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Specific immunoglobulin E for staphylococcal enterotoxins in nasal polyps from patients with aspirin-intolerant asthma.

BACKGROUND: Nasal polyps infiltrated with eosinophils are commonly found in chronic asthmatic patients, more frequently in those with aspirin-intolerant asthma (AIA) than aspirin-tolerant asthma (ATA). Some studies have suggested a contribution of superantigens derived from Staphylococcus sp to nasal polyposis and eosinophilia, but their relative importance in AIA and ATA subjects is unknown. OBJECTIVE: We investigated whether local production of specific IgE to staphylococcal enterotoxins A and B (SEA and SEB) and relationships with markers of eosinophilic inflammation differ in the nasal polyps of AIA and ATA subjects. METHODS: Fifteen AIA subjects with positive responses to lysine-aspirin bronchoprovocation and 15 ATA subjects underwent polypectomy. Immunoassays were used to quantify eosinophil cationic protein (ECP), IL-5, mast cell tryptase, soluble IL-2 receptors (sIL-2R), total IgE, and specific IgE for SEA and SEB. RESULTS: ECP levels in nasal polyp homogenates were higher in AIA subjects than in ATA subjects (P < 0.02), with no significant differences in tryptase, IL-5 or sIL-2R. Total IgE, and specific IgE to both SEA and SEB, were detectable in some nasal polyps from both subject groups, but median levels were markedly higher in AIA subjects than in ATA subjects (P = 0.04, 0.01, 0.05, respectively). Levels of specific IgE to SEA and SEB correlated significantly with levels of ECP and IL-5, but not those of tryptase or sIL-2R. CONCLUSION: These findings suggest that staphylococcal superantigens may drive local eosinophilic inflammation in nasal polyp tissue, and that this is exacerbated in subjects with AIA.

Adult↗

Numerical chromosome changes in a nasal polyp.

The etiology of nasal polyposis is not fully understood. We found numerical chromosome changes in one out of five cytogenetically investigated nasal polyps. The histological picture of this case was characterized by the presence of histiocyte-like cells, which were absent in the remaining cytogenetically normal polyps.

Adult↗

[The significance of matrix metalloproteinases expression in nasal polyps].

OBJECTIVE: To explore the role of matrix metalloproteinases (MMPs) in nasal polyp formation. METHODS: The expression of MMP9, MMP2 and MMP3 was studied in 32 nasal polyps by immunohistochemical method. RESULTS: MMPs could not be detected in all samples of normal mucosa. In nasal polyp tissue, MMP9 was observed epithelial in cells, inflammatory cell and blood cells, MMP2 was detected in fibroblasts, epithelial cells and inflammatory cells, and MMP3 was detected in inflammatory cells and epithelial cells. Compare to normal mucosa, MMP9, MMP2 and MMP3 was over expressed in their positive cells of polyp. The expression of MMP9 was higher than that of MMP2 and MMP3 in nasal polyp tissue (P < 0.01). CONCLUSION: MMP9, MMP2 and MMP3 were strongly correlated with nasal polyp formation. They cause pathological changes in nasal mucosa and MMP9 may play the most important role among them.

Adolescent↗

Distribution of mast cells and eosinophils in nasal polyps from atopic and nonatopic subjects: a morphometric study.

The pathogenetic mechanism of nasal polyps remains unknown, although polyps seem to be an expression of chronic nasal inflammation of both allergic and nonallergic origin. The goal of our study was to compare the distribution mast cells and eosinophils (cells traditionally associated with allergic inflammation) in nasal polyps from well defined atopic and nonatopic patients, using advanced morphometric analysis system. Nasal polyps were removed during routine nasal polypectomy performed in 17 atopic and 19 nonatopic patients. Parafin sections of nasal polyps were stained with haematoxilin/eosin, chromotrope R2 or toluidine blue, and light microscopy, assisted with computerized picture analysis system, was used to count the number of cells in the superficial and stromal layer of the mucosa. Regardless of the presence or absence of atopy, eosinophils were predominant cells in the polyps, and both eosinophils and mast cells were more abundant in the superficial layer than in the stromal layer of the mucosa. The density of eosinophils in both layers and mast cells in the stromal layer was similar in atopic and nonatopic patients. Only the density of mast cells in the superficial layer of the mucosa was slightly higher (p < 0.005 in atopic compared to nonatopic patients): In both groups of patients a significant correlation between the number of mast cells and eosinophils in the superficial layer of the polyp mucosa was found (r = 0.84; p < 0.001). Our study demonstrates that eosinophils and mast cells are abundant in nasal polyps from both atopic and nonatopic patients and that mast cells seem to be more superficially distributed in atopic compared to nonatopic patients.

