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Sherman T, Schlegel P, Santuray R, Zhang Z, Long JL. Vocal Fold Injury Produces Similar Biomechanical Outcomes in Male and Female Rabbits. J Voice 2024:S0892-1997(24)00261-3. [PMID: 39227273 DOI: 10.1016/j.jvoice.2024.08.014] [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: 06/06/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE Sex differences in response to trauma and physiologic stressors have been identified in numerous organ systems but have not yet been defined in the larynx. The objective of this study was to develop an endoscopic vocal fold injury model in rabbits and to compare structural and functional outcomes between male and female subjects. STUDY DESIGN Basic science study. METHODS Two male and two female rabbits underwent unilateral endoscopic cordectomy. Animals were intubated with a size 3-0 neonatal endotracheal tube, and laryngoscopy was performed with a 4 mm Hopkins rod telescope. While visualizing, a 2 mm cupped forceps grasped and resected the mid-membranous portion of the right true vocal fold. Larynges were then harvested after 8weeks. Excised larynx phonation with high-speed videography and kymography was used to assess vibrational quality. Tissue elastic (Young's) modulus was measured by indentation. RESULTS Injured larynges phonated with fundamental frequencies between 237-415 Hz. In both males and females, the scarred vocal fold exhibited an increased Young's modulus compared to the contralateral nonoperated vocal fold. There were no notable differences in glottal closure pattern or vocal fold oscillation symmetry between sexes. CONCLUSION We have demonstrated a model for vocal fold scarring in rabbits. Vibrational and structural outcomes were similar between the examined male and female larynges.
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Affiliation(s)
- Trent Sherman
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Rodell Santuray
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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2
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Santuray R, Schlegel P, Zhang Z, Reddy N, Alhiyari Y, Long JL. Cell-Based Outer Vocal Fold Replacement Both Treats and Prevents Vocal Fold Scarring in Rabbits. Laryngoscope 2024; 134:764-772. [PMID: 37597170 PMCID: PMC10842642 DOI: 10.1002/lary.30952] [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: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Numerous pharmacological and cell-based treatments have shown promise in preventing vocal fold (VF) scarring when applied at the time of injury. A common clinical scenario, however, is the finding of mature scar impeding voicing. Many treatments are less effective in remodeling existing scar tissue. This objective of this study is to determine if a cell-based outer vocal fold replacement (COVR) effectively restores VF function when applied to existing scar. METHODS Eighteen rabbits were allocated to three groups: unilateral COVR implant at the time of cordectomy (acute COVR); unilateral cordectomy followed by COVR implant 2 months later (chronic COVR); and unilateral cordectomy followed by sham implant surgery 2 months later (chronic scar). Larynges were harvested 2 months after implant or sham surgery. RESULTS All larynges in the COVR groups demonstrated human leukocyte antigen labeling on immunohistochemistry (IHC). COVR groups had increased hyaluronic acid content compared with normal. VF stiffness as measured by elastic moduli in acute COVR and chronic COVR were similar to their contralateral unoperated VF. CONCLUSION COVR implantation in both acutely injured and chronically scarred VF demonstrate persistence of implanted cells, restored tissue biomechanics, and increased hyaluronic acid content. LEVEL OF EVIDENCE NA Laryngoscope, 134:764-772, 2024.
