Objectives/Hypothesis: Glutamine metabolism is a critical energy source for iatrogenic laryngotracheal stenosis (iLTS) scar fibroblasts, and glutaminase (GLS) is an essential enzyme converting glutamine to glutamate. We hypothesize that the GLS-specific inhibitor BPTES will block glutaminolysis and reduce iLTS scar fibroblast proliferation, collagen deposition, and fibroblast metabolism in vitro. Study Design: Test-tube Lab Research. Methods: Immunohistochemistry of a cricotracheal resection (n = 1) and a normal airway specimen (n = 1) were assessed for GLS expression. GLS expression was assessed in brush biopsies of subglottic/tracheal fibrosis and normal airway from patients with iLTS (n = 6). Fibroblasts were isolated and cultured from biopsies of subglottic/tracheal fibrosis (n = 6). Fibroblast were treated with BPTES and BPTES + dimethyl α-ketoglutarate (DMK), an analogue of the downstream product of GLS. Fibroblast proliferation, gene expression, protein production, and metabolism were assessed in all treatment conditions and compared to control. Results: GLS was overexpressed in brush biopsies of iLTS scar specimens (P =.029) compared to normal controls. In vitro, BPTES inhibited iLTS scar fibroblast proliferation (P =.007), collagen I (Col I) (P <.0001), collagen III (P =.004), and α-smooth muscle actin (P =.0025) gene expression and protein production (P =.031). Metabolic analysis demonstrated that BPTES reduced glycolytic reserve (P =.007) but had no effects on mitochondrial oxidative phosphorylation. DMK rescued BPTES inhibition of Col I gene expression (P =.0018) and protein production (P =.021). Conclusions: GLS is overexpressed in iLTS scar. Blockage of GLS with BPTES significantly inhibits iLTS scar fibroblasts proliferation and function, demonstrating a critical role for GLS in iLTS. Targeting GLS to inhibit glutaminolysis may be a successful strategy to reverse scar formation in the airway. Level of Evidence: NA. Laryngoscope, 2020.
- Laryngotracheal stenosis
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