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Kaboodkhani R, Mehrabani D, Moghaddam A, Salahshoori I, Khonakdar HA. Tissue engineering in otology: a review of achievements. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1105-1153. [PMID: 38386362 DOI: 10.1080/09205063.2024.2318822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
Tissue engineering application in otology spans a distance from the pinna to auditory nerve covered with specialized tissues and functions such as sense of hearing and aesthetics. It holds the potential to address the barriers of lack of donor tissue, poor tissue match, and transplant rejection through provision of new and healthy tissues similar to the host and possesses the capacity to renew, to regenerate, and to repair in-vivo and was shown to be a bypasses for any need to immunosuppression. This review aims to investigate the application of tissue engineering in otology and to evaluate the achievements and challenges in external, middle and inner ear sections. Since gaining the recent knowledge and training on use of different scaffolds is essential for otology specialists and who look for the recovery of ear function and aesthetics of patients, it is shown in this review how utilizing tissue engineering and cell transplantation, regenerative medicine can provide advancements in hearing and ear aesthetics to fit different patients' needs.
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Affiliation(s)
- Reza Kaboodkhani
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Davood Mehrabani
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
- Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | | | | | - Hossein Ali Khonakdar
- Iran Polymer and Petrochemical Institute (IPPI), Tehran, Iran
- Max Bergmann Center of Biomaterials and Institute of Materials Science, Technische Universität Dresden, Dresden, Germany
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El-Saied S, Amar A, Kaplan DM, Shitrit R, Kaminer BM, Keshet A, Lewis EC. Local Alpha1-Antitrypsin Accelerates the Healing of Tympanic Membrane Perforation in Mice. Laryngoscope 2024. [PMID: 38651563 DOI: 10.1002/lary.31454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/10/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Most tympanic membrane (TM) perforations heal spontaneously, but 10%-20% remain chronic and might lead to impaired hearing and recurrent middle ear infections. Alpha1-antitrypsin (AAT) is a circulating tissue-protective protein that is elevated under inflammatory conditions and is currently indicated for genetic AAT deficiency. Recently, AAT has been shown to promote tissue remodeling and inflammatory resolution. OBJECTIVE This study aimed to examine the effects of local clinical-grade AAT treatment on tissue repair in a mouse model of acute traumatic TM perforation. METHODS Wild-type mice underwent unilateral TM perforation and were either left untreated or treated locally with human AAT (9 × 10-3 mL at 20 mg/mL on days 0, 1, and 2; n = 15/group). The perforations were evaluated macroscopically on a serial basis. Mice were sacrificed on various days post-injury, and TMs were excised for gene analysis by RT-PCR. RESULTS There were no adverse reactions in hAAT-treated ears throughout the study period. Compared with untreated animals, TM closure occurred earlier in the treated group (days until full closure, median: 4 and 9, respectively). According to gene expression analysis, VEGF, TGFβ, and collagen-5A1 were induced earlier in AAT-treated mice (day 4-5 compared with day 9). Additionally, IL-10 expression levels were higher and IL-6 levels were lower in treated versus untreated mice. CONCLUSION A local tissue environment rich in AAT promotes early tissue repair in a perforated TM model both macroscopically and molecularly. Studies are underway to examine TM functionality and recombinant AAT formulations for micro-dosing in the format of a single local application. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Amit Amar
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Rivka Shitrit
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benyamin M Kaminer
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Aharon Keshet
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli C Lewis
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Lou Z, Li C, Yu D, Wang J, Chen Z, Yin S. Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle. Laryngoscope Investig Otolaryngol 2023; 8:1648-1656. [PMID: 38130269 PMCID: PMC10731538 DOI: 10.1002/lio2.1175] [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: 04/05/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle. Materials and methods Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Results Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Conclusion Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.
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Affiliation(s)
- Zihan Lou
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Chunyan Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Dongzhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Jingjing Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Zhengnong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Shankai Yin
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
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Tissue engineering and regenerative medicine strategies for the repair of tympanic membrane perforations. BIOMATERIALS AND BIOSYSTEMS 2022; 6:100046. [PMID: 36824158 PMCID: PMC9934438 DOI: 10.1016/j.bbiosy.2022.100046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the high success rate of autologous grafts in tympanic membrane repair, clinical alternatives are required for the closure of unresponsive chronic perforations that can lead to recurring infection and hearing loss. Tissue engineering and regenerative medicine approaches have emerged as another strategy to repair the eardrum, in addition to negating the need for donor tissue harvest and related surgical iatrogenicities. This review highlights the main approaches using biomaterials, growth factors, and cell therapies towards the healing of complex TM perforations. In addition, we discuss the challenges and advances for the development of reliable animal models, which will allow the optimisation and development of novel techniques. Finally, we indicate technologies that are currently used clinically and others that are closer to the market. The advances here discussed on tissue engineering and regenerative medicine strategies applied to the field of TM perforations will allow otologists, surgeons, and researchers to better bring novel technologies to the bedside as well as to develop new ones.
