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Sierra-Vargas MP, Montero-Vargas JM, Debray-García Y, Vizuet-de-Rueda JC, Loaeza-Román A, Terán LM. Oxidative Stress and Air Pollution: Its Impact on Chronic Respiratory Diseases. Int J Mol Sci 2023; 24:853. [PMID: 36614301 PMCID: PMC9821141 DOI: 10.3390/ijms24010853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Redox regulation participates in the control of various aspects of metabolism. Reactive oxygen and nitrogen species participate in many reactions under physiological conditions. When these species overcome the antioxidant defense system, a distressed status emerges, increasing biomolecular damage and leading to functional alterations. Air pollution is one of the exogenous sources of reactive oxygen and nitrogen species. Ambient airborne particulate matter (PM) is important because of its complex composition, which includes transition metals and organic compounds. Once in contact with the lungs' epithelium, PM components initiate the synthesis of inflammatory mediators, macrophage activation, modulation of gene expression, and the activation of transcription factors, which are all related to the physiopathology of chronic respiratory diseases, including cancer. Even though the pathophysiological pathways that give rise to the development of distress and biological damage are not fully understood, scientific evidence indicates that redox-dependent signaling pathways are involved. This article presents an overview of the redox interaction of air pollution inside the human body and the courses related to chronic respiratory diseases.
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Affiliation(s)
- Martha Patricia Sierra-Vargas
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Josaphat Miguel Montero-Vargas
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Yazmín Debray-García
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Juan Carlos Vizuet-de-Rueda
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Alejandra Loaeza-Román
- Departmento de Investigación en Toxicología y Medicina Ambiental, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
| | - Luis M. Terán
- Departmento de Investigación en Inmunogenética y Alergia, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas (INER), Ciudad de México 14080, Mexico
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Zorlu ME, Uygur KK, Yılmaz NS, Demirel ÖÖ, Aydil U, Kızıl Y, Uslu S. Evaluation of Advanced Oxidation Protein Products (AOPP) and Superoxide Dismutase (SOD) Tissue Levels in Patients with Nasal Polyps. Indian J Otolaryngol Head Neck Surg 2022; 74:4824-4830. [PMID: 36742727 PMCID: PMC9895680 DOI: 10.1007/s12070-022-03124-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/10/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this study is to eveluate levels of advanced oxidation protein products (AOPP) which are thought to increase in the polyp tissue and superoxide dismutase (SOD), an antioxidant enzyme, with using specthrophotometry in polyp tissue and healthy mucosa. 30 nasal polyp patients without inflammatory disease except for nasal polyposis were included in the study. The control group consisted of 18 patients who did not have allergy, asthma, inflammatory and granulomatous disease and planned surgery due to septum deviation and concha hypertrophy. AOPP and SOD tissue levels were measured by spectrophotometry in polyp tissue specimens taken from patients with nasal polyps and concha samples taken from patients in the control group. The mean AOPP tissue level of patients in the nasal polyposis group was statistically significantly higher than the control group. (p < 0.05). The mean SOD activity level was significantly lower in the nasal polyposis group than the control group. (p < 0.05) As a result of this study, high AOPP levels in polyp tissue and low SOD levels in polyp tissue compared to healthy nasal mucosa, oxidative stress plays an important role in nasal polyp development.
