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Lue PY, Oliver MH, Neeff M, Thorne PR, Suzuki-Kerr H. Sheep as a large animal model for hearing research: comparison to common laboratory animals and humans. Lab Anim Res 2023; 39:31. [PMID: 38012676 PMCID: PMC10680324 DOI: 10.1186/s42826-023-00182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
Sensorineural hearing loss (SNHL), caused by pathology in the cochlea, is the most common type of hearing loss in humans. It is generally irreversible with very few effective pharmacological treatments available to prevent the degenerative changes or minimise the impact. Part of this has been attributed to difficulty of translating "proof-of-concept" for novel treatments established in small animal models to human therapies. There is an increasing interest in the use of sheep as a large animal model. In this article, we review the small and large animal models used in pre-clinical hearing research such as mice, rats, chinchilla, guinea pig, rabbit, cat, monkey, dog, pig, and sheep to humans, and compare the physiology, inner ear anatomy, and some of their use as model systems for SNHL, including cochlear implantation surgeries. Sheep have similar cochlear anatomy, auditory threshold, neonatal auditory system development, adult and infant body size, and number of birth as humans. Based on these comparisons, we suggest that sheep are well-suited as a potential translational animal model that bridges the gap between rodent model research to the clinical use in humans. This is especially in areas looking at changes across the life-course or in specific areas of experimental investigation such as cochlear implantation and other surgical procedures, biomedical device development and age-related sensorineural hearing loss research. Combined use of small animals for research that require higher throughput and genetic modification and large animals for medical translation could greatly accelerate the overall translation of basic research in the field of auditory neuroscience from bench to clinic.
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Affiliation(s)
- Po-Yi Lue
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
| | - Mark H Oliver
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- Ngapouri Research Farm Laboratory, University of Auckland, Waiotapu, New Zealand
| | - Michel Neeff
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Peter R Thorne
- Department of Physiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- Section of Audiology, The University of Auckland, Auckland, New Zealand
| | - Haruna Suzuki-Kerr
- Department of Physiology, The University of Auckland, Auckland, New Zealand.
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand.
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Claussen AD, Quevedo RV, Kirk JR, Higgins T, Mostaert B, Rahman MT, Oleson J, Hernandez R, Hirose K, Hansen MR. Chronic cochlear implantation with and without electric stimulation in a mouse model induces robust cochlear influx of CX3CR1 +/GFP macrophages. Hear Res 2022; 426:108510. [PMID: 35527124 PMCID: PMC9596618 DOI: 10.1016/j.heares.2022.108510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/27/2022] [Accepted: 04/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cochlear implantation is an effective auditory rehabilitation strategy for those with profound hearing loss, including those with residual low frequency hearing through use of hybrid cochlear implantation techniques. Post-mortem studies demonstrate the nearly ubiquitous presence of intracochlear fibrosis and neo-ossification following cochlear implantation. Current evidence suggests post-implantation intracochlear fibrosis is associated with delayed loss of residual acoustic hearing in hybrid cochlear implant (CI) recipients and may also negatively influence outcomes in traditional CI recipients. This study examined the contributions of surgical trauma, foreign body response and electric stimulation to intracochlear fibrosis and the innate immune response to cochlear implantation and the hierarchy of these contributions. METHODS Normal hearing CX3CR1+/GFP mice underwent either round window opening (sham), acute CI insertion or chronic CI insertion with no, low- or high-level electric stimulation. Electric stimulation levels were based on neural response telemetry (NRT), beginning post-operative day 7 for 5 h per day. Subjects (n=3 per timepoint) were sacrificed at 4 h, 1,4,7,8,11,14 and 21 days. An unoperated group (n=3) served as controls. Cochleae were harvested at each time-point and prepared for immunohistochemistry with confocal imaging. The images were analyzed to obtain CX3CR1+ macrophage cell number and density in the lateral wall (LW), scala tympani (ST) and Rosenthal's canal (RC). RESULTS A ST peri-implant cellular infiltrate and fibrosis occurred exclusively in the chronically implanted groups starting on day 7 with a concurrent infiltration of CX3CR1+ macrophages not seen in the other groups. CX3CR1+ macrophage infiltration was seen in the LW and RC in all experimental groups within the first week, being most prominent in the 3 chronically implanted groups during the second and third week. CONCLUSIONS The cochlear immune response was most prominent in the presence of chronic cochlear implantation, regardless of electric stimulation level. Further, the development of intracochlear ST fibrosis was dependent on the presence of the indwelling CI foreign body. An innate immune response was evoked by surgical trauma alone (sham and acute CI groups) to a lesser degree. These data suggest that cochlear inflammation and intrascalar fibrosis after cochlear implantation are largely dependent on the presence of a chronic indwelling foreign body and are not critically dependent on electrical stimulation. Also, these data support a role for surgical trauma in inciting the initial innate immune response.
