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Chang GH, Yang PR, Cheng YC, Hsu KH, Wu CY, Yang YH, Lin YS, Hsu CM, Tsai MS, Tsai YT, Chang PJ. Nasal irrigation with licorice extract (Glycyrrhiza glabra) in treating nasal polyps by reducing fibroblast differentiation and extracellular matrix production in TGF-β1-stimulated nasal polyp-derived fibroblasts by inhibiting the MAPK/ERK-1/2 pathway - an in vitro and in clinic study. BMC Complement Med Ther 2022; 22:313. [PMID: 36447209 PMCID: PMC9706886 DOI: 10.1186/s12906-022-03791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To date, treating nasal polyps (NPs) is still a medical challenge. However, we have developed an innovative therapy using licorice extract (LE: Glycyrrhiza glabra) to treat rhinitis and sinusitis via nasal irrigation and have discovered that it significantly affects treatment of NPs. HYPOTHESIS/PURPOSE This study investigated the mechanism of LE on NPs. STUDY DESIGN NPs were collected from three patients using tissue biopsies before and 2 weeks after nasal irrigation with licorice for histopathological analysis. Additionally, NPs from two patients were collected, and nasal polyp-derived fibroblasts (NPDF) were isolated and cultured. METHODS The TGF-β1-stimulated NPDF model was used to examine the effect of LE on fibroblast differentiation (biomarker: α-SMA), the consequent production of extracellular matrix (ECM; biomarkers: fibronectin, FBN), and the functional signaling pathway. RESULTS Immunohistochemistry (IHC) revealed that the number of eosinophils and the expression of α-SMA and interstitial collagen of polyps after licorice treatment significantly decreased. Additionally, RT-PCR, western blotting, and immunofluorescence (IF) showed that α-SMA and FBN expressions were significantly increased in the NPDF, which was stimulated by TGF-β1, and LE dose-dependently could effectively reduce this effect. Furthermore, western blotting showed that LE could attenuate α-SMA and FBN expressions by preventing the signaling pathway of MAPK/ERK-1/2, which IHC and IF further confirmed. In addition, LE effectively suppressed the cell migration of NPDF, which is related to polyp expansion. CONCLUSION LE is clinically used to treat sinusitis with NPs through nasal irrigation, which significantly reduces the size of NPs. This effect could attenuate fibroblast differentiation, ECM production and cell migration, and one of the functional mechanisms may be through inhibition of the MAPK/ERK-1/2 signaling pathway. TRIAL REGISTRATION ISRCTN (No. 51425529) registered on 17/04/2020 (retrospectively registered) - http://www.isrctn.com/ISRCTN51425529.
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Affiliation(s)
- Geng-He Chang
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.454212.40000 0004 1756 1410Head and Neck Infection Treatment Center, Chang Gung memorial Hospital, Chiayi, Taiwan
| | - Pei-Rung Yang
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Cheng
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ke-Hsin Hsu
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Yuan Wu
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- grid.454212.40000 0004 1756 1410Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shih Lin
- grid.454212.40000 0004 1756 1410Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- grid.454212.40000 0004 1756 1410Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan ,grid.145695.a0000 0004 1798 0922Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pey-Jium Chang
- grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Yang N, Cheng H, Mo Q, Zhou X, Xie M. miR‑155‑5p downregulation inhibits epithelial‑to‑mesenchymal transition by targeting SIRT1 in human nasal epithelial cells. Mol Med Rep 2020; 22:3695-3704. [PMID: 33000196 PMCID: PMC7533509 DOI: 10.3892/mmr.2020.11468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/26/2020] [Indexed: 12/21/2022] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) in nasal epithelial cells is involved with tissue remodeling of nasal polyps. The present study investigated the molecular mechanisms through which miR-155-5p regulated EMT in chronic rhinosinusitis (CRS). Patients were divided into the following groups: CRSsNP, CRS without nasal polyposis group, CRSwNP, CRS with nasal polyposis and controls. The expression of transforming growth factor (TGF)-β1, EMT markers, sirtuin 1 (SIRT1) and miR-155-5p were determined by western blotting and reverse transcription-quantitative PCR. Cell morphology following TGF-β1 treatment in the presence of miR-155-5p inhibitors or controls was observed under a microscope. Target genes and potential binding sites between miR-155-5p and SIRT1 were predicted by TargetScan and confirmed using dual-luciferase reporter assay. In patients with CRS, the expression levels of E-cadherin were downregulated and the expression levels of TGF-β1, mesenchymal markers and miR-155-5p were upregulated. Additionally, these changes in expression levels were reduced or increased to a greater extent in the CRSwNP group compared with the CRSsNP group. Furthermore, TGF-β1 expression promoted EMT in human nasal epithelial cells (HNEpCs) and upregulated miR-155-5p expression. These effects were reversed by miR-155-5p inhibitors. Additionally, SIRT1 was predicted as a target gene of miR-155-5p. Downregulation of miR-155-5p upregulated epithelial marker expression and downregulated mesenchymal marker expression by regulating SIRT1. Therefore, the downregulation of miR-155-5p inhibited EMT in HNEpCs by targeting SIRT1.
