京都大学 / 0048 / 新制・論文博士 / 博士(農学) / 乙第12876号 / 論農博第2803号 / 新制||農||1028(附属図書館) / 学位論文||H26||N4875(農学部図書室) / 31594 / (主査)教授 伏木 亨, 教授 保川 清, 教授 入江 一浩 / 学位規則第4条第2項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

Chronic neuropathic pain is a leading cause of disability worldwide and is associated with immense economic burden. Of all chronic neuropathic pain conditions, chemotherapy-induced peripheral neuropathy (CIPN) persists as a monumental public health crisis, as it is the most common comorbidity among those receiving chemotherapy for cancer treatment. CIPN is unique compared to other forms of neuropathic pain in that it is severely dose-limiting, often leading to disruption or cessation of chemotherapeutic treatment and complicating an individual’s cancer prognosis. Current pharmacological treatments for combatting CIPN are widespread yet are all accompanied with the same hindrances – they are limited in therapeutic efficacy when administered chronically and are associated with severe risk for adverse effects. Therefore, there is a clear unmet need for novel pharmacotherapies for CIPN that achieve strong therapeutic efficacy while minimizing the susceptibility to adverse events.Here, we characterize the therapeutic efficacy and pharmacological mechanisms of a novel, plant-derived alkaloid mitragynine (MG), a constituent of the kratom plant (Mitragyna speciosa) in a mouse model of CIPN. Kratom products have emerged in the US in recent years as a popular form of self-treating pain, opioid withdrawal, and symptoms of anxiety and depression, but these intended uses are largely based on anecdotal reports in humans. MG possesses a unique, mixed pharmacological profile combining opioid, adrenergic, and serotonergic properties – resembling the pharmacology of current CIPN pharmacotherapies such as antidepressants. However, the relation of these pharmacological mechanisms of MG to the context of CIPN remain under characterized. Kratom products are also commonly used in combination with cannabis products, which are also used for self-treating pain, and play a significant role in palliative care for terminal cancer patients. Yet, interactions between kratom alkaloids and cannabinoid signaling have yet to be studied in the context of CIPN. Lastly, the basis of potential utility of individual kratom constituents such as MG on anxiety- and depression-like behaviors, which are heavily comorbid in individuals with CIPN, remain understudied. The present studies were conducted to explore the role of the kratom alkaloid MG on both pain and affective behaviors associated with CIPN, at the pharmacological, cellular, and molecular level. To accomplish this, we measured 1. Contributions of opioid and adrenergic signaling mechanisms to the therapeutic efficacy of MG in a mouse model of oxaliplatin-induced mechanical hypersensitivity using pharmacological inhibition. 2. Contributions of cannabinoid signaling to the therapeutic efficacy of MG in a mouse model of oxaliplatin-induced mechanical hypersensitivity and inflammatory pain using pharmacological and genetic approaches. 3. Effects of MG on affective behaviors associated with CIPN using mouse models of the tail-suspension test, elevated zero maze, and conditioned place preference. Overall, the findings from this dissertation support the hypothesis that MG displays therapeutic efficacy against nocifensive behavior of CIPN and pain-related affective behaviors. Opioid, adrenergic, and cannabinoid mechanisms all contribute to the effect of MG on oxaliplatin-induced mechanical hypersensitivity. MG is also capable of normalizing aberrant neurotrophic factor signaling associated with CIPN. Lastly, MG produces anxiolytic effects when repeatedly administered without developing a conditioned place preference, suggesting that it achieves therapeutic efficacy in a model of CIPN without risk of adverse events. / Biomedical Sciences

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Treatments for chronic pain are inadequate, and new options are needed. Nonpharmaceutical approaches are especially attractive with many potential advantages including safety. Light therapy has been suggested to be beneficial in certain medical conditions such as depression, but this approach remains to be explored for modulation of pain. We investigated the effects of light-emitting diodes (LEDs), in the visible spectrum, on acute sensory thresholds in naive rats as well as in experimental neuropathic pain. Rats receiving green LED light (wavelength 525 nm, 8 h/d) showed significantly increased paw withdrawal latency to a noxious thermal stimulus; this antinociceptive effect persisted for 4 days after termination of last exposure without development of tolerance. No apparent side effects were noted and motor performance was not impaired. Despite LED exposure, opaque contact lenses prevented antinociception. Rats fitted with green contact lenses exposed to room light exhibited antinociception arguing for a role of the visual system. Antinociception was not due to stress/anxiety but likely due to increased enkephalins expression in the spinal cord. Naloxone reversed the antinociception, suggesting involvement of central opioid circuits. Rostral ventromedial medulla inactivation prevented expression of light-induced antinociception suggesting engagement of descending inhibition. Green LED exposure also reversed thermal and mechanical hyperalgesia in rats with spinal nerve ligation. Pharmacological and proteomic profiling of dorsal root ganglion neurons from green LED-exposed rats identified changes in calcium channel activity, including a decrease in the N-type (CaV2.2) channel, a primary analgesic target. Thus, green LED therapy may represent a novel, nonpharmacological approach for managing pain.

