Aspects of etiopathogeny and cell therapy in the treatment of recurrent and chronic rhinosinusitis in children

Abstract

Introduction. Chronic rhinosinusitis is an important problem of otolaryngology, its treatment being so far below the expected level. The incidence of rhinosinusitis in the last decades has increased almost 3 times, while there is a clear tendency to increase the frequency of recurrent and chronic forms of sinusitis. The study of the etiology, pathogenesis and development of effective sinusitis treatment principles is also due to the appearance, in some cases, of severe pansinusitis with orbital or intracranial complications with the development of septic states. At the same time, chronic inflammatory pathology of the nasal cavity and paranasal sinuses often leads to body allergies, the development of bronchopulmonary pathologies and the dysfunction of several organ systems. Thus, a new research is needed regarding the study of the pathogenesis of chronic sinusitis and the pathogenetic basis of the new complex treatment principles of inflammatory rhinosinusal pathologies using cell therapy with the application of autologous mononuclear cells, cell strain, drug-carrying nanoparticles and antioxidants. Aim of the study. Studying specialized literature in order to carry out a research of the etiopathogenesis oriented to the optimization of the treatment of recurrent and chronic rhinosinusitis in children, through cell therapy. Materials and methods. This article analyzes the data from the literature on the etiopathogeny and the importance of cell therapy in the treatment of rhinosinus inflammatory pathology. The bibliographic databases Cohrane, PubMed, Medline were accessed. Results. A study of sixty-seven patients with chronic low-level CD8 + T lymphocyte rhinosinusitis were investigated and analyzed according to demographic data, disease progression and bacteriological culture, which were compared with a group of 480 patients with CRS with nasal polyposis. The medium CD8 + level in the CRS / CD8 population was 0.15 × 10 (9) / L (range, 0.20-1.5 × 10 (9) / L). There was no difference between the two groups regarding the history of allergy, asthma, eczema, acetylsalicylic acid (ASA) intolerance or smoking. The bacteriology was similar between the two groups (S. aureus: CRS / Low CD8 +: 35%; CRS 32%, p = 0.643). The disease progression was slightly easier in CRS / Low CD8 +, with fewer patients requiring surgery, and the first surgery was performed at an older age. However, antibiotic use was higher in CRS / Low CD8 +. Analysis of subgroups limited to CRS with nasal polyposis (CRSwNP) / low CD8 or CRS without nasal polyposis (CRSsNP) / low CD8 phenotypes did not substantially change these results. Another multicenter study of systemic administration of bone marrow-derived mesenchymal cell preparation (MSC) (Prochymal; Osiris Therapeutics Inc) in patients with moderately severe chronic obstructive bronchopneumopathy (COPD) in the United States has demonstrated to be safety without acute infusion toxicity and no attributable mortality or serious adverse reactions over a follow-up period of two years. Several laboratory studies show that Stem cells derived from adipose tissue (AUC) have the ability to regenerate mucosal lesions of the vocal cords. Professor Danilov L. (2016) proposed a new method of local immunocorrection (with autologous mononuclear cells) in the conservative complex treatment of compensated chronic tonsillitis in children which has been shown to be very effective, through the positive clinical effect, the normalization of the preimmune resistance status of the body, obvious decrease of the increased rates of allergic reactions, decrease of the levels of specific cellular sensitization to streptococcal, pneumococcal antigens, increase of the total lymphocyte content, increase of the levels and functional activity of the T and B lymphocytes, efficiency of the cytokine profile, decrease of the cytokine levels (IL-8, IL-1β) and increased serum concentrations of anti-inflammatory cytokine (IL-4).Conclusions. The studies presented in this review argue the need for further research into the etiopathogenesis of rhinosinusitis and cell therapy methods for the treatment of chronic inflammatory diseases of the nose and paranasal sinuses.