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Waltz TB, Chao D, Prodoehl EK, Enders JD, Ehlers VL, Dharanikota BS, Dahms NM, Isaeva E, Hogan QH, Pan B, Stucky CL. Fabry disease Schwann cells release p11 to induce sensory neuron hyperactivity. JCI Insight 2024; 9:e172869. [PMID: 38646936 PMCID: PMC11141882 DOI: 10.1172/jci.insight.172869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
Patients with Fabry disease suffer from chronic debilitating pain and peripheral sensory neuropathy with minimal treatment options, but the cellular drivers of this pain are unknown. Here, we propose a mechanism we believe to be novel in which altered signaling between Schwann cells and sensory neurons underlies the peripheral sensory nerve dysfunction we observed in a genetic rat model of Fabry disease. Using in vivo and in vitro electrophysiological recordings, we demonstrated that Fabry rat sensory neurons exhibited pronounced hyperexcitability. Schwann cells probably contributed to this finding because application of mediators released from cultured Fabry Schwann cells induced spontaneous activity and hyperexcitability in naive sensory neurons. We examined putative algogenic mediators using proteomic analysis and found that Fabry Schwann cells released elevated levels of the protein p11 (S100A10), which induced sensory neuron hyperexcitability. Removal of p11 from Fabry Schwann cell media caused hyperpolarization of neuronal resting membrane potentials, indicating that p11 may contribute to the excessive neuronal excitability caused by Fabry Schwann cells. These findings demonstrate that sensory neurons from rats with Fabry disease exhibit hyperactivity caused in part by Schwann cell release of the protein p11.
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Affiliation(s)
| | | | | | | | | | | | - Nancy M. Dahms
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elena Isaeva
- Department of Cell Biology, Neurobiology & Anatomy
| | | | - Bin Pan
- Department of Anesthesiology; and
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2
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Lai A, Iliff D, Zaheer K, Gansau J, Laudier DM, Zachariou V, Iatridis JC. Annulus Fibrosus Injury Induces Acute Neuroinflammation and Chronic Glial Response in Dorsal Root Ganglion and Spinal Cord-An In Vivo Rat Discogenic Pain Model. Int J Mol Sci 2024; 25:1762. [PMID: 38339040 PMCID: PMC10855200 DOI: 10.3390/ijms25031762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic painful intervertebral disc (IVD) degeneration (i.e., discogenic pain) is a major source of global disability needing improved knowledge on multiple-tissue interactions and how they progress in order improve treatment strategies. This study used an in vivo rat annulus fibrosus (AF) injury-driven discogenic pain model to investigate the acute and chronic changes in IVD degeneration and spinal inflammation, as well as sensitization, inflammation, and remodeling in dorsal root ganglion (DRG) and spinal cord (SC) dorsal horn. AF injury induced moderate IVD degeneration with acute and broad spinal inflammation that progressed to DRG to SC changes within days and weeks, respectively. Specifically, AF injury elevated macrophages in the spine (CD68) and DRGs (Iba1) that peaked at 3 days post-injury, and increased microglia (Iba1) in SC that peaked at 2 weeks post-injury. AF injury also triggered glial responses with elevated GFAP in DRGs and SC at least 8 weeks post-injury. Spinal CD68 and SC neuropeptide Substance P both remained elevated at 8 weeks, suggesting that slow and incomplete IVD healing provides a chronic source of inflammation with continued SC sensitization. We conclude that AF injury-driven IVD degeneration induces acute spinal, DRG, and SC inflammatory crosstalk with sustained glial responses in both DRGs and SC, leading to chronic SC sensitization and neural plasticity. The known association of these markers with neuropathic pain suggests that therapeutic strategies for discogenic pain need to target both spinal and nervous systems, with early strategies managing acute inflammatory processes, and late strategies targeting chronic IVD inflammation, SC sensitization, and remodeling.
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Affiliation(s)
- Alon Lai
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Denise Iliff
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Kashaf Zaheer
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Jennifer Gansau
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Damien M. Laudier
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
| | - Venetia Zachariou
- Department of Pharmacology, Physiology and Biophysics, Chobanian and Avedisian School of Medicine at Boston University, Boston, MA 02118, USA;
| | - James C. Iatridis
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.I.); (K.Z.); (J.G.); (D.M.L.); (J.C.I.)
