Elevated nitric oxide metabolite levels in chronic sinusitis

[The effectiveness of complex drugs in the treatment of acute rhinitis]

Purpose of the study. Generalization of data on the value of alternative and additional treatment of acute infectious rhinitis with Korizalia.

MATERIAL AND METHODS

The material of scientific publications included in the Cochrane Library, information bases of the RSCI, MEDLINE, PubMed was used as a data source. The choice of material was carried out using the key words: colds, acute rhinitis, herbal medicine, homeopathic remedies.

RESULTS

Analysis of published clinical trial descriptions suggests the potential value of homeopathic medicines, in particular Korizalia, in improving the effectiveness of the treatment of acute rhinitis. The use of Korizalia in acute infectious rhinitis was more effective in relation to the main symptoms of ARI compared with placebo.

CONCLUSION

The lack of optimal drugs for the etiotropic treatment of viral acute respiratory infections determines the relevance of alternative and complementary methods of treatment using drugs of natural origin. The drug Korizalia can be used for acute respiratory infections (acute infectious rhinitis) as an alternative drug or in combination with other drugs.

Nasal nitric oxide in relation to psychiatric status of patients with empty nose syndrome

BACKGROUND

Although cases of empty nose syndrome (ENS) are not very common, the suffering that ENS causes patient is immense and could be very difficult to imagine. Nasal nitric oxide (nNO) is an airway disease biomarker, and its levels increase after endoscopic sinus surgery. The trend of nNO levels in ENS before and after surgical treatment remains unknown. This study aimed to evaluate the role of nNO in ENS.

METHODS

Patients with ENS who received surgical implantation and with chronic hypertrophic rhinitis (CHR) who underwent turbinoplasty and completed at least 1 year of follow-up were prospectively enrolled. nNO measurements and subjective assessments [SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI)] were performed preoperatively and at 3, 6, and 12 months postoperatively.

RESULTS

We enrolled 19 ENS and 12 CHR patients. nNO levels were significantly lower in the ENS than in the CHR patients before surgical treatment (p < 0.001). nNO levels in the ENS patients significantly increased 3 months after implantation and remained plateaued (p = 0.015). BDI-II and BAI scores significantly improved after surgical treatment for the ENS patients but not for the CHR patients; changes in nNO levels correlated well with improvements in BDI-II and BAI scores (p = 0.025 and 0.035, respectively).

CONCLUSIONS

nNO significantly increased at third month after surgical treatment and remained plateaued in ENS patients. This increase correlated with improvements in BDI-II and BAI scores. Therefore, nNO may be important in assessing the psychiatric status of empty nose syndrome.

The Influence of the Size of the Maxillary Sinus Ostium on the Nasal and Sinus Nitric Oxide Levels

Background

Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of “mini-functional endoscopic sinus surgery” has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO.

Methods

Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding.

Results

This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO.

Conclusions

The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.

[Medically-induced rhinitis]

This paper summarizes the currently accepted concepts of the pathogenetic mechanisms underlying the morphological and functional changes in intranasal mucosa of the patients having a long history of the application of the long-acting topical vasoconstrictor agents. The author presents the data illustrating the effectiveness of various methods for the pharmacotherapeutic treatment of medically-induced rhinitis.

Monitoring of Oral and Nasal Exhaled Nitric Oxide in Eosinophilic Chronic Rhinosinusitis: A Prospective Study

Background

We aimed to examine the effect of different therapeutic modalities on levels of fractional concentrations of exhaled nitric oxide (FeNO) in patients with eosinophilic chronic rhinosinusitis (ECRS).

Methods

Thirty-six ECRS patients with nasal polyps were treated either medically or surgically. Oral and nasal FeNO levels were measured using an electrochemical NO analyzer initially and at 1 and 6 months. The mRNA expression and localization of nitric oxide synthase (NOS) isoforms in sinus mucosa and nasal polyps were analyzed by real-time polymerase chain reaction (PCR) and immunohistochemistry.

