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Chronic Rhinosinusitis: Clinical and Immunological Research
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Chronic Rhinosinusitis: Clinical and Immunological Research

A special issue of Sinusitis and Asthma (ISSN 2624-7003).

Deadline for manuscript submissions: closed (31 January 2016) | Viewed by 47621

Special Issue Editor

Dr. Claudina A. Pérez Novo

E-Mail Website
Guest Editor
Upper Airways Research Laboratory, Department of Ear-, Nose-, and Throat diseases , Ghent University Hospital, Medical Research Building (MRB, groundfloor), De Pintelaan 185 9000 Ghent, Belgium
Interests: chronic rhinosinusitis; nasal polyposis; aspirin exacerbated respiratory disease; epigenetics, eicosanoids and lipid mediators;S. aureus enterotoxins; biomarkers; molecular mechanisms

Special Issue Information

Dear Colleagues,

Rhinosinusitis is defined as the inflammation of the nose and of the paranasal sinuses. The condition has a prevalence rate of about 11% within the population of Europe and of 14% within the population of the United States. Rhinosinusitis can be classified according to the temporal course of the disease (duration and frequency of episodes) as: a) acute rhinosinusitis, b) recurrent acute or chronic rhinosinusitis, and c) acute exacerbation of chronic sinusitis. The disease's clinical diagnosis is based on the presence of two or more symptoms (nasal blockage/congestion, nasal discharge, and others), by endoscopic signs (edema, nasal polyps, etc.) and/or CT-scan changes, such as mucosal changes.  Rhinosinusitis may often co-occur with other pathologies, such as nasal polyps, asthma, allergy, and aspirin-exacerbated respiratory disease. In terms of disease management, rhinosinusitis is mainly treated, depending on the cause and type of the disease and the presence or absence of other co-morbidities, with topical and/or oral corticosteroids; in the most severe and persistent cases, surgery is needed.  In the last decade, extensive research has been performed for elucidating the mechanisms behind the pro-inflammatory and immunological changes observed in patients with the disease. Thus, it is now known that imbalances of not only T-helper 2, but also of T-helper 1, immune responses play crucial roles in the development and maintenance of the disease. Further, other related mechanisms involving tissue remodeling (e.g., altered expressions of TGF-β1, collagen, and extracellular matrix molecules), imbalances of eicosanoids and lipid mediators, as well as genetics and epigenetics events (e.g., polymorphisms, differential gene methylation, and altered miRNA expression) are now considered to be crucial players in the pathogenesis of this condition. This Special Issue will focus on new insights into the management of the disease, novel diagnosis tools, and recent research work concerning the molecular networks involved in the pathogenesis of rhinosinusitis and co-morbidities.

Dr. Claudina A. Pérez Novo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Sinusitis and Asthma is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) is waived for well-prepared manuscripts submitted to this issue. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • rhinosinusitis
  • phenotypes
  • molecular mechanisms
  • diagnosis
  • management
  • infection
  • co-morbidities

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Published Papers (6 papers)

