Prestin as a potential biomarker for cochlear injury: Current evidence and future directions

PURPOSE: Prestin has been identified as a potential biomarker for cochlear damage and consequent ototoxicity. Although several preclinical and clinical studies have investigated prestin, a comprehensive overview of the evidence regarding its diagnostic value across different types of auditory damage and its use for cancer treatment-related ototoxicity is currently lacking. METHODS: A structured literature review, based on a systematic PubMed search, was conducted to summarize preclinical and clinical studies that evaluated serum and/or plasma prestin levels in association with cochlear damage. Studies were categorized by etiology, moment of biomarker assessment, and correlation with functional hearing outcomes. RESULTS: Twenty-one studies (six animal, 15 human) were included. In animal models, prestin levels increased within hours to days after cochlear injury. Clinical studies showed elevated prestin levels within 30 days after acute damage, due to cisplatin exposure, noise exposure, or surgery. Higher prestin levels correlated with elevated hearing thresholds in six studies, whereas findings were more variable in age-related or chronic hearing loss. So far, no pediatric populations have been studied, and reference values or diagnostic thresholds for prestin are lacking. CONCLUSION: Prestin shows potential for use as a biomarker for acute cochlear damage, with time-dependent patterns observed in both animal and human studies. However, heterogeneity in study design, patient populations, and measurement methods limits current general conclusions and recommendations for its use in the clinical field. Further standardized and longitudinal studies, including pediatric and cancer-survivor cohorts, are needed to determine its clinical utility.