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Pakalniskis J, Soares S, Rajan S, Vyshnevska A, Schmelz M, Solinski HJ, Rukwied R, Carr R. Human pain ratings to electrical sinusoids increase with cooling through a cold-induced increase in C-fibre excitability. Pain 2023; 164:1524-1536. [PMID: 36972485 DOI: 10.1097/j.pain.0000000000002849] [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: 05/04/2022] [Accepted: 12/01/2022] [Indexed: 03/29/2023]
Abstract
ABSTRACT Low-frequency sinusoidal current applied to human skin evokes local axon reflex flare and burning pain, indicative of C-fibre activation. Because topical cooling works well as a local analgesic, we examined the effect of cooling on human pain ratings to sinusoidal and rectangular profiles of constant current stimulation. Unexpectedly, pain ratings increased upon cooling the skin from 32 to 18°C. To explore this paradoxical observation, the effects of cooling on C-fibre responses to stimulation with sinusoidal and rectangular current profiles were determined in ex vivo segments of mouse sural and pig saphenous nerve. As expected by thermodynamics, the absolute value of electrical charge required to activate C-fibre axons increased with cooling from 32°C to 20°C, irrespective of the stimulus profile used. However, for sinusoidal stimulus profiles, cooling enabled a more effective integration of low-intensity currents over tens of milliseconds resulting in a delayed initiation of action potentials. Our findings indicate that the paradoxical cooling-induced enhancement of electrically evoked pain in people can be explained by an enhancement of C-fibre responsiveness to slow depolarization at lower temperatures. This property may contribute to symptoms of enhanced cold sensitivity, especially cold allodynia, associated with many forms of neuropathic pain.
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Affiliation(s)
- Julius Pakalniskis
- Department of Experimental Pain Research, Mannheim Centre for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Kraus RL, Zhao F, Pall PS, Zhou D, Vardigan JD, Danziger A, Li Y, Daley C, Ballard JE, Clements MK, Klein RM, Holahan MA, Greshock TJ, Kim RM, Layton ME, Burgey CS, Serra J, Henze DA, Houghton AK. Na v1.7 target modulation and efficacy can be measured in nonhuman primate assays. Sci Transl Med 2021; 13:13/594/eaay1050. [PMID: 34011626 DOI: 10.1126/scitranslmed.aay1050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/03/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022]
Abstract
Humans with loss-of-function mutations in the Nav1.7 channel gene (SCN9A) show profound insensitivity to pain, whereas those with gain-of-function mutations can have inherited pain syndromes. Therefore, inhibition of the Nav1.7 channel with a small molecule has been considered a promising approach for the treatment of various human pain conditions. To date, clinical studies conducted using selective Nav1.7 inhibitors have not provided analgesic efficacy sufficient to warrant further investment. Clinical studies to date used multiples of in vitro IC50 values derived from electrophysiological studies to calculate anticipated human doses. To increase the chance of clinical success, we developed rhesus macaque models of action potential propagation, nociception, and olfaction, to measure Nav1.7 target modulation in vivo. The potent and selective Nav1.7 inhibitors SSCI-1 and SSCI-2 dose-dependently blocked C-fiber nociceptor conduction in microneurography studies and inhibited withdrawal responses to noxious heat in rhesus monkeys. Pharmacological Nav1.7 inhibition also reduced odor-induced activation of the olfactory bulb (OB), measured by functional magnetic resonance imaging (fMRI) studies consistent with the anosmia reported in Nav1.7 loss-of-function patients. These data demonstrate that it is possible to measure Nav1.7 target modulation in rhesus macaques and determine the plasma concentration required to produce a predetermined level of inhibition. The calculated plasma concentration for preclinical efficacy could be used to guide human efficacious exposure estimates. Given the translatable nature of the assays used, it is anticipated that they can be also used in phase 1 clinical studies to measure target modulation and aid in the interpretation of phase 1 clinical data.
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Affiliation(s)
- Richard L Kraus
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA.
| | - Fuqiang Zhao
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Parul S Pall
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Dan Zhou
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Joshua D Vardigan
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Andrew Danziger
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Yuxing Li
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Christopher Daley
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Jeanine E Ballard
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Michelle K Clements
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Rebecca M Klein
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Marie A Holahan
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Thomas J Greshock
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Ronald M Kim
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Mark E Layton
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Christopher S Burgey
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Jordi Serra
- Department of Clinical Neurophysiology, Ruskin Wing, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Darrell A Henze
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
| | - Andrea K Houghton
- Merck & Co. Inc., WP-14, 770 Sumneytown Pike, P.O. Box 4, West Point, PA 19486, USA
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Werland F, Hirth M, Rukwied R, Ringkamp M, Turnquist B, Jorum E, Namer B, Schmelz M, Obreja O. Maximum axonal following frequency separates classes of cutaneous unmyelinated nociceptors in the pig. J Physiol 2021; 599:1595-1610. [DOI: 10.1113/jp280269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Fiona Werland
- Department of Experimental Pain Research, MCTN Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Michael Hirth
- Department of Experimental Pain Research, MCTN Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Roman Rukwied
- Department of Experimental Pain Research, MCTN Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Matthias Ringkamp
- Department of Neurosurgery Johns Hopkins University Baltimore MD USA
| | - Brian Turnquist
- Faculty of Mathematics and Computer Science Bethel University MN USA
| | - Ellen Jorum
- Section of Clinical Neurophysiology, Department of Neurology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Barbara Namer
- IZKF Neuroscience Research Group, University Hospital RWTH Aachen and Department of Physiology and Pathophysiology University of Erlangen‐Nuremberg Erlangen Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Otilia Obreja
- Department of Experimental Pain Research, MCTN Medical Faculty Mannheim Heidelberg University Mannheim Germany
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Mulders D, de Bodt C, Lejeune N, Courtin A, Liberati G, Verleysen M, Mouraux A. Dynamics of the perception and EEG signals triggered by tonic warm and cool stimulation. PLoS One 2020; 15:e0231698. [PMID: 32324752 PMCID: PMC7179871 DOI: 10.1371/journal.pone.0231698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Thermosensation is crucial for humans to probe the environment and detect threats arising from noxious heat or cold. Over the last years, EEG frequency-tagging using long-lasting periodic radiant heat stimulation has been proposed as a means to study the cortical processes underlying tonic heat perception. This approach is based on the notion that periodic modulation of a sustained stimulus can elicit synchronized periodic activity in the neuronal populations responding to the stimulus, known as a steady-state response (SSR). In this paper, we extend this approach using a contact thermode to generate both heat- and cold-evoked SSRs. Furthermore, we characterize the temporal dynamics of the elicited responses, relate these dynamics to perception, and assess the effects of displacing the stimulated skin surface to gain insight on the heat- and cold-sensitive afferents conveying these responses. Two experiments were conducted in healthy volunteers. In both experiments, noxious heat and innocuous cool stimuli were applied during 75 seconds to the forearm using a Peltier-based contact thermode, with intensities varying sinusoidally at 0.2 Hz. Displacement of the thermal stimulation on the skin surface was achieved by independently controlling the Peltier elements of the thermal probe. Continuous intensity ratings to sustained heat and cold stimulation were obtained in the first experiment with 14 subjects, and the EEG was recorded in the second experiment on 15 subjects. Both contact heat and cool stimulation elicited periodic EEG responses and percepts. Compared to heat stimulation, the responses to cool stimulation had a lower magnitude and shorter latency. All responses tended to habituate along time, and this response attenuation was most pronounced for cool compared to warm stimulation, and for stimulation delivered using a fixed surface compared to a variable surface.
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Affiliation(s)
- Dounia Mulders
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Cyril de Bodt
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nicolas Lejeune
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Arthur Courtin
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Giulia Liberati
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Verleysen
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - André Mouraux
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
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Pelot NA, Grill WM. In vivo quantification of excitation and kilohertz frequency block of the rat vagus nerve. J Neural Eng 2020; 17:026005. [PMID: 31945746 DOI: 10.1088/1741-2552/ab6cb6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There is growing interest in treating diseases by electrical stimulation and block of peripheral autonomic nerves, but a paucity of studies on the excitation and block of small-diameter autonomic axons. We conducted in vivo quantification of the strength-duration properties, activity-dependent slowing (ADS), and responses to kilohertz frequency (KHF) signals for the rat vagus nerve (VN). APPROACH We conducted acute in vivo experiments in urethane-anaesthetized rats. We placed two cuff electrodes on the left cervical VN and one cuff electrode on the anterior subdiaphragmatic VN. The rostral cervical cuff was used to deliver pulses to quantify recruitment and ADS. The caudal cervical cuff was used to deliver KHF signals. The subdiaphragmatic cuff was used to record compound action potentials (CAPs). MAIN RESULTS We quantified the input-output recruitment and strength-duration curves. Fits to the data using standard strength-duration equations were qualitatively similar, but the resulting chronaxie and rheobase estimates varied substantially. We measured larger thresholds for the slowest fibres (0.5-1 m s-1), especially at shorter pulse widths. Using a novel cross-correlation CAP-based analysis, we measured ADS of ~2.3% after 3 min of 2 Hz stimulation, which is comparable to the ADS reported for sympathetic efferents in somatic nerves, but much smaller than the ADS in cutaneous nociceptors. We found greater ADS with higher stimulation frequency and non-monotonic changes in CV in select cases. We found monotonically increasing block thresholds across frequencies from 10 to 80 kHz for both fast and slow fibres. Further, following 25 s of KHF signal, neural conduction could require tens of seconds to recover. SIGNIFICANCE The quantification of mammalian autonomic nerve responses to conventional and KHF signals provides essential information for the development of peripheral nerve stimulation therapies and for understanding their mechanisms of action.
