Abstract
The nose provides a route of access to the body for inhalants and fluids. Unsurprisingly it has a strong immune defense system, with involvement of innate (e.g., epithelial barrier, muco- ciliary clearance, nasal secretions with interferons, lysozyme, nitric oxide) and acquired (e.g., secreted immunoglobulins, lymphocytes) arms. The lattice network of dendritic cells surrounding the nostrils allows rapid uptake and sampling of molecules able to negotiate the epithelial barrier. Despite this many respiratory infections, including SARS-CoV2, are initiated through nasal mucosal contact, and the nasal mucosa is a significant “reservoir” for microbes including Streptococcus pneumoniae, Neisseria meningitidis and SARS -CoV-2. This review includes consideration of the augmentation of immune defense by the nasal application of interferons, then the reduction of unnecessary inflammation and infection by alteration of the nasal microbiome. The nasal mucosa and associated lymphoid tissue (nasopharynx-associated lymphoid tissue, NALT) provides an important site for vaccine delivery, with cold-adapted live influenza strains (LAIV), which replicate intranasally, resulting in an immune response without significant clinical symptoms, being the most successful thus far. Finally, the clever intranasal application of antibodies bispecific for allergens and Intercellular Adhesion Molecule 1 (ICAM-1) as a topical treatment for allergic and RV-induced rhinitis is explained.
Highlights
Yorissa Padayachee 1, Sabine Flicker 2, Sophia Linton 3,4, John Cafferkey 1, Onn Min Kon 5, Sebastian L
The authors concluded that a minimum dose of 5-million international units (MU) IFN-α2 in family contacts is necessary to achieve acceptable post-exposure RV protection [44]. These findings suggest that it is possible for high-dose IFN-α2 to reduce the spread of common colds in family settings, in locations where RV infections are prevalent [37, 41,42,43]
De Grandi et al investigated the effects of a 7-day treatment regimen of S. salivarius 24SMBc and S. oralis 89a in 22 healthy volunteers. They a saw significant temporary decrease in Corynebacterium diphtheriae, Haemophilus parainfluenzae, Moraxella catarrhalis, Prevotella denticola, Prevotella melaninogenica, Rothia dentocariosa, Staphylococcus aureus, and Streptococcus pseudopneumoniae. These findings suggest a potential ability of S. salivarius 24SMBc and S. oralis 89a to regulate and reorganize the nasal microbiota composition, TABLE 1 | Human clinical trials investigating intranasal probiotic formulations
Summary
Two puffs per nostril 1 week 60 children 1–8 y.o with SOM and 19 healthy controls. No sig. dif. in episodes of AOM than placebo No sig. dif. in nasopharyngeal flora than placebo ↓ H. influenzae in the active group. The feasibility of such an approach has been demonstrated by a series of in vitro experiments [193]. Using this refined technology two fully human IgG4 antibodies specific for Fel d 1, the major cat allergen were generated recently and shown to be effective for the treatment of cat allergy in a clinical trial (Figure 2) [213] This proof of principle study showed that a single subcutaneous injection of a mixture of these two human monoclonal IgG4 antibodies significantly reduced allergic symptoms in cat allergic patients and the effect of treatment lasted for ∼3 months [213]. This study suggested that treatment by passive immunization with allergen-specific IgG which blocks allergic patients IgE binding to the culprit allergen can be an effective treatment for allergy but there are limitations of this approach
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