京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20247号 / 医博第4206号 / 新制||医||1020(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊佐 正, 教授 鈴木 茂彦, 教授 高橋 淳 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

<p>Our knowledge of the fine structure of the Human Spiral Ganglion (HSG) is still inadequate and new treatment techniques for deafness using electric stimulation, call for further information and studies on the neuronal elements of the human cochlea. This thesis presents results of analyses of human cochlear tissue and specimens obtained during neurosurgical transpetrosal removal of life-threatening meningeomas. The use of surgical biopsies produced a well-preserved material suitable for ultrastructural and immunohistochemical studies on the human inner ear. The SG was studied with respect to fine structure, using TEM technique and the immunostaining pattern of synaptophysin, which is an integral membrane protein of neuronal synaptic vesicles. The immunostaining patterns of the tight junctional protein ZO-1 and the gap junctional proteins Cx26 and Cx43 in the human cochlea were also studied. The ultrastructural morphology revealed an absence of myelination pattern in the HSG, thus differing from that in other species. Furthermore, formation of structural units as well as signs of neural interaction between the type 1 neurons could be observed. Type 1 cells were tightly packed in clusters, sharing the ensheathment of Schwann cells. The cells frequently made direct physical contact in Schwann cell gaps in which membrane specializations appeared. These specializations consisted of symmetrically or asymmetrically distributed filamentous densities along the apposed cell membranes. The same structures were also present between individual unmyelinated nerve fibres and the type 1 cells. Synapses were observed on the type 2 neurons, with nerve fibres originating from the intraganglionic spiral bundle. Such synapses, though rare, were also observed on the type 1 cells. The ultrastructural findings were confirmed by the synaptophysin study. A 3-D model of a Schwann cell gap between two type 1 cells was constructed, describing the distribution pattern of membrane specializations. In the immunohistochemical studies on the human cochlea, ZO-1 was expressed in tissues lining scala media, thus contributing to the formation of a closed compartment system, important for the maintenance of the specific ionic composition of the endolymph. Protein Cx26 could be identified in non-sensory epithelial cells of the organ of Corti, in connective tissue cells of the spiral ligament and spiral limbus, as well as in the basal and intermediate cell layers of stria vascularis. Cx26 in this region may be involved in the recycling of potassium. Protein Cx43 stained weakly in the spiral ligament, but intense staining in the SG may indicate that gap junctions exist between these neurons. A different functional role for the HSG can be assumed from the morphological characteristics and the signs of a neural interaction between the SG cells. This might be relevant for neural processing mechanisms in speech coding and could have implications for cochlear implant techniques.</p>

Our knowledge of the fine structure of the Human Spiral Ganglion (HSG) is still inadequate and new treatment techniques for deafness using electric stimulation, call for further information and studies on the neuronal elements of the human cochlea. This thesis presents results of analyses of human cochlear tissue and specimens obtained during neurosurgical transpetrosal removal of life-threatening meningeomas. The use of surgical biopsies produced a well-preserved material suitable for ultrastructural and immunohistochemical studies on the human inner ear. The SG was studied with respect to fine structure, using TEM technique and the immunostaining pattern of synaptophysin, which is an integral membrane protein of neuronal synaptic vesicles. The immunostaining patterns of the tight junctional protein ZO-1 and the gap junctional proteins Cx26 and Cx43 in the human cochlea were also studied. The ultrastructural morphology revealed an absence of myelination pattern in the HSG, thus differing from that in other species. Furthermore, formation of structural units as well as signs of neural interaction between the type 1 neurons could be observed. Type 1 cells were tightly packed in clusters, sharing the ensheathment of Schwann cells. The cells frequently made direct physical contact in Schwann cell gaps in which membrane specializations appeared. These specializations consisted of symmetrically or asymmetrically distributed filamentous densities along the apposed cell membranes. The same structures were also present between individual unmyelinated nerve fibres and the type 1 cells. Synapses were observed on the type 2 neurons, with nerve fibres originating from the intraganglionic spiral bundle. Such synapses, though rare, were also observed on the type 1 cells. The ultrastructural findings were confirmed by the synaptophysin study. A 3-D model of a Schwann cell gap between two type 1 cells was constructed, describing the distribution pattern of membrane specializations. In the immunohistochemical studies on the human cochlea, ZO-1 was expressed in tissues lining scala media, thus contributing to the formation of a closed compartment system, important for the maintenance of the specific ionic composition of the endolymph. Protein Cx26 could be identified in non-sensory epithelial cells of the organ of Corti, in connective tissue cells of the spiral ligament and spiral limbus, as well as in the basal and intermediate cell layers of stria vascularis. Cx26 in this region may be involved in the recycling of potassium. Protein Cx43 stained weakly in the spiral ligament, but intense staining in the SG may indicate that gap junctions exist between these neurons. A different functional role for the HSG can be assumed from the morphological characteristics and the signs of a neural interaction between the SG cells. This might be relevant for neural processing mechanisms in speech coding and could have implications for cochlear implant techniques.

