1
|
Kimura A, Khan MI, Easwaran M, Soo J, Golchin A, Erickson-DiRenzo E. Establishing a Mouse Model of Surgical Vocal Fold Injury. Laryngoscope 2024. [PMID: 39180435 DOI: 10.1002/lary.31732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/15/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Animal models of vocal fold (VF) surgical injury and scar formation provide insight into the wound healing process. The purpose of this study was to establish an alternative model of surgical injury to the mouse VF using materials commonly available in most research laboratories or for purchase and to investigate wound healing of the epithelium (EP) and lamina propria (LP). METHODS Mice were anesthetized by isoflurane gas delivery and positioned on a platform so that the larynx could be observed using a laryngoscope and dissection microscope. Unilateral VF injury was created using a wire brush. Mice were euthanized and the larynx evaluated 1-, 3-, 5-, 7-, 14-, and 28-days following injury. Histological and immunofluorescent analysis was used to evaluate thickness of the EP, LP area, proliferative (Ki67+) and basal cells (p63+) in the EP, and collagen III content in the LP. RESULTS The depth of injury reached the superficial thyroarytenoid muscle on Day 1. The thickness of the EP of the injured VF was increased on Days 3 and 5, and the LP area was increased on Days 3, 5, and 7 as compared with the uninjured VF. Ki67+ and p63+ cells were increased on Day 3 and collagen III content was increased on Days 5 and 28 as compared with the uninjured VF. CONCLUSION We successfully established an alternative method of creating unilateral VF injury in the mouse. This method will be useful for future research regarding VF surgical injury and wound healing. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
Collapse
Affiliation(s)
- Akari Kimura
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Mohammed Imran Khan
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Meena Easwaran
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Joanne Soo
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Amirbahador Golchin
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology - Head & Neck surgery, School of Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
2
|
Venkatraman A, Hawkins J, McCain R, Duan C, Cannes do Nascimento N, Cox A, Sivasankar MP. The role of systemic dehydration in vocal fold healing: Preliminary findings. Laryngoscope Investig Otolaryngol 2022; 7:1936-1942. [PMID: 36544957 PMCID: PMC9764801 DOI: 10.1002/lio2.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 01/03/2023] Open
Abstract
Rationale Systemic dehydration negatively alters the expression of vocal fold inflammatory and cell junction markers. These biological changes can have downstream effects on the healing processes of injured vocal folds. In the dermis, reduced hydration prolongs inflammation and delays healing. It is unknown whether this biological effect is observed in vocal fold tissue. Objective To investigate the effects of systemic dehydration on vocal fold healing outcomes following acute, bilateral vocal fold injury in a rodent model. Methods Eighteen systemic dehydrated and 18 euhydrated adult male Sprague Dawley rats experienced bilateral vocal fold injuries or no injury (N = 9/group). Vocal fold gene expression levels of inflammatory mediators and epithelial cell junction markers were measured 24 h post-injury. Results Pro-inflammatory gene markers (IL-1β; TNF-α) were differentially expressed in response to systemic dehydration with vocal fold injury compared to non-injury. Epithelial cell junction markers (Cadherin-3, Desmoglein-1) also exhibited divergent trends following systemic dehydration, but these data were not statistically significant. Conclusions Systemic dehydration may affect cellular vocal fold healing processes within 24 h. These findings lay the groundwork for further investigation of how hydration status can affect vocal fold tissue recovery and influence clinical care.
Collapse
Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing SciencesPurdue UniversityWest LafayetteIndianaUSA
| | - Jan Hawkins
- Department of Veterinary Clinical SciencesPurdue UniversityWest LafayetteIndianaUSA
| | - Robyn McCain
- Center for Comparative and Translation ResearchPurdue UniversityWest LafayetteIndianaUSA
| | - Chenwei Duan
- Department of Biomedical EngineeringPurdue UniversityWest LafayetteIndianaUSA
| | | | - Abigail Cox
- Department of Comparative PathobiologyPurdue UniversityWest LafayetteIndianaUSA
| | - M. Preeti Sivasankar
- Department of Speech, Language, and Hearing SciencesPurdue UniversityWest LafayetteIndianaUSA
| |
Collapse
|
3
|
Lima Neto JL, Fonseca ARBD, Tavares ELM, Gramuglia ACJ, Martins RHG. Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery. Int Arch Otorhinolaryngol 2022; 27:e77-e82. [PMID: 36714896 PMCID: PMC9879646 DOI: 10.1055/s-0042-1743463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/01/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.
