1
|
Suehiro A, Kojima T, Iwanaga K, Fujimura S, Kawai Y, Kishimoto Y, Omori K. Phonosurgery training using Japanese deer larynx. Auris Nasus Larynx 2024; 51:713-716. [PMID: 38796982 DOI: 10.1016/j.anl.2024.05.003] [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] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To develop phonosurgery skills, surgical training of the actual larynx is essential. In our institution, the Japanese deer (Cervus Nippon aplodontids) larynx is used in phonosurgery training. This study aimed to examine the similarities and differences between the Japanese deer and human larynx and to demonstrate their utility in vocal surgery practice. METHODS A comparative study was conducted using 30 Japanese deer larynges and 51 human donor larynges, evaluating the overall framework, dimensions, and angle of the thyroid cartilage, vocal cord length, and location of the arytenoid cartilage muscular process. The changes and movements of the vocal folds during contraction and relaxation of each internal laryngeal muscle were also visually analyzed. RESULTS The larynx size of Japanese deer is intermediate between that of human males and females. The adduction and abduction of the vocal folds induced by contraction of the posterior and lateral cricoarytenoid muscles, as well as the extension of the vocal folds induced by contraction of the cricothyroid muscle, behaved in the same manner as in the human larynx. CONCLUSION The morphology of the Japanese deer larynx is similar to that of the human larynx, making it suitable for use in dissection and surgical practice. Owing to the recent animal damage problem and the popularity of gibier cuisine, large quantities of Japanese deer larynx are available at low prices. We believe that the Japanese deer larynx is the most appropriate animal for phonosurgery training so far.
Collapse
Affiliation(s)
- Atsushi Suehiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tsuyoshi Kojima
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Iwanaga
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
2
|
Hamilton NJI, Tait A, Weil B, Daniels J. The Use of a Dehydrated Cellularized Collagen Matrix to Replace Fibrotic Vocal Fold Mucosa. Laryngoscope 2024; 134:882-893. [PMID: 37681762 DOI: 10.1002/lary.31034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Fibrosis of the vocal fold lamina propria reduces vocal cord vibration resulting in a chronically hoarse voice. We describe a novel approach using umbilical cord-derived mesenchymal stem cells in a dehydrated collagen matrix (cellogen) to reconstruct the delicate balance of extracellular matrix within the vocal fold lamina propria whilst limiting the host inflammatory response to the implant. METHODS Human umbilical cord-derived mesenchymal stem-cells were embedded in bovine type I collagen hydrogel and dehydrated using the RAFT™ 3D culture system. The extracellular matrix, cellular viability and composition, paracrine profile, and genomic profile were assessed and the scaffold engrafted onto the hind muscle of NUDE mice. RESULTS The cells retained stem-cell markers following fabrication and secreted collagen III, fibronectin, and glycosaminoglycans within the scaffold. Electron microscopy showed the scaffold consisted of single strands of protein with interspersed bundles of a similar size to native vocal fold lamina propria. The use of the dehydration step improved cell viability and upregulated the expression of genes important in wound healing and matrix organization compared with unmodified collagen hydrogel carriers. The cells were shown to secrete exosomes and cytokines and, following engraftment within an immunocompromised mouse model, appeared to modulate the host inflammatory response compared with controls. CONCLUSION This article provides a scalable cell-protein scaffold that with further modifications could provide a replacement for lost or damaged vocal fold mucosa. Further investigations are required to assess the mechanical properties of the scaffold and inhibit the differentiation of the umbilical cord-derived stem-cells following implantation. Laryngoscope, 134:882-893, 2024.
Collapse
Affiliation(s)
- Nick J I Hamilton
- Head & Neck Academic Centre, UCL Division of Surgery and Interventional Sciences, University College London, London, UK
- Royal National Ear Nose & Throat Hospital, University College London Hospitals NHS Trust, London, UK
| | - Angela Tait
- Centre for Cell, Gene & Tissue Therapy, Royal Free London NHS Foundation Trust, London, UK
| | - Ben Weil
- Centre for Cell, Gene & Tissue Therapy, Royal Free London NHS Foundation Trust, London, UK
| | - Julie Daniels
- Cells for Sight, Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
3
|
Zhang C, Pang W, Gong T, Jiang JJ, Silverman M, Li G. 5-Aminolevulinic Acid-Mediated Photodynamic Therapy Improves Vocal Fold Wound Healing in Rats. Laryngoscope 2023; 133:1943-1951. [PMID: 36278803 DOI: 10.1002/lary.30427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Studies showed that photodynamic therapy (PDT) might be able to prevent vocal fold scar formation when treating laryngeal lesions. We aim to investigate if PDT improves vocal wound healing and reduces scar formation in both prophylactic and remodeling procedures performed in vivo. STUDY DESIGN In vivo. METHODS Vocal fold stripping was performed in Sprague-Dawley rats. PDT was performed with intraperitoneal injection of 100 mg/kg 5-Aminolevulinic Acid (5-ALA) and 635 nm laser irradiation of 20, 40, and 60 J/cm2 . PDT was performed immediately after surgery to study the prophylactic effect and 4 weeks after surgery to study the remodeling effect. Gene expression was evaluated with real-time PCR at 1 week after PDT. Histologic evaluations were performed 12 weeks after PDT, including hematoxylin-eosin, Masson, Alcian blue staining, and immunohistochemical staining of collagen I and III. RESULTS PDT induced similar effects on the vocal fold wound healing outcomes in both prophylactic and remodeling procedures. Expression of MMP8, MMP13, HAS2, and TGFβ1 was significantly elevated. Histologic evaluation revealed significantly increased thickness, decreased density of collagen, and increased deposition of hyaluronic acid in the lamina propria. Immunohistochemistry also revealed better distribution and reduced density of collagen I and III. The most obvious changes were seen in the 60 J/cm2 PDT group. CONCLUSION PDT could significantly improve vocal wound healing by providing both prophylactic effects and remodeling effects. It may be a minimally invasive treatment for vocal fold lesions with slight vocal scarring, and may be used to treat acute or chronic vocal injury to reduce vocal scarring. LEVEL OF EVIDENCE N/A Laryngoscope, 133:1943-1951, 2023.
Collapse
Affiliation(s)
- Chi Zhang
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wenting Pang
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ting Gong
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matthew Silverman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gelin Li
- From the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
4
|
Jeon GH, Seon SW, Lee SW. Comparative Results of Vocal Fold Injury According to the Fiber-Based Laser in a Rabbit Vocal Fold Model. J Voice 2023:S0892-1997(23)00029-2. [PMID: 36849301 DOI: 10.1016/j.jvoice.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES We assessed the safety of flexible fiber-based lasers including the potassium-titanyl-phosphate (KTP), CO2, and Holmium lasers using a rabbit vocal fold model and provided the safety evidence of laser before human clinical trial. METHODS In all, 120 male New Zealand white rabbits were used. Each laser was used to induce acute and chronic vocal fold injuries in 40 rabbits. The same laser energy with the same intensity and frequency were used in all cases, and we evaluated outcomes via surface scanning electron microscopy (SEM) and histological examination 1 day after injury. Histological and high-speed vocal fold vibration examinations were evaluated 1 month after injury. Surface injury roughness grading was done via SEM, and the Acute injury ratio and lamina propria (LP) ratio were also calculated. The dynamic glottal gap was measured through functional analyses based on recordings from a high-speed digital camera. RESULTS The Holmium laser caused significantly more vocal fold damage than did the KTP and CO2 lasers as revealed by SEM and evaluation of acute and chronic injuries. Functional analysis with high-speed digital camera indicated that the holmium laser reduced dynamic glottal gap compared with the normal vocal fold, where the other lasers did not. CONCLUSIONS The histological and functional analyses of rabbit vocal fold experiments indicated that fiber-based laryngeal laser surgery for vocal fold lesions could be performed relatively safely using a KTP or CO2 laser.
Collapse
Affiliation(s)
- Gyeong Hwa Jeon
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sang Woo Seon
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Seung Won Lee
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
| |
Collapse
|
5
|
Kawai Y, Mizuta M, Tateya I, Kishimoto Y, Fujimura S, Suehiro A, Hiwatashi N, Omori K. Intraoperative computed tomography imaging for laryngoplasty. Auris Nasus Larynx 2023; 50:94-101. [PMID: 35701287 DOI: 10.1016/j.anl.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/09/2022] [Accepted: 05/31/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Intraoperative cone beam computed tomography (CBCT) imaging has the potential to facilitate the surgical procedure. The current preliminary retrospective chart review investigated the benefits of intraoperative CBCT during laryngoplasty. METHOD This study examined 26 cases that underwent intraoperative CBCT imaging during laryngoplasty, with one patient who counted twice due to first and revision surgery. The visual quality of structures of interest (glottal shape, thyroid cartilage, arytenoid cartilage, and implants) was determined using intraoperative CBCT during laryngoplasty. Each patient also underwent an aerodynamic assessment. RESULTS CBCT provided unique information, such as surgical landmarks in severe scarring, the subglottal shape, and the rotation angle of the arytenoid cartilage during arytenoid adduction. Nonetheless, 26.9% (7 of 26) of cases were affected by motion artifact, due to the long acquisition time. When motion artifact-negative cases were evaluated, 100% of glottal shape and more than 89% of thyroid cartilage were well visualized. All arytenoids were well-visualized in patients ≥ 50 years of age and without motion artifact, while CBCT failed to visualize the arytenoids in 2 of 4 patients who were < 50 years, due to the lack of calcifications. After medialization surgery, the yields of improved maximal phonation times (MPTs) in the motion artifact-negative and -positive groups were 8.7 sec and 3.4 sec, respectively (p = 0.032; Welch's t test). This comparison indicates intraoperative CBCT would contribute in MPT improvement, if CBCT is taken in measurable quality. CONCLUSION The potential benefits of intraoperative CBCT during laryngoplasty were demonstrated. A corollary, prospective study is warranted to further confirmation.
Collapse
Affiliation(s)
- Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Fujita Health University, Aichi, Japan.