The main functional cells of the inner ear are neurons and sensory cells that are formed from a common embryonic epithelial neurosensory domain. Discovering genes important for specification and differentiation of sensory cells and neurons in the inner ear is a crucial basis for understanding the pathophysiology of hearing loss. Some of these factors are necessary not only for the inner ear but also for the development of other neurosensory systems such as the visual and olfactory system. The aim of this work was to reveal functions of transcription factor SOX2 in inner ear development by using mouse models with different conditional deletions of Sox2 gene. Sox2 gene was deleted by cre-loxP recombination. In Isl1-cre, Sox2 CKO mutant, reduced number of hair cells differentiated only in some inner ear organs (utricle, saccule and cochlear base) and not in others (cristae and cochlear apex). Early forming inner ear neurons in the vestibular ganglion and neurons innervating the cochlear base developed in these mutants but died by apoptosis due to the lack of neurotrophic support from sensory cells. Late forming neurons in the cochlear apex never formed. In Foxg1-cre, Sox2 CKO mutant, only rudimental ear with no sensory cells was formed. The initial formation of vestibular ganglion with peripheral and...

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Les surdités neurosensorielles sont classiquement décrites par une élévation des seuils auditifs généralement corrélée à une dégénérescence des cellules ciliées externes (CCE). Toutefois, des travaux récents sur des modèles animaux ont montré qu’un audiogramme normal pouvait être associé à des atteintes auditives périphériques. Ce travail de thèse a contribué à mieux caractériser chez des modèles murins, ces déficiences supraliminaires cachées liées d’une part, à des altérations des CCE et d’autre part, à la dégénérescence de certaines fibres nerveuses auditives. Dans la première partie de cette thèse, l’évolution des profils auditifs de souris présentant une dégénérescence accélérée des CCE, les souris de souche CD1-RjOrl : SWISS, a été caractérisée. Dans cette étude longitudinale, menée au cours du premier mois postnatal, une progressivité de la déficience auditive a été montrée. Toutefois, une discordance surprenante a été mise en évidence entre des seuils auditifs proches des valeurs normales à haute fréquence combinés à des produits de distorsions acoustiques (PDA) absents. Les courbes d’accord de masquage montrent un décalage des pointes vers les basses fréquences. Ces données indiquent que les CCE de la base ne sont plus fonctionnelles et que la perception des hautes fréquences est perturbée. Les observations en microscopie électronique à balayage ont révélé une conformation anormale de la touffe stéréociliaire des CCE au niveau de la base de la cochlée. Ces données témoignent d’une désorganisation de la tonotopie cochléaire. Dans la deuxième partie de cette thèse, l’effet de l’oxaliplatine sur la fonction auditive et sur la morphologie cochléaire a été décrit chez des souris adultes de souche CBA/J. L’oxaliplatine, un sel de platine utilisé en chimiothérapie, a de nombreux effets secondaires parmi lesquels l’apparition d’une neuropathie périphérique. À la suite d’un traitement avec cette drogue, les souris ne présentent pas d’élévation des seuils auditifs et pas d’altération de la fonction des CCE. Cependant, l’étude histologique révèle une dégénérescence surprenante des fibres auditives du ganglion spiral. Avec des tests électrophysiologiques supplémentaires, une diminution de l’amplitude du potentiel d’action composite a été mise en évidence. Le réflexe du système efférent olivocochléaire médian, évalué par un test de suppression controlatéral, semble également être diminué par le traitement. Les souris traitées avec de l’oxaliplatine constituent donc un modèle animal précieux de surdité cachée, qui demande à être mieux caractérisé. Les résultats de ces études confirment l’insuffisance de l’audiogramme pour détecter des altérations subtiles de la cochlée et montrent la nécessité d’améliorer le diagnostic de ces déficiences supraliminaires. Ainsi, les atteintes cachées des CCE peuvent être détectées par l’absence de PDA associée à des potentiels évoqués auditifs normaux et les neuropathies par des PDA présents associés à des potentiels évoqués auditifs anormaux. La combinaison de ces différents tests fonctionnels et électrophysiologiques permettrait une meilleure prise en charge des patients et une amélioration de leur qualité de vie. / Sensorineural hearing loss are classically described by auditory thresholds elevation usually correlated with outer hair cells (OHC) degeneration. However, recent work on animal models has shown that normal audiogram can be associated with peripheral hearing impairments. This thesis contributed to better characterize, in mouse models, these hidden supraliminal deficiencies related on the one hand, with OHC alterations and on the other, to auditory nerve fibers degeneration. In the first part of this thesis, the auditory profiles evolution of mice exhibiting an OHC accelerated degeneration, the CD1-RjOrl: SWISS strain mice, was characterized. In this longitudinal study, conducted in the first postnatal month, a progressivity of the hearing impairment has been observed. However, a surprising discrepancy was found between high frequency hearing thresholds close to normal values associated with missing distortion product otoacoustic emission (DPOAE). The masking tuning curves dips are shifted toward low frequencies. Those data indicate that basal OHC are no longer functional and the perception of high frequencies is disrupted. Observations in scanning electron microscopy revealed an abnormal conformation of the OHC stereocilia bundles at the cochlea base. These results represent an evidence of a disorganized cochlear tonotopy. In the second part of this thesis, the effect of oxaliplatin on the auditory function and on the cochlear morphology was described in adult CBA/J strain mice. Oxaliplatin, a platinum salt used in chemotherapy, has many side effects including development of peripheral neuropathy. Following one treatment with this drug, mice did not present any hearing threshold elevation or OHC function impairment. However, the histological study reveals a surprising degeneration of the spiral ganglion cells. With additional electrophysiological tests, a decrease in the compound action potential amplitude has been demonstrated. The median olivocochlear efferent system reflex, evaluated by a contralateral suppression test, also seems to be diminished by the treatment. The mice treated with oxaliplatin, therefore constitute a precious animal model of hidden deafness, which needs to be better characterized. The results of these studies confirm the audiogram insufficiency to detect subtle cochlea alterations and reveal the need to improve supraliminal deficiencies diagnosis. Thus, hidden OHC impairments can be detected by the absence of DPOAE associated with normal auditory evoked potentials and neuropathies by the presence of DPOAE associated with abnormal auditory evoked potentials. The combination of these functional and electrophysiological tests would allow better management of patients and an improvement in their quality of life.Keywords: hidden hearing loss, CD1 mice, outer hair cells, masking tuning curves, tonotopy, oxaliplatine, spiral