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Research

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11 pages, 2228 KB  
Article
LTD4 and TGF-β1 Induce the Expression of Metalloproteinase-1 in Chronic Rhinosinusitis via a Cysteinyl Leukotriene Receptor 1-Related Mechanism
by Rogerio Pezato, Cindy Claeys, Gabriele Holtappels, Claus Bachert and Claudina A. Pérez-Novo
Sinusitis 2016, 1(1), 65-75; https://doi.org/10.3390/sinusitis1010065 - 19 May 2016
Cited by 1 | Viewed by 5473
Abstract
Background: Cysteinyl leukotrienes (CysLTs) play a crucial role in the pathogenesis of airway remodeling. The use of CysLTs receptor antagonists has been included in the management of asthma and rhinitis. However, despite the action of these compounds on leukotriene production has been [...] Read more.
Background: Cysteinyl leukotrienes (CysLTs) play a crucial role in the pathogenesis of airway remodeling. The use of CysLTs receptor antagonists has been included in the management of asthma and rhinitis. However, despite the action of these compounds on leukotriene production has been well documented, their role in airway remodeling remains unclear. Objective: We aimed to investigate the capability of the leukotriene receptor antagonist Montelukast to inhibit MMPs release after CysLTs stimulation in nasal tissue fibroblasts. Methods: Fibroblasts were isolated from sinunasal tissue collected from five patients suffering of chronic rhinosinusitis without nasal polyposis. Cells were cultured and stimulated first with LTC4 and LTD4 (10−10, 10−8, 10−6 M) using as pre-stimulus 10 ng/mL of: IL-4, IL-13, or TGF-beta1 and in presence or absence of Montelukast (10−10, 10−8, 10−6 M). To evaluate the regulation of MMP-1 and TIMP-1 we used enzyme immunoassays and to evaluate CysLT1 receptor we used real time PCR. Results: LTD4 but not LTC4 induced production of mRNA for CysLT1 receptor in a dose dependent manner and with an additive effect when the cells where primed with TGF-β1. TNF-α, IL-4, and IL-13 did not influence the expression of the receptor. Levels of MMP-1 but not of TIMP-1 were statistically enhanced in cells primed with TGF-β1 and stimulated with LTD4. Montelukast significantly decreased Cys-LT1 receptor and MMP-1 concentrations in a dose-dependent way in cells stimulated with LTD4 and TGF-β1 separately and when they were applied together. Conclusion: The leukotriene pathway may play an important role in extra-cellular matrix formation in an inflamed environment, such as chronic sinusitis and, consequently, leukotriene receptor antagonists such as Montelukast may be of great benefit in management of this disease. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)
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10 pages, 212 KB  
Article
Fatty Acid Composition of Cultured Fibroblasts Derived from Healthy Nasal Mucosa and Nasal Polyps
by Suha Jabr Ayyad, Jordi Roca-Ferrer and César Picado
Sinusitis 2016, 1(1), 55-64; https://doi.org/10.3390/sinusitis1010055 - 11 Apr 2016
Cited by 2 | Viewed by 5582
Abstract
Background: Fibroblasts from nasal polyps (NP) of asthma patients have reduced expression of cyclooxygenase 2 (COX-2) and production of prostaglandin E2 (PGE2). We hypothesized that the reported alterations are due to alterations in the availability of arachidonic acid (AA). Objective: [...] Read more.
Background: Fibroblasts from nasal polyps (NP) of asthma patients have reduced expression of cyclooxygenase 2 (COX-2) and production of prostaglandin E2 (PGE2). We hypothesized that the reported alterations are due to alterations in the availability of arachidonic acid (AA). Objective: The objective was to determine the fatty acid composition of airway fibroblasts from healthy subjects and from asthma patients with and without aspirin intolerance. Methods: We analyzed the fatty acid composition of cultured fibroblasts from non-asthmatics (n = 6) and from aspirin-tolerant (n = 6) and aspirin-intolerant asthmatics (n = 6) by gas chromatography-flame ionization detector. Fibroblasts were stimulated with acetyl salicylic acid (ASA). Results: The omega-6 fatty acids dihomo-gamma-linolenic acid (C20:3) and AA (C20:4), and omega-3 fatty acids docosapentaenoic acid (DPA) (C22:5) and docosahexaenoic acid (DHA) (C22:6) were significantly higher in NP fibroblasts than in fibroblasts derived from nasal mucosa. The percentage composition of the fatty acids palmitic acid (C16:0) and palmitoleic acid (C16:1) was significantly higher in fibroblasts from patients with NP and aspirin intolerance than in fibroblasts derived from the nasal NP of aspirin-tolerant patients. ASA did not cause changes in either omega-3 or omega-6 fatty acids. Conclusions. Our data do not support the hypothesis that a reduced production of AA in NP fibroblasts can account for the reported low production of PGE2 in nasal polyps. Whether the increased proportion of omega-3 fatty acids can contribute to reduced PGE2 production in nasal polyps by competitively inhibiting COX-2 and reducing the amount of AA available to the COX-2 enzyme remains to be elucidated. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)
5 pages, 172 KB  
Article
Chronic Rhinosinusitis and Obstructive Sleep Apnea: CPAP Reservoir Bacterial Colonization Is Not Associated with Sinus Culture Positivity
by Rosa B. Lipin, Anita Deshpande, Sarah K. Wise, John M. DelGaudio and Zara M. Patel
Sinusitis 2016, 1(1), 44-48; https://doi.org/10.3390/sinusitis1010044 - 9 Mar 2016
Cited by 1 | Viewed by 7233
Abstract
Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) are both highly prevalent chronic diseases in the United States. Association between culture positivity of CPAP machines and sinus samples has not been studied in patients with both disease states. Our objective was to compare [...] Read more.
Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) are both highly prevalent chronic diseases in the United States. Association between culture positivity of CPAP machines and sinus samples has not been studied in patients with both disease states. Our objective was to compare the microbes present in the sinus cavities and CPAP reservoirs of patients with both CRS and OSA. Patients from an academic tertiary care Rhinology practice were identified with both CRS and OSA and enrolled prospectively. Inclusion criteria included age over 18 years; diagnosis of OSA by sleep study; regular CPAP use; and an active diagnosis of CRS. Exclusion criteria included treatment with antibiotics or cleaning of the CPAP reservoir in the month prior. Cultures were taken from participants’ sinus cavities and CPAP reservoirs and resulting microbial growth was compared. The most common organisms on CPAP culture were Enterobacter cloacae and Acinetobacter baumanii, whereas the most common on sinus culture were Staphyloccoccus aureus and Pseudomonas aeruginosa. Microbial growth from the sinus cavities and the CPAP reservoirs were not concordant in any of our patients. There is no association between bacterial colonization of the CPAP reservoir and the sinus cavities of those with CRS and OSA based on microbiologic cultures. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)
10 pages, 683 KB  
Article
Effect of a Chitosan-Based Biodegradable Middle Meatal Dressing after Endoscopic Sinus Surgery: A Prospective Randomized Comparative Study
by Kevin Hsu, Matthew Ericksen and Peter Catalano
Sinusitis 2016, 1(1), 3-12; https://doi.org/10.3390/sinusitis1010003 - 25 Nov 2015
Cited by 10 | Viewed by 9749
Abstract
Introduction: The use of biomaterials to improve wound healing after endoscopic sinus surgery (ESS) is not new. Many types of resorbable and non-resorbable materials have been tried as a middle meatal (MM) dressing, spacer, or stent to prevent lateralization of the middle turbinate, [...] Read more.
Introduction: The use of biomaterials to improve wound healing after endoscopic sinus surgery (ESS) is not new. Many types of resorbable and non-resorbable materials have been tried as a middle meatal (MM) dressing, spacer, or stent to prevent lateralization of the middle turbinate, formation of synechia, granulation tissue, adhesions and scarring. The FDA has recently approved Chitosan-based nasal dressing/spacers which have optimal wound healing characteristics, including hemostatic and bacteriostatic properties. Herein, we compare a new chitosan-based biomaterial to a popular fully synthetic resorbable dressing in patients undergoing ESS. Materials and Methods: A prospective randomized controlled study was performed comparing a new Chitosan-based bioresorbable nasal dressing (Posi-Sep X) against a previously studied and well known fully synthetic polyurethane-based control (Nasopore). Post-operative outcome metrics included the degree of crusting, amount of retained implant, patient comfort, wound healing, epistaxis, and post-operative infection at two weeks. Results: Thirty-five patients were enrolled and a total seventy implants were placed (n = 70) at the completion of ESS. The results show a statistically significant difference between the Chitosan-based product and the control with respect to wound healing, degree of crusting, and resorption profile. In addition, the Chitosan-based dressing had a markedly lower requirement for post-operative debridement, and a lower incidence of epistaxis and infection, which corresponds to superior patient comfort. Conclusion: Our study is consistent with the biomaterials literature regarding the potential advantages of Chitosan-based MM dressings after ESS regarding improved wound healing, biocompatibility, and patient comfort. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)
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Review