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Affiliation(s)
- Niannian Yang
- Department of Otorhinolaryngology, Shaoyang Central Hospital, Shaoyang, Hunan 422000, P.R. China
| | - Hao Cheng
- Department of Nasopharyngeal Carcinoma, The First People's Hospital of Chenzhou, Southern Medical University, Chenzhou, Hunan 423000, P.R. China
| | - Qiao Mo
- Department of Otorhinolaryngology, Shaoyang Central Hospital, Shaoyang, Hunan 422000, P.R. China
| | - Xiaobiao Zhou
- Department of Pathology, Shaoyang Central Hospital, Shaoyang, Hunan 422000, P.R. China
| | - Minqiang Xie
- Department of Otorhinolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
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Wogonin attenuates liver fibrosis via regulating hepatic stellate cell activation and apoptosis. Int Immunopharmacol 2019; 75:105671. [DOI: 10.1016/j.intimp.2019.05.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
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Li X, Li C, Zhu G, Yuan W, Xiao ZA. TGF-β1 Induces Epithelial-Mesenchymal Transition of Chronic Sinusitis with Nasal Polyps through MicroRNA-21. Int Arch Allergy Immunol 2019; 179:304-319. [PMID: 30982052 DOI: 10.1159/000497829] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/02/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To characterize the epithelial-mesenchymal transition (EMT) in chronic rhinosinusitis with nasal polyps (CRSwNP) and to investigate the mechanism by which microRNA-21 (miR-21) regulates EMT in CRSwNP. METHOD (1) Tissue experiments: Mucosa tissues were collected from 13 patients with CRSwNP and 12 patients with CRS without nasal polyps (CRSsNP), as well as 11 patients without CRS (controls). Protein localization and quantification were achieved by immunofluorescence staining and Western blotting, involving the epithelial marker protein E-cadherin and the mesenchymal marker proteins α-smooth muscle actin (α-SMA), fibronectin, and vimentin. Quantitative RT-PCR was used to detect the relative expression levels of miR-21 and TGF-β1 mRNAs. (2) Cellular experiments: Primary human nasal epithelial cells (PHNECs) treated with TGF-β1, or TGF-β1 with miR-21 inhibitor, or miR-21 mimics alone were observed for morphology changes under a phase-contrast microscope. The expression levels of epithelial/mesenchymal marker proteins were determined as aforementioned. PTEN and phosphorylated Akt were detected by Western blotting. RESULTS (1) Tissue experiments: Compared with the CRSsNP and control groups, the expression of E-cadherin was downregulated in the CRSwNP group, whereas the expression of TGF-β1, α-SMA, fibronectin, and vimentin was upregulated. The expression levels of miR-21 and TGF-β1 mRNAs in CRSwNP were significantly higher than those in CRSsNP and controls. (2) Cellular experiments: TGF-β1 induced EMT-like transformation in PHNECs, featured by changes in cell morphology and upregulation of mesenchymal proteins and miR-21. The miR-21 inhibitor, as well as the Akt-specific -inhibitor, suppressed TGF-β1-induced EMT. Mechanically, downregulation of miR-21 resulted in increased PTEN and decreased Akt phosphorylation. Furthermore, overexpression of miR-21 had the opposite effects. CONCLUSIONS Our findings suggest that the TGF-β1-miR-21-PTEN-Akt axis may contribute to the pathogenesis of CRSwNP. miR-21 might be a reliable target for treating nasal polyp genesis through EMT suppression. Moreover, miR-21 inhibitors could be a novel class of antipolyp drug that modulates PTEN expression and Akt activation. In addition, further investigation regarding the reason underlying miR-21 overexpression in CRSwNP could provide a molecular target for novel treatment strategies for nasal polyposis.