Adolescent↗

[Secretion and expression of E-selectin in nasal polyps].

OBJECTIVE: To investigate the significance of E-selectin in nasal polyps. METHOD: The E-selectin was measured by enzyme linked immunosorbent assay in 25 patients and 9 control cases from polyp tissue and normal inferior turbinates respectively. Meanwhile, the expression of E-selectin in these samples was studied with immunohistochemistry. All these samples were also studied by HE stain and observed under optical microscope. RESULT: Plentiful eosinophils infiltrated the matrix were observed in nasal polyps group. The level of E-selectin was(42.58 +/- 13.52) microg/L,significantly higer than that of controls (11.35 +/- 3.17) microg/L, (P < 0.001). E-selectin express mainly in the vascular endothelial, the gland cells and the extracellular matrix with infiltrated inflammation cells of nasal polyps. The expressions in the vascular endothelial and the matrix of nasal polyps were significantly higher than those of inferior turbinates (84.0% and 92.0%, P = 0.05, 0.01, respectively). The statistical analysis showed there was positive correlation between the expression of E-selectin in the vascular endothelial and in the matrix (r = 0.544, P < 0.01). CONCLUSION: This study demonstrates that the secretion and expression of E-selectin in nasal polyps increase significantly. E-selectin may play a key role involving in the occurrence of nasal polyps in the chronic inflammation procedure with inflammation cells to attach to the vascular, to migrate into the matrix as well as to be activated.

Adolescent↗

Inflammatory cells as well as epithelial cells in nasal polyps express vascular endothelial growth factor.

In nasal polyps (NPs), locally secreted growth factors are involved in the remodelling of the epithelium and extracellular matrix but little is known concerning vessel remodelling. The in situ expression of vascular endothelial growth factor (VEGF) in NPs and control nasal mucosa (CM) were evaluated and in vitro secretion of VEGF from primary human cultures of nasal epithelial cells (HNECs) was quantified. VEGF expression was evaluated in NP (n=14) and CM (n=6) after immunolabelling. In supernatants from HNECs cultured at air/liquid interface, VEGF was quantified by immunoassay, under baseline conditions and after transforming growth factor-beta1 (TGF-beta1) stimulation. In HNEC lysates, VEGF and VEGF messenger ribonucleic acid (mRNA) were detected using Western blot analysis and reverse transcriptase polymerase chain reaction respectively. VEGF positivity was more frequent in inflammatory cells in NPs (14 of 14) than in CM (three of six) (p<0.05) and in the epithelium in NPs (six of 14) than in CM (two of six) (nonsignificant). Under baseline conditions, the VEGF concentration in HNEC culture medium increased from day 2 to 4, then decreased and became undetectable. VEGF concentrations increased significantly after TGF-beta1 stimulation. In HNEC lysates, VEGF and VEGF mRNA were detected on days 4 and 14 of culture. It was concluded that vascular endothelial growth factor is intensely expressed in situ in nasal polyps, mainly in inflammatory cells but also in epithelial cells. Human nasal epithelial cells are able to secrete in vitro vascular endothelial growth factor. Transforming growth factor-beta1 upregulates this secretion. This suggests that vascular endothelial growth factor, inducing oedema and angiogenesis, could be involved in the pathogenesis of nasal polyps.