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3
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Waltz TB, Chao D, Prodoehl EK, Ehlers VL, Dharanikota BS, Dahms NM, Isaeva E, Hogan QH, Pan B, Stucky CL. Schwann cell release of p11 induces sensory neuron hyperactivity in Fabry disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.26.542493. [PMID: 37292928 PMCID: PMC10245981 DOI: 10.1101/2023.05.26.542493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with Fabry disease suffer from chronic debilitating pain and peripheral sensory neuropathy with minimal treatment options, but the cellular drivers of this pain are unknown. Here, we propose a novel mechanism by which altered signaling between Schwann cells and sensory neurons underlies the peripheral sensory nerve dysfunction we observe in a genetic rat model of Fabry disease. Using in vivo and in vitro electrophysiological recordings, we demonstrate that Fabry rat sensory neurons exhibit pronounced hyperexcitability. Schwann cells likely contribute to this finding as application of mediators released from cultured Fabry Schwann cells induces spontaneous activity and hyperexcitability in naïve sensory neurons. We examined putative algogenic mediators using proteomic analysis and found that Fabry Schwann cells release elevated levels of the protein p11 (S100-A10) which induces sensory neuron hyperexcitability. Removal of p11 from Fabry Schwann cell media causes hyperpolarization of neuronal resting membrane potential, indicating that p11 contributes to the excessive neuronal excitability caused by Fabry Schwann cells. These findings demonstrate that rats with Fabry disease exhibit sensory neuron hyperexcitability caused in part by Schwann cell release of the protein p11.
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4
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Singh S, Winkelstein BA. Inhibiting the β1integrin subunit increases the strain threshold for neuronal dysfunction under tensile loading in collagen gels mimicking innervated ligaments. Biomech Model Mechanobiol 2022; 21:885-898. [DOI: 10.1007/s10237-022-01565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
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Kartha S, Ghimire P, Winkelstein BA. Inhibiting spinal secretory phospholipase A 2 after painful nerve root injury attenuates established pain and spinal neuronal hyperexcitability by altering spinal glutamatergic signaling. Mol Pain 2021; 17:17448069211066221. [PMID: 34919471 PMCID: PMC8721705 DOI: 10.1177/17448069211066221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Neuropathic injury is accompanied by chronic inflammation contributing to the onset and maintenance of pain after an initial insult. In addition to their roles in promoting immune cell activation, inflammatory mediators like secretory phospholipase A2 (sPLA2) modulate nociceptive and excitatory neuronal signaling during the initiation of pain through hydrolytic activity. Despite having a known role in glial activation and cytokine release, it is unknown if sPLA2 contributes to the maintenance of painful neuropathy and spinal hyperexcitability later after neural injury. Using a well-established model of painful nerve root compression, this study investigated if inhibiting spinal sPLA2 7 days after painful injury modulates the behavioral sensitivity and/or spinal dorsal horn excitability that is typically evident. The effects of sPLA2 inhibition on altered spinal glutamatergic signaling was also probed by measuring spinal intracellular glutamate levels and spinal glutamate transporter (GLAST and GLT1) and receptor (mGluR5, GluR1, and NR1) expression. Spinal sPLA2 inhibition at day 7 abolishes behavioral sensitivity, reduces both evoked and spontaneous neuronal firing in the spinal cord, and restores the distribution of neuronal phenotypes to those of control conditions. Inhibiting spinal sPLA2 also increases intracellular glutamate concentrations and restores spinal expression of GLAST, GLT1, mGluR5, and GluR1 to uninjured expression with no effect on NR1. These findings establish a role for spinal sPLA2 in maintaining pain and central sensitization after neural injury and suggest this may be via exacerbating glutamate excitotoxicity in the spinal cord.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Prabesh Ghimire
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Valerio P, Marzano F, Milazzo F, De Larrea AE, Placella G, Caraffa A, Rinonapoli G. Facet joint syndrome treated with interventional procedures: a review article with an update on the current evidence and practice. CURRENT ORTHOPAEDIC PRACTICE 2020; 31:571-578. [DOI: 10.1097/bco.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background:
Facet Joint Syndrome (FJS) is a common progressive disease affecting small joints of the spine and can have painful symptoms. When conservative treatment measures fail, there are a wide range of interventional procedures that can be used. Varied results have been obtained with different procedures, and standardized indications and guidelines are unclear. The authors aimed to review the most current evidence on indications, utilization of interventional procedures, results, and complication risks for the treatment of FJS.
Methods:
Customized structured electronic searches were performed in PubMed and Cochrane databases. Meta-analyses, randomized controlled trials (RCT), and systematic reviews on FJS treated with interventional minimally invasive procedures published from 1st of January 2015 to 29th of February 2020 were included. We initially selected 320 studies, and 25 studies (two meta-analyses, six systematic reviews, and 17 RCT) were selected according to inclusion and exclusion criteria.
Results:
A certain amount of improvement of pain was reported in 100% of the patients, with no significant complications reported. Most studies showed efficacy of all interventional procedures at all levels of evidence, without providing definitive data on indications and superiority of one procedure over others.
Conclusions:
The authors suggest a standardized stepladder approach to the management of FJS, with conservative measures initially and interventional procedures if those measures fail. All procedures were reported to be safe and efficient when clinically indicated and properly performed. Further studies with appropriate methodology are needed.
Level of Evidence:
Level IV.
