Localization of IL-1 beta mRNA and cell adhesion molecules in the maxillary sinus mucosa of patients with chronic sinusitis

Rhinosinusitis and Stroke: A Systematic Review

Rhinosinusitis is one of the most common inflammatory diseases. It has been recognized that intracranial vessels are involved and there might be an association with stroke occurrence. The aim of this study was to evaluate the association between rhinosinusitis and cardiovascular diseases, especially stroke, through a literature review. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from February 2000 to February 2022, using the search terms 'rhinosinusitis' OR 'chronic rhinosinusitis' AND 'stroke' OR 'ischemic stroke'. Fourteen studies were eligible and included in the analysis. Overall, the studies encompassed a total of 1,006,338 patients included in this review. All studies concluded that there is a statistically significant correlation between clinical or radiological sinus inflammation and the risk of stroke, which is independent of traditional stroke risk factors. In conclusion, rhinosinusitis is associated with an increased incidence of stroke.

Chronic rhinosinusitis increases the risk of hemorrhagic and ischemic stroke: A longitudinal follow-up study using a national sample cohort

BACKGROUND

Several studies have reported that chronic rhinosinusitis (CRS) increases the risk of stroke. The aim of this study is to elucidate the putative association between CRS and stroke (ischemic or hemorrhagic) using large population-based national health insurance data.

METHODS

Using the national cohort study from the Korean Health Insurance Review and Assessment Service, CRS patients (n = 22,959) and control participants (n = 91,836) were selected and matched at a rate of 1:4 (age, sex, income, region, hypertension, diabetes, and dyslipidemia). A Cox-proportional hazard model was used to analyze the hazard ratio (HR) of CRS for hemorrhagic stroke and ischemic stroke. We divided the participants according to age and gender for the subgroup analysis.

RESULTS

The HR for hemorrhagic and ischemic stroke was significantly increased in the CRS patients compared to that in the controls (adjusted HR = 2.43, 95% confidence interval [CI] = 2.10-2.80 for hemorrhagic stroke; adjusted HR = 1.76, 95% CI = 1.61-1.92 for ischemic stroke) after adjusting for age, sex, income, region of residence, hypertension, diabetes, dyslipidemia, ischemic heart disease, migraine, chronic kidney disease, depression, sleep disorder, and chronic obstructive pulmonary disorder. In the subgroup analysis, the HR of hemorrhagic stroke was significantly increased in the CRS group regardless of age and gender. The HR of ischemic stroke was also significantly increased in all subgroups of the CRS group.

CONCLUSION

CRS consistently increased the risk of ischemic and hemorrhagic stroke regardless of age and gender.

Differential protein expression in the secretory fluids of maxillary sinusitis and maxillary retention cyst

Both maxillary sinusitis (MS) and maxillary retention cyst (MRC) involve the maxillary sinus and show similar clinical features. Clinically, differentiating between MS and MRC is sometimes difficult in asymptomatic patients, despite their quite different pathogenic behaviors. To identify differential protein expressions in the secretory fluids of MS and MRC, 25 cases of asymptomatic MS and 15 cases of asymptomatic MRC were examined pathologically in this study. All patients underwent routine endoscopic sinus surgery or modified Caldwell-Luc procedure and the sinus mucosal specimens obtained during these procedures with the approval of the Institutional Review Board. Their secretory fluids were analyzed via immunoprecipitation-based high-performance liquid chromatography (IP-HPLC) using 25 types of antiserum, including inflammatory cytokines, antimicrobial proteins, and mucosal protective proteins. In the histological examinations, MS and MRC showed similar features in the secretory columnar epithelial lining and thick submucosal connective tissue, both of which contained few inflammatory cells infiltrates. The IP-HPLC analysis revealed that TNFα, IL-1, -8, MMP-3, -10, α1-antitrypsin, cathepsin C, lysozyme, lactoferrin, β-defensin-1, -3, LL-37, mucocidin, and mucin-1 were more intensely expressed in MS than in MRC; whereas IgA, cystatin A, and proline-rich proteins were more strongly expressed in MRC than in MS. These data indicate that the secretory fluid of MS is indicative of a more robust inflammatory reaction to certain bacteria compared to that of MRC, while the secretory fluid of MRC contains more abundant mucosal protective proteins compared to that of MS. Taken together, the IP-HPLC analysis of MS and MRC secretory fluid revealed that MRC showed a weaker inflammatory reaction but a stronger mucosal protective function than MS.

