Escalation in mucus cystatin 2, pappalysin-A, and periostin levels over time predict need for recurrent surgery in chronic rhinosinusitis with nasal polyps

Mueller SK, Wendler OD, Nocera A, Grundtner P, Schlegel P, Agaimy A, Iro H, Bleier BS (2019)

Publication Type: Journal article

Publication year: 2019

Journal

International Forum of Allergy and Rhinology Wiley-VCH Verlag

DOI: 10.1002/alr.22407

Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is treated using oral/topical steroids and surgery. Despite maximal medical therapy, some patients remain recalcitrant. Mucus cystatin 2, pappalysin-A, and periostin can predict the presence of CRSwNP and correlate with disease severity. This study was designed to determine whether prospective sampling of these mucus proteins could predict medical failure and the need for revision surgery. Methods: This investigation was an institutional review board‒approved, prospective study of 66 patients with CRSwNP. All patients underwent surgery, administration of topical/oral steroids, and outpatient mucus sampling at 10 time-points over 2 years. Five proteins, including cystatin 2 (CST2), pappalysin-A (PAPP-A), and periostin (PST), were analyzed and correlated with subjective parameters (including scores on the 22-item Sino-Nasal Outcomes Test [SNOT-22]). Variables were then analyzed and compared between those requiring revision surgery within 2 years (n = 5) and those with stable disease (n = 61). Results: All patients demonstrated a significant decline in CST2, PAPP-A, and periostin after their initial surgery. The recalcitrant group demonstrated escalations in all proteins despite steroids, with levels higher than those of the stable group at 1 year (CST2: 258.1 ± 205.2 pg/mL vs 235.3 ± 275.7 pg/mL, p = 0.86; PAPP-A: 170.3 ± 150.4 pg/mL vs 74.6 ± 106.7 pg/mL, p < 0.05; periostin: 188.8 ± 192.4 ng/mL vs 54.5 ± 47.6 ng/mL, p < 0.001). Escalation in all proteins correlated significantly with worsening SNOT-22 score at each time-point (domain 1: 8.2 ± 1.3 vs 5.5 ± 1.1; p < 0.05). Conclusion: Early recurrences and medical recalcitrance in CRSwNP may be predicted noninvasively through the serial, prospective sampling of mucus CST2, PAPP-A, and periostin levels. These biosignatures may help to predict disease course and guide individualized therapy.

Authors with CRIS profile

Sarina Müller-Hübner Department of Otorhinolaryngology – Head and Neck Surgery Patrick Schlegel Professur für Computational Medicine (DFG-Forschungsprofessur) Abbas Agaimy Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie Heinrich Iro Lehrstuhl für Hals-, Nasen- und Ohrenheilkunde

Involved external institutions

Veterans Affairs Healthcare System Boston and Harvard Medical School US United States (USA) (US)

How to cite

APA:

Mueller, S.K., Wendler, O.D., Nocera, A., Grundtner, P., Schlegel, P., Agaimy, A.,... Bleier, B.S. (2019). Escalation in mucus cystatin 2, pappalysin-A, and periostin levels over time predict need for recurrent surgery in chronic rhinosinusitis with nasal polyps. International Forum of Allergy and Rhinology. https://doi.org/10.1002/alr.22407

MLA:

Mueller, Sarina K., et al. "Escalation in mucus cystatin 2, pappalysin-A, and periostin levels over time predict need for recurrent surgery in chronic rhinosinusitis with nasal polyps." International Forum of Allergy and Rhinology (2019).

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