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Kurabi A, Dewan K, Kerschner JE, Leichtle A, Li JD, Santa Maria PL, Preciado D. PANEL 3: Otitis media animal models, cell culture, tissue regeneration & pathophysiology. Int J Pediatr Otorhinolaryngol 2024; 176:111814. [PMID: 38101097 DOI: 10.1016/j.ijporl.2023.111814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To review and summarize recently published key articles on the topics of animal models, cell culture studies, tissue biomedical engineering and regeneration, and new models in relation to otitis media (OM). DATA SOURCE Electronic databases: PubMed, National Library of Medicine, Ovid Medline. REVIEW METHODS Key topics were assigned to the panel participants for identification and detailed evaluation. The PubMed reviews were focused on the period from June 2019 to June 2023, in any of the objective subject(s) or keywords listed above, noting the relevant references relating to these advances with a global overview and noting areas of recommendation(s). The final manuscript was prepared with input from all panel members. CONCLUSIONS In conclusion, ex vivo and in vivo OM research models have seen great advancements in the past 4 years. From the usage of novel genetic and molecular tools to the refinement of in vivo inducible and spontaneous mouse models, to the introduction of a wide array of reliable middle ear epithelium (MEE) cell culture systems, the next five years are likely to experience exponential growth in OM pathophysiology discoveries. Moreover, advances in these systems will predictably facilitate rapid means for novel molecular therapeutic studies.
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Affiliation(s)
- Arwa Kurabi
- Department of Otolaryngology, University of California San Diego, School of Medicine, La Jolla, CA, USA.
| | - Kalyan Dewan
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anke Leichtle
- Department of Otorhinolaryngology, University of Luebeck, Luebeck, Germany
| | - Jian-Dong Li
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Diego Preciado
- Children's National Hospital, Division of Pediatric Otolaryngology, Washington, DC, USA
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Kouhi A, Xia A, Khomtchouk K, Santa Maria PL. Minimally invasive trans-tympanic eustachian tube occlusion animal model. Int J Pediatr Otorhinolaryngol 2022; 156:111070. [PMID: 35228098 DOI: 10.1016/j.ijporl.2022.111070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Eustachian tube dysfunction is believed to be involved in the pathogenesis of many middle ear diseases including chronic suppurative otitis media. We aimed to describe a simple and reliable animal model of Eustachian Tube obstruction to further research into middle ear disorders. STUDY DESIGN Prospective cohort study in animals. SETTING University laboratory. SUBJECTS AND METHODS 30 mice C57Bl/6J (n = 15) and CBA/CaJ (n = 15) aged 6-8 weeks received transtympanic Eustachian tube occlusion on left ear trough an acute tympanic membrane perforation using thermoplastic latex used in dental procedures (gutta percha). Control mice (n = 6) received tympanic membrane perforation only. At two and four weeks, the mice were observed for signs of Eustachian tube dysfunction and compared to control ears. ET dysfunction was defined as presence of effusion in the middle ear. RESULTS 100% (n = 30) of the treated ears had otoscopic signs of Eustachian tube dysfunction at two weeks and the endpoint time of four weeks, compared to 0% in control mice (0/6). Temporary head tilt lasting up to 2 days were observed in 3 mice (10%). No other potential adverse events were recorded. No bacterial growth was determined in the middle ear fluid. CONCLUSION We describe a technically easy and reliable method for Eustachian tube occlusion in mice with an excellent success rate and minimal morbidity.
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Affiliation(s)
- Ali Kouhi
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anping Xia
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA
| | - Kelly Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, USA.
