Regeneration of Inner Ear Cells from Stem Cell Precursors—A Future Concept of Hearing Rehabilitation?

Attitudes of the UK ear, nose and throat clinical community to the future potential use of stem cell therapies to treat deafness

AIMS

Hearing loss is commonly due to the degeneration and death of hair cells and their associated spiral ganglion neurons. A total of 250 million people are affected worldwide. Stem cell treatments offer new and powerful strategies to enable recovery from hearing loss. This study focuses on the translational process required to move stem cell therapy from the laboratory to clinical use as a novel treatment of deafness and an alternative to conventional therapy. In particular, this study aims to inform and enable the adoption process for such therapies, including understanding the awareness of and attitudes towards stem cell therapy for hearing loss among ear, nose and throat surgeons, physicians, audiologists and scientists, who are key stakeholders in the adoption process.

METHODS

A structured questionnaire has been developed and applied to assess the knowledge and awareness of the clinical community with respect to the future potential use of stem cell therapies to treat deafness.

RESULTS

Results showed >87% of the clinicians sampled have very little or no knowledge of stem cell therapy. A total of 11% have been asked by patients about the use of stem cell therapies to treat deafness, and 64% felt a new treatment is needed for deafness. Significantly, 40% felt that a stem cell therapy would be a good adjuvant to a cochlear implant. In total, 78% were supportive of investment in stem cell therapy research and manufacturing. This investment should be in work directed at those areas where clinicians favor adoption.

CONCLUSION

Alignment is required between the scientific and clinical communities. This should not only take into account the likelihood of scientific success when pursuing the therapeutic alternatives, but should also consider the clinical trial requirements, regulatory landscape and reimbursement conditions for each option.

Potential roles of stem cells in the management of sensorineural hearing loss

BACKGROUND

In the management of sensorineural hearing loss, effective therapy for degenerated hair cells, third order neurons, ganglions, dendrites and synaptic areas of the vestibulo-cochleo-cerebral pathway remains an enigma. Transplantation of stem and progenitor cells appears to be an emerging potential solution, and is the focus of this review.

AIM

To review recent developments in the management of sensorineural hearing loss in the field of stem cell research.

MATERIALS AND METHOD

A systematic review of the English language literature included all experimental and non-experimental studies with a Jadad score of three or more, published between 2000 and 2010 and included in the following databases: Cochrane Library Ear, Nose and Throat Disorders; Medline; Google Scholar; Hinari; and the Online Library of Toronto University.

RESULTS

Of the 455 and 29 600 articles identified from Medline and Google Scholar, respectively, 48 met the inclusion criteria. These were independently reviewed and jointly analysed.

CONCLUSION

Although there is not yet any evidence from successful human studies, stem cell and 'alternative stem cell' technology seems to represent the future of sensorineural hearing loss management.

Transplantation of mouse embryonic stem cells into the cochlea of an auditory-neuropathy animal model: effects of timing after injury

Application of ouabain to the round window membrane of the gerbil selectively induces the death of most spiral ganglion neurons and thus provides an excellent model for investigating the survival and differentiation of embryonic stem cells (ESCs) introduced into the inner ear. In this study, mouse ESCs were pretreated with a neural-induction protocol and transplanted into Rosenthal's canal (RC), perilymph, or endolymph of Mongolian gerbils either 1-3 days (early post-injury transplant group) or 7 days or longer (late post-injury transplant group) after ouabain injury. Overall, ESC survival in RC and perilymphatic spaces was significantly greater in the early post-injury microenvironment as compared to the later post-injury condition. Viable clusters of ESCs within RC and perilymphatic spaces appeared to be associated with neovascularization in the early post-injury group. A small number of ESCs transplanted within RC stained for mature neuronal or glial cell markers. ESCs introduced into perilymph survived in several locations, but most differentiated into glia-like cells. ESCs transplanted into endolymph survived poorly if at all. These experiments demonstrate that there is an optimal time window for engraftment and survival of ESCs that occurs in the early post-injury period.

Propagation and maintenance of undifferentiated human embryonic stem cells

Human embryonic stem (hES) cells, like other stem cells, have the capacity to self-renew without differentiation. Although hES cells can be differentiated to many different tissue types in vitro, clinical uses have not yet been realized from the study of hES cells. Anticipation that these cells would be immediately useful for creating models of human disease has not yet been fulfilled. However, because of their self-renewing and pluripotential nature, hES cells indeed hold unique promise for many areas of research and medicine. A major problem complicating developments in hES cell research is the difficulty of propagating and maintaining these cells in vitro without differentiation. This review addresses this problem and potential solutions in detail. In addition, the current state of research regarding the growth and maintenance of hES cells is summarized, along with basic protocols utilized by our laboratory for the successful propagation, characterization, and investigation of hES cells.

Neural cograft stimulates the survival and differentiation of embryonic stem cells in the adult mammalian auditory system

Mouse embryonic stem (ES) cells were transplanted into the cochlea of adult guinea pigs in order to explore their survival, differentiation, and possible integration with the host tissue. With the purpose of investigating the possible effect of manipulating the local embryonic microenvironment, ES cells were transplanted into the cochlea with or without an embryonic neuronal cograft consisting of dorsal root ganglion (DRG) tissue. To detect the survival and differentiation of ES cells, cells expressing green fluorescent protein (GFP) were used in combination with immunohistochemical detection of a neuronal marker, neural class III beta-tubulin (TUJ1 antibody). At 4 weeks following transplantation implanted ES cells were found close both to the sensory epithelium, and the spiral ganglion neurons (SGNs) with their peripheral dendritic processes projecting to the organ of Corti. There was a significant difference in the number of surviving TUJ1 (+) ES cells between the DRG cograft group and the non-cograft group (P < 0.01, ANOVA). Neurite-like projections were also identified between TUJ1-positive ES cells and the peripheral dendritic processes from SGNs. The results suggest that an embryonic neuronal microenvironment may be one of the key factors in the survival and differentiation of ES cells in the adult auditory system.

Strategies for replacing lost cochlear hair cells

The auditory sensory epithelium is a mosaic composed of sensory (hair) cells and several types of non-sensory (supporting) cells. All these cells are highly differentiated in their structure and function. Mosaic epithelia (and other complex tissues) are generally formed by differentiation of distinct and specialized cell types from common progenitors. Most types of epithelial tissues maintain a population of undifferentiated (basal) cells which facilitate turnover (renewal) and repair, but this is not the case for the organ of Corti in the cochlea. Therefore, when cochlear hair cells are lost they cannot be replaced. Consequently, sensorineural hearing loss is permanent. In designing therapy for sensorineural deafness, the most important task is to find a way to generate new cochlear hair cells to replace lost cells.