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Affiliation(s)
- Pace Valerio
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
- Spinal Unit, The Royal National Orthopaedic Hospital, Stanmore, London, United Kingdom
| | - Fabrizio Marzano
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
| | - Federico Milazzo
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
| | | | - Giacomo Placella
- Trauma & Orthopaedics Department, Instituto di Ricovero e Cura a Carattere Scientifico, San, Raffaele Hospital, Milan, Italy
| | - Auro Caraffa
- Trauma & Orthopaedics Department, University of Perugia, Perugia, Italy
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7
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Singh S, Kartha S, Bulka BA, Stiansen NS, Winkelstein BA. Physiologic facet capsule stretch can induce pain & upregulate matrix metalloproteinase-3 in the dorsal root ganglia when preceded by a physiological mechanical or nonpainful chemical exposure. Clin Biomech (Bristol, Avon) 2019; 64:122-130. [PMID: 29523370 PMCID: PMC6067996 DOI: 10.1016/j.clinbiomech.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain from cervical facet loading is common and induces inflammation and upregulation of nerve growth factor (NGF) that can sensitize the joint afferents. Yet, the mechanisms by which these occur and whether afferents can be pre-conditioned by certain nonpainful stimuli are unknown. This study tested the hypothesis that a nonpainful mechanical or chemical insult predisposes a facet joint to generate pain after a later exposure to typically nonpainful distraction. METHODS Rats were exposed to either a nonpainful distraction or an intra-articular subthreshold dose of NGF followed by a nonpainful distraction two days later. Mechanical hyperalgesia was measured daily and C6 dorsal root ganglia (DRG) tissue was assayed for NGF and matrix metalloproteinase-3 (MMP-3) expression on day 7. FINDINGS The second distraction increased joint displacement and strains compared to its first application (p = 0.0011). None of the initial exposures altered behavioral sensitivity in either of the groups being pre-conditioned or in controls; but, sensitivity was established in both groups receiving a second distraction within one day that lasted until day 7 (p < 0.024). NGF expression in the DRG was increased in both groups undergoing a pre-conditioning exposure (p < 0.0232). Similar findings were observed for MMP-3 expression, with a pre-conditioning exposure increasing levels after an otherwise nonpainful facet distraction. INTERPRETATION These findings suggest that nonpainful insults to the facet joint, when combined, can generate painful outcomes, possibly mediated by upregulation of MMP-3 and mature NGF.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Ben A Bulka
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Nicholas S Stiansen
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA.
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8
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Kartha S, Bulka BA, Stiansen NS, Troche HR, Winkelstein BA. Repeated High Rate Facet Capsular Stretch at Strains That are Below the Pain Threshold Induces Pain and Spinal Inflammation With Decreased Ligament Strength in the Rat. J Biomech Eng 2018; 140:2679583. [PMID: 30003250 PMCID: PMC6056195 DOI: 10.1115/1.4040023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/12/2018] [Indexed: 12/21/2022]
Abstract
Repeated loading of ligamentous tissues during repetitive occupational and physical tasks even within physiological ranges of motion has been implicated in the development of pain and joint instability. The pathophysiological mechanisms of pain after repetitive joint loading are not understood. Within the cervical spine, excessive stretch of the facet joint and its capsular ligament has been implicated in the development of pain. Although a single facet joint distraction (FJD) at magnitudes simulating physiologic strains is insufficient to induce pain, it is unknown whether repeated stretching of the facet joint and ligament may produce pain. This study evaluated if repeated loading of the facet at physiologic nonpainful strains alters the capsular ligament's mechanical response and induces pain. Male rats underwent either two subthreshold facet joint distractions (STFJDs) or sham surgeries each separated by 2 days. Pain was measured before the procedure and for 7 days; capsular mechanics were measured during each distraction and under tension at tissue failure. Spinal glial activation was also assessed to probe potential pathophysiologic mechanisms responsible for pain. Capsular displacement significantly increased (p = 0.019) and capsular stiffness decreased (p = 0.008) during the second distraction compared to the first. Pain was also induced after the second distraction and was sustained at day 7 (p < 0.048). Repeated loading weakened the capsular ligament with lower vertebral displacement (p = 0.041) and peak force (p = 0.014) at tissue rupture. Spinal glial activation was also induced after repeated loading. Together, these mechanical, physiological, and neurological findings demonstrate that repeated loading of the facet joint even within physiologic ranges of motion can be sufficient to induce pain, spinal inflammation, and alter capsular mechanics similar to a more injurious loading exposure.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Ben A. Bulka
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Nick S. Stiansen
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Harrison R. Troche
- Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall,
210 South 33rd Street,
Philadelphia, PA 19104
e-mail:
| | - Beth A. Winkelstein
- Fellow ASME
Department of Bioengineering,
University of Pennsylvania,
Suite 240 Skirkanich Hall 210,
South 33rd Street,
Philadelphia, PA 19104
e-mail:
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9
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Zhang S, Zarei V, Winkelstein BA, Barocas VH. Multiscale mechanics of the cervical facet capsular ligament, with particular emphasis on anomalous fiber realignment prior to tissue failure. Biomech Model Mechanobiol 2018; 17:133-145. [PMID: 28821971 PMCID: PMC5809183 DOI: 10.1007/s10237-017-0949-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/04/2017] [Indexed: 12/11/2022]
Abstract
The facet capsular ligaments encapsulate the bilateral spinal facet joints and are common sources of painful injury due to afferent innervation. These ligaments exhibit architectural complexity, which is suspected to contribute to the experimentally observed lack of co-localization between macroscopic strain and microstructural tissue damage. The heterogeneous and multiscale nature of this ligament, combined with challenges in experimentally measuring its microscale mechanics, hinders the ability to understand sensory mechanisms under normal or injurious loading. Therefore, image-based, subject-specific, multiscale finite-element models were constructed to predict the mechanical responses of the human cervical facet capsular ligament under uniaxial tensile stretch. The models precisely simulated the force-displacement responses for all samples ([Formula: see text]) and showed promise in predicting the magnitude and location of peak regional strains at two different displacements. Yet, there was a loss of agreement between the model and experiment in terms of fiber organization at large tissue stretch, possibly due to a lack of accounting for tissue failure. The mean fiber stretch ratio predicted by the models was found to be significantly higher in regions that exhibited anomalous fiber realignment experimentally than in regions with normal realignment ([Formula: see text]). The development of microstructural abnormalities was associated with the predicted fiber-level stretch ([Formula: see text]), but not with the elemental maximum principal stress or maximum principal strain by logistic regression. The multiscale models elucidate a potential mechanical basis for predicting injury-prone tissue domains and for defining the relationships between macroscopic ligament stretch and microscale pathophysiology in the subfailure regime.
