51
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Ameri A, Poshtmahi S, Heydarirad G, Cramer H, Choopani R, Hajimehdipoor H, Azghandi S, Pasalar M. Effect of Honey–Lemon Spray Versus Benzydamine Hydrochloride Spray on Radiation-Induced Acute Oral Mucositis in Head and Neck Cancer Patients: A Pilot, Randomized, Double-Blind, Active-Controlled Clinical Trial. J Altern Complement Med 2021; 27:255-262. [DOI: 10.1089/acm.2020.0468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ahmad Ameri
- Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Poshtmahi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ghazaleh Heydarirad
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Rasoul Choopani
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homa Hajimehdipoor
- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Azghandi
- Department of Radiation Oncology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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52
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Catozzi S, Halasz M, Kiel C. Predicted 'wiring landscape' of Ras-effector interactions in 29 human tissues. NPJ Syst Biol Appl 2021; 7:10. [PMID: 33580066 PMCID: PMC7881153 DOI: 10.1038/s41540-021-00170-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Ras is a plasma membrane (PM)-associated signaling hub protein that interacts with its partners (effectors) in a mutually exclusive fashion. We have shown earlier that competition for binding and hence the occurrence of specific binding events at a hub protein can modulate the activation of downstream pathways. Here, using a mechanistic modeling approach that incorporates high-quality proteomic data of Ras and 56 effectors in 29 (healthy) human tissues, we quantified the amount of individual Ras-effector complexes, and characterized the (stationary) Ras "wiring landscape" specific to each tissue. We identified nine effectors that are in significant amount in complex with Ras in at least one of the 29 tissues. We simulated both mutant- and stimulus-induced network re-configurations, and assessed their divergence from the reference scenario, specifically discussing a case study for two stimuli in three epithelial tissues. These analyses pointed to 32 effectors that are in significant amount in complex with Ras only if they are additionally recruited to the PM, e.g. via membrane-binding domains or domains binding to activated receptors at the PM. Altogether, our data emphasize the importance of tissue context for binding events at the Ras signaling hub.
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Affiliation(s)
- Simona Catozzi
- UCD Charles Institute of Dermatology, School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland
- Systems Biology Ireland, School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Melinda Halasz
- Systems Biology Ireland, School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Christina Kiel
- UCD Charles Institute of Dermatology, School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland.
- Systems Biology Ireland, School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland.
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53
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Rocchi C, Barazzuol L, Coppes RP. The evolving definition of salivary gland stem cells. NPJ Regen Med 2021; 6:4. [PMID: 33526786 PMCID: PMC7851389 DOI: 10.1038/s41536-020-00115-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Dysfunction of the salivary gland and irreversible hyposalivation are the main side effects of radiotherapy treatment for head and neck cancer leading to a drastic decrease of the quality of life of the patients. Approaches aimed at regenerating damaged salivary glands have been proposed as means to provide long-term restoration of tissue function in the affected patients. In studies to elucidate salivary gland regenerative mechanisms, more and more evidence suggests that salivary gland stem/progenitor cell behavior, like many other adult tissues, does not follow that of the hard-wired professional stem cells of the hematopoietic system. In this review, we provide evidence showing that several cell types within the salivary gland epithelium can serve as stem/progenitor-like cells. While these cell populations seem to function mostly as lineage-restricted progenitors during homeostasis, we indicate that upon damage specific plasticity mechanisms might be activated to take part in regeneration of the tissue. In light of these insights, we provide an overview of how recent developments in the adult stem cell research field are changing our thinking of the definition of salivary gland stem cells and their potential plasticity upon damage. These new perspectives may have important implications on the development of new therapeutic approaches to rescue radiation-induced hyposalivation.
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Affiliation(s)
- Cecilia Rocchi
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, 9713 AV, Groningen, The Netherlands. .,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands. .,Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, Edinburgh, EH16 4UU, UK.
| | - Lara Barazzuol
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, 9713 AV, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Rob P Coppes
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, 9713 AV, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
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54
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Ok SM, Ho D, Lynd T, Ahn YW, Ju HM, Jeong SH, Cheon K. Candida Infection Associated with Salivary Gland-A Narrative Review. J Clin Med 2020; 10:E97. [PMID: 33396602 PMCID: PMC7795466 DOI: 10.3390/jcm10010097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 11/22/2022] Open
Abstract
Candida species are common global opportunistic pathogens that could repeatedly and chronically cause oral mucosa infection and create an inflammatory environment, leading to organ dysfunction. Oral Candida infections may cause temporary or permanent damage to salivary glands, resulting in the destruction of acinar cells and the formation of scar tissue. Restricted function of the salivary glands leads to discomfort and diseases of the oral mucosa, such as dry mouth and associated infection. This narrative review attempts to summarize the anatomy and function of salivary glands, the associations between Candida and saliva, the effects of Candida infection on salivary glands, and the treatment strategies. Overall, clinicians should proactively manage Candida infections by educating patients on oral hygiene management for vulnerable populations, conducting frequent checks for a timely diagnosis, and providing an effective treatment plan.
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Affiliation(s)
- Soo-Min Ok
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Donald Ho
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Tyler Lynd
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
| | - Yong-Woo Ahn
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Hye-Min Ju
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Sung-Hee Jeong
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea; (S.-m.O.); (Y.-W.A.); (H.-M.J.); (S.-H.J.)
- Dental Research Institute, Pusan National University Dental Hospital, Yangsan 50612, Korea
| | - Kyounga Cheon
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (D.H.); (T.L.)
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55
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Current and Future Perspectives of the Use of Organoids in Radiobiology. Cells 2020; 9:cells9122649. [PMID: 33317153 PMCID: PMC7764598 DOI: 10.3390/cells9122649] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
The majority of cancer patients will be treated with radiotherapy, either alone or together with chemotherapy and/or surgery. Optimising the balance between tumour control and the probability of normal tissue side effects is the primary goal of radiation treatment. Therefore, it is imperative to understand the effects that irradiation will have on both normal and cancer tissue. The more classical lab models of immortal cell lines and in vivo animal models have been fundamental to radiobiological studies to date. However, each of these comes with their own limitations and new complementary models are required to fill the gaps left by these traditional models. In this review, we discuss how organoids, three-dimensional tissue-resembling structures derived from tissue-resident, embryonic or induced pluripotent stem cells, overcome the limitations of these models and thus have a growing importance in the field of radiation biology research. The roles of organoids in understanding radiation-induced tissue responses and in moving towards precision medicine are examined. Finally, the limitations of organoids in radiobiology and the steps being made to overcome these limitations are considered.
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56
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Mona M, Kobeissy F, Park YJ, Miller R, Saleh W, Koh J, Yoo MJ, Chen S, Cha S. Secretome Analysis of Inductive Signals for BM-MSC Transdifferentiation into Salivary Gland Progenitors. Int J Mol Sci 2020; 21:E9055. [PMID: 33260559 PMCID: PMC7730006 DOI: 10.3390/ijms21239055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Severe dry mouth in patients with Sjögren's Syndrome, or radiation therapy for patients with head and neck cancer, significantly compromises their oral health and quality of life. The current clinical management of xerostomia is limited to palliative care as there are no clinically-proven treatments available. Previously, our studies demonstrated that mouse bone marrow-derived mesenchymal stem cells (mMSCs) can differentiate into salivary progenitors when co-cultured with primary salivary epithelial cells. Transcription factors that were upregulated in co-cultured mMSCs were identified concomitantly with morphological changes and the expression of acinar cell markers, such as α-amylase (AMY1), muscarinic-type-3-receptor(M3R), aquaporin-5(AQP5), and a ductal cell marker known as cytokeratin 19(CK19). In the present study, we further explored inductive molecules in the conditioned media that led to mMSC reprogramming by high-throughput liquid chromatography with tandem mass spectrometry and systems biology. Our approach identified ten differentially expressed proteins based on their putative roles in salivary gland embryogenesis and development. Additionally, systems biology analysis revealed six candidate proteins, namely insulin-like growth factor binding protein-7 (IGFBP7), cysteine-rich, angiogenetic inducer, 61(CYR61), agrin(AGRN), laminin, beta 2 (LAMB2), follistatin-like 1(FSTL1), and fibronectin 1(FN1), for their potential contribution to mMSC transdifferentiation during co-culture. To our knowledge, our study is the first in the field to identify soluble inductive molecules that drive mMSC into salivary progenitors, which crosses lineage boundaries.
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Affiliation(s)
- Mahmoud Mona
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (M.M.); (R.M.)
- Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA
| | - Firas Kobeissy
- Department of Emergency Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA;
| | - Yun-Jong Park
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA;
| | - Rehae Miller
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (M.M.); (R.M.)
| | - Wafaa Saleh
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt;
| | - Jin Koh
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL 32610, USA; (J.K.); (S.C.)
| | - Mi-Jeong Yoo
- Department of Biology, Clarkson University, Potsdam, NY 13699, USA;
| | - Sixue Chen
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL 32610, USA; (J.K.); (S.C.)
- Department of Biology, Genetics Institute, University of Florida, Gainesville, FL 32610, USA
| | - Seunghee Cha
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (M.M.); (R.M.)
- Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA
- Center for Orphaned Autoimmune Disorders, University of Florida College of Dentistry, Gainesville, FL 32610, USA
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57
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Marimuthu D, Han KM, Mohamad MSF, Azman M. Saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia: a randomized controlled trial. Clin Oral Investig 2020; 25:3105-3115. [PMID: 33175253 PMCID: PMC8060215 DOI: 10.1007/s00784-020-03634-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
Objectives Xerostomia is a prevalent sequelae among nasopharyngeal cancer (NPC) survivors; yet, effective treatment protocols have been elusive. This study was a prospective randomized clinical trial to compare the effects of saliva substitute mouthwash in nasopharyngeal cancer survivors with xerostomia, between two treatment arms, conducted in a tertiary center. Materials and methods This study measured the effects within 4 weeks in relation to summated xerostomia inventory (SXI) and unstimulated whole saliva (UWS). Patients randomized into the interventional arm were prescribed an immunologically active saliva substitute (IASS), while patients in the control arm were prescribed a non-immunologically active mouthwash as placebo. Results The study population consisted of 94 patients. There was a significant difference in SXI difference (p < 0.0001) and UWS difference (p < 0.0001) between control and interventional arms. No harmful side effects associated with the use of either mouthwash encountered throughout the study duration. Conclusion IASS mouthwash significantly reduces subjective xerostomia scores measured using SXI and improves objective measurement of salivary flow using UWS among nasopharyngeal cancer survivors with xerostomia. Clinical relevance IASS is significantly more effective in improving subjective and objective xerostomia measurements compared to non-immunologically active mouthwash. Additionally, this treatment is very safe, with superior side effect profiles. Trial registration ClinicalTrials.gov Identifier: NCT04491435
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Affiliation(s)
- Dayaabaran Marimuthu
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Kong Min Han
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mohd Shawal Firdaus Mohamad
- Centre of Studies for Oral and Maxillofacial Surgery, Faculty of Dentistry, UiTM Sungai Buloh Campus, Jalan Hospital, 47000, Sugai Buloh, Selangor, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology and Head and Neck Surgery, Level 9, Clinical Block, UKM Medical Centre, National University of Malaysia Kuala Lumpur Campus, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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58
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Porcheri C, Meisel CT, Mitsiadis TA. Molecular and Cellular Modelling of Salivary Gland Tumors Open New Landscapes in Diagnosis and Treatment. Cancers (Basel) 2020; 12:E3107. [PMID: 33114321 PMCID: PMC7690880 DOI: 10.3390/cancers12113107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
Salivary gland tumors are neoplasms affecting the major and minor salivary glands of the oral cavity. Their complex pathological appearance and overlapping morphological features between subtypes, pose major challenges in the identification, classification, and staging of the tumor. Recently developed techniques of three-dimensional culture and organotypic modelling provide useful platforms for the clinical and biological characterization of these malignancies. Additionally, new advances in genetic and molecular screenings allow precise diagnosis and monitoring of tumor progression. Finally, novel therapeutic tools with increased efficiency and accuracy are emerging. In this review, we summarize the most common salivary gland neoplasms and provide an overview of the state-of-the-art tools to model, diagnose, and treat salivary gland tumors.
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Affiliation(s)
- Cristina Porcheri
- Orofacial Development and Regeneration, Institute of Oral Biology, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (C.T.M.); (T.A.M.)
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Cellular senescence contributes to radiation-induced hyposalivation by affecting the stem/progenitor cell niche. Cell Death Dis 2020; 11:854. [PMID: 33056980 PMCID: PMC7566836 DOI: 10.1038/s41419-020-03074-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Radiotherapy for head and neck cancer is associated with impairment of salivary gland function and consequent xerostomia, which has a devastating effect on the quality of life of the patients. The mechanism of radiation-induced salivary gland damage is not completely understood. Cellular senescence is a permanent state of cell cycle arrest accompanied by a secretory phenotype which contributes to inflammation and tissue deterioration. Genotoxic stresses, including radiation-induced DNA damage, are known to induce a senescence response. Here, we show that radiation induces cellular senescence preferentially in the salivary gland stem/progenitor cell niche of mouse models and patients. Similarly, salivary gland-derived organoids show increased expression of senescence markers and pro-inflammatory senescence-associated secretory phenotype (SASP) factors after radiation exposure. Clearance of senescent cells by selective removal of p16Ink4a-positive cells by the drug ganciclovir or the senolytic drug ABT263 lead to increased stem cell self-renewal capacity as measured by organoid formation efficiency. Additionally, pharmacological treatment with ABT263 in mice irradiated to the salivary glands mitigates tissue degeneration, thus preserving salivation. Our data suggest that senescence in the salivary gland stem/progenitor cell niche contributes to radiation-induced hyposalivation. Pharmacological targeting of senescent cells may represent a therapeutic strategy to prevent radiotherapy-induced xerostomia.
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60
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Traditional Herbal Medicine Mediated Regulations during Head and Neck Carcinogenesis. Biomolecules 2020; 10:biom10091321. [PMID: 32942674 PMCID: PMC7565208 DOI: 10.3390/biom10091321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most prevalent neoplasms worldwide. It is well recognized that environmental challenges such as smoking, viral infection and alcohol consumption are key factors underlying HNSCC pathogenesis. Other than major clinical interventions (e.g., surgical resection, chemical and radiotherapy) that have been routinely practiced over years, adjuvant anticancer agents from Traditional Herbal Medicine (THM) are proposed, either alone or together with conventional therapies, to be experimentally effective for improving treatment efficacy in different cancers including HNSCCs. At a cellular and molecular basis, THM extracts could modulate different malignant indices via distinct signaling pathways and provide better control in HNSCC malignancy and its clinical complications such as radiotherapy-induced xerostomia/oral mucositis. In this article, we aim to systemically review the impacts of THM in regulating HNSCC tumorous identities and its potential perspective for clinical use.
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61
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Lombaert IMA, Patel VN, Jones CE, Villier DC, Canada AE, Moore MR, Berenstein E, Zheng C, Goldsmith CM, Chorini JA, Martin D, Zourelias L, Trombetta MG, Edwards PC, Meyer K, Ando D, Passineau MJ, Hoffman MP. CERE-120 Prevents Irradiation-Induced Hypofunction and Restores Immune Homeostasis in Porcine Salivary Glands. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:839-855. [PMID: 32953934 PMCID: PMC7479444 DOI: 10.1016/j.omtm.2020.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
Salivary gland hypofunction causes significant morbidity and loss of quality of life for head and neck cancer patients treated with radiotherapy. Preventing hypofunction is an unmet therapeutic need. We used an adeno-associated virus serotype 2 (AAV2) vector expressing the human neurotrophic factor neurturin (CERE-120) to treat murine submandibular glands either pre- or post-irradiation (IR). Treatment with CERE-120 pre-IR, not post-IR, prevented hypofunction. RNA sequencing (RNA-seq) analysis showed reduced gene expression associated with fibrosis and the innate and humoral immune responses. We then used a minipig model with CERE-120 treatment pre-IR and also compared outcomes of the contralateral non-IR gland. Analysis of gene expression, morphology, and immunostaining showed reduced IR-related immune responses and improved secretory mechanisms. CERE-120 prevented IR-induced hypofunction and restored immune homeostasis, and there was a coordinated contralateral gland response to either damage or treatment. CERE-120 gene therapy is a potential treatment for head and neck cancer patients to influence communication among neuronal, immune, and epithelial cells to prevent IR-induced salivary hypofunction and restore immune homeostasis.
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Affiliation(s)
- Isabelle M A Lombaert
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA.,Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vaishali N Patel
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Christina E Jones
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Derrick C Villier
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Ashley E Canada
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Matthew R Moore
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Elsa Berenstein
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
| | - Changyu Zheng
- Translational Research Core, NIDCR, NIH, DHHS, Bethesda, MD 20892, USA
| | | | - John A Chorini
- Adeno-Associated Virus Section, NIDCR, NIH, DHHS, Bethesda, MD 20892, USA
| | - Daniel Martin
- Genomics and Computational Biology Core, NIDCR, NIH, DHHS, Bethesda, MD 20892, USA
| | - Lee Zourelias
- Gene Therapy Program, Department of Medicine, Division of Cardiovascular Medicine, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Mark G Trombetta
- Department of Oncology, Division of Radiation Oncology, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Paul C Edwards
- Department of Oral Pathology, Medicine, and Radiology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
| | - Kathleen Meyer
- Sangamo BioSciences, Inc., 501 Canal Blvd., Richmond, CA 94804
| | - Dale Ando
- Sangamo BioSciences, Inc., 501 Canal Blvd., Richmond, CA 94804
| | - Michael J Passineau
- Gene Therapy Program, Department of Medicine, Division of Cardiovascular Medicine, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Matthew P Hoffman
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, NIH, DHHS, Bethesda, MD 20892, USA
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62
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Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. J Natl Cancer Inst Monogr 2020; 2019:5551361. [PMID: 31425600 DOI: 10.1093/jncimonographs/lgz016] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The most manifest long-term consequences of radiation therapy in the head and neck cancer patient are salivary gland hypofunction and a sensation of oral dryness (xerostomia). METHODS This critical review addresses the consequences of radiation injury to salivary gland tissue, the clinical management of salivary gland hypofunction and xerostomia, and current and potential strategies to prevent or reduce radiation injury to salivary gland tissue or restore the function of radiation-injured salivary gland tissue. RESULTS Salivary gland hypofunction and xerostomia have severe implications for oral functioning, maintenance of oral and general health, and quality of life. Significant progress has been made to spare salivary gland function chiefly due to advances in radiation techniques. Other strategies have also been developed, e.g., radioprotectors, identification and preservation/expansion of salivary stem cells by stimulation with cholinergic muscarinic agonists, and application of new lubricating or stimulatory agents, surgical transfer of submandibular glands, and acupuncture. CONCLUSION Many advances to manage salivary gland hypofunction and xerostomia induced by radiation therapy still only offer partial protection since they are often of short duration, lack the protective effects of saliva, or potentially have significant adverse effects. Intensity-modulated radiation therapy (IMRT), and its next step, proton therapy, have the greatest potential as a management strategy for permanently preserving salivary gland function in head and neck cancer patients.Presently, gene transfer to supplement fluid formation and stem cell transfer to increase the regenerative potential in radiation-damaged salivary glands are promising approaches for regaining function and/or regeneration of radiation-damaged salivary gland tissue.
