Neuropathic pain affects up to 50% of the 29 million diabetic patients in the United States. Neuropathic pain in diabetes manifests as a disease of the peripheral and central nervous systems. The prevalence of type 2 diabetes is far greater than type 1 (90%), yet the overwhelming focus on type 1 models this has left the mechanisms of pain in type 2 diabetes largely unknown. Therefore I aimed to improve the current mechanistic understanding of pain associated with type 2 diabetes using two preclinical rodent models: Zucker Diabetic Fatty rats and db/db mice. In addition, I highlight the translational importance of simultaneous measurement of evoked/sensory and non-evoked/affective pain-related behaviors in preclinical models. This work is the first to show a measure of motivational-affective pain in a model of type 2 diabetes. I used methodological approaches including: (1) immunohistochemical and calcium imaging to assess stimulus-evoked sensitization; (2) measurement nociceptive behaviors and evoked sensory thresholds as well as pain affect using novel mechanical conflict avoidance and conditioned place preference/aversion assays; (3) pharmacological and genetic manipulation of methylglyoxal, TRPA1, AC1, and PPARγ. I hypothesized that the thiazolidinedione class of peroxisome proliferator-activated receptor gamma (PPARγ) agonists would reduce neuropathic pain-like behavior and spinal neuron sensitization in traumatic nerve injury and type 2 diabetes. As PPARγ is a nuclear receptor, and already targeted clinically to promote cellular insulin sensitization to reduce hyperglycemia, sustained changes in gene expression are widely believed to be the mechanism of pain reduction. In two separate research aims, I challenged this view and tested whether the PPARγ agonist pioglitazone would (1) rapidly alleviate neuropathic pain through a non-genomic mechanism and (2) reduce painful sensitization in nociceptive and neuropathic pain models independent from lowering blood glucose. I aimed to investigate the contribution of the glucose metabolite methylglyoxal to painful type 2 diabetes. I tested the hypothesis that methylglyoxal produces nociceptive, evoked, and affective pain that is dependent on activation of the sensory neuron cation channel TRPA1 and the secondary messenger enzyme AC1. I also tested whether pioglitazone or the novel methylglyoxal scavenging peptide GERP10 could alleviate painful type 2 diabetes.

京都大学 / 0048 / 新制・課程博士 / 博士(薬学) / 甲第19651号 / 薬博第821号 / 新制||薬||239(附属図書館) / 32687 / 京都大学大学院薬学研究科薬学専攻 / (主査)教授 金子 周司, 教授 佐治 英郎, 教授 竹島 浩 / 学位規則第4条第1項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

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This thesis examined how and why TRPV1 function is being modulated in sensory neuropathy and explored the potential of its rescue in the urinary bladder of STZ-­‐induced diabetic rats. Diabetes induced a rapid decline in TRPV1 function and changes in neurogenically mediated electrically-­‐evoked responses together with a gradual decline in muscarinic function. Diabetic bladder was also deficient in muscarinic and TRPV1 organ bath temperature-­‐induced changes but not in those affecting spontaneous contractile activity. Exposure to a potential neuropathy causative agent, methylglyoxal was studied and its mechanism of action explored through the use of TRPA1 ligands. Methylglyoxal exposure mimicked some of the effects of diabetes on TRPV1, neurogenic electrically evoked responses and muscarinic function. Methylglyoxal effects were seen to be partly through TRPA1 receptor activation but other as yet undefined pathways were also involved. Use of TRPA1 ligands revealed an unexpected complexity of the interaction of the TRPA1 receptor with TRPV1. Finally the potential of reversing the diminished TRPV1 response was examined through the use of three known sensitising agents, bradykinin, NGF and insulin. Bradykinin was the only agent seen to reverse the TRPV1 diminished response back up to to control equivalent levels and through the use of bradykinin selective ligands, it was seen that the dual activation of BK-­‐1 and BK-­‐2 receptor was necessary to rescue the TRPV1 response. The likely mechanism of action of bradykinin was through prostaglandin production as indomethacin blocked TRPV1 rescue. In the acute stage of diabetes, TRPV1 function is downregulated and may be caused by exposure to a neuropathy-­‐causing metabolite such as methylglyoxal. The TRPV1 function still retains plasticity at this acute stage because function could be enhanced back to control levels by bradykinin receptor activation : a potential for early therapeutic intervention.

