Stem cell treatments for oropharyngeal dysphagia: Rationale, benefits, and challenges

Abstract

Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.

Human Adipose-Derived Stem/Stromal Cells Promote Proliferation and Migration in Head and Neck Cancer Cells

“…In the head and neck area, adipose tissue transplantation belongs to the most common topical stem cell therapies [ 11 , 47 ]. For augmentation of volume defects and treatment of impaired wound healing, adipose tissue transplantation is an established regenerative and reconstructive approach in head and neck cancer patients [ 48 ]. Therefore, ASCs are injected into tissues that might still contain residual tumor cells; in the head and neck area, these are most likely from squamous cell carcinoma [ 35 , 49 ].…”

Immunomodulatory extracellular matrix hydrogel induces tissue regeneration in a model of partial glossectomy

“…Considering these deficiencies in treatment, a number of investigative cell-based therapies that seek to regenerate tongue muscle or provide structural augmentation to improve tongue function have emerged. While preclinical investigation of allogeneic mesenchymal stem cell injection in an athymic rat model has demonstrated some potential [ 7 , 8 ], the manufacturing, cost, and difficulties associated with a living stem cell product pose translational challenges. Additionally, autologous muscle-derived cell therapy demonstrated safety but lacked efficacy after 2 years in a Phase 1 trial [ 9 ].…”

Immunomodulatory Extracellular Matrix Hydrogel Mitigates Scar Formation in a Model of Tongue Fibrosis

“…7 Considering these deficiencies in treatment of tongue dysphagia following head and neck cancer treatment, a number of investigative cell-based therapies that seek to regenerate tongue muscle or to provide structural augmentation to improve tongue function have emerged. While preclinical investigation of allogeneic mesenchymal stem cell injection in an athymic rat model has demonstrated some potential, 8,9 the manufacturing, cost, and difficulties associated with a living stem cell product pose substantial translational challenges. Additionally, autologous muscle-derived cell therapy demonstrated safety but lacked efficacy after 2 years in a Phase 1 trial.…”