Regeneration of the mammalian vestibular sensory epithelium following gentamicin-induced damage.

OBJECTIVES: The aims of this study are (1) to investigate if significant long-term recovery of mature hair bundle (MHB) numbers takes place following gentamicin-induced damage to the mammalian vestibular sensory epithelium and (2) to assess if the different MHB types in the vestibular sensory epithelium have a different susceptibility to ototoxic damage. METHODS: Gentamicin (8 mg in 0.1-mL sterile water) was injected transtympanically into one ear of guinea pigs, the contralateral ear acting as a control. The animals were killed at 4 days, 4 weeks, and 3 and 10 months post-treatment and the utricles (n = 38) were extracted from both ears. Mature hair bundle and immature-looking hair bundle (IHB) densities on the surface of the utricle were determined using scanning electron microscopy. RESULTS: The MHB density showed a significant decline between 4 days and 4 weeks post-treatment. There was greater loss of type I MHBs (tallest stereocilia comparable in height to the kinocilium) than type II MHBs (kinocilium taller than the tallest stereocilia). A significant increase in IHB density was seen at 4 weeks post-treatment, after which it declined rapidly. A significant but incomplete recovery in MHB density (to 66% of control value) was seen in the striolar region at 10 months post-treatment, and these were composed mainly of type II MHBs. CONCLUSIONS: It would appear that the mature mammalian vestibular sensory epithelium does have the capacity for long-term recovery of MHB numbers following gentamicin-induced damage, but this is limited and does not result in complete restoration of the epithelium. Type I MHBs are more susceptible to ototoxic damage than type II MHBs. Sommaire     

Pattern of hair cell loss and delayed peripheral neuron degeneration in inner ear by a high-dose intratympanic gentamicin

To gain insights into the ototoxic effects of aminoglycoside antibiotics (AmAn) and delayed peripheral ganglion neuron death in the inner ear, experimental animal models were widely used with several different approaches including AmAn systemic injections, combination treatment of AmAn and diuretics, or local application of AmAn. In these approaches, systemic AmAn treatment alone usually causes incomplete damage to hair cells in the inner ear. Co-administration of diuretic and AmAn can completely destroy the cochlear hair cells, but it is impossible to damage the vestibular system. Only the approach of AmAn local application can selectively eliminate most sensory hair cells in the inner ear. Therefore, AmAn local application is more suitable for studies for complete hair cell destructions in cochlear and vestibular system and the following delayed peripheral ganglion neuron death. In current studies, guinea pigs were unilaterally treated with a high concentration of gentamicin (GM, 40 mg/ml) through the tympanic membrane into the middle ear cavity. Auditory functions and vestibular functions were measured before and after GM treatment. The loss of hair cells and delayed degeneration of ganglion neurons in both cochlear and vestibular system were quantified 30 days or 60 days after treatment. The results showed that both auditory and vestibular functions were completely abolished after GM treatment. The sensory hair cells were totally missing in the cochlea, and severely destroyed in vestibular end-organs. The delayed spiral ganglion neuron death 60 days after the deafening procedure was over 50%. However, no obvious pathological changes were observed in vestibular ganglion neurons 60 days post-treatment. These results indicated that a high concentration of gentamycin delivered to the middle ear cavity can destroy most sensory hair cells in the inner ear that subsequently causes the delayed spiral ganglion neuron degeneration. This model might be useful for studies of hair cell regenerations, delayed degeneration of peripheral auditory neurons, and/or vestibular compensation. In addition, a potential problem of ABR recording for unilateral deafness and issues about vestibular compensation are also discussed.     

The protective effect of brain-derived neurotrophic factor after gentamicin ototoxicity.