A famÃlia de receptores de potencial transitÃrio (TRP) incluindo o receptor de potencial transitÃrio anquirina, subtipo 1 (TRPA1) tem mostrado ser um alvo terapÃutico potencial para o tratamento da dor aguda e crÃnica. Alguns estudos tÃm demonstrado que a resposta nociceptiva somÃtica se deve à ativaÃÃo dos receptores TRPA1 e sÃo efetivamente modulados atravÃs da ferramenta experimental, HC-030031, um antagonista seletivo. Contudo, existem poucos estudos que avaliam o papel dos receptores TRPA1 na dor visceral. Portanto, investigamos o papel do TRPA1 em modelos animais de nocicepÃÃo visceral induzido por diferentes substÃncias e tambÃm exploramos os possÃveis mecanismos envolvidos. Camundongos Swiss, machos (N=6) receberam carboximetilcelulose 0,5% (veÃculo CMC 0,5%, 1 mL/Kg, v.o.), HC-030031 (75, 150 ou 300 mg/Kg, v.o.), ou L-NAME (10 e 40 mg/Kg, s.c.) ou somente L-Arginina (600 mg/Kg, i.p.), 1 h apÃs foi administrado uma Ãnica injeÃÃo de IFO (400 mg/Kg, i.p.). A nocicepÃÃo visceral foi avaliada atravÃs do teste de Von Frey eletrÃnico previamente (T0) e 12 h (T1) apÃs a injeÃÃo de IFO com estimulaÃÃo abdominal atravÃs de um analgesÃmetro digital. Os resultados foram obtidos em gramas (T0-T1) pela variaÃÃo da hiperalgesia. Em seguida as bexigas dos animais foram removidas para pesagem, anÃlise e foram atribuÃdos escores macro e microscopicamente. Investigou-se, tambÃm, o efeito antinociceptivo visceral do HC-030031 atravÃs do modelo de nocicepÃÃo visceral induzido por Ãleo de mostarda (OM). Os animais foram tratados com CMC 0,5%, HC-030031 (18,75; 37,5 ou 75 mg/kg, v.o.) ou Morfina (5 mg/Kg, s.c.) isoladamente ou receberam Naloxona (2 mg/Kg, i.p.) previamente a estas drogas. Em seguida, OM 0,75% (50 &#956;L/colon) foi instilado localmente no cÃlon. A nocicepÃÃo visceral foi verificada atravÃs do teste de Von Frey previamente (T0) e 10 min. (T1) apÃs a injeÃÃo do OM. Em outro protocolo experimental, os animais foram tratados com CMC 0,5% (10 mL/kg, v.o.) ou HC-030031 (18,75; 37,5 ou 75 mg/Kg, v.o.) previamente a uma injeÃÃo intraperitoneal com Ãcido acÃtico 0,6% (AA, 10 mL/Kg,), zymosan (Zym, 1 mg/cavidade) ou misoprostol (MPT, 1 Âg/cavidade, um anÃlogo estÃvel de prostaglandinas). Imediatamente apÃs a injeÃÃo desses algogÃnicos, contabilizaram-se as contorÃÃes abdominais por 30 min. Adicionalmente, para investigar o papel de cÃlulas peritoneais residentes sobre o efeito do HC-030031, a cavidade peritoneal dos camundongos foi lavada com uma soluÃÃo de 30 mL (PBS + heparina) e os estÃmulos AA, Zym e MPT foram injetados i.p. Um grupo Sham foi incluÃdo tambÃm neste protocolo. Ao final do experimento, as contorÃÃes abominais foram registradas por 30 mim. Utilizou-se para a anÃlise estatÃstica, ANOVA/Student e Newman/Keul, foi considerado significativo um p < 0,05 (CEPA: Protocolo: 92/10). A IFO induziu significativa (p<0,05) nocicepÃÃo visceral (6,25Â1,08) e resposta inflamatÃria [escores edema 2(1-3); hemorragia 3(1-3) e peso bexiga (42,78 3,10)] comparado com o grupo salina (1,97Â0,89),[ 0(0-0); 0(0-0) e 20,01 0,7749] respectivamente. AlÃm disso, HC-030031(75 mg/Kg) e L-NAME (10 e 40 mg/Kg) preveniram de maneira significativa (p<0,05) da resposta nociceptiva (2,30Â1,07; 1,58Â0,86 e 0,2500  0,73) respectivamente quando comparado com o grupo IFO. O prÃ-tratamento com L-Arginina (6,844Â1,235) reverteu o efeito antinociceptivo do L-NAME 10 mg/Kg, (6,84Â1,23), mas foi ineficaz sobre o efeito do L-NAME 40 