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Irfan M, Fatima M, Shehzadi M. Letter to the editor: "Age, preoperative tumor volume and widening of the internal acoustic meatus are independent factors associated with poor preoperative hearing in vestibular schwannoma patients - results of a single-center retrospective analysis". Neurosurg Rev 2024; 47:299. [PMID: 38951277 DOI: 10.1007/s10143-024-02539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Muhammad Irfan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Lyari, Karachi, Pakistan.
| | - Misaal Fatima
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Lyari, Karachi, Pakistan
| | - Maryam Shehzadi
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Lyari, Karachi, Pakistan
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Silva VAR, Lavinsky J, Pauna HF, Vianna MF, Santos VM, Ikino CMY, Sampaio ALL, Tardim Lopes P, Lamounier P, Maranhão ASDA, Soares VYR, Polanski JF, Denaro MMDC, Chone CT, Bento RF, Castilho AM. Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101313. [PMID: 37813009 PMCID: PMC10563065 DOI: 10.1016/j.bjorl.2023.101313] [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: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO
| | - Joel Lavinsky
- Sociedade Brasileira de Otologia - SBO; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Melissa Ferreira Vianna
- Sociedade Brasileira de Otologia - SBO; Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Hospital Universitário, Departamento de Cirurgia, Florianópolis, SC, Brazil
| | - André Luiz Lopes Sampaio
- Sociedade Brasileira de Otologia - SBO; Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Paula Tardim Lopes
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Pauliana Lamounier
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), Departamento de Otorrinolaringologia, Goiânia, GO, Brazil
| | - André Souza de Albuquerque Maranhão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vitor Yamashiro Rocha Soares
- Hospital Flavio Santos e Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackenzie do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil
| | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil; Sociedade Brasileira de Otologia - SBO.
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Mohamed T, Melfi V, Colciago A, Magnaghi V. Hearing loss and vestibular schwannoma: new insights into Schwann cells implication. Cell Death Dis 2023; 14:629. [PMID: 37741837 PMCID: PMC10517973 DOI: 10.1038/s41419-023-06141-z] [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: 04/12/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
Hearing loss (HL) is the most common and heterogeneous disorder of the sensory system, with a large morbidity in the worldwide population. Among cells of the acoustic nerve (VIII cranial nerve), in the cochlea are present the hair cells, the spiral ganglion neurons, the glia-like supporting cells, and the Schwann cells (SCs), which alterations have been considered cause of HL. Notably, a benign SC-derived tumor of the acoustic nerve, named vestibular schwannoma (VS), has been indicated as cause of HL. Importantly, SCs are the main glial cells ensheathing axons and forming myelin in the peripheral nerves. Following an injury, the SCs reprogram, expressing some stemness features. Despite the mechanisms and factors controlling their biological processes (i.e., proliferation, migration, differentiation, and myelination) have been largely unveiled, their role in VS and HL was poorly investigated. In this review, we enlighten some of the mechanisms at the base of SCs transformation, VS development, and progression, likely leading to HL, and we pose great attention on the environmental factors that, in principle, could contribute to HL onset or progression. Combining the biomolecular bench-side approach to the clinical bedside practice may be helpful for the diagnosis, prediction, and therapeutic approach in otology.
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Affiliation(s)
- Tasnim Mohamed
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via G. Balzaretti 9, 20133, Milan, Italy
| | - Valentina Melfi
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via G. Balzaretti 9, 20133, Milan, Italy
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Alessandra Colciago
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via G. Balzaretti 9, 20133, Milan, Italy
| | - Valerio Magnaghi
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via G. Balzaretti 9, 20133, Milan, Italy.
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Koetsier KS, Locher H, Koot RW, van der Mey AGL, van Benthem PPG, Jansen JC, Hensen EF. The Course of Hearing Loss in Patients With a Progressive Vestibular Schwannoma. Otolaryngol Head Neck Surg 2023; 169:622-632. [PMID: 36939458 DOI: 10.1002/ohn.277] [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: 09/07/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study evaluates the natural course of hearing loss (HL) prior to treatment in patients with progressive tumors and an indication for active intervention. Evaluating this patient group specifically can put hearing outcomes after vestibular schwannoma therapy into an adequate context. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. METHODS Inclusion criteria comprised unilateral vestibular schwannomas prior to active treatment, with ≥2 mm extracanalicular (EC) tumor growth and ≥2 audiograms. We performed a comprehensive assessment of hearing using multiple outcome parameters including (the annual decrease in) pure-tone averages (PTAs; an average of 0.5, 1, 2, and 3 kHz). Predictors for HL were evaluated (patient age, tumor size/progression, follow-up duration, baseline hearing). RESULTS At presentation, 86% of patients suffered from sensorineural HL on the affected side (≥20 dB PTA) with a median of 39 dB (interquartile rate [IQR]: 27-51 dB). The median follow-up duration was 21 months (IQR: 13-34 months), after which 58% (187/322) of patients experienced progressive HL (≥10 dB), with a median increase of 6.4 dB/year. At the last follow-up, the median PTA was 56 dB (IQR: 37-73). Median speech discrimination scores deteriorated from 90% (IQR: 70%-100%) to 65% (IQR: 35%-100%). Tumor progression (maximal EC diameter) was significantly correlated to the progression of sensorineural HL, corrected for follow-up (F(2,228) = 10.4, p < .001, R2 = 8%). CONCLUSION The majority of patients (58%) with radiologically confirmed progressive vestibular schwannomas experience progressive sensorineural HL during observation. Tumor progression rate, EC tumor extension, and longer follow-up are factors associated with more sensorineural HL.
