Correlation between pure tone audiogram and cochlear pathology in guinea-pigs intoxicated with ototoxic antibiotics

Secondary apoptosis of spiral ganglion cells induced by aminoglycoside: Fas-Fas ligand signaling pathway

OBJECTIVES/HYPOTHESIS

Hair cell loss results in the secondary loss of spiral ganglion neurons (SGNs), over a period of several weeks. The death of the SGNs themselves results from apoptosis. Previous studies have shown that several molecules are involved in the apoptosis of SGNs that occurred secondary to hair cell loss. However, the precise mechanism of apoptosis of the SGNs remains unclear. The aim of this study was to ascertain the secondary apoptosis of spiral ganglion cells induced by aminoglycoside and to investigate the role of the Fas-FasL signaling pathway using guinea pigs as an experimental animal model.

STUDY DESIGN

Laboratory study using experimental animals.

METHODS

Guinea pigs weighing 250 to 300 g (n = 21) from 3 to 4 weeks of age were used. Gentamicin (60 microL) was injected through a cochleostomy site on their left side. At 1 (n = 7), 2 (n = 7), and 3 (n = 7) weeks after gentamicin treatment, their cochleas were obtained from their temporal bone. Hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining were performed to observe apoptosis. To investigate the involvement of the Fas-FasL signaling pathway in the secondary apoptosis of SGNs, we performed reverse transcription-polymerase chain reaction (RT-PCR), western blotting, and immunohistochemistry.

RESULTS

A progressive loss of spiral ganglion cells with increasing time after gentamicin treatment was observed on light microscopic examination. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining demonstrated induction of apoptotic cell death in SGNs after gentamicin treatment. Expression of FasL increased over time after gentamicin treatment as determined by RT-PCR and western blotting. On immunohistochemical staining, we observed the localization of FasL in the SGNs. The proapoptotic molecules Bax and Bad were increased, but levels of the antiapoptotic molecule Bcl-2 were decreased at increasing survival times after gentamicin treatment on RT-PCR. The gentamicin-treated group displayed initial activation of caspase-8 and increased the cleavage of caspase-3, caspase-8, and PARP protein in a time-dependent manner.

CONCLUSIONS

The secondary apoptosis of SGNs could be a result of the apoptotic Fas-FasL signaling pathway. Blocking the Fas-FasL signaling pathway could be considered as a method for preventing secondary degeneration of SGNs, and further studies are needed to confirm this.

The ototoxic interaction of styrene and noise

The interaction between noise and inhaled styrene on the structure and function of the auditory organ of the male Wistar rat was studied. The animals were exposed either to 600 ppm, 300 ppm or 100 ppm styrene (12 h/day, 5 days/week, for 4 weeks) alone or in combination with a simultaneous 100-105 dB industrial noise stimulant. Auditory sensitivity was tested by auditory brainstem audiometry at 1.0, 2.0, 4.0 and 8.0 kHz frequencies. Inner ear changes were studied by light microscopy. Exposure to 600 ppm styrene alone caused a 3 dB hearing loss only at the highest test frequency (8 kHz). Quantitative morphological analysis of cochlear hair cells (cytocochleograms) showed a severe outer hair cell (OHC) loss particularly in the third OHC row of the upper basal and lower middle coil. Exposure to noise alone caused only a mild hearing loss (2-9 dB), and only an occasional loss of OHCs (<1% missing). Exposure to the combination of noise and 600 ppm styrene caused a moderate flat hearing loss of 23-27 dB. The cytocochleograms showed a more severe damage of the OHCs than after exposure to 600 ppm styrene alone. The inner hair cells were found to be destroyed in some animals in the upper basal turn only after the combination exposure. Only in combination with noise exposure, the lower styrene concentrations (100 and 300 ppm) induced a hearing loss which was equivalent to that seen after exposure to noise alone. We conclude that: (1) There is an ototoxic interaction between styrene and noise. (2) Synergism is manifested only if styrene is applied in concentrations above the critical level (between 300 and 600 ppm in this study).

