Abstract

Relevance: Matrix metalloproteinases (MMPs) play crucial roles in regulating immune responses. Dysregulation of MMP synthesis can lead to chronic inflammation due to excessive MMP activity. Moreover, MMP deficiency, particularly low levels of MMP-9, may also contribute to inflammation of the nasal mucosa and sinuses, potentially leading to the development of chronic rhinosinusitis (CRS). Considering the prevalence of CRS and its potential association with tissue remodelling enzymes, MMP-9 may serve as a target for potential pharmacotherapeutic interventions to reduce the frequency of CRS recurrences in patients.

Objective: The aim of this study was to determine the level of MMP-9 in preoperative serum, bone membrane, and polyp tissue samples obtained during surgical intervention, as well as to analyse the frequency of CRS recurrences in patients after treatment.

Materials and Methods: The study included a total of 87 patients diagnosed with chronic rhinosinusitis, divided into subgroups – CRS with nasal polyposis (38 patients) and CRS without nasal polyposis (with maxillary sinus cysts; 49 individuals), according to the EPOS 2020 criteria, and 12 patients with deviated nasal septum as the control group. All patients underwent standardized preoperative preparation and additional determination of MMP-9 in serum. During CRS surgical treatment, excised material (cysts, polyps) was fragmented and sent for histopathological examination. Part of this material was selected for immunohistochemical analysis using the Lechapt-Zalcman method. Statistical analysis was performed using IBM SPSS Statistics Version 22.

Results: For the subgroup with nasal polyposis, the MMP-9 plasma level was 315±31 ng/ml, for CRS without nasal polyposis – 284±38 ng/ml, and for the control group – 264±33 ng/ml. When comparing groups using t-test, no significant difference was found between the groups (p>0.05). Immunohistochemistry revealed a significantly higher MMP-9 field ratio index in the CRS with nasal polyposis subgroup, reaching 40% compared to other groups. The index for the CRS without nasal polyposis group was 24%, and for the control group, it was 18%. Within a 5-year period, the CRS with nasal polyposis subgroup had 9 recurrences, while the CRS without nasal polyposis subgroup had 3. Moreover, 7 out of 9 early recurrences in the CRS with nasal polyposis subgroup were observed in patients with a history of bronchial asthma or allergic rhinitis.

Conclusions: A significantly higher MMP-9 index was detected in the CRS with nasal polyposis subgroup, confirming a higher expression of tissue remodelling processes in patients with polyposis. The CRS with nasal polyposis subgroup experienced more recurrences within 5 years compared to the CRS without nasal polyposis subgroup, with recurrences more frequent in patients with allergic rhinitis or bronchial asthma. The obtained data suggest a potential correlation between early CRS recurrence and high MMP-9 levels in patients’ tissues, especially in patients with a history of atopy.

Keywords: MMP-9, Chronic rhinosinusitis, Nasal polyposis, Immunohistochemistry, Tissue remodelling.