Safety and efficacy of ebselen for the prevention of noise-induced hearing loss: a randomised, double-blind, placebo-controlled, phase 2 trial.

BACKGROUND: Noise-induced hearing loss is a leading cause of occupational and recreational injury and disease, and a major determinant of age-related hearing loss. No therapeutic agent has been approved for the prevention or treatment of this disorder. In animal models, glutathione peroxidase 1 (GPx1) activity is reduced after acute noise exposure. Ebselen, a novel GPx1 mimic, has been shown to reduce both temporary and permanent noise-induced hearing loss in preclinical studies. We assessed the safety and efficacy of ebselen for the prevention of noise-induced hearing loss in young adults in a phase 2 clinical trial. METHODS: In this single-centre, randomised, double-blind, placebo-controlled phase 2 trial, healthy adults aged 18-31 years were randomly assigned (1:1:1:1) at the University of Florida (Gainsville, FL, USA) to receive ebselen 200 mg, 400 mg, or 600 mg, or placebo orally twice daily for 4 days, beginning 2 days before a calibrated sound challenge (4 h of pre-recorded music delivered by insert earphones). Randomisation was done with an allocation sequence generated by an independent third party. The primary outcome was mean temporary threshold shift (TTS) at 4 kHz measured 15 min after the calibrated sound challenge by pure tone audiometry; a reduction of 50% in an ebselen dose group compared with the placebo group was judged to be clinically relevant. All participants who received the calibrated sound challenge and at least one dose of study drug were included in the efficacy analysis. All randomly assigned patients were included in the safety analysis. This trial is registered with ClinicalTrials.gov, number NCT01444846. FINDINGS: Between Jan 11, 2013, and March 24, 2014, 83 participants were enrolled and randomly assigned to receive ebselen 200 mg (n=22), 400 mg (n=20), or 600 mg (n=21), or placebo (n=20). Two participants in the 200 mg ebselen group were discontinued from the study before the calibrated sound challenge because they no longer met the inclusion criteria; these participants were excluded from the efficacy analysis. Mean TTS at 4 kHz was 1·32 dB (SE 0·91) in the 400 mg ebselen group compared with 4·07 dB (0·90) in the placebo group, representing a significant reduction of 68% (difference -2·75 dB, 95% CI -4·54 to -0·97; p=0·0025). Compared with placebo, TTS at 4 kHz was non-significantly reduced by 21% in the 200 mg ebselen group (3·23 dB [SE 0·91] vs 4·07 dB [0·90] in the placebo group; difference -0·84 dB, 95% CI -2·63 to 0·94; p=0·3542) and by 7% in the 600 mg ebselen group (3·81 dB [0·90] vs 4·07 dB [0·90] in the placebo group; difference -0·27, 95% CI -2·03 to 1·50; p=0·7659). Ebselen treatment was well tolerated across all doses and no significant differences were seen in any haematological, serum chemistry, or radiological assessments between the ebselen groups and the placebo group. INTERPRETATION: Treatment with ebselen was safe and effective at a dose of 400 mg twice daily in preventing a noise-induced TTS. These data lend support to a role of GPx1 activity in acute noise-induced hearing loss. FUNDING: Sound Pharmaceuticals.

Mutations in mitochondrial histidyl tRNA synthetase HARS2 cause ovarian dysgenesis and sensorineural hearing loss of Perrault syndrome.

Perrault syndrome is a genetically heterogeneous recessive disorder characterized by ovarian dysgenesis and sensorineural hearing loss. In a nonconsanguineous family with five affected siblings, linkage analysis and genomic sequencing revealed the genetic basis of Perrault syndrome to be compound heterozygosity for mutations in the mitochondrial histidyl tRNA synthetase HARS2 at two highly conserved amino acids, L200V and V368L. The nucleotide substitution creating HARS2 p.L200V also created an alternate splice leading to deletion of 12 codons from the HARS2 message. Affected family members thus carried three mutant HARS2 transcripts. Aminoacylation activity of HARS2 p.V368L and HARS2 p.L200V was reduced and the deletion mutant was not stably expressed in mammalian mitochondria. In yeast, lethality of deletion of the single essential histydyl tRNA synthetase HTS1 was fully rescued by wild-type HTS1 and by HTS1 p.L198V (orthologous to HARS2 p.L200V), partially rescued by HTS1 p.V381L (orthologous to HARS2 p.V368L), and not rescued by the deletion mutant. In Caenorhabditis elegans, reduced expression by RNAi of the single essential histydyl tRNA synthetase hars-1 severely compromised fertility. Together, these data suggest that Perrault syndrome in this family was caused by reduction of HARS2 activity. These results implicate aberrations of mitochondrial translation in mammalian gonadal dysgenesis. More generally, the relationship between HARS2 and Perrault syndrome illustrates how causality may be demonstrated for extremely rare inherited mutations in essential, highly conserved genes.

