Gastric proton pump is expressed in the inner ear and choroid plexus of the rat

Association between Benign Paroxysmal Positional Vertigo and Previous Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort

The present nested case−control study evaluated the impact of previous proton pump inhibitor (PPI) prescription on the risk of benign paroxysmal positional vertigo (BPPV). A ≥40-year-old Korean population was included. A total of 34,441 patients with BPPV was matched with 137,764 comparison participants for demographic and socioeconomic factors. Previous histories of PPI use and PPI prescription dates were compared between the BPPV and comparison groups. The odds ratios (ORs) with 95% confidence intervals (CIs) of PPI use for BPPV were calculated using a logistic regression. The demographic and socioeconomic factors and comorbidities were adjusted in the adjusted model. Both current and past PPI users were associated with higher odds for BPPV than non-PPI users (adjusted OR (aOR) = 3.57, 95% CI = 3.33−3.83, and p < 0.001 for current PPI users and aOR = 1.76, 95% CI = 1.64−1.89, and p < 0.001 for past PPI users). In addition, longer dates of PPI use were related to higher odds for BPPV (aOR (95% CI) = 1.95 [1.81−2.10] for ≥1 day and <30 days of PPI prescription, <2.88 [2.68−3.10] for ≥30 days and <365 days of PPI prescription, and <3.45 [3.19−3.73] for ≥365 days of PPI prescription). PPI use was linked with an elevated risk of BPPV in the adult population. The odds for BPPV were higher in patients with a longer duration of PPI use.

Proton pump inhibitor use and hearing loss in patients with type 2 diabetes: evidence from a hospital-based case-control study and a population-based cohort study

OBJECTIVES

This study aimed to investigate the association between proton pump inhibitor (PPI) use and risk of sensorineural hearing loss (SNHL) or tinnitus in patients with type 2 diabetes using hospital- and population-based data.

METHODS

For the case-control study using the Asan biomedical research environment (ABLE) database, the characteristics between cases and sex-, age-, and index-year-matched controls were compared by the chi-squared test. Conditional logistic regression was used to estimate the odds ratios (ORs). For the cohort study using the Korean National Health Insurance Service-National Sample Cohort, the hazard ratios (HRs) for SNHL or tinnitus associated with PPI use were analyzed by the Cox proportional hazard regression model.

RESULTS

The case-control study included 1,379 cases and 5,512 matched controls. After adjustment, PPI use was associated with an increased risk of SNHL or tinnitus (OR: 1.61, 95% CI: 1.30-1.99). The ORs were higher for current or recent use of PPI and high average daily dose. In the cohort study including 17,233 pairs of PPI users and non-users after propensity score matching, the risk of SNHL or tinnitus increased in PPI users compared with non-users (HR: 1.50, 95% CI: 1.40-1.61). In the stratified analyses, risks remained significant, and the magnitude of association was relatively high in those of younger age, patients without gastroesophageal reflux disease, and patients not receiving histamine 2 receptor blockers.

CONCLUSIONS

Our study suggests that PPI use is associated with an increased risk of SNHL or tinnitus. Given the widespread use of PPIs, the potential ototoxic effects of PPIs remain an important concern.

Association between Proton Pump Inhibitors and Hearing Impairment: A Nested Case-Control Study

This study investigated the association of previous use of proton pump inhibitors (PPIs) with the rate of hearing impairment. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort was enrolled. The 6626 registered hearing-impaired patients were matched with 508,240 control participants for age, sex, income, region of residence, and index date (date of hearing impairment diagnosis). The prescription histories of PPIs were collected for 2 years before the index date. The odds ratios of the duration of PPI use for hearing impairment were analyzed using conditional logistic regression. Subgroups of age/sex and severity of hearing impairments were additionally analyzed for the relation of PPI use with hearing impairment. PPI use for 30-365 days was associated with a 1.65-times higher odds of hearing impairment (95% confidence interval (CI) = 1.47-1.86 for 30-365 days of PPI medication). PPI use for ≥365 days was also related to 1.52-times higher odds of hearing impairment (95% CI = 1.35-1.72, p < 0.001). All age and sex subgroups demonstrated a positive association between PPI use and hearing impairment. Severe hearing impairment showed consistently higher odds of a relation with PPI use. PPI use was associated with an increased rate of hearing impairment.

