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PubMed2002

Role of allergy in the therapeutic response of nasal polyps.

The objective of this study was to determine whether the allergy factor affects therapeutic response of nasal polyps. A total of 68 patients were enrolled between 1 October 1999 and 1 January 2002 at the Allergy and Rhinology Clinic, Faculty of Medicine, Songklanagarind Hospital. Allergy skin prick test was performed in order to divide patients into a positive skin test group and a negative skin test group. Their medical history was recorded including age, sex, nasal symptoms, concomitant diseases and medications. Patients in both groups were treated over a 6 week period with Budesonide nasal spray. Nasal symptoms, polyp size, nasal and oral expiratory peak flow were evaluated at each visit. Overall assessment of treatment efficacy was evaluated by patients at 3 and 6 weeks after treatment. The mean value of these variables during treatment and a baseline period were compared within and between groups. After 3 and 6 weeks of treatment of nasal polyps with topical Budesonide nasal spray, nasal symptoms, polyp size, nasal and oral expiratory peak flow index and overall response to treatment were improved within both groups. Comparing the two groups, there were greater improvements in the negative skin test group compared to the positive skin test group in all variables. These differences in variable scores between groups showed a tendency to increase overtime after treatment was terminated. The results demonstrate that nasal polyps with positive allergen skin test had less improvement compared to nasal polyps with negative allergen skin test in all nasal signs and symptoms and these differences in improvement showed a tendency to increase over time after treatment.

Administration, Topical↗
PubMed2006

Overexpression of hepatocyte growth factor and its receptor c-Met in nasal polyps.

OBJECTIVES: To investigate the expression and distribution of hepatocyte growth factor (HGF) and c-Met proteins in normal nasal mucosa and in nasal polyps and to evaluate the possible effects of HGF and c-Met on the development of nasal polyps. DESIGN: Prospective study. SETTING: Tertiary academic institution. PATIENTS: Normal inferior turbinate mucosa was obtained from 20 patients undergoing surgery for augmentation rhinoplasty. Nasal polyps were obtained from 20 patients undergoing endoscopic sinus surgery for chronic polypoid sinusitis. INTERVENTIONS: Semiquantitative reverse-transcriptase polymerase chain reaction, immunohistochemistry, and Western blot analysis were performed. MAIN OUTCOME MEASURES: The expression and distribution of HGF and c-Met were analyzed. RESULTS: Using immunohistochemistry, moderate to high levels of HGF were mainly localized in submucosal glands of nasal polyps, while c-Met was detected in submucosal glands and in epithelial cells. In normal turbinate mucosa, immunopositive HGF was detected in submucosal glands, where faint staining was found, while c-Met was noted in epithelial cells and in submucosal glands. Semiquantitative reverse-transcriptase polymerase chain reaction and Western blot analysis showed that HGF expression was increased in nasal polyps compared with that in normal turbinate mucosa. The same result was observed for c-Met. CONCLUSION: Elevated c-Met expression in combination with expression of HGF in nasal polyps may enhance the proliferation of epithelial cells and submucosal glandular cells through the release of HGF, which activates c-Met receptors in nasal polyps.

Adult↗
PubMed2000

[Significance and detection of interleukin-8 in human nasal polyps].

OBJECTIVE: To investigate the distribution and content of immunoreaction interleukin-8(IL-8) antigen in the human nasal polyps. METHODS: Twenty-two cases of nasal polyp and 10 cases of normal inferior turbinate were studied with immunohistochemical SABC method and ELISA method. RESULTS: Immunohistochemical results demonstrated that IL-8 antigen staining occurred predominantly within inflammatory and epithelium cell plasm. The level of IL-8 in nasal polyp tissue was higher than in normal control specimens. The value in nasal polyp tissue was in 322.06-2091.41 pg/ml, but in normal with a range of 29.31-332.19 pg/ml. The results demonstrated a remarkable difference between the two groups (P < 0.001). CONCLUSION: These data demonstrated the presence of IL-8 antigen in nasal polyps. Thus IL-8 likely plays a significant role in the pathogenesis of this disease process. There is an important significance of finding a potential treatment method.

Adolescent↗
PubMedDate not supplied

The presence of atopy does not determine the type of cellular infiltrate in nasal polyps.