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Suehiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
6
|
Nozawa M, Takahashi S, Kanazawa T, Kurakami K, Hasegawa T, Hirosaki M, Kamitomai M, Komazawa D, Konomi U, Ito M, Watanabe Y. Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor. Laryngoscope Investig Otolaryngol 2022; 7:1465-1473. [PMID: 36258881 PMCID: PMC9575124 DOI: 10.1002/lio2.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3-6 months after injection. Results In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence 4.
Collapse
Affiliation(s)
- Miki Nozawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Satoka Takahashi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Takeharu Kanazawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Kazuya Kurakami
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Department of Otolaryngology‐Head and Neck SurgeryYamagata University, Faculty of MedicineYamagataJapan
| | - Tomohiro Hasegawa
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Mayu Hirosaki
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Manami Kamitomai
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Daigo Komazawa
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- AKASAKA Voice Health CenterTokyoJapan
| | - Ujimoto Konomi
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Voice and Dizziness Clinic Futakotamagawa OtolaryngologyTokyoJapan
| | - Makoto Ito
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery, School of MedicineJichi Medical UniversityShimotsukeJapan
| | - Yusuke Watanabe
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| |
Collapse
|
7
|
Yamauchi T, Kanazawa T, Hasegawa T, Kurakami K, Konomi U, Hirosaki M, Komazawa D, Nozawa M, Takahashi S, Watanabe Y. Long-term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis. Laryngoscope Investig Otolaryngol 2022; 7:799-806. [PMID: 35734070 PMCID: PMC9194994 DOI: 10.1002/lio2.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Treatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short-term results. In this study, we present the long-term results and safety of vocal fold bFGF injection as a treatment for UVFP. Methods This retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 μg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23-gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection. Results Overall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery. Conclusion In total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long-term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.
Collapse
Affiliation(s)
- Tomohiko Yamauchi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck SurgeryJichi Medical UniversityShimotsukeJapan
| | - Takeharu Kanazawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck SurgeryJichi Medical UniversityShimotsukeJapan
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Tomohiro Hasegawa
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Kazuya Kurakami
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Department of Otolaryngology Head and Neck Surgery, Faculty of MedicineYamagata UniversityYamagataJapan
| | - Ujimoto Konomi
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- Voice and Dizziness Clinic Futakotamagawa OtolaryngologyTokyoJapan
| | - Mayu Hirosaki
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| | - Daigo Komazawa
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
- AKASAKA Voice Health CenterTokyoJapan
| | - Miki Nozawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck SurgeryJichi Medical UniversityShimotsukeJapan
| | - Satoka Takahashi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck SurgeryJichi Medical UniversityShimotsukeJapan
| | - Yusuke Watanabe
- Tokyo Voice CenterInternational University of Health and WelfareTokyoJapan
| |
Collapse
|
8
|
González-Pérez M, Camasão DB, Mantovani D, Alonso M, Rodríguez-Cabello JC. Biocasting of an elastin-like recombinamer and collagen bi-layered model of the tunica adventitia and external elastic lamina of the vascular wall. Biomater Sci 2021; 9:3860-3874. [PMID: 33890956 DOI: 10.1039/d0bm02197k] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of techniques for fabricating vascular wall models will foster the development of preventive and therapeutic therapies for treating cardiovascular diseases. However, the physical and biological complexity of vascular tissue represents a major challenge, especially for the design and the production of off-the-shelf biomimetic vascular replicas. Herein, we report the development of a biocasting technique that can be used to replicate the tunica adventitia and the external elastic lamina of the vascular wall. Type I collagen embedded with neonatal human dermal fibroblast (HDFn) and an elastic click cross-linkable, cell-adhesive and protease-sensitive elastin-like recombinamer (ELR) hydrogel were investigated as readily accessible and tunable layers to the envisaged model. Mechanical characterization confirmed that the viscous and elastic attributes predominated in the collagen and ELR layers, respectively. In vitro maturation confirmed that the collagen and ELR provided a favorable environment for the HDFn viability, while histology revealed the wavy and homogenous morphology of the ELR and collagen layer respectively, the cell polarization towards the cell-attachment sites encoded on the ELR, and the enhanced expression of glycosaminoglycan-rich extracellular matrix and differentiation of the embedded HDFn into myofibroblasts. As a complementary assay, 30% by weight of the collagen layer was substituted with the ELR. This model proved the possibility to tune the composition and confirm the versatile character of the technology developed, while revealing no significant differences with respect to the original construct. On-demand modification of the model dimensions, number and composition of the layers, as well as the type and density of the seeded cells, can be further envisioned, thus suggesting that this bi-layered model may be a promising platform for the fabrication of biomimetic vascular wall models.
Collapse
Affiliation(s)
- Miguel González-Pérez
- BIOFORGE (Group for Advanced Materials and Nanobiotechnology), University of Valladolid, CIBER-BBN, 47011 Valladolid, Spain.
| | - Dimitria Bonizol Camasão
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair I in Biomaterials and Bioengineering for the Innovation in Surgery, Department of Min-Met-Materials Engineering, Research Center of CHU de Québec, Division of Regenerative Medicine, Laval University, Québec, QC, Canada G1V 0A6
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair I in Biomaterials and Bioengineering for the Innovation in Surgery, Department of Min-Met-Materials Engineering, Research Center of CHU de Québec, Division of Regenerative Medicine, Laval University, Québec, QC, Canada G1V 0A6
| | - Matilde Alonso
- BIOFORGE (Group for Advanced Materials and Nanobiotechnology), University of Valladolid, CIBER-BBN, 47011 Valladolid, Spain.
| | - José Carlos Rodríguez-Cabello
- BIOFORGE (Group for Advanced Materials and Nanobiotechnology), University of Valladolid, CIBER-BBN, 47011 Valladolid, Spain.
| |
Collapse
|
9
|
Hirano S, Sugiyama Y, Kaneko M, Mukudai S, Fuse S, Hashimoto K. Intracordal Injection of Basic Fibroblast Growth Factor in 100 Cases of Vocal Fold Atrophy and Scar. Laryngoscope 2020; 131:2059-2064. [PMID: 33107605 DOI: 10.1002/lary.29200] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold atrophy, scar, and sulcus reduce the vibratory function of the vocal fold mucosa, which causes severe refractory dysphonia. We have reported encouraging preliminary results using an intracordal injection of basic fibroblast growth factor (bFGF) and showed improvement in phonatory parameters and voice. The present study summarizes our experience with 100 cases of stiffened vocal folds that were treated with bFGF injections. STUDY DESIGN Retrospective chart review with Interstitial Review Board (IRB) approval. METHODS Local injection of bFGF was performed in 100 cases of vocal fold pathology, which included 43 cases of vocal fold atrophy, 41 cases with scar, and 16 cases with sulcus. Ten micrograms of bFGF were injected into the vocal folds under topical anesthesia 4 times in each patient. Therapeutic outcomes were examined with maximum phonation time (MPT), voice handicap index-10 (VHI-10), and GRBAS scale. RESULTS MPT, VHI-10, and GRBAS scores significantly improved in all pathology groups. An improvement on the VHI-10 greater than five points was observed in 82% of atrophy cases, 78% of scar cases, and 67% of sulcus cases. Improvement on the VHI-10 was significantly better in the atrophy group than the scar or sulcus groups. The mild/moderate cases of scar and sulcus showed better improvement than severe cases. CONCLUSIONS The current large case series indicates positive effects of intracordal injection of bFGF for improvement of voice with no severe adverse events. The effects appeared best for cases of atrophy, while the treatment of severe scar and sulcus requires further improvement. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2059-2064, 2021.
Collapse
Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology, Kanai Hospital, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology, Kanai Hospital, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiko Hashimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
10
|
Li X, Wang H, Xu W. HGF and bFGF Secreted by Adipose-Derived Mesenchymal Stem Cells Revert the Fibroblast Phenotype Caused by Vocal Fold Injury in a Rat Model. J Voice 2020; 36:622-629. [PMID: 32921552 DOI: 10.1016/j.jvoice.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate how adipose-derived mesenchymal stem cells (ADSCs), secreted hepatocyte growth factor (HGF), and basic fibroblast growth factor (bFGF) affect the fibroblast phenotype after vocal fold injury. METHODS We cultured primary normal (uninjured) and injured vocal fold fibroblasts (VFFs). A transwell co-culture system of ADSCs and injured VFFs was constructed in vitro, then the effects of HGF or bFGF were inhibited. The proliferation, extracellular matrix (ECM) secretion and transformation of VFFs were observed. RESULTS Compared with uninjured VFFs, the secretion of collagen by injured VFFs increased significantly, hyaluronan synthase 1 (HAS1) secretion decreased, and VFF transformation increased significantly. After co-culture with ADSCs, the proliferation of VFFs was accelerated and the transformation was inhibited. Co-culture inhibited the expression of type I and III collagen and promoted the expression of HAS1. When HGF or bFGF secretion was inhibited, the proliferation of injured VFFs was inhibited. The inhibitory effect on collagen was reduced by both groups, but this was more obvious with the anti-HGF group. The anti-bFGF group had a more prominent effect on HAS1 secretion after injury than the anti-HGF group but the difference was not statistically significant. The inhibition of the transformation of injured VFFs was reduced while α-smooth muscle actin was upregulated, which was more obvious with the anti-HGF group. CONCLUSIONS ADSCs and secreted HGF and bFGF can revert the fibroblast phenotype caused by vocal fold injury. The effects of HGF are more significant than bFGF on collagen secretion and the transformation of VFFs into myofibroblasts. However, bFGF is more effective than HGF in upregulating HAS1.