Numerous studies showed that cochlear implant (CI) users generally prefer individualized stimulation rates in order to maximize their speech understanding. The underlying reasons for the reported variation in speech perception performance as a function of CI stimulation rate is unknown. However, multiple interacting electrophysiological processes influence the auditory nerve (AN) in response to high-rate CI stimulation. Experiments studying electrical pulse train stimulation of cat AN fibers (ANFs) have demonstrated that spike rates slowly decrease over time relative to onset stimulation and is often attributed to spike rate (spike-triggered) adaptation in addition to refractoriness. Interestingly, this decay tends to adapt more rapidly to higher stimulation rates. This suggests that subthreshold adaptation (accommodation) plays a critical role in reducing neural excitability. Using biophysical computational models of cat ANF including ion channel types such as hyperpolarization-activated cyclic nucleotide-gated (HCN) and low threshold potassium (KLT) channels, we measured the strength of adaptation in response to pulse train stimulation for a range of current amplitudes and pulse rates. We also tested these stimuli using a phenomenological computational ANF model capable of applying any combination of refractoriness, facilitation, accommodation, and/or spike rate adaptation. The simulation results show that HCN and KLT channels contribute to reducing model ANF excitability on the order of 1 to 100 ms. These channels contribute to both spike rate adaptation and accommodation. Using our phenomenological model ANF we have also shown that accommodation alone can produce a slow decay in ANF spike rates responding to ongoing stimulation. The CI users that do not benefit from relatively high stimulation rates may be due to ANF accommodation effects. It may be possible to use electrically evoked compound action potentials (ECAP) recordings to identify CI users exhibiting strong effects of accommodation, i.e., the increasing strength of adaptation as a function of increasing stimulation rate. / Dissertation / Doctor of Philosophy (PhD) / Cochlear implants (CI) attempt to restore hearing to individuals with severe to profound hearing deficits by stimulating the auditory nerve with a series of electrical pulses. Recent CI stimulation strategies have attempted to improve speech perception by stimulating at high pulse rates. However, studies have shown that speech perception performance does not necessarily improve with pulse rate increases, leading to speculation of possible causes. Certain ion channels located in auditory nerve fibers may contribute to driving the nerve to reduce its excitability in response to CI stimulation. In some cases, those channels could force nerve fibers to cease responding to stimulation, causing a breakdown in communication from the CI to the auditory nervous system. Our simulation studies of the auditory nerve containing certain types of channels showed that the effective rate of communication to the brain is reduced when stimulated at high rates due to the presence of these channels.

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