Prospective clinical study of the expression of the cox-2 gene in nasal polyposis

Abstract

Problem: Nasosinusal polyposis (NP) is an inflammatory disease, with higher incidence in asthmatic patients than nonasthmatic, especially in aspirin-intolerant asthmatics. Corticoids are the first line of treatment of NP. The research objective was to demonstrate the existence of different degrees of inflammation in the NP associated or not with asthma, and its different response to corticoid treatment. Methods: Our sample consisted of 80 patients with NP, 19 of whom were assigned to the control group and 61 to the experimental group. Of the latter group, 22 did not have asthma (NPNA), 21 had tolerable asthma (NP+TA), and 18 had intolerant asthma to acetylsalicylic acid (PN+IA). We performed a clinical evaluation (subjective nasal obstruction, nasal endoscopy, rhinomanometry, and computerized tomography) and experimental evaluation (expression of the Cox-1 and Cox-2 gene) after 4 weeks without corticoid treatment (baseline), after 2 weeks of treatment with oral corticoids (OCC), and 12 weeks of intranasal corticoids (ICC). Results: At week 2 there are significant differences between the study and control groups ( P < 0.001). After treatment with OCC, patients with NP improve clinically and significantly increase the expression of the Cox-2 gene ( P < 0.01). The ICC maintain the clinical improvement ( P < 0.01) but not the increased expression of the Cox-2 gene. The expression of Cox-1 does not present variations, not even after treatment with OCC or ICC. The endoscopic evaluations are correlated with the tomographic grade before (r = 0.51; P < 0.01) and after the treatment (r = 0.6; P < 0.01). Conclusion: We conclude from these results that OCC and ICC are effective with all patients, but to a lesser extent when associated with tolerant or intolerant asthma to acetylsalicylic. Also, nasal endoscopy is at least as useful a technique as the computerized tomography for the follow-up of NP. Significance: The expression of Cox-2 gene changes in patients with NP under OCC treatment but not under ICC. Support: Grant from the Ministry of Health FIS 99–0133. 1999–2001. Project: Nasal poliposi and inflammation.