1
|
Tanner K, Robison HJ, Stevens ME, Merrill RM, Dromey C, Barkmeier-Kraemer J, Ben Christensen M. Corticosteroid-LABA inhalers increase phonation threshold pressure (PTP) and flow (PTF) in rabbits. Laryngoscope 2023; 133:2680-2686. [PMID: 36757019 PMCID: PMC10409873 DOI: 10.1002/lary.30585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES This study examined the effects of a combination corticosteroid plus long-acting beta2 -adrenergic agonist inhaler (IC) on rabbit phonation. METHODS White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2 O) and flow (PTF; L/min) were quantified. RESULTS Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. CONCLUSION Following 8-week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. LEVEL OF EVIDENCE NA Laryngoscope, 133:2680-2686, 2023.
Collapse
Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
| | | | - Maya Elena Stevens
- Department of Communication Sciences & Disorders, The University of Utah
| | | | | | - Julie Barkmeier-Kraemer
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
- Department of Communication Sciences & Disorders, The University of Utah
| | | |
Collapse
|
2
|
Sayce L, Zimmerman Z, Gartling G, Rousseau B, Branski RC. Epithelial response to vocal fold microflap injury in a preclinical model. Laryngoscope 2023; 133:350-356. [PMID: 35538915 PMCID: PMC11066888 DOI: 10.1002/lary.30169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Functional outcomes following microflap surgery for vocal fold pathology are favorable. Although the stratified squamous epithelium appears to heal rapidly, persistent physiologic tissue alterations are likely. We sought to elucidate key biochemical processes including recruitment of immune cells, regulation of cellular junction proteins, and long-term alterations to epithelial tissue permeability following microflap with an eye toward enhanced clinical outcomes. METHODS Forty New Zealand rabbits were assigned to eight groups (n = 5/group): no-injury control or bilateral microflap with survival for 0 h, 12 h, 1 day, 3 days, 7 days, 30 days, and 60 days post-microflap. The epithelium was dissected from one vocal fold and transepithelial resistance was quantified. The contralateral fold was subjected to transmission electron microscopy. Images were evaluated by a blinded rater and paracellular space dilation was quantified using ImageJ. Immune cell infiltration was evaluated and recorded qualitatively. RESULTS Increased innate immune response was observed 12 h as well as 7 and 30 days after microflap. At 60 days following injury, decreased epithelial resistance was observed. Paracellular spaces were dilated at all time-points following injury. CONCLUSIONS The vocal fold epithelium was significantly altered at 60 days following microflap. The implications for this tissue phenotype are unclear. However, compromised epithelial barrier function is implicated in various diseases and may increase the risk of subsequent injury. LEVEL OF EVIDENCE NA Laryngoscope, 133:350-356, 2023.
Collapse
Affiliation(s)
- Lea Sayce
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Zachary Zimmerman
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Gary Gartling
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
| | - Bernard Rousseau
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ryan C Branski
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, U.S.A
| |
Collapse
|
3
|
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] [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
|
4
|
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
|
5
|
King RE, Ward-Shaw ET, Hu R, Lambert PF, Thibeault SL. Expanded Basal Compartment and Disrupted Barrier in Vocal Fold Epithelium Infected with Mouse Papillomavirus MmuPV1. Viruses 2022; 14:v14051059. [PMID: 35632798 PMCID: PMC9146965 DOI: 10.3390/v14051059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Laryngeal infection with low-risk human papillomaviruses can cause recurrent respiratory papillomatosis (RRP), a disease with severe effects on vocal fold epithelium resulting in impaired voice function and communication. RRP research has been stymied by limited preclinical models. We recently reported a murine model of laryngeal MmuPV1 infection and disease in immunodeficient mice. In the current study, we compare quantitative and qualitative measures of epithelial proliferation, apoptosis, differentiation, and barrier between mice with MmuPV1-induced disease of the larynx and surrounding tissues and equal numbers of uninfected controls. Findings supported our hypothesis that laryngeal MmuPV1 infection recapitulates many features of RRP. Like RRP, MmuPV1 increased proliferation in infected vocal fold epithelium, expanded the basal compartment of cells, decreased differentiated cells, and altered cell–cell junctions and basement membrane. Effects of MmuPV1 on apoptosis were equivocal, as with RRP. Barrier markers resembled human neoplastic disease in severe MmuPV1-induced disease. We conclude that MmuPV1 infection of the mouse larynx provides a useful, if imperfect, preclinical model for RRP that will facilitate further study and treatment development for this intractable and devastating disease.