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Affiliation(s)
- Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Mary E Reyland
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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Barazzuol L, Coppes RP, van Luijk P. Prevention and treatment of radiotherapy-induced side effects. Mol Oncol 2020; 14:1538-1554. [PMID: 32521079 PMCID: PMC7332214 DOI: 10.1002/1878-0261.12750] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 01/10/2023] Open
Abstract
Radiotherapy remains a mainstay of cancer treatment, being used in roughly 50% of patients. The precision with which the radiation dose can be delivered is rapidly improving. This precision allows the more accurate targeting of radiation dose to the tumor and reduces the amount of surrounding normal tissue exposed. Although this often reduces the unwanted side effects of radiotherapy, we still need to further improve patients' quality of life and to escalate radiation doses to tumors when necessary. High-precision radiotherapy forces one to choose which organ or functional organ substructures should be spared. To be able to make such choices, we urgently need to better understand the molecular and physiological mechanisms of normal tissue responses to radiotherapy. Currently, oversimplified approaches using constraints on mean doses, and irradiated volumes of normal tissues are used to plan treatments with minimized risk of radiation side effects. In this review, we discuss the responses of three different normal tissues to radiotherapy: the salivary glands, cardiopulmonary system, and brain. We show that although they may share very similar local cellular processes, they respond very differently through organ-specific, nonlocal mechanisms. We also discuss how a better knowledge of these mechanisms can be used to treat or to prevent the effects of radiotherapy on normal tissue and to optimize radiotherapy delivery.
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Affiliation(s)
- Lara Barazzuol
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Rob P. Coppes
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Peter van Luijk
- Department of Biomedical Sciences of Cells and SystemsUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Radiation OncologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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64
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Serrano Martinez P, Cinat D, van Luijk P, Baanstra M, de Haan G, Pringle S, Coppes RP. Mouse parotid salivary gland organoids for the in vitro study of stem cell radiation response. Oral Dis 2020; 27:52-63. [PMID: 32531849 PMCID: PMC7818507 DOI: 10.1111/odi.13475] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Hyposalivation-related xerostomia is an irreversible, untreatable, and frequent condition after radiotherapy for head and neck cancer. Stem cell therapy is an attractive option of treatment, but demands knowledge of stem cell functioning. Therefore, we aimed to develop a murine parotid gland organoid model to explore radiation response of stem cells in vitro. MATERIALS AND METHODS Single cells derived from murine parotid gland organoids were passaged in Matrigel with defined medium to assess self-renewal and differentiation potential. Single cells were irradiated and plated in a 3D clonogenic stem cell survival assay to assess submandibular and parotid gland radiation response. RESULTS Single cells derived from parotid gland organoids were able to extensively self-renew and differentiate into all major tissue cell types, indicating the presence of potential stem cells. FACS selection for known salivary gland stem cell markers CD24/CD29 did not further enrich for stem cells. The parotid gland organoid-derived stem cells displayed radiation dose-response curves similar to the submandibular gland. CONCLUSIONS Murine parotid gland organoids harbor stem cells with long-term expansion and differentiation potential. This model is useful for mechanistic studies of stem cell radiation response and suggests similar radiosensitivity for the parotid and submandibular gland organoids.
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Affiliation(s)
- Paola Serrano Martinez
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Davide Cinat
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mirjam Baanstra
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerald de Haan
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sarah Pringle
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert P Coppes
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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65
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Saito E, Watari I, Mizumachi-Kubono M, Hsu-Hayashi S, Ono T. Occlusional Modifications Reversibly Alter Aquaporin 5 Expression and Localization in Rat Salivary Glands. Front Physiol 2020; 11:528. [PMID: 32587522 PMCID: PMC7298139 DOI: 10.3389/fphys.2020.00528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Aquaporin 5 (AQP5) is a water channel–forming protein that plays a key role in saliva secretion. A decrease in masticatory function associated with the molar extraction adversely affects the submandibular salivary gland (SMG) in rats, inducing hypertrophic changes in the acinar cells and the expression of AQP5 in acinar cells or intercalated duct of the SMG. However, changes in AQP5 expression and localization in the SMG in association with occlusal modification have not been fully characterized. Methods We examined the influence of the decline and recovery of masticatory function on expression and localization of AQP5 in the rat SMG by inserting and removing an incisor bite plate (IBP). Thirty 5-week-old male Wistar rats were randomly divided into IBP (n = 12), recovery (REC) (n = 6), and control (CON) (n = 12) groups. Each rat in both the IBP and REC groups was fitted with the IBP on its maxillary incisors. Rats without the IBPs served as controls. All rats were fed powder diet and water ad libitum. Rats in the IBP and CON groups were sacrificed after 14 (n = 6) and 28 (n = 6) days after the IBP attachment. In the REC group, the IBP was detached on the 14th day and sacrificed on 28th day after the IBP attachment. AQP5 mRNA expression was quantified by reverse transcription–polymerase chain reaction. Changes in the localization of AQP5 were tracked by immunohistochemical staining. Results Attachment of IBP resulted in a decrease in the expression of AQP5 in the IBP group. Changes in the localization of AQP5 were observed between 14 and 28 days in the IBP group. In contrast, changes in the expression and localization of AQP5 were not observed in the REC group. Conclusion Findings suggested that a loss of molar occlusion, due to the IBP attachment, altered AQP5 expression and localization in the rat SMG. However, removal of the bite plate allowed the recovery of both AQP5 expression and its normal localization in the SMGs.
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Affiliation(s)
- Eri Saito
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ippei Watari
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Mizumachi-Kubono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sumire Hsu-Hayashi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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66
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Spijkervet FKL, Schuurhuis JM, Stokman MA, Witjes MJH, Vissink A. Should oral foci of infection be removed before the onset of radiotherapy or chemotherapy? Oral Dis 2020; 27:7-13. [PMID: 32166855 PMCID: PMC7818265 DOI: 10.1111/odi.13329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 01/22/2023]
Abstract
Pretreatment dental screening aims to locate and eliminate oral foci of infection in order to eliminate local, loco-regional, or systemic complications during and after oncologic treatment. An oral focus of infection is a pathologic process in the oral cavity that does not cause major infectious problems in healthy individuals, but may lead to severe local or systemic inflammation in patients subjected to oncologic treatment. As head and neck radiotherapy patients bear a lifelong risk on oral sequelae resulting from this therapy, the effects of chemotherapy on healthy oral tissues are essentially temporary and reversible. This has a large impact on what to consider as an oral focus of infection when patients are subjected to, for example, head and neck radiotherapy for cancer or intensive chemotherapy for hematological disorders. While in patients subjected to head and neck radiotherapy oral foci of infection have to be removed before therapy that may cause problems ultimately, in patients that will receive chemotherapy such, so-called chronic, foci of infection are not in need of removal of teeth but can be treated during a remission phase. Acute foci of infection always have to be removed before or early after the onset of any oncologic treatment.
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Affiliation(s)
- Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jennifer M Schuurhuis
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique A Stokman
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rocchi C, Emmerson E. Mouth-Watering Results: Clinical Need, Current Approaches, and Future Directions for Salivary Gland Regeneration. Trends Mol Med 2020; 26:649-669. [PMID: 32371171 DOI: 10.1016/j.molmed.2020.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Permanent damage to the salivary glands and resulting hyposalivation and xerostomia have a substantial impact on patient health, quality of life, and healthcare costs. Currently, patients rely on lifelong treatments that alleviate the symptoms, but no long-term restorative solutions exist. Recent advances in adult stem cell enrichment and transplantation, bioengineering, and gene transfer have proved successful in rescuing salivary gland function in a number of animal models that reflect human diseases and that result in hyposalivation and xerostomia. By overcoming the limitations of stem cell transplants and better understanding the mechanisms of cellular plasticity in the adult salivary gland, such studies provide encouraging evidence that a regenerative strategy for patients will be available in the near future.
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Affiliation(s)
- Cecilia Rocchi
- The MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Elaine Emmerson
- The MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, Edinburgh, EH16 4UU, UK.
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68
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Krčálová E, Horáček J, Gabalec F, Žák P, Doležal J. Scintigraphic evaluation of salivary gland function in thyroid cancer patients after radioiodine remnant ablation. Eur J Oral Sci 2020; 128:204-210. [PMID: 32239618 PMCID: PMC7318700 DOI: 10.1111/eos.12689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
Radioiodine (131I, RAI) has traditionally been used in thyroid cancer treatment but its benefit should be balanced against possible risks. Among them, salivary gland dysfunction has often been discussed, although the reported data have been inconsistent. The aim of our prospective study was to evaluate salivary gland function in 31 thyroidectomised patients (6 men, 25 women; median age 52 yr) before and 4–6 months after RAI remnant ablation (RRA), using activity of 3.7 GBq 131I‐NaI. Salivary gland uptake and excretion fractions were quantitatively assessed with 99mTc – pertechnetate salivary gland scintigraphy. Pre‐ and post‐treatment values were compared using Wilcoxon signed rank test. No statistically significant difference in the pre‐ and post‐treatment values was observed in parotid or submandibular glands uptake, or in the parotid or submandibular excretion fractions. The calculated power for minimum relevant difference of 25% with the sample size of 31 ranged between 86% and 96% for the individual variables, making our negative results reasonably reliable. The results suggest that RRA with the most commonly used activity of 3.7 GBq has no important impact on salivary gland function. Therefore, the concerns about putative salivary gland functional deterioration following RRA are probably unjustified.
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Affiliation(s)
- Eva Krčálová
- Nuclear Medicine Department, University Hospital Hradec Králové, Hradec Králové, Czech Republic.,Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jiří Horáček
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Filip Gabalec
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Pavel Žák
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.,4th Department of Internal Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Doležal
- Nuclear Medicine Department, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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69
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Radaideh KM. Dosimetric impact of weight loss and anatomical changes at organs at risk during intensity-modulated radiotherapy for head-and-neck cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2020. [DOI: 10.1080/16878507.2020.1731125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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70
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Kwon MS, Lee BS, Choi BJ, Lee JW, Ohe JY, Jung JH, Hwang BY, Kwon YD. Closure of oroantral fistula: a review of local flap techniques. J Korean Assoc Oral Maxillofac Surg 2020; 46:58-65. [PMID: 32158682 PMCID: PMC7049762 DOI: 10.5125/jkaoms.2020.46.1.58] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/01/2022] Open
Abstract
Oroantral fistula (OAF), also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the maxillary sinus and the oral cavity. The most common causes of this pathological communication are known to be dental implant surgery and extraction of posterior maxillary teeth. The purpose of this article is to describe OAF; introduce the approach algorithm for the treatment of OAF; and review the fundamental surgical techniques for fistula closure with their advantages and disadvantages. The author included a thorough review of the previous studies acquired from the PubMed database. Based on this review, this article presents cases of OAF patients treated with buccal flap, buccal fat pad (BFP), and palatal rotational flap techniques.
