Controlled study of the frequency of anti-HSP 70 with the ELISA and the Western Blot methods in patients with Ménière Disease

OBJECTIVES

To establish the frequency of auto-antibodies anti-HSP 70 using ELISA and Western Blot (WB) methods and to compare the results of each method among patients with the Ménière's Disease (MD) and internal ear diseases (IED) who do not fulfill criteria for MD. Sensibility, specificity and predictive values of anti-HSP70 test in diagnosis of MD were calculated.

STUDY

Prospective, case-control.

METHODS

Blood samples were collected from 31 patients with MD and 78 patients with non Ménière IED. Data regarding cochlear and vestibular symptoms were obtained and blood sample was tested.

RESULTS

ELISA tests results were positive in 4(13%) patients and results of WB were positive in 8(26%) patients. Among patients with positive ELISA results, 1 patient presented active disease and in the remaining 3 patients the disease was inactive. Among the 8 WB positive patients, only 2 patients presented active disease. Statistical analyses did not establish any association between serologic findings and clinical factors of MD.

CONCLUSION

The presence of anti-HSP70 using the ELISA and the WB methods did not demonstrate clinical value for the diagnosis of MD. We did not find association between idiopathic MD nor unspecific etiology MD and the presence of anti-HSP70 auto-antibodies.

Distribution of bone marrow-derived cells in the vestibular end organs and the endolymphatic sac

CONCLUSION

Bone marrow-derived cells (BMDCs) are constitutively present in the vestibular end organs and in the endolymphatic sac, and may play a role in the maintenance of inner ear homeostasis.

OBJECTIVES

The aim was to examine the distribution and characteristics of BMDCs in the vestibular end organs and in the endolymphatic sac.

METHODS

Bone marrow-chimeric mice were generated by bone marrow transplantation from mice genetically labeled with enhanced green fluorescent protein to C57 Bl/6 mice to visualize BMDCs. Three months after bone marrow transplantation, inner ear specimens were processed for histochemical analyses.

RESULTS

BMDCs were widely distributed in the vestibular end organs and the endolymphatic sac, whereas there were differences in the phenotype and the distribution between the vestibular end organs and the endolymphatic sac. A subpopulation of BMDCs in the vestibular end organs expressed antigen-presenting protein MHC class II. Moreover, the density of BMDCs in the vestibular end organs increased in response to local mechanical stress.

Expressions of Aquaporin-2, Vasopressin Type 2 Receptor, Transient Receptor Potential Channel Vanilloid (TRPV)1, and TRPV4 in the Human Endolymphatic Sac

OBJECTIVE

To localize aquaporin (AQP)2, vasopressin type 2 receptor (V2-R), and transient receptor potential channel vanilloid subfamily 1, 4 (TRPV1, TRPV4) in the human endolymphatic sac (ES).

METHODS

Three samples of human ES were sampled during the removal of vestibular schwannoma by way of the translabyrinthine approach. The samples were immediately fixed in 4% paraformaldehyde and embedded in OCT compound; immunohistochemistry was performed with AQP2, V2-R, TRPV1, and TRPV4 polyclonal antibodies.

RESULTS

AQP2, V2-R, TRPV1, and TRPV4 proteins were detected in the epithelial layer of the ES but were not observed in connective tissue around the ES. TRPV1 was also expressed in blood vascular endothelial cells of the connective tissue of ES.

CONCLUSIONS

AQP2, V2-R, and TRPV4 were expressed in the luminal epithelium of human ES. The same characteristic distribution of water and ion channels is seen in the kidney, where a significant amount of fluid is filtrated and resorbed. ES probably plays an active role in the homeostasis of the endolymph.

Interferon-gamma expression in the inner ear of rats following secondary immune reaction in the endolymphatic sac

Recently, we demonstrated increased intercellular adhesion molecule-1 (ICAM-1) expression in the inner ear of systemically pre-sensitized rats after antigen [keyhole limpet hemocyanin (KLH)] challenge into the endolymphatic sac (ES), in good correlation with the cellular infiltration. Interferon-gamma (IFN-gamma) is an important cytokine that upregulates the expression of ICAM-1. Here, we report upregulation of IFN-gamma expression in the inner ear of systemically pre-sensitized rats after antigen (KLH) challenge into the ES. Immunoreactivity for IFN-gamma was detected in the spiral ligament, suprastrial region, spiral modiolar veins, spiral collecting venules, surface membrane of the perilymphatic compartment and perilymphatic space of immunized, but not control, rats. IFN-gamma expression was detected at 1.5 h post-challenge, peaked at 6 h and gradually returned to baseline levels after 7 days. Interestingly, the time kinetics of IFN-gamma expression were in good correlation with those of ICAM-1. These observations demonstrate that antigen challenge into the ES induces IFN-gamma expression, which can then upregulate ICAM-1 expression and induce cell infiltration, suggesting that IFN-gamma may play a crucial role in immune-mediated inner ear diseases.

Le sac endolymphatique : ses fonctions au sein de l’oreille interne

The endolymphatic sac is a non-sensory organ of the inner ear. It is connected to the endolymphatic compartment that is filled with endolymph, a potassium-rich fluid that bathes the apical side of inner ear sensory cells. The main functions ascribed to the endolymphatic sac are the regulation of the volume and pressure of endolymph, the immune response of the inner ear, and the elimination of endolymphatic waste products by phagocytosis. Functional alteration of these functions, leading to deficient endolymph homeostasis and/or altered inner ear immune response, may participate to the pathophysiology of Ménière's disease, an inner ear pathology that causes episodes of vertigo, sensorineural hearing loss and tinnitus, and is characterized by an increase in volume of the cochleo-vestibular endolymph (endolymphatic hydrops).

Cell proliferation in the endolymphatic sac in situ after the rat Waldeyer ring equivalent immunostimulation

OBJECTIVES/HYPOTHESIS

It has been recognized that immunological mechanisms could be involved in the pathogenesis of different inner ear disorders, such as progressive sensorineural hearing loss, Meniere's disease, and even sudden deafness. The endolymphatic sac acts as an immune control organ for the inner ear and has been considered as an effector site of the mucosa-associated lymphoid tissue. The purpose of the study was to determine the potentially immunological relationship between endolymphatic sac and Waldeyer ring equivalent, one of the most important affector organs in mucosa-associated lymphoid tissue.

