1
|
King SN, Kuntz A, Scott N, Smiley B, Portocarrero Bonifaz A, Blackburn M. Chemoradiation to the submental muscles alters hyoid movement during swallowing in a rat model. J Appl Physiol (1985) 2024; 136:1076-1086. [PMID: 38482576 DOI: 10.1152/japplphysiol.00538.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 04/30/2024] Open
Abstract
Hyolaryngeal dysfunction is a commonly reported swallowing problem after chemoradiation treatment for head and neck cancer. The displacement of the hyolaryngeal complex during swallowing protects the airway and assists in opening the upper esophageal sphincter. Activation of the submental muscles, specifically the mylohyoid and geniohyoid muscles, is thought to facilitate movement of the hyoid. The purpose of this study was to determine if targeted radiation to the submental muscles given concurrently with chemotherapy alters hyolaryngeal displacement 1 mo after treatment. We hypothesized that chemoradiation treatment would result in abnormal patterns of hyoid movement compared with controls. Furthermore, we propose that these changes are associated with alterations in bolus size and discoordination of the jaw during drinking. Eighteen rats underwent either chemoradiation, radiation, or no treatment. Radiation treatment was targeted to submental muscles using a clinical linear accelerator given in 12 fractions of 4 Gy (3 days per week). Cycles of 1 mg/kg of cisplatin were administered concurrently each week of radiation. One month posttreatment, videofluoroscopy swallow studies (VFSS) were performed in self-drinking rats using a fluoroscope customized with a high-speed camera. The hyoid, jaw, and hard palate were tracked during swallowing from VFSS. Hyoid kinematics were analyzed from the start to the end of hyoid movement, and parameters were compared with bolus size and jaw movement. Significant differences in hyoid retraction parameters were found postchemoradiation. Alterations in the trajectory of hyoid motion during swallowing were observed. The findings demonstrate early changes in hyoid motion during swallowing associated with chemoradiation treatment.NEW & NOTEWORTHY Chemoradiation treatment for head and neck cancer can cause functional impairments in swallowing, which can adversely affect quality of life. This study provides new evidence that chemoradiation targeted to the submental muscles provokes early adaptations in hyoid movement during swallowing, which correlate with changes in bolus size. We also demonstrate a method for tracking the hyoid during swallowing in a rat model of chemoradiation injury.
Collapse
Affiliation(s)
- Suzanne N King
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Abigail Kuntz
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Nathan Scott
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Brittany Smiley
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Andres Portocarrero Bonifaz
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Megan Blackburn
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| |
Collapse
|
2
|
Soejima S, Wu CH, Matsuse H, Terakado M, Okano S, Inoue T, Kumai Y. Swallowing-related muscle inflammation and fibrosis induced by a single dose of radiation exposure in mice. Lab Anim Res 2024; 40:12. [PMID: 38561867 PMCID: PMC10983736 DOI: 10.1186/s42826-024-00199-2] [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: 10/18/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Although radiotherapy is commonly used to treat head and neck cancer, it may lead to radiation-associated dysphagia (RAD). There are various causes of RAD, however, the mechanism has not yet been fully identified. Currently, the only effective treatment for RAD is rehabilitation. Additionally, there are few available animal models of RAD, necessitating the development of new models to establish and evaluate RAD treatments. We hypothesize that radiation-induced neck muscle fibrosis could be one of the causes of RAD due to impairment of laryngeal elevation. Therefore, in this study, we focused on the changes in inflammation and fibrosis of the strap muscles (Sternohyoid, Sternothyroid, and Thyrohyoid muscles) after a single-dose irradiation. This research aims to provide a reference animal model for future studies on RAD. RESULTS Compared to control mice, those treated with 72-Gy, but not 24-Gy, irradiation had significantly increased tumor necrosis factor-α (TNF-α) (p < 0.01) and α-smooth muscle actin (αSMA) (p < 0.05) expression at 10 days and significantly increased expression levels of motif chemokine ligand-2 (CCL2), α-SMA, tumor growth factor-β1 (TGF-β1), type1 collagen, and interleukin-1β (IL-1β) (p < 0.05) in the muscles at 1 month by real-time PCR analysis. The results of immunohistochemistry showed that the deposition of type 1 collagen gradually increased in extracellular space after radiation exposure, and the positive area was significantly increased at 3 months compared to non-irradiated control. CONCLUSIONS A single dose of 72-Gy irradiation induced significant inflammation and fibrosis in the strap muscles of mice at 1 month, with immunohistochemical changes becoming evident at 3 months. This cervical irradiation-induced fibrosis model holds potential for establishing an animal model for RAD in future studies. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Shuntaro Soejima
- Department of Otolaryngology Head and Neck Surgery Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Chia-Hsien Wu
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Haruna Matsuse
- Department of Otolaryngology Head and Neck Surgery Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Mariko Terakado
