How are the inner hair cells and auditory nerve fibers activated without the mediation of the outer hair cells and the cochlear amplifier?

Predicting the Need for a Tier II Ototoxicity Study From Early Renal Function Data

History has established that many drugs, such as the antibiotics, chemotherapies, and loop diuretics, are capable of inducing both nephrotoxicity and ototoxicity. The exact mechanisms by which cellular damage occurs remain to be fully elucidated. Monitoring the indices of renal function conducted in the Food and Drug Administration's prescribed set of early investigational new drug (IND)-enabling studies may be the first signs of ototoxicity properties of the new drug candidate. In developing improved and efficacious new molecular entities, it is critically necessary to understand the cellular and molecular mechanisms underlying the potential ototoxic effects as early in the drug development program as possible. Elucidation of these mechanisms will facilitate the development of safe and effective clinical approaches for the prevention and amelioration of drug-induced ototoxicity prior to the first dose in man. Biomarkers for nephrotoxicity in early tier I or tier II nonclinical IND-enabling studies should raise an inquiry as to the need to conduct a full auditory function assay early in the game to clear the pipeline with a safer candidate that has a higher probability of continued therapeutic compliance once approved for distribution.

Combined effects of salicylic acid and furosemide and noise on hearing

Background

A major cause of the hearing loss following exposure to intense noise involves release of free radicals resulting from the elevated metabolism. The free radicals induce damage to several of the components of the cochlear amplifier including the outer hair cells and indirectly to the transduction currents. Salicylic acid induces a reversible hearing loss since it binds to the motor protein prestin in the outer hair cells, reducing electromotility. Furosemide also induces a reversible hearing loss since it reduces the endocochlear potential which is a major component of the cochlear transduction currents. On the other hand, each of these drugs also provides protection from a noise induced hearing loss if they are injected just before a noise exposure, probably as a result of the decreased metabolism induced in their presence, with release of lower levels of free radicals. In this study, both drugs were administered in order to assess whether their protective effects would be additive.

Methods

The study was conducted on normal hearing albino mice of the Sabra strain. They were injected with either salicylic acid alone (N = 11), or furosemide alone (N = 14), or both together (N = 14), or with saline control (N = 11) and exposed to broad band noise for 3.5 hours. An additional group of 9 mice was injected with both salicylic acid and furosemide, but not exposed to noise. The degree of the resulting hearing loss was assessed by recording thresholds of the auditory nerve brainstem evoked responses to broad band clicks before the injections and noise, and 7, 14 and 21 days after.

Results

The noise induced hearing loss in the mice injected with salicylic acid alone or furosemide alone was smaller than in those injected with saline, i.e. these drugs provided protection, as in previous studies in this laboratory. There was no threshold elevation after two weeks in the mice injected with both drugs without noise exposure, i.e. the effects of the two drugs given together was reversible. On the other hand, there was a significant hearing loss (i.e. threshold elevation) in the group which received both drugs and was also exposed to noise, with mean threshold elevations of 38.8 ± 19.0 dB and 28.3 ± 11.7 dB 7 days after noise exposure.

Conclusions

This result is very surprising, if not paradoxical. Drugs which provide protection from a noise induced hearing loss when administered alone, not only do not provide protection when given together, but also induce a greater hearing loss when accompanied by noise. This observation may be related to the finding that the depression of the endocochlear potential normally caused by furosemide is reduced in the presence of salicylic acid, so that the protection usually provided by furosemide is not present when it is administered together with salicylic acid. Thus it seems that each drug may interfere with the protective action of the other when coupled with noise.

Effects of developmental exposure to polychlorinated biphenyls and/or polybrominated diphenyl ethers on cochlear function

Developmental exposure to polychlorinated biphenyls (PCBs) causes hearing loss that may be due to reduced thyroxine during cochlear development. Polybrominated diphenyl ethers (PBDEs) are structurally similar to PCBs and reduce thyroxine. This study utilized an environmental PCB mixture and a commercial PBDE mixture, DE-71, that represents the PBDEs found in humans to assess the potential for additive effects of PCBs and PBDEs on cochlear function. Female Long-Evans rats were dosed with corn oil vehicle, PCBs (3 or 6 mg/kg), molar equivalent doses of PBDEs (5.7 or 11.4 mg/kg), 3 mg/kg PCBs + 5.7 mg/kg PBDEs, or 6 mg/kg PCBs + 11.4 mg/kg PBDEs throughout gestation and lactation. At weaning, pup blood was taken to assess thyroxine concentrations. One male and one female from each litter were maintained until adulthood for distortion product otoacoustic emission (DPOAE) measurements of cochlear function. DPOAE amplitudes were decreased and thresholds were elevated in the 6 mg/kg PCB group. Exposure to PBDEs did not cause DPOAE deficits. There was an interactive effect from combined exposure such that the individual low doses of PCBs and PBDEs did not result in DPOAE deficits, but the two combined produced a deficit similar to that in the high-dose PCB group. Serum thyroxine concentrations of all groups were reduced compared with controls, but PBDEs produced a less dramatic reduction than PCBs, which could explain the lack of DPOAE effects. Importantly, there was evidence that the co-exposure to subthreshold doses of PCBs and PBDEs can have an additive effect on cochlear function.