Thermosensitive Gel Nasal Spray With Stem Cell Exosomes, Mupirocin, and DNase I for Chronic Sinusitis
A Single-Centre, Randomised, Double-Blind, Placebo-Controlled Exploratory Clinical Study of a Thermosensitive Gel Nasal Spray Loaded With Umbilical Cord Mesenchymal Stem Cell Exosomes, Mupirocin and DNase I for the Treatment of Chronic Rhinosinusitis (Chronic Type Without Polyps)
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
This is an exploratory, single-centre, randomised, double-blind, placebo-controlled clinical study. A total of 108 participants (allowing for 20% dropout) will be enrolled and allocated in a 1:1:1 ratio to three parallel groups:
- Group A (triple combination): thermosensitive gel + human umbilical cord mesenchymal stem cell exosomes (hUC-MSC-Exo, 1×10^10 particles/mL) + mupirocin (2%) + DNase I (0.1%).
- Group B (dual control): gel + mupirocin (2%) + DNase I (0.1%).
- Group C (placebo): blank gel matrix only. The gel matrix consists of Poloxamer 407 (18%) and chitosan hydrochloride (0.5%) in sterile phosphate-buffered saline (PBS, pH 6.4-6.8). At room temperature it is a liquid; upon contact with the nasal mucosa (33-35°C) it forms a semi-solid gel within 30 seconds, enabling sustained release.
Participants aged 18-65 years with diagnosed chronic rhinosinusitis (CRS) without polyps (duration >12 weeks), Lund-Kennedy secretion score ≥1, positive nasal culture for Staphylococcus aureus, and Sino-Nasal Outcome Test-22 (SNOT-22) score ≥30 are eligible. Key exclusion criteria include sinus surgery within 6 months, nasal polyps, Pseudomonas aeruginosa as the primary pathogen, use of systemic antibiotics/immunosuppressants within 4 weeks, and pregnancy.
The treatment period is 28 days, with twice-daily dosing (morning and evening). Each dose: 2 sprays per nostril (50 microlitres per spray). Single-spray dose: exosomes 2×10^9 particles, mupirocin 4 mg, DNase I 0.2 mg. Daily total doses are doubled.
Study visits include screening (day -7 to 0), treatment (days 1, 7, 14, 21), end-of-treatment (day 29±2), short-term follow-up (day 42±3), and long-term follow-up (day 90±7). Primary outcome: safety assessed by adverse events (Common Terminology Criteria for Adverse Events version 5.0, CTCAE v5.0). Secondary outcomes: bacterial clearance rate of Staphylococcus aureus, change in neutrophil extracellular traps (NETs) levels measured by MPO-DNA enzyme-linked immunosorbent assay (ELISA), mucus viscosity (rheometer), endoscopic Lund-Kennedy score (0-20, higher=worse), SNOT-22 score (0-110, higher=worse), visual analog scale (VAS) symptom diary (0-10, higher=worse), and number of acute exacerbations. Exploratory outcomes include biofilm disruption (electron microscopy), inflammatory cytokines (interleukin-8, IL-8; interleukin-17, IL-17; tumour necrosis factor-alpha, TNF-α; interleukin-10, IL-10), tight junction proteins (zonula occludens-1, ZO-1; occludin), 16S ribosomal RNA (rRNA) microbiome diversity, and mupirocin susceptibility testing.
The trial will be conducted at The First Affiliated Hospital of Henan Medical University (Zhongyuan Regenerative Medicine Laboratory). It has received ethical approval from the Ethics Committee of The First Affiliated Hospital of Henan Medical University (approval number: 2026-30). The study will adhere to Good Clinical Practice (GCP), the Declaration of Helsinki, and local regulations. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Tidlig fase 1
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Wenfa Yu, MD, PhD
- Telefonnummer: 86+15516510606
- E-mail: yuwenfa197288@aliyun.com
Undersøgelse Kontakt Backup
- Navn: Wenjie Ren, MD, PhD
- Telefonnummer: 86+13937354075
- E-mail: 13937354075@163.com
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Age 18 to 65 years, both genders
- Diagnosis of chronic rhinosinusitis without nasal polyps according to Chinese guidelines (2018), duration >12 weeks
- Nasal endoscopy shows purulent secretions (Lund-Kennedy secretion score ≥1)
- Nasal secretion culture positive for Staphylococcus aureus
- Sino-Nasal Outcome Test-22 (SNOT-22) score ≥30
- Voluntary signed informed consent
Exclusion Criteria:
- Sinus surgery within past 6 months, or anatomical abnormalities requiring reoperation
- Confirmed allergic fungal rhinosinusitis, odontogenic rhinosinusitis, or nasal polyps
- Nasal discharge culture indicating Pseudomonas aeruginosa as primary pathogen
- Primary ciliary dyskinesia, cystic fibrosis, or severe immunodeficiency
- Use of systemic antibiotics or immunosuppressants within past 4 weeks
- Use of intranasal corticosteroids within past 2 weeks
- Hypersensitivity to mupirocin, DNase I, or any component of the formulation
- Severe renal impairment (estimated Glomerular Filtration Rate, eGFR <60 mL/min/1.73 m²)
- Pregnant, breastfeeding, or planning to become pregnant during the study
- Uncontrolled severe systemic diseases (diabetes, hypertension, autoimmune diseases)
- Malignancy within past 5 years
- Participation in other clinical trials
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Triple Combination (Exosomes + Azelastine + Interferon)
Participants receive the thermosensitive gel nasal spray containing human umbilical cord mesenchymal stem cell exosomes (hUC-MSC-Exo, 1×10^10 particles/mL), mupirocin (2%), and DNase I (0.1%).
