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Brotto D, Greggio M. Intratympanic Gels for Inner Ear Disorders: A Scoping Review of Clinical Trials. Otolaryngol Head Neck Surg 2024; 170:1613-1629. [PMID: 38308599 DOI: 10.1002/ohn.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/02/2023] [Accepted: 01/06/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Intratympanic injections are a safe, well tolerated procedure routinely performed by ENT's specialists. Intratympanic injections of gels have the potential to deliver therapeutics into the cochlea through the round window membrane prolonging the release of drugs in the inner ear compartment. Aim of the present review is to summarize clinical trials testing pharmacological treatments for inner ear pathologies through intratympanic gel formulations. DATA SOURCES Online databases (Google scholar and PubMed) and registers (Clinicaltrials.gov and Euclinicaltrial) were used to identify clinical trials performed between 1990 and 2022. REVIEW METHODS PRISMA criteria have been followed. Clinical trials testing gel formulations administered through local intratympanic injections and targeting inner ear disorders were included. All the reports were identified by the authors working in pairs sequentially selecting only studies respecting the inclusion criteria. RESULTS A total of 45 clinical studies have been noticed; the gels for intratympanic injection are in the form of poloxamers or hyaluronic acid combinations; the trials found target different kind of inner ear disorders: acquired-stable SNHL, tinnitus, acute sudden SNHL, Meniere disease, cisplatin induced ototoxicity and hearing preservation in patients undergoing cochlear implant surgery. CONCLUSION Few studies listed do not provide the specific kind of gel formulation used but only report the intratympanic delivery vehicle as "gel" or "thermogel". Multiple clinical studies have been targeting several forms of inner ear disorders by injecting different compounds through poloxamer and hyaluronic acid formulations. Larger and more advanced clinical stages are necessary to confirm the efficacy of these chemical compounds.
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Affiliation(s)
- Davide Brotto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Marco Greggio
- Department of Neuroscience DNS, Degree Course in Audiometric Techniques, Padova University, Padova, Italy
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Saillant A, Campedel L. [Sodium thiosulfate in preventing ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors]. Bull Cancer 2024; 111:129-130. [PMID: 38092636 DOI: 10.1016/j.bulcan.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/09/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Arnaud Saillant
- CHU de Poitiers, service d'oncologie médicale, 86000 Poitiers, France.
| | - Luca Campedel
- Centre hospitalier universitaire Gabriel-Montpied, service d'oncologie médicale, Clermont-Ferrand, France
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Lee J, Fernandez K, Cunningham LL. Hear and Now: Ongoing Clinical Trials to Prevent Drug-Induced Hearing Loss. Annu Rev Pharmacol Toxicol 2024; 64:211-230. [PMID: 37562496 DOI: 10.1146/annurev-pharmtox-033123-114106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Each year over half a million people experience permanent hearing loss caused by treatment with therapeutic drugs with ototoxic side effects. There is a major unmet clinical need for therapies that protect against this hearing loss without reducing the therapeutic efficacy of these lifesaving drugs. At least 17 clinical trials evaluating 10 therapeutics are currently underway for therapies aimed at preventing aminoglycoside- and/or cisplatin-induced ototoxicity. This review describes the preclinical and clinical development of each of these approaches, provides updates on the status of ongoing trials, and highlights the importance of appropriate outcome measures in trial design and the value of reporting criteria in the dissemination of results.
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Affiliation(s)
- John Lee
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA;
| | - Katharine Fernandez
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA;
| | - Lisa L Cunningham
- Laboratory of Hearing Biology and Therapeutics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA;
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Correa-Morales JE, Giraldo-Moreno S, Mantilla-Manosalva N, Cuellar-Valencia L, Borja-Montes OF, Bedoya-Muñoz LJ, Iriarte-Aristizábal MF, Quintero-Muñoz E, Zuluaga-Liberato AM. Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review. Clin Otolaryngol 2024; 49:1-15. [PMID: 37818931 DOI: 10.1111/coa.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/04/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. METHODS Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. RESULTS Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. CONCLUSIONS Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities.