BACKGROUND AND OBJECTIVES: Any relationship between atopy and nasal polyposis remains to be further studied to determine the contribution of atopy to the pathogenesis of nasal polyps. MATERIALS AND METHOD: We have compared the inflammatory cellular infiltrate in nasal polyp tissue taken during resection from 10 atopic and 11 non-atopic subjects. We have used immunohistochemistry to enumerate the individual inflammatory cell types using monoclonal antibodies against tryptase (AA1) to identify mast cells, the secreted forms of eosinophil cationic protein (EG2) to identify activated eosinophils, neutrophil elastase (NE+) to demonstrate neutrophils, and T cell surface markers (CD3) to identify pan T cells. RESULT: The number of AA1+ and NE+ cells tended to be higher in atopics, but no statistical significance was found (p = 0.06, p = 0.12). Eosinophil numbers (EG2) were abundant in both groups and found to be not different between them (p = 0.65). Some subjects had CD3+ cells with no significant difference between atopic and non-atopic subjects (p = 0.21). Significant correlation was found between NE+ and AA1+ or EG2 cells (r = 0.59, r = 0.63, p < 0.05, respectively). CONCLUSION: These results suggest that the presence of atopy does not determine either the type of extent of cellular infiltration of nasal polyps.

Analysis of Variance↗
PubMed1980

HLA antigens, nasal polyps and asthma.

HLA typing has been performed on a selected series of 29 patients with nasal polyps, with or without asthma. Despite the small series there was a significant incease in the haplotype AI/B8 in patients with both nasal polyps and asthma. No association was found in those with polyps alone. However, those with both conditions, who were positive for AI/B8, had more severe polyp disease. Three out of 4 patients with nasal polyps, asthma and sensitivity to aspirin were positive for AI/B8. In patients with nasal polyps, tissue typing sensitivity to aspirin were positive for AI/B8. In patients with nasal polyps, tissue typing might be of use in predicting both those who are most at risk of developing asthma, and also those who are most likely to have severe polyp disease. The association of AI/B8 with severe polyp disease and asthma, may imply that abnormalities of immune response are likely to be associated with the pathogenesis of both conditions.

Adolescent↗
PubMed2000

Immunocytochemical distribution of the c-H-ras protein in nasal polyps: localization to the terminal bars.

OBJECTIVE: This study was performed to investigate the role of proto-oncogene products, c-H-ras and c-erbB-2, in the pathophysiology of nasal polyps. METHODS: An immunocytochemical investigation of the expression of proto-oncogene products of c-H-ras and c-erbB-2 was performed on 16 nasal polyps and 15 nasal mucosa specimens. RESULTS: The c-H-ras protein was found to be localized to the terminal bars of apical cells of the epithelium in 11 of 16 nasal polyps and in seven of 15 nasal mucosa. Localized staining at the terminal bars for the c-H-ras protein was significantly more frequently observed in glandular-cystic type than in edematous type nasal polyps. Such localized staining was significantly more frequently seen in polyp specimens with invaginated epithelia than in those with no invaginated epithelium. Our findings confirmed that the c-erbB-2 protein was mainly localized to the plasma membrane in all samples. CONCLUSION: These results suggest that the c-H-ras protein localized to the terminal bars plays an important role in the pathophysiology of glandular-cystic type nasal polyps and that it may be related to invagination of nasal polyp epithelium.

Cytoplasm↗
PubMedDate not supplied

The clinical relationship of nasal polyps to asthma.

From a meta-analysis on the clinical related literature on asthma and nasal polyps, it was found that patients with asthma had polyps in 7 to 15% with the highest frequency in the age group above 50 years. Between 36% and 96% of acetylsalicylic acid (ASA) intolerant patients had polyps. Patients with nasal polyps had asthma at an average of 29.9% in those referred to ENT departments, and more than 70% in those referred to allergy departments. An average of 12.8% had ASA intolerance. Male to female ratio showed a tendency toward lower values in the series, with the highest frequency of asthma and ASA intolerance. Not all polyp patients had an associated lower airway disease, neither as manifest asthma, nor as hyperreactive airways on challenge test. Females with polyps were more likely to have asthma than males. Patients with polyps, asthma, and ASA intolerance showed a later onset of both asthma and polyps compared to those without these characteristics. Asthma developed before polyps in an average of 69% of the series. Most patients showed improvement or at the least were unchanged in the control of their asthma after surgery. Bronchospasm during endonasal surgery was observed in less than 2%. Active asthma before treatment and surgery under local anaesthesia have been factors considered important. Control of polyps and sinus disease showed a poorer outcome in patients with asthma, and this was even more pronounced in patients having ASA intolerance. This survey supports the belief that the eosinophilic nasal polyp patients includes patients with different aetiopathogenetic factors and with different clinical outcomes regarding both the upper and lower airways. Identification of such entities is still needed through basic and clinical research to improve treatment.