Collapse
Affiliation(s)
- José Luiz Lima Neto
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Antônio Rodrigues Bueno da Fonseca
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Elaine Lara Mendes Tavares
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Andrea Cristina Joia Gramuglia
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Regina Helena Garcia Martins
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil,Address for correspondence Regina Helena Garcia Martins, MD, PhD Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatudistrito de Rubião Junior, s/n. CEP- 18618-970, São PauloBrasil
| |
Collapse
|
4
|
Ujvary LP, Blebea CM, Dindelegan MG, Tiple C, Sevastre B, Maniu AA, Chirilă M, Cosgarea M. Experimental model for controlled endoscopic subepithelial vocal fold injury in rats. Acta Cir Bras 2022; 37:e370106. [PMID: 35416860 PMCID: PMC9000975 DOI: 10.1590/acb370106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: To present a detailed, reproducible, cost-efficient surgical model for
controlled subepithelial endoscopic vocal fold injury in the rat model. Methods: Six male Sprague Dawley rats were enrolled in the experiment. The left vocal
folds were used to carry out the injury model, and the right vocal fold
served as control. After deep sedation, the rats were placed on a custom
operating platform. The vocal fold injury by subepithelial stripping was
carried out using custom-made microsurgical instruments under endoscopic
guidance. Data were analyzed for procedural time and post-procedural pain.
Microcomputed tomography (micro-CT) scan and histologic images were obtained
to assess the length, area, and depth of injury to the vocal fold. Results: The mean procedural time was 112 s. The mean control vocal fold length was
0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The
mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion
area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ±
42.8 μm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as
well as lesion area to vocal fold surface area was 0.29 ± 0.02. Conclusions: Our described experimental vocal fold injury model in rats is found to be
fast, safe, cost-efficient, and reproducible with a rapid learning
curve.
Collapse
Affiliation(s)
| | | | | | - Cristina Tiple
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania
| | - Bogdan Sevastre
- University of Agricultural Sciences and Veterinary Medicine, Romania
| | | | | | - Marcel Cosgarea
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Romania
| |
Collapse
|
5
|
Björck G, Hertegård S, Ekelund J, Marsk E. Voice rest after vocal fold polyp surgery: A Swedish register study of 588 patients. Laryngoscope Investig Otolaryngol 2022; 7:486-493. [PMID: 35434318 PMCID: PMC9008164 DOI: 10.1002/lio2.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the impact of voice rest on patient‐reported voice outcome 4 months after vocal fold polyp surgery. Methods Preoperative information was collected about age, sex, and smoking habits and the voice handicap index‐10 (VHI‐10). Four months postoperatively, voice rest (total voice rest, spoke single words, and spoke normally), and pre and postoperative voice therapy were reported. This was correlated to voice satisfaction from a two‐category subjective evaluation “satisfied/ not satisfied” and to VHI‐10. Logistic regression models with relative risk for NOT being satisfied with voice after surgery were performed. Results Data from 588 patients were available. The group “spoke normally” showed the highest degree of patient satisfaction (92%). Younger patients (<59 years) were more satisfied than older (90% vs. 81.5%). High age and low VHI‐10 scores before surgery were statistically significant for negative voice outcome. Gender or voice rest type did not significantly affect outcome. The largest improvement in VHI‐scores was in the group who spoke normally and least in the group who spoke single words. Conclusion We found no significant difference in the two‐category subjective voice outcome depending on voice rest. VHI‐10 showed a statistically significant positive effect on self‐evaluated voice outcome, with the largest improvement in the group with no voice rest. However, the clinical relevance of the VHI changes is unclear. The present study does not show any advantage of total voice rest as compared to relative voice rest or speaking freely. High age and low preoperative VHI scores were significant risk factors for worse voice outcome. Level of evidence: 4
Collapse
Affiliation(s)
- Gunnar Björck
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | - Stellan Hertegård
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | | | - Elin Marsk
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| |
Collapse
|
6
|
King RE, Novaleski CK, Rousseau B. Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:912-922. [PMID: 35179998 PMCID: PMC9150674 DOI: 10.1044/2021_ajslp-21-00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 11/14/2021] [Indexed: 06/01/2023]
Abstract
PURPOSE Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. METHOD Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. RESULTS Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. CONCLUSION VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19178459.
