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Wang M, Ma X, Zong S, Su Y, Su R, Zhang H, Liu Y, Wang C, Li Y. The prescription design and key properties of nasal gel for CNS drug delivery: A review. Eur J Pharm Sci 2024; 192:106623. [PMID: 37890640 DOI: 10.1016/j.ejps.2023.106623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Central nervous system (CNS) diseases are among the major health problems. However, blood-brain barrier (BBB) makes traditional oral and intravenous delivery of CNS drugs inefficient. The unique direct connection between the nose and the brain makes nasal administration a great potential advantage in CNS drugs delivery. However, nasal mucociliary clearance (NMCC) limits the development of drug delivery systems. Appropriate nasal gel viscosity alleviates NMCC to a certain extent, gels based on gellan gum, chitosan, carbomer, cellulose and poloxamer have been widely reported. However, nasal gel formulation design and key properties for alleviating NMCC have not been clearly discussed. This article summarizes gel formulations of different polymers in existing nasal gel systems, and attempts to provide a basis for researchers to conduct in-depth research on the key characteristics of gel matrix against NMCC.
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Affiliation(s)
- Miao Wang
- Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Xinyu Ma
- Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Shiyu Zong
- Institute of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China; Key Laboratory of TCM Drug Delivery, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China
| | - Yaqiong Su
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education/College of Life Science, Northwest University, Xi'an 710069, China
| | - Rui Su
- Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Hong Zhang
- Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang 712046, China; Institute of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China; Key Laboratory of TCM Drug Delivery, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China
| | - Yang Liu
- Institute of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China; Key Laboratory of TCM Drug Delivery, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China
| | - Chunliu Wang
- Institute of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China; Key Laboratory of TCM Drug Delivery, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China.
| | - Ye Li
- Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang 712046, China; Institute of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China; Key Laboratory of TCM Drug Delivery, Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710001, China.
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Rajan N, Choudhury B, Prakash D, Soni K, Kaushal D, Shakrawal N, Nair NP, Goyal A. Does Prolonged Use of N95 Masks Affect Nasal Mucociliary Clearance? A Single Group Pre-Post Study. Ann Otol Rhinol Laryngol 2021; 131:730-736. [PMID: 34459285 DOI: 10.1177/00034894211041821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It has been shown that prolonged use of face masks results in physiological changes in the nasal cavity. The objective of this study was to examine the effect of prolonged use of face masks on nasal mucociliary clearance (NMC). METHODS A single group pre-post study was conducted to determine the effects of prolonged use of N95 face mask (≥4 hours) on the NMC rates in health care workers. Saccharin transit time (STT) was used to measure the NMC. STT before and after using an N95 mask for at least 4 hours was measured for all participants in controlled conditions of temperature and humidity. RESULTS Forty-eight volunteers (20 female and 28 male) completed the study after the enrollment of 57 volunteers. The mean STT before mask use was 580.27 ± 193.93 seconds (95% CI; 523.95-636.58 seconds) and after mask use was 667.47 ± 237.42 seconds (95% CI; 598.53-736.42 seconds). There was significant prolongation of the NMC after prolonged use of N95 mask on performing the paired t-test (P = .002). The mean prolongation was 87.20 ± 184.97 seconds with an actual effect size of 0.40. Ambient temperature and humidity were not significantly different at the two test instances. CONCLUSION Use of the N95 face masks for 4 hours results in prolongation of the nasal mucociliary clearance as measured by STT. Susceptibility to any respiratory infection may be increased following doffing of the personal protective equipment, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself.
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Affiliation(s)
- Nikhil Rajan
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bikram Choudhury
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Dipika Prakash
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kapil Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Darwin Kaushal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Neha Shakrawal
- Department of Otorhinolaryngology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Nithin Prakasan Nair
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Chen B, Antunes MB, Claire SE, Palmer JN, Chiu AG, Kennedy DW, Cohen NA. Reversal of Chronic Rhinosinusitis-Associated Sinonasal Ciliary Dysfunction. ACTA ACUST UNITED AC 2018; 21:346-53. [PMID: 17621822 DOI: 10.2500/ajr.2007.21.3029] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Although multiple etiologies contribute to the development of chronic rhinosinusitis (CRS), a common pathophysiological sequelae is ineffective sinonasal mucociliary clearance, leading to stasis of sinonasal secretions, with subsequent infection and/or persistent inflammation. Proper therapeutic intervention typically restores mucociliary activity, suggesting that the pathophysiological process(es) responsible for CRS-associated mucostasis may be reversible. We previously demonstrated a blunted response of CRS sinonasal cilia after purinergic stimulation. This study investigated whether the blunted ciliary response is unique to purinergic stimulation and addressed whether the blunted effect is primarily caused by local CRS-associated mediators or inherent genetic defects in ciliary function. Methods A dual temperature-controlled perfusion chamber, differential interference contrast microscopy, and high-speed digital video were used to analyze both basal as well as cholinergic, adrenergic, and purinergic stimulation of cilia in human sinonasal mucosal explants. Additionally, enzymically dissociated sinonasal ciliated cells were maintained ex vivo in submersion, on glass coverslips, and assessed daily for purinergic ciliary beat frequency stimulation. Results Cholinergic and adrenergic stimulation generally were blunted in mucosal explants obtained from CRS patients. Ex vivo maintenance of samples demonstrated that the majority of CRS samples developed a stimulatory phenotype within 36 hours of culturing. Conclusion CRS is a common debilitating disease principally affecting sinonasal epithelial function with a resultant diminution of mucociliary transport. Presently, little is known about how this disease process affects the sinonasal epithelial ciliated cells. Our data suggest that ciliary response to environmental insults is blunted in a reversible manner in CRS patients.