Results

The mean oral FeNO levels in the surgical group had decreased significantly from 50.9 to 36.8 ppb 6 months after endoscopic sinus surgery. All patients in this group showed significantly higher nasal FeNO levels after treatment. The mean nasal FeNO levels were 62.3 ppb at 1 month and 93.6 ppb at 6 months. Mean oral and nasal FeNO levels in the medical group after treatment remained unchanged when compared with the baseline levels. Positive immunoreactivity of inducible NOS (iNOS) was observed in both epithelial cells and submucosal inflammatory cells. Real-time PCR analysis showed significant up-regulation of iNOS and IL-5 mRNA expression.

Conclusion

A combination of oral and nasal FeNO measurements is useful to monitor the extent of inflammation in CRS patients. The increase in nasal FeNO in the surgical group indicates prompt recovery of NO release from healed sinus mucosa through the opened sinus ostia. Reduction of oral FeNO levels may reflect a cessation of the underlying lower airway inflammation that is characteristic of ECRS.

Suppression of nitric oxide production from nasal fibroblasts by metabolized clarithromycin in vitro

Background

Low-dose and long-term administration of 14-membered macrolide antibiotics, so called macrolide therapy, has been reported to favorably modify the clinical conditions of chronic airway diseases. Since there is growing evidence that macrolide antibiotic-resistant bacteria's spreaders in the populations received macrolide therapy, it is strongly desired to develop macrolide antibiotics, which showed only anti-inflammatory action. The present study was designed to examine the influence of clarithromycin (CAM) and its metabolized materials, M-1, M-4 and M-5, on free radical generation from nasal polyp fibroblasts (NPFs) through the choice of nitric oxide (NO), which is one of important effector molecule in the development of airway inflammatory disease in vitro.

Methods

NPFs (5 × 10⁵ cells/ml) were stimulated with 1.0 μg/ml lipopolysaccharide (LPS) in the presence of agents for 24 hours. NO levels in culture supernatants were examined by the Griess method. We also examined the influence of agents on the phosphorylation of MAPKs, NF-κB activation, iNOS mRNA expression and iNOS production in NPFs cultured for 2, 4, 8, and 12 hours, respectively.

Results

The addition of CAM (> 0.4 μg/ml) and M-4 (> 0.04 μg/ml) could suppress NO production from NPFs after LPS stimulation through the suppression of iNOS mRNA expression and NF-κB activation. CAM and M-4 also suppressed phosphorylation of MAPKs, ERK and p38 MAPK, but not JNK, which are increased LPS stimulation. On the other hand, M-1 and M-5 could not inhibit the NO generation, even when 0.1 μg/ml of the agent was added to cell cultures.

Conclusion

The present results may suggest that M-4 will be a good candidate for the agent in the treatment of chronic airway inflammatory diseases, since M-4 did not have antimicribiological effects on gram positive and negative bacteria.

[Revision of surgical treatment of rhinosinusitis]

The aim of this revision paper is to provide an update of available resources to achieve the best endoscopic sinus surgery outcomes of adult rhinosinusitis. The cause and mechanisms of rhinosinusitis remain unknown, and curative treatment does not exist. Recent new insights into paranasal sinus pathophysiology, along with technical advances in imaging and endoscopy, have revolutionised surgical treatment of rhinosinusitis. Since an increasing number of patients undergo functional endoscopic sinus surgery as a therapeutic regimen for their disease, appropriate use of computed tomography is critical in providing a "roadmap" for the surgeon to delimit the surgical procedure, as well as to ensure safety and accuracy. With proper training and technique, endoscopic surgery is quite safe, but prevention and management of complications must be known.

Nitric oxide: a new concept in chronic sinusitis pathogenesis

PURPOSE

Exhaled NO is produced mainly in paranasal sinuses and nasal mucosa. Nasal NO has been suggested to have a variety of effects in nasal cavity. Decreased exhaled NO is found in chronic sinusitis, and NO metabolite levels are increased in animal models of chronic sinusitis, suggesting a role for them in sinusitis pathogenesis. There was no data available on human NO metabolite level.

MATERIALS AND METHODS

We lavaged maxillary sinuses in a control and 2 patient groups. The control group was patients who underwent functional endoscopic sinus surgery (FESS) due to any other reason than chronic sinusitis. The patient groups had chronic rhinosinusitis with and without polyposis who underwent FESS. Maxillary sinuses were lavaged during FESS, and NO metabolites (nitrate and nitrite) were lavaged in the lavage fluid.

