Le [6]-gingérol est un analogue structurel de la capsaïcine, une molécule agoniste au récepteurs TRPV1 et ayant des propriétés thérapeutiques connues dans le traitement de la douleur. Deux objectifs principaux ont été poursuivis lors de la réalisation de ce projet de recherche. D’abord, établir une meilleure caractérisation du métabolisme du [6]-gingérol chez le rat. Pour ce faire, une méthode sensible et spécifique pour la quantification du [6]-gingérol et ses métabolites par HPLC-ESI/MS/MS a été développée. Une étude de stabilité métabolique in vitro utilisant des microsomes hépatiques de rats a ensuite été réalisée. Les résultats démontrent une dégradation lente avec un temps de demi-vie de 163 minutes et une clairance intrinsèque relativement basse de 0.0043 mL/min. D’autres analyses ont ensuite été performées pour caractériser les métabolites in vitro et in vivo. Trois principaux métabolites de phase I et quatre métabolites de phase II ont été identifiés par HPLC-MS/MS et HPLC-MSD TOF. Les résultats suggèrent que le principal métabolite excrété dans l’urine est un glucuronide du [6]-gingérol hydroxylé. Le second objectif de ce projet était de déterminer l’effet central du [6]-gingérol sur la douleur neuropathique lorsqu’injecté par voie intrathécale. La distribution de la molécule a d’abord été évaluée suite à une administration intra-péritonéale de 40 mg/kg de [6]-gingérol et les ratios des concentrations cerveau-plasma et moelle épinière-plasma (0.73 et 1.7, respectivement) suggèrent que le [6]-gingérol se distribue efficacement au niveau du système nerveux central. Une injection intrathécale de 10 μg de [6]-gingérol à été performée chez les rats suite à l’induction de douleur par la pose de ligatures au niveau du nerf sciatique. Les résultats suggèrent une réduction significative de l’allodynie mécanique et de l’hyperalgésie thermique à 30 min, 2 h et 4 h suivant l’injection (p < 0.05, p < 0.01 et p < 0.001). Le [6]-gingérol se distribue donc adéquatement au niveau du système nerveux central des rats, permettant une action au niveau des récepteurs TRPV1. Ainsi, le [6]-gingérol pourrait soulager la douleur neuropathique en agissant centralement au niveau de la moelle épinière. / [6]-Gingerol is a structural analog of capsaicin, an agonist of the transient receptor potential channel vanilloid 1, which is known to have therapeutic properties for the treatment of pain. Based on this premise, this research project had two main objectives. The first objective was to establish a better characterization of [6]-gingerol metabolism in rat. A selective and sensitive method for the quantification of [6]-gingerol and its metabolites by HPLC-ESI/MS/MS was first developed. An in vitro metabolic stability study using rat liver microsomes was then performed. The results show slow degradation with a T1/2 of 163 min and a relatively low intrinsic clearance of 0.0043 mL/min. Further analyses were performed to characterize in vitro and in vivo metabolites. Three main phase I metabolites and four phase II metabolites were identified by HPLC-MS/MS and HPLC-MSD TOF. The results suggest that glucuronidation of hydroxylated [6]-gingerol is the primary metabolite excreted in urine. The second objective of this study was to determine the central effect of [6]-gingerol on neuropathic pain when injected intrathecally at the level of the lumbar spinal cord. [6]-Gingerol distribution was evaluated following a 40 mg/kg intraperitoneal injection, and the brain-to-plasma and spinal cord-to-plasma ratios (0.73 and 1.7, respectively) suggest that [6]-gingerol has a good distribution in the central nervous system of rats. Induction of pain was performed using the sciatic nerve ligation model on rats. Following the surgery, a 10-µg intrathecal injection of [6]-gingerol was performed to evaluate its central effect. The results suggest a significant decrease of secondary mechanical allodynia assessed with the Von Frey filaments after 30 min, 2 h and 4 h (p < 0.05, p < 0.01 and p < 0.001) and thermal hyperalgesia assessed with the Hargreave’s test after 30 min, 2 h and 4 h (p < 0.05, p < 0.01 and p < 0.01). In conclusion, [6]-gingerol has a good distribution in the central nervous system of rats, suggesting a possible interaction with the TRPV1 receptors. [6]-Gingerol could therefore alleviate neuropathic pain by acting centrally at the level of the spinal cord and be an interesting alternative to the traditional molecules currently used in pain management.