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13 pages, 227 KB  
Review
Medical Management of Chronic Rhinosinusitis in Adults
by John Malaty
Sinusitis 2016, 1(1), 76-87; https://doi.org/10.3390/sinusitis1010076 - 28 May 2016
Cited by 1 | Viewed by 11590
Abstract
Chronic rhinosinusitis can be refractory and has detrimental effects not only on symptoms, but also on work absences, work productivity, annual productivity costs, and disease-specific quality of life measures. The pathophysiology of chronic rhinosinusitis continues to evolve. There is evidence that it is [...] Read more.
Chronic rhinosinusitis can be refractory and has detrimental effects not only on symptoms, but also on work absences, work productivity, annual productivity costs, and disease-specific quality of life measures. The pathophysiology of chronic rhinosinusitis continues to evolve. There is evidence that it is driven by various inflammatory pathways and host factors and is not merely an infectious problem, although pathogens, including bacterial biofilms, may certainly contribute to this inflammatory cascade and to treatment resistance. Given this, medical management should be tailored to the specific comorbidities and problems in an individual patient. In addition to treating acute exacerbations of chronic rhinosinusitis with amoxicillin-clavulanate, second or third generation cephalosporins, or fluoroquinolones, one must consider if nasal polyps are present, when symptoms and disease severity correlate to mucosal eosinophilia, and there is the best evidence for intranasal corticosteroids and saline irrigation. Asthma worsens severity of chronic rhinosinusitis and it is felt to be mediated by increased leukotrienes, when leukotriene antagonists may be utilized. Cystic fibrosis has a genetic defect and increased mucin, which are potential treatment targets with dornase alfa showing efficacy. Other comorbidities that may impact treatment include allergies, ciliary dyskinesia, immunodeficiency, and possibly allergic fungal rhinosinusitis. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)

