$$\rightleftharpoonup{xx}$$
$$\longleftharp{xx}$$,
$$\longrightharp{xx}$$,
The human vocal fold, composed of an epithelial layer, the lamina propria (LP) and the vocalis muscle, is a specialized soft tissue that converts air flow from the lungs into acoustic waves for sound production.1 Vocal folds oscillate regularly during normal phonation, exhibiting strains of up to 30% at fundamental frequencies ranging from 100-300 Hz.2 Adult vocal fold LP is a gradient structure composed of a superficial (SLP), an intermediate (ILP) and a deep (DLP) layer. Further classification groups the epithelium and the SLP as the mucosa layer, and combines the ILP and DLP into the vocal ligament.3 The SLP layer contains primarily an amorphous matrix with sparsely dispersed collagenous fibers, while the ligament is enriched with mature collagen and elastin fibers to provide sufficient strength.4 The structure and mechanics of newborn vocal folds vary significantly from their mature counterparts. Although mechanisms regulating vocal fold development and maturation are not yet fully understood, experimental evidence has pointed to the defining roles of vocalization-derived mechanical stress.
Several medical conditions, including voice abuse, infections, chemical irritants and surgical procedures, can damage the vocal fold. Vocal fold disorders affect an estimated 3-9% of the U.S. population. Current treatment methods for vocal fold disorders are limited5 and a stem cell-based tissue engineering approach has emerged as a promising strategy for restoring vocal fold function. Mesenchymal stem cells (MSCs) are a suitable alternative to the primary vocal fold fibroblasts for vocal fold tissue engineering.6-9 Stem cell fate specification and subsequent tissue development are mediated by the specific niche they reside in, of which the mechanical condition is a vital factor.10 Mechanical forces are essential regulators of tissue morphogenesis and homeostasis, especially for tissues that are routinely subjected to loading.11 From a tissue engineering perspective, it has been demonstrated that exposure to physiologically relevant mechanical stimulations promotes stem cell differentiation and tissue-specific matrix remodeling.12-15
Tissue culture bioreactors are designed to simulate the desired physiological environment for cell or tissue growth in vitro. For vocal fold tissue engineering, it is especially critical to recreate the mechanical environment of the phonating vocal folds. An ideal vocal fold bioreactor should effectively deliver vibratory cues to culture cells, allowing facile control over frequency, amplitude and duration of vibrations. Titze and coworkers devised a vocal fold bioreactor (T1 bioreactor)16 that combines static stretch with high frequency (20-200 Hz) oscillations to stimulate the cellular production of matrix proteins. Using this bioreactor, Webb and colleagues17 studied the effects of 10-day, 100-Hz vibrations on dermal fibroblasts cultured in a hyaluronic acid (HA)-based hydrogel. Constructs subjected to vibration exhibited an elevated expression of HA synthase-2 (HAS2), decorin, fibromodulin and matrix metalloproteinase-1 (MMP1), relative to the static controls. The stimulatory effects were found to be time dependent. More recently, our group18 assembled a vocal fold bioreactor (J1 bioreactor) using a power amplifier, a function generator, an enclosed loud speaker and a circumferentially-anchored silicone membrane that transfers the oscillating air to the attached cells. Neonatal foreskin fibroblasts cultivated in the J1 bioreactor were subjected to 1 hr of vibration at 60, 110 or 300 Hz, with an in-plane strain of up to 0.05%. The qPCR results suggested that the expression of some ECM genes was moderately altered in response to the varied vibratory frequencies and amplitudes.
These bioreactor designs, while intriguing, have several limitations. For example, the T1 system requires a large number of connectors and bars for mechanical coupling, limiting the maximum frequencies attainable. Moreover, cells may be subjected to undesirable mechanical agitation and fluid perturbation that complicate the data interpretation. The J1 bioreactor, on the other hand, exhibits relatively low energy conversion efficiency and is not user-friendly. In addition, vibration frequently detaches the cell-laden constructs from the underlying silicone membrane. The J2 vocal fold bioreactor reported here, designed based on the same principle as the J1 version, is optimized for consistency and reproducibility. The phonation-mimicking vibrations are generated aerodynamically in individually fitted vibration chambers where MSC-populated fibrous poly(ε-caprolactone) (PCL) scaffolds are effectively secured. Laser Doppler Vibrometry (LDV) allows the user to verify the vibratory profile of the membrane/scaffold assembly. In our demonstration, MSCs are exposed to 200-Hz sinusoidal vibrations with a 1-hr-on-1-hr-off (OF) pattern for a total of 12 hr daily for 7 days. Cellular responses to the imposed vibratory cues are investigated systematically. Overall, the J2 vocal fold provides the most user-friendly features, allowing dynamic cell culture studies to be conducted in a high throughput and reproducible fashion.