三种内耳抗原与自身免疫性内耳病的相关性研究

目的探讨3种纯化的内耳抗原与自身免疫性内耳病的关系,并确定其在耳蜗的表达.方法以粗制内耳抗原的3种亚组份(31000、42000～45000和60000蛋白)作为抗原,分别免疫动物(B、C和D组),观察听阈、血清IgG水平和内耳形态学的改变,并应用免疫组织化学方法确定其在耳蜗的表达.A组为对照组,以不含抗原的聚丙烯酰胺凝胶匀浆液代替内耳抗原.结果免疫前各组听阈差异无显著性(F=0.07,P>0.05),免疫后对照组和C组听阈和内耳形态学未见明显改变,B组(9/30只)和D组(7/28只)部分动物出现听力损失.组间听阈差异有显著性(F=9.12,P<0.01).实验组动物血清IgG均显著性升高(F=7.46,P<0.01),B、C和D组与对照组相比差异有显著性.31000蛋白完全分布于耳蜗神经纤维,而42000～45000和60000蛋白分布广泛,螺旋神经节、Corti器、血管纹和螺旋韧带均有分布.结论粗制内耳抗原中31000和60000亚组份均能独立诱发自身免疫性内耳病,31000蛋白具有很高的组织特异性,可能作为一种标志性蛋白用于自身免疫性内耳病的临床诊断.     

三种内耳抗原与自身免疫性内耳病的相关性研究

目的 探讨3种纯化的内耳抗原与自身免疫性内耳病的关系,并确定其在耳蜗的表达。方法 以粗制内耳抗原的3种亚组分（31000、42000－45000和60000蛋白）作为抗原,分别免疫动物（B、C和D组）,观察听阈、血清IgG水平和内耳形态学的改变,并应用免疫组织化学方法确定其在耳蜗的表达。A组为对照组,以不含抗原的聚丙烯酰凝胶匀浆液代替内耳抗原。结果 免疫前各组听阈差异无显著性（F＝0．07,P＞0．05）,免疫后对照组和C组听阈和内耳形态学未见明显改变,B组（9／30只）和D组（7／28只）部分动物出现听力损失。组间听阈差异有显著性（F＝9．12,P＜0．01）。实验组动物血清IgG均显著性升高（F＝7．46,P＜0．01）,B、C和D组与对照组相比差异有显著性。31000蛋白完全分布于耳蜗神经纤维,而42000－45000和60000蛋白分布广泛,螺旋神经节、Corti器、血管纹和螺旋韧带均有分布。结论 粗制内耳抗原中31000和60000亚组份均能独立诱发自身免疫性内耳病,31000蛋白具有很高的组织特异性,可能作为一种标志性蛋白用于自身免疫性内耳病的临床诊断。     

Experimental autoimmune inner ear disease

A guinea pig animal model of autoimmune inner ear disease is presented. The functional, anatomical, and immunological inner ear changes were tested electrophysiologically, histologically and by the immunofluorescence test. Using a homologous crude inner ear antigen (CIEAg) we were able to induce endolymphatic hydrops, vasculitis, mild cellular infiltration of the endolymphatic sac, and occasional spiral ganglion degeneration. Threshold shift was seen in 20% of the tested ears. Specific fluorescence was revealed around the modiolar vessels and in the basilar membrane. The endolymphatic sac and duct showed occasional fluorescence in the epithelial and/or subepithelial layers. The findings were discussed in light of the other models immunized with various forms of inner ear antigens. Similarities between the detected specific fluorescence and the fluorescence revealed by sera of patients with cochleovestibular disorders were discussed.     

Sudden hearing loss and autoimmune inner ear disease

This case report describes the audiologic and medical diagnostic evaluations, results, and treatment options in a patient with a classic presentation of immune-mediated sensorineural hearing loss, commonly called autoimmune inner ear disease (AIED). It reviews findings of the basic battery, immittance audiometry, transient otoacoustic emissions, and auditory brainstem response measures and medical findings over more than 2 years. AIED generally causes asymmetric bilateral sensorineural hearing loss with atypical configuration. Although hearing loss is generally fluctuant, the overall pattern is usually rapid progression, particularly in the absence of early medical intervention. Word recognition is usually disproportionately poor. In our case, otoacoustic emissions and auditory brainstem responses suggest both cochlear and retrocochlear involvement and may initially appear to be inconsistent with pure-tone thresholds. Audiologists must be familiar with AIED because early identification is critical. Additionally, an immunologic basis may be a factor in other disorders, including many cases of Meniere's disease.     