Chronic pain affects the life of millions of people. Current treatments have deleterious side effects. We have advanced a strategy for targeting protein interactions which regulate the N-type voltage-gated calcium (CaV2.2) channel as an alternative to direct channel block. Peptides uncoupling CaV2.2 interactions with the axonal collapsin response mediator protein 2 (CRMP2) were antinociceptive without effects on memory, depression, and reward/addiction. A search for small molecules that could recapitulate uncoupling of the CaV2.2-CRMP2 interaction identified (S)-lacosamide [(S)-LCM], the inactive enantiomer of the Food and Drug Administration-approved antiepileptic drug (R)-lacosamide [(R)-LCM, Vimpat]. We show that (S)-LCM, but not (R)-LCM, inhibits CRMP2 phosphorylation by cyclin dependent kinase 5, a step necessary for driving CaV2.2 activity, in sensory neurons. (S)-lacosamide inhibited depolarization-induced Ca influx with a low micromolar IC50. Voltage-clamp electrophysiology experiments demonstrated a commensurate reduction in Ca currents in sensory neurons after an acute application of (S)-LCM. Using constellation pharmacology, a recently described high content phenotypic screening platform for functional fingerprinting of neurons that uses subtype-selective pharmacological agents to elucidate cell-specific combinations (constellations) of key signaling proteins that define specific cell types, we investigated if (S)-LCM preferentially acts on certain types of neurons. (S)-lacosamide decreased the dorsal root ganglion neurons responding to mustard oil, and increased the number of cells responding to menthol. Finally, (S)-LCM reversed thermal hypersensitivity and mechanical allodynia in a model of postoperative pain, and 2 models of neuropathic pain. Thus, using (S)-LCM to inhibit CRMP2 phosphorylation is a novel and efficient strategy to treat pain, which works by targeting specific sensory neuron populations.