Le projet porte sur l’étude de l’effet de l’eugénol, composant principal du clou de girofle, sur la douleur neuropathique. L’objectif principal du projet était de déterminer la contribution du système nerveux central dans l’effet analgésique de l’eugénol. Lors d’une étude préliminaire, la pénétrabilité de l’eugénol a été évaluée dans le système nerveux central du rat. Des échantillons de sang, de cerveau et de moelle épinière ont été prélevés et les concentrations d’eugénol dans ces différents tissus ont été analysées à l’aide d’un spectromètre de masse. Les résultats ont montré que l’eugénol pénètre bien le système nerveux central avec une distribution plus importante dans la moelle épinière. Après l’induction de la douleur neuropathique à des rats Sprague-Dawley par le modèle de ligatures du nerf sciatique, des injections intrathécales d’eugénol furent réalisées afin d’évaluer l’effet central de l’eugénol. La plus forte dose d’eugénol a atténué l’allodynie secondaire après 15min, 2h et 4h et a aussi amélioré l’hyperalgésie thermique après 2h et 4h. Ces résultats confirment l’hypothèse que l’eugénol atténue les deux aspects de la douleur neuropathique que sont l’allodynie et l’hyperalgésie. Les injections au niveau lombaire permettent de penser que l’eugénol, un agoniste/antagoniste des récepteurs vanilloïdes pourrait diminuer la douleur neuropathique en agissant notamment au niveau des récepteurs vanilloïdes situés dans la corne dorsale de la moelle épinière. / The project is based on the study of the effects of eugenol, the main component of clove oil, on neuropathic pain. The main objective was to determine the central effect of eugenol. In a preliminary study we evaluated the penetrability of eugenol in the central nervous system of rats. Blood, brain and spinal cord samples were collected and concentrations were determined by mass spectrometry. Brain-toplasma and spinal cord-to-plasma ratios suggest that eugenol penetrates the central nervous system of rats relatively well, with a preferential distribution in the spinal cord. Following the induction of neuropathic pain in male Sprague-Dawley rats using the sciatic nerve ligation model, intrathecal injections of eugenol were done to evaluate the central effect of eugenol. Treatment with the high dose of eugenol significantly decreased secondary mechanical allodynia measured by the Von Frey test after 15min, 2h and 4h and improved thermal hyperalgesia measured by the Hargreaves device after 2h and 4h. Results support the hypothesis that eugenol may alleviate neuropathic pain, both allodynia and hyperalgesia. Eugenol, a vanilloid agonist/antagonist may therefore reduce neuropathic pain by acting on vanilloid receptors at the level of the dorsal horn of the spinal cord.

L'objectif de notre travail était dans un premier temps d'étudier les liens entre l'altération des fibres nerveuses de petit diamètre et la présence de douleurs chez des patients ayant une neuropathie périphérique. Notre deuxième objectif était d'évaluer la pertinence de certaines techniques neurophysiologiques pour mettre en évidence l'atteinte de ces petites fibres nerveuses. Notre première étude réalisée sur une large cohorte de patients présentant divers types de neuropathie a montré, grâce à une étude quantifiée de la sensibilité, qu'il n'y avait pas de corrélation entre la perte ou perte de fonction des fibres nerveuses de petit diamètre et la présence de douleurs. Ceci a été confirmé par notre deuxième étude portant sur une population plus homogène de patients ayant une neuropathie amyloïde familiale et étudiés avec une batterie neurophysiologique plus large. Ainsi, les douleurs neuropathiques des patients présentant une neuropathie périphérique sont probablement dues à la combinaison de facteurs d'hyperexcitabilité périphérique et de sensibilisation centrale et non directement liée à la perte en petites fibres. Il reste cependant pertinent de développer des techniques objectives d'exploration de ces petites fibres notamment dans un but de diagnostic clinique. Notre troisième étude a montré que certaines méthodes neurophysiologiques étaient particulièrement sensibles dans ce cadre en prenant pour exemple la détection d'anomalies précoces d'atteinte des petites fibres au cours de la neuropathie amyloïde familiale. Une batterie de tests comprenant l'enregistrement des potentiels évoqués laser, la mesure du seuil de détection du chaud et de la conductance cutanée, s'est avérée être la combinaison la plus pertinente, comme l'a montré notre quatrième étude sur une grande cohorte de patients susceptibles de présenter une neuropathie des petites fibres. / The aim of our work was initially to study the relationship between alterations in small diameter nerve fibers and the presence of pain in patients with peripheral neuropathy. Our second objective was to assess the relevance of some neurophysiological tests to characterize these alterations in small nerve fibers. Our first study of a large cohort of patients with various types of neuropathy showed, using quantitative sensory testing, that there was no correlation between the loss or loss of function of small nerve fibers and the presence of pain. This was confirmed by our second study focused on a more homogeneous population of patients with familial amyloid neuropathy and studied with a larger neurophysiological battery. Thus, neuropathic pain in patients with peripheral neuropathy is probably due to a combination of factors of peripheral hyperexcitability and central sensitization and not directly related to the loss of small nerve fibers. However, it remains relevant to develop techniques of objective investigation of these small nerve fibers for a purpose of clinical diagnosis. Our third study showed that some neurophysiological methods were particularly sensitive in this context, taking the example of the detection of early alteration of small nerve fibers in familial amyloid neuropathy. A battery of tests, including laser evoked potential recording, warm detection threshold and electrochemical skin conductance measurement, proved to be the most appropriate combination for this diagnostic purpose, as shown by our fourth study on a large cohort of patients likely to have a small fiber neuropathy.

