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Fleming JC, Woo J, Moutasim K, Hanley CJ, Frampton SJ, Wood O, Ward M, Woelk CH, Ottensmeier CH, Hafizi S, Kim D, Thomas GJ. CTEN Induces Tumour Cell Invasion and Survival and Is Prognostic in Radiotherapy-Treated Head and Neck Cancer. Cancers (Basel) 2020; 12:E2963. [PMID: 33066224 PMCID: PMC7602105 DOI: 10.3390/cancers12102963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/18/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a heterogenous disease treated with surgery and/or (chemo) radiotherapy, but up to 50% of patients with late-stage disease develop locoregional recurrence. Determining the mechanisms underpinning treatment resistance could identify new therapeutic targets and aid treatment selection. C-terminal tensin-like (CTEN) is a member of the tensin family, upregulated in several cancers, although its expression and function in HNSCC are unknown. We found that CTEN is commonly upregulated in HNSCC, particularly HPV-ve tumours. In vitro CTEN was upregulated in HPV-ve (n = 5) and HPV+ve (n = 2) HNSCC cell lines. Stable shRNA knockdown of CTEN in vivo significantly reduced tumour growth (SCC-25), and functional analyses in vitro showed that CTEN promoted tumour cell invasion, colony formation and growth in 3D-culture (SCC-25, Detroit 562). RNA sequencing of SCC-25 cells following CTEN siRNA knockdown identified 349 differentially expressed genes (logFC > 1, p < 0.05). Gene ontology analysis highlighted terms relating to cell locomotion and apoptosis, consistent with in vitro findings. A membrane-based antibody array confirmed that CTEN regulated multiple apoptosis-associated proteins, including HSP60 and cleaved caspase-3. Notably, in a mixed cohort of HPV+ve and HPV-ve HNSCC patients (n = 259), we found a significant, independent negative association of CTEN with prognosis, limited to those patients treated with (chemo)radiotherapy, not surgery, irrespective of human papillomavirus (HPV) status. These data show that CTEN is commonly upregulated in HNSCC and exerts several functional effects. Its potential role in modulating apoptotic response to therapy suggests utility as a predictive biomarker or radio-sensitising target.
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Affiliation(s)
- Jason C. Fleming
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool L3 9GA, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK
| | - Jeongmin Woo
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (J.W.); (C.H.W.)
| | - Karwan Moutasim
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
| | - Christopher J. Hanley
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
| | - Steven J. Frampton
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
| | - Oliver Wood
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
| | - Matthew Ward
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
| | - Christopher H. Woelk
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (J.W.); (C.H.W.)
- Exploratory Science Center, Merck & Co., Inc., Cambridge, MA 02141, USA
| | - Christian H. Ottensmeier
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool L3 9GA, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, UK
| | - Sassan Hafizi
- School of Pharmacy & Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK;
| | - Dae Kim
- St. George’s University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, UK;
| | - Gareth J. Thomas
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; (K.M.); (C.J.H.); (S.J.F.); (O.W.); (M.W.); (C.H.O.)