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Affiliation(s)
- N A Pelot
- Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick CIEMAS, 101 Science Drive, Campus Box 90281, Durham, NC 27708, United States of America
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Jonas R, Namer B, Schnakenberg M, Soares S, Pakalniskis J, Carr R, Schmelz M, Rukwied R. Sympathetic efferent neurons are less sensitive than nociceptors to 4 Hz sinusoidal stimulation. Eur J Pain 2019; 24:122-133. [DOI: 10.1002/ejp.1467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Robin Jonas
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Barbara Namer
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
- Department Physiology I Friedrich‐Alexander‐University Erlangen‐Nuremberg Erlangen Germany
| | - Mark Schnakenberg
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Sabrina Soares
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Julius Pakalniskis
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Richard Carr
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Martin Schmelz
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Roman Rukwied
- Department Experimental Pain Research, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
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McDermott LA, Weir GA, Themistocleous AC, Segerdahl AR, Blesneac I, Baskozos G, Clark AJ, Millar V, Peck LJ, Ebner D, Tracey I, Serra J, Bennett DL. Defining the Functional Role of Na V1.7 in Human Nociception. Neuron 2019; 101:905-919.e8. [PMID: 30795902 PMCID: PMC6424805 DOI: 10.1016/j.neuron.2019.01.047] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/03/2018] [Accepted: 01/18/2019] [Indexed: 12/17/2022]
Abstract
Loss-of-function mutations in NaV1.7 cause congenital insensitivity to pain (CIP); this voltage-gated sodium channel is therefore a key target for analgesic drug development. Utilizing a multi-modal approach, we investigated how NaV1.7 mutations lead to human pain insensitivity. Skin biopsy and microneurography revealed an absence of C-fiber nociceptors in CIP patients, reflected in a reduced cortical response to capsaicin on fMRI. Epitope tagging of endogenous NaV1.7 revealed the channel to be localized at the soma membrane, axon, axon terminals, and the nodes of Ranvier of induced pluripotent stem cell (iPSC) nociceptors. CIP patient-derived iPSC nociceptors exhibited an inability to properly respond to depolarizing stimuli, demonstrating that NaV1.7 is a key regulator of excitability. Using this iPSC nociceptor platform, we found that some NaV1.7 blockers undergoing clinical trials lack specificity. CIP, therefore, arises due to a profound loss of functional nociceptors, which is more pronounced than that reported in rodent models, or likely achievable following acute pharmacological blockade. VIDEO ABSTRACT.
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Affiliation(s)
- Lucy A McDermott
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Greg A Weir
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | | | - Andrew R Segerdahl
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Iulia Blesneac
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Alex J Clark
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Val Millar
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Liam J Peck
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Daniel Ebner
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jordi Serra
- Department of Clinical Neurophysiology, King's College Hospital, London SE5 9RS, UK
| | - David L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK.
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Ackerley R, Watkins RH. Microneurography as a tool to study the function of individual C-fiber afferents in humans: responses from nociceptors, thermoreceptors, and mechanoreceptors. J Neurophysiol 2018; 120:2834-2846. [PMID: 30256737 DOI: 10.1152/jn.00109.2018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The technique of microneurography-recording neural traffic from nerves in awake humans-has provided us with unrivaled insights into afferent and efferent processes in the peripheral nervous system for over 50 years. We review the use of microneurography to study single C-fiber afferents and provide an overview of the knowledge gained, with views to future investigations. C-fibers have slowly conducting, thin-diameter, unmyelinated axons and make up the majority of the fibers in peripheral nerves (~80%). With the use of microneurography in humans, C-fiber afferents have been differentiated into discrete subclasses that encode specific qualities of stimuli on the skin, and their functional roles have been investigated. Afferent somatosensory information provided by C-fibers underpins various positive and negative affective sensations from the periphery, including mechanical, thermal, and chemical pain (C-nociceptors), temperature (C-thermoreceptors), and positive affective aspects of touch (C-tactile afferents). Insights from microneurographic investigations have revealed the complexity of the C-fiber system, methods for delineating fundamental C-fiber populations in a translational manner, how C-fiber firing can be used to identify nerve deficits in pathological states, and how the responses from C-fibers may be modified to change sensory percepts, including decreasing pain. Understanding these processes may lead to future medical interventions to diagnose and treat C-fiber dysfunction. NEW & NOTEWORTHY The technique of microneurography allows us to directly investigate the functional roles of single C-fiber afferents in awake human beings. Here we outline and discuss the current field of C-fiber research on this heterogeneous population of afferents in healthy subjects, in pathological states, and from a translational perspective. We cover C-fibers encoding touch, temperature, and pain and provide perspectives on the future of C-fiber microneurography investigations in humans.
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Affiliation(s)
- Rochelle Ackerley
- Aix Marseille University, CNRS, LNSC (Laboratoire de Neurosciences Sensorielles et Cognitives - UMR 7260), Marseille, France.,Department of Physiology, University of Gothenburg , Gothenburg , Sweden
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10
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Z'Graggen WJ, Solà R, Graf NE, Serra J, Bostock H. Sensitivity to ischaemia of single sympathetic nerve fibres innervating the dorsum of the human foot. J Physiol 2017; 595:4467-4473. [PMID: 28378458 DOI: 10.1113/jp274324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/30/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Changes in nerve conduction velocity following an impulse (i.e. velocity recovery cycles) reflect after-potentials, and can provide an indication of altered nerve membrane properties. This study used microneurography to assess the effects of ischaemia on single human sympathetic fibres innervating the dorsum of the foot. It was found that velocity recovery cycles can distinguish whether a sympathetic nerve fibre is depolarized or not. The method may be used to detect membrane depolarization of sympathetic nerve fibres in human patients when autonomic neuropathy is suspected. ABSTRACT The aim of this study was to determine whether velocity recovery cycles (VRCs) could detect the effects of ischaemia on sympathetic nerve fibres. VRCs of human sympathetic nerve fibres of the superficial peroneal nerve innervating the dorsum of the foot were recorded by microneurography in seven healthy volunteers. Sympathetic nerve fibres were identified by studying their response to manoeuvres increasing sympathetic outflow and by measuring activity-dependent slowing at 2 Hz stimulation. VRCs were assessed at rest, during 30 min of induced limb ischaemia and during 20 min of recovery after ischaemia. From each VRC was measured the relative refractory period (RRP), the supernormality and the time to peak supernormality (SN@). During ischaemia, RRP increased from the baseline value of 37.4 ± 8.7 ms (mean ± SEM) to 67.1 ± 12.1 ms (P < 0.01) and SN@ increased from 68.6 ± 9.8 ms to 133.8 ± 11.0 ms (P < 0.005). The difference between SN@ and RRP separated ischaemic from non-ischaemic sympathetic nerve fibres. It is concluded that these sympathetic nerve fibres are sensitive to ischaemia, and that VRCs provide a method to study changes of axonal membrane potential of human sympathetic nerve fibres in vivo.