RESULTS

Nitric oxide metabolite levels (mean +/- SEM) were 8.085 +/- 1.43 mumol/L in healthy maxillary sinus lavage fluid and 18.04 +/- 3.51 and 16.78 +/- 2.91 mumol/L in chronic rhinosinusitis with and without polyposis, respectively. Lavage fluid of sinuses with chronic sinusitis had elevated levels of NO metabolites, which were significantly higher than the control group. The difference between the chronic sinusitis with and without polyposis groups was not significant.

CONCLUSIONS

Nitric oxide metabolites were significantly higher in maxillary sinuses of patients with chronic sinusitis. Elevated levels of NO and NO metabolites in sinusitis might damage healthy sinus epithelium. NO metabolites may have an important role in sinusitis pathogenesis.

Primary role of growth-related oncogene-alpha and granulocyte chemotactic protein-2 as neutrophil chemoattractants in chronic rhinosinusitis

BACKGROUND

The aetiology of chronic rhinosinusitis (CRS) remains unclear. The purpose of this study was to investigate neutrophil-attracting chemokine patterns in CRS without nasal polyposis.

METHODS

The biological activity of the chemokines was identified using a two-step high-performance liquid chromatography (HPLC) technique combined with a bioassay in extracts from 55 CRS patients, and in the turbinate mucosa (TM) of patients (N=51) undergoing septumplasty. The biologic activity of each chemokine was assessed using blocking antibodies to chemokines. Immunolocalization of detected neutrophil chemokines was performed by quantitative evaluation of immunohistochemistry. Besides, PCR analysis was performed to quantify neutrophil chemokine mRNA.

RESULTS

In CRS, the chemokines primarily detected by two-step HPLC were growth-related oncogene-alpha (GRO-alpha) and the granulocyte chemotactic protein-2 (GCP-2). Blocking of GCP-2 and GRO-alphad each resulted in chemotaxis inhibition rates of 43.3% and 35.9%, respectively, whereas anti-IL-8 and anti-ENA-78 had no effect. Both GCP-2 and GRO-alphad were generally synthesized by the surface epithelium and mucosal glands while GRO-alpha in particular was synthesized by endothelial cells, as shown by immunohistochemistry. The concentrations of the chemokines IL-8 and epithelial cell-derived neutrophil attractant-78 (ENA-78) were low in CRS and TM.

CONCLUSION

It appears that both GRO-alpha and GCP-2 contribute to neutrophil chemotaxis in CRS, whereas IL-8 and ENA-78 appear to be of secondary importance for the chemotaxis of neutrophils in this condition. The expression of chemokines in mucosal gland cells is the main phenomenon involved in constitutive neutrophil chemotaxis in the TM.

Effect of treatment on maxillary sinus and nasal nitric oxide concentrations in patients with nosocomial maxillary sinusitis

STUDY OBJECTIVES

In maxillary nosocomial sinusitis (MNS) related to severe sepsis, nitric oxide (NO) concentration in the maxillary sinuses is drastically reduced secondarily to a downregulation of type-2 NO synthase. NO plays a major role in nonspecific immune defense of sinuses. We therefore aimed to study maxillary NO concentration during the treatment of MNS with drainage, daily lavage, and removal of any nasally introduced tube.

PATIENTS AND METHODS

Nine patients were studied during the first 4 days of treatment of MNS. We measured the concentration of NO gas in the maxillary sinus and in the nasal cavity, and the NO metabolite levels (nitrites/nitrates [NOx]) in the sinus lavages.

MEASUREMENTS AND RESULTS

Maxillary NO concentration (median [25 to 75 percentile]) increased from 70 parts per billion (ppb) [40 to 100 ppb] to 2,050 ppb (1,700 to 3,000 ppb) after 4 days of treatment of MNS (p < 0.0001). In the meantime, nasal NO increased from a median of 100 ppb (98 to 148 ppb) to 180 ppb (180 to 188 ppb) [p < 0.001]. At any time, there was a correlation between maxillary NO (logarithmic value) and nasal NO (r2 = 0.57, p < 0.0001). NOx levels remained stable in the lavages.

CONCLUSIONS

We conclude that the treatment of the sinusitis with drainage, daily lavage, and removal of the gastric tube lead to a spectacular increase of maxillary and nasal NO concentrations.

