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Grossmann T, Kirsch A, Gerstenberger C, Steffan B, Gugatschka M. Describing the Cellular Impact of IQOS™ Smoke Extract and Vibration on Human Vocal Fold Fibroblasts. J Voice 2024:S0892-1997(24)00135-8. [PMID: 38705740 DOI: 10.1016/j.jvoice.2024.04.015] [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: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES The isolated or combined effects of vibration and smoke extract (SE) from the IQOS™ "heat-not-burn" technology on human vocal fold fibroblasts (hVFF) were evaluated in an in vitro setting in order to elucidate their influence on vocal fold (patho-) physiology. STUDY DESIGN Experimental pilot study using intervention with IQOS™-SE in vitro. METHODS Immortalized hVFF were exposed to IQOS™-SE or control medium under static or vibrational conditions. A phonomimetic bioreactor was used to deliver vibrational patterns to hVFF over a period of 5days. Cytotoxicity was quantified by lactate dehydrogenase assay. Effects on extracellular matrix production, inflammation, fibrogenesis, and angiogenesis were assessed by reverse transcription-quantitative polymerase chain reaction, western blot, enzyme-linked immunosorbent assay, and Magnetic Luminex assays. RESULTS We observed significant changes induced either by IQOS™-SE exposure alone (matrix metalloproteinase 1, fibronectin, cyclooxygenase (COX)1, interleukin-8 gene expression), or by the combination of IQOS™-SE and vibration (hyaluronidase 2, COX2, interleukin-8 protein levels, vascular endothelial growth factor D). CONCLUSION Short-term in vitro exposure of hVFF to IQOS™-SE did not result in cytotoxicity and reduced the gene expression of measured inflammation mediators, but had no effect on their protein expression. However, the clinical effects of long-term IQOS™ use are still not known and further research is needed in order to assess, if IQOS™ is in fact less harmful than conventional cigarettes.
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Affiliation(s)
- Tanja Grossmann
- Division of Phoniatrics, ENT University Hospital Graz, Medical University of Graz, Graz, Austria.
| | - Andrijana Kirsch
- Division of Phoniatrics, ENT University Hospital Graz, Medical University of Graz, Graz, Austria
| | - Claus Gerstenberger
- Division of Phoniatrics, ENT University Hospital Graz, Medical University of Graz, Graz, Austria
| | - Barbara Steffan
- Division of Phoniatrics, ENT University Hospital Graz, Medical University of Graz, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, ENT University Hospital Graz, Medical University of Graz, Graz, Austria
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Easwaran M, Maria CS, Martinez JD, Hung B, Yu X, Soo J, Kimura A, Gross ER, Erickson-DiRenzo E. Effects of Short-term Electronic(e)-Cigarette Aerosol Exposure in the Mouse Larynx. Laryngoscope 2024; 134:1316-1326. [PMID: 37698394 PMCID: PMC10922082 DOI: 10.1002/lary.31043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES The effects of electronic cigarettes (e-cigarettes) on the larynx are relatively unknown. This study examined the short-term effects of e-cigarette inhalation on cellular and inflammatory responses within the mouse laryngeal glottic and subglottic regions after exposure to pod-based devices (JUUL). METHODS Male C57BL6/J mice (8-9 weeks) were assigned to control (n = 9), JUUL flavors Mint (JMi; n = 10) or Mango (JMa; n = 10). JUUL mice were exposed to 2 h/day for 1, 5, and 10 days using the inExpose inhalation system. Control mice were in room air. Vocal fold (VF) epithelial thickness, cell proliferation, subglandular area and composition, inflammatory cell infiltration, and surface topography were evaluated in the harvested larynges. Mouse body weight and urinary nicotine biomarkers were also measured. Chemical analysis of JUUL aerosols was conducted using selective ion flow tube mass spectrometry. RESULTS JUUL-exposed mice had reduced body weight after day 5. Urinary nicotine biomarker levels indicated successful JUUL exposure and metabolism. Quantitative analysis of JUUL aerosol indicated that chemical constituents differ between JMi and JMa flavors. VF epithelial thickness, cellular proliferation, glandular area, and surface topography remained unchanged after JUUL exposures. Acidic mucus content increased after 1 day of JMi exposure. VF macrophage and T-cell levels slightly increased after 10 days of JMi exposures. CONCLUSIONS Short-term e-cigarette exposures cause minimal flavor- and region-specific cellular and inflammatory changes in the mouse larynx. This work provides a foundation for long-term studies to determine if these responses are altered with multiple e-cigarette components and concentrations. LEVEL OF EVIDENCE N/A Laryngoscope, 134:1316-1326, 2024.