Collapse
Affiliation(s)
- Renee E. King
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Ella T. Ward-Shaw
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Susan L. Thibeault
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
- Correspondence:
| |
Collapse
|
6
|
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
|
7
|
Foote AG, Lungova V, Thibeault SL. Piezo1-expressing vocal fold epithelia modulate remodeling via effects on self-renewal and cytokeratin differentiation. Cell Mol Life Sci 2022; 79:591. [PMID: 36376494 PMCID: PMC9663367 DOI: 10.1007/s00018-022-04622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Mechanoreceptors are implicated as functional afferents within mucosa of the airways and the recent discovery of mechanosensitive channels Piezo1 and Piezo2 has proved essential for cells of various mechanically sensitive tissues. However, the role for Piezo1/2 in vocal fold (VF) mucosal epithelia, a cell that withstands excessive biomechanical insult, remains unknown. The purpose of this study was to test the hypothesis that Piezo1 is required for VF mucosal repair pathways of epithelial cell injury. Utilizing a sonic hedgehog (shh) Cre line for epithelial-specific ablation of Piezo1/2 mechanoreceptors, we investigated 6wk adult VF mucosa following naphthalene exposure for repair strategies at 1, 3, 7 and 14 days post-injury (dpi). PIEZO1 localized to differentiated apical epithelia and was paramount for epithelial remodeling events. Injury to wildtype epithelium was most appreciated at 3 dpi. Shhcre/+; Piezo1loxP/loxP, Piezo2 loxP/+ mutant epithelium exhibited severe cell/nuclear defects compared to injured controls. Conditional ablation of Piezo1 and/or Piezo2 to uninjured VF epithelium did not result in abnormal phenotypes across P0, P15 and 6wk postnatal stages compared to heterozygote and control tissue. Results demonstrate a role for Piezo1-expressing VF epithelia in regulating self-renewal via effects on p63 transcription and YAP subcellular translocation-altering cytokeratin differentiation.
Collapse
Affiliation(s)
- Alexander G. Foote
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| | - Vlasta Lungova
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| | - Susan L. Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Wisconsin, USA
| |
Collapse
|
8
|
Erickson-DiRenzo E, Easwaran M, Martinez JD, Dewan K, Sung CK. Mainstream Cigarette Smoke Impacts the Mouse Vocal Fold Epithelium and Mucus Barrier. Laryngoscope 2021; 131:2530-2539. [PMID: 33864646 PMCID: PMC8502200 DOI: 10.1002/lary.29572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cigarette smoke (CS) is a primary risk factor for the development of numerous benign and malignant laryngeal diseases. The epithelium and mucus lining the vocal folds (VF) are the first barriers against CS. The primary objective of this study was to investigate epithelial and mucus barrier changes in the mouse laryngeal mucosa upon exposure to subacute CS. The secondary objective was to compare mucus barrier changes in mice and human smokers and nonsmokers. Study Design Animal model. METHODS Mice were exposed to CS for 4 weeks for 4 hours (N = 12, high dose [HD]) or 1 hour (N = 12, low dose [LD]) per day. Air-exposed mice were used as a control group (N = 10). Larynges were harvested and VF epithelial barrier integrity was evaluated including cellular proliferation and expression of cell junctions. We also investigated mucus production by examining mucus cell area and mucin expression in mice and human smokers and nonsmokers. RESULTS HD CS increased VF epithelial cellular proliferation but did not alter the expression of cell junctions. HD CS also induced hypertrophy of the mucus-producing submucosal glands. However, only LD CS increased MUC5AC gene expression. MUC5AC staining appeared elevated in laryngeal specimens from smokers, but this was not significant as compared to nonsmokers. CONCLUSIONS These findings help us identify potential adaptive mechanisms to CS exposure as well as set the foundation for further study of key aspects of epithelial and mucus barrier integrity that may be implicated in laryngeal disease development following prolonged smoking. LEVEL OF EVIDENCE NA Laryngoscope, 131:2530-2539, 2021.