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Affiliation(s)
- Kimberley S Koetsier
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Heiko Locher
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Radboud W Koot
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andel G L van der Mey
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter-Paul G van Benthem
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Lin J, You N, Li X, Huang J, Wu H, Lu H, Hu J, Zhang J, Lou X. Atypical functional hierarchy contributed to the tinnitus symptoms in patients with vestibular schwannoma. Front Neurosci 2023; 17:1084270. [PMID: 36875656 PMCID: PMC9982843 DOI: 10.3389/fnins.2023.1084270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023] Open
Abstract
Objective Tinnitus is frequently found in patients with vestibular schwannoma (VS), but its underlying mechanisms are currently unclear. Methods Both preoperative (VS pre ) and postoperative (VS post ) functional MR images were collected from 32 patients with unilateral VS and matched healthy controls (HCs). Connectome gradients were generated for the identification of altered regions and perturbed gradient distances. Tinnitus measurements were conducted for predictive analysis with neuroimaging-genetic integration analysis. Results There were 56.25% of preoperative patients and 65.63% of postoperative patients suffering from ipsilateral tinnitus, respectively. No relevant factors were identified including basic demographics info, hearing performances, tumor features, and surgical approaches. Functional gradient analysis confirmed atypical functional features of visual areas in VS pre were rescued after tumor resection, while the gradient performance in the postcentral gyrus continues to maintain (VS post vs. HC : P = 0.016). The gradient features of the postcentral gyrus were not only significantly decreased in patients with tinnitus (P FDR = 0.022), but also significantly correlated with tinnitus handicap inventory (THI) score (r = -0.30, P = 0.013), THI level (r = -0.31, P = 0.010), and visual analog scale (VAS) rating (r = -0.31, P = 0.0093), which could be used to predict VAS rating in the linear model. Neuropathophysiological features linked to the tinnitus gradient framework were linked to Ribosome dysfunction and oxidative phosphorylation. Conclusion Altered functional plasticity in the central nervous system is involved in the maintenance of VS tinnitus.
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Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Na You
- Department of Neurosurgery, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Xiaolong Li
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Jiayu Huang
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Haoyang Wu
- Basic Medicine School, Air Force Military Medical University, Xi'an, China
| | - Haoxuan Lu
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Jianxing Hu
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Jun Zhang
- Department of Neurosurgery, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese People's Liberation Army General Hospital/Medical School of Chinese People's Liberation Army, Beijing, China
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Tumor Biology and Microenvironment of Vestibular Schwannoma-Relation to Tumor Growth and Hearing Loss. Biomedicines 2022; 11:biomedicines11010032. [PMID: 36672540 PMCID: PMC9856152 DOI: 10.3390/biomedicines11010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Vestibular schwannoma is the most common benign neoplasm of the cerebellopontine angle. It arises from Schwann cells of the vestibular nerve. The first symptoms of vestibular schwannoma include hearing loss, tinnitus, and vestibular symptoms. In the event of further growth, cerebellar and brainstem symptoms, along with palsy of the adjacent cranial nerves, may be present. Although hearing impairment is present in 95% of patients diagnosed with vestibular schwannoma, most tumors do not progress in size or have low growth rates. However, the clinical picture has unpredictable dynamics, and there are currently no reliable predictors of the tumor's behavior. The etiology of the hearing loss in patients with vestibular schwannoma is unclear. Given the presence of hearing loss in patients with non-growing tumors, a purely mechanistic approach is insufficient. A possible explanation for this may be that the function of the auditory system may be affected by the paracrine activity of the tumor. Moreover, initiation of the development and growth progression of vestibular schwannomas is not yet clearly understood. Biallelic loss of the NF2 gene does not explain the occurrence in all patients; therefore, detection of gene expression abnormalities in cases of progressive growth is required. As in other areas of cancer research, the tumor microenvironment is coming to the forefront, also in vestibular schwannomas. In the paradigm of the tumor microenvironment, the stroma of the tumor actively influences the tumor's behavior. However, research in the area of vestibular schwannomas is at an early stage. Thus, knowledge of the molecular mechanisms of tumorigenesis and interactions between cells present within the tumor is crucial for the diagnosis, prediction of tumor behavior, and targeted therapeutic interventions. In this review, we provide an overview of the current knowledge in the field of molecular biology and tumor microenvironment of vestibular schwannomas, as well as their relationship to tumor growth and hearing loss.
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Gan J, Zhang Y, Wu J, Lei D, Zhang F, Zhao H, Wang L. Current Understanding of Hearing Loss in Sporadic Vestibular Schwannomas: A Systematic Review. Front Oncol 2021; 11:687201. [PMID: 34476211 PMCID: PMC8406761 DOI: 10.3389/fonc.2021.687201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Hearing loss is the most common initial symptom in patients with sporadic vestibular schwannomas (SVS). Hearing preservation is an important goal of both conservative and surgical therapy. However, the mechanism of SVS-associated hearing loss remains unclear. Thus, we performed this systematic review to summarize the current understanding of hearing loss in the SVS and distill a testable hypothesis to further illuminate its underlying mechanism. Methods A systematic review querying four databases (PubMed, Medline, Embase, and Web of Science) was performed to identify studies evaluating hearing loss in patients with SVS and exploring the potential mechanisms of hearing impairment. Results A total of 50 articles were eligible and included in this review. After analysis, the retrieved studies could be categorized into four types: (1) 29 studies explore the relationship between hearing loss and the growth pattern of the tumor (e.g., tumor size/volume, growth rate, tumor location, etc.); (2) ten studies investigate the potential role of cochlear dysfunction in hearing deterioration, including structural abnormality, protein elevation in perilymph, and cochlear malfunctioning; (3) two studies looked into SVS-induced impairment of auditory pathway and cortex; (4) in the rest nine studies, researchers explored the molecular mechanism underlying hearing loss in SVS, which involves molecular and genetic alterations, inflammatory response, growth factors, and other tumor-associated secretions. Conclusions Multiple factors may contribute to the hearing impairment in SVS, including the growth pattern of tumor, cochlear dysfunction, impairment of auditory pathway and cortex, genetic and molecular changes. However, our current understanding is still limited, and future studies are needed to explore this multifactorial hypothesis and dig deeper into its underlying mechanism.