Toxicodynamics and toxicokinetics of amikacin in the guinea pig cochlea

An extensive overview of the relationship between cochlear toxicity and amikacin blood concentrations in the guinea pig is provided which should assist in the clinical application of this class of antibiotic. A data set previously used to relate the incidence of amikacin ototoxicity to dosing rates and blood concentrations was re-examined to assess the toxicodynamics of amikacin in terms of decibels of hearing loss across dosing rate, hearing frequency and time following drug exposure. Animals in this data set had received continuously i.v. infused amikacin over an 8-fold range of dosing rates. Preliminary analysis indicated that the data were consistent with a sigmoid relationship between hearing loss (decibels) and area under the amikacin plasma concentration vs time curve cumulated over the entire course of drug administration (cAUC). The sigmoid model was therefore used as the backbone of a far more comprehensive toxicodynamic model which described all the data with a single equation. Testing with this model showed that the cAUC required to produce half-maximum hearing loss (cAUC-1/2) was related to dosing rate (P < 0.01), to hearing frequency (P < 0.00001), and to post-drug interval (P < 0.00001). Maximum hearing loss (difference between upper and lower sigmoid asymptotes) was less than total and was significantly related to frequency (P < 0.00001). No effects could be detected on the sigmoid slope. Further modelling of the significant effects detected by the comprehensive toxicodynamic model was done to determine if they could be described by simple relationships or by biologically relevant sub-models. Modelling of maximum hearing loss (postulated to represent loss of mainly outer hair cell function) indicated that this parameter was constant at about 61 decibels for 2-12 kHz and linearly decreased with log frequency for frequencies > 12 kHz. Modelling of cAUC-1/2 on frequency indicated that there was a strong inverse linear relationship to log frequency. Modelling of cAUC-1/2 on post-drug interval indicated that delayed ototoxicity continued at progressively slower rates for at least 56 days after drug administration had ceased. Modelling of cAUC-1/2 on dosing rate showed an increased requirement for drug as the dosing rate decreased. However, cAUC-1/2 changed no more than 20% across the range of dosing rates compared to the 8-fold difference in mean steady-state plasma concentrations, suggesting that plasma concentration is not a primary determinant of ototoxicity. A toxicokinetic model was developed which explained the dosing rate effect on cAUC-1/2 very successfully.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuronal degeneration of primary cochlear and vestibular innervations after local injection of sisomicin in the guinea pig

This paper reports on a dynamic study of the morphological changes within the cochlear and vestibular ganglia of the guinea pig after local application of Sisomicin in the inner ear. The treatment leads to a rapid, complete and irreversible destruction of the sensory cells in the cochlear and vestibular neuroepithelia. A progressive degeneration of the type I and type II afferent neurons, presenting a decreasing gradient from the base towards the apex of the cochlea, is rapidly observed and becomes almost complete as early as 15 days after the peripheral injury. Five months after the treatment the spiral ganglion cells have almost completely disappeared. At this time the vestibular ganglion cell density appears normal but the neurons exhibit important signs of alteration. Such damage to the cochlear and vestibular afferent neurons may result from either retrograde neuronal degeneration and/or direct neurotoxic effect of the drug. Thus the combination of the two mechanisms could lead to neuronal losses in spiral and Scarpa's ganglia after the local aminoglycoside intoxication of the inner ear. The difference in the time course of degeneration for these two afferent ganglia could be due to their specific susceptibilities or to their different anatomical locations.

Interaction between sound and gentamicin: immediate threshold and stereociliary changes

Our aim was to determine whether the immediate effects of a just-damaging sound exposure (8 kHz at 116 dB SPL for 1 h) might be potentiated by a single sub-ototoxic dose of gentamicin (50 mg kg-1). Auditory brainstem responses in pigmented guinea pigs were measured before and after treatment and used to calculate threshold shift (TS). Histological disturbances to sensory hair cells were assessed by scanning electron microscopy. All experimental ears excepting the gentamicin only group showed TS and histological changes. The largest TSs occurred at half an octave above the exposure frequency, and were greatest in the gentamicin + sound (G + S) group. First row outer hair cells showed most histological disturbances, followed by inner hair cells. The severest histological damage occurred at the exposure frequency and basally from it, the G + S group being most affected. Generally, there was good correlation between the severity of TS and histological damage. Results from both analyses indicated greater changes with gentamicin present.

