Growing up as the child of a voice instructor, Emily Hardy developed a lifelong interest in singing. But the third-year student at Mayo Clinic Alix School of Medicine never dreamed her interest in vocals would lead to research related to the first larynx transplant at Mayo Clinic.

"When I first learned that Mayo Clinic was advancing the larynx transplant, I thought the procedure is something that will be exciting for Mayo to be able to do for patients — something I couldn't even fathom," she says. "I knew I wanted to be fully involved in advancing the research in this area."

In addition to her medical degree, Hardy is pursuing a master's degree at Mayo Clinic Graduate School of Biomedical Sciences. Her research project is looking at ways to make the post-laryngeal transplant regimen easier for patients. Because receiving a transplant requires lifelong immunosuppressive drugs to prevent rejection of the new organ, Hardy is investigating removing the cells of a laryngeal transplant model, looking for approaches that reduce the immune response and, hopefully, the need for medication.

"If we can reduce the immune response or the need for immunosuppression that could make laryngeal transplant available to more patients and improve their quality of life," she says. 

Voice as a hobby and a scientific study

Finding joy in singing with others, Hardy participated in a choir in college, and, when she came to medical school at Mayo Clinic in Arizona, she performed with a community-based barbershop group.

"I've always loved anything related to the voice," she says. "When I came to medical school, I'd never thought of incorporating that into my career until I began learning about laryngology and ear nose and throat surgery and realized how those specialties matched that specific interest."

As a medical student also interested in conducting biomedical research, her interest in the intersection of that work and singing would put her at the cutting edge of a brand-new field of study: regenerative sciences. During her first year of medical school, as she sought opportunities to work in a lab, she found David Lott, M.D., chair of the Department of Otolaryngology (ENT) - Head and Neck Surgery/Audiology at Mayo Clinic in Arizona. His research applies the approaches of regenerative medicine to restoring the voices of patients who have had a laryngectomy — a surgery to remove the voice box.

Regenerative medicine is an approach that shifts the focus from treating disease to rebuilding health by repairing, replacing or restoring damaged tissues, cells or organs. As director of the Head and Neck Regenerative Medicine Lab at Mayo Clinic, Dr. Lott has focused on establishing techniques to regenerate the voice box and restore its abilities after diseases or traumas.

His work led to the first laryngeal transplant at Mayo Clinic — actually replacing a damaged voice box with all its necessary functions. People whose voice box was damaged from injury, cancer or the residual effects of radiation treatment — as many as 60,000 people in the U.S. — can neither speak with their natural voices nor breathe through their noses. Mayo Clinic is in the process of establishing the first ongoing larynx transplant program in the country. Dr. Lott and colleagues are advancing the transplant procedure and also exploring other regenerative approaches to larynx restoration, including the use of stem cells and growth factors to help grow functional tissue.

As Hardy learned about the lab's various approaches to laryngeal transplant and the potential to restore function through regenerative sciences, she knew she wanted to contribute to research to further options for voice-impaired patients.

The field of regenerative medicine is so new that few people are versed in its principles and techniques. Mayo Clinic is at the forefront of training the workforce in this emerging field, offering doctoral and post-graduate training in Regenerative Sciences through the Mayo Clinic Graduate School of Biomedical Sciences. Hardy is an example of the future physician-scientists that Mayo is training to deliver the newest regenerative technologies and carry on the work for the next generation.

"Education plays a key role, complementing the research and practice components, in the laryngeal transplant," says Dr. Lott. The entire staff involved in a transplant rehearsed and trained for it, including nurses who underwent specialized in-service training and online courses. Training for the laryngeal transplant provided a unique learning opportunity for residents at Mayo Clinic School of Graduate Medical Education, including head and neck surgical resident Payam Entezami, M.D., who assisted the surgical team. 

To address patient needs following the transplant, Hardy found she could amplify her medical school training by pausing it to pursue a master's degree in regenerative sciences, attending classes about its innovative approaches and conducting research in Dr. Lott's lab. She is among Mayo's first students in the program, and says she is impressed by the topics involved — stem cells, tissue engineering, 3D bioprinting — and the vast areas of medicine it touches.

"There are so many different approaches within regenerative medicine and ways to apply it to specific clinical areas of interest," she says.

"We’re educating a specialized clinical workforce of the future, who will have the understanding to manifest the potential held within regenerative medicine," says Saranya Wyles, M.D., Ph.D. a dermatologist and associate director of education at Mayo Clinic Center for Regenerative Biotherapeutics. "Regenerative technologies, focused on restoring form and function, have the potential to transform standard of care. The approach begets a new set of skills."

Dr. Lott is enthusiastic that Hardy's research will contribute to the growing information about laryngeal transplant. He's also emphatic about the importance of the various educational opportunities emerging in regenerative medicine.

"We're training the next generation of scientists and clinicians who are going to be pushing the field ahead," he says. "It's one thing to be able to develop regenerative approaches for patients now. It's a whole other to establish the experts in this new field who can help patients for years and years down the road."

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