Collapse
Affiliation(s)
- Renee E. King
- Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Carolyn K. Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| |
Collapse
|
7
|
Ujvary PL, Blebea CM, Maniu AA, Pop S, Sarpataki O, Cosgarea M. Vocal fold injury models in rats: a literature review on techniques and methodology. J Med Life 2022; 15:336-343. [PMID: 35449991 PMCID: PMC9015177 DOI: 10.25122/jml-2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
This study reviewed the current literature on technical aspects regarding controlled vocal fold injuries in the rat model. Data from PubMed, Embase, and Scopus database for English language literature was collected to identify methodological steps leading to a controlled surgical injury of the rat vocal fold. Inclusion criteria: full disclosure of anesthesia protocol, positioning of the rat for surgery, vocal fold visualization method, instrumentation for vocal fold injury, vocal fold injury type. Articles with partial contribution were evaluated and separately included due to the limited number of original methodologies. 724 articles were screened, and eleven articles were included in the analysis. Anesthesia: ketamine hydrochloride and xylazine hydrochloride varied in dose from 45 mg/kg and 4.5 mg/kg to 100 mg/kg and 10 mg/kg. Visualization: The preferred method was the 1.9 mm, 25-30 degree endoscopes. The widest diameter endoscope used was 2.7 mm with a 0 or 30 degree angle of view. Instruments for lesion induction range from 18 to 31G needles, microscissors, micro forceps to potassium titanyl phosphate, and blue light lasers. Injury types: vocal fold stripping was the main injury type, followed by vocal fold scarring and charring. One article describes scaffold implantation with injury to the superior aspect of the vocal fold. Rats are good candidates for in vivo larynx and vocal folds research. A more standardized approach should be considered regarding the type of vocal fold injury to ease data comparison.
Collapse
Affiliation(s)
- Peter Laszlo Ujvary
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Maria Blebea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Cristina Maria Blebea, Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Alma Aurelia Maniu
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sever Pop
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Orsolya Sarpataki
- Department of Physiology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
8
|
Imaizumi M, Nakamura R, Nakaegawa Y, Dirja BT, Tada Y, Tani A, Sugino T, Tabata Y, Omori K. Regenerative potential of basic fibroblast growth factor contained in biodegradable gelatin hydrogel microspheres applied following vocal fold injury: Early effect on tissue repair in a rabbit model. Braz J Otorhinolaryngol 2019; 87:274-282. [PMID: 31711791 PMCID: PMC9422641 DOI: 10.1016/j.bjorl.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Postoperative dysphonia is mostly caused by vocal fold scarring, and careful management of vocal fold surgery has been reported to reduce the risk of scar formation. However, depending on the vocal fold injury, treatment of postoperative dysphonia can be challenging. Objective The goal of the current study was to develop a novel prophylactic regenerative approach for the treatment of injured vocal folds after surgery, using biodegradable gelatin hydrogel microspheres as a drug delivery system for basic fibroblast growth factor. Methods Videoendoscopic laryngeal surgery was performed to create vocal fold injury in 14 rabbits. Immediately following this procedure, biodegradable gelatin hydrogel microspheres with basic fibroblast growth factor were injected in the vocal fold. Two weeks after injection, larynges were excised for evaluation of vocal fold histology and mucosal movement. Results The presence of poor vibratory function was confirmed in the injured vocal folds. Histology and digital image analysis demonstrated that the injured vocal folds injected with gelatin hydrogel microspheres with basic fibroblast growth factor showed less scar formation, compared to the injured vocal folds injected with gelatin hydrogel microspheres only, or those without any injection. Conclusion A prophylactic injection of basic fibroblast growth factor -containing biodegradable gelatin hydrogel microspheres demonstrates a regenerative potential for injured vocal folds in a rabbit model.