Basilar artery territory stroke secondary to invasive fungal sphenoid sinusitis: a case report and review of the literature

Background

Mucormycosis is a fungal infection with the following 5 classic forms: cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral. The rhinocerebral form can be rapidly progressive and invasive with a high mortality rate. We present a case of a 38-year-old man with invasive mucormycosis that led to a basilar artery territory stroke. Rhinocerebral mucormycosis is an unusual cause of stroke.

Case Report

A 38-year-old man with a past medical history of diabetes mellitus presented with altered mental status. A lumbar puncture revealed eosinophilic pleocytosis with a mildly elevated total protein and borderline low glucose level. CT revealed a left medullary and cerebellar infarct confirmed by MRI. MRI also displayed a diffuse marrow signal abnormality in the clivus with contiguous sinus disease. Endoscopic sinus surgery confirmed that the fungal sinusitis was mucormycosis of the Rhizopus genus, which had affected the left sphenoid sinus, invaded through the skull base, and involved the basilar artery. He was given liposomal amphotericin (500 mg i.v.) with posaconazole (400 mg i.v. twice daily). Due to the severity of the invasion and poor prognosis, the patient was discharged with comfort care measures.

Discussion

Clinicians should be aware of invasive sinusitis as a rare cause of stroke in diabetics. Once the subarachnoid space and basal arteries of the brain have been invaded, the prognosis is very poor. The key to improvement of outcomes is early recognition and treatment, and examination of the sinuses on neuroimaging in all cases of stroke is vital.

Chronic rhinosinusitis increased the risk of stroke: a 5-year follow-up study

OBJECTIVES/HYPOTHESIS

It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population-based cohort study in Taiwan.

METHODS

All study cohorts were retrieved from the Taiwan Longitudinal Health Insurance Database. This study included 15,846 CRS subjects in the study cohort and 47,538 randomly selected subjects in the comparison cohort. We individually tracked each subject in this study for a 5 year period following their index dates to identify each subject that received a subsequent diagnosis of stroke. Stratified Cox proportional hazards regressions were analyzed to compare the 5 year risk of subsequent stroke following a diagnosis of CRS.

RESULTS

The incidence rate of stroke during the 5-year follow-up period was 10.65 (95% CI: 9.93-11.41) per 100 person years and 7.53 (95% CI: 7.18-7.89) per 100 person years for the study and comparison cohort, respectively. The covariate-adjusted hazard ratio (HR) for stroke revealed that that subjects with CRS were more likely than comparison subjects to have a diagnosis of ischemic stroke during the 5-year follow-up period (HR = 1.34, 95% CI = 1.18-1.53). However, there was no significant difference in the risk of subarachnoid hemorrhage (HR = 1.52, 95% CI = 0.94-2.47) or intracerebral hemorrhage (HR = 0.96, 95% CI = 0.71-1.31).

CONCLUSIONS

Patients with CRS were at higher risk for stroke occurrence during the 5 year follow-up.

Inflammatory mechanisms and remodeling in chronic rhinosinusitis and nasal polyps

Chronic rhinosinusitis (CRS) is presently classified into two subgroups: CRS without and CRS with nasal polyps. A variety of inflammatory mediators, including cytokines and chemokines, as well as adhesion molecules and matrix metalloproteinases, are upregulated in both subgroups of CRS; remodeling is also observed in both. However, there are also characteristic differences. Whereas CRS without nasal polyps has more neutrophilic infiltration, in CRS with nasal polyps (especially when associated with allergy/asthma) eosinophil infiltration is strikingly increased. Although several features of remodeling (eg, squamous metaplasia, basement membrane thickening, collagen deposition, hyperplasia of mucous glands, and goblet cells) are features seen in both subgroups of CRS, epithelial shedding as observed in asthma is not seen in either subgroup. Furthermore, pseudocyst formation seen in CRS with nasal polyps is not seen in CRS without nasal polyps.

Establishment of osteoblast culture from human ethmoidal sinus

OBJECTIVE

Chronic sinusitis is characterized by persistent chronic inflammation of the sinus system and local expression and release of various cytokines, such as IL-1 beta, IL-4, IL-6, IL-8, TGF-beta and TNF-alpha are deeply involved in the pathogenesis of the disease. We hypothesized that not only the sinus mucosa-containing cells, such as epithelial cells and fibroblasts, but also osteoblasts, of which sinus bone structure consists, may contribute to this inflammatory network. This study evaluates the development and establishment of an osteoblasts culture system derived from human ethmoidal sinus as an initial step toward verifying this hypothesis.

