Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 25;2(4):100098.
doi: 10.1016/j.bvth.2025.100098. eCollection 2025 Nov.

Nasal RADA16 hydrogel application decreases epistaxis severity scores in adults with hereditary hemorrhagic telangiectasia

Avraham Adelman  1 , Eunice Im  1 , Lindsey Jackson  1 , Anil Patel  1 , Nikita Chapurin  1 , Christina Eagan  2 , Ali Ataya  2 , Marc Zumberg  3 , Jennifer K Mulligan  1 , Carl Atkinson  4 , Brian C Lobo  1 , Jeb M Justice  1
Affiliations

Nasal RADA16 hydrogel application decreases epistaxis severity scores in adults with hereditary hemorrhagic telangiectasia

Avraham Adelman et al. Blood Vessel Thromb Hemost. .

Abstract

More than 90% of adults with hereditary hemorrhagic telangiectasia (HHT) experience epistaxis, which can be recurrent and cause significant morbidity. RADA16 is a self-assembling peptide hydrogel approved by the US Food and Drug Administration for hemostasis and wound healing. In this cohort study, we assessed the effectiveness of nasal RADA16 application in controlling HHT-related epistaxis. A retrospective chart review was performed on a cohort of adult patients who received nasal RADA16 without any other changes in treatment. Pre- and post-Epistaxis Severity Scores (ESS), hemoglobin, and hematocrit were collected to assess treatment response. Of the included patients (n = 22), there were 26 applications of RADA16. The cohort was 54.5% male and 86.4% White, had a mean age of 55.5 years, and had a predominantly ACVRL1 genotype (40.9%). Baseline mean ESS was 5.0 and decreased by an average of 2.0 at an average of 46.9 days after treatment, which is 2.8 times more than the minimal clinically important difference for ESS in HHT (0.71). The mean baseline hemoglobin (n = 13) and hematocrit (n = 10), were 11.3 g/dL and 37.5%, respectively, and did not exhibit significant changes after RADA16 application. No bleeding, pain, or allergic reactions occurred due to the application. Several patients reported mild nasal congestion. Our experience demonstrates that RADA16 can be considered as a safe epistaxis treatment modality for HHT that is easy to apply and does not require the operating suite.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: J.M.J., B.C.L., and J.K.M. are all consultants for 3-D Matrix, the manufacturer of the RADA16 hydrogel used in this study. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Decreased ESS score post-RADA16. Change in ESS, represented on the individual patient (A) and cohort (B) level. Baseline ESS of 5.0 (SD, 1.6) decreased by a mean of 2.0 (SD, 1.6) to an ESS of 3.0 (SD, 1.6) at a mean duration of 46.9 days after treatment.
Figure 2.
Figure 2.
Nasal mucosa before and after RADA16 application. Right nasal cavity of patient with HHT revealing (A) crusting and inflammation associated with HHT-related epistaxis, (B) Application of RADA16 in its hydrogel form combined with methylene blue for visualization (arrow). (C) Follow-up examination revealing well-moisturized nasal mucosa without inflammation, crusting, or bleeding.
See this image and copyright information in PMC

References

    1. Al Tabosh T, Al Tarrass M, Tourvieilhe L, Guilhem A, Dupuis-Girod S, Bailly S. Hereditary hemorrhagic telangiectasia: from signaling insights to therapeutic advances. J Clin Invest. 2024;134(4) - PMC - PubMed
    1. Alkhalid Y, Darji Z, Shenkar R, et al. Multidisciplinary coordinated care of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) Vasc Med. 2023;28(2):153–165. - PubMed
    1. Kolarich AR, Solomon AJ, Bailey C, et al. Imaging manifestations and interventional treatments for hereditary hemorrhagic telangiectasia. Radiographics. 2021;41(7):2157–2175. - PubMed
    1. Faughnan ME, Mager JJ, Hetts SW, et al. Second international guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. Ann Intern Med. 2020;173(12):989–1001. - PubMed
    1. Kühnel T, Wirsching K, Wohlgemuth W, Chavan A, Evert K, Vielsmeier V. Hereditary hemorrhagic telangiectasia. Otolaryngol Clin North Am. 2018;51(1):237–254. - PubMed

LinkOut - more resources