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Upper airway microbiome transplantation for patients with chronic rhinosinusitis

Mårtensson, Anders LU ; Cervin-Hoberg, Charlotte LU ; Huygens, Flavia ; Lindstedt, Malin LU ; Sakellariou, Christina LU orcid ; Greiff, Lennart LU and Cervin, Anders LU (2023) In International Forum of Allergy and Rhinology 13(6). p.979-988
Abstract

Background: Chronic or recurrent rhinosinusitis without polyps (CRSsNP) is characterized by a persistent inflammation of the sinonasal mucosa. The underlying cause is unclear but increasing interest has been directed toward changes in the sinonasal microbiome as a potential driver. Methods: Twenty-two patients diagnosed with CRSsNP were treated with antibiotics for 13 days, followed by 5 consecutive days of nasal microbiome transplants from healthy donors. Outcome measures were 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire, total nasal symptom score (TNSS), endoscopic grading, 16S ribosomal RNA (rRNA) next generation sequencing (microbiome analysis), and nasal lavage fluid analysis of inflammatory cytokines. Patients were... (More)

Background: Chronic or recurrent rhinosinusitis without polyps (CRSsNP) is characterized by a persistent inflammation of the sinonasal mucosa. The underlying cause is unclear but increasing interest has been directed toward changes in the sinonasal microbiome as a potential driver. Methods: Twenty-two patients diagnosed with CRSsNP were treated with antibiotics for 13 days, followed by 5 consecutive days of nasal microbiome transplants from healthy donors. Outcome measures were 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire, total nasal symptom score (TNSS), endoscopic grading, 16S ribosomal RNA (rRNA) next generation sequencing (microbiome analysis), and nasal lavage fluid analysis of inflammatory cytokines. Patients were examined at the start of the study and after antibiotic treatment as well as 10 days and 3 months after the transplant series. Results: At the end of the study, patients reported significantly reduced SNOT-22 scores and microbiome analysis showed significantly increased abundance and diversity. No significant change was observed for TNSS or endoscopic scoring. Conclusion: Nasal microbiome transplants obtained from healthy individuals and administered as nasal lavages to patients with CRSsNP are feasible. The patients reported significant and lasting reduction of symptoms and these findings were associated with a lasting increase in abundance and diversity of the local bacterial flora. The observations, which need to be confirmed by randomized controlled trials, may constitute a new treatment avenue for these difficult to treat patients where antibiotics only provide short lasting symptom control.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic rhinosinusitis, SNOT-22, therapy, topical therapy for chronic rhinosinusitis
in
International Forum of Allergy and Rhinology
volume
13
issue
6
pages
979 - 988
publisher
Wiley-Blackwell
external identifiers
  • scopus:85145416262
  • pmid:36515012
ISSN
2042-6976
DOI
10.1002/alr.23122
language
English
LU publication?
yes
id
ebd3205e-edd4-4da8-ad4f-199c3bfc4c3c
date added to LUP
2023-02-09 11:42:21
date last changed
2024-06-11 13:22:59
@article{ebd3205e-edd4-4da8-ad4f-199c3bfc4c3c,
  abstract     = {{<p>Background: Chronic or recurrent rhinosinusitis without polyps (CRSsNP) is characterized by a persistent inflammation of the sinonasal mucosa. The underlying cause is unclear but increasing interest has been directed toward changes in the sinonasal microbiome as a potential driver. Methods: Twenty-two patients diagnosed with CRSsNP were treated with antibiotics for 13 days, followed by 5 consecutive days of nasal microbiome transplants from healthy donors. Outcome measures were 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire, total nasal symptom score (TNSS), endoscopic grading, 16S ribosomal RNA (rRNA) next generation sequencing (microbiome analysis), and nasal lavage fluid analysis of inflammatory cytokines. Patients were examined at the start of the study and after antibiotic treatment as well as 10 days and 3 months after the transplant series. Results: At the end of the study, patients reported significantly reduced SNOT-22 scores and microbiome analysis showed significantly increased abundance and diversity. No significant change was observed for TNSS or endoscopic scoring. Conclusion: Nasal microbiome transplants obtained from healthy individuals and administered as nasal lavages to patients with CRSsNP are feasible. The patients reported significant and lasting reduction of symptoms and these findings were associated with a lasting increase in abundance and diversity of the local bacterial flora. The observations, which need to be confirmed by randomized controlled trials, may constitute a new treatment avenue for these difficult to treat patients where antibiotics only provide short lasting symptom control.</p>}},
  author       = {{Mårtensson, Anders and Cervin-Hoberg, Charlotte and Huygens, Flavia and Lindstedt, Malin and Sakellariou, Christina and Greiff, Lennart and Cervin, Anders}},
  issn         = {{2042-6976}},
  keywords     = {{chronic rhinosinusitis; SNOT-22; therapy; topical therapy for chronic rhinosinusitis}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{979--988}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{International Forum of Allergy and Rhinology}},
  title        = {{Upper airway microbiome transplantation for patients with chronic rhinosinusitis}},
  url          = {{http://dx.doi.org/10.1002/alr.23122}},
  doi          = {{10.1002/alr.23122}},
  volume       = {{13}},
  year         = {{2023}},
}