HYPOTHESIS: Brain-derived neurotrophic factor (BDNF) influences the process of hair cell recovery in the vestibular sensory epithelium of the chinchilla after local application of gentamicin (GM). BACKGROUND: Hair cell regeneration in the inner ear after GM ototoxicity has been demonstrated. However, the mechanisms responsible for this recovery have yet to be completely elucidated. This report examines the protective and proliferative effects that BDNF exerts on vestibular hair cells in experiments designed to further elucidate the mechanisms of hair cell regeneration. METHODS: The inner ears of three separate groups of chinchillas were treated with GM only, GM and BDNF simultaneously, and GM followed by BDNF 1 week later. The numbers of hair and supporting cells in the horizontal cristae of each group were then estimated at 1, 2, 4, and 8 weeks, and the data were compared. RESULTS: Type I hair cells after GM treatment completely disappeared. After simultaneous BDNF and GM treatment, their numbers decreased to 23% at 1 week and progressively disappeared by week 8. When BDNF was applied 1 week after GM administration, type I hair cells recovered to 12% at week 4 and 28% at week 8. Type II hair cells after GM treatment decreased to 15%, but recovered to 83% 4 weeks later. Simultaneous administration of BDNF and GM prevented the ototoxic effects of GM alone. When BDNF was administered 1 week after GM, type II hair cell recovery was accelerated and was greater than after GM alone (81% versus 18%). Supporting cells after GM treatment decreased to 74% at 1 week after treatment, recovered to 91% at 2 weeks, and remained at 86% at 4 weeks and 85% at 8 weeks. With the simultaneous administration of BDNF and GM, supporting cells significantly decreased at 2 weeks after treatment (63%), but recovered to normal by week 8. CONCLUSIONS: These results suggest that BDNF provided simultaneously with GM minimizes the ototoxic effect of GM on type II hair cells. The increase in the number of new hair cells when BDNF is provided after ototoxic damage is evidence of the proliferative capacity of this neurotrophic factor.     

An in vitro rapid evaluation of drug-induced ototoxicity and of reductive effect of calcium on aminoglycoside ototoxicity using organ culture

The ototoxicity of aminoglycoside and anticancer platinum drug was analysed using an organ culture system. The effect of calcium antagonism on aminoglycoside ototoxicity was investigated by the same system. The inner ears of mice, 16-day embryos, were cultured for 5 days with or without gentamicin (GM) or kanamycin (KM) or streptomycin (SM), or ribostamycin (RSM), including 1, 10, 100, or 1000 micrograms/ml respectively. The 21st gestational day-inner ear was cultured in vitro during 4 days with or without Cisplatin (CDDP) or platinum analog DWA2114R (DWA), including 0.1, 1, or 10 micrograms/ml, respectively. The 16th gestational day-inner ear was cultured in vitro for 5 days with 10 micrograms/ml KM, adding 5 mM Ca2+ or 10 mM Ca2+ to the culture medium. The damages of crista ampullaris and macula utriculi of cultured inner ear were estimated according to the ototoxicity score based on morphological changes by a light microscopic observation of serial sections of the materials. We defined four grades for the damages according to the following criteria; grade 1: damage of apical surface of the hair cells, grade 2: the existence of debris in the endolymph space, grade 3: disappearance of the hair cells, grade 4: degeneration of the supporting cells. Using this system following results were obtained: 1) the effect of aminoglycoside was dose dependent, 2) the order of ototoxicity was following; GM greater than KM greater than SM greater than RSM, 3) the drug concentration of 1000 micrograms/ml is sufficient to study its ototoxic potential in this system, 4) the effect of both CDDP and DWA was obvious at a concentration of 0.1 microgram/ml, 5) DWA showed almost the same ototoxicity as CDDP at the same concentration, 6) Adding 5 mM Ca2+ or 10 mM Ca2+ to the culture medium, the ototoxic damage induced by 10 micrograms/ml of KM was not noticed. A protective effect of Ca2+ against KM ototoxicity was observed in vitro. This organ culture and ototoxicity score system can serve as a useful and adequate model system for evaluating the ototoxicity.     

