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Mackay G, Allen J. Platelet Rich plasma injection of the vocal folds in benign vocal pathologies. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08824-5. [PMID: 39014252 DOI: 10.1007/s00405-024-08824-5] [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: 06/02/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE There are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability. METHODS Patients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy). RESULTS 75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months. CONCLUSIONS VF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases. LEVEL OF EVIDENCE Level III: prospective cohort study.
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Affiliation(s)
- Georgia Mackay
- Department of Surgery, University of Auckland, Private Bag 91019, Grafton Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, University of Auckland, Private Bag 91019, Grafton Auckland, New Zealand.
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Santuray R, Schlegel P, Zhang Z, Reddy N, Alhiyari Y, Long JL. Cell-Based Outer Vocal Fold Replacement Both Treats and Prevents Vocal Fold Scarring in Rabbits. Laryngoscope 2024; 134:764-772. [PMID: 37597170 PMCID: PMC10842642 DOI: 10.1002/lary.30952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Numerous pharmacological and cell-based treatments have shown promise in preventing vocal fold (VF) scarring when applied at the time of injury. A common clinical scenario, however, is the finding of mature scar impeding voicing. Many treatments are less effective in remodeling existing scar tissue. This objective of this study is to determine if a cell-based outer vocal fold replacement (COVR) effectively restores VF function when applied to existing scar. METHODS Eighteen rabbits were allocated to three groups: unilateral COVR implant at the time of cordectomy (acute COVR); unilateral cordectomy followed by COVR implant 2 months later (chronic COVR); and unilateral cordectomy followed by sham implant surgery 2 months later (chronic scar). Larynges were harvested 2 months after implant or sham surgery. RESULTS All larynges in the COVR groups demonstrated human leukocyte antigen labeling on immunohistochemistry (IHC). COVR groups had increased hyaluronic acid content compared with normal. VF stiffness as measured by elastic moduli in acute COVR and chronic COVR were similar to their contralateral unoperated VF. CONCLUSION COVR implantation in both acutely injured and chronically scarred VF demonstrate persistence of implanted cells, restored tissue biomechanics, and increased hyaluronic acid content. LEVEL OF EVIDENCE NA Laryngoscope, 134:764-772, 2024.
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Affiliation(s)
- Rodell Santuray
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Neha Reddy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Yazeed Alhiyari
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer L. Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
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Svistushkin M, Shpichka A, Bikmulina P, Fayzullin A, Zolotova A, Kosheleva N, Selezneva L, Shavkuta B, Lobacheva V, Nikiforova A, Kochetkov P, Kotova S, Starostina S, Shekhter A, Svistunov A, Svistushkin V, Timashev P. Vocal fold restoration after scarring: biocompatibility and efficacy of an MSC-based bioequivalent. Stem Cell Res Ther 2023; 14:303. [PMID: 37865795 PMCID: PMC10590531 DOI: 10.1186/s13287-023-03534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND There is growing interest to application of regenerative medicine approaches in otorhinolaryngological practice, especially in the framework of the therapy of vocal fold (VF) scar lesions. The used conservative and surgical methods, despite the achieved positive outcomes, are frequently unpredictable and do not result in the restoration of the VF's lamina propria's structure, which provides the mechanical properties necessary for vibration. In this connection, the aim of this study was to ascertain the safety and efficacy of a bioequivalent in the treatment of VF scars using a rabbit model of chronic damage. METHODS The bioequivalent consisted of a hydrogel system based on a PEG-fibrin conjugate and human bone marrow-derived MSC. It was characterized and implanted heterotopically into rats and orthotopically into rabbits after VF scar excision. RESULTS We showed that the fabricated bioequivalent consisted of viable cells retaining their metabolic and proliferative activity. While being implanted heterotopically, it had induced the low inflammatory reaction in 7 days and was well tolerated. The orthotopic implantation showed that the gel application was characterized by a lower hemorrhage intensity (p = 0.03945). The intensity of stridor and respiratory rate between the groups in total and between separate groups had no statistically significant difference (p = 0.96 and p = 1; p = 0.9593 and p = 0.97…1, respectively). In 3 days post-implantation, MSC were detected only in the tissues closely surrounding the VF defect. The bioequivalent injection caused that the scar collagen fibers were packed looser and more frequently mutually parallel that is inherent in the native tissue (p = 0.018). In all experimental groups, the fibrous tissue's ingrowth in the adjacent exterior muscle tissue was observed; however, in Group 4 (PEG-Fibrin + MSC), it was much less pronounced than it was in Group 1 (normal saline) (p = 0.008). The difference between the thicknesses of the lamina propria in the control group and in Group 4 was not revealed to be statistically significant (p = 0.995). The Young's modulus of the VF after the bioequivalent implantation (1.15 ± 0.25 kPa) did not statistically significantly differ from the intact VF modulus (1.17 ± 0.45 kPa); therefore, the tissue properties in this group more closely resembled the intact VF. CONCLUSIONS The developed bioequivalent showed to be biocompatible and highly efficient in the restoration of VF's tissue.
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Affiliation(s)
| | - Anastasia Shpichka
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Moscow, Russia
| | - Polina Bikmulina
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Alexey Fayzullin
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Anna Zolotova
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Nastasia Kosheleva
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- FSBSI Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Liliya Selezneva
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Boris Shavkuta
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | | | - Anna Nikiforova
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Peter Kochetkov
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Svetlana Kotova
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- Department of Polymers and Composites, N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | | | - Anatoly Shekhter
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | | | | | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.
- Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia.
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Schlegel P, Yan K, Upadhyaya S, Buyens W, Wong K, Chen A, Faull KF, Al-Hiyari Y, Long J. Tissue-engineered vocal fold replacement in swine: Methods for functional and structural analysis. PLoS One 2023; 18:e0284135. [PMID: 37083641 PMCID: PMC10120936 DOI: 10.1371/journal.pone.0284135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
We have developed a cell-based outer vocal fold replacement (COVR) as a potential therapy to improve voice quality after vocal fold (VF) injury, radiation, or tumor resection. The COVR consists of multipotent human adipose-derived stem cells (hASC) embedded within a three-dimensional fibrin scaffold that resembles vocal fold epithelium and lamina propria layers. Previous work has shown improved wound healing in rabbit studies. In this pilot study in pigs, we sought to develop methods for large animal implantation and phonatory assessment. Feasibility, safety, and structural and functional outcomes of the COVR implant are described. Of eight pigs studied, six animals underwent COVR implantation with harvest between 2 weeks and 6 months. Recovery of laryngeal tissue structure was assessed by vibratory and histologic analyses. Recovery of voice function was assessed by investigating acoustic parameters that were derived specifically for pigs. Results showed improved lamina propria qualities relative to an injured control animal at 6 months. Acoustic parameters reflected voice worsening immediately after surgery as expected; acoustics displayed clear voice recovery in the animal followed for 6 months after COVR. These methods form the basis for a larger-scale long-term pre-clinical safety and efficacy study.
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Affiliation(s)
- Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Kenneth Yan
- Department of Otolaryngology/Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Sreenivasa Upadhyaya
- Department of Computer Science, Katholieke Universiteit Leuven, Leuven, Belgium
- SoundTalks N.V, Leuven, Belgium
| | | | - Kirsten Wong
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Anthony Chen
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Kym F. Faull
- Department of Psychiatry & Biobehavioral Sciences, Pasarow Mass Spectrometry Laboratory, Jane & Terry Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Yazeed Al-Hiyari
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
| | - Jennifer Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, United States of America
- Surgery and Perioperative Careline, Greater Los Angeles VA Healthcare System, Los Angeles, California, United States of America
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Tran EK, Alhiyari Y, Juarez K, Gowda BS, Schrader F, Sajed DP, Long JL. A xenograft study of human adipose stromal cell-based vocal fold mucosal replacement in rabbits. Laryngoscope Investig Otolaryngol 2022; 7:1521-1531. [PMID: 36258854 PMCID: PMC9575091 DOI: 10.1002/lio2.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Vocal fold (VF) scarring, manifested by increased collagen, decreased glycosaminoglycans (GAGs), and disrupted elastic fibers, remains a negative consequence of VF injury or resection. The objective of this study is to compare four reconstructive options after Vf mucosal resection in rabbits. A Cell-Based Outer Vocal fold Replacement (COVR) using human adipose-derived mesenchymal stromal cells (hASCs) in fibrin scaffold is directly compared with a decellularized scaffold implant, hASC injection, and resection alone without reconstruction. The primary hypothesis is that the cells-in-scaffold construct better reconstitutes the VF structure than either cells or scaffold alone, or than healing by secondary intention. Methods A total of49 rabbits received bilateral VF cordectomy, followed by either COVR implant, decellularized scaffold implant, hASC injection, or no reconstruction (injured control group). Larynges were harvested after 6 weeks. Results Histology demonstrated greater lamina propria thickness, less collagen deposition, and more GAGs in COVR animals versus all other treatment groups. Evidence of persistent human cells was found in about half of the cell-treated animals. RNA levels of fibrosis pathway and macrophage phenotype markers were statistically unchanged among treatment groups at 6 weeks. Conclusion These data support the efficacy of COVR implantation in restoring VF microstructure in rabbits. The intact COVR was required; isolated components of decellularized scaffold or injected hASC still produced histologic scarring. We propose that the unique bilayered cell structure within fibrin enables controlled matrix remodeling to minimize wound contraction and fibrosis, and to promote GAG deposition. Level of Evidence Basic science study.
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Affiliation(s)
- Eric K. Tran
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
| | - Yazeed Alhiyari
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
| | - Kevin Juarez
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Department of Anesthesiology and Perioperative CareUniversity of California‐San Francisco HealthSan FranciscoCaliforniaUSA
| | - Bhavani Shankara Gowda
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
| | - Feng Schrader
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
| | - Dipti P. Sajed
- Department of Pathology and Laboratory Medicine, Los AngelesDavid Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer L. Long
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los AngelesLos AngelesCaliforniaUSA
- Greater Los Angeles Veterans Affairs Healthcare SystemLos AngelesCaliforniaUSA
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Svistushkin MV, Kotova S, Shpichka A, Starostina S, Shekhter A, Bikmulina P, Nikiforova A, Zolotova A, Royuk V, Kochetkov PA, Timashev S, Fomin V, Vosough M, Svistushkin V, Timashev P. Stem cell therapy for vocal fold regeneration after scarring: a review of experimental approaches. Stem Cell Res Ther 2022; 13:176. [PMID: 35505357 PMCID: PMC9066721 DOI: 10.1186/s13287-022-02853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 11/12/2022] Open
Abstract
This review aims at becoming a guide which will help to plan the experimental design and to choose adequate methods to assess the outcomes when testing cell-based products in the treatment of the damaged vocal folds. The requirements to preclinical trials of cell-based products remain rather hazy and dictated by the country regulations. Most parameters like the way the cells are administered, selection of the cell source, selection of a carrier, and design of in vivo studies are decided upon by each research team and may differ essentially between studies. The review covers the methodological aspects of preclinical studies such as experimental models, characterization of cell products, assessment of the study outcome using molecular, morphological and immunohistochemical analyses, as well as measuring the tissue physical properties. The unified recommendations to perform preclinical trials could significantly facilitate the translation of cell-based products into the clinical practice.
