1
|
Gunder N, Dörig P, Witt M, Welge-Lüssen A, Menzel S, Hummel T. Future therapeutic strategies for olfactory disorders: electrical stimulation, stem cell therapy, and transplantation of olfactory epithelium-an overview. HNO 2023; 71:35-43. [PMID: 36734997 PMCID: PMC9897160 DOI: 10.1007/s00106-022-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
Olfactory disorders may be temporary or permanent and can have various causes. Currently, many COVID-19 patients report a reduced or complete loss of olfactory function. A wide range of treatment options have been investigated in the past, such as olfactory training, acupuncture, medical therapy, transcranial magnetic stimulation, or surgical excision of olfactory epithelium, e.g., in severe qualitative smell disorders. The development of a bioelectric nose, e.g., in connection with direct electrical stimulation or transplantation of olfactory epithelium or stem cells, represent treatment options of the future. The basis of these developments and the state of knowledge is discussed in the following work.
Collapse
Affiliation(s)
- N Gunder
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - P Dörig
- Universitäts-HNO Klinik Basel, Basel, Switzerland
| | - M Witt
- Institut für Anatomie, Universitätsmedizin Rostock, Rostock, Germany
| | | | - S Menzel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - T Hummel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| |
Collapse
|
2
|
Hummel T, Power Guerra N, Gunder N, Hähner A, Menzel S. Olfactory Function and Olfactory Disorders. Laryngorhinootologie 2023; 102:S67-S92. [PMID: 37130532 PMCID: PMC10184680 DOI: 10.1055/a-1957-3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.
Collapse
Affiliation(s)
- T Hummel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - N Power Guerra
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Medizinische Universität Rostock, Rostock
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden
| | - A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - S Menzel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| |
Collapse
|
3
|
Dörig P, Gunder N, Witt M, Welge-Lüssen A, Hummel T. [Future therapeutic strategies for olfactory disorders: electrical stimulation, stem cell therapy, and transplantation of olfactory epithelium-an overview]. HNO 2021; 69:623-632. [PMID: 33988723 PMCID: PMC8120256 DOI: 10.1007/s00106-021-01060-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/08/2022]
Abstract
Passagere oder permanente Riechstörungen können verschiedene Ursachen haben. Ganz aktuell berichtet eine Vielzahl von Patienten im Rahmen von COVID-19-Infektionen über ein fehlendes oder vermindertes Riechvermögen. In der Vergangenheit wurden vielfältige Therapieoptionen untersucht, diese variieren vom Riechtraining über Akupunktur und medikamentöse Therapien bis hin zur transkraniellen Magnetstimulation oder, z. B. bei ausgeprägten qualitativen Riechstörungen, der chirurgischen Resektion der Riechschleimhaut. Die Entwicklung einer bioelektrischen Nase, z. B. in Verbindung mit direkter elektrischer Stimulation des Bulbus olfactorius, oder die Transplantation von Riechschleimhaut oder von Stammzellen stellen Behandlungsmöglichkeiten der Zukunft dar. Die Grundlagen für diese Entwicklungen sowie der Stand des Wissens werden in der vorliegenden Arbeit erläutert.