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Affiliation(s)
- W J Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - R Solà
- Neuroscience Technologies, Barcelona, Spain
| | - N E Graf
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J Serra
- Neuroscience Technologies, Barcelona, Spain
| | - H Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
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Kist AM, Sagafos D, Rush AM, Neacsu C, Eberhardt E, Schmidt R, Lunden LK, Ørstavik K, Kaluza L, Meents J, Zhang Z, Carr TH, Salter H, Malinowsky D, Wollberg P, Krupp J, Kleggetveit IP, Schmelz M, Jørum E, Lampert A, Namer B. SCN10A Mutation in a Patient with Erythromelalgia Enhances C-Fiber Activity Dependent Slowing. PLoS One 2016; 11:e0161789. [PMID: 27598514 PMCID: PMC5012686 DOI: 10.1371/journal.pone.0161789] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022] Open
Abstract
Gain-of-function mutations in the tetrodotoxin (TTX) sensitive voltage-gated sodium channel (Nav) Nav1.7 have been identified as a key mechanism underlying chronic pain in inherited erythromelalgia. Mutations in TTX resistant channels, such as Nav1.8 or Nav1.9, were recently connected with inherited chronic pain syndromes. Here, we investigated the effects of the p.M650K mutation in Nav1.8 in a 53 year old patient with erythromelalgia by microneurography and patch-clamp techniques. Recordings of the patient’s peripheral nerve fibers showed increased activity dependent slowing (ADS) in CMi and less spontaneous firing compared to a control group of erythromelalgia patients without Nav mutations. To evaluate the impact of the p.M650K mutation on neuronal firing and channel gating, we performed current and voltage-clamp recordings on transfected sensory neurons (DRGs) and neuroblastoma cells. The p.M650K mutation shifted steady-state fast inactivation of Nav1.8 to more hyperpolarized potentials and did not significantly alter any other tested gating behaviors. The AP half-width was significantly broader and the stimulated action potential firing rate was reduced for M650K transfected DRGs compared to WT. We discuss the potential link between enhanced steady state fast inactivation, broader action potential width and the potential physiological consequences.
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Affiliation(s)
- Andreas M. Kist
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dagrun Sagafos
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital -Rikshospitalet, Oslo, Norway
| | | | - Cristian Neacsu
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Esther Eberhardt
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Anesthesiology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
| | - Roland Schmidt
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Lars Kristian Lunden
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital -Rikshospitalet, Oslo, Norway
| | - Kristin Ørstavik
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital -Rikshospitalet, Oslo, Norway
| | - Luisa Kaluza
- Institute of Physiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jannis Meents
- Institute of Physiology, RWTH Aachen University Hospital, Aachen, Germany
| | | | | | | | | | | | | | - Inge Petter Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital -Rikshospitalet, Oslo, Norway
| | - Martin Schmelz
- Department of Anesthesiology Mannheim, Heidelberg University, Mannheim, Germany
| | - Ellen Jørum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital -Rikshospitalet, Oslo, Norway
- * E-mail: (EJ); (AL); (BN)
| | - Angelika Lampert
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Physiology, RWTH Aachen University Hospital, Aachen, Germany
- * E-mail: (EJ); (AL); (BN)
| | - Barbara Namer
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Anesthesiology Mannheim, Heidelberg University, Mannheim, Germany
- * E-mail: (EJ); (AL); (BN)
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Single-Fiber Recordings of Nociceptive Fibers in Patients With HSAN Type V With Congenital Insensitivity to Pain. Clin J Pain 2016; 32:636-42. [DOI: 10.1097/ajp.0000000000000303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Specific changes in conduction velocity recovery cycles of single nociceptors in a patient with erythromelalgia with the I848T gain-of-function mutation of Nav1.7. Pain 2016; 156:1637-1646. [PMID: 25993546 DOI: 10.1097/j.pain.0000000000000229] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Seven patients diagnosed with erythromelalgia (EM) were investigated by microneurography to record from unmyelinated nerve fibers in the peroneal nerve. Two patients had characterized variants of sodium channel Nav1.7 (I848T, I228M), whereas no mutations of coding regions of Navs were found in 5 patients with EM. Irrespective of Nav1.7 mutations, more than 50% of the silent nociceptors in the patients with EM showed spontaneous activity. In the patient with mutation I848T, all nociceptors, but not sympathetic efferents, displayed enhanced early subnormal conduction in the velocity recovery cycles and the expected late subnormality was reversed to supranormal conduction. The larger hyperpolarizing shift of activation might explain the difference to the I228M mutation. Sympathetic fibers that lack Nav1.8 did not show supranormal conduction in the patient carrying the I848T mutation, confirming in human subjects that the presence of Nav1.8 crucially modulates conduction in cells expressing EM mutant channels. The characteristic pattern of changes in conduction velocity observed in the patient with the I848T gain-of function mutation in Nav1.7 could be explained by axonal depolarization and concomitant inactivation of Nav1.7. If this were true, activity-dependent hyperpolarization would reverse inactivation of Nav1.7 and account for the supranormal CV. This mechanism might explain normal pain thresholds under resting conditions.
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Tigerholm J, Petersson ME, Obreja O, Eberhardt E, Namer B, Weidner C, Lampert A, Carr RW, Schmelz M, Fransén E. C-fiber recovery cycle supernormality depends on ion concentration and ion channel permeability. Biophys J 2016; 108:1057-71. [PMID: 25762318 DOI: 10.1016/j.bpj.2014.12.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/30/2014] [Accepted: 12/17/2014] [Indexed: 12/20/2022] Open
Abstract
Following each action potential, C-fiber nociceptors undergo cyclical changes in excitability, including a period of superexcitability, before recovering their basal excitability state. The increase in superexcitability during this recovery cycle depends upon their immediate firing history of the axon, but also determines the instantaneous firing frequency that encodes pain intensity. To explore the mechanistic underpinnings of the recovery cycle phenomenon a biophysical model of a C-fiber has been developed. The model represents the spatial extent of the axon including its passive properties as well as ion channels and the Na/K-ATPase ion pump. Ionic concentrations were represented inside and outside the membrane. The model was able to replicate the typical transitions in excitability from subnormal to supernormal observed empirically following a conducted action potential. In the model, supernormality depended on the degree of conduction slowing which in turn depends upon the frequency of stimulation, in accordance with experimental findings. In particular, we show that activity-dependent conduction slowing is produced by the accumulation of intraaxonal sodium. We further show that the supernormal phase results from a reduced potassium current Kdr as a result of accumulation of periaxonal potassium in concert with a reduced influx of sodium through Nav1.7 relative to Nav1.8 current. This theoretical prediction was supported by data from an in vitro preparation of small rat dorsal root ganglion somata showing a reduction in the magnitude of tetrodotoxin-sensitive relative to tetrodotoxin -resistant whole cell current. Furthermore, our studies provide support for the role of depolarization in supernormality, as previously suggested, but we suggest that the basic mechanism depends on changes in ionic concentrations inside and outside the axon. The understanding of the mechanisms underlying repetitive discharges in recovery cycles may provide insight into mechanisms of spontaneous activity, which recently has been shown to correlate to a perceived level of pain.
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Affiliation(s)
- Jenny Tigerholm
- Department of Computational Biology, School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden; Stockholm Brain Institute, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Marcus E Petersson
- Department of Computational Biology, School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden; Stockholm Brain Institute, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Otilia Obreja
- Anaesthesiology, Universitaetsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Esther Eberhardt
- Institute of Physiology and Pathophysiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Barbara Namer
- Department of Anesthesiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Weidner
- Department of Anesthesiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Angelika Lampert
- Institute of Physiology and Pathophysiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Institute of Physiology, RWTH Aachen University, Aachen, Germany
| | - Richard W Carr
- Anaesthesiology, Universitaetsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Schmelz
- Anaesthesiology, Universitaetsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Erik Fransén
- Department of Computational Biology, School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden; Stockholm Brain Institute, KTH Royal Institute of Technology, Stockholm, Sweden.
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Abstract
Chronic widespread pain is a serious medical problem, yet the mechanisms of nociception and pain are poorly understood. Using a reserpine-induced pain model originally reported as a putative animal model for fibromyalgia, this study was undertaken to examine the following: (1) expression of several ion channels responsible for pain, mechanotransduction, and generation/propagation of action potentials in the dorsal root ganglion (DRG), (2) activities of peripheral nociceptive afferents, and (3) alterations in spinal microglial cells. A significant increase in mRNA expression of the acid-sensing ion channel (ASIC)-3 was detected in the DRG, and the behavioral mechanical hyperalgesia was significantly reversed by subcutaneous injection of APETx2, a selective blocker of ASIC3. Single-fiber recordings in vitro revealed facilitated mechanical responses of mechanoresponsive C-fibers both in the skin and muscle although the proportion of mechanoresponsive C-nociceptors was paradoxically decreased. In the spinal dorsal horn, microglial cells labeled with Iba1 immunoreactivity was activated, especially in laminae I-II where the nociceptive input is mainly processed compared with the other laminae. The activated microglia and behavioral hyperalgesia were significantly tranquilized by intraperitoneal injection of minocycline. These results suggest that the increase in ASIC3 in the DRG facilitated mechanical response of the remaining C-nociceptors and that activated spinal microglia may direct to intensify pain in this model. Pain may be further amplified by reserpine-induced dysfunction of the descending pain inhibitory system and by the decrease in peripheral drive to this system resulting from a reduced proportion of mechanoresponsive C-nociceptors.
