1
|
Chen J, Bai T, Su J, Cong X, Lv L, Tong L, Yu H, Feng Y, Yu G. Salivary Gland Transplantation as a Promising Approach for Tear Film Restoration in Severe Dry Eye Disease. J Clin Med 2024; 13:521. [PMID: 38256655 PMCID: PMC10816601 DOI: 10.3390/jcm13020521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
With increased awareness of dry eye disease (DED), a multitude of therapeutic options have become available. Nevertheless, the treatment of severe DED remains difficult. In a patient whose DED is related to the loss of lacrimal function without severe destruction of the salivary glands, autologous transplantation of the latter as functioning exocrine tissue to rebuild a stable tear film is an attractive idea. All three major and minor salivary glands have been used for such transplantation. Due to the complications associated with and unfavorable prognosis of parotid duct and sublingual gland transplantation, surgeons now prefer to use the submandibular gland (SMG) for such procedures. The transplantation of the SMG not only has a high survival rate, but also improves dry eye symptoms and signs for more than 20 years post-surgery. The regulation of the secretion of the transplanted SMG is critical because the denervated SMG changes its mechanism of secretion. Innovative procedures have been developed to stimulate secretion in order to prevent the obstruction of the Wharton's duct and to decrease secretion when postoperative "epiphora" occurs. Among the minor salivary glands, the transplantation of the labial salivary glands is the most successful in the long-term. The measurement of the flow rates of minor salivary glands and donor-site selection are critical steps before surgery.
Collapse
Affiliation(s)
- Jiayi Chen
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Tianyi Bai
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jiazeng Su
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xin Cong
- Key Laboratory of Molecular Cardiovascular Sciences, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Ministry of Education, Beijing 100191, China;
| | - Lan Lv
- Department of Ophthalmology, Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing 100730, China
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Eye-Academic Clinical Program, Duke-National University of Singapore, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Haozhe Yu
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Yun Feng
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Guangyan Yu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| |
Collapse
|
2
|
Singh S, Basu S, Geerling G. Salivary gland transplantation for dry eye disease: Indications, techniques, and outcomes. Ocul Surf 2022; 26:53-62. [DOI: 10.1016/j.jtos.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
|
3
|
Kim JW, Kim JM, Choi ME, Kim SK, Kim YM, Choi JS. Adipose-derived mesenchymal stem cells regenerate radioiodine-induced salivary gland damage in a murine model. Sci Rep 2019; 9:15752. [PMID: 31673085 PMCID: PMC6823479 DOI: 10.1038/s41598-019-51775-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 10/08/2019] [Indexed: 02/08/2023] Open
Abstract
After radioiodine (RI) therapy, patients with thyroid cancer frequently suffer from painful salivary gland (SG) swelling, xerostomia, taste alterations, and oral infections. This study was aimed to determine whether adipose-derived mesenchymal stem cells (AdMSCs) might restore RI-induced SG dysfunction in a murine model. Forty -five mice were divided into three groups; a PBS sham group, a RI+ PBS sham group (0.01 mCi/g mouse, orally), and an RI+AdMSCs (1 × 105 cells/150 uL, intraglandular injection on experimental day 28) treated group. At 16 weeks after RI treatment, body weights, SG weight, salivary flow rates (SFRs), and salivary lag times were measured. Morphologic and histologic examinations and immunohistochemistry (IHC) were performed and the activities of amylase and EGF in saliva were also measured. Changes in salivary 99mTc pertechnetate excretion were followed by SPECT and TUNEL assays were performed. The body and SG weights were similar in the AdMSCs and sham groups. Hematoxylin and eosin staining revealed the AdMSCs group had more mucin-containing acini than the RI group. Furthermore, AdMSCs treatment resulted in tissue remodeling and elevated expressions of epithelial (AQP5) and endothelial (CD31) markers, and increased SFRs. The activities of amylase and EGF were higher in the AdMSCs group than in the RI treated group. 99mTc pertechnetate excretions were similar in the AdMSCs and sham group. Also, TUNEL positive apoptotic cell numbers were less in the AdMSCs group than in the RI group. Local delivery of AdMSCs might regenerate SG damage induced by RI.