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Affiliation(s)
- Alexander D Claussen
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States; Department of Otolaryngology Head and Neck Surgery, University of California San Diego, San Diego, CA 92103, United States.
| | - René Vielman Quevedo
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States; Department of Biomedical Sciences, Creighton University, Omaha, NE 68178, United States
| | | | - Timon Higgins
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Brian Mostaert
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Muhammad Taifur Rahman
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Jacob Oleson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Reyna Hernandez
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Keiko Hirose
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Marlan R Hansen
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
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3
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Santi PA, Johnson S, Wüster J, Griesbach M, Claussen A, Kirk J. Cochlear Implant Imaging in the Mouse and Guinea Pig Using Light-Sheet Microscopy. Hear Res 2022; 426:108639. [DOI: 10.1016/j.heares.2022.108639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022]
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4
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Reiss LA, Kirk J, Claussen AD, Fallon JB. Animal Models of Hearing Loss after Cochlear Implantation and Electrical Stimulation. Hear Res 2022; 426:108624. [DOI: 10.1016/j.heares.2022.108624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/28/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022]
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Rahman MT, Chari DA, Ishiyama G, Lopez I, Quesnel AM, Ishiyama A, Nadol JB, Hansen MR. Cochlear implants: Causes, effects and mitigation strategies for the foreign body response and inflammation. Hear Res 2022; 422:108536. [PMID: 35709579 PMCID: PMC9684357 DOI: 10.1016/j.heares.2022.108536] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
Cochlear implants provide effective auditory rehabilitation for patients with severe to profound sensorineural hearing loss. Recent advances in cochlear implant technology and surgical approaches have enabled a greater number of patients to benefit from this technology, including those with significant residual low frequency acoustic hearing. Nearly all cochleae implanted with a cochlear implant electrode array develop an inflammatory and fibrotic response. This tissue reaction can have deleterious consequences for implant function, residual acoustic hearing, and the development of the next generation of cochlear prosthetics. This article reviews the current understanding of the inflammatory/foreign body response (FBR) after cochlear implant surgery, its impact on clinical outcome, and therapeutic strategies to mitigate this response. Findings from both in human subjects and animal models across a variety of species are highlighted. Electrode array design, surgical techniques, implant materials, and the degree and type of electrical stimulation are some critical factors that affect the FBR and inflammation. Modification of these factors and various anti-inflammatory pharmacological interventions have been shown to mitigate the inflammatory/FBR response. Ongoing and future approaches that seek to limit surgical trauma and curb the FBR to the implanted biomaterials of the electrode array are discussed. A better understanding of the anatomical, cellular and molecular basis of the inflammatory/FBR response after cochlear implantation has the potential to improve the outcome of current cochlear implants and also facilitate the development of the next generation of neural prostheses.
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Affiliation(s)
- Muhammad T Rahman
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Divya A Chari
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Gail Ishiyama
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Ivan Lopez
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Akira Ishiyama
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Marlan R Hansen
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa, Iowa City, IA, USA.
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Zhang C, Li Q, Chen M, Lu T, Min S, Li S. The role of oxidative stress in the susceptibility of noise-impaired cochleae to synaptic loss induced by intracochlear electrical stimulation. Neuropharmacology 2021; 196:108707. [PMID: 34246683 DOI: 10.1016/j.neuropharm.2021.108707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022]
Abstract
Intracochlear electrical stimulation (ES) generated by cochlear implants (CIs) is used to activate auditory nerves to restore hearing perception in deaf subjects and those with residual hearing who use electroacoustic stimulation (EAS) technology. Approximately 1/3 of EAS recipients experience loss of residual hearing a few months after ES activation, but the underlying mechanism is unknown. Clinical evidence indicates that the loss is related to the previous history of noise-induced hearing loss (NIHL). In this report, we investigated the impact of intracochlear ES on oxidative stress levels and synaptic counts in inner hair cells (IHCs) of the apical, middle and basal regions of guinea pigs with normal hearing (NH) and NIHL. Our results demonstrated that intracochlear ES with an intensity of 6 dB above the thresholds of electrically evoked compound action potentials (ECAPs) could induce the elevation of oxidative stress levels, resulting in a loss of IHC synapses near the electrodes in the basal and middle regions of the NH cochleae. Furthermore, the apical region of cochleae with NIHL were more susceptible to synaptic loss induced by relatively low-intensity ES than that of NH cochleae, resulting from the additional elevation of oxidative stress levels and the reduced antioxidant capability throughout the whole cochlea.