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Affiliation(s)
- Min-Soo Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Baek-Soo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Byung-Joon Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jun-Ho Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Bo-Yeon Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
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71
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Al Hagbani T, Kamal MM, Nazzal S. A full factorial experimental design to study the effect of flavoring agents on the mechanical properties of curcumin chewing gum tablets with high solids content. Drug Dev Ind Pharm 2020; 46:539-546. [PMID: 32090628 DOI: 10.1080/03639045.2020.1734019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Developing chewing gum tablets (CGTs) with high drug loads is a challenge due to the loss of mastication properties. We postulated that poor mastication properties of such gums could be improved by adjusting the concentration of liquid flavors to serve as plasticizers and consequently increase the flexibility of the elastomer in the gum base. To test this hypothesis, the objective of this work was to evaluate the effects of flavor type and concentration, and storage conditions on the textural properties of CGTs loaded with 20% curcumin (CUR) by weight.Methods: CGTs were made by directly compressing Health in Gum® base with CUR. The resultant CGTs were characterized by single and two bites textural tests to measure their yield strength, post-bite failure rate, and compressibility.Results: Flavor concentration (X2) had a significant impact on the masticatory properties of the chewing gums, which could be ascribed to the plasticizing effect of peppermint oil. Addition of liquid flavors and storage at low temperature (X4) produced CGTs with the desirable properties of low yield strength (Y1) and post-bite structural failure rate (Y2), and high compressibility (Y3). The effect of flavors however was negated at high temperatures, especially when flavored gums were stored for extended time at 50 °C. Flavor type (X1) on the other hand had no effect on the masticatory properties of the chewing gums.Conclusions: This study concluded that it is feasible to formulate CGTs with high solids content without negatively impacting their mechanical properties by controlling the concentration of liquid flavors.
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Affiliation(s)
- Turki Al Hagbani
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana Monroe, Monroe, LA, USA.,College of Pharmacy, Hail University, Hail, Saudi Arabia
| | - Mohammad M Kamal
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana Monroe, Monroe, LA, USA.,Research and Development, Akorn Pharmaceuticals, Vernon Hills, IL, USA
| | - Sami Nazzal
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA
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72
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Nayebi I, Rajabi O, Chamani J, Izi S. In vitro evaluation of biophysical properties of an artificial saliva produced from Aloe vera gel’. J Herb Med 2020. [DOI: 10.1016/j.hermed.2019.100307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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73
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Weng PL, Aure MH, Maruyama T, Ovitt CE. Limited Regeneration of Adult Salivary Glands after Severe Injury Involves Cellular Plasticity. Cell Rep 2020; 24:1464-1470.e3. [PMID: 30089258 DOI: 10.1016/j.celrep.2018.07.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022] Open
Abstract
In the adult salivary glands, the origin of replacement and regenerated acinar cells remains unclear. Although many reports describe the identification of stem cells in adult salivary glands, we have shown that differentiated acinar cells can be maintained and regenerated through self-duplication. Here, we have used genetic mouse models to further investigate acinar cell replacement and regeneration during homeostasis and after injury. Under normal conditions or after duct ligation, replacement of duct and acinar cells occurs through lineage-restricted progenitors. In contrast, after irradiation, in vivo lineage tracing shows that acinar, as well as duct, cells contribute to acinar cell regeneration, revealing that cellular plasticity is involved in salivary gland repair. Our results also indicate that even after radiation damage, several cell populations have regenerative potential for restoring salivary gland function.
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Affiliation(s)
- Pei-Lun Weng
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Marit H Aure
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Takamitsu Maruyama
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Catherine E Ovitt
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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BARBIERI T, COSTA KCD, GUERRA LDFC. Current alternatives in the prevention and treatment of xerostomia in cancer therapy. ACTA ACUST UNITED AC 2020. [DOI: 10.1590/1981-86372020000163546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT In the last decades, there has been a substantial increase in the occurrence of cancer. The most commonly used treatment for this disease involves surgery, radiotherapy and chemotherapy. These treatment modalities are associated with different kinds of side effects, acute or late. Xerostomia is one of the main oral complications that affect patients undergoing antineoplastic treatments, mainly head and neck cancer patients. It is characterized by a “dry mouth” sensation resulting from decreased salivary flow. It is persistent and affects the integrity of oral tissues, thereby significantly affecting patients’ quality of life. Many strategies have been applied and others developed to prevent and reduce xerostomia. Accordingly, the objective of this study was to review the literature about current prevention and treatment measures aimed at improving the quality of life of xerostomic patients.
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75
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Paterson C, Thomson M, Caldwell B, Young R, McLean A, Porteous S, Clark S, Messow C, Kean S, Grose D, Lamb C, Rizwannullah M, James A, Schipani S, Wilson C, Rulach R, Jones R. Radiotherapy-induced xerostomia: a randomised, double-blind, controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2019; 57:1119-1125. [DOI: 10.1016/j.bjoms.2019.10.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
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Gaillard D, Shechtman LA, Millar SE, Barlow LA. Fractionated head and neck irradiation impacts taste progenitors, differentiated taste cells, and Wnt/β-catenin signaling in adult mice. Sci Rep 2019; 9:17934. [PMID: 31784592 PMCID: PMC6884601 DOI: 10.1038/s41598-019-54216-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/10/2019] [Indexed: 12/13/2022] Open
Abstract
Head and neck cancer patients receiving conventional repeated, low dose radiotherapy (fractionated IR) suffer from taste dysfunction that can persist for months and often years after treatment. To understand the mechanisms underlying functional taste loss, we established a fractionated IR mouse model to characterize how taste buds are affected. Following fractionated IR, we found as in our previous study using single dose IR, taste progenitor proliferation was reduced and progenitor cell number declined, leading to interruption in the supply of new taste receptor cells to taste buds. However, in contrast to a single dose of IR, we did not encounter increased progenitor cell death in response to fractionated IR. Instead, fractionated IR induced death of cells within taste buds. Overall, taste buds were smaller and fewer following fractionated IR, and contained fewer differentiated cells. In response to fractionated IR, expression of Wnt pathway genes, Ctnnb1, Tcf7, Lef1 and Lgr5 were reduced concomitantly with reduced progenitor proliferation. However, recovery of Wnt signaling post-IR lagged behind proliferative recovery. Overall, our data suggest carefully timed, local activation of Wnt/β-catenin signaling may mitigate radiation injury and/or speed recovery of taste cell renewal following fractionated IR.
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Affiliation(s)
- Dany Gaillard
- Department of Cell & Developmental Biology, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA.
- Rocky Mountain Taste & Smell Center, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Lauren A Shechtman
- Department of Cell & Developmental Biology, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA
- Rocky Mountain Taste & Smell Center, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA
| | - Sarah E Millar
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Cell, Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linda A Barlow
- Department of Cell & Developmental Biology, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA.
- Rocky Mountain Taste & Smell Center, University of Colorado Anschutz Medical Campus, Mail Stop 8108, 12801 East 17th Avenue, Aurora, CO, 80045, USA.
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77
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O'Keefe KJ, DeSantis KA, Altrieth AL, Nelson DA, Taroc EZM, Stabell AR, Pham MT, Larsen M. Regional Differences following Partial Salivary Gland Resection. J Dent Res 2019; 99:79-88. [PMID: 31765574 DOI: 10.1177/0022034519889026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Regenerative medicine aims to repair, replace, or restore function to tissues damaged by aging, disease, or injury. Partial organ resection is not only a common clinical approach in cancer therapy but also an experimental injury model used to examine mechanisms of regeneration and repair in organs. We performed a partial resection, or partial sialoadenectomy, in the female murine submandibular salivary gland (SMG) to establish a model for investigation of repair mechanisms in salivary glands (SGs). After partial sialoadenectomy, we performed whole-gland measurements over a period of 56 d and found that the gland increased slightly in size. We used microarray analysis and immunohistochemistry (IHC) to examine messenger RNA and protein changes in glands over time. Microarray analysis identified dynamic changes in the transcriptome 3 d after injury that were largely resolved by day 14. At the 3-d time point, we detected gene signatures for cell cycle regulation, inflammatory/repair response, and extracellular matrix (ECM) remodeling in the partially resected glands. Using quantitative IHC, we identified a transient proliferative response throughout the gland. Both secretory epithelial and stromal cells expressed Ki67 that was detectable at day 3 and largely resolved by day 14. IHC also revealed that while most of the gland underwent a wound-healing response that resolved by day 14, a small region of the gland showed an aberrant sustained fibrotic response characterized by increased levels of ECM deposition, sustained Ki67 levels in stromal cells, and a persistent M2 macrophage response through day 56. The partial submandibular salivary gland resection model provides an opportunity to examine a normal healing response and an aberrant fibrotic response within the same gland to uncover mechanisms that prevent wound healing and regeneration in mammals. Understanding regional differences in the wound-healing responses may ultimately affect regenerative therapies for patients.