Collapse
Affiliation(s)
- Elizabeth Erickson-DiRenzo
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Meena Easwaran
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Joshua D Martinez
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Karuna Dewan
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Chih Kwang Sung
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| |
Collapse
|
9
|
Ravikrishnan A, Fowler EW, Stuffer AJ, Jia X. Hydrogel-Supported, Engineered Model of Vocal Fold Epithelium. ACS Biomater Sci Eng 2021; 7:4305-4317. [PMID: 33635635 DOI: 10.1021/acsbiomaterials.0c01741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a critical need for the establishment of an engineered model of the vocal fold epithelium that can be used to gain understanding of its role in vocal fold health, disease, and facilitate the development of new treatment options. Toward this goal, we isolated primary vocal fold epithelial cells (VFECs) from healthy porcine larynxes and used them within passage 3. Culture-expanded VFECs expressed the suprabasal epithelial marker cytokeratin 13 and intercellular junctional proteins occludin, E-cadherin, and zonula occludens-1. To establish the engineered model, we cultured VFECs on a hyaluronic acid-derived synthetic basement membrane displaying fibronectin-derived integrin-binding peptide (RGDSP) and/or laminin 111-derived syndecan-binding peptide AG73 (RKRLQVQLSIRT). Our results show that matrix stiffness and composition cooperatively regulate the adhesion, proliferation, and stratification of VFECs. Cells cultured on hydrogels with physiological stiffness (elastic shear modulus, G' = 1828 Pa) adopted a cobblestone morphology with close cell-cell contacts, whereas those on softer matrices (G' = 41 Pa) were spindle shaped with extensive intracellular stress fibers. The development of stratified epithelium with proliferating basal cells and additional (1-2) suprabasal layers requires the presence of both RGDSP and AG73 peptide signals. Supplementation of cytokines produced by vimentin positive primary porcine vocal fold fibroblasts in the VFEC culture led to the establishment of 4-5 distinct cell layers. The engineered vocal fold epithelium resembled native tissue morphologically; expressed cytokeratin 13, mucin 1, and tight/adherens junction markers; and secreted basement membrane proteins collagen IV and laminin 5. Collectively, our results demonstrate that stiffness matching, cell-matrix engagement, and paracrine signaling cooperatively contribute to the stratification of VFECs. The engineered epithelium can be used as a versatile tool for investigations of genetic and molecular mechanisms in vocal fold health and disease.
Collapse
Affiliation(s)
- Anitha Ravikrishnan
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Eric W Fowler
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Alexander J Stuffer
- Department of Biological Sciences, University of Delaware, Newark, Delaware 19716, United States
| | - Xinqiao Jia
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware 19716, United States.,Department of Biological Sciences, University of Delaware, Newark, Delaware 19716, United States.,Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716, United States.,Delaware Biotechnology Institute, University of Delaware, Newark, Delaware 19711, United States
| |
Collapse
|
10
|
Erickson-DiRenzo E, Singh SP, Martinez JD, Sanchez SE, Easwaran M, Valdez TA. Cigarette smoke-induced changes in the murine vocal folds: a Raman spectroscopic observation. Analyst 2021; 145:7709-7717. [PMID: 32996925 DOI: 10.1039/d0an01570a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Raman spectroscopic methods are being projected as novel tools to study the early invisible molecular level changes in a label-free manner. In the present study, we have used Raman spectroscopy to explore the earliest biochemical changes in murine vocal folds in response to time-bound cigarette smoke exposure. Mice were exposed to cigarette smoke for 2 or 4-weeks through a customized smoke inhalation system. The larynx was collected and initial evaluations using standard methods of analysis such as histopathology and immunofluorescence was performed. Concurrent unstained sections were used for Raman imaging. Two common pathological features of vocal fold disorders including alterations in collagen content and epithelial hypercellularity, or hyperplasia, were observed. The mean spectra, principal component analysis, and Raman mapping also revealed differences in the collagen content and hypercellularity in the smoke exposed tissues. The differences in 2-week exposed tissues were found to be more prominent as compared to 4-week. This was attributed to adaptive responses and the already reported biphasic effects, which suggest that collagen synthesis is significantly reduced at higher cigarette smoke concentrations. Overall findings of the study are supportive of the prospective application of Raman imaging in monitoring changes due to cigarette smoke in the vocal folds.