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Abstract
Mast cells (MCs), apart from their classic role in allergy, contribute to a number of biologic processes including wound healing. In particular, two aspects of their histologic distribution within the skin have attracted the attention of researchers to study their wound healing role; they represent up to 8% of the total number of cells within the dermis and their cutaneous versions are localized adjacent to the epidermis and the subdermal vasculature and nerves. At the onset of a cutaneous injury, the accumulation of MCs and release of proinflammatory and immunomodulatory mediators have been well documented. The role of MC-derived mediators has been investigated through the stages of wound healing including inflammation, proliferation, and remodeling. They contribute to hemostasis and clot formation by enhancing the expression of factor XIIIa in dermal dendrocytes through release of TNF-α, and contribute to clot stabilization. Keratinocytes, by secreting stem cell factor (SCF), recruit MCs to the site. MCs in return release inflammatory mediators, including predominantly histamine, VEGF, interleukin (IL)-6, and IL-8, that contribute to increase of endothelial permeability and vasodilation, and facilitate migration of inflammatory cells, mainly monocytes and neutrophils to the site of injury. MCs are capable of activating the fibroblasts and keratinocytes, the predominant cells involved in wound healing. MCs stimulate fibroblast proliferation during the proliferative phase via IL-4, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) to produce a new extracellular matrix (ECM). MC-derived mediators including fibroblast growth factor-2, VEGF, platelet-derived growth factor (PDGF), TGF-β, nerve growth factor (NGF), IL-4, and IL-8 contribute to neoangiogenesis, fibrinogenesis, or reepithelialization during the repair process. MC activation inhibition and targeting the MC-derived mediators are potential therapeutic strategies to improve wound healing through reduced inflammatory responses and scar formation.
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Affiliation(s)
- Daniel Elieh Ali Komi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kelly Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA.
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Rameau A, Hong RS, Djalilian H, Erbele ID, Phillips KM, Capasso R, Rose AS, Brenner MJ, Santa Maria PL. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2019. OTO Open 2020; 4:2473974X20932506. [PMID: 32537556 PMCID: PMC7268138 DOI: 10.1177/2473974x20932506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To review new devices and drugs relevant to otolaryngology-head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2019. DATA SOURCES Approval notifications for 2019 were extracted from the ENT (ear, nose, and throat) and general and plastic surgery sections of the FDA's medical devices and therapeutics listings. REVIEW METHODS New therapeutics and medical devices identified from the query were analyzed by members of the American Academy of Otolaryngology-Head and Neck Surgery's Medical Devices and Drugs Committee. Technologies were assessed by 2 independent reviewers to ascertain relevance to otolaryngology, prioritized, and classified to subspecialty field with critical review based on extant scientific literature. CONCLUSIONS Query of the FDA drug and device database returned 105 ENT devices (50 cleared, 55 with premarket approval, and 0 de novo), 543 general and plastic surgery devices (372 cleared, 170 with premarket approval, and 1 de novo), and 46 new otolaryngology-relevant drug approvals that occurred in 2019. Advances spanned all subspecialty areas with otology predominating, primarily due to hearing-related technologies. While scientific evidence was available for all new devices, there was significant heterogeneity in rigor of supporting scientific data. IMPLICATIONS FOR PRACTICE Technological and pharmaceutical innovation is an important catalyst for advances in the surgical specialties. Familiarity with new devices and therapeutics in otolaryngology-head and neck surgery ensures that clinicians keep abreast of developments with potential to improve prevailing standards of care.
