1
|
Brown M, Okuyama H, Yamashita M, Tabrizian M, Li-Jessen NYK. Trends in Injectable Biomaterials for Vocal Fold Regeneration and Long-Term Augmentation. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 39212941 DOI: 10.1089/ten.teb.2024.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Human vocal folds (VF), a pair of small, soft tissues in the larynx, have a layered mucosal structure with unique mechanical strength to support high-level tissue deformation by phonation. Severe pathological changes to VF have causes including surgery, trauma, age-related atrophy, and radiation, and lead to partial or complete communication loss and difficulty in breathing and swallowing. VF glottal insufficiency requires injectable VF biomaterials such as hyaluronan, calcium hydroxyapatite, and autologous fat to augment VF functions. Although these biomaterials provide an effective short-term solution, significant variations in patient response and requirements of repeat reinjection remain notable challenges in clinical practice. Tissue engineering strategies have been actively explored in the search of an injectable biomaterial that possesses the capacity to match native tissue's material properties while promoting permanent tissue regeneration. This review aims to assess the current status of biomaterial development in VF tissue engineering. The focus will be on examining state-of-the-art techniques including modification with bioactive molecules, cell encapsulation, composite materials, as well as, in situ crosslinking with click chemistry. We will discuss potential opportunities that can further leverage these engineering techniques in the advancement of VF injectable biomaterials.
Collapse
Affiliation(s)
- Mika Brown
- McGill University, Biomedical Engineering, Montreal, Quebec, Canada
- McGill University, Bioengineering, Montreal, Quebec, Canada;
| | - Hideaki Okuyama
- McGill University, School of Communication Sciences and Disorders, Montreal, Quebec, Canada;
| | - Masaru Yamashita
- Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Kagoshima, Japan;
| | - Maryam Tabrizian
- McGill University, Biomedical Engineering, Montreal, Quebec, Canada
- McGill University, Bioengineering, Montreal, Quebec, Canada
- McGill University, Faculty of Dentistry, Montreal, Quebec, Canada;
| | - Nicole Y K Li-Jessen
- McGill University, School of Communication Sciences and Disorders, Montreal, Quebec, Canada
- McGill University, Department of Otolaryngology - Head and Neck Surgery, Montreal, Quebec, Canada
- McGill University, Biomedical Engineering, Montreal, Quebec, Canada
- McGill University, Research Institute of McGill University Health Center, Montreal, Quebec, Canada;
| |
Collapse
|
2
|
Batıoğlu-Karaaltın A, Ugurlar M, Enver N, Erdur ZB, Yılmaz YZ, Bozkurt ER. Development of an Animal Model for Type II Sulcus (Sulcus Vergeture). J Voice 2023:S0892-1997(23)00001-2. [PMID: 36682999 DOI: 10.1016/j.jvoice.2023.01.001] [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: 01/19/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To develop a reproducible experimental animal model for sulcus vergeture in rabbits. STUDY DESIGN Experimental animal study. MATERIAL METHOD We evaluated three methods of inducing sulcus in twelve New Zealand white rabbits to produce a sulcus model. Experimental groups comprised: group 1 (n = 4) underwent submucosal injury following endolaryngeal epithelial incision; group 2 (n = 4) received submucosal injury via thyrotomy; group 3 (n = 4) received submucosal injury via thyrotomy, followed with horizontal mucosal lateralization suture. Right vocal folds of the rabbits underwent surgery to produce sulcus vocalis and left vocal folds were used for the comparison. In the sixth week after the procedure, the rabbits were sacrificed and the larynxes were harvested and analyzed histopathologically. RESULTS No animals in group 1 or 2 developed sulcus vocalis. Sulcus formation was observed in all rabbits in group 3, under endoscopic examination and microscopic sulcus formation was demonstrated for the first, second, and third rabbits. An epithelial depression area was seen at the glandular ductal opening zone for the fourth rabbit, but it could also be accepted as a sulcus formation. CONCLUSION We successfully developed a reproducible survival model for sulcus using a submucosal injury via thyrotomy, followed with a horizontal mucosal lateralization suture. This model provides the groundwork for future research into the applicability of new approaches for sulcus management.
