Do mesenchymal stem cells play a role in vocal fold fat graft survival?

OBJECTIVES: Adipose tissue in vocal fold lipoinjection is currently used to treat patients affected by laryngeal hemiplegia or anatomical defects. The aim of this study has been to evaluate the efficacy of this clinical strategy, by long-term follow-up of the patients and to investigate whether the fat samples used to treat them contain a stem cell population with a wide differentiation potential. MATERIALS AND METHODS: Fat samples harvested from 12 patients affected by severe breathy dysphonia who had undergone vocal fold lipoinjection were analysed by immunocytochemistry, by flow cytometry and reverse transcription-polymerase chain reaction, and the isolated adipose derived mesenchymal stem cells (ADMSCs) were evaluated in order to define their ability to produce soluble factors possibly involved in tissue regeneration, and to differentiate towards different lineages. RESULTS: ADMSCs were efficiently and successfully isolated from all of the samples. They were positive for SSEA-4, an embryonic marker recently identified on bone marrow MSCs and which could explain their high differentiation plasticity. Molecular analysis showed that these cells also expressed Oct-4, Runx-1 and ABCG-2, which characterize the stem cell state, and a number of other specific lineage markers. Flow cytometry revealed mesenchymal markers expressed on ADMSCs and identified a subpopulation characterized by CD146(+)/34(-)/45(-) cells consistent with perivascular/pericyte-like cells. Osteogenic, adipogenic and endothelial tissue differentiation were obtained. CONCLUSIONS: Our results confirmed the therapeutic efficacy of this clinical approach and showed that adipose tissue, administered to patients in order to restore glottic competence, contains mesenchymal stem cells.