Endothelial Growth Factors↗

[A primary study about the correlation between superantigens produced by Staphylococcus aureus and chronic rhinosinusitis with nasal polyps].

OBJECTIVE: To study the role of superantigens produced by Staphylococcus aureus in the pathogenesis of nasal polyps. METHOD: sinonasal mucus and polyp/mucosa tissue were obtained from sixty-nine patients with chronic rhinosinusitis (42 patients with bilateral nasal polyps, 27 without nasal polyps). Samples from twelve normal subjects were also obtained for comparative negative controls. Mucus specimens were cultured for bacteria. Tissue specimens were assayed by ELISA for staphylococcal exotoxins. In addition, the histopathology of nasal polyps was studied. The paraffin sections were stained with hematoxylin and eosin, and these were examined for eosinophil counts. RESULT: The percentages of Staphylococcus aureus in sinonasal mucus were 7.1 for chronic rhinosinusitis with nasal polyp (CRSwNP) subjects, 3.7% for chronic rhinosinusitis without nasal polyps (CRSsNP). and 0 for controls respectively. There were no significant differences between these groups. In CRSwNP subjects 23 of 42 samples (54.76%) demonstrated reactivity for at least one staphylococcal exotoxin. There were no positive results in the CRSsNP or control groups. The mean eosinophil counts were 23. 94+/-13. 88 in CRSwNP group, 0.29+/-0.51 in CRSsNP group, and 0. 08+/-0.28 in controls. The differences in these three groups were all significant ( P <0.05). There was a trend toward higher eosinophil levels in polyps of ELISA-positive patients compared with that of ELISA-negative patients, although this was not statistically different ( P >0.05). CONCLUSION: There were correlation between Staphylococcal superantigens and nasal CRSwNP, and superantigens were possible etiological agents in the pathogenesis of CRSwNP.

Adult↗

Malignant transformation of nasal polyp. Case report.

Malignant transformation of nasal polyps is believed to be very rare. A 49-year-old man had suffered from nasal polyposis and visited the hospital complaining of nasal obstruction and a huge nasal polyp in the right nostril. Histologic findings showed squamous cell carcinoma with microinvasion on the surface of the polyp and no invasion of carcinoma in the stalk. Simultaneously, malignant transformation of a small polyp was found in the left nasal cavity. Clinical and histologic findings are discussed.

Carcinoma, Squamous Cell↗

[Immunohistological study of eosinophilic infiltration of nasal polyps in aspirin-induced asthma].

It is well known that nasal polyps frequently develop in patients with aspirin-induced asthma, which is thought to be a non-atopic disease. We immunohistochemically examined the eosinophils infiltrating the nasal polyps in patients with aspirin-induced asthma. It has also been established that the monoclonal antibody EG1 reacts with both stored and secretion type ECP (eosinophil cationic protein), and that EG2 reacts only with the secretion type of ECP. EG2 positive cells may thus be considered to be activated eosinophils. Seven cases with nasal polyps associated with aspirin-induced asthma participated in our study. Blood eosinophilia was observed in all 7 cases, but 6 showed normal blood values IgE. Two reacted to house dust antigen, on skin tests and RAST. In the nasal polyps, many EG2 positive cells were observed. On serial sections, the number and distribution of EG1 and EG2 positive cells were almost equal. In the superficial lamina propria, extra-cellular release of ECP was noted. However, epithelial damage did not relate to the number of EG2 positive cells or the degree of extra-cellular EG2 release. In the deep lamina propria, slight extra-cellular ECP release was found. From these results, the eosinophils in nasal polyps accompanying aspirin-induced asthma were thought to be activated. Eosinophils seem to play an important role in the development of nasal polyps. However, tissue injury induced by eosinophils, was not be demonstrated in this study.

Adult↗

Detection of activated eosinophils in nasal polyps of an aspirin-induced asthma patient.