Collapse
Affiliation(s)
- Ayşegül Batıoğlu-Karaaltın
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Muge Ugurlar
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zulkuf Burak Erdur
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yetkin Zeki Yılmaz
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erol Rustu Bozkurt
- Department of Pathology, Istanbul Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Coburn PT, Li X, Li JY, Kishimoto Y, Li-Jessen NY. Progress in Vocal Fold Regenerative Biomaterials: An Immunological Perspective. ADVANCED NANOBIOMED RESEARCH 2022; 2:2100119. [PMID: 35434718 PMCID: PMC9007544 DOI: 10.1002/anbr.202100119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Vocal folds, housed in the upper respiratory tract, are important to daily breathing, speech and swallowing functions. Irreversible changes to the vocal fold mucosae, such as scarring and atrophy, require a regenerative medicine approach to promote a controlled regrowth of the extracellular matrix (ECM)-rich mucosa. Various biomaterial systems have been engineered with an emphasis on stimulating local vocal fold fibroblasts to produce new ECM. At the same time, it is imperative to limit the foreign body reaction and associated immune components that can hinder the integration of the biomaterial into the host tissue. Modern biomaterial designs have become increasingly focused on actively harnessing the immune system to accelerate and optimize the process of tissue regeneration. An array of physical and chemical biomaterial parameters have been reported to effectively modulate local immune cells, such as macrophages, to initiate tissue repair, stimulate ECM production, promote biomaterial-tissue integration, and restore the function of the vocal folds. In this perspective paper, the unique immunological profile of the vocal folds will first be reviewed. Key physical and chemical biomaterial properties relevant to immunomodulation will then be highlighted and discussed. A further examination of the physicochemical properties of recent vocal fold biomaterials will follow to generate deeper insights into corresponding immune-related outcomes. Lastly, a perspective will be offered on the opportunity of integrating material-led immunomodulatory strategies into future vocal fold tissue engineering therapies.
Collapse
Affiliation(s)
- Patrick T. Coburn
- School of Communication Sciences and Disorders, McGill University, Canada
| | - Xuan Li
- Department of Mechanical Engineering, McGill University, Canada
| | - Jianyu. Y. Li
- Department of Mechanical Engineering, McGill University, Canada
- Department of Biomedical Engineering, McGill University, Canada
| | - Yo Kishimoto
- Department of Otolaryngology – Head & Neck Surgery, Kyoto University, Kyoto, Japan
| | - Nicole Y.K. Li-Jessen
- School of Communication Sciences and Disorders, McGill University, Canada
- Department of Biomedical Engineering, McGill University, Canada
- Department of Otolaryngology – Head & Neck Surgery, McGill University, Canada
| |
Collapse
|
4
|
Ogawa M, Mukudai S, Sugiyama Y, Matsushita H, Kinoshita S, Ozawa S, Hashimoto K, Fuse S, Kaneko M, Nakanishi Y, Yoshizaki T, Sotozono C, Hirano S. The Effects of Amniotic Membrane Transplantation on Vocal Fold Regeneration. Laryngoscope 2021; 132:2017-2025. [PMID: 34951490 DOI: 10.1002/lary.29997] [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: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold (VF) scar and sulcus cause severe vocal problems, but optimal methods have not been established. Total replacement of the mucosa is required particularly for cases in which the whole lamina propria is occupied by severe fibrosis and vibratory function is totally lost. The amniotic membrane (AM) has been proven to have regenerative potential, as it contains stem cells and growth factors. The current study investigated the biocompatibility and effects of AM for regeneration of the VF mucosa. STUDY DESIGN In vitro and in vivo studies. METHODS Vocal fold fibroblasts (VFFs) from 13 Sprague-Dawley rats were seeded on AM and subjected to histology and immunohistochemistry, and gene expressions in the VFFs on AM were examined in in vitro study. Twelve New Zealand White rabbits were used in in vivo study. VFs were stripped down and were reconstructed with AM. The regenerative effects were examined 3 months later by histological examination. RESULTS In vitro study indicated VFFs survived on AM and stained positively for Ki67, vimentin, and fibronectin. Gene expressions of Has1, Has2, and Hgf were significantly increased in the VFFs on AM compared with the other groups. The in vivo study indicated AM-transplanted VFs showed a significantly higher density of hyaluronic acid and lower density of collagen compared with sham VFs. CONCLUSIONS The current preliminary study suggests biocompatibility and possible regenerative effects of AM for VFs. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
Collapse
Affiliation(s)
- Machiko Ogawa
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoichiro Sugiyama
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Matsushita
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Kinoshita
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satomi Ozawa
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiko Hashimoto
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mami Kaneko
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology Head and Neck Surgery, Kanazawa University, Kanazawa, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
5
|
