Positive therapy of andrographolide in vocal fold leukoplakia

Effects of vocal fold lesions on particle deposition in a mouth-throat model: A numerical study

OBJECTIVE

Dysphonia is very common worldwide and aerosol drug inhalation is an important treatment for patients with dysphonia. This study aimed to explore the effects of vocal fold (VF) lesions on the particle deposition pattern using computational modeling.

METHODS

A realistic mouth-throat (MT) model of a healthy adult was constructed based on computed tomography images. Small and large vocal fold lesions were incorporated in the original model. A steady inhalation flowrate of 15 and 30 liter per minute (LPM) was used as the velocity inlet and monodisperse particles with diameters of 5 to 10 µm were simulated.

RESULTS

Particles of larger size are more likely to be deposited in MT models, most of them distributed in oral cavity, oropharynx and supraglottis. The ideal sizes at 30 LPM ranged over 7-10 µm for healthy VFs and 6-8 µm for VF lesions. The best sizes at 15 LPM ranged over 6-8 µm for healthy VFs and 8-9 µm for VF lesions.

CONCLUSION

Based on this study, VF lesions influence the deposition pattern in the glottis obviously. The ideal sizes differ at the flow rates of 15 and 30 LPM.

Biomarkers for Malignant Potential in Vocal Fold Leukoplakia: A State of the Art Review

OBJECTIVE

To explore biomarkers that are candidates for understanding potential degeneration to malignancy of vocal fold leukoplakia (VFL), with the goal of guiding future diagnostic and treatment recommendations.

DATA SOURCES

PubMed and Medline search engines.

REVIEW METHODS

A systematic review was conducted by searching the following key words: vocal fold or laryngeal, coupled with leukoplakia or dysplasia, and combined with the term prognostic markers. We collated the biomarkers and their significance, followed by observing the power of their evidence by assessing the quality of the studies according to guidelines of tumor marker prognostic studies (REMARK).

CONCLUSIONS

Prognostic biomarkers in the 16 studies are generally divided into 3 categories according to their biological roles: proliferation (Ki-67, CK-1 RS14024 SNP), cell cycle control (P53, p16, cyclin D1, p57kip2, interleukin-10 [IL-10], miR-10a, and miR-34c), cell adhesion, and invasion (neutrophil-to-lymphocyte ratio, OPN/CD44v6 axis, MMP-1, vascular endothelial growth factor A, MMP-9, serpin peptidase inhibitor 1, plasminogen activator, CTNN/B1, β-catenin, NANOG, HERG1). The prognostic use of these biomarkers is limited due to the variable methodologies, study design, assay methods, and statistical analysis performed.

IMPLICATIONS FOR PRACTICE

Prognostic factors in vocal fold leukoplakia have important clinical implications regarding the potential for malignant degeneration. Although further study is needed, the currently available evidence suggests that p53, p16, cyclin D1, IL-10, NLR, OPN and CD44v6, CTNNB1, and CTTN and FAK might be of particular interest in determining prognosis of VFL as related to malignancy. Future, large, well-designed, prospective studies are expected to determine the prognostic power of these biomarkers before their implementation in routine clinical practice.

Andrographolide sensitizes Hep-2 human laryngeal cancer cells to carboplatin-induced apoptosis by increasing reactive oxygen species levels

Andrographolide is a natural diterpenoid from Andrographis paniculata that has been proposed as an anticancer agent as well as a chemosensitizer for use in combination with anticancer drugs. Carboplatin is the first-line chemotherapeutic agent for advanced laryngeal carcinoma. However, the clinical efficacy of carboplatin is limited by drug resistance and side effects. The aim of this study was to investigate whether andrographolide has a synergistic antitumor effect with carboplatin on human laryngeal cancer cells. Hep-2 cells were exposed to andrographolide with or without carboplatin. The effects of indicated therapies were examined using the Cell Counting Kit-8 assay, the colony-forming assay, the Hoechst 33342/PI double staining, and flow cytometry analysis. The molecular mechanism was assessed by reactive oxygen species (ROS) detection and western blot. At the sublethal concentration, andrographolide increased carboplatin sensitivity of Hep-2 cells by increasing carboplatin-induced apoptosis and inhibiting cell viability. Moreover, we found that andrographolide sensitized carboplatin mainly through the induction of ROS generation and apoptotic signaling. Taken together, these results indicate that andrographolide, along with carboplatin, synergistically inhibited cell proliferation and induced mitochondrial apoptosis of Hep-2 cells by increasing the intracellular ROS, regulating the mitogen-activated protein kinase and phosphatidylinositol 3-kinase (PI3K/AKT) pathways, altering the BCL2/BAX ratio, and ultimately activating the cleavage of Caspase-3 and PARP. These results suggest that andrographolide sensitizes human laryngeal cancer cells to carboplatin-induced apoptosis by increasing ROS levels.