Aspirin-induced asthma (AIA) is frequently accompanied by nasal polyps. Eosinophil infiltration is a characteristic feature of nasal polyps associated with AIA. Even though steroids are well known to be effective on managing AIA and its nasal polyps, histochemical examinations after steroid therapy and at recurrence, involving eosinophil infiltration of nasal polyps, have been less studied. To know the histochemical effects of steroid treatment on eosinophil accumulation in nasal polyps of AIA and the histochemical feature of a recurring polyp and to detect distributional differences between storage and secreted forms of eosinophil cationic proteins, we carried out immunocytochemical labelling with antibodies against EGI (recognizing resting and activated eosinophils) and EG2 (recognizing only activated eosinophils), and determined eosinophil infiltration in nasal polyps that were obtained before and after steroid treatment, and at recurrence of polyps. A large number of eosinophils in AIA polyps were found before steroid treatment and at recurrence, and they were predominantly composed of activated eosinophils (EG2-positive). In contrast, eosinophil infiltration was rare in polyps obtained immediately after steroid treatment. This finding suggests that eosinophil infiltration may be associated with nasal polyp formation in AIA, and that activation of eosinophils plays an important role in accumulation of eosinophils and polyp formation beginning with the initial stage.

Adrenal Cortex Hormones↗

Histochemical and immunohistochemical characteristics of mast cells in nasal polyps.

In surgically excised nasal polyps, most epithelial mast cells were formalin sensitive, chloroacetate esterase (CAE) negative, and chymase negative. Thus, this represents a population of mast cells not identified by staining for CAE. On the other hand, most stromal mast cells were formalin resistant and CAE positive, and although there was some polyp-to-polyp variability in their content of neutral protease, most of these cells were positive for both tryptase and chymase. The percentage of metachromatic cells in the epithelium and the number of metachromatic cells per unit area of polyp tissue did not correlate with an index of allergy skin test reactivity or the serum IgE concentration. The percentage of mast cells surrounded by pericellular tryptase, suggesting activation/degranulation, was significantly higher in the stroma than in the epithelium. The findings demonstrate differences between the stroma and the epithelium in phenotype and state of activation of mast cells; these are postulated to be due to distinct microenvironmental factors that affect mast cells at these sites.

Acetates↗

[Serum levels and clinical values of soluble intercellular adhesion molecule-1 in patients with nasal polyps].

OBJECTIVE: To assess the role of soluble intercellular adhesion molecule-1 (sICAM-1) in etiology of nasal polyps. METHOD: Twenty-nine patients with nasal polyps and 20 healthy control cases were chosen. Their serum sICAM-1 was determined by a sandwich enzyme-linked immunosorbent assay (ELISA). All patients were treated by glucocorticoid, serum sICAM-1 was determined post-treatment again. RESULT: (1) Serum levels of sICAM-1 in patients with nasal polyps were higher than that of control group: (2) Serum levels of sICAM-1 in patients were reduced after glucocorticoid treatment, the decrease of sICAM-1 was more apparent in evident-effect group than in effect group; (3) There was a close correlation between the decrease of polyp-size scores and the decrease of serum sICAM-1. CONCLUSION: The elevated expressions of sICAM-1 in patients with nasal polyps indicate its important role in eosinophil recruitment, which was considered as a representative hallmark for nasal polyps. The sICAM-1 is down-regulated by systemic and topical glucocorticoid treatment and the decrease of sICAM-1 is correlated with clinical effect. To take these lines of evidence together, anti-adhesion therapy may be effective for nasal polyps, serum sICAM-1 levels may be use to monitor the effect of steroid therapy in nasal polyps.

Adolescent↗

Immunohistochemical characterization of cellular infiltrate in nasal polyp from aspirin-sensitive asthmatic patients.