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Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vahhab Zarei
- Department of Mechanical Engineering, University of Minnesota - Twin Cities, Minneapolis, MN, 55455, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota - Twin Cities, Minneapolis, MN, 55455, USA.
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10
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Zhang S, Singh S, Winkelstein BA. Collagen organization regulates stretch-initiated pain-related neuronal signals in vitro: Implications for structure-function relationships in innervated ligaments. J Orthop Res 2018; 36:770-777. [PMID: 28722281 PMCID: PMC5775066 DOI: 10.1002/jor.23657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
Injury to the spinal facet capsule, an innervated ligament with heterogeneous collagen organization, produces pain. Although mechanical facet joint trauma activates embedded afferents, it is unclear if, and how, the varied extracellular microstructure of its ligament affects sensory transduction for pain from mechanical inputs. To investigate the effects of macroscopic deformations on afferents in collagen matrices with different organizations, an in vitro neuron-collagen construct (NCC) model was used. NCCs with either randomly organized or parallel aligned collagen fibers were used to mimic the varied microstructure in the facet capsular ligament. Embryonic rat dorsal root ganglia (DRG) were encapsulated in the NCCs; axonal outgrowth was uniform and in all directions in random NCCs, but parallel in aligned NCCs. NCCs underwent uniaxial stretch (0.25 ± 0.06 strain) corresponding to sub-failure facet capsule strains that induce pain. Macroscopic NCC mechanics were measured and axonal expression of phosphorylated extracellular signal-regulated kinase (pERK) and the neurotransmitter substance P (SP) was assayed at 1 day to assess neuronal activation and nociception. Stretch significantly upregulated pERK expression in both random and aligned gels (p < 0.001), with the increase in pERK being significantly higher (p = 0.013) in aligned than in random NCCs. That increase likely relates to the higher peak force (p = 0.025) and stronger axon alignment (p < 0.001) with stretch direction in the aligned NCCs. In contrast, SP expression was greater in stretched NCCs (p < 0.001) regardless of collagen organization. These findings suggest that collagen organization differentially modulates pain-related neuronal signaling and support structural heterogeneity of ligament tissue as mediating sensory function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:770-777, 2018.
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Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104
| | - Sagar Singh
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104
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11
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Sperry MM, Ita ME, Kartha S, Zhang S, Yu YH, Winkelstein B. The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints. J Biomech Eng 2017; 139:2597611. [PMID: 28056123 DOI: 10.1115/1.4035647] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 12/16/2022]
Abstract
Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain.
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Affiliation(s)
- Megan M Sperry
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Meagan E Ita
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Ya-Hsin Yu
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
| | - Beth Winkelstein
- Departments of Bioengineering and Neurosurgery, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104-6321 e-mail:
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12
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Weisshaar CL, Kras JV, Pall PS, Kartha S, Winkelstein BA. Ablation of IB4 non-peptidergic afferents in the rat facet joint prevents injury-induced pain and thalamic hyperexcitability via supraspinal glutamate transporters. Neurosci Lett 2017; 655:82-89. [PMID: 28689926 DOI: 10.1016/j.neulet.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
The facet joint is a common source of neck pain, particularly after excessive stretch of its capsular ligament. Peptidergic afferents have been shown to have an important role in the development and maintenance of mechanical hyperalgesia, dysregulated nociceptive signaling, and spinal hyperexcitability that develop after mechanical injury to the facet joint. However, the role of non-peptidergic isolectin-B4 (IB4) cells in mediating joint pain is unknown. Isolectin-B4 saporin (IB4-SAP) was injected into the facet joint to ablate non-peptidergic cells, and the facet joint later underwent a ligament stretch known to induce pain. Behavioral sensitivity, thalamic glutamate transporter expression, and thalamic hyperexcitability were evaluated up to and at day 7. Administering IB4-SAP prior to a painful injury prevented the development of mechanical hyperalgesia that is typically present. Intra-articular IB4-SAP also prevented the upregulation of the glutamate transporters GLT-1 and EAAC1 in the ventral posterolateral nucleus of the thalamus and reduced thalamic neuronal hyperexcitability at day 7. These findings suggest that a painful facet injury induces changes extending to supraspinal structures and that IB4-positive afferents in the facet joint may be critical for the development and maintenance of sensitization in the thalamus after a painful facet joint injury.