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Affiliation(s)
- K J O'Keefe
- Molecular, Cellular, Developmental, and Neural Biology Graduate Program, State University of New York, University at Albany, Albany, NY, USA.,Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - K A DeSantis
- Molecular, Cellular, Developmental, and Neural Biology Graduate Program, State University of New York, University at Albany, Albany, NY, USA.,Gen*NY*Sis Center for Excellence in Cancer, Department of Environmental Health Sciences, School of Public Health, State University of New York, University at Albany, Albany, NY, USA
| | - A L Altrieth
- Molecular, Cellular, Developmental, and Neural Biology Graduate Program, State University of New York, University at Albany, Albany, NY, USA.,Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - D A Nelson
- Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - E Z M Taroc
- Molecular, Cellular, Developmental, and Neural Biology Graduate Program, State University of New York, University at Albany, Albany, NY, USA.,Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - A R Stabell
- Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA.,Current address: Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, USA
| | - M T Pham
- Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA.,Current address: The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Campus, Midlothian, Scotland, UK
| | - M Larsen
- Molecular, Cellular, Developmental, and Neural Biology Graduate Program, State University of New York, University at Albany, Albany, NY, USA.,Department of Biological Sciences, State University of New York, University at Albany, Albany, NY, USA
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78
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Strategies for Developing Functional Secretory Epithelia from Porcine Salivary Gland Explant Outgrowth Culture Models. Biomolecules 2019; 9:biom9110657. [PMID: 31717706 DOI: 10.3390/biom9110657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Research efforts have been made to develop human salivary gland (SG) secretory epithelia for transplantation in patients with SG hypofunction and dry mouth (xerostomia). However, the limited availability of human biopsies hinders the generation of sufficient cell numbers for epithelia formation and regeneration. Porcine SG have several similarities to their human counterparts, hence could replace human cells in SG modelling studies in vitro. Our study aims to establish porcine SG explant outgrowth models to generate functional secretory epithelia for regeneration purposes to rescue hyposalivation. Cells were isolated and expanded from porcine submandibular and parotid gland explants. Flow cytometry, immunocytochemistry, and gene arrays were performed to assess proliferation, standard mesenchymal stem cell, and putative SG epithelial stem/progenitor cell markers. Epithelial differentiation was induced and different SG-specific markers investigated. Functional assays upon neurostimulation determined α-amylase activity, trans-epithelial electrical resistance, and calcium influx. Primary cells exhibited SG epithelial progenitors and proliferation markers. After differentiation, SG markers were abundantly expressed resembling epithelial lineages (E-cadherin, Krt5, Krt14), and myoepithelial (α-smooth muscle actin) and neuronal (β3-tubulin, Chrm3) compartments. Differentiated cells from submandibular gland explant models displayed significantly greater proliferation, number of epithelial progenitors, amylase activity, and epithelial barrier function when compared to parotid gland models. Intracellular calcium was mobilized upon cholinergic and adrenergic neurostimulation. In summary, this study highlights new strategies to develop secretory epithelia from porcine SG explants, suitable for future proof-of-concept SG regeneration studies, as well as for testing novel muscarinic agonists and other biomolecules for dry mouth.
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79
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Weng PL, Luitje ME, Ovitt CE. Cellular plasticity in salivary gland regeneration. Oral Dis 2019; 25:1837-1839. [PMID: 31560148 DOI: 10.1111/odi.13205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Pei-Lun Weng
- Department of Dermatology, Department of Pathology, Yale University, New Haven, Connecticut
| | - Martha E Luitje
- Department of Otolaryngology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Catherine E Ovitt
- Center for Oral Biology, Department of Biomedical Genetics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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80
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Ingalls MH, Hollomon AJ, Newlands SD, McDavid AN, Ovitt CE. Intrinsic mitotic activity supports the human salivary gland acinar cell population. FEBS Lett 2019; 594:376-382. [PMID: 31538335 DOI: 10.1002/1873-3468.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022]
Abstract
To develop treatments for salivary gland dysfunction, it is important to understand how human salivary glands are maintained under normal homeostasis. Previous data from our lab demonstrated that murine salivary acinar cells maintain the acinar cell population through self-duplication under conditions of homeostasis, as well as after injury. Early studies suggested that human acinar cells are mitotically active, but the identity of the resultant daughter cells was not clear. Using markers of cell cycle activity and mitosis, as well as an ex vivo 5-Ethynyl-2´-deoxyuridine assay, we show that human salivary gland acinar cells divide to generate daughter acinar cells. As in mouse, our data indicate that human salivary gland homeostasis is supported by the intrinsic mitotic capacity of acinar cells.
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Affiliation(s)
- Matthew H Ingalls
- Center for Oral Biology, Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, NY, USA
| | - Andrew J Hollomon
- Department of Biomedical Engineering, University of Rochester, NY, USA
| | - Shawn D Newlands
- Department of Otolaryngology, Department of Neuroscience, Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, NY, USA
| | - Andrew N McDavid
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, NY, USA
| | - Catherine E Ovitt
- Center for Oral Biology, Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, NY, USA
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81
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Paim ÉD, Berbert MCB, Zanella VG, Macagnan FE. Electrical stimulation in the treatment of radiotherapy-induced hyposalivation. Codas 2019; 31:e20180176. [PMID: 31483040 DOI: 10.1590/2317-1782/20192018176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/10/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation. RESEARCH STRATEGIES Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases. SELECTION CRITERIA Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish. DATA ANALYSIS The PEDro scale was used for the methodological evaluation of the studies. RESULTS The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias. CONCLUSION The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.
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Affiliation(s)
- Émille Dalbem Paim
- Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | | | | | - Fabricio Edler Macagnan
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
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82
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Physiology, Pathology and Regeneration of Salivary Glands. Cells 2019; 8:cells8090976. [PMID: 31455013 PMCID: PMC6769486 DOI: 10.3390/cells8090976] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/03/2023] Open
Abstract
Salivary glands are essential structures in the oral cavity. A variety of diseases, such as cancer, autoimmune diseases, infections and physical traumas, can alter the functionality of these glands, greatly impacting the quality of life of patients. To date, no definitive therapeutic approach can compensate the impairment of salivary glands, and treatment are purely symptomatic. Understanding the cellular and molecular control of salivary glands function is, therefore, highly relevant for therapeutic purposes. In this review, we provide a starting platform for future studies in basic biology and clinical research, reporting classical ideas on salivary gland physiology and recently developed technology to guide regeneration, reconstruction and substitution of the functional organs.
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83
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Establishment of a Murine Pro-acinar Cell Line to Characterize Roles for FGF2 and α3β1 Integrins in Regulating Pro-acinar Characteristics. Sci Rep 2019; 9:10984. [PMID: 31358811 PMCID: PMC6662831 DOI: 10.1038/s41598-019-47387-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022] Open
Abstract
Radiation therapy for head and neck cancers results in permanent damage to the saliva producing acinar compartment of the salivary gland. To date, a pure pro-acinar cell line to study underlying mechanisms of acinar cell differentiation in culture has not been described. Here, we report the establishment of a pro-acinar (mSG-PAC1) and ductal (mSG-DUC1) cell line, from the murine submandibular salivary gland (SMG), which recapitulate developmental milestones in differentiation. mSG-DUC1 cells express the ductal markers, keratin-7 and keratin-19, and form lumenized spheroids. mSG-PAC1 cells express the pro-acinar markers SOX10 and aquaporin-5. Using the mSG-PAC1 cell line, we demonstrate that FGF2 regulates specific steps during acinar cell maturation. FGF2 up-regulates aquaporin-5 and the expression of the α3 and α6 subunits of the α3β1 and α6β1 integrins that are known to promote SMG morphogenesis and differentiation. mSG-DUC1 and mSG-PAC1 cells were derived from genetically modified mice, homozygous for floxed alleles of the integrin α3 subunit. Similar to SMGs from α3-null mice, deletion of α3 alleles in mSG-PAC1 cells results in the up-regulation of E-cadherin and the down-regulation of CDC42. Our data indicate that mSG-DUC1 and mSG-PAC1 cells will serve as important tools to gain mechanistic insight into salivary gland morphogenesis and differentiation.
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84
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Cancer Stem Cells in Head and Neck Carcinomas: Identification and Possible Therapeutic Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1083:89-102. [PMID: 29139089 DOI: 10.1007/5584_2017_116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The recurrence and/or lack of response of certain tumors to radio- and chemotherapy has been attributed to a small subpopulation of cells termed cancer stem cells (CSCs). CSCs have been identified in many tumors (including solid and hematological tumors). CSCs are characterized by their capacity for self-renewal, their ability to introduce heterogeneity within a tumor mass and its metastases, genomic instability, and their insensitivity to both radiation and chemotherapy. The latter highlights the clinical importance of studying this subpopulation since their resistance to traditional treatments may lead to metastatic disease and/or tumor relapse. Head and neck squamous cell carcinomas (HNSCCs) are the sixth most common malignancy worldwide with the highest incidence occurring in East Asia and eastern and southern Africa. Several cellular subpopulations believed to have CSC properties have been isolated from HNSCCs, but at present, identification and characterization of CSCs remains an experimental challenge with no established or standardized protocols in place to confirm their identity. In this review we discuss current approaches to the study of CSCs with a focus on HNSCCs, particularly in the context of what this might mean from a therapeutic perspective.
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85
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Rakici SY, Tumkaya L, Edirvanli OC, Yazici U, Dursun E, Arpa M, Mercantepe T. Radioprotective effect of endogenous melatonin secretion associated with the circadian rhythm in irradiated rats. Int J Radiat Biol 2019; 95:1236-1241. [PMID: 31287351 DOI: 10.1080/09553002.2019.1642532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: We investigated the radioprotective effect of endogenous melatonin release at different times associated with the circadian rhythm on head and neck radiotherapy. Materials and methods: Two groups of animals were subjected daily to 8 Gy single fraction radiotherapy in the head and neck region from 5:00 to 6:00 (the morning group) or from 19:00 to 20:00 (the evening group). Corresponding untreated groups served as controls. Submandibular glands from rats sacrificed on the seventh day after irradiation were assessed biochemically and histopathologically. Melatonin, malondialdehyde and superoxide dismutase levels in blood collected immediately prior to irradiation were measured with rat-specific ELISA kits. Results: In irradiated rats, melatonin, malondialdehyde and superoxide dismutase levels were significantly higher in the evening group than in the morning group. In nonirradiated rats, melatonin and superoxide dismutase levels were significantly higher in the evening group than in the morning group. The areas of seromucous acinar cells were similar between the irradiated and nonirradiated evening groups, but the area was higher in the evening irradiated group than in the morning irradiated group. Conclusion: Consideration of endogenous melatonin secretion associated with the circadian rhythm may offer new therapeutic solutions for the complications of head and neck radiotherapy.