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Affiliation(s)
- Bei Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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5
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Triantafillou V, Workman AD, Kohanski MA, Cohen NA. Taste Receptor Polymorphisms and Immune Response: A Review of Receptor Genotypic-Phenotypic Variations and Their Relevance to Chronic Rhinosinusitis. Front Cell Infect Microbiol 2018; 8:64. [PMID: 29564227 PMCID: PMC5845873 DOI: 10.3389/fcimb.2018.00064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/21/2018] [Indexed: 01/22/2023] Open
Abstract
Bitter (T2R) and sweet taste (T1R) receptors have emerged as regulators of upper airway immune responses. Genetic variation of these taste receptors additionally confers susceptibility to infection and has been implicated in severity of disease in chronic rhinosinusitis (CRS). Ongoing taste receptor research has identified a variety of biologically active compounds that activate T1R and T2R receptors, increasing our understanding of not only additional receptor isoforms and their function but also how receptor function may contribute to the pathophysiology of CRS. This review will discuss the function of taste receptors in mediating airway immunity with a focus on recently described modulators of receptor function and directions for future research into the potential role of genotypic and phenotypic receptor variation as a predictor of airway disease and response to therapy.
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Affiliation(s)
- Vasiliki Triantafillou
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Alan D Workman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States.,Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
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6
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Workman AD, Carey RM, Kohanski MA, Kennedy DW, Palmer JN, Adappa ND, Cohen NA. Relative susceptibility of airway organisms to antimicrobial effects of nitric oxide. Int Forum Allergy Rhinol 2017; 7:770-776. [PMID: 28544570 DOI: 10.1002/alr.21966] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/16/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nitric oxide (NO) is released in the airway as a critical component of innate immune defense against invading pathogenic organisms. It is well documented that bacteriostatic and bactericidal effects of NO are concentration-dependent. However, few data exist comparing relative susceptibility of common pathogens to NO at physiologic concentrations. In this study we evaluated the effects of NO on 4 common airway bacteria and 1 fungus, and examined the potential implications of discrepancies in sensitivity. METHODS Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans cultures were adjusted to a uniform optical density (OD) and grown in log phase at 37°C with varying concentrations of NO formed by DETA NONOate. Both OD readings and colony forming units (CFUs) were measured at varying time-points to evaluate for inhibitory effects of NO. RESULTS P aeruginosa and C albicans were significantly more sensitive to NO at physiologic concentrations typical of the human airway. S aureus was attenuated by NO to a lesser degree, and K pneumoniae and S epidermis were more resistant to NO at all concentrations tested. Air surface liquid from cultured human sinonasal epithelial cells had an additive effect in bacterial killing of P aeruginosa, but not in S aureus. CONCLUSION Common airway pathogens have varying levels of susceptibility to NO at physiologic concentrations of innate immune defense. Relative sensitivity of P aeruginosa and relative resistance of S epidermis may help explain the composition of the healthy microbiome, as well as opportunistic infection in the absence of induced NO release.