Ebselen treatment reduces noise induced hearing loss via the mimicry and induction of glutathione peroxidase.

Previous studies indicate that noise induced hearing loss (NIHL) involves a decrease in glutathione peroxidase (GPx) activity and a subsequent loss of outer hair cells (OHC). However, the cellular localization of this GPx decrease and the link to OHC loss are still poorly understood. In this report, we examined the cellular localization of GPx (GPx1, GPx 3 and GPx 4) in F-344 rat before and after noise exposure and after oral treatment with ebselen, a small molecule mimic of GPx activity. Results indicate that GPx1 is the major isoform within the cochlea and is highly expressed in cells of the organ of Corti, spiral ganglia, stria vascularis, and spiral ligament. Within 5h of noise exposure (4h at 113 dB, 4-16 kHz), significant OHC loss was already apparent in regions coincident with the 8-16 kHz region of the cochlea. In addition, the stria vascularis exhibited significant edema or swelling and a decrease in GPx1 immunoreactivity or fluorescent intensity. Treatment with ebselen (4 mg/kg p.o.) before and immediately after noise exposure reduced both OHC loss and the swelling of the stria vascularis typically observed within 5h post-noise exposure. Interestingly, GPx1 levels increased in the stria vascularis after noise and ebselen treatment vs noise and vehicle-only treatment, and exceeded baseline no noise control levels. These data indicate that ebselen acts to prevent the acute loss of OHCs and reduces the acute swelling of the stria vascularis by two potential mechanisms: one, as a ROS/RNS scavenger through its intrinsic GPx activity, and two, as a stimulator of GPx1 expression or activity. This latter mechanism may be due to the preservation of endogenous GPx1 from ROS/RNS induced degradation and/or the stimulation of GPx1 expression or activity.

Compounds for the prevention and treatment of noise-induced hearing loss.

Noise-induced hearing loss (NIHL) is the leading occupational disease and a major contributor to the development of age-related hearing loss. The pharmacological prevention and treatment of NIHL has been under preclinical investigation for the past 20 years. Promising treatments have now been identified and entered into clinical development. Within the next five years, safe and effective drugs could be approved as the first generation of otoprotectants. This review covers strategies that are under investigation for NIHL. Drugs that effectively prevent and treat NIHL will have a significant impact on medical costs, disability compensation and several issues affecting the quality of life.

Reduction of acute cisplatin ototoxicity and nephrotoxicity in rats by oral administration of allopurinol and ebselen.

Cisplatin ototoxicity has been associated with the generation of toxic levels of reactive oxygen species (ROS) which can lead to injury or loss of outer hair cells in the organ of Corti, damage to the stria vascularis, and loss of spiral ganglion cells, resulting in permanent hearing loss. In an attempt to reduce the formation of ROS and to bolster the innate oxidative stress defenses of the cochlea, we tested individual and combined formulations of allopurinol, a xanthine oxidase inhibitor, and ebselen, a glutathione peroxidase mimic. We used an acute cisplatin toxicity rat model (16 mg/kg i.p.) to analyze allopurinol and ebselen alone and in combination for their ability to reduce cisplatin associated hearing loss and nephrotoxicity. The results from our studies indicate that a combined formulation of ebselen and allopurinol affords significant protection to the cochlea and kidney from cisplatin toxicity. In the cochlea, protection is dependent on the preservation of outer hair cell number, while in the kidney, protection is associated with the preservation of proximal tubular epithelia. Further evaluation of the chemoprotective effects of ebselen and allopurinol on cisplatin side effects in the presence of tumor appears warranted.

Ebselen-mediated protection from single and repeated noise exposure in rat.

