title: Dynamics of soluble and cellular inflammatory markers in nasal lavage obtained from cystic fibrosis patients during intravenous antibiotic treatment.
abstract: BACKGROUND
  In cystic fibrosis (CF) patients, the upper airways display the same ion channel defect as evident in the lungs, resulting in chronic inflammation and infection. Recognition of the sinonasal area as a site of first and persistent infection with pathogens, such as Pseudomonas aeruginosa, reinforces the "one-airway" hypothesis. Therefore, we assessed the effect of systemic antibiotics against pulmonary pathogens on sinonasal inflammation.
  
  
  METHODS
  Nasal lavage fluid (NLF) from 17 CF patients was longitudinally collected prior to and during elective intravenous (i.v.) antibiotic treatment to reduce pathogen burden and resulting inflammation (median treatment time at time of analysis: 6 days). Samples were assessed microbiologically and cytologically. Cytokine and chemokine expression was measured by Cytometric Bead Array and ELISA (interleukin (IL)-1β, IL-6, IL-8, MPO, MMP9, RANTES and NE). Findings were compared with inflammatory markers from NLF obtained from 52 healthy controls.
  
  
  RESULTS
  Initially, the total cell count of the NLF was significantly higher in CF patients than in controls. However after i.v. antibiotic treatment it decreased to a normal level. Compared with controls, detection frequencies and absolute concentrations of MPO, IL-8, IL-6 and IL-1β were also significantly higher in CF patients. The detection frequency of TNF was also higher. Furthermore, during i.v. therapy sinonasal concentrations of IL-6 decreased significantly (P = 0.0059), while RANTES and MMP9 levels decreased 10-fold and two-fold, respectively. PMN-Elastase, assessed for the first time in NFL, did not change during therapy.
  
  
  CONCLUSIONS
  Analysis of NLF inflammatory markers revealed considerable differences between controls and CF patients, with significant changes during systemic i.v. AB treatment within just 6 days. Thus, our data support further investigation into the collection of samples from the epithelial surface of the upper airways by nasal lavage as a potential diagnostic and research tool.
authors.affiliation: CF-Centre, Pediatrics, Jena University Hospital, Jena, Germany. Julia.hentschel@med.uni-jena.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Hentschel
authors.forename: Manuela
authors.initials: M
authors.lastname: Jäger
authors.forename: Natalie
authors.initials: N
authors.lastname: Beiersdorf
authors.forename: Nele
authors.initials: N
authors.lastname: Fischer
authors.forename: Franziska
authors.initials: F
authors.lastname: Doht
authors.forename: Ruth K
authors.initials: RK
authors.lastname: Michl
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehmann
authors.forename: Udo R
authors.initials: UR
authors.lastname: Markert
authors.forename: Klas
authors.initials: K
authors.lastname: Böer
authors.forename: Peter M
authors.initials: PM
authors.lastname: Keller
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
authors.forename: Jochen G
authors.initials: JG
authors.lastname: Mainz
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000188:drug therapy*; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D019272:Leukocyte Elastase / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D017817:Nasal Lavage Fluid / Q000737:chemistry* / Q000166:cytology; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D019272:Leukocyte Elastase