mg/Kg (1,500Â0,7361) e HC-030031 75 mg/Kg (0,7200Â0,6953). Contudo, o prÃ-tratamento com HC-030031 nÃo apresentou efeito antiinflamatÃrio. Adicionalmente, verificou-se que o OM induziu significativo (p<0,05) comportamento nociceptivo (6,333Â0,9458) quando comparado ao grupo salina (1,250Â0,9204). AlÃm disso, o HC-030031 preveniu de maneira significativa da resposta nociceptiva provocada pelo OM (1,536 Â0,7653). Avaliou-se tambÃm o envolvimento do sistema opiÃide no efeito antinociceptivo do HC-030031. Verificou-se que a morfina apresentou uma importante atividade antinociceptiva (0,07143Â0,07143) contra a nocicepÃÃo induzida por OM a qual foi significativamente revertida pelo prÃ-tratamento com naloxona (3,125 1,302). Por outro lado, o efeito antinociceptivo do HC-030031 nÃo foi afetado pela naloxona (2,240Â1,263). Adicionalmente, AA, Zym e MPT induziram respostas de contorÃÃes abdominais significativas (43,71Â4,43; 11,00Â2,11 e 9,00Â2.30, respectivamente) as quais foram significativamente inibidas com HC-030031 (18,75, 37,5 ou 75 mg/kg, v.o.) em todas as doses utilizadas no teste com AA (29,07%; 53,35% e 41,59%), no teste com Zym (55,85%; 61,03% e 71,20%) e no teste com MPT (63,88%; 83,33% e 88,88%). Uma vez que a prostaglandina ativa o nociceptor diretamente, demonstrou-se que o HC-030031 possivelmente inibe a nocicepÃÃo visceral atravÃs da estabilizaÃÃo direta de nociceptores. O efeito antinociceptivo do HC-030031 parece ser independente da inibiÃÃo de cÃlulas residentes inflamatÃrias, do Ãxido nÃtrico ou do sistema opiÃide. Este estudo fornece perspectivas para o manuseio da dor visceral atravÃs da modulaÃÃo dos canais TRPA1. / The description of the TRP family of receptors including TRPA1 has provided potential therapeutic targets for treating acute and chronic pain. Some studies have shown a somatic nociceptive response due to the TRPA1 receptors activation which is effectively modulated with the experimental tool, HC-030031, a TRPA1 antagonist. However, there are a few studies evaluating the role of TRPA1 receptors in visceral pain. Then aimed to investigate the role of TRPA1 in the animal models of visceral nociception induced by different substances and to explore the possible mechanisms involved. Swiss male mice (n=6) were given only Carboxymethyl cellulose (vehicle CMC 0.5%, 1 mL/kg, p.o.), the compound HC-030031 (75, 150 or 300 mg/Kg, p.o.) or L-NAME (10 or 40 mg/Kg, s.c.) alone or with L-arginine (600mg/Kg, i.p.) 1h previously a alone injection of IFO (400 mg/kg, i.p.). Visceral nociception was assessed through the von Frey test previously (T0) and 12h (T1) later IFO injection by the abdominal stimulation with a pressure meter. The results were obtained in grams (T0-T1). The bladder of these animals were also removed to weighted (BWW), analyzed and after given scores macro and microscopically. We also investigated the antinociceptive effect of HC-030031 in the model of mustard oil-induced visceral nociception. The animals were treated with CMC 0.5% or HC-030031 (18.75, 37,5 or 75 mg/kg) or Morphine (5 mg/Kg, s.c.) alone or with Naloxone (2 mg/Kg, i.p.) 1h previously the injection of Mustard oil (MO) 0,75% (MO, 50 ul/colon). Visceral nociception was assessed through the von Frey test previously (T0) and 10 min (T1) after MO injection by the abdominal stimulation with a pressure meter. The results were obtained in grams (T0-T1). In another experimental setting, the animals were treated with