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Affiliation(s)
- Xun Li
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chuang Li
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ganghua Zhu
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenhui Yuan
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zi-An Xiao
- Department of Otolaryngology, Head and Neck Surgery, Second Xiangya Hospital, Central South University, Changsha, China,
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Jung H, Lee DS, Park SK, Choi JS, Jung WK, Park WS, Choi IW. Fucoxanthin Inhibits Myofibroblast Differentiation and Extracellular Matrix Production in Nasal Polyp-Derived Fibroblasts via Modulation of Smad-Dependent and Smad-Independent Signaling Pathways. Mar Drugs 2018; 16:E323. [PMID: 30201895 PMCID: PMC6165344 DOI: 10.3390/md16090323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/26/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022] Open
Abstract
Nasal polyps (NPs) are a multifactorial disorder associated with a chronic inflammatory state of the nasal mucosa. Fucoxanthin (Fx) is a characteristic orange carotenoid obtained from brown algae and has diverse immunological properties. The present study investigated whether Fx inhibits fibrosis-related effects in nasal polyp-derived fibroblasts (NPDFs) and elucidated the molecular signaling pathways involved. The production of collagen type I (Col-1) was investigated in NP tissue via immunohistochemistry and western blot analysis. NPDFs were treated with transforming growth factor (TGF)-β1 (1 ng/mL) in the presence or absence of Fx (5⁻30 µM). The levels of α-smooth muscle actin (α-SMA), Col-1, and phosphorylated (p)-Smad 2/3, signal protein-1 (SP-1), MAPKs (mitogen-activated protein kinases), and Akt were measured by western blot analysis. The expression of Col-1 was detected in NP tissues. TGF-β1 stimulated the production of α-SMA and Col-1, and stimulated the contraction of collagen gel. However, pretreatment with Fx attenuated these effects. Furthermore, these inhibitory effects were mediated through modulation of both Smad 2/3 and Akt/SP-1 signaling pathways in TGF-β1-induced NPDFs. The results from the present study suggest that Fx may be a novel anti-fibrotic agent for the treatment of NP formation.
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Affiliation(s)
- Hyun Jung
- Department of Otorhinolaryngology-Head & Neck Surgery, Inje University College of Medicine, Busan 47392, Korea.
| | - Dae-Sung Lee
- Department of Applied Research, National Marine Biodiversity Institute of Korea, Seocheon 33662, Korea.
| | - Seong Kook Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Inje University College of Medicine, Busan 47392, Korea.
| | - Jung Sik Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan 47392, Korea.
| | - Won-Kyo Jung
- Department of Biomedical Engineering, Center for Marine-Integrated Biomedical Technology (BK21 Plus) Pukyong National University, Busan 48513, Korea.
| | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine, Chuncheon 24341, Korea.
| | - Il-Whan Choi
- Department of Microbiology and Immunology, College of Medicine Inje University, Busan 47392, Korea.
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Liu H, Zhang Z, Li Y, Wang X, Zhang Y, Chu Y, Yuan X, Wang X. Preparation and evaluation of anti-renal fibrosis activity of novel truncated TGF-β receptor type II. Biotechnol Appl Biochem 2018; 65:834-840. [PMID: 30066965 DOI: 10.1002/bab.1667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022]
Abstract
Production of excessive transforming growth factor-beta 1 (TGF-β1) with elevated TGF-β1 activity has been implicated in renal fibrosis via renal epithelial cells activation and collagen deposition. As such, attenuating the binding of TGF-β1 to its receptor TGF-beta receptor type II (TGF-βRII) in TGF-β1-dependent signaling is an attractive target for the control of renal fibrosis. Here, we verified the interaction between novel truncated human TGF-βRII (thTβRII, Thr23-Gln166) and TGF-β1, prepared thTβRII in Escherichia coli, and assessed the effects of thTβRII on TGF-β1-induced human kidney epithelial cells (HK-2) and unilateral ureteral obstruction (UUO) model of renal fibrosis. Our data showed that thTβRII accounted for up to 20% of the total protein and 40% of the inclusion bodies of whole cell lysates under the optimal conditions (0.8 mM IPTG and 25°C for 6 H). Most of the expressed protein in inclusion body was refolded by dialysis refolding procedures and purified by Ni2+ -IDA affinity chromatography. Furthermore, thTβRII decreased type I collagen and α-smooth muscle actin protein expression in TGF-β1-induced HK-2 cells, and ameliorated kidney morphology and fibrotic responses in fibrosis animal. These findings indicate that thTβRII holds great promise for developing new treatments for renal fibrosis.
