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Zhong Y, Li Y, Zhang H. Silencing TBX1 Exerts Suppressive Effects on Epithelial-Mesenchymal Transition and Inflammation of Chronic Rhinosinusitis Through Inhibition of the TGF β-Smad2/3 Signaling Pathway in Mice. Am J Rhinol Allergy 2019; 34:16-25. [PMID: 31422678 DOI: 10.1177/1945892419866543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Chronic rhinosinusitis (CRS) is a multifactorial inflammatory disease characterized by high prevalence and morbidity, and little is known about the mechanisms that underlie its pathogenesis. Objective This study focuses on the effect of T-box 1 (TBX1) on the epithelial–mesenchymal transition (EMT) and inflammation of CRS via the transforming growth factor (TGF)β-Smad2/3 signaling pathway. Methods CRS mice models were established by Merocel nasal packing material, followed by the streptococcus pneumoniae cultivation. The expression levels of TBX1 in the sinus mucosa tissues of mice were measured accordingly. The successfully modeled mice were subsequently injected with TBX1 mimic or TBX1 inhibitor and the TGFβ-Smad2/3 signaling pathway inhibitor (SB-431542) to elucidate the influence of TBX1 on EMT and inflammation in CRS, with the expression of the EMT-related factors (E-cadherin, Vimentin, alpha-smooth muscle actin [α-SMA]), Th1 cytokines (interleukin [IL]-2, interferon-γ), and Th2 cytokines (IL-4, IL-8, total immunoglobulin E) assayed. Results TBX1 expression exhibited upregulated levels in the sinus mucosa tissues of the mice. In addition, TBX1 downregulation was found to inhibit the expression of TGFβ as well as the extent of Smad2 and Smad3 phosphorylation. Silencing TBX1 was shown to elevate the expression of Th1 cytokines and E-cadherin, while diminishing expression of Th2 cytokines, Vimentin and α-SMA. Conclusions Taken together, the key findings of our study highlight the inhibitory role of TBX1 in the process of EMT and inflammation in CRS mice via the inhibition of the TGFβ-Smad2/3 signaling pathway, underlining the promise of TBX1 as a potential target for CRS therapy.
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Affiliation(s)
- Yu Zhong
- Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, P.R. China
| | - Yunqiu Li
- Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, P.R. China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, P.R. China
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Abstract
Purpose of Review Chronic rhinosinusitis is a disease with high prevalence, significant impact on health-related quality of life (HRQoL) and it is associated with substantial healthcare and productivity costs. We face an urgent need to improve the level of disease control and achieve higher patient satisfaction and disease prevention. Precision medicine is increasingly recognized as the way forward in optimal patient care. The combination of personalized care, prevention of disease, prediction of success of treatment, and participation of the patient in the elaboration of the treatment plan is expected to guarantee the best possible therapeutic approach for individuals suffering from a chronic disabling condition. Recent Findings This is a narrative review on the current state of endotypes, biomarkers, and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses. Different phenotypes of rhinitis and chronic rhinosinusitis (CRS) have been described based on symptom severity and duration, atopy status, level of control, comorbidities, and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different endotypes being recognized. Novel emerging therapies are targeting specific pathophysiological pathways or endotypes. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment. Summary This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
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Adriaensen GFJPM, Lim KH, Fokkens WJ. Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial. Int Forum Allergy Rhinol 2017; 7:813-820. [PMID: 28558147 DOI: 10.1002/alr.21963] [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: 12/11/2016] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative wound healing after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) is an important factor in procedural success. Local steroids and separation of opposing mucosa are commonly implemented to optimize healing. A bioabsorbable, fluticasone propionate (FP)-eluting implant, SinuBand FP, was assessed for its safety and efficacy when used in patients with CRS and nasal polyps, who were indicated for ESS including bilateral anterior and posterior ethmoidectomy. METHODS A first-in-human, randomized, partially double-blind, single-tertiary-referral-center, controlled trial enrolling 30 patients receiving 2 of 3 treatments (1 per sinus, intrapatient control): SinuBand FP, SinuBand (without FP), or standard nasal pack (Merocel®). Primary outcome measures were local safety, ocular safety (intraocular pressure [IOP], lens opacity), and 24-hour urine cortisol. Secondary measures (evaluated by independent review of postoperative video endoscopies) were ethmoid inflammation, polyp score, adhesion formation, and Lund-Kennedy score. Patient-reported outcomes of postoperative pain, nasal congestion, and nasal discharge were collected. RESULTS Of 30 enrolled patients (used for safety analysis), 27 patients completed the trial. SinuBand FP showed local safety, ocular safety, and no significant change in 24-hour urine cortisol. SinuBand FP showed a trend to do better concerning inflammation. Concerning polyp score SinuBand FP did significantly better compared to Merocel (p = 0.03). No significance compared to SinuBand without corticosteroids (p = 0.97). Adhesions were comparable across treatments. Patient reported pain was nominally lower in the SinuBand group. CONCLUSION SinuBand FP was well tolerated and showed evidence of efficacy. A larger study is needed to further evaluate and confirm the benefits of SinuBand FP.
