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Kojima K, Katsuno T, Kishimoto Y, Mizuta M, Nakamura R, Ohnishi H, Yamada K, Kawai Y, Tateya I, Omori K. In vitro model to evaluate effect of acidic pepsin on vocal fold barrier function. Biochem Biophys Res Commun 2024; 732:150401. [PMID: 39033554 DOI: 10.1016/j.bbrc.2024.150401] [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: 04/27/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
The pathophysiology of laryngopharyngeal reflux (LPR) and its impact on the vocal fold is not well understood, but may involve acid damage to vocal fold barrier functions. Two different components encompass vocal fold barrier function: the mucus barrier and tight junctions. Mucus retained on epithelial microprojections protects the inside of the vocal fold by neutralizing acidic damage. Tight junctions control permeability between cells. Here we developed an in vitro experimental system to evaluate acidic injury and repair of vocal fold barrier functions. We first established an in vitro model of rat vocal fold epithelium that could survive at least one week after barrier function maturation. The model enabled repeated evaluation of the course of vocal fold repair processes. Then, an injury experiment was conducted in which vocal fold cells were exposed to a 5-min treatment with acidic pepsin that injured tight junctions and cell surface microprojections. Both of them healed within one day of injury. Comparing vocal fold cells treated with acid alone with cells treated with acidic pepsin showed that acidic pepsin had a stronger effect on intercellular permeability than acid alone, whereas pepsin had little effect on microprojections. This result suggests that the proteolytic action of pepsin has a larger effect on protein-based tight junctions than on phospholipids in microprojections. This experimental system could contribute to a better understanding of vocal fold repair processes after chemical or physical injuries, as well as voice problems due to LPR pathogenesis.
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Affiliation(s)
| | - Tatsuya Katsuno
- Center of Anatomical, Pathological and Forensic Medical Researches, Graduate School of Medicine, Kyoto University, Japan
| | - Yo Kishimoto
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan.
| | | | - Ryosuke Nakamura
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, USA
| | - Hiroe Ohnishi
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Koichiro Yamada
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Ichiro Tateya
- Department of Otorhinolaryngology, Fujita Health University, Japan
| | - Koichi Omori
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
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Bailey TW, do Nascimento NC, Santos AP, Cox A, Sivasankar MP. Impact of Rehydration Following Systemic Dehydration on Vocal Fold Gene Expression. Laryngoscope 2023; 133:3499-3505. [PMID: 37345579 PMCID: PMC10739564 DOI: 10.1002/lary.30840] [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: 02/13/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Biological data on the beneficial effects of vocal fold rehydration are lacking. This study aimed to examine the effects of acute systemic dehydration on vocal fold gene expression and determine whether rehydration would reverse these changes. METHODS Male New Zealand White rabbits (N = 24, n = 8/group) provided the animal model. Systemic dehydration was induced by 5 days of water volume restriction. Rehydration was provided by ad-lib water for 3 days following dehydration. Euhydrated rabbits were used as the control group. Vocal fold tissue was dissected. Seventeen genes were selected based on physiological function and role in supporting vocal fold structure, oxidative stress, hemodynamics, and extracellular matrix turnover. Relative gene expression was assessed by RT-qPCR. RESULTS Rehydration following systemic dehydration can modulate gene expression, with expression patterns suggesting that rehydration reverses dehydration-induced changes in over half of the tested genes. CLIC5 (chloride intracellular channel 5) and EFEMP1 (EGF containing fibulin extracellular matrix protein 1) genes were significantly upregulated in the dehydration group compared with the euhydrated control. A1BG (alpha-1B-glycoprotein) and IL1RAP (interleukin 1 receptor accessory protein) were downregulated by rehydration compared with the dehydration group. CONCLUSION This study provides molecular evidence for a transcriptional response to rehydration following acute systemic dehydration in the vocal folds. These data are the first to study gene expression following realistic dehydration and rehydration paradigms and provide biological data to support clinical recommendations to increase water intake after acute dehydration. LEVEL OF EVIDENCE NA Laryngoscope, 133:3499-3505, 2023.
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Affiliation(s)
- Taylor W Bailey
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | | | - Andrea P Santos
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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Venkatraman A, Fujiki RB, Sivasankar MP. A Review of Factors Associated with Voice Problems in the Fitness Instructor Population. J Voice 2023; 37:805.e13-805.e17. [PMID: 34154914 DOI: 10.1016/j.jvoice.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
There is a high prevalence of reported dysphonia symptomology in the fitness instructor population. This is concerning as these reported symptoms of dysphonia, aphonia, and vocal fatigue can significantly compromise quality of life. The purpose of this review is to explore key factors that may contribute to voice problems in the fitness instructor population. Voicing with concurrent phonation and exercise may be influenced by (1) the increased cardiovascular requirement during exercise, (2) the increased cognitive load associated with dual tasking, (3) the altered hydration state associated with prolonged exercise, and (4) the phonatory dose associated with continued voicing with loud background music. This manuscript will explore the literature on these key factors (ie, phonatory dose, dehydration, metabolic bioenergetics, cognitive load, and psychosocial stress) as they pertain to fitness instructors.
