Upregulation of inflammatory genes in the nasal mucosa of patients undergoing endonasal dacryocystorhinostomy

Abstract

BackgroundEpiphora is a common complaint of nasolacrimal duct obstruction (NLDO) in adults. The precise pathogenesis of NLDO is still unknown, but inflammatory processes are believed to be predisposing factors. Endoscopic dacryocystorhinostomy (EN-DCR) is an effective surgical technique for treating symptomatic NLDO. The purpose of the procedure is to relieve the patient’s symptoms by creating an opening, ie, a rhinostoma, between the lacrimal sac and the nasal cavity. Although the success rates after EN-DCR are high, the procedure sometimes fails due to onset of a fibrotic process at the rhinostomy site. The aim of this prospective comparative study was to investigate inflammation-related gene expression in the nasal mucosa at the rhinostomy site.MethodsTen participants were consecutively recruited from eligible adult patients who underwent primary powered EN-DCR (five patients) or septoplasty (five controls). Nasal mucosa specimens were taken from the rhinostomy site at the beginning of surgery for analysis of gene expression. Specimens were taken from the same site on the lateral nasal wall for controls. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed for the inflammatory genes interleukin (IL)-6, IL-1β, and CCL2, and because of a clear trend of increased inflammation in the EN-DCR samples, a wider PCR array was performed to compare inflammation-related gene expression in EN-DCR subjects and corresponding controls.ResultsOur qRT-PCR results revealed a clear trend of increased transcription of IL-6, IL-1β, and CCL2 (P=0.03). The same trend was also evident in the PCR array, which additionally revealed notable differences between EN-DCR subjects and controls with regard to expression of several other inflammation-related mediators. At 6-month follow-up, the success rate after primary EN-DCR was 60%, ie, in three of five patients.ConclusionThe present study demonstrates that there is an intense inflammation gene expression response in the nasal mucosa of patients undergoing EN-DCR.

Endoscopic Dacryocystorhinostomy as Treatment for Lower Lacrimal Pathway Obstructions in Adults: Review Article

“…The cause of failure can also be linked to the biology of wound healing in the nasal mucosa. 83 , 84 Recently, Smirnov et al , 77 evaluated the factors related to wound healing and demonstrated that the presence of squamous metaplasia in the surface epithelium was associated with unsuccessful EN-DCR. However, the precise mechanisms involved in wound healing in the respiratory mucosa remain unclear.…”

“…[95][96][97][98] Future studies should be directed at projects related to wound healing and regulation of inflammation and fibrosis in the nasal mucosa, which might reveal novel predictors of outcomes for operations in the nasal cavity. 84 These studies are needed to clarify whether these predictors have any implications for operative techniques and for preoperative and postoperative treatments in patients with NLDO. There is also a definite need to create generally accepted and cost-effective clinical treatment protocols for patients with NLDO.…”

Influence of TGF-β cytokine and a number of other biochemical factors on regenerative process

“…E. Pent-tilä и соавт. [67] изучали экспрессию цитокинов воспаления в полости носа больных с хроническим дакриоциститом и выявили ее значительное увеличение по сравнению с данными контрольной группы. Тем не менее экспрессия перечисленных выше про-и антифибротических факторов в слизистой полости носа и ее влияние на исход данного вмешательства до настоящего времени изучены не были.…”