmacology, Seoul National University College of Medicine, Seoul, South Korea; charlie{at}


Background Epithelial to mesenchymal transition (EMT) is associated with the pathophysiology of chronic rhinosinusitis with nasal polyp (CRSwNP). Wnt signaling is causative for EMT, whereas the mechanism in CRSwNP is not fully understood.

Objective We sought to evaluate the role of Wnt signaling in EMT of CRSwNP using a murine nasal polyp (NP) model and human tissues.

Methods Inflammatory markers and EMT-related molecules were evaluated in NP models using adenomatosis polyposis coli (Apc)Min/+ mice with activated Wnt signaling and NP models treated with Wnt signaling inhibitor, indocyanine green-001 (ICG-001). EMT markers and Wnt signaling-associated mediators were analysed using human sinonasal tissues from control subjects and CRSwNP patients.

Results ApcMin/+ mice-induced NPs exhibited more frequent polypoid lesions and upregulation of Wnt-related molecules, including nuclear β-catenin, WNT3A and cyclin D1. Markers of EMT were significantly overexpressed in the ApcMin/+ NP mice (p<0.001 for E-cadherin and α-smooth muscle actin), and interleukin (IL)-17A+ cells and neutrophilic infiltration were increased in ApcMin/+ NP mice (p<0.001). Inhibition of Wnt signaling via ICG-001 resulted in significantly decreased nasal polypoid lesions (p<0.001), EMT-related markers (p=0.019 for E-cadherin and p=0.002 for vimentin) and the mRNA levels of IL-4 (p<0.001) and IL-17A (p=0.004) compared with the positive control group. Finally, nuclear β-catenin (p=0.042) was significantly increased compared with the control, and the expression levels of Wnt ligands and receptors were upregulated in human NP tissues (p=0.045 for WNT3A and p=0.042 for FZD2), suggesting increased Wnt signaling and EMT in CRSwNP.

Conclusion Wnt signaling may contribute to the pathogenesis of NPs through EMT. Therefore, inhibition of Wnt signaling may be a potential therapeutic strategy for patients with CRSwNP.

  • airway epithelium
  • cytokine biology
  • histology/cytology
  • innate immunity

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  • H-WS and J-HM are joint senior authors.

  • J-SB and GR contributed equally.

  • Contributors Conception and design: J-SB, GR and J-HM; acquisition of data: J-SB, JHK, EHK, YHR and J-HM; analysis and interpretation of data: J-SB, GR, JHK, Y-JC, DWK, ShL, H-WS and J-HM; drafting the article or revising it critically for important intellectual content: J-SB, GR, DWK, P-SC, H-WS and J-HM.

  • Funding This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2016R1A2B4010407 and NRF-2020R1A2C1012105) and by the Ministry of Education (NRF-2020R1A6A1A03043283) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by Ministry of Health & Welfare, Republic of Korea (grant number: HI15C1524 and HI17C1669).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of the Dankook University Hospital (IRB No. 2012-11-008-002).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request to the corresponding authors.