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Affiliation(s)
- Chen Zhang
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Qiang Li
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Min Chen
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Tianhao Lu
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Shiyao Min
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Shufeng Li
- Department of Otolaryngology - Head and Neck Surgery, Eye & ENT Hospital of Fudan University, Shanghai, 200031, China; NHC Key Laboratory of Hearing Medicine, Shanghai, China.
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Viral-mediated transduction of auditory neurons with opsins for optical and hybrid activation. Sci Rep 2021; 11:11229. [PMID: 34045604 PMCID: PMC8160204 DOI: 10.1038/s41598-021-90764-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
Optical stimulation is a paradigm-shifting approach to modulating neural activity that has the potential to overcome the issue of current spread that occurs with electrical stimulation by providing focused stimuli. But optical stimulation either requires high power infrared light or genetic modification of neurons to make them responsive to lower power visible light. This work examines optical activation of auditory neurons following optogenetic modification via AAV injection in two species (mouse and guinea pig). An Anc80 viral vector was used to express the channelrhodopsin variant ChR2-H134R fused to a fluorescent reporter gene under the control of the human synapsin-1 promoter. The AAV was administered directly to the cochlea (n = 33) or posterior semi-circular canal of C57BL/6 mice (n = 4) or to guinea pig cochleae (n = 6). Light (488 nm), electrical stimuli or the combination of these (hybrid stimulation) was delivered to the cochlea via a laser-coupled optical fibre and co-located platinum wire. Activation thresholds, spread of activation and stimulus interactions were obtained from multi-unit recordings from the central nucleus of the inferior colliculus of injected mice, as well as ChR2-H134R transgenic mice (n = 4). Expression of ChR2-H134R was examined by histology. In the mouse, transduction of auditory neurons by the Anc80 viral vector was most successful when injected at a neonatal age with up to 89% of neurons transduced. Auditory neuron transductions were not successful in guinea pigs. Inferior colliculus responses to optical stimuli were detected in a cochleotopic manner in all mice with ChR2-H134R expression. There was a significant correlation between lower activation thresholds in mice and higher proportions of transduced neurons. There was no difference in spread of activation between optical stimulation and electrical stimulation provided by the light/electrical delivery system used here (optical fibre with bonded 25 µm platinum/iridium wire). Hybrid stimulation, comprised of sub-threshold optical stimulation to 'prime' or raise the excitability of the neurons, lowered the threshold for electrical activation in most cases, but the impact on excitation width was more variable compared to transgenic mice. This study demonstrates the impact of opsin expression levels and expression pattern on optical and hybrid stimulation when considering optical or hybrid stimulation techniques for neuromodulation.
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Abstract
The cochlea of our auditory system is an intricate structure deeply embedded in the temporal bone. Compared with other sensory organs such as the eye, the cochlea has remained poorly accessible for investigation, for example, by imaging. This limitation also concerns the further development of technology for restoring hearing in the case of cochlear dysfunction, which requires quantitative information on spatial dimensions and the sensorineural status of the cochlea. Here, we employed X-ray phase-contrast tomography and light-sheet fluorescence microscopy and their combination for multiscale and multimodal imaging of cochlear morphology in species that serve as established animal models for auditory research. We provide a systematic reference for morphological parameters relevant for cochlear implant development for rodent and nonhuman primate models. We simulate the spread of light from the emitters of the optical implants within the reconstructed nonhuman primate cochlea, which indicates a spatially narrow optogenetic excitation of spiral ganglion neurons.
