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Polystyrene microplastics induce auditory neurotoxicity in mammals: Integrated multi-omics profiling reveals oxidative damage and synaptic molecular dysregulation.

Microplastics (MPs) are ubiquitous environmental pollutants, yet their neurotoxic effects on the auditory system remain poorly understood. This study develops an integrated multi-level analytical framework combining auditory neurophysiology, behavioral assessment, tissue biochemistry, transcriptomics, and proteomics to investigate polystyrene (PS)-MPs-induced auditory neurotoxicity in rats. PS-MPs infiltrate the auditory system and significantly impair auditory processing, with central dysfunction emerging earlier and more prominently than peripheral alterations. Multi-omics analyses reveal coordinated suppression of glutamatergic synapse and Wnt signaling pathways in the cochlear nucleus. Mechanistically, PS-MPs perturb the crosstalk between glutamatergic synaptic and Wnt signaling, promoting AMPA receptor (AMPAR) internalization and potentially affecting synaptic plasticity-related processes and neuronal responsiveness. In parallel, PS-MPs trigger oxidative stress, apoptosis, and glial activation, reflecting pronounced neuroinflammatory and redox imbalance. In primary cochlear nucleus neurons (PCNNs), these mechanisms were further validated in vitro, where activation of Wnt signaling by Wnt3a significantly alleviated oxidative injury and reduced AMPAR internalization. Collectively, these findings provide comprehensive preclinical evidence for the neurotoxic potential of MPs and reveal a previously unrecognized PS-MPs-induced auditory neurotoxicity, although further studies are needed for human relevance. Results from the rat model further implicate Wnt-mediated signaling as a potential modulatory pathway underlying MPs-induced synaptic molecular alterations and redox dysfunction.

Animals↗

Reversal of desferrioxamine induced auditory neurotoxicity during treatment with Ca-DTPA.

Auditory neurotoxicity occurred in 13 (26%) of 50 evaluable patients receiving long term desferrioxamine chelation. In five of these patients, all of whom were receiving high doses of desferrioxamine, the toxicity caused deafness. These five patients were treated with subcutaneous calcium diethylene triamine pentacetic acid (Ca-DTPA) with zinc supplements instead of desferrioxamine, and their hearing improved during periods of seven to 19 months. Their serum ion concentrations remained unchanged. We suggest that all patients receiving long term desferrioxamine should have audiometric assessments at 6-12 monthly intervals. Ca-DTPA with oral zinc supplements should be considered as alternative to desferrioxamine as an iron chelating treatment in patients with auditory neurotoxicity.

Adolescent↗

Serial studies of auditory neurotoxicity in patients receiving deferoxamine therapy.

Visual and auditory neurotoxicity was previously documented in 42 of 89 patients with transfusion-dependent anemia who were receiving iron chelation therapy with daily subcutaneous deferoxamine. Twenty-two patients in the affected group had abnormal audiograms with deficits mostly in the high frequency range of 4,000 to 8,000 Hz and in the hearing threshold levels of 30 to 100 decibels. When deferoxamine therapy was discontinued and serial studies were performed, audiograms in seven cases reverted to normal or near normal within two to three weeks, and nine of 13 patients with symptoms became asymptomatic. Audiograms from 15 patients remained abnormal and four patients required hearing aids because of permanent disability. Since 18 of the 22 patients were initially receiving deferoxamine doses in excess of the commonly recommended 50 mg/kg per dose, therapy was restarted with lower doses, usually 50 mg/kg per dose or less depending on the degree of auditory abnormality, and with the exception of two cases no further toxicity was demonstrated. Auditory deterioration and improvement, demonstrated serially in individual patients receiving and not receiving deferoxamine, respectively, provided convincing evidence for a cause-and-effect relation between deferoxamine administration and ototoxicity. Based on these data, a plan of management was developed that allows effective yet safe administration of deferoxamine. A dose of 50 mg/kg is recommended in those without audiogram abnormalities. With mild toxicity, a reduction to 30 or 40 mg/kg per dose should result in a reversal of the abnormal results to normal within four weeks. Moderate abnormalities require a reduction of deferoxamine to 25 mg/kg per dose with careful monitoring. In those with symptoms of hearing loss, the drug should be stopped for four weeks, and when the audiogram is stable or improved, therapy should be restarted at 10 to 25 mg/kg per dose. Serial audiograms should be performed every six months in those without problems and more frequently in young patients with normal serum ferritin values and in those with auditory dysfunction.

