内耳感觉细胞的损伤会导至永久性的感音神经性耳聋,人工耳蜗植入等替代治疗方法不能重建受损的听觉生理机构并终恢复正常的听觉生理功能、感音神经性耳聋治疗的根本方法,是内耳感觉细胞的修复或再生,国内外大量的研究取得诸多令人可喜的进展。已有多种方式通过对听觉系统发育的关键调控基因进行操作,获得了内耳感觉细胞的保护、增殖和分化,并进一步实现了听功能的部分恢复。本篇述评将结合国际最新研究动态,集中杨仁明课题组近10年为攻克感音神经聋治疗难题的基础研究工作。首先课题组在国家自然科学基金青年基金、面目项目以及重点项目支持下,建立耳聋动物新模型,并以些作为切入点的耳聋干预提供了必要的研究平台;第二,在国家863和国家自然科学基金重点项目联合资助下,探索了内耳基因治疗的可能性,为了最终临床应用正在解决诸多技术瓶颈,如高效安全的内耳递送技术,尤其是生物活性分子的递送载体;第三,在国家973听觉干细胞项目以及973重大科学问题导向项目资助下,基于耳聋干细胞治疗基础研究也取得了较多突破。我们的研究发现,无论是基因操作,基因治疗、分子治疗还是干细胞治疗,有效干预策略的建立都需要充分阐述内耳分子病理的发病机制,从而有针对性选择合适的干预方式和最佳的干预时间窗。感音神经性耳聋治疗将倾向于多元素联合和个体化干预模式,并成为多学科交叉发展的最前沿领域。
Permanent sensorineural hearing loss could be caused by lesions of inner ear sensory cells.The damaged auditory physiological structure cannot be reconstructed by replacement therapies,e.g.cochlear implant.The ultimate treatment of sensorineural hearing loss is the repair and regeneration of inner ear sensory cells.Numerous advances currentlyhave been achieved. Manipulation of key regulatory genes of auditory development system may help achieve the goals of pro- tection, proliferation and differentiation of inner ear sensory cells and subsequent recovery of hearing function. This review focuses on the progress of Shi-Ming Yang' s group in the treatment of sensorineural hearing loss and describes the lastest worldwide advance. Firstly, we have established a series of new animal models of hearing loss, supported by the Youth Proj- ect, General Project and Major Project of National Natural Science Foundation, which provided a necessary research plat- form for the intervention of auditory function and was used to identify potential intervention targets. Secondly, we have ex- plored the possibility of gene therapy in the inner ear and are now solving many technical difficulties in clinical application, such as the efficient and safe technology of inner ear delivery, especially delivery vectors of bioactive molecules. These works have been supported by both the National 863 Project and Major Project of the National Natural Science Foundation. Thirdly, breakthroughs have been made in basic research based on stem cell treatment of deafness, which were funded by Auditory Stem Cell Project and Significant Scientific Problem Orientation Project of National 973 Project. The results of our studies suggest that it is necessary to fully understand the pathogenesis of inner ear molecular pathology in order to develop efficient intervention strategies regardless of gene therapy, molecular therapy or stem cell treatment, as such information is helpful for choosing the proper intervention approach and best intervention time. We b