动物生理学原理耳鸣和听觉过敏的神经生物学机制ppt课件.ppt

Advances in neurobiology of tinnitus and hyreracusis耳鸣和听觉过敏的神经生物学研究进展杨明建2014.12.16研究背景研究背景Hearing impairment is a considerable disease burden.It hasbeen estimated that adult-onset hearing impairment is the thirdleading cause of disability (WHO,2008).Forty-two previous reports published between 1973 and 2010 in 29 countries have revealed increased hearing loss with age;Developing countries report higher rates of moderate and moderately-severe hearing impairment due to higher rates of pre-and postnatal childhood infections such as rubella(风疹）风疹）,measles（麻（麻疹）疹）and meningit（脑膜炎）（脑膜炎）,and from the use of ototoxic drugs（耳毒性药物）（耳毒性药物）(Stevens et al.,2013).However,in industrialized countries,noise-induced hearing loss (NIHL)（噪声性听力损失）（噪声性听力损失）is a common cause of hearing impairments (Lu et al.,2005),with a prevalence that is second to presbycusis（老年性耳（老年性耳 聋）聋）(Stanbury et al.,2008).Hyperacusi and tinnitus are potentially devastating conditions that are still incurable.Epidemiology（流行病学）（流行病学）of tinnitusTinnitus is a disorder of perception of phantom sound that is also known as ringing in the ear or head.Tinnitus affects 1020%of the general population (Galazyuk et al.,2012;Shargorodsky et al.,2010);According to the American Tinnitus Association,an estimated 50 million people in the United States have chronic tinnitus,persisting for longer than six months (Shargorodsky et al.,2010).For 12 million individuals,it is severe enough to interfere with daily activities.Tinnitus can occur in children (Shetye and Kennedy,2010)and prevalence increases with age (Adams et al.,1999;Ahmad and Seidman,2004),peaking between 60 and 69 years of age(Shargorodsky et al.,2010).More common in men than in women,more likely in former smokers,and in adults with hypertension,hearing impairment,loud noise exposure,or generalized anxiety disorder(广泛性广泛性焦虑障碍）焦虑障碍）(Shargorodsky et al.,2010).Hearing loss and stress (emotional as well as psychosocial)are important risk factors for tinnitus (Hebert et al.,2012;Jastreboff,2007;Langguth et al.,2009),although tinnitus can occur independently from broad increase of hearing thresholds (Geven et al.,2011;Langers et al.,2012;Lockwood et al.,2002).耳鸣的分类耳鸣的分类耳鸣有耳鸣有间歇性，也有持续性间歇性，也有持续性。有。有单一频率窄带噪单一频率窄带噪音或白噪音音或白噪音等多种表现。耳鸣一般可分为等多种表现。耳鸣一般可分为中枢性中枢性及周围性两大类及周围性两大类。周围性耳鸣根据是否被别人听。周围性耳鸣根据是否被别人听见分为见分为主观性耳鸣和客观性耳鸣主观性耳鸣和客观性耳鸣。前者多见，后。前者多见，后者少见。耳鸣又可根据其特征分为者少见。耳鸣又可根据其特征分为持续性耳鸣与持续性耳鸣与节律性耳鸣节律性耳鸣。持续性耳鸣可有单一频率或多频率。持续性耳鸣可有单一频率或多频率声调的混合，多为主观性耳鸣。节律性耳鸣多与声调的混合，多为主观性耳鸣。节律性耳鸣多与血管跳动一致，偶尔与呼吸一致，耳鸣的频率较血管跳动一致，偶尔与呼吸一致，耳鸣的频率较低。如为肌肉收缩引起，则耳鸣的频率较高。节低。如为肌肉收缩引起，则耳鸣的频率较高。节律性耳鸣，多为客观性耳鸣。律性耳鸣，多为客观性耳鸣。Epidemiology（流行病学）（流行病学）of hyperacusisHyperacusis is a disorder of loudness perception（响度感知紊乱）（响度感知紊乱）,in which sound intensities that are considered comfortable by most people are perceived unbearably loud (Baguley,2003).In hyperacusis,sounds are not simply a bit loud,but truly unbearable（难以忍受）（难以忍受）.Hyperacusis can occur without a loss of hearing thresholds (Gu et al.,2010).Statistics on hyperacusis are scarce,and although it is often coincident with tinnitus,limited evidence has supported the co-occurrence of the two conditions (Andersson et al.,2002;Gu et al.,2010;Nelson and Chen,2004).With an approximate prevalence of about 1015%of the population (Gilles et al.,2012),the prevalence of hyperacusis is comparable to tinnitus (Shargorodsky et al.,2010).For tinnitus and hyperacusis,hearing loss,however,is a major risk factor.As the incidence of hearing loss will increase with the aging of the population,also the incidence of tinnitus and hyperacusis may increase.Are tinnitus and hyperacusis in the ear or the brain?越来越多的证据表明耳鸣和听觉过敏形成的机制中越来越多的证据表明耳鸣和听觉过敏形成的机制中外周听觉器官损伤只是起因外周听觉器官损伤只是起因，耳鸣和听觉过敏的形，耳鸣和听觉过敏的形成和维持更多的是成和维持更多的是 听觉传导通路上各级中枢的作听觉传导通路上各级中枢的作用用。