Bone morphogenetic protein-2 as a novel biomarker for refractory chronic rhinosinusitis with nasal polyps

Jin Youp Kim, Suha Lim, Hee Suk Lim, Yi Sook Kim, Kyoung Mi Eun, Roza Khalmuratova, Yuju Seo, Joon Kon Kim, Young Seok Kim, Min Kyung Kim, Siyeon Jin, Seung Cheol Han, Suyeon Pyo, Seung No Hong, Jong Wan Park, Hyun Woo Shin, Dae Woo Kim

Research output: Contribution to journalArticlepeer-review


Background: Bone morphogenetic proteins (BMPs), which are members of the TGF-β superfamily, regulate bone remodeling by stimulating osteoblasts and osteoclasts. Although the association between osteitis and poor surgical outcomes is well known in patients with chronic rhinosinusitis (CRS), BMPs have not been fully investigated as potential biomarkers for the prognosis of CRS. Objective: Our aim was to investigate the role of BMPs in osteitis in patients with CRS with nasal polyps (NPs) (CRSwNPs), as well as associations between BMPs and inflammatory markers in sinonasal tissues from patients with CRSwNP. Methods: We investigated the expression of 6 BMPs (BMP-2, BMP-4, BMP-6, BMP-7, BMP-9, and BMP-10) and their cellular origins in NPs of human subjects by using immunohistochemistry and ELISA of NP tissues. Exploratory factor analysis was performed to identify associations between BMPs and inflammatory markers. Air-liquid interface cell culture of human nasal epithelial cells was performed to evaluate the induction of the epithelial-mesenchymal transition by BMPs. Results: Of the 6 BMPs studied, BMP-2 and BMP-7 were associated with refractoriness. Only BMP-2 concentrations were higher in patients with severe osteitis and advanced disease extent according to the computed tomography findings. Eosinophils and some macrophages were identified as cellular sources of BMP-2 in immunofluorescence analysis. An in vitro experiment revealed that BMP-2 induced epithelial-mesenchymal transition in air-liquid interface–cultured human nasal epithelial cells, particularly in a TH2 milieu. Conclusion: BMP-2 could reflect the pathophysiology of mucosa and bone remodeling and may be a novel biomarker for refractory CRSwNP.

Original languageEnglish
Pages (from-to)461-472.e13
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - Aug 2021


  • Nasal polyp
  • biomarker
  • bone morphogenetic proteins
  • osteitis
  • sinusitis


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