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Affiliation(s)
- Mehmet Ekrem Zorlu
- Department of Otolaryngology and Head and Neck Surgery, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Saim Cikrikci Street, Karabaglar, Izmir Izmir, Turkey
- Department of Otorhinolaryngology and Head and Neck Surgery, Gazi University School of Medicine, 06500 Beşevler, Ankara, Turkey
| | - K. Kemal Uygur
- Department of Otorhinolaryngology and Head and Neck Surgery, Gazi University School of Medicine, 06500 Beşevler, Ankara, Turkey
| | - Niyazi Samet Yılmaz
- Department of Biochemistry, Polatlı Duatepe State Hospital, Ankara, Turkey
- Department of Biochemistry, Gazi University School of Medicine, Beşevler, Ankara Turkey
| | - Özlem Özbaş Demirel
- Department of Biochemistry, Ankara Training and Research Hospital, Ankara, Turkey
| | - Utku Aydil
- Department of Otorhinolaryngology and Head and Neck Surgery, Gazi University School of Medicine, 06500 Beşevler, Ankara, Turkey
| | - Yusuf Kızıl
- Department of Otorhinolaryngology and Head and Neck Surgery, Gazi University School of Medicine, 06500 Beşevler, Ankara, Turkey
| | - Sabri Uslu
- Department of Otorhinolaryngology and Head and Neck Surgery, Gazi University School of Medicine, 06500 Beşevler, Ankara, Turkey
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Mihalj H, Butković J, Tokić S, Štefanić M, Kizivat T, Bujak M, Baus Lončar M, Mihalj M. Expression of Oxidative Stress and Inflammation-Related Genes in Nasal Mucosa and Nasal Polyps from Patients with Chronic Rhinosinusitis. Int J Mol Sci 2022; 23:5521. [PMID: 35628331 PMCID: PMC9145877 DOI: 10.3390/ijms23105521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a prevalent, multifaceted inflammatory condition affecting the nasal cavity and the paranasal sinuses, frequently accompanied by formation of nasal polyps (CRSwNP). This apparently uniform clinical entity is preceded by heterogeneous changes in cellular and molecular patterns, suggesting the presence of multiple CRS endotypes and a diverse etiology. Alterations of the upper airway innate defense mechanisms, including antimicrobial and antioxidant capacity, have been implicated in CRSwNP etiology. The aim of this study was to investigate mRNA expression patterns of antioxidative enzymes, including superoxide dismutase (SOD) and peroxiredoxin-2 (PRDX2), and innate immune system defense players, namely the bactericidal/permeability-increasing fold-containing family A, member 1 (BPIFA1) and PACAP family members, particularly adenylate-cyclase-activating polypeptide receptor 1 (ADCYAP1) in nasal mucosa and nasal polyps from CRSwNP patients. Additional stratification based on age, sex, allergic comorbidity, and disease severity was applied. The results showed that ADCYAP1, BPIFA1, and PRDX2 transcripts are differentially expressed in nasal mucosa and scale with radiologically assessed disease severity in CRSwNP patients. Sinonasal transcriptome is not associated with age, sex, and smoking in CRSwNP. Surgical and postoperative corticosteroid (CS) therapy improves endoscopic appearance of the mucosa, but variably reverses target gene expression patterns in the nasal cavity of CRSwNP patients. Transcriptional cross-correlations analysis revealed an increased level of connectedness among differentially expressed genes under inflammatory conditions and restoration of basic network following CS treatment. Although results of the present study imply a possible engagement of ADCYAP1 and BPIFA1 as biomarkers for CRSwNP, a more profound study taking into account disease severity and CRSwNP endotypes prior to the treatment would provide additional information on their sensitivity.
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Affiliation(s)
- Hrvoje Mihalj
- Clinical Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Osijek, HR-31000 Osijek, Croatia;
- Department of Otorhinolaryngology, Maxillofacial Surgery Faculty of Medicine University of Osijek, HR-31000 Osijek, Croatia;
| | - Josip Butković
- Department of Otorhinolaryngology, Maxillofacial Surgery Faculty of Medicine University of Osijek, HR-31000 Osijek, Croatia;
- Department of Oral and Maxillofacial Surgery, University Hospital Osijek, HR-31000 Osijek, Croatia
| | - Stana Tokić
- Department of Laboratory Medicine and Pharmacy, Faculty of Medicine, University of Osijek, HR-31000 Osijek, Croatia;
| | - Mario Štefanić
- Department of Nuclear Medicine and Oncology, Faculty of Medicine, University of Osijek, HR-31000 Osijek, Croatia; (M.Š.); (T.K.)
| | - Tomislav Kizivat
- Department of Nuclear Medicine and Oncology, Faculty of Medicine, University of Osijek, HR-31000 Osijek, Croatia; (M.Š.); (T.K.)
