Clinical aspects and distribution of immunologically active cells in the nasal mucosa of patients with nasal polyps after endoscopic sinus surgery and treatment with topical corticosteroids

Abstract

Clinical parameters of 72 patients who were operated upon for nasal polyps were evaluated as well as biopsy specimens of the mucosa of the middle and inferior turbinates of 41 of these patients. Biopsies were taken at the time of endoscopic sinus surgery (ESS), after 6 months and after 1 year in 23 patients. During the follow-up period the patients were treated with topical corticosteroids (budesonide). At the time of ESS significantly more CD8+ (suppressor/cytotoxic) cells than CD4+ (helper/inducer) cells were found in the middle and inferior turbinates. At 6 months significantly more CD4+ cells were found than at the time of ESS, whereas at 1 year the number of CD4+ cells had decreased and was lower than at 6 months. These data support the theory that the occurrence of nasal polyps is associated with T-cell-dependent disturbances. Clinical evaluation revealed that most of the patients with chronic airway obstruction had better pulmonary functions postoperatively or required less medication for lung disease. These findings show that ESS combined with topical corticosteroids has a positive effect on upper and lower respiratory tract pathology.

Galectin-1 Is Overexpressed in Nasal Polyps under Budesonide and Inhibits Eosinophil Migration

“…Eosinophil infiltration is a striking feature of nasal polyps: eosinophils are markedly more numerous in most nasal polyps than in the mucosa of the middle and inferior turbinates (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993. Increased numbers of macrophages and other lymphocytes are also observed in nasal polyps as compared with normal nasal mucosa (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993. These types of inflammatory cells, particularly eosinophils because of their large majority, increase A, schematically illustrates the trajectories of two cells with different types of behavior pattern.…”

“…As stated by Bernstein et al (1995), various hypotheses have been proposed to explain the cause of nasal polyps, with the two most plausible and widely discussed theories being allergy and inflammation. Eosinophil infiltration is a striking feature of nasal polyps: eosinophils are markedly more numerous in most nasal polyps than in the mucosa of the middle and inferior turbinates (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993. Increased numbers of macrophages and other lymphocytes are also observed in nasal polyps as compared with normal nasal mucosa (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993.…”

“…The predominant inflammatory cells in nasal polyps are eosinophils, which may therefore play prominent roles in the immunologic and inflammatory processes in nasal polyps (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993. Glucocorticoids are already used in hospitals to treat nasal polyps (Bachert and Gevaert, 1999;Barnes, 1998;Stoop et al, 1992) because they suppress inflammation processes by acting at different target sites.…”

“…The predominant inflammatory cells in nasal polyps are eosinophils, which may therefore play prominent roles in the immunologic and inflammatory processes in nasal polyps (Bernstein et al, 1995;Stoop et al, 1992Stoop et al, , 1993. Glucocorticoids are already used in hospitals to treat nasal polyps (Bachert and Gevaert, 1999;Barnes, 1998;Stoop et al, 1992) because they suppress inflammation processes by acting at different target sites. It is widely known that glucocorticoids regulate gene expression of pro-and anti-inflammatory effectors extending to adhesion molecules such as E-selectin, intercellular adhesion molecules (ICAMs), and certain mucins (Cronstein et al, 1992;Holgate and Mavroleon, 1998;Rothenberg, 1998;Tingsgaard et al, 1998).…”

Chronic rhinosinusitis ? need for further classification?

“…Highest levels of IL-8 and the highest percentages of lavage neutrophilia were seen in subjects classified as "nonallergic." In contrast, patients with chronic rhinosinusitis and associated allergic rhinitis had a modestly increased percentage of neutrophils and elevated IL-8 levels in the lavage fluid [30,31]. In a related study [32], increases in IL-8 were found by quantitative competitive PCR in sinus tissue obtained at the time of sinus surgery.…”