La gestion de la douleur neuropathique reste un challenge en médecine, malgré le nombre de traitements actuellement disponible. L'expérimentation animale a généré beaucoup d'informations concernant la douleur, mais ces connaissances demeurent insuffisantes pour développer de nouveaux analgésiques plus efficaces tout en restant sécuritaires. La douleur est un symptôme clinique complexe avec de multiples origines, et les mécanismes de douleur centraux et périphériques dépendent de l'évolution de la pathologie. Il est donc essentiel d'investiguer plus profondément les mécanismes moléculaires responsables de l'initiation et du maintien de la douleur, afin de cibler de nouvelles voies de transmission de la nociception plus prometteuses pour soulager la neuropathie et développer de meilleures stratégies thérapeutiques. Ce projet s'est donc intéressé plus particulièrement à la famille des tachykinines issues du gène TAC1 (substance P, ses précurseurs et métabolites, et neurokinine A sont les peptides ciblés pour ce projet de recherche), une famille de neuropeptides qui joue un rôle critique dans la transmission nociceptive. Pour réaliser cette étude, nous avons d'abord développé une stratégie de quantification afin de quantifier les expressions des différents neuropeptides bioactifs cibles, par HPLCMS/ MS. Puisqu'il existe différentes stratégies de quantification des peptides par HPLCMS/ MS, une méthode analytique fiable et robuste était nécessaire pour répondre aux objectifs de recherche. Nous avons développé une méthode utilisant la quantification relative avec un étalon interne stable marqué isotopiquement. En effet, pour quantifier les neuropeptides d'intérêt de l'étude, c'est la stratégie qui s'est avérée la plus reproductible et précise. Suite à la mise au point de la stratégie de quantification, nous avons utilisé des modèles animaux, souvent nécessaires pour faire progresser la recherche scientifique sur la compréhension de la douleur / The management of neuropathic pain remains a challenge in medicine, despite the availability of numerous drugs. Animal experimentation has generated a tremendous amount of information about pain, but this knowledge is still insufficient for new more efficient and safe analgesics. Pain is a complex clinical symptom with multiple origins, and peripheral and central pain mechanisms depend on the pathology evolution. Thus, it is essential to further investigate the mechanisms responsible for the initiation and maintenance of pain in order to develop better effective therapies. This project is particularly focused on the tachykinin family encoded by TAC1 gene (substance P, its precursors and metabolites, neurokinin A), a family of neuropeptides that plays a critical role in nociceptive transmission. We initially developed a quantification strategy in order to study the targeted bioactive neuropeptide expression modulation by HPLC-MS and HPLC-MS/MS. And it is critical to develop reliable and robust analytical methods to reach the objectives. So, we developed a method using relative quantification with stable isotopic labeled internal standards. In fact, in order to quantify target neuropeptides, this strategy was the most reproducible and accurate. Following the development of the relative quantification strategy, we used validated animal models, fundamental to better knowledges of painful molecular mechanisms

La stimulation magnétique répétitive transcrânienne (rTMS) du cortex moteur à visée antalgique réunit deux conditions extrêmement intéressantes: un accès non invasif à une cible corticale éloquente et, par la modulation de son activité, la possibilité d'influencer le transfert et l'intégration du message nociceptif. L'objectif de cette thèse est d'évaluer comment une approche de recherche clinique permet à la fois de progresser dans la compréhension des mécanismes qui sous-tendent l'effet antalgique de la rTMS et d'optimiser cet effet chez le patient. Une première étude paramétrique, concernant la technique de stimulation, a montré que l'orientation du courant était cruciale pour le développement d'un effet antalgique, l'orientation la plus favorable étant celle activant des interneurones corticaux. Nous n'avons toutefois pas objectivé de modification spécifique d'une composante sensorielle de la douleur en rapport avec cet effet local, ni une influence liée au caractère somatotopique de la stimulation. Ainsi, l'efficacité de la stimulation ne semble pas tributaire de sa localisation en regard de la représentation corticale du territoire douloureux. L'action sur la composante sensorielle de la douleur n'expliquant pas à elle seule l'effet antalgique de la rTMS, nous avons analysé les interactions entre effet antalgique et effet placebo : la rTMS a une efficacité propre, indépendante de l'effet placebo et lorsqu'elle est efficace, elle majore l'effet d'une séance placebo réalisée par la suite, par un phénomène de conditionnement. La rTMS active facilite les mécanismes de contrôle central de la douleur grâce à ses connexions à distance et à son action sur les systèmes