Increased expression of estrogen receptor beta in idiopathic progressive subglottic stenosis

Background/ObjectivesIdiopathic progressive subglottic stenosis (IPSS) predominantly affects females in perimenopause. It has, therefore, been hypothesized that estrogen is involved in its pathogenesis. There are two main types of estrogen receptors: ER-alpha and ER-beta. Abnormal variants of ER-beta have previously been shown to be associated with poor wound healing. Estrogen receptors have recently been identified in subglottic tissue samples, with elevated levels of ER-alpha and progesterone receptors, and no expression of ER-beta, in stenotic specimens reported in one study. The objective of this study was to confirm the presence of estrogen receptors in the subglottis and investigate levels of expression and types of estrogen receptors in normal and stenotic subglottic tissue. MethodsSubglottic tissue was obtained from three female and one male cadaver without laryngotracheal pathology to serve as controls. Subglottic tissue specimens from five female patients with IPSS were also analysed. Immunofluorescence stains for ER-alpha and ER-ss were performed on specimens. Staining patterns were compared qualitatively and semi-qualitatively between control and IPSS specimens. ResultsImmunofluorescence stains demonstrated the presence of both ER-alpha and ER-beta in subglottic tissue. IPSS specimens demonstrated significantly greater staining intensity of ER-alpha in the epithelium and ER-ss in glands and ducts compared to controls. ConclusionsThis study confirms the presence of estrogen receptors in the subglottis. Increased expression of ER-alpha in the epithelium and ER-ss in glands and ducts in IPSS compared to controls may help to explain the predisposition to stenosis in these individuals. Level of Evidence3b Laryngoscope, 2019