Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
Can J Anaesth. 2013 Aug;60(8):780-6. doi: 10.1007/s12630-013-9975-x. Epub 2013 Jun 6.
Intractable neuropathic dynamic allodynia remains one of the major symptoms of human trigeminal neuropathy and is commonly accepted to be the most excruciatingly painful condition known to humankind. At present, a validated animal model of this disorder is necessary for efficient and effective development of novel drug treatments. Intracisternal strychnine in rats has been shown to result in localized trigeminal dynamic allodynia, thus representing a possible model of trigeminal neuralgia. The purpose of this study was to validate a mouse model of trigeminal glycinergic inhibitory dysfunction using established positive (carbamazepine epoxide) and negative (morphine) controls.
The actions of conventional first-line treatment (carbamazepine epoxide [CBZe]) and clinically ineffective morphine were tested for trigeminal dynamic mechanical allodynia produced by intracisternal strychnine. In mice under halothane anesthesia, we injected either strychnine (0.3 μg), strychnine with CBZe (4 ng), or artificial cerebrospinal fluid (aCSF) intracisternally (i.c.). In a separate set of experiments, subcutaneous morphine (3 mg·kg(-1) sc) was injected with intracisternal strychnine. Dynamic mechanical allodynia was induced by stroking the fur with polyethylene (PE-10) tubing. The response of each mouse was rated to determine its allodynia score, and scores of each group were compared. In addition, in a separate dichotomous disequilibrium study, pairs of mice were injected with strychnine/saline, strychnine/strychnine-CBZe, or strychnine/strychnine-morphine. A blinded observer recorded which mouse of each pair had the greater global pain behaviour.
Strychnine (i.c.) produced higher quantitative allodynia scores in the trigeminal distribution (mean 81.5%; 95% confidence interval [CI] 76.4 to 86.6) vs the aCSF group (mean 11.3%; 95% CI 8.1 to 14.4) (P < 0.0001). Carbamazepine epoxide (i.c.) completely abolished allodynia when co-injected with strychnine (mean 83.2%; 95% CI 78.1 to 88.4) vs strychnine alone (mean 3.2%; 95% CI -0.9 to 7.2) (P < 0.0001). Morphine co-injected with strychnine did not result in reduced allodynia (mean 65.7%; 95% CI 42.0 to 89.4) compared with strychnine alone (mean 87.6%; 95% CI 77.6 to 97.6) (P = 0.16). In a further global allodynia assessment, strychnine (i.c.) produced greater allodynia than both aCSF and strychnine administered with CBZe (P = 0.03). Morphine (ip) administered with strychnine did not result in reduced global allodynia compared with strychnine administered alone (P = 1.0).
In this study, we have developed and validated a novel murine model of trigeminal dynamic allodynia induced by intracisternal strychnine. The use of mice to study trigeminal allodynia has many benefits, including access to a vast repository of transgenic mouse variants, ease of handling, low cost, and minimal variance of results. The present model may have utility in screening drug treatments for dynamic mechanical allodynia resulting from trigeminal neuropathies.
难以治疗的神经性感觉异常性疼痛仍然是人类三叉神经病变的主要症状之一,通常被认为是人类所经历的最痛苦的疾病。目前,为了有效地开发新的药物治疗方法,这种疾病的验证动物模型是必要的。大鼠蛛网膜下腔士的宁已被证明会导致局部三叉神经感觉异常性疼痛,因此代表了一种可能的三叉神经痛模型。本研究的目的是使用已建立的阳性(卡马西平环氧化物)和阴性(吗啡)对照物,验证使用三叉神经甘氨酸抑制功能障碍的小鼠模型。
用常规一线治疗药物(卡马西平环氧化物[CBZe])和临床上无效的吗啡测试蛛网膜下腔士的宁引起的三叉神经动态机械性感觉异常。在异氟烷麻醉下的小鼠中,我们分别向蛛网膜下腔注射士的宁(0.3 μg)、士的宁与 CBZe(4 ng)或人工脑脊液(aCSF)。在另一组实验中,皮下注射吗啡(3 mg·kg-1 sc),同时向蛛网膜下腔注射士的宁。用聚乙烯(PE-10)管刷毛诱导动态机械性感觉异常。通过评定每只小鼠的反应来确定其感觉异常评分,并比较每组的评分。此外,在另一项独立的不平衡研究中,将小鼠分为蛛网膜下腔士的宁/生理盐水、蛛网膜下腔士的宁/士的宁-CBZe 或蛛网膜下腔士的宁/士的宁-吗啡。一位盲法观察者记录了每对小鼠中哪只的整体疼痛行为更严重。
蛛网膜下腔士的宁(i.c.)在三叉神经分布中产生更高的定量感觉异常评分(平均 81.5%;95%置信区间[CI]为 76.4%至 86.6%),而对照组为 aCSF(平均 11.3%;95% CI 8.1%至 14.4%)(P<0.0001)。当与士的宁共同注射时,卡马西平环氧化物(i.c.)完全消除了感觉异常(平均 83.2%;95% CI 78.1%至 88.4%),而单独注射士的宁(平均 3.2%;95% CI -0.9%至 7.2%)(P<0.0001)。与单独注射士的宁相比,吗啡与士的宁共同注射并没有导致感觉异常减轻(平均 65.7%;95% CI 42.0%至 89.4%)(P=0.16)。在进一步的整体感觉异常评估中,与 aCSF 和与 CBZe 共同注射的士的宁相比,蛛网膜下腔士的宁(i.c.)引起的感觉异常更严重(P=0.03)。与单独注射士的宁相比,皮下注射吗啡(ip)并没有导致整体感觉异常减轻(P=1.0)。
在这项研究中,我们开发并验证了一种新的蛛网膜下腔士的宁诱导的三叉神经动态感觉异常的小鼠模型。使用小鼠研究三叉神经感觉异常有许多好处,包括可以访问大量的转基因小鼠变体、易于处理、成本低和结果差异小。目前的模型可能对筛选治疗三叉神经病变引起的动态机械感觉异常的药物治疗方法具有一定的应用价值。