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Osijek, HR-31000 Osijek, Croatia
| | - Maro Bujak
- Department of Materials Chemistry, Ruđer Bošković Institute, HR-10000 Zagreb, Croatia;
| | - Mirela Baus Lončar
- Department of Molecular Medicine, Ruđer Bošković Institute, HR-10000 Zagreb, Croatia
| | - Martina Mihalj
- Department of Dermatology and Venereology, University Hospital Osijek, HR-31000 Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine University of Osijek, HR-31000 Osijek, Croatia
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Fallacara A, Busato L, Pozzoli M, Ghadiri M, Ong HX, Young PM, Manfredini S, Traini D. In vitro characterization of physico-chemical properties, cytotoxicity, bioactivity of urea-crosslinked hyaluronic acid and sodium ascorbyl phosphate nasal powder formulation. Int J Pharm 2019; 558:341-350. [PMID: 30659923 DOI: 10.1016/j.ijpharm.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
Abstract
An innovative lyophilized dry powder formulation consisting of urea-crosslinked hyaluronic acid (HA-CL) and sodium ascorbyl phosphate (SAP) - LYO HA-CL - SAP- was prepared and characterized in vitro for physico-chemical and biological properties. The aim was to understand if LYO HA-CL - SAP could be used as adjuvant treatment for nasal inflammatory diseases. LYO HA-CL - SAP was suitable for nasal delivery and showed to be not toxic on human nasal septum carcinoma-derived cells (RPMI 2650 cells) at the investigated concentrations. It displayed porous, polygonal particles with unimodal, narrow size distribution, mean geometric diameter of 328.3 ± 27.5 µm, that is appropriate for nasal deposition with no respirable fraction and 88.7% of particles with aerodynamic diameter >14.1 µm. Additionally, the formulation showed wound healing ability on RPMI 2650 cells, and reduced interleukin-8 (IL-8) level in primary nasal epithelial cells pre-induced with lipopolysaccharide (LPS). Transport study across RPMI 2650 cells showed that HA-CL could act not only as carrier for SAP and active ingredient itself, but potentially also as mucoadhesive agent. In conclusion, these results suggest that HA-CL and SAP had anti-inflammatory activity and acted in combination to accelerate wound healing. Therefore, LYO HA-CL - SAP could be a potential adjuvant in nasal anti-inflammatory formulations.
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Affiliation(s)
- Arianna Fallacara
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia; Department of Life Sciences and Biotechnology, University of Ferrara, Via L. Borsari 46, 44121 Ferrara, Italy.
| | - Laura Busato
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia; Department of Life Sciences and Biotechnology, University of Ferrara, Via L. Borsari 46, 44121 Ferrara, Italy
| | - Michele Pozzoli
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Maliheh Ghadiri
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Hui Xin Ong
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Paul M Young
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Stefano Manfredini
- Department of Life Sciences and Biotechnology, University of Ferrara, Via L. Borsari 46, 44121 Ferrara, Italy
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
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Role of asthma and intolerance to acetylsalicylic acid on the redox profile in nasal polyp tissue. Eur Arch Otorhinolaryngol 2018; 275:2027-2033. [PMID: 29948268 DOI: 10.1007/s00405-018-5034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Nasal polyposis is a chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. The etiology of nasal polyposis is unclear; however, it may be associated with asthma and intolerance to acetylsalicylic acid, possibly altering the redox profile. The study intends to compare the redox profile in polyps surgically removed from three clinical groups of patients with nasal polyposis who were divided according to the presence of asthma and intolerance to acetylsalicylic acid. METHODS Patients were divided into three groups: nasal polyposis only (n = 30); nasal polyposis and asthma (n = 19); and nasal polyposis, asthma and intolerance to acetylsalicylic acid (n = 10). The following redox evaluations were performed: enzymatic antioxidant activity of superoxide dismutase, glutathione peroxidase, hydrogen peroxide consumption and glutathione S-transferase; non-enzymatic antioxidant levels of vitamin C, vitamin E and glutathione; levels of the oxidative damage biomarkers carbonyl groups (measuring protein damage) and malondialdehyde (measuring lipid peroxidation); and nitrite and nitrate levels. RESULTS Compared with the polyposis only group, hydrogen peroxide consumption, glutathione S-transferase, vitamin E and malondialdehyde were lower in the asthma group. Total glutathione (0.12 ± 0.01 vs. 33.34 ± 10.48 µmol/mg) and nitrite and nitrate (0.06 ± 0.01 vs. 15.95 ± 1.38 nmol/mg) levels were higher in the nasal polyposis, asthma and intolerance to acetylsalicylic acid group. CONCLUSIONS In patients with nasal polyposis, asthma may alter the redox profile associated with the hydrogen peroxide and lipid damage pathways, whereas asthma and intolerance to acetylsalicylic acid increase nitrite and nitrate and total glutathione levels.