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Affiliation(s)
- Mikhail V Svistushkin
- Department for ENT Diseases, Sechenov University, Moscow, Russia.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia
| | - Svetlana Kotova
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,Department of Polymers and Composites, N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia Shpichka
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia. .,Institute for Regenerative Medicine, Sechenov University, Moscow, Russia. .,Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
| | | | - Anatoliy Shekhter
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Polina Bikmulina
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia.,Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Anna Nikiforova
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Anna Zolotova
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Valery Royuk
- University Hospital No 1, Sechenov University, Moscow, Russia
| | - P A Kochetkov
- Department for ENT Diseases, Sechenov University, Moscow, Russia
| | - Serge Timashev
- National Research Nuclear University «MEPhI», Moscow, Russia
| | - Victor Fomin
- Department of Internal Medicine No 1, Sechenov University, Moscow, Russia
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | | | - Peter Timashev
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov University, Moscow, Russia. .,Institute for Regenerative Medicine, Sechenov University, Moscow, Russia. .,Department of Polymers and Composites, N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia. .,Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
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Lott DG, Shah M, Myers C, McPhail M, Neubauer J, Struthers J, Madsen CS, Grandjean D, Zacharias SRC, Tchoukalova YD. A Tissue Engineered Construct for Laryngeal Regeneration: A Proof-of-Concept Device Design Study. Laryngoscope 2022; 132 Suppl 9:S1-S11. [PMID: 35084750 DOI: 10.1002/lary.30029] [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: 08/30/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Develop a patient-specific tissue engineered construct for laryngeal reconstruction following a partial laryngectomy. STUDY DESIGN Bench and animal research. METHODS A construct made from a porous polyethylene scaffold shaped in a canine-specific configuration and seeded with autologous canine adipose-derived stem cells in fibrin glue was implanted in a canine following a partial laryngectomy. After 1 year, the construct was first evaluated in vivo with high-speed imaging and acoustic-aerodynamic measures. It was then explanted and evaluated histologically. RESULTS The canine study at 1 year revealed the construct provided voicing (barking) with acoustic and aerodynamic measures within normal ranges. The canine was able to eat and breathe normally without long-term support. The construct was integrated with epithelialization of all areas except the medial portion of the vocal fold structure. No anti-infective agents were needed after the standard perioperative medications were completed. CONCLUSION This study provided a successful first step toward developing a patient-specific composite construct for patients undergoing partial laryngectomies. LEVEL OF EVIDENCE Not Applicable Laryngoscope, 2022.
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Affiliation(s)
- David G Lott
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A.,Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Manisha Shah
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Cheryl Myers
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Michael McPhail
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Juergen Neubauer
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Jason Struthers
- Department of Pathology and Population Medicine of Midwestern University's College of Veterinary Medicine, Glendale, Arizona, U.S.A
| | - Cathy S Madsen
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Danielle Grandjean
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
| | - Stephanie R C Zacharias
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A.,Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Yourka D Tchoukalova
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona, U.S.A
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Abstract
PURPOSE OF REVIEW Vocal fold (VF) fibrosis remains an insoluble problem in most cases, with a severe impact on vocal quality and effort. This review examines current investigations and research strands that explore the understanding of VF wound healing and applied treatments for the management of VF scar. RECENT FINDINGS Recent work focused on VF fibrosis has examined wound healing in the glottis, fibrosis-modifying medication, and tissue engineering approaches that span cytokine and growth factor therapy, scaffold and cell delivery platforms, seeded scaffolds, conditioned media and stem cell therapy. Many show promise and may deliver improvements in the wound bed favouring less fibrogenic healing patterns, ultimately with the goal of preserving or restoring VF vibration. Further collaborative research is required that examines combined approaches, long term outcomes, better three-dimensional modelling of cell-cell interactions and delivery modalities for molecular therapies. SUMMARY VF fibrosis research continues to expand and explore a variety of mechanistic pathways in order to understand VF healing and identify novel and complementary targets for manipulation. Many different approaches show promise and may also offer synergistic benefits. Research continues to strive for healing that more closely resembles true VF architecture and function.
