Silk Protein Microparticle-based Filler for Injection Augmentation
Primary Purpose
Vocal Cord Paralysis Unilateral, Dysphonia, Dysphagia, Oropharyngeal
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Silk Microparticle Filler Injection
Sponsored by
About this trial
This is an interventional treatment trial for Vocal Cord Paralysis Unilateral focused on measuring vocal fold paralysis, glottal insufficiency, vocal fold injection, augmentation, medialization, laryngoplasty, silk
Eligibility Criteria
Inclusion Criteria:
- Unilateral vocal fold immobility with glottal insufficiency present for at least 2 weeks from onset
- Willingness to partake in study and follow-up as documented by signed informed consent
Exclusion Criteria:
- History of allergy/hypersensitivity to silk or silk containing products
- History of allergy/hypersensitivity to hyaluronic acid (HA) or HA containing products
- History of allergy/hypersensitivity to lidocaine or amide-based anesthetics
- History of an autoimmune condition
- Significant immunocompromised state (i.e. immunosuppression s/p transplantation)
- Pregnancy
- Active infection or inflammation in the larynx
- Comorbid known laryngeal conditions including but not limited to vocal fold scar, vocal tremor, laryngeal dystonia, etc. that would warrant other interventions for optimal treatment
- History of laryngeal surgery
- Life expectancy of less than 6 months
Sites / Locations
- University of Southern California
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Silk Microparticle Filler Injection
Arm Description
A silk protein microparticle-based filler will be injected deep to the thyroarytenoid muscle of the paralyzed vocal fold to augment/medialize its position.
Outcomes
Primary Outcome Measures
Incidence of Treatment-Emergent Adverse Events as assessed by FDA/CBER Adverse Event Severity Grading Scale
Adverse event severity grading scale from 1 to 4, with grade 1 as mild, grade 2 as moderate, grade 3 as severe, and grade 4 potentially life-threatening.
Secondary Outcome Measures
Quality of Life as assessed by Voice Handicap Index-10 (VHI-10)
VHI-10 is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Quality of Life as assessed by Vocal Fatigue Index (VFI)
VFI is a patient questionnaire with 19 statements rated from 0-4 with overall scale 0-76.
Quality of Life as assessed by Dyspnea Index (DI)
DI is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Quality of Life as assessed by Eating Assessment Tool (EAT-10)
EAT-10 is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Objective Vocal Quality as assessed by experts using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) instrument
Blinded evaluations of audio voice recordings will be performed by laryngologists and speech-language pathologists using the CAPE-V, which grades overall severity, roughness, breathiness, strain, pitch, and loudness from 0-100.
Vocal Fold Appearance as assessed by experts using a modified version of the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form
Blinded assessments of recorded laryngeal videostroboscopy exams will be performed by laryngologists and speech-language pathologists using a modified version of the VALI, which is a graphical rating form to grade various components seen on stroboscopy.
Objective Acoustic Testing as assessed by fundamental frequency
Measurement of fundamental frequency (F0) during sustained vowel phonation.
Objective Acoustic Testing as assessed by Sound Pressure Level (SPL)
Measurement of minimum/maximum SPL during phonation.
Objective Acoustic Testing as assessed by Cepstral Peak Prominence (CPP)
Measurement of CPP during phonation.
Objective Aerodynamic Testing as assessed by Vital Capacity (VC)
Measurement of VC.
Objective Aerodynamic Testing as assessed by Maximum Phonation Time (MPT)
Measurement of MPT.
Objective Aerodynamic Testing as assessed by Mean Glottal Flow Rate (MGFR)
Measurement of MGFR.
Objective Aerodynamic Testing as assessed by Subglottal Pressure (SGP)
Measurement of SGP.
Objective Aerodynamic Testing as assessed by Cough Velocity (CV)
Measurement of maximum CV.
Full Information
NCT ID
NCT03790956
First Posted
November 25, 2018
Last Updated
May 8, 2023
Sponsor
University of Southern California
Collaborators
Sofregen Medical, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03790956
Brief Title
Silk Protein Microparticle-based Filler for Injection Augmentation
Official Title
Safety and Efficacy of a Silk Protein Microparticle-based Filler for Injection Augmentation in Treating Unilateral Vocal Fold Paralysis
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
July 1, 2020 (Actual)
Primary Completion Date
March 15, 2023 (Actual)
Study Completion Date
March 15, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Southern California
Collaborators
Sofregen Medical, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study will investigate the safety and efficacy of a silk protein microparticle-based filler for vocal fold injection augmentation to treat dysphonia/dysphagia secondary to vocal fold paralysis. Participants will receive one injection and follow-up for a planned period of 12 months.
