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Keilholz AN, Pathak I, Smith CL, Osman KL, Smith L, Oti G, Golzy M, Ma L, Lever TE, Nichols NL. Tongue exercise ameliorates structural and functional upper airway deficits in a rodent model of hypoglossal motor neuron loss. Front Neurol 2024; 15:1441529. [PMID: 39296960 PMCID: PMC11408480 DOI: 10.3389/fneur.2024.1441529] [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: 05/31/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction Tongue weakness and atrophy can lead to deficits in the vital functions of breathing and swallowing in patients with motor neuron diseases (MNDs; e.g., amyotrophic lateral sclerosis (ALS) and pseudobulbar palsy), often resulting in aspiration pneumonia, respiratory failure, and death. Available treatments for patients with MNDs are largely palliative; thus, there is a critical need for therapies targeting preservation of upper airway function and suggesting a role for tongue exercise in patients with MNDs. Here, we leveraged our inducible rodent model of hypoglossal (XII) motor neuron degeneration to investigate the effects of a strength endurance tongue exercise program on upper airway structure and function. Our model was created through intralingual injection of cholera toxin B conjugated to saporin (CTB-SAP) into the genioglossus muscle of the tongue to induce targeted death of XII motor neurons. Methods Rats in this study were allocated to 4 experimental groups that received intralingual injection of either CTB-SAP or unconjugated CTB + SAP (i.e., control) +/- tongue exercise. Following tongue exercise exposure, we evaluated the effect on respiratory function (via plethysmography), macrostructure [via magnetic resonance imaging (MRI) of the upper airway and tongue], and ultrafine structure [via ex vivo magnetic resonance spectroscopy (MRS) of the tongue] with a focus on lipid profiles. Results Results showed that sham exercise-treated CTB-SAP rats have evidence of upper airway restriction (i.e., reduced airflow) and structural changes present in the upper airway (i.e., airway compression) when compared to CTB-SAP + exercise rats and control rats +/- tongue exercise, which was ameliorated with tongue exercise. Additionally, CTB-SAP + sham exercise rats have evidence of increased lipid expression in the tongue consistent with previously observed tongue hypertrophy when compared to CTB-SAP + exercise rats or control rats +/- tongue exercise. Conclusion These findings provide further evidence that a strength endurance tongue exercise program may be a viable therapeutic treatment option in patients with XII motor neuron degeneration in MNDs such as ALS. Future directions will focus on investigating the underlying mechanism responsible for tongue exercise-induced plasticity in the hypoglossal-tongue axis, particularly inflammatory associated factors such as BDNF.
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Affiliation(s)
- Amy N Keilholz
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Ishan Pathak
- Research Division, Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
- Department of Physics and Astronomy, College of Arts and Science, University of Missouri, Columbia, MO, United States
| | - Catherine L Smith
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Kate L Osman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Lauren Smith
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Grace Oti
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Mojgan Golzy
- Biostatistics Unit, Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
| | - Lixin Ma
- Research Division, Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
- Department of Physics and Astronomy, College of Arts and Science, University of Missouri, Columbia, MO, United States
- Department of Radiology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Teresa E Lever
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Nicole L Nichols
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
- Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO, United States
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States
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Britton D, Kain A, Chen YW, Wiedrick J, Benditt JO, Merati AL, Graville D. Extreme Sawtooth-Sign in Motor Neuron Disease (MND) suggests Laryngeal Resistance to Forced Expiratory Airflow. Ann Otol Rhinol Laryngol 2023; 132:266-274. [PMID: 35430894 DOI: 10.1177/00034894221089407] [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: 11/16/2022]
Abstract