STUDY DESIGN

Animal model.

METHODS

Thirty-six rats were employed. Two animals were killed for histological observation of Waldeyer ring equivalent, and another 34 animals were randomly divided into experimental and control groups and received bilateral intranasal immunizations with keyhole limpet hemocyanin or Freund adjuvant, respectively. The ears of immunized animals and control animals were examined for keyhole limpet hemocyanin-positive memory cells and immunoglobulin G-positive plasma cells with the technique of immunohistochemical analysis. The histopathological changes and cell proliferation in those ears were also assessed.

RESULTS

There were paired and organized lymphoid tissues in the lateral wall of the first choana in the rat. Keyhole limpet hemocyanin-positive lymphocytes appeared within the endolymphatic sac at 3 days after the first anti-genetic stimulus of the Waldeyer ring equivalent. Endolymphatic hydrops in the cochlea, elevated amounts of immunocompetent cells, and increased activity of cell proliferation within the endolymphatic sac were also considered after four intranasal injections of keyhole limpet hemocyanin.

CONCLUSION

Presumably, endolymphatic sac is supplied with immunocompetent cells from Waldeyer ring equivalent and has an ability of co-reaction with Waldeyer ring equivalent.

[Immuno-pathogenesis in Meniere's disease]

Since the report of Duke in which an allergic etiology was considered to be the cause of Meniere's disease, the hypothesis that a certain type of Meniere's disease is generated through immuno-pathological mechanisms has been advocated for 70 years. During this period, another entity of immune-mediated inner ear disorders, i. e., autoimmune inner ear disease was introduced. Fundamental immunological phenomena of the inner ear have been rapidly elucidated since 1980. The endolymphatic sac is the only site which contains immuno-competent cells within the inner ear. The inner ear is capable of mounting active immune responses when appropriately stimulated and the endolymphatic sac plays an integral function for inner ear immune response. Actually, many reports have been published that link immunity and Meniere's disease with a variety of proposed immune-related etiologies from autoimmunity to non-autoimmunity. It is suggested that immune injury to the endolymphatic sac plays an important role in the pathogenesis of Meniere's disease. These functional and morphological circumstances strongly suggest that an immunological etiology of Meniere's disease is not theoretically unfounded.

Autoimmune inner ear disease: diagnostic and therapeutic approaches in a multidisciplinary setting

Autoimmune Inner Ear Disease (AIED) is a clinical syndrome of uncertain pathogenesis. It is associated with bilateral rapidly progressive hearing loss. The hearing loss may be associated with vestibular symptoms. Autoimmunity has been proposed as the pathogenesis of this sort of hearing loss, although the mechanism of the disease is poorly understood. It is well accepted that the endolymphatic sac is an immunocompetent organ and circulating autoantibodies against inner ear antigens have been reported, as have viral antigens in the endolymph, although the sensitivity, specificity, and roles of those antibodies in a disease process are poorly defined. We will describe the clinical aspects of the disease, the histopathology, the immunologic indicators, the types of presentation, both from the audiologic and vestibular point of view, clinical trials for treatment and the follow-up. One of our conclusions is that many of these patients respond favorably to the treatment Methotrexate.

[Clearance function of endolymphatic sac to extraneous TD-antigen]

OBJECTIVE

To study the clearance function of the rat endolymphatic sac to TD antigen.

METHOD

30 healthy adult S-D rats were employed in the experiment. At two weeks after being sensitized systemically with keyhole limpet hemocyanin (KLH) (Thymus-dependent antigen), the animals were inoculated into the labyrinth through cochlea base tune with the same antigen. At 1, 3 h, 1, 3,7 and 14 day after labyrinth vaccination, the rats were sacrificed and the temporal bones were removed, then the frozen-sections of the decalcified samples were examined respectively. Using Anti-KLH McAb, the SABC immunohistochemical methods were utilized to investigate the changes of KLH in the endolymphatic sac.

RESULT

At 3 h after labyrinth vaccination the antigen appeared in the endolymphatic sac. While the KLH were trapped and phagocytized in the endolymphatic sac at 1-7 day after labyrinth vaccination, the antigen in the cochleae gradually reduced. At the 14th day only feeble KLH positive stains can be found in the endolymphatic sac.

CONCLUSION

The rat endolymphatic sac can phagocytize, dispose and removal extraneous antigen, which verifies the immune defense function of endolymphatic sac in inner ear immune response.

Th1: mediator lymphocytes in experimental autoimmune labyrinthitis

A previous study on experimental autoimmune labyrinthitis (EAL) consistently demonstrated transient infiltration of lymphocytes only into the inner ear of mice. To clarify the profile of lymphocytes in the initiation of EAL, the present study investigated cell surface antigens, as well as cytokines, from Day 4 to Day 35, using immunohistochemical techniques. Many CD4+ cells mainly infiltrated the endolymphatic sac as early as Day 4 and gradually spread to the rest of the inner ear. Infiltration peaked on Day 12 and persisted in most animals until Day 35, although the number of cells gradually decreased. In contrast, very few CD8+ cells were found to have appeared in the inner ear of all animals on Day 10, and the number of cells rapidly decreased. Many cells positive for IFN-gamma and IL-2 were identified in the endolymphatic sac on Day 4. These results suggest that helper T1 lymphocytes, rather than cytotoxic T lymphocytes, may play a central role in the initiation of EAL.

[Cell proliferation in endolymphatic sac during the immune response of inner ear]

OBJECTIVE

To study the cell proliferation in endolymphatic sac(ES) during the secondary immune response in inner ear.

METHODS

Fifteen healthy, female SD rats were employed in the experiment. Sensitized systematically with keyhole limpet hemocyanin (KLH), the animals were inoculated with the same antigen through cochlea basal turn into the labyrinth. Administrated 5-bromo-2'-deoxyuridine (BrdUrd) intraperitoneally, the rats were sacrificed and the temporal bones were harvested at 3, 7, 14 day after labyrinth vaccination respectively. The frozen sections of the decalcified samples were dealt with H-E staining and immunohistochemical methods to investigate the cellular infiltration, BrdUrd and IgG positive cells in the ES.

