1
|
Wen B, Pan Y, Cheng J, Xu L, Xu J. The Role of Neuroinflammation in Complex Regional Pain Syndrome: A Comprehensive Review. J Pain Res 2023; 16:3061-3073. [PMID: 37701560 PMCID: PMC10493102 DOI: 10.2147/jpr.s423733] [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: 06/16/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023] Open
Abstract
Complex Regional Pain Syndrome (CRPS) is an excess and/or prolonged pain and inflammation condition that follows an injury to a limb. The pathogenesis of CRPS is multifaceted that remains incompletely understood. Neuroinflammation is an inflammatory response in the peripheral and central nervous systems. Dysregulated neuroinflammation plays a crucial role in the initiation and maintenance of pain and nociceptive neuronal sensitization, which may contribute to the transition from acute to chronic pain and the perpetuation of chronic pain in CRPS. The key features of neuroinflammation encompass infiltration and activation of inflammatory cells and the production of inflammatory mediators in both the central and peripheral nervous systems. This article reviews the role of neuroinflammation in the onset and progression of CRPS from six perspectives: neurogenic inflammation, neuropeptides, glial cells, immune cells, cytokines, and keratinocytes. The objective is to provide insights that can inform future research and development of therapeutic targets for CRPS.
Collapse
Affiliation(s)
- Bei Wen
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Yinbing Pan
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Jianguo Cheng
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neuroscience, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Jijun Xu
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Inflammation and Immunity; Cleveland Clinic, Cleveland, OH, 44195, USA
| |
Collapse
|
2
|
High Angiotensin-Converting Enzyme and Low Carboxypeptidase N Serum Activity Correlate with Disease Severity in COVID-19 Patients. J Pers Med 2022; 12:jpm12030406. [PMID: 35330406 PMCID: PMC8949860 DOI: 10.3390/jpm12030406] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Angiotensin-converting enzyme 2 (ACE2) is a functional receptor of SARS-CoV-2 and counter-balances ACE in the renin–angiotensin system (RAS). An imbalance of the RAS could be associated with severe COVID-19 progression. (2) Methods: Activities of serum proteases angiotensin-converting enzyme (ACE) and carboxypeptidase N (CPN) for 45 hospitalized and 26 convalescent COVID-19 patients were investigated vs. healthy controls using labeled bradykinin (DBK) degradation with and without inhibition by captopril as a read-out. Data were correlated to clinical parameters. (3) Results: DBK degradation and CPN activity were significantly reduced gender-independently in COVID-19 and returned to normal during convalescence. ACE activity was over-active in severe disease progression; product DBK1-5 was significantly increased in critically ill patients and strongly correlated with clinical heart and liver parameters. ACE inhibitors seemed to be protective, as DBK1-5 levels were normal in moderately ill patients in contrast to critically ill patients. (4) Conclusions: CPN and ACE serum activity correlated with disease severity. The RAS is affected in COVID-19, and ACE could be a therapeutic target. Further proof from dedicated studies is needed.