Andrographolide, a diterpene lactone from Andrographis paniculata and its therapeutic promises in cancer

The diterpene lactone andrographolide, isolated from Andrographis paniculata, has been proven to possess several important protective biological activities, including antioxidant, anti-inflammatory, immunomodulatory, antiseptic, antimicrobial, cytotoxic, hypolipidemic, cardioprotective, hepatoprotective, and neuroprotective effects. In addition, it has been reported to play a therapeutic role in the treatment of major human diseases, such as Parkinson's disease, rheumatoid arthritis, and colitis. This systematic review aims to highlight andrographolide as a promising agent in cancer treatment. To this purpose, a number of databases were used to search for the cytotoxic/anticancer effects of andrographolide in pre-clinical and clinical studies. Among 1703 identified literature articles, 139 were included in this review; 109 were investigated as non-clinical, whereas 24, 3, and 3 were pre-clinical, clinical, and non-pre-clinical trials, respectively. Among the model systems, cultured cell lines appeared as the most frequently (79.14%) used, followed by in vivo models using rodents, among others. Furthermore, andrographolide was found to exert cytotoxic/anticancer effects on almost all types of cell lines with the underlying mechanisms involving oxidative stress, cell cycle arrest, anti-inflammatory and immune system mediated effects, apoptosis, necrosis, autophagy, inhibition of cell adhesion, proliferation, migration, invasion, anti-angiogenic activity, and other miscellaneous actions. After careful consideration of the relevant evidence, we suggest that andrographolide can be one of the potential agents in the treatment of cancer in the near future.

Nonsurgical Treatment for Vocal Fold Leukoplakia: An Analysis of 178 Cases

OBJECTIVE

To assess the effectiveness and identify vocal fold leukoplakia types appropriate for nonsurgical treatment.

METHODS

The vocal fold leukoplakia in 178 patients was divided by gross appearance into three subtypes: flat and smooth, elevated and smooth, and rough. All patients received nonsurgical treatment including smoking and drinking cessation, voice rest, omeprazole, and Chinese medication therapy. The clinical response of three subtypes was assessed after a 6-month follow-up.

RESULTS

Vocal fold leukoplakia subtypes included flat and smooth (n = 66; 37.1%), elevated and smooth (n = 103; 57.9%), and rough (n = 9; 5.0%). The rate of complete response was 80.3%, 66.0%, and 0.0% for the 3 lesion types, respectively (rough versus flat and smooth, P < 0.001; rough versus elevated and smooth, P < 0.001, Fisher's exact test). The incidence of carcinoma in rough leukoplakia was significantly higher than that in smooth leukoplakia (44.4% versus 2.4%, P = 0.002, Fisher's exact test). Clinical type was the only significant factor for clinical response of nonsurgical treatment (P = 0.005, ordinal logistic regression).

CONCLUSIONS

The effectiveness of nonsurgical treatment for smooth vocal fold leukoplakia is better in comparison to rough vocal fold leukoplakia. Smooth leukoplakia could be managed with nonsurgical treatment; more aggressive treatments should be considered for rough leukoplakia.

Use Videostrobokymography to Quantitatively Analyze the Vibratory Characteristics Before and After Conservative Medical Treatment of Vocal Fold Leukoplakia

OBJECTIVES

To quantitatively analyze the vibratory characteristics of vocal folds before and after conservative treatments to evaluate the outcomes of conservative treatments for vocal fold leukoplakia using videostrobokymography (VSK).

STUDY DESIGN

This is a prospective study.

METHODS

Twenty patients and 20 controls were enrolled into the study. All patients received conservative treatments for 3 weeks and received VSK examination before and 3 weeks after the treatments. All controls only received VSK examination once. Vocal fold lengths of 25%, 50%, and 75% were chosen as the line-scan positions to evaluate the vocal fold vibration. Open quotient (OQ) and asymmetry index (AI) were obtained using VSK.

RESULTS

Significant improvements in the main symptoms including voice hoarseness were found. Videostroboscopic findings showed that the white lesions on the vocal folds almost completely disappeared in all patients, and the vocal fold flexibility returned to normal. All OQs and AIs at each line-scan position in patients before the treatments were larger than those in controls (P < 0.017), whereas all OQs and AIs at each line-scan position decreased 3 weeks after conservative treatments (P < 0.017). No significant differences in OQs and AIs at each line-scan position were detected between patients after the treatments and controls (P > 0.017).

CONCLUSIONS

VSK could quantitatively evaluate the vibratory characteristics of vocal folds before and after the treatments, and conservative treatment could improve VSK measurements to normal control values, suggesting that VSK is a tool to assess the outcomes of the conservative treatments for vocal fold leukoplakia.