1
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Jha R, Bernstock JD, Chalif JI, Hoffman SE, Gupta S, Guo H, Lu Y. Updates on Pathophysiology of Discogenic Back Pain. J Clin Med 2023; 12:6907. [PMID: 37959372 PMCID: PMC10647359 DOI: 10.3390/jcm12216907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Discogenic back pain, a subset of chronic back pain, is caused by intervertebral disc (IVD) degeneration, and imparts a notable socioeconomic health burden on the population. However, degeneration by itself does not necessarily imply discogenic pain. In this review, we highlight the existing literature on the pathophysiology of discogenic back pain, focusing on the biomechanical and biochemical steps that lead to pain in the setting of IVD degeneration. Though the pathophysiology is incompletely characterized, the current evidence favors a framework where degeneration leads to IVD inflammation, and subsequent immune milieu recruitment. Chronic inflammation serves as a basis of penetrating neovascularization and neoinnervation into the IVD. Hence, nociceptive sensitization emerges, which manifests as discogenic back pain. Recent studies also highlight the complimentary roles of low virulence infections and central nervous system (CNS) metabolic state alteration. Targeted therapies that seek to disrupt inflammation, angiogenesis, and neurogenic pathways are being investigated. Regenerative therapy in the form of gene therapy and cell-based therapy are also being explored.
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Affiliation(s)
- Rohan Jha
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua I. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Samantha E. Hoffman
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Hong Guo
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
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2
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Zhao D, Zeng LF, Liang GH, Pan JK, Luo MH, Han YH, Liu J, Yang WY. Does anti-nerve growth factor monoclonal antibody treatment have the potential to replace nonsteroidal anti-inflammatory drugs and opioids in treating hip or knee osteoarthritis? A systematic review of randomized controlled trials. EFORT Open Rev 2022; 7:470-480. [PMID: 35900204 PMCID: PMC9297056 DOI: 10.1530/eor-21-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Ling-feng Zeng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Gui-hong Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jian-ke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming-hui Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-hong Han
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-yi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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3
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Zhao D, Luo MH, Pan JK, Zeng LF, Liang GH, Han YH, Liu J, Yang WY. Based on minimal clinically important difference values, a moderate dose of tanezumab may be a better option for treating hip or knee osteoarthritis: a meta-analysis of randomized controlled trials. Ther Adv Musculoskelet Dis 2022; 14:1759720X211067639. [PMID: 35069811 PMCID: PMC8777347 DOI: 10.1177/1759720x211067639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Tanezumab is a nerve growth factor monoclonal antibody that may regulate pain
in hip or knee osteoarthritis (OA). This meta-analysis was performed to
evaluate the efficacy and safety of low and moderate doses of tanezumab in
treating hip or knee OA. Methods: PubMed, EMBASE, the Cochrane Library, and Web of Science were comprehensively
searched for clinical trials published before 1 May 2021. Patients were
assessed via efficacy and safety outcomes. Results: Twelve randomized controlled trials including 6022 patients were identified.
Both low and moderate doses of tanezumab significantly improved efficacy
outcomes. However, only the point estimates (mean difference, MD) of
moderate-dose tanezumab significantly exceeded the minimal clinically
important differences (MCIDs). There were no significant differences in the
incidence of treatment-related adverse events (AEs), withdrawals due to AEs,
serious AEs, and total joint replacement between the tanezumab and placebo
groups, whereas the incidence of AEs was higher in the tanezumab group
(relative risk, RR = 1.10; 95% confidence interval, 95% CI = 1.04–1.17). The
incidence of rapidly progressive OA was significantly higher in the combined
low- and moderate-dose tanezumab groups than in the placebo group
(RR = 5.01; 95% CI = 1.17–21.33). Furthermore, both low and moderate doses
of tanezumab significantly increased the incidence of abnormal peripheral
sensation (RR = 1.99, 95% CI = 1.21–3.28; RR = 2.64, 95% CI = 1.91–3.67,
respectively). Compared with nonsteroidal anti-inflammatory drugs (NSAIDs)
and opioids, tanezumab showed significantly improved efficacy outcomes
(p < 0.05). However, the point estimates (MD) of
tanezumab were not greater than the MCID. Pooled analysis showed no
significant differences between tanezumab and NSAIDs and opioids in safety
outcomes (p > 0.05). Conclusion: Tanezumab is efficacious in patients with hip or knee OA. Tanezumab is
relatively well tolerated and safe but increases the incidence of AEs and
reversible abnormal peripheral sensation. Additional studies on the
occurrence of rapidly progressive OA are needed. A moderate dose of
tanezumab may maximize the benefits for hip or knee OA.
