Yuichiro Yaguchi

Sprouty genes prevent excessive FGF signalling in multiple cell types throughout development of the cerebellum

Fibroblast growth factors (FGFs) and regulators of the FGF signalling pathway are expressed in several cell types within the cerebellum throughout its development. Although much is known about the function of this pathway during the establishment of the cerebellar territory during early embryogenesis, the role of this pathway during later developmental stages is still poorly understood. Here, we investigated the function of sprouty genes (Spry1, Spry2 and Spry4), which encode feedback antagonists of FGF signalling, during cerebellar development in the mouse. Simultaneous deletion of more than one of these genes resulted in a number of defects, including mediolateral expansion of the cerebellar vermis, reduced thickness of the granule cell layer and abnormal foliation. Analysis of cerebellar development revealed that the anterior cerebellar neuroepithelium in the early embryonic cerebellum was expanded and that granule cell proliferation during late embryogenesis and early postnatal development was reduced. We show that the granule cell proliferation deficit correlated with reduced sonic hedgehog (SHH) expression and signalling. A reduction in Fgfr1 dosage during development rescued these defects, confirming that the abnormalities are due to excess FGF signalling. Our data indicate that sprouty acts both cell autonomously in granule cell precursors and non-cell autonomously to regulate granule cell number. Taken together, our data demonstrate that FGF signalling levels have to be tightly controlled throughout cerebellar development in order to maintain the normal development of multiple cell types.

Comparison between endoscopic and microscopic stapes surgery.

To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope.

Fibroblast growth factor (FGF) gene expression in the developing cerebellum suggests multiple roles for FGF signaling during cerebellar morphogenesis and development

The cerebellum is derived from the anterior‐most segment of the embryonic hindbrain, rhombomere 1 (r1). Previous studies have shown that the early development and patterning of r1 requires fibroblast growth factor (FGF) signaling. However, many of the developmental processes that shape cerebellar morphogenesis take place later in embryonic development and during the first 2 weeks of postnatal life in the mouse. Here, we present a more comprehensive analysis of the expression patterns of genes encoding FGF receptors and secreted FGF ligands during these later stages of cerebellar development. We show that these genes are expressed in multiple cell types in the developing cerebellum, in an astonishing array of distinct patterns. These data suggest that FGF signaling functions throughout cerebellar development to regulate many processes that shape the formation of a functional cerebellum. Developmental Dynamics, 2009.

Middle ear mucosal regeneration with three-dimensionally tissue-engineered autologous middle ear cell sheets in rabbit model

The likelihood of recurrent retraction and adhesion of newly formed tympanic membrane is high when middle ear mucosa is extensively lost during cholesteatoma and adhesive otitis media surgery. If rapid postoperative regeneration of the mucosa on the exposed bone surface can be achieved, prevention of recurrent eardrum adhesion and cholesteatoma formation, for which there has been no definitive treatment, can be expected. Suture‐less transplantation of tissue‐engineered mucosal cell sheets was examined immediately after the operation of otitis media surgery in order to quickly regenerate middle ear mucosa lost during surgery in a rabbit model. Transplantable middle ear mucosal cell sheets with a three‐dimensional tissue architecture very similar to native middle ear mucosa were fabricated from middle ear mucosal tissue fragments obtained in an autologous manner from middle ear bulla on temperature‐responsive culture surfaces. Immediately after the mucosa was resected from middle ear bone bulla inner cavity, mucosal cell sheets were grafted at the resected site. Both bone hyperplasia and granulation tissue formation were inhibited and early mucosal regeneration was observed in the cell sheet‐grafted group, compared with the control group in which only mucosal removal was carried out and the bone surface exposed. This result indicates that tissue engineered mucosal cell sheets would be useful to minimize complications after the surgical operation on otitis media and future clinical application is expected. Copyright

Cholesteatoma Fibroblasts Promote Epithelial Cell Proliferation through Overexpression of Epiregulin