Possible Effects of Proton Pump Inhibitors on Hearing Loss Development

Considered safe and often available as over-the-counter (OTC) drugs, proton pump inhibitors (PPI) are one of the most frequently used medicines. Over recent years much research analyzing PPI has been conducted and these studies shed light on PPI side effects and the mechanisms of these processes. In this study we summarize the findings of these studies and through deduction present some hypotheses on the impact of PPI on health. Of particular interest is the impact of PPI on hearing loss development. However, despite this side effect being localized, its mechanisms are complex, systemic and involve changes in whole body. This paper summarizes how through, inter alia, alterations in the circulatory system, respiratory system, central nervous system and metabolism PPI can cause hearing impairment, which can occur in every age group and is connected with long-term use of this group of drugs. This article also discusses the role PPI plays in the acceleration of presbycusis development, in relation to the fact that older people are the group who most frequently use PPI in long term. Hearing loss negatively impacts affects quality of life, especially among older patients who are also the most afflicted group; administration of PPI should therefore be considered carefully, taking into consideration all potential benefits and side effects.

Prospective Study of Gastroesophageal Reflux, Use of Proton Pump Inhibitors and H2-Receptor Antagonists, and Risk of Hearing Loss

OBJECTIVES

Gastroesophageal reflux disease (GERD) is common and often treated with proton pump inhibitors (PPIs) or H2-receptor antagonists (H2-RAs). GERD has been associated with exposure of the middle ear to gastric contents, which could cause hearing loss. Treatment of GERD with PPIs and H2-RAs may decrease exposure of the middle ear to gastric acid and decrease the risk of hearing loss. We prospectively investigated the relation between GERD, use of PPIs and H2-RAs, and the risk of hearing loss in 54,883 women in Nurses' Health Study II.

DESIGN

Eligible participants, aged 41 to 58 years in 2005, provided information on medication use and GERD symptoms in 2005, answered the question on hearing loss in 2009 or in 2013, and did not report hearing loss starting before the date of onset of GERD symptoms or medication use. The primary outcome was self-reported hearing loss. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

During 361,872 person-years of follow-up, 9842 new cases of hearing loss were reported. Compared with no GERD symptoms, higher frequency of GERD symptoms was associated with higher risk of hearing loss (multivariable adjusted relative risks: <1 time/month 1.04 [0.97, 1.11], several times/week 1.17 [1.09, 1.25], daily 1.33 [1.19, 1.49]; p value for trend <0.001). After accounting for GERD symptoms, neither PPI nor H2-RA use was associated with the risk of hearing loss.

CONCLUSIONS

GERD symptoms are associated with higher risk of hearing loss in women, but use of PPIs and H2-RAs are not independently associated with the risk.

Gastric-type H+,K+-ATPase in mouse vestibular end organs

CONCLUSION

Gastric type H⁺,K⁺-ATPase in the vestibular end organs may be of importance for K⁺ circulation and may also be related to pH regulation in vestibular end organs and endolymphatic sac.

OBJECTIVE

To analyze the expression of gastric-type H⁺,K⁺-ATPase in normal mouse vestibular end organs.

METHODS

8 weeks old CBA/J mice were used in this study. The presence of gastric-type H⁺,K⁺-ATPase α and β in the vestibular end organs, viz. utricle, saccule, ampulla, vestibular ganglion, and endolymphatic sac, was investigated using immunohistochemistry.

RESULTS

In the vestibular end organs, H⁺,K⁺-ATPase α and β were almost identical. H⁺,K⁺-ATPase was expressed in sensory cells, the basolateral surface of dark cells, fibrocytes, in vestibular ganglion cells, and in the upper region of the endolymphatic sac epithelial cells.