耳蜗损伤耳蜗损伤等造成的异常神经活动经中枢核团逐等造成的异常神经活动经中枢核团逐级传递并在边缘系统等非听觉系统的参与下最终在级传递并在边缘系统等非听觉系统的参与下最终在听皮层被感知为耳鸣。听皮层被感知为耳鸣。M.Knipper,P.V.Dijk，I.Nunes，et al.Advances in the neurobiology of hearing disorders:Recent developments regarding the basis of tinnitus and hyperacusis Progress in Neurobiology,111 (2013)1733J.J.Eggermont，L.E.Roberts.The neuroscience of tinnitus.TRENDS in Neurosciences,27(2004)676-682.Fig.1.Schematic illustration of the adult organ of Corti.The nerve fibers of IHCs(内毛细胞）send information to the brain,whereas the nerves of OHCs（外毛细胞）mainly receive information from the brain.IHCs are,therefore,the true sensory cells of hearing.OHCs are characterized by their electromotile properties;they are responsible for the amplification of the acoustic signal,which in turn activates IHCs.The IHCs transmit electrical signals in a frequency-specific manner to higher auditory brain areas.内耳柯蒂氏器（螺旋器）示意图1.cochlear damageNIHL（噪声性听力损失）（噪声性听力损失）has been,in a previous view,typically defined by a permanent loss of hearing thresholds（听阈永久性损失）（听阈永久性损失）.Normal thresholds rely on the proper function of outer hair cells (OHCs)(Dallos and Harris,1978).Per inner ear,there are approximately 11,000 OHCs,which are,in the human cochlea,typically arranged in 3 rows (Fig.1,OHC).OHC function is to nonlinearly amplify basilar membrane vibration in response to soft sounds near the place of characteristic frequency within the cochlea (Ashmore,2008).OHCs are therefore crucial for the high sensitivity of the hearing organ,its frequency selectivity,and understanding speech in noise (Ashmore,2008;Dallos,2008).After mild acoustic overexposure,hearing function can recover within 23 weeks (Miller et al.,1963).This corresponds to a temporary threshold shift（暂时性阈移）（暂时性阈移）due to reversible damage to the mechanosensory hair bundles of hair cells (Fig.1,stereocilia)(Liberman and Dodds,1984a,b;Schneider et al.,2002).After intense or repeated acoustic overstimulation,however,hearing function stabilizes at an elevated value,leading to permanent threshold shift（永久性阈移）（永久性阈移）that mostly occurs due to destruction of OHCs(Spoendlin,1985).In the daily clinical routine,permanent hearing loss is typically detected through the increase of hearing thresholds as tested by tone-audiometry（听力测定）（听力测定）.More detailed clinical diagnostic testing may also include auditory brainstem response (ABR)（听性脑干反应）（听性脑干反应）testing or recording distortion product otoacoustic emissions (DPOAEs)（畸变产物耳声发射）（畸变产物耳声发射）.ABR responses represent the summed activity of neurons in the ascending auditory pathways.The specific function of intact OHCs can be measured by amplitudes of DPOAEs.DPOAEs are acoustic signals that arise from distortions in the OHCs mechanoelectrical response to two continuous tones.These distortion products,which are at frequencies not present in the input stimulus,are generated by the OHCs biological motors and can be detected with a microphone in the ear canal.DPOAEs responses thus reflect the electromotile properties of OHCs (Fitzgerald et al.,1993;Huang et al.,2005).We can conclude that loss of hearing thresholds after noise exposure is mostly linked to OHC loss,which specifically can be measured by DPOAEs.Through DPOAE and ABR measurements,in combination,a differential damage of OHCs and IHCs can be detected.Fig.2.Predicted subcellular positions of high-and low-SR fibers at the inner haircell (IHC).Afferent auditory nerve fibers of IHCs are classified accordingto their spontaneous action potential discharge rate (SR).High-threshold,low-and medium-SR fibers are presumably preferentially located at the modiolar side of the IHC,where larger ribbons are associated with smaller patches of NMDA-R and AMPA-R.Low-threshold,high-SR fibers are presumably preferentially located at the pillar side of the IHC,where smaller ribbons oppose larger AMPA-R patches.Also characteristic of ribbon synapses(带状突触）,CaV1.3 channels are clustered near synaptic ribbons,and thereby stabilize the contact with afferent neurons.