endorphiniques, également impliqués dans l'effet antalgique du placebo. A la lumière de ces résultats, nous avons analysé les critères cliniques sur lesquels reposent l'efficacité à long terme des procédures de stimulation épidurale antalgique du cortex moteur et la valeur prédictive de la rTMS: l'efficacité de la rTMS apparaît comme un marqueur utile pour prédire l'efficacité au long cours de la stimulation corticale épidurale, lorsque la douleur est évaluée non seulement dans sa dimension sensorielle pure mais également à travers son retentissement psychologique global. L'ensemble de ces travaux suggère une action multiple de la rTMS s'exerçant probablement dans les 3 sphères (sensori-discriminative, affective et cognitive) qui sous- tendent la perception et le vécu de la douleur chronique / Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex allows a non- invasive access to an eloquent cortical area and, by the modulation of its activity, the possible interference with central integration of pain. ln this thesis we have applied clinical research methods to enhance the understanding of the mechanisms of pain relief by rTMS and to optimize its clinical effect in chronic pain patients. A first parametrical study, concerning technical aspects of the stimulation, showed the crucial role of current orientation to increase the magnitude of analgesic effects, a postero-anterior orientation promoting interneuronal activation being superior to a latero-medial direction. We found neither a selective modification of sensorial component of pain nor a somatotopic effect of the stimulation: indeed, rTMS analgesic efficacy was not dependent upon stimulation being applied to the cortical representation of the painful territory. The impossibility to explain the whole analgesic effect of rTMS by an isolated modulation of sensory components of pain prompted us to study the interactions between real and placebo rTMS analgesic effects. Active rTMS has a specific analgesic effect, and, when efficacious, it was able to enhance the placebo effect of subsequent sham stimulation. The value of rTMS to adequately predict the long-term efficacy of invasive motor cortex epidural stimulation (surgically implanted MCS) was assessed in a further study. The analgesic efficacy of single-point rTMS proved to be useful to predict the long-term outcome of surgically implanted MCS, provided that such outcome assessment was not exclusively founded on pain intensity but also on the psychological consequences of chronic pain. These results suggest that rTMS exerts its analgesic effects at multiple levels, and probably modifies the 3 different spheres (sensori-discriminative, affective and cognitive) at the origin of perception and consequences of chronic pain in daily life

A dor é descrita como uma sensação sensorial e emocional desagradável de extrema importância para sobrevivência e integridade do organismo. As dores crônicas de origem neuropática são de difícil tratamento e seus mecanismos fisiopatológicos pouco conhecidos. Este estudo foi realizado após inoculação do vírus HSV-1 na pata traseira esquerda de camundongos machos da linhagem Balb/C, e teve como objetivo investigar comportamentalmente o desenvolvimento de alodínia mecânica e hipernocicepção nas fases herpética e pós herpética, caracterizar a atividade de vias intracelulares de sinalização das proteínas JNK, AKT CREB, P38, ERK, Glutamina Sintetase e Stat 3, através de western blot na coluna dorsal da medula espinal nas fases herpética e pós herpética, além de verificar a presença do vírus HSV-1 na medula espinal e gânglio dos animais por meio da reação em cadeia da polimerase em tempo real (RT-PCR). Os resultados evidenciaram alteração de sensibilidade nos animais a partir do 7º dia que permaneceu até o 28º dia após a inoculação do vírus. Houve uma mudança na expressão das proteínas MAPKs, com aumento na expressão de JNK, AKT e CREB no corno dorsal da medula no 8º e 21º dia após a inoculação do vírus HSV-1, aumento na expressão de P 38 e P ERK no 8º dia após inoculação do vírus e uma diminuição na expressão da proteína Stat 3 no 8º e 21º dia após a inoculação do vírus, sugerindo assim a participação dessas proteínas na alteração de sensibilidade tanto no período herpético quanto pós herpético. Também ocorreu um aumento na amplificação do DNA viral HSV-1 na medula espinal e gânglio espinal esquerdo no período herpético após inoculação do vírus HSV-1 / The pain is described as a sensorial and emotional unpleasant sensation of extreme importance for survival and integrity of the organism. The chronic pains that has neuropathic source are hard to treat and its physiopathologic mechanisms not well known. This study was performed after inoculation of the virus HSV-1 in the left back foot of male Balb/C mouse, and had as main objectives to behaviorally investigate the development of mechanical allodynia and hyper nociception during the herpetic and post-herpetic phase, characterize the activity of the intracellular signalization paths of the proteins JNK, AKT CRB, P38, ERK, glutamine synthetase and