Proton Pump Inhibitors Inhibit Pancreatic Secretion: Role of Gastric and Non-Gastric H+/K+-ATPases

The mechanism by which pancreas secretes high HCO₃^- has not been fully resolved. This alkaline secretion, formed in pancreatic ducts, can be achieved by transporting HCO₃^- from serosa to mucosa or by moving H⁺ in the opposite direction. The aim of the present study was to determine whether H⁺/K⁺-ATPases are expressed and functional in human pancreatic ducts and whether proton pump inhibitors (PPIs) have effect on those. Here we show that the gastric HKα1 and HKβ subunits (ATP4A; ATP4B) and non-gastric HKα2 subunits (ATP12A) of H⁺/K⁺-ATPases are expressed in human pancreatic cells. Pumps have similar localizations in duct cell monolayers (Capan-1) and human pancreas, and notably the gastric pumps are localized on the luminal membranes. In Capan-1 cells, PPIs inhibited recovery of intracellular pH from acidosis. Furthermore, in rats treated with PPIs, pancreatic secretion was inhibited but concentrations of major ions in secretion follow similar excretory curves in control and PPI treated animals. In addition to HCO₃^-, pancreas also secretes K⁺. In conclusion, this study calls for a revision of the basic model for HCO₃^- secretion. We propose that proton transport is driving secretion, and that in addition it may provide a protective pH buffer zone and K⁺ recirculation. Furthermore, it seems relevant to re-evaluate whether PPIs should be used in treatment therapies where pancreatic functions are already compromised.

Regional expression of the ADAMs in developing chicken cochlea

The expression patterns of five members of the ADAM (a disintegrin and metalloprotease) family including ADAM9, ADAM10, ADAM17, ADAM22, and ADAM23 were analyzed in different anatomical structures of the developing chicken cochlea by in situ hybridization and immunohistochemistry. Results show that ADAM9, ADAM10, and ADAM17 are widely expressed in the sensory epithelium of the basilar papilla, by homogene cells, spindle-shaped cells, and acoustic ganglion cells, and in the tegmentum vasculosum, each with a different pattern. ADAM22 expression is restricted to spindle-shaped cells and acoustic ganglion cells, while ADAM23 is prominently expressed by hair cells and acoustic ganglion cells. Furthermore, ADAM10 protein is coexpressed with several members of the classic cadherins, including cadherin-7, N-cadherin, and R-cadherin in distinct anatomical regions of the cochlea except for acoustic ganglion cells. The expression of the ADAMs in the developing cochlea suggests a contribution of the ADAMs to the development of distinct cochlear structures.

The renal H,K-ATPases

PURPOSE OF REVIEW

We integrate recent evidence that demonstrates the importance of the gastric (HKalpha1) and nongastric (HKalpha2)-containing hydrogen potassium adenosine triphosphatases (H,K-ATPases) on physiological function and their role in potassium (K), sodium (Na), and acid-base balance.

RECENT FINDINGS

Previous studies focused on the primary role of H,K-ATPases as a mechanism of K conservation during states of K deprivation. Both isoforms function in H secretion and K absorption in vivo during K deprivation, but recent findings show that these pumps also function in acid secretion in animals fed normal K-replete diets. The complicated pharmacological inhibition of both pumps is reviewed. Interestingly, HKalpha2-null mice have a reduced expression and activity of the renal epithelial Na channel alpha subunit in the colon. When the human nongastric isoform was studied in a heterologous expression system with its cognate beta subunit (NaKbeta1), the pump exhibited substantial Na affinity at the 'K'-binding site. Evidence cited herein raises the possibility that either directly or indirectly the renal HKalpha2-containing H,K-ATPase may affect Na balance.

SUMMARY

Both H,K-ATPase isoforms are active in normal animals and not just under conditions of K depletion. The possibility that either one or both isoforms contribute to Na absorption, particularly in humans, raises important clinical implications for these pumps in the kidney.

