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Massa HM, Spann KM, Cripps AW. Innate Immunity in the Middle Ear Mucosa. Front Cell Infect Microbiol 2021; 11:764772. [PMID: 34778109 PMCID: PMC8586084 DOI: 10.3389/fcimb.2021.764772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/11/2021] [Indexed: 01/14/2023] Open
Abstract
Otitis media (OM) encompasses a spectrum of clinical presentations ranging from the readily identifiable Acute OM (AOM), which is characterised by otalgia and fever, to chronic otitis media with effusion (COME) where impaired hearing due to middle ear effusion may be the only clinical symptom. Chronic suppurative OM (CSOM) presents as a more severe form of OM, involving perforation of the tympanic membrane. The pathogenesis of OM in these varied clinical presentations is unclear but activation of the innate inflammatory responses to viral and/or bacterial infection of the upper respiratory tract performs an integral role. This localised inflammatory response can persist even after pathogens are cleared from the middle ear, eustachian tubes and, in the case of respiratory viruses, even the nasal compartment. Children prone to OM may experience an over exuberant inflammatory response that underlies the development of chronic forms of OM and their sequelae, including hearing impairment. Treatments for chronic effusive forms of OM are limited, with current therapeutic guidelines recommending a "watch and wait" strategy rather than active treatment with antibiotics, corticosteroids or other anti-inflammatory drugs. Overall, there is a clear need for more targeted and effective treatments that either prevent or reduce the hyper-inflammatory response associated with chronic forms of OM. Improved treatment options rely upon an in-depth understanding of OM pathogenesis, particularly the role of the host innate immune response during acute OM. In this paper, we review the current literature regarding the innate immune response within the middle ear to bacterial and viral otopathogens alone, and as co-infections. This is an important consideration, as the role of respiratory viruses as primary pathogens in OM is not yet fully understood. Furthermore, increased reporting from PCR-based diagnostics, indicates that viral/bacterial co-infections in the middle ear are more common than bacterial infections alone. Increasingly, the mechanisms by which viral/bacterial co-infections may drive or maintain complex innate immune responses and inflammation during OM as a chronic response require investigation. Improved understanding of the pathogenesis of chronic OM, including host innate immune response within the middle ear is vital for development of improved diagnostic and treatment options for our children.
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Affiliation(s)
- Helen M Massa
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Kirsten M Spann
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Allan W Cripps
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast, QLD, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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Hur DG, Kurabi A, Lim HW, Spriggs M, Pak K, Ryan AF. Macrophage Depletion in CCR2-/- Mice Delays Bacterial Clearance and Enhances Neutrophil Infiltration in an Acute Otitis Media Model. J Infect Dis 2021; 223:333-341. [PMID: 32572481 DOI: 10.1093/infdis/jiaa353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Otitis media (OM) is a common and potentially serious disease of childhood. Although OM is multifactorial on origin, bacterial infection is a unifying component. Many studies have established a critical role for innate immunity in bacterial clearance and OM resolution. A key component of innate immunity is the recruitment of immune and inflammatory cells, including macrophages. METHODS To explore the role of macrophages in OM, we evaluated the expression of genes related to macrophage function during a complete episode of acute OM in the mouse caused by middle ear (ME) inoculation with Haemophilus influenzae. We also combined CCR2 deficiency with chlodronate liposome toxicity to deplete macrophages during OM. RESULTS Macrophage genes were robustly regulated during OM. Moreover, macrophage depletion enhanced and prolonged the infiltration of neutrophils into the infected ME and increased the persistence of bacterial infection. CONCLUSIONS The results illustrate the critical role played by macrophages in OM resolution.
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Affiliation(s)
- Dong Gu Hur
- Department of Surgery and Otolaryngology, School of Medicine, University of California, San Diego, La Jolla, California, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Arwa Kurabi
- Department of Surgery and Otolaryngology, School of Medicine, University of California, San Diego, La Jolla, California, USA.,Research Service, Veterans Administration Medical Center, San Diego, California, USA
| | - Hyun Woo Lim
- Department of Surgery and Otolaryngology, School of Medicine, University of California, San Diego, La Jolla, California, USA.,Department of Otorhinolaryngology, Gangneung Asan Hospital, Gangneung, South Korea
| | - Meghan Spriggs
- Department of Surgery and Otolaryngology, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kwang Pak
- Research Service, Veterans Administration Medical Center, San Diego, California, USA
| | - Allen F Ryan
- Department of Surgery and Otolaryngology, School of Medicine, University of California, San Diego, La Jolla, California, USA.,Research Service, Veterans Administration Medical Center, San Diego, California, USA
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Gisselsson-Solén M, Tähtinen PA, Ryan AF, Mulay A, Kariya S, Schilder AG, Valdez TA, Brown S, Nolan RM, Hermansson A, van Ingen G, Marom T. Panel 1: Biotechnology, biomedical engineering and new models of otitis media. Int J Pediatr Otorhinolaryngol 2020; 130 Suppl 1:109833. [PMID: 31901291 PMCID: PMC7176743 DOI: 10.1016/j.ijporl.2019.109833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To summarize recently published key articles on the topics of biomedical engineering, biotechnology and new models in relation to otitis media (OM). DATA SOURCES Electronic databases: PubMed, Ovid Medline, Cochrane Library and Clinical Evidence (BMJ Publishing). REVIEW METHODS Articles on biomedical engineering, biotechnology, material science, mechanical and animal models in OM published between May 2015 and May 2019 were identified and subjected to review. A total of 132 articles were ultimately included. RESULTS New imaging technologies for the tympanic membrane (TM) and the middle ear cavity are being developed to assess TM thickness, identify biofilms and differentiate types of middle ear effusions. Artificial intelligence (AI) has been applied to train software programs to diagnose OM with a high degree of certainty. Genetically modified mice models for OM have further investigated what predisposes some individuals to OM and consequent hearing loss. New vaccine candidates protecting against major otopathogens are being explored and developed, especially combined vaccines, targeting more than one pathogen. Transcutaneous vaccination against non-typeable Haemophilus influenzae has been successfully tried in a chinchilla model. In terms of treatment, novel technologies for trans-tympanic drug delivery are entering the clinical domain. Various growth factors and grafting materials aimed at improving healing of TM perforations show promising results in animal models. CONCLUSION New technologies and AI applications to improve the diagnosis of OM have shown promise in pre-clinical models and are gradually entering the clinical domain. So are novel vaccines and drug delivery approaches that may allow local treatment of OM. IMPLICATIONS FOR PRACTICE New diagnostic methods, potential vaccine candidates and the novel trans-tympanic drug delivery show promising results, but are not yet adapted to clinical use.
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Affiliation(s)
- Marie Gisselsson-Solén
- Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Paula A. Tähtinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Allen F. Ryan
- Division of Otolaryngology, Department of Surgery, University of California, San Diego, La Jolla, CA, USA,San Diego Veterans Affairs Healthcare System, Research Department, San Diego, CA, USA
| | - Apoorva Mulay
- The Stripp Lab, Pulmonary Department, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Anne G.M. Schilder
- EvidENT, Ear Institute, University College London, London, UK,National Institute for Health Research University College London Biomedical Research Centre, London, UK,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tulio A. Valdez
- Department of Otolaryngology Head & Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Steve Brown
- MRC Harwell Institute, Mammalian Genetics Unit, Harwell Campus, Oxfordshire, UK
| | | | - Ann Hermansson
- Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Gijs van Ingen
- Department of Otolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences Ben Gurion University, Ashdod, Israel.
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