Adult↗
PubMed2003

[Expression of NO and NOS in nasal polyps].

OBJECTIVE: To investigate the expression of nitric oxide synthase(NOS) in nasal polyps tissue and also to study the function of nitric oxide in the pathology of nasal polyps. METHOD: Investigating the expression of iNOS, eNOS with immunohistochemical staining, and the expression of iNOS mRNA with hybridization in situ. Analysing the production of nitric oxide in the nasal polyps through nitrate reductase technique. RESULT: In the polyps group, eNOS located in gland cells, epithelial and vascular endothelial cells, the staining of which was a little stronger than those of controls. The staining of iNOS was fairly strong in the epithelial cells, and it expressed mostly in the inflammatory cells inside the tissue. CONCLUSION: eNOS may play a role in glandular secretion and vascular dilatation. The increase of eNOS might respond to the enhanced nasal secretion and edema of nasal mocusa. Large amount of NO produced by iNOS may deteriorate the inflammation process of nasal polyps.

Adult↗
PubMed2005

Expression and distribution of thioredoxin and thioredoxin reductase in human nasal mucosa and nasal polyp.

CONCLUSIONS: The results of this study indicate that thioredoxin (Trx) and thioredoxin reductase (TrxR) may play a role in the defense of normal human nasal mucosa against external noxious stimuli. Based on the fact that normal nasal mucosa is continuously exposed to inhaled toxicants and contains a considerable number of inflammatory cells, Trx and TrxR may be upregulated even in normal nasal mucosa and perhaps the difference in their expression levels between normal nasal mucosa and nasal polyp, if it exists at all, is small and therefore difficult to detect. Further studies will be needed to clarify the roles of Trx and TrxR in the pathogenesis of nasal polyp. OBJECTIVES: The cellular antioxidant defense system includes thiol-containing proteins such as Trx and TrxR, which have recently attracted much attention due to their strong antioxidant radical quenching capabilities and other important biological functions related to the regulation of the cellular redox state. This study was undertaken to investigate the expression and distribution of Trx and TrxR in normal human nasal mucosa and nasal polyp, and to improve understanding of the significance of the Trx system in these conditions. MATERIAL AND METHODS: The expression and distribution of Trx and TrxR in normal human inferior turbinate mucosa and nasal polyp were investigated using reverse transcriptase polymerase chain reaction (RT-PCR), semiquantitative RT-PCR, Western blotting and immunohistochemistry. RESULTS: mRNAs and protein for both Trx and TrxR were detected in normal human inferior turbinate mucosa and nasal polyp. Semiquantitative RT-PCR and Western blotting revealed that there was no significant difference in the expression levels of Trx and TrxR between inferior turbinate mucosa and nasal polyp. Immunoreactivity for both Trx and TrxR was seen in nasal epithelial cells, glands and vascular endothelium of inferior turbinate mucosa and nasal polyp. Trx and TrxR immunoreactivity was also found in inflammatory infiltrating cells in inferior turbinate mucosa and nasal polyp.

Adult↗
PubMed2004

Immunohistochemical demonstration and semi-quantitation of vascular endothelial growth factor in recurrent versus non-recurrent nasal polyps.