Delay in hearing loss following drug administration. A consistent feature of amikacin ototoxicity

The time course of threshold increase in the VIII nerve compound action potential was studied in guinea pigs following amikacin administration at four different constant infusion rates. Despite the wide range of dosing durations required to achieve drug ototoxicity (2-24 days), the full development of both high and low frequency hearing loss was invariably found to be delayed with respect to the time of drug removal. The greatest degree of delayed hearing loss generally occurred within the first 7 days after drug removal, with smaller losses occurring during later time intervals. The delay showed a tendency to decrease as the ototoxic dose was increased. Using the data from the two highest dosing rates, it was estimated that a minimum of 4 days had to elapse before any hearing loss could be detected, once an ototoxic amount of drug had been administered. These data suggest that hearing loss is always substantially delayed with respect to the receipt of an ototoxic dose of amikacin, and that this must be taken into account when conducting animal experiments and when monitoring hearing in patients for the early detection of ototoxicity.

Incidence of amikacin ototoxicity: a sigmoid function of total drug exposure independent of plasma levels

A sigmoid curve was found to closely describe the relationship between the incidence of amikacin ototoxicity (greater than or equal to 15 dB hearing loss at a given frequency) and either (1) total dose, or (2) the area under the curve (AUC) describing plasma drug concentration v time over the total period of amikacin administration (total AUC) in continuously infused guinea pigs. Total dose or total AUC estimates of the drug exposure required to produce ototoxicity in 50% of the animals (ED50s) were not significantly different over an eight-fold range of dosing rates or plasma concentrations. A theoretical explanation for this result is that ototoxicity occurs only when a critical amount of drug is accumulated at the ototoxic site by an essentially unidirectional process with a rate that is slow and linearly related to the extracellular drug concentration. The sigmoid relationships for pooled data were parallel in slope for all hearing frequencies from 2 to 32 kHz, and the ED50s showed a strong negative linear relationship to the log of the hearing frequency over this range. The magnitude of ototoxicity expressed as the number of octaves (frequency ratios of 2) for which hearing loss damage was continuous from 32 kHz downward, was correlated to both total dose (r = .605) and total AUC (r = 0.703). No relationship between ototoxicity and plasma level or dosing rate was found. The extreme steepness of the dose-effect curve for the incidence of ototoxicity greatly amplified the variability between individuals and offers an explanation for the unpredictability of aminoglycoside ototoxicity in human patients. The results indicate that either total dose or total AUC (in cases of highly unpredictable blood levels), and not peak or trough serum levels, should be used as an index of ototoxic risk and that the safety limits of drug exposure should be set conservatively.

Neurochemical basis of auditory fatigue: a new hypothesis

Neuroactive polypeptides such as substance P and enkephalin have recently been demonstrated in the neuronal elements of the inner ear. It has been suggested that the same neuropeptides have a transmitter role in various sensory systems. Transmitter roles for the neuropeptides in the cochlear processes could provide new explanations for many physiological phenomena of hearing. The neuropeptides are particularly well suited to explain such a noise-induced auditory overloading condition as temporary threshold shift.

Changes in cochlear microphonic response after Y-ray irradiation of the inner ear of the guinea-pig

The effects of ionizing irradiation on the cochlear microphonic response of guinea-pigs were studied. The cochlear microphonics (CM) of both ears were recorded in a total of 36 animals. Recording was carried out by the differential electrode technique on the basal turn of the cochlea. One week prior to recording, the left ear of each animal had been exposed to 35-70 Gy radiation in increments of 5 Gy. Doses of 40 Gy and above led to a reduction in CM response. After doses of 60 Gy or more, no CM response could be detected. Damage most probably occurred in the outer and inner hair cells.

Age-dependent changes of the compound action potential in the guinea pig

As a measure of age-related changes in the most peripheral neural part of the auditory pathway, the compound action potential of the guinea pig was analyzed. In addition to a marked threshold elevation, there was a significantly lower potential amplitude in old animals. By contrast, the latency of the compound action potential was unchanged. In view of the fact that the relative amplitude increase in the intensity range tested was the same in old as in young animals, the implication is that the auditory-nerve neurons that are still excited do not exhibit functional deterioration with aging.