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Affiliation(s)
- Alan D Workman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ryan M Carey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - David W Kennedy
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Noam A Cohen
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA.,Division of Otolaryngology-Head and Neck Surgery, Philadelphia Veterans Administration Medical Center, Philadelphia, PA
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7
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Workman AD, Carey RM, Kohanski MA, Adappa ND, Palmer JN, Cohen NA. Effects of ophthalmologic solutions on sinonasal ciliated epithelium. Int Forum Allergy Rhinol 2017; 7:801-808. [DOI: 10.1002/alr.21953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/27/2017] [Accepted: 04/14/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Alan D. Workman
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA
| | - Ryan M. Carey
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia PA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia PA
| | - James N. Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia PA
| | - Noam A. Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia PA
- Division of Otolaryngology-Head and Neck Surgery; Philadelphia Veterans Administration Medical Center; Philadelphia PA
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8
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Luo W, Yi H, Taylor J, Li JD, Chi F, Todd NW, Lin X, Ren D, Chen P. Cilia distribution and polarity in the epithelial lining of the mouse middle ear cavity. Sci Rep 2017; 7:45870. [PMID: 28358397 PMCID: PMC5372464 DOI: 10.1038/srep45870] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/03/2017] [Indexed: 12/15/2022] Open
Abstract
The middle ear conducts sound to the cochlea for hearing. Otitis media (OM) is the most common illness in childhood. Moreover, chronic OM with effusion (COME) is the leading cause of conductive hearing loss. Clinically, COME is highly associated with Primary Ciliary Dyskinesia, implicating significant contributions of cilia dysfunction to COME. The understanding of middle ear cilia properties that are critical to OM susceptibility, however, is limited. Here, we confirmed the presence of a ciliated region near the Eustachian tube orifice at the ventral region of the middle ear cavity, consisting mostly of a lumen layer of multi-ciliated and a layer of Keratin-5-positive basal cells. We also found that the motile cilia are polarized coordinately and display a planar cell polarity. Surprisingly, we also found a region of multi-ciliated cells that line the posterior dorsal pole of the middle ear cavity which was previously thought to contain only non-ciliated cells. Our study provided a more complete understanding of cilia distribution and revealed for the first time coordinated polarity of cilia in the epithelium of the mammalian middle ear, thus illustrating novel structural features that are likely critical for middle ear functions and related to OM susceptibility.
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Affiliation(s)
- Wenwei Luo
- Department of Cell Biology Emory University, Atlanta, USA.,Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, PR China
| | - Hong Yi
- Electronic Microscopy Laboratory, Emory University, Atlanta, USA
| | - Jeannette Taylor
- Electronic Microscopy Laboratory, Emory University, Atlanta, USA
| | - Jian-Dong Li
- Center for Inflammation, Immunity and Infection, Institution for Biomedical Sciences, Georgia State University, Atlanta, USA
| | - Fanglu Chi
- Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, PR China
| | - N Wendell Todd
- Department of Otolaryngology, Emory University, Atlanta, USA
| | - Xi Lin
- Department of Otolaryngology, Emory University, Atlanta, USA
| | - Dongdong Ren
- Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, PR China
| | - Ping Chen
- Department of Cell Biology Emory University, Atlanta, USA
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Abstract
Although much has been elucidated in the past 170 years concerning the precise mechanism of ciliary function in the healthy or diseased human respiratory system, significant questions remain. The first description of ciliary action is credited to Sharpey in 1835. However, the importance of mucosal function was not apparent until Hilding's investigations of the postsurgical canine sinus demonstrated scar formation and disruption of mucociliary clearance. Subsequently, several techniques for mucosal coverage of exposed bone, most notably by Sewall and Boyden, were reported. The underlying physiology explaining the importance of the mucosa and the concept of mucosal preservation became apparent with the description of the sinonasal mucociliary flow patterns by Messerklinger; and thus the restoration of natural sinus physiology, ie, mucociliary clearance, became the goal of both medical and surgical treatment of sinonasal inflammatory disease. Clearance of benign and pathological substances in the mucus is governed by the propulsive force of the beating cilia and the physical characteristics of the overlying mucus. The respiratory cilia continually beat in a coordinated fashion, and in times of stress (eg, exercise, infection, or fever) ciliary beat frequency increases to accelerate mucus clearance. Thus, upper airway ciliary motility is under dynamic modulation. Multiple investigations incontrovertibly demonstrate a marked decrease in sinonasal mucociliary clearance in patients with chronic rhinosinusitis. Possible explanations for this finding are 1) a reduced basal ciliary beat frequency, 2) an alteration of the viscoelastic properties of airway secretions, and/or 3) a blunted dynamic response of sinonasal cilia to environmental stimuli. Studies of the first two explanations yield conflicting results, and to date, the third possibility remains uninvestigated. A review of the current understanding of the cellular regulation of respiratory ciliary activity and its contribution to chronic rhinosinusitis is presented.
