title: Why sinonasal disease spares the inferior turbinate: An immunohistochemical analysis.
abstract: Clinically, inflammatory polyps are found in the middle turbinate (MT) in patients with chronic rhinosinusitis (CRS) but not in the inferior turbinate (IT). The purpose of this study was to investigate differences in protein expression between IT and MT tissue in patients with CRS.
  
  
  
  Prospective cohort.
  
  
  
  Pathologic specimens obtained from patients with CRS undergoing functional endoscopic sinus surgery with IT reduction were evaluated by immunohistochemical analysis of inflammatory markers cysteinyl leukotriene 1 receptor (CysLT1R), toll-like receptor 2 (TLR2), and vascular cell adhesion molecule 1 (VCAM1). Protein expression was quantified with nuance multispectral analysis and results compared between MT and IT tissue.
  
  
  
  The total expression of VCAM1 and CysLT1R was decreased in the IT compared to the MT. There was no difference in total TLR2 expression between the IT and MT. When comparing patients with eosinophilic CRS to noneosinophilic CRS (neCRS), there was decreased expression of VCAM1 in the IT of patients with neCRS. When comparing patients with nasal polyposis to those without polyps, there was decreased expression of VCAM1 in the IT of patients without polyps.
  
  
  
  There is a difference in protein receptor expression of VCAM1 and CysLT1R in MT compared to IT tissue. Although the leukotrienes are a well-known target for treatment of chronic sinusitis, this is the first study demonstrating an upregulation of VCAM1 expression in the MT and could be a potential future target for the treatment of CRS.
  
  
  
  NA Laryngoscope, 126:E179-E183, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: White
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia.
authors.forename: Paul
authors.initials: P
authors.lastname: Weinberger
authors.affiliation: Department of Pathology, Georgia Regents University, Augusta, Georgia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Coulson
authors.affiliation: Center for Biotechnology, Georgia Regents University, Augusta, Georgia.
authors.forename: Dehuang
authors.initials: D
authors.lastname: Guo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Duke University, Durham, North Carolina, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Jang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia.
authors.forename: Jose
authors.initials: J
authors.lastname: Gurrola
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia.
authors.forename: Stilianos E
authors.initials: SE
authors.lastname: Kountakis
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004802:Eosinophilia / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D011446:Prospective Studies; D018077:Receptors, Leukotriene / Q000032:analysis; D012220:Rhinitis / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D012852:Sinusitis / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D051195:Toll-Like Receptor 2 / Q000032:analysis; D014420:Turbinates / Q000378:metabolism* / Q000473:pathology; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis
chemical_list: D018077:Receptors, Leukotriene; C495342:TLR2 protein, human; D051195:Toll-Like Receptor 2; D019010:Vascular Cell Adhesion Molecule-1; C083169:leukotriene D4 receptor
keywords: Chronic sinusitis; inferior turbinate; inflammatory protein expression; middle turbinate