- Department of Otolaryngology Head and Neck Surgery Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shinji Okano
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Inoue
- Department of Physiology of Visceral Function and Body Fluid, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology Head and Neck Surgery Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| |
Collapse
|
3
|
King SN, Kaissieh N, Haxton C, Shojaei M, Malott L, Devara L, Thompson R, Osman KL, Millward J, Blackburn M, Lever TE. Radiation induced changes in profibrotic markers in the submental muscles and their correlation with tongue movement. PLoS One 2023; 18:e0287044. [PMID: 37352202 PMCID: PMC10289304 DOI: 10.1371/journal.pone.0287044] [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: 11/04/2022] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
Swallowing impairment is a major complication of radiation treatment for oropharyngeal cancers. Developing targeted therapies that improve swallowing outcomes relies on an understanding of the mechanisms that influence motor function after radiation treatment. The purpose of this study was to determine whether there is a correlation between radiation induced changes in tongue movement and structural changes in irradiated submental muscles, as well as assess other possible causes for dysfunction. We hypothesized that a clinically relevant total radiation dose to the submental muscles would result in: a) quantifiable changes in tongue strength and displacement during drinking two months post treatment; and b) a profibrotic response and/or fiber type transition in the irradiated tissue. Sprague-Dawley adult male rats received radiation to the submental muscles at total dose-volumes known to provoke dysphagia in humans. A clinical linear accelerator administered 8 fractions of 8Gy for a total of 64Gy. Comparisons were made to sham-treated rats that received anesthesia only. Swallowing function was assessed using videofluoroscopy and tongue strength was analyzed via force lickometer. TGFβ1 expression was analyzed via ELISA. The amount of total collagen was analyzed by picrosirius red staining. Immunofluorescence was used to assess fiber type composition and size. Significant changes in licking function during drinking were observed at two months post treatment, including a slower lick rate and reduced tongue protrusion during licking. In the mylohyoid muscle, significant increases in TGFβ1 protein expression were found post radiation. Significant increases in the percentage of collagen content were observed in the irradiated geniohyoid muscle. No changes in fiber type expression were observed. Results indicate a profibrotic transition within the irradiated swallowing muscles that contributes to tongue dysfunction post-radiation treatment.
Collapse
Affiliation(s)
- Suzanne N. King
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Nada Kaissieh
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Chandler Haxton
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Marjan Shojaei
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Luke Malott
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Lekha Devara
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Rebecca Thompson
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Kate L. Osman
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Jessica Millward
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Megan Blackburn
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Teresa E. Lever
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| |
Collapse
|
4
|
King SN, Greenwell E, Kaissieh N, Devara L, Carter Z, Fox J, Blackburn M. Acute effects of radiation treatment to submental muscles on burrowing and swallowing behaviors in a rat model. PLoS One 2022; 17:e0268457. [PMID: 35560040 PMCID: PMC9106154 DOI: 10.1371/journal.pone.0268457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
Swallowing impairments are a major complication of radiation treatment for oropharyngeal cancers, influencing oral intake and quality of life. The timing and functional consequences of radiation treatment on the swallowing process is not clearly understood. A rodent radiation injury model was used to investigate the onset of oral and pharyngeal dysfunctions in deglutition related to radiation treatment. This study tested the hypothesis that (Wall et al., 2013) alterations in normal biting, licking, and swallowing performance would be measurable following 64Gy of fractionated radiation to the submental muscles; and (Kotz et al., 2004) radiation will affect the animal’s general well-being as measured via burrowing activity. Seven rats received radiation using a clinical linear accelerator given in 8 fractions of 8Gy and another seven animals received sham anesthesia only treatment. Swallowing bolus transit/size was assessed via videofluoroscopy, tongue movement during drinking was measured via an electrical lick sensor, and biting was analyzed from acoustic recordings of a vermicelli pasta test. Burrowing activity was measured by the amount of gravel substrate displaced within a container. Measurements were taken at baseline, during treatment (1–4 weeks), and after completion of treatment (weeks 5 & 6). Decreases in licking frequency and increases in inter-lick interval were observed 5- and 6-weeks post-treatment. Significant decreases in burrowing performance, swallowing frequency, and inter-swallow interval were observed starting the last week of treatment and continuing up to 2-weeks after completion. Results suggest that tongue dysfunction is one of the first treatment related feeding problems to present immediately after the completion of radiation to the submental muscles.