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Fleming JC, Woo J, Moutasim K, Mellone M, Frampton SJ, Mead A, Ahmed W, Wood O, Robinson H, Ward M, Woelk CH, Ottensmeier CH, King E, Kim D, Blaydes JP, Thomas GJ. HPV, tumour metabolism and novel target identification in head and neck squamous cell carcinoma. Br J Cancer 2019; 120:356-367. [PMID: 30655616 PMCID: PMC6353968 DOI: 10.1038/s41416-018-0364-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metabolic changes in tumour cells are used in clinical imaging and may provide potential therapeutic targets. Human papillomavirus (HPV) status is important in classifying head and neck cancers (HNSCC), identifying a distinct clinical phenotype; metabolic differences between these HNSCC subtypes remain poorly understood. METHODS We used RNA sequencing to classify the metabolic expression profiles of HPV+ve and HPV-ve HNSCC, performed a meta-analysis on FDG-PET imaging characteristics and correlated results with in vitro extracellular flux analysis of HPV-ve and HPV+ve HNSCC cell lines. The monocarboxylic acid transporter-1 (MCT1) was identified as a potential metabolic target and tested in functional assays. RESULTS Specific metabolic profiles were associated with HPV status, not limited to carbohydrate metabolism. There was dominance of all energy pathways in HPV-negative disease, with elevated expression of genes associated with glycolysis and oxidative phosphorylation. In vitro analysis confirmed comparative increased rates of oxidative phosphorylation and glycolysis in HPV-negative cell lines. PET SUV(max) scores however were unable to reliably differentiate between HPV-positive and HPV-negative tumours. MCT1 expression was significantly increased in HPV-negative tumours, and inhibition suppressed tumour cell invasion, colony formation and promoted radiosensitivity. CONCLUSION HPV-positive and negative HNSCC have different metabolic profiles which may have potential therapeutic applications.
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Affiliation(s)
- Jason C Fleming
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
- St. George's University Hospitals NHS Foundation Trust, Tooting, London, UK.
| | - Jeongmin Woo
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Karwan Moutasim
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Massimiliano Mellone
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Steven J Frampton
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Abbie Mead
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Waseem Ahmed
- St. George's University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Oliver Wood
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hollie Robinson
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthew Ward
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christopher H Woelk
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Emma King
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dae Kim
- St. George's University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Jeremy P Blaydes
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gareth J Thomas
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Hanley CJ, Mellone M, Ford K, Thirdborough SM, Mellows T, Frampton SJ, Smith DM, Harden E, Szyndralewiez C, Bullock M, Noble F, Moutasim KA, King EV, Vijayanand P, Mirnezami AH, Underwood TJ, Ottensmeier CH, Thomas GJ. Targeting the Myofibroblastic Cancer-Associated Fibroblast Phenotype Through Inhibition of NOX4. J Natl Cancer Inst 2018; 110:4060751. [PMID: 28922779 PMCID: PMC5903651 DOI: 10.1093/jnci/djx121] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/08/2017] [Accepted: 05/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background Cancer-associated fibroblasts (CAFs) are tumor-promoting and correlate with poor survival in many cancers, which has led to their emergence as potential therapeutic targets. However, effective methods to manipulate these cells clinically have yet to be developed. Methods CAF accumulation and prognostic significance in head and neck cancer (oral, n = 260; oropharyngeal, n = 271), and colorectal cancer (n = 56) was analyzed using immunohistochemistry. Mechanisms regulating fibroblast-to-myofibroblast transdifferentiation were investigated in vitro using RNA interference/pharmacological inhibitors followed by polymerase chain reaction (PCR), immunoblotting, immunofluorescence, and functional assays. RNA sequencing/bioinformatics and immunohistochemistry were used to analyze NAD(P)H Oxidase-4 (NOX4) expression in different human tumors. NOX4's role in CAF-mediated tumor progression was assessed in vitro, using CAFs from multiple tissues in Transwell and organotypic culture assays, and in vivo, using xenograft (n = 9-15 per group) and isograft (n = 6 per group) tumor models. All statistical tests were two-sided. Results Patients with moderate/high levels of myofibroblastic-CAF had a statistically significant decrease in cancer-specific survival rates in each cancer type analyzed (hazard ratios [HRs] = 1.69-7.25, 95% confidence intervals [CIs] = 1.11 to 31.30, log-rank P ≤ .01). Fibroblast-to-myofibroblast transdifferentiation was dependent on a delayed phase of intracellular reactive oxygen species, generated by NOX4, across different anatomical sites and differentiation stimuli. A statistically significant upregulation of NOX4 expression was found in multiple human cancers (P < .001), strongly correlating with myofibroblastic-CAFs (r = 0.65-0.91, adjusted P < .001). Genetic/pharmacological inhibition of NOX4 was found to revert the myofibroblastic-CAF phenotype ex vivo (54.3% decrease in α-smooth muscle actin [α-SMA], 95% CI = 10.6% to 80.9%, P = .009), prevent myofibroblastic-CAF accumulation in vivo (53.2%-79.0% decrease in α-SMA across different models, P ≤ .02) and slow tumor growth (30.6%-64.0% decrease across different models, P ≤ .04). Conclusions These data suggest that pharmacological inhibition of NOX4 may have broad applicability for stromal targeting across cancer types.