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Kaboodkhani R, Mehrabani D, Karimi-Busheri F. Achievements and Challenges in Transplantation of Mesenchymal Stem Cells in Otorhinolaryngology. J Clin Med 2021; 10:2940. [PMID: 34209041 PMCID: PMC8267672 DOI: 10.3390/jcm10132940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022] Open
Abstract
Otorhinolaryngology enrolls head and neck surgery in various tissues such as ear, nose, and throat (ENT) that govern different activities such as hearing, breathing, smelling, production of vocal sounds, the balance, deglutition, facial animation, air filtration and humidification, and articulation during speech, while absence of these functions can lead to high morbidity and even mortality. Conventional therapies for head and neck damaged tissues include grafts, transplants, and artificial materials, but grafts have limited availability and cause morbidity in the donor site. To improve these limitations, regenerative medicine, as a novel and rapidly growing field, has opened a new therapeutic window in otorhinolaryngology by using cell transplantation to target the healing and replacement of injured tissues. There is a high risk of rejection and tumor formation for transplantation of embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs); mesenchymal stem cells (MSCs) lack these drawbacks. They have easy expansion and antiapoptotic properties with a wide range of healing and aesthetic functions that make them a novel candidate in otorhinolaryngology for craniofacial defects and diseases and hold immense promise for bone tissue healing; even the tissue sources and types of MSCs, the method of cell introduction and their preparation quality can influence the final outcome in the injured tissue. In this review, we demonstrated the anti-inflammatory and immunomodulatory properties of MSCs, from different sources, to be safely used for cell-based therapies in otorhinolaryngology, while their achievements and challenges have been described too.
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Affiliation(s)
- Reza Kaboodkhani
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71936-36981, Iran;
| | - Davood Mehrabani
- Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz 71987-74731, Iran
- Comparative and Experimental Medicine Center, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
- Li Ka Shing Center for Health Research and Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Feridoun Karimi-Busheri
- Department of Oncology, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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Mattei A, Bertrand B, Jouve E, Blaise T, Philandrianos C, Grimaud F, Giraudo L, Aboudou H, Dumoulin C, Arnaud L, Revis J, Galant C, Velier M, Veran J, Dignat-George F, Dessi P, Sabatier F, Magalon J, Giovanni A. Feasibility of First Injection of Autologous Adipose Tissue-Derived Stromal Vascular Fraction in Human Scarred Vocal Folds: A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg 2021; 146:355-363. [PMID: 32053141 DOI: 10.1001/jamaoto.2019.4328] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Patients with scarred vocal folds, whether congenitally or after phonosurgery, often exhibit dysphonia that negatively affects daily life and is difficult to treat. The autologous adipose tissue-derived stromal vascular fraction (ADSVF) is a readily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. Objective To evaluate the feasibility and tolerability of local injections of autologous ADSVF in patients with scarred vocal folds. Design, Setting, and Participants CELLCORDES (Innovative Treatment for Scarred Vocal Cords by Local Injection of Autologous Stromal Vascular Fraction) is a prospective, open-label, single-arm, single-center, nonrandomized controlled trial with a 12-month follow-up and patient enrollment from April 1, 2016, to June 30, 2017. Eight patients with severe dysphonia attributable to vocal fold scarring associated with a congenital malformation or resulting from microsurgical sequelae (voice handicap index score >60 of 120) completed the study. Data analysis was performed from September 1, 2018, to January 1, 2019. Interventions Injection of ADSVF into 1 or 2 vocal folds. Main Outcomes and Measures The primary outcomes were feasibility and the number and severity of adverse events associated with ADSVF-based therapy. The secondary outcomes were changes in vocal assessment, videolaryngostroboscopy, self-evaluation of dysphonia, and quality of life at 1, 6, and 12 months after cell therapy. Results Seven women and 1 man (mean [SD] age, 44.6 [10.4] years) were enrolled in this study. Adverse events associated with liposuction and ADSVF injection occurred; most of them resolved spontaneously. One patient received minor treatment to drain local bruising, and another experienced a minor contour defect at the liposuction site. At 12 months, the voice handicap index score was improved in all patients, with a mean (SD) improvement from baseline of 40.1 (21.5) points. Seven patients (88%) were considered to be responders, defined as improvement by 18 points or more in the voice handicap index score (the minimum clinically important difference). Conclusions and Relevance The findings suggest that autologous ADSVF injection in scarred vocal folds is feasible and tolerable. The findings require confirmation in a randomized clinical trial with a larger population. Trial Registration ClinicalTrials.gov Identifier: NCT02622464.
