Fungicidal activity of lysozyme is inhibited in vitro by commercial sinus irrigation solutions

The Nasal Innate Immune Proteome After Saline Irrigation: A Pilot Study in Healthy Individuals

BACKGROUND

Previous research has shown diminished nasal immune function following nasal saline irrigation (NSI), returning to baseline at 6 hours. The aim of this study was to examine the immune nasal proteome before and after 14 days of nasal irrigation.

METHODS

Seventeen healthy volunteers received either isotonic (IsoSal) or low salt (LowNa) NSI. Nasal secretions were collected before and 30 min after NSI at baseline and again after 14 days. Specimens were analyzed using mass spectrometry to detect proteins of relevance to nasal immune function.

RESULTS

One thousand eight hundred and sixty-five proteins were identified with significant changes in 71 proteins, of which 23 were identified as part of the innate immune system. Baseline analysis demonstrated an increase of 9 innate proteins after NSI, most after IsoSal. After 14 days, a greater increase in innate peptides was present, with most now in the LowNa group. When NSI solutions were compared, a significant increase in 4 innate proteins, including a 211% in lysozyme, was detected in the LowNa group.

CONCLUSION

LowNa NSI demonstrates evidence of improving the innate immune secretions, especially lysozyme, in healthy volunteers.

[Nasal irrigation: opportunities and disadvantages]

RELEVANCE

Despite the widespread use of nasal irrigation in routine medical practice and a significant list of salt solution for nasal irrigation on the pharmaceutical market, contradictions remain in understanding of process essence, when salt solution acts on the mucous membrane of nasal cavity and evaluation of their effectiveness.

AIM

analysis of current data of frequency, methods and efficiency of systematic nasal irrigation and effect of salt solution at the mucous membrane of nasal cavity.

RESULTS

In review the authors generalized and analyzed recent information about meaning of nasal irrigation for upper respiratory tract disease, about role of nasal mucus at maintaining homeostasis in nasal cavity and initial respiratory tract in general. Describes the data about effect of nasal irrigation on antinfectious protect of mucous membrane of nasal cavity.

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.

The effect of nasal irrigation formulation on the antimicrobial activity of nasal secretions

BACKGROUND

Saline-based irrigation solutions are evidence-based rhinological treatments; however, the formulation of these solutions could theoretically alter the function of innate antimicrobial peptides. The aim of this study was to determine if the antimicrobial activity of normal human nasal secretions in vivo is altered by commercially available large volume irrigation solutions.

METHODS

Minimally manipulated sinonasal secretions were collected from patients with chronic rhinosinusitis (CRS; n = 10) and normal healthy volunteers (n = 20). In a subset of control patients (n = 10) secretions were collected prior to, and at 1 hour, 6 hours, and 24 hours after nasal irrigation with 4 commercial irrigation solutions. Lysozyme and lactoferrin levels were analyzed and the antimicrobial activity of secretions determined using a radial diffusion assay.

RESULTS

The antimicrobial activity of nasal secretions was reduced in CRS patients compared to healthy volunteers (p < 0.01), but there was no significant difference in antimicrobial peptide concentrations. Isotonic nasal irrigation reduced lysozyme and lactoferrin levels, which returned to baseline levels by 6 hours; in addition to a sustained decrease in antimicrobial activity before returning to baseline at 24 hours. Low-salt solution stimulated peptide secretion by approximately 40% at 6 hours and 24 hours, but produced a transient decrease in antimicrobial activity, returning to baseline levels by 6 hours. Hypertonic solution initially decreased lysozyme and lactoferrin levels but maintained baseline levels of antimicrobial activity and increased peptide secretion by approximately 30% at 24 hours.

CONCLUSION

The formulation of nasal irrigation solutions significantly affects the measured levels and functionality of sinonasal antimicrobial peptides.

The effect of maxillary sinus irrigation on early prognostic factors after endoscopic sinus surgery: a preliminary study

BACKGROUND

Sinus irrigation has been used to treat chronic rhinosinusitis refractory to medical and surgical treatments. The aim of this study was to evaluate the effect of maxillary sinus saline irrigation on the prevention of purulent rhinorrhea, extensive granulation formation, and polyp recurrence after endoscopic sinus surgery (ESS).

METHODS

This prospective, controlled study was approved by the Institutional Review Board of Gachon University Gil Medical Center. Between August 1, 2011, and May 31, 2012, we recruited a total of 30 patients who underwent bilateral ESS. Group A was composed of 15 patients that were treated with bilateral maxillary sinus saline irrigation for 2 months after ESS. Group B was composed of 15 patients who were followed up during the same period after ESS. We checked for persistent purulent discharge, extensive granulation, and recurrent polyps in both groups to evaluate the effects of maxillary sinus irrigation on their prevention.

RESULTS

Age, gender, and preoperative Lund-Mackay scores were not significantly different between the two groups (p > 0.05). In group A, one patient showed polyp recurrence. In group B, one patient showed extensive granulation tissue, two patients showed uncontrolled purulent discharge, three patients showed extensive granulation tissues and uncontrolled purulent discharge, and one patient showed recurrent polyps (p = 0.03). In addition, total endoscopic scores in the 3rd month were significantly different between groups A and B (p = 0.01).

CONCLUSION

Maxillary sinus saline irrigation may be effective in the prevention of poor prognostic factors, such as persistent purulent discharge, at the early stages after ESS.

Chapter 4: Chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is the second most common chronic medical condition in the United States. It represents a group of disorders characterized by inflammation of the nasal mucosa and paranasal sinuses of at least 12 weeks duration. CRS with or without nasal polyps is defined as inflammation of the nose characterized by two or more symptoms, one of which should be either nasal blockage, obstruction, congestion, or nasal discharge (anterior/posterior nasal drip); with or without facial pain/pressure; and/or with or without reduction or loss of smell. Symptomatology should be supported by obvious disease evident in either nasal endoscopy or computed tomography imaging. Although CRS is not likely to be cured by either medical or surgical therapy, it can generally be controlled. Best medical evidence supports maintenance therapy with intranasal corticosteroids and saline irrigation. For exacerbations, short to intermediate courses of antibiotics (up to 4-weeks) with or without oral corticosteroids are recommended. For patients with difficult-to-treat CRS, functional endoscopic sinus surgery provides an adjunctive therapeutic option.