International forum of allergy & rhinology · 2025
Mechanisms and Kinetics of Wound Healing in Chronic Rhinosinusitis Patients After Complete Sinus Surgery and Its Improvement by Doxycycline Therapy.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Vandewalle Elke, De Schryver Els, Calus Lien, Blauwblomme Manon, Janssen Pauline, Ketelaere Ellen, Van Nevel Sharon, Eeckels Anne-Sophie, De Ruyck Natalie, Holtappels Gabriele, Derycke Lara, Bachert Claus, Vanhee Stijn, Gevaert Philippe, Van Zele Thibaut
Аннотация
BACKGROUND: Chronic rhinosinusitis (CRS) may require endoscopic sinus surgery (ESS) as a complement to medical therapies. Type 2 dominant inflammation underlies nasal polyposis (CRSwNP), and is characterized by eosinophilic inflammation, poor therapeutic response, and high recurrence risk. Type 2 inflammation was defined as eosinophilic CRS (ECRS) based on clinical presentation and laboratory findings. Unfavorable wound healing, associated with elevated levels of matrix metalloproteinase 9 (MMP-9), can lead to failure of ESS. Doxycycline with its antibiotic, anti-inflammatory, and anti-protease (including MMP-9) properties may improve postoperative healing.
MATERIALS AND METHODS: Thirty-three adult CRS patients scheduled for ESS were randomly assigned to receive either doxycycline or placebo for 56 days postoperative and were followed up until 48 weeks post-ESS. Postoperative wound healing was assessed endoscopically. Nasal secretions, serum, and patient-reported outcome measures were collected throughout the study. Nasal secretions were analyzed to monitor local myeloperoxidase (MPO), MMP-9, eosinophilic cationic protein (ECP), and IgE levels from baseline until 48 weeks post-ESS. Proteomics analysis, using LC-MS/MS, of nasal secretions was performed at baseline, 2- and 8-weeks post-ESS to investigate wound healing mechanisms.
RESULTS: Postoperative doxycycline significantly improved wound healing quality in patients with CRSwNP or ECRS. Increased local MMP-9, neutrophilic (MPO), and eosinophilic (ECP) inflammation post-ESS was dampened by doxycycline. Wound healing and extracellular matrix remodeling processes were upregulated by doxycycline treatment. In contrast, the placebo group showed increased neutrophilic inflammation and delayed healing.
CONCLUSIONS: Postoperative doxycycline therapy facilitated wound healing in CRSwNP and ECRS patients and suppressed local mucosal inflammation.
MATERIALS AND METHODS: Thirty-three adult CRS patients scheduled for ESS were randomly assigned to receive either doxycycline or placebo for 56 days postoperative and were followed up until 48 weeks post-ESS. Postoperative wound healing was assessed endoscopically. Nasal secretions, serum, and patient-reported outcome measures were collected throughout the study. Nasal secretions were analyzed to monitor local myeloperoxidase (MPO), MMP-9, eosinophilic cationic protein (ECP), and IgE levels from baseline until 48 weeks post-ESS. Proteomics analysis, using LC-MS/MS, of nasal secretions was performed at baseline, 2- and 8-weeks post-ESS to investigate wound healing mechanisms.
RESULTS: Postoperative doxycycline significantly improved wound healing quality in patients with CRSwNP or ECRS. Increased local MMP-9, neutrophilic (MPO), and eosinophilic (ECP) inflammation post-ESS was dampened by doxycycline. Wound healing and extracellular matrix remodeling processes were upregulated by doxycycline treatment. In contrast, the placebo group showed increased neutrophilic inflammation and delayed healing.
CONCLUSIONS: Postoperative doxycycline therapy facilitated wound healing in CRSwNP and ECRS patients and suppressed local mucosal inflammation.