RESULTS

While the ES lumen and perisaccular region were infiltrated with mononuclear-phagocyte at the 3rd day post-vaccination, plasmocyte and lymphatic cells become the predominant infiltrating cells in the ES at the 7th day. The KLH in the ES lumen were phagocytized at the 3-7th day post-vaccination. S-phase cells and IgG positive cells in ES increased markedly in the 3rd day and 7-14 days post-vaccination respectively with similar localization.

CONCLUSION

The activity of cell proliferation in the ES enhance and local proliferated cells may differentiate in situ into immunocompetent cells during the secondary immune response against TD antigen in the inner ear. This indicates that ES plays an important role in immune response of inner ear.

Detection of single-stranded DNA in the hydropic vestibule after the direct injection of antigen into the endolymphatic sac of guinea pigs

Immunohistochemical study for single-stranded DNA (ssDNA) with vestibule of guinea pigs was performed after the injection of keyhole limpet hemocyanin (KLH) into the right endolymphatic sac. Endolymphatic hydrops became evident by expansion of the Reissner's membrane in the cochlea of all animals 1 day after the injection of KLH. Increased ssDNA expression was detected in the sensory epithelium and transitional area, while temporal bones in the control group did not show any ssDNA immunoreactivities. ssDNA is accompanied with the apoptotic change in the vestibule. Our results suggest that apoptotic changes could be involved in the hydropic vestibule and these phenomena lead inner ear disturbance as seen in endolymphatic hydrops.

Immune response and immunopathology of the inner ear: an update

Immune-mediated inner-ear disease includes clinical conditions associated with unilateral or bilateral rapidly progressive forms of sensorineural hearing loss. A systemic autoimmune disorder can be present in less than one-third of cases. Because of the lack of well defined detection methods to identify immune-mediated processes within the inner ear, and the fact that the human inner ear is not amenable to diagnostic biopsy, there has been great interest in developing animal models. Experimental models of sterile and virus-induced labyrinthitis support the participation of the immune system in the aetiopathogenesis of inner-ear disorders: interleukin-2 emanates from the endolymphatic sac and assists in changing the spiral modiolar vein, as in the expression of intercellular adhesion molecule 1, which allows the egrees of immune cells from the circulation. The formation of a fibro-osseous matrix ultimately results in degeneration of the inner ear. These investigations have allowed us to alter the immune response for the purpose of regulating its intensity and the subsequent damage to patients.

T cells infiltrating from the systemic circulation proliferate in the endolymphatic sac

It has been reported that autoimmune mechanisms are involved in the development of inner ear disorders such as Meniere's disease and steroid-responsive sensorineural hearing loss. In the present study, using an animal model for graft-versus-host disease, we investigated the immune regulatory mechanism in the endolymphatic sac and demonstrated that donor T cells injected into the systemic circulation of recipients infiltrate and proliferate in the perisaccular region. These findings suggest that immunocompetent cells are supplied from the systemic circulation through blood-labyrinth and blood-endolymph barriers into the endolymphatic sac, and that the endolymphatic sac allows these cells to proliferate locally as a local immune defense. It therefore seems likely that the endolymphatic sac plays a crucial role in not only graft-versus-host disease but also autoimmune inner ear disorders.

Intercellular adhesion molecule-1 expression in the inner ear of rats following secondary immune reaction in the endolymphatic sac

An immunological aetiology for inner ear diseases has long been proposed. The endolymphatic sac (ES) is the only immunoprivileged site in the inner ear with a resident population of immunocompetent cells. By keyhole limpet hemocyanin (KLH) challenge into the ES of systemically pre-immunized guinea pigs, we previously demonstrated an infiltration of inflammatory cells into the perilymphatic space of the cochlea. In order to understand the mechanisms involved in the recruitment of immunocompetent cells into the inner ear, and their relation to the development of endolymphatic hydrops (EH), we investigated the expression and time-kinetics of intercellular adhesion molecule 1 (ICAM-1) in the inner ear of systemically pre-immunized rats after antigen (KLH) challenge into the ES, its relation to cell infiltration in the cochlea and subsequent development of EH. By immunohistochemistry, strong ICAM-1 expression was detected in the spiral ligament, suprastrial region, spiral prominence, spiral modiolar veins, spiral collecting venules, surface membrane of the perilymphatic compartment, perilymphatic space and ES of immunized rats, but not of control rats. ICAM-1 expression was detected at 5-6 h, peaked at 10-15 h, and gradually reduced by 2 weeks. Cell infiltration into the cochlea started at 6-12 h and peaked at day one. By 6 h, 50% of challenged rats developed EH. This figure rose to 70% at 12 h, and then gradually reduced. However, immunoreactivity for KLH (antigen) was only detected in the ES. These results emphasize that the sac is the central immunological organ of the inner ear, and suggest that ICAM-1 may play a pivotal role in the aetiology of immune-mediated inner ear diseases through the recruitment of immunocompetent cells into the inner ear and subsequent development of EH.

[Antigen removal after inoculation into the endolymphatic sac of immunized guinea pigs]

Antigen removal in the endolymphatic sac (ES) was immunohistochemically examined. Forty-five adult female Hartley guinea pigs were used in this study. After keyhole limpet hemocyanin (KLH) systemic immunization, KLH was directly injected into the lumen of the right ES. The presence of KLH was detected in histological sections using immunohistochemistry. After KLH challenge into endolymphatic sac lumen, high concentrations of KLH were diffusely found within phagocytes in the endolymphatic lumen and peri-saccular tissue on day 2. After day 14, KLH disappeared from the immunized inner ear. The above results suggest that KLH is removed from the inner ear by diffusion through the endolymphatic epithelial cells which have altered permeability or by phagocytosis of the phagocytic cells. No KLH was observed in the left endolymphatic sac and bilateral cochlea as well as vestibular organ during 5 months of follow up. This study showed that the endolymphatic sac is capable of appropriately trapping macromolecule, KLH antigen (molecular weight: about 400 KDa), and removing antigens quickly from the inner ear.