内耳毛细胞高自发放电率和低自发放电率纤维亚细胞位置Regarding more recent findings on NIHL,it is most important to remember that OHC loss can be accompanied by IHC (Fig.1,IHC)damage (Liberman and Dodds,1984a,b).The IHCs are the primary sensory hair cells of the cochlea that transmit sound information over an intensity range spanning 12 orders of magnitude (120 dB)and 3 orders of magnitude of frequency (20 Hz to 20 kHz)(Robles and Ruggero,2001).This powerful capacity of IHC synapses is achieved through their numerous specialized afferent contacts.Each IHC is innervated by 8 (human)or up to 20 (rodents)(Glowatzki and Fuchs,2002)unbranched spiral ganglion neurons（螺旋神经节神经元）（螺旋神经节神经元）,which represent about 9095%of all afferent fibers (AF)in the auditory nerve (AN)(Fig.1,AN;Figs.1 and 2,AF type I).Each IHC contains electron-dense presynaptic subcellular structures（高电子密度突触前亚细胞结构）（高电子密度突触前亚细胞结构）,so-called ribbons (Figs.1 and 2,red)that tether 100 synaptic vesicles (Glowatzki and Fuchs,2002).This specialized presynaptic machinery thereby maintains a large releasable pool of neurotransmitter,allowing afferent auditory neurons to code the temporal characteristics of sound with high reliability and temporal precision (Buran et al.,2010)（更可靠和精（更可靠和精确编码声音的时相特征）确编码声音的时相特征）.The 3500 IHCs (Figs.1 and 2,IHC)in the cochlea rarely die from NIHL,however.Instead,the innervated dendrites of the auditory nerve fibers undergo neurodegeneration（神经退化）（神经退化）(Kujawa and Liberman,2009;Lin et al.,2011).This process has been revealed to be tightly correlated with an altered number of transmitter release sites in IHC nerve terminals (Fig.2,blue)(Jaumann et al.,2012;Kujawa and Liberman,2009;Lin et al.,2011;Zuccottiet al.,2012).the long-standing dogma that cochlear nerve degeneration is a consequence of IHC death after acoustic trauma was only recently overturned,as degeneration can occur when IHCs are present.A complete set of functional,intact IHC ribbon synapses（带状突触）（带状突触）and their proper contacts to auditory fibers are crucial elements to achieve the full dynamic loudness range,as well as high precision of temporal sound information.Fig.3.Comparison of the basolateral pole length of inner hair cells (IHCs)from rats with or without tinnitus in indicated cochlear turns.Both groups exhibited reduced length of the basolateral pole of IHCs in high frequency cochlear turns (Ruttiger et al.,2013)2.Altered central brain responses to cochlear damageThe first ABR wave (Fig.3B,ABR wave I)represents the summed activity of the auditory nerve,whereas later ABR waves arise from synchronous neural activity in the auditory brainstem (Melcher and Kiang,1996).Sound processing can also activate limbic structures（边缘系统）（边缘系统）(Fig.3A,drawn in green).The amygdala（杏仁核）（杏仁核）and the hippocampus（海马）（海马）,two major regions of the limbic system,receive direct and indirect neuralinput from the central auditory system.Noise-induced stress can activate the basolateral amygdala)(（底（底外侧杏仁核外侧杏仁核)through the hypothalamic-pituitary-adrenal axis)(下丘下丘脑脑-垂体垂体-肾上腺轴）肾上腺轴）(HPA axis)（Fig.3A).Thus,acoustic trauma can damage the cochlea and affect the basolateral amygdala and the hippocampus.