Published ahead of print on April 17, 2003, doi:10.1164/rccm.200207-640OC Am. J. Respir. Crit. Care Med., Volume 168, Number 3, August 2003, 281-286 A more recent version of this article appeared on August 1, 2003
Submitted on July 2, 2002 Reduced nitric oxide in sinus epithelium of patients with radiologic maxillary sinusitis and sepsisMaria Deja1,1 Anesthesiology and lntensive Care Medicine, Charite, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany, 2 Anatomy, Charite, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany, 3 Pathology, Charite, Campus Mitte, Humboldt University, Berlin, Germany, 4 Maxillofacial Surgery, Charite, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany, 5 Center of Pharmacology, Johann Wolfgang Goethe University, Frankfurt, Germany * To whom correspondence should be addressed. 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 anti-bacterial 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 in patients without airway inflammation (n=11, controls). Despite of local inflammation and infection, we found considerably lower maxillary nitric oxide levels than in controls (31±10 vs. 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. Applying ultrastructural immunolocalization, we identified cilia and microvilli of the maxillary sinus epithelium as the major nitric oxide production site in controls. Our findings provide evidence for a markedly reduced nitric oxide production in maxillary sinuses of patients with radiologic maxillary sinusitis and sepsis that implicates impaired local host defense and an increased risk for secondary infections. Key words: nitric oxide, radiologic maxillary sinusitis, inducible nitric oxide synthase expression
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