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Affiliation(s)
- Noam A Cohen
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5 Silverstein/Ravdin, 3400 Spruce St, Philadelphia, PA 19104, USA
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10
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Bonnomet A, Luczka E, Coraux C, de Gabory L. Non-diluted seawater enhances nasal ciliary beat frequency and wound repair speed compared to diluted seawater and normal saline. Int Forum Allergy Rhinol 2016; 6:1062-1068. [PMID: 27101776 PMCID: PMC5074274 DOI: 10.1002/alr.21782] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 01/05/2023]
Abstract
Background The regulation of mucociliary clearance is a key part of the defense mechanisms developed by the airway epithelium. If a high aggregate quality of evidence shows the clinical effectiveness of nasal irrigation, there is a lack of studies showing the intrinsic role of the different irrigation solutions allowing such results. This study investigated the impact of solutions with different pH and ionic compositions, eg, normal saline, non‐diluted seawater and diluted seawater, on nasal mucosa functional parameters. Methods For this randomized, controlled, blinded, in vitro study, we used airway epithelial cells obtained from 13 nasal polyps explants to measure ciliary beat frequency (CBF) and epithelial wound repair speed (WRS) in response to 3 isotonic nasal irrigation solutions: (1) normal saline 0.9%; (2) non‐diluted seawater (Physiomer®); and (3) 30% diluted seawater (Stérimar). The results were compared to control (cell culture medium). Results Non‐diluted seawater enhanced the CBF and the WRS when compared to diluted seawater and to normal saline. When compared to the control, it significantly enhanced CBF and slightly, though nonsignificantly, improved the WRS. Interestingly, normal saline markedly reduced the number of epithelial cells and ciliated cells when compared to the control condition. Conclusion Our results suggest that the physicochemical features of the nasal wash solution is important because it determines the optimal conditions to enhance CBF and epithelial WRS thus preserving the respiratory mucosa in pathological conditions. Non‐diluted seawater obtains the best results on CBF and WRS vs normal saline showing a deleterious effect on epithelial cell function.
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Affiliation(s)
- Arnaud Bonnomet
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France.,Cellular and Tissular Imaging Platform (PICT), University of Reims-Champagne-Ardenne, Reims, France
| | - Emilie Luczka
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France
| | - Christelle Coraux
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France
| | - Ludovic de Gabory
- Ear Nose and Throat (ENT) Department, University Hospital of Bordeaux, Hôpital Pellegrin, Bordeaux, France.
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11
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Laberko EL, Talalaev AG, Bogomil'sky MR, Bullikh AV. [The method for the direct evaluation of the state of mucociliary clearance in the children]. Vestn Otorinolaringol 2016; 80:40-44. [PMID: 26145743 DOI: 10.17116/otorino201580240-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to develop a readily available, simple to use and acceptable for the application in the childhood method for the evaluation of the state of mucociliary clearance. We have proposed and presented the detailed description of the simple approach to the direct investigation of the ciliary apparatus of the ciliary epithelium cells that requires neither the expensive sophisticated equipment nor the software programs to be implemented. Investigations by this method made it possible to elucidate and identify certain details of the functioning of ciliary epithelium. Other methods for the study of the ciliary apparatus are considered with special reference to their main advantages and disadvantages. Some debatable problems pertaining to the choice of optimal techniques for the evaluation of the functional state of ciliary epithelium are discussed.
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Affiliation(s)
- E L Laberko
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - A G Talalaev
- Morozovskaya City Children's Clinical Hospital Moscow Health Department, Moscow, Russia, 119049
| | - M R Bogomil'sky
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - A V Bullikh
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
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12
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Workman AD, Palmer JN, Adappa ND, Cohen NA. The Role of Bitter and Sweet Taste Receptors in Upper Airway Immunity. Curr Allergy Asthma Rep 2016; 15:72. [PMID: 26492878 DOI: 10.1007/s11882-015-0571-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Over the past several years, taste receptors have emerged as key players in the regulation of innate immune defenses in the mammalian respiratory tract. Several cell types in the airway, including ciliated epithelial cells, solitary chemosensory cells, and bronchial smooth muscle cells, all display chemoresponsive properties that utilize taste receptors. A variety of bitter products secreted by microbes are detected with resultant downstream inflammation, increased mucous clearance, antimicrobial peptide secretion, and direct bacterial killing. Genetic variation of bitter taste receptors also appears to play a role in the susceptibility to infection in respiratory disease states, including that of chronic rhinosinusitis. Ongoing taste receptor research may yield new therapeutics that harness innate immune defenses in the respiratory tract and may offer alternatives to antibiotic treatment. The present review discusses taste receptor-protective responses and analyzes the role these receptors play in mediating airway immune function.
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Affiliation(s)
- Alan D Workman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James N Palmer
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Noam A Cohen
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Monell Smell and Taste Center, Philadelphia, PA, USA. .,Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
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13
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Yazıcı H. Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion. Curr Allergy Asthma Rep 2016; 15:74. [PMID: 26496764 DOI: 10.1007/s11882-015-0576-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.
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Affiliation(s)
- Hasmet Yazıcı
- Balikesir University Faculty of Medicine Ear Nose Throat Clinic, Mimar sinan Cad. Eylül sitesi B Blok Kat3 No: 5, Balikesir, Turkey, 10000.