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Sundt D, Gamper N, Jaffe DB. Spike propagation through the dorsal root ganglia in an unmyelinated sensory neuron: a modeling study. J Neurophysiol 2015; 114:3140-53. [PMID: 26334005 PMCID: PMC4686302 DOI: 10.1152/jn.00226.2015] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/30/2015] [Indexed: 12/31/2022] Open
Abstract
Unmyelinated C-fibers are a major type of sensory neurons conveying pain information. Action potential conduction is regulated by the bifurcation (T-junction) of sensory neuron axons within the dorsal root ganglia (DRG). Understanding how C-fiber signaling is influenced by the morphology of the T-junction and the local expression of ion channels is important for understanding pain signaling. In this study we used biophysical computer modeling to investigate the influence of axon morphology within the DRG and various membrane conductances on the reliability of spike propagation. As expected, calculated input impedance and the amplitude of propagating action potentials were both lowest at the T-junction. Propagation reliability for single spikes was highly sensitive to the diameter of the stem axon and the density of voltage-gated Na+ channels. A model containing only fast voltage-gated Na+ and delayed-rectifier K+ channels conducted trains of spikes up to frequencies of 110 Hz. The addition of slowly activating KCNQ channels (i.e., KV7 or M-channels) to the model reduced the following frequency to 30 Hz. Hyperpolarization produced by addition of a much slower conductance, such as a Ca2+-dependent K+ current, was needed to reduce the following frequency to 6 Hz. Attenuation of driving force due to ion accumulation or hyperpolarization produced by a Na+-K+ pump had no effect on following frequency but could influence the reliability of spike propagation mutually with the voltage shift generated by a Ca2+-dependent K+ current. These simulations suggest how specific ion channels within the DRG may contribute toward therapeutic treatments for chronic pain.
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Affiliation(s)
- Danielle Sundt
- Department of Biology, UTSA Neurosciences Institute, University of Texas at San Antonio, San Antonio, Texas
| | - Nikita Gamper
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, People's Republic of China; and Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - David B Jaffe
- Department of Biology, UTSA Neurosciences Institute, University of Texas at San Antonio, San Antonio, Texas;
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Neishabouri A, Faisal AA. Saltatory conduction in unmyelinated axons: clustering of Na(+) channels on lipid rafts enables micro-saltatory conduction in C-fibers. Front Neuroanat 2014; 8:109. [PMID: 25352785 PMCID: PMC4195365 DOI: 10.3389/fnana.2014.00109] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/15/2014] [Indexed: 11/17/2022] Open
Abstract
THE ACTION POTENTIAL (AP), THE FUNDAMENTAL SIGNAL OF THE NERVOUS SYSTEM, IS CARRIED BY TWO TYPES OF AXONS: unmyelinated and myelinated fibers. In the former the action potential propagates continuously along the axon as established in large-diameter fibers. In the latter axons the AP jumps along the nodes of Ranvier-discrete, anatomically specialized regions which contain very high densities of sodium ion (Na(+)) channels. Therefore, saltatory conduction is thought as the hallmark of myelinated axons, which enables faster and more reliable propagation of signals than in unmyelinated axons of same outer diameter. Recent molecular anatomy showed that in C-fibers, the very thin (0.1 μm diameter) axons of the peripheral nervous system, Nav1.8 channels are clustered together on lipid rafts that float in the cell membrane. This localized concentration of Na(+) channels resembles in structure the ion channel organization at the nodes of Ranvier, yet it is currently unknown whether this translates into an equivalent phenomenon of saltatory conduction or related-functional benefits and efficiencies. Therefore, we modeled biophysically realistic unmyelinated axons with both conventional and lipid-raft based organization of Na(+) channels. We find that APs are reliably conducted in a micro-saltatory fashion along lipid rafts. Comparing APs in unmyelinated fibers with and without lipid rafts did not reveal any significant difference in either the metabolic cost or AP propagation velocity. By investigating the efficiency of AP propagation over Nav1.8 channels, we find however that the specific inactivation properties of these channels significantly increase the metabolic cost of signaling in C-fibers.
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Affiliation(s)
- Ali Neishabouri
- Brain and Behaviour Lab, Department of Computing, Imperial College LondonLondon, UK
- Brain and Behaviour Lab, Department of Bioengineering, Imperial College LondonLondon, UK
| | - A. Aldo Faisal
- Brain and Behaviour Lab, Department of Computing, Imperial College LondonLondon, UK
- Brain and Behaviour Lab, Department of Bioengineering, Imperial College LondonLondon, UK
- Faculty of Medicine, MRC Clinical Sciences CentreLondon, UK
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Tigerholm J, Petersson ME, Obreja O, Lampert A, Carr R, Schmelz M, Fransén E. Modeling activity-dependent changes of axonal spike conduction in primary afferent C-nociceptors. J Neurophysiol 2013; 111:1721-35. [PMID: 24371290 DOI: 10.1152/jn.00777.2012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Action potential initiation and conduction along peripheral axons is a dynamic process that displays pronounced activity dependence. In patients with neuropathic pain, differences in the modulation of axonal conduction velocity by activity suggest that this property may provide insight into some of the pathomechanisms. To date, direct recordings of axonal membrane potential have been hampered by the small diameter of the fibers. We have therefore adopted an alternative approach to examine the basis of activity-dependent changes in axonal conduction by constructing a comprehensive mathematical model of human cutaneous C-fibers. Our model reproduced axonal spike propagation at a velocity of 0.69 m/s commensurate with recordings from human C-nociceptors. Activity-dependent slowing (ADS) of axonal propagation velocity was adequately simulated by the model. Interestingly, the property most readily associated with ADS was an increase in the concentration of intra-axonal sodium. This affected the driving potential of sodium currents, thereby producing latency changes comparable to those observed for experimental ADS. The model also adequately reproduced post-action potential excitability changes (i.e., recovery cycles) observed in vivo. We performed a series of control experiments replicating blockade of particular ion channels as well as changing temperature and extracellular ion concentrations. In the absence of direct experimental approaches, the model allows specific hypotheses to be formulated regarding the mechanisms underlying activity-dependent changes in C-fiber conduction. Because ADS might functionally act as a negative feedback to limit trains of nociceptor activity, we envisage that identifying its mechanisms may also direct efforts aimed at alleviating neuronal hyperexcitability in pain patients.
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Affiliation(s)
- Jenny Tigerholm
- Department of Computational Biology, School of Computer Science and Communication, KTH Royal Institute of Technology, Stockholm, Sweden
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19
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Hirth M, Rukwied R, Gromann A, Turnquist B, Weinkauf B, Francke K, Albrecht P, Rice F, Hägglöf B, Ringkamp M, Engelhardt M, Schultz C, Schmelz M, Obreja O. Nerve growth factor induces sensitization of nociceptors without evidence for increased intraepidermal nerve fiber density. Pain 2013; 154:2500-2511. [DOI: 10.1016/j.pain.2013.07.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 07/09/2013] [Accepted: 07/19/2013] [Indexed: 01/07/2023]
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Discriminative sensory characteristics of the lateral femoral cutaneous nerve after mepivacaine-induced block. Scand J Pain 2013; 4:95-100. [DOI: 10.1016/j.sjpain.2012.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/06/2012] [Indexed: 11/18/2022]
Abstract
Abstract
Background and objectives
Unmyelinated C-fibres comprise the largest group of somatic afferents and have demonstrated a crucial role not only in the perception of high-threshold mechanically, thermally or chemically induced pain, but also in non-harmful low-threshold mechanical stimuli [1,2]. The objective of our study was to characterize differential sensitivity changes of C-fibre related subclasses of high-threshold and low-threshold polymodal nociceptors and low-threshold mechanoreceptors to the local anaesthetic (LA) mepivacaine during nerve block of the purely sensory lateral femoral cutaneous nerve (LFCN) in human. We assumed a diverse response of different classes of afferents to the two different concentrations of the LA mepivacaine (Scandicaine).
Methods
In a double-blind randomized experimental setting, an ultrasound-guided nerve block of the LFCN was performed in 10 healthy male subjects, each with two different concentrations of mepivacaine (0.5 and 1%). Responsiveness of afferent nerve fibres to different noxious and non-noxious stimuli was tested by Quantitative Sensory Testing (QST) 30, 180, and 300 min after nerve block. Both LA concentrations of mepivacaine were compared for time course of the areas of anaesthesia for the tested sensory modalities.
Results
Initial extension of anaesthetic areas at 30 min did not differ between both LA concentrations. At 180 min only the anaesthetic areas to nociceptive stimuli were reduced at the site of lower mepivacaine injection (260mN: 204mm2 (18; 244; median difference and 95% confidence interval; p < 0.05), heat: 276mm2 (3; 305)). In contrast, no significant differences were found between the two concentration when non-nociceptive stimuli were used (100mN: 187mm2 (4; 240), p >0.05, brush: 159mm2 (–59; 202)).
