Interaction between substance P and excitatory amino acid receptors in modulation of nociceptive responses of cat spinal dorsal horn neurons

Roles of glutamate, substance P, and gastrin-releasing peptide as spinal neurotransmitters of histaminergic and nonhistaminergic itch

We investigated roles for substance P (SP), gastrin-releasing peptide (GRP), and glutamate in the spinal neurotransmission of histamine-dependent and -independent itch. In anesthetized mice, responses of single superficial dorsal horn neurons to intradermal (i.d.) injection of chloroquine were partially reduced by spinal application of the α-amino-3-hydroxy-5-methyl-4-isoxazole proprionate acid (AMPA)/kainate antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). Co-application of CNQX plus a neurokinin-1 (NK-1) antagonist produced stronger inhibition, while co-application of CNQX, NK-1, and GRP receptor (GRPR) antagonists completely inhibited firing. Nociceptive-specific and wide dynamic range-type neurons exhibited differential suppression by CNQX plus either the GRPR or NK-1 antagonist, respectively. Neuronal responses elicited by i.d. histamine were abolished by CNQX alone. In behavioral studies, individual intrathecal administration of a GRPR, NK-1, or AMPA antagonist each significantly attenuated chloroquine-evoked scratching behavior. Co-administration of the NK-1 and AMPA antagonists was more effective, and administration of all 3 antagonists abolished scratching. Intrathecal CNQX alone prevented histamine-evoked scratching behavior. We additionally employed a double-label strategy to investigate molecular markers of pruritogen-sensitive dorsal root ganglion (DRG) cells. DRG cells responsive to histamine and/or chloroquine, identified by calcium imaging, were then processed for co-expression of SP, GRP, or vesicular glutamate transporter type 2 (VGLUT2) immunofluorescence. Subpopulations of chloroquine- and/or histamine-sensitive DRG cells were immunopositive for SP and/or GRP, with >80% immunopositive for VGLUT2. These results indicate that SP, GRP, and glutamate each partially contribute to histamine-independent itch. Histamine-evoked itch is mediated primarily by glutamate, with GRP playing a lesser role. Co-application of NK-1, GRP, and AMPA receptor antagonists may prove beneficial in treating chronic itch.

Differential contributions of NMDA and non-NMDA receptors to spinal Fos expression evoked by superficial tissue and muscle inflammation in the rat

The role of N-methyl-D-aspartate (NMDA) and non-NMDA receptors in the spinal cord in the transmission of nociceptive afferents from superficial tissue and muscle was studied by examining the effects of NMDA or non-NMDA receptor antagonists on Fos expression in the spinal dorsal horn. Muscle inflammation was induced by injection of turpentine oil into the gastrocnemius muscle, whereas superficial tissue inflammation was induced by an intraplantar injection of turpentine oil into the hindpaw. The NMDA receptor antagonist DL-2-amino-5-phosphonovaleric acid (AP-5), the non-NMDA receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX) or normal saline were intrathecally administered 15 min before an intramuscular or intraplantar injection of turpentine oil. Muscle inflammation evoked expression of Fos-like immunoreactive neurons staining in neurons that were predominantly distributed in the middle portions of laminae I-II(outer) and the lateral portions of laminae V-VI of the ipsilateral dorsal horn at the spinal L(4)-L(5). DNQX, but not AP-5, significantly reduced the total number of Fos-like immunoreactive neurons evoked by muscle inflammation. In contrast, superficial tissue inflammation evoked expression of Fos-like immunoreactive neurons in the medial portions of laminae I-II(outer) and V-VI of the ipsilateral dorsal horn at the spinal L(4)-L(5) that was blocked by AP-5, but not by DNQX. Injection of normal saline did not influence the numbers of Fos-LI neurons. These results indicate that different glutamate receptors in the dorsal horn of the spinal cord may mediate nociceptive input from superficial tissue (particularly skin) and muscle. DNQX receptors may mediate transmission of nociceptive information originating in muscle, while NMDA receptors may preferentially mediate transmission of nociceptive information originating in skin.

