The Potential Role of Hyaluronan in Minimizing Symptoms and Preventing Exacerbations of Chronic Rhinosinusitis

Casale, Manuele; Sabatino, Lorenzo; Frari, Valeria; Mazzola, Francesco; Dell'Aquila, Rosa; Baptista, Peter; Mladina, Ranko; Salvinelli, Fabrizio

doi:10.2500/ajra.2014.28.4045

Cited by 26 publications

(45 citation statements)

References 17 publications

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“…59 By increasing the size of the dendrimer, researchers observed decreased degradation with lower systemic exposure and greater lung retention. 27 These observations correlate with the molecular weight observed for HAs that persisted in the lungs. The relative hydrophobic character of HA may also contribute to differences in lung persistence, until HA solution viscosity limited penetration of the instilled dose.…”

Section: Discussionsupporting

confidence: 63%

Hyaluronic Acid Molecular Weight Determines Lung Clearance and Biodistribution after Instillation

et al. 2016

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Hyaluronic acid (HA) has emerged as a versatile polymer for drug delivery. Multiple commercial products utilize HA, it can be obtained in a variety of molecular weights, and it offers chemical handles for cross-linkers, drugs, or imaging agents. Previous studies have investigated multiple administration routes, but the absorption, biodistribution, and pharmacokinetics of HA after delivery to the lung is relatively unknown. Here, pharmacokinetic parameters were investigated by delivering different molecular weights of HA (between 7 and 741 kDa) to the lungs of mice. HA was labeled with either a near-infrared dye or with iodine-125 conjugated to HA using a tyrosine linker. In initial studies, dye-labeled HA was instilled into the lungs and fluorescent images of organs were collected at 1, 8, and 24 h post administration. Data suggested longer lung persistence of higher molecular weight HA, but signal diminished for all molecular weights at 8 h. To better quantitate pharmacokinetic parameters, different molecular weights of iodine-125 labeled HA were instilled and organ radioactivity was determined after 1, 2, 4, 6, and 8 h. The data showed that, after instillation, the lungs contained the highest levels of HA, as expected, followed by the gastrointestinal tract. Smaller molecular weights of HA showed more rapid systemic distribution, while 67 and 215 kDa HA showed longer persistence in the lungs. Lung exposure appeared to be optimum in this size range due to the rapid absorption of <67 kDa HA and the poor lung penetration and mucociliary clearance of viscous solutions of HA > 215 kDa. The versatility of HA molecular weight and conjugation chemistries may, therefore, provide new opportunities to extend pulmonary drug exposure and potentially facilitate access to lymph nodes draining the pulmonary bed.

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Section: Discussionsupporting

confidence: 63%

Hyaluronic Acid Molecular Weight Determines Lung Clearance and Biodistribution after Instillation

et al. 2016

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“…Depending on individual characteristics, onset, duration, and season, the sudden onset or worsening of NSS could be an indication for allergic rhinitis (AR), acute rhinosinusitis (ARS), an acute exacerbation of chronic rhinosinusitis (AECRS), or other related diagnoses. Published studies of exacerbation among CRS patients have primarily focused on bacteriology, immunology, and medical treatments, as opposed to population‐based occurrence, severity, risk factors, and natural history. The International Consensus Statement on Allergy and Rhinology (ICAR), therefore, has declared a need for prevalence estimates of AECRS and more prospective studies, especially those which compare several definitions of AECRS …”

Section: Introductionmentioning

confidence: 99%

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status

Kuiper

Hirsch

Bandeen‐Roche

et al. 2018

Allergy

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“…Facial pain 0 (0-0) 0 (0-0) 0.388 exacerbations of chronic rhinosinusitis and in the postoperative tissue repair after sinonasal surgery, contributing to the regeneration of the nasal mucosa and promoting post-infection and post-operative remodelling actions [6][7][8][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…In the last few years, intranasal sodium hyaluronate is being used more often in the treatment of chronic sinonasal diseases [5][6][7]. Sodium hyaluronate has a reparative effect on the nasal mucosa; it modulates mucosal inflammation and increases mucociliary clearance even after nasal and sinus surgery.…”

Section: Introductionmentioning

confidence: 99%

Olfactory dysfunction in acute rhinosinusitis: intranasal sodium hyaluronate as adjuvant treatment

Ciofalo

Vincentiis

Zambetti

et al. 2016

Eur Arch Otorhinolaryngol

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Acute rhinosinusitis (ARS) is defined as an inflammation of the mucosa of the nose and paranasal sinuses and affects 1-5 % of general population in Europe. Sinonasal diseases represent the main cause of smell alterations in adult patients and lead to mucosal congestion, increased quantity and density of secretions and altered mucociliary transport. For this reason the odorous molecules contained in the inspired air, cannot interact with the olfactory epithelium. Medical therapy of ARS has to reduce the severity and duration of symptoms and prevent complications. Recent studies have shown that Sodium hyaluronate modulate inflammation and has a reparative effect on the nasal mucosa. 48 patients affected by acute rhinosinusitis proven by CT scan, were enrolled. They were submitted to nasal endoscopy, olfactometric and mucociliary transport evaluation (MCTt), Visual Analogue Scale Questionnaire (VAS) at T0, after 14-18 days (T1) and after 30-35 days (T2). The patients were randomized into two treatment groups, A and B, and were treated for 30 days; each group was composed of 24 subjects. All patients received Levofloxacin (500 mg for 10 days) and Prednisone (50 mg for 8 days, 25 mg for 4 days and 12, 5 mg for 4 days). Moreover, Group A received twice a day for 30 days high molecular weight Sodium Hyaluronate (3 %) plus saline solution (3 mL sodium chloride-NaCl-0.9 %) using a nebulizer ampoule for nasal douche. Group B received twice a day for 30 days saline solution (6 mL sodium chloride-NaCl-0.9 %) using a nebulizer ampoule for nasal douche. At T1 Group A shown lower values in MCTt and threshold score was significantly higher than in Group B. VAS showed statistically significant differences between the two groups, in particular for smell, nasal obstruction and for nasal discharge. At T2 Group A MCTt was significantly lower than in Group B; odour threshold improved in both groups but in Group A was still significantly higher than in Group B. No statistical differences between two groups regarding odour discrimination and odour identification were confirmed at T1 and T2. VASy score showed statistically significant differences between the two groups only for nasal discharge.

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The Potential Role of Hyaluronan in Minimizing Symptoms and Preventing Exacerbations of Chronic Rhinosinusitis

Abstract: The results of this study suggested that intermittent treatment with topical 9-mg sodium hyaluronate plays a role in minimizing symptoms and could prevent exacerbations of CRS.

Cited by 26 publications

References 17 publications

Hyaluronic Acid Molecular Weight Determines Lung Clearance and Biodistribution after Instillation

Hyaluronic Acid Molecular Weight Determines Lung Clearance and Biodistribution after Instillation

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status

Olfactory dysfunction in acute rhinosinusitis: intranasal sodium hyaluronate as adjuvant treatment

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