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Affiliation(s)
- Meena Easwaran
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
| | - Chloe Santa Maria
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
| | - Joshua D. Martinez
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
| | - Barbara Hung
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA
| | - Xuan Yu
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA
| | - Joanne Soo
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
| | - Akari Kimura
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
| | - Eric R. Gross
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology - Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA
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Kirsch A, Grossmann T, Steffan B, Groselj-Strele A, Gerstenberger C, Gugatschka M. Vocal fold fibroblasts and exposure to vibration in vitro: Does sex matter? PLoS One 2024; 19:e0297168. [PMID: 38335206 PMCID: PMC10857603 DOI: 10.1371/journal.pone.0297168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/30/2023] [Indexed: 02/12/2024] Open
Abstract
Studies have shown that certain vocal fold pathologies are more common in one sex than the other. This is often explained by differences in the composition of the lamina propria and anatomical differences between female and male vocal folds, resulting in e.g. different fundamental frequencies. Here, we investigated a potential sex-specific voice frequency effect in an in vitro setting using vocal fold fibroblasts from one male and one female donor with and without cigarette smoke extract (CSE) addition. After exposure to either male or female vibration frequency with or without CSE, cells and supernatants were harvested. Gene and protein analysis were performed by means of qPCR, western blot, ELISA and Luminex. We found that exposure of cells to both male and female vibration pattern did not elicit significant changes in the expression of extracellular matrix-, inflammation-, and fibrosis-related genes, compared to control cells. The addition of CSE to vibration downregulated the gene expression of COL1A1 in cells exposed to the female vibration pattern, as well as induced MMP1 and PTGS2 in cells exposed to both female and male vibration pattern. The protein expression of MMP1 and COX2 was found to be significantly upregulated only in cells exposed to CSE and female vibration pattern. To conclude, different vibration patterns alone did not cause different responses of the cells. However, the female vibration pattern in combination with CSE had a tendency to elicit/maintain more pro-inflammatory responses in cells than the male vibration pattern.
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Affiliation(s)
- Andrijana Kirsch
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Graz, Austria
| | - Tanja Grossmann
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Graz, Austria
| | - Barbara Steffan
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Graz, Austria
| | - Andrea Groselj-Strele
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Claus Gerstenberger
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Graz, Austria
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4
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Steffan B, Grossmann T, Grill M, Kirsch A, Groselj-Strele A, Gugatschka M. Comparing Effects of Short- and Long-Term Exposure of Cigarette Smoke Extract on Human Vocal Fold Fibroblasts. J Voice 2023:S0892-1997(23)00243-6. [PMID: 37696688 DOI: 10.1016/j.jvoice.2023.08.002] [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: 06/05/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To explore the effects of short- and long-term cigarette smoke extract (CSE) stimulation on the expression of extracellular matrix (ECM) components and inflammatory cytokines in an in vitro model for studying Reinke's edema using human vocal fold fibroblasts (hVFF). STUDY DESIGN Experimental pilot study using intervention with CSE in vitro. METHODS Immortalized hVFF were pretreated with 5% CSE or control medium over a period of 2 or 8 weeks, followed by a final 3-day incubation time. We evaluated cell proliferation and examined gene and protein expression of control- and CSE-treated cells using quantitative polymerase chain reaction, Western Blot and enzyme linked immunosorbent assay. RESULTS Cell numbers of CSE-treated hVFF strongly decreased after 8 weeks and limited the overall duration of the experiment. We observed significant upregulations in gene expression and protein levels of inflammatory markers (cyclooxygenase COX1, COX2) and ECM components (decorin, matrix metalloproteinase 1, transglutaminase 2, gremlin 2) induced by CSE after 2 and 8 weeks. Interleukin 1 receptor 1, prostaglandin I2 synthase, collagen- and hyaluronan-related gene expression showed minor upregulations. The majority of the observed genes were similarly regulated at both time points. However, the CSE-induced mRNA level of COX1 was ablated after 8 weeks. CONCLUSION Long-term treatment did not yield results significantly different from the short-term protocol. Therefore, we propose that prolonged CSE exposure is not superior to short-term settings, which save both time and materials.