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Affiliation(s)
- Jinlu Gan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingnan Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deqiang Lei
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangcheng Zhang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Peter N, Huber A, Egli S, Held U, Steigmiller K, Röösli C. Retrospective Investigation of Contralateral Hearing Thresholds of Patients With Sporadic Vestibular Schwannoma. Otolaryngol Head Neck Surg 2021; 166:933-942. [PMID: 34340628 DOI: 10.1177/01945998211033570] [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: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the contralateral hearing of patients with sporadic vestibular schwannoma (VS). STUDY DESIGN Retrospective cohort study. SETTING Pure-tone audiograms of the contralateral ear from patients with a wait-and-scan strategy were compared to the ones who received therapy. Due to a possible bias caused by the therapy, hearing thresholds before and after radiotherapy or surgery were compared separately with the wait-and-scan group. METHODS From 1979 to 2017, 508 patients with sporadic VS could be included in the study. Of these, 240 received regular controls in the sense of wait-and-scan, 72 underwent radiotherapy (63 audiograms before and 43 after radiotherapy), and 196 had a surgery (186 audiograms before and 146 after surgery). Age-normalized hearing thresholds of the contralateral ear from patients with a wait-and-scan strategy were compared to ones who received therapy. In addition, hearing thresholds were compared to norm values. RESULTS There was no evidence for a difference in the contralateral hearing of patients with sporadic VS between the wait-and-scan and therapy groups. The mean difference of hearing thresholds in our sample to norm values was found to be larger for the high frequencies and more pronounced in male patients. CONCLUSION There was no evidence for a difference in the contralateral hearing loss of patients with sporadic VS between the wait-and-scan and therapy groups. However, there was some indirect indication of poorer contralateral hearing in all patients with sporadic VS compared to normative values.
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Affiliation(s)
- Nicole Peter
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simon Egli
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Klaus Steigmiller
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lee JWY, Hassannia F, Rutka JA. Contralesional High-Acceleration Vestibulo-Ocular Reflex Function in Vestibular Schwannoma. Otol Neurotol 2021; 42:e1106-e1110. [PMID: 34191780 DOI: 10.1097/mao.0000000000003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Impairment of ipsilesional vestibulo-ocular reflex (VOR) function is well described in vestibular schwannoma (VS) and a correlation between gain of the VOR and tumor size has been suggested. Bilateral VOR impairment may also occur in VS patients, but its mechanisms are poorly understood. We sought to explore the effect of unilateral VS on ipsilesional and contralesional high-acceleration VOR function using video head impulse testing, and evaluate potential factors responsible for contralesional VOR impairment. MATERIALS AND METHODS Chart review in tertiary referral center of patients with unilateral VS, who completed neurotological examination and vestibular function testing. RESULTS One hundred one patients (mean age 57.4 yrs) were included. Maximal tumor diameter ranged from 0.3 to 5.0 cm. Forty one patients had evidence of brainstem compression from VS on magnetic resonance imaging (MRI). Ipsilesional and contralesional VOR impairment was present in 81 (80%) and 44 (43%) patients, respectively. Bilateral VOR impairment was seen in 42 (42%) patients. Bilateral VOR impairment correlated with tumor size. Presence of brainstem compression was associated with reduced ipsilesional VOR gain, but not contralesional VOR gain.
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Affiliation(s)
- Jennifer Wing Yee Lee
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, ON, Canada
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Ren Y, Tawfik KO, Mastrodimos BJ, Cueva RA. Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas. Otolaryngol Head Neck Surg 2020; 165:344-353. [PMID: 33290167 DOI: 10.1177/0194599820978246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify preoperative radiographic predictors of hearing preservation (HP) after retrosigmoid resection of vestibular schwannomas (VSs). STUDY DESIGN Retrospective case series with chart review. SETTING Tertiary skull base referral center. METHODS Adult patients with VSs <3 cm and word recognition scores (WRSs) ≥50% who underwent retrosigmoid resection and attempted HP between February 2008 and December 2018 were identified. Pure tone average (PTA), WRS, and magnetic resonance imaging radiographic data, including tumor diameter and dimensional extension relative to the internal auditory canal (IAC), were examined. RESULTS A total of 151 patients were included. The average tumor size was 13.8 mm (range, 3-28). Hearing was preserved in 41.7% (n = 63). HP rates were higher for intracanalicular tumors than tumors with cerebellopontine angle (CPA) components (57.6% vs 29.4%, P = .03). On multivariate analysis, maximal tumor diameter (odds ratio [OR], 0.892; P < .001) and preoperative PTA (OR, 0.974; P = .026) predicted HP, while mediolateral tumor diameter predicted postoperative PTA (OR, 1.21; P = .005) and WRS (OR, -1.89; P < .001). For tumors extending into the CPA, younger age (OR, 0.913; P = .012), better preoperative PTA (OR, 0.935; P = .049), smaller posterior tumor extension (OR, 0.862; P = .001), and smaller caudal extension relative to the IAC (OR, 0.844; P = .001) all predicted HP. CONCLUSION Rates of HP are highest in patients with small intracanalicular VSs and good preoperative hearing. For tumors extending into the CPA, greater posterior and caudal tumor extension relative to the IAC may portend worse hearing outcomes.
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Affiliation(s)
- Yin Ren
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, San Diego, California, USA
| | - Kareem O Tawfik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, San Diego, California, USA.,Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bill J Mastrodimos
- Department of Neurosurgery, Kaiser Permanente Southern California Group, San Diego, California, USA
| | - Roberto A Cueva
- Department of Head and Neck Surgery, Kaiser Permanente Southern California Group, San Diego, California, USA
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Katsumi S, Sahin MI, Lewis RM, Iyer JS, Landegger LD, Stankovic KM. Intracochlear Perfusion of Tumor Necrosis Factor-Alpha Induces Sensorineural Hearing Loss and Synaptic Degeneration in Guinea Pigs. Front Neurol 2020; 10:1353. [PMID: 32116980 PMCID: PMC7025643 DOI: 10.3389/fneur.2019.01353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine that plays a prominent role in the nervous system, mediating a range of physiologic and pathologic functions. In the auditory system, elevated levels of TNF-α have been implicated in several types of sensorineural hearing loss, including sensorineural hearing loss induced by vestibular schwannoma, a potentially fatal intracranial tumor that originates from the eighth cranial nerve; however, the mechanisms underlying the tumor's deleterious effects on hearing are not well-understood. Here, we investigated the effect of acute elevations of TNF-α in the inner ear on cochlear function and morphology by perfusing the cochlea with TNF-α in vivo in guinea pigs. TNF-α perfusion did not significantly change thresholds for compound action potential (CAP) responses, which reflect cochlear nerve activity, or distortion product otoacoustic emissions, which reflect outer hair cell integrity. However, intracochlear TNF-α perfusion reduced CAP amplitudes and increased the number of inner hair cell synapses without paired post-synaptic terminals, suggesting a pattern of synaptic degeneration that resembles that observed in primary cochlear neuropathy. Additionally, etanercept, a TNF-α blocker, protected against TNF-α-induced synaptopathy when administered systemically prior to intracochlear TNF-α perfusion. Findings motivate further investigation into the harmful effects of chronically elevated intracochlear levels of TNF-α, and the potential for etanercept to counter these effects.