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9
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Colesa DJ, Devare J, Swiderski DL, Beyer LA, Raphael Y, Pfingst BE. Development of a chronically-implanted mouse model for studies of cochlear health and implant function. Hear Res 2021; 404:108216. [PMID: 33691255 DOI: 10.1016/j.heares.2021.108216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 01/16/2023]
Abstract
Mice with chronic cochlear implants can significantly contribute to our understanding of the relationship between cochlear health and implant function because of the availability of molecular tools for controlling conditions in the cochlea and transgenic lines modeling human disease. To date, research in implanted mice has mainly consisted of short-term studies, but since there are large changes in implant function following implant insertion trauma, and subsequent recovery in many cases, longer-term studies are needed to evaluate function and perception under stable conditions. Because frequent anesthetic administration can be especially problematic in mice, a chronic model that can be tested in the awake condition is desirable. Electrically-evoked compound action potentials (ECAPs) recorded with multichannel cochlear implants are useful functional measures because they can be obtained daily without anesthesia. In this study, we assessed changes and stability of ECAPs, electrically-evoked auditory brainstem responses (EABRs), ensemble spontaneous activity (ESA), and impedance data over time after implanting mice with multichannel implants. We then compared these data to histological findings in these implanted cochleae, and compared results from this chronic mouse model to data previously obtained in a well-established chronically-implanted guinea pig model. We determined that mice can be chronically implanted with cochlear implants, and ECAP recordings can be obtained frequently in an awake state for up to at least 42 days after implantation. These recordings can effectively monitor changes or stability in cochlear function over time. ECAP and EABR amplitude-growth functions (AGFs), AGF slopes, ESA levels and impedances in mice with multichannel implants appear similar to those found in guinea pigs with long-term multichannel implants. Animals with better survival of spiral ganglion neurons (SGNs) and inner hair cells (IHCs) have steeper AGF slopes, and larger ESA responses. The time course of post-surgical ear recovery may be quicker in mice and can show different patterns of recovery which seem to be dependent on the degree of insertion trauma and subsequent histological conditions. Histology showed varying degrees of cochlear damage with fibrosis present in all implanted mouse ears and small amounts of new bone in a few ears. Impedance changes over time varied within and across animals and may represent changes over time in multiple variables in the cochlear environment post-implantation. Due to the small size of the mouse, susceptibility to stress, and the higher potential for implant failure, chronic implantation in mice can be challenging, but overall is feasible and useful for cochlear implant research.
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Affiliation(s)
- Deborah J Colesa
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA
| | - Jenna Devare
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA
| | - Donald L Swiderski
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA
| | - Lisa A Beyer
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA
| | - Yehoash Raphael
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA
| | - Bryan E Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology - Head and Neck Surgery, 1150 West Medical Center Drive, University of Michigan, Ann Arbor 48109-5616, MI, USA.
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Thompson AC, Wise AK, Hart WL, Needham K, Fallon JB, Gunewardene N, Stoddart PR, Richardson RT. Hybrid optogenetic and electrical stimulation for greater spatial resolution and temporal fidelity of cochlear activation. J Neural Eng 2020; 17:056046. [PMID: 33036009 DOI: 10.1088/1741-2552/abbff0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Compared to electrical stimulation, optogenetic stimulation has the potential to improve the spatial precision of neural activation in neuroprostheses, but it requires intense light and has relatively poor temporal kinetics. We tested the effect of hybrid stimulation, which is the combination of subthreshold optical and electrical stimuli, on spectral and temporal fidelity in the cochlea by recording multiunit activity in the inferior colliculus of channelrhodopsin (H134R variant) transgenic mice. APPROACH Pulsed light or biphasic electrical pulses were delivered to cochlear spiral ganglion neurons of acutely deafened mice, either as individual stimuli or as hybrid stimuli for which the timing of the electrical pulse had a varied delay relative to the start of the optical pulse. Response thresholds, spread of activation and entrainment data were obtained from multi-unit recordings from the auditory midbrain. MAIN RESULTS Facilitation occurred when subthreshold electrical stimuli were applied at the end of, or up to 3.75 ms after subthreshold optical pulses. The spread of activation resulting from hybrid stimulation was significantly narrower than electrical-only and optical-only stimulation (p < 0.01), measured at equivalent suprathreshold levels of loudness that are relevant to cochlear implant users. Furthermore, temporal fidelity, measured as maximum following rates to 300 ms pulse trains bursts up to 240 Hz, was 2.4-fold greater than optical-only stimulation (p < 0.05). SIGNIFICANCE By significantly improving spectral resolution of electrical- and optical-only stimulation and the temporal fidelity of optical-only stimulation, hybrid stimulation has the potential to increase the number of perceptually independent stimulating channels in a cochlear implant.
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Liang Q, Shen N, Lai B, Xu C, Sun Z, Wang Z, Li S. Electrical Stimulation Degenerated Cochlear Synapses Through Oxidative Stress in Neonatal Cochlear Explants. Front Neurosci 2019; 13:1073. [PMID: 31680814 PMCID: PMC6803620 DOI: 10.3389/fnins.2019.01073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
Neurostimulation devices use electrical stimulation (ES) to substitute, supplement or modulate neural function. However, the impact of ES on their modulating structures is largely unknown. For example, recipients of cochlear implants using electroacoustic stimulation experienced delayed loss of residual hearing over time after ES, even though ES had no impact on the morphology of hair cells. In this study, using a novel model of cochlear explant culture with charge-balanced biphasic ES, we found that ES did not change the quantity and morphology of hair cells but decreased the number of inner hair cell (IHC) synapses and the density of spiral ganglion neuron (SGN) peripheral fibers. Inhibiting calcium influx with voltage-dependent calcium channel (VDCC) blockers attenuated the loss of SGN peripheral fibers and IHC synapses induced by ES. ES increased ROS/RNS in cochlear explants, but the inhibition of calcium influx abolished this effect. Glutathione peroxidase 1 (GPx1) and GPx2 in cochlear explants decreased under ES and ebselen abolished this effect and attenuated the loss of SGN peripheral fibers. This finding demonstrated that ES induced the degeneration of SGN peripheral fibers and IHC synapses in a current intensity- and duration-dependent manner in vitro. Calcium influx resulting in oxidative stress played an important role in this process. Additionally, ebselen might be a potential protector of ES-induced cochlear synaptic degeneration.