Collapse
Affiliation(s)
- Xueyan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Ministry of Education of China, Beijing, China
| | - Haizhou Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Ministry of Education of China, Beijing, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Ministry of Education of China, Beijing, China.
| |
Collapse
|
11
|
Choi JS, Heang Oh S, Kim YM, Lim JY. Hyaluronic Acid/Alginate Hydrogel Containing Hepatocyte Growth Factor and Promotion of Vocal Fold Wound Healing. Tissue Eng Regen Med 2020; 17:651-658. [PMID: 32676953 DOI: 10.1007/s13770-020-00280-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocyte growth factor (HGF) has been shown to facilitate vocal fold (VF) wound healing. This study was undertaken to determine whether the therapeutic efficacy of HGF could be enhanced by applying it in hyaluronic acid and alginate (HA/ALG) composite hydrogels into VFs after injury in a rabbit model. METHODS HGF was loaded into HA/ALG composite hydrogel (HGF-HA/ALG) and its in vitro release profile was evaluated. In addition, HGF-HA/ALG was injected into the VFs of rabbits immediately after direct injury and HGF or PBS was injected in the same manner into control groups. Macroscopic features were observed by endoscopy at 3 months post-injury. Functional analyses including mucosal waves of VFs and viscoelastic properties were performed by kymography following high-speed digital imaging and rheometer. Histopathological and immunohistochemical evaluations were also conducted on VFs. RESULTS HGF release from HGF-HA/ALG was sustained for up to 3 weeks. Rabbits treated with HGF-HA/ALG showed improved mucosal vibrations and VF viscoelastic properties as compared with the PBS and HGF controls. Histopathological staining revealed HGF-HA/ALG treated VFs showed less fibrosis than PBS and HGF controls, and immunohistochemical analysis demonstrated amounts of type I collagen and fibronectin were lower in HGF-HA/ALG treated animals than in PBS and HGF controls at 3 months post-injury. CONCLUSION HGF containing HA/ALG hydrogel enhanced healing in our rabbit model of VF injury.
Collapse
Affiliation(s)
- Jeong-Seok Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Inha University School of Medicine, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, 31116, Republic of Korea
| | - Young-Mo Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Inha University School of Medicine, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
12
|
Xu H, Fan GK. The Role of Cytokines in Modulating Vocal Fold Fibrosis: A Contemporary Review. Laryngoscope 2020; 131:139-145. [PMID: 32293731 DOI: 10.1002/lary.28507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/11/2019] [Accepted: 12/29/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Vocal fold (VF) scarring and laryngeal stenosis are a significant clinical challenge. Excessive scar formation causes low voice quality or even life-threatening obstructions. Cytokines are thought to modulate multiple steps of the establishment of VF fibrosis, but there is no systematic report regarding their role in modulating VF fibrosis. This review aims to investigate the role of cytokines in modulating vocal fold fibrosis. STUDY DESIGN Literature review. METHODS This review searched for all relevant peer publications in English for the period 2009 to 2019 in the PubMed database using search terms: "laryngeal stenosis," "vocal fold scarring," and "cytokines." A thorough investigation of the methods and results of the reviewed studies was performed. RESULTS Comprehensive research in various studies, including analyses of prostaglandin E2 (PGE2), granulocyte-macrophage colony-stimulating factor (GM-CSF), hepatocyte growth factor (HGF), basic fibroblast growth factor (bFGF), transforming growth factor-β3 (TGF-β3), and interleukin-10 (IL-10), supports cytokine therapy for VF scarring and laryngeal stenosis to some extent. A few clinical studies on this topic support the conclusion that HGF and bFGF can be selected as effective drugs, and no serious side effects were found. CONCLUSIONS This review describes the potential of cytokines for modulating the process of VF fibrogenesis, although cytokines are still an unproven treatment method. As no ideal drugs exist, cytokines may be considered the candidate treatment for preventing VF fibrogenesis. Laryngoscope, 131:139-145, 2021.
Collapse
Affiliation(s)
- Haoyuan Xu
- Department of Otolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guo-Kang Fan
- Department of Otolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
13
|
Okui A, Konomi U, Kanazawa T, Komazawa D, Nakamura K, Matsushima K, Watanabe Y. Therapeutic Efficacy of Basic Fibroblast Growth Factor in Patients With Vocal Fold Atrophy. Laryngoscope 2020; 130:2847-2852. [PMID: 32034961 DOI: 10.1002/lary.28541] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS In recent years, basic fibroblast growth factor (bFGF) injection has been used in the treatment of aging-related vocal fold atrophy. This injection not only improves closure by increasing the mass of the vocal fold but also improves its viscoelasticity. However, it has been reported that fibroblasts targeted by bFGF treatment decrease in number with age. The purpose of this study was to examine the effects of local injection of bFGF on age-related vocal atrophy as well as the influence of age on phonological outcomes. STUDY DESIGN Retrospective chart review. METHODS Fifty-three patients with age-related vocal fold atrophy underwent single injections of bFGF in their vocal folds. Phonological outcomes were evaluated 3 and 6 months after injection by acoustic and aerodynamic measurements. RESULTS Voice Handicap Index (VHI), maximum phonation time (MPT), jitter, shimmer, and pitch range improved after injection, and the effects continued for 6 months. In those over 70 years of age, VHI and MPT showed improvement at 3 and 6 months after injection. In addition, the degree of improvement in VHI and MPT did not differ significantly between those older than 70 years and those younger than 70 years. CONCLUSIONS Regenerative treatments dependent on bFGF single injection was safe and effective for both early and late elderly patients suffering of vocal fold atrophy. LEVEL OF EVIDENCE 2c Laryngoscope, 2020.
Collapse
Affiliation(s)
- Ayako Okui
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Graduate School of Medicine, International University of Health and Welfare Graduate School, Tokyo
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Department of Otolaryngology-Head and Neck Surgery, Nihon University, Itabashi Hospital, Tokyo
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo.,Department of Otolaryngology-Head and Neck Surgery, Toho University, Omori Medical Center, Tokyo, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo
| |
Collapse
|
14
|
Lee S, Seon S, Park K, Ryu J. Vocal Fold Reconstruction Using an Autologous Pedicled Fat Flap in a Rabbit Model. Laryngoscope 2019; 130:1770-1774. [DOI: 10.1002/lary.28303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/15/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Seungwon Lee
- Department of Otolaryngology–Head and Neck SurgerySoonchunhyang University College of Medicine Bucheon South Korea
| | - Sangwoo Seon
- Department of Otolaryngology–Head and Neck SurgerySoonchunhyang University College of Medicine Bucheon South Korea
| | - Kinam Park
- Department of Otolaryngology–Head and Neck SurgerySoonchunhyang University College of Medicine Bucheon South Korea
| | - Junsun Ryu
- Department of Otolaryngology–Head and Neck SurgeryNational Cancer Center Goyang South Korea
| |
Collapse
|
15
|
Chen H, Erndt-Marino J, Diaz-Rodriguez P, Kulwatno J, Jimenez-Vergara AC, Thibeault SL, Hahn MS. In vitro evaluation of anti-fibrotic effects of select cytokines for vocal fold scar treatment. J Biomed Mater Res B Appl Biomater 2019; 107:1056-1067. [PMID: 30184328 PMCID: PMC7011756 DOI: 10.1002/jbm.b.34198] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/30/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023]
Abstract
Scarring of the vocal fold lamina propria (LP) can cause considerable voice disorders due to reduced pliability in scar tissue, attributed in part to abnormal extracellular matrix (ECM) deposition produced by the fibrotic vocal fold fibroblast (fVFF). Cytokines with anti-fibrotic potential have been investigated to limit abnormal LP ECM, but are limited by the need for repeat injections. Moreover, the potentially significant role played by activated macrophages (AMOs) is usually not considered even though the interaction between AMO and fibrotic fibroblasts is known to regulate scar formation across different tissues. AMO are also regulated by cytokines that are used for LP scar removal, but little is known about AMO behaviors in response to these cytokines within the context of LP scar. In the present study, we evaluated anti-fibrotic effects of hepatocyte growth factor (HGF), interleukin-10 (IL-10) and interleukin-6 (IL-6) in a 3D, in vitro fVFF-AMO co-culture system using poly(ethylene glycol) diacrylate (PEGDA) hydrogels. Data from all cytokines was synthesized into a heat-map that enabled assessment of specific associations between AMO and fVFF phenotypes. Cumulatively, our results indicated that both HGF and IL-10 are potentially anti-fibrotic (reduction in fibrotic markers and enhancement in normal, anti-fibrotic VFF markers), while IL-6 displays more complex, marker specific effects. Possible associations between AMO and fVFF phenotypes were found and may highlight a potential desirable macrophage phenotype. These data support the therapeutic potential of HGF and IL-10 for LP scar treatment, and shed light on future strategies aimed at targeting specific AMO phenotypes. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1056-1067, 2019.
Collapse
Affiliation(s)
- Hongyu Chen
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | - Josh Erndt-Marino
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | - Jonathan Kulwatno
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mariah S. Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| |
Collapse
|
16
|
Pitman MJ, Kurita T, Powell ME, Kimball EE, Mizuta M, Chang S, Garrett CG, Rousseau B. Vibratory function and healing outcomes after small intestinal submucosa biomaterial implantation for chronic vocal fold scar. Laryngoscope 2017; 128:901-908. [PMID: 29105772 DOI: 10.1002/lary.26883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/04/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar is a major cause of dysphonia, and optimal treatments do not currently exist. Small intestinal submucosa (SIS) is a biomaterial developed for the treatment of a variety of pathologies. The purpose of this study was to investigate the effects of SIS implantation on tissue remodeling in scarred vocal folds using routine staining, immunohistochemistry, and high-speed videoendoscopy (HSV). STUDY DESIGN Prospective, blinded group analysis. METHODS Thirteen New Zealand White rabbits underwent a vocal fold scarring procedure followed by microflap elevation with or without SIS implantation. Seven months later, they underwent a phonation procedure with HSV and laryngeal harvest. Alcian blue and elastica van Gieson staining and immunohistochemistry for collagen types I and III were used to evaluate histological healing outcomes. Dynamic functional remodeling of the scarred vocal fold in the presence of SIS implants was evaluated using HSV imaging to capture restoration of vibratory amplitude, amplitude ratio, and left-right phase symmetry. RESULTS Density of collagen I was significantly decreased in SIS versus microflap-treated vocal folds. No differences were found between groups for hyaluronic acid, elastin, or collagen type III. Organization of elastin in the subepithelial region appeared to affect amplitude of vibration and the shape of the vocal fold edge. CONCLUSIONS SIS implantation into chronic scar reduced the density of collagen I deposits. There was no evidence of a negative impact or complication from SIS implantation. Regardless of treatment type, organization of elastin in the subepithelial region may be important to vibratory outcomes. LEVEL OF EVIDENCE NA. Laryngoscope, 128:901-908, 2018.