Sat 3 during herpetic and post-herpetic phase using Western Blot, besides checking as well for the presence of HSV-1 viral load in the spinal cord and ganglions using RT-PCR. The results evidenced alteration of sensitivity in the animals from the 7th day that remained until the 28th day after inoculation of the virus, a change in the MAPKs proteins expression, with a raise of expression of JNK, AKT e CREB in the dorsal horn of the spinal cord in the 8th and 21st day after the HSV-1 virus inoculation, thus suggesting the participation of these proteins in the alteration of sensitivity both in the herpetic and post herpetic periods. It is also possible to observe the presence of viral load in the spinal cord and left spinal ganglion in the herpetic period after HSV-1 virus inoculation

O fator de crescimento neural (NGF) está relacionado à dor e ao aumento de Substância P (SP). Ressonância magnética funcional de forma não invasiva investiga áreas cerebrais. O Anti-NGF é um tratamento para dor, porém não investigado em dor neuropática. Nós avaliamos no modelo CCI a resposta comportamental e o envolvimento do NGF e da SP após tratamento com o Anti-NGF. Nós observamos NGF aumentado a longo prazo no gânglio da coluna posterior (DRG) e na medula espinal, já a SP aumentada no DRG em ambos os tempos e apenas tardiamente na medula espinal. O tratamento com Anti-NGF diminuiu a nocicepção dos animais. O Anti-NGF reverteu os altos níveis de NGF e SP no DRG e na medula espinal. Houve aumento de Fos no grupo CCI e diminuição após tratamento com Anti-NGF no córtex cingulado anterior. Observamos modificações da conectividade do tálamo, córtex somatossensorial primário e córtex cingulado com todo o encéfalo. Esperamos que estes resultados possam ser usados para o desenvolvimento de uma estratégia terapêutica que auxilie pacientes com dor neuropática crônica. / Nerve growth factor (NGF) is related to pain and increase of Substance P (SP). Non-invasively functional magnetic resonance imaging investigates brain areas. Anti-NGF is a treatment for pain, but not investigated in neuropathic pain. We evaluated the behavioral response and the involvement of NGF and SP in the CCI model after Anti-NGF treatment. We observed increased long-term NGF in the dorsal root ganglion (DRG) and spinal cord, as well as increased SP in DRG at both time and only late in the spinal cord. Treatment with Anti-NGF decreased the nociception of the animals. Anti-NGF reversed high levels of NGF and SP in DRG and spinal cord. There was an increase in Fos in CCI group and a decrease after Anti-NGF treatment in the anterior cingulate cortex. We observed changes in the connectivity of the thalamus, primary somatosensory cortex and cingulate cortex with the entire brain. We hope that these results can be used to develop a therapeutic strategy that will help patients with chronic neuropathic pain.

La transmission des messages douloureux depuis les nocicepteurs périphériques jusqu’aux structures supraspinales est sous le contrôle de systèmes modulateurs, parmi lesquels figurent les voies bulbo-spinales sérotoninergiques. Cependant leur rôle n’est pas complètement élucidé puisque selon le type de récepteur sérotoninergique mis en jeu, elles pourraient soit réduire la sensation douloureuse soit au contraire l’exacerber. De plus, le contrôle exercé par la sérotonine (5 HT) pourrait dépendre du type de douleur, aiguë, inflammatoire ou neuropathique chronique. En réalité, ces ambiguïtés tiennent au fait que les études réalisées jusqu’à présent ont surtout impliqué des approches pharmacologiques souvent peu fiables. Ce constat m’a conduit à mettre en œuvre une nouvelle approche expérimentale pour tenter de cerner le véritable rôle modulateur des voies sérotoninergiques bulbo-spinales sur différents types de douleur dans des conditions physiologiques normales ou physiopathologiques chez le rat. A cette fin, j’ai réalisé ce travail de thèse en trois étapes. La première étape a consisté à préciser les caractéristiques anatomiques des voies sérotoninergiques bulbo-spinales visualisées par un marquage antérograde (PHA-L) couplé à l’immunomarquage du transporteur de la sérotonine (SERT). L’étude différentielle des deux sous-structures de la région bulbaire B3 : le noyau raphé magnus (RMg) et le noyau paragigantocellulaire latéral (LPGi) m’a permis de montrer que les neurones sérotoninergiques qu’elles contiennent se projettent respectivement dans les couches profondes (VI-VI) et superficielles (I-II) de la corne dorsale, à tous les étages de la moelle épinière. Afin de dépléter sélectivement la 5-HT dans la corne dorsale, j’ai, dans une deuxième étape, injecté bilatéralement dans la région B3 un lentivirus recombinant LV-shTPH2 pour y éteindre l’expression de la TPH2, l’enzyme limitante de la synthèse de 5-HT. Les contrôles immunohistochimiques ont montré l’inhibition bilatérale de l’expression de la TPH2 dans le RMg et le LPGi, et la diminution de l’immunomarquage de la 5-HT sélectivement dans la corne dorsale, l’expression inchangée du transporteur SERT confirmant le maintien