Uptake of amikacin by hair cells of the guinea pig cochlea and vestibule and ototoxicity: Comparison with gentamicin

The distribution of amikacin (AK), an exclusive cochleo-toxic aminoglycosidic antibiotic (AA), and of gentamicin (GM), which is both cochleo- and vestibulo-toxic, has been studied in cochlear and vestibular hair cells. Guinea pigs were treated during six days with one daily injection of AK (450 mg/kg/day) or GM (60 mg/kg/day). AAs were detected, using immunocytochemical technique with scanning laser confocal microscopy, in isolated cells from guinea pigs sacrificed from 2 to 30 days after the end of the treatments. Results demonstrate a rapid uptake (as soon as after 2-day treatment) of both AAs by cochlear and vestibular hair cells and a very slow clearance. Particularly GM and AK are detected in type I and type II hair cells of the utricles and cristae ampullaris. The presence of these two molecules with different toxic potentialities towards cochlear and vestibular hair cells indicates that the selective ototoxicity of aminoglycosides cannot be explained simply on the basis of particular uptake and accumulation in the different sensory hair cells.     

庆大霉素损伤后豚鼠前庭感觉上皮细胞凋亡和再生

目的 研究豚鼠前庭毛细胞庆大霉素损伤后前庭感觉上皮细胞凋亡和细胞增殖之间的关系。方法 成年豚鼠肌肉注射庆大霉素１００ｍｇ／ｋｇ／ｄ连续１４ｄ,停用庆大在霉素后１ｄ和１０ｄ。腹腔注射Ｂｒｄｕ ３００ｍｇ／ｋｇ ６ｈ后处死实验动物,免疫组化显色壶腹嵴可见Ｂｒｄｕ标记细胞,同时应用ＴＵＮＥＬ技术原位显示凋亡细胞,观察应用庆大霉素后１ｄ和１０ｄ壶腹嵴毛细胞损伤区域细胞凋亡和细胞增殖状况,结果 损伤后１ｄ,     

OTOTOXIC EFFECTS OF CARBOPLATIN IN ORGANOTYPIC CULTURES IN CHINCHILLAS AND RATS

Carboplatin, a second-generation platinum chemotherapeutic drug, is considerably less ototoxic than cisplatin. While common laboratory species such as mice, guinea pigs and rats are highly resistant to carboplatin ototoxicity, the chinchilla stands out as highly susceptible. Moreover, carboplatin causes an unusual gradient of cell death in chinchillas. Moderate doses selectively damage type I spiral ganglion neurons (SGN) and inner hair cells (IHC) and the lesion tends to be relatively uniform along the length of the cochlea. Higher doses eventually damage outer hair cells (OHC), but the lesion follows the traditional gradient in which damage is more severe in the base than the apex. While carboplatin ototoxicity has been well documented in adult animals in vivo, little is known about its in vitro toxicity. To elucidate the ototoxic effects of carboplatin in vitro, we prepared cochlear and vestibular organotypic cultures from postnatal day 3 rats and adult chinchillas. Chinchilla cochlear and vestibular cultures were treated with carboplatin concentrations ranging from 50 μM to 10 mM for 48 h. Consistent with in vivo data, carboplatin selectively damaged IHC at low concentrations (50-100 μM). Surprisingly, IHC loss decreased at higher doses and IHC were intact at doses exceeding 500 μM. The mechanisms underlying this nonlinear response are unclear but could be related to a decrease in carboplatin uptake via active transport mechanisms (e.g., copper). Unlike the cochlea, the carboplatin dose-response function increased with dose with the highest dose destroying all chinchilla vestibular hair cells. Cochlear hair cells and auditory nerve fibers in rat cochlear organotypic cultures were unaffected by carboplatin concentrations <10 μM; however, the damage in OHC were more severe than IHC once the dose reached 100 μM. A dose at 500 μM destroyed all the cochlear hair cells, but hair cell loss decreased at high concentrations and nearly all the cochlear hair cells were present at the highest dose, 5 mM. Unlike the nonlinear dose-response seen with cochlear hair cells, rat auditory nerve fiber and spiral ganglion losses increased with doses above 50 μM with the highest dose destroying virtually all SGN. The remarkable species differences seen in vitro suggest that chinchilla IHC and type I SGN posse some unique biological mechanism that makes them especially vulnerable to carboplatin toxicity.     