Collapse
Affiliation(s)
- Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center/New York Presbyterian, New York, New York, U.S.A
| | - Takashi Kurita
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Maria E Powell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Chang
- Corning Research and Development Corporation, Painted Post, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| |
Collapse
|
17
|
Xu CC, Chan RW, Sun H, Zhan X. A mixed-effects model approach for the statistical analysis of vocal fold viscoelastic shear properties. J Mech Behav Biomed Mater 2017; 75:477-485. [PMID: 28823902 PMCID: PMC6486179 DOI: 10.1016/j.jmbbm.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022]
Abstract
A mixed-effects model approach was introduced in this study for the statistical analysis of rheological data of vocal fold tissues, in order to account for the data correlation caused by multiple measurements of each tissue sample across the test frequency range. Such data correlation had often been overlooked in previous studies in the past decades. The viscoelastic shear properties of the vocal fold lamina propria of two commonly used laryngeal research animal species (i.e. rabbit, porcine) were measured by a linear, controlled-strain simple-shear rheometer. Along with published canine and human rheological data, the vocal fold viscoelastic shear moduli of these animal species were compared to those of human over a frequency range of 1-250Hz using the mixed-effects models. Our results indicated that tissues of the rabbit, canine and porcine vocal fold lamina propria were significantly stiffer and more viscous than those of human. Mixed-effects models were shown to be able to more accurately analyze rheological data generated from repeated measurements.
Collapse
Affiliation(s)
- Chet C Xu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Graduate Program in Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Roger W Chan
- Department of Speech Language Pathology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Han Sun
- Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, OH, 44195, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Xiaowei Zhan
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| |
Collapse
|
18
|
Shintani K, Uemura T, Takamatsu K, Yokoi T, Onode E, Okada M, Nakamura H. Protective effect of biodegradable nerve conduit against peripheral nerve adhesion after neurolysis. J Neurosurg 2017; 129:815-824. [PMID: 29053076 DOI: 10.3171/2017.4.jns162522] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Peripheral nerve adhesion caused by extraneural and intraneural scar formation after neurolysis leads to nerve dysfunction. The authors previously developed a novel very flexible biodegradable nerve conduit composed of poly(L-lactide) and poly(ε-caprolactone) for use in peripheral nerve regeneration. In the present study, they investigated the effect of protective nerve wrapping on preventing adhesion in a rat sciatic nerve adhesion model. METHODS Rat sciatic nerves were randomly assigned to one of the following four groups: a no-adhesion group, which involved neurolysis alone without an adhesion procedure; an adhesion group, in which the adhesion procedure was performed after neurolysis, but no treatment was subsequently administered; a nerve wrap group, in which the adhesion procedure was performed after neurolysis and protective nerve wrapping was then performed with the nerve conduit; and a hyaluronic acid (HA) group, in which the adhesion procedure was performed after neurolysis and nerve wrapping was then performed with a 1% sodium HA viscous solution. Six weeks postoperatively, the authors evaluated the extent of scar formation using adhesion scores and biomechanical and histological examinations and assessed nerve function with electrophysiological examination and gastrocnemius muscle weight measurement. RESULTS In the adhesion group, prominent scar tissue surrounded the nerve and strongly adhered to the nerve biomechanically and histologically. The motor nerve conduction velocity and gastrocnemius muscle weight were the lowest in this group. Conversely, the adhesion scores were significantly lower, motor nerve conduction velocity was significantly higher, and gastrocnemius muscle weight was significantly higher in the nerve wrap group than in the adhesion group. Additionally, the biomechanical breaking strength was significantly lower in the nerve wrap group than in the adhesion group and HA group. The morphological properties of axons in the nerve wrap group were preserved. Intraneural macrophage invasion, as assessed by the number of CD68- and CCR7-positive cells, was less severe in the nerve wrap group than in the adhesion group. CONCLUSIONS The nerve conduit prevented post-neurolysis peripheral nerves from developing adhesion and allowed them to maintain their nerve function because it effectively blocked scarring and prevented adhesion-related damage in the peripheral nerves.
Collapse
Affiliation(s)
- Kosuke Shintani
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| | - Takuya Uemura
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| | - Kiyohito Takamatsu
- 2Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Takuya Yokoi
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| | - Ema Onode
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| | - Mitsuhiro Okada
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| | - Hiroaki Nakamura
- 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine; and
| |
Collapse
|
19
|
Erndt-Marino JD, Jimenez-Vergara AC, Diaz-Rodriguez P, Kulwatno J, Diaz-Quiroz JF, Thibeault S, Hahn MS. In vitro evaluation of a basic fibroblast growth factor-containing hydrogel toward vocal fold lamina propria scar treatment. J Biomed Mater Res B Appl Biomater 2017; 106:1258-1267. [PMID: 28580765 DOI: 10.1002/jbm.b.33936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/11/2017] [Accepted: 05/16/2017] [Indexed: 12/25/2022]
Abstract
Scarring of the vocal fold lamina propria can lead to debilitating voice disorders that can significantly impair quality of life. The reduced pliability of the scar tissue-which diminishes proper vocal fold vibratory efficiency-results in part from abnormal extracellular matrix (ECM) deposition by vocal fold fibroblasts (VFF) that have taken on a fibrotic phenotype. To address this issue, bioactive materials containing cytokines and/or growth factors may provide a platform to transition fibrotic VFF within the scarred tissue toward an anti-fibrotic phenotype, thereby improving the quality of ECM within the scar tissue. However, for such an approach to be most effective, the acute host response resulting from biomaterial insertion/injection likely also needs to be considered. The goal of the present work was to evaluate the anti-fibrotic and anti-inflammatory capacity of an injectable hydrogel containing tethered basic fibroblast growth factor (bFGF) in the dual context of scar and biomaterial-induced acute inflammation. An in vitro co-culture system was utilized containing both activated, fibrotic VFF and activated, pro-inflammatory macrophages (MΦ) within a 3D poly(ethylene glycol) diacrylate (PEGDA) hydrogel containing tethered bFGF. Following 72 h of culture, alterations in VFF and macrophage phenotype were evaluated relative to mono-culture and co-culture controls. In our co-culture system, bFGF reduced the production of fibrotic markers collagen type I, α smooth muscle actin, and biglycan by activated VFF and promoted wound-healing/anti-inflammatory marker expression in activated MΦ. Cumulatively, these data indicate that bFGF-containing hydrogels warrant further investigation for the treatment of vocal fold lamina propria scar. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1258-1267, 2018.
Collapse
Affiliation(s)
- Josh D Erndt-Marino
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | | | - Jonathan Kulwatno
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | - Susan Thibeault
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mariah S Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| |
Collapse
|
20
|
Kobayashi T, Mizuta M, Hiwatashi N, Kishimoto Y, Nakamura T, Kanemaru SI, Hirano S. Drug delivery system of basic fibroblast growth factor using gelatin hydrogel for restoration of acute vocal fold scar. Auris Nasus Larynx 2017; 44:86-92. [DOI: 10.1016/j.anl.2016.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/24/2016] [Accepted: 04/01/2016] [Indexed: 01/26/2023]
|
21
|
Karbiener M, Darnhofer B, Frisch MT, Rinner B, Birner-Gruenberger R, Gugatschka M. Comparative proteomics of paired vocal fold and oral mucosa fibroblasts. J Proteomics 2017; 155:11-21. [PMID: 28099887 PMCID: PMC5389448 DOI: 10.1016/j.jprot.2017.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 12/12/2022]
Abstract
Injuries of the vocal folds frequently heal with scar formation, which can have lifelong detrimental impact on voice quality. Current treatments to prevent or resolve scars of the vocal fold mucosa are highly unsatisfactory. In contrast, the adjacent oral mucosa is mostly resistant to scarring. These differences in healing tendency might relate to distinct properties of the fibroblasts populating oral and vocal fold mucosae. We thus established the in vitro cultivation of paired, near-primary vocal fold fibroblasts (VFF) and oral mucosa fibroblasts (OMF) to perform a basic cellular characterization and comparative cellular proteomics. VFF were significantly larger than OMF, proliferated more slowly, and exhibited a sustained TGF-β1-induced elevation of pro-fibrotic interleukin 6. Cluster analysis of the proteomic data revealed distinct protein repertoires specific for VFF and OMF. Further, VFF displayed a broader protein spectrum, particularly a more sophisticated array of factors constituting and modifying the extracellular matrix. Conversely, subsets of OMF-enriched proteins were linked to cellular proliferation, nuclear events, and protection against oxidative stress. Altogether, this study supports the notion that fibroblasts sensitively adapt to the functional peculiarities of their respective anatomical location and presents several molecular targets for further investigation in the context of vocal fold wound healing. BIOLOGICAL SIGNIFICANCE Mammalian vocal folds are a unique but delicate tissue. A considerable fraction of people is affected by voice problems, yet many of the underlying vocal fold pathologies are sparsely understood at the molecular level. One such pathology is vocal fold scarring - the tendency of vocal fold injuries to heal with scar formation -, which represents a clinical problem with highly suboptimal treatment modalities. This study employed proteomics to obtain comprehensive insight into the protein repertoire of vocal fold fibroblasts, which are the cells that predominantly synthesize the extracellular matrix in both physiological and pathophysiological conditions. Protein profiles were compared to paired fibroblasts from the oral mucosa, a neighboring tissue that is remarkably resistant to scarring. Bioinformatic analyses of the data revealed a number of pathways as well as single proteins (e.g. ECM-remodeling factors, transcription factors, enzymes) that were significantly different between the two fibroblast types. Thereby, this study has revealed novel interesting molecular targets which can be analyzed in the future for their impact on vocal fold wound healing.