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14
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
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- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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15
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Workman AD, Cohen NA. The effect of drugs and other compounds on the ciliary beat frequency of human respiratory epithelium. Am J Rhinol Allergy 2015; 28:454-64. [PMID: 25514481 DOI: 10.2500/ajra.2014.28.4092] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cilia in the human respiratory tract play a critical role in clearing mucus and debris from the airways. Their function can be affected by a number of drugs or other substances, many of which alter ciliary beat frequency (CBF). This has implications for diseases of the respiratory tract and nasal drug delivery. This article is a systematic review of the literature that examines 229 substances and their effect on CBF. METHODS MEDLINE was the primary database used for data collection. Eligibility criteria based on experimental design were established, and 152 studies were ultimately selected. Each individual trial for the substances tested was noted whenever possible, including concentration, time course, specific effect on CBF, and source of tissue. RESULTS There was a high degree of heterogeneity between the various experiments examined in this article. Substances and their general effects (increase, no effect, decrease) were grouped into six categories: antimicrobials and antivirals, pharmacologics, human biological products, organisms and toxins, drug excipients, and natural compounds/other manipulations. CONCLUSION Organisms, toxins, and drug excipients tend to show a cilioinhibitory effect, whereas substances in all other categories had mixed effects. All studies examined were in vitro experiments, and application of the results in vivo is confounded by several factors. The data presented in this article should be useful in future respiratory research and examination of compounds for therapeutic and drug delivery purposes.
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Affiliation(s)
- Alan D Workman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Lai Y, Dilidaer D, Chen B, Xu G, Shi J, Lee RJ, Cohen NA. In vitro studies of a distillate of rectified essential oils on sinonasal components of mucociliary clearance. Am J Rhinol Allergy 2015; 28:244-8. [PMID: 24980236 DOI: 10.2500/ajra.2014.28.4036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Herbal remedies predate written history and continue to be used frequently for many common ailments. The essential oil mixture standardized is a phytopharmaceutical with a distillate of a mixture of rectified essential oils of eucalyptus, sweet orange, myrtle, and lemon as active ingredients used to treat respiratory diseases such as bronchitis and rhinosinusitis. We evaluated the pharmacologic effects of a distillate of rectified essential oils standardized on primary human upper respiratory epithelial cultures specifically addressing electrolyte transport, cilia beat frequency (CBF), airway surface liquid (ASL) hydration, and mucus transport velocity. METHODS Well-differentiated primary human sinonasal epithelial cultures grown at an air-liquid interface were treated on the apical or basolateral surface with varying concentrations of a distillate of rectified essential oils standardized. Changes in CBF were determined using the Sissons-Ammons Video Analysis system while changes in chloride flux were determined using the fluorescent dye 6-methoxy-N-(3-sulfopropyl)quinolinium. ASL hydration was quantified using Texas red dextran and mucociliary transport velocity was measured using fluorescent microspheres and time lapse photography. RESULTS When applied to the basolateral surface, a distillate of rectified essential oils standardized activated chloride efflux and ciliary beat in a dose-dependent fashion, increasing ASL height and accelerating mucociliary transport velocity. The ancillary apical application of a distillate of rectified essential oils standardized had minimal effects on the CBF. CONCLUSION Basolateral application of a distillate of rectified essential oils standardized stimulates both chloride efflux and cilia beat frequency resulting in a synergistic effect dramatically augmenting mucociliary transport velocity. These in vitro data support the clinical efficacy of this phytopharmaceutical in respiratory inflammatory disorders.
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Affiliation(s)
- Yinyan Lai
- department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Zhao KQ, Cowan AT, Lee RJ, Goldstein N, Droguett K, Chen B, Zheng C, Villalon M, Palmer JN, Kreindler JL, Cohen NA. Molecular modulation of airway epithelial ciliary response to sneezing. FASEB J 2012; 26:3178-87. [PMID: 22516297 DOI: 10.1096/fj.11-202184] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Our purpose was to evaluate the effect of the mechanical force of a sneeze on sinonasal cilia function and determine the molecular mechanism responsible for eliciting the ciliary response to a sneeze. A novel model was developed to deliver a stimulation simulating a sneeze (55 mmHg for 50 ms) at 26°C to the apical surface of mouse and human nasal epithelial cells. Ciliary beating was visualized, and changes in ciliary beat frequency (CBF) were determined. To interrogate the molecular cascades driving sneeze-induced changes of CBF, pharmacologic manipulation of intra- and extracellular calcium, purinergic, PKA, and nitric oxide (NO) signaling were performed. CBF rapidly increases by ≥150% in response to a sneeze, which is dependent on the release of adenosine triphosphate (ATP), calcium influx, and PKA activation. Furthermore, apical release of ATP is independent of calcium influx, but calcium influx and subsequent increase in CBF are dependent on the ATP release. Lastly, we observed a blunted ciliary response in surgical specimens derived from patients with chronic rhinosinusitis compared to control patients. Apical ATP release with subsequent calcium mobilization and PKA activation are involved in sinonasal ciliary response to sneezing, which is blunted in patients with upper-airway disease.