Collapse
Affiliation(s)
- Ji Won Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Jeong Mi Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Mi Eun Choi
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Young-Mo Kim
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea
| | - Jeong-Seok Choi
- Department of Otolaryngology, Inha University, College of Medicine, Incheon, Republic of Korea.
| |
Collapse
|
4
|
Cong X, Min SN, Wu LL, Cai ZG, Yu GY. [Role and mechanism of muscarinic acetylcholine receptor in the regulation of submandibular gland secretion]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:390-396. [PMID: 31209407 DOI: 10.19723/j.issn.1671-167x.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the underlying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated salivary secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithelium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.
Collapse
Affiliation(s)
- X Cong
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.,Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - S N Min
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - L L Wu
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.,Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - Z G Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - G Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| |
Collapse
|
5
|
Mesenchymal Stem Cell Therapy in Submandibular Salivary Gland Allotransplantation: Experimental Study. Transplantation 2019; 103:1111-1120. [DOI: 10.1097/tp.0000000000002612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
6
|
Zhang L, Su JZ, Cai ZG, Lv L, Zou LH, Liu XJ, Wu J, Zhu ZH, Mao C, Wang Y, Peng X, Song B, Li XX, Yu GY. Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease. Int J Oral Maxillofac Surg 2019; 48:40-47. [PMID: 30057239 DOI: 10.1016/j.ijom.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/04/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - J-Z Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Z-G Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - L Lv
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - L-H Zou
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - X-J Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - J Wu
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China; Department of Ophthalmology, Affiliated Beijing Bo Ai Hospital, Capital University of Medical Science, Beijing, 100068, China
| | - Z-H Zhu
- Department of Stomatology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - C Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Y Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - B Song
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - X-X Li
- Clinical Laboratory, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| |
Collapse
|
7
|
Qi W, Cong X, Zhang XM, Wang ZY, Yang NY, Ding C, Shan XF, Wu LL, Yu GY. Parasympathectomy increases resting salivary secretion in normal and irradiated submandibular glands of rats. Eur J Oral Sci 2017; 125:110-118. [PMID: 28084660 DOI: 10.1111/eos.12330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 01/03/2023]
Abstract
Fluid and ion secretion from the submandibular gland (SMG) is mainly regulated by parasympathetic nerves. This study evaluated the effect of parasympathectomy on salivary secretion from normal and irradiated rat SMGs from 1 to 24 wk after denervation. Although stimulated salivary secretion was significantly lower in denervated SMGs compared with contralateral self-controls, the resting salivary flow rates were markedly higher in the denervated SMGs at 1, 12, and 24 wk after denervation. The levels of muscarinic acetylcholine M1 and M3 receptors, as well as of aquaporin 5, were up-regulated. Notably, although irradiated SMGs showed significantly lower resting and stimulated salivary secretion rates than non-irradiated SMGs, the resting salivary secretion rates of the irradiated and denervated SMGs were markedly higher than seen in the irradiated self-control SMGs at 1, 12, and 24 wk after parasympathectomy, and were even higher than seen in the non-irradiated sham-operated rats. The expression of M1 and M3 receptors was similarly elevated. Taken together, our results suggest that parasympathetic denervation increases resting salivary secretion of both normal and irradiated SMGs. This approach might provide a potential modality for relieving radiation-induced xerostomia, which is a common complication following treatment of head and neck cancer.
Collapse
Affiliation(s)
- Wei Qi
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xin Cong
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University School of Basic Medical Sciences, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Xue-Ming Zhang
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Zong-Ye Wang
- Department of Radiation Oncology, The 306th Hospital of the People's Liberation Army, Beijing, China
| | - Ning-Yan Yang
- Department of Pediatric Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chong Ding
- Center Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Li-Ling Wu
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University School of Basic Medical Sciences, Beijing, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| |
Collapse
|
8
|
Muscarinic acetylcholine receptor-mediated tight junction opening is involved in epiphora in late phase of submandibular gland transplantation. J Mol Histol 2017; 48:99-111. [PMID: 28078480 DOI: 10.1007/s10735-016-9709-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
Submandibular gland (SMG) autotransplantation is an effective therapy for treating severe dry eye syndrome. However, epiphora occurs in more than 40% of patients 6 months after operation. We previously found that muscarinic acetylcholine receptor (mAChR) plays a crucial role in regulating SMG secretion partially through the modulation on tight junction (TJ)-based paracellular pathway. Therefore, the present study aimed to investigate the possible involvement of mAChR and TJ in a rabbit long-term model of SMG transplantation. We found that SMG secretion was significantly increased on postoperative days 90 and 180, which imitated epiphora observed in the patients with SMG transplantation. Although the mRNA expression and fluorescence intensity of M1 and M3 mAChR subtypes were reversed to control levels on postoperative days 30, 90, and 180, the content of β-arrestin2, but not β-arrestin1, was gradually decreased after transplantation, which suggests that mAChR may be hypersensitive in late phase of SMG transplantation. The width of acinar TJs was enlarged and fluorescence intensity of F-actin in peri-apicolateral membranes were remarkably increased on postoperative days 90 and 180. Topical treatment with atropine gel significantly reduced SMG secretion, TJ width, as well as F-actin intensity in peri-apicolateral membranes on postoperative days 180. Moreover, in a perfused rabbit SMG, carbachol increased salivary secretion, enlarged TJ width, and induced F-actin rearrangement, whereas these responses were inhibited by atropine pretreatment. Taken together, our findings suggest that the hypersensitive mAChR may contribute to epiphora in late phase of SMG transplantation through modulating TJ-based paracellular permeability.
