Treatment of vocal fold scarring with autologous bone marrow-derived human mesenchymal stromal cells—first phase I/II human clinical study

Abstract

Background: Vocal fold (VF) scarring, caused by surgery or inflammation, often results in severe voice problems or aphonia. Effective lasting treatment is lacking. Previous in vitro and in vivo animal studies reported positive effects on VF scar resolution with mesenchymal stromal cell (MSC) implantation. The principal aim of this study was to examine safety aspects and secondly treatment efficacy vocal fold function in patients with VF scarring and severe voice problems. Methods: In this open-label phase I/II study, 16 patients were treated with surgical scar resection followed by injection of autologous MSCs (0.5-2 × 10 6 MSCs/patient). Patients were monitored 1 year for serious adverse events (SAE) or minor complications. Therapeutic efficacy on treated VFs was evaluated by measurement of VF vibrations using high-speed laryngoscopy (HSL) and phonation pressure threshold (PTP) for elasticity and VF function. Patients self-reported voice change using the Voice Handicap Index (VHI). Results: No SAE or minor side effects were reported. Video ratings of VF vibrations and digitized analysis of HSL and PTP were significantly improved for 62-75% of the patients (depending on parameter). Two patients showed deteriorated VF vibrations, but improved PTP. VHI was significantly improved in 8 patients, with the remaining experiencing no significant change. Conclusions: The results indicate that local injection of autologous MSC into scarred VFs with severe voice problems may offer a safe and feasible therapeutic option. VF vibration and elasticity were improved in approximately two thirds of treated patients. This clinical study is registered in clinicaltrials.gov (ID: NCT01981330). Retrospective registration of first patient (20130511). https//: register.clinicaltrials.gov/.

Achievements and Challenges in Transplantation of Mesenchymal Stem Cells in Otorhinolaryngology

“…Functional measures, including high-speed imaging, acoustic voice analysis, and phonation pressure measurement were evaluated. The outcome was improved healing of scarred vocal fold, one year postoperatively [123]. Assistance Publique Hopitaux De Marseille in an open labeled single-group clinical trial enrolling eight 18 years and older patients with vocal fold scarring and dysphonia injected autologous AdSCs and reported the feasibility, safety, and efficacy of the procedure and functional measures of voice handicap index evaluated by laryngostroboscopy [124].…”

Molekulare Laryngologie

“…In den letzten Jahren gab es immer wieder Versuche, bei denen verschiedene Arten von Stammzellen auch im humanen Setting in SL injiziert wurden. Die Ergebnisse waren, ebenso wie die Krankheitsbilder, sehr variabel und wurden nicht immer mit objektiven Parametern gemessen [ 37 , 38 ]. Zudem stellt sich die prinzipielle Frage, ob Stammzellen es tatsächlich vermögen, die ursprüngliche Gewebsstruktur inkl.…”

Stem cell therapy for vocal fold regeneration after scarring: a review of experimental approaches

“…For the last several years, the efficiency of stem cells in the treatment of VF scarring has been demonstrated in a large number of experimental studies [ 29 – 32 ]. However, the number of conducted clinical trials remains somewhat small [ 33 – 35 ], which may be related to the essential differences in the experimental design and, in general, to the lack of a standard approach to the estimation of the results of the VF repair. In particular, a wide variety of animals (rabbits, dogs, rats, etc.)…”