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Affiliation(s)
- Di Zhao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Ming-hui Luo
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-ke Pan
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-feng Zeng
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gui-hong Liang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-hong Han
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-yi Yang
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Rizzo RRN, Ferraro MC, Wewege MA, Cashin AG, Leake HB, O'Hagan ET, Jones MD, Gustin SM, McLachlan AJ, Day R, McAuley JH. Targeting Neurotrophic Factors for Low Back Pain and Sciatica: A Systematic Review and Meta-analysis. Rheumatology (Oxford) 2021; 61:2243-2254. [PMID: 34677587 DOI: 10.1093/rheumatology/keab785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This meta-analysis aims to investigate the efficacy and safety of medicines that target neurotrophic factors for low back pain (LBP) or sciatica. METHODS We searched published and trial registry reports of randomised controlled trials evaluating the effect of medicines that target neurotrophic factors to LBP or sciatica in seven databases from inception to December 2020. Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty in the evidence. RESULTS Nine studies (3349 participants) were included in the meta-analyses. Low certainty evidence showed that anti-NGF may reduce pain at four weeks (MD -6.63, 95% CI -8.51 to -4.76), and 12 weeks (MD -6.10, -8.34 to -3.87), and may increase adverse effects for chronic LBP (OR 1.16, 0.99-1.36). Higher doses of anti-NGF may offer a clinically important reduction in pain at the cost of increased adverse effects for chronic LBP. Very low certainty evidence showed that anti-NGF and glial cell line-derived neurotrophic factor (pro-GDNF) may not reduce pain for sciatica at four weeks (MD -1.40, -8.26-5.46), at 12 weeks (MD -2.91, -13.69-7.67), and may increase adverse effects for sciatica (OR 3.27, 1.78-6.00). CONCLUSION Anti-NGF may offer small reductions in pain intensity for chronic LBP. The effect may depend on the dose and types of medicines. For sciatica, anti-NGF or pro-GDNF may not reduce pain. Medicines that target neurotrophic factors for LBP or sciatica are associated with different adverse effects from commonly prescribed medicines for these conditions.
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Affiliation(s)
- Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, University of Sydney, Sydney, NSW, 2050, Australia
| | - Richard Day
- Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
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5
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Cao Z, Li Q, Guo J, Li Y, Wu J. Is Targeting Nerve Growth Factor Antagonist a New Option for Pharmacologic Treatment of Low Back Pain? A Supplemental Network Meta-Analysis of the American College of Physicians Guidelines. Front Pharmacol 2021; 12:727771. [PMID: 34531752 PMCID: PMC8438173 DOI: 10.3389/fphar.2021.727771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/18/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: It has been found that targeting nerve growth factor antagonists (ANGF) have excellent effects in the treatment of chronic pain, and the current pharmacologic treatments have very limited effects on low back pain (LBP). Thus we conducted this network meta-analysis (NMA) to study the efficacy and safety of ANGF for the treatment of LBP, and to guide for clinical practice and further research. Method: PubMed, Scopus, Embase, CNKI, and the Cochrane Library were searched from January 1980 to March 2021. A frequentist framework network meta-analysis with a random-effect model was performed. Ranking effects were calculated by surface under the cumulative ranking analysis (SUCRA) and clusterank analysis. Results: This NMA identified 30 studies, involving 9,508 patients with LBP. ANGF reported both superior effect on pain relief {SUCRA 82.1%, SMD 0.89, 95% CI [(0.26,1.51)]} and function improvement {SUCRA 77.3%, SMD 0.93, 95% CI [(0.27,1.58)]} than placebo, and did not showed any higher risk of treatment-emergent adverse effects {RR 1.11, 95% CI [(0.97,1.27)]} or serious adverse effects {RR 1.03, 95% CI [(0.54,1.97)]}, but it was associate with a special risk of rapidly progressive osteoarthritis. ANGF displayed the greatest potential to be the most effective and safest treatment (cluster-rank value for function improvement and safety: 4266.96, for pain relief and safety: 4531.92). Conclusion: ANGF could relieve pain and improve function effectively and are superior to other traditional drugs recommended by guidelines. Although no significant difference in tolerability and safety between ANGFs and placebo was found, the rapid progression of original osteoarthritis which may be related to the use of ANGFs still needs special attention and furtherly verification by clinical trials. Systematic Review Registration: PROSPERO, identifier [CRD42021258033].
