Kim Dong Wook, Kim Eun Ji, Kim Eun Na, Sung Myung Whun, Kwon Tack-Kyun, Cho Yong Woo, Kwon Seong Keun
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Chemical Engineering, Hanyang University, Ansan, Gyeonggi-do 426-791, Republic of Korea.
PLoS One. 2016 Oct 21;11(10):e0165265. doi: 10.1371/journal.pone.0165265. eCollection 2016.
Vocal fold paralysis results from various etiologies and can induce voice changes, swallowing complications, and issues with aspiration. Vocal fold paralysis is typically managed using injection laryngoplasty with fat or synthetic polymers. Injection with autologous fat has shown excellent biocompatibility. However, it has several disadvantages such as unpredictable resorption rate, morbidities associated with liposuction procedure which has to be done in operating room under general anesthesia. Human adipose-derived extracellular matrix (ECM) grafts have been reported to form new adipose tissue and have greater biostability than autologous fat graft. Here, we present an injectable hydrogel that is constructed from adipose tissue derived soluble extracellular matrix (sECM) and methylcellulose (MC) for use in vocal fold augmentation. Human sECM derived from adipose tissue was extracted using two major steps-ECM was isolated from human adipose tissue and was subsequently solubilized. Injectable sECM/MC hydrogels were prepared by blending of sECM and MC. Sustained vocal fold augmentation and symmetric vocal fold vibration were accomplished by the sECM/MC hydrogel in paralyzed vocal fold which were confirmed by laryngoscope, histology and a high-speed imaging system. There were increased number of collagen fibers and fatty granules at the injection site without significant inflammation or fibrosis. Overall, these results indicate that the sECM/MC hydrogel can enhance vocal function in paralyzed vocal folds without early resorption and has potential as a promising material for injection laryngoplasty for stable vocal fold augmentation which can overcome the shortcomings of autologous fat such as unpredictable duration and morbidity associated with the fat harvest.
声带麻痹由多种病因引起，可导致声音改变、吞咽并发症及误吸问题。声带麻痹通常采用脂肪或合成聚合物注射喉成形术进行治疗。自体脂肪注射显示出良好的生物相容性。然而，它有几个缺点，如吸收率不可预测，与抽脂手术相关的并发症，抽脂手术必须在全身麻醉下于手术室进行。据报道，人脂肪来源的细胞外基质（ECM）移植物可形成新的脂肪组织，且比自体脂肪移植物具有更高的生物稳定性。在此，我们展示一种可注射水凝胶，它由脂肪组织衍生的可溶性细胞外基质（sECM）和甲基纤维素（MC）构建而成，用于声带增厚。从脂肪组织中提取人sECM分两个主要步骤——先从人脂肪组织中分离出ECM，随后将其溶解。通过混合sECM和MC制备可注射的sECM/MC水凝胶。通过喉镜、组织学和高速成像系统证实，sECM/MC水凝胶在麻痹的声带中实现了持续的声带增厚和对称的声带振动。注射部位的胶原纤维和脂肪颗粒数量增加，无明显炎症或纤维化。总体而言，这些结果表明，sECM/MC水凝胶可增强麻痹声带的发声功能且不会早期吸收，作为一种有前景的材料用于注射喉成形术以实现稳定的声带增厚，可克服自体脂肪的缺点，如持续时间不可预测以及与取脂相关的并发症。