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Xiaoli Z, Jian Z, Peiran T, Xiang C. The latest progress of tympanic membrane repair materials. Am J Otolaryngol 2022; 43:103408. [DOI: 10.1016/j.amjoto.2022.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
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Mesenchymal Stem Cells for Treatment of Delayed-Healing Tympanic Membrane Perforations Using Hyaluronate-based Laminas as a Delivery System. Otol Neurotol 2022; 43:e497-e506. [DOI: 10.1097/mao.0000000000003468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Cho GW, Moon C, Song A, Vijayakumar KA, Ang MJ, Jang CH. Effect of Growth Factor-Loaded Acellular Dermal Matrix/MSCs on Regeneration of Chronic Tympanic Membrane Perforations in Rats. J Clin Med 2021; 10:jcm10071541. [PMID: 33917576 PMCID: PMC8038787 DOI: 10.3390/jcm10071541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 01/09/2023] Open
Abstract
The success rate of grafting using acellular dermal matrix (ADM) for chronic tympanic membrane was reported in previous studies to be lower than fascia or perichondrium. Combining mesenchymal stem cells (MSCs) and growth factor-loaded ADM for the regeneration of chronic TMP has not been reported so far. In this study, we hypothesized that combining growth factor-loaded ADM/MSCs could promote the recruitment of MSCs and assist in TMP regeneration. We evaluated the regeneration and compared the performance of four scaffolds in both in vitro and in vivo studies. MTT, qPCR, and immunoblotting were performed with MSCs. In vivo study was conducted in 4 groups (control; ADM only, ADM/MSC, ADM/MSC/bFGF, ADM/MSC/EGF) of rats and inferences were made by otoendoscopy and histological changes. Attachment of MSCs on ADM was observed by confocal microscopy. Proliferation rate increased with time in all treated cells. Regeneration-related gene expression in the treated groups was higher. Also, graft success rate was significantly higher in ADM/MSC/EGF group than other groups. Significant relationships were disclosed in neodrum thickness between each group. The results suggest, in future, combining EGF with ADM/MSCs could possibly be used as an outpatient treatment, without the need for surgery for eardrum regeneration.
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Affiliation(s)
- Gwang-Won Cho
- Department of Biology, College of Natural Science, Chosun University, Gwangju 61452, Korea;
- BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea; (A.S.); (K.A.V.)
| | - Changjong Moon
- Department of Veterinary Anatomy, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, Korea; (C.M.); (M.J.A.)
| | - Anji Song
- BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea; (A.S.); (K.A.V.)
| | - Karthikeyan A. Vijayakumar
- BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea; (A.S.); (K.A.V.)
| | - Mary Jasmin Ang
- Department of Veterinary Anatomy, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, Korea; (C.M.); (M.J.A.)
| | - Chul Ho Jang
- Department of Otolaryngology, Medical School, Chonnam National University, Hakdong 8, Dongku, Gwangju 61452, Korea
- Correspondence: ; Tel.: +82-62-220-6774
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Hussain Z, Pei R. Necessities, opportunities, and challenges for tympanic membrane perforation scaffolding-based bioengineering. Biomed Mater 2021; 16. [PMID: 33260166 DOI: 10.1088/1748-605x/abcf5d] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation.