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Affiliation(s)
- Ziqin Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qiangxiang Li
- Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,National Clinical Research Center for Geriatric Disorders of Xiangya Hospital, Central South University, Yinchuan, China.,Department of Hunan Institute of Geriatrics, Hunan People's Hospital, Changsha, China
| | - Jia Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhuang Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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6
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Jovanovic F, Pirvulescu I, Knezevic E, Candido KD, Knezevic NN. Comparative safety review of current treatment options for chronic low back pain and unmet needs: a narrative review. Expert Opin Drug Saf 2021; 20:1005-1033. [PMID: 33945371 DOI: 10.1080/14740338.2021.1921142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The healthcare expenditures in the United States are substantial for the management of refractory, chronic low back pain (CLBP). The objective of this review is to summarize and evaluate the safety profiles of different pharmacological treatment options used in the management of CLBP.Areas covered: The authors conducted a search of randomized controlled trials (RCTs) assessing the safety profiles of different pharmacological agents used in the management of CLBP. This narrative review covered corticosteroids, opioids, antidepressants, gabapentinoids, nonsteroidal anti-inflammatory drugs, muscle relaxants, anti-nerve growth factor antibodies and topical agents, as monotherapy or in combination.Expert opinion: The risk-benefit ratio of a particular treatment is a subject driving the ongoing development of pharmaceuticals. The most commonly reported AEs across all drug classes are of gastrointestinal nature, followed by neurological and skin-related. These AEs include nausea, dizziness, constipation, arthralgia, headache, dry mouth, pruritus, etc. The majority of the AEs reported are not life-threatening, although they may lower patients' quality of life, thus, affecting their compliance. One of the biggest limitations of our review stems from the paucity of safety assessments in published RCTs. Advances in our understanding of the neurobiology of pain will promote development of new therapeutic strategies.
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Affiliation(s)
- Filip Jovanovic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Iulia Pirvulescu
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Emilija Knezevic
- College of Liberal Arts & Sciences, University of Illinois at Urbana Champaign, IL, United States
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, IL, United States.,Department of Surgery, College of Medicine, University of Illinois, Chicago, IL, United States
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, IL, United States.,Department of Surgery, College of Medicine, University of Illinois, Chicago, IL, United States
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7
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Rizzo RRN, Wewege MA, Leake HB, McAuley JH. Commentary: The Efficacy of Nerve Growth Factor Antibody for the Treatment of Osteoarthritis Pain and Chronic Low-Back Pain: A Meta-analysis. Front Pharmacol 2021; 12:619344. [PMID: 33981217 PMCID: PMC8108005 DOI: 10.3389/fphar.2021.619344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of NSW, Sydney, NSW, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of NSW, Sydney, NSW, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,IIMPACT in Health, University of SA, Adelaide, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of NSW, Sydney, NSW, Australia
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8
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Park TSW, Khan N, Kuo A, Nicholson JR, Corradini L, Smith MT. Characterisation of a rat model of mechanical low back pain at an advanced stage using immunohistochemical methods. Clin Exp Pharmacol Physiol 2021; 48:96-106. [PMID: 32888350 DOI: 10.1111/1440-1681.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/25/2020] [Accepted: 08/25/2020] [Indexed: 01/23/2023]
Abstract
Chronic low back pain (LBP) has high prevalence in the adult population which is associated with enormous disability. Hence, our aim was to further characterise our LBP rat model by using immunohistological and immunohistochemical methods at an advanced stage (day 49) of the model. Male Sprague-Dawley rats were anaesthetised and their lumbar L4/L5 and L5/L6 intervertebral discs (IVDs) were punctured (0.5 mm outer diameter, 2 mm-deep) 10 times per disc. Sham-rats underwent similar surgery, but no discs were punctured. For LBP- but not sham-rats, noxious pressure hyperalgesia was fully developed in the lumbar axial deep tissues on day 21 post-surgery, which was maintained until at least day 49. In the lumbar (L4-L6) dorsal root ganglia (DRGs), somatostatin (SRIF) and the somatostatin receptor type 4 (SST4 receptor) were co-localised with substance P and IB4, markers of small diameter unmyelinated peptidergic and non-peptidergic C-fibres respectively as well as with NF200, a marker of medium to large diameter neurons. On day 49, there was increased expression of SRIF but not the somatostatin receptor type 4 (SST4 receptor) in the lumbar DRGs and the spinal dorsal horns. There were increased DRG expression levels of the putative pro-nociceptive mediators: phosphorylated p38 (pp38) mitogen-activated protein kinase (MAPK) and phosphorylated p44/p42 MAPK (pp44/pp42 MAPK) as well as pp38 MAPK expression levels in the lumbar spinal cord. Taken together, the increased expression of SRIF in the lumbar DRGs and spinal cord and its co-localisation with nociceptive fibres in DRG sections suggest a potential role of SRIF in modulating chronic mechanical LBP.