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Affiliation(s)
- Sachiyo Katsumi
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States
| | - Mehmet I Sahin
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States
| | - Rebecca M Lewis
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States
| | - Janani S Iyer
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States
| | - Lukas D Landegger
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, United States.,Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, United States.,Harvard Program in Therapeutic Science, Harvard Medical School, Boston, MA, United States
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12
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Gugel I, Ebner FH, Grimm F, Czemmel S, Paulsen F, Hagel C, Tatagiba M, Nahnsen S, Tabatabai G. Contribution of mTOR and PTEN to Radioresistance in Sporadic and NF2-Associated Vestibular Schwannomas: A Microarray and Pathway Analysis. Cancers (Basel) 2020; 12:cancers12010177. [PMID: 31936793 PMCID: PMC7016954 DOI: 10.3390/cancers12010177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
The use of radiation treatment has increased for both sporadic and neurofibromatosis type 2 (NF2)-associated vestibular schwannoma (VS). However, there are a subset of radioresistant tumors and systemic treatments that are seldom used in these patients. We investigated molecular alterations after radiation in three NF2-associated and five sporadically operated recurrent VS after primary irradiation. We compared these findings with 49 non-irradiated (36 sporadic and 13 NF2-associated) VS through gene-expression profiling and pathway analysis. Furthermore, we stained the key molecules of the distinct pathway by immunohistochemistry. A total of 195 differentially expressed genes in sporadic and NF2-related comparisons showed significant differences based on the criteria of p value < 0.05 and a two-fold change. These genes were involved in pathways that are known to be altered upon irradiation (e.g., mammalian target of rapamycin (mTOR), phosphatase and tensin homolog (PTEN) and vascular endothelial growth factor (VEGF) signaling). We observed a combined downregulation of PTEN signaling and an upregulation of mTOR signaling in progressive NF2-associated VS after irradiation. Immunostainings with mTOR and PTEN antibodies confirmed the respective molecular alterations. Taken together, mTOR inhibition might be a promising therapeutic strategy in NF2-associated VS progress after irradiation.
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Affiliation(s)
- Isabel Gugel
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2980325; Fax: +49-07071-295245
| | - Florian H. Ebner
- Department of Neurosurgery, Alfried Krupp Hospital, 45131 Essen, Germany
| | - Florian Grimm
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
| | - Stefan Czemmel
- Quantitative Biology Center (QBiC), University of Tübingen, 72076 Tübingen, Germany
| | - Frank Paulsen
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marcos Tatagiba
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Sven Nahnsen
- Quantitative Biology Center (QBiC), University of Tübingen, 72076 Tübingen, Germany
| | - Ghazaleh Tabatabai
- Center for Neuro-Oncol., Comprehensive Cancer Center Tübingen Stuttgart, 72076 Tübingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
- Interdisciplinary Division of Neuro-Oncol., University Hospital Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
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13
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Lassaletta L, Calvino M, Morales-Puebla JM, Lapunzina P, Rodriguez-de la Rosa L, Varela-Nieto I, Martinez-Glez V. Biomarkers in Vestibular Schwannoma-Associated Hearing Loss. Front Neurol 2019; 10:978. [PMID: 31620068 PMCID: PMC6759574 DOI: 10.3389/fneur.2019.00978] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
Vestibular schwannomas (VSs) are benign tumors composed of differentiated neoplastic Schwann cells. They can be classified into two groups: sporadic VS and those associated with neurofibromatosis type 2 (NF2). VSs usually grow slowly, initially causing unilateral sensorineural hearing loss (HL) and tinnitus. These tumors cause HL both due to compression of the auditory nerve or the labyrinthine artery and due to the secretion of different substances potentially toxic to the inner ear or the cochlear nerve. As more and more patients are diagnosed and need to be managed, we are more than ever in need of searching for biomarkers associated with these tumors. Owing to an unknown toxic substance generated by the tumor, HL in VS may be linked to a high protein amount of perilymph. Previous studies have identified perilymph proteins correlated with tumor-associated HL, including μ-Crystallin (CRYM), low density lipoprotein receptor-related protein 2 (LRP2), immunoglobulin (Ig) γ-4 chain C region, Ig κ-chain C region, complement C3, and immunoglobulin heavy constant γ 3. Besides, the presence of specific subtypes of heat shock protein 70 has been suggested to be associated with preservation of residual hearing. It has been recently demonstrated that chemokine receptor-4 (CXCR4) is overexpressed in sporadic VS as well as in NF2 tumors and that hearing disability and CXCR4 expression may be correlated. Further, the genetic profile of VS and its relationship with poor hearing has also been studied, including DNA methylation, deregulated genes, growth factors, and NF2 gene mutations. The knowledge of biomarkers associated with VS would be of significant value to maximize outcomes of hearing preservation in these patients.