Collapse
Affiliation(s)
- Mitsuyoshi Imaizumi
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan.
| | | | - Yuta Nakaegawa
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Bayu Tirta Dirja
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Yasuhiro Tada
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Akiko Tani
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Takashi Sugino
- Shizuoka Cancer Center, Division of Pathology, Shizuoka, Japan
| | - Yasuhiko Tabata
- Kyoto University, Institute for Frontier Life and Medical Sciences, Department of Regeneration Science and Engineering, Laboratory of Biomaterials, Kyoto, Japan
| | - Koichi Omori
- Kyoto University, Department of Otolaryngology, Kyoto, Japan
| |
Collapse
|
9
|
Imaizumi M, Li-Jessen NY, Sato Y, Yang DT, Thibeault SL. Retention of Human-Induced Pluripotent Stem Cells (hiPS) With Injectable HA Hydrogels for Vocal Fold Engineering. Ann Otol Rhinol Laryngol 2017; 126:304-314. [DOI: 10.1177/0003489417691296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: One prospective treatment option for vocal fold scarring is regeneration with an engineered scaffold containing induced pluripotent stem cells (iPS). In the present study, we investigated the feasibility of utilizing an injectable hyaluronic acid (HA) scaffold encapsulated with human-iPS cell (hiPS) for regeneration of vocal folds. Methods: Thirty athymic nude rats underwent unilateral vocal fold injury. Contralateral vocal folds served as uninjured controls. Hyaluronic acid hydrogel scaffold, HA hydrogel scaffold containing hiPS, and HA hydrogel scaffold containing hiPS with epidermal growth factor (EGF) were injected in both vocal folds immediately after surgery. One and 2 weeks after injection, larynges were excised for histology, immunohistochemistry, and fluorescence in situ hybridization (FISH). Results: Presence of HA hydrogel was confirmed in vocal folds 1 and 2 weeks post injection. The FISH analysis confirmed the presence and viability of hiPS in the injected vocal folds. Histological results demonstrated that vocal folds injected with HA hydrogel scaffold containing EGF demonstrated less fibrosis than those with HA hydrogel only. Conclusions: Human-iPS survived in injured rat vocal folds. The HA hydrogel with hiPS and EGF ameliorated the fibrotic response. Additional work is necessary to optimize hiPS differentiation and further confirm the safety of hiPS for clinical applications.
Collapse
Affiliation(s)
- Mitsuyoshi Imaizumi
- Department of Otolaryngology, School of Medicine, Fukushima Medical University, Fukushima City, Japan
| | - Nicole Y.K. Li-Jessen
- School of Communication Sciences and Disorders, McGill University, Montreal, QC, Canada
| | - Yuka Sato
- Department of Otolaryngology, School of Medicine, Fukushima Medical University, Fukushima City, Japan
| | - David T. Yang
- Department of Pathology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Susan L. Thibeault
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
10
|
Rohlfs AK, Schmolke S, Clauditz T, Hess M, Müller F, Püschel K, Roemer FW, Schumacher U, Goodyer E. Quantification of change in vocal fold tissue stiffness relative to depth of artificial damage. LOGOP PHONIATR VOCO 2016; 42:108-117. [PMID: 27572633 DOI: 10.1080/14015439.2016.1221445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To quantify changes in the biomechanical properties of human excised vocal folds with defined artificial damage. METHODS The linear skin rheometer (LSR) was used to obtain a series of rheological measurements of shear modulus from the surface of 30 human cadaver vocal folds. The tissue samples were initially measured in a native condition and then following varying intensities of thermal damage. Histological examination of each vocal fold was used to determine the depth of artificial alteration. The measured changes in stiffness were correlated with the depth of cell damage. RESULTS For vocal folds in a pre-damage state the shear modulus values ranged from 537 Pa to 1,651 Pa (female) and from 583 Pa to 1,193 Pa (male). With increasing depth of damage from the intermediate layer of the lamina propria (LP), tissue stiffness increased consistently (compared with native values) following application of thermal damage to the vocal folds. The measurement showed an increase of tissue stiffness when the depth of tissue damage was extending from the intermediate LP layer downwards. CONCLUSIONS Changes in the elastic characteristics of human vocal fold tissue following damage at defined depths were demonstrated in an in vitro experiment. In future, reproducible in vivo measurements of elastic vocal fold tissue alterations may enable phonosurgeons to infer the extent of subepithelial damage from changes in surface elasticity.