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Affiliation(s)
- Thomas S W Park
- Faculty of Medicine, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Department of Neurophysiology, Mannheim Centre for Translational Neuroscience, Heidelberg University, Mannheim, Germany
| | - Nemat Khan
- Faculty of Medicine, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Andy Kuo
- Faculty of Medicine, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Laura Corradini
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Maree T Smith
- Faculty of Medicine, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
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9
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Zhang S, Hu B, Liu W, Wang P, Lv X, Chen S, Shao Z. The role of structure and function changes of sensory nervous system in intervertebral disc-related low back pain. Osteoarthritis Cartilage 2021; 29:17-27. [PMID: 33007412 DOI: 10.1016/j.joca.2020.09.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Low back pain (LBP) is a common musculoskeletal symptom, which can be developed in multiple clinical diseases. It is widely recognized that intervertebral disc (IVD) degeneration (IVDD) is one of the leading causes of LBP. However, the pathogenesis of IVD-related LBP is still controversial, and the treatment means are also insufficient to date. In recent decades, the role of structure and function changes of sensory nervous system in the induction and the maintenance of LBP is drawing more and more attention. With the progress of IVDD, IVD cell exhaustion and extracellular matrix degradation result in IVD structural damage, while neovascularization, innervation and inflammatory activation further deteriorate the microenvironment of IVD. New nerve ingrowth into degenerated IVD amplifies the impacts of IVD-derived nociceptive molecules on sensory endings. Moreover, IVDD is usually accompanied with disc herniation, which could injure and inflame affected nerves. Under mechanical and pro-inflammatory stimulation, the pain-transmitting pathway exhibits a sensitized function state and ultimately leads to LBP. Hence, relevant pathogenic factors, such as neurotrophins, ion channels, inflammatory factors, etc., are supposed to serve as promising therapeutic targets for LBP. The purpose of this review is to comprehensively summarize the current evidence on 1) the pathological changes of sensory nervous system during IVDD and their association with LBP, and 2) potential therapeutic strategies for LBP targeting relevant pathogenic factors.
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Affiliation(s)
- S Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - B Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - W Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - P Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - X Lv
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - S Chen
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Z Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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10
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Nerve growth factor antibody for the treatment of osteoarthritis pain and chronic low-back pain: mechanism of action in the context of efficacy and safety. Pain 2020; 160:2210-2220. [PMID: 31145219 PMCID: PMC6756297 DOI: 10.1097/j.pain.0000000000001625] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic pain continues to be a significant global burden despite the availability of a variety of nonpharmacologic and pharmacologic treatment options. Thus, there is a need for new analgesics with novel mechanisms of action. In this regard, antibodies directed against nerve growth factor (NGF-Abs) are a new class of agents in development for the treatment of chronic pain conditions such as osteoarthritis and chronic low-back pain. This comprehensive narrative review summarizes evidence supporting pronociceptive functions for NGF that include contributing to peripheral and central sensitization through tropomyosin receptor kinase A activation and stimulation of local neuronal sprouting. The potential role of NGF in osteoarthritis and chronic low-back pain signaling is also examined to provide a mechanistic basis for the observed efficacy of NGF-Abs in clinical trials of these particular pain states. Finally, the safety profile of NGF-Abs in terms of common adverse events, joint safety, and nerve structure/function is discussed.