OBJECTIVE: The expression of some growth factors in nasal polyps has been examined, although investigations addressing the reason for recurrence in some patients are lacking. Vascular endothelial growth factor (VEGF) is expressed by inflammatory cells, as well as by endothelial and epithelial cells of nasal polyps. To determine whether VEGF may play a role in the recurrence of nasal polyps, we aimed to compare VEGF expression in recurrent versus non-recurrent polyps. In addition, expression in polyps from asthmatic patients was compared with that in polyps from non-asthmatics. MATERIAL AND METHODS: A total of 30 patients with newly diagnosed nasal polyposis were included. Polypectomy was performed at enrolment in the long-term follow-up study. Fifteen patients had only 1 polypectomy (non-recurrence group; median observation period 81 months) and 15 had a median of 6.4 polypectomies (multiple recurrence group; median observation period 108 months). Five of 10 patients with asthma belonged to the non-recurrence group and 5 to the recurrence group. The polyp obtained at the initial polypectomy was examined for expression of VEGF by immunohistochemistry, using a polyclonal antibody. A blinded semi-quantitation and comparison of the intensity of immunolabelling were performed in recurrent versus non-recurrent polyps, as well as in asthmatics versus non-asthmatics. RESULTS: VEGF expression was seen as varying staining of the polyp surface and gland epithelium, as well as of the vessel endothelium and some stromal mono- and polymorphonuclear leukocytes. Semi-quantitation of the staining intensity showed no significant differences between recurrent and non-recurrent polyps, or between asthmatics and non-asthmatics. CONCLUSION: Our findings indicate that the level of immunohistochemical expression of VEGF in recurrent and nonrecurrent nasal polyposis is equivalent. Thus, the level of VEGF expression cannot predict a subsequent recurrence. The expression of VEGF is not upregulated in patients with asthma. Further studies are needed to determine the role of VEGF in nasal polyposis, with special reference to different stages of polyp formation, vascularization and growth.

Adolescent↗
PubMed2004

Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery.

BACKGROUND: Local corticosteroids are widely used in the treatment of nasal polyps and chronic rhinosinusitis both before and after nasal surgery. Their efficacy after functional endoscopic sinus surgery (FESS) has not been fully established by placebo-controlled trials. OBJECTIVE: This double-blind placebo-controlled randomized study was performed in order to investigate whether fluticasone propionate aqueous nasal spray (FPANS) reduces the recurrence rate of nasal polyps and chronic rhinosinusitis during the first year after FESS. PATIENTS AND METHODS: The trial looked at 162 patients aged 18 years and older requiring FESS for chronic rhinosinusitis or nasal polyps. After FESS combined with peri-operative systemic corticosteroids, patients were randomized and given FPANS 400 microg b.i.d., FPANS 800 microg b.i.d. or placebo b.i.d. for the duration of 1 year. Patients were withdrawn from the trial (but still included in the study for statistical purposes) if there were recurrent or persistent diseases, defined as progressive regrowth of nasal polyps, recurrent signs and symptoms of chronic sinusitis combined with abnormalities on computed tomography scan and persistent complaints for at least 2 months after FESS. RESULTS: A significant reduction of symptoms was seen after FESS. After 1 year, 46 patients had been withdrawn from the trial because of recurrent diseases and 32 patients because of persistent symptoms. No differences in the number of patients withdrawn because of recurrent or persistent diseases were found between the patients treated with FPANS and patients treated with placebo. We were also unable to find a positive effect of FPANS compared with placebo in several subgroups such as patients with nasal polyps, high score at FESS or no previous sinus surgery. CONCLUSION: This placebo-controlled study does not show that treatment with FPANS up to 1 year after FESS had a positive effect compared with placebo.

Administration, Intranasal↗
PubMed1997

Cyclooxygenase and lipoxygenase metabolite generation in nasal polyps.

A role of prostaglandins (PGs) and leukotrienes (LTs) in the pathogenesis of nasal polyps has been recently suggested. Cyclooxygenase (CO) products (thromboxane B2, PGE2 and 6-keto PGF1 alpha) and lipoxygenase (LO) products (LTB4 and LTC4) were investigated by radioimmunoassay in polyps, hypertrophic turbinates and nasal mucosa from 14 patients with non-allergic (n = 6), allergic chronic rhinitis (n = 6) and aspirin-sensitive asthma (ASA) (n = 2), who underwent polypectomy. In all tissues CO metabolite levels were found higher than LO products (P < 0.01). Nasal polyps showed a significantly lower (P < 0.05) arachidonic acid (AA) metabolism in comparison to nasal mucosa. In polyps of allergic patients significantly higher LTB4 levels (P < 0.001) and a tendency to produce higher amounts of CO products in comparison to non-allergic subjects were observed, whereas in turbinates of non-allergic patients LT levels were significantly higher in comparison to those of allergic ones (P < 0.01). In ASA patients a decreased CO/LO ratio was found supporting the hypothesis of an imbalance of AA metabolism in this syndrome. These findings seem to indicate that the occurrence of nasal polyps may represent the result of different chronic inflammatory stimuli, regulated in part by AA metabolites.

