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Mucus in respiratory airways.

Abstract
Mucus in respiratory airways is produced by several sources, mainly goblet cells, it has complex gene
regulation for its production and its alterations are mostly present in obstructive reversible and non-
reversible respiratory disease, such as in COPD and asthma. It is related with the formation of biofilm
and in this way allows bacterial infection.

Introduction
The mucus is a complex mixture of proteins, lipids, water, and electrolytes that, under normal
conditions, maintains the moisture of the airway epithelium. It allows the air to be conditioned adhering
particles which bypasses upper airways. The main protein of the mucus is the mucin.

Mucin
Imagen credit:
Taken from Lafitte, in
http://worldtrip.bloguez.com/worldtrip/1515071/Mucin
It is produced by goblet, mucous, and serous cells ( Flicker JH et al, 2008 ) and stored until a secretory
signal is given. The mucus secretion may be stimulated by mediators produced by macrophages,
lymphocytes, and epithelium.

Goblet cell in H/E staining


Credit of image
http://www.vivo.colostate.edu/hbooks/pathphys/misc_topics/goblets.html
Goblet secrets mucin, suspended in a solution of electrolytes.

Goblet cells, serous glands in bronchi. Hematoxyllin and eosine staining


Image credit:
http://www.mc.vanderbilt.edu/histology/labmanual2002/labsection2/Respiratory03.htm
The proteic component is assembled from amino acids on ribosomes, then it move up trough
endoplasmic reticulum to enter to the Golgi saccules. In this Golgi saccules simple sugars enter and
combine with proteins by glycosylation and sulfate is added. The saccules of glycoprotein are
transformed and hydrated into globules of mucus. Finally the mucin globules move toward the cell
apex for subsequent release from the cell into the lumen.

Drawing of a Goblet cell, depicting the different structures giving place to mucoprotein.
From Neutra and Leblond, taken with modifications of
http://www.comprehensivephysiology.com/WileyCDA/CompPhysArticle/refId-cp090116.html
Function of mucus
The mucus-lined nasal and sinus passages collect pollen, dust, dirt, fungal spores, and other particulates from
the air. Mucus production is balanced with the sweeping action of ciliated epithelium, which facilitates drainage
and particulate removal.

Different particles in air: molds, polen dust mites.

The consistency of mucus (a complex of water, sugar, lipids, and protein) can change from a planar
structure to a globular structure that is not as effective at covering mucosal membranes and collecting
particulates.
( Helms and Miller, 2006).

Mucins

Mucins are large glycoproteins and can be divided into membrane-bound and secreted mucins. There
are nine membrane-bound (MUC1, MUC3A, MUC3B, MUC4, MUC12, MUC13, MUC16, MUC17
and MUC20) and six secreted mucins (MUC2, MUC5B, MUC5AC, MUC6, MUC7 and MUC19) have
been described.
The secreted mucins can be further subdivided into gel-forming (MUC2, MUC5B, MUC5AC, MUC6
and MUC19) and non-gel-forming mucins (MUC7). The gel-forming mucins constitute the main
structural component of the mucus gel protecting the underlying epithelia. (Lidell ME and Hansson
GC, 2006 )

Biofilm in mucus
Biofilms play an important role in otitis media, sinusitis, chronic cholesteatomatous otitis media,
tonsillitis and adenoiditis, thus demonstrating that adenoidectomy may be helpful to children suffering
from such a morbid conditions. It is presently estimated that biofilm formation is involved in at least
60% of all chronic and/or recurrent infections. In addition, 30% of the exudates developing in the
course of otitis media has shown to be positive for the presence of biofilms; likewise biofilms have
been found in tonsillar crypts and in odontostomatologic infections as well. Studies have been carried
out on both the use and the efficacy of N-acetylcysteine (NAC) in biofilm breakdown. It has been
shown that NAC, used at different concentrations, is able to reduce bacterial adhesion in several
anatomical districts.

Mucus hypersecretion in COPD


Neutrophils are the key cells in pathologies such as the called chronic obstructive pulmonary disease
(COPD); there is emerging evidence that these neutrophils play a key role in Epidermal Growth Factor
Receptor (EGFR)-mediated mucin production through releasing tumor necrosis factor-alpha (TNF-α)
and hence inducing EGFR expression. Moreover, the differentiation of the mucus cells as well as
secretion of the mucus from airway glands are induced by neutrophil elastase.

Nevertheless, by entrapping and removing foreign materials, the mucus forms a basic defense system
of the respiratory system; is easier for the lung cleaning to eliminate particles by mucociliary clearance
instead of phagocytic process by the alveolar macrophages.
In the large airways, mucus hypersecretion causes coughing and sputum production. In the peripheral
airways, because of the smaller diameter, the formed mucus plugs are difficult to remove and may
block the peripheral airway completely. This, in turn, may result in gas trapping with increased total
lung capacity (TLC) and decreased forced vital capacity (FVC). In COPD, the mucus hypersecretion is
so then associated with decline in functional class, disease exacerbation (Poole and Black, 2003),
accelerated decline in FEV1 and inflammatory cell infiltration ( Wedzicha and Donaldson 2003).