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11
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Yang S, Huang Y, Ye Z, Li L, Zhang Y. The Efficacy of Nerve Growth Factor Antibody for the Treatment of Osteoarthritis Pain and Chronic Low-Back Pain: A Meta-Analysis. Front Pharmacol 2020; 11:817. [PMID: 32694993 PMCID: PMC7339523 DOI: 10.3389/fphar.2020.00817] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nerve growth factor (NGF) plays a crucial role in pain modulation and is being considered as a new therapeutic target for pain therapy. The purpose of this meta-analysis was to study the efficacy of anti-NGF antibodies for the treatment of osteoarthritis pain and chronic low-back pain, and to provide evidence and direction for further research and practice. METHODS PubMed, Embase, Wanfang Data, and China National Knowledge Infrastructure (CNKI) were searched from inception to November 30, 2019. Eligible studies should include randomized clinical trial-based investigations of anti-NGF antibody treatment for osteoarthritis pain and chronic low-back pain. Pooled overall mean changes from baseline to check point in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) measures of pain, physical function, and Patient's Global Assessment (PGA) were calculated with either a fixed-effects model or a random-effects model, depending on the tests for heterogeneity. Sensitivity analysis and bias of publication were assessed. RESULTS A total of seven studies (3890 patients) were included in this meta-analysis. The pooled analysis showed a statistically significant reduction in the WOMAC pain (standardized mean difference (SMD) = -2.22, 95% confidence interval (CI) = -3.44 to -0.99, Z = -3.55, P = 0.0004; I2 = 99%), the WOMAC Physical Function (SMD = -2.76, 95% CI = -4.22 to -1.30, Z = -3.71, P = 0.0002; I2 = 99%), and the PGA Index (SMD = -2.76, 95% CI = -4.42 to -1.09, Z = -3.24, P = 0.0012; I2 = 99%). Pooled differences of adverse events rates in experimental and control groups was 0.11 (95% CI = 0.02 to 0.20, Z = 2.41, P = 0.016; I2 = 83%). CONCLUSION Our meta-analysis data indicate that anti-NGF antibodies can relieve pain and improve function in patients with osteoarthritis pain and chronic low-back pain.
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Affiliation(s)
- Si Yang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Huang
- Department of Laboratory Medicine, Hubei NO.3 People’s Hospital of Jianghan University, Wuhan, China
| | - Ziqi Ye
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Li
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Zhang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Kelly KM, Sanga P, Zaki N, Wang S, Haeussler J, Louie J, Thipphawong J. Safety and efficacy of fulranumab in osteoarthritis of the hip and knee: results from four early terminated phase III randomized studies. Curr Med Res Opin 2019; 35:2117-2127. [PMID: 31387410 DOI: 10.1080/03007995.2019.1653068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To evaluate the safety and efficacy of fulranumab as adjunct or monotherapy in patients with knee or hip pain related to moderate-to-severe osteoarthritis.Methods: Osteoarthritic patients (aged ≥18 years) from four phase 3 randomized, double-blind (DB), placebo-controlled studies were randomized to receive placebo, fulranumab 1 mg every 4 weeks (Q4wk), or 3 mg Q4wk in 16-week DB phase, followed by a 52-week post-treatment follow-up phase. Safety assessments included treatment-emergent adverse events (TEAEs), and neurological, sympathetic, and joint-related events of interest. Efficacy assessments included pain and physical function sub-scales of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.Results: Of 245 patients from the ITT set (median age = 64 years; 62% women), 84 (34%) completed the DB phase; the majority of discontinuations (57%) were due to early study termination. In the DB phase, the incidence of TEAEs in fulranumab 3 mg (57.8%) and 1 mg (56.8%) was similar to placebo (56.8%). Two events adjudicated as joint-related events of interest include rapidly progressive osteoarthritis and fracture of unknown etiology. There were no new neurological TEAEs. Fulranumab showed evidence of efficacy in improving pain and physical function based on WOMAC sub-scale scores. Due to premature study termination, the number of patients enrolled were too small to make any definitive efficacy claims.Conclusions: Treatment with fulranumab was generally tolerated with no new safety signals. Within the limited sample analyzed, fulranumab showed evidence of improvement of pain and function in patients with moderate-to-severe osteoarthritis who had failed prior therapy and were candidates for joint replacement surgery.Clinical trial registration numbers: NCT02336685; NCT02336698; NCT02289716; NCT02301234KEY POINTSFulranumab as adjuvant or monotherapy was well tolerated with no new safety signalsFulranumab demonstrated evidence suggestive of efficacy in osteoarthritic pain of hip and kneeFulranumab demonstrated evidence suggestive of improvement of pain and physical function in osteoarthritis.
