title: Surfactant protein A and D in chronic rhinosinusitis with nasal polyposis and corticosteroid response.
abstract: BACKGROUND
  Corticosteroids are a mainstay of treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP). Data related to the effect of systemic methylprednisolone on surfactant protein (SP) expression in CRSwNP is limited. This study aimed to reveal the consequences  of systemic methylprednisolone treatment on levels of SP-A and SP-D, which play a role in innate immunity, in patients with CRSwNP.
  
  
  METHODS
  Twenty-one patients with CRSwNP were included in the study, along with 15 control patients scheduled for dacryocystorhinostomy. A  polypoid tissue biopsy was taken under local anesthesia, and 15 CRSwNP patients were scheduled for endoscopic sinus surgery after 3 weeks of oral methylprednisolone. Posttreatment biopsies were performed perioperatively. Pre- and posttreatment endoscopic polyp grades were determined, as were  symptom scores regarding nasal obstruction, headache, and nasal discharge using a visual analog scale (VAS). SP-A and SP-D levels were measured using enzyme-linked immunosorbent assay and the results were compared.
  
  
  RESULTS
  All patients reported relief from clinical symptoms  through VAS after methylprednisolone treatment. The posttreatment polyp grade was reduced (p < 0.0001). SP-A and SP-D levels did not yield a significant difference between CRSwNP patients and controls (p = 0.25 and p = 0.13, respectively). Statistically significant up-regulation was detected  in SP-A and SP-D levels after oral methylprednisolone (p = 0.0002 and p = 0.0004, respectively).
  
  
  CONCLUSIONS
  In this study, significant up-regulation of SP-A and SP-D was revealed in patients with CRSwNP after systemic steroid treatment. The role of SP-A and SP-D up-regulation  in CRSwNP pathogenesis and therapeutic outcomes of corticosteroids have potential importance for the introduction of new therapeutic modalities that are more effective and produce fewer adverse effects.
authors.affiliation: Second Clinic of Otolaryngology Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Salman
authors.forename: Meltem Esen
authors.initials: ME
authors.lastname: Akpinar
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yigit
authors.forename: Uzay
authors.initials: U
authors.lastname: Gormus
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D009297:Nasal Mucosa / Q000187:drug effects / Q000378:metabolism; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D037662:Pulmonary Surfactant-Associated Protein A / Q000235:genetics / Q000378:metabolism*; D037663:Pulmonary Surfactant-Associated Protein D / Q000235:genetics / Q000378:metabolism*; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000305:Adrenal Cortex Hormones; D037662:Pulmonary Surfactant-Associated Protein A; D037663:Pulmonary Surfactant-Associated Protein D; D008775:Methylprednisolone