Collapse
|
3
|
Van Der Heijden H, Fatou B, Sibai D, Hoyt K, Taylor M, Cheung K, Lemme J, Cay M, Goodlett B, Lo J, Hazen MM, Halyabar O, Meidan E, Schreiber R, Jaimes C, Ecklund K, Henderson LA, Chang MH, Nigrovic PA, Sundel RP, Steen H, Upadhyay J. Proteomics based markers of clinical pain severity in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:3. [PMID: 35033099 PMCID: PMC8761318 DOI: 10.1186/s12969-022-00662-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is a cluster of autoimmune rheumatic diseases occurring in children 16 years of age or less. While it is well-known that pain may be experienced during inflammatory and non-inflammatory states, much remains ambiguous regarding the molecular mechanisms that may drive JIA pain. Thus, in this pilot study, we explored the variability of the serum proteomes in relation to pain severity in a cohort of JIA patients. METHODS Serum samples from 15 JIA patients (male and female, 12.7 ± 2.8 years of age) were assessed using liquid chromatography/mass spectrometry (LC/MS). Correlation analyses were performed to determine the relationships among protein levels and self-reported clinical pain severity. Additionally, how the expression of pain-associated proteins related to markers of inflammation (Erythrocyte Sedimentation Rate (ESR)) or morphological properties of the central nervous system (subcortical volume and cortical thickness) implicated in JIA were also evaluated. RESULTS 306 proteins were identified in the JIA cohort of which 14 were significantly (p < 0.05) associated with clinical pain severity. Functional properties of the identified pain-associated proteins included but were not limited to humoral immunity (IGLV3.9), inflammatory response (PRG4) and angiogenesis (ANG). Associations among pain-associated proteins and ESR (IGHV3.9, PRG4, CST3, VWF, ALB), as well as caudate nucleus volume (BTD, AGT, IGHV3.74) and insular cortex thickness (BTD, LGALS3BP) were also observed. CONCLUSIONS The current proteomic findings suggest both inflammatory- and non-inflammatory mediated mechanisms as potential factors associated with JIA pain. Validation of these preliminary observations using larger patient cohorts and a longitudinal study design may further point to novel serologic markers of pain in JIA.
Collapse
Affiliation(s)
- Hanne Van Der Heijden
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA ,grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, The Netherlands ,grid.7177.60000000084992262Faculty of Science, Biomedical Sciences Neurobiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Benoit Fatou
- grid.38142.3c000000041936754XDepartment of Pathology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Diana Sibai
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kacie Hoyt
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Maria Taylor
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kin Cheung
- BioSAS Consulting, Inc, Wellesley, MA USA
| | - Jordan Lemme
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mariesa Cay
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Benjamin Goodlett
- grid.38142.3c000000041936754XDivision of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jeffery Lo
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Melissa M. Hazen
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Olha Halyabar
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Esra Meidan
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Rudy Schreiber
- grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, The Netherlands
| | - Camilo Jaimes
- grid.38142.3c000000041936754XDepartment of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kirsten Ecklund
- grid.38142.3c000000041936754XDepartment of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Lauren A. Henderson
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Margaret H. Chang
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Peter A. Nigrovic
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Robert P. Sundel
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hanno Steen
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Neurobiology Program, Boston Children's Hospital, Boston, MA, USA. .,Precision Vaccines Program, Boston Children's Hospital, Boston, MA, USA.
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Psychiatry, McLean Hospital, Harvard Medical School, MA, Belmont, USA.
| |
Collapse
|
4
|
Bharwani KD, Kersten AB, Stone AL, Birklein F, Bruehl S, Dirckx M, Drummond PD, Gierthmühlen J, Goebel A, Knudsen L, Huygen FJPM. Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome. J Pain Res 2021; 14:3359-3376. [PMID: 34737631 PMCID: PMC8558034 DOI: 10.2147/jpr.s326638] [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: 06/26/2021] [Accepted: 09/03/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Several articles have claimed that complex regional pain syndrome (CRPS) does not exist. Although a minority view, it is important to understand the arguments presented in these articles. We conducted a systematic literature search to evaluate the methodological quality of articles that claim CRPS does not exist. We then examined and refuted the arguments supporting this claim using up-to-date scientific literature on CRPS. Methods A systematic search was conducted in MEDLINE, EMBASE and Cochrane CENTRAL databases. Inclusion criteria for articles were (a) a claim made that CRPS does not exist or that CRPS is not a distinct diagnostic entity and (b) support of these claims with subsequent argument(s). The methodological quality of articles was assessed if possible. Results Nine articles were included for analysis: 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report. Seven points of controversy were used in these articles to argue that CRPS does not exist: 1) disagreement with the label “CRPS”; 2) the “unclear” pathophysiology; 3) the validity of the diagnostic criteria; 4) CRPS as a normal consequence of immobilization; 5) the role of psychological factors; 6) other identifiable causes for CRPS symptoms; and 7) the methodological quality of CRPS research. Conclusion The level of evidence for the claim that CRPS does not exist is very weak. Published accounts concluding that CRPS does not exist, in the absence of primary evidence to underpin them, can harm patients by encouraging dismissal of patients’ signs and symptoms.