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Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA.
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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Duan C, Jimenez JM, Goergen C, Cox A, Sivasankar PM, Calve S. Hydration State and Hyaluronidase Treatment Significantly Affect Porcine Vocal Fold Biomechanics. J Voice 2023; 37:348-354. [PMID: 33541766 PMCID: PMC8325720 DOI: 10.1016/j.jvoice.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The understanding of vocal fold hydration state, including dehydrated, euhydrated, rehydrated tissue, and how hydration affects vocal fold biomechanical properties is still evolving. Although clinical observations support the benefits of increasing vocal fold hydration after dehydrating events, more mechanistic information on the effects of vocal fold dehydration and the beneficial effects of rehydration are needed. Alterations to hyaluronic acid (HA), an important component of the vocal fold extracellular matrix, are likely to influence the biomechanical properties of vocal folds. In this study, we investigated the influence of hydration state and HA on vocal fold tissue stiffness via biomechanical testing. STUDY DESIGN Prospective, ex vivo study design. METHODS Fresh porcine vocal folds (N = 18) were examined following sequential immersion in hypertonic (dehydration) and isotonic solutions (rehydration). In a separate experiment, vocal folds were incubated in hyaluronidase (Hyal) to remove HA. Control tissues were not exposed to any challenges. A custom micromechanical system with a microforce sensing probe was used to measure the force-displacement response. Optical strain was calculated, and ultrasound imaging was used to measure tissue cross-sectional area to obtain stress-strain curves. RESULTS Significant increases (P ≤ 0.05) were found in tangent moduli between dehydrated and rehydrated vocal folds at strains of ε = 0.15. The tangent moduli of Hyal-digested tissues significantly increased at both ε = 0.15 and 0.3 (P ≤ 0.05). CONCLUSION Vocal fold dehydration increased tissue stiffness and rehydration reduced the stiffness. Loss of HA increased vocal fold stiffness, suggesting a potential mechanical role for HA in euhydrated vocal folds.
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Affiliation(s)
- Chenwei Duan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Julian M Jimenez
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado
| | - Craig Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana
| | - Preeti M Sivasankar
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Sarah Calve
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado.
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Bailey TW, do Nascimento NC, Dos Santos AP, Sivasankar MP, Cox A. Comparative proteomic changes in rabbit vocal folds undergoing systemic dehydration and systemic rehydration. J Proteomics 2023; 270:104734. [PMID: 36174951 PMCID: PMC9851386 DOI: 10.1016/j.jprot.2022.104734] [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: 07/27/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A considerable body of clinical evidence suggests that systemic dehydration can negatively affect voice production, leading to the common recommendation to rehydrate. Evidence for the corrective benefits of rehydration, however, is limited with mixed conclusions, and biological data on the underlying tissue changes with rehydration is lacking. In this study, we used a rabbit model (n = 24) of acute (5 days) water restriction-induced systemic dehydration with subsequent rehydration (3 days) to explore the protein-level changes underlying the molecular transition from euhydration to dehydration and following rehydration using LC-MS/MS protein quantification in the vocal folds. We show that 5-day water restriction led to an average 4.3% decrease in body weight with relative increases in anion gap, Cl-, creatinine, Na+, and relative decreases in BUN, iCa2+, K+, and tCO2 compared to control (euhydrated) animals. A total of 309 differentially regulated (p < 0.05) proteins were identified between the Control and Dehydration groups. We observed a noteworthy similarity between the Dehydration and Rehydration groups, both well differentiated from the Control group, highlighting the distinct timelines of resolution of the clinical symptoms of systemic dehydration and the underlying molecular changes. SIGNIFICANCE Voice disorders are a ubiquitous problem with considerable economic and psychological impact. Maintenance of proper hydration is commonly prescribed as a general vocal hygiene practice. There is evidence that dehydration negatively impacts phonation, but our understanding of the state of vocal folds in the context of systemic dehydration are limited, particular from a molecular perspective. Further, ours is a novel molecular study of the short-term impact of rehydration on the tissue. Given the relatively minimal difference in vocal fold proteomic profiles between the Dehydration and Rehydration groups, our data demonstrate a complex physiological response to acute systemic dehydration, and highlight the importance of considering persistent underlying molecular pathology despite the rapid resolution of clinical measures. This study sets a foundation for future research to confirm the nature of potential beneficial outcomes of clinical recommendations related to hydration.