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Affiliation(s)
- Juan Esteban Correa-Morales
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Nidia Mantilla-Manosalva
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Laura Cuellar-Valencia
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Lennis Jazmin Bedoya-Muñoz
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
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Guidotti L, Tomassi E, Marracci S, Lai M, Lapi D, Pesi R, Pucci L, Novellino E, Albi E, Garcia-Gil M. Effects of Nutraceuticals on Cisplatin-Induced Cytotoxicity in HEI-OC1 Cells. Int J Mol Sci 2023; 24:17416. [PMID: 38139245 PMCID: PMC10743635 DOI: 10.3390/ijms242417416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Cisplatin is a chemotherapeutic drug for the treatment of several solid tumors, whose use is limited by its nephrotoxicity, neurotoxicity, ototoxicity, and development of resistance. The toxicity is caused by DNA cross-linking, increase in reactive oxygen species and/or depletion of cell antioxidant defenses. The aim of the work was to study the effect of antioxidant compounds (Lisosan G, Taurisolo®) or hydrogen sulfide (H2S)-releasing compounds (erucin) in the auditory HEI-OC1 cell line treated with cisplatin. Cell viability was determined using the MTT assay. Caspase and sphingomyelinase activities were measured by fluorometric and colorimetric methods, respectively. Expression of transcription factors, apoptosis hallmarks and genes codifying for antioxidant response proteins were measured by Western blot and/or RT-qPCR. Lisosan G, Taurisolo® and erucin did not show protective effects. Sodium hydrosulfide (NaHS), a donor of H2S, increased the viability of cisplatin-treated cells and the transcription of heme oxygenase 1, superoxide dismutase 2, NAD(P)H quinone dehydrogenase type 1 and the catalytic subunit of glutamate-cysteine ligase and decreased reactive oxygen species (ROS), the Bax/Bcl2 ratio, caspase-3, caspase-8 and acid sphingomyelinase activity. Therefore, NaHS might counteract the cytotoxic effect of cisplatin by increasing the antioxidant response and by reducing ROS levels and caspase and acid sphingomyelinase activity.
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Affiliation(s)
- Lorenzo Guidotti
- General Physiology Unit, Department of Biology, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy; (L.G.); (S.M.); (D.L.)
| | - Elena Tomassi
- Institute of Agricultural Biology and Biotechnology, Italian National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (E.T.); (L.P.)
| | - Silvia Marracci
- General Physiology Unit, Department of Biology, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy; (L.G.); (S.M.); (D.L.)
| | - Michele Lai
- Retrovirus Centre, Department of Translational Medicine and New Technologies in Medicine and Surgery, University of Pisa, Strada Statale del Brennero 2, 56127 Pisa, Italy;
| | - Dominga Lapi
- General Physiology Unit, Department of Biology, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy; (L.G.); (S.M.); (D.L.)
| | - Rossana Pesi
- Biochemistry Unit, Department of Biology, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy;
| | - Laura Pucci
- Institute of Agricultural Biology and Biotechnology, Italian National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (E.T.); (L.P.)
| | - Ettore Novellino
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Elisabetta Albi
- Department of Pharmaceutical Sciences, Interno Orto Botanico, University of Perugia, Via Romana, 06126 Perugia, Italy;
| | - Mercedes Garcia-Gil
- General Physiology Unit, Department of Biology, University of Pisa, Via San Zeno 31, 56127 Pisa, Italy; (L.G.); (S.M.); (D.L.)
- Interdepartmental Research Center Nutrafood “Nutraceuticals and Food for Health”, University of Pisa, 56124 Pisa, Italy
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Le Prell CG. Preclinical prospects of investigational agents for hearing loss treatment. Expert Opin Investig Drugs 2023; 32:685-692. [PMID: 37695693 DOI: 10.1080/13543784.2023.2253141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION : Hearing loss has a high prevalence, with aging, noise exposure, ototoxic drug therapies, and genetic mutations being some of the leading causes of hearing loss. Health conditions such as cardiovascular disease and diabetes are associated with hearing loss, perhaps due to shared vascular pathology in the ear and in other tissues. AREAS COVERED : Issues in the design of preclinical research preclude the ability to make comparisons regarding the relative efficacy of different drugs of interest for possible hearing loss prevention or hearing restoration. This has not slowed the advancement of candidate therapeutics into human clinical testing. There is a robust pipeline with drugs that have different mechanisms of action providing diverse candidate therapies and opportunities for combination therapies to be considered. EXPERT OPINION : Much of the preclinical research literature lacks standard study design elements such as dose response testing, and lack of standardization of test protocols significantly limits conclusions regarding relative efficacy. Nonetheless, the many positive results to date have supported translation of preclinical efforts into clinical trials assessing potential human benefits. Approval of the first hearing loss prevention therapeutic is a major success, providing a pathway for other drugs to follow.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, USA
- Callier Center for Communication Disorders, University of Texas at Dallas, Dallas, TX, USA
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Guthrie OW, Spankovich C. Emerging and established therapies for chemotherapy-induced ototoxicity. J Cancer Surviv 2023; 17:17-26. [PMID: 36637631 DOI: 10.1007/s11764-022-01317-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Ototoxicity is considered a dose-limiting side effect of some chemotherapies. Hearing loss, in particular, can have significant implications for the quality of life for cancer survivors. Here, we review therapeutic approaches to mitigating ototoxicity related to chemotherapy. METHODS Literature review. CONCLUSIONS Numerous otoprotection strategies are undergoing active investigation. However, numerous challenges exist to confer adequate protection while retaining the anti-cancer efficacy of the chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS Ototoxicity can have significant implications for cancer survivors, notably those receiving cisplatin. Clinical translation of multiple otoprotection approaches will aid in limiting these consequences.