CMC 0.5% (1 mL/kg, p.o) or HC-030031 (18.75; 37.5 or 75mg/Kg, p.o.) previously an intraperitoneal injection with acetic acid 0.6% (AA, 10 mL/kg), zymosan (Zym, 1 mg/cavity) or misoprostol (MPT, a stable prostaglandin analogous, 1&#956;g/cavity) and immediately had the writhing responses counted for 30 min. In order to investigate the role of resident peritoneal cells on the effect of HC-030031, we washed the peritoneal cavity of mice with heparin added PBS (30 mL) and then AA, Zym or MPT were injected i.p. A Sham group was included. Eventually, the writhing responses were recorded. Statistical analysis was performed with ANOVA/Student Newman Keul as appropriate. p<0.05 was accepted. (CEPA: Protocol 92/10). IFO induced significant (p<0.05) visceral nociception (6.25Â1.08) and inflammatory response [scores to edema 2(1-3); hemorrhage 3(1-3); and bladder wet weight (42.78  3.1)] in comparison with saline treated group (1.97Â0.89), [0(0-0); 0(0-0); 20.01 0.7749] respectively. Moreover, HC-030031(75) and L-NAME (10 or 40 mg/Kg) prevented in a significant manner (p<0.05) the nociceptive response (2.30Â1.07; 1.58Â0.860 and 2500Â0.7361) respectively when compared with IFO-treated group. Although the pretreatment with L-arginine (6.844Â1.235) was able to reverse the antinoceceptive effect of L-NAME 10 mg/Kg, (6.84Â1.23), it failed to do the same (p>0.05) with L-NAME 40 mg/Kg (1.500Â0.7361) and HC-0300031 75 mg/Kg (0.72Â0.69). The same reversible effect of L-Arginine was observed for the anti-inflammatory activity of L-NAME (p<0.05). However, HC-030031 presented no anti-inflammatory effect. The antinociceptive activity of HC-030031 was also assessed in the MO nociception model. We verified that MO induced a significant (p<0.05) nociceptive behavior (6.333Â0.9458) when compared to saline injected mice (1.250Â0.9204). Moreover, HC-030031 prevented in a significant manner the nociceptive response elicited by MO (1.536Â0.7653). Furthermore, the involvement of opioid system in the antinociceptive effect of HC-030031 as tested. We observed that morphine presented an important antinociceptive activity (0.07143Â0.07143) against MO-induced nociception which was significantly reverted by naloxone pre-treatment (3.125 1.302). On the other hand, the antinociceptive effect of HC-030031 remained in spite the injection of naloxone (2.240Â1.263). In addition to that, AA, Zym and MPT induced significant writhing responses (43.71Â4.43; 11.00Â2.11; 9.00Â2.30; respectively) which was significantly inhibited with HC-030031(18.75, 37.5 e 75 mg/kg, p.o.) treated mice in all the doses tested (29.07%, 53.35% and 41.59%, in the AA test, 55.85%, 61.03% and 71.20%, in the Zym test, 63.88%, 83.33% and 88.88%, in the MPT induced nociception, respectively to 18.75, 37.5 and 75 mg/kg doses. Eventually, the reduction of cell population in the peritoneal cavity prevented the development of writhing responses in both AA and Zym injected mice, with no effect was visualized on MPT treated mice. We the conclude that, since prostaglandin activates the nociceptor directly, it was shown that HC-030031 inhibits visceral nociception possibly through the stabilization of the neuronal ends. The antinociceptive effect of HC-030031 seems to be independent of the inhibition of inflammatory resident cells, opioid and nitric oxide pathways. This study provides perspective for the effective management of visceral pain through the modulation of TRPA1 channels.