Collapse
Affiliation(s)
- P Dörig
- Universitäts-HNO Klinik Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden, Deutschland
| | - M Witt
- Institut für Anatomie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A Welge-Lüssen
- Universitäts-HNO Klinik Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - T Hummel
- Universitäts-HNO Klinik Dresden, Dresden, Deutschland
| |
Collapse
|
4
|
Mueller SK, Scangas G, Amiji MM, Bleier BS. Prospective transfrontal sheep model of skull-base reconstruction using vascularized mucosa. Int Forum Allergy Rhinol 2017; 8:614-619. [PMID: 29227037 DOI: 10.1002/alr.22058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/24/2017] [Accepted: 11/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND No high-fidelity animal model exists to examine prospective wound healing following vascularized reconstruction of the skull base. Such a model would require the ability to study the prospective behavior of vascularized mucosal repairs of large dural and arachnoid defects within the intranasal environment. The objective of this study was to therefore develop and validate a novel, in vivo, transfrontal sheep model of cranial base repair using vascularized sinonasal mucosa. METHODS Twelve transfrontal craniotomy and 1.5-cm durotomy reconstructions were performed in 60-kg to 70-kg Dorset/Ovis Aries sheep using vascularized mucosa with or without an adjunctive Biodesign™ underlay graft (n = 6 per group). Histologic outcomes were graded (scale, 0 to 4) by a blinded veterinary histopathologist after 7, 14, and 28 days for a range of wound healing parameters. RESULTS All sheep tolerated the surgery, which required 148 ± 33 minutes. By day 7, the mucosa was fully adherent with complete partitioning of the sinus and intracranial compartments. Fibroblast infiltration and flap neovascularization scores significantly increased between day 7 (0.3 ± 0.5 and 0.0 ± 0.0) and day 28 (4.0 ± 0.0, p = 0.01 and 2.0 ± 0.8, p = 0.01; respectively), while hemorrhage scores significantly decreased from 2.5 ± 0.6 to 0.0 ± 0.0 (p = 0.01). The inflammatory scores were not significantly different between the heterologous graft and control sides. CONCLUSION The described sheep model accurately reflects prospective intranasal wound healing following vascularized mucosal reconstruction of dural defects. This model can be used in future studies to examine novel reconstructive materials, tissue glues, and transmucosal drug delivery to the central nervous system.
Collapse
Affiliation(s)
- Sarina K Mueller
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.,Department of Otolaryngology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - George Scangas
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Mansor M Amiji
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Ishihara M, Mochizuki-Oda N, Iwatsuki K, Kishima H, Ohnishi YI, Moriwaki T, Umegaki M, Yoshimine T. Primary olfactory mucosal cells promote axonal outgrowth in a three-dimensional assay. J Neurosci Res 2014; 92:847-55. [DOI: 10.1002/jnr.23367] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/31/2013] [Accepted: 01/02/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Masahiro Ishihara
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Noriko Mochizuki-Oda
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Koichi Iwatsuki
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Haruhiko Kishima
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Yu-ichiro Ohnishi
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Takashi Moriwaki
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Masao Umegaki
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Suita City Osaka Japan
| |
Collapse
|
6
|
Olfactory epithelial transplantation: possible mechanism for restoration of smell. Curr Opin Otolaryngol Head Neck Surg 2011; 19:54-7. [PMID: 21102335 DOI: 10.1097/moo.0b013e328341e242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To discuss the unique properties of the olfactory epithelium and the potential use of olfactory epithelial grafts to restore olfactory function. RECENT FINDINGS Sensory neurons in the olfactory epithelium undergo continuous regeneration, grow new axons, and reestablish connections with the olfactory bulb throughout life. When transplanted into different regions of the brain, olfactory epithelial graft cells retain their morphological and regenerative properties. Olfactory cells within the grafts grow axons that enter into the surrounding brain tissue. Recent studies have shown that the olfactory epithelium can be grafted directly to the olfactory bulb. SUMMARY The olfactory epithelium has a remarkable capacity to continuously generate new sensory neurons and survives grafting into different regions of the brain. A review of the literature and the future use of olfactory grafts as a potential method to restore olfactory function is discussed.
Collapse
|
7
|
Abstract
BACKGROUND Impaired olfactory function leads to a decrease in the quality of life for many patients. Surgical treatment options are limited, especially for those suffering from hyposmia or anosmia after posttraumatic injury to the olfactory nerves. Stem cells located in the olfactory epithelium (OE) have the capacity to grow new neurons, making the OE an ideal candidate for restorative tissue grafting. This study was performed to determine if strips of OE survive transplantation directly to the olfactory bulb (OB). METHODS Transgenic mice, expressing a green fluorescent protein (GFP), were used to obtain the donor graft tissue. Strips of OE from GFP donor mice were transplanted directly to sites in the OB and cerebral cortex (CC; control sites) of wild-type mice. Graft survival rates at 30 days were determined for transplant sites in the OB and CC. RESULTS Strips of OE from transgenic mice survived transplantation to the OB and continued to express the GFP marker protein. The 30-day survival rate in the OB (83%, 5 of 6 grafts) was the same as in the CC (10 of 12 grafts). The morphology of the graft revealed characteristics found in normal OE. CONCLUSION We showed that strips of OE can be successfully grafted to both the OB and CC. Grafts of the OE, if strategically positioned on the ventral surface of the bulb and given access to the nasal cavity, could provide the basis for new surgical treatments to restore olfactory function.