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Affiliation(s)
- Ke-Qing Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Platt MP, Soler ZM, Kao SY, Metson R, Stankovic KM. Topographic gene expression in the sinonasal cavity of patients with chronic sinusitis with polyps. Otolaryngol Head Neck Surg 2011; 145:171-5. [PMID: 21493287 PMCID: PMC3752390 DOI: 10.1177/0194599811402030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 02/07/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether variations in gene expression exist at multiple subsites along the sinonasal tract in patients with chronic sinusitis with polyps and in healthy controls. STUDY DESIGN Prospective, controlled study. SETTING Academic medical center. SUBJECTS AND METHODS Tissue expression levels of 5 genes, previously found to be characteristic of ethmoid polyps, were measured using real-time quantitative polymerase chain reaction in 100 sinonasal tissue samples. Specimens harvested from 5 regions--the ethmoid sinus, septum, inferior turbinate, middle turbinate, and lateral nasal wall--in 10 patients with chronic sinusitis and ethmoid polyps were compared to tissue from similar regions in 10 control patients without sinusitis. Western blot analysis was performed to validate differential gene expression at the protein level. RESULTS Gene expression levels of ethmoid polyps differed significantly from those of healthy ethmoid mucosa, as well as tissue from 4 surrounding anatomical sites in both patients with chronic sinusitis and controls. Alterations specific to the polyp tissue included downregulated genes, prolactin-induced protein (fold change 377.2 ± 169.0, P < .0001), and zinc α2-glycoprotein (fold change 72.1 ± 26.5, P < .0001), as well as upregulated genes, met proto-oncogene (fold change 2.5 ± 0.7, P = .029), and periostin (fold change 7.5 ± 3.4, P = .003). No significant differences in gene expression was found for neurabin 2 (fold change 1.0, P = .99). CONCLUSION The transcriptional pattern of ethmoid polyps appears to be unique compared with other subsites in the sinonasal cavity of patients with chronic sinusitis. Care must be taken when collecting specimens for molecular studies of the sinonasal tract to differentiate polyp from nonpolyp tissue in chronic sinusitis.
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Affiliation(s)
- Michael P. Platt
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston University, Boston, Massachusetts, USA
| | - Zachary M. Soler
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Shyan-Yuan Kao
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ralph Metson
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Konstantina M. Stankovic
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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19
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Hua X, Zeman KL, Zhou B, Hua Q, Senior BA, Tilley SL, Bennett WD. Noninvasive real-time measurement of nasal mucociliary clearance in mice by pinhole gamma scintigraphy. J Appl Physiol (1985) 2010; 108:189-96. [PMID: 19797687 PMCID: PMC2885071 DOI: 10.1152/japplphysiol.00669.2009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 09/25/2009] [Indexed: 11/22/2022] Open
Abstract
Mucociliary clearance (MCC) is the key defense mechanism in the upper airways, as the removal of debris-laden mucus in the sinuses completely depends on MCC. So far, how the nasal MCC is regulated remains unknown. Recently, mice deficient in genes encoding the components of MCC apparatus have been generated, which will allow investigators to conduct more in-depth nasal MCC studies. However, the methodology necessary to comprehensively evaluate the nasal MCC in this species is not well established. We therefore developed a novel method to measure nasal MCC in live mice using pinhole gamma camera. Insoluble radiolabeled particles were delivered into the noses of lightly anesthetized mice. The nasal clearance of these particles was measured continuously in a real-time manner. The effect of three different anesthetics-avertin, pentobarbital, and isoflurane-on nasal MCC was also determined. In mice anesthetized by 1.1% isoflurane, radiolabeled particles were immediately moved into the oropharynx, which was significantly accelerated by the treatment of hypertonic but not isotonic saline. According to the clearance rate, the mouse nasal MCC presented two distinct phases: a rapid phase and a slow phase. In addition, we found that isoflurane had a very small inhibitory effect on nasal MCC vs. both avertin and pentobarbital. This was further supported by its dose response. Collectively, we have developed a noninvasive method to monitor the real-time nasal MCC in live mice under physiological conditions. It provides more comprehensive evaluation on nasal MCC rather than assessing a single component of the MCC apparatus in isolation.