METHODS

Ethmoidal sinus bone was obtained from patients at the time of sinus surgery for chronic sinusitis and outgrowth cell sheets were obtained according to the explant-outgrowth cell culture technique. In order to examine the specific characteristics of osteoblasts in the obtained cells, four major features of osteoblasts (collagen type I, osteocalcin synthesis, alkaline phosphatase activity and extracellular matrix mineralization ability) were investigated at the third passage of the culture and productions of TGF-beta 1, which modulate osteoblast proliferation and maturation in an autocrine fashion, in the cultured medium was also investigated in time of culture up to 20 days.

RESULTS

The cells obtained in our study clearly show collagen type I synthesis, osteocalcin synthesis, alkaline phosphatase activity and production of visible extracellular matrix mineralization. Production of TGF-beta 1 in the medium did not significantly different in time of culture up to 20 days.

CONCLUSION

Our results, the first of their kind, indicate that osteoblast-like cells can be cultured from adult human ethmoidal sinus bones. It suggested that proliferation and maturation of the osteoblast were continuously modulated in an autocrine fashion by producing TGF-beta 1.

Fosfomycin nebulizer therapy to chronic sinusitis

OBJECTIVE

effects of Fosfomycin (FOM) nebulizer therapy were studied in patients with chronic sinusitis.

METHODS

about 28 patients with chronic sinusitis were administered 2 ml of FOM sodium (3% w/v) by nebulizer three times per week for 4 weeks. Levels of IL-1 beta, IL-6, IL-8, and TNF-alpha in nasal lavage were also measured before and at the end of treatment.

RESULTS

the overall efficacy of this treatment on the basis of both subjective and objective symptoms, was 'excellent' for 28.6%, 'good' for 10.7%, 'fair' for 39.4%, and yield 'no change' for 21.4% of the patients. Both IL-1 beta and IL-6 concentrations were significantly decreased after treatment. Although the IL-8 level did not significantly decrease, it seems to be related to the overall efficacy. TNF-alpha was not detected in all of the samples.

CONCLUSION

FOM nebulization therapy is highly effective in treatment for chronic sinusitis, and efficacy may be due to an immunomodulatory mechanism, as well as its bactericidal effect.

Application of YAMIK sinus catheter for patients with paranasal sinusitis with and without nasal allergy

PURPOSE

YAMIK sinus catheter (YAMIK) has already been reported to be a useful therapeutic device for sinusitis cases. The purpose of this study was to compare the effectiveness of YAMIK in sinusitis cases with and without nasal allergy in order to contribute toward establishing its indication.

METHODS

YAMIK was tried in 10 chronic sinusitis cases complicated with nasal allergy and 20 cases without nasal allergy. Clinical symptoms, endoscopic findings and pathological opacification in X-ray photographs were compared in these cases with and without nasal allergy.

RESULTS

No significant differences were seen in the effectiveness of YAMIK between cases with and without nasal allergy.

CONCLUSION

These findings suggest that YANIK is useful and applicable even in sinusitis cases complicated with nasal allergy.

Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis

OBJECTIVE

To compare concentrations of interleukin-5 (IL-5), immunoglobulin E (IgE), eosinophilic cationic protein (ECP), and soluble intercellular adhesion molecule-1 (sICAM-1) in nasal secretion and serum of patients with chronic nonallergic sinusitis, allergic rhinitis, and nonallergic nasal polyposis to obtain information about the pathogenesis of these diseases.

METHODS

Nasal secretion and serum were analyzed by routine enzyme-linked immunosorbent assay techniques. Nineteen patients with chronic nonallergic sinusitis, 24 patients with seasonal allergic rhinitis, and 18 patients with nonallergic nasal polyposis were included in the study. Eight healthy, nonallergic probands served as control subjects.

RESULTS

Significantly elevated concentrations of IL-5 (5-fold, P < .05) and IgE (15-fold, P < .01) were detected in nasal secretion of patients with allergic rhinitis (IL-5, 51.8 +/- 13.2 pg/mL; IgE, 41.9 +/- 20.9 kU/L) or nonallergic nasal polyposis (IL-5, 57.9 +/- 36.9 pg(mL; IgE, 40.5 +/- 20.2 kU/L) compared with controls (IL-5, 10.6 +/- 7.8 pg/mL; IgE, 2.8 +/- 0.5 kU/L) or with patients with chronic nonallergic sinusitis (IL-5, 16.5 +/- 13.2 pg/mL; IgE, 5.4 +/- 3.1 kU/L). There were no significant differences between patients with allergic rhinitis and those with nonallergic nasal polyposis. Concentrations of ECP were significantly elevated (sixfold, P < .01) in patients with allergic rhinitis (297.8 ng/mL +/- 173.1) compared with controls (52.4 +/- 28.0 ng/mL) or patients with chronic nonallergic sinusitis (44.8 +/- 40.1 ng/mL), whereas twofold higher concentrations (not significant) of ECP were observed in patients with nonallergic nasal polyposis (107.1 +/- 26.6 ng/mL). Significantly elevated concentrations of sICAM-1 in nasal secretion (threefold, P < .05) were detected only in patients with chronic nonallergic sinusitis (79.4 +/- 45.6 ng/mL). The elevated sICAM-1 nasal secretion values in this group correlated significantly (P < .05) to the serum values.