To investigate whether keratinocytes proliferate in response to epiregulin produced by subepithelial fibroblasts derived from middle ear cholesteatoma. Tissue samples were obtained from patients undergoing tympanoplasty. The quantitative polymerase chain reaction and immunohistochemistry were performed to examine epiregulin expression and localization in cholesteatoma tissues and retroauricular skin tissues. Fibroblasts were cultured from cholesteatoma tissues and from normal retroauricular skin. These fibroblasts were used as feeder cells for culture with a human keratinocyte cell line (PHK16-0b). To investigate the role of epiregulin in colony formation by PHK16-0b cells, epiregulin mRNA expression was knocked down in fibroblasts by using short interfering RNA and epiregulin protein was blocked with a neutralizing antibody. Epiregulin mRNA expression was significantly elevated in cholesteatoma tissues compared with that in normal retroauricular skin. Staining for epiregulin was more intense in the epithelial cells and subepithelial fibroblasts of cholesteatoma tissues than in retroauricular skin. When PHK16-0b cells were cultured with cholesteatoma fibroblasts, their colony-forming efficiency was 50% higher than when these cells were cultured with normal skin fibroblasts. Also, knockdown of epiregulin mRNA in cholesteatoma fibroblasts led to greater suppression of colony formation than knockdown in skin fibroblasts. Furthermore, the colony-forming efficiency of PHK16-0b cells was significantly reduced after treatment with an epiregulin neutralizing antibody in co-culture with cholesteatoma fibroblasts, but not in co-culture with skin fibroblasts. These results suggest that keratinocyte hyperproliferation in cholesteatoma is promoted through overexpression of epiregulin by subepithelial fibroblasts via epithelial–mesenchymal interactions, which may play a crucial role in the pathogenesis of middle ear cholesteatoma.

Middle ear mucosa regeneration by grafting of artificial mucosa

Conclusion. Artificial middle ear mucosa (AMEM), a sheet of mucosal cells grown on collagen gel populated with fibroblasts, is useful as graft material that is able to promote mucosal regeneration after middle ear surgery. Objectives. Regeneration of the middle ear mucosa and pneumatization of the mastoid cavity is critical for good prognosis. We examined whether implantation of AMEM into damaged middle ear cavity would promote mucosal regeneration. Materials and methods. AMEM was prepared as described previously using epithelial cells and fibroblasts isolated from the rabbit middle ear. We implanted AMEM into rabbit middle ear from which mucosa had been surgically removed and evaluated its histological and functional recovery 8 weeks later. Three other groups were used for comparison: a normal control group, a mucosa-eliminated group, and a collagen-implanted group. Results. AMEM grew to be morphologically similar to the native middle ear mucosa. Electron microscope studies showed that implanted AMEM has basal lamina and cilia. AMEM implantation suppressed bone hyperplasia and granulation, leading to better mucosal regeneration. Mucosal gas exchange was also significantly improved after implantation.

Autologous human nasal epithelial cell sheet using temperature‐responsive culture insert for transplantation after middle ear surgery

Postoperative mucosal regeneration of the middle ear cavity and the mastoid cavity is of great importance after middle ear surgery. However, the epithelialization of the mucosa in the middle ear is retarded because chronic inflammation without epithelialization aggravates gas exchange and clinical function. These environmental conditions in the middle ear lead to postoperative retraction and adhesion of the newly‐formed tympanic membrane. Therefore, if the mucosa on the exposed middle ear bone surface can be rapidly regenerated after surgery, the surgical treatments for cholesteatoma and adhesive middle ear disease can potentially be improved. In this study, we successfully generated a cell sheet designed for the postoperative treatment of cholesteatoma. We used nasal cells to create an artificial middle ear mucosal cell sheet with a three‐dimensional (3D) configuration similar to that of the middle ear mucosa. The sheets consisted of multi‐layered mucosal epithelia and lower connective tissue and were similar to normal middle ear mucosa. This result indicates that tissue‐engineered mucosal cell sheets would be useful to minimize complications after surgical operations in the middle ear and future clinical applications are expected. Copyright