OBJECTIVE The impact of laryngeal dysfunction on airflow has not been well characterized in motor neuron disease (MND). This study aimed to detect and characterize extreme airflow oscillations informally observed during volitional cough and forced vital capacity (FVC) tasks in individuals with MND who demonstrated neurolaryngeal impairments including reduced speed and extent of vocal fold abduction compared to healthy controls during volitional cough expulsion. The extreme airflow oscillations in the MND group, when viewed as a flow-volume loop, appeared similar to the "sawtooth-sign." If the airflow oscillations are periodic in a range similar to phonation, they may reflect reduced laryngeal patency. METHODS Volitional cough and FVC airflow data (3 trials each) from 12 participants with MND with bulbar/laryngeal involvement (3 F; ages 45-76) and 12 healthy controls (6 F; ages 41-68) were analyzed for periodicity. Percent and absolute durations of periodicity of the flow oscillations were calculated by an algorithm applied to the airflow signals. In addition, the frequency, magnitude, and kurtosis of the periodic airflow oscillations were described and compared between groups. RESULTS In both volitional cough and FVC trials, the percent of airflow periodicity during forced expiration was significantly higher (z = 3.54) in individuals with MND, adjusted for age and sex. Periodic airflow accounted for on average 28% of the total time in participants with MND and was within a frequency range similar to phonation. Magnitude of the airflow oscillations was also larger for participants with MND (z = 3.46), and kurtosis of airflow was smaller (z = -4.70) during forced expiration, indicating persistent airflow oscillations throughout exhalation. CONCLUSIONS The significantly larger-magnitude, lower-kurtosis, and more prominent presence of sawtooth-like airflow periodicity within a frequency range similar to phonation observed in individuals with MND with neurolaryngeal impairments suggests glottic airflow resistance during forced expiration.
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Affiliation(s)
- Deanna Britton
- Department of Speech and Hearing Sciences, Portland State University (PSU), Portland, OR, USA.,Northwest Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Sciences University (OHSU), Portland, OR, USA.,Department of Rehabilitation Medicine, University of Washington (UW), Seattle, WA, USA
| | - Alexander Kain
- Computer Science & Electrical Engineering, OHSU, Portland, OR, USA
| | - Yu-Wen Chen
- Postdoctoral Researcher, School of Occupational Therapy, National Taiwan University College of Medicine
| | - Jack Wiedrick
- Biostatistician, Biostatistics & Design Program, OHSU, Portland, OR, USA
| | - Joshua O Benditt
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center (UWMC), Seattle, WA, USA
| | - Albert L Merati
- Department of Otolaryngology, Head and Neck Surgery, UWMC, Seattle, WA, USA.,Department of Speech and Hearing Sciences and School of Music, UW, Seattle, WA, USA
| | - Donna Graville
- Northwest Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Sciences University (OHSU), Portland, OR, USA
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Müschen LH, Körner G, Gingele S, Hänselmann A, Bavendiek U, Skripuletz T. Treatment with patisiran of a patient with hereditary transthyretin-mediated amyloidosis with stage 3 polyneuropathy. Muscle Nerve 2021; 64:E11-E13. [PMID: 34075597 DOI: 10.1002/mus.27338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Lars H Müschen
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gudrun Körner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anja Hänselmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Lind LA, Lever TE, Nichols NL. Tongue and hypoglossal morphology after intralingual cholera toxin B-saporin injection. Muscle Nerve 2020; 63:413-420. [PMID: 33269488 DOI: 10.1002/mus.27131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION We recently developed an inducible model of dysphagia using intralingual injection of cholera toxin B conjugated to saporin (CTB-SAP) to cause death of hypoglossal neurons. In this study we aimed to evaluate tongue morphology and ultrastructural changes in hypoglossal neurons and nerve fibers in this model. METHODS Tissues were collected from 20 rats (10 control and 10 CTB-SAP animals) on day 9 post-injection. Tongues were weighed, measured, and analyzed for microscopic changes using laminin immunohistochemistry. Hypoglossal neurons and axons were examined using transmission electron microscopy. RESULTS The cross-sectional area of myofibers in the posterior genioglossus was decreased in CTB-SAP-injected rats. Degenerative changes were observed in both the cell bodies and distal axons of hypoglossal neurons. DISCUSSION Preliminary results indicate this model may have translational application to a variety of neurodegenerative diseases resulting in tongue dysfunction and associated dysphagia.
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Affiliation(s)
- Lori A Lind
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Teresa E Lever
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Nicole L Nichols
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri, USA
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