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Kalish L, Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. WITHDRAWN: Topical steroids for nasal polyps. Cochrane Database Syst Rev 2016; 4:CD006549. [PMID: 27111709 PMCID: PMC10653020 DOI: 10.1002/14651858.cd006549.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Review withdrawn from Issue 4, 2016. Replaced by new reviews 'Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis' (Chong 2016a) and 'Different types of intranasal steroids for chronic rhinosinusitis' (Chong 2016b). The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Larry Kalish
- Sydney Sinus and Allergy CentreSuite 206203‐233 New South Head RoadEdgecliffNSWAustralia2027
- Concord HospitalENT DepartmentConcordAustralia
| | - Kornkiat Snidvongs
- Chulalongkorn UniversityDepartment of Otolaryngology, Faculty of MedicineBangkokThailand
| | | | - Daron Cope
- Concord HospitalENT DepartmentConcordAustralia
| | - Richard J Harvey
- Macquarie UniversityAustralian School of Advanced MedicineSydneyAustralia
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Sari K, Gencer ZK, Ede H, Gocmen AY, Kantekin Y. Ischemia-modified albumin, brain natriuretic peptide, and growth differentiation factor-15 levels in patients with nasal polyps. Auris Nasus Larynx 2016; 43:529-36. [PMID: 26795264 DOI: 10.1016/j.anl.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Nasal polyps (NP) are a chronic inflammatory disease of the nasal mucosa; their etiology is suspected to involve oxidative stress. Growth differentiation factor-15 (GDF-15), brain natriuretic peptide (BNP), and ischemia-modified albumin (IMA) are biomarkers used especially in the early diagnosis and follow-up of cardiovascular diseases. The aim of this study was to assess levels of serum GDF-15, BNP, and IMA in patients with NP and to compare them with those of healthy subjects. METHODS This was a prospective study enrolling 41 patients with NP and 48 healthy controls, all aged 18-65 years and referred to the Department of Otorhinolaryngology, Head and Neck Surgery, between January 2014 and February 2015. After a 12-h fast, venous blood (3mL) was drawn and centrifuged (3000rpm, 10min) to collect serum. Blood samples were drawn before endoscopic sinus surgery in the NP group. Serum GDF-15, BNP, and IMA levels were measured. RESULTS GDF-15, BNP, and IMA levels of patients with NP were statistically significantly higher than in controls and GDF-15 values were higher than the normal upper limit. GDF-15, BNP, and IMA levels were significantly correlated in both groups. CONCLUSIONS As GDF-15 is a marker of chronic inflammation and oxidative stress, our finding of increased serum GDF-15 in patients with NP supports the hypothesis that its pathogenesis involves chronic inflammation and oxidative stress.
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Affiliation(s)
- Kamran Sari
- Bozok University School of Medicine, Ear Nose & Throat Department, Yozgat, Turkey.
| | | | - Huseyin Ede
- Bozok University School of Medicine, Cardiology Department, Yozgat, Turkey.
| | - Ayse Yesim Gocmen
- Bozok University School of Medicine, Biochemistry Department, Yozgat, Turkey.
| | - Yunus Kantekin
- Bozok University School of Medicine, Ear Nose & Throat Department, Yozgat, Turkey.
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Chauhan B, Gupta M, Chauhan K. Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2016; 7:74-81. [PMID: 27658183 PMCID: PMC5010436 DOI: 10.2500/ar.2016.7.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antioxidants have a preventive or therapeutic role in oxygen free radical-mediated cell and tissue damage. The study aimed to investigate the therapeutic effects of antioxidants and intranasal steroid fluticasone furoate (FF) on the clinical outcome of patients with perennial allergic rhinitis. METHODS Subjects with perennial allergic rhinitis (n = 61) were randomly divided into two groups, group A (n = 30) received FF and group B (n = 31) received FF with antioxidants for 6 weeks. Nasal and ocular symptoms were evaluated weekly by using a four-point categoric scale. The efficacy of the study drug was assessed based on the mean change from baseline of the total daytime nasal symptom scores, total nighttime nasal symptom scores, and the composite symptom scores. RESULTS The combined therapy (FF with antioxidants) resulted in marked improvements (p ≤ 0.05) in the mean total daytime nasal symptom scores, total nighttime nasal symptom scores, and composite symptom scores of subjects compared with ones treated with intranasal steroid (FF) alone, which highlighted the therapeutic effect of antioxidants in allergic rhinitis. CONCLUSION Significant improvement in clinical outcome was observed in subjects who received antioxidants along with FF. However, because this was an open-label study, the results must be interpreted with caution, and further double-blind, placebo-controlled, dose-ranging trials supplemented with different antioxidants together with intranasal steroids are suggested.