Collapse
Affiliation(s)
- Elizabeth Erickson-DiRenzo
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Parker LA, Kunduk M, Blouin D, Adkins L, McWhorter AJ. Voice Outcomes Following Multiple Surgeries for Recurrent Respiratory Papillomatosis. J Voice 2019; 34:791-798. [PMID: 30795926 DOI: 10.1016/j.jvoice.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus that presents as warty, exophytic growths in the upper airway. RRP in the larynx can lead to severe airway obstruction and voice changes. It is clinically known that patients with RRP frequently experience dysphonia. The purpose of this study was to assess the impact of multiple surgical treatments on RRP patients' voice outcomes, and to determine whether a higher number of repeated surgeries lead to decreased voice quality. METHODS A retrospective cohort study was conducted of adult RRP patients (n = 23) who underwent multiple surgeries. Group 1 included patients (n = 11) who had <5 surgeries (range 2-4 surgeries) and Group 2 included patients (n = 12) who had ≥5 surgeries (range 5-50+ surgeries). Voice recordings were selected from the following clinic visits: initial office visit (initial presurgery), first postsurgery, and the last clinic encounter(s) with no immediate planned surgery. Blinded auditory-perceptual ratings along with cepstral and spectral acoustic measures assessed voice severity. RESULTS There was significant improvement from the initial presurgery visit compared to each postoperative visit over time for all voice outcome measures for both Group 1 and Group 2. The results of the study indicated that the number of surgeries did not significantly affect mean postoperative voice outcomes, and there were no significant differences between patient groups for voice quality over time. CONCLUSIONS The results of this study suggest that RRP patients' voice quality may not suffer cumulative negative effects when using modern tissue-sparing surgical techniques.
Collapse
Affiliation(s)
- Lindsey A Parker
- Louisiana State University, Department of Communication Sciences & Disorders, Baton Rouge, Louisiana; Our Lady of the Lake Voice Center, Baton Rouge, Louisiana
| | - Melda Kunduk
- Louisiana State University, Department of Communication Sciences & Disorders, Baton Rouge, Louisiana; Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana.
| | - David Blouin
- Louisiana State University, Department of Experimental Statistics, Baton Rouge, Louisiana
| | - Lacey Adkins
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana
| | - Andrew J McWhorter
- Our Lady of the Lake Voice Center, Baton Rouge, Louisiana; Louisiana State University Health Sciences Center, School of Medicine, Department of Otolaryngology Head & Neck Surgery, New Orleans, Louisiana
| |
Collapse
|
12
|
Durkes A, Sivasankar MP. A Method to Administer Agents to the Larynx in an Awake Large Animal. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3171-3176. [PMID: 29098280 PMCID: PMC5945077 DOI: 10.1044/2017_jslhr-s-17-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This research note describes an adapted experimental methodology to administer an exogenous agent to the larynx and upper airway of awake animals. The exogenous agent could be a perturbation. In the current study, the agent was isotonic saline. Isotonic saline was selected because it is safe, of similar composition to extracellular fluid, and used in voice studies. The described approach allowed large animals such as pigs to be comfortably restrained without chemical sedation or anesthesia for extended periods while receiving the agent. METHOD Six Sinclair pigs were successfully trained with positive reinforcement to voluntarily enter and then be restrained in a Panepinto Sling. Once restrained, the pigs accepted a nose cone that delivered nebulized isotonic saline. This procedure was repeated 3 times per day for 20 days. At the end of the study, the larynx and airway tissues were excised and examined using histology and transmission electron microscopy. RESULTS Pathology related to the procedure (i.e., nebulized inhaled isotonic saline or stress) was not identified in any examined tissues. CONCLUSIONS This methodology allowed for repeated application of exogenous agents to awake, unstressed animals. This method can be used repeatedly in the laboratory to test various therapeutics for safety, toxicity, and dosage. Future studies will specifically manipulate the type of agent to further our understanding of laryngeal pathobiology.
