Redox Mechanism of S-Nitrosothiol Modulation of Neuronal CaV3.2 T-Type Calcium Channels

T-type calcium channels in the dorsal root ganglia (DRG) have a central function in tuning neuronal excitability and are implicated in sensory processing including pain. Previous studies have implicated redox agents in control of T-channel activity; however, the mechanisms involved are not completely understood. Here, we recorded T-type calcium currents from acutely dissociated DRG neurons from young rats and investigated the mechanisms of Ca_V3.2 T-type channel modulation by S-nitrosothiols (SNOs). We found that extracellular application of S-nitrosoglutathione (GSNO) and S-nitroso-N-acetyl-penicillamine rapidly reduced T-type current amplitudes. GSNO did not affect voltage dependence of steady-state inactivation and macroscopic current kinetics of T-type channels. The effects of GSNO were abolished by pretreatment of the cells with N-ethylmaleimide, an irreversible alkylating agent, but not by pretreatment with 1H-(1,2,4) oxadiazolo (4,3-a) quinoxalin-1-one, a specific soluble guanylyl cyclase inhibitor, suggesting a potential effect of GSNO on putative extracellular thiol residues on T-type channels. Expression of wild-type Ca_V3.2 channels or a quadruple Cys-Ala mutant in human embryonic kidney cells revealed that Cys residues in repeats I and II on the extracellular face of the channel were required for channel inhibition by GSNO. We propose that SNO-related molecules in vivo may lead to alterations of T-type channel-dependent neuronal excitability in sensory neurons and in the central nervous system in both physiological and pathological conditions such as neuronal ischemia/hypoxia.     

Expression and Regulation of Cav3.2 T-Type Calcium Channels during Inflammatory Hyperalgesia in Mouse Dorsal Root Ganglion Neurons

The Cav3.2 isoform of the T-type calcium channel is expressed in primary sensory neurons of the dorsal root ganglion (DRG), and these channels contribute to nociceptive and neuropathic pain in rats. However, there are conflicting reports on the roles of these channels in pain processing in rats and mice. In addition, the function of T-type channels in persistent inflammatory hyperalgesia is poorly understood. We performed behavioral and comprehensive histochemical analyses to characterize Cav3.2-expressing DRG neurons and examined the regulation of T-type channels in DRGs from C57BL/6 mice with carrageenan-induced inflammatory hyperalgesia. We show that approximately 20% of mouse DRG neurons express Cav3.2 mRNA and protein. The size of the majority of Cav3.2-positive DRG neurons (69 ± 8%) ranged from 300 to 700 μm2 in cross-sectional area and 20 to 30 μm in estimated diameter. These channels co-localized with either neurofilament-H (NF-H) or peripherin. The peripherin-positive cells also overlapped with neurons that were positive for isolectin B4 (IB4) and calcitonin gene-related peptide (CGRP) but were distinct from transient receptor potential vanilloid 1 (TRPV1)-positive neurons during normal mouse states. In mice with carrageenan-induced inflammatory hyperalgesia, Cav3.2 channels, but not Cav3.1 or Cav3.3 channels, were upregulated in ipsilateral DRG neurons during the sub-acute phase. The increased Cav3.2 expression partially resulted from an increased number of Cav3.2-immunoreactive neurons; this increase in number was particularly significant for TRPV1-positive neurons. Finally, preceding and periodic intraplantar treatment with the T-type calcium channel blockers mibefradil and NNC 55-0396 markedly reduced and reversed mechanical hyperalgesia during the acute and sub-acute phases, respectively, in mice. These data suggest that Cav3.2 T-type channels participate in the development of inflammatory hyperalgesia, and this channel might play an even greater role in the sub-acute phase of inflammatory pain due to increased co-localization with TRPV1 receptors compared with that in the normal state.     

Role of T-Type Ca2+ Channels in Painful Diabetic Neuropathy

Neurophysiology - Numerous investigations implicate pronounced changes in the functioning of T-type Ca2+ channels localized on the somata of primary nociceptor units in the development and...     

神经传导速度对糖尿病痛性周围神经病的诊断价值

目的:探讨糖尿病痛性周围神经病的神经传导特点及神经传导速度在糖尿病痛性周围神经病中的诊断价值.方法:对18例痛性周围神经病患者进行病史采集及神经系统查体.采用肌电诱发电位仪,测定患者的正中神经、尺神经、胫神经、腓总神经及腓肠神经的运动感觉神经传导速度.结果:18例患者中男性13例,女性5例.年龄40-89岁.主要表现为双足烧灼样、针刺样、过电样疼痛.神经系统查体:针刺觉减弱7例,痛觉过敏3例,音叉震动觉减弱12例,跟腱反射减弱/消失15例.18例患者中有14例神经传导速度检查结果异常,腓肠神经感觉神经检查结果异常率高,83.3％,对诊断有帮助.结论:糖尿病痛性周围神经病变出现疼痛症状时已经存在大纤维受累,故神经传导速度异常阳性率高.神经传导速度不能早期发现糖尿病痛性周围神经病,探索一种简单易行的早期筛查方法意义重大.     