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Affiliation(s)
- Rodell Santuray
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Neha Reddy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Yazeed Alhiyari
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer L. Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
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3
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Andrus L, Camli B, Mau T, Ben-Yakar A. Ultrafast Laser Microlaryngeal Surgery for In Vivo Subepithelial Void Creation in Canine Vocal Folds. Laryngoscope 2023; 133:3042-3048. [PMID: 37096749 PMCID: PMC10754041 DOI: 10.1002/lary.30713] [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: 12/19/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/OBJECTIVES Tightly-focused ultrafast laser pulses (pulse widths of 100 fs-10 ps) provide high peak intensities to produce a spatially confined tissue ablation effect. The creation of sub-epithelial voids within scarred vocal folds (VFs) via ultrafast laser ablation may help to localize injectable biomaterials to treat VF scarring. Here, we demonstrate the feasibility of this technique in an animal model using a custom-designed endolaryngeal laser surgery probe. METHODS Unilateral VF mucosal injuries were created in two canines. Four months later, ultrashort laser pulses (5 ps pulses at 500 kHz) were delivered via the custom laser probe to create sub-epithelial voids of ~3 × 3-mm2 in both healthy and scarred VFs. PEG-rhodamine was injected into these voids. Ex vivo optical imaging and histology were used to assess void morphology and biomaterial localization. RESULTS Large sub-epithelial voids were observed in both healthy and scarred VFs immediately following in vivo laser treatment. Two-photon imaging and histology confirmed ~3-mm wide subsurface voids in healthy and scarred VFs of canine #2. Biomaterial localization within a void created in the scarred VF of canine #2 was confirmed with fluorescence imaging but was not visualized during follow-up two-photon imaging. As an alternative, the biomaterial was injected into the excised VF and could be observed to localize within the void. CONCLUSIONS We demonstrated sub-epithelial void formation and the ability to inject biomaterials into voids in a chronic VF scarring model. This proof-of-concept study provides preliminary evidence towards the clinical feasibility of such an approach to treating VF scarring using injectable biomaterials. LEVEL OF EVIDENCES N/A Laryngoscope, 133:3042-3048, 2023.
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Affiliation(s)
- Liam Andrus
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
| | - Berk Camli
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, 75390, United States
| | - Adela Ben-Yakar
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, 78712, United States
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4
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Schlegel P, Yan K, Upadhyaya S, Buyens W, Wong K, Chen A, Faull KF, Al-Hiyari Y, Long J. Tissue-engineered vocal fold replacement in swine: Methods for functional and structural analysis. PLoS One 2023; 18:e0284135. [PMID: 37083641 PMCID: PMC10120936 DOI: 10.1371/journal.pone.0284135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
We have developed a cell-based outer vocal fold replacement (COVR) as a potential therapy to improve voice quality after vocal fold (VF) injury, radiation, or tumor resection. The COVR consists of multipotent human adipose-derived stem cells (hASC) embedded within a three-dimensional fibrin scaffold that resembles vocal fold epithelium and lamina propria layers. Previous work has shown improved wound healing in rabbit studies. In this pilot study in pigs, we sought to develop methods for large animal implantation and phonatory assessment. Feasibility, safety, and structural and functional outcomes of the COVR implant are described. Of eight pigs studied, six animals underwent COVR implantation with harvest between 2 weeks and 6 months. Recovery of laryngeal tissue structure was assessed by vibratory and histologic analyses. Recovery of voice function was assessed by investigating acoustic parameters that were derived specifically for pigs. Results showed improved lamina propria qualities relative to an injured control animal at 6 months. Acoustic parameters reflected voice worsening immediately after surgery as expected; acoustics displayed clear voice recovery in the animal followed for 6 months after COVR. These methods form the basis for a larger-scale long-term pre-clinical safety and efficacy study.
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Affiliation(s)
- Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Kenneth Yan
- Department of Otolaryngology/Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sreenivasa Upadhyaya
- Department of Computer Science, Katholieke Universiteit Leuven, Leuven, Belgium
- SoundTalks N.V, Leuven, Belgium
| | | | - Kirsten Wong
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Anthony Chen
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Kym F. Faull
- Department of Psychiatry & Biobehavioral Sciences, Pasarow Mass Spectrometry Laboratory, Jane & Terry Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Yazeed Al-Hiyari
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Jennifer Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
- Surgery and Perioperative Careline, Greater Los Angeles VA Healthcare System, Los Angeles, California, United States of America
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5
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Tran EK, Alhiyari Y, Juarez K, Gowda BS, Schrader F, Sajed DP, Long JL. A xenograft study of human adipose stromal cell-based vocal fold mucosal replacement in rabbits. Laryngoscope Investig Otolaryngol 2022; 7:1521-1531. [PMID: 36258854 PMCID: PMC9575091 DOI: 10.1002/lio2.929] [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: 05/27/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Vocal fold (VF) scarring, manifested by increased collagen, decreased glycosaminoglycans (GAGs), and disrupted elastic fibers, remains a negative consequence of VF injury or resection. The objective of this study is to compare four reconstructive options after Vf mucosal resection in rabbits. A Cell-Based Outer Vocal fold Replacement (COVR) using human adipose-derived mesenchymal stromal cells (hASCs) in fibrin scaffold is directly compared with a decellularized scaffold implant, hASC injection, and resection alone without reconstruction. The primary hypothesis is that the cells-in-scaffold construct better reconstitutes the VF structure than either cells or scaffold alone, or than healing by secondary intention. Methods A total of49 rabbits received bilateral VF cordectomy, followed by either COVR implant, decellularized scaffold implant, hASC injection, or no reconstruction (injured control group). Larynges were harvested after 6 weeks. Results Histology demonstrated greater lamina propria thickness, less collagen deposition, and more GAGs in COVR animals versus all other treatment groups. Evidence of persistent human cells was found in about half of the cell-treated animals. RNA levels of fibrosis pathway and macrophage phenotype markers were statistically unchanged among treatment groups at 6 weeks. Conclusion These data support the efficacy of COVR implantation in restoring VF microstructure in rabbits. The intact COVR was required; isolated components of decellularized scaffold or injected hASC still produced histologic scarring. We propose that the unique bilayered cell structure within fibrin enables controlled matrix remodeling to minimize wound contraction and fibrosis, and to promote GAG deposition. Level of Evidence Basic science study.