Collapse
Affiliation(s)
- K D Bharwani
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A B Kersten
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - F Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - S Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Dirckx
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - P D Drummond
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - J Gierthmühlen
- Division of Neurological Pain Research and Therapy, Department Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Goebel
- Director of the Pain Research Institute Reader in Pain Medicine, University of Liverpool Honorary Consultant in Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - L Knudsen
- The National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - F J P M Huygen
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
5
|
König S, Engl C, Bayer M, Escolano-Lozano F, Rittner H, Rebhorn C, Birklein F. Substance P Serum Degradation in Complex Regional Pain Syndrome - Another Piece of the Puzzle? THE JOURNAL OF PAIN 2021; 23:501-507. [PMID: 34678467 DOI: 10.1016/j.jpain.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
In a previous study, we demonstrated that the serum peptidase system might be less efficient in complex regional pain syndrome (CRPS). Since the neuropeptide substanc P (SP) contributes to inflammation in CRPS, we now investigated the metabolism of SP in CRPS specifically. An SP metabolism assay was performed in 24 CRPS patients, which constitute a subgroup of our previous investigation on BK degradation. In addition, we included 26 healthy controls (24 newly recruited plus 2 from our previous investigation), and 13 patients after limb trauma, who did not fulfil the CRPS diagnostic criteria (trauma controls, TC) were included. We adapted a thin layer chromatography assay (TLC) to quantify SP disappearance after incubation with 7.5 µL of serum. These results were compared with bradykinin (BK) metabolization to BK1-8 and BK1-5 fragments from our previous study. In addition, TC were clinically and quantitative sensory testing (QST) phenotyped; the phenotyping of CRPS patients was retrieved from our existing database. SP metabolism was less efficient in CRPS and TC patient serum vs human control (HC) serum (P < .03) suggesting reduced activity of the neutral endopeptidase (NEP) and/or the angiotensin converting enzyme (ACE). Together with the decreased occurrence of BK1-5 fragment in CRPS and TC, this suggests a reduced activation of the angiotensin converting enzyme (ACE). There was no clear clinical phenotype related to impaired SP degradation; duration of disease and gender were also not associated. Most importantly, results in TC did not differ from CRPS. Collectively, our current and previous experimental results suggest that limb trauma reduces serum peptidase metabolism of SP ex vivo, specifically serum ACE activity. However, this finding is not CRPS-specific and seems to be rather a long-term consequence of the trauma itself. PERSPECTIVE: The experimental data from this study further support the hypothesis that impaired metabolism of inflammatory peptides potentially contribute to the development of posttraumatic pain in CRPS or limb trauma patients.
