Nasal Polyps Treatment

Human nasal mucosa was obtained from 32 healthy subjects (20 males) aged 30.3 + 2.4 years, undergoing nasal corrective surgery for turbinate hypertrophy or septal dismorphy. None of the subjects were treated with steroids . The skin-prick test for common allergens was positive in five subjects (16%) and negative in 27 (84%).   Nasal polyp s were obtained from 27 patients (19 males) aged 47+ 2.6 years, undergoing nasal polypectomy. At the time when polypectomy was carried out, eight patients (30%) were receiving intranasal steroids (fluticasone or budesonide, 200-400mg/day), one (4%) was receiving oral prednisone (40 mg/day), and six (22%) were receiving both intranasal (budesonide or fluticasone, 400 mg/day) and oral steroids (prednisone or deflazacort, 20-40 mg/day). The remaining 12 patients (44%) had not received steroid treatment for at least 1 month prior to surgery. Twelve subjects (44%) had asthma, half of these were aspirin-intolerant. The skin- prick test was positive in f...

The recent study hypothesized that the recurrent of the nasal polyp epithelia to steroids might be due, at least in part, to an increased expression of GRb in epithelial cells. There may be several mechanisms accounting for the resistance to the anti inflammatory effects of steroids. Certain proinflammatory cytokines may induce activation of the transcription factor AP-1, which would block the activated GRa, thereby leading to an impaired suppression of the inflammatory response. Another suggested mechanism is the cytokine-driven reduction of the GRa binding affinity for steroids.Transfection studies have revealed the ability of GRb to act as a dominant negative inhibitor of GRa activity  through a mechanism that involves the formation of transcriptionally impaired GRaGRb hetero dimer. However, other studies have challenged this concept An overexpression of GRb may also be involved in steroids-resistant diseases. Thus, increased expression of GRb has been reported in patients with ...