Xie Jing-Dun, Chen Shao-Rui, Chen Hong, Pan Hui-Lin
Center for Neuroscience and Pain Research, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, China.
Center for Neuroscience and Pain Research, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Neuropharmacology. 2017 Sep 1;123:477-487. doi: 10.1016/j.neuropharm.2017.06.027. Epub 2017 Jun 27.
Chemotherapeutic drugs, including bortezomib, often cause painful peripheral neuropathy, which is a severe dose-limiting adverse effect experienced by many cancer patients. The glutamate N-methyl-d-aspartate receptors (NMDARs) at the spinal cord level are critically involved in the synaptic plasticity associated with neuropathic pain. In this study, we determined whether treatment with bortezomib, a proteasome inhibitor, affects the NMDAR activity of spinal dorsal horn neurons. Systemic treatment with bortezomib in rats did not significantly affect postsynaptic NMDAR currents elicited by puff application of NMDA directly to dorsal horn neurons. Bortezomib treatment markedly increased the baseline frequency of miniature excitatory postsynaptic currents (EPSCs), which was completely normalized by the NMDAR antagonist 2-amino-5-phosphonopentanoic acid (AP5). AP5 also reduced the amplitude of monosynaptic EPSCs evoked by dorsal root stimulation in bortezomib-treated, but not vehicle-treated, rats. Furthermore, inhibition of protein kinase C (PKC) with chelerythrine fully reversed the increased frequency of miniature EPSCs and the amplitude of evoked EPSCs in bortezomib-treated rats. Intrathecal injection of AP5 and chelerythrine both profoundly attenuated mechanical allodynia and hyperalgesia induced by systemic treatment with bortezomib. In addition, treatment with bortezomib induced striking membrane translocation of PKC-βII, PKC-δ, and PKC-ε in the dorsal root ganglion. Our findings indicate that bortezomib treatment potentiates nociceptive input from primary afferent nerves via PKC-mediated tonic activation of presynaptic NMDARs. Targeting presynaptic NMDARs and PKC at the spinal cord level may be an effective strategy for treating chemotherapy-induced neuropathic pain.
包括硼替佐米在内的化疗药物常常会引发疼痛性外周神经病变,这是许多癌症患者所经历的严重剂量限制性不良反应。脊髓水平的谷氨酸N-甲基-D-天冬氨酸受体(NMDARs)在与神经性疼痛相关的突触可塑性中起关键作用。在本研究中,我们确定蛋白酶体抑制剂硼替佐米的治疗是否会影响脊髓背角神经元的NMDAR活性。在大鼠中进行的硼替佐米全身治疗对直接向背角神经元吹入NMDA所引发的突触后NMDAR电流没有显著影响。硼替佐米治疗显著增加了微小兴奋性突触后电流(EPSCs)的基线频率,这可被NMDAR拮抗剂2-氨基-5-膦酰戊酸(AP5)完全恢复正常。AP5还降低了在接受硼替佐米治疗而非接受赋形剂治疗的大鼠中由背根刺激诱发的单突触EPSCs的幅度。此外,用白屈菜红碱抑制蛋白激酶C(PKC)可完全逆转硼替佐米治疗大鼠中微小EPSCs频率增加以及诱发EPSCs幅度增加的情况。鞘内注射AP5和白屈菜红碱均能显著减轻硼替佐米全身治疗所诱导的机械性异常性疼痛和痛觉过敏。此外,硼替佐米治疗可诱导背根神经节中PKC-βII、PKC-δ和PKC-ε发生显著的膜转位。我们的研究结果表明,硼替佐米治疗通过PKC介导的突触前NMDARs的强直性激活增强了来自初级传入神经的伤害性输入。在脊髓水平靶向突触前NMDARs和PKC可能是治疗化疗诱导的神经性疼痛的有效策略。