Acupuncture combined with smokeless or smoky moxibustion for regulating immune function of experimental chronic rhinosinusitis mice

Abstract

To observe the therapeutic effect of moxa fume in the treatment of chronic rhinosinusitis（CRS） and the effect of acupuncture plus smokeless moxibustion or smoky moxibustion on the expression of thymic stromal lymphopoietin (TSLP) and pituitary adenylate cyclase activating polypeptide (PACAP) proteins in the sinus mucosal tissue in CRS mice. Sixty male C57BL/6J mice were randomly divided into 6 groups, namely normal control, sham operation, CRS model, medication, acupuncture plus smokeless moxibustion (Acu+smokeless Moxi) and acupuncture plus smoky moxibustion (Acu+smoky Moxi) groups, with 20 mice in each group. The CRS model was established by inserting a piece of polyporous sponge filled with streptococcus pneumoniae into the maxillary sinus after operation. The mice in the sham operation group received skin incision after opening the maxillary sinus. Mice of the medication group received gavage of clarithromycin 0.103 g·kg-1·d-1 for 21 days. For mice of the Acu+smokeless Moxi and Acu +smoky Moxi groups, manual acupuncture stimulation was applied to bilateral "Zusanli" (ST36), "Shenshu" (BL23) and "Hegu" (LI4) with the needles retained for 30 min, once every other day, and on the following day, moxibustion was applied to "Guanyuan" (CV4) and "Shenque" (BL23) for 20 min, once every other day. The treatment was given for 21 days. Mice of the normal, sham operation and model groups received gavage of normal saline (200 μL/d) for 21 days. Histopathological changes of the nasal mucosa were observed after H.E. staining, the TSLP and PACAP contents and expression were determined by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry, separately. At the end of the treatment, mice of the model group still had symptoms of nasal obstruction and runny nose, but those of the 3 treatment groups were obviously relieved in the nasal symptoms. H.E. staining showed an obvious chronic inflammatory reaction in the sinus mucosa, uneven distribution of the mucosal epithelium and necrotic and exfoliated epithelial cells, hyperplasia of fibrous tissue in the submucosa, etc. in the model group, which were relatively milder in the medication, Acu+smokeless Moxi and Acu+smoky Moxi groups, while no obvious inflammation was found in the normal group and sham operation group. In comparison with the normal group, no significant changes were found in the expression levels of PACAP and TSLP in the sham operation group (P>0.05). The expression level of PACAP was significantly lower (P<0.05) and that of TSLP significantly higher in the model group than in the normal and sham operatin groups (P<0.05). Compared with the model group, no significant changes were found in the expression of PACAP in the medication, Acu+smokeless Moxi and Acu+smoky Moxi groups (P>0.05), and the expression of TSLP was further obviously increased in the Acu+smokeless Moxi group (P<0.01), but obviously decreased in the Acu+smoky Moxi group (P<0.01). Acupuncture combined with smoky moxibustion can down-regulate the expression of TSLP protein in the nasal sinus mucosa in CRS mice, which maybe contribute to its effect in reducing the inflammatory reaction and nasal symptoms.