Collapse
Affiliation(s)
- Anna-Katharina Rohlfs
- a Department of Voice, Speech and Hearing Disorders , University Medical Center Hamburg-Eppendorf , Germany
| | - Sebastian Schmolke
- a Department of Voice, Speech and Hearing Disorders , University Medical Center Hamburg-Eppendorf , Germany
| | - Till Clauditz
- b Department of Pathology , University Medical Center Hamburg-Eppendorf , Germany
| | - Markus Hess
- a Department of Voice, Speech and Hearing Disorders , University Medical Center Hamburg-Eppendorf , Germany
| | - Frank Müller
- a Department of Voice, Speech and Hearing Disorders , University Medical Center Hamburg-Eppendorf , Germany
| | - Klaus Püschel
- c Institute for Forensic Medicine, University Medical Center Hamburg-Eppendorf , Germany
| | - Frank W Roemer
- d Department of Radiology , University of Erlangen-Nuremberg , Erlangen , Germany
| | - Udo Schumacher
- e Department of Anatomy and Experimental Morphology , University Medical Center Hamburg-Eppendorf , Germany
| | - Eric Goodyer
- f Centre for Computational Intelligence-Bioinformatics Group , De Montfort University , Leicester , United Kingdom
| |
Collapse
|
11
|
Shiba TL, Hardy J, Luegmair G, Zhang Z, Long JL. Tissue-Engineered Vocal Fold Mucosa Implantation in Rabbits. Otolaryngol Head Neck Surg 2016; 154:679-88. [PMID: 26956198 DOI: 10.1177/0194599816628501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess phonatory function and wound healing of a tissue-engineered vocal fold mucosa (TE-VFM) in rabbits. An "artificial" vocal fold would be valuable for reconstructing refractory scars and resection defects, particularly one that uses readily available autologous cells and scaffold. This work implants a candidate TE-VFM after resecting native epithelium and lamina propria in rabbits. STUDY DESIGN Prospective animal study. SETTING Research laboratory. SUBJECTS AND METHODS Rabbit adipose-derived stem cells were isolated and cultured in three-dimensional fibrin scaffolds to form TE-VFM. Eight rabbits underwent laryngofissure, unilateral European Laryngologic Society type 2 cordectomy, and immediate reconstruction with TE-VFM. After 4 weeks, larynges were excised, phonated, and examined by histology. RESULTS Uniform TE-VFM implants were created, with rabbit mesenchymal cells populated throughout fibrin hydrogels. Rabbits recovered uneventfully after implantation. Phonation was achieved in all, with mucosal waves evident at the implant site. Histology after 4 weeks showed resorbed fibrin matrix, continuous epithelium, and mildly increased collagen relative to contralateral unoperated vocal folds. Elastic fiber appearance was highly variable. Inflammatory cell infiltrate was limited to animals receiving sex-mismatched implants. CONCLUSION TE-VFMs were successfully implanted into 8 rabbits, with minor evidence of scar formation and immune reaction. Vibration was preserved 4 weeks after resecting and reconstructing the complete vocal fold cover layer. Further studies will investigate the mechanism and durability of improvement. TE-VFM with autologous cells is a promising new approach for vocal fold reconstruction.