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Affiliation(s)
- Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), CIBER, Institute of Health Carlos III, Madrid, Spain
| | - Miryam Calvino
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain
| | | | - Pablo Lapunzina
- IdiPAZ Research Institute, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), CIBER, Institute of Health Carlos III, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain
| | - Lourdes Rodriguez-de la Rosa
- IdiPAZ Research Institute, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), CIBER, Institute of Health Carlos III, Madrid, Spain.,Institute for Biomedical Research "Alberto Sols" (IIBM), Spanish National Research Council-Autonomous University of Madrid (CSIC-UAM), Madrid, Spain
| | - Isabel Varela-Nieto
- IdiPAZ Research Institute, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), CIBER, Institute of Health Carlos III, Madrid, Spain.,Institute for Biomedical Research "Alberto Sols" (IIBM), Spanish National Research Council-Autonomous University of Madrid (CSIC-UAM), Madrid, Spain
| | - Victor Martinez-Glez
- IdiPAZ Research Institute, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), CIBER, Institute of Health Carlos III, Madrid, Spain.,Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain
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14
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Sagers JE, Sahin MI, Moon I, Ahmed SG, Stemmer-Rachamimov A, Brenner GJ, Stankovic KM. NLRP3 inflammasome activation in human vestibular schwannoma: Implications for tumor-induced hearing loss. Hear Res 2019; 381:107770. [PMID: 31430634 DOI: 10.1016/j.heares.2019.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/23/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Abstract
Vestibular schwannoma (VS) is the fourth most common intracranial tumor, arising from neoplastic Schwann cells of the vestibular nerve and often causing debilitating sensorineural hearing loss (SNHL) and tinnitus. Previous research suggests that the abnormal upregulation of inflammatory pathways plays a highly significant, though infrequently described role in VS pathobiology, and that VS-associated SNHL is due not only to mechanical compression of the auditory nerve but also to differences in the intrinsic biology of these tumors. We hypothesize that patients who present with poor hearing associated with VS experience a more robust inflammatory response to this tumor than VS patients who present with good hearing. To investigate this hypothesis, we conducted a comprehensive pathway analysis using gene expression data from the largest meta-analysis of vestibular schwannoma microarray data, comprising 80 tumors and 16 healthy peripheral nerves. We identified the NLRP3 inflammasome as a novel target worthy of further exploration in VS research and validated this finding at the gene and protein expression level in human VS tissue using qRT-PCR and immunohistochemistry. To date, NLRP3 inflammasome activation has not been reported in VS, and this finding may represent a new and potentially significant therapeutic avenue. Notably, after analysis of 30 VSs, we observe that overexpression of key components of the NLRP3 inflammasome is preferentially associated with tumors that produce increased hearing loss in VS patients. Therefore, therapeutic development for VS should include considerations for minimizing NLRP3-associated inflammation to best preserve hearing.
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Affiliation(s)
- Jessica E Sagers
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA; Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, 02115, USA; Harvard Program in Therapeutic Science, 25 Shattuck St., Boston, MA, 02115, USA
| | - Mehmet I Sahin
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - InSeok Moon
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - Sherif G Ahmed
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Anat Stemmer-Rachamimov
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Gary J Brenner
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Konstantina M Stankovic
- Eaton-Peabody Laboratories and Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA; Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, 02115, USA; Harvard Program in Therapeutic Science, 25 Shattuck St., Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
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15
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Ren Y, Stankovic KM. The Role of Tumor Necrosis Factor Alpha (TNFα)in Hearing Loss and Vestibular Schwannomas. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018; 6:15-23. [PMID: 31485383 DOI: 10.1007/s40136-018-0186-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose of review The aim of this review is to highlight relevant literature on the role of tumor necrosis factor alpha (TNFα) in sensorineural hearing loss (SNHL) and vestibular schwannomas (VS). Recent Findings A comprehensive review of publically available databases including PubMed was performed. The mechanism by which hearing loss occurs in VS is still unknown and likely multifactorial. Genetic differences between VSs and tumor secreted proteins may be responsible, at least in part, for VS-associated SNHL. TNFα has pleotropic roles in promoting inflammation, maintaining cellular homeostasis, inducing apoptosis, and mediating ototoxicity in patients with sporadic VS. TNFα-targeted therapies have shown efficacy in both animal models of sensorineural hearing loss and clinical trials in patients with immune-mediated hearing loss. Efforts are underway to develop novel nanotechnology-based methods to target TNFα and other pathogenic molecules in VS. Summary Development of molecularly targeted therapies against TNFα represents an important area of research in ameliorating VS-associated hearing loss.
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Affiliation(s)
- Yin Ren
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Konstantina M Stankovic
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Eaton Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA.,Harvard Program in Speech and Hearing Bioscience and Technology, 25 Shattuck Street, Boston, MA 02115, USA
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16
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Immediate and Long-term Hearing Outcomes With the Middle Cranial Fossa Approach for Vestibular Schwannoma Resection. Otol Neurotol 2018; 39:92-98. [DOI: 10.1097/mao.0000000000001623] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Ren Y, Sagers JE, Landegger LD, Bhatia SN, Stankovic KM. Tumor-Penetrating Delivery of siRNA against TNFα to Human Vestibular Schwannomas. Sci Rep 2017; 7:12922. [PMID: 29018206 PMCID: PMC5635039 DOI: 10.1038/s41598-017-13032-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 01/13/2023] Open
Abstract
Vestibular schwannoma (VS) is the most common tumor of the cerebellopontine angle, and it typically presents with sensorineural hearing loss. The genomic landscape of schwannoma is complex and many of the molecules implicated in VS pathogenesis represent targets not amenable to antibody-based or small molecule therapeutics. Tumor-targeted delivery of small interfering RNA (siRNA) therapeutics provides a direct and effective means to interrogate targets while minimizing off-target effects. To establish a preclinical model for therapeutic inhibition of putative targets in VS, archived tumor specimens, fresh tumor cells derived from patients with sporadic VS, and an established schwannoma cell line were screened. Nanoparticles directed by the tumor-homing peptide iRGD were selectively taken up by primary VS cultures in vitro via interactions with αvβ3/β5 integrins and neuropilin-1 (NRP-1). Cellular uptake was inhibited by a neutralizing antibody against αv integrin in a dose-dependent manner. When applied to primary VS cultures, iRGD-targeted nanoparticles delivered siRNA directed against TNFα in a receptor-specific fashion to potently silence gene expression and protein secretion. Taken together, our results provide a proof of principle for tumor-targeted, nanoparticle-mediated delivery of siRNA to VS and establish a novel platform for the development and pre-clinical screening of molecular therapeutics against VS.
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Affiliation(s)
- Yin Ren
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - Jessica E Sagers
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Harvard Program in Speech and Hearing Bioscience and Technology, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Lukas D Landegger
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Otolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sangeeta N Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Institute for Medical Engineering and Science, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Department of Electrical Engineering and Computer Science, MIT, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Howard Hughes Medical Institute, 4000 Jones Bridge Road, Chevy Chase, MD, 20815, USA
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA. .,Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA. .,Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Harvard Program in Speech and Hearing Bioscience and Technology, 25 Shattuck Street, Boston, MA, 02115, USA.