An Early Diagnostic Tool for Diabetic Peripheral Neuropathy in Rats

The skin’s rewarming rate of diabetic patients is used as a diagnostic tool for early diagnosis of diabetic neuropathy. At present, the relationship between microvascular changes in the skin and diabetic neuropathy is unclear in streptozotocin (STZ) diabetic rats. The aim of this study was to investigate whether the skin rewarming rate in diabetic rats is related to microvascular changes and whether this is accompanied by changes observed in classical diagnostic methods for diabetic peripheral neuropathy. Computer-assisted infrared thermography was used to assess the rewarming rate after cold exposure on the plantar skin of STZ diabetic rats’ hind paws. Peripheral neuropathy was determined by the density of intra-epidermal nerve fibers (IENFs), mechanical sensitivity, and electrophysiological recordings. Data were obtained in diabetic rats at four, six, and eight weeks after the induction of diabetes and in controls. Four weeks after the induction of diabetes, a delayed rewarming rate, decreased skin blood flow and decreased density of IENFs were observed. However, the mechanical hyposensitivity and decreased motor nerve conduction velocity (MNCV) developed 6 and 8 weeks after the induction of diabetes. Our study shows that the skin rewarming rate is related to microvascular changes in diabetic rats. Moreover, the skin rewarming rate is a non-invasive method that provides more information for an earlier diagnosis of peripheral neuropathy than the classical monofilament test and MNCV in STZ induced diabetic rats.     

Properties of Proton-Gated Ion Channels in Sensory Neurons of Rats

In experiments on the somata of sensory neurons isolated from the spinal and trigeminal ganglia of rats, we characterized three subclasses of proton-gated currents differing from each other in their kinetics of desensitization and characteristics of stationary desensitization (but not in the characteristics of stationary activation). A voltage clamp technique in the whole cell configuration and intracellular perfusion were used. Expression of the channels providing currents of each subclass depended on the soma diameter but not on anatomical localization of the neuron. Proton-gated channels of type I were characterized by mono- or biexponential kinetics of current desensitization with the duration of complete decay within a 1 to 15 sec range; the mean pH₅₀ of the curve of stationary desensitization was 7.21 ± 0.02. Channels of type II possessed mostly monoexponential desensitization kinetics with the duration of decay within a 1 to 3 sec range; their pH₅₀ of the stationary desensitization curve was 7.11 ± 0.02. Channels of type III showed mostly biexponential desensitization kinetics; the complete current decay lasted about 5 sec, while the mean pH₅₀ was about 6.78 ± 0.02. Channels of type I were typical of small neurons (soma diameter 10-20 m), while those of types II and III were found mostly in large cells (35-60 m).     

Block of N-type Calcium Channels in Chick Sensory Neurons by External Sodium

L-type Ca²⁺ channels select for Ca²⁺ over sodium Na⁺ by an affinity-based mechanism. The prevailing model of Ca²⁺ channel permeation describes a multi-ion pore that requires pore occupancy by at least two Ca²⁺ ions to generate a Ca²⁺ current. At [Ca²⁺] < 1 μM, Ca²⁺ channels conduct Na⁺. Due to the high affinity of the intrapore binding sites for Ca²⁺ relative to Na⁺, addition of μM concentrations of Ca²⁺ block Na⁺ conductance through the channel. There is little information, however, about the potential for interaction between Na⁺ and Ca²⁺ for the second binding site in a Ca²⁺ channel already occupied by one Ca²⁺. The two simplest possibilities, (a) that Na⁺ and Ca²⁺ compete for the second binding site or (b) that full time occupancy by one Ca²⁺ excludes Na⁺ from the pore altogether, would imply considerably different mechanisms of channel permeation. We are studying permeation mechanisms in N-type Ca²⁺ channels. Similar to L-type Ca²⁺ channels, N-type channels conduct Na⁺ well in the absence of external Ca²⁺. Addition of 10 μM Ca²⁺ inhibited Na⁺ conductance by 95%, and addition of 1 mM Mg²⁺ inhibited Na⁺ conductance by 80%. At divalent ion concentrations of 2 mM, 120 mM Na⁺ blocked both Ca²⁺ and Ba²⁺ currents. With 2 mM Ba²⁺, the IC₅₀ for block of Ba²⁺ currents by Na⁺ was 119 mM. External Li⁺ also blocked Ba²⁺ currents in a concentration-dependent manner, with an IC₅₀ of 97 mM. Na⁺ block of Ba²⁺ currents was dependent on [Ba²⁺]; increasing [Ba²⁺] progressively reduced block with an IC₅₀ of 2 mM. External Na⁺ had no effect on voltage-dependent activation or inactivation of the channel. These data suggest that at physiological concentrations, Na⁺ and Ca²⁺ compete for occupancy in a pore already occupied by a single Ca²⁺. Occupancy of the pore by Na⁺ reduced Ca²⁺ channel conductance, such that in physiological solutions, Ca²⁺ channel currents are between 50 and 70% of maximal.     