Pattern of gentamicin-induced cochlear degeneration in the guinea pig. A morphological and electrophysiological study

Gentamicin-induced cochlear degeneration in the guinea pig was studied by complete hair-cell counting (cytocochleograms) and phase-contrast and interference microscopical examination of the stria vascularis and Reissner's membrane. Gentamicin (100 mg/kg/day) was administered over a period of 7-17 days. The first loss of hair cells (OHC) occurred in a region 6-8 mm from the round window. From this 'degeneration point', the loss of haircells progressed towards the round window (fast) and the apex (slowly). The stria vascularis showed no signs of degeneration. Reissner's membrane, on the other hand, showed intracellular vacuolization of the endolymphatic cells over the complete length of the cochlea after 12 or more days intoxication. Hearing loss was measured by electrocochleography with skin electrodes. The histologic findings were compared with the objective audiograms.

Spiral ganglion neuron loss following organ of Corti loss: a quantitative study

The packing density of spiral ganglion neurons was measured in 2.5- and 13-15-month-old guinea pigs, in guinea pigs at various times after drug-deafening or acoustic trauma, and in Waltzing guinea pigs of various ages. Analysis of variance and Duncan's new multiple range tests were used to determine significant differences between treatment/survival groups. Spiral ganglion neurons in young and old normal ears did not have significantly different packing densities. Drug-deaf guinea pigs showed a significant loss of neurons by 2 weeks following treatment, a further significant loss by 2 months, and a marginally significant loss between 4 and 8 months. The neuronal population was then stable through 15 months, at about 13% of normal. Acoustic trauma ears showed the first significant loss isn the lower second turn at 1 month. Long-term (12-14 months post-exposure) trauma ears were highly variable. Waltzers lost about 50% of their normal neuronal population between 4 and 8 months; they showed an unexpected greater-than-normal density at 2 months, possible explanations of which are discussed. Thus, loss of the organ of Corti from various causes results in a slow but progressive loss of spiral ganglion neurons, the time course of which varies with the type of cochlear insult.

Age-dependence of the neural auditory thresholds of albino and pigmented guinea pigs

Short-latency brain-stem responses of albino and pigmented guinea pigs were examined for evidence of age-dependence of the auditory threshold. Both groups exhibited a loss of hearing correlated with age. Moreover, albinos had significantly lower auditory thresholds than pigmented guinea pigs of the corresponding age group. A further difference between the two groups lay in the degree of which sensitivity declined with age; hearing loss in albinos was only about half that in pigmented animals.

The source along the basilar membrane of the cochlear microphonic potential recorded by surface electrodes in man

In order to determine the region along the basilar membrane which contributes to the recorded CM, an attempt was made to record CM responses in subjects with normal hearing and in subjects with high frequency cochlear hearing losses (e.g. acoustic trauma). In such cases of high frequency hearing loss, one may assume that damage has occurred to the hair cells in the basal turn of the cochlea. The CM, elicited by one cycle sinusoidal stimuli of various frequencies, intensities, phases, etc., was recorded by means of earlobe and scalp vertex electrodes. The CM recorded in subjects with normal hearing to high frequency sounds showed (besides the previously reported properties of the CM) large amplitudes and short latencies in response to low frequency stimuli. On the other hand, the CM recorded in subjects with high frequency hearing loss were either prolonged in latency and small in amplitude or completely absent. A plot of the relationship between CM lastency to high intensity 500 HZ stimuli stimuli and audiometric hearing loss in 66 ears shows clearly that in those cases in which hearing was normal at frequencies up to about 8 kHZ, CM latency was very short. On the other hand, in those cases in which the high frequency hearing loss progressed to include more and more lower frequencies, CM latency was more prolonged and smaller in amplitude until CM could no longer be observed. These results indicate that the CM recorded in normally hearing subjects from skin electrodes in response to low frequency (500 HZ) stimuli is generated in the basal turn of the cochlea. This finding is probably a consequence of the form of the mechanical response of the basilar membrane (travelling wave) to low frequency stimuli.