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18
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Soares VYR, Atai NA, Fujita T, Dilwali S, Sivaraman S, Landegger LD, Hochberg FH, Oliveira CAPC, Bahmad F, Breakefield XO, Stankovic KM. Extracellular vesicles derived from human vestibular schwannomas associated with poor hearing damage cochlear cells. Neuro Oncol 2016; 18:1498-1507. [PMID: 27194145 DOI: 10.1093/neuonc/now099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) is a tumor of the vestibular nerve that transmits balance information from the inner ear to the brain. Sensorineural hearing loss occurs in 95% of patients with these tumors, but the cause of this loss is not well understood. We posit a role of VS-secreted extracellular vesicles (EVs) as a major contributing factor in cochlear nerve damage. METHODS Using differential centrifugation, we isolated EVs from VS cell line HEI-193 and primary cultured human VS cells from patients with good hearing or poor hearing. The EVs were characterized using a Nanosight device and transmission electron microscopy and by extracting their RNA content. The EVs' effects on cultured murine spiral ganglion cells and organotypic cochlear cultures were studied using a transwell dual-culture system and by direct labeling of EVs with PKH-67 dye. EV-induced changes in cochlear cells were quantified using confocal immunohistochemistry. Transfection of VS cells with a green fluorescent protein-containing plasmid was confirmed with reverse transcription PCR. RESULTS Human VS cells, from patients with poor hearing, produced EVs that could damage both cultured murine cochlear sensory cells and neurons. In contrast, EVs derived from VS cells from patients with good hearing did not damage the cultured cochlear cells. CONCLUSIONS This is the first report on EVs derived from VSs and on the capacity of EVs from VSs from patients with hearing loss to selectively damage cochlear cells, thereby identifying a potential novel mechanism of VS-associated sensorineural hearing loss.
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Affiliation(s)
- Vitor Y R Soares
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Nadia A Atai
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Takeshi Fujita
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Sonam Dilwali
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Sarada Sivaraman
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Lukas D Landegger
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Fred H Hochberg
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Carlos A P C Oliveira
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Fayez Bahmad
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Xandra O Breakefield
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
| | - Konstantina M Stankovic
- Department of Otolaryngology, Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts (V.Y.R.S., T.F., S.D., L.D.L., K.M.S.); Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts (V.Y.R.S., T.F., L.D.L., K.M.S.); Health Science Program and Department of Otolaryngology, University of Brasilia, Brasília, Distrito Federal, Brazil (V.Y.R.S., C.A.P.C.O., F.B.); University of Amsterdam, Amsterdam, the Netherlands (N.A.A.); Department of Neurology and Radiology, Massachusetts General Hospital and Program in Neuroscience, Harvard Medical School, Charlestown, Massachusetts (N.A.A., S.S., X.O.B.); Harvard-MIT Program in Speech and Hearing Bioscience and Technology, Boston, Massachusetts (S.D., K.M.S); Department of Neurosurgery, University of California at San Diego, San Diego, California (F.H.H.)
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Bonne NX, Vitte J, Chareyre F, Karapetyan G, Khankaldyyan V, Tanaka K, Moats RA, Giovannini M. An allograft mouse model for the study of hearing loss secondary to vestibular schwannoma growth. J Neurooncol 2016; 129:47-56. [PMID: 27177628 DOI: 10.1007/s11060-016-2150-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/06/2016] [Indexed: 02/07/2023]
Abstract
Vestibular schwannoma is a benign neoplasm arising from the Schwann cell sheath of the auditory-vestibular nerve. It most commonly affects both sides in the genetic condition Neurofibromatosis type 2, causing progressive high frequency sensorineural hearing loss. Here, we describe a microsurgical technique and stereotactic coordinates for schwannoma cell grafting in the vestibular nerve region that recapitulates local tumor growth in the cerebellopontine angle and inner auditory canal with resulting hearing loss. Tumor growth was monitored by bioluminescence and MRI in vivo imaging, and hearing assessed by auditory brainstem responses. These techniques, by potentially enabling orthotopic grafting of a variety of cell lines will allow studies on the pathogenesis of tumor-related hearing loss and preclinical drug evaluation, including hearing endpoints, for NF2-related and sporadic schwannomas.
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Affiliation(s)
- Nicolas-Xavier Bonne
- House Research Institute, Center for Neural Tumor Research, Los Angeles, CA, USA.,Department of Otology and Neurotology, University Hospital of Lille, and INSERM U1008 "Controlled Drug Delivery System and Biomaterials", University of Lille, Lille, France
| | - Jérémie Vitte
- Department of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fabrice Chareyre
- House Research Institute, Center for Neural Tumor Research, Los Angeles, CA, USA
| | - Gevorg Karapetyan
- Department of Radiology, USC Keck School of Medicine, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Vazgen Khankaldyyan
- Department of Radiology, USC Keck School of Medicine, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Karo Tanaka
- House Research Institute, Center for Neural Tumor Research, Los Angeles, CA, USA
| | - Rex A Moats
- Department of Radiology, USC Keck School of Medicine, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Marco Giovannini
- Department of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Jonsson Comprehensive Cancer Center, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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20
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Dilwali S, Landegger LD, Soares VYR, Deschler DG, Stankovic KM. Secreted Factors from Human Vestibular Schwannomas Can Cause Cochlear Damage. Sci Rep 2015; 5:18599. [PMID: 26690506 PMCID: PMC4686978 DOI: 10.1038/srep18599] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/26/2015] [Indexed: 12/25/2022] Open
Abstract
Vestibular schwannomas (VSs) are the most common tumours of the cerebellopontine angle. Ninety-five percent of people with VS present with sensorineural hearing loss (SNHL); the mechanism of this SNHL is currently unknown. To establish the first model to study the role of VS-secreted factors in causing SNHL, murine cochlear explant cultures were treated with human tumour secretions from thirteen different unilateral, sporadic VSs of subjects demonstrating varied degrees of ipsilateral SNHL. The extent of cochlear explant damage due to secretion application roughly correlated with the subjects' degree of SNHL. Secretions from tumours associated with most substantial SNHL resulted in most significant hair cell loss and neuronal fibre disorganization. Secretions from VSs associated with good hearing or from healthy human nerves led to either no effect or solely fibre disorganization. Our results are the first to demonstrate that secreted factors from VSs can lead to cochlear damage. Further, we identified tumour necrosis factor alpha (TNFα) as an ototoxic molecule and fibroblast growth factor 2 (FGF2) as an otoprotective molecule in VS secretions. Antibody-mediated TNFα neutralization in VS secretions partially prevented hair cell loss due to the secretions. Taken together, we have identified a new mechanism responsible for SNHL due to VSs.
