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Anti-biofilm activity of bacteriophages and lysins in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an otolaryngological disease with a recalcitrant nature, predominantly due to antibiotic resistant bacteria and the biofilm formation. The intracellular residency of Staphylococcus aureus bacteria was observed in CRS. The overall prevalence of CRS is estimated between 5-15% in the human population, and biofilms were formed in sinuses in 40-80% of cases. The bacterial species S. aureus and Pseudomonas aeruginosa are known to form difficult to treat biofilms in CRS. Bacteriophages (phages) or lysins can be alternatives to antibiotics in the biofilm treatment. The application of a P. aeruginosa phage cocktail ex vivo decreased biofilm biomass of bacterial isolates from the sinuses of CRS patients by a median of 70%. Further, animal studies performed on a sheep sinusitis model demonstrated significant reduction in S. aureus and P. aeruginosa biofilm biomass by phage cocktails while maintaining safe prolonged topical application (up to 20 days). Staphylococcal lysin P128 used at a concentration of ≥12.5 µg/ml in vitro against the biofilm of methicillin sensitive S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) isolates from the sinuses of CRS patients demonstrated a significant reduction of the biofilm (up to 95.5%). Staphylococcal lysin CHAP(k) applied in vivo in mice nasal infection caused a significant 2 log reduction of S. aureus suggesting its potential use against bacteria in nasal mucosa. Furthermore, a beneficial effect of phage therapy in the treatment of chronic sinusitis in humans was observed. Here, we summarize the recent, quite scarce data regarding phage application in chronic rhinosinusitis and look further into this phenomenon. Keywords: bacteriophages; biofilm; chronic rhinosinusitis; lysins; phage therapy.