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Affiliation(s)
- Bhushan Chauhan
- From the Department of Ear, Nose and Throat, Gian Sagar Medical College and Hospital, Punjab, India, and
| | - Manish Gupta
- From the Department of Ear, Nose and Throat, Gian Sagar Medical College and Hospital, Punjab, India, and
| | - Komal Chauhan
- Department of Food Science and Technology, National Institute of Food Technology Entrepreneurship and Management, Kundli, Haryana, India
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Rimmer J, Fokkens W, Chong LY, Hopkins C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev 2014; 2014:CD006991. [PMID: 25437000 PMCID: PMC11193160 DOI: 10.1002/14651858.cd006991.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nasal polyps cause nasal obstruction, discharge and reduction in or loss of sense of smell, but their aetiology is unknown. The management of chronic rhinosinusitis with nasal polyps, aimed at improving these symptoms, includes both surgical and medical treatments, but there is no universally accepted management protocol. OBJECTIVES To assess the effectiveness of endonasal/endoscopic surgery versus medical treatment in chronic rhinosinusitis with nasal polyps. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 February 2014. SELECTION CRITERIA Randomised controlled trials of any surgical intervention (e.g. polypectomy, endoscopic sinus surgery) versus any medical treatment (e.g. intranasal and/or systemic steroids), including placebo, in adult patients with chronic rhinosinusitis with nasal polyps. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. Meta-analysis was not possible due to the heterogeneity of the studies and the selective (incomplete) outcome reporting by the studies. MAIN RESULTS Four studies (231 participants randomised) are included in the review. No studies were at low risk of bias. The studies compared different types of surgery versus various types and doses of systemic and topical steroids and antibiotics. There were three comparison pairs: (1) endoscopic sinus surgery (ESS) versus systemic steroids (one study, n = 109), (2) polypectomy versus systemic steroids (two studies, n = 87); (3) ESS plus topical steroid versus antibiotics plus high-dose topical steroid (one study, n = 35). All participants also received topical steroids but doses and types were the same between the treatment arms of each study, except for the study using antibiotics. In that study, the medical treatment arm had higher doses than the surgical arm. In two of the studies, the authors failed to report the outcomes of interest. Although there were important differences in the types of treatments and comparisons used in these studies, the results were similar. PRIMARY OUTCOMES symptom scores and quality of life scores There were no important differences between groups in either the patient-reported disease-specific symptom scores or the health-related quality of life scores. Two studies (one comparing ESS plus topical steroid versus antibiotics plus high-dose topical steroid, the other ESS versus systemic steroids) failed to find a difference in generic health-related quality of life scores. The quality of this evidence is low or very low. Endoscopic scores and other secondary outcomes Two studies reported endoscopic scores. One study (ESS versus systemic steroids) reported a large, significant effect size in the surgical group, with a mean difference (MD) in score of -1.5 (95% confidence interval (CI) -1.78 to -1.22, n = 95) on a scale of 0 to 3 (0 = no polyposis, 3 = severe polyposis). In the other study (ESS plus topical steroid versus antibiotics plus high-dose topical steroid) no difference was found between the groups (MD 2.3%, 95% CI -17.4% to 12.8%, n = 34). None of the included studies reported recurrence rates. No differences were found for any objective measurements or olfactory tests in those studies in which they were measured. Complications Complication rates were not reported in all studies, but rates of up to 21% for medical treatment and 14.3% for surgical treatment are described. Epistaxis was the most commonly reported complication with both medical and surgical treatments, with severe complications reported rarely. AUTHORS' CONCLUSIONS The evidence relating to the effectiveness of different types of surgery versus medical treatment for adults with chronic rhinosinusitis with nasal polyps is of very low quality. The evidence does not show that one treatment is better than another in terms of patient-reported symptom scores and quality of life measurements. The one positive finding from amongst the several studies examining a number of different comparisons must be treated with appropriate caution, in particular when the clinical significance of the measure is uncertain.As the overall evidence is of very low quality (serious methodological limitations, reporting bias, indirectness and imprecision) and insufficient to draw firm conclusions, further research to investigate this problem, which has significant implications for quality of life and healthcare service usage, is justified.
