Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome

BackgroundAdhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone.MethodsIn this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively.ResultsA significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p < 0.05) in all three treatment groups compared with the control. There was no significant difference noted between patients who received Chitogel alone and those who received Chitogel with 1 or 5 mM deferiprone.ConclusionChitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel

Topical Therapies for the Management of Recalcitrant Chronic Rhinosinusitis

This thesis encompasses research investigating topical therapies to improve the management of recalcitrant chronic rhinosinusitis (CRS). Chapter one of this thesis reviews the current literature pertaining to CRS including its aetiopathogenesis and the role of the sinonasal microbiome. It also outlines current management and factors leading to poor outcomes after surgery such as bacterial dysbiosis, inflammation and scarring. The use of two topical agents Chitogel®, a hydrogel composed of chitosan and dextran, and deferiprone, an iron chelating drug are reviewed for their potential to improve surgical outcomes. A review of sinonasal delivery devices for topical delivery of medication is presented with particular reference to intranasal nebulisers. The second chapter presents a double-blinded randomised controlled trial to investigate the effect that Chitogel has on the sinonasal microbiome and infections following endoscopic sinus surgery (ESS). Chitogel was found to significantly improved both the nasoendoscopic appearance of the sinuses and sinus ostial patency at 12 weeks postoperative. Significantly, Chitogel was also found to restore a healthier microbiome following ESS, resulting in an increase in the relative abundance of beneficial commensals Corynebacterium and Cutibacterium (Propionibacterium). In keeping with the improvement seen in the microbiome, a significant decrease in postoperative infections was noted following use of Chitogel.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Datasheet1_Chitogel with deferiprone following endoscopic sinus surgery: improved wound healing and microbiome.pdf

BackgroundAdhesion formation, sinus ostial narrowing, and presence of pathogenic bacteria are associated with poor outcomes following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. Chitogel has been shown to improve wound healing, restore a healthier microbiome, and reduce post-operative infections post ESS. Deferiprone has antibacterial properties and has been shown to reduce adhesion formation. The aim of the study was to assess whether the addition of low concentration deferiprone to Chitogel further improves surgical outcomes following ESS compared with Chitogel alone.MethodsIn this double-blinded trial, 45 patients undergoing ESS were prospectively recruited. At the end of the surgery, patients were randomised to receive Chitogel alone, Chitogel with 1 mM of deferiprone, or Chitogel with 5 mM of deferiprone to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-ups with symptom questionnaires and nasoendoscopies performed at 2, 6, and 12 weeks post-operatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral middle meatuses were collected intraoperatively and at 12 weeks post-operatively.ResultsA significant improvement in the endoscopic appearance of the sinuses and frontal ostial patency was noted at 12 weeks post-operatively (p ConclusionChitogel alone, Chitogel with 1 mM deferiprone, and Chitogel with 5 mM deferiprone used following ESS led to a significant improvement in endoscopic appearance of the sinuses and frontal ostial preservation at 12 weeks post-operatively. No significant difference was found with the addition of deferiprone to Chitogel.</p