Abstract

PurposeCleft palate repair surgeries lack a regenerative reconstructive option and, in many cases, develop complications including oronasal fistula (ONF). Our group has developed a novel murine phenocopy of ONF to study the oral cavity wound healing program. Using this model, our team previously identified that delivery of FTY720 on a nanofiber scaffold had a unique immunomodulatory effect directing macrophages and monocytes into a pro-regenerative state during ONF healing. Here, the objective of this study was to determine the effects of local biomaterial-based FTY720 delivery in the ONF model on the early bulk gene expression and neutrophil phenotypic response within the regenerating tissue.MethodsUsing a mouse model of ONF formation, a palate defect was created and was treated with FTY720 nanofiber scaffolds or (blank) vehicle control nanofibers. At 1 and 3 days post-implantation, ONF oral mucosal tissue from the defect region was collected for RNA sequencing analysis or flow cytometry. For the RNA-seq expression profiling, intracellular pathways were assessed using the KEGG Pathway database and Gene Ontology (GO) Terms enrichment interactive graph. To assess the effects of FTY720 on different neutrophil subpopulations, flow cytometry data was analyzed using pseudotime analysis based on Spanning-tree Progression Analysis of Density-normalized Events (SPADE).ResultsRNA sequencing analysis of palate mucosa injured tissue identified 669 genes that were differentially expressed (DE) during the first 3 days of ONF wound healing after local delivery of FTY720, including multiple genes in the sphingolipid signaling pathway. Evaluation of the DE genes at the KEGG Pathway database also identified the inflammatory immune response pathways (chemokine signaling, cytokine-cytokine receptor interaction, and leukocyte transendothelial migration), and the Gene Ontology enrichment analysis identified neutrophil chemotaxis and migration terms. SPADE dendrograms of CD11b+Ly6G+ neutrophils at both day 1 and day 3 post-injury showed significantly distinct subpopulations of neutrophils in oral mucosal defect tissue from the FTY720 scaffold treatment group compared to the vehicle control group (blank). Increased expression of CD88 and Vav1, among other genes, were found and staining of the ONF area demonstrated increased VAV1 staining in FTY720‐treated healing oral mucosa.ConclusionTreatment of oral mucosal defects using FTY720 scaffolds is a promising new immunotherapy to improve healing outcomes and reducing ONF formation during cleft palate surgical repair. Local delivery of FTY720 nanofiber scaffolds during ONF healing significantly shifted early gene transcription associated with immune cell recruitment and modulation of the immune microenvironment results in distinct neutrophil subpopulations in the oral mucosal defect tissue that provides a critical shift toward pro-regenerative immune signaling.

Highlights

  • Abnormal craniofacial development can result in orofacial clefts, where there is continuity between the oral and nasal spaces

  • Failure of oral cavity wound healing following cleft palate repair in children leads to oronasal fistula (ONF) formation in up to 60% of patients

  • To determine the effect of FTY720 scaffold delivery, the 669 differentially expressed genes were analyzed using the KEGG database and we identified that 53 pathways were impacted (Supplemental Table 1)

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Summary

Introduction

Abnormal craniofacial development can result in orofacial clefts, where there is continuity between the oral and nasal spaces. Cleft palate patients (1:1000 live births) all undergo surgical palate repair; 60% develop complications including oronasal fistula (ONF) formation. Cleft palate repair surgeries lack a regenerative reconstructive option, requiring multiple repairs [2]. Persistence of the ONF despite re-repair occurs in 50% of patients, and the need for additional surgeries that require the use of local, regional, or free tissue transfer is higher in this patient population [3]. To try to reduce the frequency of persistent ONF, some surgeons use a human dermal matrix; there is a risk for prion/HIV transmission, and the dermal matrix is only functioning as a barrier, not as a regenerative therapy [4]. The high frequency and recurrence of ONF, along with the risks related to repeated anesthesia needed for re-repair, highlight the need for a regenerative approach to improve oral cavity during wound healing following cleft palate repair

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