The endolymphatic sac receives antigenetic information from the organs of the mucosa-associated lymphatic system

The endolymphatic sac holds the entire arrangement of immunocompetent cells and functions as an immunological potent control organ for the inner ear. The evidence of secretory immunoglobulin A and other features of lymphocyte subtypes characterizes the endolymphatic sac as an organ of the mucosa-associated lymphatic system (MALT). In this system a permanent recirculation of sensitized memory lymphocytes from one organ to the other has been demonstrated experimentally as serving to dispose memory lymphocytes after renewed antigenetic stimulus. The aim of this study was to prove the possible recirculation of antigen-sensitized lymphocytes to the endolymphatic sac after antigenic stimulus of another part of the mucosa-associated lymphatic system. The results are evidence that the endolymphatic sac is provided with immunocompetent cells which derive from the lymphatic tissue of the nasopharynx. While the origin of immunocompetent cells in the endolymphatic sac still remains uncertain, this study underlines the role of lympho-epithelial tissue of the nasopharynx as a possible cell source for the endolymphatic sac. The results might explain the altered or disturbed function of the endolymphatic sac as a possible cause of certain inner ear diseases.

Expression of intercellular adhesion molecule-1 in immune response of inner ear

To understand the role of intercellular adhesion molecule-1 (ICAM-1) in immune response of the inner ear, inner ear immune response was induced in rats by inoculation of keyhole limpet hemocyanine (KLH) into the scala tympani of the animals who had been systemically sensitized. The expression of ICAM-1 in the inner ear was immunohistochemically examined. ICAM-1 was found in the epithelium of the spiral modiolar vein (SMV) with its collecting venules (CVs) as early as 6 h after challenge. Expression of ICAM-1 was observed on the epithelium of the endolymphatic sac (ES) and perisaccular region at 12 h. The intensity of ICAM-1 staining reached its peak within 24-48 h in these sites of the inner ear. By day 28, most specimens were devoid of appreciable staining for ICAM-1. Our study demonstrates that adhesion molecules play an important role in extravasation of inflammatory cells from the systemic circulation in the process of inner ear immune response. It also shows that cytokines that control expression of adhesion molecules may be released by cells outside ES, besides those cells in the ES.

[A study on monoclonal antibodies against epithelial cell of endolymphatic sac in guinea pigs]

Using a microdissected endolymphatic sac of the guinea pig (n = 35) as an initial antigen preparation, serials of monoclonal antibodies were established which were used to label the epithelial cells of endolymphatic sac. The antibodies showed strong immunoreactivity with kidney, but not with other organs. It also showed isotopes IgG1, IgG2b and IgM. The results of Western blotting and SDS-PAGE indicated that the epitopes of monoclonal antibodies were proteins or glyoprotein with a molecular weight of approximately 7,400. The locations of the epitopes in epithelial cells suggest that it may play some roles in construction and function of the endolymphatic sac.

Demonstration of autoantibodies to the endolymphatic sac in Meniere's disease

Recent evidence suggests that immune mechanisms may underlie some cases of Meniere's disease. This study was conducted to determine whether an autoimmune mechanism is involved. Sera from 30 patients with Meniere's disease were reacted with human endolymphatic sacs and examined by indirect immunohistochemistry and fluorescence microscopy. Three of the samples (10%) showed positive staining, indicating immunoglobulin G (IgG) binding against the sac. No positive staining occurred when sera from healthy individuals or phosphate-buffered saline was used as a control. Clinical data showed an association between immunoreactivity and extent of disease (worse hearing over a shorter disease course and bilateral involvement). This study suggests that, in some cases of Meniere's disease, autoantibodies directed against human endolymphatic sac are present in the sera, supporting the theory that a specific autoimmune reaction takes place in a minority of patients with Meniere's disease.

Differential expression of transthyretin in papillary tumors of the endolymphatic sac and choroid plexus

Aggressive papillary tumors of the temporal bone, occurring sporadically or as part of von Hippel-Lindau disease, have been shown to originate within the endolymphatic sac or duct. Also implicated as a potential precursor from which some of these tumors may arise is ectopic choroid plexus epithelium. To aid in the differentiation between papillary tumors of endolymphatic sac and duct origin and those arising from choroid plexus, an immunohistochemical study using stains for transthyretin (TTR), cytokeratins, S-100 protein, epithelial membrane antigen (EMA), and glial fibrillary acidic protein (GFAP) was carried out on archival specimens of normal and neoplastic endolymphatic sac and duct and choroid plexus epithelium. Transthyretin, a marker for choroid plexus epithelium, was found to show differential expression between choroid plexus papillomas and aggressive papillary tumors of the endolymphatic sac or duct. Therefore the use of TTR in concert with other immunohistochemical stains appear to aid in the differentiation between intracranial and intratemporal papillary tumors arising from choroid plexus and endolymphatic sac or duct epithelium.

Preliminary study of the role of endothelin-1 in the homeostasis of the inner ear

Endothelin (ET), originally characterized as a 21-residue vasoconstrictor peptide from endothelial cells, has been reported to act as a local hormonal regulator of pressure, fluid, ions, and neurotransduction. Our previous studies suggested an important role of ET-1 in the inner ear. The present study investigated the time kinetics of ET-1 in the epithelium of the endolymphatic sac (ES) of guinea pigs and its relation to the development of endolymphatic hydrops (EH) following locally mounted secondary immune reaction. In the duration between 12 h and day 1, ET-1-like activity completely disappeared from the epithelium of the ES and was associated with the accumulation of inflammatory cells in the ES and a rapid development of EH. On day 7, ET-1-like activity recovered as a consequence of the decrease of inflammatory cells and reduction of EH. These findings suggest that ET-1 may play an important role as one of the regulators maintaining the fluid balance.

Detection of viral antigen in the endolymphatic sac

A study was devised to determine whether or not any immune defense mechanism is present when a virus invades the human endolymphatic sac (ES). The ES was removed from 14 fresh autopsy cases having no known pre-mortem diseases in the middle and inner ears. Specimens were then examined for viral antigens including herpes simplex (HSV) type 1 and 2, mumps and cytomegalovirus using immunohistochemical methods. DNA examination by in situ hybridization was also performed for HSV. HSV antigen and DNA were observed in 9 of the 14 cases studied. These findings suggest that the virus invades the ES but is impeded by an immune defense mechanism under normal conditions. Since disease may alter host defenses, further studies are warranted to study the relationship between HSV and patients with Meniere's disease.