Collapse
Affiliation(s)
- Simone König
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany
| | - Christian Engl
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany
| | - Malte Bayer
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, University of Münster, Münster, Germany
| | - Fabiola Escolano-Lozano
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heike Rittner
- Centre for Interdisciplinary Pain Medicine, Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, University Hospital of Würzburg, Würzburg, Germany
| | - Cora Rebhorn
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| |
Collapse
|
6
|
König S, Steinebrey N, Herrnberger M, Escolano-Lozano F, Schlereth T, Rebhorn C, Birklein F. Reduced serum protease activity in Complex Regional Pain Syndrome: The impact of angiotensin-converting enzyme and carboxypeptidases. J Pharm Biomed Anal 2021; 205:114307. [PMID: 34392129 DOI: 10.1016/j.jpba.2021.114307] [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: 06/01/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
Complex Regional Pain Syndrome (CRPS) occurs in about 2% of patients after fracture of the limbs. In an earlier clinical study with 102 probands we have shown that the serum protease network in CRPS might be less effective. Based on these results we hypothesized that angiotensin-converting enzyme (ACE) and carboxypeptidase N (CPN) activity contribute to the differences of labeled bradykinin (DBK) degradation by patients' sera. Details of the enzymatic processes remained however unclear. The contributions of ACE and CPN in the serum degradation of DBK were studied using specific inhibitors. CPN1-ELISA was performed in serum. It was confirmed that the majority of DBK was degraded by ACE and CPN. The data delivered proof that the ACE serum activity was lowered in CRPS. High-resolution mass spectrometry was additionally used for protein expression analysis of sera of above study cohort (CRPS vs. healthy probands). According to principal component analysis of these data, significant differences between CRPS and control samples only occurred in sera of females younger than 46 years. In these CRPS patients, a number of defence / immunity-related proteins and members of the renin-angiotensin system (RAS) protein network were regulated. The impact of CPN in CRPS pathophysiology is subject to further investigation. The data support the hypothesis that both the RAS and the innate immune system might be affected in CRPS. A database of regulated serum proteins was established for future research.
Collapse
Affiliation(s)
- Simone König
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany.
| | - Nico Steinebrey
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany
| | - Myriam Herrnberger
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Fabiola Escolano-Lozano
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tanja Schlereth
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany; Deutsche Klinik Für Diagnostik, DKD Helios Klinik Wiesbaden, Germany
| | - Cora Rebhorn
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
7
|
Prasad Md A, Chakravarthy Md K. Review of complex regional pain syndrome and the role of the neuroimmune axis. Mol Pain 2021; 17:17448069211006617. [PMID: 33788654 PMCID: PMC8020088 DOI: 10.1177/17448069211006617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Complex regional pain syndrome (CRPS) is a progressive and painful disease of
the extremities that is characterized by continuous pain inconsistent with
the initial trauma. CRPS is caused by a multi-mechanism process that
involves both the peripheral and central nervous system, with a prominent
role of inflammation in CRPS pathophysiology. This review examines what is
currently known about the CRPS inflammatory and pain mechanisms, as well as
the possible impact of neurostimulation therapies on the neuroimmune axis of
CRPS. Study design A narrative review of preclinical and clinical studies provided an overview
of the pain and inflammatory mechanisms in CRPS and addressed the effect of
neurostimulation on immunomodulation. Methods A systematic literature search was conducted based on the PRISMA guidelines
between September 2015 to September 2020. Data sources included relevant
literature identified through searches of PubMed, Embase and the Cochrane
Database of Systematic Reviews. Results Sixteen preclinical and eight clinical studies were reviewed. Preclinical
studies identified different mechanisms of pain development in the acute and
chronic CRPS phases. Several preclinical and clinical studies investigating
inflammatory mechanisms, autoimmunity, and genetic profiles in CRPS,
supported a role of neuroinflammation in the pathophysiology of CRPS. The
immunomodulatory effects of neurostimulation therapy is still unclear,
despite clinical improvement in the CRPS patients. Conclusions Increasing evidence supports a role for inflammation and neuroinflammation in
CRPS pathophysiology. Preliminary neurostimulation findings, together with
the role of (neuro)inflammation in CRPS, seems to provide a compelling
rationale for its use in CRPS pain treatment. The possible immunomodulatory
effects of neurostimulation opens new therapeutic possibilities, however
further research is needed to gain a better understanding of the working
mechanisms.