Vocal fold sulci - what are the current options for and outcomes of treatment? Curr Opin Otolaryngol Head Neck Surg 2021; 29:458-464. [PMID: 34710065 DOI: 10.1097/moo.0000000000000770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Sulcus vocalis is a benign condition of the vocal folds that, according to its severity, can affect the quality of the voice of those who have it. Voice symptoms can range from mild to severe, affecting the quality of life of patients with this condition. Although different surgical and no surgical options have been described, no gold standard treatment has been described. RECENT FINDINGS New evidence supports congenital, inflammatory, and acquired theories for sulcus vocalis. Also, recent literature demonstrated the role of the epithelium in the pathogenesis, which makes the absence of superficial lamina propria no longer the only accepted hypothesis. Technological developments improved the in-office diagnostics capabilities for this condition, but vocal fold palpation remains the gold standard. Different benign laryngeal conditions are associated with sulcus vocalis and knowing when to treat those is very important. Different treatment options are available for sulcus vocalis, however, results are diverse and no strong recommendations for one over the other can be made. SUMMARY Progress continues to be made in our understanding of sulcus vocalis from diagnosis to treatment. Novel and promising therapeutic strategies have been recently developed for this condition; however, more data and investigations are needed to improve their accuracy and reproducibility.
Collapse
|
6
|
Zhao P, Li X, Fang Q, Wang F, Ao Q, Wang X, Tian X, Tong H, Bai S, Fan J. Surface modification of small intestine submucosa in tissue engineering. Regen Biomater 2020; 7:339-348. [PMID: 32793379 PMCID: PMC7414999 DOI: 10.1093/rb/rbaa014] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
With the development of tissue engineering, the required biomaterials need to have the ability to promote cell adhesion and proliferation in vitro and in vivo. Especially, surface modification of the scaffold material has a great influence on biocompatibility and functionality of materials. The small intestine submucosa (SIS) is an extracellular matrix isolated from the submucosal layer of porcine jejunum, which has good tissue mechanical properties and regenerative activity, and is suitable for cell adhesion, proliferation and differentiation. In recent years, SIS is widely used in different areas of tissue reconstruction, such as blood vessels, bone, cartilage, bladder and ureter, etc. This paper discusses the main methods for surface modification of SIS to improve and optimize the performance of SIS bioscaffolds, including functional group bonding, protein adsorption, mineral coating, topography and formatting modification and drug combination. In addition, the reasonable combination of these methods also offers great improvement on SIS surface modification. This article makes a shallow review of the surface modification of SIS and its application in tissue engineering.
Collapse
Affiliation(s)
- Pan Zhao
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiang Li
- Department of Cell Biology, School of Life Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Qin Fang
- Cardiac Surgery, Liaoning First Hospital of China Medical University, No. 155 Nanjing Street, Heping District, Shenyang, Liaoning 110122, China
| | - Fanglin Wang
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Qiang Ao
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiaohong Wang
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiaohong Tian
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Hao Tong
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Shuling Bai
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Jun Fan
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| |
Collapse
|
7
|
Xu CC, Mau T. A tissue-specific, injectable acellular gel for the treatment of chronic vocal fold scarring. Acta Biomater 2019; 99:141-153. [PMID: 31425889 PMCID: PMC6851489 DOI: 10.1016/j.actbio.2019.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023]
Abstract
Gel-based injectable biomaterials have significant potential for treating vocal fold defects such as scarring. An ideal injectable for vocal fold lamina propria restoration should mimic the microenvironment of the lamina propria to induce scarless wound healing and functional tissue regeneration. Most current synthetic or natural injectable biomaterials do not possess the same level of complex, tissue-specific constituents as the natural vocal fold lamina propria. In this study we present a newly-developed injectable gel fabricated from decellularized bovine vocal fold lamina propria. Blyscan assay and mass spectrometry indicated that the vocal fold-specific gel contained a large amount of sulfated glycosaminoglycans and over 250 proteins. Gene Ontology overrepresentation analysis revealed that the proteins in the gel dominantly promote antifibrotic biological process. In vivo study using a rabbit vocal fold injury model showed that the injectable gel significantly reduced collagen density and decreased tissue contraction of the lamina propria in vocal folds with chronic scarring. Furthermore, this acellular gel only elicited minimal humoral immune response after injection. Our findings suggested that the tissue-specific, injectable extracellular matrix gel could be a promising biomaterial for treating vocal fold scarring, even after the formation of mature scar. STATEMENT OF SIGNIFICANCE: Vocal fold lamina propria scarring remains among the foremost therapeutic challenges in the management of patients with voice disorders. Surgical excision of scar may cause secondary scarring and yield inconsistent results. The present study reports an extracellular matrix-derived biomaterial that demonstrated antifibrotic effect on chronic scarring in vocal fold lamina propria. Its injectability minimizes the invasiveness of the delivery procedure and the degree of mucosal violation. In this work we also describe a new methodology which can more accurately identify proteins from the complex mixture of an acellular extracellular matrix gel by excluding interfering peptides produced during the enzymatic digestion in gel fabrication.
