yes / Pharmaceutical manipulation of cAMP levels exerts beneficial effects through the regulation of the exchange protein activated by cAMP (EPAC) and protein kinase A (PKA) signalling routes. Recent attention has turned to the specific regulation of EPAC isoforms (EPAC1 and EPAC2) as a more targeted approach to cAMP-based therapies. For example, EPAC2-selective agonists could promote insulin secretion from pancreatic β cells, whereas EPAC1-selective agonists may be useful in the treatment of vascular inflammation. By contrast, EPAC1 and EPAC2 antagonists could both be useful in the treatment of heart failure. Here we discuss whether the best way forward is to design EPAC-selective agonists or antagonists and the current strategies being used to develop isoform-selective, small-molecule regulators of EPAC1 and EPAC2 activity.

Chronic postoperative pain impacts millions of individuals worldwide that undergo a variety of surgical procedures. Opioids remain the mainstay analgesics of acute and perioperative pain; however, prolonged opioid therapy may lead to life-threating adverse effects, tolerance, dependence, and addiction. Therefore, unraveling the cellular mechanisms that drive persistent pain states and opposing endogenous analgesia provided by opioid receptor signaling, may lead to novel analgesics. Evidence suggests that tissue injury leads to increased sensitization of the spinal cord nociceptive neurons which increases susceptibility to chronic pain via an N-methyl-D-aspartate (NMDA) receptor activation of calcium-sensitive adenylyl cyclase isoform 1 (AC1). This phenomenon, named latent pain sensitization (LS), is mediated by a compensatory response of endogenous inhibitory systems. In this dissertation, we test the hypothesis that surgical insult promotes prolonged activation of kappa opioid receptors (KOR) which mask LS via attenuation of pro-nociceptive AC1 signaling pathways in both male and female animals. We employed a murine model of chronic postoperative pain that promotes LS in the spinal cord and closely resembles the phenotypic features of postoperative pain in human subjects. When behavioral signs of hyperalgesia resolved, we targeted spinal opioid receptor systems and pronociceptive modulators with intrathecal delivery of selective pharmacological antagonists and assessed behavioral signs of hyperalgesia and spinal nociceptive sensitization. We propose that LS is kept in remission by a long-lasting compensatory response of tonic endogenous KOR signaling that hinders a pronociceptive LS pathway that includes not only AC1 but also two downstream targets: protein kinase A (PKA) and exchange protein activated by cAMP (Epac1/2) - in a sex-dependent manner. Our results propose new therapeutic targets for the management of persistent postoperative pain and underscore the importance of tailoring sex-specific pain management strategies.

<p>Exchange proteins directly activated by cAMP (EPAC) are guanine nucleotide exchange factors for the small GTPases, Rap1 and Rap2. The central regulatory module of EPAC is a cAMP binding domain (CBD), which in the absence of cAMP provides auto-inhibition of the catalytic guanine nucleotide exchange activity. Binding of the allosteric effector, cAMP, removes the auto-inhibition exerted by the CBD of EPAC. Herein, we investigate through NMR spectroscopy the structural and dynamical basis of auto-inhibition and cAMP-dependent allosteric activation in the CBD of EPAC. Specifically, the work described in this dissertation proposes novel methods that utilize NMR chemical shifts to define the network of residues that mediates long-range intra-molecular signalling, <em>i.e.</em> the chemical shift covariance analysis (CHESCA) and the chemical shift projection analysis (CHESPA). Using CHESCA as explained in Chapter 2, we identified an allosteric network that bridges the sites of cAMP-binding and cAMP-dependent structural changes to those of cAMP-dependent dynamical changes, which are critical for the release of auto-inhibition. The CHESCA results therefore rationalize how cAMP leads to activation through modulation of both structure and dynamics. In order to dissect the determinants of auto-inhibition in the absence of cAMP, several mutations along the signaling pathways identified by CHESCA were implemented and their effect on the auto-inhibitory conformational equilibrium of the apo-CBD was assessed through CHESPA, as outlined in Chapters 3 and 4. Overall, we have shown how CHESCA and CHESPA provide unprecedented insight into the allosteric networks underlying auto-inhibition and cAMP dependent activation in the CBD of EPAC. In addition, the methods employed here to map EPAC allostery are likely to be generally applicable to other systems.</p> / Doctor of Philosophy (PhD)