CONCLUSIONS

Equally elevated concentrations of IL-5 and IgE in patients with allergic rhinitis and nonallergic nasal polyposis implicated similar pathogenic processes in both diseases. Whereas the pathogenesis of allergic rhinitis is IgE-specific, the pathogenesis of nasal polyps is not as clear. IL-5 was suggested to play a pivotal role in tissue eosinophilia, which was confirmed by data in the present study. Elevated concentrations of ECP were suggested to result from tissue eosinophilia--a characteristic of both diseases. Elevated concentrations of sICAM-1 in patients with chronic nonallergic sinusitis pointed to its key role in the recruitment of neutrophils into the inflamed tissue, whereas an important role in eosinophil recruitment was ruled out.

Sinusitis and carotid artery stroke

The relationship between sinusitis and ischemic stroke is unexplored. The anatomic proximity between the paranasal sinuses and the internal carotid artery suggests that inflammation of the sinuses could easily extend to the intracranial vasculature. We report 4 patients with acute ischemic stroke and extensive disease of the paranasal sinuses. All patients had large vessel stroke involving the internal carotid artery territory. All patients had extensive disease of the sphenoid and other sinuses. The sinus disease was demonstrated by magnetic resonance imaging. These case report observations suggest a relationship between inflammation of the paranasal sinuses, particularly sphenoid sinusitis, and ischemic stroke.

Effects of clarithromycin on cultured human nasal epithelial cells and fibroblasts

OBJECTIVE/METHODS

Long-term administration of clarithromycin has been reported to be effective in the treatment of chronic sinusitis. To investigate the mechanism underlying the anti-inflammatory activity of clarithromycin, the authors evaluated the effect of clarithromycin on the gene expression of proinflammatory cytokine and the DNA-binding activity of nuclear factor (NF)-kappa B in cultured human nasal epithelial cells and fibroblasts. Cells were incubated with endotoxin purified from nontypable Haemophilus influenzae or interleukin (IL)-1 beta in the presence of clarithromycin.

RESULTS

Northern blot analysis revealed that clarithromycin suppressed IL-1 beta gene expression in human nasal epithelial cells stimulated by H. influenzae endotoxin (HIE). Intercellular adhesion molecule-1 gene expression in nasal fibroblasts stimulated by IL-1 beta was also suppressed by clarithromycin. Furthermore, electrophoretic mobility shift assay demonstrated that clarithromycin reduced DNA-binding activity of NF-kappa B in both human nasal epithelial cells and fibroblasts stimulated by HIE or IL-1 beta, respectively.

CONCLUSION

The present results suggest that clarithromycin may reduce gene expression of proinflammatory cytokines and adhesion molecules from nasal mucosa at the transcriptional factor level and exert an anti-inflammatory effect on nasal mucosa in chronic sinusitis.

Cytokines in nasal polyposis, acute and chronic sinusitis

Cytokines are potent biologic factors involved in the regulation of inflammation, immune defense, and wound healing. Recently, growing interest has developed in the role of cytokines in chronic sinusitis and nasal polyposis. In the present study, we investigated the cytokine profile of different types of rhinosinusitis in order to evaluate whether a specific form of rhinosinusitis is associated with the expression of a certain cytokine profile. Sinus mucosa from patients with acute sinusitis (n = 10), chronic sinusitis (n = 7), antrochoanal polyp (n = 10), nasal polyps (n = 8) and controls of turbinate mucosa (n = 7) were sampled. The cytokine protein content (IL-1 beta, IL-3, IL-4, IL-5, IL-6, IL-8, IL-13, GM-CSF, interferon-gamma) of tissue homogenates was measured using ELISA technique. In acute sinusitis, the synthesis of proinflammatory cytokines and of the neutrophil chemokine IL-8 and IL-3 appeared to be upregulated. Chronic sinusitis mucosa demonstrated no significantly increased concentrations of the measured cytokines. In bilateral nasal polyposis, but not in antrochoanal polyps, the eosinophil related cytokine IL-5 was strongly upregulated. From these findings, it appears that specific cytokine patterns are found in different forms of sinusitis, and that IL-5 may represent the most important cytokine responsible for tissue eosinophilia in nasal polyposis.