Collapse
Affiliation(s)
- Chet C Xu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Biomedical Engineering Graduate Program, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
8
|
Andreadis K, Hoffman K, D'Angelo D, Sulica L. Sulcus Vocalis: Results of Excision Without Reconstruction. Laryngoscope 2019; 130:2208-2212. [DOI: 10.1002/lary.28378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/31/2019] [Accepted: 10/10/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Katerina Andreadis
- The Sean Parker Institute for the Voice, Department of Otolaryngology–Head & Neck Surgery, Weill Cornell Medical College New York, New York U.S.A
| | - Katherine Hoffman
- Division of Biostatistics & Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College/NewYork‐Presbyterian Hospital New York, New York U.S.A
| | - Debra D'Angelo
- Division of Biostatistics & Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College/NewYork‐Presbyterian Hospital New York, New York U.S.A
| | - Lucian Sulica
- The Sean Parker Institute for the Voice, Department of Otolaryngology–Head & Neck Surgery, Weill Cornell Medical College New York, New York U.S.A
| |
Collapse
|
9
|
|
10
|
Pathophysiology of Fibrosis in the Vocal Fold: Current Research, Future Treatment Strategies, and Obstacles to Restoring Vocal Fold Pliability. Int J Mol Sci 2019; 20:ijms20102551. [PMID: 31137626 PMCID: PMC6567075 DOI: 10.3390/ijms20102551] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
Communication by voice depends on symmetrical vibrations within the vocal folds (VFs) and is indispensable for various occupations. VF scarring is one of the main reasons for permanent dysphonia and results from injury to the unique layered structure of the VFs. The increased collagen and decreased hyaluronic acid within VF scars lead to a loss of pliability of the VFs and significantly decreases their capacity to vibrate. As there is currently no definitive treatment for VF scarring, regenerative medicine and tissue engineering have become increasingly important research areas within otolaryngology. Several recent reviews have described the problem of VF scarring and various possible solutions, including tissue engineered cells and tissues, biomaterial implants, stem cells, growth factors, anti-inflammatory cytokines antifibrotic agents. Despite considerable research progress, these technical advances have not been established as routine clinical procedures. This review focuses on emerging techniques for restoring VF pliability using various approaches. We discuss our studies on interactions among adipose-derived stem/stromal cells, antifibrotic agents, and VF fibroblasts using an in vitro model. We also identify some obstacles to advances in research.