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MESH Headings
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Arthralgia/diagnosis
- Arthralgia/drug therapy
- Arthralgia/etiology
- Double-Blind Method
- Early Termination of Clinical Trials
- Female
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/drug therapy
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/physiopathology
- Pain Measurement/methods
- Physical Functional Performance
- Severity of Illness Index
- Treatment Outcome
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Affiliation(s)
| | - Panna Sanga
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Naim Zaki
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Steven Wang
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | | | - John Louie
- Janssen Research and Development, LLC, Fremont, CA, USA
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Sisignano M, Parnham MJ, Geisslinger G. Novel Approaches to Persistent Pain Therapy. Trends Pharmacol Sci 2019; 40:367-377. [PMID: 31078322 DOI: 10.1016/j.tips.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/12/2019] [Accepted: 04/08/2019] [Indexed: 10/26/2022]
Abstract
Persistent and neuropathic pain affects >15% of the global population. Apart from being an individual burden to the patient, persistent pain causes considerable subsequent costs in global healthcare systems. Despite the efforts of pharmaceutical companies to develop novel analgesics, pharmacological options for the therapy of persistent and/or neuropathic pain are limited. We discuss here novel approaches to persistent pain therapy that are independent of classical target-based drug discovery, focusing on individualized diagnostic technologies, improvement of existing therapies, and expansion of current pharmacological treatments and future techniques that may broaden pharmacological options for the individual treatment of persistent pain in patients.
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Affiliation(s)
- Marco Sisignano
- Institute of Clinical Pharmacology, Pharmazentrum Frankfurt, Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit (ZAFES), University Hospital of Goethe-University, 60590 Frankfurt am Main, Germany
| | - Michael J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch for Translational Medicine and Pharmacology (TMP), Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Pharmazentrum Frankfurt, Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit (ZAFES), University Hospital of Goethe-University, 60590 Frankfurt am Main, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch for Translational Medicine and Pharmacology (TMP), Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
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14
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Emerging therapies in clinical development and new contributions for neuropathic pain. ACTA ACUST UNITED AC 2019; 66:324-334. [PMID: 31010688 DOI: 10.1016/j.redar.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 12/19/2022]
Abstract
Neuropathic pain is very challenging to manage because of the heterogeneity of aetiologies, symptoms, and underlying mechanisms. Conventional oral therapies have been limited by negative factors such as systemic side effects, drug-drug interactions, slow onset of action, the need for titration, multiple daily dosing, as well as the potential risk of addiction, dependence, withdrawal symptoms and abuse. Therefore, new therapeutic perspectives are justified. New drugs that act on different therapeutic targets are currently in preclinical development or in their first phases of clinical development. In this review, focus will be directed specifically on new pharmacological treatments for neuropathic pain for which clinical data are already available, including older and known drugs with new data on their anti-neuropathic activity.
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Dimitroulas T, Lambe T, Raphael JH, Kitas GD, Duarte RV. Biologic Drugs as Analgesics for the Management of Low Back Pain and Sciatica. PAIN MEDICINE 2018; 20:1678-1686. [DOI: 10.1093/pm/pny214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective
To discuss the current knowledge on the impact of commonly used biologic agents (i.e., anti–tumor necrosis factor–alpha [anti-TNF-α] and anti–nerve growth factor [anti-NGF]) in the management of low back pain with or without sciatica.
Methods
A narrative literature review of studies investigating the use of biologic agents for the management of low back pain and sciatica was conducted. We searched MEDLINE and EMBASE for English language publications. A hand-search of reference lists of relevant studies was also performed.
Results
Although some observational studies showed that inhibition of TNF-α reduced pain and improved function, randomized controlled trials and a meta-analysis failed to demonstrate the superiority of anti-TNF-α over placebo in this regard. Anti-TNF-α, however, reduced the risk of having invasive procedures such as discectomy and radicular block in cases of sciatica. Conversely, controlled studies showed moderate pain reduction and mild functional improvement with anti-NGF administration, but the side effect profile of anti-NGF was unfavorable compared with placebo.
