Title:
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Modulation of spinal hyper-excitability by the cannabinoid & vanilloid systems
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Despite extensive study of the pathophysiology, pain states still
represent a significant unmet clinical need. Spinal hyper-
excitability is a key feature of acute and chronic pain states, yet
the underlying mechanisms are incompletely understood. To this
end, the aim of this thesis was to examine the effects of
modulation of the spinal cannabinoid and vanilloid receptor
systems in rat models of acute and chronic pain.
Anti-nociceptive effects of inhibiting spinal cord endocannabinoid
(EC) catabolism were investigated. In naive rats, spinal
administration of the novel MAGL inhibitor JZL184 (25-100 μg)
produced a robust, dose-dependent inhibition of noxious
mechanically-evoked (15-26 g) responses of WDR neurones,
probably via a CB1 receptor-mediated mechanism. Spinal JZL184
(100 μg) also ablated the expansion of 'WDR receptive fields, a
marker of central hyper-excitability, following intra-plantar
administration of carrageenan (2 mg/l00 μL). Ex vivo analyses
failed to demonstrate the expected concomitant elevation of 2-
AG and inhibition of MAGL in whole lumbar spinal cord
homogenates. However, in vitro studies confirmed potent
inhibition of MAGL by JZL184 (IC50 = 76 - 287 nM in spinal cord),
suggesting the effects of this compound are indeed mediated by
2-AG/CB1. Gross tissue analyses may, therefore, be insufficiently
sensitive to detect biologically significant local fluctuations in EC
signalling. Interestingly, these experiments also revealed
substantial heterogeneity of monoglyceride hydrolytic activity in
rodent CNS fractions.
The involvement of the spinal EC system in both rapid and
sustained spinal plasticity in pain states was also assessed.
Levels of EC-related molecules, genes, and proteins were
measured in spinal cord tissue in the carrageenan model of acute
inflammatory pain and the monosodium iodoacetate (MIA) model
of chronic joint pain. Significant elevations in AEA were
demonstrated in both models, whilst significant increases in DEA,
PEA, and 2-AG were observed in the MIA model only. Analysis of
gene and protein expression levels suggest the early alterations
may be mediated by decreased catabolism, whilst later increases
were driven by increased synthesis.
Finally, spinal TRPV1 receptors were assessed as a therapeutic
target in the MIA model. Substantial progressive increases in
spinal TRPV1 expression were demonstrated from post-induction
day 14 to 28 following unilateral intra-articular injection of 1mg
MIA. These increases were partially correlated with the
development of distal allodynia and knee joint pathology,
suggesting a role for these receptors in the development of
spinal hyper-excitability in this model. Spinal administration of
the TRPV1 antagonist JNJ-17203212 (18.75 - 75 μg) produced
dose-dependent inhibition of noxious mechanically-evoked
responses of WDR neurones to a similar extent in both saline-
and MIA-treated rats. However, efficacy of the mid-range dose
was positively correlated with the level of spinal TRPV1
expression.
These data demonstrate the anti-nociceptive efficacy of
modulating the EC and TRPV1 signalling systems. However, the
substantial plasticity of these systems demonstrated in
nociceptive states warrants further investigation, and may have
significant bearing on the future success of such therapeutic approaches.
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