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Affiliation(s)
- Zahid Hussain
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
| | - Renjun Pei
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
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Aleemardani M, Bagher Z, Farhadi M, Chahsetareh H, Najafi R, Eftekhari B, Seifalian A. Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane? TISSUE ENGINEERING PART B-REVIEWS 2021; 27:572-589. [PMID: 33164696 DOI: 10.1089/ten.teb.2020.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
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Affiliation(s)
- Mina Aleemardani
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Chahsetareh
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Roghayeh Najafi
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Behnaz Eftekhari
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London, United Kingdom
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Application of mesenchymal stem cell for tympanic membrane regeneration by tissue engineering approach. Int J Pediatr Otorhinolaryngol 2020; 133:109969. [PMID: 32126416 DOI: 10.1016/j.ijporl.2020.109969] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/22/2020] [Accepted: 02/22/2020] [Indexed: 12/13/2022]
Abstract
Regeneration is a biological process of cell renewal that takes place in damaged tissues or organs. It is naturally stimulated by the release of different growth factors, cytokines, surface molecules, and stem cells at the wounded sites. The tympanic membrane (TM) is an essential component of the hearing process in the auditory system, which can amplify and transmit sound vibrations through a chain of mobile ossicles. Middle ear infection, external sound pressure, insertion of sharp objects into the ear, and severe trauma are the main causes of TM perforations (TMPs), which could result in deficient hearing function. So far, otolaryngologists have employed surgical procedures (myringoplasty or tympanoplasty) to close the perforated eardrum. Because of limitations such as side effects, discomfort, and high cost to patients, there is a need for better alternatives to surgical procedures. Tissue engineering is a promising tool that can overcome the operational risk and restore, maintain, and improve the function of the TM using a range of biocompatible scaffolds, commercially available growth factors, and stem cells. Currently, multipotent mesenchymal stem cells (MSCs) are a good therapeutic option for the treatment of TMPs because of their self-renewing, and autocrine and paracrine activities. As there are fewer risks of isolation in the use of MSCs for the treatment of TMPs, they are more advantageous for tissue regeneration. The delivery of either MSCs alone or a combination of MSCs with biomaterials and growth factors (GFs) at the ruptured TM sites may enhance the activation of epithelial stem cell markers and increase the migration and proliferation of keratinocytes resulting in faster closure of TMPs. This review focuses on the current strategies used to treat TMPs and the importance of MSCs in TM regeneration. Particularly, we have discussed the synergistic effect of MSCs and scaffolds or GFs or scaffolds/GFs in TM regeneration. Finally, with the advancement of tissue engineering technologies such as 3D and 4D bioprinting, MSCs can be used to design patient-specific scaffolds, which may contain physical and chemical guidance cues to improve the extent and rate of targeted tissue regeneration.
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Langston M, Grobman A, Goncalves S, Angeli SI. Animal Model of Chronic Tympanic Membrane Perforation. Anat Rec (Hoboken) 2019; 303:619-625. [PMID: 31260172 DOI: 10.1002/ar.24220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/02/2019] [Accepted: 02/28/2019] [Indexed: 01/16/2023]
Abstract
Chronic tympanic membrane perforations (TMP) can be a source of significant morbidity from hearing loss, recurrent middle ear infections, changes in lifestyle, and risk of cholesteatoma formation. Laboratory experiments of TMP have been fraught by the rapid and high rate of spontaneous healing observed in animal models. There is controversy on the minimal time that perforations in animal models must have in order to be considered chronic TMP and thus have clinical relevance, with authors suggesting time periods of perforation patency of 8-12 weeks. In this article, we sought to create a clinically significant experimental model that could yield a high rate of perforation patency for at least 8 weeks. Animals undergoing acute TMP were exposed to three different experimental situations to delay the healing of the perforation: fractionated radiation, topical lipopolysaccharide application, and a combined dexamethasone and mitomycin C (DXM/MC) solution. In our study, the use of DXM/MC reliably produced TMP lasting at least 8 weeks in 86.48% of the cases without the need to reopen the perforation, infolding the edges of the membrane, or using physical barriers to prevent TMP closure. Histologically, the resulting perforated tympanum showed hyaline changes of the remnant tympanum and hyperkeratosis of the squamous epithelia of the external auditory canal. We believe that this model is reproducible and has potential use in experiments of delayed healing of TMP. Anat Rec, 303:619-625, 2020. © 2019 American Association for Anatomy.