Collapse
Affiliation(s)
- Travis L Shiba
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Jordan Hardy
- Research Service, Department of Veterans Affairs, Los Angeles, California, USA
| | - Georg Luegmair
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer L Long
- Research Service, Department of Veterans Affairs, Los Angeles, California, USA Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| |
Collapse
|
12
|
King SN, Guille J, Thibeault SL. Characterization of the Leukocyte Response in Acute Vocal Fold Injury. PLoS One 2015; 10:e0139260. [PMID: 26430970 PMCID: PMC4591973 DOI: 10.1371/journal.pone.0139260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/10/2015] [Indexed: 11/23/2022] Open
Abstract
Macrophages location in the superficial layer of the vocal fold (VF) is not only at the first line of defense, but in a place of physiologic importance to voice quality. This study characterizes and compares macrophage function in two models of acute injury. Porcine VF injuries were created bilaterally by either surgical biopsy or lipopolysaccharide (LPS) (1.5μg/kg) injection. Animals were sacrificed at 1- or 5-day post LPS or 3-, 7-, or 23-days post-surgical injury (n = 3/time/ injury). Flow cytometry characterized immunophenotypes and RT-PCR quantified cytokine gene expression. Uninjured VF were used as controls. Post-surgical and LPS injury, SWC9+/SWC3- cells identified as hi SLA-DR+ (p<0.05) compared to controls along with hi CD16+ expression at 1-day and 3-days respectively compared to all other time points (p<0.05). Surgical injuries, SWC9+/SWC3- cells exhibited hi CD163+ (p<0.05) at 3-days along with upregulation in TNFα and TGFβ1 mRNA compared to 23-days (p<0.05). No measurable changes to IL–12, IFNγ, IL–10, IL–4 mRNA post-surgery. LPS injuries induced upregulation of TNFα, IL–12, IFNγ, IL–10, and IL–4 mRNA at 1- and 5-days compared to controls (p<0.05). Higher levels of IL–10 mRNA were found 1-day post-LPS compared to 5-days (p<0.05). No changes to CD163 or CD80/86 post-LPS were measured. Acute VF injuries revealed a paradigm of markers that appear to associate with each injury. LPS induced a regulatory phenotype indicated by prominent IL–10 mRNA expression. Surgical injury elicited a complex phenotype with early TNFα mRNA and CD163+ and persistent TGFβ1 transcript expression.
Collapse
Affiliation(s)
- Suzanne N. King
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Jeremy Guille
- Department of ENT and Head and Neck Surgery, University Hospital of Pointe Pitre, French West Indies, Pointe Pitre, Guadeloupe
| | - Susan L. Thibeault
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
- * E-mail:
| |
Collapse
|
13
|
Epidermal growth factor mediated healing in stem cell-derived vocal fold mucosa. J Surg Res 2015; 197:32-8. [PMID: 25818979 DOI: 10.1016/j.jss.2015.02.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/03/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The goal of vocal fold wound healing is the reconstitution of functional tissue, including a structurally and functionally intact epithelium. Mechanisms underlying reepithelialization in vocal folds are not known, although it is suspected that healing involves the interplay between several growth factors. We used a three-dimensional human embryonic stem cell-derived model of vocal fold mucosa to examine the effects of one growth factor, exogenous epidermal growth factor (EGF), on wound healing. MATERIALS AND METHODS A scratch wound was created in the in vitro model. Rate of wound healing, epidermal growth factor receptor (EGFR) activation, and cell proliferation after injury were analyzed with and without application of both exogenous EGF and an EGFR inhibitor, gefitinib. RESULTS Wound repair after injury was significantly hastened by application of exogenous EGF (13.3 μm/h, ± 2.63) compared with absence of exogenous EGF (7.1 μm/h ± 2.84), but inhibited with concurrent addition of Gefitinib (5.2 μm/h, ± 2.23), indicating that EGF mediates wound healing in an EGFR-dependent manner. Immunohistochemistry revealed that EGFR activation occurred only in the presence of exogenous EGF. Although not statistically significant, increased density of Ki67 staining in the epithelium adjacent to the scratch wound was observed after treatment with EGF, suggesting a tendency for exogenous EGF to increase epithelial cell proliferation. CONCLUSIONS Exogenous EGF increases the rate of wound healing in an EGFR-dependent manner in a three-dimensional stem cell-derived model of vocal fold mucosa. This model of wound healing can be used to gain insight into the mechanisms that regulate vocal fold epithelial repair after injury.