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Affiliation(s)
- O'neil W Guthrie
- Cell & Molecular Pathology Laboratory, Communication Sciences and Disorders, Northern Arizona University, Flagstaff, AZ, USA
| | - Christopher Spankovich
- Department of Otolaryngology Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
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Lough M, Plack CJ. Extended high-frequency audiometry in research and clinical practice. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:1944. [PMID: 35364938 DOI: 10.1121/10.0009766] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
Audiometric testing in research and in clinical settings rarely considers frequencies above 8 kHz. However, the sensitivity of young healthy ears extends to 20 kHz, and there is increasing evidence that testing in the extended high-frequency (EHF) region, above 8 kHz, might provide valuable additional information. Basal (EHF) cochlear regions are especially sensitive to the effects of aging, disease, ototoxic drugs, and possibly noise exposure. Hence, EHF loss may be an early warning of damage, useful for diagnosis and for monitoring hearing health. In certain environments, speech perception may rely on EHF information, and there is evidence for an association between EHF loss and speech perception difficulties, although this may not be causal: EHF loss may instead be a marker for sub-clinical damage at lower frequencies. If there is a causal relation, then amplification in the EHF range may be beneficial if the technical difficulties can be overcome. EHF audiometry in the clinic presents with no particular difficulty, the biggest obstacle being lack of specialist equipment. Currently, EHF audiometry has limited but increasing clinical application. With the development of international guidelines and standards, it is likely that EHF testing will become widespread in future.
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Affiliation(s)
- Melanie Lough
- Manchester Centre for Audiology and Deafness, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Christopher J Plack
- Manchester Centre for Audiology and Deafness, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
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Ramkumar V, Mukherjea D, Dhukhwa A, Rybak LP. Oxidative Stress and Inflammation Caused by Cisplatin Ototoxicity. Antioxidants (Basel) 2021; 10:antiox10121919. [PMID: 34943021 PMCID: PMC8750101 DOI: 10.3390/antiox10121919] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023] Open
Abstract
Hearing loss is a significant health problem that can result from a variety of exogenous insults that generate oxidative stress and inflammation. This can produce cellular damage and impairment of hearing. Radiation damage, ageing, damage produced by cochlear implantation, acoustic trauma and ototoxic drug exposure can all generate reactive oxygen species in the inner ear with loss of sensory cells and hearing loss. Cisplatin ototoxicity is one of the major causes of hearing loss in children and adults. This review will address cisplatin ototoxicity. It includes discussion of the mechanisms associated with cisplatin-induced hearing loss including uptake pathways for cisplatin entry, oxidative stress due to overpowering antioxidant defense mechanisms, and the recently described toxic pathways that are activated by cisplatin, including necroptosis and ferroptosis. The cochlea contains G-protein coupled receptors that can be activated to provide protection. These include adenosine A1 receptors, cannabinoid 2 receptors (CB2) and the Sphingosine 1-Phosphate Receptor 2 (S1PR2). A variety of heat shock proteins (HSPs) can be up-regulated in the cochlea. The use of exosomes offers a novel method of delivery of HSPs to provide protection. A reversible MET channel blocker that can be administered orally may block cisplatin uptake into the cochlear cells. Several protective agents in preclinical studies have been shown to not interfere with cisplatin efficacy. Statins have shown efficacy in reducing cisplatin ototoxicity without compromising patient response to treatment. Additional clinical trials could provide exciting findings in the prevention of cisplatin ototoxicity.
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Affiliation(s)
- Vickram Ramkumar
- Department of Pharmacology, School of Medicine, Southern Illinois University, 801 N. Rutledge Street, Springfield, IL 62702, USA; (V.R.); (A.D.)
| | - Debashree Mukherjea
- Department of Otolaryngology, School of Medicine, Southern Illinois University, 801 N. Rutledge Street, Springfield, IL 62702, USA;
| | - Asmita Dhukhwa
- Department of Pharmacology, School of Medicine, Southern Illinois University, 801 N. Rutledge Street, Springfield, IL 62702, USA; (V.R.); (A.D.)
| | - Leonard P. Rybak
- Department of Otolaryngology, School of Medicine, Southern Illinois University, 801 N. Rutledge Street, Springfield, IL 62702, USA;
- Correspondence: ; Fax: +1-217-545-6544
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