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Affiliation(s)
- Michael Langston
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Ariel Grobman
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Stefania Goncalves
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Simon I Angeli
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
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Seonwoo H, Shin B, Jang K, Lee M, Choo O, Park S, Kim YC, Choi M, Kim J, Garg P, Jang JH, Choung Y, Chung JH. Epidermal Growth Factor-Releasing Radially Aligned Electrospun Nanofibrous Patches for the Regeneration of Chronic Tympanic Membrane Perforations. Adv Healthc Mater 2019; 8:e1801160. [PMID: 30548428 DOI: 10.1002/adhm.201801160] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/15/2018] [Indexed: 01/01/2023]
Abstract
Chronic tympanic membrane (TM) perforations can cause otorrhea. To date, various types of tissue engineering techniques have been applied for the regeneration of chronic TM perforations. However, the application of nanofibers with radially aligned nanostructures and the simultaneous release of growth factors have never been applied in the regeneration of chronic TM perforations. Here, epidermal growth factor (EGF)-releasing radially aligned nanofibrous patches (ERA-NFPs) are developed and applied for the regeneration of chronic perforated TMs. First, radial alignments and the presence of EGF in the ERA-NFPs are analyzed. EGF is confirmed to be released from the ERA-NFPs until 8 weeks. In an in vitro study, cell viability assay, immunocytochemistry, and wound-healing assay indicate rational enhancement of healing by the combination of radial alignments and EGF release. The effect of ERA-NFPs on TM cells is revealed by quantitative real-time polymerase chain reaction. An in vivo animal study shows that the ERA-NFPs effectively stimulates the healing of the chronic TM perforations. The TMs healed by ERA-NFPs show histological properties similar to those of normal TMs. These results indicate that ERA-NFPs may be an efficient platform for the regeneration of chronic TM perforations, laying the foundation for nonsurgical treatments of chronic otitis media.
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Affiliation(s)
- Hoon Seonwoo
- Department of Industrial Machinery EngineeringCollege of Life Sciences and Natural ResourcesSunchon National University 255, Jungang‐ro, Suncheon‐si Jeollanam‐do 57922 Republic of Korea
| | - Beomyong Shin
- Department of Biomedical SciencesBK21 Plus Research Center for Biomedical SciencesAjou University Graduate School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Kyoung‐Je Jang
- Department of Biosystems & Biomaterials Science and EngineeringSeoul National University Seoul 151‐742 Republic of Korea
| | - Myungchul Lee
- Department of Biosystems & Biomaterials Science and EngineeringSeoul National University Seoul 151‐742 Republic of Korea
| | - Oak‐Sung Choo
- Department of OtolaryngologyAjou University School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Sang‐Bae Park
- Department of Biosystems & Biomaterials Science and EngineeringSeoul National University Seoul 151‐742 Republic of Korea
| | - Yeong Cheol Kim
- Department of Biomedical SciencesBK21 Plus Research Center for Biomedical SciencesAjou University Graduate School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Mi‐Jin Choi
- Department of Biomedical SciencesBK21 Plus Research Center for Biomedical SciencesAjou University Graduate School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Jangho Kim
- Department of Rural and Biosystems EngineeringChonnam National University Gwangju 500‐757 Republic of Korea
| | - Pankaj Garg
- Research Institute of Agriculture and Life SciencesSeoul National University Seoul 151‐742 Republic of Korea
| | - Jeong Hun Jang
- Department of OtolaryngologyAjou University School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Yun‐Hoon Choung
- Department of Biomedical SciencesBK21 Plus Research Center for Biomedical SciencesAjou University Graduate School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
- Department of OtolaryngologyAjou University School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
- Department of Medical SciencesAjou University Graduate School of Medicine San 5 Woncheon‐dong Yeongtong‐gu Suwon 443‐721 Republic of Korea
| | - Jong Hoon Chung
- Department of Biosystems & Biomaterials Science and EngineeringSeoul National University Seoul 151‐742 Republic of Korea
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15
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Novel non-angiogenic role for mesenchymal stem cell-derived vascular endothelial growth factor on keratinocytes during wound healing. Cytokine Growth Factor Rev 2018; 44:69-79. [PMID: 30470511 DOI: 10.1016/j.cytogfr.2018.11.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
Abstract
With chronic wounds remaining a substantial healthcare issue, new therapies are sought to improve patient outcomes. Various studies have explored the benefits of promoting angiogenesis in wounds by targeting proangiogenic factors such as Vascular Endothelial Growth Factor (VEGF) family members to improve wound healing. Along similar lines, Mesenchymal Stem Cell (MSC) secretions, usually containing VEGF, have been used to improve angiogenesis in wound healing via a paracrine mechanism. Recent evidence for keratinocyte VEGF receptor expression, as well as proliferative and chemotactic responses by keratinocytes to exogenous VEGFA in vitro implies distinct non-angiogenic actions for VEGF during wound healing. In this review, we discuss the expression of VEGF family members and their receptors in keratinocytes in relation to the potential for wound healing treatments. We also explore recent findings of MSC secreted paracrine wound healing activity on keratinocytes. We report here the concept of keratinocyte wound healing responses driven by MSC-derived VEGF that is supported in the literature, providing a new mechanism for cell-free therapy of chronic wounds.
