Department of Anesthesiology, Pain Research Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Department of Anesthesiology, Pain Research Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Pain. 2019 May;20(5):515-527. doi: 10.1016/j.jpain.2018.11.003. Epub 2018 Nov 22.
Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling condition accompanying several cancer drugs, including the front-line chemotherapeutic agent paclitaxel. Although CIPN can force dose reduction or even discontinuation of chemotherapy, affecting survival in cancer patients, there is no US Food and Drug Administration-approved treatment for CIPN. CIPN in mice is characterized by neuropathic pain (eg, mechanical allodynia) in association with oxidative stress and neuroinflammation in dorsal root ganglia (DRGs), as well as retraction of intraepidermal nerve fibers. Here, we report that paclitaxel-induced mechanical allodynia is associated with transcriptional increase in matrix metalloproteinase (MMP) 2 and 9 and decrease in metallopeptidase inhibitor 1 (TIMP1), a strong endogenous MMP9 inhibitor. Consistently, MMP9 protein levels are increased in DRG neurons in vivo and in vitro after paclitaxel treatment, and it is demonstrated, for the first time, that intrathecal injections of exogenous TIMP1 or a monoclonal antibody targeting MMP9 (MMP9 mAb) significantly prevented and reversed paclitaxel-induced mechanical allodynia in male and female mice. Analyses of DRG tissues showed that MMP9 mAb significantly decreased oxidative stress and neuroinflammatory mediators interleukin-6 and tumor necrosis factor α, as well as prevented paclitaxel-induced loss of intraepidermal nerve fibers. These findings suggest that MMP signaling plays a key role in paclitaxel-induced peripheral neuropathy, and MMP9 mAb may offer new therapeutic approaches for the treatment of CIPN. PERSPECTIVE: Chemotherapy-induced peripheral neuropathy (CIPN) remains ineffectively managed in cancer patients, potentially leading to the discontinuation of an otherwise life-saving treatment. Here, we demonstrate that a monoclonal antibody targeting MMP9 alleviates neuropathic pain and several mechanisms linked to CIPN. This study is particularly relevant, because a humanized MMP9 antibody is already in advanced clinical trials for the treatment of colitis and cancer, and it may be straightforwardly repurposed for the relief of CIPN.
化疗引起的周围神经病(CIPN)是伴随几种癌症药物的一种致残病症,包括一线化疗药物紫杉醇。尽管 CIPN 可能迫使减少剂量甚至停止化疗,从而影响癌症患者的生存,但目前尚无美国食品和药物管理局批准的 CIPN 治疗方法。小鼠的 CIPN 表现为神经病理性疼痛(例如机械性痛觉过敏),伴有背根神经节(DRG)中的氧化应激和神经炎症,以及表皮内神经纤维回缩。在这里,我们报告紫杉醇诱导的机械性痛觉过敏与基质金属蛋白酶(MMP)2 和 9 的转录增加以及金属蛋白酶抑制剂 1(TIMP1)减少有关,TIMP1 是 MMP9 的强内源性抑制剂。一致地,紫杉醇处理后体内和体外 DRG 神经元中 MMP9 蛋白水平增加,并且首次证明鞘内注射外源性 TIMP1 或靶向 MMP9 的单克隆抗体(MMP9 mAb)可显著预防和逆转雄性和雌性小鼠的紫杉醇诱导的机械性痛觉过敏。对 DRG 组织的分析表明,MMP9 mAb 可显著降低氧化应激和神经炎症介质白细胞介素 6 和肿瘤坏死因子 α,并防止紫杉醇诱导的表皮内神经纤维丢失。这些发现表明 MMP 信号在紫杉醇诱导的周围神经病中起关键作用,并且 MMP9 mAb 可能为 CIPN 的治疗提供新的治疗方法。观点:化疗引起的周围神经病(CIPN)在癌症患者中仍然无法有效治疗,这可能导致停止本来可以救命的治疗。在这里,我们证明靶向 MMP9 的单克隆抗体可缓解神经病理性疼痛和与 CIPN 相关的几种机制。这项研究特别相关,因为一种人源化的 MMP9 抗体已经在用于治疗结肠炎和癌症的临床试验中进入后期阶段,并且它可能直接被重新用于缓解 CIPN。
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