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Affiliation(s)
- Barbara Steffan
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Tanja Grossmann
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Magdalena Grill
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Andrijana Kirsch
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Groselj-Strele
- Center for Medical Research, Computational Bioanalytics, Medical University of Graz, 8010 Graz, Austria
| | - Markus Gugatschka
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
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Martinez JD, Easwaran M, Ramirez D, Erickson-DiRenzo E. Effects of Electronic (E)-cigarette Vapor and Cigarette Smoke in Cultured Vocal Fold Fibroblasts. Laryngoscope 2023; 133:139-146. [PMID: 35213064 DOI: 10.1002/lary.30073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The public use of electronic-cigarettes (e-cigs) is rapidly growing. When heated, e-cigs produce a vapor that is inhaled. The vocal folds are among the first tissues exposed to this insult. However, the impact of e-cigs on vocal fold health is almost entirely unknown. Our objective was to evaluate the effects of e-cig vapor on cultured human vocal fold fibroblasts (hVFFs), the primary cell type of the lamina propria. We compared the cellular effects of e-cig vapor without and with nicotine and conventional cigarette smoke. STUDY DESIGN In vitro. METHODS E-cig vapor extract (EVE) and cigarette smoke extract (CSE) were created by bubbling vapor and smoke, respectively, into the cell culture medium. hVFFs were exposed to EVE without or with nicotine or CSE for 24 hours. Untreated cells were used as a control group. Cells were harvested, and cytotoxicity, extracellular matrix and inflammatory gene expression, and DNA damage were assessed. RESULTS Undiluted EVE without and with nicotine reduced the viability of hVFFs to a cytotoxic level. CSE reduced hVFFs viability to a greater extent than EVE and induced DNA damage as measured by DNA double-strand breaks. No changes in gene expression were observed following EVE or CSE exposure. CONCLUSION EVE induces cytotoxicity in hVFFs. However, cellular responses were greater following exposure to CSE, suggesting cigarette smoke may induce more harm, at least in the short term. Findings from this investigation improve our understanding of responses of hVFFs to e-cigs and form the basis for an in vitro methodology to study the vocal fold responses to these products. LEVEL OF EVIDENCE NA Laryngoscope, 133:139-146, 2023.
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Affiliation(s)
- Joshua D Martinez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Meena Easwaran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Daniel Ramirez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Fan Z, Dong W, Wang Y, Fang J, Wang X, Zhang X. The Clinical Efficacy of Microsuture Technique Combined With Voice Therapy in Patients with Reinke's Edema. J Voice 2022:S0892-1997(22)00381-2. [PMID: 36526508 DOI: 10.1016/j.jvoice.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to explore the clinical efficacy of the microsuture technique combined with voice therapy in patients with Reinke's edema. METHODS 46 patients with Reinke's edema admitted between April 2017 and August 2021 were selected and randomly divided into simple surgical and combined therapy groups. The simple surgical and combined therapy group were evaluated preoperatively and at 3 months after surgery using subjective and objective voice analysis. RESULTS Compared with the preoperative state, there was a significant improvement in the acoustic parameters 3 months postoperatively. The G and R scores, Voice Handicap index-10 (VHI-10), and jitter parameters of the combined therapy group were lower, whereas F0 and maximum phonation time (MPT), changed significantly in the combined therapy group, fundamental frequency perturbation (jitter), and MPT acoustic parameters of the combined therapy group were lower than those of the simple surgery group (P < 0.05). CONCLUSION The microsuture technique is preferable for eliminating vocal folds surgical wounds and promoting mucosal recovery, and combined with voice therapy is more helpful to comprehensive improve the quality of phonation.
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Affiliation(s)
- Zhitao Fan
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China
| | - Wenxin Dong
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China
| | - Yabo Wang
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China
| | - Jinglei Fang
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China
| | - Xuexia Wang
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China
| | - Xiaolan Zhang
- Hebei Eye Hospital, Department of Otolaryngology, Xingtai, Hebei, China.
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7
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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.