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Affiliation(s)
- Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Jeffrey V Kras
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Parul S Pall
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 105 Hayden Hall, 3320 Smith Walk, Philadelphia, PA 19104, USA.
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The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges. J Orthop Sports Phys Ther 2017. [PMID: 28622486 DOI: 10.2519/jospt.2017.7255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Chronic neck pain is a common condition and a primary clinical symptom of whiplash and other spinal injuries. Loading-induced neck injuries produce abnormal kinematics between the vertebrae, with the potential to injure facet joints and the afferent fibers that innervate the specific joint tissues, including the capsular ligament. Mechanoreceptive and nociceptive afferents that innervate the facet have their peripheral terminals in the capsule, cell bodies in the dorsal root ganglia, and terminal processes in the spinal cord. As such, biomechanical loading of these afferents can initiate nociceptive signaling in the peripheral and central nervous systems. Their activation depends on the local mechanical environment of the joint and encodes the neural processes that initiate pain and lead to its persistence. This commentary reviews the complex anatomical, biomechanical, and physiological consequences of facet-mediated whiplash injury and pain. The clinical presentation of facet-mediated pain is complex in its sensory and emotional components. Yet, human studies are limited in their ability to elucidate the physiological mechanisms by which abnormal facet loading leads to pain. Over the past decade, however, in vivo models of cervical facet injury that reproduce clinical pain symptoms have been developed and used to define the complicated and multifaceted electrophysiological, inflammatory, and nociceptive signaling cascades that are involved in the pathophysiology of whiplash facet pain. Integrating the whiplash-like mechanics in vivo and in vitro allows transmission of pathophysiological mechanisms across scales, with the hope of informing clinical management. Yet, despite these advances, many challenges remain. This commentary further describes and highlights such challenges. J Orthop Sports Phys Ther 2017;47(7):450-461. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7255.
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Painful Cervical Facet Joint Injury Is Accompanied by Changes in the Number of Excitatory and Inhibitory Synapses in the Superficial Dorsal Horn That Differentially Relate to Local Tissue Injury Severity. Spine (Phila Pa 1976) 2017; 42:E695-E701. [PMID: 27755498 PMCID: PMC5393960 DOI: 10.1097/brs.0000000000001934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Immunohistochemistry labeled pre- and postsynaptic structural markers to quantify excitatory and inhibitory synapses in the spinal superficial dorsal horn at 14 days after painful facet joint injury in the rat. OBJECTIVE The objective of this study was to investigate the relationship between pain and synapse density in the spinal cord after facet injury. SUMMARY OF BACKGROUND DATA Neck pain is a major contributor to disability and often becomes chronic. The cervical facet joints are susceptible to loading-induced painful injury, initiating spinal central sensitization responses. Although excitatory synapse plasticity has been reported in the superficial dorsal horn early after painful facet injury, whether excitatory and/or inhibitory synapse density is altered at a time when pain is maintained is unknown. METHODS Rats underwent either a painful C6/C7 facet joint distraction or sham surgery. Mechanical hyperalgesia was measured and immunohistochemistry techniques for synapse quantification were used to quantify excitatory and inhibitory synapse densities in the superficial dorsal horn at day 14. Logarithmic correlation analyses evaluated whether the severity of facet injury correlated with either behavioral or synaptic outcomes. RESULTS Facet joint injury induces pain that is sustained until day 14 (P <0.001) and both significantly greater excitatory synapse density (P = 0.042) and lower inhibitory synapse density (P = 0.0029) in the superficial dorsal horn at day 14. Injury severity is significantly correlated with pain at days 1 (P = 0.0011) and 14 (P = 0.0002), but only with inhibitory, not excitatory, synapse density (P = 0.0025) at day 14. CONCLUSION This study demonstrates a role for structural plasticity in both excitatory and inhibitory synapses in the maintenance of facet-mediated joint pain, and that altered inhibitory, but not excitatory, synapse density correlates to the severity of painful joint injury. Understanding the functional consequences of this spinal structural plasticity is critical to elucidate mechanisms of chronic joint pain. LEVEL OF EVIDENCE N /A.