Allergic and Immunologic Aspects of Meniere's Disease

Meniere's disease, although idiopathic by definition, has been ascribed to a variety of causes, which more recently include autoimmune factors. Interest in the role of allergy in Meniere's disease has also increased. Studies from this institution and elsewhere provide evidence that allergy and immunologic factors play a role in Meniere's disease in at least some patients. The symptoms of Meniere's disease are thought to be produced by a sudden influx of fluid into the endolymphatic sac, producing a rupture of Reissner's membrane in the cochlea. The endolymphatic sac is capable of trapping antigen and generating its own immune response. It has a highly vascular subepithelial space containing numerous fenestrated blood vessels that are peripheral and “leaky.” At least three mechanisms by which allergy may play a role in the production of fluid in the endolymphatic sac are described: the endolymphatic sac itself might be a “target organ” of mediator released from systemic inhalant or food reactions; deposition of circulating immune complex may produce inflammation and interfere with the sac's filtering capability; and a predisposing viral infection in childhood that produces a mild impairment of endolymphatic sac function may interact with allergies in adulthood and cause the endolymphatic sac to decompensate, resulting in endolymphatic hydrops. The endolymphatic sac is the seat of immune reactivity in the inner ear. Repeated inflammatory reactions can produce sac dysfunction and eventual production of Meniere's disease.

A subpopulation of Menière's patients produce antibodies that bind to endolymphatic sac antigens

The endolymphatic sac (ES) has been suggested to serve an important immunological role within the inner ear. Meanwhile, immunological mechanisms have been studied in connection with Meniere's disease. The aim of this study is to look for and recognize antibodies against the ES in the sera of patients with Meniere's disease, using the technique of indirect immunofluorescence. Sera from 50 patients with Meniere's disease, from an animal model of autoimmune inner ear disease, and from healthy controls were tested against ES tissue substrates obtained from guinea pigs. Immunoglobulin deposition in the ES was found in 20 patients (40%) compared with one control (10%). The difference was statistically significant when computing the odds ratios at 95% confidence level. Fluorescein labeling was demonstrated in the ES epithelium in 16% and in the surrounding perisaccular stroma in 24%. Identical immunoreactivity against the ES tissue was depicted in the sera of the experimental animal model. These findings support the possibility of humoral immunological involvement in the Meniere's disease process. Immunological derangement of the ES function could be the first step in a cascade of reactions leading to endolymphatic hydrops and presenting as Meniere's disease.

Antigen diffusion from the perilymphatic space of the cochlea

The diffusion pattern of horseradish peroxidase (HRP) injected into the scala tympani of the cochlear basal turn of guinea pigs was studied to test whether antigen presented in this manner can gain access to the endolymphatic sac. By two hours, HRP reaction product was found throughout the cochlea, with the greatest amounts in the spiral ligament, spiral limbus, basilar membrane, and organ of Corti. In several cochleas, very weak labeling was seen in the stria vascularis. HRP reaction product was maximal in the basal turn. By two hours, HRP reaction product was also observed in the endolymphatic sac lumen, epithelial cells, subepithelial tissue, and perisaccular connective tissue. It was more common in the proximal portion. At this time, macrophages within the lumen already appeared to have phagocytosed the HRP. By 72 hours after injection, the inner ear was cleared of HRP. The results of this study support the hypothesis that antigen in the scala tympani gains access to the endolymphatic sac lumen, where it may be presented by macrophages to the systemic immune system. Antigen most likely does not gain access to the endolymphatic space in the cochlea, but it gets to the endolymphatic sac through the perilymph and the perisaccular tissue.

Fluctuating hearing loss following immune reaction in the endolymphatic sac of guinea pigs

This study has investigated immune injuries to the inner ear auditory system of guinea pigs. Following secondary antigen challenge to the endolymphatic sac, the mean hearing threshold significantly increased in the early phase from day 1 to day 3 and thereafter recovered. In the early phase, hearing threshold significantly increased simultaneously to the elevation of perilymph antibody levels. The size of hydrops was not the only factor that causes an increase in hearing loss as well as in AP/SP ratio. Scale-out hearing loss was seen in 2 animals with severe degeneration of the stria vascularis as well as the organ of Corti associated with the inflammatory cellular infiltration especially in the perilymphatic space, even in the absence of keyhole limpet hemocyanin antigen in the cochlea. On the other hand, control animals did not suffer hearing loss. These results suggest that an immune reaction in the endolymphatic sac is a possible pathogenic etiology of Ménière's disease or sudden deafness.

Cell proliferation in the endolymphatic sac in situ after inner ear immunostimulation

Cell proliferation in the endolymphatic sac (ES) after immunostimulation was assessed immunohistochemically. Guinea pigs were employed as experimental animals and keyhole limpet hemocyanin was used as the antigen. After i.p. injection of 5-bromo-2'-deoxyuridine (BrdUrd), the BrdUrd+ cells were counted to assess the number of proliferating cells. In the secondary immune reaction of the ES, the IgG+ cell count in the perisaccular region was markedly increased on days 7-14. An increased number of BrdUrd+ cells was detected, peaking on day 3, and the localization of these cells in the ES was similar to that of the IgG+ cells. This suggests that some BrdUrd+ cells may differentiate into IgG- cells within the ES.

Vascular permeability of the stria vascularis and morphology of the endolymphatic sac in two types of experimental endolymphatic hydrops

We produced two kinds of experimental endolymphatic hydrops. One was induced by obliteration of the endolymphatic sac (ES), and the other was induced by both systemic keyhole limpet hemocyanin immunization and secondary keyhole limpet hemocyanin challenge into the ES. The vascular permeability of the stria vascularis in acute and chronic phases was compared between both models by light and electron microscopy using the tracer method of horseradish peroxidase. Both models showed that the number of strial capillaries showing horseradish peroxidase leakage was significantly higher in the acute phase than in the chronic phase. In the acute phase, the ES showed acute inflammation in both models. In the chronic phase, extensive fibrosis occurred in the ES obliteration model, whereas the ES appeared to have a normal shape in the immunologically induced model. The mechanism of hydrops formation will be compared between the two models.