Les douleurs neuropathiques ayant une origine à la suite de blessures traumatiques du SNC ou du SNP sont particulièrement difficiles à traiter en utilisant les moyens thérapeutiques actuellement disponibles. Il est donc nécessaire d'identifier de nouvelles stratégies thérapeutiques. Notre objectif était donc de définir les mécanismes impliqués dans ces douleurs neuropathiques. LIMK1 est l'un des acteurs possibles de la réorganisation épinière qui caractérise les lésions nerveuses. Une fonction très caractérisé de cette protéine, est la phosphorylation d'une famille de protéines appelées « cofilines ». Sa phosphorylation, ce qui induit la réorganisation du cytosquelette d'actine. Récemment, il a été montré qu’un microARN (miARNs) nomé miR-134 régule l'expression de LIMK1 en se liant au messager de LIMK1 (ARNm), inhibant sa traduction en protéine physiologiquement active. Notre hypothèse était que la régulation de LIMK1 par miR-134 pourrait jouer un rôle essentiel dans la sensibilisation à la douleur. Cette régulation pourrait ainsi être liée non seulement à la modulation neurochimique neuronale mais aussi à la plasticité fonctionnelle associée. Au cours de cette thèse, l’HIS a montré une diminution de miR-134 chez des rats SNL (neuropathique), cette sous-expression était concomitante à une augmentation de LIMK1 illustrée par l’IHC. Il est important de noter ici que l'ISH est une méthode de détection connue récemment et qui a été identifiée pour visualiser les miARNs. Des différents protocoles de l’HIS ont également été discutés dans le cadre de cette thèse. Ce résultat a été confirmé par Le qRT-PCR . Par la suite, afin de vérifier les changements comportementaux douloureux induits par miR-134 et LIMK1. Nous avons effectués des injections intrathécales de siRNA anti-LIMK1 pour inhiber l'expression endogène de LIMK1 chez les SNL. C’était intéressant de ne pas avoir trouvé aucun changement comportemenal chez les SNL après ce type d’injection. Une surexpression artificielle de miR-134 en utilisant un précurseur de miR-134 (premiR-134) chez les SNL a montré le même effet. Ensuite, nous avons essayé d'effectuer les mêmes injections chez les Sham (control), et c’était plus intéressant de trouver que ces injections (siRNA LIMK1 et premiR-134) ont provoqué une hypersensibilité douleureuse chez les sham. Cela a été illustré au moyen de deux tests de comportement; le Von Frey (VF) et la distribution pondérale dynamique (DWB). Pour etudier l'effet inverse, nous avons inhibé miR-134 en utilisant une sonde spécifique KD (Knock-Down); une diminution significative inattendue dans le seuil de retrait a été observée avec VF et DWB. qRT-PCR dans la plupart de ces cas, a confirmé la corrélation in vivo entre miR-134 et LIMK1. Enfin, nous avons cherché un mécanisme d'action possible qui pourrait réguler cette modulation. Des données récentes publiées ont montré une implication de l'ADF/cofiline sur le trafic des récepteurs AMPA (AMPAR). En accord avec les résultats mentionnés ci-dessus, la transfection du KD de miR-134 a montré une diminution dans AMPAR adressés à la membrane plasmique. Tout ensemble ces données suggèrent que l'effet antinociceptif de KD de miR-134 et la surexpression de LIMK1 sont indirectement régulé par l'insertion des AMPAR à la membrane plasmique.Il semble que miR-134 exerce un effet différent sur la douleur neuropathique que miR-103, discuté aussi dans le cadre de cette thèse. Il était demontré comme un régulateur de plusieurs cibles, les trois sous-unités formant les canaux calciques de type-L « Cav1.2 LTC ». MiR-103 a été trouvé également réprimés chez les SNL. La surexpression de miR-103 soulage la douleur neuropathique. Contrairement au miR-134, miR-103 exerce un rôle pronociceptive pendant la douleur neuropathique. / Pains having a neuropathic origin following CNS or PNS traumatic injury are particularly difficult to treat using the actually available therapeutic means. It is thus necessary to identify new therapeutic strategies. Hence, our aim was to define the mechanisms implicated in these neuropathic pains. Nervous lesions are characterised by an anatomical reorganization of the neuronal network of the dorsal horn. Neurochemical alterations are also involved. Some of the molecular mechanisms underlying the neuronal plasticity (a main feature of neuropathic pain) have been emphasized here by a variety of complementary technical approaches. LIMK1 is one of the possible actors of this reorganization. Among this protein’s known functions, and the most characterized is the phosphorylation of a family of proteins known as cofilins. Their phosphorylation induces the reorganization of actin cytoskeleton. Recently, it has been shown that a miR-134 miRNA regulates LIMK1 expression by binding to the LIMK1 messenger, inhibiting its translation into physiologically active protein. Our hypothesis is that LIMK1 regulation by miR-134 might play an essential role in pain sensitization by modulating neuron neurochemical reorganization and the associated functional neuronal plasticity. Firstly, by means of IHC and ISH, we studied miR-134/LIMK1 distribution within the dorsal horn of the spinal cord in sham animal (control group) and in neuropathic pain model (SNL model). Important to note here that ISH is a known detection method recently identified to visualize miRNA. Different protocols of ISH were discussed in a part of this thesis. ISH showed a decrease in miR-134 expression in SNL rats concomitantly with an increase in LIMK1 illustrated by IHC. This finding has been confirmed by qRT-PCR techniques. Afterward, in order to check for the possible behavioural-induced changes of miR-134 and LIMK1. We intrathecally injected an anti-LIMK1 siRNA to inhibit endogenous LIMK1 expression in SNL rats. Interestingly no significant changes in pain behaviour have been observed. Artificial overexpression of miR-134 using a PremiR-134, showed the same effect. Then we tried to perform the same injections on sham rats, and more interestingly, siRNA LIMK1 and premiR-134 evoked pain hypersensitivity in shams rats. This was illustrated by means of two behaviour tests; Von Frey (VF) and the Dynamic Weight bearing (DWB). To explore the reverse effect, we inhibited miR-134 using a specific KD probe in SNL rats; unexpectedly a significant decrease in pain withdrawal threshold was observed with VF and DWB. qRT-PCR in most cases confirmed the in vivo correlation between miR-134 and LIMK1. Finally, we searched for the possible mechanism of action that could regulate this modulation. Recent published data showed an involvement of ADF/cofilin on AMPAR trafficking. In line with the above mentioned findings, miR-134 KD transfection showed a decrease in AMPAR addressed to the plasma membrane. Altogether suggest that the antinociceptive effect of miR-134 KD and LIMK1 overexpression are mediated by AMPAR insertion at the plasma membrane. It seems that miR-134 exerts a different effect on neuropathic pain than miR-103 another miRNA discussed within the frame of this thesis. MiR-103 has been proved to regulate multiple targets, the three subunits forming Cav1.2 LTC. Pain sensitization involves Cav1.2 activation which consequently alters gene expression during this form of plasticity. MiR-103 was found downregulated also in the SNL model. Conversely to miR-134, overexpression of miR-103 partially alleviates pain. It decreases pain withdrawal threshold of the Von Frey test. Unlike miR-134, miR-103 exerts a pronociceptive role during neuropathic pain.

