Anti-Inflammatory Properties of Xylitol in a Model of Chronic Sinus Disease

Abstract

Background. Chronic rhinosinusitis is a highly prevalent condition estimated to affect 9% of the adult population in Australia. It is responsible for a significant burden of disease at a population level and imparts considerable morbidity and reduced quality of life to affected individuals. Recent American data has suggested an $8.6 billion annual direct healthcare cost associated with chronic rhinosinusitis. Few medical options for treating chronic rhinosinusitis exist and there is a paucity of evidence in support of a best medical treatment. Currently available treatments confer a modest benefit. The hallmark of chronic rhinosinusitis is chronic inflammation of the nasal and sinus mucosa lasting in excess of twelve weeks and resulting in typical symptoms. Chronic rhinosinusitis is a multi-factorial disease for which there are many postulated contributory factors. Although the aetiology of the disease is yet to be fully elucidated, current literature suggests the primacy of immune dysfunction in its pathogenesis and treatment recalcitrance. Characteristic inflammatory cell infiltrates and cytokine response have been identified for chronic rhinosinusitis subtypes. Inflammatory mediators with altered activity and/or expression in chronic rhinosinusitis represent potential therapeutic targets. Aims and Objectives. This study sought to investigate the anti-inflammatory and immune modulating activity of xylitol, an agent that has anecdotal utility in CRS and established antibacterial and antibiofilm actions. In order to achieve this aim inflammatory mediator targets were identified and the activity of xylitol against their production was examined relative to that of established anti-inflammatory agents. A further objective in this study was to establish a cell-based in-vitro model that best resembled the clinical condition of CRS and considered the effect of xylitol on epithelial and immune cells likely to be encountered in-vivo.