Vitamin D Influence on Chronic Rhinosinusitis and Nasal Polyps

Chronic rhinosinusitis with nasal polyps is a heterogeneous disorder marked by persistent sinonasal inflammation and mucosal protrusions that affect quality of life globally. Vitamin D, beyond its classical role in calcium homoeostasis, modulates innate and adaptive immunity and influences epithelial integrity and tissue remodelling within the sinonasal mucosa. Deficiency in the principal circulating metabolite, 25-hydroxyvitamin D, has been observed in patients with both polypoid and non-polypoid forms of chronic rhinosinusitis, correlating with disease severity and recurrence risk. Mechanistic studies indicate that the active form, 1,25-dihydroxyvitamin D₃, can attenuate fibroblast-to-myofibroblast differentiation, suppress extracellular matrix production and dampen type 2 cytokine responses. These effects converge on key pathways such as Smad2/3 signalling and nuclear histone modification, suggesting a direct role for vitamin D receptor–mediated transcriptional control in nasal polyp pathophysiology. Clinically, vitamin D status has been linked to preoperative sinonasal scores and postoperative recovery, underpinning the potential of supplementation as an adjunct to standard therapies including surgery and corticosteroids.

Research from Nature Portfolio

Recent studies have demonstrated that 1,25-dihydroxyvitamin D₃ significantly reduces markers of myofibroblast differentiation—α-smooth muscle actin—and key extracellular matrix components such as fibronectin in nasal polyp–derived fibroblasts. This effect occurs via inhibition of the Smad2/3 signalling cascade activated by transforming growth factor-β₁, as well as through decreased histone H3 acetylation at fibrotic gene loci. Functional assays in organ cultures of nasal polyps have confirmed that active vitamin D diminishes tissue contractility and fibroblast motility. These findings furnish a mechanistic rationale for targeting vitamin D pathways to mitigate polyp growth and recurrence.

Vitamin D Influence on Chronic Rhinosinusitis and Nasal Polyps publication trend

The graph below shows the total number of articles in vitamin d influence on chronic rhinosinusitis and nasal polyps across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic rhinosinusitis with nasal polyps (CRSwNP): Persistent inflammation of the paranasal sinuses characterised by mucosal thickening and benign mucosal protrusions.

25-hydroxyvitamin D (25(OH)D): The main circulating form of vitamin D used to assess an individual’s vitamin D status.

1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃): The biologically active metabolite of vitamin D that binds the vitamin D receptor to regulate gene expression.

Smad2/3 signalling pathway: A TGF-β–activated intracellular cascade that controls transcription of genes involved in fibrosis and extracellular matrix synthesis.

Myofibroblast: A specialised cell exhibiting contractile and matrix-producing properties, marked by expression of α-smooth muscle actin.

Extracellular matrix (ECM): The network of structural proteins, including collagen and fibronectin, that provides scaffolding for tissue architecture.

References

1. Role of Vitamin D in the Clinical Course of Nasal Polyposis. Biomedicines (2021).
2. Vitamin D attenuates myofibroblast differentiation and extracellular matrix accumulation in nasal polyp-derived fibroblasts through smad2/3 signaling pathway. Scientific Reports (2017).
3. Association between serum vitamin D and chronic rhinosinusitis: a meta-analysis. Brazilian Journal of Otorhinolaryngology (2019).
4. Relationship between the Severity of Inflammatory Changes in Chronic Sinusitis and the Level of Vitamin D before and after the FESS Procedure. Journal of Clinical Medicine (2021).