6-Ketoprostaglandin F1 alpha↗
PubMed1994

Search for the human papillomavirus in nasal polyps, using a polymerase chain reaction-method.

Viral etiology of nasal polyps was postulated as many as 40 years ago, but so far, no study has shown an association or causal relation between any specific virus and nasal polyps. By using the polymerase chain reaction (PCR) technique, nasal polyps from both 10 patients with intolerance to nonsteroidal anti-inflammatory drugs (NSAID intolerance) (e.g., Aspirin) and from 10 patients with no history of NSAID intolerance were studied for the presence of papillomavirus DNA. Nasal mucosa from 10 patients who had undergone surgery for septoplasty served as controls. The PCR test used covers approximately 30 different types of human papillomaviruses. In this test, all tissue samples studied were found negative for papillomavirus DNA.

Adult↗
PubMedDate not supplied

Histochemical analysis of nasal polyps.

In the last 3 years, 86 nasal polyps from 76 patients were examined. Special attention was paid to the group of recurrent nasal polyps, which redeveloped from 2 to 17 times. Histological analysis was performed concerning the eosinophils, mast cells, acid and neutral mucopolysaccharides, acetylcholinesterase and fluorescence on monoamines. Macroscopically, nasal mucosa in 53 patients was considered for control purposes. The comparison was made and the results of the examination reviewed.

Acetylcholinesterase↗
PubMed2002

Expression of glucocorticoid receptors and cyclooxygenase-2 in nasal polyps from nonallergic patients.

Glucocorticoid treatment has been widely used to suppress inflammatory and immune responses. However, from a clinical point of view, its efficacy in the treatment of nasal polyposis seems to vary individually from patient to patient. In the present study, we examined the presence of glucocorticoid receptors (GRs) and cyclooxygenase-2 (COX-2) in the nasal polyps of nonallergic patients as compared with normal controls. Reverse transcription-polymerase chain reaction analyses revealed the presence of both GR messenger RNA and COX-2 messenger RNA expression in nasal polyps from nonallergic patients, as well as in normal nasal mucosa from controls. Consistent with this finding, immunohistochemical analysis demonstrated that GRs and COX-2 were labeled in both tissues. In nasal polyps, GR labeling was associated with the cytoplasm and nucleus of surface mucosa, submucosal glands, endothelial cells, and inflammatory cells. Importantly, COX-2 labeling was seen in the cytoplasm of surface mucosa, submucosal glands, and the vascular wall in nasal polyps. In contrast, in normal nasal tissues, COX-2 labeling was only found in the vascular wall, and the expression was weaker--a finding demonstrating that COX-2 is upregulated in nasal polyps. Therefore, 1) the presence of GRs and COX-2 in nasal polyps from nonallergic patients, as well as upregulation of COX-2 expression, suggests that inflammation may play an important role in the pathophysiology of nasal polyps; and 2) glucocorticoid could be a potential treatment method for suppressing inflammatory processes.

Adolescent↗
PubMed2001

Efficacy and tolerability of budesonide aqueous nasal spray treatment in patients with nasal polyps.