自身免疫性内耳病的诊治进展

自身免疫性内耳病（autoimmune inner ear disease,AIED）是一组以内耳损害为主的免疫介导的疾病, 常以波动性单或双侧感音神经性聋、眩晕、耳鸣及耳胀满感为主要临床表现。虽然临床医师已经关注到AIED,但由于缺乏典型的临床特征及特异性的实验室检查,致该病在临床上存在较多的漏诊及误诊。近年来,随着内耳免疫学研究的深入,人们对AIED的认识也取得了较大提高,现就AIED的发病机制、诊断及治疗等方面的研究现状做一综述。     

Clinical and experimental studies of autoimmune inner ear disease

Otolaryngologists have long sought to identify causes of sensorineural hearing loss that could be reversed by medical treatment. An increasing amount of clinical and experimental evidence indicates that this postulated entity is related to autoimmune inner ear disease. Because of the lack of well-defined detection methods for identifying autoimmune processes within the human inner ear and the fact that it is one of the few organs of the body not amenable to diagnostic biopsy there has been great interest in developing animal models that mimic clinical entities. Different models will be presented in this paper. The results of these studies should provide sufficient evidence to establish a clear position in mainstream immunology for the entity of autoimmune inner ear disease.     

Practical versus theoretical management of autoimmune inner ear disease

Autoimmune inner ear disease is an uncommon but distinct clinical entity. Our ignorance of the immune mediating pathways, need of further animal model experimentation, variability of laboratory test results and of patient treatment responses illustrate how poorly we understand this disorder. The purpose of this review is to compare practical vs theoretical management of autoimmune inner ear disease, based upon our current knowledge of the disease process and upon a review of clinical experience at the Cleveland Clinic Foundation. Representative case histories are presented. The following preliminary conclusions are discussed: Autoimmune inner ear disease can present as a systemic or localized otologic immune disorder. Hearing loss can begin at any age, with unilateral or bilateral sudden onset, fluctuating or progressive symptoms, with or without associated dizziness. The pathogenesis of autoimmune inner ear disease is probably multifactorial (cellular and humoral). The sensitivity and specificity of different laboratory tests vary greatly, but even the most sensitive tests may be falsely normal when symptoms are not acute or when the patient is taking immunosuppressant medication. The mainstay of autoimmune inner ear treatment is steroids: however, cytotoxic drugs are recommended when there is no response to steroid treatment. Apheresis is reserved for selected cases. Hearing improvement can be dramatic even after 2 months of profound deafness. Flare-ups of autoimmune ear disease are best managed by increasing steroid dosage or adding cytotoxic medications. Unfortunately, some patients will develop progressive hearing loss despite vigorous treatment.     

豚鼠自身免疫性梅尼埃病模型的主要内耳抗原分析

目的 探寻导致豚鼠自身免疫性梅尼埃病(autoimmune Meniere's disease,AIMD)的主要内耳组织抗原成分.方法 采用同种粗制内耳抗原免疫豚鼠,观察听觉功能、前庭功能及内耳组织形态学方面的变化,判断AIMD模型与非模型动物.采用免疫印迹法(Western blotting)对比分析模型动物与非模型动物血清内针对内耳组织抗原不同成分特异性免疫反应的差异,寻找只针对AIMD模型动物的特异性成分.结果 内耳组织所含抗原成分较多,免疫后酶联免疫吸附试验(ELISA)结果显示,AIMD模型与非AIMD模型动物均不同程度地存在针对内耳组织抗原的血清抗体水平升高.听功能检测,非AIMD模型动物听力损失不明显.Western bohting结果显示,AIMD模型动物出现针对相对分子质量为68 000、58 000、42 000及28 000蛋白质成分的反应条带,而非AIMD模型动物则未显示这些条带的特异性抗原抗体反应.结论 可能只有出现针对导致内耳自身免疫性疾病的主要抗原成分的特异性免疫反应,才会造成明显的内耳免疫病理损伤和功能障碍.相对分子质量为68 000、58 000、42 000及28 000的内耳组织抗原可能是导致豚鼠自身免疫性膜迷路积水的主要抗原成分.     