Vestibular cytotoxicity in gentamicin-treated frogs: a preliminary report

OBJECTIVE: The aim of this study is to determine the immediate effects of intraperitoneal doses of gentamicin (GM) which would result in variable degrees of destruction of crista ampullary hair cells of frogs. This information will serve as a baseline guide to cell regeneration experiments on the damaged vestibular sense organ. STUDY DESIGN: The American bullfrog was administered daily intraperitoneal doses of 50, 100, 150, and 200 mg/kg of GM for 7 days. Animals were sacrificed 1 day after the final injection for cytomorphic evaluation. Histologically processed posterior semicircular duct cristae were resin-embedded, and tissue samples were subjected to serial cross sectioning of the crista from the periphery to the central zone using glass knives in an ultramicrotome. Stained sections were analyzed in light microscope using ocular grid micrometry. The areal density of nuclear profiles of the vestibular sensory and supporting cells (sensory cells [SNCs] and supporting cells [SPCs], respectively; number per square millimeter) and the nuclear diameter of SNCs were manually determined. RESULTS: A 7-day administration of GM produced noticeable quantitative alteration of the posterior crista hair cells and SPCs. Histological analysis revealed a significant decrease in the density of SNCs and a concomitant increase in the density of SPCs (1-way analysis of variance). CONCLUSION AND SIGNIFICANCE: The cytomorphic data derived from this study show that 4 doses of intraperitoneal gentamicin administered to the bullfrog caused a decline in the areal density of sensory hair cells of the posterior canal crista ampullaris. Also noted was an increase in the density of adjacent SPCs. Although speculative, the increase in SPC population could be a harbinger of regeneration of the vestibular hair cells as suggested by other investigators in different species. The significance of present observations will be helpful to initiate future studies related to recovery of SNCs in a similarly damaged frog ampullary organ. Through a standardized quantitative approach to the study of SNCs and SPCs of the crista organ, the vestibulo-toxicity of newly developed drugs can be assessed.     

庆大霉素对离体培养小鼠前庭终器的损害

目的：观察并建立不同浓度庆大霉素损害新出生C 57小鼠前庭各终器的离体实验模型。方法：应用前庭终器分离取材技术、前庭器官离体培养技术和组织学检查技术观察不同浓度庆大霉素对新出生C 57小鼠前庭各终器的损害。结果：庆大霉素对离体培养前庭毛细胞的损害模式是随着剂量的增加而损害加重，庆大霉素对离体培养前庭毛细胞的破坏与其在体实验的耳毒性规律基本相似。结论：囊斑微纹区和壶腹嵴顶部的毛细胞比周边区的毛细胞更易遭受庆大霉素的破坏。     

Morphometric analysis and fine structure of the vestibular epithelium of aged C57BL/6NNia mice

The vestibular organs of young and very old C57BL/6NNia (B6) mice were compared by light and electron microscopy. Hair cell density decreased an average of 14% in the utricle, 19% in the saccule and posterior crista, 23% in the horizontal crista, and 24% in the anterior crista. Hair cell size remained the same throughout the mouse's life span as did the ratio of Type I to Type II hair cells. The most apparent sign of advanced age was dense inclusions found in sensory and supporting cells. Although small inclusions were present at five weeks, by 29 months, additional, larger forms appeared. An unusual melanin-like form was characteristic of old Type I hair cells. Synaptic morphology and synaptic bodies were well preserved even in very old B6 mice. Elongated bars were common in Type I hair cells and spheroid synaptic bodies were the most common form in Type II hair cells. Large clusters of synaptic bodies occurring in both young and old mice were seen only in Type I hair cells. Although the B6 strain suffers from genetically determined early cochlear degeneration, it does not experience early degeneration of the peripheral vestibular organs.     

A proposed protocol for monitoring ototoxicity in patients who take cochleo- or vestibulotoxic drugs

No widely accepted protocol or guideline exists for monitoring ototoxicity in patients who take powerful and potentially cochleotoxic and/or vestibulotoxic agents. Many physicians in other specialties who prescribe these drugs do not understand the important role of otolaryngologists and audiologists in pretreatment counseling and evaluation and the need for follow-up assessments of their patients' auditory function. Based on our combined experience of more than 50 years, we have developed a uniform yet flexible approach to monitoring cochlear and vestibular function in these patients. We discuss the mechanisms of ototoxic agents, risk factors for ototoxicity, the need for ongoing communication among the various disciplines, and the methods and timing of monitoring.     

