Reduced nitric oxide in sinus epithelium of patients with radiologic maxillary sinusitis and sepsis.
Radiologic maxillary sinusitis is an important risk factor for development of bronchopneumonia in mechanically ventilated patients. Nitric oxide produced within the paranasal sinuses is considered to provide an antibacterial environment and to modulate mucociliary clearance function. We hypothesized that a reduced formation of nitric oxide might contribute to the compromised local host defense in radiologic maxillary sinusitis and measured nitric oxide levels directly within maxillary sinuses of septic patients with radiologic maxillary sinusitis (n = 11), whose sinuses were fenestrated to eliminate a possible septic focus. Data were compared with those of patients without airway inflammation (n = 11, control subjects). Despite local inflammation and infection, we found considerably lower maxillary nitric oxide levels than in control subjects (31 +/- 10 versus 2554 +/- 385 parts per billion, mean +/- standard error of the mean, p < 0.001). Consistently, immunohistochemical and in situ hybridization investigations revealed strongly reduced expression of inducible nitric oxide synthase. By applying ultrastructural immunolocalization, we identified cilia and microvilli of the maxillary sinus epithelium as the major nitric oxide production site in control subjects. Our findings provide evidence of markedly reduced nitric oxide production in maxillary sinuses of patients with radiologic maxillary sinusitis and sepsis, implicating impaired local host defense and an increased risk for secondary infections.
Deja
Maria
M
Department of Anesthesiology and Intemsive Care Medicine, Charité Campus Virchow-Klinikum, Berlin, Germany.
Busch
Thilo
T
Bachmann
Sebastian
S
Riskowski
Kerstin
K
Campean
Valentina
V
Wiedmann
Brigitte
B
Schwabe
Michael
M
Hell
Bertold
B
Pfeilschifter
Josef
J
Falke
Konrad J
KJ
Lewandowski
Klaus
K
D000328:Adult; D001993:Bronchodilator Agents / Q000032:analysis*; D005260:Female; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D015523:Maxillary Sinusitis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D009297:Nasal Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D009569:Nitric Oxide / Q000032:analysis*; D019001:Nitric Oxide Synthase / Q000032:analysis; D052247:Nitric Oxide Synthase Type II; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D018805:Sepsis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
D001993:Bronchodilator Agents; D009569:Nitric Oxide; C496319:NOS2 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II