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Affiliation(s)
- Sema Yilmaz Rakici
- Department of Radiation Oncology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Recep Tayyip Erdogan University , Rize , Turkey
| | | | - Ufuk Yazici
- Department of Radiation Oncology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Engin Dursun
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Medeni Arpa
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University , Rize , Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Recep Tayyip Erdogan University , Rize , Turkey
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86
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Seo YJ, Lilliu MA, Abu Elghanam G, Nguyen TT, Liu Y, Lee JC, Presley JF, Zeitouni A, El-Hakim M, Tran SD. Cell culture of differentiated human salivary epithelial cells in a serum-free and scalable suspension system: The salivary functional units model. J Tissue Eng Regen Med 2019; 13:1559-1570. [PMID: 31151134 DOI: 10.1002/term.2908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/15/2018] [Accepted: 02/13/2019] [Indexed: 01/10/2023]
Abstract
Saliva aids in digestion, lubrication, and protection of the oral cavity against dental caries and oropharyngeal infections. Reduced salivary secretion, below an adequate level to sustain normal oral functions, is unfortunately experienced by head and neck cancer patients treated with radiotherapy and by patients with Sjögren's syndrome. No disease-modifying therapies exist to date to address salivary gland hypofunction (xerostomia, dry mouth) because pharmacotherapies are limited by the need for residual secretory acinar cells, which are lost at the time of diagnosis, whereas novel platforms such as cell therapies are yet immature for clinical applications. Autologous salivary gland primary cells have clinical utility as personalized cell therapies, if they could be cultured to a therapeutically useful mass while maintaining their in vivo phenotype. Here, we devised a serum-free scalable suspension culture system that grows partially digested human salivary tissue filtrates composing of acinar and ductal cells attached to their native extracellular matrix components while retaining their 3D in vivo spatial organization; we have coined these salivary spheroids as salivary functional units (SFU). The proposed SFU culture system was sub-optimal, but we have found that the cells could still survive and grow into larger salivary spheroids through cell proliferation and aggregation for 5 to 10 days within the oxygen diffusion rates in vitro. In summary, by using a less disruptive cell isolation procedure as the starting point for primary cell culture of human salivary epithelial cells, we demonstrated that aggregates of cells remained proliferative and continued to express acinar and ductal cell-specific markers.
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Affiliation(s)
- You Jung Seo
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Maria Alberta Lilliu
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria di Monserrato, Cagliari, Italy
| | - Ghada Abu Elghanam
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Anatomy and Histology, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Thomas T Nguyen
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of periodontics, School of dentistry, University of Montreal, Montreal, QC, Canada
| | - Younan Liu
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Jin Choon Lee
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan, South Korea
| | - John F Presley
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michel El-Hakim
- Department of Oral and Maxillofacial Surgery, McGill University, Montreal, QC, Canada
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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87
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Liu Y, Shi H, Huang S, Chen X, Zhou H, Chang H, Xia Y, Wang G, Yang X. Early prediction of acute xerostomia during radiation therapy for nasopharyngeal cancer based on delta radiomics from CT images. Quant Imaging Med Surg 2019; 9:1288-1302. [PMID: 31448214 DOI: 10.21037/qims.2019.07.08] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Acute xerostomia is the most common side effect of radiation therapy (RT) for head and neck (H&N) malignancies. Investigating radiation-induced changes of computed tomography (CT) radiomics in parotid glands (PGs) and saliva amount (SA) can predict acute xerostomia during the RT for nasopharyngeal cancer (NPC). Methods CT and SA data from 35 patients with stages I-IVB were randomly collected from an NPC clinical trial registered on the clinicaltrials.gov (ID: NCT01762514). All patients received radical treatment based on intensity-modulated RT (IMRT) with a prescription dose of 68.1 Gy in 30 fractions. The patients' ages ranged 24-72 years, and each patient had five CT sets acquired at treatment position: at the 0th, 10th, 20th, 30th fractions during the RT, and at 3-month later after the RT. The PGs for each CT set were delineated by a radiation oncologist and verified independently by another. Patients' saliva was collected every other 10 days during the RT. Acute xerostomia was evaluated based on the RTOG acute toxicity scoring and the SA. In total, 1,703 radiomics features were calculated for PGs from each CT set, including feature value at 0th fraction (FV0F), FV10F, and delta FV (ΔFV10F-0F), respectively. Extensive experiments were conducted to achieve the optimal results. RidgeCV and Recursive Feature Elimination (RFE) were used for feature selection, while linear regression was used for predicting SA30F. Four more patients were added for independent testing. Results Substantial changes in various radiomics metrics of PGs were observed during the RT. Eight normalized feature value (NFV), selected from NFV0F, predicted SA10F with a mean square error (MSE) of 0.9042 and a R2 score of 0.7406. Fourteen NFV, selected from ΔNFV10F-0F, NFV0F, and NFV10F to predict SA30F, showed the best predictive ability with an MSE of 0.0569. The model predicted the level of acute xerostomia with a precision of 0.9220 and a sensitivity of 100%, compared to the clinical observed SA. For the independent test, the MSE of PSA30F was 0.0233. Conclusions This study demonstrated that radiation-induced acute xerostomia level could be early predicted based on the SA and radiomics changes of the PGs during IMRT delivery. SA, NFV0F, NFV10F, and especially ΔNFV10F-0F provided the best performance on acute xerostomia prediction for individual patient based on RidgeCV_RFE_LinearRegression method of delta radiomics.
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Affiliation(s)
- Yanxia Liu
- School of Software Engineering, South China University of Technology, Guangzhou 510006, China
| | - Hongyu Shi
- School of Software Engineering, South China University of Technology, Guangzhou 510006, China
| | - Sijuan Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Xiaochuan Chen
- School of Software Engineering, South China University of Technology, Guangzhou 510006, China
| | - Huimin Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.,Department of Oncology, the Seventy-fourth Group Army Hospital of the Chinese People's Liberation Army, Guangzhou 510318, China
| | - Hui Chang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Yunfei Xia
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Guohua Wang
- School of Software Engineering, South China University of Technology, Guangzhou 510006, China
| | - Xin Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
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Hitomi S, Ujihara I, Sago-Ito M, Nodai T, Shikayama T, Inenaga K, Ono K. Hyposalivation due to chemotherapy exacerbates oral ulcerative mucositis and delays its healing. Arch Oral Biol 2019; 105:20-26. [PMID: 31238198 DOI: 10.1016/j.archoralbio.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 05/18/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Cancer therapy including chemotherapy causes gland atrophy, resulting in low salivary secretion in cancer patients. Since saliva plays an important role in oral health, the dysfunction may exacerbate oral ulcerative mucositis (OUM), which is another side effect. Here, we investigated the effect of hyposalivation on OUM using sialoadenectomized rats and examined the effects of anticancer drugs on the salivary glands. DESIGN As models for hyposalivation, the bilateral submandibular and sublingual glands except (2EXT) or together with (3EXT) the parotid glands were extracted. At 16 days after the procedure, OUM was experimentally developed by topical acetic acid treatment on the labial fornix region of the inferior incisors, and the severity and bacterial loading level were evaluated. The salivary gland weights and histology were analyzed after administration of the representative anticancer drugs 5-fluorouracil or cisplatin. RESULTS The severity of OUM was greater in both the 3EXT and 2EXT rats and delayed the healing process compared with that in sham rats without salivary gland extraction. The healing process in the 3EXT rats was longer than that in the 2EXT rats. The number of colony-forming units in the ulcerative region from the 3EXT rats was 10-fold greater than that in the sham rats. Both 5-fluorouracil and cisplatin reduced glands weights and damaged the salivary glands. CONCLUSIONS These results suggest that chemotherapy-induced hyposalivation exacerbates OUM and delays healing, most likely due to loss of salivary clearance and antimicrobial functions. This study illustrates the significance of oral health care for cancer patients undergoing chemotherapy.
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Affiliation(s)
- Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan.
| | - Izumi Ujihara
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Misa Sago-Ito
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Orofacial Functions and Orthodontics, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Tomotaka Nodai
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Takemi Shikayama
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Periodontology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kiyotoshi Inenaga
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
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Elkashty OA, Ashry R, Tran SD. Head and neck cancer management and cancer stem cells implication. Saudi Dent J 2019; 31:395-416. [PMID: 31700218 PMCID: PMC6823822 DOI: 10.1016/j.sdentj.2019.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal linings of the upper aerodigestive tract and are heterogeneous in nature. Risk factors for HNSCCs are smoking, excessive alcohol consumption, and the human papilloma virus. Conventional treatments are surgery, radiotherapy, chemotherapy, or a combined modality; however, no international standard mode of therapy exists. In contrast to the conventional model of clonal evolution in tumor development, there is a newly proposed theory based on the activity of cancer stem cells (CSCs) as the model for carcinogenesis. This “CSC hypothesis” may explain the high mortality rate, low response to treatments, and tendency to develop multiple tumors for HNSCC patients. We review current knowledge on HNSCC etiology and treatment, with a focus on CSCs, including their origins, identifications, and effects on therapeutic options.
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Key Words
- ABC, ATP-binding cassette transporters
- ATC, amplifying transitory cell
- Antineoplastic agents
- BMI-1, B cell-specific Moloney murine leukemia virus integration site 1
- Cancer stem cells
- Cancer treatment
- Carcinoma
- EGFR, epidermal growth factor receptor
- HIFs, hypoxia-inducible factors
- Head and neck cancer
- MDR1, Multidrug Resistance Protein 1
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- PI3K, phosphatidylinositol-4,5-bisphosphate 3-kinase
- Squamous cell
- TKIs, tyrosine kinase inhibitors
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Affiliation(s)
- Osama A Elkashty
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ramy Ashry
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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90
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Nam K, Dean SM, Brown CT, Smith RJ, Lei P, Andreadis ST, Baker OJ. Synergistic effects of laminin-1 peptides, VEGF and FGF9 on salivary gland regeneration. Acta Biomater 2019; 91:186-194. [PMID: 31028910 DOI: 10.1016/j.actbio.2019.04.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/25/2019] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
Hyposalivation is associated with radiation therapy, Sjögren's syndrome and/or aging, and is a significant clinical problem that decreases oral health and overall health in many patients and currently lacks effective treatment. Hence, methods to regenerate salivary glands and restore saliva secretion are urgently needed. To this end, this study describes the modification of fibrin hydrogels with a combination of laminin-1 peptides (YIGSR and A99) and human growth factors (vascular endothelial growth factor and fibroblast growth factor 9) to enhance regeneration in a salivary gland injury mouse model. Our results indicate that these fortified hydrogels enhanced angiogenesis and neurogenesis while promoting formation of acinar structures, thereby leading to enhanced saliva secretion. Such functional recovery indicates salivary gland regeneration and suggests that our technology may be useful in promoting gland regeneration and reversing hyposalivation in a clinical setting. STATEMENT OF SIGNIFICANCE: We engineered Fibrin Hydrogels (FH) to contain multiple regenerative cues including laminin-1 peptides (L1p) and growth factors (GFs). L1p and GF modified FH were used to induce salivary gland regeneration in a wounded mouse model. Treatment with L1p and GF modified FH promoted salivary epithelial tissue regeneration, vascularization, neurogenesis and healing as compared to L1p-FH or FH alone. Results indicate that L1p and GF modified FH can be used for future therapeutic applications.