Collapse
Affiliation(s)
- Michael Karbiener
- Department of Phoniatrics, ENT University Hospital, Medical University of Graz, Austria.
| | - Barbara Darnhofer
- Research Unit, Functional Proteomics and Metabolic Pathways, Institute of Pathology, Medical University of Graz, Austria; Omics Center Graz, BioTechMed-Graz, Austria; Austrian Centre of Industrial Biotechnology (ACIB), Austria
| | - Marie-Therese Frisch
- Core Facility Alternative Biomodels und Preclinical Imaging, Division of Biomedical Research, Medical University of Graz, Austria
| | - Beate Rinner
- Core Facility Alternative Biomodels und Preclinical Imaging, Division of Biomedical Research, Medical University of Graz, Austria
| | - Ruth Birner-Gruenberger
- Research Unit, Functional Proteomics and Metabolic Pathways, Institute of Pathology, Medical University of Graz, Austria; Omics Center Graz, BioTechMed-Graz, Austria; Austrian Centre of Industrial Biotechnology (ACIB), Austria
| | - Markus Gugatschka
- Department of Phoniatrics, ENT University Hospital, Medical University of Graz, Austria
| |
Collapse
|
22
|
Kaneko M, Shiromoto O, Fujiu-Kurachi M, Kishimoto Y, Tateya I, Hirano S. Optimal Duration for Voice Rest After Vocal Fold Surgery: Randomized Controlled Clinical Study. J Voice 2017; 31:97-103. [DOI: 10.1016/j.jvoice.2016.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/10/2016] [Indexed: 12/22/2022]
|
23
|
Cobden SB, Oztürk K, Duman S, Esen H, Aktan TM, Avunduk MC, Elsurer C. Treatment of Acute Vocal Fold Injury With Platelet-Rich Plasma. J Voice 2016; 30:731-735. [DOI: 10.1016/j.jvoice.2015.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 11/27/2022]
|
24
|
Kitamura M, Hirano S, Kanemaru SI, Kitani Y, Ohno S, Kojima T, Nakamura T, Ito J, Rosen CA, Gilbert TW. Glottic regeneration with a tissue-engineering technique, using acellular extracellular matrix scaffold in a canine model. J Tissue Eng Regen Med 2016; 10:825-832. [PMID: 24403099 PMCID: PMC4087089 DOI: 10.1002/term.1855] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/26/2013] [Accepted: 11/08/2013] [Indexed: 11/05/2022]
Abstract
Acellular extracellular matrix scaffold derived from porcine urinary bladder (UBM) is decellularized material that has shown success for constructive remodelling of various tissues and organs. The regenerative effects of UBM were reported for the tympanic membrane, oesophagus, trachea, larynx, pleura and pericardium in animal studies, with promising results. The aim of this study was to investigate the regenerative effects of UBM on hemilarynx, using a canine model. A left partial hemilaryngectomy was performed and the surgical defects were reconstructed by insertion of UBM scaffold. Although local infection was observed in one dog in 1 week after implantation of the scaffold, all dogs showed good re-epithelialization with minimum complication in 1 month. The effect of regeneration of the larynx was evaluated 6 months after the operation. The excised larynx experiments were performed to measure phonation threshold pressure (PTP), normalized mucosal wave amplitude (NMWA) and normalized glottal gap (NGG). The results of the measurements showed that PTP was normal or near normal in two cases and NMWA was within normal range in three cases, although there were individual variations. Histological examination was completed to evaluate structural changes in the scaffold with the appearance of the new cartilaginous structure. However, the regenerated vocal fold mucosa was mostly scarred. The UBM scaffold has shown to be biocompatible, biodegradable and useful for tissue regeneration of the hemilarynx, with possible restoration of function of the vocal fold. The vocal fold mucosa was scarred, which is the next challenge to be addressed. Copyright © 2014 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Morimasa Kitamura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan.
| | - Shigeru Hirano
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Shin-Ichi Kanemaru
- Department of Otolaryngology, Regenerative Treatment for Tympanic Membrane, Foundation for Biomedical Research and Innovation, Kobe, Japan
- Department of Otolaryngology, Head and Neck Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yoshiharu Kitani
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Satoshi Ohno
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Japan
| | - Juichi Ito
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Clark A Rosen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas W Gilbert
- McGowan Institute for Regenerative Medicine, Department of Surgery, University of Pittsburgh, PA, USA
| |
Collapse
|
25
|
Ban MJ, Park JH, Kim JW, Park KN, Lee JY, Kim HK, Lee SW. The Efficacy of Fibroblast Growth Factor for the Treatment of Chronic Vocal Fold Scarring: From Animal Model to Clinical Application. Clin Exp Otorhinolaryngol 2016; 10:349-356. [PMID: 27671715 PMCID: PMC5678041 DOI: 10.21053/ceo.2016.00941] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives This study assessed the regenerative efficacy of basic fibroblast growth factor (FGF) in a rabbit model of chronic vocal fold scarring and then confirmed its utility and safety in a prospective trial of patients with this condition. Methods FGF was injected three times, at 1-week intervals, into a chronic vocal fold scar created in a rabbit model. After 1 month, mRNA level of procollagen I, hyaluronic acid synthetase 2 (HAS 2), and matrix metalloproteinase 2 (MMP 2) were analyzed by real-time polymerase chain reaction. The relative densities of hyaluronic acid (HA) and collagen were examined 3 months post-injection. From April 2012 to September 2014, a prospective clinical trial was conducted at a tertiary hospital in Korea. FGF was injected into the mild vocal fold scar of 17 consecutive patients with a small glottic gap. The patients underwent perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index (VHI) survey prior to and 3, 6, and 12 months after FGF injection. Results FGF injection of the vocal fold scar decreased the density of collagen and increased mRNA level of HAS 2 and MMP 2 expression significantly compared to the control group injected with phosphate buffered solution in a rabbit model (P<0.05). In the clinical trial, significant improvements in the majority of the subjective and objective voice parameters were registered 3 months after FGF injection and were maintained at 12 months. Complications associated with the FGF injections, such as granuloma, were not observed during the follow-up period. Conclusion Based on the animal model and the prospective clinical trial, vocal fold injections of FGF in patients with mild chronic vocal fold scarring can significantly improve voice quality for as long as 1 year and without side effects. Our results recommend the use of FGF vocal fold injection as an alternative treatment modality for mild chronic vocal fold scarring.
Collapse
Affiliation(s)
- Myung Jin Ban
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae Hong Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae Wook Kim
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ki Nam Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Yong Lee
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Won Lee
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
26
|
Suzuki R, Kawai Y, Tsuji T, Hiwatashi N, Kishimoto Y, Tateya I, Nakamura T, Hirano S. Prevention of vocal fold scarring by local application of basic fibroblast growth factor in a rat vocal fold injury model. Laryngoscope 2016; 127:E67-E74. [DOI: 10.1002/lary.26138] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takuya Tsuji
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs; Institute for Frontier Medical Science; Kyoto University Kyoto Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery; Kyoto Prefectural University of Medicine; Kyoto Japan
| |
Collapse
|
27
|
Woo JH, King SN, Hoffman H, Dailey S, Wang S, Christensen MB, Thibeault SL. MERS versus Standard Surgical Approaches for Porcine Vocal Fold Scarring with Adipose Stem Cell Constructs. Otolaryngol Head Neck Surg 2016; 155:612-23. [PMID: 27165681 DOI: 10.1177/0194599816645772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cells, scaffold, and surgical approaches are important for regeneration of the lamina propria of the scarred vocal fold (VF). Microendoscopy of Reinke's space (MERS) is a surgical approach used to access the lamina propria. The present study evaluated MERS in the treatment of VF scarring as compared with standardized approaches for the treatment of VF scarring with adipose stem cell constructs. STUDY DESIGN Animal study. SETTING Academic center. SUBJECTS AND METHODS VF injury was performed bilaterally to induce scarring in 20 pigs. Eight weeks after injury, pigs were classified into no treatment, minithyrotomy, VF injection, VF incision/dissection, and MERS. All groups (except control) were implanted with adipose stem cell and hyaluronan. Four weeks after treatment, histology for collagen, hyaluronan, and fibronectin; mRNA expression for α-smooth muscle actin, tumor growth factor β1, collagen 1α1, collagen 3α1, matrix metalloproteinase 2, basic fibroblast growth factor, and hepatocyte growth factor; and tissue rheology were evaluated. RESULTS Differences were measured among surgical approaches for protein levels of collagen, hyaluronan, and fibronectin (P = .0133, P < .0001, and P = .0025, respectively). Fibroblast growth factor, collagen 1α1, and matrix metalloproteinase 2 transcript levels were different among treatment groups (P = .003, P = .0086, and P = .014, respectively), while no differences were measured for α-smooth muscle actin, tumor growth factor β1, hepatocyte growth factor, and collagen 3α1. Rheologically, significant differences were not measured between groups. CONCLUSION MERS is a promising surgical approach for the treatment of VF scarring, optimizing the placement of implanted biomaterials.
Collapse
Affiliation(s)
- Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Suzanne N King
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Henry Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Seth Dailey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sarah Wang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
28
|
Ohno S, Hirano S, Yasumoto A, Ikeda H, Takebayashi S, Miura M. Outcome of regenerative therapy for age-related vocal fold atrophy with basic fibroblast growth factor. Laryngoscope 2016; 126:1844-8. [DOI: 10.1002/lary.25578] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Satoshi Ohno
- Department of Otolaryngology; Head and Neck Surgery, Kokura Memorial Hospital; Fukuoka Japan
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Shigeru Hirano
- Department of Otolaryngology; Head and Neck Surgery, Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Akiyoshi Yasumoto
- Department of Otolaryngology; Head and Neck Surgery, Kokura Memorial Hospital; Fukuoka Japan
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Hiroki Ikeda
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Shinji Takebayashi
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| | - Makoto Miura
- Department of Otolaryngology; Japanese Red Cross Wakayama Medical Center; Wakayama Japan
| |
Collapse
|
29
|
Hiwatashi N, Hirano S, Suzuki R, Kawai Y, Mizuta M, Kishimoto Y, Tateya I, Kanemaru SI, Nakamura T, Dezawa M, Ito J. Comparison of ASCs and BMSCs combined with atelocollagen for vocal fold scar regeneration. Laryngoscope 2015; 126:1143-50. [PMID: 26403510 DOI: 10.1002/lary.25667] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/31/2015] [Accepted: 08/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar remains a therapeutic challenge. Mesenchymal stromal cells (MSCs) are promising tools for regenerative medicine. Nevertheless, few in vivo studies have directly compared various sources of MSCs. The aim of this study was to investigate the therapeutic potential of adipose-derived stromal cells (ASCs) in comparison with bone marrow-derived stromal cells (BMSCs) for vocal fold regeneration. STUDY DESIGN Prospective animal experiments with controls. METHODS Two months after stripping of the lamina propria, 18 beagles were divided into four implantation groups: atelocollagen alone (collagen group), atelocollagen with BMSCs (BMSC-collagen), atelocollagen with ASCs (ASC-collagen), or a sham-treated group. One or 6 months after implantation, vibratory and histological examinations were performed. RESULTS Mucosal vibration was significantly improved in both of the MSC-implanted groups compared with the sham-treated group, whereas only the ASC-collagen group showed a significantly smaller glottal gap than the collagen group. Moreover, in the ASC-collagen group, a significant reduction of collagen density was observed compared to the sham-treated group, and there was a trend for better restoration of hyaluronic acid (HA). Implanted MSCs were detected 1 month postimplantation; however, none survived 6 months postimplantation. CONCLUSIONS Although implantation of an atelocollagen sponge and ASCs into vocal fold scars induced vibratory recovery comparable to that of BMSCs, ASCs might have more potential in terms of restoration of HA and suppression of excessive collagen deposition. LEVEL OF EVIDENCE NA Laryngoscope, 126:1143-1150, 2016.