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Sagit M, Sarli B, Guler S, Namuslu M, Celik HT, Kurtul S, Korkmaz F, Somdas MA. Assessment of early atherosclerotic findings in patients with nasal polyposis. Auris Nasus Larynx 2014; 41:179-84. [DOI: 10.1016/j.anl.2013.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/15/2013] [Accepted: 09/20/2013] [Indexed: 11/25/2022]
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Serum paraoxonase, arylesterase activity, and oxidative status in patients with nasal polyp. Eur Arch Otorhinolaryngol 2012; 270:1861-5. [DOI: 10.1007/s00405-012-2307-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/27/2012] [Indexed: 12/23/2022]
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Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) represents inflammatory changes throughout the nose and sinuses from a group of disorders which all lead to swelling and overgrowth of the nasal mucosa. Topical corticosteroids have been the most widely used treatment, with each clinician using different regimes, at different doses, in different settings and with or without sinus surgery. CRSwNP requires ongoing medical management to prevent recurrence. OBJECTIVES To assess the effects of topical corticosteroids on CRSwNP and to analyse various subgroups, including patients who had sinus surgery immediately prior to the delivery of the corticosteroids, surgery any time prior to the topical corticosteroids or patients who had never had previous surgery. Also to assess the most effective dose and delivery methods for topical corticosteroids. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 10 April 2012. SELECTION CRITERIA Randomised controlled trials studying topical corticosteroids for patients with CRSwNP. DATA COLLECTION AND ANALYSIS At least two authors reviewed the search results and selected trials meeting the eligibility criteria, obtaining full texts and contacting authors. We documented our justification for the exclusion of studies. At least two authors extracted data using a pre-determined, standardised data form. MAIN RESULTS Forty studies (3624 patients) met the inclusion criteria. The trials were at low (21 trials), medium (13 trials) and high (six trials) risk of bias. The primary outcomes were sino-nasal symptoms, polyp size and polyp recurrence after surgery. When compared to placebo, topical corticosteroids improved overall symptom scores (standardised mean difference (SMD) -0.46; 95% confidence interval (CI) -0.65 to -0.27, P < 0.00001; seven trials, n = 445) and had a higher proportion of patients whose symptoms improved (responders) (risk ratio (RR) 1.71; 95% CI 1.29 to 2.26, P = 0.0002; four trials, n = 234). Topical corticosteroids also decreased the polyp score (SMD -0.73; 95% CI -1.00 to -0.46, P < 0.00001; three trials, n = 237) and had a greater proportion of patients with a reduction in polyp size (responders) (RR 2.09; 95% CI 1.65 to 2.64, P < 0.00001; eight trials, n = 785) when compared to placebo. Topical corticosteroids also prevented polyp recurrence after surgery (RR 0.59; 95% CI 0.45 to 0.79, P = 0.0004; six trials, n = 437). Subgroup analyses by sinus surgery status revealed a greater benefit in reduction of polyp score when topical steroid was administered any time after sinus surgery (SMD -1.19; 95% CI -1.54 to -0.83) compared to patients who had never had surgery (SMD -0.13; 95% CI -0.53 to 0.28, P < 0.00001). There was no difference between groups in terms of adverse events. AUTHORS' CONCLUSIONS Topical corticosteroids are a beneficial treatment for CRSwNP and the adverse effects are minor, with benefits outweighing the risks. They improve symptoms, reduce polyp size and prevent polyp recurrence after surgery. Patients having sinus surgery may have a greater response to topical corticosteroids but further research is required.
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Affiliation(s)
- Larry Kalish
- Sydney Sinus and Allergy Centre, Suite 206, 203-233 New South Head Road, Edgecliff, NSW, Australia, 2027
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Bozkus F, Ulas T, San I, Yesilova Y, Iynen I, Guldur ME, Aksoy N. Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps. Auris Nasus Larynx 2012; 40:282-5. [PMID: 23121920 DOI: 10.1016/j.anl.2012.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/10/2012] [Accepted: 09/25/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs. METHODS One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n=60) consisted of patients with NPs, and group 2 (n=60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels. RESULTS There were no statistical differences in gender, age and biochemical values between two groups (p>0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p<0.001). CONCLUSION As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.
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Affiliation(s)
- Ferhat Bozkus
- Department of Otolaryngology, Head and Neck Surgery, Harran University, Sanliurfa, Turkey.
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