Collapse
|
9
|
An Experimental Study on Botulinum Toxin Type A for the Treatment of Excessive Secretion after Submandibular Gland Transplantation in Rabbits. J Ophthalmol 2016; 2016:7058537. [PMID: 27840738 PMCID: PMC5093283 DOI: 10.1155/2016/7058537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. To investigate whether botulinum toxin type A (BTXA) could control excessive secretion after submandibular gland (SMG) transplantation in rabbits and its possible mechanisms. Methods. A new SMG transplantation model was established in rabbit. 30 successfully constructed models were randomly assigned to five groups including control group and four experimental groups. Secretion outputs were used to analyze the effect of BTXA injection on excessive secretion. Hematoxylin and eosin (HE) staining, transmission electron microscopy (TEM), Western blot, and immunofluorescence were performed to analyze its possible mechanisms. Results. After BTXA injection, a significant decrease of excessive secretion after SMG transplantation was found in 2 and 4 weeks groups, but no significant effect on 12 and 24 weeks groups. HE and TEM results showed that BTXA led to morphological and ultrastructural changes of acinar cells of transplanted SMG. Western blot results suggested that BTXA decreased the aquaporin-5 (AQP5) protein expression after BTXA injection for 2 and 4 weeks. Immunofluorescence results showed that AQP5 protein was mainly expressed in the cytoplasm after BTXA injection for 2 and 4 weeks, which might indicate that BTXA promoted AQP5 expression from the cell membrane to cytoplasm. Conclusion. BTXA could effectively control excessive secretion after SMG transplantation in rabbits.
Collapse
|
10
|
Liu XJ, Li M, Su JZ, Wang Z, Xie Z, Yu GY. Carbachol improves the secretion of transplanted submandibular glands during the latent period after microvascular autologous transplantation for severe keratoconjunctivitis sicca. Int J Oral Maxillofac Surg 2016; 45:1273-9. [DOI: 10.1016/j.ijom.2016.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/07/2016] [Accepted: 03/22/2016] [Indexed: 11/28/2022]
|
11
|
Effects of Capsaicin and Carbachol on Secretion From Transplanted Submandibular Glands and Prevention of Duct Obstruction. Cornea 2016; 35:494-500. [PMID: 26807899 DOI: 10.1097/ico.0000000000000752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate whether capsaicin and carbachol promote secretion from and prevent duct obstruction in transplanted submandibular glands (SMGs). METHODS This retrospective cohort study included consecutive patients with severe keratoconjunctivitis sicca and successful SMG transplantation. Patients were divided into 2 groups: an exposed group receiving both capsaicin and carbachol after surgery and an unexposed group receiving neither. Secretion changes in response to capsaicin and carbachol administration were recorded in the exposed group. The main outcome measures were the secretory flow rate and duct obstruction rate in the transplanted SMGs. RESULTS Forty-four patients (44 eyes) in the unexposed group and 115 patients (128 eyes) in the exposed group were followed up for more than 3 months postoperatively. The baseline characteristics were similar between the groups. The secretory flow rate before and 5, 25, 55 minutes after administration was 1 mm (0-2 mm) (median with interquartile range), 3 mm (1-5 mm), 4 mm (2-5 mm), 1 mm (0-2.5 mm), respectively, for capsaicin and 1 mm (0-3 mm), 1050 mm (450-1500 mm), 375 mm (150-600 mm), 0 mm (0-150 mm), respectively, for carbachol (P < 0.001 for both). In the exposed group, 6.2% of eyes had duct obstruction, whereas 18.2% of eyes in the unexposed group had duct obstruction (P = 0.031) (odds ratio = 0.3, 95% confidence interval, 0.105-0.856). CONCLUSIONS This study provides evidence that capsaicin and carbachol effectively promote secretion from and prevent duct obstruction in transplanted SMGs during at least 3 months after transplantation.