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Doctor of Philosophy(PhD) / Two recently identified transient receptor potential (TRP) channels, TRPM8 and TRPA1, have been proposed to play an important role in mammalian cool and cold peripheral sensory transduction. When expressed in cell-lines the cloned TRPM8 and TRPA1 receptors have distinct pharmacological and temperature response characteristics. Although these receptors are also transported to the central terminals of primary afferents, little is known about their centrally mediated actions. In this thesis, I use an in vitro electrophysiological approach to investigate the dorsal horn processing of cool afferent modalities and the role of TRP ion channels. The results of this thesis provide further information on thermal processing, indicate direction for further research and suggest possible therapeutic targets for the management of abnormal cold sensory processing. Initial experiments demonstrate that the cooling agents and known TRPM8 and TRPA1 agonists, menthol and icilin, inhibit primary afferent evoked excitatory postsynaptic currents (EPSCs) in rat spinal cord dorsal horn neurons. In addition, temperature reduction, menthol and icilin increase the frequency of miniature EPSCs without affecting amplitude distribution or kinetics. Little or no direct postsynaptic effect on dorsal horn neurons, GABAergic or glycinergic transmission was found. In combination, these observations demonstrate that temperature reduction, menthol and icilin act presynaptically to increase the probability of glutamate release from primary afferent fibres. Further examination of the changes in glutamatergic synaptic transmission induced by temperature reduction, menthol and icilin reveals a subset of neurons sensitive to innocuous cool (< 29 oC) and low concentrations of icilin (3-10 µM) which closely match the temperature activation and pharmacological profile of TRPM8. In addition, the majority of lamina I and II neurons displayed characteristics partly consistent with TRPA1-activation, including a concentration-dependent response to icilin and blockade by ruthenium red. The present experiments did not allow thermal characterisation of these TRPA1-like responses. Together these observations indicate that the effects of menthol and icilin on glutamatergic synaptic transmission in the superficial dorsal horn are mediated by TRPM8 and possibly by TRPA1. Examination of the anatomical location of neurons activated by temperature reduction, menthol, icilin and capsaicin allowed the central termination pattern of thermoreceptive primary afferent fibres with specific TRP-like response characteristics to be determined. TRPM8-like presynaptic activation was confined to a subpopulation of neurons located in lamina I and outer lamina II, while the majority of neurons throughout laminae I and II received inputs sensitive to menthol, high concentrations of icilin and capsaicin. These findings suggest that innocuous cool sensation projects to a specific subpopulation of superficial dorsal horn neurons unlike other modalities (mediated by TRPV1, possibly TRPA1 and other receptors), which non-selectively engage circuits within the entire superficial dorsal horn. No morphological specificity was identified for recovered neurons after electrophysiological characterisation. Finally, mu-opioids were shown to inhibit basal glutamatergic synaptic transmission as well as menthol- and icilin-induced transmission in the superficial dorsal horn. Of particular interest, delta-opioids selectively inhibited icilin-induced synaptic transmission within the same location. The selective effect of delta-opioids suggests a possible role in modulating receptors activated by icilin (TRPM8 and TRPA1). Overall, this thesis provides further evidence that TRPM8 is responsible for the transduction of innocuous cold sensation in mammals and is a potential therapeutic target in humans with cold hyperaesthesia secondary to abnormal thermal processing. The use of delta-opioid agonists warrants further investigation in cold hypersensitivity states and potentially other forms of pain.

