A Massachusetts man has regained his voice after surgeons removed his cancerous larynx and, in a pioneering move, replaced it with a donated one.
Transplants of the so-called voice box are extremely rare, and normally aren’t an option for people with active cancer. Marty Kedian is only the third person in the U.S. to undergo a total larynx transplant — the others, years ago, were because of injuries — and one of a handful reported worldwide.
Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial aimed at opening the potentially life-changing operation to more patients, including some with cancer, the most common way to lose a larynx.
“People need to keep their voice,” Kedian, 59, told The Associated Press four months after his transplant — still hoarse but able to keep up an hourlong conversation. “I want people to know this can be done.”
Mayo Clinic via AP
In this photo provided by the Mayo Clinic, Marty Kedian greets his dog, Baxter, on his first trip outside the Mayo Clinic Hospital after his surgery.
He became emotional recalling the first time he phoned his 82-year-old mother after the surgery “and she could hear me. … That was important to me, to talk to my mother.”
The study is small — just nine more people will be enrolled. But it may teach scientists best practices for these complex transplants so that one day they could be offered to more people who can’t breathe, swallow or speak on their own because of a damaged or surgically removed larynx.
“Patients become very reclusive, and very kind of walled off from the rest of the world,” said Dr. David Lott, Mayo’s chair of head and neck surgery in Phoenix. He started the study because “my patients tell me, ‘Yeah I may be alive but I’m not really living.’”
Lott’s team reported early results of the surgery Tuesday in the journal Mayo Clinic Proceedings.
The larynx may be best known as the voice box but it’s also vital for breathing and swallowing. Muscular tissue flaps called vocal cords open to let air into the lungs, close to prevent food or drink from going the wrong way — and vibrate when air pushes past them to produce speech.
The first two U.S. larynx transplant recipients — at the Cleveland Clinic in 1998 and the University of California, Davis, in 2010 — had lost their voices to injuries, one from a motorcycle accident and the other damaged by a hospital ventilator.
But cancer is the biggest reason. The American Cancer Society estimates more than 12,600 people will be diagnosed with some form of laryngeal cancer this year. While today many undergo voice-preserving treatment, thousands of people have had their larynx completely removed, breathing through what’s called a tracheostomy tube in their neck and struggling to communicate.
Although the earlier U.S. recipients achieved near-normal speech, doctors haven’t embraced these transplants. Partly that’s because people can survive without a larynx — while antirejection drugs that suppress the immune system could spark new or recurring tumors.
“We want to be able to push those boundaries but do it as safely and ethically as we can,” Lott said.
Head-and-neck specialists say the Mayo trial is key to helping larynx transplants become a viable option.
“It isn’t a ‘one-off,’” but an opportunity to finally learn from one patient before operating on the next, said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.
This first attempt in a cancer patient “is the next important step,” he said.
Other options are being studied, noted Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant. His patients at high risk of larynx loss record their voice in anticipation of next-generation speech devices that sound like them.
But Belafsky said there’s “still a shot” for larynx transplants to become more common while cautioning it likely will take years more research. One hurdle has been achieving enough nerve regrowth to breathe without a trach tube.
Kedian was diagnosed with a rare laryngeal cartilage cancer about a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen surgeries, eventually needing a trach tube to help him breathe and swallow — and struggled even to muster a raspy whisper through it. He had to retire on disability.
Still, the once-gregarious Kedian, known for long conversations with strangers, wouldn’t let doctors remove his entire larynx to cure the cancer. He desperately wanted to read bedtime stories to his granddaughter, with his own voice rather than what he called robotic-sounding speech devices.
Then Kedian’s wife Gina tracked down the Mayo study. Lott decided he was a good candidate because his cancer wasn’t fast-growing and — especially important — Kedian already was taking antirejection drugs for an earlier kidney transplant.
It took 10 months to find a deceased donor with a healthy enough larynx just the right size.
Then on Feb. 29, six surgeons operated for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donated one plus necessary adjoining tissues — thyroid and parathyroid glands, the pharynx and upper part of the trachea — and tiny blood vessels to supply them. Finally, using new microsurgical techniques, they connected nerves critical for Kedian to feel when he needs to swallow and to move the vocal cords.
Mayo Clinic via AP
In this photo provided by the Mayo Clinic, Dr. David Lott, surrounded by multi-disciplinary team of doctors, operates on Marty Kedian.
About three weeks later, Kedian said “hello.” Soon he’d relearned to swallow, working up from applesauce to macaroni and cheese and hamburgers. He got to say hi to granddaughter Charlotte via video, part of his homework to just keep talking.
“Every day it’s getting better,” said Kedian, who moves back to Massachusetts soon. His tracheostomy remains in place at least a few more months but “I’m pushing myself to make it go faster because I want these tubes out of me, to go back to a normal life.”
And just as Lott had assured him, Kedian retained his beloved Boston accent.
Family photo via AP
In this photo provided by the family, Marty Kedian holds his granddaughter.
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
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