Collapse
|
12
|
Su JZ, Cai ZG, Yu GY. Microvascular autologous submandibular gland transplantation in severe cases of keratoconjunctivitis sicca. Maxillofac Plast Reconstr Surg 2015; 37:5. [PMID: 25664315 PMCID: PMC4317526 DOI: 10.1186/s40902-015-0006-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
Abstract
Dry eye syndrome is a relatively common disease of the tears and ocular surfaces that results in discomfort, visual disturbance, and tear film instability with possible damage to the ocular surfaces. Microvascular submandibular gland (SMG) transfer offers a surgical alternative for a permanent autologous substitution of tears using the basal secretion of a transplanted SMG. Long-term follow-up reveals that this technique is a lasting and effective solution for patients with severe dry eye syndrome. The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced. Objective examination showed significant improvement in tear film and some features of ocular surface such as breakup time of tear film and corneal staining. Patients may suffer from obstruction of Wharton's duct or epiphora after surgery. Activation of secretion-related receptors could improve the early hypofunction of the denervated SMG and prevent the duct obstruction. Reduction surgery, partial SMG transplantation, uses of atropine gel or Botulinum toxin A could be the choices of treatment for epiphora.
Collapse
Affiliation(s)
- Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| |
Collapse
|
13
|
Shi L, Xiao M, Dai ML, Liu SH, Liu YS, Wei FC. Ischemia preconditioning protects rat submandibular glands from ischemia/reperfusion injuries. Eur J Oral Sci 2015; 122:324-31. [PMID: 25216112 DOI: 10.1111/eos.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 12/21/2022]
Abstract
To investigate the effects of ischemia/reperfusion on rat submandibular glands without denervation and the possible protective effects of ischemia preconditioning on the glands that experienced ischemia/reperfusion, in-situ ischemia/reperfusion and ischemia preconditioning experimental models of submandibular glands of healthy male Wistar rats were conducted. For ischemia/reperfusion groups, the glands were subjected to 90 min of ischemia without denervation, followed by 1, 12, 24, or 72 h of reperfusion. Ischemia preconditioning was achieved by 3 min of ischemia following 3 min of reperfusion, performed three times before ischemia/reperfusion. Salivary secretion, histological changes, alterations of tight junctions, myeloperoxidase activity, cellular apoptosis, and reactive oxygen species levels were detected. In ischemia/reperfusion glands, rising acute-inflammation responses, reduced tight-junction width, and increased myeloperoxidase activity, reactive oxygen species levels, and apoptotic cell numbers were observed, along with secretory dysfunction, especially at 1 and 12 h post-reperfusion, which seemed to gradually return to normal by 72 h post-reperfusion. In contrast, ischemia preconditioning showed the potential to ameliorate the injury-stress responses caused by ischemia/reperfusion. Our study revealed that ischemia/reperfusion could cause a series of injury-stress responses and ultimately lead to hyposecretion, independently of the parasympathetic nerve supply, which might play an important role in the early-phase dysfunction of the transplanted glands. Ischemia preconditioning could protect the involved glands and improve ischemia/reperfusion-induced hyposecretion.