Adolescent↗

Acute visual and auditory neurotoxicity in patients with end-stage renal disease receiving desferrioxamine.

We report 5 cases of acute visual and auditory neurotoxicity in patients with end-stage renal disease receiving desferrioxamine. Four patients complained of visual toxicity characterized by a decrease in visual acuity, loss of color vision and night blindness. In these patients there was a decrease in visual acuity, and the Farnsworth's test revealed a tritanopy (yellow-blue axis impairment); 1 patient also showed retinal pigmentary changes. A fifth patient complained of bilateral and severe neurosensorial deafness. Patients improved clinically upon drug-withdrawal. We recommend careful monitoring of audiovisual toxicity in patients with end-stage renal disease receiving this drug.

Acute Disease↗

Visual and auditory neurotoxicity in patients receiving subcutaneous deferoxamine infusions.

Of 89 patients receiving nightly subcutaneous deferoxamine for transfusion-dependent thalassemia major or Diamond-Blackfan anemia, 13 presented with visual loss or deafness of acute onset or both. Detailed ophthalmologic, audiologic, and evoked-potential studies uncovered abnormalities caused by neurotoxicity in 27 more. Four patients with visual loss had optic neuropathy, with a marked decrease in acuity, loss of color vision, and delayed visual evoked potentials. Five asymptomatic patients had changes in the pigment of the retinal epithelium. The hearing loss was characterized by a high-frequency sensorineural deficit, which necessitated hearing aids in six patients. When deferoxamine was stopped, recovery of vision was complete in 2 patients and partial in 2, and in 22 patients with abnormal audiograms, reversal of the hearing deficit was complete in 4 and partial in 1. An analysis of the clinical data showed that members of the affected group were younger, had lower serum ferritin values, and were self-administering higher doses of deferoxamine per kilogram of body weight. Significantly lower doses of deferoxamine were being taken by patients without abnormalities than by those with visual symptoms, abnormal audiograms, or prolonged evoked potentials (P less than 0.001, less than 0.006, and less than 0.04, respectively). The data implicate high-dose deferoxamine as a central factor in the pathogenesis of the neurotoxicity. We strongly recommend careful regulation of the deferoxamine dosage and serial audiovisual monitoring in all patients receiving the drug.

Adolescent↗

Long-term effects of carboplatin brainstem infusions on hearing thresholds in monkeys.

OBJECTIVE: To isolate the central auditory neurotoxicity of carboplatin from its well-established ototoxic effects. DESIGN: The "best-case scenario" of targeted drug delivery to brain cancer was simulated by infusing carboplatin directly into the brainstem of cynomolgus monkeys with chronically implanted catheters. Because this manner of drug administration produced low levels of carboplatin in spinal fluid and blood, it was assumed that resulting deficits were dictated by the central auditory neurotoxicity of platinum compounds and not peripheral ototoxic effects. The magnitude of this hearing loss was estimated by comparing the auditory brainstem response thresholds of treated monkeys with results from normal controls. SUBJECTS: Six adult male cynomolgus monkeys (Macaca fascicularis) weighing 4 to 6 kg (3 received carboplatin treatment and 3 served as normal controls). INTERVENTION: Brainstem infusions of carboplatin. RESULTS: The average threshold of carboplatin-treated monkeys was elevated 8.8 dB (SD = 7.3 dB) relative to normal controls 6 months after the termination of drug delivery and increased to 10.7 dB with less variation between subjects (SD = 5.6 dB) 1 year after drug treatment. Although small in magnitude, the hearing loss was statistically significant (P<.05). CONCLUSIONS: Brainstem infusions of carboplatin induced some degree of hearing impairment in all treated monkeys. These threshold elevations were modest compared with the ototoxic effects that have been reported after systemic doses of carboplatin. Our findings suggest that the neurotoxic sensitivity of cochlear hair cells is not shared by neurons in the central auditory pathways. As a result, methods for reducing the ototoxic effects of chemotherapy remain a viable strategy for preserving auditory function in patients with brain cancer.