de l’intégrité des fibres sérotoninergiques chez les rats LV-shTPH2. L’évaluation de la sensibilité des animaux ainsi déplétés en 5-HT à différents tests validés de nociception aiguë n’a pas révélé de modifications significatives par rapport aux témoins. Mais dans des conditions de forte stimulation nociceptive thermique (50°C) ou chimique (carragénine), l’augmentation de l’immunomarquage de c-Fos dans la corne dorsale chez les rats LV-shTPH2 montre que la déplétion de 5-HT facilite la sensibilisation synaptique. Des différences encore plus nettes entre les rats LV-shTPH2 et les témoins sont surtout apparues en cas de douleur inflammatoire (formaline) ou neuropathique (ligature du nerf sciatique). Les modifications induites par la déplétion de 5-HT n’étaient cependant pas univoques puisqu’une hypoalgésie a été observée dans le cas d’une douleur inflammatoire et, qu’au contraire, l’hyperalgésie associée à la douleur neuropathique était exacerbée chez les rats LV-shTPH2. Ces modulations opposées laissant à penser l’implication de projections et/ou de récepteurs sérotoninergiques distincts, nous avons réalisé, dans une troisième étape, une étude pharmacologique qui a permis de montrer que l’effet pro-hyperalgésique observé chez les rats neuropathiques déplétés en 5-HT était probablement lié à un déficit d’activation de récepteurs 5 HT7. Notre étude démontre la réalité du contrôle physiologique du relai spinal des voies nociceptives par la 5-HT, via l’implication de projections bulbo-spinales et de récepteurs sérotoninergiques dont l’identification pourrait déboucher sur de nouvelles perspectives thérapeutiques. / The transmission of pain signals from peripheral nociceptors to supraspinal structures is under the control of modulatory systems, which include bulbo-spinal serotoninergic pathways. However, their role is not yet fully understood, as they may as well reduce or exacerbate pain as a function of 5-HT receptor types involved. Furthermore, their modulatory role might also differ depending on whether pain is acute, or chronic, with inflammatory or neuropathic origin. In fact, this ambiguous knowledge results from data essentially obtained with rather unreliable pharmacological approaches. This led me to set up an innovative experimental approach for a better assessment of the real implication of bulbo-spinal serotoninergic projections in pain control mechanisms under validated physiological and pathophysiological conditions in the rat. To this goal, I performed my PhD thesis work in three steps. The first step consisted of a precise anatomical description of bulbo-spinal serotoninergic projections identified by anterograde labeling (with PHA-L) and immunolabeling of the 5-HT transporter (SERT). The differential labeling of the two sub-areas within the B3 bulbar region : the nucleus raphé magnus (RMg) and the nucleus paragigantocellularis lateralis (LPGi) allowed the demonstration that their respective 5-HT neuron groups project separately into the deep (V-VI) and superficial (I-II) laminae of the dorsal horn, at all levels of the spinal cord. For the second step, aimed at depleting 5-HT selectively within the dorsal horn, I injected bilaterally into the B3 area a recombinant lentivirus, LV-shTPH2, designed to suppress the expression of TPH2, the rate limiting enzyme for 5-HT synthesis. Immunohistochemical controls showed that the resulting bilateral inhibition of TPH2 expression in both the RMg and the LPGi was associated with 5-HT depletion but no change in SERT (as expected of unaltered 5-HT fibers) in the dorsal horn. Using various behavioral tests, I could not detect any change in acute pain sensitivity in 5-HT-depleted rats. In contrast, the increased c-Fos immunohistochemical labeling within the dorsal horn after strong thermal (50°C) or chemical (carrageenan) noxious stimulation showed that 5-HT depletion promotes synaptic sensitization. Even more striking differences between LV-shTPH2 injected rats and paired controls were observed in case of inflammatory (formalin) or neuropathic (sciatic nerve ligation) pain. However, 5-HT depletion-induced changes differed under both conditions since hypoalgesia was noted in case of inflammatory pain, whereas neuropathic pain-evoked hyperalgesia was enhanced in 5-HT depleted, LV-shTPH2-injected rats. Because such opposite modulations might have been underlain by distinct serotoninergic pathways (i.e. from the RMg versus the LPGi for instance) and/or distinct 5-HT receptors, we decided, within the time remaining for achieving my PhD work, to perform a third step, focused on the 5-HT7 receptor type. Using pharmacological approaches, we could obtain data showing that exacerbated hyperalgesia in 5-HT-depleted neuropathic rats resulted from loss of tonic 5-HT7 receptor activation by endogenous 5-HT. Altogether, our data clearly demonstrate that bulbospinal serotoninergic projections are involved in the physiological control of pain signaling at spinal cord level. Further identification of underlying neuronal pathways and receptors might open novel therapeutic perspectives.

