Regenerative treatment

Stromal vascular fraction (SVF) contains mesenchymal stem cells and other cells with regenerative and anti-inflammatory properties. To evaluate its therapeutic potential in ENS, ten patients with a history of turbinoplasty and a positive cotton test received a single SVF injection.

For this treatment, abdominal fat harvesting was performed under intravenous anesthesia. A small incision was made below the belly button to remove about 50–100 grams of the patient’s own abdominal fat.

Only two of the nine patients reported meaningful improvement (significantly reduced SNOT-25 score after 6 months). However, injection reduced the levels of inflammatory cytokines, measured by a nasal secretion analysis. Authors assume that a single SVF injection may not be enough to achieve meaningful improvement. Repeated treatments would require additional fat harvesting, which is invasive and burdensome.

Fifty-two ENS patients were randomly distributed in two equal groups: group I was subjected to submucosal fat implant injection and group II was subjected to submucosal fat implant with ADSCs injection.

Improvement was assessed using the SNOT-25 test, anterior rhinoscopy, endoscopic examination, and the saccharin test. Evaluations were performed preoperatively and at 1, 3, 6, 12, and 18 months after surgery. In addition, a punch biopsy of turbinate tissue was analyzed histopathologically and by RT-PCR to measure nasal expression of lysozyme and mucin-4.

Both groups showed significant improvement in SNOT-25 scores after surgery, which persisted throughout the 18-month follow-up. Saccharin clearance times improved in both groups. Histopathological examination revealed greater regeneration of the mucosa and submucosa in the fat + ADSC group. RT-PCR analysis showed strong expression of two key nasal mucosa markers, lysozyme and MUC4, which support local immune defense and normal mucus production.

Adipose-derived stem cells (ADSCs) produce and secret cytokines/growth factors that help repair the mucosa. 30 patients (age 22 - 30), with secondary ENS caused by a bilateral nasal surgery underwent transplantation of ADSCs combined with autologous fat grafting (patient’s own fat is taken from other part of the body). 28 of the patients experienced symptomatic improvement:

• increased moistening of the nasal mucosa

• decreased tension of the mucosa and of nasal cavity pain when breathing

• improved quality of sleep

However, only two patients experienced improvement of nasal cavity dryness, and excessive breathing remained an issue.