自身免疫性内耳病动物模型的建立

目的　建立一种自身免疫性内耳病的动物模型 ,其具有可重复性高 ,适于进行深入免疫学分析的特点。方法　提取豚鼠内耳膜迷路组织为抗原 ,与等量完全弗氏佐剂 ,百日咳杆菌一次免疫C5 7BL/6小鼠。检测反应阈、血清免疫学、内耳形态学及免疫组织化学的改变。结果　免疫后小鼠听性脑干反应阈显著提高 ,内耳中出现显著的炎性细胞浸润、内淋巴积水和螺旋神经节细胞变性、数量减少等形态学改变 ,血清中可检测到抗内耳自身抗体 ,鼓阶内浸润细胞中的淋巴细胞主要为CD4 T细胞。结论　应用这种方法在C5 7BL/6小鼠可成功建立自身免疫性内耳病的动物模型     

Utility of laboratory testing in autoimmune inner ear disease

OBJECTIVES: To assess the utility of various laboratory tests used to diagnose autoimmune inner ear disease. STUDY DESIGN: Retrospective study of 82 patients evaluated at the University of Washington Otology Clinic from 1996 through 1998 with review of clinical history, laboratory tests, audiograms, response to therapy, and final diagnoses. METHODS: Charts were reviewed for presenting history and initial workup including test results for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Clq binding assay, anticardiolipin antibody (aCL), antineutrophil cytoplasmic antibody (ANCA), microhemagglutinin assay for Treponema pallidum (microhemagglutination assay), Lyme disease titers, and the Western blot for heat shock protein 70 (hsp 70). RESULTS: The Western blot for hsp 70 is the best test for predicting corticosteroid responsiveness. The sensitivity was low at 42%, although the specificity was 90%, and the positive predictive value of this test was excellent at 91%. The ESR was as good as the CRP in detecting acute-phase reactants. The other, more specific tests in the laboratory panel (aCL, ANCA, MHA, and Lyme disease titers) did not detect any new cases of autoimmune disease in addition to those which were already identified by an abnormal ESR. CONCLUSIONS: A diagnostic test panel for autoimmune inner ear disease should include an ESR and the Western blot for hsp70. More specific laboratory testing for systemic disease is warranted when the ESR is elevated. In patients with a positive Western blot, a trial of corticosteroid therapy can be given with good conviction because the test is quite specific. However, many people who are Western blot negative may also respond to corticosteroid therapy because the test lacks sensitivity.     

凋亡及其相关基因在实验性自身免疫性内耳病小鼠内耳组织中的表达

目的探讨凋亡及其相关基因在自身免疫性内耳病形成和发展中的作用。方法选用近交系C57BL／6小鼠随机数字表法分为正常对照组和免疫7、14、21、28d组，每组16只。提取豚鼠内耳膜迷路组织为抗原，与等量完令弗氏佐剂，百日咳杆菌一次免疫实验组动物，制备自身免疫性内耳病动物模型，应用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记技术（terminal deoxynucleotidyl transferase—mediated d-UTP nick end—labing，TUNEL）检测内耳中的细胞凋亡，应用免疫组化和逆转录聚合酶链反应（RT—PCR）技术检测Fas、FasL及bcl-2在内耳的表达。结果正常小鼠内耳组织中，TUNEL染色阳性细胞极为少见，偶尔在Corti器或球囊斑的支持细胞发现。免疫7d后，内毛细胞和少量的血管纹边缘细胞TUNEL染色阳性，14d后TUNEL染色阳性的细胞数量及种类显著增加，但外毛细胞、螺旋神经节细胞与前庭神经节细胞免疫前后均未见凋亡表达。免疫组化染色显示，正常小鼠内耳中Fas表达广泛，FasL存部分螺旋神经节细胞与前庭神经节细胞表达，bcl-2仅在螺旋神经节细胞、前庭神经节细胞有较强表达。免疫后FasL在各种组织均有较强表达，bcl一2在外毛细胞出现表达，在耳蜗神经无细胞的表达增加。RT—PCR检测正常小鼠内耳组织的Fas mRNA、FasL mRNA、bcl-2mRNA均为阳性，FasL mRNA低水平表达，免疫后升高，在2周达到高峰后逐渐下降；bcl-2 mRNA在免疫后进行性升高。结论Fas／FasL信号系统介导的凋亡与自身免疫性内耳病的发生、发展过程关系密切，bcl-2对内耳中Fas／FasL介导的凋亡有重要的调节作用。     

