Steroid-eluting sinus implant for in-office treatment of recurrent polyposis: a pharmacokinetic study

BACKGROUND

Long-term use of systemic glucocorticoid therapy has been associated with hypothalamic-pituitary-adrenal axis suppression and other systemic adverse events. This pharmacokinetic study evaluated the systemic safety and performance of a bioabsorbable sinus implant that gradually releases 1350 μg of mometasone furoate directly to the sinus mucosa.

METHODS

A prospective, single-center study treating 5 adult patients with recurrent polyposis after bilateral total ethmoidectomy. Each patient received 2 steroid-releasing implants in-office under local/topical anesthesia. Plasma concentrations of mometasone furoate and cortisol were determined before placement and through 30-day follow-up, which also included endoscopic grading and patient-reported outcomes.

RESULTS

Five patients (mean age 46.2 ± 9.2 standard deviation [SD] years; 60% male) underwent successful placement in all 10 ethmoid sinuses. There were no serious adverse events. The plasma concentrations of mometasone furoate were generally below the lower limit of quantification (LLOQ) of the assay (30 pg/mL). Cortisol concentrations at follow-up ranged from 3.9 to 5.7 mg/dL compared to 4.7 mg/dL at baseline. At 1 month, there was a significant improvement in bilateral polyp grade (p = 0.037), nasal obstruction score (p = 0.002), and 22-item Sino-Nasal Outcome Test (SNOT-22) (p = 0.010) compared to baseline.

CONCLUSION

The reported 100% placement success, negligible systemic exposure to mometasone furoate released over time, lack of adrenal suppression, and the absence of serious adverse events suggest that the implant provides a valid and safe option for the in-office treatment of recurrent polyposis. Randomized, controlled, blinded clinical studies are underway to provide further evidence of safety and efficacy.

The anomalous deuterium isotope effect on the chemical shift of the bridge hydrogen in the enol tautomer of 2,4-pentanedione

The nature of the intramolecular hydrogen bond in the enol tautomer of 2,4-pentanedione has been investigated by high resolution proton and deuteron magnetic resonance spectroscopy. An unusually large deuterium isotope effect on the chemical shift of the bridge hydrogen has been observed. This unexpected result, together with the observation of a pronounced temperature dependence for both the proton and deuteron resonances, suggests that two states with different chemical shifts for the bridge hydrogen are involved in rapid equilibrium and that the anomalous deuterium isotope effect has its origin in the effect of deuterium substitution on the energy separation between these states. It is proposed that these states correspond to the symmetrical and asymmetrical structures of the intramolecular hydrogen bond.

Treatment of bilateral nasal polyposis and chronic refractory inhalant allergic rhinitis in a chimpanzee (Pan troglodytes)

Over a 15-yr time span, a 30-yr-old female chimpanzee (Pan troglodytes) exhibited recurrent upper respiratory disease that was suspected to be allergen induced. Until 1993, symptomatic therapy with several different antibiotics and antihistamines yielded variable results. In early 1993, the chimpanzee was consistently observed to be open-mouth breathing despite medication. Nasal polyposis was diagnosed using rigid endoscopy in September 1993, and the polyps were removed by loop excision. A fluorescent allergosorbent test was performed to differentiate hypersensitivity to specific regional allergens causing chronic inhalant allergic rhinitis. Oral immunotherapy was then instituted using standard human treatment for Sacramento Valley pollens. This combination of polyp removal and immunotherapy resulted in a marked reduction of clinical signs, and continuous oral immunotherapy has controlled these signs. Hyposensitization therapy will continue for at least 2-3 yr. The chimpanzee continues to breath normally following occasional antihistamine treatment.

Carbohydrate accumulation during myxospore formation in Myxococcus xanthus

During glycerol-induced myxospore formation in Myxococcus xanthus, cellular neutral polysaccharide increases by approximately 200%, respiration decreases by 80%, and net phospholipid synthesis ceases.

Coats from Myxococcus xanthus: characterization and synthesis during myxospore differentiation

An extracellular coat from glycerol-induced myxospores of Myxococcus xanthus has been isolated and characterized. Coats were examined chemically and by using both transmission and scanning electron microscopy. On a dry weight basis, approximately 75% of the coat is polysaccharide composed entirely of galactosamine and glucose. The remainder of the coat is protein (14%), glycine (8%), and organic phosphorus (less than 1%). Coats remained morphologically intact despite boiling in 10 M urea, sodium lauryl sulfate plus beta-mercaptoethanol, or extraction with warm phenol. Coats also resisted digestion with a variety of proteolytic and polysaccharide degrading enzymes. Synthesis of myxospore coat begins approximately 1 h after the addition of glycerol to a culture. One portion of the coat is complete by 5 to 6 h but additional material consisting primarily of glucose is added after 8 h.