Collapse
Affiliation(s)
- Liang Shi
- Department of Oral & Maxillofacial Surgery, Qilu Hospital, and Institute of Dental Medicine, Shandong University, Jinan, China
| | | | | | | | | | | |
Collapse
|
14
|
Zhang SE, Su YX, Zheng GS, Liang YJ, Liao GQ. Reinnervated nerves contribute to the secretion function and regeneration of denervated submandibular glands in rabbits. Eur J Oral Sci 2014; 122:372-81. [PMID: 25363784 DOI: 10.1111/eos.12154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Si-en Zhang
- Department of Oral and Maxillofacial Surgery; Guanghua School of Stomatology; Hospital of Stomatology; Guangdong Provincial Key Laboratory of Stomatology; Sun Yat-Sen University; Guangzhou China
| | - Yu-xiong Su
- Department of Oral and Maxillofacial Surgery; Guanghua School of Stomatology; Hospital of Stomatology; Guangdong Provincial Key Laboratory of Stomatology; Sun Yat-Sen University; Guangzhou China
| | - Guang-sen Zheng
- Department of Oral and Maxillofacial Surgery; Guanghua School of Stomatology; Hospital of Stomatology; Guangdong Provincial Key Laboratory of Stomatology; Sun Yat-Sen University; Guangzhou China
| | - Yu-jie Liang
- Department of Oral and Maxillofacial Surgery; Guanghua School of Stomatology; Hospital of Stomatology; Guangdong Provincial Key Laboratory of Stomatology; Sun Yat-Sen University; Guangzhou China
| | - Gui-qing Liao
- Department of Oral and Maxillofacial Surgery; Guanghua School of Stomatology; Hospital of Stomatology; Guangdong Provincial Key Laboratory of Stomatology; Sun Yat-Sen University; Guangzhou China
| |
Collapse
|
15
|
Su JZ, Yang NY, Liu XJ, Cai ZG, Lv L, Zhang L, Wu LL, Liu DG, Ren WG, Gao Y, Yu GY. Obstructive sialadenitis of a transplanted submandibular gland: chronic inflammation secondary to ductal obstruction. Br J Ophthalmol 2014; 98:1672-7. [DOI: 10.1136/bjophthalmol-2014-305117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Cai JR, Shan XF, Cai ZG, Zhang X, Yu GY. A new treatment for epiphora secondary to submandibular gland transplantation: transcutaneous atropine gel. Ocul Surf 2014; 12:221-6. [PMID: 24999104 DOI: 10.1016/j.jtos.2014.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore whether topical application of atropine gel controls epiphora secondary to submandibular gland (SMG) transplantion for severe keratoconjunctivitis sicca. METHODS Eighteen patients with epiphora after SMG transplantation participated in a double-blind, controlled, crossover study. Patients were treated with topical smear common atropine (CA) and modified atropine (MA) gels (intervals ≥1 day). The control effect of atropine gels was observed for 5 hours. Tear flow was quantified in resting and stimulated (after exercise) states using the Schirmer I test. RESULTS With the CA gel, tear flow decreased significantly at 10, 30, and 120 minutes. Average epiphora reduction rates (AERRs) were 22.37%, 18.14%, and 13.27%, respectively (P<.05). With the MA gel, tear flow decreased significantly from 5 minutes to 5 hours; AERRs increased from 24.06% to 42.67% (P<.05); Maximum efficacy was maintained from 15 minutes to 3 hours (P<.01); Tear flow gradually increased from 4 to 5 hours but was still lower than that before atropine use (P<.05). According to results of the Schirmer I test and AERRs, the control efficacy of the MA gel was significantly better than that of the CA gel (P<.05). CONCLUSIONS Topical application of atropine gel could effectively control mild epiphora for patients with SMG transplantation for severe keratoconjunctivitis sicca. The efficacy of MA gel was much better than that of the CA gel.
Collapse
Affiliation(s)
- Jian-Rui Cai
- Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China; Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Peking University, Beijing, P.R. China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China.
| | - Xuan Zhang
- School of Pharmaceutical Science, Peking University, Beijing, P.R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Peking University, Beijing, P.R. China
| |
Collapse
|
17
|
Ding C, Cong X, Zhang Y, Yang NY, Li SL, Wu LL, Yu GY. Hypersensitive mAChRs are involved in the epiphora of transplanted glands. J Dent Res 2014; 93:306-12. [PMID: 24389807 DOI: 10.1177/0022034513519107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Autologous transplantation of the submandibular gland is an effective treatment for severe dry eye syndrome. However, more than 40% of patients experience epiphora 3 to 6 months after transplantation. The underlying mechanism of epiphora remains to be elucidated. To investigate the potential roles of muscarinic acetylcholine receptors (mAChRs) in the induction of epiphora in transplanted glands, we assessed and found elevated mRNA and protein expression of M1- and M3-mAChR in transplanted glands from epiphora patients. The content of inositol 1, 4, 5-trisphosphate was also elevated. Moreover, carbachol (5 and 10 µM) induced greater increase of [Ca(2+)]i in isolated epiphora submandibular cells than in controls. Although aquaporin-5 (AQP5) content and distribution in the apical and lateral plasma of epiphora glands did not change, AQP5 content was reduced in lipid microdomains (lipid rafts and caveolae) but increased in non-lipid microdomains compared with controls. Carbachol (10 µM) increased the ratio of non-lipid microdomain to total AQP5 in the cultured control submandibular gland tissue. Taken together, these results indicated that hypersensitive mAChRs might be involved in the epiphora of transplanted submandibular glands by modulating AQP5 trafficking.
