Munehisa Fukushima

Effects of intratympanic injection of steroids on changes in rat inner ear aquaporin expression.

Although steroid treatment is generally administered for patients with inner ear disorders, including Ménières disease, the mechanism via which steroids exert their effects remains to be clarified. The aquaporins (AQPs) are a family of small transmembrane water transporters, and it has recently been revealed that they play a role in regulating homeostasis in the inner ear fluids. In order to elucidate the action points of steroids in the inner ear, we firstly identified AQP1, 2, 3, 4, 5 and 6 mRNAs in the rat cochlea and AQP1, 3, 4, 5 and 6 in the rat endolymphatic sac by means of reverse transcription-polymerase chain reaction. Subsequently, we found that intratympanic injections of steroids upregulated AQP1 mRNA of the rat cochlea in a dose-dependent manner. These results suggest that steroids may affect water homeostasis in the rat inner ear mainly via AQP1.

Up-regulation of cochlear aquaporin-3 mRNA expression after intra-endolymphatic sac application of dexamethasone.

Abstract The final aim of the present study is to see if the endolymphatic sac is really available as a drug delivery system to have effect on the inner ear organs. In the present study, we examined effects of a single insertion of dexamethasone into the rat unilateral endolymphatic sac on mRNA expression of the inner ear aquaporin (AQP) family, transmembrane water transporters and putative endolymphatic fluid modulators, by means of real-time quantitative PCR. Only AQP-3 mRNA expression in the ipsilateral cochlea was significantly up-regulated in comparison with controls and the up-regulation was demonstrated both in dose-dependent and time-dependent manners. These findings suggest that the intra-endolymphatic sac steroids could make regulatory effects on the inner ear AQP-3 expression via vestibular aqueduct and modulate the homeostasis of endolymphatic fluids, encouraging the possibility that the endolymphatic sac could be a therapeutic window for the inner ear disease.

Effects of Exposing the Opened Endolymphatic Sac to Large Doses of Steroids to Treat Intractable Meniere's Disease

To enhance the effect of treatment for intractable Menieres disease, we exposed the opened endolymphatic sac to high concentrations of steroids. This technique — endolymphatic sac drainage and steroid instillation surgery — involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into a sac lumen opened and expanded with a bundle of absorbable gelatin film. These sponges are also placed around the sac and coated with biochemical adhesive so that the medicine is slowly delivered into the sac over a prolonged period of time by means of a natural sustained-release vehicle. The short-term results (6 to 14 months) in 12 patients with Menieres disease, including those in stage IV, treated by the above techniques showed that definitive spells were completely controlled in all cases. Hearing was improved, and annoyance due to tinnitus was decreased in all cases except one.

Changes in aquaporin expression in the inner ear of the rat after i.p. injection of steroids

The aquaporins (AQPs) are a family of small transmembrane water transporters. It has recently been revealed that they play a role in regulating homeostasis in the inner ear fluids. Steroid therapy is usually administered to patients with inner ear disorders; however, the mechanism of steroid effects has not been clearly determined. To elucidate the points of action of steroids in the inner ear, we recently examined the distributions of AQP isoform mRNAs in the rat inner ear and identified AQP1–6 mRNAs in the rat cochlea and AQP1, 3, 4, 5 and 6 mRNAs in the rat endolymphatic sac by means of reverse transcriptase polymerase chain reaction (PCR). In this study, we investigated changes in expression of AQP mRNAs in the rat inner ear after i.p. injections of steroids using real-time quantitative PCR and found that AQP3 mRNA in the endolymphatic sac was significantly upregulated in both dose- and time-dependent manners. This result suggests that steroids may effect water homeostasis in the rat inner ear via AQPs.

Quantitative changes in mRNA expression of glutamate receptors in the rat peripheral and central vestibular systems following hypergravity

In order to investigate the mechanisms responsible for adaptation to altered gravity, we assessed the changes in mRNA expression of glutamate receptors in vestibular ganglion cells, medial vestibular nucleus, spinal vestibular nucleus/lateral vestibular nucleus, cerebellar flocculus, and uvula/nodulus from rats exposed to hypergravity for 2 h to 1 week using real‐time quantitative RT‐PCR methods. The mRNA expression of GluR2 and NR1 receptors in the uvula/nodulus and NR1 receptors in the medial vestibular nucleus increased in animals exposed to 2 h of hypergravity, and it decreased gradually to the control level. The mRNA expression of GluR2 receptors in vestibular ganglion cells decreased in animals exposed to 1 week of hypergravity. Neither the metabotropic glutamate receptor 1 nor δ2 glutamate receptor in flocculus and uvula/nodulus was affected by a hypergravity load for 2 h to 1 week. It is suggested that the animals adapted to the hypergravity by enhancing the cerebellar inhibition of the vestibular nucleus neurons through activation of the NR1 and GluR2 receptors on the Purkinje cells in uvula/nodulus especially at the early phase following hypergravity. In the later phase following hypergravity, the animals adapted to the hypergravity by reducing the neurotransmission between the vestibular hair cells and the primary vestibular neurons via down‐regulation of the postsynaptic GluR2 receptors in the vestibular periphery.