A dor neuropática pode ser causada por lesões e/ou disfunções no sistema somatossensorial. Nestes tipos de dores, alterações plásticas ao longo de todo o sistema sensorial nociceptivo estão associadas à cronificação do processo doloroso. A plasticidade observada pode ser resultante da indução e/ou repressão de genes, os quais geralmente são modulados por fatores de transcrição. Um dos principais fatores de transcrição até então conhecido é a proteína ativadora-1 (AP-1), que pode ser estruturalmente formado principalmente por proteínas das famílias Jun e Fos. Entretanto, na dor neuropática, a participação e o papel do AP-1 não estão bem elucidados. Dessa forma, a hipótese deste trabalho é que a ativação do AP-1 contribua para a indução e/ou manutenção da dor neuropática, através da ativação de células gliais e de proteinocinases ativadas por mitógenos (MAPK) e por indução da produção e liberação de mediadores pró-inflamatórios, bem como de metaloproteinases da matriz extracelular (MMP) na medula espinal. Esses fatores contribuem para sensibilização central causada pela SNI, facilitando a transmissão dolorosa. Assim, a inibição do AP-1 seria uma potencial estratégia terapêutica no tratamento da dor neuropática. Foi utilizado o modelo experimental de dor neuropática de lesão limitada do nervo isquiático (SNI, Spared Nerve Injury) em camundongos, os quais receberam injeção intratecal (i.t.) do inibidor de AP-1, SR11302, ou seu veículo (DMSO, tween® 20 e salina). O tratamento com o inibidor de AP-1 reduziu a hipernocicepção mecânica causada pela SNI, e o perfil de redução sugeriu que esse fator de transcrição esteja relacionado com a manutenção da dor neuropática. No sétimo dia após a SNI, observou-se na medula espinal dos camundongos, ativação da microglia, dos astrócitos e das MAPK, além de aumento na expressão de TNF-, interleucina (IL)-6, IL-1, IL-17A, quimiocina derivada de queratinócito (KC), proteína quimiotáxica de monócitos (MCP-1), óxido nítrico (NO), NO sintase induzível e das MMP-2 e -9. Todos esses eventos estão associados à sensibilização central, portanto, contribuem para a facilitação da transmissão nociceptiva. O tratamento com o inibidor de AP-1 SR11302 impediu, pelo menos parcialmente, a ativação das células gliais e das MAPK e bloqueou o aumento na expressão de todos esses mediadores pró-inflamatórios e das MMPs na medula espinal. Assim, o fator de transcrição AP-1 e, consequentemente, suas vias a jusante (downstream) são potenciais alvos farmacológicos no tratamento da dor neuropática. / Neuropathic pain results from nerve damage or dysfunction, which is associated to the painful process of chronification. This process may include participation of the inducible genes, which may be modulated by transcription factors, including the activator protein-1 (AP-1), which can structurally be formed by proteins from Jun and Fos families. However, the participation and the role of AP-1 neuropathic pain remain unclear. Our hypothesis is that the activation of AP-1 would contribute for the induction and/or maintenance of neuropathic pain, by inducing the glial cells activation and mitogen-activated protein kinases, and by inducing the production/release of pro-inflammatory mediators and extracellular matrix metalloproteinase (MMP) in mices spinal cord. All these factors are contributing to SNI-evoked central sensitization, facilitating pain transmission. Thus, inhibition of AP-1 would be a potential drug target in the treatment of neuropathic pain. The animals received inhalatory anesthesia (2% isoflurane) and were submitted to an experimental model of neuropathic pain Spared Nerve Injury (SNI). The animals were treated intrathecally (i.t.) with AP-1 inhibitor SR11302 or vehicle (DMSO, tween®20 and saline). Treatment with AP-1 inhibitor reduced the SNI-induced mechanical hypernociception, suggesting that this transcription factor is related to the maintenance of neuropathic pain. On the seventh day after SNI, there was in the spinal cord of mice microglia, astrocytes and MAPK activation, increased of expression of TNF-, interleukin (IL)-6, IL-1, IL-17A, keratinocyte-derived chemokine (KC), monocyte chemoattractant protein-1 (MCP-1), nitric oxide (NO) and inducible NO synthase, and increased the expression of MMP-2 and -9. All of these effects are related with central sensitization, thus facilitating nociceptive transmission. However, treatment with SR11302 prevented, at least partially, activation of MAPK and glial cells, as well as prevented the increase in expression of all these pro-inflammatory mediators and MMPs in the spinal cord. Thus, inhibition of AP-1 and hence its way downstream is a potential pharmacological target in the treatment of neuropathic pain.