Collapse
Affiliation(s)
- Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Otolaryngology, New York University School of Medicine, New York, New York
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin-Ichi Kanemaru
- Translational Research Informatics Center, The Foundation for Biomedical Research and Innovation, Kobe, Japan.,Department of Otolaryngology-Head and Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Mari Dezawa
- Department of Stem Cell Biology and Histology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Juichi Ito
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
30
|
Multidimensional Analysis on the Effect of Vocal Function Exercises on Aged Vocal Fold Atrophy. J Voice 2015; 29:638-44. [DOI: 10.1016/j.jvoice.2014.10.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/28/2014] [Indexed: 11/20/2022]
|
31
|
Hiwatashi N, Hirano S, Mizuta M, Kobayashi T, Kawai Y, Kanemaru SI, Nakamura T, Ito J, Kawai K, Suzuki S. The efficacy of a novel collagen-gelatin scaffold with basic fibroblast growth factor for the treatment of vocal fold scar. J Tissue Eng Regen Med 2015; 11:1598-1609. [DOI: 10.1002/term.2060] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 02/26/2015] [Accepted: 04/29/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
- Department of Otolaryngology; Vanderbilt University; Nashville TN USA
| | - Toshiki Kobayashi
- Department of Otorhinolaryngology; Jikei University of Medicine; Tokyo Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
| | - Shin-ichi Kanemaru
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
- Department of Otolaryngology-Head and Neck Surgery; Kitano Hospital, Tazuke Kofukai Medical Research Institute; Osaka Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science; Kyoto University; Japan
| | - Juichi Ito
- Department of Otolaryngology-Head and Neck Surgery; Graduate School of Medicine, Kyoto University; Japan
| | - Katsuya Kawai
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, Kyoto University; Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, Kyoto University; Japan
| |
Collapse
|
32
|
The unsolved chapter of vocal fold scars and how tissue engineering could help us solve the problem. Eur Arch Otorhinolaryngol 2015; 273:2279-84. [PMID: 26108198 DOI: 10.1007/s00405-015-3668-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/22/2015] [Indexed: 01/04/2023]
Abstract
Vocal fold scarring is a relatively small field in scar research with prerequisites found nowhere else. The deterioration of the delicate tri-layered micro-structure of the epithelium of the vocal folds leads to impaired vibration characteristics resulting in a permanent hoarse and breathy voice. Tissue engineering approaches could help to restore the pre-injury status. Despite a considerable progress in this field during the last years, routine clinical applications are not available so far. One reason might be that vocal fold fibroblasts, as the responsible cell type for fibrogenesis, have very particular properties that are only poorly characterized. Moreover, in vivo trials are costly and time consuming and a representative in vitro model does not exist so far. These particular circumstances lead to innovative in vitro strategies and concepts such as macro-molecular crowding that can also be applied in adjacent fields.
Collapse
|
33
|
Kanazawa T, Komazawa D, Indo K, Akagi Y, Lee Y, Nakamura K, Matsushima K, Kunieda C, Misawa K, Nishino H, Watanabe Y. Single injection of basic fibroblast growth factor to treat severe vocal fold lesions and vocal fold paralysis. Laryngoscope 2015; 125:E338-44. [PMID: 25953726 PMCID: PMC6718003 DOI: 10.1002/lary.25315] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2015] [Accepted: 03/16/2015] [Indexed: 11/08/2022]
Abstract
Objectives/Hypothesis Severe vocal fold lesions such as vocal fold sulcus, scars, and atrophy induce a communication disorder due to severe hoarseness, but a treatment has not been established. Basic fibroblast growth factor (bFGF) therapies by either four‐time repeated local injections or regenerative surgery for vocal fold scar and sulcus have previously been reported, and favorable outcomes have been observed. In this study, we modified bFGF therapy using a single of bFGF injection, which may potentially be used in office procedures. Study Design Retrospective chart review. Methods Five cases of vocal fold sulcus, six cases of scars, seven cases of paralysis, and 17 cases of atrophy were treated by a local injection of bFGF. The injection regimen involved injecting 50 µg of bFGF dissolved in 0.5 mL saline only once into the superficial lamina propria using a 23‐gauge injection needle. Two months to 3 months after the injection, phonological outcomes were evaluated. Results The maximum phonation time (MPT), mean airflow rate, pitch range, speech fundamental frequency, jitter, and voice handicap index improved significantly after the bFGF injection. Furthermore, improvement in the MPT was significantly greater in patients with (in increasing order) vocal fold atrophy, scar, and paralysis. The improvement in the MPT among all patients was significantly correlated with age; the MPT improved more greatly in younger patients. Conclusions Regenerative treatments by bFGF injection—even a single injection—effectively improve vocal function in vocal fold lesions. Level of Evidence 4 Laryngoscope, 125:E338–E344, 2015
Collapse
Affiliation(s)
- Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kanako Indo
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology, Kagawa University, School of Medicine, Miki, Japan
| | - Yusuke Akagi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Okayama Medical Center, Okayama, Japan
| | - Yogaku Lee
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Hachioji Medical Center, Hachioji, Japan
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otolaryngology-Head and Neck Surgery, Toho University, Omori Medical Center, Tokyo, Japan
| | - Chikako Kunieda
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.,Department of Otorhinolaryngology, Hashima City Hospital, Hashima, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
34
|
Epidermal growth factor mediated healing in stem cell-derived vocal fold mucosa. J Surg Res 2015; 197:32-8. [PMID: 25818979 DOI: 10.1016/j.jss.2015.02.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/03/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The goal of vocal fold wound healing is the reconstitution of functional tissue, including a structurally and functionally intact epithelium. Mechanisms underlying reepithelialization in vocal folds are not known, although it is suspected that healing involves the interplay between several growth factors. We used a three-dimensional human embryonic stem cell-derived model of vocal fold mucosa to examine the effects of one growth factor, exogenous epidermal growth factor (EGF), on wound healing. MATERIALS AND METHODS A scratch wound was created in the in vitro model. Rate of wound healing, epidermal growth factor receptor (EGFR) activation, and cell proliferation after injury were analyzed with and without application of both exogenous EGF and an EGFR inhibitor, gefitinib. RESULTS Wound repair after injury was significantly hastened by application of exogenous EGF (13.3 μm/h, ± 2.63) compared with absence of exogenous EGF (7.1 μm/h ± 2.84), but inhibited with concurrent addition of Gefitinib (5.2 μm/h, ± 2.23), indicating that EGF mediates wound healing in an EGFR-dependent manner. Immunohistochemistry revealed that EGFR activation occurred only in the presence of exogenous EGF. Although not statistically significant, increased density of Ki67 staining in the epithelium adjacent to the scratch wound was observed after treatment with EGF, suggesting a tendency for exogenous EGF to increase epithelial cell proliferation. CONCLUSIONS Exogenous EGF increases the rate of wound healing in an EGFR-dependent manner in a three-dimensional stem cell-derived model of vocal fold mucosa. This model of wound healing can be used to gain insight into the mechanisms that regulate vocal fold epithelial repair after injury.
Collapse
|
35
|
Hiwatashi N, Hirano S, Mizuta M, Tateya I, Kanemaru SI, Nakamura T, Ito J, Kawai K, Suzuki S. Biocompatibility and efficacy of collagen/gelatin sponge scaffold with sustained release of basic fibroblast growth factor on vocal fold fibroblasts in 3-dimensional culture. Ann Otol Rhinol Laryngol 2014; 124:116-25. [PMID: 25115594 DOI: 10.1177/0003489414546396] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Treatment of vocal fold scarring remains challenging. We have previously reported the therapeutic effects of local injection of basic fibroblast growth factor (bFGF) in animal models and humans. A novel collagen/gelatin sponge (CGS) is capable of sustained release of bFGF, which compensates for its quick absorption in vivo, avoiding multiple injections. This study aimed to evaluate the biocompatibility and efficacy of the CGS in rat vocal fold fibroblasts prior to human trials. METHODS Fibroblasts extracted from Sprague-Dawley rat vocal folds were seeded onto a CGS and then cultivated with bFGF at concentrations of 0, 10, and 100 ng/mL. Vocal fold fibroblast morphology, adhesion, proliferation, and gene expression were measured under these 3-dimensional conditions. RESULTS Cells adhered to the CGS from day 1. Although no significant differences in cell morphology were detected, cell proliferation was accelerated by bFGF administration. Expression of endogenous bFGF and hepatocyte growth factor was significantly up-regulated at 10 ng/mL bFGF. The expression of procollagen I and procollagen III was significantly suppressed, whereas HAS-1 and HAS-2 were up-regulated at 10 and 100 ng/mL bFGF. CONCLUSION The collagen/gelatin sponge is biocompatible with vocal fold fibroblasts and may be useful as a bFGF drug delivery system for the treatment of scarred vocal folds.