Collapse
Affiliation(s)
- Amrita Prasad Md
- Axxon Pain, Brisbane Private Hospital, 259 Wickham Terrace, Brisbane, Queensland 4000, Australia
| | - Krishnan Chakravarthy Md
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Department of Anesthesiology and Pain Medicine, VA San Diego Health Care, San Diego, CA, USA
| |
Collapse
|
8
|
Neuropeptide reporter assay for serum, capillary blood and blood cards. MethodsX 2020; 7:100985. [PMID: 32685383 PMCID: PMC7355720 DOI: 10.1016/j.mex.2020.100985] [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: 10/25/2019] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
In the associated main paper (JPBA 2019), substance P was shown to be a valuable neuropeptide reporter substance to monitor the protease activity of serum. The assay was developed based on the predecessor assay using bradykinin (JPBA 2017). Both neuropeptides are of interest in inflammation and pain research and were thus explored for use with capillary blood and blood cards. Here, we present the protocols and set them in perspective to above neuropeptide assays for serum.•Neuropeptide reporter substance protease activity assay for use with fresh and dried blood.•Dabsylated Substance P and bradykinin are substrates of angiotensin-converting enzyme and other proteases.•Neuropeptides of interest in inflammation and pain.
Collapse
|
9
|
Russo MA, Georgius P, Pires AS, Heng B, Allwright M, Guennewig B, Santarelli DM, Bailey D, Fiore NT, Tan VX, Latini A, Guillemin GJ, Austin PJ. Novel immune biomarkers in complex regional pain syndrome. J Neuroimmunol 2020; 347:577330. [PMID: 32731051 DOI: 10.1016/j.jneuroim.2020.577330] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
We investigated serum levels of 29 cytokines and immune-activated kynurenine and tetrahydrobiopterin pathway metabolites in 15 complex regional pain syndrome (CRPS) subjects and 14 healthy controls. Significant reductions in interleukin-37 and tryptophan were found in CRPS subjects, along with positive correlations between kynurenine/tryptophan ratio and TNF-α levels with kinesiophobia, tetrahydrobiopterin levels with McGill pain score, sRAGE, and xanthurenic acid and neopterin levels with depression, anxiety and stress scores. Using machine learning, we identified a set of binary variables, including IL-37 and GM-CSF, capable of distinguishing controls from established CRPS subjects. These results suggest possible involvement of various inflammatory markers in CRPS pathogenesis.
Collapse
Affiliation(s)
- Marc A Russo
- Hunter Pain Specialists, 91 Chatham Street, Broadmeadow, NSW, 2292, Australia; Genesis Research Services, 220 Denison St, Broadmeadow, NSW, 2292, Australia
| | - Peter Georgius
- Pain Rehab, Suite 4 Noosa Central, 6 Bottlebrush Avenue, Sunshine Coast, QLD, 4567, Australia
| | - Ananda Staats Pires
- Neuroinflammation Group; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, NSW, 2109, Australia; Laboratório de Bioenergética e Estresse Oxidativo, LABOX; Departamento de Bioquímica, CCB; Universidade Federal de Santa Catarina; Florianópolis / SC, Brazil
| | - Benjamin Heng
- Neuroinflammation Group; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, NSW, 2109, Australia
| | - Michael Allwright
- ForeFront, Brain & Mind Centre, The University of Sydney, NSW, 2006, Australia
| | - Boris Guennewig
- ForeFront, Brain & Mind Centre, The University of Sydney, NSW, 2006, Australia
| | | | - Dominic Bailey
- Genesis Research Services, 220 Denison St, Broadmeadow, NSW, 2292, Australia
| | - Nathan T Fiore
- Discipline of Anatomy & Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Vanessa X Tan
- Neuroinflammation Group; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, NSW, 2109, Australia
| | - Alexandra Latini
- Laboratório de Bioenergética e Estresse Oxidativo, LABOX; Departamento de Bioquímica, CCB; Universidade Federal de Santa Catarina; Florianópolis / SC, Brazil
| | - Gilles J Guillemin
- Neuroinflammation Group; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, NSW, 2109, Australia
| | - Paul J Austin
- Discipline of Anatomy & Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia.