Conclusions
Overall, anticytokine treatments have limited efficacy in patients with chronic low back pain with or without sciatica. However, larger and better-designed studies may need to be performed in specific patient subpopulations. Low back pain is particularly disabling in younger patients. This group therefore represents a potential target population for investigating the effectiveness of anticytokine therapies, especially where other pharmacological and nonpharmacological management strategies have failed.
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Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tosin Lambe
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Jon H Raphael
- Department of Pain Medicine, Dudley Group NHS Foundation Trust, Dudley, UK
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
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Abstract
Although there is an unmet need for pain medications that are both effective and safe, virtually no novel analgesics have been approved over the past two decades. In view of both experimental and clinical evidence of a major role for nerve growth factor (NGF) in the generation and maintenance of a wide range of pain states, the clinical development of humanised anti-nerve growth factor monoclonal antibodies (anti-NGF mAbs) aroused particular interest. However, the US Food and Drug Administration (FDA) placed a clinical hold on anti-NGF mAb clinical studies in late 2010, first because of reports of serious joint-related adverse events, and afterwards because of sympathetic nervous system safety concerns. The development programmes of tanezumab and fasinumab resumed after the FDA lifted its hold in March 2015, whereas other anti-NGF mAbs were dropped by their sponsors. This article provides an updated review on the analgesic efficacy and safety of anti-NGF agents based on data from fully published studies and public information from websites, and discusses the possible future role of these agents in managing chronic pain. The efficacy of anti-NGF mAbs was highly variable depending on the chronic pain condition studied. The most consistent and convincing results were obtained in patients with symptomatic osteoarthritis of the knee and/or hip. Conversely, studies in non-specific lower back pain and peripheral neuropathic pain generated mixed results. Finally, there was no conclusive evidence of the effectiveness of anti-NGF mAbs in cancer pain and urological chronic pelvic pain syndromes. Treatment-emergent adverse events were similar across anti-NGF mAbs, thus being suggestive of 'class-specific effects'. Although most patients tolerated anti-NGF agents well, neurosensory symptoms occurred frequently, and some patients developed new or worsened peripheral neuropathies. However, the most problematic safety issue was rapidly destructive arthropathies, leading to joint replacement surgery. To date, the aetiologies of joint-related side effects and their pathophysiology have not been clearly elucidated. However, some risk factors have been identified, such as higher doses of anti-NGF mAbs and longer drug exposure, concurrent nonsteroidal anti-inflammatory drug use and pre-existing subchondral insufficiency fractures. Taken together, the present data suggest that low-dose anti-NGF mABs may exhibit a favourable risk-benefit ratio in selected patients with certain chronic pain conditions, especially symptomatic osteoarthritis.
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Bélanger P, West CR, Brown MT. Development of pain therapies targeting nerve growth factor signal transduction and the strategies used to resolve safety issues. J Toxicol Sci 2018; 43:1-10. [PMID: 29415946 DOI: 10.2131/jts.43.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Therapeutic agents commonly used in the management of chronic pain have limited effectiveness and may be associated with issues of dependence and tolerability. Thus, a large unmet medical need exists for the development of safe and effective therapeutics for treatment of chronic pain. A novel approach includes identification of intracellular signals involved in the pain transduction pathway, such as nerve growth factor (NGF). Monoclonal antibodies targeting NGF, such as tanezumab, fulranumab and fasinumab, have been investigated for the treatment of chronic pain conditions. Due to unexpected joint adverse events in clinical studies and concerns about sympathetic nervous system toxicity in animals, these agents were placed on 2 separate partial clinical holds, which were subsequently lifted after rigorous evaluations were conducted to understand how inhibition of NGF impacts safety. To share learnings regarding the rigorous evaluation of clinical and nonclinical safety data which contributed to the removal of these partial clinical holds, this article reviews the rationale for developing agents that target NGF as potential treatments for chronic pain, describes nonclinical and clinical studies of these agents, and describes strategies used to evaluate whether inhibition of NGF has negative effects on joint or sympathetic nervous system safety.