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Affiliation(s)
- Eric K. Tran
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
| | - Yazeed Alhiyari
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
| | - Kevin Juarez
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Department of Anesthesiology and Perioperative CareUniversity of California‐San Francisco HealthSan FranciscoCaliforniaUSA
| | - Bhavani Shankara Gowda
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
| | - Feng Schrader
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
| | - Dipti P. Sajed
- Department of Pathology and Laboratory Medicine, Los AngelesDavid Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer L. Long
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
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Gong T, Yu P, Lu T, Chen J, Mi J, Fang R, Shan C. Cryotherapy Modifies Extracellular Matrix Expression of Vocal Fold in Rat Models. J Voice 2022:S0892-1997(22)00272-7. [PMID: 36182619 DOI: 10.1016/j.jvoice.2022.08.031] [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: 06/22/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Vocal fold (VF) scarring is the major cause of voice disorders. Cryotherapy is an effective anti-scarring therapy for skin lesions. The aim of this study was to explore the anti-scarring potential of cryotherapy in vocal folds. METHODS The extracellular matrix (ECM) mRNA expression of cryotherapy on normal VF tissue and the histologic results of cryotherapy on vocal fold healing were studied. Fifteen rats were introduced cryotherapy on the normal VF bilaterally and were harvested for real-time polymerase chain reaction (RT-PCR) analysis for collagen I, collagen III, TGFβ1, decorin, fibronectin and HAS1 at 1 day, 3 days and 7 days. Ten rats were unilaterally injured by stripping lamina propria and immediately treated with or without cryotherapy and were harvested at 2 months for histological and immunohistochemical analysis. RESULTS Regenerative effect of cryotherapy was validated of ECM gene expression. Histological and immunohistochemical analysis showed significantly increased hyaluronan, decreased collagen, and increased decorin deposition in injury-cryotherapy cohort compared with injury control cohort and normal control cohort. CONCLUSIONS Cryotherapy may provide an optimal environment for vocal fold tissue regeneration. The results of the present investigation suggest that cryotherapy has therapeutic potential in prevention and treatment of vocal fold scarring.
