Treating Nasal Polyps with Steroids ?

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 steroids-insensitive asthma , ulcerative colitis, nasal polyps  and in one patient with systemic steroids resistance and chronic lymphocytic leukemia . Down regulation of GRa levels after treatment with steroids  has also been postulated to be one of the possible explanations for the secondary steroids resistance phenomenon.

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