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Affiliation(s)
- Sonam Dilwali
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Harvard-MIT Program in Health, Science and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Lukas D Landegger
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Vitor Y R Soares
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Health Science Faculty, University of Brasilia, SGAN, Via L2 Norte, Quadra 604/605, 70840-050, Asa Norte, DF, Brazil
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.,Harvard-MIT Program in Health, Science and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.,Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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21
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Doherty J, Go JL, Linthicum FH. Neurofibromatosis 2 invasion of the internal auditory canal wall: clinical significance. Otol Neurotol 2015; 35:1662-8. [PMID: 25118583 DOI: 10.1097/mao.0000000000000494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the infiltration of severe phenotype ("Wishart") neurofibromatosis type 2 (NF2)-related vestibular nerve schwannomas (VSs) into the internal auditory canal wall in contrast to sporadic VS and the milder ("Gardner") phenotype NF2-related VS. STUDY DESIGN Retrospective case series involving microscopic examination and review of clinical history. SETTING Temporal bone laboratory, harboring 849 documented pairs of decalcified, formalin-fixed, celloidin-embedded, sectioned human temporal bones (hTBs) with clinical history. SUBJECTS AND METHODS Histologic sections from 56 patients who had been treated by the House Clinic for VS and who had pledged their temporal bones were identified in the data base of the laboratory. Twenty-four hTBs were from individuals with NF2.Each series of sections was examined microscopically for evidence of invasion of the walls of the internal auditory canal (IAC), hearing thresholds, speech discrimination, score (SDS), and tumor recurrence. RESULTS Infiltration of the walls of the IAC by small buds of VS was found in 17 of the 24 NF2 hTBs. The only 2 NF2 without invasion were from an elderly patient with the milder (Gardner) form of NF2. Ten of the 12 NF2 patients had undergone surgery for the removal of their tumor, but residual tumor remained in the bone surrounding the IAC. Invasive VS were associated with poorer hearing thresholds at 250, 500, 1,000, and 2,000 Hz and lower SDS score. A relationship between invasion and recurrence was not statistically significant. CONCLUSION The majority of IAC tumors associated with the severe "Wishart" phenotype demonstrate bone invasion within the IAC. Invasion of bone was associated with poorer hearing. The invasive nature of NF2-associated tumors may partially explain their higher recurrence rate after resection. Surgeons managing NF2-related VS should be aware of the small infiltrations of the wall of the IAC when removing these tumors to minimize recurrence.
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Affiliation(s)
- Joni Doherty
- *The House Temporal Bone Laboratory, University of California; and †Department of Radiology, University of Southern California, Los Angeles, California, U.S.A
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22
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Dilwali S, Briët MC, Kao SY, Fujita T, Landegger LD, Platt MP, Stankovic KM. Preclinical validation of anti-nuclear factor-kappa B therapy to inhibit human vestibular schwannoma growth. Mol Oncol 2015; 9:1359-70. [PMID: 25891780 DOI: 10.1016/j.molonc.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/22/2015] [Accepted: 03/23/2015] [Indexed: 01/25/2023] Open
Abstract
Vestibular schwannomas (VSs), the most common tumors of the cerebellopontine angle, arise from Schwann cells lining the vestibular nerve. Pharmacotherapies against VS are almost non-existent. Although the therapeutic inhibition of inflammatory modulators has been established for other neoplasms, it has not been explored in VS. A bioinformatic network analysis of all genes reported to be differentially expressed in human VS revealed a pro-inflammatory transcription factor nuclear factor-kappa B (NF-κB) as a central molecule in VS pathobiology. Assessed at the transcriptional and translational level, canonical NF-κB complex was aberrantly activated in human VS and derived VS cultures in comparison to control nerves and Schwann cells, respectively. Cultured primary VS cells and VS-derived human cell line HEI-193 were treated with specific NF-κB siRNAs, experimental NF-κB inhibitor BAY11-7082 (BAY11) and clinically relevant NF-κB inhibitor curcumin. Healthy human control Schwann cells from the great auricular nerve were also treated with BAY11 and curcumin to assess toxicity. All three treatments significantly reduced proliferation in primary VS cultures and HEI-193 cells, with siRNA, 5 μM BAY11 and 50 μM curcumin reducing average proliferation (±standard error of mean) to 62.33% ± 10.59%, 14.3 ± 9.7%, and 23.0 ± 20.9% of control primary VS cells, respectively. These treatments also induced substantial cell death. Curcumin, unlike BAY11, also affected primary Schwann cells. This work highlights NF-κB as a key modulator in VS cell proliferation and survival and demonstrates therapeutic efficacy of directly targeting NF-κB in VS.
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Affiliation(s)
- Sonam Dilwali
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Harvard-MIT Program in Speech and Hearing Bioscience and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.
| | - Martijn C Briët
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Department of Otorhinolaryngology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Shyan-Yuan Kao
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
| | - Takeshi Fujita
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Lukas D Landegger
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Michael P Platt
- Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Otolaryngology-Head and Neck Surgery, Boston University, 72 E Concord Street, Boston, MA 02118, USA.
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Department of Otolaryngology, 243 Charles Street, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Harvard-MIT Program in Speech and Hearing Bioscience and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Sporadic vestibular schwannomas associated with good hearing secrete higher levels of fibroblast growth factor 2 than those associated with poor hearing irrespective of tumor size. Otol Neurotol 2013; 34:748-54. [PMID: 23512073 DOI: 10.1097/mao.0b013e31828048ec] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
HYPOTHESIS We hypothesize that the severity of hearing loss (HL) associated with sporadic vestibular schwannomas (VS) is correlated with tumor secretion of proteins with ototoxic or otoprotective potential. BACKGROUND Because the recognition that HL associated with VS is not solely due to compression of the auditory nerve, elucidating the mechanism by which VS cause HL has been an important task. We previously showed that VS stratified by hearing have differential gene expression. We now focus on identifying differentially expressed proteins in tumor secretions. METHODS Fresh surgical specimens of VS were incubated in sterile PBS at 37°C to collect secretions. The specimens were divided into a group associated with good hearing (GH, word recognition ≥ 70% and pure-tone average ≤ 30 dB, n = 11) or poor hearing (PH, n = 10). The groups were compared using a customized cytokine array. Statistically significant results were verified with an enzyme-linked immunosorbent assay on a different set of secretions (n = 8 for GH and n = 10 for PH group). RESULTS Of the 37 molecules we studied, 9 were significantly expressed in secretions from VS compared with secretions from control nerves. Secretion of fibroblast growth factor 2 (FGF2) was 3.5-fold higher in VS associated with GH versus PH based on cytokine array analysis (p = 0.02), which was validated with enzyme-linked immunosorbent assay. CONCLUSION This study highlights FGF2, a mitogen known to protect the auditory nerve, as a potential tumor-secreted mediator of hearing protection in VS. If FGF2's significant role in hearing protection in patients with VS is validated, then FGF2 could be used as a biomarker for HL in VS, and therapeutic targeting of the FGF2 signaling pathway may reduce HL due to VS.
