Published ahead of print on April 17, 2003, doi:10.1164/rccm.200207-640OC
© 2003 American Thoracic Society Reduced Nitric Oxide in Sinus Epithelium of Patients with Radiologic Maxillary Sinusitis and SepsisDepartments of Anesthesiology and Intensive Care Medicine, Anatomy, and Maxillofacial Surgery, Charité, Campus Virchow-Klinikum; Department of Pathology, Charité, Campus Mitte, Humboldt University, Berlin; and Center of Pharmacology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany Correspondence and requests for reprints should be addressed to K. Lewandowski, M.D., Klinik für Anaesthesiologie und Operative Intensivmedizin, Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail: klaus.lewandowski{at}charite.de 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 2,554 ± 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.
Key Words: inducible nitric oxide synthase expression • nitric oxide • radiologic maxillary sinusitis This article has been cited by other articles:
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