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Affiliation(s)
- Anais Rameau
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Sean Parker Institute for the Voice, Weill Cornell Medicine, New York, New York, USA
| | - Robert Stephen Hong
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Hamid Djalilian
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California–Irvine, Irvine, California, USA
| | - Isaac David Erbele
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology, Louisiana State University of the Health Sciences, Baton Rouge, Louisiana, USA
| | - Katie M. Phillips
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Robson Capasso
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Austin S. Rose
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael Joel Brenner
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Peter Luke Santa Maria
- MedicalDevicesandDrugsCommittee,AmericanAcademyofOtolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
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Tan HEI, Santa Maria PL, Wijesinghe P, Francis Kennedy B, Allardyce BJ, Eikelboom RH, Atlas MD, Dilley RJ. Optical Coherence Tomography of the Tympanic Membrane and Middle Ear: A Review. Otolaryngol Head Neck Surg 2018; 159:424-438. [PMID: 29787354 DOI: 10.1177/0194599818775711] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To evaluate the recent developments in optical coherence tomography (OCT) for tympanic membrane (TM) and middle ear (ME) imaging and to identify what further development is required for the technology to be integrated into common clinical use. Data Sources PubMed, Embase, Google Scholar, Scopus, and Web of Science. Review Methods A comprehensive literature search was performed for English language articles published from January 1966 to January 2018 with the keywords "tympanic membrane or middle ear,""optical coherence tomography," and "imaging." Conclusion Conventional imaging techniques cannot adequately resolve the microscale features of TM and ME, sometimes necessitating diagnostic exploratory surgery in challenging otologic pathology. As a high-resolution noninvasive imaging technique, OCT offers promise as a diagnostic aid for otologic conditions, such as otitis media, cholesteatoma, and conductive hearing loss. Using OCT vibrometry to image the nanoscale vibrations of the TM and ME as they conduct acoustic waves may detect the location of ossicular chain dysfunction and differentiate between stapes fixation and incus-stapes discontinuity. The capacity of OCT to image depth and thickness at high resolution allows 3-dimensional volumetric reconstruction of the ME and has potential use for reconstructive tympanoplasty planning and the follow-up of ossicular prostheses. Implications for Practice To achieve common clinical use beyond these initial discoveries, future in vivo imaging devices must feature low-cost probe or endoscopic designs and faster imaging speeds and demonstrate superior diagnostic utility to computed tomography and magnetic resonance imaging. While such technology has been available for OCT, its translation requires focused development through a close collaboration between engineers and clinicians.
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Affiliation(s)
- Hsern Ern Ivan Tan
- 1 Ear Science Institute Australia, Subiaco, Australia.,2 Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia.,3 Department of Otolaryngology-Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Peter Luke Santa Maria
- 1 Ear Science Institute Australia, Subiaco, Australia.,2 Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia.,4 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Philip Wijesinghe
- 5 BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre; Centre for Medical Research, The University of Western Australia, Nedlands, Australia.,6 Department of Electrical, Electronic, and Computer Engineering, School of Engineering, The University of Western Australia, Nedlands, Australia
| | - Brendan Francis Kennedy
- 5 BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre; Centre for Medical Research, The University of Western Australia, Nedlands, Australia.,6 Department of Electrical, Electronic, and Computer Engineering, School of Engineering, The University of Western Australia, Nedlands, Australia
| | | | - Robert Henry Eikelboom
- 1 Ear Science Institute Australia, Subiaco, Australia.,2 Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia.,8 Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marcus David Atlas
- 1 Ear Science Institute Australia, Subiaco, Australia.,2 Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
| | - Rodney James Dilley
- 1 Ear Science Institute Australia, Subiaco, Australia.,2 Ear Sciences Centre, School of Medicine, The University of Western Australia, Nedlands, Australia
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Beswick DM, Kaushik A, Beinart D, McGarry S, Yew MK, Kennedy BF, Maria PLS. Biomedical device innovation methodology: applications in biophotonics. J Biomed Opt 2017; 23:1-7. [PMID: 29243414 DOI: 10.1117/1.jbo.23.2.021102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 05/03/2023]
Abstract
The process of medical device innovation involves an iterative method that focuses on designing innovative, device-oriented solutions that address unmet clinical needs. This process has been applied to the field of biophotonics with many notable successes. Device innovation begins with identifying an unmet clinical need and evaluating this need through a variety of lenses, including currently existing solutions for the need, stakeholders who are interested in the need, and the market that will support an innovative solution. Only once the clinical need is understood in detail can the invention process begin. The ideation phase often involves multiple levels of brainstorming and prototyping with the aim of addressing technical and clinical questions early and in a cost-efficient manner. Once potential solutions are found, they are tested against a number of known translational factors, including intellectual property, regulatory, and reimbursement landscapes. Only when the solution matches the clinical need, the next phase of building a "to market" strategy should begin. Most aspects of the innovation process can be conducted relatively quickly and without significant capital expense. This white paper focuses on key points of the medical device innovation method and how the field of biophotonics has been applied within this framework to generate clinical and commercial success.