不同内耳组织抗原免疫致自身免疫性感音神经性聋的研究

目的：探讨不同内耳组织抗原免疫所致内耳主要病理损伤部位和听力障碍类型。方法：采用同种螺旋韧带（ＳＬ）、基底膜（ＢＭ）、螺旋神经节（ＳＧ）组织抗原免疫豚鼠，观察内耳组织病理改变和听觉功能变化。结果：ＳＬＡｇ和ＢＭＡｇ免疫组主要表现耳蜗微音器电位阈值升高和复聪现象，以及蜗管内和血管纹的免疫炎性病理改变；ＳＧＡｇ免疫组主要表现听神经复合动作电位阈值升高和幅值降低，内耳病理变化主要位于蜗轴血管及周围和ＳＧ     

Theoretical and practical implications for plasmapheresis in autoimmune inner ear disease

Immune-mediated inner ear disease, by convention called autoimmune inner ear disease (AIED), has established clinical profile guidelines for diagnosis. Treatment consists of steroid and/or cytotoxic drug immunosuppression. The role of plasmapheresis (PMP) in the treatment of AIED has not been defined. Lack of a precise serological marker prevents accurate immunological understanding. Definition is, of course, difficult in a disease whose natural history is not well delineated. Successful use of PMP in one steroid and cytotoxic drug intolerant patient with AIED led to its use in a total of eight patients. The rationale for PMP was based on its known effectiveness in other autoimmune diseases and thus, its potential use in AIED. Improved auditory function occurred in 6 of the 8 patients, 3 of whom have been followed for over 3 years. Three of the six no longer require immunosuppressant medication. PMP can be used as an alternative or adjunctive therapy in AIED. These preliminary results suggest PMP can stabilize or improve auditory and vestibular symptoms in selected patients. Its use as a first line therapy followed by cytotoxic immunosuppressants bears consideration.     

Use of biologics for treatment of autoimmune inner ear disease

ObjectiveBiologic medications are novel therapeutics in the treatment of Autoimmune Inner Ear Disease (AIED), an etiology of Sensorineural Hearing Loss (SNHL). The goal of this study is to review the currently available literature on the efficacy of biologic medications on autoimmune-mediated hearing loss and associated symptomology among patients with AIED.MethodsA systematic review of Pubmed, Scopus, Cochrane, and Web of Science databases was conducted to identify studies investigating the impact of biologic medications on hearing outcomes. Bias assessment was independently conducted by three authors and studies were stratified based on risk of bias.ResultsOf 174 unique abstracts screened, 12 articles met inclusion criteria for formal review. One randomized control trial, seven prospective cohort studies, and four retrospective cohort studies were included. Seven biologic medications, Etanercept, Infliximab, Adalimumab, Golimumab, Rituximab, Anakinra, and Canakinumab, were identified targeting three unique molecular targets, TNF-α, CD20, and IL-1.ConclusionThe effects of biologic medications in treating SNHL was highly variable without clear efficacy of a drug or drug category, likely due to rarity of disease, multifactorial etiologies of AIED, and cohort heterogeneity. However, several medications alleviate symptoms associated with AIED, such as vertigo and tinnitus. While biologic medications may be promising therapeutics in AIED patients, the evidence is currently inconclusive. Large-scale randomized control trials and prospective cohort reviews are required to establish the efficacy of biologic medications in treating hearing loss.     

Experimental autoimmune inner ear disease: an electrocochleographic and histophysiologic study

Systemic immunization with swine inner ear antigens in complete Freund's adjuvant induces functional disturbances in the cochlea. Morphometric data indicate that an endolymphatic hydrops develops within 2 weeks. It diminishes 6 weeks after immunization. A progressive decrease in the compound action potential amplitude is observed from 2 to 6 weeks after immunization. Enhancement of the amplitude of the summating potential is present without a clear overall correlation to the presence of endolymphatic hydrops. The amplitude of the cochlear microphonics shows no significant changes after immunization. Western blot analysis of the sera performed 2 and 6 weeks after immunization shows enhanced reactivity at 68, 50, 45, and 27 kd molecular weights, as compared to controls. The same spectrum of cross-reacting antibodies is believed to be instrumental in immune-mediated sensorineural hearing loss in patients. Apparently, cross-reacting antibodies and released mediators disturb cochlear homeostasis, resulting in the observed changes in the electrophysiological responses. However, these changes are not clearly related to structural changes at the light and electron microscopic levels.     

