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Chien DCC, Limjunyawong N, Cao C, Meixiong J, Peng Q, Ho CY, Fay JF, Roth BL, Dong X. MRGPRX4 mediates phospho-drug-associated pruritus in a humanized mouse model. Sci Transl Med 2024; 16:eadk8198. [PMID: 38718132 DOI: 10.1126/scitranslmed.adk8198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024]
Abstract
The phosphate modification of drugs is a common chemical strategy to increase solubility and allow for parenteral administration. Unfortunately, phosphate modifications often elicit treatment- or dose-limiting pruritus through an unknown mechanism. Using unbiased high-throughput drug screens, we identified the Mas-related G protein-coupled receptor X4 (MRGPRX4), a primate-specific, sensory neuron receptor previously implicated in itch, as a potential target for phosphate-modified compounds. Using both Gq-mediated calcium mobilization and G protein-independent GPCR assays, we found that phosphate-modified compounds potently activate MRGPRX4. Furthermore, a humanized mouse model expressing MRGPRX4 in sensory neurons exhibited robust phosphomonoester prodrug-evoked itch. To characterize and confirm this interaction, we further determined the structure of MRGPRX4 in complex with a phosphate-modified drug through single-particle cryo-electron microscopy (cryo-EM) and identified critical amino acid residues responsible for the binding of the phosphate group. Together, these findings explain how phosphorylated drugs can elicit treatment-limiting itch and identify MRGPRX4 as a potential therapeutic target to suppress itch and to guide future drug design.
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Affiliation(s)
- Daphne Chun-Che Chien
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nathachit Limjunyawong
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Can Cao
- Department of Pharmacology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - James Meixiong
- Department of Dermatology, University of California San Francisco, San Francisco, CA 94115, USA
| | - Qi Peng
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Cheng-Ying Ho
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jonathan F Fay
- Department of Biochemistry and Molecular Biology, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Bryan L Roth
- Department of Pharmacology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Xinzhong Dong
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
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Veilleux C, Boulanger A. Perineal pruritus in epidural dexamethasone injections. Can J Pain 2019; 3:167-168. [PMID: 35005405 PMCID: PMC8730584 DOI: 10.1080/24740527.2019.1650614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine Veilleux
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Aline Boulanger
- Département d'anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
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Dylla L, Acquisto NM, Manzo F, Cushman JT. Dexamethasone-Related Perineal Burning in the Prehospital Setting: A Case Series. PREHOSP EMERG CARE 2018; 22:655-658. [PMID: 29485338 DOI: 10.1080/10903127.2018.1440039] [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: 10/17/2022]
Abstract
Dexamethasone is frequently used in the treatment of allergic reactions and airway inflammation because of its potent anti-inflammatory effects and long duration of action. As prehospital use becomes more common, it is important for providers to be aware of unique and potentially distressing associated adverse effects. We report eight cases of intravenous dexamethasone administration associated with perineal or diffuse burning sensation in female patients.
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El Abd O, Pimentel DC, Amadera JED. Generalized pruritus as an unusual side effect after epidural injection with dexamethasone. PM R 2014; 7:206-9. [PMID: 25289843 DOI: 10.1016/j.pmrj.2014.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/18/2014] [Accepted: 09/12/2014] [Indexed: 11/25/2022]
Abstract
A 51-year-old man with lumbar radiculopathy underwent a right L5 transforaminal epidural steroid injection with dexamethasone. One minute after the injection, the patient experienced severe pruritus and burning, which began in the groin and then spread throughout his body. The symptoms resolved completely after 1 minute, and the patient was discharged without any complications. Although there are a small number of publications reporting perineal pruritus after intravenous administration of dexamethasone, to our knowledge there is no report of a generalized reaction to an epidural dexamethasone injection such as the one described here.
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Affiliation(s)
- Omar El Abd
- Newton Wellesley Interventional Spine LLC, Wellesley, MA∗
| | | | - João Eduardo Daud Amadera
- Department of Pathology, University of São Paulo, School of Medicine, Av. Dr. Arnaldo, 455 - Cerqueira César - CEP: 01246-000, São Paulo, SP - Brazil(‡)
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Abstract
The supportive care of patients who have brain tumors consists mainly of the treatment of brain edema, seizures, venous thromboembolism, and cognitive dysfunction. Each of these complications may occur in patients who have primary or metastatic brain tumors. The development of any of these complications significantly increases the morbidity and mortality associated with brain tumors. Effective treatment is usually possible, however, and can result in an improved quality of life for these patients.
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Affiliation(s)
- Tracy T Batchelor
- Department of Neurology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Neff SPW, Stapelberg F, Warmington A. Excruciating perineal pain after intravenous dexamethasone. Anaesth Intensive Care 2002; 30:370-1. [PMID: 12075649 DOI: 10.1177/0310057x0203000319] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 microg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae. We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.
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Affiliation(s)
- S P W Neff
- Department of Anaesthesia, National Women's Hospital, Auckland, New Zealand
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Taleb N, Geahchan N, Ghosn M, Brihi E, Sacre P. Vulvar pruritus after high-dose dexamethasone. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1988; 24:495. [PMID: 3383952 DOI: 10.1016/s0277-5379(98)90024-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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