Changes in non-specific proteases and their inhibitors in the course of acute purulent rhinosinusitis treatment with mucoactive drugs

Objective of the study is to determine the influence of mucoactive drugs of various groups on the activity of non-specific proteases and their inhibitors in the blood serum and sinonasal discharge during treatment of patients with acute purulent rhinosinusitis.

Materials and methods. 48 patients with acute purulent rhinosinusitis were treated; they were randomly assigned to four groups: N-acetylcysteine was used in Group 1 (n = 11), S-carboxymethylcysteine – in Group 2 (n = 14), phytoneering herbal drug (BNO-101) Sinupret – in Group 3 (n = 13). The control group consisted of patients (n = 10) who did not receive mucoactive agents during the treatment. Normal values were determined in 12 healthy volunteers. The material for the study included blood serum and sinonasal discharge of the patients. We studied elastase-like activity, trypsin-like activity, antitryptic activity and acid-stable inhibitors.

Results. Conducted treatment course resulted in improved clinical symptoms and decreased proteolytic activity in the blood serum and sinonasal discharge of the patients with acute purulent rhinosinusitis as compared to the patients’ parameters before treatment. Against this background, the state of proteinase inhibitors did not significantly change. This is primarily caused by the fact that antitryptic activity in acute purulent rhinosinusitis remained practically unchanged as compared to the parameter at the beginning of treatment. However, there is a tendency towards an increase in the inhibitory potential during treatment with mucoactive drugs. The highest level of this increase was observed when patients were taking BNO-101. On Day 10 of the study it resulted in the significant increase in antitryptic activity(ATA) as compared to the group prior to the treatment. The level of acid-stable inhibitors (ASI) in patients with purulent rhinosinusitis significantly decreased in the settings of acute purulent inflammation, and the activity of ASI increased during the treatment.

Conclusion. The study of non-specific proteases and antiprotease potential of sinonasal discharge demonstrates that the decrease in protease activity and normalization of their inhibitors level depends on the mucoactive agent chosen. The most effective treatment option reduces the aggressive effect of non-specific proteases on mucosa and connective tissue structures. The mucoactive drugs’ effect of improved drainage increases antiprotease potential by restoring the structure and functional activity of the mucosa. Restoration of mucosa increases synthesis and secretion of acid-stable protease inhibitors which are the key component of local antiprotease protection. 

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