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Affiliation(s)
- Ting Gong
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pengcheng Yu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Tao Lu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiwei Chen
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinxia Mi
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
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7
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Gracioso Martins AM, Biehl A, Sze D, Freytes DO. Bioreactors for Vocal Fold Tissue Engineering. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:182-205. [PMID: 33446061 PMCID: PMC8892964 DOI: 10.1089/ten.teb.2020.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is estimated that almost one-third of the United States population will be affected by a vocal fold (VF) disorder during their lifespan. Promising therapies to treat VF injury and scarring are mostly centered on VF tissue engineering strategies such as the injection of engineered biomaterials and cell therapy. VF tissue engineering, however, is a challenging field as the biomechanical properties, structure, and composition of the VF tissue change upon exposure to mechanical stimulation. As a result, the development of long-term VF treatment strategies relies on the characterization of engineered tissues under a controlled mechanical environment. In this review, we highlight the importance of bioreactors as a powerful tool for VF tissue engineering with a focus on the current state of the art of bioreactors designed to mimic phonation in vitro. We discuss the influence of the phonatory environment on the development, function, injury, and healing of the VF tissue and its importance for the development of efficient therapeutic strategies. A concise and comprehensive overview of bioreactor designs, principles, operating parameters, and scalability are presented. An in-depth analysis of VF bioreactor data to date reveals that mechanical stimulation significantly influences cell viability and the expression of proinflammatory and profibrotic genes in vitro. Although the precision and accuracy of bioreactors contribute to generating reliable results, diverse gene expression profiles across the literature suggest that future efforts should focus on the standardization of bioreactor parameters to enable direct comparisons between studies. Impact statement We present a comprehensive review of bioreactors for vocal fold (VF) tissue engineering with a focus on the influence of the phonatory environment on the development, function, injury, and healing of the VFs and the importance of mimicking phonation on engineered VF tissues in vitro. Furthermore, we put forward a strong argument for the continued development of bioreactors in this area with an emphasis on the standardization of bioreactor designs, principles, operating parameters, and oscillatory regimes to enable comparisons between studies.
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Affiliation(s)
- Ana M Gracioso Martins
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University/University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Andreea Biehl
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University/University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Daphne Sze
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University/University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Donald O Freytes
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University/University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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Abstract
PURPOSE OF REVIEW Vocal fold (VF) fibrosis remains an insoluble problem in most cases, with a severe impact on vocal quality and effort. This review examines current investigations and research strands that explore the understanding of VF wound healing and applied treatments for the management of VF scar. RECENT FINDINGS Recent work focused on VF fibrosis has examined wound healing in the glottis, fibrosis-modifying medication, and tissue engineering approaches that span cytokine and growth factor therapy, scaffold and cell delivery platforms, seeded scaffolds, conditioned media and stem cell therapy. Many show promise and may deliver improvements in the wound bed favouring less fibrogenic healing patterns, ultimately with the goal of preserving or restoring VF vibration. Further collaborative research is required that examines combined approaches, long term outcomes, better three-dimensional modelling of cell-cell interactions and delivery modalities for molecular therapies. SUMMARY VF fibrosis research continues to expand and explore a variety of mechanistic pathways in order to understand VF healing and identify novel and complementary targets for manipulation. Many different approaches show promise and may also offer synergistic benefits. Research continues to strive for healing that more closely resembles true VF architecture and function.
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Cannes do Nascimento N, dos Santos AP, Sivasankar MP, Cox A. Unraveling the molecular pathobiology of vocal fold systemic dehydration using an in vivo rabbit model. PLoS One 2020; 15:e0236348. [PMID: 32735560 PMCID: PMC7394397 DOI: 10.1371/journal.pone.0236348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/03/2020] [Indexed: 01/03/2023] Open
Abstract
Vocal folds are a viscoelastic multilayered structure responsible for voice production. Vocal fold epithelial damage may weaken the protection of deeper layers of lamina propria and thyroarytenoid muscle and impair voice production. Systemic dehydration can adversely affect vocal function by creating suboptimal biomechanical conditions for vocal fold vibration. However, the molecular pathobiology of systemically dehydrated vocal folds is poorly understood. We used an in vivo rabbit model to investigate the complete gene expression profile of systemically dehydrated vocal folds. The RNA-Seq based transcriptome revealed 203 differentially expressed (DE) vocal fold genes due to systemic dehydration. Interestingly, function enrichment analysis showed downregulation of genes involved in cell adhesion, cell junction, inflammation, and upregulation of genes involved in cell proliferation. RT-qPCR validation was performed for a subset of DE genes and confirmed the downregulation of DSG1, CDH3, NECTIN1, SDC1, S100A9, SPINK5, ECM1, IL1A, and IL36A genes. In addition, the upregulation of the transcription factor NR4A3 gene involved in epithelial cell proliferation was validated. Taken together, these results suggest an alteration of the vocal fold epithelial barrier independent of inflammation, which could indicate a disruption and remodeling of the epithelial barrier integrity. This transcriptome provides a first global picture of the molecular changes in vocal fold tissue in response to systemic dehydration. The alterations observed at the transcriptional level help to understand the pathobiology of dehydration in voice function and highlight the benefits of hydration in voice therapy.