Calpain and caspase inhibitors protect vestibular sensory cells from gentamicin ototoxicity

OBJECTIVE: Apoptosis may play an important role in the mechanism of aminoglycoside ototoxicity. Caspases and calpains are regarded to be important factors in the regulation of cell death in the inner ear. We hypothesized that caspase or calpain inhibitors would protect hair cells from aminoglycoside ototoxicity. MATERIAL AND METHODS: In order to test this hypothesis we carried out a pilot study to determine if gentamicin (GM) would induce caspase and calpain immunolabeling in guinea pig hair cells Having confirmed this we carried out the main experiment using guinea pig vestibular organ culture to determine if caspase and calpain would protect the hair cells from GM ototoxicity. RESULTS: Immunoreactivity for caspase-3 and m-calpain was detected in the vestibular sensory cells and ganglia after GM treatment. Both caspase and calpain inhibitors protected hair cells against gentamicin ototoxicity. CONCLUSION: It is suggested that inhibition of apoptosis is essential in order to block aminoglycoside ototoxicity.     

Blockade of c-Jun N-terminal kinase pathway attenuates gentamicin-induced cochlear and vestibular hair cell death

The ototoxic action of aminoglycoside antibiotics leading to the loss of hair cells of the inner ear is well documented. However, the molecular mechanisms are poorly defined. We have previously shown that in neomycin-exposed organotypic cultures of the cochlea, the c-Jun N-terminal kinase (JNK) pathway--associated with stress, injury and apoptosis--is activated in hair cells and leads to their death. We have also shown that hair cell death can be attenuated by CEP-1347, an inhibitor of JNK signalling [Pirvola et al., J. Neurosci. 20 (2000) 43-50]. In the present study, we demonstrate that gentamicin-induced ototoxicity leads to JNK activation and apoptosis in the inner ear hair cells in vivo. We also show that systemic administration of CEP-1347 attenuates gentamicin-induced decrease of auditory sensitivity and cochlear hair cell damage. In addition, CEP-1347 treatment reduces the extent of hair cell loss in the ampullary cristae after gentamicin intoxication. Particularly, the inner hair cells of the cochlea and type I hair cells of the vestibular organs are protected. We have previously shown that also acoustic overstimulation leads to apoptosis of cochlear hair cells and that CEP-1347 can attenuate noise-induced sensory cell loss. These results suggest that activation of the JNK cascade may be a common molecular outcome of cellular stress in the inner ear sensory epithelia, and that attenuation of the lesion can be provided by inhibiting JNK activation.     

Glutamate-like Immunoreactivity During Hair Cell Recovery After Gentamicin Exposure in the Chinchilla Vestibular Sensory Periphery

Objective: Determine the expression of glutamate by immunohistochemistry in normal and recovering vestibular hair cells in the chinchilla crista ampullaris after gentamicin ototoxicity. Study Design: In five groups of three animals each, ototoxicity was produced by placing gentamicin (50 μg)-impregnated Gelfoam pellets within the perilymphatic space of the superior semicircular canal. Animals were sacrificed at 1, 2, 4, 8, and 16 weeks after treatment. A group of normal (n=3) animals was also processed. Methods: For the detection of glutamate the inner ears of these animals were dissected, and the horizontal cristae ampullaris embedded in plastic. Two-micron-thick tissue sections were obtained and incubated with monoclonal antibodies against glutamate. The immunoreaction was detected using the avidinbiotiny-lated-complex technique and diaminobenzidine was the chromogen. Results: Normal sensory epithelia demonstrated type I and type II hair cells with moderate glutamate-like immunoreactivity. Supporting cells demonstrated no glutamate-like immunoreactivity. Afferent nerve fibers and calyxes surrounding type I hair cells demonstrated strong glutamate-like immunoreactivity. At 1 and 2 weeks after treatment the few type II hair cells surviving ototoxic treatment (15%–18%) contained moderate glutamate-like immunoreactivity, supporting cells showed no immunoreactivity, and nerve terminals and fibers displayed strong immunoreactivity. At 4 and 8 weeks after treatment, recovered hair cells (80%) had greater glutamate-like immunoreactivity when compared with normal hair cells, supporting cells displayed no glutamate-like immunoreactivity, and afferent fibers contained strong glutamate-like immunoreactivity. At 16 weeks, glutamate-like immunoreactivity in hair cells returned to normal level. Conclusion: Glutamate may be used as an indicator of hair cell differentiation and as an index of the molecular recovery of hair cells after ototoxicity.     

