Follow your nose to discover the cause of Wegener's Disease

I read a really interesting article on Med Page Today that theorised that the nose holds the clues to the cause of vasculitis (including Wegener's Granulomatosis).  

Could the cause of Wegener's Granulomatosis be found in the nose?

It starts off with a lot of technical jargon but don't let that put you off; the practical implications of that science are explained later in the article. I'll summarise things here too, to make it even easier.

The research was undertaken by Peter C. Grayson, MD, head of the Vasculitis Translational Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, in Bethesda, Md.

For many people suffering with Wegener's Disease, the first symptoms are experienced in their nose, with nosebleeds and sinus infections very common. This is one of the reasons it can be so difficult to diagnose GPA (granulomatosis with Polyangiitis), because doctor's are treating what they think is a sinus infection rather than the real cause of the problem. Many sufferers then go on to have worse symptoms such as crusting, bleeding and even the destruction of cartilage and bone.

Examining the genes of people with vasculitis to look for a cause is not a new idea, but what Grayson did was new. Instead of taking gene samples from the sufferer's blood, he took the samples from the original source - the nose.

"Increased SERPINA1 expression in nasal mucosa of patients with GPA raises the possibility of a protease-antiprotease imbalance in the nasal environment that could play a causal role in the development of GPA," Grayson and colleagues wrote.

"The study has given us a really nice list of candidate genes and ideas and pathways to pursue in future experiments," Grayson said.

Peter C. Grayson, MD

Peter C. Grayson, MD

"The observation that some of the genes we detected were related to the innate immune system suggested that there may be interactions going on between the nasal microbiome and immune cells within the nose. That's a really attractive idea for us to follow," he said in an interview.

They also plan to examine gene expression in deeper nasal tissue biopsy samples.

While this is a really interesting development, it is clear that this is not going to lead to an imminent major breakthrough. For one thing the study was very small and that could cloud the results which could be linked to rhinitis, sarcoidosis and other diseases. However, it is good to know that research is continuing into vasculitis and gives me hope that one day the cause, and ultimately a cure, may be found.

The article is called The Nose Holds the Clues in Vasculitis and you can read it here.

Image from M&R Glasgow under Creative Commons licence.