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Affiliation(s)
- Daniel M Beswick
- Stanford University, Department of Otolaryngology, Head and Neck Surgery, Stanford, California, United States
- Oregon Health and Science University, Department of Otolaryngology, Head and Neck Surgery, Portland,, United States
| | - Arjun Kaushik
- SPARK Co-Lab, Perth, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Dylan Beinart
- SPARK Co-Lab, Perth, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sarah McGarry
- SPARK Co-Lab, Perth, Western Australia, Australia
- Curtin University, School of Occupational Therapy and Social Work, Faculty of Health Sciences, Bentl, Australia
| | - Ming Khoon Yew
- SPARK Co-Lab, Perth, Western Australia, Australia
- Royal Perth Hospital, Department of General Surgery, Perth, Western Australia, Australia
| | - Brendan F Kennedy
- QEII Medical Centre, Harry Perkins Institute of Medical Research, BRITElab, Nedlands, Western Austra, Australia
- University of Western Australia, Centre for Medical Research, Perth, Western Australia, Australia
- University of Western Australia, School of Electrical, Electronic and Computer Engineering, Perth, W, Australia
| | - Peter Luke Santa Maria
- Stanford University, Department of Otolaryngology, Head and Neck Surgery, Stanford, California, United States
- SPARK Co-Lab, Perth, Western Australia, Australia
- University of Western Australia, Department of Ear Sciences, Perth, Western Australia, Australia
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Santa Maria PL, Santa Maria C, Eisenried A, Velasquez N, Kannard BT, Ramani A, Kahn DM, Wheeler AJ, Brock-Utne JG. A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy. BMC Anesthesiol 2017; 17:102. [PMID: 28800725 PMCID: PMC5553896 DOI: 10.1186/s12871-017-0395-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/31/2017] [Indexed: 11/18/2022] Open
Abstract
Background Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care. Methods Thirty six female breast surgery patients, at a tertiary academic hospital, were randomized to the device or intraoperative FAW (stage I) with a further 18 patients randomized to the device with a single heating area only (stage II, popliteal fossa or sole of the feet). Stage I: 37 patients recruited (final 36). Stage II: 18 patients recruited (final 18). Inclusion criteria: general anesthesia with esophageal monitoring for over 30 min, legs available and able to fit the device and no contraindications to leg heating or compression. The intervention was: Stage I: Investigational prototype thermal compression device (full device group) or intraoperative FAW. Stage II: Device with only a single heating location. Primary outcomes were perioperative temperatures and incidence of IPH. Secondary outcomes were local skin temperature, general and thermal comfort scores and presence of perioperative complications, including blood loss. Results Mean temperatures in the full device group were significantly higher than the FAW group in the pre-operative (36.7 vs 36.4 °C, p < 0.001), early intraoperative (36.3 vs 35.9 °C, p < 0.001), intraoperative (36.6 vs 36.2 °C, p < 0.001) and postoperative periods (36.8 vs 36.5 °C, p < 0.001). The incidence of IPH in the device group was also significantly lower (16.7% vs 72.0%, p = 0.001). Thermal comfort scores were significantly higher in the full device group and hypothermia associated wound complications were higher in the FAW group. Conclusions The thermal compression device is feasible and has efficacy over the FAW. Further studies are recommended to investigate clinically significant outcomes. Trial registration clinicaltrials.gov (NCT02155400) Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0395-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Luke Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA.