Animals↗

Sensorineural hearing loss in children with thalassemia major in Northern Greece.

Eighty eight (88) beta-thalassemic patients undergoing regular transfusion- chelation therapy with desferrioxamine (DFO) were studied for ENT problems from 1988 to 1993, as DFO has been implicated for auditory neurotoxicity. The mean age of the patients was 9.66 +/- 3.1 years, their pre-transfusion haemoglobin level was 9 +/- 2 g/dl, serum ferritin level was 2065 +/- 898 ng/ml and the daily DFO dose was 50.7 +/- 9.5 mg/kg for 5 days/week. The ENT study included, ENT examination, pure tone audiometry, speech audiometry, tympanometry, tone decay test and ABR. During this 6-year study 24/88 (27%) patients developed bilateral or ipsilateral sensorineural hearing loss in high tone frequencies, sometimes exceeding 80 dB, which was attributed to DFO toxicity. Therefore, a reduction or temporary withdrawal of DFO followed. After this intervention 12/24 patients recovered almost completely, 7/24 remained stable and 5/24 presented aggravation of their hearing loss. This study confirms the DFO induced auditory neurotoxicity and the necessity of periodical audiology control of beta-thalassemic patients for prompt diagnosis and management of this complication.

Acoustic Impedance Tests↗

Neurotoxicity associated with deferoxamine therapy.

We have documented visual and auditory neurotoxicity in 42 of 89 patients with transfusion-dependent anemia who were receiving iron chelation therapy with subcutaneous deferoxamine (DFO). Of the affected groups, 13 presented with visual loss or deafness or both, and ophthalmologic, audiologic, and visual evoked potential studies (VEPs) uncovered abnormalities in 29 more. Four patients with visual loss had optic neuropathy with a marked decrease in acuity and loss of color vision. These 4, and 16 other asymptomatic patients, had abnormal VEPs. When DFO was stopped, 3 of 4 with visual problems regained normal visual function but VEPs remained abnormal. Of the other 16 with abnormal VEPs, 9 became normal or improved and 7 did not change; on restarting DFO, the 9 became abnormal again. There were 22 abnormal audiograms that showed a high-frequency sensorineural deficit; 13 patients were symptomatic and 4 needed hearing aids. On stopping DFO, 9 became asymptomatic but 15 audiograms remained abnormal and 2 deteriorated further on restarting the drug. An analysis of the clinical data showed that members of the affected group were younger, had lower serum ferritin values, and were self-administering higher doses of DFO/kg body weight. Significantly lower doses of DFO were being taken by patients without abnormalities than by those with visual symptoms, abnormal audiograms, or prolonged VEPs (P less than 0.001, less than 0.006, and less than 0.04, respectively). The data implicate high-dose DFO as a central factor in the pathogenesis of the neurotoxicity. Our serial studies provide the basis for effective yet safe DFO administration for patients who require the agent.

Adolescent↗

Treatment of iron overload in children and adolescents on chronic haemodialysis.

Treatment of secondary haemosiderosis with desferrioxamine (DFO) was evaluated in children and adolescents treated by chronic haemodialysis. Ten patients were treated with intravenous DFO (25 mg/kg body weight). Three patients received DFO throughout dialysis, four were treated only during the last hour of each dialysis session, and three other patients were successively treated with DFO according to both regimens. A significant decrease and normalisation of serum ferritin was achieved only with DFO administered during the last hour of dialysis. In some patients blood haemoglobin (Hb) increased during treatment. Although serum ferritin levels remained normal, Hb levels returned to pretreatment values following discontinuation of DFO treatment. Visual and auditory neurotoxicity was not noticed but increased systemic infections were observed.