Fos induction in the amygdala by vestibular information during hypergravity stimulation

Altered gravity environments including both hypo- and hypergravity can elicit motion sickness. Vestibular information is known to be essential for motion sickness, but its other neural substrates are poorly understood. We previously showed that bilateral lesions of the amygdala suppressed hypergravity-induced motion sickness in rats, using pica behavior as an emetic index. We show in the present study that during hypergravity stimulation, vestibular information activated the central nucleus of the amygdala (CeA), as determined by the induction of Fos expression, in comparison between normal and bilaterally labyrinthectomized rats. The finding that Fos expression was confined to the CeA and almost completely absent in other subnuclei of the amygdala contrasted with many previous studies that used other stressful stimuli such as foot shock, restraint and forced swimming, suggesting a specific vestibular effects on the amygdala. Prolongation of hypergravity resulted in reduction of Fos expression in the CeA, suggesting a process of habituation. Such decreases appeared earlier than in the vestibular nucleus, suggesting that adaptive changes in the CeA to hypergravity were independent of changes in the vestibular input. Our results suggest the amygdala is a neural substrate involved in the development of and habituation to motion sickness.

Role of cholinergic mossy fibers in medial vestibular and prepositus hypoglossal nuclei in vestibular compensation

Several lines of evidence have suggested that acetylcholine is a possible neurotransmitter/neuromodulator involved in vestibular compensation. Further, the central vestibular system, oculo- and spino-motor neurons and peripheral vestibular efferents contain abundant cholinergic neurons. However, details of cholinergic effective sites during vestibular compensation remain to be clarified. In the present study, we selectively damaged rat vestibulo-floccular and vestibulo-uvulonodular cholinergic mossy fibers using ethylcholine mustard aziridinium ions. In these treated animals, unilateral labyrinthectomy caused more severe vestibulo-ocular deficits especially during the initial stage. From these findings we suggest that vestibulo-floccular and vestibulo-uvulonodular cholinergic mossy fibers contribute to the restoration of a balance between intervestibular nuclear activities for the induction of vestibular compensation during the initial stage.

Effects of Pre-flocculectomy on Fos Expression and NMDA Receptor-mediated Neural Circuits in the Central Vestibular System after Unilateral Labyrinthectomy

