Strong expression of HSP47 in metaplastic nasal mucosa may predict a poor outcome after primary endoscopic dacryocystorhinostomy: a prospective study.
OBJECTIVE
Dacryocystorhinostomy (DCR) is an effective and safe procedure for patients with post-saccal obstruction of the nasolacrimal pathway. The aim of DCR is to relieve symptoms by creating a bypass between the lacrimal sac and the nasal cavity. The most common reason for failure is stenosis caused by a fibrotic process at the rhinostomy site. In this prospective study we assessed the expression of heat shock protein 47 (HSP47), a regulator of fibrosis, in the biopsies of nasal mucosa isolated from patients undergoing primary endoscopic DCR (EN-DCR).


METHODS
Thirty consecutive primary EN-DCR procedures in 30 patients were performed using the powered instrumentation technique. The nasal mucosa specimens over the rhinostomy site were collected for histological analysis at the beginning of the operation and the expression of HSP47 was evaluated by immunohistochemistry. The outcome of EN-DCR was estimated in follow-up visits at 1 week, 2 months and 6 months after surgery.


RESULTS
At the 6-month follow-up, the overall success rate after primary EN-DCR was 83%. A metaplastic change and strong expression of HSP47 in nasal mucosa were associated with EN-DCR failure (p = 0.009).


CONCLUSIONS
HSP47 may be regarded as a novel marker to predict impaired EN-DCR outcome.
Department of Otorhinolaryngology, Kuopio University Hospital, Finland. grigori.smirnov@kuh.fi
Grigori
G
Smirnov
Risto
R
Pirinen
Henri
H
Tuomilehto
Juha
J
Seppä
Markku
M
Teräsvirta
Hannu
H
Uusitalo
Juhani
J
Nuutinen
Kai
K
Kaarniranta
D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D003607:Dacryocystitis / Q000378:metabolism / Q000601:surgery*; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D050958:HSP47 Heat-Shock Proteins / Q000378:metabolism*; D006801:Humans; D007124:Immunoenzyme Techniques; D007767:Lacrimal Duct Obstruction / Q000378:metabolism; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism* / Q000473:pathology*; D011446:Prospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D050958:HSP47 Heat-Shock Proteins; C494660:SERPINH1 protein, human