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Affiliation(s)
- Taylor W Bailey
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America
| | - Naila Cannes do Nascimento
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Andrea Pires Dos Santos
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States of America.
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do Nascimento NC, Bailey TW, Santos AP, Duan C, Mohallem R, Franco J, Aryal UK, Xie J, Cox A, Sivasankar MP. Proteomic analysis reveals that aging rabbit vocal folds are more vulnerable to changes caused by systemic dehydration. BMC Genomics 2022; 23:762. [PMID: 36411412 PMCID: PMC9677652 DOI: 10.1186/s12864-022-08975-x] [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: 07/01/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Older adults are more prone to develop systemic dehydration. Systemic dehydration has implications for vocal fold biology by affecting gene and protein expression. The objective of this study was to quantify vocal fold protein changes between two age groups and hydration status, and to investigate the interaction of age and hydration status on protein expression, which has not been investigated in the context of vocal folds before. Comparative proteomics was used to analyze the vocal fold proteome of 6.5-month-old and > 3-year-old rabbits subjected to water ad libitum or water volume restriction protocol. RESULTS Young and older adult rabbits (n = 22) were either euhydrated (water ad libitum) or dehydrated by water volume restriction. Dehydration was confirmed by body weight loss of - 5.4% and - 4.6% in young and older groups, respectively, and a 1.7-fold increase of kidney renin gene expression in the young rabbits. LC-MS/MS identified 2286 proteins in the rabbit vocal folds of young and older adult rabbits combined. Of these, 177, 169, and 81 proteins were significantly (p ≤ 0.05) affected by age, hydration status, or the interaction of both factors, respectively. Analysis of the interaction effect revealed 32 proteins with opposite change patterns after dehydration between older and young rabbit vocal folds, while 31 proteins were differentially regulated only in the older adult rabbits and ten only in the young rabbits in response to systemic dehydration. The magnitude of changes for either up or downregulated proteins was higher in the older rabbits. These proteins are predominantly related to structural components of the extracellular matrix and muscle layer, suggesting a disturbance in the viscoelastic properties of aging vocal fold tissue, especially when subjected to systemic dehydration. CONCLUSIONS Water restriction is a laboratory protocol to assess systemic dehydration-related changes in the vocal fold tissue that is translatable to human subjects. Our findings showed a higher number of proteins differentially regulated with a greater magnitude of change in the vocal folds of older adult rabbits in the presence of systemic dehydration compared to younger rabbits. The association of these proteins with vocal fold structure and biomechanical properties suggests that older human subjects may be more vulnerable to the effects of systemic dehydration on vocal function. The clinical implications of these protein changes warrant more investigation, but age should be taken into consideration when evaluating vocal treatment recommendations that interfere with body fluid balance.
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Affiliation(s)
- Naila C. do Nascimento
- grid.169077.e0000 0004 1937 2197Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Taylor W. Bailey
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Andrea P. Santos
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Chenwei Duan
- grid.169077.e0000 0004 1937 2197Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Rodrigo Mohallem
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA ,grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Jackeline Franco
- grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Uma K. Aryal
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA ,grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Jun Xie
- grid.169077.e0000 0004 1937 2197Department of Statistics, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Abigail Cox
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - M. Preeti Sivasankar
- grid.169077.e0000 0004 1937 2197Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, 47907 USA
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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.
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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
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Recurring exposure to low humidity induces transcriptional and protein level changes in the vocal folds of rabbits. Sci Rep 2021; 11:24180. [PMID: 34921171 PMCID: PMC8683398 DOI: 10.1038/s41598-021-03489-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Voice disorders are an important human health condition. Hydration is a commonly recommended preventive measure for voice disorders though it is unclear how vocal fold dehydration is harmful at the cellular level. Airway surface dehydration can result from exposure to low humidity air. Here we have induced airway surface dehydration in New Zealand White rabbits exposed to a recurring 8-h low humidity environment over 15 days. This model mimics an occupational exposure to a low humidity environment. Exposure to moderate humidity was the control condition. Full thickness soft-tissue samples, including the vocal folds and surrounding laryngeal tissue, were collected for molecular analysis. RT-qPCR demonstrated a significant upregulation of MUC4 (mucin 4) and SCL26A9 (chloride channel) and a large fold-change though statistically non-significant upregulation of SCNNA1 (epithelial sodium channel). Proteomic analysis demonstrated differential regulation of proteins clustering into prospective functional groups of muscle structure and function, oxidative stress response, and protein chaperonin stress response. Together, the data demonstrate that recurring exposure to low humidity is sufficient to induce both transcriptional and translational level changes in laryngeal tissue and suggest that low humidity exposure induces cellular stress at the level of the vocal folds.
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