Child↗

Topical administration of Caroverine in somatic tinnitus treatment: proof-of-concept study.

This prospective study, which conformed with good clinical practice (GCP-conform), tested the concept that the topical transtympanic administration of the quinoxaline derivative Caroverine promises a new approach to the treatment of tinnitus. The rationale for the study is the hypothesis that tinnitus reflects sequelae of auditory neurotoxicity that can prevented and repaired by the neuroprotective and neuroregenerative activities of quinoxaline derivatives exhibited in previous preclinical tests. In a representative patient cohort, the probability of a long-lasting tinnitolytic effect of lipophilic eardrops containing 1% Caroverine as their active ingredient gained in significance, crossing from low-intensity levels to high-intensity levels of individual tinnitus sensations. These results encouraged us to design consequential GCP-conform phase 2 and phase 3 studies.

Administration, Topical↗

Evoked potentials in rats with misonidazole neurotoxicity. I. Brain stem auditory evoked potentials.

Central neurotoxicity produced in rats by daily administration of 300 mg/kg of misonidazole (MISO) 5 times/week for 4-5 weeks (total dose = 6.0 gm/kg) was evaluated weekly wit brain stem auditory evoked potentials (BAEPs). Compared to untreated control rats, all treated rats had a prolongation of the I-IV interpeak latency (p less than 0.005) at a mean of 13.2 +/- 2.7 days at a cumulative dose of approximately 4.0 gm/kg of MISO per rat. In some rats, the I-III and I-II interwave latencies were prolonged and waves III and IV were lost. Control rats did not show any significant alteration in BAEP latency or amplitude. Histopathologic examination of the brain stems of treated rats showed that necrotic lesions were present primarily in the nuclei of the tegmentum of the fourth ventricle, with scattered nuclear involvement in the cerebellar roof nuclei, inferior olive, and nucleus of the spinal tract of the trigeminal nerve. The cerebral cortex appeared to be normal in all treated rats. Changes in BAEPs caused by central neurotoxicity correlated with the histopathologic findings. We conclude that BAEPs are a sensitive method for evaluating MISO central neurotoxicity in the rat model.

Animals↗

Somatosensory and brainstem auditory evoked potentials in the Gunn rat model of acute bilirubin neurotoxicity.

Brainstem auditory evoked potentials (BAEPs) are a sensitive indicator of bilirubin neurotoxicity. Somatosensory evoked potentials (SEPs) have been proposed as another measure of toxicity, though the lemniscal pathways that generate the SEP are not involved in kernicterus. In 16 to 17-d-old jaundiced (jj) Gunn rats, serial BAEPs and SEPs were obtained up to 8 h after acute bilirubin toxicity. jjs were injected with 150 mg/kg sulfadimethoxine to displace bilirubin into brain tissue (n = 8); littermate controls were jjs given saline (n = 4) and nonjaundiced given sulfadimethoxine or saline (n = 7). After anesthesia, BAEP and SEP recordings were obtained at baseline and serially after injection. SEPs to median nerve stimulation were recorded from surface electrodes over the brachial plexus (Erb's) and contralateral parietal cortex, and subtracted to obtain central conduction time (CCT). There were no statistically significant different baseline values between groups. Baseline BAEP I, I-II, and I-III were 1.22 +/- 0.13, 1.11 +/- 0.12, and 2.10 +/- 0.15 ms, and SEP Erb's and CCT were 1.48 +/- 0.20 and 5.59 +/- 0.50 ms, respectively (n = 19). At 6.8 +/- 1.5 h after injection BAEP I, I-II, and I-III increased 0.10 +/- 0.08, 0.18 +/- 0.17, and 0.56 +/- 0.33 ms over baseline, respectively (p = 0.005, 0.01, and 0.001, respectively, paired, 1-tailed t-tests), in experimental but not control groups. SEP Erb's decreased slightly, -0.06 +/- 0.04 ms in experimental and -0.08 +/- 0.08 ms in control groups, while CCT did not change significantly. BAEPs were completely abolished in two jjs with no SEP changes. When injection of sulfonamide induced significant peripheral and central BAEP abnormalities in jaundiced rats, no SEP abnormalities occurred. SEPs assess proprioception but not other somatosensory function or sensory integration. The results demonstrate the selectivity of acute bilirubin toxicity for the auditory nervous system.

