title: Expression and distribution of hyaluronic acid and CD44 in unphonated human vocal fold mucosa.
abstract: OBJECTIVE
  The tension caused by phonation (vocal fold vibration) is hypothesized to stimulate vocal fold stellate cells (VFSCs) in the maculae flavae (MFe) to accelerate production of extracellular matrices. The distribution of hyaluronic acid (HA) and expression of CD44 (a cell surface receptor for HA) were examined in human vocal fold mucosae (VFMe) that had remained unphonated since birth.
  
  
  METHODS
  Five specimens of VFMe (3 adults, 2 children) that had remained unphonated since birth were investigated with Alcian blue staining, hyaluronidase digestion, and immunohistochemistry for CD44.
  
  
  RESULTS
  The VFMe containing MFe were hypoplastic and rudimentary. The VFMe did not have a vocal ligament, Reinke's space, or a layered structure, and the lamina propria appeared as a uniform structure. In the children, HA was distributed in the VFMe containing MFe. In the adults, HA had decreased in the VFMe containing MFe. In both groups, the VFSCs in the MFe and the fibroblasts in the lamina propria expressed little CD44.
  
  
  CONCLUSIONS
  This study supports the hypothesis that the tensions caused by vocal fold vibration stimulate the VFSCs in the MFe to accelerate production of extracellular matrices and form the layered structure. Phonation after birth is one of the important factors in the growth and development of the human VFMe.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Japan.
authors.forename: Kiminori
authors.initials: K
authors.lastname: Sato
authors.forename: Hirohito
authors.initials: H
authors.lastname: Umeno
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakashima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nonaka
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Harabuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D018960:Hyaluronan Receptors / Q000032:analysis*; D006820:Hyaluronic Acid / Q000032:analysis*; D007150:Immunohistochemistry; D008297:Male; D009092:Mucous Membrane / Q000737:chemistry / Q000473:pathology; D010699:Phonation / Q000502:physiology*; D014827:Vocal Cords / Q000737:chemistry* / Q000473:pathology
chemical_list: D018960:Hyaluronan Receptors; D006820:Hyaluronic Acid