Drug-Eluting Endotracheal Tubes May Prevent Bacterial Inflammation in Patients with Subglottic Stenosis

Can engineered novel drug-eluting endotracheal (ET) tubes prevent bacterial inflammation in subglottic stenosis (SGS)?

BOTTOM LINE

An effective eluting ET tube to modulate upper-airway bacterial infection during intubation could be deployed to help prevent SGS.

BACKGROUND: SGS is caused by dysregulated laryngotracheal fibroblasts leading to the formation of scar tissue. Most treatments for SGS have high rates of restenosis; however, recent studies have shown correlations between SGS and dysregulated laryngotracheal microbiomes, which suggests that bacterial modulation is a potentially preventative treatment for SGS.

STUDY DESIGN: Controlled in vitro study.

SETTING: Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa.

SYNOPSIS: To modulate the microbiome in SGS patients, researchers sought to introduce antimicrobial peptides (AMPs) as an antibacterial therapy. Noting that most iatrogenic SGS cases are induced by laryngotracheal injury associated with trauma intubations or use of oversized ET tubes (followed by microbial dysbiosis and inflammation), researchers designed an AMP- and polymer-coated ET tube. Their selected peptide, Lasioglossin-III (Lasio), was released from the tubes linearly, with release quantified over two weeks via fluorometric peptide assays. The antibacterial activity was tested against airway microbes by placing Lasio/poly(D,Llactide- co-glycolide) (PLGA)-coated tubes and appropriate controls in 48 well plates with diluted bacteria. The researchers achieved a homogeneous coating that yielded a prolonged, linear release for over one week. They observed significant antibacterial activity against Staphylococcus epidermidis, Streptococcus pneumoniae, and human microbiome samples, as well as prevention of bacterial adherence to the tube. The released Lasio did not cause cytotoxicity toward laryngotracheal fibroblasts or lung epithelial cells in vitro. Although there are areas requiring further investigation prior to implementation in patients, authors concluded that Lasio/PLGA-coated ET tubes represent a clinically translatable technology that is easy to produce and can predictably elute AMPs continuously over the normal duration of chronically intubated patients.

CITATION: Aronson MR, Ghavimi SAA, Gehret PM, et al. Drug-eluting endotracheal tubes for preventing bacterial inflammation in subglottic stenosis [published online ahead of print July 28, 2021]. Laryngoscope. doi:10.1002/lary.29769.