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Affiliation(s)
- Kihoon Nam
- School of Dentistry, The University of Utah, Salt Lake City, UT 84108, United States
| | - Spencer M Dean
- School of Dentistry, The University of Utah, Salt Lake City, UT 84108, United States
| | - Callie T Brown
- School of Dentistry, The University of Utah, Salt Lake City, UT 84108, United States
| | - Randall J Smith
- Department of Biomedical Engineering, School of Engineering and Applied Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States
| | - Pedro Lei
- Department of Chemical and Biological Engineering, School of Engineering and Applied Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States
| | - Stelios T Andreadis
- Department of Chemical and Biological Engineering, School of Engineering and Applied Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States; Department of Biomedical Engineering, School of Engineering and Applied Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States; Center of Bioinformatics and Life Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, United States.
| | - Olga J Baker
- School of Dentistry, The University of Utah, Salt Lake City, UT 84108, United States.
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91
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Elsaadany B, Zakaria M, Mousa MR. Transplantation of Bone Marrow-Derived Mesenchymal Stem Cells Preserve the Salivary Glands Structure after Head and Neck Radiation in Rats. Open Access Maced J Med Sci 2019; 7:1588-1592. [PMID: 31210805 PMCID: PMC6560309 DOI: 10.3889/oamjms.2019.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/18/2019] [Accepted: 05/19/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The salivary glands are one of the radiation sensitive tissues during radiotherapy in the treatment of head and neck cancer. Within the first weeks of radiotherapy, the radiation causes progressive loss of gland function, then continue throughout the later of the patient's life. AIM The present work was designed to discover the potential effect of bone marrow-derived mesenchymal stem cells (MSCs) injected locally and in decreasing the unwanted effects of radiation on rats salivary gland. MATERIAL AND METHODS 6 rats used as the control group (N) and 12 rats had a single radiation dose of 13Gy in the head and neck then, they were equally allocated into two groups: Irradiated only as a group (C), Irradiated then treated with MSCs as a group (S). The animals were euthanised 7 days post radiation. Then, submandibular salivary glands were cut up; the histological examination was done. RESULTS Histological examination of the treated group(S) shown an apparent improvement in the SG structure and function compared to the irradiated group (C), this improvement represented mainly as preserving acini diameter (mean diameter in µm group (C) 183.1 ± 4.5, in group (S) 356.3 ± 33.5 while, in (N) group 408.9 ± 5.9) and decrease in fibrotic areas in the gland (mean fibrosis parentage in group (C) 26.5 ± 5.9 in (C) group , in group (S) 11.7 ± 4.13 while in (N) group 0.2 ± 0.31). CONCLUSION BM-MSCs has revealed to be promising in mitigating the side effects of radiotherapy on salivary glands structure.
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Affiliation(s)
- Basma Elsaadany
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mai Zakaria
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mohamed Refat Mousa
- Pathology Department, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
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92
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi Università Cattolica del Sacro Cuore Roma Italia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
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93
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Dai TQ, Zhang LL, An Y, Xu FF, An R, Xu HY, Liu YP, Liu B. In vitro transdifferentiation of adipose tissue-derived stem cells into salivary gland acinar-like cells. Am J Transl Res 2019; 11:2908-2924. [PMID: 31217863 PMCID: PMC6556663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
Current clinical approaches to treat irradiation-induced salivary gland hypofunction are ineffective. We previously reported that adipose-derived stem cell (ADSC)-based therapy ameliorates damaged salivary gland function in mice and that the effects were enhanced when the therapy was co-administrated with platelet-rich fibrin (PRF). We examined the feasibility of ADSC transdifferentiation into salivary gland acinar-like cells (SGALCs) and analyzed the potential of PRF to promote the transdifferentiation process in vitro. Salivary gland cells (SGCs) and ADSCs were indirectly co-cultured using Transwell inserts, and increasing concentrations of PRF-conditioned medium were applied to the co-culture system. The expression of α-amylase and AQP-5 were used to evaluate ADSC transdifferentiation. Notably, on day 7, 14, and 21, expression of both α-amylase and AQP-5 were detected in the co-cultured ADSCs. Additionally, PRF increased α-amylase and AQP-5 levels in ADSCs that were co-cultured for 7 days. These data demonstrate that ADSCs have the potential to transdifferentiate into SGALCs and that PRF can promote the transdifferentiation process. Therefore, these data reveal a possible mechanism to treat irradiation-induced salivary gland hypofunction and have translational medicine implications.
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Affiliation(s)
- Tai-Qiang Dai
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Lin-Lin Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontology, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Ying An
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontology, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Fang-Fang Xu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Ran An
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases, Laboratory Animal Center, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Hai-Yan Xu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases, Laboratory Animal Center, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Yan-Pu Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
| | - Bin Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases, Laboratory Animal Center, School of Stomatology, The Fourth Military Medical UniversityXi’an 710032, PR China
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94
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Shin K, Koo KH, Jeong J, Park SJ, Choi DJ, Ko YG, Kwon H. Three-Dimensional Culture of Salivary Gland Stem Cell in Orthotropic Decellularized Extracellular Matrix Hydrogels. Tissue Eng Part A 2019; 25:1396-1403. [PMID: 30632466 DOI: 10.1089/ten.tea.2018.0308] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Radiotherapy in patients with cancer can kill cancer cells but also damage normal cells or tissues. During the treatment of patients with head and neck cancer or thyroid cancer, hyposalivation is a representative chronic side effect of radio-damaged salivary glands (SGs). The major symptom of hyposalivation is mouth dryness, resulting in several subsequent long-term complications. No effective therapeutic approaches have been developed to manage this symptom. In this study, we developed the first rat SG tissue-derived decellularized extracellular matrix hydrogel (DSGM-hydrogel) as a functional orthotropic bioscaffold for future efficient SG stem cell therapy. DSGM-hydrogels were characterized by rheological or biochemical analyses, and rat SG stem/progenitor cells (rSGSCs) were then subjected to three-dimensional culture in the DSGM-hydrogels. Interestingly, DSGM-hydrogel-embedded rSGSCs survived and expressed SG functional differentiation marker of amylase IA and increased enzyme activity of α-amylase in protein level, whereas they showed reduced levels of adult ductal stem/progenitor markers, including c-Kit, c-Met, and CD44. Furthermore, the expression levels of basic epithelial tight junction markers were recovered to levels similar to those naked SG tissues after culture in DSGM-hydrogels in transcription level. Therefore, our findings suggested that the DSGM-hydrogels could provide an appropriate microenvironment for stem/progenitor cell survival and a source of SG cytodifferentiation. This approach could be an applicable method to SG stem cell research as a potential source for an organoid and for clinical regenerative reagents to manage radio-damaged SGs in vivo. Impact Statement In this study, we established the first rat salivary gland (SG) tissue-derived decellularized extracellular matrix hydrogel (DSGM-hydrogel) and assessed the role of this hydrogel as a functional orthotropic bioscaffold. Our findings provide important insights into the applications of the DSGM-hydrogel as a biocompatible matrix for regenerative therapy of radio-damaged SGs.
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Affiliation(s)
- Kyungshin Shin
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea.,Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Kyung Hee Koo
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Jaemin Jeong
- Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Dong Jin Choi
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Young-Gyu Ko
- Department of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Heechung Kwon
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
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95
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Ferreira JN, Hasan R, Urkasemsin G, Ng KK, Adine C, Muthumariappan S, Souza GR. A magnetic three-dimensional levitated primary cell culture system for the development of secretory salivary gland-like organoids. J Tissue Eng Regen Med 2019; 13:495-508. [PMID: 30666813 DOI: 10.1002/term.2809] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/08/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022]
Abstract
Salivary gland (SG) hypofunction and oral dryness can be induced by radiotherapy for head and neck cancers or autoimmune disorders. These are common clinical conditions that involve loss of saliva-secreting epithelial cells. Several oral complications arise with SG hypofunction that interfere with routine daily activities such as chewing, swallowing, and speaking. Hence, there is a need for replacing these saliva-secreting cells. Recently, researchers have proposed to repair SG hypofunction via various cell-based approaches in three-dimensional (3D) scaffold-based systems. However, majority of the scaffolds used cannot be translated clinically due to the presence of non-human-based substrates. Herein, saliva-secreting organoids/mini-glands were developed using a new scaffold/substrate-free culture system named magnetic 3D levitation (M3DL), which assembles and levitates magnetized primary SG-derived cells (SGDCs), allowing them to produce their own extracellular matrices. Primary SGDCs were assembled in M3DL to generate SG-like organoids in well-established SG epithelial differentiation conditions for 7 days. After such culture time, these organoids consistently presented uniform spheres with greater cell viability and pro-mitotic cells, when compared with conventional salisphere cultures. Additionally, organoids formed by M3DL expressed SG-specific markers from different cellular compartments: acinar epithelial including adherens junctions (NKCC1, cholinergic muscarinic receptor type 3, E-cadherin, and EpCAM); ductal epithelial and myoepithelial (cytokeratin 14 and α-smooth muscle actin); and neuronal (β3-tubulin and vesicular acetylcholine transferase). Lastly, intracellular calcium and α-amylase activity assays showed functional organoids with SG-specific secretory activity upon cholinergic stimulation. Thus, the functional organoid produced herein indicate that this M3DL system can be a promising tool to generate SG-like mini-glands for SG secretory repair.
