Relationship Between Pepsin Expression and Dysplasia Grade in Patients With Vocal Cord Leukoplakia

Abstract

Objective To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance. Study Design Retrospective analysis of pathologic archive specimens. Setting Affiliated university hospital. Subjects and Methods The study included 45 patients with vocal fold leukoplakia and 19 with vocal fold polyps who underwent surgical treatment between December 2013 and July 2016. Masses were detected on both vocal cords in 5 patients with vocal fold leukoplakia and in 1 patient with vocal fold polyps. Immunohistochemistry was used to assess pepsin expression. In addition, the relationship of pepsin expression level with clinical characteristics of vocal fold leukoplakia was assessed. Results The rate of pepsin expression was high in the polyp group (75%) and the leukoplakia group (68%); however, the difference between groups was not significant ( P > .05). Pepsin expression significantly increased according to grade of dysplasia (mild, 57.1%; moderate, 88.9%; severe, 100.0%; P = .034). Similarly, the percentage of lesions that exhibited strongly positive pepsin expression increased with the grade of dysplasia (mild, 37.1%; moderate, 66.7%; severe, 100.0%; P = .005). The leukoplakia recurrence rate was higher in patients with positive pepsin expression than in patients with negative pepsin expression but without a significant difference ( P > .05). Conclusion Our study suggests that pepsin was associated with the grade of dysplasia of vocal cord leukoplakia. Further investigation with appropriate control groups and controlling for other risk factors, such as smoking or alcohol consumption, is needed.

The role of Glut-1 and H+/K+-ATPase expression in hyperplasia of mice laryngeal epithelium induced by pepsin

“…Tissue damage caused by pepsin is an important pathogenetic factor [4]. Esophageal mucosal epithelial injury is caused principally by gastric acid secreted by the proton pump H + /K + -ATPase [3]; pepsin damages the laryngopharyngeal epithelium [4,5]. Pepsin is abnormally expressed in patients with voice disorders, vocal cord polyps, laryngeal stenosis, vocal cord leukoplakia, and malignant lesions [5,6].…”

“…Esophageal mucosal epithelial injury is caused principally by gastric acid secreted by the proton pump H + /K + -ATPase [3]; pepsin damages the laryngopharyngeal epithelium [4,5]. Pepsin is abnormally expressed in patients with voice disorders, vocal cord polyps, laryngeal stenosis, vocal cord leukoplakia, and malignant lesions [5,6]. We earlier reported high pepsin levels in vocal cord polyps and patients with vocal cord leukoplakia [5]; the latter expression level increased significantly as the dysplasia grade rose [5].…”

“…Pepsin is abnormally expressed in patients with voice disorders, vocal cord polyps, laryngeal stenosis, vocal cord leukoplakia, and malignant lesions [5,6]. We earlier reported high pepsin levels in vocal cord polyps and patients with vocal cord leukoplakia [5]; the latter expression level increased significantly as the dysplasia grade rose [5]. We also found that high Glut-1 expression may improve the development of vocal cord leukoplakia by upregulating laryngeal H + /K + -ATPase expression to reactivate absorbed pepsin resulting in laryngeal mucosa injury in vitro [6].…”

Acidified Pepsin Promotes Laryngeal Precancerosis by Upregulating H+/K+-ATPase and Activating Mitophagy in Laryngeal Epithelial Cells

“…We previously showed that the pepsin level was elevated in vocal cord polyps and leukoplakia and was correlated with the grade of dysplasia [22]. Here, we assessed the effects of acidic pepsin on the growth and viability of laryngeal epithelial cells and found that at low (pH = 3) and moderate (pH = 5) pH, increasing pepsin levels signi cantly increased cell viability (Fig.…”

Acidified Pepsin Promotes Laryngeal Precancerosis by Upregulating H ⁺/K ⁺-ATPase and Activating Mitophagy in Laryngeal Epithelial Cells

“…Non-acidic pepsin (pH = 7) has been shown to increase the proliferation of laryngeal carcinoma cells [21]. We previously showed that the pepsin level was elevated in vocal cord polyps and leukoplakia and was correlated with the grade of dysplasia [22]. Here, we assessed the effects of acidic pepsin on the growth and viability of laryngeal epithelial cells and found that at low (pH = 3) and moderate (pH = 5) pH, increasing pepsin levels signi cantly increased cell viability (Fig.…”