| |
Collapse
|
10
|
Lunde CE, Sieberg CB. Walking the Tightrope: A Proposed Model of Chronic Pain and Stress. Front Neurosci 2020; 14:270. [PMID: 32273840 PMCID: PMC7113396 DOI: 10.3389/fnins.2020.00270] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
Pain and stress are both phenomena that challenge an individual’s homeostasis and have significant overlap in conceptual and physiological processes. Allostasis is the ability to adapt to pain and stress and maintain homeostasis; however, if either process becomes chronic, it may result in negative long-term outcomes. The negative effects of stress on health outcomes on physiology and behavior, including pain, have been well documented; however, the specific mechanisms of how stress and what quantity of stress contributes to the maintenance and exacerbation of pain have not been identified, and thus pharmacological interventions are lacking. The objective of this brief review is to: 1. identify the gaps in the literature on the impact of acute and chronic stress on chronic pain, 2. highlight future directions for stress and chronic pain research; and 3. introduce the Pain-Stress Model in the context of the current literature on stress and chronic pain. A better understanding of the connection between stress and chronic pain could provide greater insight into the neurobiology of these processes and contribute to individualized treatment for pain rehabilitation and drug development for these often comorbid conditions.
Collapse
Affiliation(s)
- Claire E Lunde
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, United States.,Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B Sieberg
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, United States.,Center for Pain and the Brain (P.A.I.N. Group), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
11
|
Schreiber U, Engl C, Bayer M, König S. Labeled substance P as a neuropeptide reporter substance for enzyme activity. J Pharm Biomed Anal 2020; 178:112953. [PMID: 31718985 DOI: 10.1016/j.jpba.2019.112953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Recently, we developed a bradykinin reporter assay and demonstrated the differing protease activity in Complex Regional Pain Syndrome patients vs. controls. In order to further characterize CRPS pathophysiology, the neuropeptide substance P was evaluated as possible reporter substance, here. It was labeled with a chromophore at the lysine residue and generated two major fragments following incubation with serum (amino acid residues 3-8 and 3-11) which were reproducibly separated by thin-layer chromatography. Dabsylated substance P was shown to be a substrate of angiotensin-converting enzyme. The combination of both bradykinin and substance P reporter substances with specific enzyme inhibitors will shed more light on biochemical pathways in inflammatory processes and pain. Comparative clinical studies are now needed to define the application range of both assays in more detail.
Collapse
Affiliation(s)
- Ulrich Schreiber
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany
| | - Christian Engl
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany
| | - Malte Bayer
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, Medical Faculty, University of Münster, Germany.
| |
Collapse
|
12
|
Russo MA, Fiore NT, van Vreden C, Bailey D, Santarelli DM, McGuire HM, Fazekas de St Groth B, Austin PJ. Expansion and activation of distinct central memory T lymphocyte subsets in complex regional pain syndrome. J Neuroinflammation 2019; 16:63. [PMID: 30885223 PMCID: PMC6423749 DOI: 10.1186/s12974-019-1449-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Complex regional pain syndrome (CRPS) is a debilitating condition where trauma to a limb results in devastating persistent pain that is disproportionate to the initial injury. The pathophysiology of CRPS remains unknown; however, accumulating evidence suggests it is an immunoneurological disorder, especially in light of evidence of auto-antibodies in ~ 30% of patients. Despite this, a systematic assessment of all circulating leukocyte populations in CRPS has never been performed. Methods We characterised 14 participants as meeting the Budapest clinical criteria for CRPS and assessed their pain ratings and psychological state using a series of questionnaires. Next, we performed immunophenotyping on blood samples from the 14 CRPS participants as well as 14 healthy pain-free controls using mass cytometry. Using a panel of 38 phenotypic and activation markers, we characterised the numbers and intracellular activation status of all major leukocyte populations using manual gating strategies and unsupervised cluster analysis. Results We have shown expansion and activation of several distinct populations of central memory T lymphocytes in CRPS. The number of central memory CD8+ T cells was increased 2.15-fold; furthermore, this cell group had increased phosphorylation of NFkB and STAT1 compared to controls. Regarding central memory CD4+ T lymphocytes, the number of Th1 and Treg cells was increased 4.98-fold and 2.18-fold respectively, with increased phosphorylation of NFkB in both populations. We also found decreased numbers of CD1c+ myeloid dendritic cells, although with increased p38 phosphorylation. These changes could indicate dendritic cell tissue trafficking, as well as their involvement in lymphocyte activation. Conclusions These findings represent the first mass cytometry immunophenotyping study in any chronic pain state and provide preliminary evidence of an antigen-mediated T lymphocyte response in CRPS. In particular, the presence of increased numbers of long-lived central memory CD4+ and CD8+ T lymphocytes with increased activation of pro-inflammatory signalling pathways may indicate ongoing inflammation and cellular damage in CRPS.