Collapse
Affiliation(s)
- Sayaka Yagi
- Department of Physiology and Biophysics, Virginia Commonwealth University, School of Medicine, Richmond, Virginia 23298-0551, USA
| | | |
Collapse
|
8
|
Tsujigiwa H, Nishizaki K, Teshima T, Takeda Y, Yoshinobu J, Takeuchi A, Orita Y, Sugata Y, Nagatsuka H, Nagai N. The engraftment of transplanted bone marrow-derived cells into the olfactory epithelium. Brain Res 2005; 1052:10-5. [PMID: 15996641 DOI: 10.1016/j.brainres.2005.05.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 05/23/2005] [Accepted: 05/27/2005] [Indexed: 12/22/2022]
Abstract
To investigate whether bone marrow cells migrate and are engrafted into the olfactory epithelium and differentiate into olfactory neurons, bone marrow cells of green fluorescence protein (GFP) mice were transplanted into lethally irradiated recipient mice. Immunohistochemical staining was performed to evaluate the engraftment of donor bone marrow cells into the olfactory epithelium. Immunostaining for GFP was found initially in the olfactory epithelium 2 weeks after bone marrow reconstruction. The percentage of GFP positive cells increased up to 12 months after bone marrow reconstruction. Double staining for GFP and olfactory marker protein showed that a population of the GFP-positive cells had characteristics of olfactory neurons. These results demonstrate that bone marrow cells can be engrafted in the olfactory epithelium and then differentiate into olfactory neuron cells.
Collapse
Affiliation(s)
- Hidetsugu Tsujigiwa
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine and Dentistry, Shikata-cho 2-5-1, Okayama 700-8558, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Transplantation of olfactory mucosa minimizes axonal branching and promotes the recovery of vibrissae motor performance after facial nerve repair in rats. J Neurosci 2002. [PMID: 12177208 DOI: 10.1523/jneurosci.22-16-07121.2002] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The occurrence of abnormally associated movements is inevitable after facial nerve transection. The reason for this post-paralytic syndrome is poor guidance of regrowing axons, whereby a given muscle group is reinnervated by misrouted axonal branches. Olfactory ensheathing glia have been shown to reduce axonal sprouting and stimulate axonal regeneration after transplantation into the spinal cord. In the present study, we asked whether transplantation of olfactory mucosa (OM) would also reduce sprouting of a damaged peripheral pure motor nerve. The adult facial nerve was transected, and the effect of the OM placed at the lesion site was analyzed with regard to the accuracy of target reinnervation, axonal sprouting of motoneurons, and vibrissal motor performance. Accuracy of target reinnervation and axonal sprouting were studied using preoperative/postoperative labeling and triple retrograde labeling of facial motoneurons, respectively. The vibrissal motor performance was monitored using a video-based motion analysis. We show here that implantation of OM, compared with simple facial-facial anastomosis, (1) improved the protraction, amplitude, angular velocity, and acceleration of vibrissal movements up to 80% of the control values, (2) reduced the percentage of branching motoneurons from 76 to 39%, and (3) improved the accuracy of reinnervation from 22 to 49%. Moreover, we present evidence, that transplanted OM but not buccal mucous membrane induced a sustained upregulation of trophic factors at the lesion site. It is concluded that transplantation of OM to the transected facial nerve significantly improves nerve regeneration.
Collapse
|