Le système somato-sensoriel permet à l'organisme de percevoir une large palette de stimuli externes/internes, qui peuvent être soit agréables, soit nocifs. Le corps cellulaire des neurones somato-sensoriels, responsables de ces processus et qui innervent tous les organes du corps, est situé dans les ganglions de la racine dorsale. La douleur est perçue par les nocicepteurs qui constituent un ensemble hétérogène de neurones, aussi bien d'un point de vue fonctionnel, électrophysiologique que moléculaire. Afin de mieux comprendre la spécialisation fonctionnelle des nocicepteurs, une des stratégies de l'équipe a été d'identifier de nouveaux marqueurs moléculaires exprimés par des sous-populations des neurones du DRG et de mettre en place des outils génétiques pour étudier leur fonction spécifique. Nous avons mis en évidence un nouveau gène, qui définit une sous-population de nocicepteurs. Suite à mes travaux de thèse, qui ont révélés la fonction moléculaire de la protéine associée à ce gène, nous l'avons nommé GINIP pour Galpha INhibitory Interacting Protein. Au cours de ma thèse, j'ai montré que : - GINIP interagit physiquement avec les protéines G-alpha inhibitrices- la perte de fonction de GINIP (souris GINIP KO) amplifie les douleurs de type neuropathique- le mécanisme sous-jacent fait intervenir la signalisation GABAergique Les douleurs pathologiques sont, entre autres, dues à un disfonctionnement des nocicepteurs, et leurs mécanismes restent mal connus. Dans ce contexte, l'ensemble de mes résultats met en évidence une nouvelle voie impliquée dans la régulation négative des nocicepteurs, qui pourra à l'avenir être la cible de stratégies thérapeutiques. / The somato-sensory system allows our organism to detect a myriad of external and internal stimuli that can range from innocuous stimuli (pleasant touch,etc) to noxious ones (burns, tissue injury, etc). The somato-sensory neurons involved in these processes innervate the entire organism and have their cell bodies clustered within the dorsal root ganglion. Pain is a modality of the somatosensory system, sensed through nociceptors. Nociceptors represent a heterogeneous class of somato-sensory neurons with respect to functional, electrophysiological and molecular criteria. In order to expand the knowledge of the functional specialization of nociceptors, our team's strategy aimed at identifying new molecular markers of nociceptors subsets. Subsequent design of the corresponding genetic tools allowed us investigating their specific function. Therefore, we found a gene that was never described before and that marks a specific subset of nociceptors. We named it GINIP (Gaplha Inhibitory Interacting Protein) as during my thesis I showed that:- GINIP physically interacts with inhibitory G-proteins- GINIP loss of function (GINIP knock out mouse) leads to the amplification of neuropathic pain- the associated mechanism involves GABAergic signalingPathological pain (chronic inflammatory pain and neuropathic pain) is, among others, a consequence of nociceptor dysfunction. Importantly, the mechanisms leading to this aberrant function are still not totally understood. Altogether, my results underscore a new pathway involved in the negative control of nociceptors under neuropathic pain conditions, and this opens a path for new therapeutic strategies.

The incidence of mild blast traumatic brain injuryhas risen due tothe increased use of improvised explosive devices (IEDs) in militaryconflicts. Mild blast TBI (mbTBI) is especially relevant due to its lack of acutely observable symptoms, and to its association with long-term neurodegenerative and neuropsychiatric disorders. Predominantly, TBI patients often suffer from chronic stress, neuropathic pain and headaches, which greatly compromise the health and quality of life of these individuals. Treatments for neuropathic pain have been empirically found and produce little effect in lessening neuropathic pain, likely due to the lack of targeted therapies. This highlights the need for better understanding of the molecular mechanisms underlying neuropathicpain, TBI and chronic stress that could lead to mechanistic therapeutic targets. Oxidative stress is an important mechanism of the pathophysiology of neuropathic pain, TBI and chronic stress. We hypothesize that acrolein, an endogenously formed neurotoxin, is able to stay active in the body for up to 10 days, is involved in the pathophysiology of neuropathic pain in TBI and chronic stress. This study aims to correlate acrolein elevation in the body with neuropathic pain, deepen the understanding of underlying mechanisms of pain in TBI and chronic stress, and mitigate this pain with acrolein scavenging. The ultimate goal of this research is to provide therapies for TBI and chronic stress patients that can eliminate pain and significantly improve their healthand quality of life

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