REMODELING OF NASAL MUCOSA DEPENDING ON THE PHENOTYPE OF CHRONIC RHINOSINUSITIS AND ENDOPROTEASE EXPRESSION

Ostrovska DA

Bogomolets National Medical University

Email: dr.ostrovskaya.d@gmail.com

Abstract

Background: As of today, chronic rhinosinusitis (CRS) characterized by inflammatory processes and tissue remodeling of the mucosal lining is classified into two phenotypes: chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent endopeptidases that play a crucial role in degrading basement membranes and extracellular matrix. MMP-7 and MMP-9 may play significant roles in CRS development.

Objective: To determine the level of zinc-dependent endopeptidases in the tissues of patients with CRSwNP and CRSsNP.

Materials and Methods: The study included 54 patients meeting the inclusion criteria, among them 12 patients in the control group, and 21 patients each in subgroup A (CRSwNP) and subgroup B (CRSsNP) of the main group. Patients underwent SNOT-22 questionnaire, endoscopic evaluation using the Lund-Kennedy scale, CT scans graded by the Lund-Mackay scale, and levels of MMP-9 and MMP-7 enzymes were determined in surgically removed fragments of pathological tissues.

Results: It was found that CRSwNP is more commonly associated with olfactory dysfunction. However, obstruction of the olfactory cleft by polypoid elements, according to CT scans, was observed in only 19.04% of cases (4 out of 21 patients). The level of MMP-7 for the control group was 8.17±5.15 μg/ml, for subgroup A it was 23.67±11.89 μg/ml, and for subgroup B it was 17.93±9.88 μg/ml. Student’s t-test revealed no significant difference between subgroups A and B of the main group, p>0.05 (T-statistic: 1.7; p-value: 0.09). However, when compared individually with the control group, a statistical difference was observed in each case, p<0.05. In contrast to MMP-7 data, statistically significant differences were observed when comparing the MMP-9 levels of each group using the t-test, p<0.05. The distribution of mean MMP-9 levels for the groups was as follows: control group – 17.49±8.81 μg/ml, subgroup A – 36.04±16.03 μg/ml, and subgroup B – 26.06±11.04 μg/ml.

Conclusions: MMP-9 and MMP-7 are key enzymes involved in the formation of polypoid tissue or pseudocysts in different phenotypes of CRS and influence the severity of the disease’s clinical course. Therefore, these endopeptidases could potentially serve as biomarkers for CRS activity and as targets for new therapeutic agents that could inhibit them.

Keywords: chronic rhinosinusitis, endoproteases, MMP-9, MMP-7, nasal cavity, nasal mucosa, nasal polyps, nasal cavity pseudocysts.