自身免疫性内耳病动物模型的建立

目的建立一种自身免疫性内耳病的动物模型，其具有可重复性高，适于进行深入免疫学分析的特点。方法提取豚鼠内耳膜迷路组织为抗原，与等量完全弗氏佐剂，百日咳杆菌一次免疫C57BL／6小鼠。检测反应阈、血清免疫学、内耳形态学及免疫组织化学的改变。结果免疫后小鼠听性脑干反应阈显著提高，内耳中出现显著的炎性细胞浸润、内淋巴积水和螺旋神经节细胞变性、数量减少等形态学改变，血清中可检测到抗内耳自身抗体，鼓阶内浸润细胞中的淋巴细胞主要为CD4^ T细胞。结论应用这种方法在C57BL／6小鼠可成功建立自身免疫性内耳病的动物模型。     

纯化内耳P0蛋白诱发实验性自身免疫性内耳病动物模型

目的：用从内耳组织中纯化的P0蛋白免疫豚鼠,建立P0蛋白诱发的自身免疫性内耳病动物模型,研究其在自身免疫性内耳病中的作用。方法：采用制备性SDS-PAGE从内耳组织中分离、纯化P0蛋白。以纯化的豚鼠内耳P0蛋白作为抗原免疫豚鼠,观察其听性脑干反应阈,血清中抗体水平和内耳形态学的改变,并用免疫组织化学法确定P0蛋白在耳蜗的分布情况。结果：SDS-PAGE结果显示纯化的蛋白质只在分子量为30 000的位置上出现单一的蛋白染色带,Western blot结果示该蛋白即为P0蛋白。免疫后有22%豚鼠的听性脑干反应阈升高,对照组动物无变化。实验组血清IgG显著升高（F=6.48,P〈0.01）,反应阈提高豚鼠的螺旋神经节细胞均有不同程度的数目减少,蜗轴小血管周围有炎性细胞浸润。P0蛋白在耳蜗仅分布于螺旋神经节、蜗轴神经纤维的髓鞘上。结论：用制备性SDS-PAGE能够成功地从内耳纯化P0蛋白,用于自身免疫性内耳病的研究。P0蛋白在部分豚鼠能够诱发自身免疫性内耳病,可能是自身免疫性内耳病的自身抗原之一。     

The diagnosis of autoimmune inner ear disease: evidence and critical pitfalls

The purpose of this paper is to review the current diagnostic work-up for patients with suspected Autoimmune Inner Ear Disease (AIED). AIED is a rare disease accounting for less than 1% of all cases of hearing impairment or dizziness, characterized by a rapidly progressive, often fluctuating, bilateral SNHL over a period of weeks to months. While specific tests for autoimmunity to the inner ear would be valuable, at the time of writing, there are none that are both commercially available and proven to be useful. Thus far, most of the identified antigens lack a clear association with localized inner ear pathology and the diagnosis of AIED is based either on clinical criteria and/or on a positive response to steroids. For clinical practice, we recommend an antigen-non-specific test battery including blood test for autoimmune disorders and for conditions that resemble autoimmune disorders. Nevertheless, if financial resources are limited, a very restricted work-up study may have a similar efficiency.     

Inner ear autoantibodies and their targets in patients with autoimmune inner ear diseases

Immunological mechanisms are thought to play an important role in the pathogenesis of some cochleo-vestibular diseases. This study attempts to present further evidence of autoantibodies reactive against guinea pig inner ear proteins found in patients with autoimmune inner ear diseases (AIED) and specifically identifies the main target antigens of these antibodies. Sera from 110 patients with a clinical diagnosis of either rapidly progressive sensorineural hearing loss (n = 32). Ménière's disease (n = 41), sudden deafness (n = 6) or other aetiologies of hearing loss (n = 11) were screened by the Western blot technique. Forty-four percent of the patients' sera had antibodies to several inner ear proteins, of which the 30, 42 and 68 kDa proteins were found to be the most reactive. These highly reactive proteins were identified by gas-phase micro sequencing after digestion with trypsin and separation of peptide fragments by high-performance liquid chromatography. A partial sequence of each protein was determined. These data, together with those obtained from 2-dimensional gel electrophoresis followed by Western blotting, demonstrated that the 30 and 42 kDa inner ear proteins are the major peripheral myelin protein P0 and the beta-actin protein, respectively, while sequence analysis indicated that the 68 kDa protein is novel. These findings further support the hypothesis that several populations of antibodies may contribute to the enhanced immunological activity of AIED patients. They also add a new dimension to our knowledge of AIED and may open new avenues in the development of simple serological assays, which are easier to perform and more rapid than Western blotting.