Pharmacological profiles of the murine gastric and colonic H,K-ATPases

BACKGROUND

The H,K-ATPase, consisting of α and ß subunits, belongs to the P-type ATPase family. There are two isoforms of the α subunit, HKα₁ and HKα₂ encoded by different genes. The ouabain-resistant gastric HKα₁-H,K-ATPase is Sch28080-sensitive. However, the colonic HKα₂-H,K-ATPase from different species shows poor primary structure conservation of the HKα₂ subunit between species and diverse pharmacological sensitivity to ouabain and Sch28080. This study sought to determine the contribution of each gene to functional activity and its pharmacological profile using mouse models with targeted disruption of HKα₁, HKα₂, or HKbeta genes.

METHODS

Membrane vesicles from gastric mucosa and distal colon in wild-type (WT), HKα₁, HKα₂, or HKß knockout (KO) mice were extracted. K-ATPase activity and pharmacological profiles were examined.

RESULTS

The colonic H,K-ATPase demonstrated slightly greater affinity for K(+) than the gastric H,K-ATPase. This K-ATPase activity was not detected in the colon of HKα₂ KO but was observed in HKß KO with properties indistinguishable from WT. Neither ouabain nor Sch28080 had a significant effect on the WT colonic K-ATPase activity, but orthovanadate abolished this activity. Amiloride and its analogs benzamil and 5-N-ethyl-N-isopropylamiloride inhibited K-ATPase activity of HKα₁-containing H,K-ATPase; the dose dependence of inhibition was similar for all three inhibitors. In contrast, the colonic HKα₂-H,K-ATPase was not inhibited by these compounds.

CONCLUSIONS

These data demonstrate that the mouse colonic H,K-ATPase exhibits a ouabain- and Sch28080-insensitive, orthovanadate-sensitive K-ATPase activity. Interestingly, pharmacological studies suggested that the mouse gastric H,K-ATPase is sensitive to amiloride.

GENERAL SIGNIFICANCE

Characterization of the pharmacological profiles of the H,K-ATPases is important for understanding the relevant knockout animals and for considering the specificity of the inhibitors.

Meniere's disease: update of etiopathogenetic theories and proposal of a possible model of explanation

Meniere's Disease (MD) is an affection consisting of an association of sensorineural hearing loss, tinnitus and vertigo initially presenting by crises. A review of the most considered possible causative factors and pathophysiologic interpretations allows us to underline the uncertainties which still exist about the genesis of this illness. We propose a mechanistic model based on the effect of a haemodynamic imbalance leading to transient ischaemia which could have an effect on the pH of the inner ear as well as on the work of the inner ear proton pumps. It is hypothesized that under ischaemic conditions and consequent metabolic acidity a preserved proton pump activity can generate an overload of anions in the endolymphatic partition, which is a closed system, thus resulting in an enhancement of osmolarity and consequently in the formation of a hydrops resulting in the development of fluctuating hearing loss, tinnitus and vertigo which characterize Meniere's Disease.

Proton pump inhibitor lansoprazole is a nuclear liver X receptor agonist

The liver X receptors (LXRalpha and LXRbeta) are transcription factors that control the expression of genes primarily involved in cholesterol metabolism. In the brain, in addition to normal neuronal function, cholesterol metabolism is important for APP proteolytic cleavage, secretase activities, Abeta aggregation and clearance. Particularly significant in this respect is LXR mediated transcriptional control of APOE, which is the only proven risk factor for late onset Alzheimer's disease. Using a transactivation reporter assay for screening pharmacologically active compounds and off patent drugs we identified the proton pump inhibitor Lansoprazole as an LXR agonist. In secondary screens and counter-screening assays, it was confirmed that Lansoprazole directly activates LXR, increases the expression of LXR target genes in brain-derived human cell lines, and increases Abca1 and Apo-E protein levels in primary astrocytes derived from wild type but not LXRalpha/beta double knockout mice. Other PPIs activate LXR as well, but the efficiency of activation depends on their structural similarities to Lansoprazole. The identification of a widely used drug with LXR agonist-like activity opens the possibility for systematic preclinical testing in at least two diseases--Alzheimer's disease and atherosclerosis.

