title: Effects of Fluticasone Furoate on Clinical and Immunological Outcomes (IL-17) for Patients With Nasal Polyposis Naive to Steroid Treatment.
abstract: OBJECTIVE
  We investigated the effect of topical steroids on clinical outcomes and related immune response of chronic rhinosinusitis with nasal polyp (CRSwNP) patients and in eradicating some polyps. We want to explore a new potential mechanism linked to Th-17 cells.
  
  
  METHODS
  Prospective, double-blind, placebo-controlled studies with 24 allergic and nonallergic patients were randomized to either placebo or fluticasone furoate for 12 weeks. Assessment of clinical response, endoscopic score with biopsies of the inferior turbinate, and polyps before and after treatment were performed. Biopsies were stained for T-cells, eosinophils, neutrophils, and IL-17A/F.
  
  
  RESULTS
  Steroid treatment improved the mean symptoms scores from 7.12 to 4.02 (P < .01) and the polyp score from 5.13 to 3.31 (P < .05), but the comparison with placebo was not statistically significant in nonallergics due to insufficient study power. Steroid treatment decreased eosinophil counts on allergics but not neutrophils or T-cells. The IL-17A/F expression was higher in nonallergics with high neutrophil counts and was inclined by steroids. Compared to baselines, IL-17 cells were significantly less in allergic individuals and were not observed in allergics and with high neutrophil counts.
  
  
  CONCLUSIONS
  Topical steroids were more effective on certain nasal polyp phenotypes. Identification of polyp phenotype might be essential to ensure a better therapeutic response to intranasal corticosteroids.
authors.affiliation: Meakins-Christie Laboratories, McGill University, Montreal, Canada.
authors.forename: Narayanan
authors.initials: N
authors.lastname: Venkatesan
authors.affiliation: CHUM Université de Montréal, Montreal, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lavigne
authors.affiliation: CHUM Université de Montréal, Montreal, Canada f.lavigne@videotron.ca.
authors.forename: Francois
authors.initials: F
authors.lastname: Lavigne
authors.affiliation: Meakins-Christie Laboratories, McGill University, Montreal, Canada.
authors.forename: Qutayba
authors.initials: Q
authors.lastname: Hamid
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone / Q000627:therapeutic use*; D006801:Humans; D007124:Immunoenzyme Techniques; D020381:Interleukin-17 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; C508717:IL17A protein, human; D020381:Interleukin-17; D000068298:Fluticasone
keywords: chronic rhinosinusitis; clinical outcomes research; eosinophilic rhinosinusitis; innate immunity; nasal and sinus surgery; nasal polyps; obstructive sleep apnea