Collapse
Affiliation(s)
- Abigail Durkes
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN
| | | |
Collapse
|
13
|
Suzuki R, Katsuno T, Kishimoto Y, Nakamura R, Mizuta M, Suehiro A, Yamashita M, Nakamura T, Tateya I, Omori K. Process of tight junction recovery in the injured vocal fold epithelium: Morphological and paracellular permeability analysis. Laryngoscope 2017; 128:E150-E156. [PMID: 29086429 DOI: 10.1002/lary.26959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS The vocal fold epithelium that includes tight junction (TJ)-based barrier function protects underlying connective tissues from external insults. TJs play an important role to control paracellular permeability of not only solutes but also ions, and preserve the vocal fold homeostasis. However, the distribution of TJs and paracellular diffusion barrier across the entire vocal fold epithelium are still unknown. The aim of this study was to identify the distribution of TJs in the vocal fold epithelium and to characterize the recovery process of TJ-based paracellular diffusion barrier in a rat model of vocal fold injury. STUDY DESIGN Animal experiments with controls. METHODS Normal and vocal fold-injured rats were used. Larynges were harvested for immunohistochemical examination of TJ proteins. For functional analysis, a tracer permeability assay was performed using EZ-Link Sulfo-NHS-LC-Biotin. RESULTS TJ proteins occludin and zonula occludens 1 signals were localized to the junctional regions of the most luminal cell layers of the vocal fold epithelium. The injured region had been recovered with epithelium at 5 days postinjury, but the paracellular diffusion barrier assays revealed that biotinylation reagents diffused into the lamina propria at 5 days postinjury, and were blocked at the epithelium at 14 and 28 days postinjury. CONCLUSIONS It was strongly suggested that TJs in the vocal fold epithelium exist at the junctional regions of the first layer of stratified squamous epithelium. TJ-based paracellular diffusion barrier following vocal fold injury is recovered by 14 days postinjury, and this period corresponds with the time course of structural changes in the regenerating epithelium layer. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E150-E156, 2018.
Collapse
Affiliation(s)
- Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Katsuno
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Nakamura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Suehiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaru Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Tissue engineering is a rapidly expanding field in medicine and involves regeneration and restoration of many organs, including larynx and the airways. Currently, this is not included in routine practice; however, a number of clinical trials in humans are ongoing or starting. This review will cover publications during the past 2 years and the focus is on larynx and trachea. RECENT FINDINGS Recent reports concern the development and investigations of cell therapies, including biological factors such as growth factors which promote healing of damage and increased vascular support of the tissue. A separate section concerns studies of stromal cells and stem cells in tissue engineering. Cell therapies and treatment with biological active factors are often combined with the development of scaffolds to support or reconstruct the soft tissue in the larynx or the cartilages in trachea or larynx. New techniques for scaffold construction, such as 3D printing, are developed. The trend in the recent publications is to combine these methods. SUMMARY Recent advances in tissue engineering of the larynx and trachea include the development of cell therapies or treatment with biological active factors often in combination with scaffolds.
Collapse
|
15
|
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
|