| | - Chloe Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA
| | | | - Nathalia Velasquez
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA.,Department of Anesthesiology, Stanford University, Stanford, USA
| | | | | | - David Mark Kahn
- Department of Plastic Surgery, Stanford University, Stanford, USA
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Santa Maria PL, Gottlieb P, Santa Maria C, Kim S, Puria S, Yang YP. Functional Outcomes of Heparin-Binding Epidermal Growth Factor-Like Growth Factor for Regeneration of Chronic Tympanic Membrane Perforations in Mice. Tissue Eng Part A 2017; 23:436-444. [PMID: 28142401 DOI: 10.1089/ten.tea.2016.0395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We aim to demonstrate that regeneration of chronic tympanic perforations with heparin-binding epidermal growth factor-like growth factor (HB-EGF) delivered by an injectable hydrogel restored hearing to levels similar to that of nonperforated tympanic membranes. Chronic tympanic membrane perforation is currently managed as an outpatient surgery with tympanoplasty. Due to the costs of this procedure in the developed world and a lack of accessibility and resources in developing countries, there is a great need for a new treatment that does not require surgery. In this study, we show in a mouse model through measurement of auditory brainstem response and distortion product otoacoustic emissions that tympanic perforations lead to hearing loss and this can be predominantly recovered with HB-EGF treatment (5 μg/mL). Our animal model suggests a return to function between 2 and 6 months after treatment. Auditory brainstem response thresholds had returned to the control levels at 2 months, but the distortion product otoacoustic emissions returned between 2 and 6 months. We also show how the vibration characteristics of the regenerated tympanic membrane, as measured by laser Doppler vibrometry, can be similar to that of an unperforated tympanic membrane. Using the best available methods for preclinical evaluation in animal models, it is likely that HB-EGF-like growth factor treatment leads to regeneration of chronic tympanic membrane perforations and restoration of the tympanic membrane to normal function, suggesting a potential route for nonsurgical treatment.
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Affiliation(s)
- Peter Luke Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California.,2 Ear Sciences Centre, The University of Western Australia , Nedlands, Australia .,3 Ear Science Institute Australia , Subiaco, Australia
| | - Peter Gottlieb
- 4 Department of Mechanical Engineering, Stanford University , Stanford, California
| | - Chloe Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California.,2 Ear Sciences Centre, The University of Western Australia , Nedlands, Australia .,3 Ear Science Institute Australia , Subiaco, Australia
| | - Sungwoo Kim
- 5 Department of Orthopedic Surgery, Stanford University , Stanford, California
| | - Sunil Puria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California.,4 Department of Mechanical Engineering, Stanford University , Stanford, California
| | - Yunzhi Peter Yang
- 5 Department of Orthopedic Surgery, Stanford University , Stanford, California.,6 Department of Materials Science and Engineering, Stanford University , Stanford, California.,7 Department of Bioengineering, Stanford University , Stanford, California
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Santa Maria PL, Maria CS, Kim S, Yang YP. Single Administration of a Sustained-Release Formulation of KB-R7785 Inhibits Tympanic Membrane Regeneration in an Animal Model. J Int Adv Otol 2016; 12:237-240. [DOI: 10.5152/iao.2016.3124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santa Maria PL, Kim S, Varsak YK, Yang YP. In Response to the Letter to the Editor Regarding: Heparin Binding-Epidermal Growth Factor-Like Growth Factor for the Regeneration of Chronic Tympanic Membrane Perforations in Mice. Tissue Eng Part A 2016; 22:570-1. [PMID: 26908042 DOI: 10.1089/ten.tea.2016.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Luke Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California
| | - Sungwoo Kim
- 2 Department of Orthopedic Surgery, Stanford University , Stanford, California
| | - Yasin Kursad Varsak
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California
| | - Yunzhi Peter Yang
- 2 Department of Orthopedic Surgery, Stanford University , Stanford, California.,3 Materials Science and Engineering, Stanford University , Stanford, California
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Abstract
CONTEXT Heparin-binding epidermal growth factor like growth factor (HB-EGF) is an emerging therapeutic for the regeneration of the tympanic membrane (TM). OBJECTIVE Our aim was to determine whether the doses of HB-EGF delivered in a sustained release hydrogel into a middle ear mouse model, would be measurable in the systemic circulation. We also aimed to observe, in the scenario that the intended dose was absorbed directly into the circulation, whether these levels could be measured above the background levels of HB-EGF in the circulation. METHODS A total of 12 mice had transtympanic injections of 5 μg/ml of HB-EGF contained within a previously described novel hydrogel vehicle, while another 12 mice had intravenous delivery of 10 μg/kg of HB-EGF. Intravenous blood samples were collected at 0-, 3-, 24-, 168-, 288- and 720-h post-injection. A double-antibody sandwich one-step process enzyme-linked immunosorbent assay (ELISA) was used to determine the level of HB-EGF in the serum. RESULTS No mice in the transtympanic administration group and no mice in the intravenous administration group were found to have blood level measured above that in the controls. DISCUSSION The inability of the positive control to measure levels above background, suggest the total dose used in our studies, even if 100% absorbed into the system circulation is insignificant. CONCLUSIONS HB-EGF at the doses and delivery method proposed for treatment of chronic TM perforation in a mouse model are likely to have no measurable systemic effect.
