Epithelial hyperplasia and metaplasia are common features of inflammatory and neoplastic disease, but the basis for the altered epithelial phenotype is often uncertain. Here we show that long-term ciliated cell hyperplasia coincides with mucous (goblet) cell metaplasia after respiratory viral clearance in mouse airways. This chronic switch in epithelial behavior exhibits genetic susceptibility and depends on persistent activation of EGFR signaling to PI3K that prevents apoptosis of ciliated cells and on IL-13 signaling that promotes transdifferentiation of ciliated to goblet cells. Thus, EGFR blockade (using an irreversible EGFR kinase inhibitor designated EKB-569) prevents virus-induced increases in ciliated and goblet cells whereas IL-13 blockade (using s-IL-13Rα2-Fc) exacerbates ciliated cell hyperplasia but still inhibits goblet cell metaplasia. The distinct effects of EGFR and IL-13 inhibitors after viral reprogramming suggest that these combined therapeutic strategies may also correct epithelial architecture in the setting of airway inflammatory disorders characterized by a similar pattern of chronic EGFR activation, IL-13 expression, and ciliated-to-goblet cell metaplasia.
IntroductionEpithelial cell hyperplasia and metaplasia are common consequences of inflammation and may be associated with protective as well as pathogenic outcomes. In the lung, airway epithelial remodeling can be life threatening, since mucous cell metaplasia is the foundation for hypersecretion that can obstruct the airway lumen. Despite the critical nature of this process, little is known about how mucous cell metaplasia develops in the setting of acute or chronic inflammatory disease. Particularly, little is known about the mechanism for what is likely the most common cause of mucous cell metaplasia in the lung, i.e., respiratory viral infection, since previous work has focused on bacterial, allergic, and carcinogenic stimuli. Perhaps because of the paucity of mechanistic information, no effective and specific pharmacologic treatment is currently available to treat epithelial cell metaplasia in general or mucous cell metaplasia in particular.In this context, recent work on mucous cell metaplasia has often focused on signaling pathways initiated by activation of the IL-13 receptor (IL-13R) and EGFR (also designated ErbB1 and HER1). The experimental role of IL-13R was established when a decoy receptor for IL-13 (soluble IL-13Rα2-Fc) was found to inhibit allergen-induced mucous (goblet) cell formation in mice (1, 2). These reports have been followed by evidence that IL-13 can directly drive mucin gene expression in airway epithelial cells cultured under physiologic conditions and in vivo (3-6). Moreover, IL-13 is often overexpressed in the setting of mucous cell metaplasia in asthma