Role of adhesion molecules for the immunological defense of the inner ear

Previous experiments demonstrated an organ-specific migration of sensitized lymphocytes to the inner ear and enabled us to establish an animal model for an autoimmunological labyrinthitis in the guinea pig. For a nonrandom emigration from capillaries into tissues of their immunological destination, memory lymphocytes need homing receptors on their cell surface to interact with specialized postcapillary venules, the so-called high endothelial venules. These molecules were already demonstrated in organs of the mucosa-associated lymphatic system (MALT). This study was performed to demonstrate these adhesion molecules on endothelial cells and lymphocytes of the inner ear by using two monoclonal antibodies: MECA-325 and MEL-14. Special interest was directed to the posterior spiral modiolar vein as a known port of entry for lymphocytes during an immune response. Emphasis was placed on the development of new or additional binding sites for lymphocytes on the above-mentioned structures using immunohistochemistry during an immune response of the inner ear. The results suggest a constant recirculation of memory lymphocytes through the endolymphatic sac as known for other organs of the MALT. The acquisition of high endothelial venules in the cochlea during an immune response could serve for the cellular requirements of a sympathetic cochleolabyrinthitis with the spiral modiolar vein as port of entry for lymphocytes. Furthermore, this study supports the hypothesis of the endolymphatic sac as central immunological control organ of the inner ear and as the primary place for antigen processing.

[Free radicals in inner ear immune responses; immunohistochemical study of myeloperoxidase]

Previously, we reported that immune reactions in the endolymphatic sac of guinea pigs caused spontaneous nystagmus, a suppressed caloric response, and fluctuating hearing loss. In order to evaluate immune injury to the sensory organs of the inner ear, we conducted an immunohistochemical investigation of the distribution and time course of myeloperoxidase (MPO) following immune reaction in the endolymphatic sac. MPO staining can be seen in the endolymphatic sac, outer hair cells, stria vascularis and lateral canal (ampulla), from several hours to 3 weeks after a secondary KLH challenge, and its time course parallels the time course of neutrophil infiltration of the endolymphatic sac. This result indicates that free radicals in the MPO-H2O2-Cl system are responsible for the tissue damage and dysfunction resulting from inner ear immune reactions.

[Alterations in the distributions of the basement membrane components after secondary inner ear immune reaction in guinea pigs]

Alterations in the distributions of type IV collagen (C-IV), laminin (La), and fibronectin (Fib), which are important components of the basement membrane, in the inner ear following secondary endolymphatic sac immune response were studied immunohistologically using control animals for comparison. Endolymphatic hydrops developed following direct secondary keyhole limpet hemocyanin (KLH) challenge to the endolymphatic sac in systematically pre-sensitized animals. In the endolymphatic sacs of control animals, C-IV and La were localized continuously just under epithelial cells whereas Fib was present intermittently in subepithelial connective tissue. In the endolymphatic sac, following secondary KLH challenge, linear subepithelial localizations of C-IV and La were interrupted, thinner and more loosely aggregated with numerous inflammatory cellular infiltrates on days 2-4. Following these changes, endolymphatic hydrops in the cochlea developed and peaked on days 4-7. On days 1-7, Fib was strongly but sporadically localized in subepithelial cells. These results suggest that C-IV and La may play important roles in the regulation of endolymph whereas Fib may be related to the restoration of injured endolymphatic sac tissue in animals exposed to a secondary challenge.

Immunological approach to Ménière's disease: vestibular immune injury following immune reaction of the endolymphatic sac

Following direct antigen challenge to the endolymphatic sac (sac), the relation of caloric test results and spontaneous nystagmus to the histological changes of the sensory epithelium of the vestibular organ and perilymph antibody levels was investigated in the guinea pig. In a secondary keyhole limpet hemocyanin (KLH) challenge to the sac, irritative nystagmus was followed by paralytic nystagmus and a suppression of caloric reaction. These findings correlated well with the degree of degeneration of the sensory epithelium of the vestibular organ and the levels of perilymph antibody. On the other hand, neither phosphate-buffered saline inoculation nor primary KLH challenge to the sac nor a secondary KLH challenge to the intradural space resulted in a disturbance of the vestibular function. These results suggest that the immune response of the sac may possibly be an important key to the pathogenesis of Ménière's disease.

Immunological pathogenesis of endolymphatic hydrops and its relation to Menière's disease

This study was designed to investigate an immunologically induced endolymphatic hydrops (ELH) and to focus on the issue of its pathogenesis in relation to Menière's disease. The time course of ELH was evaluated by light microscopy in a 2-hour to 7-month period following direct antigen challenge to the endolymphatic sac (ELS) in systemically pre-sensitized guinea pigs. ELH began to appear in the vestibule and the basal turn 5-7 hours after inner ear challenge and developed gradually. During the interval from the second day to the first week, ELH rapidly developed in all the cochlear turns and reached a maximum size. During the period from the second week to the eighth week, ELH gradually reduced. After 9 weeks, ELH of the saccule and the cochlea gradually recurred. During the interval from the first week to the eighth week, the time course of ELH correlated well with the grade of cellular infiltration of the perisaccular tissue. These results suggest that recurrent immunological reaction in the ELS may result in disorders of the ELS which finally lead to the onset of Menière's disease.

Immunoperoxidase study of the endolymphatic sac in Menière's disease

A growing body of evidence suggests that some cases of Menière's disease may be mediated by immune mechanisms. Because endolymphatic sac dysfunction is believed to be an underlying cause of Menière's disease, this study used immunohistochemical techniques to demonstrate the presence of immune complex deposition in the sacs of patients with Menière's disease. Positive immunoglobulin G (IgG) staining was noted in 10 of 23 sac biopsies from Menière's patients, with 2 specimens showing perivascular deposition. Only 1 of 5 control specimens was only slightly positive for IgG. Clinical correlation showed a statistically significant increase in disease bilaterality (P < .05), larger summating potential/action potential (SP/AP) ratios with electrocochleography (ECoG), and a tendency toward worse hearing and more progressive disease among the immunopositive Menière's patients. The results provided histological evidence of immune injury in the endolymphatic sacs of patients with Menière's disease.