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Affiliation(s)
- Peter Luke Santa Maria
- a Department of Otolaryngology , Head and Neck Surgery, Stanford University , Stanford , CA , USA
| | - Sungwoo Kim
- b Department of Orthopedic Surgery , Stanford University , Stanford , CA , USA
| | - Yunzhi Peter Yang
- b Department of Orthopedic Surgery , Stanford University , Stanford , CA , USA .,c Department of Materials Science and Engineering , Stanford University , Stanford , CA , USA , and.,d Department of Bioengineering , Stanford University , Stanford , CA , USA
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Jackler RK, Maria PLS, Varsak YK, Blevins NH, Nguyen A. In response to A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 126:E133. [PMID: 26421689 DOI: 10.1002/lary.25699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter Luke Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yasin K Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of Oregon Health and Science University, Portland, Oregon
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Jackler RK, Maria PLS, Varsak YK, Blevins NH, Nguyen A. In response to a new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 126:E131. [PMID: 26372503 DOI: 10.1002/lary.25654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter Luke Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yasin Kursad Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of Oregon Health and Science University, Portland, Oregon
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Jackler RK, Santa Maria PL, Varsak YK, Blevins NH, Nguyen A. In reference to A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 126:E50. [PMID: 26267761 DOI: 10.1002/lary.25542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter Luke Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yasin K Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of Oregon Health and Science University, Portland, Oregon
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Santa Maria PL, Kim S, Varsak YK, Yang YP. Heparin binding-epidermal growth factor-like growth factor for the regeneration of chronic tympanic membrane perforations in mice. Tissue Eng Part A 2015; 21:1483-94. [PMID: 25567607 DOI: 10.1089/ten.tea.2014.0474] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We aim to explore the role of epidermal growth factor (EGF) ligand shedding in tympanic membrane wound healing and to investigate the translation of its modulation in tissue engineering of chronic tympanic membrane perforations. Chronic suppurative otitis media (CSOM) is an infected chronic tympanic membrane perforation. Up to 200 million suffer from its associated hearing loss and it is the most common cause of pediatric hearing loss in developing countries. There is a need for nonsurgical treatment due to a worldwide lack of resources. In this study, we show that EGF ligand shedding is essential for tympanic membrane healing as it's inhibition, with KB-R7785, leads to chronic perforation in 87.9% (n=58) compared with 0% (n=20) of controls. We then show that heparin binding-EGF-like growth factor (5 μg/mL), which acts to shed EGF ligands, can regenerate chronic perforations in mouse models with 92% (22 of 24) compared with 38% (10 of 26), also with eustachian tube occlusion with 94% (18 of 19) compared with 9% (2 of 23) and with CSOM 100% (16 of 16) compared with 41% (7 of 17). We also show the nonototoxicity of this treatment and its hydrogel delivery vehicle. This provides preliminary data for a clinical trial where it could be delivered by nonspecialist trained healthcare workers and fulfill the clinical need for a nonsurgical treatment for chronic tympanic membrane perforation and CSOM.
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Affiliation(s)
- Peter Luke Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California
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Santa Maria PL. In response to: Regeneration of chronic tympanic membrane perforation using an EGF-releasing chitosan patch. Tissue Eng Part A 2014; 19:2109-10. [PMID: 23859315 DOI: 10.1089/ten.tea.2013.0351] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Santa Maria PL, Redmond SL, Atlas MD, Ghassemifar R. Histology of the healing tympanic membrane following perforation in rats. Laryngoscope 2010; 120:2061-70. [DOI: 10.1002/lary.20998] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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