Doctor of Philosophy(PhD) / Two recently identified transient receptor potential (TRP) channels, TRPM8 and TRPA1, have been proposed to play an important role in mammalian cool and cold peripheral sensory transduction. When expressed in cell-lines the cloned TRPM8 and TRPA1 receptors have distinct pharmacological and temperature response characteristics. Although these receptors are also transported to the central terminals of primary afferents, little is known about their centrally mediated actions. In this thesis, I use an in vitro electrophysiological approach to investigate the dorsal horn processing of cool afferent modalities and the role of TRP ion channels. The results of this thesis provide further information on thermal processing, indicate direction for further research and suggest possible therapeutic targets for the management of abnormal cold sensory processing. Initial experiments demonstrate that the cooling agents and known TRPM8 and TRPA1 agonists, menthol and icilin, inhibit primary afferent evoked excitatory postsynaptic currents (EPSCs) in rat spinal cord dorsal horn neurons. In addition, temperature reduction, menthol and icilin increase the frequency of miniature EPSCs without affecting amplitude distribution or kinetics. Little or no direct postsynaptic effect on dorsal horn neurons, GABAergic or glycinergic transmission was found. In combination, these observations demonstrate that temperature reduction, menthol and icilin act presynaptically to increase the probability of glutamate release from primary afferent fibres. Further examination of the changes in glutamatergic synaptic transmission induced by temperature reduction, menthol and icilin reveals a subset of neurons sensitive to innocuous cool (< 29 oC) and low concentrations of icilin (3-10 µM) which closely match the temperature activation and pharmacological profile of TRPM8. In addition, the majority of lamina I and II neurons displayed characteristics partly consistent with TRPA1-activation, including a concentration-dependent response to icilin and blockade by ruthenium red. The present experiments did not allow thermal characterisation of these TRPA1-like responses. Together these observations indicate that the effects of menthol and icilin on glutamatergic synaptic transmission in the superficial dorsal horn are mediated by TRPM8 and possibly by TRPA1. Examination of the anatomical location of neurons activated by temperature reduction, menthol, icilin and capsaicin allowed the central termination pattern of thermoreceptive primary afferent fibres with specific TRP-like response characteristics to be determined. TRPM8-like presynaptic activation was confined to a subpopulation of neurons located in lamina I and outer lamina II, while the majority of neurons throughout laminae I and II received inputs sensitive to menthol, high concentrations of icilin and capsaicin. These findings suggest that innocuous cool sensation projects to a specific subpopulation of superficial dorsal horn neurons unlike other modalities (mediated by TRPV1, possibly TRPA1 and other receptors), which non-selectively engage circuits within the entire superficial dorsal horn. No morphological specificity was identified for recovered neurons after electrophysiological characterisation. Finally, mu-opioids were shown to inhibit basal glutamatergic synaptic transmission as well as menthol- and icilin-induced transmission in the superficial dorsal horn. Of particular interest, delta-opioids selectively inhibited icilin-induced synaptic transmission within the same location. The selective effect of delta-opioids suggests a possible role in modulating receptors activated by icilin (TRPM8 and TRPA1). Overall, this thesis provides further evidence that TRPM8 is responsible for the transduction of innocuous cold sensation in mammals and is a potential therapeutic target in humans with cold hyperaesthesia secondary to abnormal thermal processing. The use of delta-opioid agonists warrants further investigation in cold hypersensitivity states and potentially other forms of pain.

Human body detects potentially damaging stimuli by specialized sensory nerve endings in the skin, the nociceptors. Their membranes are equipped with ion channels, molecular sensors, coding the outside stimuli into the trains of action potentials and conducting them to the higher brain centers. The most prominent group of transduction ion channels is the transient receptor potential (TRP) channel family followed by ion channels responsible for generation and conduction of action potentials from the periphery to the brain, the voltage-gated sodium channels (VGSCs). Understanding the mechanisms how particular stimulus is encoded and processed is of particular importance to find therapeutics for various types of pain conditions. We characterized the properties of VGSC subtypes NaV1.9 and NaV1.8 at high temperatures. We showed that NaV1.9 undergo large increase in current with increasing temperatures and significantly contribute to the action potential generation in dorsal root ganglion (DRG) neurons. Ciguatoxins (CTXs) are sodium channels activator toxins causing ciguatera fish poisoning, a disease manifested by sensory and neurological disturbances. We elucidated the mechanism of CTX- induced cold allodynia, a pathological phenomenon where normally innocuous cool temperatures are perceived as pain. We...