Detailed Description
Vocal fold paralysis is a clinical condition that arises commonly as a complication of surgery, endotracheal intubation, malignancy, or idiopathic etiologies. It often results in glottal insufficiency, which is the inability of the true vocal folds to meet and achieve complete closure during normal physiologic functions such as speech, swallowing, and coughing. The presence of vocal fold paralysis with glottal insufficiency can lead to decreased quality-of-life, as well as increase risks of complications such as aspiration pneumonia.
Current treatments for vocal fold paralysis are based around techniques to medialize the paralyzed vocal fold. One manner in which this is done is via injection of a filler or bulking agent into the vocal fold in order to augment it. Injection augmentation has many advantages including its minimally invasive nature, overall safety and low risk/complication rate, immediate clinical effect, and ability to perform it at the bedside or in-office. Various materials are used for injection augmentation including autologous fat, hyaluronic acid, collagen, carboxymethylcellulose, and calcium hydroxyapatite. However, all of the current injection choices have individual limitations such as temporary effect, unpredictability due to variable resorption by the body, unfavorable mechanical properties, and challenging handling attributes.
Silk is derived from the Bombyx mori silk worm and has a long history as a surgical biomaterial. Surgical scaffolds derived from silk have been used for reconstructive surgery, due to its ability to allow cellular infiltration and encourage tissue regeneration/remodeling. Given the potential advantages of such a material, Brown et al engineered and studied a novel silk protein microparticle-based filler material suitable for injection augmentation.
Patients with unilateral vocal fold paralysis identified at the study sites will be offered participation in this study to receive injection augmentation of the paralyzed vocal fold with the filler material under investigation. Outcome measures evaluated pre- and post-injection and over follow-up visits will include various patient reported quality of life indices, objective clinical assessments of voice, laryngeal videostroboscopy examinations, and acoustic/aerodynamic testing. The investigators hypothesize that the novel silk protein microparticle-based filler will have a favorable safety profile for use as an injectable material in the human larynx and it will produce durable clinical benefit lasting up to 12 months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Vocal Cord Paralysis Unilateral, Dysphonia, Dysphagia, Oropharyngeal
Keywords
vocal fold paralysis, glottal insufficiency, vocal fold injection, augmentation, medialization, laryngoplasty, silk
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Single vocal fold injection of study material with possible booster injection, and follow-up of 12 months post injection.
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Silk Microparticle Filler Injection
Arm Type
Experimental
Arm Description
A silk protein microparticle-based filler will be injected deep to the thyroarytenoid muscle of the paralyzed vocal fold to augment/medialize its position.
Intervention Type
Procedure
Intervention Name(s)
Silk Microparticle Filler Injection
Intervention Description
A silk protein microparticle-based filler will be injected deep to the thyroarytenoid muscle of the paralyzed vocal fold to augment/medialize its position.
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events as assessed by FDA/CBER Adverse Event Severity Grading Scale
Description
Adverse event severity grading scale from 1 to 4, with grade 1 as mild, grade 2 as moderate, grade 3 as severe, and grade 4 potentially life-threatening.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Quality of Life as assessed by Voice Handicap Index-10 (VHI-10)
Description
VHI-10 is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Time Frame
12 months
Title
Quality of Life as assessed by Vocal Fatigue Index (VFI)
Description
VFI is a patient questionnaire with 19 statements rated from 0-4 with overall scale 0-76.
Time Frame
12 months
Title
Quality of Life as assessed by Dyspnea Index (DI)
Description
DI is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Time Frame
12 months
Title
Quality of Life as assessed by Eating Assessment Tool (EAT-10)
Description
EAT-10 is a patient questionnaire with 10 statements rated from 0 to 4 with overall scale 0-40.
Time Frame
12 months
Title
Objective Vocal Quality as assessed by experts using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) instrument
Description
Blinded evaluations of audio voice recordings will be performed by laryngologists and speech-language pathologists using the CAPE-V, which grades overall severity, roughness, breathiness, strain, pitch, and loudness from 0-100.
Time Frame
12 months
Title
Vocal Fold Appearance as assessed by experts using a modified version of the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form
Description
Blinded assessments of recorded laryngeal videostroboscopy exams will be performed by laryngologists and speech-language pathologists using a modified version of the VALI, which is a graphical rating form to grade various components seen on stroboscopy.
Time Frame
12 months
Title
Objective Acoustic Testing as assessed by fundamental frequency
Description
Measurement of fundamental frequency (F0) during sustained vowel phonation.