Change in excitability and phenotype of substance P and its receptor in cat Abeta sensory neurons following peripheral inflammation

The effect of peripheral inflammation on spontaneous firing and level of substance P (SP) and its receptor in electrophysiologically identified cat Abeta neurons of dorsal root ganglion (DRG) was studied in vivo using a combination of intracellular recording, dye injection and immunohistochemical techniques. Following injection of carrageenan (Carg) into cat hindpaw, the number of Abeta neurons with spontaneous firing was enhanced significantly (42.9%, n=182) in comparison with control (16.8%, n=149, P<0.01). DRG Abeta neurons became less depolarized 2-4 h following Carg injection. After identifying the cell properties, Lucifer Yellow was injected and SP-like immunoreactivity (SP-LI) was then detected. A total of 17% of Abeta sensory neurons exhibited SP-LI in inflammatory cat. We also found in rat DRGs that the number of SP-LI positive large cells (>35 microm) was also significantly increased in Carg-treated DRG (11.8+/-1.2, n=8) compared with untreated DRG (1.8+/-0.8, n=8, P<0.01). In control cat, the topical use of SP in DRG did not induce any response of Abeta neurons. However, in Carg-treated cat, SP depolarized the membrane potential in most Abeta neurons (68.2%, n=22). L668,169, an antagonist of SP receptor, completely blocked the SP-induced responses. Furthermore, repeated application of SP did not induce obvious desensitization of Abeta neurons. These data suggest that peripheral inflammation increased the excitability, SP level and sensitivity of SP receptor of Abeta neurons. Therefore, we concluded that Abeta sensory neurons appear to contribute to inflammatory allodynia.

Dose-response study of the analgesic effect of lanepitant in patients with painful diabetic neuropathy

Lanepitant is effective in the formalin analgesic model suggesting efficacy in painful neuropathy. This study was designed to evaluate the dose-response effect of lanepitant in patients with daily moderate to severe, bilateral, distal neuropathic pain. After a 1-to 3-week lead-in period, patients were randomly allocated to double-blind, parallel treatment with lanepitant 50 mg daily (n = 27), 100 mg daily (n = 27), 200 mg twice daily (n = 13), or placebo (n = 26) over 8 weeks. Patients reported average daytime pain and average nighttime pain intensity. Plasma concentrations and amount of adjunctive analgesic medication were obtained at all visits after baseline. Patient global evaluation and clinician global impression were obtained at weeks 3 and 8. Safety was assessed by adverse events, vital signs, laboratory analytes, and electrocardiogram. No dosage of lanepitant differed significantly from placebo. Efficacy did not increase with lanepitant dosage, and higher plasma concentrations were no more effective than lower plasma concentrations. The adverse event diarrhea was more frequent for lanepitant-treated patients. Although well tolerated, lanepitant was ineffective in relieving pain of diabetic neuropathy.

Activation of silent mechanoreceptive cat C and Adelta sensory neurons and their substance P expression following peripheral inflammation

The effect of inflammation on the excitability and the level of substance P (SP) in cat mechanoreceptive C and Adelta dorsal root ganglion (DRG) neurons were studied in vivo using intracellular recording and immunocytochemical techniques. Following injections of carrageenan (Carg) into the cat hindpaw, the percentage of C neurons exhibiting spontaneous activity increased from 7.2 to 20.7% and the percentage of Adelta neurons increased from 6.9 to 18.6%. In contrast to most cells from normal cats, which fired regularly below 10 Hz, many cells from Carg-treated cats fired at higher frequencies or in bursts. Inflammation (Carg treatment) also depolarized membrane potentials, increased membrane input resistance, caused the disappearance of inward rectifying currents and lowered the mean current thresholds of tibial nerve-evoked responses in DRG neurons. With inflammation, the percentage of C or Adelta neurons responding to low threshold mechanoreceptive stimuli increased (C neurons: normal, 13%; inflamed, 41%; Adelta neurons: normal, 13 %; inflamed, 39 %), while the percentage of C or Adelta neurons responding to high threshold mechanoreceptive stimuli remained unchanged. Some receptive field (RF)-responsive cells were injected with Lucifer Yellow and their SP immunoreactivity was determined. Following Carg treatment, substantially higher percentages of RF-responsive cells were SP positive (C neurons: normal, 35.7%; inflamed, 60%; Adelta neurons: normal, 18.2%; inflamed, 66.7%). These combined increases in the excitability of DRG neurons and SP-containing RF-responsive neurons could lead to sensitization of sensory neurons, thus contributing to the development of hyperalgesia.

