Nasal mucous transplants can change lives, study says
St. Paul’s Hospital site of groundbreaking research
There’s healthy snot, then there’s the other kind. And now those people with good nasal mucous 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 like what happens in bowel disorders, good microorganisms in the sinus (microbiome) are disrupted and outnumbered by slimy groups of damaging bacterial and/or viral micro-organisms. Not only is antibiotic therapy often useless, but it can be 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 whom are patients with the chronic sinus condition.
Ethics approval for the St. Paul’s Hospital Sino Nasal Microbiota Transplant (SNMT) 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.
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.
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 bluelight 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 gets 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 such as 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.”