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Delsmann MM, Bonik P, Ocokoljic A, Häussler SM, Püschel K, Praetorius M, Amling M, Peichl J, Rolvien T. Cholesteatoma Severely Impacts the Integrity and Bone Material Quality of the Incus. Calcif Tissue Int 2023; 113:609-617. [PMID: 37872266 PMCID: PMC10673740 DOI: 10.1007/s00223-023-01144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/25/2023]
Abstract
Cholesteatoma can lead to progressive destruction of the auditory ossicles along with conductive hearing loss but precise data on the microstructural, cellular, and compositional aspects of affected ossicles are not available. Here, we obtained incus specimens from patients who had cholesteatoma with conductive hearing loss. Incudes were evaluated by micro-computed tomography, histomorphometry on undecalcified sections, quantitative backscattered electron imaging, and nanoindentation. Results were compared with two control groups taken from patients with chronic otitis media as well as from skeletally intact donors at autopsy. The porosity of incus specimens was higher in cholesteatoma than in chronic otitis media, along with a higher osteoclast surface per bone surface. Histomorphometric assessment revealed higher osteoid levels and osteocyte numbers in cholesteatoma incudes. Incudes affected by cholesteatoma also showed lower matrix mineralization compared with specimens from healthy controls and chronic otitis media. Furthermore, the modulus-to-hardness ratio was higher in cholesteatoma specimens compared with controls. Taken together, we demonstrated increased porosity along with increased osteoclast indices, impaired matrix mineralization, and altered biomechanical properties as distinct features of the incus in cholesteatoma. Based on our findings, a possible impact of impaired bone quality on conductive hearing loss should be further explored.
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Affiliation(s)
- Maximilian M Delsmann
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Bonik
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ana Ocokoljic
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sophia M Häussler
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Praetorius
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan Peichl
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Osteoclastic activity in chronic otitis media with cholesteatoma-related bone destruction. The Journal of Laryngology & Otology 2021; 135:879-882. [PMID: 34348812 DOI: 10.1017/s0022215121002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cholesteatoma-related bone destruction is the cause of many complications due to chronic otitis media. This study aimed to evaluate osteoclastic activity in cholesteatoma-related bone destruction using tartrate-resistant acid phosphatase 5b, an enzyme specific to osteoclastic activity. METHOD Seventy-two patients diagnosed with chronic otitis media were included in this study and were divided into two groups: with and without bone destruction. The blood serum and tissue tartrate-resistant acid phosphatase 5b levels from both groups were compared. RESULTS There were no significant differences in the level of serum enzymes between both groups. However, in tissue samples, tartrate-resistant acid phosphatase 5b levels were significantly lower in the bone destruction group than the group without bone destruction. CONCLUSION This study determined that the level of tartrate-resistant acid phosphatase 5b, a specific enzyme for osteoclastic activity in cholesteatoma-related bone destruction, is locally decreased. This data suggests that osteoclastic activity may decrease in cholesteatoma-related bone destruction. However, further experimental and clinical studies are required to clarify this highly complex mechanism.
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Jung SY, Kwon KJ, Min HK, Kang DW, Park DC, Kim YI, Ryu J, Yeo SG. Expression of endoplasmic reticulum stress mRNAs in otitis media. Acta Otolaryngol 2021; 141:459-465. [PMID: 33641571 DOI: 10.1080/00016489.2021.1883733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endoplasmic reticulum (ER) stress is a cellular defense mechanism that occurs when ER function is impaired. OBJECTIVE This study was designed to evaluate the expression of major mRNAs of ER stress in patients with otitis media with effusion (OME), chronic otitis media (COM), and COM with cholesteatoma (CholeOM). MATERIAL AND METHODS Specimens were collected during surgery from patients with OME, COM, and CholeOM, and the levels of ER stress mRNAs measured by real-time polymerase chain reaction. Levels of ER stress mRNAs were compared in the three groups and correlated with clinical findings and pus culture results. RESULTS The level of CHOP mRNA was higher, and the levels of sXBP1 and ATF6 mRNAs lower, in the OME than in the other two groups (p < .05 each). Evaluation of bacterial pus culture negative patients showed that the level of ATF6 mRNA was higher in the CholeOM than in the other two groups (p < .05), whereas evaluation of bacterial pus culture positive patients showed that the level of CHOP mRNA was higher in the OME than in the other groups (p < .05). CONCLUSIONS AND SIGNIFICANCE ER stress may be involved in the pathophysiology of OM and the levels of ER stress mRNAs were expressed differently in each type of otitis media according to bacterial culture test results.
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Affiliation(s)
- Su Young Jung
- Department of Otorhinolaryngology – Head and Neck Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Ki Jin Kwon
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hye Kyu Min
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Woong Kang
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dong Choon Park
- St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Young Il Kim
- Kyung Hee University Medical Center, Medical Science Research Institute, Seoul, Republic of Korea
| | - Jeewon Ryu
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology – Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
- Kyung Hee University Medical Center, Medical Science Research Institute, Seoul, Republic of Korea
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Karali E, Yis OM. Serum sclerostın levels ın chronıc otıtıs medıa wıth and wıthout cholesteatoma. Rev Assoc Med Bras (1992) 2020; 66:966-972. [DOI: 10.1590/1806-9282.66.7.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/26/2020] [Indexed: 11/21/2022] Open
Abstract
SUMMARY OBJECTIVE Sclerostin is a glycoprotein that plays a catabolic role in bone and is involved in the regulation of bone metabolism by increasing the osteoclastic bone resorption. In this study, serum sclerostin levels were measured in chronic otitis media (COM) with and without cholesteatoma, assuming that it might have a role in the aetiopathogenesis of bone resorption. METHODS A total of 44 patients with cholesteatomatous COM (cCOM) (n = 22) and non-cholesteatomatous COM (ncCOM) (n = 22) were included in this study, and 26 healthy volunteers without any chronic ear disease problem(s) constituted the control group (n = 26). RESULTS No significant difference was not found in terms of serum iPTH, ALP, and vitamin D levels between ncCOM, cCOM, and the control groups. A significant difference was found in terms of serum sclerostin, Ca, and P levels between ncCOM, cCOM, and the control groups (p<0.05). Serum sclerostin levels in the study groups were significantly higher but their serum Ca and P levels were significantly lower compared to the control group. CONCLUSION We think that serum sclerostin concentrations, which were significantly higher in patients with cCOM and ncCOM compared to healthy controls are associated with bone erosion. There is a need for further studies with larger samples in order to determine the relationship between sclerostin and bone erosion in cholesteatoma to help in establishing preventive measures against cholesteatoma and set new targets for the development of non-surgical treatments.
