25-Hydroxyl Vitamin D Deficiency in Nasal Polyposis

THIEME 308 Original Research 25-Hydroxyl Vitamin D Deficiency in Nasal Polyposis Ankur Kumar Chandrakar1 Karthikeyan Ramasamy1 Arun Alexander1 Medha R.2 1 Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India 2 Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India Kalaiselvi Rajendiran2 Address for correspondence Dr Arun Alexander, MS, DNB, Department of ENT, JIPMER, Puducherry, 605006, India (e-mail: ). Int Arch Otorhinolaryngol 2020;24(3):308–312. Abstract Keywords ► Vitamin D ► hs-CRP ► nasal polyposis Introduction Vitamin D is known to have immunomodulatory functions and has action on chronic inflammatory processes, such as nasal polyposis. Objective The present study assessed the levels of 25-hydroxy vitamin D and highsensitivity C-reactive protein (hs-CRP) in patients with nasal polyposis, as compared with healthy control subjects, and identified their association with disease severity in nasal polyposis. It further assessed the levels of 25-hydroxyl vitamin D and hs-CRP in patients with nasal polyposis and atopy and compared it with patients with nasal polyposis without atopy. Methods This was a cross-sectional study involving 2 groups: 80 patients with nasal polyposis and 80 healthy subjects. In patients with nasal polyposis, the disease severity is assessed by the sino-nasal outcome test (SNOT20) and by the Lund & Mackay staging system. Levels of 25-hydroxy vitamin D and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA). Result The mean 25-hydroxyl vitamin D levels (ng/ml) was 12.01
7.29 for cases and 22.87
14.95 for controls, with p < 0.0001. The mean hs-CRP levels (mg/L) was 5.99
2.74 in cases and 2.41
1.95 in controls, with p < 0.0001. The severity of polyposis correlated negatively with serum levels of 25-hydroxy vitamin D and positively with hs-CRP. Conclusion The study has thus shown significant correlation between vitamin D deficiency and inflammation in patients with nasal polyps. Introduction Nasal polyps are associated with chronic inflammation of the paranasal sinuses and may be associated with atopy. It is still unclear why only some patients with atopy develop polyps. Chronic rhinosinusitis with nasal polyps is a major problem for the patients due to its chronicity, severity of symptoms, recurrence and the unavailability of a standard protocol for its treatment. The etiopathogenesis of polyps, however, still remains unclear despite advances in molecular biology.1 Epithelial received July 17, 2019 accepted September 24, 2019 published online December 13, 2019 DOI https://doi.org/ 10.1055/s-0039-3399541. ISSN 1809-9777. cell dysfunction and eosinophilic inflammation of the upper respiratory tract mucosa are other factors that are crucial in the development of nasal polyposis.2 There occurs to be an interplay of various inflammatory mediators in the genesis of nasal polyposis. Although nasal polyposis is not a life-threatening condition, it causes significant morbidity interfering with the daily life of the patient and leads to substantial financial burden. The understanding of various immunomodulatory effects of vitamin D in recent times has encouraged studies for its possible association in the etiopathogenesis of nasal polyposis and Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 25-Hydroxyl Vitamin D Deficiency in Nasal Polyposis thereby exploring new targets for intervention. The active form of 25-hydroxyl vitamin D influences innate and adaptive immunity. It acts on antigen-presenting cells and T cells to promote peripheral tolerance via inhibition of inflammatory responses and induction to T-regs. Vitamin D is involved in the essential regulatory mechanisms, such as cellular proliferation, differentiation, apoptosis and angiogenesis in various types of cells.3 The fact that active Vitamin D has an immunomodulatory role in the human body may make it useful in the treatment of chronic inflammatory diseases like polyposis. The study on the influence of vitamin D derivatives on the inflammatory process in nasal polyposis may shed light not only on the mechanism of its etiology, but also prove its potential use in the pharmacotherapy of nasal polyposis. Synthesis of vitamin D derivatives of similar anti-proliferative and immunomodulative capabilities without unwanted effects opens new therapeutic challenges. Vitamin D derivatives have been used successfully in the therapy of psoriasis and other hyper-keratotic skin disorders.3 C-reactive protein (CRP) is an acute phase reactant, which increases in inflammatory conditions, like nasal polyposis. Its rate of increase seems to be related to the extent of tissue injury and inflammation severity. There are few studies worldwide evaluating the levels of 25-hydroxy vitamin D and high-sensitivity C-reactive protein (hs-CRP) in nasal polyposis. Chandrakar et al. was calculated using the PS Power and Sample Size Program version 3.0.43 software (Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA). Study Population and Workup Subjects with any comorbid condition that could affect vitamin D serum level, such as rickets, osteomalacia, sarcoidosis, thyroid dysfunction, rheumatoid arthritis, ulcerative colitis, Crohn disease, pregnancy, hepatic and renal disease were excluded. Subjects with acute nasal infections and those on any medication for nasal polyposis for the month preceding the workup were also excluded. Adult patients > 18 years old diagnosed with nasal polyps based on history, examination and radiological investigations were recruited as subjects. In all patients with nasal polyposis, the disease severity was assessed clinically by the Sino nasal outcome test 20 (SNOT20) and radiologically by the Lund & Mackay staging system. All of the subjects underwent the allergen skin prick test and were divided into atopy or nonatopy subgroups. Common allergens in the community like grass, cereals, common insects and plants were used in the study. A total of 24 different allergens were used to assess atopy. A subject was deemed atopic if he or she was allergic to > 5 allergens. The association of biochemical parameters with disease severity was also studied. Assay of Study Parameters Aims and Objectives The present study assessed the levels of 25-hydroxyl vitamin D and hs-CRP in patients with nasal polyposis as compared with healthy control subjects and identified their association with disease severity in nasal polyposis. It further assessed the levels of 25-hydroxyl vitamin D and hs-CRP in patients with nasal polyposis and atopy and compared it with patients with nasal polyposis without atopy. Biochemical parameters were estimated in the 5-ml blood sample drawn from all study subjects. Levels of 25-hydroxy vitamin D and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA) using commercially available (...truncated)