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15
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Zhang S, Kartha S, Lee J, Winkelstein BA. Techniques for Multiscale Neuronal Regulation via Therapeutic Materials and Drug Design. ACS Biomater Sci Eng 2017; 3:2744-2760. [DOI: 10.1021/acsbiomaterials.7b00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Jasmine Lee
- Department of Physics and Astronomy, University of Pennsylvania, 209 S. 33rd Street, David Rittenhouse Laboratory, Philadelphia, Pennsylvania 19104, United States
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
- Department
of Neurosurgery, University of Pennsylvania, Stemmler Hall, 3450 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
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16
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Philips BH, Weisshaar CL, Winkelstein BA. Use of the Rat Grimace Scale to Evaluate Neuropathic Pain in a Model of Cervical Radiculopathy. Comp Med 2017; 67:34-42. [PMID: 28222837 PMCID: PMC5310623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/21/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Although neck and low-back pain are common sources of neuropathic pain with high societal costs, the pathophysiology of neuropathic pain is not well-defined. Traditionally, most rodent pain studies rely on evoked reflex-based testing to measure pain. However, these testing methods do not reveal spontaneous pain, particularly early after injury. The rat grimace scale (RGS) for quantifying spontaneous pain has been validated after visceral, incisional, orthopedic, and inflammatory insults but not neuropathic pain. The current study used a rat model of radiculopathy to investigate the time course of RGS, the effect of the NSAID meloxicam on RGS, and the reliability and consistency of RGS across testers. RGS values at baseline and at 3, 6, 24, and 48 h after cervical nerve root compression (NRC) that induced robust evoked pain responses were compared with those obtained after sham surgery. The RGS was also evaluated at 6 h after NRC in another set of rats that had received meloxicam treatment prior to surgery. At 6 h, NRC induced higher RGS scores (1.27 ± 0.18) than did sham surgery (0.93 ± 0.20), and scores remained above baseline for as long as 48 h. Treatment with meloxicam before NRC reduced RGS at 6 h to sham levels, which were lower than those of injury without treatment. The RGS was associated with very good interobserver reliability (intraclass correlation coefficient, 0.91) and excellent internal consistency (Cronbach α, 0.87). These findings suggest that RGS is a useful approach to identifying and monitoring acute neuropathic pain in rats.
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Affiliation(s)
- Blythe H Philips
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania;,
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Holsgrove TP, Jaumard NV, Zhu N, Stiansen NS, Welch WC, Winkelstein BA. Upper Cervical Spine Loading Simulating a Dynamic Low-Speed Collision Significantly Increases the Risk of Pain Compared to Quasi-Static Loading With Equivalent Neck Kinematics. J Biomech Eng 2016; 138:2554134. [PMID: 27636191 DOI: 10.1115/1.4034707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 12/23/2022]
Abstract
Dynamic cervical spine loading can produce facet capsule injury. Despite a large proportion of neck pain being attributable to the C2/C3 facet capsule, potential mechanisms are not understood. This study replicated low-speed frontal and rear-end traffic collisions in occiput-C3 human cadaveric cervical spine specimens and used kinematic and full-field strain analyses to assess injury. Specimens were loaded quasi-statically in flexion and extension before and after dynamic rotation of C3 at 100 deg/s. Global kinematics in the sagittal plane were tracked at 1 kHz, and C2/C3 facet capsule full-field strains were measured. Dynamic loading did not alter the kinematics from those during quasi-static (QS) loading, but maximum principal strain (MPS) and shear strain (SS) were significantly higher (p = 0.028) in dynamic flexion than for the same quasi-static conditions. The full-field strain analysis demonstrated that capsule strain was inhomogeneous, and that the peak MPS generally occurred in the anterior aspect and along the line of the C2/C3 facet joint. The strain magnitude in dynamic flexion continued to rise after the rotation of C3 had stopped, with a peak MPS of 12.52 ± 4.59% and a maximum SS of 5.34 ± 1.60%. The peak MPS in loading representative of rear-end collisions approached magnitudes previously shown to induce pain in vivo, whereas strain analysis using linear approaches across the facet joint was lower and may underestimate injury risk compared to full-field analysis. The time at which peak MPS occurred suggests that the deceleration following a collision is critical in relation to the production of injurious strains within the facet capsule.