Collapse
Affiliation(s)
- C Ding
- Center Laboratory and Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology, 22 Zhong Guan Cun South St., Beijing, 100081, P.R. China
| | | | | | | | | | | | | |
Collapse
|
18
|
Botulinum toxin A inhibits salivary secretion of rabbit submandibular gland. Int J Oral Sci 2013; 5:217-23. [PMID: 24158141 PMCID: PMC3967320 DOI: 10.1038/ijos.2013.82] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 08/13/2013] [Indexed: 11/25/2022] Open
Abstract
Botulinum toxin A (BTXA) has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor (M3 receptor) and aquaporin-5 (AQP5) mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular glands.
Collapse
|
19
|
Cong X, Zhang Y, Yang NY, Li J, Ding C, Ding QW, Su YC, Mei M, Guo XH, Wu LL, Yu GY. Occludin is required for TRPV1-modulated paracellular permeability in the submandibular gland. J Cell Sci 2013; 126:1109-21. [PMID: 23345400 DOI: 10.1242/jcs.111781] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Occludin plays an important role in maintaining tight junction barrier function in many types of epithelia. We previously reported that activation of transient receptor potential vanilloid subtype 1 (TRPV1) in rabbit submandibular gland promoted salivary secretion, partly by an increase in paracellular permeability. We have now explored the role of occludin in TRPV1-modulated paracellular permeability in a rat submandibular gland cell line SMG-C6. Both TRPV1 and occludin were expressed in SMG-C6 cells, and capsaicin induced redistribution of occludin, but not claudin-3, claudin-4 or E-cadherin, from the cell membrane into the cytoplasm. Capsaicin also decreased transepithelial electrical resistance (TER) and increased the Trypan Blue and FITC-dextran flux. Capsazepine (CPZ), a TRPV1 antagonist, inhibited the capsaicin-induced occludin redistribution and TER decrease. Moreover, occludin knockdown by shRNA suppressed, whereas occludin re-expression restored, the TER response to capsaicin. Mechanistically, TRPV1 activation increased ERK1/2 and MLC2 phosphorylation. PD98059, an ERK1/2 kinase inhibitor, abolished the capsaicin-induced MLC2 phosphorylation, whereas ML-7, an MLC2 kinase inhibitor, did not affect ERK1/2 phosphorylation, suggesting that ERK1/2 is the upstream signaling molecule of MLC2. Capsaicin also induced F-actin reorganization, which was abolished by CPZ, PD98059 and ML-7, indicating that TRPV1 activation altered F-actin organization in an ERK1/2- and MLC2-dependent manner. Furthermore, either PD98059 or ML-7 could abolish the capsaicin-induced TER response and occludin redistribution, whereas knockdown of ERK1/2 further confirmed that the TRPV1-modulated paracellular permeability was ERK1/2 dependent. Taken together, these results identified a crucial role of occludin in submandibular epithelial cells, and more importantly, demonstrated that occludin was required to mediate TRPV1-modulated paracellular permeability.
Collapse
Affiliation(s)
- Xin Cong
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Yang NY, Shi L, Zhang Y, Ding C, Cong X, Fu FY, Wu LL, Yu GY. Ischemic preconditioning reduces transplanted submandibular gland injury. J Surg Res 2013; 179:e265-73. [DOI: 10.1016/j.jss.2012.02.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/04/2012] [Accepted: 02/29/2012] [Indexed: 12/20/2022]
|
21
|
Ding C, Zhang Y, Peng X, Wang Y, Zhang L, Cong X, Ding QW, Xiang RL, Wu LL, Yu GY. Proteomic Analysis of Human Transplanted Submandibular Gland in Patients with Epiphora after Transplantation. J Proteome Res 2011; 10:2206-15. [PMID: 21384922 DOI: 10.1021/pr100965q] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Chong Ding
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Yan Zhang
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Cong
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Qian-Wen Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ruo-Lan Xiang
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Li-Ling Wu
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Centre and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| |
Collapse
|