Orphanin FQ/nociceptin modulates glutamate- and kainic acid-induced currents in acutely isolated rat spinal dorsal horn neurons

The heptadecapeptide orphanin FQ (OFQ), also known as nociceptin (NOC), is a newly discovered endogenous ligand for the opioid-like G-protein coupled receptor, ORL1. In the present study, the effects of OFQ/NOC on glutamate (Glu), kainic acid (KA) and quisqualic acid (QA) induced currents were examined in isolated rat spinal dorsal horn neurons of young rats using whole-cell patch-clamp techniques. Glu, KA and QA elicited rapid inward currents in 90%, 69%, 83% of tested neurons. OFQ/NOC(0.03 approximately 300 nM) failed to induce any changes of membrane currents, but modulated Glu-, KA- and QA-elicited currents. OFQ/NOC inhibited and potentiated Glu-induced currents in 40.6% and 27.3% of examined cells (n=106) respectively. In about one third examined neurons, OFQ/NOC had no detectable effects on Glu responses. OFQ/NOC also inhibited and enhanced KA- and QA-induced currents (inhibition: KA, 67.1%, n=76; QA, 50%, n=36. Potentiation: KA, 23.7%, n=76; QA, 16.7%, n=36). In about 10% of tested cells, Glu-induced currents were potentiated after the application of OFQ/NOC, and lasted for 20 approximately 30 min. The inhibitory effects of OFQ/NOC on KA and QA responses were naloxone-insensitive. The C-terminal fragment OFQ(8-17) presented same effects on EAA-induced responses. Taken together, OFQ/NOC primarily inhibited Glu-, KA- and QA-induced currents in isolated rat spinal dorsal horn neurons via non-opioid mechanism, which might contribute to nociceptive transmission in the spinal level.

The substance P receptor antagonist CP-99,994 reduces acute postoperative pain

BACKGROUND

Animal studies suggest that substance P, a peptide that preferentially activates the neurokinin-1 (NK1) receptor, is involved in pain transmission, with particular importance in pain after inflammation.

METHODS

The analgesic efficacy of CP-99,994, a NK1 receptor antagonist, was compared with ibuprofen and placebo in 78 subjects undergoing third molar extraction. The initial 60 subjects randomly received 1 of 3 possible treatments in a double-blind fashion before oral surgery: 750 microg/kg CP-99,994 infused intravenously over 5 hours on a tapering regimen starting 2 hours before surgery, 600 mg oral ibuprofen 30 minutes before surgery, or placebo. In a second study, 18 subjects were randomized to the same regimens starting 30 minutes before surgery to maximize the amount of CP-99,994 circulating during pain onset.

RESULTS

In the first study, ibuprofen significantly reduced pain, as measured by visual analog scale, from 90 to 240 minutes postoperatively compared with placebo. CP-99,994 produced analgesia that was significant at 90 minutes (P < 0.01 compared with placebo), but not at subsequent time points. In the second study, ibuprofen and, to a lesser extent, CP-99,994 significantly suppressed pain in comparison to placebo at 60, 90, and 120 minutes (P < 0.05). The incidence of side effects was similar across groups.

CONCLUSIONS

This replicate demonstration that a NK1 receptor blocker relieves clinical pain supports the hypothesis that substance P contributes to the generation of pain in humans. The reduction in postoperative pain at doses not producing side effects suggests that NK1 antagonists may be clinically useful.