Effects of IL-1 beta, TNF-alpha, and TGF-beta on proliferation of human nasal epithelial cells in vitro

Previous reports suggest that cytokines may be involved in proliferation of the epithelium. The aim of this study was to determine the effects of cytokines, IL-1 beta, TNF-alpha, and TGF-beta on proliferation of human nasal epithelial cells (HNECs) in vitro. Primary cells were cultured from HNECs on collagen gel matrix. Subcultured HNECs were incubated in a medium with recombinant human (rh) cytokines, rhIL-1 beta, rhTNF-alpha, and rhTGF-beta at different concentrations of 0.01 ng/mL, 0.1 ng/mL, 1 ng/mL, 10 ng/mL, and 100 ng/mL. After 2-day incubation with these cytokines, daily cell proliferation was measured by MTT assay for 6 days. While rhIL-1 beta inhibited proliferation of HNECs in concentration-dependent and time-dependent manners, rhTNF-a stimulated HNEC growth at concentrations ranging from 0.01 ng/mL to 10 ng/mL in concentration-dependent and time-dependent manner. In contrast, rhTGF-b inhibited HNEC growth irrespective of concentration and incubation time. This study suggests that IL-1 beta, TNF-alpha, and TGF-beta may have an important role in the repair of the nasal mucosa by regulating proliferation of the nasal epithelium.

Expression of adhesion molecules in nonallergic chronic sinusitis

Endothelial and epithelial adhesion molecules are important in the recruitment of leukocytes to inflammatory sites. To determine the relationship between recruited leukocytes and adhesion molecules in the paranasal sinus mucosa of nonallergic chronic sinusitis, we surgically obtained mucosa from 16 patients and identified the expression of intercellular adhesion molecules (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, and P-selectin by immunohistochemistry. Neutrophils were significantly dominant in the nasal discharge as compared with eosinophils. The degree of neutrophil infiltration in the paranasal sinus mucosa was prominent in both intraepithelial and subepithelial areas as compared with the lamina propria. In each tissue site, the degree of infiltration of neutrophils was similar to that of eosinophils. These findings suggest that the tissue neutrophils actively and rapidly migrated into the lumen. All the adhesion molecules except VCAM-1 were expressed in the vascular endothelial cells. On the other hand, the surface epithelial cells showed the expression of only ICAM-1. The expression of ICAM-1 on the endothelial cells correlated with the degree of neutrophil infiltration in the mucosa The eosinophil infiltration was not dependent on any adhesion molecules examined here. It was concluded that ICAM-1 expression in the mucosa may be involved in neutrophil recruitment and may contribute to the establishment of the inflammatory cell distribution in the paranasal sinus of nonallergic chronic sinusitis.

Mechanism of neutrophil recruitment induced by IL-8 in chronic sinusitis

BACKGROUND

The mechanism of neutrophil recruitment in patients with chronic sinusitis is unclear.

OBJECTIVE

This study aims to elucidate the role of IL-8 in inducing neutrophil accumulation in the nasal discharge of patients with chronic sinusitis.

METHODS

Nasal discharge and mucosal specimens were obtained from two groups of patients, those with chronic sinusitis and those with allergic rhinitis. The samples were subjected to immunohistochemical examination and in situ hybridization. The IL-8 level in the nasal discharge was measured by enzyme immunoassay.

RESULTS

Immunoreactivity to IL-8 was observed in polymorphonuclear cells of nasal smear, in nasal gland duct cells, and in epithelial cells of the chronic sinusitis group; whereas those of the allergic rhinitis group mostly showed little or no reaction. Similar patterns of localization were shown by in situ hybridization for IL-8 messenger RNA. The IL-8 level in nasal discharge was significantly higher in the chronic sinusitis group than in the allergic rhinitis group.

CONCLUSION

These results suggest that chemotactic factors in sinus effusion, including IL-8 derived from nasal gland duct cells and epithelial cells, attract neutrophils out of mucosa, and the neutrophils that have emigrated into the sinus effusion secrete IL-8. This induces further neutrophil accumulation in the sinus effusion of patients with chronic sinusitis.