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Affiliation(s)
- Alexia Mattei
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France.,Laboratoire Parole et Langage, Centre National de la Recherche Scientifique, Aix Marseille University, Aix-en-Provence, France
| | - Baptiste Bertrand
- Department of Plastic and Reconstructive Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - Elisabeth Jouve
- Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, Institut de Neurosciences des Systèmes, Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Investigation Clinique Centre de Pharmacologie Clinique et d'Évaluation Thérapeutique, Aix Marseille University, Marseille, France
| | - Théo Blaise
- Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, Institut de Neurosciences des Systèmes, Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Investigation Clinique Centre de Pharmacologie Clinique et d'Évaluation Thérapeutique, Aix Marseille University, Marseille, France
| | - Cécile Philandrianos
- Department of Plastic and Reconstructive Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - Fanny Grimaud
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Laurent Giraudo
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Houssein Aboudou
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Chloé Dumoulin
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Laurent Arnaud
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Joana Revis
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France.,Laboratoire Parole et Langage, Centre National de la Recherche Scientifique, Aix Marseille University, Aix-en-Provence, France
| | - Camille Galant
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France.,Laboratoire Parole et Langage, Centre National de la Recherche Scientifique, Aix Marseille University, Aix-en-Provence, France
| | - Mélanie Velier
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France.,Institut National de la Sante et de la Recherche Medicale and Institut National de la Recherche Agronomique, Aix Marseille University, Centre Recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Julie Veran
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Françoise Dignat-George
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France.,Institut National de la Sante et de la Recherche Medicale and Institut National de la Recherche Agronomique, Aix Marseille University, Centre Recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Patrick Dessi
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France.,French National Centre for Scientific Research, Centre National de la Recherche Scientifique, Etablissement Français du Sang, Anthropologie bio-culturelle, Droit, Ethique et Santé, Aix Marseille University, Marseille, France
| | - Florence Sabatier
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France.,Institut National de la Sante et de la Recherche Medicale and Institut National de la Recherche Agronomique, Aix Marseille University, Centre Recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Jérémy Magalon
- Cell Therapy Department, Assistance Publique-Hôpitaux de Marseille, Institut National de la Sante et de la Recherche Medicale, La Conception University Hospital, Aix Marseille University, Marseille, France.,Institut National de la Sante et de la Recherche Medicale and Institut National de la Recherche Agronomique, Aix Marseille University, Centre Recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Antoine Giovanni
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, Marseille, France.,Laboratoire Parole et Langage, Centre National de la Recherche Scientifique, Aix Marseille University, Aix-en-Provence, France
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11
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Kolosova K, Gao Q, Tuznik M, Bouhabel S, Kost KM, Wang H, Li-Jessen NYK, Mongeau L, Wiseman PW. Characterizing Vocal Fold Injury Recovery in a Rabbit Model With Three-Dimensional Virtual Histology. Laryngoscope 2020; 131:1578-1587. [PMID: 32809236 DOI: 10.1002/lary.29028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS In animal studies of vocal fold scarring and treatment, imaging-based evaluation is most often conducted by tissue slicing and histological staining. Given variation in anatomy, injury type, severity, and sacrifice timepoints, planar histological sections provide limited spatiotemporal details of tissue repair. Three-dimensional (3D) virtual histology may provide additional contextual spatial information, enhancing objective interpretation. The study's aim was to evaluate the suitability of magnetic resonance imaging (MRI), microscale computed tomography (CT), and nonlinear laser-scanning microscopy (NM) as virtual histology approaches for rabbit studies of vocal fold scarring. METHODS A unilateral injury was created using microcup forceps in the left vocal fold of three New Zealand White rabbits. Animals were sacrificed at 3, 10, and 39 days postinjury. ex vivo imaging of excised larynges was performed with MRI, CT, and NM modalities. RESULTS The MRI modality allowed visualization of injury location and morphological internal features with 100-μm spatial resolution. The CT modality provided a view of the injury defect surface with 12-μm spatial resolution. The NM modality with optical clearing resolved second-harmonic generation signal of collagen fibers and two-photon autofluorescence in vocal fold lamina propria, muscle, and surrounding cartilage structures at submicrometer spatial scales. CONCLUSIONS Features of vocal fold injury and wound healing were observed with MRI, CT, and NM. The MRI and CT modalities provided contextual spatial information and dissection guidance, whereas NM resolved extracellular matrix structure. The results serve as a proof of concept to motivate incorporation of 3D virtual histology techniques in future vocal fold injury animal studies. LEVEL OF EVIDENCE NA Laryngoscope, 131:1578-1587, 2021.
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Affiliation(s)
- Ksenia Kolosova
- Department of Physics, McGill University, Montreal, Quebec, Canada
| | - Qiman Gao
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Marius Tuznik
- Small Animal Imaging Laboratory of the McConnell Brain Imaging Centre at the Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Sarah Bouhabel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Karen M Kost
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Huijie Wang
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - Nicole Y K Li-Jessen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada.,School of Communication Sciences and Disorders, McGill University, Montreal, Quebec, Canada
| | - Luc Mongeau
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Paul W Wiseman
- Department of Physics, McGill University, Montreal, Quebec, Canada.,Department of Chemistry, McGill University, Montreal, Quebec, Canada
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12
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Cannes do Nascimento N, dos Santos AP, Sivasankar MP, Cox A. Unraveling the molecular pathobiology of vocal fold systemic dehydration using an in vivo rabbit model. PLoS One 2020; 15:e0236348. [PMID: 32735560 PMCID: PMC7394397 DOI: 10.1371/journal.pone.0236348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/03/2020] [Indexed: 01/03/2023] Open
Abstract
Vocal folds are a viscoelastic multilayered structure responsible for voice production. Vocal fold epithelial damage may weaken the protection of deeper layers of lamina propria and thyroarytenoid muscle and impair voice production. Systemic dehydration can adversely affect vocal function by creating suboptimal biomechanical conditions for vocal fold vibration. However, the molecular pathobiology of systemically dehydrated vocal folds is poorly understood. We used an in vivo rabbit model to investigate the complete gene expression profile of systemically dehydrated vocal folds. The RNA-Seq based transcriptome revealed 203 differentially expressed (DE) vocal fold genes due to systemic dehydration. Interestingly, function enrichment analysis showed downregulation of genes involved in cell adhesion, cell junction, inflammation, and upregulation of genes involved in cell proliferation. RT-qPCR validation was performed for a subset of DE genes and confirmed the downregulation of DSG1, CDH3, NECTIN1, SDC1, S100A9, SPINK5, ECM1, IL1A, and IL36A genes. In addition, the upregulation of the transcription factor NR4A3 gene involved in epithelial cell proliferation was validated. Taken together, these results suggest an alteration of the vocal fold epithelial barrier independent of inflammation, which could indicate a disruption and remodeling of the epithelial barrier integrity. This transcriptome provides a first global picture of the molecular changes in vocal fold tissue in response to systemic dehydration. The alterations observed at the transcriptional level help to understand the pathobiology of dehydration in voice function and highlight the benefits of hydration in voice therapy.