Small sensory neurons in the rat dorsal root ganglia express functional NK-1 tachykinin receptor

The tachykinins substance P (SP) and neurokinin A, released by the C-type primary afferent fibre terminals of the small dorsal root ganglion (DRG) neurons, play important roles in spinal nociception. By means of non-radioactive in situ hybridization and whole-cell recording, we showed that the small rat DRG neurons also express the NK-1 tachykinin receptor. In situ hybridization demonstrated that the positive neurons in rat DRG sections were mainly small cells (85.9%) with diameters less than 25 microm. The remaining positive neurons (14.1%) were cells with medium diameters between 26 and 40 microm. No positive large neurons (diameters > 40 microm) were observed. Expression in small DRG neurons (diameter < 21 microm) was confirmed by in situ hybridization of isolated cells, which were demonstrated to express NK-1 receptor mRNA at a very high frequency (> 90% of small DRG neurons) and therefore were subjected to whole-cell recording. In 57 of 61 cells recorded, SP or the selective NK-1 receptor agonist [Sar9, Met(O2)11]SP (Sar-SP, 1 or 2 microM) produced a delayed vibrating inward current (50-300 nA) with a long duration of 0.5-2 h. These currents were blocked by co-application of the NK-1 receptor antagonist L-668, 169 (1 microM), but were not affected by the NK-2 antagonist L-659, 877 (2 microM). Both current-clamp recording and cell-attached single-channel recording demonstrated that the long-lasting response was due to the opening of a channel with an inward current. Employment of non-Ca2+ and Ca2+ + choline solutions revealed that this channel might be a Ca2+-permeable, non-selective cation channel. The prolonged NK-1 tachykinin response exhibited extreme desensitization. This work suggests that presynaptic NK-1 autoreceptors may be present on the primary afferent terminals in the spinal cord, where they could contribute to the chronic pain and hyperalgesia.

Synaptic organization of substance P, glutamate and GABA-immunoreactive boutons on functionally identified neurons in cat spinal deeper dorsal horn

In order to determine how nociceptive input conveyed by the C-fibers terminating in superficial laminae of the spinal cord reaches the wide dynamic range (WDR) cells in deeper dorsal horn, which functions as ascending projection pathway, the morphological features of some WDR cells in the deeper dorsal horn of the cat lumbar spinal cord were studied by intracellular injection of horseradish peroxidase and physiological characterization. One of the fully stained neurons with somata in lamina V and dendrites that entered lamina II were examined by electron microscopy. Immunogold staining of ultrathin sections through the labeled proximal dendrites in lamina II revealed that these dendrites received numerous synapses from substance P and glutamate immunoreactive (IR) axons, which were considered originating from C-fibers. In addition, many GABA-IR terminals were found presynaptic to the labeled dendrites. The results, therefore, suggest that the information carried by primary afferent can be sent from the superficial dorsal horn to the deeper laminae through monosynaptic contacts between C-fiber terminals and the long dorsal dendrites of some WDR cells in the deeper laminae, and that GABAergic system is involved in postsynaptic control to modulate the transmission of nociceptive sensory information.

An isobolographic analysis of the effects of N-methyl-D-aspartate and NK1 tachykinin receptor antagonists on inflammatory hyperalgesia in the rat

1. The interaction between N-methyl-D-aspartate (NMDA) and NK1 tachykinin receptors was analyzed isobolographically in rats with inflammatory hyperalgesia induced by intraplantar injection of complete Freund's adjuvant-saline emulsion (CFA, 100 micrograms Mycobacterium tuberculosis). 2. Thermal hyperalgesia of the inflamed paw, determined by paw withdrawal response to a heat stimulus, was dose-dependently attenuated by intrathecal administration of an NMDA receptor antagonist, dextrorphan (2.5-40 micrograms, ED50 = 7.2 micrograms), and two NK1 tachykinin receptor antagonists, WIN 51,708 (0.01-200 micrograms, ED50 = 10.4 micrograms) or CP-96,345 (5-200 micrograms, ED50 = 82.1 micrograms). There was no effect of these agents on the nociceptive threshold of the non-inflamed paw. CP-96,344, an enantiomer of CP-96,345 that is inactive as an NK1 tachykinin receptor antagonist, slightly attenuated hyperalgesia at a dose of 200 micrograms. 3. Combinations of dextrorphan and WIN 51,708 were administered at fixed ratios (10%:90%; 41%:59%; 90%:10%). Isobolographic analysis revealed that the ED50s obtained from the three combination ratios were not significantly different from those that were expected from a simple additive effect. 4. Thus, an additive interaction was demonstrated between NMDA and NK1 tachykinin receptor systems at the spinal level. These results suggest that both NMDA and NK1 tachykinin receptors are activated in response to peripheral inflammation, but that they may contribute independently to development of hyperalgesia.