Conclusion
Equal initial sizes of anaesthesia areas for all sensory modalities can be explained by supramaximal perineural LA molecule concentration in both administered mepivacaine dosages. Upon washout of the LA nociceptive function is restored faster as compared to non-nociceptive sensation and higher concentration of the LA are required to maintain the analgesia. Quantitative sensory testing is able to detect different susceptibility of low threshold mechanosensors and subtypes of nociceptive C-fibres to mepivacaine. Using painful mechanical, heat and electrical stimulation different classes of nociceptors will be activated. The analgesic areas to electrical stimulation were particularly small; one might therefore hypothesize that the proposed protocol allows to also differentiate mechano-insensitive (“silent”) and mechanosensitive (“polymodal”) nociceptors.
Implications
QST is a non-invasive method to functionally examine sensory modalities and their pharmacological modulation in humans. The method is sufficiently sensitive to differentiate the analgesic properties of mepivacaine at 0.5 and 1% and might also be adequate to different classes of nociceptors. Further development of nociceptive stimuli including supra-threshold encoding characteristics will enable to investigate peripheral analgesic effects more specifically and thus might help to design new analgesics with preferential effect on high frequency discharge of nociceptors.
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Differential Effects of Low Dose Lidocaine on C-Fiber Classes in Humans. THE JOURNAL OF PAIN 2012. [DOI: 10.1016/j.jpain.2012.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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22
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Kleggetveit IP, Namer B, Schmidt R, Helås T, Rückel M, Ørstavik K, Schmelz M, Jørum E. High spontaneous activity of C-nociceptors in painful polyneuropathy. Pain 2012; 153:2040-2047. [DOI: 10.1016/j.pain.2012.05.017] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
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23
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Obreja O, Hirth M, Turnquist B, Rukwied R, Ringkamp M, Schmelz M. The Differential Effects of Two Sodium Channel Modulators on the Conductive Properties of C-Fibers in Pig Skin In Vivo. Anesth Analg 2012; 115:560-71. [DOI: 10.1213/ane.0b013e3182542843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Double spikes to single electrical stimulation correlates to spontaneous activity of nociceptors in painful neuropathy patients. Pain 2012; 153:391-398. [DOI: 10.1016/j.pain.2011.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 09/29/2011] [Accepted: 10/28/2011] [Indexed: 11/21/2022]
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25
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Microneurographic identification of spontaneous activity in C-nociceptors in neuropathic pain states in humans and rats. Pain 2011; 153:42-55. [PMID: 21993185 DOI: 10.1016/j.pain.2011.08.015] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/11/2011] [Accepted: 08/15/2011] [Indexed: 12/21/2022]
Abstract
C-nociceptors do not normally fire action potentials unless challenged by adequate noxious stimuli. However, in pathological states nociceptors may become hyperexcitable and may generate spontaneous ectopic discharges. The aim of this study was to compare rat neuropathic pain models and to assess their suitability to model the spontaneous C-nociceptor activity found in neuropathic pain patients. Studies were performed in normal rats (n=40), healthy human subjects (n=15), peripheral neuropathic pain patients (n=20), and in five rat neuropathic pain models: nerve crush (n=24), suture (n=14), chronic constriction injury (n=12), STZ-induced diabetic neuropathy (n=56), and ddC-induced neuropathy (n=15). Microneurographic recordings were combined with electrical stimulation to monitor activity in multiple C fibers. Stimulation at 0.25 Hz allowed spontaneous impulses to be identified by fluctuations in baseline latency. Abnormal latency fluctuations could be produced by several mechanisms, and spontaneous activity was most reliably identified by the presence of unexplained latency increases corresponding to two or more additional action potentials. Spontaneous activity was present in a proportion of mechano-insensitive C-nociceptors in the patients and all rat models. The three focal traumatic nerve injury models provided the highest proportion (59.5%), whereas the two polyneuropathy models had fewer (18.6%), and the patients had an intermediate proportion (33.3%). Spontaneously active mechano-sensitive C-nociceptors were not recorded. Microneurographic recordings of spontaneous activity in diseased C-nociceptors may be useful for both short- and long-term drug studies, both in animals and in humans.
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Obreja O, Ringkamp M, Turnquist B, Hirth M, Forsch E, Rukwied R, Petersen M, Schmelz M. Nerve growth factor selectively decreases activity-dependent conduction slowing in mechano-insensitive C-nociceptors. Pain 2011; 152:2138-2146. [DOI: 10.1016/j.pain.2011.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/27/2011] [Accepted: 05/18/2011] [Indexed: 01/07/2023]
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27
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Bucher D, Goaillard JM. Beyond faithful conduction: short-term dynamics, neuromodulation, and long-term regulation of spike propagation in the axon. Prog Neurobiol 2011; 94:307-46. [PMID: 21708220 PMCID: PMC3156869 DOI: 10.1016/j.pneurobio.2011.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 05/27/2011] [Accepted: 06/07/2011] [Indexed: 12/13/2022]
Abstract
Most spiking neurons are divided into functional compartments: a dendritic input region, a soma, a site of action potential initiation, an axon trunk and its collaterals for propagation of action potentials, and distal arborizations and terminals carrying the output synapses. The axon trunk and lower order branches are probably the most neglected and are often assumed to do nothing more than faithfully conducting action potentials. Nevertheless, there are numerous reports of complex membrane properties in non-synaptic axonal regions, owing to the presence of a multitude of different ion channels. Many different types of sodium and potassium channels have been described in axons, as well as calcium transients and hyperpolarization-activated inward currents. The complex time- and voltage-dependence resulting from the properties of ion channels can lead to activity-dependent changes in spike shape and resting potential, affecting the temporal fidelity of spike conduction. Neural coding can be altered by activity-dependent changes in conduction velocity, spike failures, and ectopic spike initiation. This is true under normal physiological conditions, and relevant for a number of neuropathies that lead to abnormal excitability. In addition, a growing number of studies show that the axon trunk can express receptors to glutamate, GABA, acetylcholine or biogenic amines, changing the relative contribution of some channels to axonal excitability and therefore rendering the contribution of this compartment to neural coding conditional on the presence of neuromodulators. Long-term regulatory processes, both during development and in the context of activity-dependent plasticity may also affect axonal properties to an underappreciated extent.
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Affiliation(s)
- Dirk Bucher
- The Whitney Laboratory and Department of Neuroscience, University of Florida, St. Augustine, FL 32080, USA.
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28
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Obreja O, Kluschina O, Mayer A, Hirth M, Schley M, Schmelz M, Rukwied R. NGF enhances electrically induced pain, but not axon reflex sweating. Pain 2011; 152:1856-1863. [DOI: 10.1016/j.pain.2011.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/23/2011] [Accepted: 04/01/2011] [Indexed: 01/16/2023]
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29
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Tulleuda A, Cokic B, Callejo G, Saiani B, Serra J, Gasull X. TRESK channel contribution to nociceptive sensory neurons excitability: modulation by nerve injury. Mol Pain 2011; 7:30. [PMID: 21527011 PMCID: PMC3095542 DOI: 10.1186/1744-8069-7-30] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/28/2011] [Indexed: 01/01/2023] Open
Abstract
Background Neuronal hyperexcitability is a crucial phenomenon underlying spontaneous and evoked pain. In invertebrate nociceptors, the S-type leak K+ channel (analogous to TREK-1 in mammals) plays a critical role of in determining neuronal excitability following nerve injury. Few data are available on the role of leak K2P channels after peripheral axotomy in mammals. Results Here we describe that rat sciatic nerve axotomy induces hyperexcitability of L4-L5 DRG sensory neurons and decreases TRESK (K2P18.1) expression, a channel with a major contribution to total leak current in DRGs. While the expression of other channels from the same family did not significantly change, injury markers ATF3 and Cacna2d1 were highly upregulated. Similarly, acute sensory neuron dissociation (in vitro axotomy) produced marked hyperexcitability and similar total background currents compared with neurons injured in vivo. In addition, the sanshool derivative IBA, which blocked TRESK currents in transfected HEK293 cells and DRGs, increased intracellular calcium in 49% of DRG neurons in culture. Most IBA-responding neurons (71%) also responded to the TRPV1 agonist capsaicin, indicating that they were nociceptors. Additional evidence of a biological role of TRESK channels was provided by behavioral evidence of pain (flinching and licking), in vivo electrophysiological evidence of C-nociceptor activation following IBA injection in the rat hindpaw, and increased sensitivity to painful pressure after TRESK knockdown in vivo. Conclusions In summary, our results clearly support an important role of TRESK channels in determining neuronal excitability in specific DRG neurons subpopulations, and show that axonal injury down-regulates TRESK channels, therefore contributing to neuronal hyperexcitability.