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Affiliation(s)
- Naila Cannes do Nascimento
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail: (NCN); (AC)
| | - Andrea P. dos Santos
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, United States of America
| | - M. Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail: (NCN); (AC)
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13
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Pöttler M, Fliedner A, Bergmann J, Bui LK, Mühlberger M, Braun C, Graw M, Janko C, Friedrich O, Alexiou C, Lyer S. Magnetic Tissue Engineering of the Vocal Fold Using Superparamagnetic Iron Oxide Nanoparticles. Tissue Eng Part A 2019; 25:1470-1477. [DOI: 10.1089/ten.tea.2019.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marina Pöttler
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna Fliedner
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Bergmann
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Linh Katrin Bui
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Marina Mühlberger
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Braun
- Institute of Legal Medicine, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Matthias Graw
- Institute of Legal Medicine, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Christina Janko
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander Universität Erlangen–Nürnberg, Erlangen, Germany
| | - Christoph Alexiou
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Lyer
- Section of Experimental Oncology and Nanomedicine, Head and Neck Surgery, Department of Otorhinolaryngology, Else Kröner-Fresenius-Foundation-Professorship, Universitätsklinikum Erlangen, Erlangen, Germany
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14
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Choi YH, Ahn HJ, Park MR, Han MJ, Lee JH, Kwon SK. Dual growth factor-immobilized bioactive injection material for enhanced treatment of glottal insufficiency. Acta Biomater 2019; 86:269-279. [PMID: 30599245 DOI: 10.1016/j.actbio.2018.12.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/19/2018] [Accepted: 12/28/2018] [Indexed: 01/27/2023]
Abstract
With increasing demand for treatment of glottal insufficiency, several injection materials have been examined. However, biological resorption, degradation of injected materials, and the subsequent need to perform multiple injections still remain major clinical problems. In this study, we fabricated two different growth factor (GF) [single basic fibroblast growth factor (bFGF), single hepatocyte growth factor (HGF), or dual bFGF/HGF]-immobilized polycaprolactone (PCL)/Pluronic F127 microspheres. These materials were investigated for their potential use as bioactive injection laryngoplasty agents. HGF was found to be continuously released over 20 days and the bFGF was found to be continuously released over 25 days, as demonstrated by ELISA assay. Human vocal fold fibroblasts (hVFFs) showed significantly higher proliferative ability on dual GF-immobilized microspheres. GF-immobilized microspheres (bFGF, HGF, and dual GF) were injected into paralyzed vocal folds of New Zealand white rabbits. Through endoscopic observation and H&E staining, we identified that the microspheres remained localized at the injection site, resulting in constant volume augmentation of the paralyzed vocal fold without significant loss of the initial volume after 4 weeks. The expression of genes related to the extracellular matrix (ECM) in the vocal fold was upregulated by dual GF-immobilized microspheres. Furthermore, dual GF-immobilized microspheres inhibited muscle degeneration and upregulation of myogenic-related genes. In conclusion, dual GF-immobilized microspheres passively augmented the volume of the paralyzed vocal fold while actively inducing ECM synthesis at the injected vocal fold and preserving muscle tissue. Dual GF-immobilized microspheres could be a new and promising injection material for paralyzed vocal folds. STATEMENT OF SIGNIFICANCE: Limitation of prolonged augmentation of vocal fold and degeneration of vocal fold tissue still remain as major clinical problems in the treatment of vocal fold paralysis. Herein, we fabricated the polycaprolactone (PCL)/Pluronic F127 microspheres to augment volume of paralyzed vocal folds. On top of that, we additionally immobilized the growth factors (bFGF, HGF, or dual bFGF/HGF) on the surface of these microspheres. We highlight the efficacy of the dual GF-immobilized microspheres which augmented the volume of the paralyzed vocal fold passively, induced ECM synthesis actively at the injected vocal fold and preserved laryngeal muscle tissue. Our results suggest that the dual GF-immobilized microsphere could be a new promising injection material for injection laryngoplasty to treat paralyzed vocal fold.