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Affiliation(s)
- Naila Cannes do Nascimento
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail: (NCN); (AC)
| | - Andrea P. dos Santos
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, United States of America
| | - M. Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail: (NCN); (AC)
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10
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Ma Y, Long J, Amin MR, Branski RC, Damrose EJ, Sung CK, Achlatis S, Kearney A, Chhetri DK. Autologous fibroblasts for vocal scars and age-related atrophy: A randomized clinical trial. Laryngoscope 2019; 130:2650-2658. [PMID: 31804729 DOI: 10.1002/lary.28453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 11/04/2019] [Accepted: 11/18/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the safety and efficacy of autologous cultured fibroblasts (ACFs) to treat dysphonia related to vocal fold scar and age-related vocal atrophy (ARVA). STUDY DESIGN Randomized, double-blinded, placebo-controlled, multi-institutional, phase II trial. METHODS ACFs were expanded from punch biopsies of the postauricular skin in each subject; randomization was 2:1 (treatment vs. placebo). Three injections of 1-2 × 107 cells or placebo saline was performed at 4-week intervals for each vocal fold. Follow-up was performed at 4, 8, and 12 months. The primary outcome was improved mucosal waves. Secondary outcomes included Voice Handicap Index (VHI)-30, patient reported voice quality outcomes, and perceptual analysis of voice. RESULTS Fifteen subjects received ACF and six received saline injections. At 4, 8, and 12 months after ACF treatments, a significant improvement in mucosal wave grade relative to baseline was observed in both vocal scar and ARVA groups. Relative to control group, mucosal waves were significantly improved in the ARVA group at 4 and 8 months. Perceptual analysis significantly improved in the vocal scar group 12 months after ACF treatments compared to controls. Vocal scar group reported significantly improved vocal quality from baseline. VHI and expert rater voice grade improved in both groups, but did not achieve significance. No adverse events related to fibroblast injections were observed. CONCLUSIONS In this cohort, injection of ACFs into the vocal fold lamina propria (LP) was safe and significantly improved mucosal waves in patients with vocal scar and ARVA. ACF may hold promise to reconstruct the LP. LEVEL OF EVIDENCE 1 Laryngoscope, 130:2650-2658, 2020.
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Affiliation(s)
- Yue Ma
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Jennifer Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Ryan C Branski
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Edward J Damrose
- Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Chih-Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Stratos Achlatis
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Ann Kearney
- Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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11
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Pöttler M, Fliedner A, Bergmann J, Bui LK, Mühlberger M, Braun C, Graw M, Janko C, Friedrich O, Alexiou C, Lyer S. Magnetic Tissue Engineering of the Vocal Fold Using Superparamagnetic Iron Oxide Nanoparticles. Tissue Eng Part A 2019; 25:1470-1477. [DOI: 10.1089/ten.tea.2019.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marina Pöttler
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna Fliedner
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Bergmann
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Linh Katrin Bui
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Marina Mühlberger
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Braun
- Institute of Legal Medicine, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Matthias Graw
- Institute of Legal Medicine, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Christina Janko
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander Universität Erlangen–Nürnberg, Erlangen, Germany
| | - Christoph Alexiou
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Lyer
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