Nos últimos anos, inúmeros avanços têm sido alcançados no que diz respeito aos mecanismos moleculares que participam na indução e manutenção da dor crônica, incluindo ativação glial. Já foi demonstrado que alguns receptores de reconhecimento padrão (PRRs), como os receptores do tipo Toll (TLRs) participam desse processo e, que em modelos de inflamação/infecção do Sistema Nervoso Central, os TLRs e os receptores do tipo NOD (NLRs) cooperam na ativação das células da glia, o que nos levou a hipotetizar que os receptores NOD1 e NOD2 também possam desempenhar um papel importante no processo de dor crônica. O NOD2 é responsável pela detecção intracelular do muramil dipeptídeo (MDP) enquanto que NOD1 reconhece o ácido diaminopimélico (iE-DAP), ambos padrões moleculares associados a patógenos (PAMPs) encontrados no peptideoglicano de bactérias. Após o reconhecimento, NLRs recrutam diretamente RIPK2 (proteína 2 de interação com o receptor RICK), uma serina-treonina quinase importante na ativação do fator nuclear kB (NF-kB). Assim, o objetivo do presente estudo foi avaliar a participação de NOD1 e NOD2, via RIPK2, no desenvolvimento da hipersensibilidade mecânica neuropática focando principalmente nos mecanismos espinais envolvidos. Dessa maneira, foi observado que os animais NOD1-/-, NOD2-/- e RIPK2-/- apresentaram redução significativa da hipersensibilidade nociceptiva mecânica quando comparado aos animais selvagens após indução de neuropatia periférica pelo modelo experimental de lesão limitada do nervo isquiático (SNI, Spared Nerve Injury). Ao contrário, a hipersensibilidade inflamatória induzida pelo adjuvante completo de Freud (CFA) não foi reduzida nesses animais. A redução da dor neuropática em NOD1-/-, NOD2-/- e RIPK2-/- foi associada a uma diminuição da expressão de IBA-1, GFAP, IL-1, TNF- e P2X4 na medula espinal quando comparado ao grupo WT. In vitro, foi observado que culturas primárias de micróglia não induziram liberação de IL-1, TNF-, IL-6 em resposta ao MDP (10g/mL) e iE-DAP (100ng/mL). No entanto, quando o MDP foi administrado juntamente com uma baixa concentração de lipopolissacarídeo (LPS) (0,1ng/mL), apresentou uma forte produção destas citocinas. Além disso, também foi demonstrado que células periféricas que infiltram na medula espinal podem expressar NOD1 e NOD2 e portanto serem capazes de induzir hipersensibilidade mecânica e ativação microglial após a indução de neuropatia. Dessa maneira, os resultados sugerem que NOD1 e NOD2, via RIPK2, contribuem para a gênese da dor neuropática, possivelmente mediando a liberação de citocinas pró-nociceptivas e a ativação de células gliais. Além disso, os resultados apontam ação potencial de NOD2 com TLR4 no intuito de estimular a ativação glial. Estes mecanismos representam uma nova abordagem para elucidar os mecanismos envolvidos na fisiopatologia da dor crônica e um possível alvo para o desenvolvimento de drogas para o tratamento da dor neuropática. / In the last years, many advances have been made related to the molecular mechanisms involved in the induction and maintenance of chronic pain, including glial activation. It has been shown that some pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs) are involved in this process, and that in inflammation/infection models of the CNS, the TLRs and Nod-like receptors (NLRs) cooperate in activation of glial cells, which led us to hypothesize that NOD1 and NOD2 receptors may also play an important role in chronic pain process. NOD2 are responsible by intracellular detection of muramyl dipeptide (MDP) and NOD1 detects meso-diaminopimelic acid (iE-DAP), pathogen-associated molecular patterns (PAMPs) found in the peptidoglycan from bacteria. Upon recognition, NLRs recruit directly RIPK2, an adaptor protein, important in NLRs-mediated NFB activation. In the present study, we aimed to evaluate the participation of NOD1 and NOD2, via RIPK2, in the development of neuropathic mechanical hypersensitivity focusing mainly on spinal mechanisms involved. The results demonstrate that NOD1-/-, NOD2-/-, RIPK2-/- showed a significant reduction in mechanical hypersensitivity when compared to WT mice, after submitted to an experimental model of neuropathic pain Spared Nerve Injury (SNI). Interestingly, CFA-induced chronic inflammatory hypersensitivity was not decreased in these mice. The reduction in neuropathic pain in NOD1-/-, NOD2-/- and RIPK2-/- mice was associated with a decrease in the expression of IBA-1, GFAP, IL-1, TNF- and P2X4 in spinal cord when compared with WT. In vitro, it was observed that primary cultures of microglia did not produce IL-1, TNF-, IL-6 in response to MDP (3g/mL) or iE-DAP (100ng/mL). However, MDP, together with an ineffective concentration of LPS (0.1ng/mL), produced a robust production of these cytokines. Moreover, it was also demonstrated that peripheral cells infiltrating the spinal cord could express NOD1 and NOD2 and thus, be able to induce mechanical hypersensitivity and microglial activation after induction of peripheral neuropathy. The results suggest that NOD1 and NOD2, via RIPK2, contribute to the genesis of neuropathic pain, possibly by mediating the release of pronociceptive cytokines and increased glial cells activation. Moreover, the results indicate potential action of NOD2 with TLR4 in attempt to stimulate glial cells activation. These mechanisms represent a novel approach for elucidating the pathophysiology of chronic pain, and a target for the development of drugs for the treatment of neuropathic pain.