Nasal mucus as a prognostic fluid in human physiology and disease

One of the greatest advances in modern medicine has been the use of changes in blood and urine to predict occurrence of disease prior to appearance of clinical symptoms. In this manner, several disease processes have been either averted or treated successfully before occurrence of the full‐blown disease. For example, measurements of low blood ceruloplasmin have been used to predict presence of Wilson’s disease and subsequent treatment with a copper chelator has avoided the full‐blown disease. Similarly, blood endoglin has been found elevated in women with preeclampsia about 10 weeks prior to development of clinical manifestations of this disorder; this substance has also been found in nasal mucus. In analogous studies N‐terminal Pro‐B‐type natriuretic peptide has been found in blood as a predictor of long term mortality in patients with stable coronary heart disease; this peptide can also be found in nasal mucus. D‐dimer is found in blood among patients who have stopped anticoagulation therapy for treatment of thromboembolism; among patients with abnormal D‐dimer levels after termination of anticoagulation about 15% develop a repeat thromboembolic event. Measurements of D‐dimer offer a prognostic diagnosis of a future thromboembolic event among patients who have stopped anticoagulation; this substance can also be found in nasal mucus. We have measured these substances in blood and nasal mucus using a 96 plate colorimetric ELISA assay. We plan to reduce this technique to a point of care nasal swab test so that we can use nasal mucus, independent of blood, as an inexpensive, safe and powerful prognostic device to screen patients worldwide to avoid development of these disorders before disease pathology is evident.