Moreover, the remaining sputum hinders the accessibility of inhaled medication to the peripheral
airways. Therefore the mucus clearance and sterility maintenance are of importance in COPD.
There is a large number of medications available that are meant to change the properties of airway
secretion or block its production or release, or both. The so called mucolytics are responsible for the
disruption of the mucous gel, generally by altering the degree of the cross-linking or the interactions
between molecules in the gel. Mucolytics include compounds as N-acetylcysteine (NAC) and related
compounds, dornase–α, F-actin, de-polymerizing agents and nondestructive mucolytics, like hypertonic
saline and oligosaccharide agents and were previously reviewed (King and Rubin, 2002 ).

Mucus hypersecretion in asthma


The secretion of tenacious mucus forming plugs is a hallmark of asthma, and it may results in variable
degrees of severity of the disease. It is the result of the inflammatory process in the small airways.

Credit of image:
http://littledoctors.wordpress.com/2011/01/12/chronic-obstructive-pulmonary-disease-bronchial-asthma/

Asthmatic airways show both a hyperplasia and metaplasia of goblet cells, all of these cells are mucin-
producing in the epithelium. The hyperplasia refers to augmented numbers of goblet cells in larger
airways, while metaplasia refers to the appearance of these cells in smaller airways where they
normally are not seen. With the augmented number of mucin-producing and secreting cells, there is a
simultaneous hypersecretion of mucin which characterizes asthma.
A major regulator of airway mucin secretion in both in vitro and in vivo studies has been shown to be
MARCKS (myristoylated alanine-rich C kinase substrate) protein, a ubiquitous substrate of protein
kinase C (PKC) at a cellular level (Green TD et al, 2011 )

References
Ficker JH. [Physiology and pathophysiology of bronchial secretion]. Pneumologie. 2008 Mar;62
Suppl 1:S11-S3 http://www.ncbi.nlm.nih.gov/pubmed/18317975

Green TD, Crews AL, Park J, Fang S, Adler KB. Regulation of mucin secretion and inflammation
in asthma: A role for MARCKS protein? Biochim Biophys Acta. 2011 Jan 31. [Epub ahead of
print] PubMed PMID: 1281703. http://www.ncbi.nlm.nih.gov/pubmed/21281703

Helms S, Miller A. Natural treatment of chronic rhinosinusitis. Altern Med Rev. 2006
Sep;11(3):196-207. Review. PubMed PMID: 17217321.
http://www.thorne.com/altmedrev/.fulltext/11/3/196.pdf

King M, Rubin BK. Pharmacological approaches to discovery and development of new mucolytic
agents. Adv Drug Deliv Rev. 2002 Dec 5;54(11):1475-
90 http://www.ncbi.nlm.nih.gov/pubmed/12458156

Lidell ME, Hansson GC. Cleavage in the GDPH sequence of the C-terminal cysteine-rich part of
the human MUC5AC mucin. Biochem J. 2006 Oct 1;399(1):121-9. PubMed PMID: 16787389.
http://www.ncbi.nlm.nih.gov/pubmed/16787389 Full text in
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570170/pdf/bj3990121.pdf

Neutra M, Leblond CP. The Golgi apparatus. Sci. Am. 1969; 220: 100–107
http://www.ncbi.nlm.nih.gov/pubmed?term=237402

Pintucci JP, Corno S, Garotta M. Biofilms and infections of the upper respiratory tract. Eur Rev
Med Pharmacol Sci. 2010 Aug;14(8):683-90. PubMed PMID: 20707288.
http://www.ncbi.nlm.nih.gov/pubmed/20707288

Poole PJ, Black PN. Preventing exacerbations of chronic bronchitis and COPD: therapeutic
potential of mucolytic agents. Am J Respir Med. 2003;2(5):367-370
http://www.ncbi.nlm.nih.gov/pubmed/14719989

Sadowska AM, Verbraecken J, Darquennes K, De Backer WA. Role of N-acetylcysteine in the


management of COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(4):425-34. Review. PubMed
PMID: 18044098;
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707813/pdf/copd-1-425.pdf

Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir
Care. 2003 Dec;48(12):1204-13; discussion 1213-5. Review. PubMed PMID: 14651761.
http://www.rcjournal.com/contents/12.03/12.03.1204.pdf
Alejandro Melo-Florián MD
Internal Medicine Specialist
Pontificia Universidad Javeriana
Bogotá D.C. – Colombia
Competing Interests: Working with pharmaceutical
manufacturer
e-mail: alejandromeloflorian@gmail.com

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