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Affiliation(s)
- Timothy P. Holsgrove
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, 210 South 33rd Street, Room 240 Skirkanich Hall, Philadelphia, PA 19104 e-mail:
| | - Nicolas V. Jaumard
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Washington Square West Building, 235 South 8th Street, Philadelphia, PA 19106 e-mail:
| | - Nina Zhu
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, 210 South 33rd Street, Room 240 Skirkanich Hall, Philadelphia, PA 19104 e-mail:
| | - Nicholas S. Stiansen
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, 210 South 33rd Street, Room 240 Skirkanich Hall, Philadelphia, PA 19104 e-mail:
| | - William C. Welch
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Washington Square West Building, 235 South 8th Street, Philadelphia, PA 19106 e-mail:
| | - Beth A. Winkelstein
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, 210 South 33rd Street, Room 240 Skirkanich Hall, Philadelphia, PA 19104
- Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Washington Square West Building, 235 South 8th Street, Philadelphia, PA 19106 e-mail:
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Zhang S, Cao X, Stablow AM, Shenoy VB, Winkelstein BA. Tissue Strain Reorganizes Collagen With a Switchlike Response That Regulates Neuronal Extracellular Signal-Regulated Kinase Phosphorylation In Vitro: Implications for Ligamentous Injury and Mechanotransduction. J Biomech Eng 2016; 138:021013. [PMID: 26549105 DOI: 10.1115/1.4031975] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Indexed: 12/26/2022]
Abstract
Excessive loading of ligaments can activate the neural afferents that innervate the collagenous tissue, leading to a host of pathologies including pain. An integrated experimental and modeling approach was used to define the responses of neurons and the surrounding collagen fibers to the ligamentous matrix loading and to begin to understand how macroscopic deformation is translated to neuronal loading and signaling. A neuron-collagen construct (NCC) developed to mimic innervation of collagenous tissue underwent tension to strains simulating nonpainful (8%) or painful ligament loading (16%). Both neuronal phosphorylation of extracellular signal-regulated kinase (ERK), which is related to neuroplasticity (R2 ≥ 0.041; p ≤ 0.0171) and neuronal aspect ratio (AR) (R2 ≥ 0.250; p < 0.0001), were significantly correlated with tissue-level strains. As NCC strains increased during a slowly applied loading (1%/s), a "switchlike" fiber realignment response was detected with collagen reorganization occurring only above a transition point of 11.3% strain. A finite-element based discrete fiber network (DFN) model predicted that at bulk strains above the transition point, heterogeneous fiber strains were both tensile and compressive and increased, with strains in some fibers along the loading direction exceeding the applied bulk strain. The transition point identified for changes in collagen fiber realignment was consistent with the measured strain threshold (11.7% with a 95% confidence interval of 10.2-13.4%) for elevating ERK phosphorylation after loading. As with collagen fiber realignment, the greatest degree of neuronal reorientation toward the loading direction was observed at the NCC distraction corresponding to painful loading. Because activation of neuronal ERK occurred only at strains that produced evident collagen fiber realignment, findings suggest that tissue strain-induced changes in the micromechanical environment, especially altered local collagen fiber kinematics, may be associated with mechanotransduction signaling in neurons.
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Crosby ND, Winkelstein BA. Spinal Astrocytic Thrombospondin-4 Induced by Excitatory Neuronal Signaling Mediates Pain After Facet Capsule Injury. Ann Biomed Eng 2016; 44:3215-3224. [PMID: 27160673 DOI: 10.1007/s10439-016-1639-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Thrombospondin-4 (TSP4) is a synaptogenic molecule that is upregulated in the spinal cord after painful facet joint injury and may contribute to spinal hyperexcitability. However, the mechanisms leading to increased spinal TSP4 are unclear. Because primary afferent activity is critical in the development of spinal hyperexcitability after facet joint injury, this study evaluated the role of afferent firing in the increase of spinal TSP4 and excitatory synapses. Intra-articular bupivacaine was administered immediately or 4 days after painful facet joint injury in male Holtzman rats, and TSP4 and excitatory synapses were quantified in the spinal cord at day 7. Immediate, but not delayed bupivacaine treatment, prevents the injury-induced increase in TSP4 and excitatory synapses in the dorsal horn (p < 0.0001). Preliminary in vitro experiments suggest that the excitatory signaling molecules ATP and glutamate may stimulate astrocytic TSP4 expression (p ≤ 0.04). Collectively, these results suggest that afferent activity early after facet joint injury is critical for the induction of spinal TSP4. This study advances the understanding of the timing and role of afferent activity in TSP4 expression after injury, which is critical for the therapeutic targeting of TSP4 to treat persistent pain conditions.
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Affiliation(s)
- Nathan D Crosby
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St, Philadelphia, PA, 19104-6321, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S. 33rd St, Philadelphia, PA, 19104-6321, USA. .,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Kras JV, Kartha S, Winkelstein BA. Intra-articular nerve growth factor regulates development, but not maintenance, of injury-induced facet joint pain & spinal neuronal hypersensitivity. Osteoarthritis Cartilage 2015; 23:1999-2008. [PMID: 26521746 PMCID: PMC4630778 DOI: 10.1016/j.joca.2015.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/06/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the current study is to define whether intra-articular nerve growth factor (NGF), an inflammatory mediator that contributes to osteoarthritic pain, is necessary and sufficient for the development or maintenance of injury-induced facet joint pain and its concomitant spinal neuronal hyperexcitability. METHOD Male Holtzman rats underwent painful cervical facet joint distraction (FJD) or sham procedures. Mechanical hyperalgesia was assessed in the forepaws, and NGF expression was quantified in the C6/C7 facet joint. An anti-NGF antibody was administered intra-articularly in additional rats immediately or 1 day following facet distraction or sham procedures to block intra-articular NGF and test its contribution to initiation and/or maintenance of facet joint pain and spinal neuronal hyperexcitability. NGF was injected into the bilateral C6/C7 facet joints in separate rats to determine if NGF alone is sufficient to induce these behavioral and neuronal responses. RESULTS NGF expression increases in the cervical facet joint in association with behavioral sensitivity after that joint's mechanical injury. Intra-articular application of anti-NGF immediately after a joint distraction prevents the development of both injury-induced pain and hyperexcitability of spinal neurons. Yet, intra-articular anti-NGF applied after pain has developed does not attenuate either behavioral or neuronal hyperexcitability. Intra-articular NGF administered to the facet in naïve rats also induces behavioral hypersensitivity and spinal neuronal hyperexcitability. CONCLUSION Findings demonstrate that NGF in the facet joint contributes to the development of injury-induced joint pain. Localized blocking of NGF signaling in the joint may provide potential treatment for joint pain.