KCNQ1 and KCNE1 K+ channel components are involved in early left-right patterning in Xenopus laevis embryos

Several ion transporters have been implicated in left-right (LR) patterning. Here, we characterize a new component of the early bioelectrical circuit: the potassium channel KCNQ1 and its accessory subunit KCNE1. Having cloned the native Xenopus versions of both genes, we show that both are asymmetrically localized as maternal proteins during the first few cleavages of frog embryo development in a process dependent on microtubule and actin organization. Molecular loss-of-function using dominant negative constructs demonstrates that both gene products are required for normal LR asymmetry. We propose a model whereby these channels provide an exit path for K(+) ions brought in by the H(+),K(+)-ATPase. This physiological module thus allows the obligate but electroneutral H(+),K(+)-ATPase to generate an asymmetric voltage gradient on the left and right sides. Our data reveal a new, bioelectrical component of the mechanisms patterning a large-scale axis in vertebrate embryogenesis.

Functional significance of channels and transporters expressed in the inner ear and kidney

A number of ion channels and transporters are expressed in both the inner ear and kidney. In the inner ear, K+cycling and endolymphatic K+, Na+, Ca2+, and pH homeostasis are critical for normal organ function. Ion channels and transporters involved in K+cycling include K+channels, Na+-2Cl−-K+cotransporter, Na+/K+-ATPase, Cl−channels, connexins, and K+/Cl−cotransporters. Furthermore, endolymphatic Na+and Ca2+homeostasis depends on Ca2+-ATPase, Ca2+channels, Na+channels, and a purinergic receptor channel. Endolymphatic pH homeostasis involves H+-ATPase and Cl−/HCO3−exchangers including pendrin. Defective connexins (GJB2 and GJB6), pendrin (SLC26A4), K+channels (KCNJ10, KCNQ1, KCNE1, and KCNMA1), Na+-2Cl−-K+cotransporter (SLC12A2), K+/Cl−cotransporters (KCC3 and KCC4), Cl−channels (BSND and CLCNKA + CLCNKB), and H+-ATPase (ATP6V1B1 and ATPV0A4) cause hearing loss. All these channels and transporters are also expressed in the kidney and support renal tubular transport or signaling. The hearing loss may thus be paralleled by various renal phenotypes including a subtle decrease of proximal Na+-coupled transport (KCNE1/KCNQ1), impaired K+secretion (KCNMA1), limited HCO3−elimination (SLC26A4), NaCl wasting (BSND and CLCNKB), renal tubular acidosis (ATP6V1B1, ATPV0A4, and KCC4), or impaired urinary concentration (CLCNKA). Thus, defects of channels and transporters expressed in the kidney and inner ear result in simultaneous dysfunctions of these seemingly unrelated organs.

Gastric type H+,K+-ATPase in the cochlear lateral wall is critically involved in formation of the endocochlear potential

Cochlear endolymph has a highly positive potential of approximately +80 mV known as the endocochlear potential (EP). The EP is essential for hearing and is maintained by K(+) circulation from perilymph to endolymph through the cochlear lateral wall. Various K(+) transport apparatuses such as the Na(+),K(+)-ATPase, the Na(+)-K(+)-2Cl(-) cotransporter, and the K(+) channels Kir4.1 and KCNQ1/KCNE1 are expressed in the lateral wall and are known to play indispensable roles in cochlear K(+) circulation. The gastric type of the H(+),K(+)-ATPase was also shown to be expressed in the cochlear lateral wall (Lecain E, Robert JC, Thomas A, and Tran Ba Huy P. Hear Res 149: 147-154, 2000), but its functional role has not been well studied. In this study we examined the precise localization of H(+),K(+)-ATPase in the cochlea and its involvement in formation of EP. RT-PCR analysis showed that the cochlea expressed mRNAs of gastric alpha(1)-, but not colonic alpha(2)-, and beta-subunits of H(+),K(+)-ATPase. Immunolabeling of an antibody specific to the alpha(1) subunit was detected in type II, IV, and V fibrocytes distributed in the spiral ligament of the lateral wall and in the spiral limbus. Strong immunoreactivity was also found in the stria vascularis. Immunoelectron microscopic examination exhibited that the H(+),K(+)-ATPase was localized exclusively at the basolateral site of strial marginal cells. Application of Sch-28080, a specific inhibitor of gastric H(+),K(+)-ATPase, to the spiral ligament as well as to the stria vascularis caused prominent reduction of EP. These results may imply that the H(+),K(+)-ATPase in the cochlear lateral wall is crucial for K(+) circulation and thus plays a critical role in generation of EP.