Middle ear mucosal regeneration by tissue-engineered cell sheet transplantation

The recurrence of cholesteatoma after surgical treatment often occurs as a result of poor mucosal regeneration in the middle ear cavity and mastoid cavity and changes, such as granulation tissue formation, which impair gas exchange in the middle ear cavity. Conventional tympanoplasty often results in a lack of mucosal regeneration in the resected area of the mastoid cavity. In particular, mucosal regeneration in a poorly pneumatized mastoid cavity is extremely difficult. If the middle ear mucosa can be preserved or rapid postoperative regeneration of mucosa on the exposed bone surface can be achieved after middle ear surgery, the results of surgical treatment for otitis media, including cholesteatoma, can potentially be improved and the physiological function of the middle ear can be recovered. To overcome these limitations, we developed a novel treatment method combining tympanoplasty and autologous nasal mucosal epithelial cell sheet transplantation for postoperative regeneration of the middle ear mucosa. In clinical research, we endoscopically removed an approximately 10 × 10 mm2 piece of nasal mucosal tissue. Tissue-engineered autologous nasal mucosal epithelial cell sheets were fabricated by culturing the harvested cells in an aseptic environment in a good manufacturing practice-compliant cell processing facility. The cultivated cell sheets were transplanted, during tympanoplasty, onto the exposed bony surface of the attic of the tympanic and mastoid cavities where the mucosa had been lost. We performed this procedure on four patients with middle ear cholesteatoma and one patient with adhesive otitis media. All patients showed favorable postoperative course with no adverse events or complications and the patients’ hearing ability post-transplantation remained good.Nose tissue that helps the ear healTransplanting a sheet of cells from the nose to the middle ear could improve postoperative prognosis for middle ear inflammatory conditions. Kazuhisa Yamamoto of Jikei University School of Medicine and colleagues in Japan developed a novel surgical technique to prevent postoperative recurrence of chronic middle ear conditions. In adhesive otitis media, the eardrum gets sucked into and stuck in the middle ear space. Cholesteatoma involves abnormal skin growth in the middle ear. Recurrence often follows surgical treatment for these conditions due to delays in regeneration of the middle ear’s mucosal epithelium. The new technique involves transplanting cultured cells from the lining of the nasal cavity to the middle ear during surgery. Five patients treated this way had favorable postoperative outcomes with no adverse effects or complications and satisfactory improvement in hearing levels.

The effect of transplantation of nasal mucosal epithelial cell sheets after middle ear surgery in a rabbit model.

Postoperative regeneration of the middle ear mucosa and pneumatization of the middle ear cavity are of great importance after middle ear surgery. This study developed a new method to transplant autologous nasal mucosal epithelial cell sheets into the damaged middle ear cavity. The aim of this study was to evaluate postoperative healing after the transplantation of the cell sheets. Rabbit nasal mucosal epithelial cell sheets were fabricated on a temperature-responsive culture dish, and transplanted into the damaged middle ear of rabbit, which was surgically created. The healing of middle ears was evaluated by histology and X-ray computed tomography after transplantation. Functional evaluation was performed by measuring the maximum middle ear total pressure reflecting a trans-mucosal gas exchange function. Two control groups were used: the normal control group and the mucosa-eliminated control group. Transplantation of cell sheets suppressed the bone hyperplasia and the narrowing of pneumatic space in the middle ear cavity compared with the mucosa-eliminated control group. The mucosal gas exchange function was also better in the cell sheet-transplanted group. Nasal mucosal epithelial cell sheet was confirmed to be useful as an effective graft material after middle ear surgery and hopefully become a novel therapy in the future.

Endoscope-assisted surgery via the middle cranial fossa approach for a petrous cholesteatoma.

OBJECTIVE Surgical approaches to petrous cholesteatomas are the translabyrinthine-transcochlear approach, partial labyrinthectomy, and the middle cranial fossa approach. Selection of surgical approach is determined by region of cholesteatoma in the petrous bone as well as preoperative status of hearing and facial nerve function. The middle cranial fossa approach is the best approach for patient having good preoperative hearing and facial nerve function. However, application of this approach is limited for patients having relatively small petrous cholesteatomas, and sometimes difficult for patients in whom inner ear function is preserved but a cholesteatoma surrounds whole cochlea and extends to lower part of the labyrinth. In such case, we performed endoscope-assisted surgery via the middle cranial fossa approach to preserve cochlear and its function. METHODS 30 degrees and 70 degrees rigid endoscopes were used for the operation via the middle cranial fossa. RESULTS The inferior surface of the cochlea and the region around the internal carotid artery could be well visualized by use of endoscopy, and we succeeded in removal of petrous cholesteatoma surrounding the cochlea completely with preserving preoperative hearing. CONCLUSION Endoscope-assisted surgical technique that allowed safe and complete removal of a cholesteatoma extended inferior surface of coclear and around carotid artery in the petrous.