Animals↗

Electrophysiological measures of visual and auditory function as indices of neurotoxicity.

The application of auditory and visual evoked potentials (VEP) to neurotoxicity testing of humans and animals is reviewed. VEPs elicited by flash, reversing-checkerboard patterns, and sine wave grating are described. The flask evoked potential in rats is altered by exposure to many heavy metals, pesticides and solvents. The brainstem auditory evoked potential also appears to be sensitive to neurotoxic chemicals, but the evidence available is limited. The homology of auditory and visual evoked potentials in rats and humans is useful for cross-species extrapolation in neurotoxicology research.

Animals↗

Glutamate neurotoxicity in rat auditory system: cochlear nuclear complex.

In other systems such as the hypothalamus and hippocampus, it has been shown that cells postsynaptic with respect to glutamatergic inputs degenerate when exposed to large doses of glutamate ("glutamate neurotoxicity"). We have shown that large doses of glutamate administered intraperitoneally are toxic to spiral ganglion cells in the inner ear of the rat. In the present study, we have investigated whether similar levels of glutamate cause alterations in the neurons of the cochlear nuclei. Specifically, we have studied the morphology and size of the cochlear nuclear complex and its subdivisions as well as the size and density of cochlear nucleus neurons following administration of glutamate. The morphological evidence indicates that glutamate caused severe anatomical alteration of the cochlear nuclei. The changes were most pronounced in the anteroventral cochlear nucleus, especially in the neurons that receive terminals of the end bulbs of Held from the cochlear nerve. This could be a direct effect of glutamate in the cochlear nuclei or secondary to degeneration of cochlear nerve fibers in the inner ear.

Animals↗

Is auditory brainstem response a bilirubin neurotoxicity marker?

PURPOSE: To find a correlation between increasing levels of serum bilirubin and auditory brainstem responses (ABR) and to find the use of ABR as a bilirubin neurotoxicity marker. MATERIAL AND METHODS: A prospective study of 60 neonates in which ABR of hyperbilirubinemic neonates was compared with the normal neonates. All cases with abnormal ABR were studied for 6 months and after 1 month and 6 months a repeat ABR was performed. RESULTS: Brainstem conduction time was found to be prolonged from 5.12+/-0.26 to 5.83+/-0.14 in neonates with a mean serum bilirubin level of 16.6 mg/dL (12 mg/dL to 18 mg/dL), which was found to be additionally prolonged to 6.0+/-1.0 with an increase in mean serum bilirubin level to 21.98 mg/dL (P < .01). At first retest after 1 month, 33.33% of cases with a mean serum bilirubin level of 19.46 mg/dL and 80.00% with a mean serum bilirubin level of 15.97 mg/dL showed total recovery. After 6 months, three cases with mean serum bilirubin levels of 26.3 mg/dL and one case with a mean serum bilirubin level of 17.7 mg/dL failed to show any improvement. CONCLUSION: A positive correlation was found between increasing levels of serum bilirubin and brainstem conduction time (P < .01). ABR was found to be a very sensitive tool in picking up the earliest signs of neurotoxicity. Neonates with distortion of normal wave patterns on ABR were found to have poorer prognosis compared with those with delayed inter-peak (I-P) latencies.

Acoustic Impedance Tests↗