Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.

Molecular mechanisms and physiological changes behind benign tracheal and subglottic stenosis in adults / Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico. - In: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES. - ISSN 1661-6596. - 23:(2022), pp. 1-21. [10.3390/ijms23052421]

Molecular mechanisms and physiological changes behind benign tracheal and subglottic stenosis in adults.

Alessandro Marchioni;Roberto Tonelli;Alessandro Andreani;Gaia Cappiello;Matteo Fermi;Fabiana Trentacosti;Ivana Castaniere;Dario Andrisani;Filippo Gozzi;Giulia Bruzzi;Linda Manicardi;Serena Baroncini;Anna Valeria Samarelli;Daniele Marchioni;Massimo Pinelli;Giorgio De Santis;Alessandro Stefani;Francesco Mattioli;Enrico Clini
2022

Abstract

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.
2022
23
1
21
Molecular mechanisms and physiological changes behind benign tracheal and subglottic stenosis in adults / Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico. - In: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES. - ISSN 1661-6596. - 23:(2022), pp. 1-21. [10.3390/ijms23052421]
Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1263710
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