Morphology of the nerve endings in laryngeal mucosa of the horse

Singer’s Nodules: Investigating the Etiopathogenetic Markers Progressing Their Pathogenesis and Clinical Manifestations

Simple Summary

Vocal nodules, together with vocal polyps, are the most common benign vocal cord structures that are thought to be caused by extensive vocal abuse (shouting, talking loudly for prolonged periods) and are routinely treated surgically. However, surgical excision of these nodules, does not exclude the possibility of recurrence of these nodules, especially if lifestyle changes are not adapted to prevent phonetic trauma. Furthermore, the etiopathogenetic pathways governing the formation and maintenance of these nodules are not known. Herein, we investigated the etiopathogenetic markers for proliferation, apoptosis, growth, ischemia (tissue hypoxia), inflammation and innervation to elucidate the causative pathways. We found a profound and significant intensification of apoptosis in tissue epithelium, which strongly correlated with proliferative, ischemic, and inflammatory changes, highlighting the underlying complex interactions between various mechanisms on a cellular and tissue level, which occur during the morpho-pathogenesis of vocal nodules.

Abstract

Vocal nodules (or Singer’s nodules) are benign vocal cord structures which are commonly encountered by clinicians. Though phonetic trauma/abuse is thought to be the main cause of the development of vocal nodules, the exact etiopathogenesis remains unknown. Hence, we compared the immunohistochemical markers for proliferation (Ki-67), apoptosis (TUNEL), growth (EGFR), ischemia (VEGF), inflammation (IL-1α and 10), and immunoreactive innervation (PGP 9.5), in vocal nodule tissue samples obtained from 10 females (17–56 years) and vocal cord tissue from seven controls. A statistically significant increase in Ki-67, TUNEL, EGFR, VEGF and IL-1α expression was noted (p < 0.05) between nodule tissue and control tissue in both epithelial and subepithelial layers. However, the difference was non-significant for both IL-10 and PGP 9.5 (p > 0.05). All markers demonstrated moderate to strong positive correlations, except for IL-10. These findings suggest increased cellular growth and proliferation in vocal nodules coupled with a persistent presence of inflammatory and ischemic environment. Furthermore, global prevalence of apoptotic cells and decreased anti-inflammatory cytokines highlight the presence of underlying complex mechanisms in the etiopathogenesis of vocal nodules, with age having a negligible impact on the marker levels. Our results could potentially further our knowledge in understanding the effects of different treatment modalities available at the cellular level.

Sensory Innervation of the Larynx and the Search for Mucosal Mechanoreceptors

Purpose The larynx is a uniquely situated organ, juxtaposed between the gastrointestinal and respiratory tracts, and endures considerable immunological challenges while providing reflexogenic responses via putative mucosal mechanoreceptor afferents. Laryngeal afferents mediate precise monitoring of sensory events by relay to the internal branch of the superior laryngeal nerve (iSLN). Exposure to a variety of stimuli (e.g., mechanical, chemical, thermal) at the mucosa-airway interface has likely evolved a diverse array of specialized sensory afferents for rapid laryngeal control. Accordingly, mucosal mechanoreceptors in demarcated laryngeal territories have been hypothesized as primary sources of sensory input. The purpose of this article is to provide a tutorial on current evidence for laryngeal afferent receptors in mucosa, the role of mechano-gated ion channels within airway epithelia and mechanisms for mechanoreceptors implicated in laryngeal health and disease. Method An overview was conducted on the distribution and identity of iSLN-mediated afferent receptors in the larynx, with specific focus on mechanoreceptors and their functional roles in airway mucosa. Results/Conclusions Laryngeal somatosensation at the cell and molecular level is still largely unexplored. This tutorial consolidates various animal and human researches, with translational emphasis provided for the importance of mucosal mechanoreceptors to normal and abnormal laryngeal function. Information presented in this tutorial has relevance to both clinical and research arenas. Improved understanding of iSLN innervation and corresponding mechanotransduction events will help shed light upon a variety of pathological reflex responses, including persistent cough, dysphonia, and laryngospasm.