(Kraus et al.,2010).Fig.4.Central auditory circuits and auditory brainstem responses.Besids central auditory circuits,There are auditory-limbic interactions (drawn in green).The basolateral amygdala (BLA)(底外侧杏仁核)receives directneural inputs from the auditory thalamus (MGB,green and the (AC).The BLA,in turn,contacts the hippocampus which has direct contact with the AC.The BLA also projects to the IC ,thereby generating an amygdalar-auditory feedback loop(杏仁核听觉反馈环路）.The BLA also activates (e.g.due to noise-induced stress)the hypothalamic-pituitary-adrenal axis (HPA axis)(下丘脑-垂体-肾上腺轴）,thereby influencing the level of blood cortisol 皮质醇(human)or corticosterone 皮质酮 (rodents),as well as the cochlea (greendashed lines).The normal ABR consists of five prominent waves that occur during the first 10 ms after presentation of a transient sound.The central auditory system compensates for diminished input by upregulating its responsiveness in central circuitries (Salvi et al.,2000).Central compensation that follows reduced auditory nerve activity may occur first at the level of the auditory brainstem,from where altered activity patterns then spread to ascending auditory nuclei (Manzoor et al.,2013;Mulders and Robertson,2013).In humans (Gu et al.,2012)and animals (Singeret al.,2013),auditory nerve and brainstem function in response to sound,assessed by ABRs,have been used to analyze compensating central activity following cochlear damage.3.Research on tinnitus or hyperacusis in animalsIn both humans and animals,determining the presence of tinnitus and hyperacusis is a challenge.Humans can,of course,indicate the presence of tinnitus,but it is not possible to confirm this with an objective measurement.Animals are unable to report the presence of tinnitus,and hence behavioral models have been developed for this purpose.Interesting in this context is that only recently,in a mouse model,it has been observed that the central brain responds in two different ways to auditory deprivation and IHC ribbon loss,depending on the presence or absence of brain-derived neurotrophic factor(脑源性神经营养因子）脑源性神经营养因子）(BDNF)that stabilizes or destabilizes IHC/auditory nerve contacts (Zuccotti et al.,2012)First,it can respond with an increase in response gain (synaptic strength)maintaining the stable neuronal circuit,and second,it can respond with a failure to appropriately adapt the central response gain,which may cause tinnitus or hyperacusis.3.1 耳鸣的动物模型目前用于研 究耳鸣的动物模型主要有两类：一类是强声暴露(intense sound exposure)引起的耳鸣，另一类是耳 毒性药物(如水杨酸盐、奎宁等)引起的耳鸣，两者皆从病因学角度模拟人类耳鸣发生条件。Jastrebof（1994）等 用行为学方法验证了注射水杨酸或强 声暴露的大鼠能够产生耳鸣的感觉，从而为用注射 水杨酸或强声暴露的方法造成动物耳鸣模型进行进一步研究的途径提供了实验依据。These models depend on an animals learned or reflex-like behavior in the presence of tinnitus.Various animal models have been developed to detect tinnitus which include either a conditioned behavioral response to silence (Bauerand Brozoski,2001;Heffner and Koay,2005;Jastreboff andBrennan,1994;Jastreboff et al.,1988;Middleton et al.,2011)or the failure of a pre-pulse gap to suppress a sound-pulse-evoked startle reflex (Berger et al.,2013;Dehmel et al.,2012a;Engineer et al.,2011;Kraus et al.,2010;Lobarinas et al.,2013;Middleton et al.,2011;Nowotny et al.,2011;Turner et al.,2006;Turner and Parrish,2008);Gaps in noise bands serves as pre-pulses to suppress a sound pulse-evoked startle reflex,assuming that ongoing tinnitus masks the gap and results in impaired gap detection.However,the startle reflex is mediated by subcortical areas only.Therefore,it is unclear whether the conditions that lead to an abnormal startle response also correspond to abnormal activity in the auditory cortex(Egger-mont,2013).However,a study directly comparing the outcome of the startle reflex method and a conditioned response method has shown similar results (Turner et al.,2006).J.J.Eggermont，L.E.Roberts.The neuroscience of tinnitus.TRENDS in Neurosciences,27(2004)676-682.3.2 听觉过敏的动物模型(研究较少）Wei Sun,Anchun Deng,Aditi Jayaram,et al.Noise exposure enhances auditory cortex responses related to hyperacusis behavior.Brain Research,1485(2012):