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Affiliation(s)
- Qiong Liang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Shanghai, China
| | - Na Shen
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Shanghai, China.,Department of Otolaryngology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Bin Lai
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Changjian Xu
- Shanghai Cochlear Engineering Technology Research Center, Shanghai, China
| | - Zengjun Sun
- Shanghai Cochlear Engineering Technology Research Center, Shanghai, China
| | - Zhengmin Wang
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Shanghai, China
| | - Shufeng Li
- Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Shanghai, China
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Alpaugh M, Saint-Pierre M, Dubois M, Aubé B, Arsenault D, Kriz J, Cicchetti A, Cicchetti F. A novel wireless brain stimulation device for long-term use in freely moving mice. Sci Rep 2019; 9:6444. [PMID: 31015544 PMCID: PMC6478908 DOI: 10.1038/s41598-019-42910-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/08/2019] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) has been used in clinical settings for many years despite a paucity of knowledge related to the anatomical and functional substrates that lead to benefits and/or side-effects in various disease contexts. In order to maximize the potential of this approach in humans, a better understanding of its mechanisms of action is absolutely necessary. However, the existing micro-stimulators available for pre-clinical models, are limited by the lack of relevant small size devices. This absence prevents sustained chronic stimulation and real time monitoring of animals during stimulation, parameters that are critical for comparison to clinical findings. We therefore sought to develop and refine a novel small wireless micro-stimulator as a means by which to study consequent behavioural to molecular changes in experimental animals. Building on previous work from our group, we refined our implantable micro-stimulator prototype, to be easily combined with intravital 2-photon imaging. Using our prototype we were able to replicate the well described clinical benefits on motor impairment in a mouse model of Parkinson's disease in addition to capturing microglia dynamics live during stimulation. We believe this new device represents a useful tool for performing pre-clinical studies as well as dissecting brain circuitry and function.
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Affiliation(s)
- Melanie Alpaugh
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada
| | - Martine Saint-Pierre
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada
| | - Marilyn Dubois
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada
| | - Benoit Aubé
- CERVO Brain Research Center, Québec, QC, Canada
| | - Dany Arsenault
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada
| | - Jasna Kriz
- CERVO Brain Research Center, Québec, QC, Canada.,Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada
| | - Antonio Cicchetti
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, 2705, Boulevard Laurier, Québec, QC, Canada. .,Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.
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13
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Claussen AD, Vielman Quevedo R, Mostaert B, Kirk JR, Dueck WF, Hansen MR. A mouse model of cochlear implantation with chronic electric stimulation. PLoS One 2019; 14:e0215407. [PMID: 30998726 PMCID: PMC6472764 DOI: 10.1371/journal.pone.0215407] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/01/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives Cochlear implants provide an effective treatment option for those with severe hearing loss, including those with preserved low frequency hearing. However, certain issues can reduce implant efficacy including intracochlear tissue response and delayed loss of residual acoustic hearing. We describe a mouse model of cochlear implantation with chronic electric stimulation that can be used to study cochlear implant biology and related pathologies. Methods Twelve normal hearing adult CBA/J mice underwent unilateral cochlear implantation and were evenly divided into one group receiving electric stimulation and one not. Serial impedance and neural response telemetry (NRT) measurements were made to assess implant functionality. Functionality was defined as having at least one electrode with an impedance ≤ 35 kOhms. Mouse cochleae were harvested for histology and 3D x-ray microscopy 21 days post-operatively, or, in case the implant was still functional, at a later time point when the implant failed. A separate experiment measured the hearing preservation rate in 7 adult CBA/J mice undergoing unilateral cochlear implantation with serial auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE). Results Implants maintained functionality for a mean of 35 days in the non-stimulated group and 19.8 days in the stimulated group. Reliable NRT and behavioral responses to electric stimulation were recorded. A robust intracochlear peri-implant tissue response with neo-ossification was seen in all cochleae. Six of seven mice maintained intact low frequency hearing up to 6 weeks following cochlear implantation. Conclusions We demonstrate the feasibility of cochlear implantation and behaviorally significant electric stimulation in the mouse, with the potential for hearing preservation. This model may be combined with established mouse models of hearing loss and the large genetic and molecular research toolkit unique to the mouse for mechanistic and therapeutic investigations of cochlear implant biology.