Collapse
Affiliation(s)
- Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin-Ichi Kanemaru
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan Department of Otolaryngology-Head and Neck Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Juichi Ito
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuya Kawai
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
36
|
Bohlender J. Diagnostic and therapeutic pitfalls in benign vocal fold diseases. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc01. [PMID: 24403969 PMCID: PMC3884536 DOI: 10.3205/cto000093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis.
Collapse
Affiliation(s)
- Jörg Bohlender
- Phoniatrics and Logopedics, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
37
|
Mizuta M, Hirano S, Hiwatashi N, Tateya I, Kanemaru SI, Nakamura T, Ito J. Effect of astaxanthin on vocal fold wound healing. Laryngoscope 2013; 124:E1-7. [PMID: 23686840 DOI: 10.1002/lary.24197] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our previous study demonstrated that a large amount of reactive oxygen species (ROS) is produced during the early phase of vocal fold wound healing. In the current study, we investigated the effect of astaxanthin, which is a strong antioxidant, on the regulation of oxidative stress and scarring during vocal fold wound healing. STUDY DESIGN Prospective animal experiment with control. METHODS Sprague-Dawley rats were dosed with astaxanthin (Ast-treated group, 100 mg/kg/day) or olive oil (sham-treated group) by oral gavage daily from preinjury day 1 to postinjury day 4. After vocal folds were injured under the endoscope, larynges were harvested for histological and immunohistochemical examinations on postinjury days 1, 3, 5, and 56, and quantitative real time polymerase chain reaction (PCR) on postinjury days 1 and 3. RESULTS The expression of 4-hydroxy-2-nonenal, which is an oxidative stress marker, was reduced significantly in the lamina propria of the Ast-treated group as compared to the sham-treated group. Histological examination showed significantly less tissue contraction with favorable deposition of hyaluronic acid in the lamina propria of the Ast-treated group compared to the sham-treated group. Real time PCR revealed significantly upregulated mRNA expression of basic fibroblast growth factor on postinjury day 1 and procollagen type I in the Ast-treated group compared to the sham-treated group. CONCLUSIONS These findings suggest that astaxanthin has the potential to prevent vocal fold scarring by regulating oxidative stress during the early phase of vocal fold wound healing.
Collapse
Affiliation(s)
- Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
38
|
Nagai H, Nishiyama K, Seino Y, Kimura Y, Tabata Y, Okamoto M. Fascia implantation with fibroblast growth factor on vocal fold paralysis. Am J Otolaryngol 2013; 34:331-6. [PMID: 23517569 DOI: 10.1016/j.amjoto.2013.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this prospective study was to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on unilateral vocal fold paralysis (UVFP) in a rat model. MATERIALS AND METHODS Unilateral recurrent laryngeal nerve (RLN) section was performed on 15 rats. Ten rats received an autologous fascia implant and gelatin hydrogel with or without bFGF (1 μg) to their larynxes (fascia only, "fascia group"; bFGF + fascia, "fascia + bFGF group"), while the rest underwent RLN transection ("RLN section group"). Four months later, evaluation of the laryngeal glottal gap and histological analysis were performed. RESULTS The glottal gap was significantly reduced in the fascia + bFGF group, and fat volume increased significantly relative to the RLN section. The volume of the remaining fascia in the bFGF + fascia group was significantly greater than that of the fascia group. CONCLUSIONS ATFV with controlled release of bFGF may compensate for diminished laryngeal volume in UVFP by reducing resorption of the implanted fascia and increasing fat volume. Our findings suggest that this modality may represent an attractive option for treating UVFP.
Collapse
|
39
|
|
40
|
Hirano S, Mizuta M, Kaneko M, Tateya I, Kanemaru SI, Ito J. Regenerative phonosurgical treatments for vocal fold scar and sulcus with basic fibroblast growth factor. Laryngoscope 2013; 123:2749-55. [PMID: 23553343 DOI: 10.1002/lary.24092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/19/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar and sulcus are still challenges. Basic fibroblast growth factor (bFGF) has proven to be effective to resolve scar tissue in animal models. This study reports the efficacy of regenerative treatments using bFGF on vocal fold scar and sulcus in human cases. STUDY DESIGN Retrospective chart review. METHODS Fifteen cases (7 scar; 8 sulcus) were treated by either local injection of bFGF (n = 6) or regenerative surgery using bFGF (n = 9). Injection regimen was to locally apply 10 micrograms of bFGF in 0.5 mL saline into each vocal fold under topical anesthesia repeatedly (4 times with intervals of 1 week between each injection). The regenerative surgical procedure consisted of the dissection of scar tissue and the implant of gelatin sponge with bFGF. Follow-up periods ranged from 6 months to 24 months. RESULTS Maximum Phonation Time (MPT); Voice Handicap Index (VHI)-10; and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were assessed in both groups. The injection group showed significant improvement on VHI-10 and GRBAS. The regenerative surgery group showed significant improvement in all parameters. Jitter and shimmer were evaluated in the surgery group, and the results indicated improvement in six and five cases of nine cases, respectively. No major adverse effects were observed in both treatment groups. CONCLUSIONS Regenerative treatments using bFGF has shown to be effective for improvement of vocal function in scar and sulcus.
Collapse
Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
41
|
Akita S, Akino K, Hirano A. Basic Fibroblast Growth Factor in Scarless Wound Healing. Adv Wound Care (New Rochelle) 2013; 2:44-49. [PMID: 24527324 DOI: 10.1089/wound.2011.0324] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Indexed: 11/13/2022] Open
Abstract
SIGNIFICANCE The benefit and role of basic fibroblast growth factor (bFGF) in scarless wound healing in clinical application and basic mechanism are discussed. bFGF is a glycoprotein which is widely used in treating wounds and ulcers. bFGF is easily applicable to any type of wound and leads to a better outcome in color, texture, and firmness. RECENT ADVANCES The amniotic fluids from human mid-gestational trimester may play an important role in scarless wound healing. To investigate cell properties, we used amniotic fluid to augment both adult and fetal fibroblast mitogenic activities, including DNA synthesis and cell proliferation. Preincubation by both bFGF receptor blocker and anti-bFGF antibody significantly decreases proliferative activity in both adult and fetal skin fibroblasts. CRITICAL ISSUES Adult wound healing, to some extent, demonstrates scar formation, leading to unfavorable clinical mismatch of tissue texture and color and causing stiffness. bFGF may improve the outcome of wound healing by normalizing the tissue texture and color to the adjacent intact skin and optimally enhancing wound healing. FUTURE DIRECTIONS bFGF activates ERK and Akt phosphorylation in a dose-dependent manner in both adult and fetal skin fibroblasts, which suggests that bFGF in amniotic fluid plays the most major role in cell proliferation. Application of bFGF from an early wounding stage may lead to better fibroblast proliferation and DNA synthesis through the process of ERK/Akt phosphorylation.
Collapse
Affiliation(s)
- Sadanori Akita
- Division of Plastic and Reconstructive Surgery, Department of Developmental and Reconstructive Medicine, Nagasaki University, Graduate School of Biomedical and Sciences, Nagasaki, Japan
| | - Kozo Akino
- Division of Plastic and Reconstructive Surgery, Department of Developmental and Reconstructive Medicine, Nagasaki University, Graduate School of Biomedical and Sciences, Nagasaki, Japan
| | - Akiyoshi Hirano
- Division of Plastic and Reconstructive Surgery, Department of Developmental and Reconstructive Medicine, Nagasaki University, Graduate School of Biomedical and Sciences, Nagasaki, Japan
| |
Collapse
|
42
|
Lim JY, Choi BH, Lee S, Jang YH, Choi JS, Kim YM. Regulation of wound healing by granulocyte-macrophage colony-stimulating factor after vocal fold injury. PLoS One 2013; 8:e54256. [PMID: 23372696 PMCID: PMC3556034 DOI: 10.1371/journal.pone.0054256] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/10/2012] [Indexed: 11/25/2022] Open
Abstract
Objectives Vocal fold (VF) scarring remains a therapeutic challenge. Granulocyte-macrophage colony-stimulating factor (GM-CSF) facilitates epithelial wound healing, and recently, growth factor therapy has been applied to promote tissue repair. This study was undertaken to investigate the effect of GM-CSF on VF wound healing in vivo and in vitro. Methods VF scarring was induced in New Zealand white rabbits by direct injury. Immediately thereafter, either GM-CSF or PBS was injected into the VFs of rabbits. Endoscopic, histopathological, immunohistochemical, and biomechanical evaluations of VFs were performed at 3 months post-injury. Human vocal fold fibroblasts (hVFFs) were cultured with GM-CSF. Production of type I and III collagen was examined immunocytochemically, and the synthesis of elastin and hyaluronic acids was evaluated by ELISA. The mRNA levels of genes related to ECM components and ECM production-related growth factors, such as HGF and TGF-ß1, were examined by real time RT-PCR. Results The GM-CSF-treated VFs showed reduced collagen deposition in comparison to the PBS-injected controls (P<0.05). Immunohistochemical staining revealed lower amounts of type I collagen and fibronectin in the GM-CSF-treated VFs (P<0.05 and P<0.01, respectively). Viscous and elastic shear moduli of VF samples were significantly lower in the GM-CSF group than in the PBS-injected group (P<0.001 and P<0.01, respectively). Mucosal waves in the GM-CSF group showed significant improvement when compared to the PBS group (P = 0.0446). GM-CSF inhibited TGF-β1-induced collagen synthesis by hVFFs (P<0.05) and the production of hyaluronic acids increased at 72 hours post-treatment (P<0.05). The expressions of HAS-2, tropoelastin, MMP-1, HGF, and c-Met mRNA were significantly increased by GM-CSF, although at different time points (P<0.05). Conclusion The present study shows that GM-CSF offers therapeutic potential for the remodeling of VF wounds and the promotion of VF regeneration.
