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CELL DEATH IN THE INNER EAR

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SGN cultures from postnatal or adult rats significantly increases SGN survival.

4.4. Therapeutic interventions to prevent SGN death

Over the past two decades, significant improvements have occurred in the development of hearing aids and cochlear implants to help hearing-impaired and deaf individuals overcome their disabilities. The main therapeutic effect of hearing aids is sound amplification, with the goal of delivering sound that is loud enough to be detected by remaining hair cells without being uncomfortably loud. In contrast, cochlear implants involve functional electrical stimulation of SGNs and thus do not require any hair cell function to be therapeutic. Cochlear implants are used successfully in many patients with severe hearing loss in which hearing aids are unlikely to provide therapeutic benefit. However, the success of cochlear implants depends in part on a viable population of SGNs. This has been an indication for commencing cochlear implant surgery sooner rather than later after the death of hair cells. Some studies have focused on strategies aimed at delivering pharmacological agents to target specific growth factor signaling pathways to boost SGN survival. Not surprisingly, delivery of BDNF, NT3, and GDNF using mini-osmotic pumps or viral vectors promotes SGN survival. Unfortunately, clinical applications of neurotrophins as part of a regimen to treat sensorineural hearing loss are complicated by the fact that SGNs degenerate rapidly when exogenous neurotrophins are withdrawn. In addition, peripheral processes in BDNF-treated SGNs show a disorganized sprouting pattern, reminiscent of abnormal branches and sprouting of gustatory fibers in tongue tissues of transgenic mice over-expressing BDNF. Whereas these observations pinpoint the potential dangers of ectopic neurotrophin delivery, they also illustrate the necessity of fully understanding the biological processes underlying neurotrophin action in relation to SGN survival. Such an understanding will inform therapeutic strategies aimed at complementing cochlear implants with a drug-based therapy.

ACKNOWLEDGMENTS

The authors gratefully acknowledge Dr. Judy R. Dubno and Dr. Richard A. Schmiedt for helpful comments on this manuscript. This work was funded by the National Institutes of Health (NIH) National Institute of Deafness and Other Communication Disorders Grant No. DC 5R01–07613 (L.L.C.) and by the Garnett Passe and Rodney Williams Memorial Foundation (J.T.).

Additional support was from the NIH/National Center for Research Resources extramural research facilities (C06) Grants No. C06 RR015455 and C06 RR14516.

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