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Affiliation(s)
- Young Hwan Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea; School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hee-Jin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Ri Park
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, Republic of Korea
| | - Mi-Jung Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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15
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Goel AN, Gowda BS, Veena MS, Shiba TL, Long JL. Adipose-Derived Mesenchymal Stromal Cells Persist in Tissue-Engineered Vocal Fold Replacement in Rabbits. Ann Otol Rhinol Laryngol 2018; 127:962-968. [PMID: 30296832 DOI: 10.1177/0003489418806008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES: Cell therapies using mesenchymal stromal cells (MSCs) have been proposed as a promising new tool for the treatment of vocal fold scarring. However, the mechanisms by which MSCs promote healing as well as their duration of survival within the host vocal fold have yet to be defined. The aim of this work was to assess the persistence of embedded MSCs within a tissue-engineered vocal fold mucosal replacement in a rabbit model of vocal fold injury. METHODS: Male rabbit adipose-derived MSCs were embedded within a 3-dimensional fibrin gel, forming the cell-based outer vocal fold replacement. Four female rabbits underwent unilateral resection of vocal fold epithelium and lamina propria and reconstruction with cell-based outer vocal fold replacement implantation. Polymerase chain reaction and fluorescent in situ hybridization for the sex-determining region of the Y chromosome (SRY-II) in the sex-mismatched donor-recipient pairs sought persistent cells after 4 weeks. RESULTS: A subset of implanted male cells was detected in the implant site at 4 weeks. Many SRY-II-negative cells were also detected at the implant site, presumably representing native female cells that migrated to the area. No SRY-II signal was detected in contralateral control vocal folds. CONCLUSIONS: The emergent tissue after implantation of a tissue-engineered outer vocal fold replacement is derived both from initially embedded adipose-derived stromal cells and infiltrating native cells. Our results suggest this tissue-engineering approach can provide a well-integrated tissue graft with prolonged cell activity for repair of severe vocal fold scars.
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Affiliation(s)
- Alexander N Goel
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bhavani S Gowda
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mysore S Veena
- 2 Research Service, Greater Los Angeles Veterans Affairs Hospital System, Los Angeles, CA, USA
| | - Travis L Shiba
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Long
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Research Service, Greater Los Angeles Veterans Affairs Hospital System, Los Angeles, CA, USA
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16
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Luo R, Kong W, Wei X, Lamb J, Jiang JJ. Development of Excised Larynx. J Voice 2018; 34:38-43. [PMID: 30262190 DOI: 10.1016/j.jvoice.2018.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/20/2018] [Accepted: 07/25/2018] [Indexed: 11/24/2022]
Abstract
The larynx is a complex organ which has a role in a variety of functions such as phonation, breathing, and swallowing. To research these functions, it is widely accepted that in vivo studies provide more anatomically and physiologically relevant findings. However, invasive procedures are generally needed to measure variables such a subglottal pressure, vocal fold tension and stiffness, and cricothyroid muscle stretch. Performing studies using excised larynges is a useful technique which makes it possible to not only measure phonation parameters but control them as well. Early studies using excised larynges mainly focused on controlling specific parameters and mathematical modeling simulations. The use of these studies has helped further research in laryngeal anatomy, imaging techniques, as well as aerodynamic, acoustic, and biomechanical properties. Here, we describe the progress of this research over the past 5 years. The number of accepted animal models has increased and ideas from excised larynx studies are starting to be applied to treatment methods for laryngeal disorders. These experiments are only valid for an excised situation and must continue to be combined with animal experimentation and clinical observations.
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Affiliation(s)
- Rong Luo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Wei
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jim Lamb
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin
| | - Jack J Jiang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin.
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17
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Pöttler M, Fliedner A, Schreiber E, Janko C, Friedrich RP, Bohr C, Döllinger M, Alexiou C, Dürr S. Impact of Superparamagnetic Iron Oxide Nanoparticles on Vocal Fold Fibroblasts: Cell Behavior and Cellular Iron Kinetics. NANOSCALE RESEARCH LETTERS 2017; 12:284. [PMID: 28431461 PMCID: PMC5398974 DOI: 10.1186/s11671-017-2045-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/04/2017] [Indexed: 05/10/2023]
Abstract
PURPOSE The voice is the most important instrument of communication. Tissue defects in the vocal fold (VF) area lead to serious reduction in quality of life, but thus far, no satisfactory VF implant exists. Therefore, we aim to establish a functional VF implant in a rabbit model by magnetic tissue engineering (MTE) using superparamagnetic iron oxide nanoparticles (SPION). Hence, iron quantification over time as well as cell behavior studies upon SPION treatment are of great importance. METHODS Rabbit VF fibroblasts (VFF) were treated with different concentrations of SPIONs (20, 40, and 80 μg/cm2), and iron content was examined for up to 40 days using microwave plasma-atom emission spectroscopy. The effects of SPION treatment on VFF (adhesion, spreading, and migration), which are important for the formation of 3D structures, were tested. RESULTS Cellular SPION quantification revealed that there was no residual iron remaining in VFFs after 40 days. SPIONs had a dose-dependent effect on cell adhesion, with good tolerability observed up to 20 μg/cm2. Migration and spreading were not significantly influenced by SPION treatment up to 80 μg/cm2. DISCUSSION AND CONCLUSION To develop 3D structures, cell behavior should not be affected by SPION uptake. After 40 days, cells were free of iron as a result of metabolism or rarefication during cell division. Cell functions including adhesion, spreading, and migration were proven to be intact in a dose-dependent manner after SPION treatment, suggesting a safe usage of MTE for voice rehabilitation. Our results thus constitute a solid basis for a successful transfer of this technique into 3D constructs, in order to provide an individual and personalized human VF implant in the future.