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Affiliation(s)
- Jeffrey V. Kras
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104
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21
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Kras JV, Weisshaar CL, Pall PS, Winkelstein BA. Pain from intra-articular NGF or joint injury in the rat requires contributions from peptidergic joint afferents. Neurosci Lett 2015; 604:193-8. [PMID: 26240991 DOI: 10.1016/j.neulet.2015.07.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 02/06/2023]
Abstract
Non-physiological stretch of the cervical facet joint's capsular ligament induces persistent behavioral hypersensitivity and spinal neuronal hyperexcitability via an intra-articular NGF-dependent mechanism. Although that ligament is innervated by nociceptors, it is unknown if a subpopulation is exclusively responsible for the behavioral and spinal neuronal responses to intra-articular NGF and/or facet joint injury. This study ablated joint afferents using the neurotoxin saporin targeted to neurons involved in either peptidergic ([Sar(9),Met (O2)(11)]-substance P-saporin (SSP-Sap)) or non-peptidergic (isolectin B4-saporin (IB4-Sap)) signaling to investigate the contributions of those neuronal populations to facet-mediated pain. SSP-Sap, but not IB4-Sap, injected into the bilateral C6/C7 facet joints 14 days prior to an intra- articular NGF injection prevents NGF-induced mechanical and thermal hypersensitivity in the forepaws. Similarly, only SSP- Sap prevents the increase in mechanical forepaw stimulation- induced firing of spinal neurons after intra-articular NGF. In addition, intra-articular SSP-Sap prevents both behavioral hypersensitivity and upregulation of NGF in the dorsal root ganglion after a facet joint distraction that normally induces pain. These findings collectively suggest that disruption of peptidergic signaling within the joint may be a potential treatment for facet pain, as well as other painful joint conditions associated with elevated NGF, such as osteoarthritis.
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Affiliation(s)
- Jeffrey V Kras
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Parul S Pall
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Curatolo M, Arendt-Nielsen L. Central Hypersensitivity in Chronic Musculoskeletal Pain. Phys Med Rehabil Clin N Am 2015; 26:175-84. [DOI: 10.1016/j.pmr.2014.12.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Crosby ND, Zaucke F, Kras JV, Dong L, Luo ZD, Winkelstein BA. Thrombospondin-4 and excitatory synaptogenesis promote spinal sensitization after painful mechanical joint injury. Exp Neurol 2014; 264:111-20. [PMID: 25483397 DOI: 10.1016/j.expneurol.2014.11.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 02/08/2023]
Abstract
Facet joint injury induces persistent pain that may be maintained by structural plasticity in the spinal cord. Astrocyte-derived thrombospondins, especially thrombospondin-4 (TSP4), have been implicated in synaptogenesis and spinal sensitization in neuropathic pain, but the TSP4 response and its relationship to synaptic changes in the spinal cord have not been investigated for painful joint injury. This study investigates the role of TSP4 in the development and maintenance of persistent pain following injurious facet joint distraction in rats and tests the hypothesis that excitatory synaptogenesis contributes to such pain. Painful facet joint loading induces dorsal horn excitatory synaptogenesis along with decreased TSP4 in the DRG and increased astrocytic release of TSP4 in the spinal cord, all of which parallel the time course of sustained tactile allodynia. Blocking injury-induced spinal TSP4 expression with antisense oligonucleotides or reducing TSP4 activity at its neuronal receptor in the spinal cord with gabapentin treatment both attenuate the allodynia and dorsal horn synaptogenesis that develop after painful facet joint loading. Increased spinal TSP4 also facilitates the development of allodynia and spinal hyperexcitability, even after non-painful physiological loading of the facet joint. These results suggest that spinal TSP4 plays an important role in the development and maintenance of persistent joint-mediated pain by inducing excitatory synaptogenesis and facilitating the transduction of mechanical loading of the facet joint that leads to spinal hyperexcitability.
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Affiliation(s)
- Nathan D Crosby
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Frank Zaucke
- Center for Biochemistry, Medical Faculty, University of Cologne, D-50931 Cologne, Germany
| | - Jeffrey V Kras
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ling Dong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Z David Luo
- Department of Anesthesiology and Perioperative Care, University of California Irvine Medical Center, Irvine, CA 92868, United States; Department of Pharmacology, University of California Irvine Medical Center, Irvine, CA 92868, United States
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, United States.
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