University at Buffalo - The State University of New York

Published: November 30, 2006

By KEVIN FRYLING
Reporter Staff Writer

When Jens Ponikau left Germany 10 years ago to do research in the United States on chronic sinus inflammation, he expected to stay nine months.

Jens Ponikau’s eureka moment in a lab at the Mayo Clinic may lead to a new treatment for a persistent sinus ailment.
PHOTO: NANCY J. PARISI

Then a major breakthrough—uncovering the root cause of a persistent sinus ailment that, despite its effect on 37 million people in the United States alone, has no FDA-approved treatment—changed everything.

"Not many people have the chance to make a significant change for the better," says Ponikau, clinical assistant professor in the Department of Otolaryngology, School of Medicine and Biomedical Sciences. "I felt that it came to me, that I could make a significant influence or change, so I took it and I ran with it."

His research—conducted over the course of nine years at the Mayo Clinic and continuing now at UB—shows that chronic sinus inflammation, or sinusitis, is caused by a reaction to fungus in nasal mucus. Ponikau was the first to discover the fungus in sinusitis sufferers because he was the first to examine not only tissue samples from patients' nostrils, but the mucus inside as well.

"We had never found the fungus because we had never looked at the snot," he explains.

While previous research had focused on nasal tissue because sinusitis sufferers get frequent bacterial infections, Ponikau says nasal infections are merely a symptom caused by an underlying fungal reaction.

"Antibiotics have never worked long-term in chronic sinusitis," he points out. "We found an underlying inflammation in the tissue, which erodes away the protective layer. Patients had secondary bacterial infections—not because bad bacteria were there, but because the nasal skin was eroded away."

Ponikau recalls the actual moment he realized he might hold the key to unlocking a condition affecting about 15 percent of the population. It happened late one night, while he was alone burning the midnight oil in a lab at the Mayo Clinic.

"I always tell people there was this eureka moment when I was looking at snot under an electron microscope," he laughs.

Although the initial discovery of fungus in sinusitis sufferers came in 1994 while he was a fourth-year German medical student studying at Mayo, Ponikau explains the significant breakthrough—the one that kept him in the U.S.—came after he returned to the famous Minnesota research hospital fresh from a two-year residency at his father's small ear, nose and throat clinic in Hof, Germany. He then uncovered the fundamental connection between the fungus' presence in patients' mucus and the actual nasal infections that characterize the condition.

Under the electron microscope, Ponikau noticed an unusual level of inflammatory white blood cells, called eosinophils, in the mucus of sinusitis sufferers. These cells had been noted in the nasal tissue of some sinusitis patients, he says, but no one had explained their presence.

Studying the mucus, he realized the true target of the destructive cells lay outside the body. The eosinophils were traveling though the tissue to cluster around the fungus in the mucus.

"That was the big breakthrough," he says. "I saw that the inflammatory cells were destroying the fungi and releasing all their toxins in that process."

But pinning sinusitis on fungus, rather than bacteria, represented such a "big step out of the box" that Ponikau spent years convincing the medical community.

"When we introduced it, the whole scientific field was up in arms," he says. Since then, however, support has started pouring in from such prestigious organizations as the National Institutes of Health, which has contributed about $5 million to the project. In addition, he notes the Food and Drug Administration is nearing the final phase of tests on an anti-fungal treatment for sinusitis, which he has co-developed with David Sherris, his closest research collaborator at the Mayo Clinic and now chair of UB's Department of Otolaryngology. Sherris joined the UB faculty in 2003 to reinvigorate the ear, nose and throat department and re-establish its residency program, which was disbanded in 2002. Ponikau followed Sherris to UB this fall to direct the research branch of the department and guide the projects of its medical residents, the first of whom will join the program in July 2007.

"I think there's a lot of excitement about having the residency program back," Ponikau says, noting that a good medical program provides students with a combination of experience in the classroom, a clinical environment and a research lab.

"You cannot have a department without having a research arm," he points out. "We're in the process of getting a team together here focusing on fungal sinusitis."

In addition to his UB duties, Ponikau serves as president of Gromo L.L.C., an intellectual-property holding company that protects the rights to his discoveries. He says the license to market the first-ever fungal sinusitis test has been granted to a Buffalo-based biomedical company, Immco Diagnostics Inc., which currently processes several hundred of the tests per month.

On top of the business-and-research opportunities offered by Buffalo and UB, Ponikau notes that settling in New York State's second-largest city has been a welcome change from living in Rochester, Minn., a city of less than 100,000. Today, he resides in Amherst with his wife, Ragna, and three children: Sidney, 8, Felicia, 7, and Isabella, 2.

"I think Buffalo is great," he says. "It's my kind of town, a blue-collar town. Plus, the restaurants are great here. I've never had a bad meal in Buffalo."

Nor does the region's winter weather concern the former ski instructor, who earned extra cash in medical school teaching on weekends in the Alps. "I just bought a boat to do some water skiing with the kids," he says, "and I also like to (snow) ski. So I don't mind a place where you can do both."