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Affiliation(s)
- Alexander D. Claussen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, United States of America
| | - René Vielman Quevedo
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, United States of America
| | - Brian Mostaert
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, United States of America
| | | | | | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, United States of America
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States of America
- * E-mail:
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Shepherd RK, Villalobos J, Burns O, Nayagam DAX. The development of neural stimulators: a review of preclinical safety and efficacy studies. J Neural Eng 2018; 15:041004. [PMID: 29756600 PMCID: PMC6049833 DOI: 10.1088/1741-2552/aac43c] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Given the rapid expansion of the field of neural stimulation and the rigorous regulatory approval requirements required before these devices can be applied clinically, it is important that there is clarity around conducting preclinical safety and efficacy studies required for the development of this technology. APPROACH The present review examines basic design principles associated with the development of a safe neural stimulator and describes the suite of preclinical safety studies that need to be considered when taking a device to clinical trial. MAIN RESULTS Neural stimulators are active implantable devices that provide therapeutic intervention, sensory feedback or improved motor control via electrical stimulation of neural or neuro-muscular tissue in response to trauma or disease. Because of their complexity, regulatory bodies classify these devices in the highest risk category (Class III), and they are therefore required to go through a rigorous regulatory approval process before progressing to market. The successful development of these devices is achieved through close collaboration across disciplines including engineers, scientists and a surgical/clinical team, and the adherence to clear design principles. Preclinical studies form one of several key components in the development pathway from concept to product release of neural stimulators. Importantly, these studies provide iterative feedback in order to optimise the final design of the device. Key components of any preclinical evaluation include: in vitro studies that are focussed on device reliability and include accelerated testing under highly controlled environments; in vivo studies using animal models of the disease or injury in order to assess efficacy and, given an appropriate animal model, the safety of the technology under both passive and electrically active conditions; and human cadaver and ex vivo studies designed to ensure the device's form factor conforms to human anatomy, to optimise the surgical approach and to develop any specialist surgical tooling required. SIGNIFICANCE The pipeline from concept to commercialisation of these devices is long and expensive; careful attention to both device design and its preclinical evaluation will have significant impact on the duration and cost associated with taking a device through to commercialisation. Carefully controlled in vitro and in vivo studies together with ex vivo and human cadaver trials are key components of a thorough preclinical evaluation of any new neural stimulator.
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Affiliation(s)
- Robert K Shepherd
- Bionics Institute, East Melbourne, Australia. Medical Bionics Department, University of Melbourne, Melbourne, Australia
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15
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Wise AK, Tan J, Wang Y, Caruso F, Shepherd RK. Improved Auditory Nerve Survival with Nanoengineered Supraparticles for Neurotrophin Delivery into the Deafened Cochlea. PLoS One 2016; 11:e0164867. [PMID: 27788219 PMCID: PMC5082918 DOI: 10.1371/journal.pone.0164867] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022] Open
Abstract
Cochlear implants electrically stimulate spiral ganglion neurons (SGNs) in order to provide speech cues to severe-profoundly deaf patients. In normal hearing cochleae the SGNs depend on endogenous neurotrophins secreted by sensory cells in the organ of Corti for survival. SGNs gradually degenerate following deafness and consequently there is considerable interest in developing clinically relevant strategies to provide exogenous neurotrophins to preserve SGN survival. The present study investigated the safety and efficacy of a drug delivery system for the cochlea using nanoengineered silica supraparticles. In the present study we delivered Brain-derived neurotrophic factor (BDNF) over a period of four weeks and evaluated SGN survival as a measure of efficacy. Supraparticles were bilaterally implanted into the basal turn of cochleae in profoundly deafened guinea pigs. One ear received BDNF-loaded supraparticles and the other ear control (unloaded) supraparticles. After one month of treatment the cochleae were examined histologically. There was significantly greater survival of SGNs in cochleae that received BDNF supraparticles compared to the contralateral control cochleae (repeated measures ANOVA, p = 0.009). SGN survival was observed over a wide extent of the cochlea. The supraparticles were well tolerated within the cochlea with a tissue response that was localised to the site of implantation in the cochlear base. Although mild, the tissue response was significantly greater in cochleae treated with BDNF supraparticles compared to the controls (repeated measures ANOVA, p = 0.003). These data support the clinical potential of this technology particularly as the supraparticles can be loaded with a variety of therapeutic drugs.