Collapse
|
14
|
Welham NV, Ling C, Dawson JA, Kendziorski C, Thibeault SL, Yamashita M. Microarray-based characterization of differential gene expression during vocal fold wound healing in rats. Dis Model Mech 2015; 8:311-21. [PMID: 25592437 PMCID: PMC4348567 DOI: 10.1242/dmm.018366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The vocal fold (VF) mucosa confers elegant biomechanical function for voice production but is susceptible to scar formation following injury. Current understanding of VF wound healing is hindered by a paucity of data and is therefore often generalized from research conducted in skin and other mucosal systems. Here, using a previously validated rat injury model, expression microarray technology and an empirical Bayes analysis approach, we generated a VF-specific transcriptome dataset to better capture the system-level complexity of wound healing in this specialized tissue. We measured differential gene expression at 3, 14 and 60 days post-injury compared to experimentally naïve controls, pursued functional enrichment analyses to refine and add greater biological definition to the previously proposed temporal phases of VF wound healing, and validated the expression and localization of a subset of previously unidentified repair- and regeneration-related genes at the protein level. Our microarray dataset is a resource for the wider research community and has the potential to stimulate new hypotheses and avenues of investigation, improve biological and mechanistic insight, and accelerate the identification of novel therapeutic targets.
Collapse
Affiliation(s)
- Nathan V Welham
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Changying Ling
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - John A Dawson
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Masaru Yamashita
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| |
Collapse
|
15
|
Leydon C, Imaizumi M, Bartlett RS, Wang SF, Thibeault SL. Epithelial cells are active participants in vocal fold wound healing: an in vivo animal model of injury. PLoS One 2014; 9:e115389. [PMID: 25514022 PMCID: PMC4267843 DOI: 10.1371/journal.pone.0115389] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/21/2014] [Indexed: 12/21/2022] Open
Abstract
Vocal fold epithelial cells likely play an important, yet currently poorly defined, role in healing following injury, irritation and inflammation. In the present study, we sought to identify a possible role for growth factors, epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGFβ1), in epithelial regeneration during wound healing as a necessary first step for uncovering potential signaling mechanisms of vocal fold wound repair and remodeling. Using a rat model, we created unilateral vocal fold injuries and examined the timeline for epithelial healing and regeneration during early and late stages of wound healing using immunohistochemistry (IHC). We observed time-dependent secretion of the proliferation marker, ki67, growth factors EGF and TGFβ1, as well as activation of the EGF receptor (EGFR), in regenerating epithelium during the acute phase of injury. Ki67, growth factor, and EGFR expression peaked at day 3 post-injury. Presence of cytoplasmic and intercellular EGF and TGFβ1 staining occurred up to 5 days post-injury, consistent with a role for epithelial cells in synthesizing and secreting these growth factors. To confirm that epithelial cells contributed to the cytokine secretion, we examined epithelial cell growth factor secretion in vitro using polymerase chain reaction (PCR). Cultured pig vocal fold epithelial cells expressed both EGF and TGFβ1. Our in vivo and in vitro findings indicate that epithelial cells are active participants in the wound healing process. The exact mechanisms underlying their roles in autocrine and paracrine signaling guiding wound healing await study in a controlled, in vitro environment.
Collapse
Affiliation(s)
- Ciara Leydon
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin – Madison, Madison, Wisconsin, United States of America
| | - Mitsuyoshi Imaizumi
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin – Madison, Madison, Wisconsin, United States of America
| | - Rebecca S. Bartlett
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin – Madison, Madison, Wisconsin, United States of America
| | - Sarah F. Wang
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin – Madison, Madison, Wisconsin, United States of America
| | - Susan L. Thibeault
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin – Madison, Madison, Wisconsin, United States of America
| |
Collapse
|