engleski

Arachidonic acid metabolites and sinonasal polyposis: possible prognostic value

Several recent investigations have shown AAm characteristics have change, i.e. it's more active in SNp allergic patients then in non-allergic patients. In our study, we also found a higher mean AAm concentration in allergic patients than in non-allergic patients (59, 1% and 40.9% of all patients, respectively), but the difference was not significant. This may caused by the small number of patients included in study. Furthermore, an incread synthesis of LOO products of AAm, predominantly LTs, has been reported, which may account for the increased glandular secretion in the upper airways. In addition, conversion of LTA4 to lipoxins and 15-HETE acid has been reported to be 3-5 times higher in SNp, suggesting the possible pathogenic role of this products. Finally, high level of LTs and low level of PGs in SNp were found to be associated with aspirin-sensitive asthma (ASA). Although we found a somewhat higher LTC4 level and lower levels of PGE2, PGI2 and TxA2 in our ASA patients, these differences were not significant, probably because of the small number of patients included in the study. But, our results appeared to indicate that LTC4 production is higher in patients in whom SNp recurred after surgery, or in those who had had several surgeries and recurrences, then in patients free of disease recurrence after the surgery. The level of LTC4 production appeared to have a predictive value, i.e. the higher the production the more frequent the disease recurrence after the surgery. The possible pathogenic role of LTC4 might be the induction of vascular dilatations and mucous secretion, or formation of stromal edema, or cellular infiltration, and so on. LTC4 itself may be responsible for creating "adequate" local conditions for SNp recurrences. If these differences in the production of AAm are important for the pathogenesis of SNp, as suggested by our results, they open away for the application of a appropriate therapy in the treatment of this disease, i.e. administration of the components that inhibit AA release from membrane phospholipides. The beneficial effect of the use of corticosteroids (CS) in therapy of SNp has been described elsewhere. This method has been found better then the treatment of SNp with surgery alone, resulting in a varying and uncontrollable proportion of recurrences. Future studies comparing the effects of CS with postoperative findings and different concentrations of AAm expressed in SNp are expected to shed more light on the ethiology of SNp.

Arachidonic acid metabolites; sinonasal polyposis

ISBN 953-6451-077 (pogrešan)