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Chartier SR, Mitchell SA, Majuta LA, Mantyh PW. Immunohistochemical localization of nerve growth factor, tropomyosin receptor kinase A, and p75 in the bone and articular cartilage of the mouse femur. Mol Pain 2017; 13:1744806917745465. [PMID: 29166838 PMCID: PMC5724636 DOI: 10.1177/1744806917745465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sequestration of nerve growth factor (NGF) significantly attenuates skeletal pain in both animals and humans. However, relatively little is known about the specific cell types that express NGF or its cognate receptors tropomyosin receptor kinase A (TrkA) and p75 in the intact bone and articular cartilage. In the present study, antibodies raised against NGF, TrkA, and p75 (also known as CD271) were used to explore the expression of these antigens in the non-decalcified young mouse femur. In general, all three antigens displayed a remarkably restricted expression in bone and cartilage with less than 2% of all DAPI+ cells in the femur displaying expression of any one of the three antigens. Robust NGF immunoreactivity was found in mostly CD-31− blood vessel-associated cells, a small subset of CD-31+ endothelial cells, an unidentified group of cells located at the subchondral bone/articular cartilage interface, and a few isolated, single cells in the bone marrow. In contrast, p75 and TrkA were almost exclusively expressed by nerve fibers located nearby NGF+ blood vessels. The only non-neuronal expression of either p75 or TrkA in the femur was the expression of p75 by a subset of cells located in the deep and middle zone of the articular cartilage. Understanding the factors that tightly regulate the basal level of expression in normal bone and how the expression of NGF, TrkA, and p75 change in injury, disease, and aging may provide insights into novel therapies that can reduce skeletal pain and improve skeletal health.
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Affiliation(s)
| | | | - Lisa A Majuta
- 1 Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Patrick W Mantyh
- 1 Department of Pharmacology, University of Arizona, Tucson, AZ, USA.,2 Cancer Center, University of Arizona, Tucson, AZ, USA
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Nagakura Y. The need for fundamental reforms in the pain research field to develop innovative drugs. Expert Opin Drug Discov 2016; 12:39-46. [PMID: 27838932 DOI: 10.1080/17460441.2017.1261108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic pain is a major healthcare issue owing to its high prevalence, significant physical and emotional burden on the patients, and huge financial burden on the society. The efficacy of currently available medications is unsatisfactory owing to their limited effect size and the low responder rate (less than 50%). Thus, there is a large unmet need for innovative therapies for chronic pain. Areas covered: In this review, the author points out the need for fundamental reforms in pain research. For the last several decades, drug discovery research has extensively focused on designing new therapies using animal models of chronic pain. It has, however, made insufficient progress with respect to the launch of innovative analgesic drugs, because the translation from preclinical to clinical stages has not been satisfactory. Thus, the strategies for developing innovative analgesic drugs are discussed. Expert opinion: Points to be considered in the discovery of drugs for pain relief include: (1) the exclusion of bias incorporation and the alignment of clinical and preclinical endpoints in the assessment of analgesic efficacy; (2) the understanding of primary unmet needs; (3) the assessment of new therapies by biomarker-prioritized frameworks, and (4) the stratification of chronic pain sufferers.
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Affiliation(s)
- Yukinori Nagakura
- a Faculty of Pharmaceutical Sciences , Aomori University , Aomori-shi , Aomori , Japan
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Demir IE, Tieftrunk E, Schorn S, Friess H, Ceyhan GO. Nerve growth factor & TrkA as novel therapeutic targets in cancer. Biochim Biophys Acta Rev Cancer 2016; 1866:37-50. [PMID: 27264679 DOI: 10.1016/j.bbcan.2016.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/24/2016] [Accepted: 05/28/2016] [Indexed: 12/11/2022]
Abstract
In the past 20years, nerve growth factor (NGF) and its receptors TrkA & p75NTR were recognized to be overexpressed in the overwhelming majority of human solid cancers. Recent studies discovered the presence of overactive TrkA signaling due to TrkA rearrangements or TrkA fusion products in frequent cancers like colorectal cancer, thyroid cancer, or acute myeloid leukemia. Thus, targeting TrkA/NGF via selective small-molecule-inhibitors or antibodies has gained enormous attention in the drug discovery sector. Clinical studies on the anti-cancer impact of NGF-blocking antibodies are likely to be accelerated after the recent removal of clinical holds on these agents by regulatory authorities. Based on these current developments, the present review provides not only a broad overview of the biological effects of NGF-TrkA-p75NTR on cancer cells and their microenvironment, but also explains why NGF and its receptors are going to evoke major interest as promising therapeutic anti-cancer targets in the coming decade.
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Affiliation(s)
- Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany.
| | - Elke Tieftrunk
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Stephan Schorn
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Güralp O Ceyhan
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
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