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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
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Raskin J, Nasrollahi T, Borrelli M, Nasseri S. Acute Variceal Hemorrhage and Airway Obstruction in a Patient With Reinke's Edema. EAR, NOSE & THROAT JOURNAL 2022; 101:30S-32S. [PMID: 36052403 DOI: 10.1177/01455613221123825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental stressors, such as smoking and vocal cord usage, thus, treatment involves their corresponding cessation.1 Here, we report a case of a patient with severe Reinke's edema and bilateral chronic vocal cord varices. The patient had a 30-pack-year history of cigarette smoking and was obstructed with intubation due to acute variceal hemorrhage and severe swelling of Reinke's edema. Moreover, a review of the literature regarding Reinke's edema and variceal hemorrhage treatment and their complications was performed.
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Affiliation(s)
- Jonathan Raskin
- William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA.,22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,472525California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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9
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Grigaliute E, Fiamingo MN, Albanese PG, La Mantia I. Phonosurgery of Reinke's edema with microdebrider. Eur Arch Otorhinolaryngol 2022; 279:4053-4059. [PMID: 35403885 PMCID: PMC9249694 DOI: 10.1007/s00405-022-07377-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/25/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To present our experience with a new microsurgical approach for treatment of the Reinke's edema in suspension laryngoscopy-microdebridement. After a short review of existing literature we introduce speech therapy before and after the surgery into the protocol. METHODS The authors compare the phonatory outcome, laryngostroboscopical results and subjective improvement of the voice of 30 patients with Reinke's edema that were operated with either microdebridement or cold steel surgery techniques. "Sandwich" speech therapy strategy was applied for the vocal rehabilitation before and after surgery in both patient groups. RESULTS After the microdebridement and the speech therapy the mucosal wave was regular, symmetric and periodic in all patients. No signs of abnormal scar tissue or anterior adhesions were observed. Significant improvement of vocal parameters was found after the surgery in both groups of patients: operated with the microdebridement technique and the cold steel technique. The subjective voice evaluated by Voice Handicap Index (VHI-10) was improved for both patient groups in a homogenous way. CONCLUSIONS Based on the similarity of the vocal outcome in the two groups, microdebridement of the vocal folds is an excellent method for removing the edema of the Reinke's space. Careful suction at a low voltage protects the lamina propria during the microdebridement. The authors discuss the indication to this innovating procedure in patients with difficult laryngeal exposure and small operating field.
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Affiliation(s)
- Egle Grigaliute
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy.
| | - Maria Novella Fiamingo
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy
| | | | - Ignazio La Mantia
- Department of Otorhinolaryngology, University of Catania, Via S.Sofia 14, 95125, Catania, Italy
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Grill M, Lazzeri I, Kirsch A, Steurer N, Grossmann T, Karbiener M, Heitzer E, Gugatschka M. Vocal Fold Fibroblasts in Reinke's Edema Show Alterations Involved in Extracellular Matrix Production, Cytokine Response and Cell Cycle Control. Biomedicines 2021; 9:biomedicines9070735. [PMID: 34206882 PMCID: PMC8301432 DOI: 10.3390/biomedicines9070735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
The voice disorder Reinke’s edema (RE) is a smoking- and voice-abuse associated benign lesion of the vocal folds, defined by an edema of the Reinke’s space, accompanied by pathological microvasculature changes and immune cell infiltration. Vocal fold fibroblasts (VFF) are the main cell type of the lamina propria and play a key role in the disease progression. Current therapy is restricted to symptomatic treatment. Hence, there is an urgent need for a better understanding of the molecular causes of the disease. In the present study, we investigated differential expression profiles of RE and control VFF by means of RNA sequencing. In addition, fast gene set enrichment analysis (FGSEA) was performed in order to obtain involved biological processes, mRNA and protein levels of targets of interest were further evaluated. We identified 74 differentially regulated genes in total, 19 of which were upregulated and 55 downregulated. Differential expression analysis and FGSEA revealed upregulated genes and pathways involved in extracellular matrix (ECM) remodeling, inflammation and fibrosis. Downregulated genes and pathways were involved in ECM degradation, cell cycle control and proliferation. The current study addressed for the first time a direct comparison of VFF from RE to control and evaluated immediate functional consequences.