OBJECTIVES/HYPOTHESIS: Ebselen, a glutathione peroxidase mimic, is a candidate compound for the prevention of noise-induced hearing loss. STUDY DESIGN: Single-blinded, placebo-controlled study. METHODS: Methods included single and repeated noise exposures on F-344 female rats given oral or injected ebselen or vehicle before and after noise, evoked auditory brainstem responses using click and pure-tone stimuli, light and fluorescence microscopy of cochleae stained with 4',6-Diamidino-2-phenylindole (DAPI) and fluorescein isothiocyanate-phalloidin, and statistical power determined by ANOVA. RESULTS: Auditory brainstem response indicated that ebselen provided significant protection from both temporary and permanent threshold shifts following single and repeated noise exposure. On average, three times more outer hair cells were lost in control versus ebselen-treated animals. CONCLUSION: Ebselen reduces noise-induced hearing loss in rats.

Comparison of SPE and fast LC to eliminate mass spectrometric matrix effects from microsomal incubation products.

Twenty-seven highly diversified pharmaceutical compounds were used as a test set to evaluate matrix effects from microsomal media on LC/MS analyses. The individual effects of Tris buffer, NADPH and microsomes on ESI response were investigated. Direct flow injection MS/MS analysis, using no sample preparation or HPLC separation, gave an average of 2.2-5-fold matrix suppression in MS response from Tris buffer and NADPH. More polar analytes were affected the greatest. To reduce the loss in response, an automated solid phase extraction (SPE) procedure was developed. A much smaller average matrix effect was observed when samples were prepared using a Waters Oasis HLB 96-well SPE. As little as 1 ml of methanol (MeOH) was sufficient to elute most compounds with more than 80% recovery. Comparable results were obtained by directly injecting a protein-precipitated incubation onto a fast gradient LC separation prior to MS/MS detection. No advantage was seen by using both SPE and a fast LC separation prior to MS/MS analysis.

Mutations in a novel isoform of TRIOBP that encodes a filamentous-actin binding protein are responsible for DFNB28 recessive nonsyndromic hearing loss.

In a large consanguineous Palestinian kindred, we previously mapped DFNB28--a locus associated with recessively inherited, prelingual, profound sensorineural hearing impairment--to chromosome 22q13.1. We report here that mutations in a novel 218-kDa isoform of TRIOBP (TRIO and filamentous actin [F-actin] binding protein) are associated with DFNB28 hearing loss in a total of nine Palestinian families. Two nonsense mutations (R347X and Q581X) truncate the protein, and a potentially deleterious missense mutation (G1019R) occurs in a conserved motif in a putative SH3-binding domain. In seven families, 27 deaf individuals are homozygous for one of the nonsense mutations; in two other families, 3 deaf individuals are compound heterozygous for the two nonsense mutations or for Q581X and G1019R. The novel long isoform of TRIOBP has a restricted expression profile, including cochlea, retina, and fetal brain, whereas the original short isoform is widely expressed. Antibodies to TRIOBP reveal expression in sensory cells of the inner ear and colocalization with F-actin along the length of the stereocilia.

Combined oral delivery of ebselen and allopurinol reduces multiple cisplatin toxicities in rat breast and ovarian cancer models while enhancing anti-tumor activity.

The chemoprotective effects of combined ebselen and allopurinol in breast (MTLn3) and ovarian (NuTu-19) cancer models using a repeated cisplatin dosing schedule (6 mg/kg i.p.x3 weeks) were studied. Otoprotection was evaluated using auditory evoked brainstem response (ABR) to determine threshold and latency shifts, and outer hair cell counts. Nephroprotection was analyzed by serological markers [blood urea nitrogen (BUN) and creatinine] and histological evaluation. Myelotoxicity was quantified using cytological counts for platelets and changes in hematocrit. Hepatotoxicity was determined by changes in the serological markers amino alanine transferase (ALT) and aspartate amino transferase. Significant chemoprotective effects were observed for multiple organ systems including oto- (ABR threshold shifts for click and 24-kHz stimuli, p<0.05, 8 and 16 kHz, p<0.01, MTLn3 group; hair cell counts, p<0.05 both groups), nephro- (BUN and creatinine, p<0.01), myelo- (platelet p<0.05, hematocrit p<0.05) and hepatotoxicity (ALT p<0.05) in rats receiving oral ebselen and allopurinol. Importantly, the anti-tumor activity of cisplatin was not compromised. On the contrary, improved mortality, morbidity and outcome were observed in the ovarian cancer model. This combined oral formulation of ebselen and allopurinol is an attractive candidate for clinical evaluation.