In this study in order to elucidate the role of the flocculus in the whole process of vestibular compensation from the very early stage to the chronic stage, we first examined unilateral labyrinthectomy (UL)-induced spontaneous nystagmus (SN), a behavioral marker of vestibular compensation, and Fos expression, a marker of neural activity, in the vestibular brainstem in pre-unilateral flocculectomized (pre-UF) rats. UL in pre-UF rats caused more severe vestibulo-ocular deficits at the very early stage than it did in floccular-intact rats. Fos expression occurred in the medial vestibular nucleus contralateral to the UL side (contra-MVe) and the prepositus hypoglossal nucleus ipsilateral to the UL side (ipsi-PrH), whereas Fos expression was never seen after UL in floccular-intact rats. Therefore, these findings suggest the UL in pre-UF rats activates the contra-MVe and ipsi-PrH neurons and causes great imbalance between intervestibular nuclear activities, inducing more severe vestibular symptoms at the very early stage than those in floccular-intact rats. Next, we observed MK801 (a specific antagonist on the NMDA receptor)-induced SN in pre-UF rats at the chronic stage after UL. MK801 administration to pre-UL rats caused reappearance of SN even 14 days after UL, while administration to floccular-intact rats at a post-UL interval of 14 days never induced decompensation. Therefore, these findings suggest that the flocculus takes part in NMDA receptor-mediated neural circuits involved in vestibular compensation and modifies the neural interactions at the chronic stage after UL. Taken together, those results suggest that the flocculus plays important roles in the restoration of a balance between intervestibular nuclear activities, to reduce vestibular symptoms during the very early stage, and thereafter in the modification of NMDA receptor-mediated neural interactions in the central vestibular system at the chronic stage.In this study in order to elucidate the role of the flocculus in the whole process of vestibular compensation from the very early stage to the chronic stage, we first examined unilateral labyrinthectomy (UL)-induced spontaneous nystagmus (SN), a behavioral marker of vestibular compensation, and Fos expression, a marker of neural activity, in the vestibular brainstem in pre-unilateral flocculectomized (pre-UF) rats. UL in pre-UF rats caused more severe vestibulo-ocular deficits at the very early stage than it did in floccular-intact rats. Fos expression occurred in the medial vestibular nucleus contralateral to the UL side (contra-MVe) and the prepositus hypoglossal nucleus ipsilateral to the UL side (ipsi-PrH), whereas Fos expression was never seen after UL in floccular-intact rats. Therefore, these findings suggest the UL in pre-UF rats activates the contra-MVe and ipsi-PrH neurons and causes great imbalance between intervestibular nuclear activities, inducing more severe vestibular symptoms at the very early stage than those in floccular-intact rats. Next, we observed MK801 (a specific antagonist on the NMDA receptor)-induced SN in pre-UF rats at the chronic stage after UL. MK801 administration to pre-UL rats caused reappearance of SN even 14 days after UL, while administration to floccular-intact rats at a post-UL interval of 14 days never induced decompensation. Therefore, these findings suggest that the flocculus takes part in NMDA receptor-mediated neural circuits involved in vestibular compensation and modifies the neural interactions at the chronic stage after UL. Taken together, those results suggest that the flocculus plays important roles in the restoration of a balance between intervestibular nuclear activities, to reduce vestibular symptoms during the very early stage, and thereafter in the modification of NMDA receptor-mediated neural interactions in the central vestibular system at the chronic stage.

Extracapsular dissection: Minimally invasive surgery applied to patients with parotid pleomorphic adenoma

Abstract Conclusions: We performed extracapsular dissection (ECD) on 31 patients with pleomorphic adenoma, including 7 deep lobe cases. ECD is minimally invasive and has limited complications compared with other conventional parotidectomy procedures. This is the first report on performance of ECD in patients with deep lobe parotid pleomorphic adenomas. Surgeons who are capsule-conscious can perform ECD with good results. Objective: Pleomorphic adenoma, the most common benign neoplasm occurring in the parotid gland, has a constant frequency of recurrence and facial paralysis in patients after surgery. ECD is one of the surgical procedures performed on patients with these tumors, but its validity is still unclear because of its similarity to enucleation. Methods: We performed ECD in patients with untreated parotid neoplasms that were clinically diagnosed as benign before surgery. Of these, resected samples from 31 patients were histologically diagnosed as pleomorphic adenoma. Results: We achieved resection in patients with pleomorphic adenoma with no permanent facial paralysis or tumor recurrence, with a median follow-up time of 61 months (range 18–125 months).

Factors relating to the vertigo control and hearing changes following intratympanic gentamicin for intractable Ménière's disease.

Objective: To look for factors relating to the vertigo control and hearing changes after intratympanic injections of gentamicin (GM). Study design: Prospective. Setting: Tertiary referral medical center. Patients: Twenty-eight patients with intractable Ménières disease. Interventions: Three intratympanic injections of GM (once per day for three consecutive days). Main Outcome Measures: Although five patients needed further GM injections or vestibular neurectomy because of poor control (Group I), 23 patients had their vertigo controlled for more than two years without further treatment (Group II). The number of vertigo spells per month, pure-tone audiometry, electrocochleography, caloric response, post-head shake nystagmus, and plasma vasopressin as a stress marker were examined. Results: Before GM injections, there was no difference in the number of vertigo spells per month between Groups I and II. However, the hearing thresholds were higher in Group I. Hearing improvement, increase in percentage of canal paresis and induction of post-head shake nystagmus were observed after GM injections only in Group II. Even in the 11 patients who showed an improvement in hearing of more than 10 dB (hearing improvement group), percentage of canal paresis was increased after GM. More, premedication plasma vasopressin levels were lower in the hearing improvement group as compared with the hearing loss/no changes group. Four of eight patients became negative for dominant negative summating potential in electrocochleography after GM injections in the hearing improvement group. Conclusion: Our data indicate that the frequency of vertigo is not a key factor in the vertigo control after GM injections, that induction of vestibular damage in the injected ear is essential for the control of vertigo and this effect is mostly pronounced in patients with milder hearing loss, and that hearing improvement is not only a consequence of good vertigo control but also affected by the stress level before treatment.