Collapse
|
11
|
Hintze JM, Tchoukalova YD, Sista R, Shah MK, Zhang N, Lott DG. Development of xeno-free epithelial differentiation media for adherent, non-expanded adipose stromal vascular cell cultures. Biochem Biophys Res Commun 2018; 503:3128-3133. [PMID: 30166060 DOI: 10.1016/j.bbrc.2018.08.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Reconstruction of respiratory epithelium is critical for the fabrication of bioengineered airway implants. Epithelial differentiation is typically achieved using bovine pituitary extract (BPE). Due to the xenogenic nature and undefined composition of BPE, an alternative for human clinical applications, devoid of BPE, must be developed. The goal of this study was to develop two different BPE-free media, with and without select pituitary hormone (PH), which could initiate epithelial differentiation for use in human implantation. METHODS The ability of the two BPE-free media to initiate epithelial differentiation of adherent, non-expanded stromal-vascular cells grown on porcine small intestinal submucosa was compared to traditional BPE-containing media (M1). Nanostring® was used to measure differences in gene expression of stemness (MSC), basal cell (basal), and ciliated markers (muco-cil), and staining was performed support the gene data. RESULTS Compared to baseline, both BPE-free media upregulated epithelial and stemness genes, however this was to a lower degree than BPE-containing media. In general, the expression of basal cell markers (COL17A1, DSG3, ITGA6, KRT6A, LOXL2) and secreted mucous proteins (PLUNC, MUC5B, SCGB2A1) was upregulated. The gene expression of ciliated markers C9orf24, TUBA3 and DNCL2B but not of the key transcription factor for cilagenesis FOXJ1 were upregulated, indicating that mucus-secreting cell differentiation occurs more rapidly than ciliogenesis. The ability of the adherent stromal vascular cells to upregulate gene expression of both epithelial and stemness markers suggests maintenance of the self-renewal capacity of undifferentiated and/or basal cell-like cells contributing to proliferation and ensuring a persisting source of cells for regenerative medicine applications. CONCLUSION This study provides the initial step to defining a BPE-free epithelial differentiation medium for clinical translation. Thus, either of the proposed BPE-free medium are viable alternatives to BPE-containing medium for partial epithelial differentiation for human translational applications.
Collapse
Affiliation(s)
- Justin M Hintze
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Yourka D Tchoukalova
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Ramachandra Sista
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Manisha K Shah
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - David G Lott
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA; Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA.
| |
Collapse
|
12
|
Pitman MJ, Kurita T, Powell ME, Kimball EE, Mizuta M, Chang S, Garrett CG, Rousseau B. Vibratory function and healing outcomes after small intestinal submucosa biomaterial implantation for chronic vocal fold scar. Laryngoscope 2017; 128:901-908. [PMID: 29105772 DOI: 10.1002/lary.26883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/04/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold scar is a major cause of dysphonia, and optimal treatments do not currently exist. Small intestinal submucosa (SIS) is a biomaterial developed for the treatment of a variety of pathologies. The purpose of this study was to investigate the effects of SIS implantation on tissue remodeling in scarred vocal folds using routine staining, immunohistochemistry, and high-speed videoendoscopy (HSV). STUDY DESIGN Prospective, blinded group analysis. METHODS Thirteen New Zealand White rabbits underwent a vocal fold scarring procedure followed by microflap elevation with or without SIS implantation. Seven months later, they underwent a phonation procedure with HSV and laryngeal harvest. Alcian blue and elastica van Gieson staining and immunohistochemistry for collagen types I and III were used to evaluate histological healing outcomes. Dynamic functional remodeling of the scarred vocal fold in the presence of SIS implants was evaluated using HSV imaging to capture restoration of vibratory amplitude, amplitude ratio, and left-right phase symmetry. RESULTS Density of collagen I was significantly decreased in SIS versus microflap-treated vocal folds. No differences were found between groups for hyaluronic acid, elastin, or collagen type III. Organization of elastin in the subepithelial region appeared to affect amplitude of vibration and the shape of the vocal fold edge. CONCLUSIONS SIS implantation into chronic scar reduced the density of collagen I deposits. There was no evidence of a negative impact or complication from SIS implantation. Regardless of treatment type, organization of elastin in the subepithelial region may be important to vibratory outcomes. LEVEL OF EVIDENCE NA. Laryngoscope, 128:901-908, 2018.