Collapse
Affiliation(s)
- Marc A Russo
- Hunter Pain Clinic, 91 Chatham Street, Broadmeadow, NSW, 2292, Australia.,Genesis Research Services, 220 Denison St, Broadmeadow, NSW, 2292, Australia
| | - Nathan T Fiore
- Discipline of Anatomy & Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Room E513, Anderson Stuart Building, Sydney, NSW, 2006, Australia
| | - Caryn van Vreden
- Ramaciotti Centre for Human Systems Biology, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Sydney Cytometry, Centenary Institute and the Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW, 2050, Australia
| | - Dominic Bailey
- Genesis Research Services, 220 Denison St, Broadmeadow, NSW, 2292, Australia
| | | | - Helen M McGuire
- Ramaciotti Centre for Human Systems Biology, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Centre for Human Systems Biology, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Paul J Austin
- Discipline of Anatomy & Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Room E513, Anderson Stuart Building, Sydney, NSW, 2006, Australia.
| |
Collapse
|
13
|
Dermal nerve fibre and mast cell density, and proximity of mast cells to nerve fibres in the skin of patients with complex regional pain syndrome. Pain 2019; 159:2021-2029. [PMID: 29905655 DOI: 10.1097/j.pain.0000000000001304] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
An interaction between cutaneous nerves and mast cells may contribute to pain in complex regional pain syndrome (CRPS). To explore this, we investigated the density of dermal nerve fibres, and the density and proximity of mast cells to nerve fibres, in skin biopsies obtained from the affected and unaffected limbs of 57 patients with CRPS and 28 site-matched healthy controls. The percentage of the dermis stained by the pan-neuronal marker protein gene-product 9.5 was lower in the affected limb of patients than in controls (0.12 ± 0.01% vs 0.22 ± 0.04%, P < 0.05), indicating a reduction in dermal nerve fibre density. This parameter did not correlate with CRPS duration. However, it was lower in the affected than unaffected limb of patients with warm CRPS. Dermal mast cell numbers were similar in patients and controls, but the percentage of mast cells less than 5 µm from nerve fibres was significantly lower in the affected and unaffected limbs of patients than in controls (16.8 ± 1.7%, 16.5 ± 1.7%, and 31.4 ± 2.3% respectively, P < 0.05). We confirm previous findings of a mild neuropathy in CRPS. Our findings suggest that this either develops very early after injury or precedes CRPS onset. Loss of dermal nerve fibres in CRPS might result in loss of chemotactic signals, thus halting mast cell migration toward surviving nerve fibres. Failure of normal nerve fibre-mast cell interactions could contribute to the pathophysiology of CRPS.
Collapse
|
14
|
|
15
|
Bayer M, König S. A vote for robustness: Monitoring serum enzyme activity by thin-layer chromatography of dabsylated bradykinin products. J Pharm Biomed Anal 2017; 143:199-203. [DOI: 10.1016/j.jpba.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/02/2017] [Accepted: 06/03/2017] [Indexed: 11/16/2022]
|