Secretory component and IgA in the endolymphatic sac

Immunohistochemical methods were used to investigate secretory component (SC) and immunoglobulin A within the inner ears of Sprague Dawley rats and BALB/c mice. Utilizing specific antisera against SC and IgA, the distribution and localization of SC and IgA were studied in normal, non-immunized ears of both animal species. The kinetics of SC and IgA were also investigated during a secondary immune response following keyhole limpet hemocyanin (KLH) challenge of murine inner ears. In the non-immunized murine inner ear, neither SC or IgA were found. In contrast, SC was localized within the epithelial cells and lumen of the endolymphatic sac (ES) in non-immunized rats and faint luminal IgA staining was seen in one-third of the animals, as well as an occasional IgA-bearing cell in the ES. In the inner ear secondary immune response, SC was found only within the endolymphatic sac of approximately 50% of the immunized mice 14 days after KLH challenge. IgA-bearing cells were also observed within the ES 2 to 3 weeks following KLH challenge. We conclude that there are species differences in the distribution of SC and IgA within the inner ear, and that under pathological conditions the endolymphatic sac may be a site of IgA and SC induction.

[Vestibular immune injury related to perilymph antigen specific antibody levels in the guinea pig]

This study demonstrates that degeneration of vestibular sensory cells depends on the integrity of immune responses in the endolymphatic sac (ES). Degeneration of the saccule occurred nearly twice as often as degeneration of the utricle and ampulla. Perilymph antibody levels were assessed following direct antigen (KLH) challenge to the endolymphatic sac in systemic presensitized guinea pigs. Mean perilymph antibody levels were significantly elevated in ears showing degeneration as compared to those which did not. Serum anti-KLH antibody levels were also significantly elevated in the ears with degeneration as compared to those without. Whether degeneration or recovery occurs, is largely dependent on the level of systemic immunization and perilymph antibody level within one week of antigen challenge to the ES.

Evidence of direct communication of bone marrow cells with the endolymphatic sac in experimental autoimmune labyrinthitis

In experimental autoimmune labyrinthitis, we found that the guinea pigs sensitized with bovine inner ear antigen (IEAg) developed cellular infiltration within the endolymphatic sac (E. sac). In this study, we investigated the distribution of immune mediated cells within bony vascular channels. The channels, which are normally found around the E. sac, are tiny and contain few immune-mediated cells. In contrast, in guinea pigs sensitized with IEAg bony vascular channels were large and contained immune-mediated cells. We hypothesize that immune-mediated cells in these channels are the result of the immune response directed against inner ear antigen, and that some immune-mediated cells seen in the E. sac during inner ear inflammatory events have migrated from the adjacent bone marrow.

[Cochlear immune injury following direct antigen challenge to the endolymphatic sac]

Following direct KLH antigen challenge to the endolymphatic sac (e. sac) in guinea pigs, degeneration of the cochlea was examined histologically by light microscopy. Degeneration was seen in 21 out of 140 animals presensitized systemically from day 1 to 5 weeks post secondary KLH challenge to the e. sac. Degeneration of the organ of Corti, stria vascularis and spiral ganglion cells was seen from day 1 in 19, 17 and 7 animals, respectively. There was no increase in these degenerative processes during the time course. In the period from day 1 to day 4, severe bleeding in the perilymphatic space occurred simultaneously with cochlear deterioration. Three animals showed perilymphatic fibrosis which was noted after the first week post KLH secondary challenge. In contrast, animals primarily challenged with KLH (locally administered to the e. sac) showed no cochlear degeneration. These results suggest that a locally mounted immune response in the e. sac can cause direct immune injury to cochlear tissues.

[Development of endolymphatic hydrops following immune response in the endolymphatic sac of guinea pigs--long-term observation]

We report findings for endolymphatic hydrops in specimens obtained 5 to 28 weeks after a direct challenge with secondary KLH antigen to the endolymphatic sac (ES) of guinea pigs. Following gradual disappearance of endolymphatic hydrops (EH) in the period between the 5th and 8th weeks, the inferior labyrinth EH gradually developed again from the 3rd month onward in the saccule and from the 4th month onward in the cochlea. Many lymphocytes and plasma cells infiltrated into the perisaccular space for up to 7 months. These results suggest that an immune response in the ES may ultimately induce chronic dysfunction of the ES and thereby lead to progressive EH.

Alterations of charge barrier in the inner ear following immune reactions

We investigated electron microscopically the changes of anionic sites of a charge barrier in the capillary basement membrane of the stria vascularis and endolymphatic sac following inner ear immune reactions. Hartley guinea pigs were immunized with bovine type II collagen, keyhole limpet hemocyanin, or horseradish peroxidase, with boosted and challenged antigens through the stylomastoid foramen. Animals were killed painlessly from several days up to 56 days after the antigen challenge. Polyethylenimine was used as a cationic tracer in order to observe the localization of anionic sites of the charge. In the animals immunized with bovine type II collagen or horseradish peroxidase, a significant decrease of anionic charge in the stria and the sac was found in the early stage of immunization. However, the keyhold limpet hemocyanin immunization group did not show any remarkable changes in the charge because of its lesser transfer into the inner ear due to of its high molecular weight and negative surface charge. A decrease of the charge under immunologic conditions may induce a hyperpermeability of vessels and a malabsorption of endolymph, and thus may cause endolymphatic hydrops.

Vestibular disorders following immune response of the endolymphatic sac in the guinea pig

The effect of a direct antigen challenge to the endolymphatic sac on vestibular function was investigated in guinea pigs. Following keyhole limpet hemocyanin (KLH) challenge to the sac in systemically presensitized guinea pigs, caloric responses were examined in 18 animals on days 1, 7, 14, 21, and 28. Caloric responses were significantly suppressed in 13 animals by day 7; of these, 5 animals had recovered by day 14 and 8 animals had not yet recovered by day 28. The behavior of spontaneous nystagmus was examined every hour in 10 animals at intervals of 3 to 56 hours after sac challenge. Irritative spontaneous nystagmus preceding paralytic nystagmus appeared in 5 animals, for which the mean onset was 14.6 +/- 3.1 hours and the mean duration was 4.4 +/- 6.5 hours. Paralytic spontaneous nystagmus appeared in all animals, for which the mean onset time was 23.3 +/- 12.3 hours. Neither direct KLH primary challenge of the sac nor phosphate-buffered saline injection to the sac caused significant changes in the vestibular function. These results suggest that an immune response of the sac induces a vestibular disorder and may produce an attack of vertigo similar to that of Meniere's disease.