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16
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Mittal R, Jung HD, Mittal J, Eshraghi AA. A perspective on stem cell therapy for ear disorders. J Cell Physiol 2017; 233:1823-1824. [PMID: 28608552 DOI: 10.1002/jcp.26048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/12/2017] [Indexed: 12/29/2022]
Abstract
The use of stem cells in cell-based therapy is an emerging concept for the treatment of ear disorders. Tympanic membrane perforation (TMP) and inner ear disorders are some of the most commonly presented otologic disorders that can benefit from advances in cell-based therapy. Studies have already demonstrated that stem cell-based therapy can potentially be an effective treatment modality for acute and chronic TMP. Recent studies have also shown promise in application of cell-based approach to treat inner ear dysfunction. In this perspective, we will discuss the recent advancements regarding the use of cell-based therapy for ear disorders.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hyunseo D Jung
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeenu Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Adrien A Eshraghi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
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17
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Goncalves S, Bas E, Langston M, Grobman A, Goldstein BJ, Angeli S. Histologic changes of mesenchymal stem cell repair of tympanic membrane perforation. Acta Otolaryngol 2017; 137:411-416. [PMID: 27960618 DOI: 10.1080/00016489.2016.1261411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONCLUSION Mesenchymal stem-cells are good candidates for cell-therapy of chronic tympanic membranes perforations. OBJECTIVES To determine the effects of cell-based therapy in tympanic membrane perforations. METHODS Young C57BL/6 mice were anesthetized with intraperitoneal administration of ketamine and xylazine and randomly divided into three groups (n = 4 ears/group) that underwent bilateral sub-total pars tensa perforations of equal sizes using a sterile 27-gauge needle under a surgical microscope. Six-to-eight hours after injury, one group of mice did not receive treatment (acute perforation control), and the last two groups were treated with BM-MSCs embedded within HA scaffolds previously soaked in PBS to rinse culture media residues to avoid confounders and were euthanized 1 or 2 weeks after treatment. RESULTS Untreated tympanic membrane perforations developed a hyper-cellular infiltrate surrounding the injury site, while BM-MSC treated eardrums showed a reduced inflammatory response after the first week and a restoration of the trilaminar configuration 2 weeks after treatment, mimicking a normal tympanic membrane.
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Affiliation(s)
- Stefania Goncalves
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Esperanza Bas
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Langston
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Ariel Grobman
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Bradley J. Goldstein
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
- Department of Otolaryngology, Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, FL, USA
| | - Simon Angeli
- Department of Otolaryngology, Head and Neck Surgery, Jackson Memorial Hospital, Miami, FL, USA
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18
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Ong HT, Redmond SL, Marano RJ, Atlas MD, von Unge M, Aabel P, Dilley RJ. Paracrine Activity from Adipose-Derived Stem Cells on In Vitro Wound Healing in Human Tympanic Membrane Keratinocytes. Stem Cells Dev 2017; 26:405-418. [DOI: 10.1089/scd.2016.0204] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Huan Ting Ong
- Ear Science Institute Australia, Nedlands, Australia
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
| | - Sharon L. Redmond
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Robert J. Marano
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Marcus D. Atlas
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Magnus von Unge
- Division of Surgery, Akershus University Hospital and University of Oslo, Oslo, Norway
- Centre for Clinical Research Västerås, University of Uppsala, Uppsala, Sweden
| | - Peder Aabel
- Division of Surgery, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Rodney J. Dilley
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
- Centre for Cell Therapy and Regenerative Medicine, University of Western Australia, Perth, Australia
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19
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Fat volume is critical when performing fat-plug myringoplasty. Eur Arch Otorhinolaryngol 2017; 274:2661-2663. [DOI: 10.1007/s00405-017-4458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
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20
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Goncalves S, Bas E, Goldstein BJ, Angeli SI. Response to "Animal Model of Chronic Perforation Is Best for Eardrum Regeneration Using Biological Materials". Otolaryngol Head Neck Surg 2016; 155:370. [PMID: 27481888 DOI: 10.1177/0194599816651247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Lou ZC. Animal Model of Chronic Perforation Is Best for Eardrum Regeneration Using Biological Materials. Otolaryngol Head Neck Surg 2016; 155:369. [DOI: 10.1177/0194599816651246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials. Eur Arch Otorhinolaryngol 2016; 273:4045-4046. [DOI: 10.1007/s00405-016-4019-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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