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Affiliation(s)
- Andrew K. Wise
- The Bionics Institute, 384–388 Albert Street, East Melbourne, Melbourne, Australia
- The Department of Medical Bionics, University of Melbourne, Melbourne, Australia
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Justin Tan
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia
| | - Yajun Wang
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and the Department of Chemical and Biomolecular Engineering, the University of Melbourne, Melbourne, Australia
| | - Frank Caruso
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, and the Department of Chemical and Biomolecular Engineering, the University of Melbourne, Melbourne, Australia
| | - Robert K. Shepherd
- The Bionics Institute, 384–388 Albert Street, East Melbourne, Melbourne, Australia
- The Department of Medical Bionics, University of Melbourne, Melbourne, Australia
- Department of Otolaryngology, University of Melbourne, Melbourne, Australia
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16
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Wiegner A, Wright CG, Vollmer M. Multichannel cochlear implant for selective neuronal activation and chronic use in the free-moving Mongolian gerbil. J Neurosci Methods 2016; 273:40-54. [PMID: 27519925 DOI: 10.1016/j.jneumeth.2016.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Animal models for chronic multichannel cochlear implant stimulation and selective neuronal activation contribute to a better understanding of auditory signal processing and central neural plasticity. NEW METHOD This paper describes the design and surgical implantation of a multichannel cochlear implant (CI) system for chronic use in the free-moving gerbil. For chronic stimulation, adult-deafened gerbils were connected to a multichannel commutator that allowed low resistance cable rotation and stable electric connectivity to the current source. RESULTS Despite the small scale of the gerbil cochlea and auditory brain regions, final electrophysiological mapping experiments revealed selective and tonotopically organized neuronal activation in the auditory cortex. Contact impedances and electrically evoked auditory brainstem responses were stable over several weeks demonstrating the long-term integrity of the implant and the efficacy of the stimulation. COMPARISON WITH EXISTING METHODS Most animal models on multichannel signal processing and stimulation-induced plasticity are limited to larger animals such as ferrets, cats and primates. Multichannel CI stimulation in the free-moving rodent and evidence for selective neuronal activation in gerbil auditory cortex have not been previously reported. CONCLUSIONS Overall, our results show that the gerbil is a robust rodent model for selective and tonotopically organized multichannel CI stimulation. We anticipate that this model provides a useful tool to develop and test both passive stimulation and behavioral training strategies for plastic reorganization and restoration of degraded unilateral and bilateral central auditory signal processing in the hearing impaired and deaf central auditory system.
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Affiliation(s)
- Armin Wiegner
- Comprehensive Hearing Center, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
| | - Charles G Wright
- Department of Otolaryngology-Head and Neck Surgery, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States.
| | - Maike Vollmer
- Comprehensive Hearing Center, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany.
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King J, Shehu I, Roland JT, Svirsky MA, Froemke RC. A physiological and behavioral system for hearing restoration with cochlear implants. J Neurophysiol 2016; 116:844-58. [PMID: 27281743 DOI: 10.1152/jn.00048.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Cochlear implants are neuroprosthetic devices that provide hearing to deaf patients, although outcomes are highly variable even with prolonged training and use. The central auditory system must process cochlear implant signals, but it is unclear how neural circuits adapt-or fail to adapt-to such inputs. The knowledge of these mechanisms is required for development of next-generation neuroprosthetics that interface with existing neural circuits and enable synaptic plasticity to improve perceptual outcomes. Here, we describe a new system for cochlear implant insertion, stimulation, and behavioral training in rats. Animals were first ensured to have significant hearing loss via physiological and behavioral criteria. We developed a surgical approach for multichannel (2- or 8-channel) array insertion, comparable with implantation procedures and depth in humans. Peripheral and cortical responses to stimulation were used to program the implant objectively. Animals fitted with implants learned to use them for an auditory-dependent task that assesses frequency detection and recognition in a background of environmentally and self-generated noise and ceased responding appropriately to sounds when the implant was temporarily inactivated. This physiologically calibrated and behaviorally validated system provides a powerful opportunity to study the neural basis of neuroprosthetic device use and plasticity.
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Affiliation(s)
- Julia King
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York
| | - Ina Shehu
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Biology, Hunter College, New York, New York; and
| | - J Thomas Roland
- Department of Otolaryngology, New York University School of Medicine, New York, New York
| | - Mario A Svirsky
- Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York; Center for Neural Science, New York University, New York, New York. *, co-senior authors
| | - Robert C Froemke
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York; Center for Neural Science, New York University, New York, New York. *, co-senior authors.
