Medicine by Alexandros G. Sfakianakis: Nasal mucus transplant

Thursday, April 18, 2019

Nasal mucus transplant

https://vancouversun.com/news/local-news/believe-it-or-snot-st-pauls-nasal-mucous-transplant-study-targets-inflamed-sinuses

Believe it or snot: St. Paul's nasal mucus transplant study targets inflamed sinuses

In the first study of its kind, patients with chronic sinus conditions will get transplanted nasal mucus from close relatives with healthy snot.

PAMELA FAYERMAN

Dr. Amin Javer, with study subject Maggie Bernet, shows how photodynamic therapy — a blue-light treatment that sterilizes the nasal cavity as it kills bacterial and viruses — works as part of the broader nasal mucous transplant study at St. Paul's Hospital.

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There's healthy snot, then there's the other kind. And now those with good nasal mucus will be donating their slimy stuff to relatives suffering from chronically inflamed sinuses in a novel transplantation study at St. Paul's Hospital.

Study leader Dr. Amin Javer said in an interview the inspiration for the chronic rhinosinusitis (CRS) study is the success of fecal transplants for inflammatory bowel diseases and colitis caused by Clostridium difficile (C-diff). A member of his research team — epidemiologist Amee Manges — has been involved in several human microbiome studies related to the higher risk of hospitalized patients getting potentially deadly C-diff infections.

Just as in bowel disorders, good microorganisms — known as microbiome — in the sinus are disrupted and outnumbered by slimy groups of damaging bacterial and/or viral micro-organisms. Antibiotic therapy is not only often useless but often more damaging since antibiotics cut a wide swath, taking down good bacteria along with the bad.

The chronic sinus condition is common; it is said to affect up to 12 per cent of the North American population. Indeed, the hospital clinic gets 6,000 outpatient visits a year, many of them patients with the chronic sinus condition.

Ethics approval for the St. Paul's Hospital sino nasal microbiota transplant study, as it is called, has been granted by the hospital and the University of B.C. But Javer is waiting for final approval from Health Canada, which he expects to get next month.

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The study aims to answer whether transplants are both beneficial and safe in patients with the chronic condition. The working hypothesis is that inflammation, mucous discharge and recurring infections will indeed be improved by renewing and replenishing the sinus microbiome with healthy snot from donors.

What would recovery look like? No more constant coughing, no more blocked nasal passages, no more dripping from their noses, no more headaches, sinus infections, fatigue and poor sleep, among many other symptoms.

A patient getting photodynamic therapy with a blue light that sterilizes sinuses by killing bacterial and viral germs. (Photo: Handout)

A patient getting photodynamic therapy with a blue light that sterilizes sinuses by killing bacterial and viral germs. HANDOUT

Potential donors are now being screened and patients enrolled in the non-transplant arm of the study. Those patients will receive only photodynamic therapy — a blue-light treatment that sterilizes the nasal cavity as it kills all bacteria and viruses. While two-thirds of patients who get such treatment reportedly improve, the effect is short term. Just like antibiotics, it doesn't distinguish between beneficial germs and bad ones, so a small number of patients actually get worse.

A second group in the study will be randomized to phototherapy plus the transplant while a third will get only the transplant. About 200 participants will be enrolled in the study.

Former nurse Pat Taylor is one of the participants in the trial. She's been randomized to the branch of patients receiving only blue-light therapy. The Victoria resident said most people have no idea how life-altering and disabling chronic sinusitis is.

"It is financially, physically and emotionally debilitating with a poor quality of life. Many health professionals know little or nothing about CRS, so many people go undiagnosed," she said, adding that patients often bounce around between specialists like respirologists and allergists, often to no avail.

Javer echoes her sentiments. "Chronic sinusitis has been shown by research to totally ruin the quality of life of patients. It's a disease that creates so much emotional distress for people. I've got patients who tell me they'd rather be dead than endure all these symptoms. One patient from Prince George recently said to me that if I couldn't fix him, he'd rather I killed him."

Javer said he's convinced a "sinus probiotic" is needed to repopulate unhealthy sinus cavities with healthy microbes. Without a beneficial probiotic, harmful pathogens find a way to return and multiply in the nasal cavity, ensuring the recurrence of the sinus disorder.

'We think the transplants using healthy donor microbiome could drastically improve the long-term health of those with diseased sinuses," he said, adding that a recently started study in Sweden is also exploring the use of sinus microbiome transplants. In that study, phototherapy is not being used and no results have yet been reported.

Javer said research has not yet pointed to the cause of the sinus disorder but it starts when something alters the environment in the nasal/sinus cavity.

"It can be a virus or a cold that starts this cascade of symptoms, and what's worse is patients get antibiotics from their family doctors and the vast majority of them don't need them," said Javer. "Prescribing oral antibiotics when you aren't sure they are needed can be the worst thing you can do because they can alter the microbiome."

The $300,000 study is funded through private donations to a charitable foundation that Javer established at St. Paul's Hospital. The funds are earmarked for sinus disorders.

pfayerman@postmedia.com

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Thursday, April 18, 2019

Nasal mucus transplant

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