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Affiliation(s)
- Christopher J Hanley
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Massimiliano Mellone
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Kirsty Ford
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Steve M Thirdborough
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Toby Mellows
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Steven J Frampton
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - David M Smith
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Elena Harden
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Marc Bullock
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Fergus Noble
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Karwan A Moutasim
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Emma V King
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Alex H Mirnezami
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Timothy J Underwood
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Gareth J Thomas
- Cancer Sciences Unit, University of Southampton Faculty of Medicine, Southampton, UK
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Tod J, Hanley CJ, Morgan MR, Rucka M, Mellows T, Lopez M, Kiely P, Moutasim KA, Frampton SJ, Sabnis D, Fine DR, Johnson C, Marshall JF, Scita G, Jenei V, Thomas GJ. Pro-migratory and TGF-β-activating functions of αvβ6 integrin in pancreatic cancer are differentially regulated via an Eps8-dependent GTPase switch. J Pathol 2017; 243:37-50. [PMID: 28608476 PMCID: PMC5601247 DOI: 10.1002/path.4923] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/25/2017] [Accepted: 05/24/2017] [Indexed: 12/13/2022]
Abstract
The integrin αvβ6 is up-regulated in numerous carcinomas, where expression commonly correlates with poor prognosis. αvβ6 promotes tumour invasion, partly through regulation of proteases and cell migration, and is also the principal mechanism by which epithelial cells activate TGF-β1; this latter function complicates therapeutic targeting of αvβ6, since TGF-β1 has both tumour-promoting and -suppressive effects. It is unclear how these different αvβ6 functions are linked; both require actin cytoskeletal reorganization, and it is suggested that tractive forces generated during cell migration activate TGF-β1 by exerting mechanical tension on the ECM-bound latent complex. We examined the functional relationship between cell invasion and TGF-β1 activation in pancreatic ductal adenocarcinoma (PDAC) cells, and confirmed that both processes are αvβ6-dependent. Surprisingly, we found that cellular functions could be biased towards either motility or TGF-β1 activation depending on the presence or absence of epidermal growth factor receptor pathway substrate 8 (Eps8), a regulator of actin remodelling, endocytosis, and GTPase activation. Similar to αvβ6, we found that Eps8 was up-regulated in >70% of PDACs. In complex with Abi1/Sos1, Eps8 regulated αvβ6-dependent cell migration through activation of Rac1. Down-regulation of Eps8, Sos1 or Rac1 suppressed cell movement, while simultaneously increasing αvβ6-dependent TGF-β1 activation. This latter effect was modulated through increased cell tension, regulated by Rho activation. Thus, the Eps8/Abi1/Sos1 tricomplex acts as a key molecular switch altering the balance between Rac1 and Rho activation; its presence or absence in PDAC cells modulates αvβ6-dependent functions, resulting in a pro-migratory (Rac1-dependent) or a pro-TGF-β1 activation (Rho-dependent) functional phenotype, respectively. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Jo Tod
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Christopher J Hanley
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Mark R Morgan
- Institute of Translational MedicineUniversity of Liverpool, Crown StreetLiverpoolUK
| | - Marta Rucka
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Toby Mellows
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Maria‐Antoinette Lopez
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Philip Kiely
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Karwan A Moutasim
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Steven J Frampton
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Durgagauri Sabnis
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - David R Fine
- Clinical and Experimental Sciences, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Colin Johnson
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - John F Marshall
- Barts Cancer Institute, Barts and The London School of Medicine and DentistryQueen Mary University of London, Charterhouse SquareLondonUK
| | - Giorgio Scita