Study of the gerbil utricular macula following treatment with gentamicin, by use of bromodeoxyuridine and calmodulin immunohistochemical labelling.

Effects of ototoxic drugs on the gerbil vestibular sensory epithelium were probed by use of immunocytochemical labelling with antibodies to both a mitogenic marker (bromodeoxyuridine) and a hair cell specific protein (calmodulin). Nine animals had gentamicin administered once daily for 5 days, as a transtympanic injection into the right middle ear. They additionally were given a daily intraperitoneal injection of bromodeoxyuridine, starting on the same day as the gentamicin injection and continuing until the day of sacrifice. Nine other animals, serving as controls for bromodeoxyuridine incorporation, received only the intraperitoneal injections of bromodeoxyuridine. The inner ears from three gerbils were obtained at 1, 2 or 4 weeks following the last gentamicin injection and utricles from the injected ears were processed for immunohistochemical analysis. In specimens where gentamicin was administered, we found evidence of bromodeoxyuridine incorporation in 17 cells (10 single cells and 7 pairs of cells) in a total of 216 sections taken from the central regions of the 9 utricles. However, in control specimens, no bromodeoxyuridine labelling was found in any cells of the 216 sections examined. Of 10 single cells labelled with bromodeoxyuridine, two cells in the hair cell layer were labelled with antibodies against calmodulin. One had a faint labelling in the nucleus and the other in the stereocilia, but not in the cell bodies. Of 7 pairs of cells, two pairs with nuclei localized in the hair cell layer had faint labelling for calmodulin in the nuclei, but no labelling in any other part of the cell. The other 13 cells labelled with antibodies to bromodeoxyuridine were not labelled with antibodies to calmodulin. Our results suggest that the bromodeoxyuridine-labelled cells could not be positively identified as hair cells based on immunohistochemical labelling for calmodulin.     

Anatomic and Morphometric Changes to Gerbil Posterior Cristas Following Transtympanic Administration of Gentamicin and Streptomycin

Many studies have sought to document ototoxic damage and to study repair and regeneration of mammalian vestibular sensory epithelia. However, linear density analysis of the sensory cells or use of methods that focus on detection of actin in the stereocilia and cuticular plates at the reticular lamina detect only the disappearance of "hair cells" as defined by a narrow set of criteria. The research presented here focuses on the effects of two ototoxic drugs (gentamicin and streptomycin). We used light microscopic analysis of semithin sections to observe changes in the distribution of sensory and supporting cell nuclei and to elucidate other, previously undetected, morphological changes that occurred within the vestibular epithelia. Age-matched untreated and vehicle-treated controls showed that the gerbil posterior crista is asymmetrical on either side of the septum cruciatum; the longer end is taller and narrower than the shorter end. In cross sections taken throughout the length of each posterior crista, the thickness of the sensory epithelium along the sides (peripheral zone) is greater than at the apex (central zone). In tissue sections of the sensory epithelium, the ratio of sensory cell nuclei to support cell nuclei is slightly over 1:1.5 in all regions except the septum cruciatum where most sensory cells are absent and supporting cells predominate. In tissue sections from the most damaged drug-treated specimens, there was a decrease in the linear density of nuclei in the sensory cell layer, with a compensatory increase in the linear density of nuclei in the support cell layer of the sensory epithelia. In these specimens, linear density of total nuclei/tissue section remained the same. In these regions, the width of the epithelium became up to 50% thinner. The ratio of sensory to supporting cell nuclei changed to 1:6. Drug exposure led additionally to a decrease in length of the cristas, but there was not a linear relationship between the change in length of the crista and length of the septum cruciatum in these shorter cristas. In drug-treated cristas, other changes included a decrease in calculated surface area and volume of the epithelia. Thus, while linear density measurements of sensory cell nuclei provide an indication of damage, there are additional anatomic changes to the cristas and caution is advised with regard to interpreting changes as "loss" of cells.     

