脊髓神经肽信号传导的促进和炎症介质表达的上调促成了骨折后伤害性感受敏化。

Facilitated spinal neuropeptide signaling and upregulated inflammatory mediator expression contribute to postfracture nociceptive sensitization.

作者信息

Shi Xiaoyou, Guo Tian-Zhi, Wei Tzuping, Li Wen-Wu, Clark David J, Kingery Wade S

机构信息

Physical Medicine and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.

出版信息

Pain. 2015 Oct;156(10):1852-1863. doi: 10.1097/j.pain.0000000000000204.

Abstract

Tibia fracture induces exaggerated substance P (SP) and calcitonin gene-related peptide (CGRP) signaling and neuropeptide-dependent nociceptive and inflammatory changes in the hind limbs of rats similar to those seen in complex regional pain syndrome. Inflammatory changes in the spinal cord contribute to nociceptive sensitization in a variety of animal pain models. This study tested the hypothesis that fracture-induced exaggerated neuropeptide signaling upregulates spinal inflammatory mediator expression, leading to postfracture hind limb nociceptive sensitization. At 4 weeks after performing tibia fracture and casting in rats, we measured hind limb allodynia, unweighting, warmth, edema, and spinal cord neuropeptide and inflammatory mediator content. The antinociceptive effects of intrathecally injected neuropeptide and inflammatory mediator receptor antagonists were evaluated in fracture rats. Transgenic fracture mice lacking SP or the CGRP RAMP1 receptor were used to determine the effects of neuropeptide signaling on postfracture pain behavior and spinal inflammatory mediator expression. Hind limb allodynia, unweighting, warmth, edema, increased spinal SP and CGRP, and increased spinal inflammatory mediator expression (TNF, IL-1, IL-6, CCL2, and nerve growth factor) were observed at 4 weeks after fracture in rats. Fracture-induced increases in spinal inflammatory mediators were not observed in fracture mice lacking SP or the CGRP receptor, and these mice had attenuated postfracture nociceptive sensitization. Intrathecal injection of selective receptor antagonists for SP, CGRP, TNF, IL-1, IL-6, CCL2, or nerve growth factor each reduced pain behaviors in the fracture rats. Collectively, these data support the hypothesis that facilitated spinal neuropeptide signaling upregulates the expression of spinal inflammatory mediators contributing to nociceptive sensitization in a rodent fracture model of complex regional pain syndrome.

摘要

胫骨骨折会引发大鼠后肢中P物质(SP)和降钙素基因相关肽(CGRP)信号的过度增强,以及神经肽依赖性伤害性感受和炎症变化,类似于复杂区域疼痛综合征中的表现。在多种动物疼痛模型中,脊髓的炎症变化会导致伤害性感受敏化。本研究检验了以下假设:骨折诱导的神经肽信号过度增强会上调脊髓炎症介质的表达,从而导致骨折后后肢伤害性感受敏化。在对大鼠进行胫骨骨折并打石膏后的4周,我们测量了后肢的痛觉过敏、负重减轻、温度、水肿以及脊髓神经肽和炎症介质的含量。对骨折大鼠鞘内注射神经肽和炎症介质受体拮抗剂,评估其镇痛效果。利用缺乏SP或CGRP RAMP1受体的转基因骨折小鼠,确定神经肽信号对骨折后疼痛行为和脊髓炎症介质表达的影响。在大鼠骨折后的4周,观察到后肢痛觉过敏、负重减轻、温度、水肿,脊髓SP和CGRP增加,以及脊髓炎症介质表达增加(肿瘤坏死因子、白细胞介素-1、白细胞介素-6、趋化因子配体2和神经生长因子)。在缺乏SP或CGRP受体的骨折小鼠中未观察到骨折诱导的脊髓炎症介质增加,且这些小鼠的骨折后伤害性感受敏化有所减轻。鞘内注射SP、CGRP、肿瘤坏死因子﹑白细胞介素-1、白细胞介素-6、趋化因子配体2或神经生长因子的选择性受体拮抗剂,均可减轻骨折大鼠的疼痛行为。总体而言,这些数据支持了以下假设:在复杂区域疼痛综合征的啮齿动物骨折模型中,脊髓神经肽信号增强会上调脊髓炎症介质的表达,从而导致伤害性感受敏化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c61c/4770355/b39a59c6231e/jop-156-1852-g002.jpg

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