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Affiliation(s)
- Gwijde F J P M Adriaensen
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Keng-Hua Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Park SJ, Kook JH, Kim HK, Kang SH, Lim SH, Kim HJ, Kim KW, Kim TH, Lee SH. Macrolides increase the expression of 11β-hydroxysteroid dehydrogenase 1 in human sinonasal epithelium, contributing to glucocorticoid activation in sinonasal mucosa. Br J Pharmacol 2015; 172:5083-95. [PMID: 26228509 DOI: 10.1111/bph.13273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/16/2015] [Accepted: 07/27/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE The anti-inflammatory and immunomodulatory effects of macrolides include the ability to decrease mucus secretion and inhibit inflammatory mediators in chronic rhinosinusitis. Nevertheless, their mechanisms of action remain to be determined. Here we have investigated the effects of macrolide antibiotics (clarithromycin, azithromycin and josamycin; representating the 14-, 15- and 16-membered macrolides) on endogenous steroids in human sinonasal epithelial cells and mouse nasal mucosa. EXPERIMENTAL APPROACH The effects of macrolides on the expression of steroid-converting enzymes [11β-hydroxysteroid dehydrogenase (11β-HSD1 and 11β-HSD2)], steroid-synthesizing enzymes (3β-HSD, CYP21, CYP11B1 and CYP11A1) and cortisol levels were assessed in cultured human epithelial cells. In control and adrenalectomized mice , these enzymes and corticosterone levels were evaluated in nasal mucosa and serum after administration of macrolides. KEY RESULTS The expression levels of 3β-HSD, CYP21, 11β-HSD1 and CYP11B1 increased in human epithelial cells treated with clarithromycin and azithromycin, whereas the expression levels of 11β-HSD2 and CYP11A1 were not affected. Josamycin had no effects on the expression of these enzymes. Cortisol levels increased in epithelial cells treated with clarithromycin or azithromycin. The expression of 3β-HSD, CYP11A1, CYP21, CYP11B1 and 11β-HSD1 was upregulated in nasal mucosa of mice treated with clarithromycin or azithromycin, but not in adrenalectomized mice. CONCLUSIONS AND IMPLICATIONS This study provides evidence that 14- and 15-membered macrolide antibiotics may affect the expression of steroid-synthesizing and steroid-converting enzymes in human sinonasal epithelial cells and mouse nasal mucosa, increasing the endogenous cortisol levels in sinonasal mucosa.
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Affiliation(s)
- Se Jin Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Jin Ho Kook
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Gangwon Do, South Korea
| | - Ha Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sung Hoon Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sae Hee Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Hyun Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Kyung Won Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea
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Lu-Myers Y, Deal AM, Miller JD, Thorp BD, Sreenath SB, McClurg SM, Senior BA, Zanation AM, Ebert CS. Comparison of Socioeconomic and Demographic Factors in Patients with Chronic Rhinosinusitis and Allergic Fungal Rhinosinusitis. Otolaryngol Head Neck Surg 2015; 153:137-43. [PMID: 25917670 DOI: 10.1177/0194599815580978] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/18/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The primary objective of this study is to evaluate the differences in socioeconomic, demographic, and disease severity factors between patients with chronic rhinosinusitis (CRS) and those with allergic fungal rhinosinusitis (AFRS). STUDY DESIGN A retrospective cohort analysis was performed. SETTING The study was conducted at the hospital of the University of North Carolina at Chapel Hill. SUBJECTS AND METHODS A total of 186 patients were included (93 AFRS, 93 CRS with and without nasal polyps). Socio- economic and demographic data were obtained from the North Carolina State Data Center. Indicators of disease severity were measured by Lund-Mackay scores, serum immunoglobulin E (IgE) levels, diagnosis of asthma and/or allergic rhinitis, and the number of surgeries and computed tomography scans performed. Associations were analyzed with Fisher's exact, Wilcoxon rank sum, and Pearson's correlations tests. RESULTS Compared with patients with AFRS, patients in both CRS groups were predominantly white (P < .0001), were older at the time of diagnosis (P < .0001), had higher county-based income per capita (P = .004), had lower quantitative serum IgE level (P < .001), and had lower Lund-Mackay scores (P < .0001). No associations between disease severity, socioeconomic status, and demographic factors were found within the CRS groups. CONCLUSION Within our cohort of patients residing in North Carolina, those with CRS have higher income, more access to primary care, and lower markers of disease severity than those with AFRS. These data continue to support the notion that AFRS merits classification as a distinct subtype of CRS.
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Affiliation(s)
- Yemeng Lu-Myers
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison M Deal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Justin D Miller
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stanley M McClurg
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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