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Affiliation(s)
- Xiaoyang Hua
- Pulmonary Division, Department of Medicine, CB 7219, Burnett Womack Bldg., Univ. of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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20
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Gelardi M, Cassano M, Cassano P, Fiorella M, Russo C, Fiorella R, di Gioacchino G, Schiavone C, di Gioacchino M, Ciprandi G. Survival Time of Nasal Mucous Membrane Ciliated Cells: A Preliminary Study of Cytological Examination by Phase-Contrast Microscopy. EUR J INFLAMM 2010; 8:37-41. [DOI: 10.1177/1721727x1000800106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Abstract
The observation of the ciliated cell dynamics by phase-contrast microscope has allowed a profound study of some parameters of the cellular components. The aim of this preliminary study is to assess the surviving time of ciliary cells using the phase-contrast microscope. Nasal cytology was carried out on 50 healthy volunteers. The ciliary beat time was assessed by a video-camera connected with a PC. The time of ciliary beat persistence was extraordinarily long (mean 210 minutes, with range 74–1260). The ciliary activity remained valid as rhythm, synchronism and metachronality. In conclusion, this preliminary study demonstrated that cilia has an energetic autonomy of great importance, able to allow a valid functional activity also in the case of partial sufferance of the cellular unit.
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Affiliation(s)
| | - M. Cassano
- Department of Otolaryngology, University of Foggia, Chieti
| | - P. Cassano
- Department of Otolaryngology, University of Foggia, Chieti
| | | | | | | | - G. di Gioacchino
- Allergy Related Disease Unit, G. d'Annunzio University Foundation, Chieti
| | - C. Schiavone
- Allergy Related Disease Unit, G. d'Annunzio University Foundation, Chieti
| | - M. di Gioacchino
- Allergy Related Disease Unit, G. d'Annunzio University Foundation, Chieti
| | - G. Ciprandi
- Department of Internal Medicine, Azienda Ospedaliera Universitaria San Martino, University of Genoa, Genoa, Italy
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21
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Mantovani G, Pifferi M, Vozzi G. Automated software for analysis of ciliary beat frequency and metachronal wave orientation in primary ciliary dyskinesia. Eur Arch Otorhinolaryngol 2009; 267:897-902. [PMID: 19924426 DOI: 10.1007/s00405-009-1161-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 11/06/2009] [Indexed: 10/20/2022]
Abstract
Patients with primary ciliary dyskinesia (PCD) have structural and/or functional alterations of cilia that imply deficits in mucociliary clearance and different respiratory pathologies. A useful indicator for the difficult diagnosis is the ciliary beat frequency (CBF) that is significantly lower in pathological cases than in physiological ones. The CBF computation is not rapid, therefore, the aim of this study is to propose an automated method to evaluate it directly from videos of ciliated cells. The cells are taken from inferior nasal turbinates and videos of ciliary movements are registered and eventually processed by the developed software. The software consists in the extraction of features from videos (written with C++ language) and the computation of the frequency (written with Matlab language). This system was tested both on the samples of nasal cavity and software models, and the results were really promising because in a few seconds, it can compute a reliable frequency if compared with that measured with visual methods. It is to be noticed that the reliability of the computation increases with the quality of acquisition system and especially with the sampling frequency. It is concluded that the developed software could be a useful mean for PCD diagnosis.
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Affiliation(s)
- Giulia Mantovani
- Interdepartmental Research Center E. Piaggio, Faculty of Engineering, University of Pisa, via Diotisalvi, 2, 56126 Pisa, Italy.
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22
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Millas I, Maria Liquidato B, Lutaif Dolci JE, Guerreiro Fregnani JHT, Rafael Macéa J. Histological analysis of the distribution pattern of glandular tissue in normal inferior nasal turbinates. Braz J Otorhinolaryngol 2009; 75:507-10. [PMID: 19784418 PMCID: PMC9446069 DOI: 10.1016/s1808-8694(15)30488-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 07/29/2008] [Indexed: 11/22/2022] Open
Abstract
Nasal turbinates play an important role in nasal physiology. These functions include the important function of particle filtration by the mucocilliary system. Many nasal mucosal diseases, such as rhinitis and rhinosinusitis, are directly related with structural alterations of the mucosal lining of the turbinates. Aim To study the distribution pattern of the glandular epithelium of the lamina propria in the normal lower nasal turbinate mucosa of the anterior, medium and posterior portions. Material and Method A prospective study in which small linear fragment of the lower nasal turbinate was removed from ten patients undergoing aesthetic nose surgery. The slides were hematoxilineosin stained, examined histologically and photographed. Glandular epithelium was delimited individually, the total area of the lamina propria on the anterior, medium and posterior portions of nasal turbinates was calculated (μm2). Results There was no statistically significant difference in the distribution pattern of the glandular epithelium of the lamina propria. Conclusion This study showed no predominance of glandular epithelium distribution in anterior and posterior portions of lower nasal turbinates in normal subjects.