Morphology of nerve endings in vocal fold of human newborn

Sensory receptors are distributed throughout the oral cavity, pharynx, and larynx. Laryngeal sensitivity is crucial for maintaining safe swallowing, thus avoiding silent aspiration. Morphologic description of different receptor types present in larynx vary because of the study of many different species, from mouse to humans. The most commonly sensory structures described in laryngeal mucosa are free nerve endings, taste buds, muscle spindles, glomerular and corpuscular receptors. This study aimed at describing the morphology and the distribution of nerve endings in premature newborn glottic region. Transversal serial frozen sections of the whole vocal folds of three newborns were analyzed using an immuno-histochemical process with a pan-neuronal marker anti-protein gene product 9.5 (PGP 9.5). Imaging was done using a confocal laser microscope. Nerve fiber density in vocal cord was calculated using panoramic images in software Morphometric Analysis System v1.0. Some sensory structures, i.e. glomerular endings and intraepithelial free nerve endings were found in the vocal cord mucosa. Muscle spindles, complex nerve endings (Meissner-like, spherical, rectangular and growing) spiral-wharves nerve structures were identified in larynx intrinsic muscles. Nervous total mean density in vocal cord was similar in the three newborns, although they had different gestational age. The mean nerve fiber density was higher in the posterior region than anterior region of vocal cord. The present results demonstrate the occurrence of different morphotypes of sensory corpuscles and nerve endings premature newborn glottic region and provide information on their sensory systems.

Age-Related Expression of α-Gustducin in the Rat Larynx

Objectives:

The age-related changes in distribution of α-gustducin–immunoreactive structures in the larynx of Sprague-Dawley rats were studied.

Methods:

For this purpose, tissues obtained from 12 male rats ranging in age from 5 to 21 weeks were compared with respect to the distribution and morphology of laryngeal taste buds immunoreactive for α-gustducin, the α-subunit of a taste cell–specific G protein.

Results:

Three different morphological types of α-gustducin–immunoreactive structures were seen: typical gemmal forms, clusters composed of 2 or 3 cells, and isolated immunoreactive cells not associated with taste buds. α-Gustducin–immunoreactive structures were most abundant in the epiglottis in all age groups. α-Gustducin–immunoreactive cells in rats seem to be located along the lateral food channels, in which they may come in contact with food. The total number of these α-gustducin–immunoreactive structures did not show any age-related changes, but the percentage of solitary immunoreactive cells in 5-week-old rats was significantly larger than the percentages in 8-, 14-, and 21-week-old animals.

Conclusions:

Solitary α-gustducin–immunoreactive cells, which are abundant in 5-week-old rats but are found in fewer numbers along the base of the epiglottis in mature rats, may be nociceptic in function, whereas the chemosensory clusters or buds that contain α-gustducin–positive cells and are distributed along the lateral food channels on the pharyngeal side of the larynx may have a role in gustatory reception.

The distribution of galanin-immunoreactive nerve fibers in the rat pharynx

Galanin (GAL) consists of a chain of 29/30 amino acids which is widely distributed in the central and peripheral nervous systems. In this study, the distribution of GAL-immunoreactive (-IR) nerve fibers was examined in the rat pharynx and its adjacent regions. GAL-IR nerve fibers were located beneath the epithelium and taste bud-like structure of the pharynx, epiglottis, soft palate and larynx. These nerve fibers were abundant in the laryngeal part of the pharynx, and were rare in other regions. Mucous glands were mostly devoid of GAL-IR nerve fibers. In the musculature of pharyngeal constrictor muscles, many GAL-IR nerve fibers were also located around small blood vessels. However, intrinsic laryngeal muscles contained only a few GAL-IR nerve fibers. The double immunofluorescence method demonstrated that the distribution pattern of GAL-IR nerve fibers was partly similar to that of calcitonin gene-related peptide-IR nerve fibers in the pharyngeal mucosa and muscles. The present findings suggest that the pharynx is one of main targets of GAL-containing nerves in the upper digestive and respiratory systems. These nerves may have sensory and autonomic origins.