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Affiliation(s)
- Haifeng Liu
- Heilongjiang Province Key Laboratory for Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, People's Republic of China.,Laboratory of Medical Immunology and Pathogen Biology, Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Zhongmin Zhang
- Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Yuting Li
- Laboratory of Medical Immunology and Pathogen Biology, Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Xiaoli Wang
- Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Yufei Zhang
- Heilongjiang Province Key Laboratory for Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Yanhui Chu
- Heilongjiang Province Key Laboratory for Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Xiaohuan Yuan
- Heilongjiang Province Key Laboratory for Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, People's Republic of China
| | - Xiaohua Wang
- Heilongjiang Province Key Laboratory for Anti-Fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, People's Republic of China.,Laboratory of Medical Immunology and Pathogen Biology, Mudanjiang Medical University, Mudanjiang, People's Republic of China
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Wogonin attenuates nasal polyp formation by inducing eosinophil apoptosis through HIF-1α and survivin suppression. Sci Rep 2018; 8:6201. [PMID: 29670184 PMCID: PMC5906673 DOI: 10.1038/s41598-018-24356-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/28/2018] [Indexed: 02/06/2023] Open
Abstract
Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is an inflammatory sinonasal disorder characterized by eosinophilic inflammation and T-helper 2 skewing. Eosinophil accumulation in sinonasal mucosa comprises a major feature of CRSwNP. The study aimed to investigate the effect of the flavone wogonin in nasal polyposis by assessing its ability to induce eosinophil apoptosis in vitro and attenuate eosinophilic CRSwNP in mice. Double immunofluorescence, immunohistochemistry, flow cytometry, and immunoblotting were performed to evaluate hypoxia-inducible factor (HIF)-1α, survivin, and apoptotic markers in the human eosinophilic EoL-1 cell line or sinonasal tissues from patients with CRS with or without NPs. In sinonasal specimens from patients with CRS, HIF-1α and survivin were up-regulated in eosinophils from patients with NPs compared with levels in patients without NPs. Under hypoxia, HIF-1α and survivin expression was up-regulated in EoL-1 cells. Wogonin down-regulated both HIF-1α and survivin in EoL-1 cells. In addition, overexpression of survivin protected EoL-1 cells against apoptosis in response to wogonin. Moreover, wogonin attenuated nasal polyp formation in a murine model. Our findings suggest that wogonin could induce caspase-3 activation by suppressing HIF-1α and survivin expression in EoL-1 cells. Further studies regarding novel therapeutic options for CRSwNP targeting eosinophil apoptosis are needed.
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Shin JM, Kang JH, Lee SA, Park IH, Lee HM. Effect of Doxycycline on Epithelial-Mesenchymal Transition via the p38/Smad Pathway in Respiratory Epithelial Cells. Am J Rhinol Allergy 2017; 31:71-77. [DOI: 10.2500/ajra.2017.31.4410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Doxycycline has antibacterial and anti-inflammatory effects, and it also suppresses collagen biosynthesis. This study aimed to confirm the effects and mechanism of doxycycline on transforming growth factor (TGF) beta 1 induced epithelial-mesenchymal transition and cell migration in A549 and primary nasal epithelial cells. Methods A 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide assay and phalloidin-fluorescein isothiocyanate staining were used to evaluate cytotoxicity and cellular morphologic changes. Western blot and immunofluorescence staining were used to determine the expression levels of E-cadherin, vimentin, alpha-smooth muscle actin, fibronectin, phosphorylated Smad2/3, and mitogen-activated protein kinases. Scratch and transwell migration assays were used to assess cellular migration ability. Results Doxycycline (0-10 μg/mL) had no significant cytotoxic effects in A549 and primary nasal epithelial cells. Increased expression of mesenchymal markers, including vimentin, alpha-smooth muscle actin, and fibronectin in TGF beta 1 induced A549 cells were downregulated by doxycycline treatment. In contrast, E-cadherin expression was upregulated in TGF beta 1 induced A549 cells. An in vitro cell migration assay showed that doxycycline also inhibited the ability of TGF beta 1 induced migration. Doxycycline treatment suppressed the activation of Smad2/3 and p38, whereas its inhibitory effects were similar to each element-specific inhibitor in A549 and primary nasal epithelial cells. Conclusion Doxycycline inhibited TGF beta 1 induced epithelial-to-mesenchymal transition and migration by targeting Smad2/3 and p38 signal pathways in respiratory epithelial cells.
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Affiliation(s)
- Jae-Min Shin
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul, South Korea
| | - Ju-Hyung Kang
- Division of Brain Korea 21 Program for Biomedical Science, Seoul, South Korea
| | - Seoung-Ae Lee
- Division of Brain Korea 21 Program for Biomedical Science, Seoul, South Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul, South Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Seoul, South Korea
- Institute for Korea University Medical Devices Support Center, Korea University College of Medicine, Seoul, South Korea
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