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Abstract
Background: Nasal polyps (NPs) are benign pedicled mucosal protrusions into the nasal cavity of multifactorial origin. Vitamin D
has been demonstrated as having potential immunomodulatory activity and act as an antiproliferative agents.
Aim of the work: To determine the possible antiproliferative effect and immunomodulatory activity of VD on human nasal polyposis.
Material and methods: Based on thirty patients and divided equally into 3 groups. Group (healthy subjects). Group were received
low daily oral dose of VD(1000 IU) for 4 weeks. Group were received high daily oral dose of VD(4000 IU) for 4 weeks.Each
group and divided into 2 subgroups; group b: patients with NP before taking VD and group a: patients with NP after taking.
Nasal biopsies were obtained of all groups for histological examination and immunohistochemical detection of Toll-like receptors 9
expression.
Results: patients of nasal polyps before VD taking (groups IIb and IIIb) presented with symptoms of Visual Analogue Scale, VAS
score (facial pain, headache, nasal blockage, nasal discharge, post-nasal drip and olfactory disturbance) and endoscopic appearance of
Lund and Mackey score (polypi, edema and discharge), damage of respiratory epithelium, extensive accumulation of collagen fibers
in lamina propria and highly expressed TLR-9. The high dose VD group (IIIa) showed near normal respiratory epithelium, significant
decrease (P<0.05) in all symptoms of VAS score, endoscopic appearance of Lund and Mackey score. The mean area % of submucosal
accumulation of collagen fibers and TLR-9 expression were also significant decreased but decrease was insignificant (P<0.05) in the
low dose VD group (IIa).
Conclusion: VD participate significantly in protection against human nasal polyposis when used by high therapeutic dose, by
reducing the size of nasal polyps, relieving the symptoms and signs of nasal polyposis.
Keywords: Nasal polyposis, vitamin D, TLR-9 expression, visual analogue scale
Introduction
2014 Faruk et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License
(http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
doi: 10.7243/2055-091X-1-2
Subjective assessment
Objective assessment
1-General examination.
2-Full ORL examination.
3-Anterior rhinoscopic examination.
4-Diagnostic nasal endoscopy: was performed using 0
and 30 degree.
Evaluation was done according to Lund-Mackay endoscopic
appearance score [15]. The evaluated endoscopic findings
were (polyp, edema and discharge) as in (Table 1).
Table 1. Lund-Mackay endoscopic appearance score [15].
Characteristic
Score
Endoscopic findings
Polyps
0
1
2
3
absence of polyps
polyps in middle meatus (MM) only
polyps beyond the MM, but not completely
obstructing the nose
polyps completely obstructing the nose
Edema
0
1
2
absent
mild
severe
Discharge
0
1
2
no discharge
clear, thin discharge
thick purulent discharge
doi: 10.7243/2055-091X-1-2
Statistical analysis
Endoscopic
Histological results
H&E
Results
Table 2. Showing the mean, SD and P value of different symptoms of VAS score before (b) and after (a)
taking of VD in groups II, III. (a) compared with (b) in each group.
Low vit. D dose group (II)
Symptom(Score by VAS)
Mean
b
SD
Mean
b
SD
P value
4.8
4.3
1.398
0.483
0.3221
4.9
2.5
1.375
1.178
0.0001S
Headache
7.2
6.5
0.748
1.027
0.0662
7.1
3.2
0.700
1.536
0.0001S
Nasal blockage
7.3
6.8
2.259
0.979
0.2443
7.3
3.2
1.100
2.012
0.0001S
Nasal discharge
7.1
6.4
1.937
0.966
0.0662
7.2
3.2
0.600
2.065
0.0001S
Post-nasal drip
4.9
4.8
0.737
0.632
0.7577
2.9
0.894
0.738
0.0002S
Olfactory disturbance
4.6
4.1
0.843
0.567
0.0957
4.6
0.663
0.666
0.0003S
Groups
Histogram 1. Showing the mean of different symptoms of VAS score in groups IIb, IIa,
IIIb and IIIa.
doi: 10.7243/2055-091X-1-2
Table 3. Showing the mean, SD and P value of Lund Mackay score in groups II (b and a) and
III (b and a). (a) compared with (b) in each group.
Endoscopic appearance
( Lund Mackay score )
SD
Polypi
1.5
1.3
0.527
0.483
Edema
1.6
1.1
0.516
Discharge
1.5
1.2
0.527
Mean
SD
P value
0.1678
1.7
0.8
0.483
0.422
0.0007S
0.316
0.0149 S
1.4
0.5
0.516
0.527
0.0007S
0.422
0.5911
1.3
0.2
0.483
0.422
0.0002S
Groups
plasma cells) and few blood vessels (Figure 2b). After taking
VD (group IIa), it showed partial damage of respiratory
epithelium rests on thick basal lamina and lamina propria
with numerous cells infiltration and few blood vessels
(Figure 2c). High dose VD group before taking VD (group
IIIb) showed the same features of group IIb (Figure 2d). After
taking VD (group IIIa), it showed near normal nasal mucosa
with overcrowded respiratory epithelium rests on thin basal
lamina and lamina propria of loose connective tissue with
Massons trichrome
Immunohistochemical
Group II
Group III
Mean area %
0.04 %
0.17%
0.12%
0.18%
0.05%
P value
--
--
0.09
--
0.001S
S = Significant.
doi: 10.7243/2055-091X-1-2
Groups
Discussion
doi: 10.7243/2055-091X-1-2
Groups
Conclusion
doi: 10.7243/2055-091X-1-2
efficacy of different doses and routs of VD on nasal polyposis.
Competing interests
Authors contributions
Authors contributions
EMF
MMY
TM
--
--
--
--
Statistical analysis
--
--
Acknowledgement
We thank prof Omayma Kamal Helal for her critical review and
helpful comments.
Publication history
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doi: 10.7243/2055-091X-1-2
Citation:
Faruk EM, Yousef MM and Mohamed T. Does
vitamin D have protective effect on human nasal
polyposis: histological and immunohistochemical
study. J Histol Histopathol. 2014; 1:2.
http://dx.doi.org/10.7243/2055-091X-1-2