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Affiliation(s)
- Magdalena Grill
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
| | - Isaac Lazzeri
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, 8010 Graz, Austria; (I.L.); (E.H.)
| | - Andrijana Kirsch
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
- Correspondence:
| | - Nina Steurer
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
| | - Tanja Grossmann
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
| | - Michael Karbiener
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
- Global Pathogen Safety, Baxter AG, (part of Takeda), 1220 Vienna, Austria
| | - Ellen Heitzer
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, 8010 Graz, Austria; (I.L.); (E.H.)
| | - Markus Gugatschka
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, 8036 Graz, Austria; (M.G.); (N.S.); (T.G.); (M.K.); (M.G.)
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11
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[Molecular laryngology : A new chapter in the understanding of laryngeal diseases]. HNO 2021; 69:695-704. [PMID: 33822268 PMCID: PMC8413179 DOI: 10.1007/s00106-021-01016-1] [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] [Accepted: 01/05/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Despite considerable advances in laryngological research, there is still a plethora of (benign) vocal fold pathologies that cannot be treated causally. This is due to the limited accessibility and sensitive microarchitecture of the vocal folds, which cannot be investigated at a cellular level. Consequently, current pathophysiological knowledge is frequently based on macroscopic findings. The impact of interventions is mainly evaluated endoscopically or via indirect diagnostic methods. OBJECTIVE The aim of this article is to discuss state-of-the-art biotechnological methods used in laryngological research, illustrated by practical examples. RESULTS In recent years, animal and in vitro experiments have significantly contributed to a continuous expansion of knowledge in this field, particularly regarding vocal fold inflammation and scar formation. Vocal fold fibroblasts, the most important cellular component of the lamina propria, can be accredited a central role in these processes. CONCLUSION Our knowledge regarding macroanatomy and macropathophysiology of several pathologies has increased considerably in recent years. In vitro trials have shown, e.g., that vocal fold fibroblasts in an inflammatory setting secrete less profibrotic and proinflammatory cytokines when exposed to vibration. Early vocal exercises after surgical interventions on the vocal folds may therefore promote better wound healing and consequently improved phonation. Research in molecular laryngology should create a solid basis of knowledge for subsequent clinical studies.
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Hortobagyi D, Grossmann T, Tschernitz M, Grill M, Kirsch A, Gerstenberger C, Gugatschka M. In vitro mechanical vibration down-regulates pro-inflammatory and pro-fibrotic signaling in human vocal fold fibroblasts. PLoS One 2020; 15:e0241901. [PMID: 33211714 PMCID: PMC7676657 DOI: 10.1371/journal.pone.0241901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/22/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Voice rest following phonotrauma or phonosurgery has a considerable clinical impact, but clinical recommendations are inconsistent due to inconclusive data. As biopsies of the vocal folds (VF) for molecular biology studies in humans are unethical, we established a new in vitro model to explore the effects of vibration on human vocal fold fibroblasts (hVFF) in an inflammatory and normal state, which is based on previously published models. METHODS By using a phonomimetic bioreactor we were able to apply predefined vibrational stress patterns on hVFF cultured under inflammatory or normal conditions. Inflammatory and pro-fibrotic stimuli were induced by interleukin (IL)1β and transforming growth factor (TGF)β1, respectively. Mechanical stimulation was applied four hours daily, over a period of 72 hours. Outcome measurements comprised assessment of extracellular matrix (ECM)-related components, angiogenic factors, and inflammatory and fibrogenic markers on gene expression and protein levels. RESULTS Under inflammatory conditions, the inflammatory cytokine IL11, as well as the myofibroblast marker alpha smooth muscle actin (α-SMA) were significantly reduced when additional vibration was applied. The desirable anti-fibrotic ECM component hyaluronic acid was increased following cytokine treatment, but was not diminished following vibration. CONCLUSION Our experiments revealed the effect of vibrational stress on hVFF in an inflammatory state. Elevated levels of certain pro-inflammatory/pro-fibrotic factors could be mitigated by additional vibrational excitation in an in vitro setting. These findings corroborate clinical studies which recommend early voice activation following an acute event.
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Affiliation(s)
- David Hortobagyi
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Tanja Grossmann
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | | | - Magdalena Grill
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Andrijana Kirsch
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
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