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Affiliation(s)
- Astrid Tulleuda
- Neurophysiology Lab, Dept, Physiological Sciences I, Medical School, University of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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30
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Campero M, Bostock H, Baumann TK, Ochoa JL. Activity-dependent slowing properties of an unmyelinated low threshold mechanoreceptor in human hairy skin. Neurosci Lett 2011; 493:92-6. [PMID: 21335061 DOI: 10.1016/j.neulet.2011.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 02/01/2011] [Accepted: 02/05/2011] [Indexed: 02/04/2023]
Abstract
It has been previously shown that unmyelinated afferent fibres in human skin are differentiated not only by their receptor characteristics, but also by their profiles of activity-dependent slowing. One type of profile, described originally as 'type 3', is different from that of nociceptors (type 1), cold afferents (type 2) and sympathetic efferents (type 4), in that these fibres display a minimal activity-dependent slowing (∼1% at 2 Hz). However, their function remains to be determined. Here we describe one unit with a typical 'type 3' activity-dependent slowing profile recorded from an undamaged fascicle of the superficial peroneal nerve of a patient. Its conduction velocity was 1.8 m s(-1) and it slowed by 1.3% during the 2 Hz tetanus. This unit had a mechanical receptive field in the hairy skin and responded readily to weak mechanical stimuli, and not to cold. This suggests that the low threshold unmyelinated mechanoreceptors recently described in human hairy skin are probably endowed with a 'type 3' activity-dependent profile.
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Affiliation(s)
- Mario Campero
- Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Chile.
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Serra J, Solà R, Aleu J, Quiles C, Navarro X, Bostock H. Double and triple spikes in C-nociceptors in neuropathic pain states: An additional peripheral mechanism of hyperalgesia. Pain 2011; 152:343-353. [DOI: 10.1016/j.pain.2010.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 09/20/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
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Taguchi T, Ota H, Matsuda T, Murase S, Mizumura K. Cutaneous C-fiber nociceptor responses and nociceptive behaviors in aged Sprague-Dawley rats. Pain 2010; 151:771-782. [PMID: 20933329 DOI: 10.1016/j.pain.2010.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/11/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
Abstract
The change with age in pain perception in humans and the nociceptive behaviors in animals elicited by noxious stimuli to the skin are not well understood, and little is known about the peripheral neural mechanisms of cutaneous nociception in the aged. We systematically examined cutaneous nociceptor responses and nociceptive behaviors in young (9-14 w) and in aged (127-138 w) Sprague-Dawley rats. C-fiber nociceptors in the skin were identified by mechanical and electrical stimulation, and extracellularly recorded from hind paw skin-saphenous nerve preparations in vitro. In the aged rats, the proportions of mechano-responsive and/or heat-responsive C-nociceptors were significantly lower. The proportion of mechano- and thermo-insensitive units, on the other hand, was significantly increased. In addition, the response threshold to mechanical stimulus tended to be higher and the magnitude of the response tended to be smaller. There were no differences between the two age groups in the response magnitudes of mechano-responsive C-nociceptors to bradykinin, cold or heat. Repetitive electrical stimulation of afferent fibers revealed exaggerated slowing of conduction velocity in mechano-responsive C-fibers in the aged. This showed for the first time that not only receptive properties of afferent terminals but also membrane properties of conducting axons are changed in aged rats. Nociceptive behaviors in response to noxious levels of cold (cold plate test) and heat (Hargreaves' radiant heat test) were facilitated in aged animals, while mechanical sensitivity measured by von Frey hairs remained unchanged. These discrepancies between the changes in peripheral afferents and the behavioral outcomes might be explained by facilitatory changes in the central nervous system.
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Affiliation(s)
- Toru Taguchi
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
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Campero M, Bostock H, Baumann TK, Ochoa JL. A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome. Clin Neurophysiol 2010; 121:1072-9. [PMID: 20359942 PMCID: PMC2879435 DOI: 10.1016/j.clinph.2009.12.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Although the term 'reflex sympathetic dystrophy' has been replaced by 'complex regional pain syndrome' (CRPS) type I, there remains a widespread presumption that the sympathetic nervous system is actively involved in mediating chronic neuropathic pain ["sympathetically maintained pain" (SMP)], even in the absence of detectable neuropathophysiology. METHODS We have used microneurography to evaluate possible electrophysiological interactions in 24 patients diagnosed with CRPS I (n=13), or CRPS II (n=11) by simultaneously recording from single identified sympathetic efferent fibers and C nociceptors, while provoking sympathetic neural discharges in cutaneous nerves. RESULTS We assessed potential effects of sympathetic activity upon 35 polymodal nociceptors and 19 mechano-insensitive nociceptors, recorded in CRPS I (26 nociceptors) and CRPS II patients (28 nociceptors). No evidence of activation of nociceptors related to sympathetic discharge was found, although nociceptors in six CRPS II patients exhibited unrelated spontaneous pathological nerve impulse activity. CONCLUSIONS We conclude that activation of nociceptors by sympathetic efferent discharges is not a cardinal pathogenic event in either CRPS I or CRPS II patients. SIGNIFICANCE This study shows that sympathetic-nociceptor interactions, if they exist in patients communicating chronic neuropathic pain, must be the exception.
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Affiliation(s)
- Mario Campero
- Departamento de Neurología, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile. Av. Manquehue Norte 1410, piso 10, Vitacura, Santiago, Chile.
| | - Hugh Bostock
- Institute of Neurology, Queen Square, London WC1N 3BG, U.K.,
| | - Thomas K. Baumann
- Department of Neurological Surgery, CR-137, Oregon Health & Science University, Portland, OR, U.S.A.,
| | - José L. Ochoa
- Legacy Good Samaritan Hospital & Medical Center and Oregon Health & Science University, Portland, OR, U.S.A.,
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Ringkamp M, Johanek LM, Borzan J, Hartke TV, Wu G, Pogatzki-Zahn EM, Campbell JN, Shim B, Schepers RJ, Meyer RA. Conduction properties distinguish unmyelinated sympathetic efferent fibers and unmyelinated primary afferent fibers in the monkey. PLoS One 2010; 5:e9076. [PMID: 20140089 PMCID: PMC2816714 DOI: 10.1371/journal.pone.0009076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 01/11/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Different classes of unmyelinated nerve fibers appear to exhibit distinct conductive properties. We sought a criterion based on conduction properties for distinguishing sympathetic efferents and unmyelinated, primary afferents in peripheral nerves. METHODOLOGY/PRINCIPAL FINDINGS In anesthetized monkey, centrifugal or centripetal recordings were made from single unmyelinated nerve fibers in the peroneal or sural nerve, and electrical stimuli were applied to either the sciatic nerve or the cutaneous nerve endings, respectively. In centrifugal recordings, electrical stimulation at the sympathetic chain and dorsal root was used to determine the fiber's origin. In centrifugal recordings, sympathetic fibers exhibited absolute speeding of conduction to a single pair of electrical stimuli separated by 50 ms; the second action potential was conducted faster (0.61 0.16%) than the first unconditioned action potential. This was never observed in primary afferents. Following 2 Hz stimulation (3 min), activity-dependent slowing of conduction in the sympathetics (8.6 0.5%) was greater than in one afferent group (6.7 0.5%) but substantially less than in a second afferent group (29.4 1.9%). In centripetal recordings, most mechanically-insensitive fibers also exhibited absolute speeding to twin pulse stimulation. The subset that did not show this absolute speeding was responsive to chemical stimuli (histamine, capsaicin) and likely consists of mechanically-insensitive afferents. During repetitive twin pulse stimulation, mechanosensitive afferents developed speeding, and speeding in sympathetic fibers increased. CONCLUSIONS/SIGNIFICANCE The presence of absolute speeding provides a criterion by which sympathetic efferents can be differentiated from primary afferents. The differences in conduction properties between sympathetics and afferents likely reflect differential expression of voltage-sensitive ion channels.