Minocycline attenuates gentamicin induced hair cell loss in neonatal cochlear cultures

Minocycline, a second-generation tetracycline antibiotic used against gram-negative and gram-positive bacteria, protects against a wide range of neurodegenerative disorders by inhibiting caspases, iNOS and the release of cytochrome c. Since aminoglycoside antibiotics damage sensory hair cells in the inner ear by activating caspase-mediated cell death pathways, we hypothesized that minocycline would protect against gentamicin (GM) ototoxicity. To test this hypothesis, postnatal day 3 (P3) rat, cochlear organotypic cultures were treated with GM alone or in combination with minocycline (10-500 microM). Treatment with GM induced a dose-dependent loss of outer hair cells (OHC) and inner hair cells (IHC). Addition of minocycline to the GM-treated cultures greatly reduced the amount of GM-induced hair cell damage in P3 cochlear cultures. The greatest protection was achieved with 100 microM of minocycline. Application of minocycline alone had no adverse effects on hair cell survival. The advantage of this combination therapy is that minocycline prevents GM-induced hair cell loss while helping to suppress the bacterial infection.     

Systemic Lipopolysaccharide Induces Cochlear Inflammation and Exacerbates the Synergistic Ototoxicity of Kanamycin and Furosemide

Aminoglycoside antibiotics are highly effective agents against gram-negative bacterial infections, but they cause adverse effects on hearing and balance dysfunction as a result of toxicity to hair cells of the cochlea and vestibular organs. While ototoxicity has been comprehensively studied, the contributions of the immune system, which controls the host response to infection, have not been studied in antibiotic ototoxicity. Recently, it has been shown that an inflammatory response is induced by hair cell injury. In this study, we found that lipopolysaccharide (LPS), an important component of bacterial endotoxin, when given in combination with kanamycin and furosemide, augmented the inflammatory response to hair cell injury and exacerbated hearing loss and hair cell injury. LPS injected into the peritoneum of experimental mice induced a brisk cochlear inflammatory response with recruitment of mononuclear phagocytes into the spiral ligament, even in the absence of ototoxic agents. While LPS alone did not affect hearing, animals that received LPS prior to ototoxic agents had worse hearing loss compared to those that did not receive LPS pretreatment. The poorer hearing outcome in LPS-treated mice did not correlate to changes in endocochlear potential. However, LPS-treated mice demonstrated an increased number of CCR2⁺ inflammatory monocytes in the inner ear when compared with mice treated with ototoxic agents alone. We conclude that LPS and its associated inflammatory response are harmful to the inner ear when coupled with ototoxic medications and that the immune system may contribute to the final hearing outcome in subjects treated with ototoxic agents.     

Cisplatin: evaluation of its ototoxic potential

The ototoxic potential of cisplatin was analyzed in an organ culture model exposing the hair cells and other inner ear structures to cisplatin doses from 0.1 to 10 micrograms/ml. Selective hair cell degeneration was obvious at concentrations of 0.1 microgram/ml. Incubation with 1 microgram/ml caused morphologic damage in the supporting cells in both the cochlear and vestibular parts of the labyrinth. Exposure to 10 micrograms/ml during five days caused a total collapse of the membranous labyrinth. The morphologic degeneration pattern at the ultrastructural level is nonspecific, except that nuclear chromatin was either swollen and disintegrated or considerably condensed. Based on inner ear concentrations equivalent to aminoglycoside antibiotics in the range of 0.1 to 10 micrograms/ml, cisplatin is, in the in vitro model used in this study, the most ototoxic drug known. However, because of its single dose administration and long intervals between administration, clinical ototoxicity is less pronounced than that from aminoglycoside antibiotics.