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Fabrication and evaluation of an improved polymer-based cochlear electrode array for atraumatic insertion. Biomed Microdevices 2016; 17:32. [PMID: 25681972 DOI: 10.1007/s10544-015-9941-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An atraumatic cochlear electrode array has become indispensable to high-performance cochlear implants such as electric acoustic stimulation (EAS), wherein the preservation of residual hearing is significant. For an atraumatic implantation, we propose and demonstrate a new improved design of a cochlear electrode array based on liquid crystal polymer (LCP), which can be fabricated by precise batch processes and a thermal lamination process, in contrast to conventional wire-based cochlear electrode arrays. Using a thin-film process of LCP-film-mounted silicon wafer and thermal press lamination, we devise a multi-layered structure with variable layers of LCP films to achieve a sufficient degree of basal rigidity and a flexible tip. A peripheral blind via and self-aligned silicone elastomer molding process can reduce the width of the array. Measuring the insertion and extraction forces in a human scala tympani model, we investigate five human temporal bone insertion trials and record electrically evoked auditory brainstem responses (EABR) acutely in a guinea pig model. The diameters of the finalized electrode arrays are 0.3 mm (tip) and 0.75 mm (base). The insertion force with a displacement of 8 mm from a round window and the maximum extraction force are 2.4 mN and 34.0 mN, respectively. The electrode arrays can be inserted from 360° to 630° without trauma at the basal turn. The EABR data confirm the efficacy of the array. A new design of LCP-based cochlear electrode array for atraumatic implantation is fabricated. Verification indicates that foretells the development of an atraumatic cochlear electrode array and clinical implant.
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Hanekom T, Hanekom JJ. Three-dimensional models of cochlear implants: A review of their development and how they could support management and maintenance of cochlear implant performance. NETWORK (BRISTOL, ENGLAND) 2016; 27:67-106. [PMID: 27136100 DOI: 10.3109/0954898x.2016.1171411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Three-dimensional (3D) computational modeling of the auditory periphery forms an integral part of modern-day research in cochlear implants (CIs). These models consist of a volume conduction description of implanted stimulation electrodes and the current distribution around these, coupled with auditory nerve fiber models. Cochlear neural activation patterns can then be predicted for a given input stimulus. The objective of this article is to present the context of 3D modeling within the field of CIs, the different models, and approaches to models that have been developed over the years, as well as the applications and potential applications of these models. The process of development of 3D models is discussed, and the article places specific emphasis on the complementary roles of generic models and user-specific models, as the latter is important for translation of these models into clinical application.
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Affiliation(s)
- Tania Hanekom
- a Bioengineering, Department of Electrical, Electronic and Computer Engineering , University of Pretoria , Pretoria , South Africa
| | - Johan J Hanekom
- a Bioengineering, Department of Electrical, Electronic and Computer Engineering , University of Pretoria , Pretoria , South Africa
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20
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Arsenault D, Drouin-Ouellet J, Saint-Pierre M, Petrou P, Dubois M, Kriz J, Barker RA, Cicchetti A, Cicchetti F. A novel combinational approach of microstimulation and bioluminescence imaging to study the mechanisms of action of cerebral electrical stimulation in mice. J Physiol 2015; 593:2257-78. [PMID: 25653107 DOI: 10.1113/jphysiol.2014.287243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/30/2015] [Indexed: 12/12/2022] Open
Abstract
Deep brain stimulation (DBS) is used to treat a number of neurological conditions and is currently being tested to intervene in neuropsychiatric conditions. However, a better understanding of how it works would ensure that side effects could be minimized and benefits optimized. We have thus developed a unique device to perform brain stimulation (BS) in mice and to address fundamental issues related to this methodology in the pre-clinical setting. This new microstimulator prototype was specifically designed to allow simultaneous live bioluminescence imaging of the mouse brain, allowing real time assessment of the impact of stimulation on cerebral tissue. We validated the authenticity of this tool in vivo by analysing the expression of toll-like receptor 2 (TLR2), corresponding to the microglial response, in the stimulated brain regions of TLR2-fluc-GFP transgenic mice, which we further corroborated with post-mortem analyses in these animals as well as in human brains of patients who underwent DBS to treat their Parkinson's disease. In the present study, we report on the development of the first BS device that allows for simultaneous live in vivo imaging in mice. This tool opens up a whole new range of possibilities that allow a better understanding of BS and how to optimize its effects through its use in murine models of disease.
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Affiliation(s)
- Dany Arsenault
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Janelle Drouin-Ouellet
- John van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Martine Saint-Pierre
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Petros Petrou
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Marilyn Dubois
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Jasna Kriz
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.,Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
| | - Roger A Barker
- John van Geest Centre for Brain Repair, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Antonio Cicchetti
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec (CHUQ), Axe Neurosciences, Québec, QC, Canada.,Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada
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