Collapse
Affiliation(s)
- Jae-Yol Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea.
| | | | | | | | | | | |
Collapse
|
43
|
Gugatschka M, Ohno S, Saxena A, Hirano S. Regenerative medicine of the larynx. Where are we today? A review. J Voice 2012; 26:670.e7-13. [PMID: 22795981 DOI: 10.1016/j.jvoice.2012.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 03/20/2012] [Indexed: 12/14/2022]
Abstract
Tissue engineering is a multidimensional process combining cells, scaffold matrices, and chemical signals to produce a structure similar to a target tissue. These techniques have opened a completely new field in diagnosis and therapy in numerous fields, including that of laryngology. Laryngeal tissue engineering has emerged in the last decade, although clinical applications are rare. The reasons therefore are numerous including ethical reasons, as well as the extremely complex anatomical structure of the vocal fold. The search for new treatment options has also enlarged our knowledge about the microphysiology and micropathophysiology of the vocal fold. To date, only specific growth factors are in clinical use for treatment of vocal fold atrophy. Big advances have been made in creating state-of-the-art scaffolds with various techniques including biomaterials as well as fully synthetic polymers. These scaffolds are supposed to provide an optimal environment for residual or implanted cells. Several in vitro settings showed practicability of these scaffolds, also in studying effects of growth factors. Cell therapy is a powerful tool in regenerative medicine but bears the uncertainty of possible malignant transformation. The aim of this review was to give a comprehensive overview about current knowledge in the field of laryngeal tissue engineering and regenerative medicine, including restoration of both vocal folds and laryngeal cartilage, and furthermore to elucidate further trends in this fascinating field.
Collapse
Affiliation(s)
- Markus Gugatschka
- Department of Phoniatrics, ENT University Hospital Graz, Medical University Graz, Graz, Austria.
| | | | | | | |
Collapse
|
44
|
Ohno S, Hirano S, Kanemaru SI, Kitani Y, Kojima T, Ishikawa S, Mizuta M, Tateya I, Nakamura T, Ito J. Transforming growth factor β3 for the prevention of vocal fold scarring. Laryngoscope 2012; 122:583-9. [PMID: 22252900 DOI: 10.1002/lary.22389] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scarring poses a therapeutic challenge. It causes hoarseness and decreases the quality of life. Transforming growth factor β3 (TGFβ3) is highly expressed in fetal wounds that heal without scarring, and administration of TGFβ3 has been reported to prevent scarring of the skin and the buccal mucosa. Thus TGFβ3 is considered to be a key molecule in scar-free healing. This study aimed to examine the ability of TGFβ3 to prevent vocal fold scarring, with particular attention paid to the distribution of extracellular matrices and functional outcomes. STUDY DESIGN Prospective study using an animal model. METHODS Ten beagles were used in this study; 500 μL of TGFβ3 (0.5 μg/mL: 5 beagles) or saline (5 beagles) was injected into the vocal fold lamina propria. Fifteen minutes after injection, vocal folds were injured by stripping off the entire layer of the lamina propria. Six months after surgery, animals were euthanized and the larynges were harvested. Vibratory and histologic examinations were performed. RESULTS The administration of TGFβ3 suppressed granulation-tissue formation and scarring. TGFβ3-treated vocal folds showed significantly better vibratory properties, resembling normal vocal folds. Histologic analysis revealed favorable restoration of elastin and hyaluronic acid in the lamina propria. The distribution of collagen was well organized, and collagen deposition was less dense in TGFβ3-treated vocal folds compared to sham-treated vocal folds. CONCLUSIONS Administration of TGFβ3 before injury significantly suppressed scar formation and induced favorable restoration of extracellular matrices in the vocal fold lamina propria, resulting in much improved phonatory function.
Collapse
Affiliation(s)
- Satoshi Ohno
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
PURPOSE OF REVIEW In vocal fold scars the lamina propria layer is lost or deficient. Lamina propria replacement therapy remains a clinical challenge because this layer has a highly specialized three-dimensional organization of extracellular matrix molecules and unique viscoelastic properties. Use of a polymer such as hyaluronic acid appears most promising for replacement therapy because it has the optimal viscoelasticity and also plays a role in the maturation and maintenance of vocal fold lamina propria. RECENT FINDINGS A variety of cross-linked hyaluronic acid formulations and growth factor therapies targeted to increase hyaluronic acid production have been used in the treatment of both acute and established vocal fold scars. Therapeutic strategies have focused on prevention of scar at the time of initial injury, and rejuvenation of lamina propria layer in established scars. Both strategies show improved histologic, viscoelastic, acoustic, and aerodynamic measures. SUMMARY Cross-linked hyaluronic acid formulations appear useful in the treatment of vocal fold scarring. Their use at the time of acute injury especially appears to lessen the degree of long-term scar formation and appears promising. While animal studies have demonstrated the safety profile of many hyaluronic acid formulations, further improvement in these materials and well designed and controlled human trials are needed to further establish the safety and efficacy of these materials and therapeutic approaches.
Collapse
|
46
|
Characterization of vocal fold scar formation, prophylaxis, and treatment using animal models. Curr Opin Otolaryngol Head Neck Surg 2011; 18:481-6. [PMID: 20962643 DOI: 10.1097/moo.0b013e3283407d87] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent literature on animal models used to study the pathogenesis, detection, prevention, and treatment of vocal fold scarring. Animal work is critical to studying vocal fold scarring because it is the only way to conduct systematic research on the biomechanical properties of the layered structure of the vocal fold lamina propria, and therefore develop reliable prevention and treatment strategies for this complex clinical problem. RECENT FINDINGS During the period of review, critical anatomic, physiologic, and wound healing characteristics, which may serve as the bases for selection of a certain species to help answer a specific question, have been described in mouse, rat, rabbit, ferret, and canine models. A number of different strategies for prophylaxis and chronic scar treatment in animals show promise for clinical application. The pathways of scar formation and methods for quantifying treatment-induced change have become better defined. SUMMARY Recent animal vocal fold scarring studies have enriched and confirmed earlier work indicating that restoring pliability to the scarred vocal fold mucosa is challenging but achievable. Differences between animal models and differences in outcome measurements across studies necessitate considering each study individually to obtain guidance for future research. With increased standardization of measurement techniques it may be possible to make more inter-study comparisons.
Collapse
|
47
|
Karajanagi SS, Lopez-Guerra G, Park H, Kobler JB, Galindo M, Aanestad J, Mehta DD, Kumai Y, Giordano N, d'Almeida A, Heaton JT, Langer R, Herrera VLM, Faquin W, Hillman RE, Zeitels SM. Assessment of canine vocal fold function after injection of a new biomaterial designed to treat phonatory mucosal scarring. Ann Otol Rhinol Laryngol 2011; 120:175-84. [PMID: 21510143 DOI: 10.1177/000348941112000306] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Most cases of irresolvable hoarseness are due to deficiencies in the pliability and volume of the superficial lamina propria of the phonatory mucosa. By using a US Food and Drug Administration-approved polymer, polyethylene glycol (PEG), we created a novel hydrogel (PEG30) and investigated its effects on multiple vocal fold structural and functional parameters. METHODS We injected PEG30 unilaterally into 16 normal canine vocal folds with survival times of 1 to 4 months. High-speed videos of vocal fold vibration, induced by intratracheal airflow, and phonation threshold pressures were recorded at 4 time points per subject. Three-dimensional reconstruction analysis of 11.7 T magnetic resonance images and histologic analysis identified 3 cases wherein PEG30 injections were the most superficial, so as to maximally impact vibratory function. These cases were subjected to in-depth analyses. RESULTS High-speed video analysis of the 3 selected cases showed minimal to no reduction in the maximum vibratory amplitudes of vocal folds injected with PEG30 compared to the non-injected, contralateral vocal fold. All PEG30-injected vocal folds displayed mucosal wave activity with low average phonation threshold pressures. No significant inflammation was observed on microlaryngoscopic examination. Magnetic resonance imaging and histologic analyses revealed time-dependent resorption of the PEG30 hydrogel by phagocytosis with minimal tissue reaction or fibrosis. CONCLUSIONS The PEG30 hydrogel is a promising biocompatible candidate biomaterial to restore form and function to deficient phonatory mucosa, while not mechanically impeding residual endogenous superficial lamina propria.
Collapse
Affiliation(s)
- Sandeep S Karajanagi
- Department of Surgery, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:577-81. [DOI: 10.1097/moo.0b013e328340ea77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Suehiro A, Hirano S, Kishimoto Y, Tateya I, Rousseau B, Ito J. Effects of basic fibroblast growth factor on rat vocal fold fibroblasts. Ann Otol Rhinol Laryngol 2010; 119:690-6. [PMID: 21049855 DOI: 10.1177/000348941011901008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The overarching goal of this line of research is to translate basic fibroblast growth factor (bFGF) treatment for vocal fold scarring into practical clinical use. In a previous canine investigation, we demonstrated that bFGF improves phonation threshold pressure, mucosal wave amplitude, and histologic measures in vocal folds treated after injury. In the present study, we studied the effects of bFGF on gene expression of the extracellular matrix and growth factors in rat vocal fold fibroblasts. METHODS Fibroblasts harvested from the vocal folds of 5 rats were treated with 3 concentrations of bFGF (0, 10, and 100 ng/mL). The fibroblasts were collected at 24 hours and 72 hours after bFGF administration. Quantitative polymerase chain reaction was then used to investigate the gene expression of the investigated growth factors and extracellular matrices. RESULTS The results revealed significantly down-regulated expression of procollagen I and significantly up-regulated expression of hyaluronic acid synthase (HAS) 2 and fibronectin in fibroblasts treated with bFGF. The administration of bFGF also resulted in the up-regulation of bFGF and hepatocyte growth factor (HGF). No changes in the expression of HAS-1, tropoelastin, or procollagen III were observed between the treatment and control conditions. CONCLUSIONS Treatment with bFGF induces the down-regulation of procollagen I and the up-regulation of HAS-2 in vocal fold fibroblast cell cultures. These gene expression alterations to key mediators of the wound healing process may translate into potential benefits in the remediation of vocal fold injury. The up-regulation of HGF, an antifibrotic effector molecule, may demonstrate additional benefits by optimizing the wound healing environment and by accelerating the wound repair cascade. These findings may provide fuel for additional discoveries into the development of growth factor therapy for the treatment of vocal fold scar.
Collapse
Affiliation(s)
- Atsushi Suehiro
- Dept of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | | | | | | | | | | |
Collapse
|