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King RE, Lau HK, Zhang H, Sidhu I, Christensen MB, Fowler EW, Li L, Jia X, Kiick KL, Thibeault SL. Biocompatibility and Viscoelastic Properties of Injectable Resilin-Like Polypeptide and Hyaluronan Hybrid Hydrogels in Rabbit Vocal Folds. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019; 5:373-386. [DOI: 10.1007/s40883-019-00094-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brookes S, Voytik-Harbin S, Zhang H, Zhang L, Halum S. Motor endplate-expressing cartilage-muscle implants for reconstruction of a denervated hemilarynx. Laryngoscope 2018; 129:1293-1300. [PMID: 30548608 DOI: 10.1002/lary.27575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tissue engineering of the larynx requires a complex, multiple tissue layer design. Additionally, spontaneous reinnervation of the larynx after recurrent laryngeal nerve (RLN) injury is often disorganized, resulting in subpar function. This study investigates use of tissue-engineered cartilage and motor endplate-expressing (MEE) tissue-engineered skeletal muscle implants for laryngeal reconstruction and the promotion of organized reinnervation after RLN injury. METHODS F344 rat primary muscle progenitor cells (MPCs) were isolated. Three-dimensional muscle constructs were created by encapsulating MPCs in type I oligomeric collagen under passive tension. Constructs were then cultured in differentiation medium (MPC control constructs) or induced to form motor endplates (MEE constructs) with neurotrophic agents. Three-dimensional cartilage constructs were created with adipose stem cells differentiated in chondrocyte medium. The muscle and cartilage constructs were implanted into surgically created myochondral defects in the F344 rat larynx with injured or intact (control) RLN. At 1-, 3-, and 6-month timepoints, videolaryngoscopy, electromyography (EMG), histology, and immunohistochemistry were used to assess outcomes. RESULTS At all timepoints, cartilage-muscle implants were well integrated into host tissue. Functionally, there was increased vocal fold adduction and EMG activity in nerve-injured rats treated with the MEE constructs when compared to those treated with the MPC control constructs. Motor endplate-expressing constructs had increased myofiber cross-sectional area compared to MPC control constructs. CONCLUSION Although our laboratory previously demonstrated that muscle and cartilage constructs could be used separately for hemilaryngeal reconstruction, this study suggests combining them with the modification of MEEs rather than MPCs, resulting in improved muscle recovery after recurrent laryngeal nerve injury. LEVEL OF EVIDENCE NA Laryngoscope, 129:1293-1300, 2019.
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Affiliation(s)
- Sarah Brookes
- Department of Basic Medical Sciences, West Lafayette, Indiana, U.S.A
| | - Sherry Voytik-Harbin
- Department of Basic Medical Sciences, West Lafayette, Indiana, U.S.A.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, U.S.A
| | - Hongji Zhang
- Department of Speech, Language and Hearing Sciences, West Lafayette, Indiana, U.S.A
| | - Lujuan Zhang
- Department of Speech, Language and Hearing Sciences, West Lafayette, Indiana, U.S.A
| | - Stacey Halum
- Department of Speech, Language and Hearing Sciences, West Lafayette, Indiana, U.S.A
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Titze IR, Riede T, Palaparthi A, Hynan LS, Hamilton A, Toles L, Mau T. Individualized Patient Vocal Priorities for Tailored Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2884-2894. [PMID: 30515514 PMCID: PMC6440314 DOI: 10.1044/2018_jslhr-s-18-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/23/2018] [Indexed: 05/04/2023]
Abstract
PURPOSE The purposes of this study are to introduce the concept of vocal priorities based on acoustic correlates, to develop an instrument to determine these vocal priorities, and to analyze the pattern of vocal priorities in patients with voice disorders. METHOD Questions probing the importance of 5 vocal attributes (vocal clarity, loudness, mean speaking pitch, pitch range, vocal endurance) were generated from consensus conference involving speech-language pathologists, laryngologists, and voice scientists, as well as patient feedback. The responses to the preliminary items from 213 subjects were subjected to exploratory factor analysis, which confirmed 4 of the predefined domains. The final instrument consisted of a 16-item Vocal Priority Questionnaire probing the relative importance of clarity, loudness, mean speaking pitch, and pitch range. RESULTS The Vocal Priority Questionnaire had high reliability (Cronbach's α = .824) and good construct validity. A majority of the cohort (61%) ranked vocal clarity as their highest vocal priority, and 20%, 12%, and 7% ranked loudness, mean speaking pitch, and pitch range, respectively, as their highest priority. The frequencies of the highest ranked priorities did not differ by voice diagnosis or by sex. Considerable individual variation in vocal priorities existed within these large trends. CONCLUSIONS A patient's vocal priorities can be identified and taken into consideration in planning behavioral or surgical intervention for a voice disorder. Inclusion of vocal priorities in treatment planning empowers the patient in shared decision making, helps the clinician tailor treatment, and may also improve therapy compliance.