Collapse
Affiliation(s)
- Suzanne N. King
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
| | - Evan Greenwell
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Nada Kaissieh
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Lekha Devara
- School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Zachary Carter
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, United States of America
| | - James Fox
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, United States of America
| | - Megan Blackburn
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky, United States of America
| |
Collapse
|
5
|
Zeng X, Xie L, Ge Y, Zhou Y, Wang H, Chen Y, Zhu X, Liu H, Liao Q, Kong Y, Pan L, Li J, Xue L, Li S, Zhou X, Shi C, Sheng X. Satellite Cells are Activated in a Rat Model of Radiation-Induced Muscle Fibrosis. Radiat Res 2022; 197:638-649. [PMID: 35294551 DOI: 10.1667/rade-21-00183.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
Radiation-induced muscle fibrosis is a long-term side effect of radiotherapy that significantly affects the quality of life and even reduces the survival of cancer patients. We have demonstrated that radiation induces satellite cell (SC) activation at the molecular level; however, cellular evidence in a rat model of radiation-induced muscle fibrosis was lacking. In this study, we evaluated SC activation in vivo and investigated whether radiation affects the proliferation and differentiation potential of SCs in vitro. For in vivo studies, Sprague-Dawley rats were randomly divided into six groups (n = 6 per group): non-irradiated controls, 90 Gy/1 week-, 90 Gy/2 weeks-, 90 Gy/4 weeks-, 90 Gy/12 weeks- and 90 Gy/24 weeks-postirradiation groups. Rats received a single dose of radiation in the left groin area and rectus femoris tissues were collected in the indicated weeks. Fibrosis, apoptosis, and autophagy were evaluated by Masson's trichrome staining, TUNEL staining, and electron microscopy, respectively. SC activation and central nuclear muscle fibers were evaluated by immunofluorescence staining and hematoxylin and eosin staining. IL-1β concentrations in serum and irradiated muscle tissue samples were determined by ELISA. For in vitro studies, SCs were isolated from rats with radiation-induced muscle fibrosis and their proliferation and differentiation were evaluated by immunofluorescence staining. In vivo, fibrosis increased over time postirradiation. Apoptosis and autophagy levels, IL-1β concentrations in serum and irradiated skin tissues, and the numbers of SCs and central nuclear muscle fibers were increased in the irradiated groups when compared with the control group. In vitro, cultured SCs from irradiated muscle were positive for the proliferation marker Pax7, and differentiated SCs were positive for the myogenic differentiation marker MyHC. This study provided cellular evidence of SC activation and proliferation in rats with radiation-induced muscle fibrosis.
Collapse
Affiliation(s)
- Xiaoling Zeng
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Luyuan Xie
- Changsha Medical University, Changsha, Hunan Province, China
| | - Yuxin Ge
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Yue Zhou
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Hui Wang
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Yongyi Chen
- Nursing Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Xiaomei Zhu
- Nursing Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Huayun Liu
- Nursing Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Qianjin Liao
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Yu Kong
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Lijun Pan
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Junjun Li
- Pathology Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Lei Xue
- Pathology Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Sha Li
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Xiao Zhou
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Chunmeng Shi
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, China
| | - Xiaowu Sheng
- Graduate Collaborative Training of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Department of Head and Neck Surgery, Central laboratory, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| |
Collapse
|
6
|
King SN, Hurley J, Carter Z, Bonomo N, Wang B, Dunlap N, Petruska J. Swallowing dysfunction following radiation to the rat mylohyoid muscle is associated with sensory neuron injury. J Appl Physiol (1985) 2021; 130:1274-1285. [PMID: 33600281 DOI: 10.1152/japplphysiol.00664.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Radiation-based treatments for oropharyngeal and hypopharyngeal cancers result in impairments in swallowing mobility, but the mechanisms behind the dysfunction are not clear. The purpose of this study was to determine if we could establish an animal model of radiation-induced dysphagia in which mechanisms could be examined. We hypothesized that 1) radiation focused at the depth of the mylohyoid muscle would alter normal bolus transport and bolus size and 2) radiation to the mylohyoid muscle will induce an injury/stress-like response in trigeminal sensory neurons whose input might modulate swallow. Rats were exposed to 48 or 64 Gy of radiation to the mylohyoid given 8 Gy in 6 or 8 fractions. Swallowing function was evaluated by videofluoroscopy 2 and 4 wk following treatment. Neuronal injury/stress was analyzed in trigeminal ganglion by assessing activating transcription factor (ATF)3 and GAP-43 mRNAs at 2, 4, and 8 wk post treatment. Irradiated rats exhibited decreases in bolus movement through the pharynx and alterations in bolus clearance. In addition, ATF3 and GAP-43 mRNAs were upregulated in trigeminal ganglion in irradiated rats, suggesting that radiation to mylohyoid muscle induced an injury/stress response in neurons with cell bodies that are remote from the irradiated tissue. These results suggest that radiation-induced dysphagia can be assessed in the rat and radiation induces injury/stress-like responses in sensory neurons.NEW & NOTEWORTHY Radiation-based treatments for head and neck cancer can cause significant impairments in swallowing mobility. This study provides new evidence supporting the possibility of a neural contribution to the mechanisms of swallowing dysfunction in postradiation dysphagia. Our data demonstrated that radiation to the mylohyoid muscle, which induces functional deficits in swallowing, also provokes an injury/stress-like response in the ganglion, innervating the irradiated muscle.
Collapse
Affiliation(s)
- Suzanne N King
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky
| | - Justin Hurley
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Zachary Carter
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Nicholas Bonomo
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Brian Wang
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Jeffrey Petruska
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| |
Collapse
|