Abstract

BackgroundAccidentally removed parathyroid glands are still challenging in neck surgery, leading to hypoparathyroidism characterized with abnormally low levels of parathyroid hormone. Parathyroid auto-transplantation is usually applied in compensation. To improve the efficiency of parathyroid transplantation, we introduced a method by co-transplanting with adipose-derived cells, including stromal vascular fractions (SVFs) and adipose-derived stem cells (ADSCs), and investigated the underlying molecular mechanisms involved in parathyroid transplantation survival.MethodsRat and human parathyroid tissues were transplanted into nude mice as parathyroid transplantation model to examine the effects of SVFs and ADSCs on grafts angiogenesis and survival rates, including blood vessel assembly and parathyroid hormone levels. Several angiogenic factors, such as vascular endothelial growth factor (VEGF)-A and fibroblast growth factor (FGF) 2, were assessed in parathyroid grafts. The effects of hypoxia were investigated on ADSCs. The modulatory roles of the eyes absent homolog 1 (EYA1), which is vital in parathyroid development, was also investigated on angiogenic factor production and secretion by ADSCs. All experimental data were statistically processed. Student’s t test was used to assess significant differences between 2 groups. For multiple comparisons with additional interventions, two-way ANOVA followed by Tukey’s post hoc test was performed. P < 0.05 was considered as significant.ResultsSVFs improve rat parathyroid transplantation survival and blood vessel assembly, as well as FGF2 and VEGF-A expression levels in parathyroid transplantation mice. Functional human parathyroid grafts have higher microvessel density and increased VEGF-A expression. The supernatant of ADSCs induced tubule formation and migration of human endothelial cells in vitro. Hypoxia had no effect on proliferation and apoptosis of human ADSCs but induced higher angiogenic factor levels of VEGF-A and FGF2, modulated by EYA1, which was confirmed by parathyroid glands transplantation in mice.ConclusionsAdipose-derived cells, including ADSCs and SVFs, improve parathyroid transplantation survival via promoting angiogenesis through EYA1-regulating angiogenetic factors in vitro and in vivo. Our studies proved an effective method to improve the parathyroid autotransplantation, which is promising for clinical patients with hypoparathyroidism when parathyroid glands were accidentally injured, removed, or devascularized.

Highlights

  • Removed parathyroid glands are still challenging in neck surgery, leading to hypoparathyroidism characterized with abnormally low levels of parathyroid hormone

  • Our studies proved an effective method to improve the parathyroid autotransplantation, which is promising for clinical patients with hypoparathyroidism when parathyroid glands were accidentally injured, removed, or devascularized

  • Our results indicated that adipose-derived stem cells (ADSCs) in the stromal vascular fractions (SVFs) increased Parathyroid autotransplantation (PA) survival via promoting angiogenesis through DACH1/SIX1/eyes absent homolog 1 (EYA1) pathway, suggesting the beneficial roles of adipose tissues during parathyroid transplantation

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Summary

Introduction

Removed parathyroid glands are still challenging in neck surgery, leading to hypoparathyroidism characterized with abnormally low levels of parathyroid hormone. Surgery for thyroid, throat, and other head-neck tumors, as well as parathyroidectomy in patients with parathyroid hyperplasia, usually leads to hypoparathyroidism characterized with abnormally low levels of parathyroid hormone (PTH) [1]. The incidence rate of accidental parathyroidectomy was reported 5.2 to 21.6% in thyroidectomy, especially with central lymph nodes dissection [2, 3]. The incidence of transient hypoparathyroidism was reported ranging from 28.4 to 49%, and that of permanent hypoparathyroidism ranged from 1.7 to 13% [4]. Our preliminary clinical researches showed that the grafts with surrounding adipose tissues appeared with lower incidence of permanent hypoparathyroidism than those grafts without adipose tissues, suggesting that adipose tissue might be a factor to improve transplantation survival

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