BACKGROUND: The immunopathologic mechanism of nasal polyp in aspirin-sensitive asthma remains to be further defined. OBJECTIVE: To characterize the features of the inflammatory cellular infiltrate in the nasal polyp tissue from aspirin-sensitive asthmatic patients. METHODS: We have taken nasal polyp tissue during nasal polyp resection from 13 aspirin-sensitive asthma, 6 allergic, and 12 non-allergic subjects. Immunohistochemistry was employed to stain and enumerate the individual inflammatory cell types using monoclonal antibodies against tryptase (AA1) to identify mast cells, against secreted forms of eosinophil cationic protein (EG2), to identify activated eosinophils, against neutrophil elastase (NE) for neutrophils and against T cell surface markers (CD3) to identify total T cells. RESULTS: There were no significant differences in AA1 + cells among three groups (P>.05). EG2 + cells tended to be higher in ASA-sensitive asthmatic patients than in allergic and non-allergic subjects, but no statistical significance was observed. NE+ cells were found in most subjects of the three groups and their numbers were significantly higher in allergic subjects than in aspirin-sensitive asthma (P<.05). Some patients had CD3+ cells with no statistical significance among the three groups. Significant correlation was found in numbers between NE+ cell and AA1+ cell (r=.44, P=.01), and between NE+ cell and EG2+ cell (r=.40, P=.02). CONCLUSION: These findings suggested that major effector cells such as mast cells and eosinophils might be placed in the center of the inflammatory response of nasal polyps, regardless of their association with aspirin sensitivity.

Adult↗

Cost effectiveness of nasal budesonide versus surgical treatment for nasal polyps.

OBJECTIVE: To conduct a cost-effectiveness study of nasal budesonide versus surgical treatment in the management of nasal polyps. DESIGN AND METHODS: A decision-tree model reflecting two different treatment strategies for nasal polyps in Sweden was developed. The first strategy was initial polypectomy, performed under three different sets of circumstances: inpatient functional endoscopic surgery, outpatient evulsion with sedation, or outpatient evulsion with local anaesthesia; all treatments were followed by intranasal treatment with budesonide (Rhinocort) 128 microg twice daily. The second strategy was initial intranasal treatment with budesonide 128 microg twice daily. PERSPECTIVE: Healthcare provider perspective. OUTCOME MEASURES AND RESULTS: After 1 month, treatment with nasal budesonide was classified as a success (82.5%) or a failure (17.5%) based on clinical study data. In cases of success, the treatment was continued, and in cases of failure, polypectomy was undertaken, followed by budesonide 128 microg twice daily. Treatments were evaluated after 4 months using prices from the Central Hospital in Skövde, Sweden. The expected reduction in cost from using initial nasal budesonide treatment compared with the different alternatives of polypectomy were 9760 Swedish kronors (SEK) for inpatient functional endoscopic surgery, SEK2747 for outpatient evulsion with sedation, and SEK672 for outpatient evulsion with anaesthesia (1998 values). Nasal budesonide 128 microg twice daily treatment for nasal polyps revealed a potential reduction in costs of 53% compared with the primary surgery approach. CONCLUSION: Initial treatment of nasal polyps with nasal budesonide provides lower costs than treatment with initial polypectomy with maintained effectiveness.

Administration, Intranasal↗

[Relationship between expressions of GATA-3 and interleukin-5 in nasal polyps].

OBJECTIVE: To evaluate the role of transcription factor GATA-3 in the pathogenesis of nasal polyps. METHODS: The expression of GATA-3 was detected by immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR) in 28 cases of nasal polyps and 17 specimens of normal nasal epithelium. The expression of interleukin-5 (IL-5) in these specimens was detected by enzyme-linked immunosorbent assay (ELISA) meanwhile. RESULTS: Immunohistochemistry showed, as confirmed by RT-PCR, a positive rate of GATA-3 of 89.3% in the nasal polyp (25/28) and 29.4% in the normal nasal mucosa (5/17), P < 0.05. GATA-3 was mainly distributed in submucous inflammatory cells. The relative density ratio of GATA-3 to GAPDH was 0.618 +/- 0.137 in nasal polyp and 0.21 +/- 0.11 in normal nasal mucosa (P < 0.05) as indicated by RT-PCR and agarose electrophoresis. The concentrations of IL-5 were 69.4 +/- 15.1 pg/ml and 25.7 +/- 13.0 pg/mg in the two groups respectively. The expression of GATA-3 was positively correlated to the expression of IL-5 in the nasal polyp. CONCLUSION: Contributing to the overexpression of such cytokines as IL-5, GATA-3 may play an important role in the pathogenesis of nasal polyps.

