A few bacterial toxins (. diphtheria) are known to utilize both direct entry and RME to enter into host cells, which is not surprising since both mechanisms are variations on a theme. Bacterial toxins with similar enzymatic mechanisms may enter their target cells by different mechanisms. Thus, the diphtheria toxin and Pseudomonas exotoxin A, which have identical mechanisms of enzymatic activity, enter their host cells in slightly different ways. The adenylate cyclase toxin of Bordetella pertussis (pertussis AC) and anthrax EF produced by Bacillus anthracis , act similarly to catalyze the production of cAMP from host cell intracellular ATP reserves. However, the anthrax toxin enters cells by receptor mediated endocytosis, whereas the pertussis adenylate cyclase traverses the cell membrane directly.
Research in chronic sinusitis suggested that inhaled mold caused an intense inflammatory response in the sinuses in some patients. This led to studies of antifungal treatments sprayed into the nose but the results were disappointing. Though most sinus patients do not respond to topical antifungal therapy select patients may exhibit a dramatic response. Sometime the appearance of nasal mucous or the pathology specimen from sinus surgery provides a clue as to who will benefit. By the time we see a patient with chronic sinusitis, they usually have a mixture of inflammation, nasal polyps and bacterial infection. The bacterial infections need to be cleared first before anything else can be accomplished. If you have already had sinus surgery then many of the topical therapies for sinus disease, including treatment for mold, may enter the sinus cavities.
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