The distribution of TRPV1 and TRPV2 in the rat pharynx

Immunohistochemistry for two nociceptive transducers, the transient receptor potential cation channel subfamily V members 1 (TRPV1) and 2 (TRPV2), was performed on the pharynx and its adjacent regions. TRPV1-immunoreactivity (IR) was detected in nerve fibers beneath and within the epithelium and/or taste bud-like structure. In the pharynx, these nerve fibers were abundant in the naso-oral part and at the border region of naso-oral and laryngeal parts. They were also numerous on the laryngeal side of the epiglottis and in the soft palate. TRPV2-IR was expressed by dendritic cells in the pharynx and epiglottis, as well as in the root of the tongue and soft palate. These cells were located in the epithelium and lamina propria. TRPV2-immunoreactive (IR) dendritic cells were numerous in the naso-oral part of the pharynx, epiglottis, and tongue. Abundance of TRPV2-IR dendritic processes usually obscured the presence of TRPV2-IR nerve fibers in these portions. However, some TRPV2-IR nerve fibers could be observed in the epithelium of the soft palate. Retrograde tracing method also revealed that sensory neurons which innervate the pharynx or soft palate were abundant in the jugular-petrosal ganglion complex and relatively rare in the nodose ganglion. In the jugular-petrosal ganglion complex, TRPV1- and TRPV2-IR were expressed by one-third of pharyngeal and soft palate neurons. TRPV2-IR was also detected in 11.5 % pharyngeal and 30.9 % soft palate neurons in the complex. Coexpression of TRPV1 and CGRP was frequent among pharyngeal and soft palate neurons. The present study suggests that TRPV1- and TRPV2-IR jugular-petrosal neurons may be associated with the regulation of the swallowing reflex.

The distribution of transient receptor potential melastatin-8 in the rat soft palate, epiglottis, and pharynx

Immunohistochemistry for transient receptor potential melastatin-8 (TRPM8), the cold and menthol receptor, was performed on the rat soft palate, epiglottis and pharynx. TRPM8-immunoreactive (IR) nerve fibers were located beneath the mucous epithelium, and occasionally penetrated the epithelium. These nerve fibers were abundant in the posterior portion of the soft palate and at the border region of naso-oral and laryngeal parts of the pharynx. The epiglottis was free from such nerve fibers. The double immunofluorescence method demonstrated that TRPM8-IR nerve fibers in the pharynx and soft palate were mostly devoid of calcitonin gene-related peptide-immunoreactivity (CGRP-IR). The retrograde tracing method also demonstrated that 30.1 and 8.7 % of sensory neurons in the jugular and petrosal ganglia innervating the pharynx contained TRPM8-IR, respectively. Among these neurons, the co-expression of TRPM8 and CGRP-IR was very rare. In the nodose ganglion, however, pharyngeal neurons were devoid of TRPM8-IR. Taste bud-like structures in the soft palate and pharynx contained 4-9 TRPM8-IR cells. In the epiglottis, the mucous epithelium on the laryngeal side had numerous TRPM8-IR cells. The present study suggests that TRPM8 can respond to cold stimulation when food and drinks pass through oral and pharyngeal cavities.

Characterisation of the response of equine digital arteries and veins to substance P

Substance P (SP), a potent vasodilator, has been detected in equine digital sensory-motor nerves. The aim of the study was to characterise the functional responses of equine digital blood vessels to exogenous SP. Pre-constricted equine digital arteries (EDA) and veins (EDV) vasodilated in a biphasic, endothelium- and concentration-dependent manner to SP. A nitric oxide (NO) synthase inhibitor Nomega-nitro-L-arginine methyl ester hydrochloride (L-NAME; 300 microm) inhibited both phases of the relaxation response curve of EDAs to SP by >70%. In EDVs, the first relaxant phase to SP was largely L-NAME-resistant, whereas the second phase was inhibited by 60%. Both L-NAME and a cyclo-oxygenase inhibitor (ibuprofen; 10 microm) were required to inhibit EDV relaxation to SP by > or =80%. Experiments determining the receptor mediated responses to physiological concentrations of SP (1 nm) revealed that the relaxant responses of both EDA and EDV were inhibited by a neurokinin-1 (NK1) receptor antagonist (CP-96 345; 10 nm). In conclusion, SP is an endothelium-dependent vasodilator of both EDA and EDV. NO is the predominant pathway activated in EDA, whereas both prostacyclin and NO pathways are involved in EDVs. NK1 receptors appear to mediate responses to low concentrations of SP.