Increased Expression of Estrogen Receptor Beta in Idiopathic Progressive Subglottic Stenosis

Idiopathic 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-α and ER-β. Abnormal variants of ER-β 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-α and progesterone receptors, and no expression of ER-β, 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.

Subglottic 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-α and ER-β were performed on specimens. Staining patterns were compared qualitatively and semi-qualitatively between control and IPSS specimens.

Immunofluorescence stains demonstrated the presence of both ER-α and ER-β in subglottic tissue. IPSS specimens demonstrated significantly greater staining intensity of ER-α in the epithelium and ER-β in glands and ducts compared to controls.

This study confirms the presence of estrogen receptors in the subglottis. Increased expression of ER-α in the epithelium and ER-β in glands and ducts in IPSS compared to controls may help to explain the predisposition to stenosis in these individuals.

3b Laryngoscope, 130:2186-2191, 2020.