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Abstract
Sneezing is a protective reflex, and is sometimes a sign of various medical conditions. Sneezing has been a remarkable sign throughout the history. In Asia and Europe, superstitions regarding sneezing extend through a wide range of races and countries, and it has an ominous significance. Although sneezing is a protective reflex response, little else is known about it. A sneeze (or sternutation) is expulsion of air from the lungs through the nose and mouth, most commonly caused by the irritation of the nasal mucosa. Sneezing can further be triggered through sudden exposure to bright light, a particularly full stomach and physical stimulants of the trigeminal nerve, as a result of central nervous system pathologies such as epilepsy, posterior inferior cerebellar artery syndrome or as a symptom of psychogenic pathologies. In this first comprehensive review of the sneeze reflex in the English literature, we aim to review the pathophysiology, etiology, diagnosis, treatment and complications of sneezing.
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Affiliation(s)
- Murat Songu
- Department of Otorhinolaryngology, Dr Behçet Uz Children's Hospital and Department of Otorhinolaryngology, Izmir Ataturk Research and Training Hospital, Izmir, Turkey
| | - Cemal Cingi
- Department of Otorhinolaryngology, Osmangazi University Medical Faculty, Eskişehir, Turkey
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24
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Antunes MB, Cohen NA. Mucociliary clearance – a critical upper airway host defense mechanism and methods of assessment. Curr Opin Allergy Clin Immunol 2007; 7:5-10. [PMID: 17218804 DOI: 10.1097/aci.0b013e3280114eef] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mucociliary clearance is a critical host defense mechanism of the airways. Effective mucociliary clearance requires appropriate mucus production and coordinated ciliary activity. The important role of these two components is best demonstrated in disorders such as primary ciliary dyskinesia and cystic fibrosis, both of which lead to lifelong recurrent respiratory tract infections. We review the methods used to analyze mucociliary clearance. RECENT FINDINGS Utilization of microdialysis probes has improved temporal resolution of mucociliary clearance in murine airways, availing many genetic mouse models to critical mucociliary clearance analysis, while improved fixation technique for transmission electron microscopy has allowed for detailed resolution of the airway surface liquid. High-speed digital video analysis has improved quantification of ciliary beat frequency while advancements in air-liquid interface culturing techniques have generated in-vitro models to investigate mucociliary clearance. SUMMARY Advancements in techniques for analysis of mucociliary clearance have improved our understanding of the interaction between the respiratory epithelium and the airway surface liquid, resulting in the ability to study pathologic processes involving mucociliary clearance in great detail.
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Affiliation(s)
- Marcelo B Antunes
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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25
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Chen B, Shaari J, Claire SE, Palmer JN, Chiu AG, Kennedy DW, Cohen NA. Altered sinonasal ciliary dynamics in chronic rhinosinusitis. ACTA ACUST UNITED AC 2006; 20:325-9. [PMID: 16871938 DOI: 10.2500/ajr.2006.20.2870] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although multiple etiologies contribute to the development of rhinosinusitis, a common pathophysiological sequelae is ineffective sinonasal mucociliary clearance, resulting in stasis of sinonasal secretions, with subsequent infection, and persistent inflammation. The respiratory cilia beat continually at a basal rate, while during times of stress, such as exercise or infection, ciliary beat frequency (CBF) increases, accelerating mucus clearance. Previous investigations have led to conflicting results with some authors reporting decreased CBF while others have found normal values of CBF in patients with chronic rhinosinusitis (CRS). Additionally, these studies have only analyzed basal CBF. The goal of this study was to compare the basal as well as the stimulated sinonasal CBF in patients with CRS versus controls. METHODS A dual temperature controlled perfusion chamber, differential interference contrast microscopy, and high-speed digital video were used to analyze both basal and adenosine triphosphate (100 microM)-stimulated CBF in human sinonasal mucosal explants. RESULTS Although no difference in basal CBF was detected between control and CRS patients, a marked difference in stimulated CBF was noted. Exogenously applied adenosine triphosphate resulted in a 50-70% increase of CBF in control tissue with a minimally observed CBF increase in explants from CRS patients. CONCLUSION Dynamic regulation of respiratory ciliary activity is critical for the respiratory epithelium to adapt to varying environmental situations. Thus, diminished or absent adaptation could predispose the sinonasal cavity to accumulation of inhaled infectious and noxious particulate matter resulting in infection/inflammation. Our findings suggest that CRS patients have decreased sinonasal ciliary adaptation to environmental stimuli.
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Affiliation(s)
- Bei Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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