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Affiliation(s)
- Ingo R. Titze
- National Center for Voice and Speech, University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Tobias Riede
- Department of Physiology, Midwestern University, Glendale, AZ
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City
| | - Linda S. Hynan
- Departments of Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Amy Hamilton
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Laura Toles
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
- MGH Institute of Health Professions, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas
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Gong T, Zhang C, Kang J, Lou Z, Scholp A, Jiang JJ. The effects of cryotherapy on vocal fold healing in a rabbit model. Laryngoscope 2018; 129:E151-E157. [PMID: 30468242 DOI: 10.1002/lary.27629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS Cryotherapy has been shown to be a scarless treatment modality for dermal lesions; however, there are limited data addressing the effect of cryotherapy on vocal fold tissue. The aim of this study was to clarify the effectiveness of cryotherapy for prevention of postsurgical vocal fold scarring. STUDY DESIGN Prospective animal study in rabbits. METHODS The lamina propria of 20 rabbit vocal folds was bilaterally stripped, followed by randomized unilateral cryotherapy. Five larynges were harvested for real-time polymerase chain reaction (RT-PCR) analysis at 1 day, 3 days, and 7 days postinjury. The remaining five were harvested for histologic analysis at 3 months. Images of the healing phase were recorded by laryngoscopy. Analyses of RT-PCR for cyclooxygenase (COX)-2, interleukin (IL)-6, collagen I, collagen III, matrix metallopeptidase 1 (MMP1), transforming growth factor β (TGFβ1), α smooth muscle actin (α-SMA), and hyaluronan synthase 1 (HAS1) were completed. Histological samples were completed for collagen and hyaluronic acid analysis. RESULTS RT-PCR results revealed that higher expressions of HAS1 and MMP1 and lower expressions of COX-2, IL-6, collagen I, collagen III, TGFβ1, and α-SMA were observed, and histological examination showed significantly increased hyaluronic acid, decreased deposition, and more organized configuration of collagen in injury with the cryotherapy cohort compared with the injury cohort. CONCLUSIONS Cryotherapy can inhibit the inflammatory reaction and simulate a fetal healing environment in extracellular matrix synthesis to regenerate vocal fold tissue with less fibrosis. Histological results showed that cryotherapy achieves a mature healing result with less scar, which tends to return to normal. In summary, the findings of this study suggest that administration of cryotherapy at the time of injury has the potential to minimize vocal fold scarring. LEVEL OF EVIDENCE NA Laryngoscope, 129:E151-E157, 2019.
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Affiliation(s)
- Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jing Kang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Zhewei Lou
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Goel AN, Gowda BS, Veena MS, Shiba TL, Long JL. Adipose-Derived Mesenchymal Stromal Cells Persist in Tissue-Engineered Vocal Fold Replacement in Rabbits. Ann Otol Rhinol Laryngol 2018; 127:962-968. [PMID: 30296832 DOI: 10.1177/0003489418806008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES: Cell therapies using mesenchymal stromal cells (MSCs) have been proposed as a promising new tool for the treatment of vocal fold scarring. However, the mechanisms by which MSCs promote healing as well as their duration of survival within the host vocal fold have yet to be defined. The aim of this work was to assess the persistence of embedded MSCs within a tissue-engineered vocal fold mucosal replacement in a rabbit model of vocal fold injury. METHODS: Male rabbit adipose-derived MSCs were embedded within a 3-dimensional fibrin gel, forming the cell-based outer vocal fold replacement. Four female rabbits underwent unilateral resection of vocal fold epithelium and lamina propria and reconstruction with cell-based outer vocal fold replacement implantation. Polymerase chain reaction and fluorescent in situ hybridization for the sex-determining region of the Y chromosome (SRY-II) in the sex-mismatched donor-recipient pairs sought persistent cells after 4 weeks. RESULTS: A subset of implanted male cells was detected in the implant site at 4 weeks. Many SRY-II-negative cells were also detected at the implant site, presumably representing native female cells that migrated to the area. No SRY-II signal was detected in contralateral control vocal folds. CONCLUSIONS: The emergent tissue after implantation of a tissue-engineered outer vocal fold replacement is derived both from initially embedded adipose-derived stromal cells and infiltrating native cells. Our results suggest this tissue-engineering approach can provide a well-integrated tissue graft with prolonged cell activity for repair of severe vocal fold scars.
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Affiliation(s)
- Alexander N Goel
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bhavani S Gowda
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mysore S Veena
- 2 Research Service, Greater Los Angeles Veterans Affairs Hospital System, Los Angeles, CA, USA
| | - Travis L Shiba
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Long
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Research Service, Greater Los Angeles Veterans Affairs Hospital System, Los Angeles, CA, USA
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