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Updated: Jun 29, 2025

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity
Published on: March 16, 2018
Ivacaftor attenuates gentamicin-induced ototoxicity through the CFTR-Nrf2-HO1/NQO1 pathway
Rui Hu1,2, Fan Wu2,3,4, Yi-Qing Zheng1,2,3
1Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei, People's Republic of China.
Objectives:
Gentamicin is one of the most common ototoxic drugs that can lower patients' quality of life. Oxidative stress is a key factors inducing sensory hair cell death during gentamicin administration. So far, there are no effective drugs to prevent or treat gentamicin- induced hearing loss. A recent study found cystic fibrosis transmembrane conductance regulator (CFTR) as a new target to modulate cellular oxidative balance. The objective of this study was to estimate the effect of the CFTR activator ivacaftor on gentamicin-induced ototoxicity and determine its mechanism.
Methods:
The hair cell count was analyzed by Myosin 7a staining. Apoptosis was analyzed by TUNEL Apoptosis Kit. Cellular reactive oxygen species (ROS) level was detected by DCFH-DA probes. The Nrf2 related proteins expression levels were analyzed by western blot.
Results:
An in vitro cochlear explant model showed that gentamicin caused ROS accumulation in sensory hair cells and induced apoptosis, and this effect was alleviated by pretreatment with ivacaftor. Western blotting showed that ivacaftor administration markedly increased the protein expression of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO1), and NAD(P)H:quinone oxidoreductase 1 (NQO1). The protective effect of ivacaftor was abolished by the Nrf2 inhibitor ML385.
Discussion:
Our results indicate the protective role of the CFTR-Nrf2-HO1/NQO1 pathway in gentamicin-induced ototoxicity. Ivacaftor may be repositioned or repurposed towards aminoglycosides-induced hearing loss.
Insights
Ivacaftor, a CFTR activator, protects against gentamicin-induced ototoxicity by reducing oxidative stress and apoptosis. This suggests potential for treating aminoglycoside-induced hearing loss.
Area of Science:
- Ototoxicity research
- Drug discovery
- Cellular biology
Background:
- Gentamicin is a common ototoxic drug causing hearing loss.
- Oxidative stress is a key factor in gentamicin-induced hair cell death.
- No effective treatments currently exist for this hearing loss.
Purpose of the Study:
- To evaluate ivacaftor's effect on gentamicin-induced ototoxicity.
- To elucidate the mechanism of ivacaftor's protective action.
Main Methods:
- In vitro cochlear explant model.
- Myosin 7a staining for hair cell count.
- TUNEL assay for apoptosis.
- DCFH-DA probes for reactive oxygen species (ROS).
- Western blot for Nrf2 pathway proteins.
Main Results:
- Gentamicin induced ROS accumulation and apoptosis in hair cells.
- Ivacaftor pretreatment alleviated gentamicin's ototoxic effects.
- Ivacaftor increased Nrf2, HO1, and NQO1 protein expression.
- The Nrf2 inhibitor ML385 abolished ivacaftor's protective effect.
Conclusions:
- The CFTR-Nrf2-HO1/NQO1 pathway is protective against gentamicin ototoxicity.
- Ivacaftor shows potential for treating aminoglycoside-induced hearing loss.
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