Endolymphatic hydrops induced by immune response of the endolymphatic sac: relation to perilymph antibody levels

This study investigated the effect of a secondary immune response in the endolymphatic sac on the development of endolymphatic hydrops in guinea pigs. Following secondary keyhole limpet hemocyanin (KLH) challenge directly to the sac in systemically presensitized animals, hydrops rapidly developed within 1 week, then gradually reduced by 4 weeks. After 5 weeks, hydrops gradually recurred and developed again. Mean perilymph anti-KLH antibody levels rose from day 1 to 4 weeks and then decreased. The elevation of perilymph anti-KLH antibody levels on day 2 was due to an increased vascular permeability and there was a local regeneration by the challenge of the sac after day 7. The development of hydrops correlated well with mean perilymph anti-KLH antibody levels in the period from day 1 to day 7. After 2 weeks, there was no correlation between them. These results suggest that an immune response of the sac may induce an excess secretion of endolymph in the initial stage and may further lead to irreversible dysfunction of the sac at a later stage.

Distribution of immunocompetent cells in the endolymphatic sac

To better understand the role of immunocompetent cells in the defense mechanism of the inner ear, the distribution patterns of those cells were investigated in the endolymphatic sac (ES) of mice maintained in three different conditions: germ-free (GF), specific pathogen-free (SPF), and conventional (CV). In another experiment, the recruitment of lymphocyte subsets was examined in the ES of SPF rats undergoing a perilymphatic antigen challenge after systemic presensitization. In the ES of GF mice, no immunocompetent cells were found. In the ES of SPF and CV mice, cells positive for IgG, IgA, IgM, and Lyt-1 were present in much smaller numbers than in the nasal mucosa. Cells positive for Lyt-2 were not seen in the ES of any mice. In the ES of rats that underwent a perilymphatic antigenic stimulation after a systemic presensitization, B lymphocyte subsets (positive for IgG, IgA, IgM) were mobilized in increased numbers, and T cell subsets (helper/inducer and suppressor) were also found 1 week after perilymphatic antigen challenge. These results taken together suggest that the ES is not originally equipped to possess immunocompetent cells and mount an immune response, but that once it has been activated with the inner ear antigenic stimuli, the ES can be the active site of a local immune response of the inner ear.

[Immuno-injury to the inner ear auditory system following secondary endolymphatic sac immune response]

This study investigated immuno-injury to the inner ear auditory system following inner ear immune response in the guinea pig. The endolymphatic sac (ES) was directly challenged with keyhole limpet hemocyanin (KLH). Auditory brainstem response with click sound stimulation was assessed pre and post KLH challenge of the ES. In systematically presensitized animals, secondary KLH challenge to the ES produced significant elevation of the mean threshold level on day 3 and 17 as compared to that of pre challenge levels. However, no significant prolongation of the latency (N1-N3) was observed. On the other hand, neither phosphate buffered saline injection into the ES nor primary KLH challenges of the ES were capable of elevating the threshold level and changing the latency. These results indicate that elevation of threshold was apparently induced by a secondary immune response of the ES, not by nonspecific mechanical damage to the ES, the central auditory system or KLH toxicity to the inner ear, suggesting that local immune response of the ES is a possible pathogenesis of sensorineural hearing loss.

[Effects of inner ear immune responses on auditory function in guinea pigs]

Following direct challenge with KLH antigen primary or secondary (after systemic immunization) to the ES (endolymphatic sac) in guinea pigs, ECoG (electrocochleograms) were recorded from the round window induced by click and tone pips. The recordings were carried out on the 2nd, 7th and 21st days after local antigen challenge. There were no abnormal findings in the ECoG of the primary antigen challenged animals. On the other hand, prolongation of latencies, decrease in amplitudes of APs (compound action potentials) and increases in SP/AP ratios were observed in the 2nd day recordings of the secondary antigen challenged animals. However, all parameters of ECoG in the 7th day recordings were normal. Decreases in AP amplitudes were again found in the 21st day recordings. The ECoG findings with click and tone pip stimulation showed similar results. From these findings, in conjunction with morphological observations, it is speculated that these ECoG findings are caused by immuno-injury to the ES and cochlea, as well as the resultant endolymphatic hydrops which develops acutely and gradually subsides after secondary challenge.

Development of endolymphatic hydrops following immune response in the endolymphatic sac of the guinea pig

The present study investigated immune injury associated with endolymphatic hydrops (e.hydrops) following locally mounted immune reaction in the endolymphatic sac (e.sac) of guinea pigs. E.hydrops occurred, progressing rapidly within the first week post secondary Keyhole limpet hemocyanin (KLH) challenge in the e.sac and developed into two phases, acute and chronic. On the other hand, primary KLH challenge of the e.sac, PBS inoculation into the e.sac or intradural secondary KLH challenge were incapable of inducing e.hydrops. These results indicate that reversible and irreversible e.hydrops are induced by the immune response of the e.sac, suggesting that local immunological events of the e.sac may provide an animal model of Meniere's disease.

Functional morphology of the human endolymphatic sac. A review

Modern immunohistochemical methods allow a functional characterization of the human endolymphatic sac (ES) and its associated cell populations. The currently available immunohistochemical data on the extraosseous part of the human ES support the assumption that the epithelium is metabolically active and capable of both secretion and absorption. The reactivity of some epithelial cells with antibodies against neuroendocrine antigens implies a paracrine activity of the human ES. Further results provide evidence for a possible role of the human ES in inner ear immune defense and indicate a putative functional relationship of the human ES to the common mucosa-associated immune system.

[Mechanisms of development of endolymphatic hydrops following secondary immune response in the endolymphatic sac of guinea pigs]

Previously the author reported the immediate development of endolymphatic hydrops (e. hydrops) following direct challenge of secondary antigen to the endolymphatic sac (ES) in guinea pigs, during the early phases of postchallenge, ranging from 1 to 5 weeks. The present study reports the results of specimens taken up to 10 weeks postchallenge, and correlation of e.hydrops to perilymph in antigen-specific antibody levels. From the present results, mechanisms of e.hydrops induced ES immune reaction are suggested as follows. 1) In the early stage of e.hydrops, an acute inflammatory reaction in the ES may produce endolymph by an increased vascular permeability of the inner ear and may impair endolymph absorption from the ES. 2) In the latter stage of e.hydrops, the moderate cellular infiltration in the ES may cause chronic impairment of endolymph absorption in the ES.