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Secreted P‐glycoprotein is a noninvasive biomarker of chronic rhinosinusitis
Author(s) -
Nocera Angela L.,
Meurer Ana T.,
Miyake Marcel M.,
Sadow Peter M.,
Han Xue,
Bleier Benjamin S.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26249
Subject(s) - chronic rhinosinusitis , nasal polyps , medicine , gastroenterology , biomarker , mucus , sinusitis , glycoprotein , immunology , biology , microbiology and biotechnology , biochemistry , ecology
Objective The discovery of noninvasive biomarkers of chronic rhinosinusitis (CRS) is critical to enable our ability to provide prognostic information and targeted medical therapy. Epithelial P‐glycoprotein (P‐gp) is overexpressed in CRS and exists in an extracellular, secreted form. The objective of this study was to determine whether secreted P‐gp concentrations are elevated in CRS and can be used to predict disease severity. Methods Institutional review board‐approved study examining mucus concentrations of P‐gp in 36 patients (10 control, 16 CRS without nasal polyps [CRSsNP], and 10 CRS with nasal polyps [CRSwNP]). P‐gp concentrations were determined by enzyme‐linked immunosorbent assay and normalized to total protein (TP). Clinical indices of disease severity, including the Sino‐Nasal Outcomes Test (SNOT‐22) and Lund‐Mackay score, were collected for all patients. Results Secreted P‐gp concentration was significantly higher in CRS versus control patients (mean ± standard deviation; 247.8 ± 224.8 vs. 102.4 ± 81.7 pcg P‐gp/μg TP, P = 0.022). A threshold value of 250 pcg/μg TP was used to differentiate low versus high secretors. High P‐gp secretors with CRS (sNP and wNP, n = 9) demonstrated significantly higher SNOT‐22 and Lund‐Mackay scores (57.1 ± 7.9 and 13.9 ± 7.3) versus low secretors (38.3 ± 23.9 and 6.8 ± 7.3; P = 0.030 and P = 0.013, respectively) and had a significantly higher proportion of CRSwNP (66.7%) versus the low secretors (23.5%, n = 17, P = 0.046). Conclusion P‐gp secretion levels are significantly elevated in patients with CRS. High P‐gp secretion is associated with a higher incidence of CRSwNP and confers worse subjective and objective measures of disease severity. The presence of elevated P‐gp secretion may therefore represent a novel noninvasive biomarker of CRS and could be used to predict patients who may benefit from P‐gp inhibitory therapeutic strategies. Level of Evidence NA Laryngoscope , 127:E1–E4, 2017