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Relucenti M, Miglietta S, Bove G, Donfrancesco O, Battaglione E, Familiari P, Barbaranelli C, Covelli E, Barbara M, Familiari G. SEM BSE 3D Image Analysis of Human Incus Bone Affected by Cholesteatoma Ascribes to Osteoclasts the Bone Erosion and VpSEM dEDX Analysis Reveals New Bone Formation. SCANNING 2020; 2020:9371516. [PMID: 32158510 PMCID: PMC7048945 DOI: 10.1155/2020/9371516] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/22/2020] [Indexed: 06/10/2023]
Abstract
Bone erosion is considered a typical characteristic of advanced or complicated cholesteatoma (CHO), although it is still a matter of debate if bone erosion is due to osteoclast action, being the specific literature controversial. The purpose of this study was to apply a novel scanning characterization approach, the BSE 3D image analysis, to study the pathological erosion on the surface of human incus bone involved by CHO, in order to definitely assess the eventual osteoclastic resorptive action. To do this, a comparison of BSE 3D image of resorption lacunae (resorption pits) from osteoporotic human femur neck (indubitably of osteoclastic origin) with that of the incus was performed. Surface parameters (area, mean depth, and volume) were calculated by the software Hitachi MountainsMap© from BSE 3D-reconstructed images; results were then statistically analyzed by SPSS statistical software. Our findings showed that no significant differences exist between the two groups. This quantitative approach implements the morphological characterization, allowing us to state that surface erosion of the incus is due to osteoclast action. Moreover, our observation and processing image workflow are the first in the literature showing the presence not only of bone erosion but also of matrix vesicles releasing their content on collagen bundles and self-immuring osteocytes, all markers of new bone formation on incus bone surface. On the basis of recent literature, it has been hypothesized that inflammatory environment induced by CHO may trigger the osteoclast activity, eliciting bone erosion. The observed new bone formation probably takes place at a slower rate in respect to the normal bone turnover, and the process is uncoupled (as recently demonstrated for several inflammatory diseases that promote bone loss) thus resulting in an overall bone loss. Novel scanning characterization approaches used in this study allowed for the first time the 3D imaging of incus bone erosion and its quantitative measurement, opening a new era of quantitative SEM morphology.
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Affiliation(s)
- Michela Relucenti
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
| | - Selenia Miglietta
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
| | - Gabriele Bove
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
| | - Orlando Donfrancesco
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
| | - Ezio Battaglione
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
| | - Pietro Familiari
- Department NESMOS, Neurosurgery Unit, Sapienza University of Rome, Via di Grottarossa 1039, 00189 Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Edoardo Covelli
- Department NESMOS, ENT Unit, Sapienza University of Rome, Via di Grottarossa 1039, 00189 Rome, Italy
| | - Maurizio Barbara
- Department NESMOS, ENT Unit, Sapienza University of Rome, Via di Grottarossa 1039, 00189 Rome, Italy
| | - Giuseppe Familiari
- Department SAIMLAL Section of Human Anatomy, Laboratory of Electron Microscopy “Pietro M. Motta”, Sapienza University of Rome, Via Alfonso Borelli 50, 00161 Rome, Italy
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Osteoclasts Modulate Bone Erosion in Cholesteatoma via RANKL Signaling. J Assoc Res Otolaryngol 2019; 20:449-459. [PMID: 31254133 DOI: 10.1007/s10162-019-00727-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Cholesteatoma starts as a retraction of the tympanic membrane and expands into the middle ear, eroding the surrounding bone and causing hearing loss and other serious complications such as brain abscess and meningitis. Currently, the only effective treatment is complete surgical removal, but the recurrence rate is relatively high. In rheumatoid arthritis (RA), osteoclasts are known to be responsible for bone erosion and undergo differentiation and activation by receptor activator of NF-κB ligand (RANKL), which is secreted by synovial fibroblasts, T cells, and B cells. On the other hand, the mechanism of bone erosion in cholesteatoma is still controversial. In this study, we found that a significantly larger number of osteoclasts were observed on the eroded bone adjacent to cholesteatomas than in unaffected areas, and that fibroblasts in the cholesteatoma perimatrix expressed RANKL. We also investigated upstream transcription factors of RANKL using RNA sequencing results obtained via Ingenuity Pathways Analysis, a tool that identifies relevant targets in molecular biology systems. The concentrations of four candidate factors, namely interleukin-1β, interleukin-6, tumor necrosis factor α, and prostaglandin E2, were increased in cholesteatomas compared with normal skin. Furthermore, interleukin-1β was expressed in infiltrating inflammatory cells in the cholesteatoma perimatrix. This is the first report demonstrating that a larger-than-normal number of osteoclasts are present in cholesteatoma, and that the disease involves upregulation of factors related to osteoclast activation. Our study elucidates the molecular basis underlying bone erosion in cholesteatoma.
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