Collapse
Affiliation(s)
- Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center/New York Presbyterian, New York, New York, U.S.A
| | - Takashi Kurita
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Maria E Powell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Chang
- Corning Research and Development Corporation, Painted Post, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| |
Collapse
|
13
|
Erndt-Marino JD, Jimenez-Vergara AC, Diaz-Rodriguez P, Kulwatno J, Diaz-Quiroz JF, Thibeault S, Hahn MS. In vitro evaluation of a basic fibroblast growth factor-containing hydrogel toward vocal fold lamina propria scar treatment. J Biomed Mater Res B Appl Biomater 2017; 106:1258-1267. [PMID: 28580765 DOI: 10.1002/jbm.b.33936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/11/2017] [Accepted: 05/16/2017] [Indexed: 12/25/2022]
Abstract
Scarring of the vocal fold lamina propria can lead to debilitating voice disorders that can significantly impair quality of life. The reduced pliability of the scar tissue-which diminishes proper vocal fold vibratory efficiency-results in part from abnormal extracellular matrix (ECM) deposition by vocal fold fibroblasts (VFF) that have taken on a fibrotic phenotype. To address this issue, bioactive materials containing cytokines and/or growth factors may provide a platform to transition fibrotic VFF within the scarred tissue toward an anti-fibrotic phenotype, thereby improving the quality of ECM within the scar tissue. However, for such an approach to be most effective, the acute host response resulting from biomaterial insertion/injection likely also needs to be considered. The goal of the present work was to evaluate the anti-fibrotic and anti-inflammatory capacity of an injectable hydrogel containing tethered basic fibroblast growth factor (bFGF) in the dual context of scar and biomaterial-induced acute inflammation. An in vitro co-culture system was utilized containing both activated, fibrotic VFF and activated, pro-inflammatory macrophages (MΦ) within a 3D poly(ethylene glycol) diacrylate (PEGDA) hydrogel containing tethered bFGF. Following 72 h of culture, alterations in VFF and macrophage phenotype were evaluated relative to mono-culture and co-culture controls. In our co-culture system, bFGF reduced the production of fibrotic markers collagen type I, α smooth muscle actin, and biglycan by activated VFF and promoted wound-healing/anti-inflammatory marker expression in activated MΦ. Cumulatively, these data indicate that bFGF-containing hydrogels warrant further investigation for the treatment of vocal fold lamina propria scar. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1258-1267, 2018.
Collapse
Affiliation(s)
- Josh D Erndt-Marino
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | | | - Jonathan Kulwatno
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | | | - Susan Thibeault
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mariah S Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| |
Collapse
|
14
|
Xu Q, Shanti RM, Zhang Q, Cannady SB, O'Malley BW, Le AD. A Gingiva-Derived Mesenchymal Stem Cell-Laden Porcine Small Intestinal Submucosa Extracellular Matrix Construct Promotes Myomucosal Regeneration of the Tongue. Tissue Eng Part A 2017; 23:301-312. [PMID: 27923325 DOI: 10.1089/ten.tea.2016.0342] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In the oral cavity, the tongue is the anatomic subsite most commonly involved by invasive squamous cell carcinoma. Current treatment protocols often require significant tissue resection to achieve adequate negative margins and optimal local tumor control. Reconstruction of the tongue while preserving and/or restoring its critical vocal, chewing, and swallowing functions remains one of the major challenges in head and neck oncologic surgery. We investigated the in vitro feasibility of fabricating a novel combinatorial construct using porcine small intestinal submucosa extracellular matrix (SIS-ECM) and human gingiva-derived mesenchymal stem cells (GMSCs) as a GMSC/SIS-ECM tissue graft for the tongue reconstruction. We developed a rat model of critical-sized myomucosal defect of the tongue that allowed the testing of therapeutic effects of an acellular SIS-ECM construct versus a GMSC/SIS-ECM construct on repair and regeneration of the tongue defect. We showed that the GMSC/SIS-ECM construct engrafted at the host recipient site, promoted soft tissue healing, and regenerated the muscular layer, compared to the SIS-ECM alone or nontreated defect controls. Furthermore, our results revealed that transplantation of the GMSC/SIS-ECM construct significantly increased the expression of several myogenic transcriptional factors and simultaneously suppressed the expression of type I collagen at the wounded area of the tongue. These compelling findings suggest that, unlike the tongue contracture and fibrosis of the nontreated defect group, transplantation of the combinatorial GMSC/SIS-ECM constructs accelerates wound healing and muscle regeneration and maintains the overall tongue shape, possibly by both enhancing the function of endogenous skeletal progenitor cells and suppressing fibrosis. Together, our findings indicate that GMSC/SIS-ECM potentially served as a myomucosal graft for tongue reconstruction postsurgery of head and neck cancer.
Collapse
Affiliation(s)
- Qilin Xu
- 1 Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine , Philadelphia, Pennsylvania
| | - Rabie M Shanti
- 1 Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine , Philadelphia, Pennsylvania.,2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania.,3 Department of Oral and Maxillofacial Surgery, Penn Medicine Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Qunzhou Zhang
- 1 Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine , Philadelphia, Pennsylvania
| | - Steven B Cannady
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - Bert W O'Malley
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - Anh D Le
- 1 Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine , Philadelphia, Pennsylvania.,3 Department of Oral and Maxillofacial Surgery, Penn Medicine Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| |
Collapse
|