Neel Distinguished Research Guest Lecturer reveals how our individual taste receptors can be linked to acute and chronic infections.
Sunday, September 29 | 11:00 am – Noon | Grand Ballroom C
Established by family and friends in 1993, the H. Bryan Neel III, MD, PhD Distinguished Research Lecture serves to inform the otolaryngology community regarding advancements in biomedical science. This year’s Guest Lecturer is Noam A. Cohen, MD, PhD. Dr. Cohen is the Ralph Butler Professor of Otorhinolaryngology – Head and Neck Surgery and director of Rhinology Research at the Perelman School of Medicine at the University of Pennsylvania. He is also an adjunct member of the Monell Chemical Senses Center and a staff surgeon at the Philadelphia VA Medical Center.
Dr. Cohen’s research interests include host-microbe interactions in the upper airway with an emphasis on sinonasal innate defenses focusing on airway taste receptors and mucociliary clearance, microbial biofilms, solitary chemosensory cells (aka tuft cells), and the development of novel sinonasal topical antimicrobial therapies. AAO-HNSF Meeting Daily News spoke with Dr. Cohen in advance of the Annual Meeting to learn more about his research.
Q: Congratulations on being named the H. Bryan Neel III, MD, PhD Distinguished Research Guest Lecturer. What does it mean to be presented with this esteemed recognition?
Dr. Cohen: It’s a huge honor to receive this recognition. You know, I’ve been focused on the rhinology side of our business for the last 20 years, so to see this percolate out, so to speak, to the other subspecialties is like a dream come true. Our research on the nose and sinuses and mucosal infections has broader implications for all of otolaryngology. To receive this recognition from the entire specialty, not just our small subspecialty, is very humbling and a significant honor from my point of view.
Q: Can you share some pivotal moments in your training and career up to this point?
Dr. Cohen: I’ve been doing this research for about 35 years, and one person who had a big influence on me when I was working on my PhD at Johns Hopkins was Solomon (“Sol”) Snyder, MD, DSc, DPhil, one of the top neuroscientists in the country. He made so many important contributions to science and was truly an out-of-the-box thinker. He looked at scientific questions and challenges from many different angles and that early training in my career gave me the freedom and security to ask questions that were perhaps a little “off the beaten path.”
The next pivotal moment was as I was doing my residency here at the University of Pennsylvania, and I had the opportunity to work with David W. Kennedy, MD, one of the Academy’s Past Presidents (2008 – 2009) and Bert W. O’Malley, Jr., MD, They were both innovators and other out-of-the-box thinkers, with David pioneering endoscopic sinus surgery and Bert helping mature TransOral Robotic Surgery (TORS) for obstructive sleep apnea. They both supported me when I first started doing research in rhinology and that gave me the confidence to keep asking questions and moving forward. Additionally, they provided both intellectual support as well as financial support early on in my position at Penn, where I’ve been for two decades.
Finally, about 15 years ago, I developed a relationship with a small, standalone research institute here in West Philadelphia called the Monell Chemical Senses Center. They are the world’s only independent, nonprofit scientific institute dedicated to interdisciplinary research on the senses of taste and smell. I connected with one of the researchers over there, Danielle Reed, PhD, and that opened doors to a lot of the research that we’ve developed over the last 15 years.
Q: Your presentation is titled, “Taste Receptors in Upper Airway Innate Immunity: Implications in ENT Diseases.” Can you give readers a brief preview of how your research impacts patients and providers?
Dr. Cohen: Many disorders that otolaryngologists deal with come from bacteria cohabitating in the microbiome. In the ENT space ─ the ear, the nose, the larynx, the throat ─ there’s a microbiome collection of all the bacteria, fungi, viruses, and their genes that naturally live on and inside our bodies.
One of the key observations that this lecture is going to talk about is a new role for taste receptors that were initially identified in the tongue to detect bitter molecules such as brussels sprouts. Some of the molecules that these receptors detect in the body are products that bacteria secrete, and they stimulate a defensive response to get rid of bacteria when they detect it. The time frame for this activation is in seconds to minutes, unlike a lot of other microbial detecting pathways that take place over hours. Even before the bacteria get there, these receptors can detect potentially invading pathogens and ramp up localized defenses.
While we’ve been focusing on the pathway in the nose, these receptors have been found in the ear, in the throat, in the gut, in the urinary system, anywhere the body encounters and defends against bacteria. More recently, they’ve been demonstrated to stimulate inflammation and if you think about infectious or inflammatory disorders, that’s more than 50% of the types of conditions that otolaryngologists treat, right? Whether you have a chronic infection or an acute infection, whether it’s in your tonsils or in your ear, whether it’s something like laryngitis, there could be broad ramifications for this work and research across most ENT subspecialties.
Where the story gets interesting is if you think about people’s preferences for food: some people like hot, spicy food, other people don’t. Some people love brussels sprouts, others don’t. That’s genetically determined; there are genetic differences in people’s ability to perceive bitter molecules on their tongue. Well, it turns out that the genetics that determine how bitter brussels sprouts taste also determine how effective these receptors are at detecting bacteria.
For instance, for people who find the taste of brussels sprouts very bitter, and therefore tend not to eat them, that means their system is very active and should help protect against the type of infection (from Pseudomonas Gram-negative bacteria) we’ve been studying. Our research has shown that you can give a patient something to taste, and if it is bitter to them, you know that that system’s intact. But if they don’t taste anything, that patient is more likely to be susceptible to a subtype of bacterial infection. The genetics of bitter taste perception with specific molecules correlate to different types of sinus infections.
Q: Annual Meeting attendees range from medical students and residents to mid-career and late-career physicians, as well as various subspecialists. What will different groups of attendees be able to take away from your presentation?
Dr. Cohen: For medical students and residents who are just starting to form their clinical acumen, and they’re faced with a clinical question they can’t quite figure out ─ why some patients respond to treatment a certain way, but other patients do not, let’s say ─ how do you turn that clinical question into a scientific question? How do you bring a bedside or clinical problem into a lab, develop experiments to try and explain the science behind what’s going on, then bring that science back to the patient?
In our research, we had an observation that certain patients were getting these chronic infections. I can perform the same procedure on patients one, two, and three and they will all have positive results, but patients four and five will not. Why is that? What’s different about patients four and five? We started looking into what type of infection it is and why patients four and five seem to have a weakness in one of their taste receptors making them more susceptible to infection.
And while we were focusing on it from the standpoint of sinusitis, you could have something similar going on with otitis media and ear infections and there may be longtime physicians out there who have had these questions in the backs of their minds for years. You know, so much of what we do in pediatrics, for example, is recurrent acute infections, so what if we could determine which kids are getting recurrent ear infections while their siblings don’t because they don’t have the appropriate taste receptor? There are ramifications for this research in any part of the specialty that deals with acute and chronic infections, and I want people to understand that they can apply this in their clinical practice.
