American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 352-355, (2002)
© 2002 American Thoracic Society
Effects of Recombinant Human DNase and Hypertonic Saline on Airway Inflammation in Children with Cystic Fibrosis
Ranjan Suri,
Lindsay J. Marshall,
Colin Wallis,
Christopher Metcalfe,
Andrew Bush and
Janis K. Shute
Department of Respiratory Paediatrics, Royal Brompton Hospital, London; Respiratory Unit, Great Ormond Street Hospital, London; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth; and Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, United Kingdom
Correspondence and requests for reprints should be addressed to Dr. Ranjan Suri, MRCPCH, Department of Respiratory Paediatrics, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK. E-mail: suriranjan{at}hotmail.com
Recombinant human DNase (rhDNase) is an established treatment in cystic fibrosis (CF), but it may liberate cationic mediators bound to DNA in the airways. An alternative mucolytic therapy is hypertonic saline (HS); however, HS may potentiate neutrophilic inflammation. We compared the effect of rhDNase and HS on cationic proinflammatory mediators in CF sputum. In a randomized, crossover trial, 48 children with CF were allocated consecutively to 12 weeks of once-daily 2.5 mg rhDNase, alternate-day 2.5 mg rhDNase, and twice-daily 7% HS. Sputum levels of total interleukin-8 (IL-8), free IL-8, myeloperoxidase, eosinophil cationic protein, and neutrophil elastase (NE) activity were measured before and after each treatment. The change in mediator levels from baseline with daily rhDNase and HS was not significant; however, with alternate-day rhDNase, there was an increase in free IL-8. When changes in mediator levels with daily rhDNase were compared with alternate-day rhDNase and HS, no significant differences were detected. Only changes in NE activity were associated with changes in lung function. In summary, we were unable to show that rhDNase or HS promote airway inflammation in CF.
Key Words: cystic fibrosis • inflammation • rhDNase • saline
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