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Affiliation(s)
- Marina Pöttler
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), University Hospital Erlangen, Glückstraße 10a, 91054 Erlangen, Germany
| | - Anna Fliedner
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Eveline Schreiber
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Christina Janko
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Ralf Philipp Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Döllinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Alexiou
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
| | - Stephan Dürr
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine, Else Kröner Fresenius Stiftung-Professorship, University Hospital Erlangen, Erlangen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
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18
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Abstract
OBJECTIVE A vibratory vocal fold replacement would introduce a new treatment paradigm for structural vocal fold diseases such as scarring and lamina propria loss. This work implants a tissue-engineered replacement for vocal fold lamina propria and epithelium in rabbits and compares histology and function to injured controls and orthotopic transplants. Hypotheses were that the cell-based implant would engraft and control the wound response, reducing fibrosis and restoring vibration. STUDY DESIGN Translational research. METHODS Rabbit adipose-derived mesenchymal stem cells (ASC) were embedded within a three-dimensional fibrin gel, forming the cell-based outer vocal fold replacement (COVR). Sixteen rabbits underwent unilateral resection of vocal fold epithelium and lamina propria, as well as reconstruction with one of three treatments: fibrin glue alone with healing by secondary intention, replantation of autologous resected vocal fold cover, or COVR implantation. After 4 weeks, larynges were examined histologically and with phonation. RESULTS Fifteen rabbits survived. All tissues incorporated well after implantation. After 1 month, both graft types improved histology and vibration relative to injured controls. Extracellular matrix (ECM) of the replanted mucosa was disrupted, and ECM of the COVR implants remained immature. Immune reaction was evident when male cells were implanted into female rabbits. Best histologic and short-term vibratory outcomes were achieved with COVR implants containing male cells implanted into male rabbits. CONCLUSION Vocal fold cover replacement with a stem cell-based tissue-engineered construct is feasible and beneficial in acute rabbit implantation. Wound-modifying behavior of the COVR implant is judged to be an important factor in preventing fibrosis. LEVEL OF EVIDENCE NA. Laryngoscope, 128:153-159, 2018.
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Affiliation(s)
- Jennifer L Long
- Research Service, Greater Los Angeles VAHS, Los Angeles, California, U.S.A.,Department of Head and Neck Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, U.S.A
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Mattei A, Magalon J, Bertrand B, Philandrianos C, Veran J, Giovanni A. Cell therapy and vocal fold scarring. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:339-345. [PMID: 28689790 DOI: 10.1016/j.anorl.2017.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vocal fold microstructure is complex and can be affected by laryngeal microsurgery, inducing scarring that prevents mechanical uncoupling of epithelium and muscle, leading to vibration disorder and disabling dysphonia. Treatment options presently are few, and often without efficacy for vibration, having only an impact on volume to reduce glottal closure defect. The present review of the literature had two aims: (i) to report the current state of the literature on cell therapy in vocal fold scarring; and (ii) to analyze the therapeutic interest of the adipose-derived stromal vascular fraction in the existing therapeutic armamentarium. A PubMed® search conducted in September 2016 retrieved English or French-language original articles on the use of stem cells to treat vocal fold scarring. Twenty-seven articles published between 2003 and 2016 met the study selection criteria. Mesenchymal stem cells were most widely used, mainly derived from bone marrow or adipose tissue. Four studies were performed in vitro on fibroblasts, and 18 in vivo on animals. End-points comprised: (i) scar analysis (macro- and micro-scopic morphology, viscoelastic properties, extracellular matrix, fibroblasts); and (ii) assessment of stem cell survival and differentiation. The studies testified to the benefit of mesenchymal stem cells, and especially those of adipose derivation. The stromal vascular fraction exhibits properties that might improve results by facilitating production logistics.
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Affiliation(s)
- A Mattei
- Aix Marseille université, 13000 Marseille, France; Service d'oto-rhino-laryngologie et chirurgie cervicofaciale, La Conception, Assistance publique-Hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille, France.
| | - J Magalon
- VRCM Inserm UMR 1076, faculté de pharmacie de Marseille, Aix Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France; Inserm CBT-1409, laboratoire de culture et thérapie cellulaire, La Conception, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - B Bertrand
- Service de chirurgie plastique et réparatrice, La Conception, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - C Philandrianos
- Service de chirurgie plastique et réparatrice, La Conception, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - J Veran
- Inserm CBT-1409, laboratoire de culture et thérapie cellulaire, La Conception, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - A Giovanni
- Service d'oto-rhino-laryngologie et chirurgie cervicofaciale, La Conception, Assistance publique-Hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille, France; CNRS, laboratoire parole et langage, Aix Marseille université, 5, avenue Pasteur, 13100 Aix-en-Provence, France
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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.
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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
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Abstract
PURPOSE OF REVIEW Tissue engineering is a rapidly expanding field in medicine and involves regeneration and restoration of many organs, including larynx and the airways. Currently, this is not included in routine practice; however, a number of clinical trials in humans are ongoing or starting. This review will cover publications during the past 2 years and the focus is on larynx and trachea. RECENT FINDINGS Recent reports concern the development and investigations of cell therapies, including biological factors such as growth factors which promote healing of damage and increased vascular support of the tissue. A separate section concerns studies of stromal cells and stem cells in tissue engineering. Cell therapies and treatment with biological active factors are often combined with the development of scaffolds to support or reconstruct the soft tissue in the larynx or the cartilages in trachea or larynx. New techniques for scaffold construction, such as 3D printing, are developed. The trend in the recent publications is to combine these methods. SUMMARY Recent advances in tissue engineering of the larynx and trachea include the development of cell therapies or treatment with biological active factors often in combination with scaffolds.
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