OBJECTIVE: To assess the efficacy and tolerability of once-daily treatment with budesonide aqueous nasal spray in patients with nasal polyps. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Sixteen hospital clinics. PATIENTS: One hundred eighty-three patients with moderate-sized nasal polyps causing clinically significant symptoms during a 1-week run-in period. INTERVENTIONS: Patients were randomized to receive 1 of the following 4 budesonide aqueous nasal spray treatments: 128 microg once daily in the morning and placebo in the evening, 128 microg twice daily, 256 microg once daily in the morning and placebo in the evening, or placebo for 8 weeks. Nasal polyp size was scored and peak nasal inspiratory flow was measured at clinic visits at the beginning and end of the run-in period and after 4 and 8 weeks' treatment. Patients recorded daily peak nasal inspiratory flow, symptom scores (ie, blocked nose, runny nose, and sneezing) and sense of smell on diary cards. MAIN OUTCOME MEASURES: Mean change in nasal polyp size at the end of treatment; mean changes in combined and individual symptom scores. RESULTS: All doses of budesonide aqueous nasal spray significantly (P<.01) reduced polyp size; no significant differences were noted between the 4 treatment groups. The mean improvement in clinic peak nasal inspiratory flow at 8 weeks was 65.9 L/min with budesonide aqueous nasal spray, 128 microg twice daily; 71.6 L/min with budesonide aqueous nasal spray, 256 microg once daily; and 54.6 L/min with budesonide aqueous nasal spray, 128 microg once daily (all P<.001 vs placebo). Combined and individual symptom scores and sense of smell improved significantly in all budesonide-treated groups; the effect on symptoms became apparent within 1 to 2 days of the first dose. Budesonide aqueous nasal spray was well tolerated. CONCLUSIONS: Doses of budesonide aqueous nasal spray, 128 microg once daily, were found to be effective in the treatment of nasal polyps, and doses of budesonide aqueous nasal spray, 256 microg once daily, did not show any significant additional efficacy.

Administration, Intranasal↗
PubMed2003

Hyaluronan and alpha-atrial natriuretic polypeptide in human nasal polyps: contributing factors to oedema formation and polyp growth?

OBJECTIVES: To identify and localize hyaluronan (HYA) and alpha-atrial natriuretic polypeptide (ANP) in human nasal polyps and to measure the HYA concentrations. MATERIAL AND METHODS: Twelve nasal polyps were collected during routine polypectomies and processed histochemically and biochemically to determine the occurrence of HYA. The distribution of ANP was investigated using an immunocytochemical method. RESULTS: HYA was unevenly distributed, being found abundantly in the surface epithelium and basement membrane and around fibres and vessels in the lamina propria. It was also present around seromucinous glands and in the secretion of cysts in the stroma. The HYA concentration was 1,000-fold higher than in serum. ANP was abundant in the apical part of ciliated surface epithelial cells and extracellularly in the basement membrane. In the stroma, ANP was confined to apical acinar cells of the seromucinous glands. CONCLUSIONS: Osmotically active HYA and numerous ANP-immunoreactive cells, active in fluid and/or ion transport functions, are present in human nasal polyps. These substances may well be involved in oedema formation and the successive growth of nasal polyps. The high concentrations of HYA in nasal polyps may be of clinical significance for the future development of a local enzyme treatment for nasal polyposis.

Adult↗
PubMed2006

[Effect of erythromycin on apoptosis of epithelial cell in nasal polyps].

OBJECTIVE: To study the effect of erythromycin on apoptosis and expression of Bax and Bcl-2 of epithelial cell in nasal polyps. METHODS: Epithelial cells from thirty nasal polyps and fifteen inferior turbinates were cultured in Dulbecco Eagle and Ham F12 (1:1) and divided into two groups (one group were treated with Erythromycin). Apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling and expression of Bcl-2 and Bax detected by immunohistochemistry at 1, 3, 5 days after culture. RESULTS: The apoptosis indexes (AI) of epithelial cell in nasal polyps after cultured for 1, 3, 5 days with erythromycin were (33.23 +/- 6.50)%, (38.21 +/- 7.22)% and (52.63 +/- 7.86)% respectively. The AI of epithelial cell in inferior turbinates were (31.02 +/- 5.60)%, (32.13 +/- 7.15)% and (39.64 +/- 7.48)% respectively. There was significant difference between two groups at 5 day after culture (P < 0.05). Expression of Bax and Bcl-2 of epithelial cell was significantly higher in nasal polyps than that in inferior turbinates (P < 0.01). Expression of Bax of epithelial cell cultured with erythromycin was significantly higher than that in the controls (P < 0.05). Apoptosis was clearly promoted after 5 day culture with Erythromycin (P < 0.05). CONCLUSIONS: Erythromycin promoted expression of Bax and apoptosis of epithelial cell in nasal polyps.

Adolescent↗