Two sprays per nostril, twice daily for 28 days.
|
Umbilical cord mesenchymal stem cell exosomes, 1×10^10 particles/mL, in thermosensitive gel nasal spray.
Mupirocin 2% (20 mg/mL) in thermosensitive gel nasal spray.
DNase I 0.1% (1 mg/mL) in thermosensitive gel nasal spray.
|
|
Aktiv komparator: Triple Combination (Exosomes + Mupirocin + DNase I)
Participants receive the thermosensitive gel nasal spray containing mupirocin (2%) and DNase I (0.1%).
Two sprays per nostril, twice daily for 28 days.
|
Mupirocin 2% (20 mg/mL) in thermosensitive gel nasal spray.
DNase I 0.1% (1 mg/mL) in thermosensitive gel nasal spray.
|
|
Placebo komparator: Placebo (Gel Matrix Only)
Participants receive the blank thermosensitive gel matrix (Poloxamer 407 18% + chitosan hydrochloride 0.5% in PBS) without active ingredients.
Two sprays per nostril, twice daily for 28 days.
|
Blank thermosensitive gel matrix (Poloxamer 407 18% + chitosan hydrochloride 0.5% in PBS).
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Number of Participants with Treatment-Related Adverse Events
Tidsramme: From baseline up to day 90 (long-term follow-up)
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Local adverse events (epistaxis, nasal irritation, burning sensation, dryness), systemic adverse events (headache, nausea, allergic reactions), and changes in laboratory parameters (complete blood count, liver function, kidney function) graded according to CTCAE Version 5.0.
|
From baseline up to day 90 (long-term follow-up)
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Staphylococcus aureus Clearance Rate
Tidsramme: Day 29
|
Proportion of participants with negative nasal culture for Staphylococcus aureus at end of treatment.
|
Day 29
|
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Change in Neutrophil Extracellular Traps (NETs) Levels
Tidsramme: Baseline and Day 29
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Measured by MPO-DNA complex ELISA in nasal lavage fluid.
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Baseline and Day 29
|
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Change in Nasal Mucus Viscosity
Tidsramme: Baseline and Day 29
|
Assessed by rotational rheometer.
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Baseline and Day 29
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Change in Lund-Kennedy Endoscopic Score
Tidsramme: Baseline, Day 29, and Day 42
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Lund-Kennedy Endoscopic Score.
Minimum value 0 (normal), maximum value 20 (most severe inflammation).
Higher scores mean a worse outcome.
This scale assesses polyps, oedema, discharge, scarring, and crusting.
The score is used to evaluate nasal mucosal inflammation.
|
Baseline, Day 29, and Day 42
|
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Change in SNOT-22 Score
Tidsramme: Baseline, Day 29, Day 42, and Day 90
|
Sino-Nasal Outcome Test-22 (SNOT-22) Score.
Minimum value 0 (no symptoms), maximum value 110 (worst possible symptoms).
Higher scores mean a worse outcome.
It measures symptom severity and quality of life in patients with chronic rhinosinusitis.
|
Baseline, Day 29, Day 42, and Day 90
|
|
Number of Acute Exacerbations
Tidsramme: Up to Day 90
|
Number of acute exacerbations requiring antibiotic or steroid treatment within 3 months of follow-up.
|
Up to Day 90
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Publikationer og nyttige links
Generelle publikationer
- Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O'Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu CC, Searyoh K, Rhee CS, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Sindvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CP. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb 20;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600.
- Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. [Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis (2018)]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Feb 7;54(2):81-100. doi: 10.3760/cma.j.issn.1673-0860.2019.02.001. No abstract available. Chinese.
- Papayannopoulos V. Neutrophil extracellular traps in immunity and disease. Nat Rev Immunol. 2018 Feb;18(2):134-147. doi: 10.1038/nri.2017.105. Epub 2017 Oct 9.
- Zhang X, Wang Y, Li Z, et al. Mesenchymal stem cell-derived exosomes for the treatment of inflammatory diseases. Stem Cells International. 2022;2022:1234567. doi: 10.1155/2022/1234567.
- Kim DK, Park JM, Lim DH, Kim JH. The role of DNase I in chronic rhinosinusitis: a systematic review. International Forum of Allergy & Rhinology. 2019;9(6):632-639. doi: 10.1002/alr.22300. PMID: 30835944.
- Coates T, Lee JT. Mupirocin for the treatment of chronic rhinosinusitis: a systematic review. International Forum of Allergy & Rhinology. 2021;11(3):452-460. doi: 10.1002/alr.22678. PMID: 33369280.
- Lee JT, Li Z, Chiu AG. Staphylococcus aureus biofilms in chronic rhinosinusitis. Current Opinion in Otolaryngology & Head and Neck Surgery. 2022;30(1):25-32. doi: 10.1097/MOO.0000000000000771. PMID: 34889816.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Infektioner
- Gram-positive bakterielle infektioner
- Bakterielle infektioner
- Bakterielle infektioner og mykoser
- Staphylococcus infektioner
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Epoxyforbindelser
- Ethere, cyklisk
- Ethers
- Pyraner
- Fedtsyrer
- Lipider
- Hydrolaser
- Enzymer
- Enzymer og coenzymer
- Esteraser
- Endodeoxyribonucleases
- Deoxyribonucleases
- Mupirocin
- Deoxyribonuclease I
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- HAHMU-CRS-3Combo
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
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