Other

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6 pages, 1192 KB  
Case Report
Chronic Rhinosinusitis as a Crucial Symptom of Cystic Fibrosis—Case Report and Discussion on the Sinonasal Compartment as Site of Pseudomonas aeruginosa Acquisition into CF Airways
by Jochen G. Mainz, Christin Arnold, Andrea Gerber, Jürgen Rödel, Nina Cramer, Hans-Joachim Mentzel, James F. Beck and Burkhard Tümmler
Sinusitis 2016, 1(1), 49-54; https://doi.org/10.3390/sinusitis1010049 - 17 Mar 2016
Cited by 1 | Viewed by 7526
Abstract
Cystic fibrosis (CF) is the most frequent congenital lethal disease in Caucasians. Impaired mucociliary clearance causes chronic bacterial rhinosinusitis in up to 62% of patients, and almost all patients exhibit sinonasal pathology in CT scans. Pathogens like Pseudomonas aeruginosa (P.a.) chronically [...] Read more.
Cystic fibrosis (CF) is the most frequent congenital lethal disease in Caucasians. Impaired mucociliary clearance causes chronic bacterial rhinosinusitis in up to 62% of patients, and almost all patients exhibit sinonasal pathology in CT scans. Pathogens like Pseudomonas aeruginosa (P.a.) chronically colonize about 70% of the CF adults’ lungs and are the major reason for pulmonary destruction and premature death. In our 34-year-old female CF patient, rhinosinusitis caused massive orbital hypertelorism despite three sinonasal operations. Her sputum samples had always been negative for P.a. Then, P.a. was primarily detected in her sputum and additionally in nasal lavage, which since then persisted in both, her upper and lower airways. The P.a. strains turned out to be genetically identical in both airway levels, indicating early colonization of the entire airway system with P.a. This first report on simultaneous primary P.a. detection in the sinonasal and pulmonary compartments highlights the need to include an assessment of upper airway colonization in the standards of CF care, particularly in patients without chronic P.a. colonization. Both airway levels need to be considered as one united system, and a strong cooperation between ENT and CF specialists should be established. Prospective longitudinal studies should assess the upper airways´ role in acquisition and persistence of pathogens and evaluate conservative and surgical therapeutic options. Full article
(This article belongs to the Special Issue Chronic Rhinosinusitis: Clinical and Immunological Research)
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