Silent and humming nasal NO measurements in adults aged 18-70 years

BACKGROUND

The concentration of nitric oxide (NO) measured from the nose is much higher than in the lower airways and increases during humming. We assessed nasal NO (nNO) normal values during breath hold and during humming in healthy adults.

MATERIALS AND METHODS

Nasal NO concentrations were measured in healthy adults (ages 18-70). They held their breath for 10 s and thereafter hummed as loud as possible with their mouths closed also for 10 s. During breath hold, air was passively extracted from one nostril with 700 mL min(-1). The average NO concentration at the plateau after 7-10 s was recorded and the mean of three consecutive measurements was calculated. During humming, air was extracted with 1200 mL min(-1), the peak NO values were recorded.

RESULTS

One hundred healthy adults participated (37 men). The nNO concentrations during breath hold were distributed normally (mean: 455 parts per billion (p.p.b.), SD 147). A random subgroup of 40 out of the 100 subjects (15 men) performed nNO measurement during humming. The median peak NO value was 1019 p.p.b. (SD 561) at the first, and 837 p.p.b. (SD 408) at the second measurement. There was a significant difference between the peak NO values of first and second humming.

CONCLUSION

We present normal values for nNO in adults, which can be used to assess the value of nNO in respiratory illnesses. The peak nNO values during humming are variable, and their clinical relevance remains to be shown.

Nitric oxide level in the nasal and sinus mucosa after exposure to electromagnetic field

OBJECTIVE

The purpose of this study was to examine the changes in nitric oxide (NO) level in the nasal and paranasal sinus mucosa after exposure radiofrequency electromagnetic fields (EMF).

STUDY DESIGN AND SETTING

Thirty male Sprague-Dawley rats were randomly grouped as follows: EMF group (group I; n, 10), EMF group in which melatonin received (group II; n, 10) and the control (sham operated) group (group III; n, 10). Groups I and II were exposed to a 900 MHz. Oral melatonin was given in group II. Control rats (group III) were also placed in the tube as the exposure groups, but without exposure to EMF. At the end of 2 weeks, the rats were sacrificed, and the nasal and paranasal sinus mucosa dissected. NO was measured in nasal and paranasal mucosa.

RESULTS

The nasal and paranasal sinus mucosa NO levels of group I were significantly higher than those of the control group (group III) ( P < 0.05). However, there was no statistically significant difference between group II and the control group (group III) regarding NO output ( P > 0.05).

CONCLUSION

Exposure to EMF released by mobile phones (900 MHz) increase NO levels in the sinus and nasal mucosa.

SIGNIFICANCE

Increased NO levels may act as a defense mechanism and presumably related to tissue damage. In addition, melatonin may have beneficial effect to prevent these changes in the mucosa.

Effect of WEB 2170 BS, platelet activating factor receptor inhibitor, in the rabbit model of sinusitis

Platelet activating factor (PAF), a potent inflammatory mediator, is a biologically active phospholipid. Recent studies have shown that PAF may play an important role in the pathogenesis of inflammation. WEB 2170 BS has been shown to be a PAF antagonist both in vitro and in vivo. Nitric oxide (NO) is present in the mammalian nasal airways and originates primarily from the paranasal sinuses. Measurement of NO is thought to be a surrogate marker of upper airway inflammation. In this study, the antiinflammatory effects of WEB 2170 BS were investigated in a rabbit model of sinusitis. To induce experimental sinusitis, we applied killed Staphylococcus aureus percutaneously to the maxillary sinus of rabbits without occlusion of the natural ostium. Either WEB 2170 BS solution or placebo was administered intraperitoneally 2 hours before sinus inoculation, and this procedure was repeated twice daily for 4 days. The outcome of the treatment was determined by the measurement of NO metabolite levels and NO synthase activity in the samples of sinus mucosa and by histopathologic evaluation of sinus mucosa. The pathological grading was determined by the number of inflammatory cells found in the sinus mucosa. The levels of NO metabolites and NO synthase activity were found to be significantly lower in the WEB 2170 BS-treated group than in the control group. Histopathologic analysis of the sinus mucosa indicated decreased inflammation in the treated group as compared to the controls. These results demonstrate that WEB 2170 BS may produce significant anti-inflammatory effects in this model of sinusitis.