Identification of the β-subunit for nongastric H-K-ATPase in rat anterior prostate

The structural organization of nongastric H-K-ATPase, unlike that of closely related Na-K-ATPase and gastric H-K-ATPase, is not well characterized. Recently, we demonstrated that nongastric H-K-ATPase α-subunit (αng) is expressed in apical membranes of rodent prostate. Its highest level, as well as relative abundance, with respect to α1-isoform of Na-K-ATPase, was observed in anterior lobe. Here, we aimed to determine the subunit composition of nongastric H-K-ATPase through the detailed analysis of the expression of all known X-K-ATPase β-subunits in rat anterior prostate (AP). RT-PCR detects transcripts of β-subunits of Na-K-ATPase only. Measurement of absolute protein content of these three β-subunit isoforms, with the use of quantitative Western blotting of AP membrane proteins, indicates that the abundance order is β1> β3≫ β2. Immunohistochemical experiments demonstrate that β1is present predominantly in apical membranes, coinciding with αng, whereas β3is localized in the basolateral compartment, coinciding with α1. This is the first direct demonstration of the αng-β1colocalization in situ indicating that, in rat AP, αngassociates only with β1. The existence of αng-β1complex has been confirmed by immunoprecipitation experiments. These results indicate that β1-isoform functions as the authentic subunit of Na-K-ATPase and nongastric H-K-ATPase. Putatively, the intracellular polarization of X-K-ATPase isoforms depends on interaction with other proteins.

Encéphalopathie myoclonique : rôle des inhibiteurs de la pompe à protons

Two men (66 and 73 Years) with a cardiovascular history were hospitalized for rapid onset encephalopathy associated with myoclonia and an extrapyramidal syndrome. On the basis of the French Pharmacovigilance system, this symptomatology has been attributed to the coadministration of a proton pump inhibitor, lansoprazole (15mg/day) with levodopa. Lansoprazole withdrawal led to a normalisation of the situation.

The betam protein, a member of the X,K-ATPase beta-subunits family, is located intracellularly in pig skeletal muscle

The sequence of the pig cDNA encoding the muscle-specific betam-protein, a member of the X,K-ATPase beta-subunits family, was determined. Two alternatively spliced transcripts encoding polypeptide chains of 355 and 351 residues were identified. The tissue specificity of expression of betam and other X,K-ATPase beta-subunit genes was studied by RT-PCR performed on 24 tissues from newborn pigs. The betam expression was shown to be highly tissue-specific, being detected at the highest level in skeletal muscle, at a lower level in heart, and at much lower level in skin. The betam transcripts are more abundant in the tissues from the newborn than adult. Immunoblotting and deglycosylation shift assay indicated that skeletal muscle membranes of newborn pigs contain betam protein with an electrophoretic mobility and carbohydrate content very similar to that of human betam. Fractionation of membranes from both newborn and adult pig skeletal muscles by isopycnic centrifugation revealed that the majority of the betam protein is concentrated in the sarcoplasmic reticulum-containing fractions. This intracellular location is a unique property that distinguishes the betam protein from other members of the X,K-ATPase beta-subunit family.