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24
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Celis-Aguilar E, Lassaletta L, Torres-Martín M, Rodrigues FY, Nistal M, Castresana JS, Gavilan J, Rey JA. The molecular biology of vestibular schwannomas and its association with hearing loss: a review. GENETICS RESEARCH INTERNATIONAL 2012; 2012:856157. [PMID: 22567403 PMCID: PMC3335540 DOI: 10.1155/2012/856157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/08/2011] [Accepted: 11/03/2011] [Indexed: 01/16/2023]
Abstract
Hearing loss is the most common symptom in patients with vestibular schwannoma (VS). In the past, compressive mechanisms caused by the tumoral mass and its growth have been regarded as the most likely causes of the hearing loss associated with VS. Interestingly, new evidence proposes molecular mechanisms as an explanation for such hearing loss. Among the molecular mechanisms proposed are methylation of TP73, negative expression of cyclin D1, expression of B7-H1, increased expression of the platelet-derived growth factor A, underexpression of PEX5L, RAD54B, and PSMAL, and overexpression of CEA. Many molecular mechanisms are involved in vestibular schwannoma development; we review some of these mechanisms with special emphasis on hearing loss associated with vestibular schwannoma.
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Affiliation(s)
- Erika Celis-Aguilar
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, 14269 Ciudad de México, DF, Mexico
| | - Luis Lassaletta
- Department of Otolaryngology, “La Paz” University Hospital, 28046 Madrid, Spain
| | - Miguel Torres-Martín
- Unidad de Investigación, Laboratorio Oncogenetica Molecular, “La Paz” University Hospital, 28046 Madrid, Spain
| | - F. Yuri Rodrigues
- Department of Pathology, “La Paz” University Hospital, 28046 Madrid, Spain
| | - Manuel Nistal
- Department of Pathology, “La Paz” University Hospital, 28046 Madrid, Spain
| | - Javier S. Castresana
- Brain Tumor Biology Unit, CIFA, University of Navarra School of Sciences, 31009 Pamplona, Spain
| | - Javier Gavilan
- Department of Otolaryngology, “La Paz” University Hospital, 28046 Madrid, Spain
| | - Juan A. Rey
- Department of Pathology, “La Paz” University Hospital, 28046 Madrid, Spain
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25
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Lysaght AC, Kao SY, Paulo JA, Merchant SN, Steen H, Stankovic KM. Proteome of human perilymph. J Proteome Res 2011; 10:3845-51. [PMID: 21740021 DOI: 10.1021/pr200346q] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Current diagnostic tools limit a clinician's ability to discriminate between many possible causes of sensorineural hearing loss. This constraint leads to the frequent diagnosis of the idiopathic condition, leaving patients without a clear prognosis and only general treatment options. As a first step toward developing new diagnostic tools and improving patient care, we report the first use of liquid chromatography-tandem mass-spectrometry (LC-MS/MS) to map the proteome of human perilymph. Using LC-MS/MS, we analyzed four samples, two collected from patients with vestibular schwannoma (VS) and two from patients undergoing cochlear implantation (CI). For each cohort, one sample contained pooled specimens collected from five patients and the second contained a specimen obtained from a single patient. Of the 271 proteins identified with high confidence among the samples, 71 proteins were common in every sample and used to conservatively define the proteome of human perilymph. Comparison to human cerebrospinal fluid and blood plasma, as well as murine perilymph, showed significant similarity in protein content across fluids; however, a quantitative comparison was not possible. Fifteen candidate biomarkers of VS were identified by comparing VS and CI samples. This list will be used in future investigations targeted at discriminating between VS tumors associated with good versus poor hearing.
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Affiliation(s)
- Andrew C Lysaght
- Program in Speech and Hearing Bioscience and Technology, Harvard & MIT, Cambridge, Massachusetts 02139, United States
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Fundal fluid as a predictor of hearing preservation in the middle cranial fossa approach for vestibular schwannoma. Otol Neurotol 2010; 31:1128-34. [PMID: 20657334 DOI: 10.1097/mao.0b013e3181e8fc3f] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Determine if the presence of cerebrospinal fluid in the fundal region of the internal auditory canal on preoperative magnetic resonance imaging (MRI) scans is predictive of improved hearing preservation after removal of vestibular schwannoma through the middle cranial fossa approach. Relationships between fundal fluid, tumor nerve of origin, tumor size, and hearing preservation also are examined. STUDY DESIGN Retrospective review. SETTING Private practice tertiary neurotology referral center. PATIENTS One hundred one patients with preoperative MRI, complete preoperative and postoperative audiologic data, and histopathologically confirmed vestibular schwannoma treated with a middle cranial fossa approach between January 1, 2006, and June 30, 2009. INTERVENTIONS Primary middle cranial fossa approach for removal of vestibular schwannoma. MAIN OUTCOME MEASURES Fundal fluid status (presence or absence), preoperative and postoperative pure-tone average, and speech discrimination scores and tumor nerve of origin. RESULTS Fundal fluid was present in 75% of cases. Those with fluid had a higher rate of postoperative measurable hearing (77.6%) compared with those without fundal fluid (52%) (p <or= 0.014). Tumors arising from the superior vestibular nerve also were associated with a higher rate of preserved, serviceable, and measurable hearing, whereas the combination of the presence of fundal fluid and superior nerve tumor had a significantly better chance of hearing preservation than either factor alone. CONCLUSION The presence of fundal fluid on preoperative MRI is predictive of hearing outcomes and should be used in counseling patients who are considering hearing preservation surgery via a middle cranial fossa approach for the treatment of isolated vestibular schwannoma.
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