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Affiliation(s)
- Matthias Ringkamp
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
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Obreja O, Schmelz M. Single-fiber recordings of unmyelinated afferents in pig. Neurosci Lett 2010; 470:175-9. [DOI: 10.1016/j.neulet.2009.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 10/01/2009] [Accepted: 10/02/2009] [Indexed: 11/28/2022]
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Carr RW, Sittl R, Fleckenstein J, Grafe P. GABA increases electrical excitability in a subset of human unmyelinated peripheral axons. PLoS One 2010; 5:e8780. [PMID: 20098693 PMCID: PMC2808338 DOI: 10.1371/journal.pone.0008780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 12/29/2009] [Indexed: 11/28/2022] Open
Abstract
Background A proportion of small diameter primary sensory neurones innervating human skin are chemosensitive. They respond in a receptor dependent manner to chemical mediators of inflammation as well as naturally occurring algogens, thermogens and pruritogens. The neurotransmitter GABA is interesting in this respect because in animal models of neuropathic pain GABA pre-synaptically regulates nociceptive input to the spinal cord. However, the effect of GABA on human peripheral unmyelinated axons has not been established. Methodology/Principal Findings Electrical stimulation was used to assess the effect of GABA on the electrical excitability of unmyelinated axons in isolated fascicles of human sural nerve. GABA (0.1–100 µM) increased electrical excitability in a subset (ca. 40%) of C-fibres in human sural nerve fascicles suggesting that axonal GABA sensitivity is selectively restricted to a sub-population of human unmyelinated axons. The effects of GABA were mediated by GABAA receptors, being mimicked by bath application of the GABAA agonist muscimol (0.1–30 µM) while the GABAB agonist baclofen (10–30 µM) was without effect. Increases in excitability produced by GABA (10–30 µM) were blocked by the GABAA antagonists gabazine (10–20 µM), bicuculline (10–20 µM) and picrotoxin (10–20 µM). Conclusions/Significance Functional GABAA receptors are present on a subset of unmyelinated primary afferents in humans and their activation depolarizes these axons, an effect likely due to an elevated intra-axonal chloride concentration. GABAA receptor modulation may therefore regulate segmental and peripheral components of nociception.
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Affiliation(s)
- Richard W Carr
- Institute of Physiology, Ludwig-Maximilians University, Munich, Germany.
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37
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Obreja O, Ringkamp M, Namer B, Forsch E, Klusch A, Rukwied R, Petersen M, Schmelz M. Patterns of activity-dependent conduction velocity changes differentiate classes of unmyelinated mechano-insensitive afferents including cold nociceptors, in pig and in human. Pain 2010; 148:59-69. [DOI: 10.1016/j.pain.2009.10.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 09/08/2009] [Accepted: 10/06/2009] [Indexed: 11/30/2022]
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Campero M, Baumann TK, Bostock H, Ochoa JL. Human cutaneous C fibres activated by cooling, heating and menthol. J Physiol 2009; 587:5633-52. [PMID: 19822550 DOI: 10.1113/jphysiol.2009.176040] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Differential A-fibre block of human peripheral nerves changes the sensation evoked by innocuous cooling (approximately 24 degrees C) of the skin from 'cold' to 'hot' or 'burning', and this has been attributed to activity in unidentified unmyelinated fibres that is normally masked or inhibited by activity in Adelta cold fibres. Application of the TRPM8 agonist menthol to the skin evokes 'burning/stinging' as well as 'cold', and the unpleasant sensations are also enhanced by A-fibre block. In this study we used microneurography to search for C fibres in human skin activated by cooling and menthol, which could be responsible for these phenomena. Afferent C fibres were classified by activity-dependent slowing as Type 1A (polymodal nociceptor), Type 1B (mechanically insensitive nociceptor) or Type 2 (cold sensitive), and their responses to heating and cooling ramps were measured before and after topical application of menthol preparations (2-50%). The only C fibres activated by menthol were the Type 2 fibres, which discharged vigorously with innocuous cooling and were strongly activated and sensitized to cooling by menthol. Unlike an Adelta cold fibre, they continued to discharge at skin temperatures down to 0 degrees C, and most (13/15) were also activated by heating. We propose that the Type 2 C fibres, although resembling Adelta cold fibres in their responses to innocuous cooling and menthol, have a more complex sensory function, colouring with a 'hot-burning' quality the perceptions of low and high temperatures. Their bimodal thermoreceptive properties may help account for several puzzling psychophysical phenomena, such as 'innocuous cold nociception', 'paradoxical heat' and the thermal grill illusion, and also for some neuropathic pains.
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Affiliation(s)
- M Campero
- Facultad de Medicina, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
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Microneurography in rats: a minimally invasive method to record single C-fiber action potentials from peripheral nerves in vivo. Neurosci Lett 2009; 470:168-74. [PMID: 19800936 DOI: 10.1016/j.neulet.2009.09.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 09/27/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
Abstract
Microneurography is a method suitable for recording intraneural single or multiunit action potentials in conscious subjects. Microneurography has rarely been applied to animal experiments, where more invasive methods, like the teased fiber recording technique, are widely used. We have tested the feasibility of microneurographic recordings from the peripheral nerves of rats. Tungsten microelectrodes were inserted into the sciatic nerve at mid-thigh level. Single or multiunit action potentials evoked by regular electrical stimulation were recorded, digitized and displayed as a raster plot of latencies. The method allows unambiguous recording and recognition of single C-fiber action potentials from an in vivo preparation, with minimal disruption of the nerve being recorded. Multiple C-fibers can be recorded simultaneously for several hours, and if the animal is allowed to recover, repeated recording sessions can be obtained from the same nerve at the same level over a period of weeks or months. Also, single C units can be functionally identified by their changes in latency to natural stimuli, and insensitive units can be recognized as 'silent' nociceptors or sympathetic efferents by their distinctive profiles of activity-dependent slowing during repetitive electrical stimulation, or by the effect on spontaneous efferent activity of a proximal anesthetic block. Moreover, information about the biophysical properties of C axons can be obtained from their latency recovery cycles. Finally, we show that this preparation is potentially suitable for the study of C-fiber behavior in models of neuropathies and nerve lesions, both under resting conditions and in response to drug administration.
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40
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Age related changes in human C-fiber function. Neurosci Lett 2009; 470:185-7. [PMID: 19607877 DOI: 10.1016/j.neulet.2009.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 07/06/2009] [Accepted: 07/08/2009] [Indexed: 11/23/2022]
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Namer B, Barta B, Ørstavik K, Schmidt R, Carr R, Schmelz M, Handwerker HO. Microneurographic assessment of C-fibre function in aged healthy subjects. J Physiol 2008; 587:419-28. [PMID: 19064617 DOI: 10.1113/jphysiol.2008.162941] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Physiological changes in the nervous system occur with ageing. Both a decline of function and a decrease in the number of C-fibres in the skin have been reported for healthy aged subjects. With the use of microneurographic recordings from single C-fibres in humans we have compared the sensory and axonal properties of these neurones in young and aged healthy subjects. A total of 146 C-fibres were recorded from the common peroneal nerve in young subjects (mean age 24.7 years) and 230 C-fibres were recorded in aged subjects (mean age 56.2 years). In aged subjects, changes were found in the composition of the C-fibre population and in sensory and axonal properties. The relative incidence of afferent to efferent C-fibres was relatively constant independent of the age of subjects. The ratio of mechano-responsive to mechano-insensitive nociceptors was approximately 8 : 2 in the young controls while in aged subjects it was 7 : 3. In aged subjects 13% of the fibres showed atypical discharge characteristics, while this was not observed in young subjects. Spontaneous activity, sensitization and loss of sensory function were found regularly. Changes in functions of the conductile membrane were also observed in fibres from aged subjects. The degree of activity-dependent conduction velocity slowing in response to high frequency stimulation (2 Hz) was more pronounced, while the normalization of conduction velocity subsequent to high frequency stimulation was protracted. We found that both sensitization and desensitization or degeneration of afferent C-fibres occur with age, but are still rare compared to patients with neuropathy. The changes in the axonal properties of C-fibres in aged subjects are compatible with hypoexcitability of the fibres. These findings are important for the understanding and differential diagnoses regarding pathological processes and normal ageing.
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Affiliation(s)
- B Namer
- Department of Physiology and Pathophysiology, University of Erlangen, Erlangen, Germany.
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42
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De Col R, Messlinger K, Carr RW. Conduction velocity is regulated by sodium channel inactivation in unmyelinated axons innervating the rat cranial meninges. J Physiol 2007; 586:1089-103. [PMID: 18096592 DOI: 10.1113/jphysiol.2007.145383] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Axonal conduction velocity varies according to the level of preceding impulse activity. In unmyelinated axons this typically results in a slowing of conduction velocity and a parallel increase in threshold. It is currently held that Na(+)-K(+)-ATPase-dependent axonal hyperpolarization is responsible for this slowing but this has long been equivocal. We therefore examined conduction velocity changes during repetitive activation of single unmyelinated axons innervating the rat cranial meninges. In direct contradiction to the currently accepted postulate, Na(+)-K(+)-ATPase blockade actually enhanced activity-induced conduction velocity slowing, while the degree of velocity slowing was curtailed in the presence of lidocaine (10-300 microm) and carbamazepine (30-500 microm) but not tetrodotoxin (TTX, 10-80 nm). This suggests that a change in the number of available sodium channels is the most prominent factor responsible for activity-induced changes in conduction velocity in unmyelinated axons. At moderate stimulus frequencies, axonal conduction velocity is determined by an interaction between residual sodium channel inactivation following each impulse and the retrieval of channels from inactivation by a concomitant Na(+)-K(+)-ATPase-mediated hyperpolarization. Since the process is primarily dependent upon sodium channel availability, tracking conduction velocity provides a means of accessing relative changes in the excitability of nociceptive neurons.