Adolescent↗

[Expression of aquaporin-1 and Bcl-2 mRNA in eosinophils of the nasal polyps and its significance].

OBJECTIVE: To study the significance of aquaporin-1 (AQP-1) expression in the eosinophils of nasal polyps. The expression and location of AQP-1 mRNA and apoptosis associated gene Bcl-2 mRNA in nasal polyps were explored. METHODS: Sixteen nasal polyp samples were collected from 11 women and 5 men aged 20-65 years during routine endonasal surgery. Nasal mucosa specimens from the inferior turbinates of 10 patients with allergic rhinitis (7 women and 3 men, aged 16-58 years), collected during septoplasty, were used as controls. The expression of AQP-1 mRNA and Bcl-2 mRNA was detected in serial adjacent sections by in situ hybridization and eosinophils were examined by stain MGG. RESULTS: AQP-1 mRNA expression was found in all 16 nasal polyps and in 4 of 10 inferior turbinate tissues, the mean expression rates were (93.16 +/- 13.25)% and (19.54 +/- 4.98)%, respectively. All 16 nasal polyps and 10 control nasal tissues expressed Bcl-2 mRNA, by the average rates of (84.74 +/- 12.10)% and (16.45 +/- 3.12)%, respectively. The expression of AQP-1 mRNA was positively correlated with Bcl-2 mRNA expression in nasal polyps (r = 0.875, P < 0.01). CONCLUSIONS: AQP-1 contributes to the survival of eosinophils in nasal polyps by keeping the permeation balance of eosinophils.

Adolescent↗

Flexible fiberoptic rhinoscopy in the diagnosis of nasal polyps in cystic fibrosis.

The incidence of nasal polyps in patients with CF in various studies varies from 6.7% to 48%. Fiberoptic rhinoscopy, a safe and minimally invasive diagnostic procedure, has the major advantage over routine physical examination of the nares because of the ability to examine the nose beyond the nasal vestibule. In examinations of both nostrils of 34 patients with CF age 4-30 years, nasal polyps were detected by rhinoscopic examination, but missed by physical examination in 17 (25%) of the nostrils. In 7% (5/64) of the nostrils in this series, rhinoscopy ruled out polyps that were reportedly identified on physician examination. This study confirms that even a careful physical examination of the nose is often inadequate to uncover significant nasal pathology such as nasal polyps.

Child↗

Nasal polyps: effects of seasonal allergen exposure.

Nasal polyps are characterized by chronic eosinophilic inflammation and often coexist with rhinitis and asthma. Many patients with polyps have no detectable allergy, and it is considered that allergy, at least in many cases, is not relevant to polyp to pathogenesis. To explore the association of nasal polyps with allergy, 16 patients with polyps and ragweed allergy (PRW +) and 16 patients with polyps who were not allergic to ragweed (PRW-) were compared with patients without polyps, 16 who were allergic to ragweed (NPRW +) and 16 who were not allergic to ragweed (NPRW-), before and during the ragweed season. The level of ragweed allergy was comparable in the PRW+ and NPRW+ populations as determined by ragweed skin test wheal diameter, ragweed IgE RAST percent binding, and total serum IgE. Symptom scores before the ragweed season recorded on visual analog scales for the symptoms of blockage, sneezing, decreased smell, itch, postnatal drip, and runny nose were high in patients in the PRW+ and PRW- groups and did not change during ragweed season. Mean symptom scores were low in the NPRW+ group before ragweed season and increased during the season to levels similar to those of patients in the PRW+ and PRW- groups. Preseason nasal lavage albumin concentration was higher in subjects with polyps than those without polyps (58.5, 98) versus (13.6, 15 micrograms/ml) (p = 0.02) and did not change significantly in any group with seasonal exposure. Data are presented as mean, 1 SD; comparisons are made with unpaired t tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