PMID- 25515126
OWN - NLM
STAT- MEDLINE
DCOM- 20151130
LR  - 20181113
IS  - 1433-0458 (Electronic)
IS  - 0017-6192 (Linking)
VI  - 63
IP  - 3
DP  - 2015 Mar
TI  - [Importance of cellular tight junction complexes in the development of 
      periprosthetic leakage after prosthetic voice rehabilitation].
PG  - 171-2, 174-8, 180-1
LID - 10.1007/s00106-014-2951-0 [doi]
AB  - BACKGROUND: The use of voice prostheses is currently the gold standard in voice 
      rehabilitation after total laryngectomy. This method combines low complication 
      rates and excellent rehabilitation results; however, approximately 30% of 
      patients show periprosthetic leakage or severe fistula enlargement after 
      laryngectomy and prosthetic voice restoration within the first 4 years. The 
      development of this enlargement is controversially discussed in the literature 
      but recently published studies have shown that high esophageal reflux plays a key 
      role in this process, which leads to an inflammatory reaction and disturbs the 
      intercellular tight junctions in the sense of an epithelial mesenchymal 
      transition (EMT). MATERIAL AND METHODS: A total of 44 patients underwent 24 h pH 
      monitoring, a sample biopsy from the region of the fistula and a subsequent 
      biomolecular examination for intracellular junction proteins as well as a 
      correlation between the severity of reflux and tracheoesophageal fistula problems 
      before and after antireflux therapy with proton pump inhibitors (PPI). RESULTS: 
      Immunohistochemical staining revealed decreases in membrane E-cadherin and 
      beta-catenin and a significant increase in the cytoplasmic fraction, depending on 
      the severity of inflammation in the fistula tissue. In patients with an 
      improvement of clinical fistula problems under oral PPI treatment an increase of 
      membrane E-cadherin could be shown, whereas patients with persisting fistula 
      enlargement demonstrated a further decrease of E-cadherin. CONCLUSION: The data 
      indicate a central role of EMT in the development of fistula enlargement after 
      total laryngectomy. Patients with periprosthetic leakage showed a loss of 
      membrane bound E-cadherin and beta-catenin with an up-regulation of vimentin 
      expression. In patients with mild or no leakage problems EMT could be resolved by 
      aggressive antireflux treatment, whereas patients without any effect of PPI 
      treatment on the fistula showed no reversal of EMT. These data contribute to the 
      understanding of treatment resistant fistula enlargement after total 
      laryngectomy.
FAU - Lorenz, K J
AU  - Lorenz KJ
AD  - Klinik fur Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus 
      Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland, kai.lorenz@extern.uni-ulm.de.
FAU - Kraft, K
AU  - Kraft K
FAU - Graf, F
AU  - Graf F
FAU - Propper, C
AU  - Propper C
FAU - Steinestel, K
AU  - Steinestel K
LA  - ger
PT  - Clinical Trial
PT  - English Abstract
PT  - Journal Article
TT  - Bedeutung zellularer Tight-junction-Komplexe bei der Entwicklung einer 
      periprothetischen Leckage bei stimmprothetischer Versorgung.
PL  - Germany
TA  - HNO
JT  - HNO
JID - 2985099R
RN  - 0 (Tight Junction Proteins)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Gastroesophageal Reflux/*etiology/metabolism/*pathology
MH  - Humans
MH  - Laryngectomy/*adverse effects/*rehabilitation
MH  - Larynx, Artificial/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Tight Junction Proteins/metabolism
MH  - Tight Junctions/*metabolism/pathology
MH  - Treatment Outcome
EDAT- 2014/12/18 06:00
MHDA- 2015/12/15 06:00
CRDT- 2014/12/18 06:00
PHST- 2014/12/18 06:00 [entrez]
PHST- 2014/12/18 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - 10.1007/s00106-014-2951-0 [doi]
PST - ppublish
SO  - HNO. 2015 Mar;63(3):171-2, 174-8, 180-1. doi: 10.1007/s00106-014-2951-0.