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Affiliation(s)
- Joao N Ferreira
- Faculty of Dentistry, Excellence Centre in Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand.,Faculty of Dentistry, Discipline of Oral and Maxillofacial Surgery, National University of Singapore, Singapore, Singapore
| | - Riasat Hasan
- Faculty of Dentistry, Discipline of Oral and Maxillofacial Surgery, National University of Singapore, Singapore, Singapore
| | - Ganokon Urkasemsin
- Faculty of Veterinary Science, Department of Preclinical and Applied Animal Science, Mahidol University, Nakhon Pathom, Thailand
| | - Kiaw K Ng
- Faculty of Dentistry, Discipline of Oral and Maxillofacial Surgery, National University of Singapore, Singapore, Singapore
| | - Christabella Adine
- Faculty of Dentistry, Discipline of Oral and Maxillofacial Surgery, National University of Singapore, Singapore, Singapore
| | - Sujatha Muthumariappan
- Faculty of Dentistry, Discipline of Oral and Maxillofacial Surgery, National University of Singapore, Singapore, Singapore
| | - Glauco R Souza
- University of Texas Health Sciences Center at Houston, Houston, TX, USA.,Nano3D Biosciences Inc., Houston, TX, USA
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96
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Han P, Lakshminarayanan P, Jiang W, Shpitser I, Hui X, Lee SH, Cheng Z, Guo Y, Taylor RH, Siddiqui SA, Bowers M, Sheikh K, Kiess A, Page BR, Lee J, Quon H, McNutt TR. Dose/Volume histogram patterns in Salivary Gland subvolumes influence xerostomia injury and recovery. Sci Rep 2019; 9:3616. [PMID: 30837617 PMCID: PMC6401158 DOI: 10.1038/s41598-019-40228-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/28/2019] [Indexed: 01/29/2023] Open
Abstract
Xerostomia is a common consequence of radiotherapy in head and neck cancer. The objective was to compare the regional radiation dose distribution in patients that developed xerostomia within 6 months of radiotherapy and those recovered from xerostomia within 18 months post-radiotherapy. We developed a feature generation pipeline to extract dose volume histogram features from geometrically defined ipsilateral/contralateral parotid glands, submandibular glands, and oral cavity surrogates for each patient. Permutation tests with multiple comparisons were performed to assess the dose difference between injury vs. non-injury and recovery vs. non-recovery. Ridge logistic regression models were applied to predict injury and recovery using clinical features along with dose features (D10-D90) of the subvolumes extracted from oral cavity and salivary gland contours + 3 mm peripheral shell. Model performances were assessed by the area under the receiver operating characteristic curve (AUC) using nested cross-validation. We found that different regional dose/volume metrics patterns exist for injury vs. recovery. Compared to injury, recovery has increased importance to the subvolumes receiving lower dose. Within the subvolumes, injury tends to have increased importance towards D10 from D90. This suggests that different threshold for xerostomia injury and recovery. Injury is induced by the subvolumes receiving higher dose, and the ability to recover can be preserved by further reducing the dose to subvolumes receiving lower dose.
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Affiliation(s)
- Peijin Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
| | - Pranav Lakshminarayanan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Wei Jiang
- Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ilya Shpitser
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Xuan Hui
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Sang Ho Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Yue Guo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Sauleh A Siddiqui
- Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Bowers
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Khadija Sheikh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Todd R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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97
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Ohm AM, Affandi T, Reyland ME. EGF receptor and PKCδ kinase activate DNA damage-induced pro-survival and pro-apoptotic signaling via biphasic activation of ERK and MSK1 kinases. J Biol Chem 2019; 294:4488-4497. [PMID: 30679314 DOI: 10.1074/jbc.ra118.006944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/16/2019] [Indexed: 01/18/2023] Open
Abstract
DNA damage-mediated activation of extracellular signal-regulated kinase (ERK) can regulate both cell survival and cell death. We show here that ERK activation in this context is biphasic and that early and late activation events are mediated by distinct upstream signals that drive cell survival and apoptosis, respectively. We identified the nuclear kinase mitogen-sensitive kinase 1 (MSK1) as a downstream target of both early and late ERK activation. We also observed that activation of ERK→MSK1 up to 4 h after DNA damage depends on epidermal growth factor receptor (EGFR), as EGFR or mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK)/ERK inhibitors or short hairpin RNA-mediated MSK1 depletion enhanced cell death. This prosurvival response was partially mediated through enhanced DNA repair, as EGFR or MEK/ERK inhibitors delayed DNA damage resolution. In contrast, the second phase of ERK→MSK1 activation drove apoptosis and required protein kinase Cδ (PKCδ) but not EGFR. Genetic disruption of PKCδ reduced ERK activation in an in vivo irradiation model, as did short hairpin RNA-mediated depletion of PKCδ in vitro In both models, PKCδ inhibition preferentially suppressed late activation of ERK. We have shown previously that nuclear localization of PKCδ is necessary and sufficient for apoptosis. Here we identified a nuclear PKCδ→ERK→MSK1 signaling module that regulates apoptosis. We also show that expression of nuclear PKCδ activates ERK and MSK1, that ERK activation is required for MSK1 activation, and that both ERK and MSK1 activation are required for apoptosis. Our findings suggest that location-specific activation by distinct upstream regulators may enable distinct functional outputs from common signaling pathways.
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Affiliation(s)
- Angela M Ohm
- From the Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Trisiani Affandi
- From the Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Mary E Reyland
- From the Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
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98
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Effects of herbal medicine for xerostomia in head and neck cancer patients: an observational study in a tertiary cancer hospital. Support Care Cancer 2019; 27:3491-3498. [PMID: 30675667 DOI: 10.1007/s00520-019-4646-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/14/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE More than 80% head and neck cancer patients endured radiotherapy-induced xerostomia which impacts their quality of life (QoL). This observational study evaluated the effect of herbal treatment on head and neck cancer patients' xerostomia and QoL. METHODS Head and neck cancer patients were recruited from July 2016 till March 2017 at National Cancer Institute, Ministry of Health, Malaysia. All study participants continued their standard oncology surveillance. Treatment group participants additionally received Chinese herbal treatment. The assessments included unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and QoL questionnaire. RESULTS Of 42 recruited participants, 28 were in the treatment group and 14 were in the control group. Participants were mainly Chinese (71.4%), stage III cancer (40.5%), and had nasopharynx cancer (76.2%). The commonly used single herbs were Wu Mei, San Qi, and Tian Hua Fen. Sha Shen Mai Dong Tang, Liu Wei Di Huang Wan, and Gan Lu Yin were the frequently prescribed herbal formulas. The baseline characteristics, USFR, SSFR, and QoL between control and treatment groups were comparable (p > 0.05). USFR between control and treatment groups were similar throughout the 6-month study period. SSFR for the treatment group significantly improved from 0.15 ± 0.28 ml/min (baseline) to 0.32 ± 0.22 ml/min (p = 0.04; at the 3rd month) and subsequently achieved 0.46 ± 0.23 ml/min (p = 0.001; at the 6th month). The treatment group had better QoL in terms of speech (p = 0.005), eating (p = 0.02), and head and neck pain (p = 0.04) at the 6th month. CONCLUSION Herbal treatment may improve xerostomia and QoL in post-radiotherapy head and cancer patients.
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99
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Urkasemsin G, Ferreira JN. Unveiling Stem Cell Heterogeneity Toward the Development of Salivary Gland Regenerative Strategies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1123:151-164. [PMID: 31016599 DOI: 10.1007/978-3-030-11096-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epithelial damage in the salivary gland (SG) resulting in irreversible dry mouth can be commonly induced by gamma radiation therapy. This radiation depletes the SG stem/progenitor cell niche slowing healing and natural gland regeneration. Biologists have been focused in understanding the development and differentiation of epithelial stem and progenitor cell niches during SG organogenesis. These organogenesis studies gave insights into novel cell-based therapies to recreate the three-dimensional (3D) salivary gland (SG) organ, recapitulate the SG native physiology, and restore saliva secretion. Such therapeutical strategies apply techniques that assemble, in a 3D organotypic culture, progenitor and stem cell lines to develop SG organ-like organoids or mini-transplants. Future studies will employ a combination of organoids, decellularized matrices, and smart biomaterials to create viable and functional SG transplants to repair the site of SG injury and reestablish saliva production.
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Affiliation(s)
- Ganokon Urkasemsin
- Faculty of Veterinary Science, Department of Preclinical and Applied Animal Science, Mahidol University, Nakhon Pathom, Thailand
| | - Joao N Ferreira
- Center of Excellence in Regenerative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. .,National University of Singapore, Singapore, Singapore.
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100
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Abstract
Neurolocalization of taste disorders requires a knowledge of the functional anatomy involved in mediating taste information from the peripheral mucosal surfaces through numerous peripheral cranial nerves to complex subcortical and cortical brain regions. Our understanding of this functional anatomy has advanced in recent years. Taste is an experience that is both innate and learned, and the "taste" experience involves the integration of information from other sensory modalities, such as olfaction and somatosensation. Normal taste perception is influenced by different neurophysiologic states, which involve endocrine function, emotions, and even attitudes and expectations toward eating. At its core, the normal effective ability to taste is a reflection of the proper function of many organ systems within the body and may be considered a marker for good health. Clinical taste disorders, on the other hand, involve the dysfunction of the normal neural taste pathways and/or aberrant influences on multisensory integration and cortical taste processing. The number of disease processes, which can adversely affect taste, are numerous and quite varied in their presentation. There may be contributory involvement of other organ systems within the body, and the appropriate management of taste disorders often requires a multidisciplinary approach to fully understand the disorder. Depending on the underlying cause, taste disorders can be effectively managed when identified. Treatments may include correcting underlying metabolic disturbances, eliminating infections, changing offending medications, replenishing nutritional deficiencies, operating on structural impairments, calming autoimmune processes, and even stabilizing electrochemical interactions.
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Affiliation(s)
- Steven M Bromley
- South Jersey MS Center and Bromley Neurology, PC, Audubon, NJ, United States.
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