Interestingly, after viral infection, most cells in the cochlea expressed the green fluorescent protein (GFP) reporter HIF inhibitor construct,
whereas only hair cells expressed the newly introduced VGLUT3 protein. Infected ears demonstrated nearly complete rescue of auditory function, based on electrophysiological measurements by auditory brainstem response (ABR). Significant yet partial improvement was also noted in the morphology of the synaptic region as well as in other physiological and behavioral measures of hearing, predicting potentially exciting future clinical benefits. Morphological rescue of the synaptic ribbon area, where inner hair cells connect with auditory nerve terminals, provided a possible structural explanation for the accompanying
Vismodegib purchase functional improvement ( Figure 1). Mutant mice without treatment also displayed a partial degeneration of auditory neurons. AAV1-VGLUT3 treatment did not prevent this degeneration, but remaining auditory neurons were nevertheless sufficient to facilitate adequate hearing thresholds. Long-term follow-up of infected ears showed that rescue of hearing ability was stable until a relatively late age in the mice (9 months), suggesting that the therapy may result in permanent structural and functional repair. Application of gene replacement therapy to treatment of deafness appears relatively simple and attractive for several reasons. Introduction of the normal (wild-type) protein into hair cells, in which its function is critical for hearing (and its absence causes deafness), is
a compelling approach for effectively and permanently treating genetic forms of deafness. Such approaches have been under consideration for some time, with phenotypic rescue for deafness by gene replacement first shown in 1998, when researchers rescued the DFNB3 deafness mouse model using germline insertion of a bacterial almost artificial chromosome (BAC) with the wild-type gene ( Probst et al., 1998). However, transgenic methods such as BAC insertion are not feasible in humans, for both practical and ethical reasons. In contrast, the approach used by Akil et al. (2012) is conceptually relevant to clinical applications. Theoretically, viral infection for inserting a wild-type gene could be used to reverse mutant phenotypes when hair cells or other critical cell populations survive yet do not function normally, such as with VGLUT3 mutations in humans and mice. Several technical advances have been made in this study that put us closer to seeing successful gene therapy in humans. Use of AAV apparently provides long-term expression, with minimal or no side effects attributed to viral infection.