- IFOM FOM FoundationInstitute FIRC of Molecular Oncology and University of Milan, School of Medicine, Department of Oncology and Hemato‐Oncology‐DIPO, Via AdamelloMilanItaly
| | - Veronika Jenei
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
| | - Gareth J Thomas
- Cancer Sciences Unit, Faculty of MedicineUniversity of Southampton, Tremona RoadSouthamptonUK
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Frampton SJ, Mitchell TE. Surgical safety issues relating to the use of diathermy in patients with cochlear implants: the patient's perspective. Cochlear Implants Int 2013; 15:48-52. [PMID: 23692987 DOI: 10.1179/1754762813y.0000000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The number of cochlear implant recipients throughout the world is set to increase markedly. Surgical diathermy used inappropriately in the head and neck region can be damaging to implant electronics and may irreversibly damage the remaining auditory neural pathways. Safety guidelines have been published but many non-implant surgeons are unaware of their existence. We aimed to examine this issue from the patient's perspective. METHODS A questionnaire was supplied to 50 adults and the parents of 50 implanted children registered at the South of England Cochlear Implant Centre. RESULTS Adults Forty-six percent felt that non-implant surgeons would be aware of the diathermy restrictions. Only one patient had undergone subsequent surgery. Eighty-six percent still possess their implant identification (ID) card, and 71% carry it with them. Seventy-seven percent felt that if they required surgery they would show their implant ID card and raise the diathermy issue. Parents Although 76% of parents believed that surgeons would be unaware of the diathermy restrictions, none of the 12% of parents whose children underwent subsequent surgery had highlighted the issue to their surgeon. Eighty-four percent of the parents/children possessed their ID card. While only 8% of parents ensured that their child carried it at all times, a further 12% reported in free text that they carry the card on behalf of their children. CONCLUSION Diathermy use in cochlear implant recipients is a significant patient safety issue. There is a role for further education of patients and surgeons, for better utilization of the ID card, and for increased clarity on manufacturers' websites.
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Affiliation(s)
- R E Oakes
- Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Poole, UK.
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Abstract
INTRODUCTION Cochlear implants are surgically inserted electrical devices that enable severely or profoundly deaf individuals to interpret sounds from their environment and communicate more effectively. As a result of their electrical nature, they are susceptible to electromagnetic interference and can be damaged by excessive electrical energy. Surgical diathermy is one source of such potentially damaging energy. The British Cochlear Implant Group guidelines advise that monopolar diathermy should not be used in the head and neck region in patients with cochlear implants and that bipolar diathermy should not be used within 2cm of the implant (http://www.bcig.org.uk/site/public/current/safety.htm). METHODS A questionnaire was provided to 36 surgeons working in different specialties in the head and neck region, inquiring as to their knowledge of the safety considerations when using diathermy in cochlear implant patients. Thirty-five surgeons provided responses. RESULTS Overall, 77% of the respondents were unaware of the existence of published guidelines. Even when given an option to seek advice, 11% erroneously felt it was safe to use monopolar diathermy above the clavicles with a cochlear implant in situ and 49% felt that there was no restriction on the use of bipolar diathermy. CONCLUSIONS There is a significant deficit in the knowledge of safe operating practice in the rapidly expanding population of patients with cochlear implants which threatens patient safety. Through this publication we aim to increase awareness of these guidelines among members of the surgical community and this paper is intended to act as a point of reference to link through to the published safety guidelines.
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Affiliation(s)
- SJ Frampton
- The South of England Cochlear Implant Centre, UK
- University Hospital Southampton NHS Foundation Trust, UK
| | - H Ismail-Koch
- University Hospital Southampton NHS Foundation Trust, UK
| | - TE Mitchell
- The South of England Cochlear Implant Centre, UK
- University Hospital Southampton NHS Foundation Trust, UK
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