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Affiliation(s)
- Roberto De Col
- Institute for Physiology and Pathophysiology, University of Erlangen-Nuremberg, Erlangen, Germany
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43
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Lang PM, Moalem-Taylor G, Tracey DJ, Bostock H, Grafe P. Activity-Dependent Modulation of Axonal Excitability in Unmyelinated Peripheral Rat Nerve Fibers by the 5-HT(3) Serotonin Receptor. J Neurophysiol 2006; 96:2963-71. [PMID: 16956988 DOI: 10.1152/jn.00716.2006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Activity-dependent fluctuations in axonal excitability and changes in interspike intervals modify the conduction of trains of action potentials in unmyelinated peripheral nerve fibers. During inflammation of a nerve trunk, long stretches of axons are exposed to inflammatory mediators such as 5-hydroxytryptamine [5-HT]. In the present study, we have tested the effects of m-chlorophenylbiguanide (mCPBG), an agonist at the 5-HT(3) serotonin receptor, on activity- and potential-dependent variations in membrane threshold and conduction velocity of unmyelinated C-fiber axons of isolated rat sural nerve segments. The increase in axonal excitability during application of mCPBG was much stronger at higher frequencies of action potentials and/or during axonal membrane hyperpolarization. The effects on the postspike recovery cycle also depended on the rate of stimulation. At an action potential frequency of 1 Hz or in hyperpolarized axons, mCPBG produced a loss of superexcitability. In contrast, at 0.33 Hz, a small increase in the postspike subexcitability was observed. Similar effects on excitability changes were found when latency instead of threshold was recorded, but only at higher action potential frequencies: at 1.8 Hz, mCPBG increased conduction velocity and reduced postspike supernormality. The latter effect would increase the interspike interval if pairs of action potentials were conducted along several cm in an inflamed nerve trunk. These data indicate that activation of axonal 5-HT(3) receptors not only enhances membrane excitability but also modulates action potential trains in unmyelinated, including nociceptive, nerve fibers at high impulse rates.
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Affiliation(s)
- Philip M Lang
- Department of Physiology, University of Munich, Pettenkoferstrasse 12, D-80336 Munich, Germany
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Ørstavik K, Namer B, Schmidt R, Schmelz M, Hilliges M, Weidner C, Carr RW, Handwerker H, Jørum E, Torebjörk HE. Abnormal function of C-fibers in patients with diabetic neuropathy. J Neurosci 2006; 26:11287-94. [PMID: 17079656 PMCID: PMC6674548 DOI: 10.1523/jneurosci.2659-06.2006] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The mechanisms underlying the development of painful and nonpainful neuropathy associated with diabetes mellitus are unclear. We have obtained microneurographic recordings from unmyelinated fibers in eight patients with diabetes mellitus, five with painful neuropathy, and three with neuropathy without pain. All eight patients had large-fiber neuropathy, and seven patients had pathological thermal thresholds in their feet, indicating the involvement of small-caliber nerve fibers. A total of 163 C-fibers were recorded at knee level from the common peroneal nerve in the patients (36-67 years old), and these were compared with 77 C-fibers from healthy controls (41-64 years old). The ratio of mechano-responsive to mechano-insensitive nociceptors was approximately 2:1 in the healthy controls, whereas in the patients, it was 1:2. In patients, a fairly large percentage of characterized fibers (12.5% in nonpainful and 18.9% in painful neuropathy) resembled mechano-responsive nociceptors that had lost their mechanical and heat responsiveness. Such fibers were rarely encountered in age-matched controls (3.2%). Afferent fibers with spontaneous activity or mechanical sensitization were found in both patient groups. We conclude that small-fiber neuropathy in diabetes affects receptive properties of nociceptors that leads to an impairment of mechano-responsive nociceptors.
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45
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George A, Serra J, Navarro X, Bostock H. Velocity recovery cycles of single C fibres innervating rat skin. J Physiol 2006; 578:213-32. [PMID: 17023508 PMCID: PMC2075106 DOI: 10.1113/jphysiol.2006.116129] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To improve knowledge about axonal membrane properties in nociceptive and non-nociceptive C fibres, we studied impulse-dependent velocity changes by in vivo microneurography in the rat sciatic nerve. Cutaneous C fibres were classified, based primarily on their activity-dependent slowing profile, as Type 1A (mechano-responsive nociceptors; CMR; n = 23), Type 1B (mechano-insensitive nociceptors; CMI; n = 24), Type 2 (cold units; n = 2), Type 3 units (unknown function; n = 4) or Type 4 (presumed sympathetics; n = 23) units. They were excited by single, double and triple electrical stimuli to the skin at mean rates of 0.25, 0.5, 1 and 2 Hz and with interstimulus intervals ranging from 2 to 1000 ms. All CMRs exhibited only postspike subnormality at 0.25 and 0.5 Hz. They gradually developed supernormality with higher stimulation rates, and 12/19 CMRs were supernormal at 1 Hz. The CMIs showed a greater tendency towards supernormality, with 10/21 already supernormal at 0.25 Hz, 17/24 at 0.5 Hz and all were supernormal at 1 Hz. In some CMIs but in none of the CMRs, the supernormal period was directly followed by a peak in late subnormality. Among non-nociceptive fibres, all Type 4 units exhibited long-lasting supernormality independent of the stimulation rate, whereas the cold units showed short-lived supernormality. In both, supernormality increased with higher stimulation rates. Regardless of fibre function or stimulation rate, a second conditioning stimulus always induced additional slowing, providing evidence for a passive origin of supernormality in all rat C fibre subtypes. However, the degree and time-course of extra slowing due to a preconditioning stimulus was highly dependent on fibre function and stimulation rate. These data indicate axonal membrane differences between different functional classes of C fibres, which resemble those previously described in human C fibres.
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Affiliation(s)
- Annette George
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
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Ochoa JL, Campero M, Serra J, Bostock H. Hyperexcitable polymodal and insensitive nociceptors in painful human neuropathy. Muscle Nerve 2005; 32:459-72. [PMID: 15973653 DOI: 10.1002/mus.20367] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Six patients with chronic pain, mechanical and thermal hyperalgesia/allodynia, and cutaneous vasodilatation starting distally in their extremities, were evaluated using clinical and neurophysiological methods and microneurography. Evidence of small-fiber polyneuropathy was documented in all, but the etiology remained cryptogenic in several. Different forms of hyperexcitability were detected by microneurography in both common polymodal and mechanically insensitive C nociceptors, which explain all the somatosensory abnormalities. Signs of hyperexcitability included reduced receptor threshold (accounting for mechanical and heat allodynias), spontaneous C nociceptor discharge (explaining spontaneous "burning" pain and antidromic vasodilatation), and multiplied nociceptor responses to stimulation (accounting for hyperalgesia). The clinical and electrophysiological profiles of these patients resemble the experimental syndrome evoked by application of capsaicin to the skin. This similarity, and the striking heat dependence of the spontaneous pain, suggest that a common feature may be altered expression or modulation of vanilloid 1 receptor, provoking abnormal nociceptor discharges.
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Affiliation(s)
- José L Ochoa
- Good Samaritan Hospital & Medical Center Oregon Health & Science University, Portland, Oregon 97210, USA.
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47
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Bostock H, Campero M, Serra J, Ochoa JL. Temperature-dependent double spikes in C-nociceptors of neuropathic pain patients. Brain 2005; 128:2154-63. [PMID: 15947060 DOI: 10.1093/brain/awh552] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Five patients with small-fibre neuropathy characterized by temperature-dependent spontaneous pain, hyperalgesia/allodynia and signs of neurogenic inflammation were studied clinically and thermographically, and by microneurography. Thermography revealed hyperthermia confined to painful and hyperalgesic skin of distal extremities, in absence of sympathetic vasomotor denervation. Quantitative sensory testing documented either reduced thresholds or increased suprathreshold magnitude for heat pain. Microneurography identified 13 primary cutaneous C-nociceptors generating abnormal impulses in response to electrical stimuli and, in one patient, nociceptors firing spontaneously. All five patients showed examples of double spikes, in which a single brief electrical stimulus occasionally or regularly evoked two impulses. In one case, a second impulse occurred at one of three different delays. In all five patients, warming of the skin increased the probability of a second impulse occurring. Impulse doubling has previously been reported as occurring rarely in normal subjects and is attributable to unfiltering of multiple orthodromic impulses due to unidirectional conduction failure at branch points. A higher incidence of double firing in neuropathic pain patients is probably due to a reduced safety factor for conduction in the terminal arborizations of their C-nociceptors. These observations show that unidirectional conduction block provides a peripheral mechanism of temperature-dependent nociceptor hyperactivity in small-fibre neuropathy that may contribute to hyperalgesia.
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