Time Frame
12 months
Title
Objective Acoustic Testing as assessed by Sound Pressure Level (SPL)
Description
Measurement of minimum/maximum SPL during phonation.
Time Frame
12 months
Title
Objective Acoustic Testing as assessed by Cepstral Peak Prominence (CPP)
Description
Measurement of CPP during phonation.
Time Frame
12 months
Title
Objective Aerodynamic Testing as assessed by Vital Capacity (VC)
Description
Measurement of VC.
Time Frame
12 months
Title
Objective Aerodynamic Testing as assessed by Maximum Phonation Time (MPT)
Description
Measurement of MPT.
Time Frame
12 months
Title
Objective Aerodynamic Testing as assessed by Mean Glottal Flow Rate (MGFR)
Description
Measurement of MGFR.
Time Frame
12 months
Title
Objective Aerodynamic Testing as assessed by Subglottal Pressure (SGP)
Description
Measurement of SGP.
Time Frame
12 months
Title
Objective Aerodynamic Testing as assessed by Cough Velocity (CV)
Description
Measurement of maximum CV.
Time Frame
12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Unilateral vocal fold immobility with glottal insufficiency present for at least 2 weeks from onset
Willingness to partake in study and follow-up as documented by signed informed consent
Exclusion Criteria:
History of allergy/hypersensitivity to silk or silk containing products
History of allergy/hypersensitivity to hyaluronic acid (HA) or HA containing products
History of allergy/hypersensitivity to lidocaine or amide-based anesthetics
History of an autoimmune condition
Significant immunocompromised state (i.e. immunosuppression s/p transplantation)
Pregnancy
Active infection or inflammation in the larynx
Comorbid known laryngeal conditions including but not limited to vocal fold scar, vocal tremor, laryngeal dystonia, etc. that would warrant other interventions for optimal treatment
History of laryngeal surgery
Life expectancy of less than 6 months
Facility Information:
Facility Name
University of Southern California
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Citations:
PubMed Identifier
11555751
Citation
Spector BC, Netterville JL, Billante C, Clary J, Reinisch L, Smith TL. Quality-of-life assessment in patients with unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 2001 Sep;125(3):176-82. doi: 10.1067/mhn.2001.117714.
Results Reference
background
PubMed Identifier
29609905
Citation
Brown JE, Gulka CP, Giordano JEM, Montero MP, Hoang A, Carroll TL. Injectable Silk Protein Microparticle-based Fillers: A Novel Material for Potential Use in Glottic Insufficiency. J Voice. 2019 Sep;33(5):773-780. doi: 10.1016/j.jvoice.2018.01.017. Epub 2018 Mar 30.
Results Reference
background
PubMed Identifier
19905955
Citation
Etienne O, Schneider A, Kluge JA, Bellemin-Laponnaz C, Polidori C, Leisk GG, Kaplan DL, Garlick JA, Egles C. Soft tissue augmentation using silk gels: an in vitro and in vivo study. J Periodontol. 2009 Nov;80(11):1852-8. doi: 10.1902/jop.2009.090231.
Results Reference
background
PubMed Identifier
23374707
Citation
Bellas E, Panilaitis BJ, Glettig DL, Kirker-Head CA, Yoo JJ, Marra KG, Rubin JP, Kaplan DL. Sustained volume retention in vivo with adipocyte and lipoaspirate seeded silk scaffolds. Biomaterials. 2013 Apr;34(12):2960-8. doi: 10.1016/j.biomaterials.2013.01.058. Epub 2013 Jan 29.
Results Reference
background
PubMed Identifier
26966076
Citation
Kijanska M, Marmaras A, Hegglin A, Kurtcuoglu V, Giovanoli P, Lindenblatt N. In vivo characterization of the integration and vascularization of a silk-derived surgical scaffold. J Plast Reconstr Aesthet Surg. 2016 Aug;69(8):1141-50. doi: 10.1016/j.bjps.2016.01.017. Epub 2016 Feb 5.
Results Reference
background
PubMed Identifier
19274731
Citation
Rosen CA, Gartner-Schmidt J, Casiano R, Anderson TD, Johnson F, Remacle M, Sataloff RT, Abitbol J, Shaw G, Archer S, Zraick RI. Vocal fold augmentation with calcium hydroxylapatite: twelve-month report. Laryngoscope. 2009 May;119(5):1033-41. doi: 10.1002/lary.20126.
Results Reference
background
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Silk Protein Microparticle-based Filler for Injection Augmentation
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