From the Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
Anesth Analg. 2022 Dec 1;135(6):1293-1303. doi: 10.1213/ANE.0000000000006228. Epub 2022 Oct 6.
Disk herniation is a primary cause of radicular back pain. The purpose of this study was to evaluate the antiallodynic effective dose in 50% of the sample (ED 50 ) and dorsal root ganglion (DRG) protein modulation of a peripheral direct adenosine monophosphate kinase alpha (AMPKα) activator (O304) in a murine model of lumbar disk puncture.
Male (n = 28) and female (n = 28) mice (C57BL6/J) were assessed for hind paw withdrawal threshold (PWT) and burrowing. Abdominal surgery was performed on all mice, and 48 received a lumbar disk puncture (27-G needle), with 8 serving as nondisk puncture controls. Assessments were repeated at day 7, and mice were then randomized into 5 groups of equal numbers of males and females: O304 at 100 mg/kg (n = 10), 150 mg/kg (n = 10), 200 mg/kg (n = 10), and 250 mg/kg (n = 10) or drug vehicle (n = 8). Starting on day 7, mice received daily gavages of O304 or vehicle for 7 days. On days 14 and 21 PWT and on day 14 burrowing were assessed. The area under the PWT by time curve (AUC) from day 7 to 21 was determined by trapezoidal integration. DRG protein modulation was evaluated in male (n = 10) and female (n = 10) mice (C57BL6/J). Following disk puncture, mice were randomized to receive O304 200 mg/kg or vehicle for 7 days starting on day 7. On day 14, mice were euthanized; the DRG harvested and immunoblot performed for mammalian target of rapamycin (mTOR), transient receptor potential ankyrin 1 (TRPA1), phosphorylated adenosine monophosphate kinase (p-AMPK), phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated eukaryotic translation initiation factor 2 subunit 1 (p-EIF2S1), phosphorylated eukaryotic translation initiation factor 4e (p-EIF4E), and glyceraldehyde 3-phosphate dehydrogenase (GADPH).
Disk puncture decreased PWT greater in female mice compared with male mice and decreased burrowing at 7 days. PWTs were increased with increasing doses of O304 from 150 to 250 mg/g on day 14 and sustained through day 21. The ED 50 (95% confidence interval [CI]) for reducing mechanical allodynia was 140 (118-164) mg/kg. Burrowing was not increased at day 14 compared to day 7 by O304 administration. Compared to vehicle-treated animals, O304 increased (95% CI) the p-AMPK/GADPH ratio, difference 0.27 (0.08-0.45; P = . 004) and decreased (95% CI) the ratios of p-TRPA1, p-ERK1/2, pEIF4E, and p-EIF2S1 to GADPH by -0.49 (-0.61 to -0.37; P < . 001), -0.53 (-0.76 to -0.29; P < . 001), -0.27 (-0.42 to 0.11; P = . 001), and -0.21 (-0.32 to -0.08; P = . 003) in the DRG, respectively.
The direct peripheral AMPK activator O304 reduced allodynia in a dose-dependent manner, and immunoblot studies of the DRG showed that O304 increased p-AMPK and decreased TRPA1, p-ERK1/2, as well as translation factors involved in neuroplasticity. Our findings confirm the role of peripheral AMPKα activation in modulating nociceptive pain.
椎间盘突出是神经根性腰痛的主要原因。本研究旨在评估外周直接腺苷单磷酸激酶α(AMPKα)激活剂(O304)在腰椎间盘穿刺的小鼠模型中的抗痛觉过敏有效剂量(ED50)和背根神经节(DRG)蛋白调节作用。
雄性(n=28)和雌性(n=28)C57BL6/J 小鼠进行后爪退缩阈值(PWT)和挖掘评估。所有小鼠均进行腹部手术,48 只接受腰椎间盘穿刺(27-G 针),8 只作为非椎间盘穿刺对照。在第 7 天重复评估,然后将小鼠随机分为 5 组,每组雄性和雌性数量相等:O304 100mg/kg(n=10)、150mg/kg(n=10)、200mg/kg(n=10)、250mg/kg(n=10)或药物载体(n=8)。从第 7 天开始,小鼠每天接受 O304 或载体灌胃 7 天。在第 14 天和第 21 天评估 PWT 和挖掘。通过梯形积分确定第 7 天至第 21 天的 PWT 时间曲线(AUC)下面积。评估雄性(n=10)和雌性(n=10)C57BL6/J 小鼠的 DRG 蛋白调节作用。在腰椎间盘穿刺后,第 7 天开始,将小鼠随机分为接受 O304 200mg/kg 或载体治疗 7 天。在第 14 天,处死小鼠;收获背根神经节并进行哺乳动物雷帕霉素靶蛋白(mTOR)、瞬时受体电位锚蛋白 1(TRPA1)、磷酸化腺苷单磷酸激酶(p-AMPK)、磷酸化细胞外信号调节激酶(p-ERK)、磷酸化真核翻译起始因子 2 亚单位 1(p-EIF2S1)、磷酸化真核翻译起始因子 4e(p-EIF4E)和甘油醛 3-磷酸脱氢酶(GADPH)免疫印迹。
与雄性小鼠相比,椎间盘穿刺使雌性小鼠的 PWT 下降更大,并且在第 7 天降低了挖掘。在第 14 天,O304 的剂量从 150 到 250mg/g 增加,PWT 增加,持续到第 21 天。减少机械性痛觉过敏的 ED50(95%置信区间[CI])为 140(118-164)mg/kg。与第 7 天相比,O304 给药在第 14 天并未增加挖掘。与载体处理的动物相比,O304 增加(95%CI)p-AMPK/GADPH 比值,差异为 0.27(0.08-0.45;P=0.004),并降低(95%CI)p-TRPA1、p-ERK1/2、pEIF4E 和 p-EIF2S1 与 GADPH 的比值分别为-0.49(-0.61 至-0.37;P<0.001)、-0.53(-0.76 至-0.29;P<0.001)、-0.27(-0.42 至 0.11;P=0.001)和-0.21(-0.32 至-0.08;P=0.003)。
直接外周 AMPK 激活剂 O304 以剂量依赖性方式减轻痛觉过敏,DRG 的免疫印迹研究表明,O304 增加了 p-AMPK,并降低了 TRPA1、p-ERK1/2 以及涉及神经可塑性的翻译因子。我们的发现证实了外周 AMPKα 激活在调节伤害性疼痛中的作用。