The Influence of Diabetic Peripheral Neuropathy on Local Postural Muscle and Central Sensory Feedback Balance Control

Poor balance control and increased fall risk have been reported in people with diabetic peripheral neuropathy (DPN). Traditional body sway measures are unable to describe underlying postural control mechanism. In the current study, we used stabilogram diffusion analysis to examine the mechanism under which balance is altered in DPN patients under local-control (postural muscle control) and central-control (postural control using sensory cueing). DPN patients and healthy age-matched adults over 55 years performed two 15-second Romberg balance trials. Center of gravity sway was measured using a motion tracker system based on wearable inertial sensors, and used to derive body sway and local/central control balance parameters. Eighteen DPN patients (age = 65.4±7.6 years; BMI = 29.3±5.3 kg/m²) and 18 age-matched healthy controls (age = 69.8±2.9; BMI = 27.0±4.1 kg/m²) with no major mobility disorder were recruited. The rate of sway within local-control was significantly higher in the DPN group by 49% (healthy local-control_slope = 1.23±1.06×10^-2 cm²/sec, P<0.01), which suggests a compromised local-control balance behavior in DPN patients. Unlike local-control, the rate of sway within central-control was 60% smaller in the DPN group (healthy central-control_slope-Log = 0.39±0.23, P<0.02), which suggests an adaptation mechanism to reduce the overall body sway in DPN patients. Interestingly, significant negative correlations were observed between central-control rate of sway with neuropathy severity (r_Pearson = 0.65-085, P<0.05) and the history of diabetes (r_Pearson = 0.58-071, P<0.05). Results suggest that in the lack of sensory feedback cueing, DPN participants were highly unstable compared to controls. However, as soon as they perceived the magnitude of sway using sensory feedback, they chose a high rigid postural control strategy, probably due to high concerns for fall, which may increase the energy cost during extended period of standing; the adaptation mechanism using sensory feedback depends on the level of neuropathy and the history of diabetes.     

Disorders of Transmission via a Peripheral Nerve Related to Experimental Diabetic Peripheral Neuropathy in Rats: Possibilities for Pharmacological Correction

We measured the conduction velocity (CV) of an excitation volley via the caudal nerve in intact rats and rats with streptozotocin-induced experimental diabetic polyneuropathy (ED PNP). We also tested the influence of four pharmacological agents (lipoic acid, N^G-nitro-L-arginine, alprostan, and pentoxifylline) on the CV via the above nerve under conditions of ED PNP. We found that the development of ED PNP in rats was accompanied by a considerable drop in the CV (to 50–40% of that in the control). Introduction of the above pharmacological agents exerted noticeable normalizing effects on the parameter under study; these effects were observed from the second week of treatment and lasted up to the end of the tests. Considering the mechanisms governing the effects of the above drugs, we discuss the role of disturbances in the systems of endogenous nitric oxide and prostaglandins in the development of experimental diabetes and ED PNP.Neirofiziologiya/Neurophysiology, Vol. 37, No. 1, pp. 74–79, January–February, 2005.     

Therapeutic Effects of 15 Hz Pulsed Electromagnetic Field on Diabetic Peripheral Neuropathy in Streptozotocin-Treated Rats

Although numerous clinical studies have reported that pulsed electromagnetic fields (PEMF) have a neuroprotective role in patients with diabetic peripheral neuropathy (DPN), the application of PEMF for clinic is still controversial. The present study was designed to investigate whether PEMF has therapeutic potential in relieving peripheral neuropathic symptoms in streptozotocin (STZ)-induced diabetic rats. Adult male Sprague–Dawley rats were randomly divided into three weight-matched groups (eight in each group): the non-diabetic control group (Control), diabetes mellitus with 15 Hz PEMF exposure group (DM+PEMF) which were subjected to daily 8-h PEMF exposure for 7 weeks and diabetes mellitus with sham PEMF exposure group (DM). Signs and symptoms of DPN in STZ-treated rats were investigated by using behavioral assays. Meanwhile, ultrastructural examination and immunohistochemical study for vascular endothelial growth factor (VEGF) of sciatic nerve were also performed. During a 7-week experimental observation, we found that PEMF stimulation did not alter hyperglycemia and weight loss in STZ-treated rats with DPN. However, PEMF stimulation attenuated the development of the abnormalities observed in STZ-treated rats with DPN, which were demonstrated by increased hind paw withdrawal threshold to mechanical and thermal stimuli, slighter demyelination and axon enlargement and less VEGF immunostaining of sciatic nerve compared to those of the DM group. The current study demonstrates that treatment with PEMF might prevent the development of abnormalities observed in animal models for DPN. It is suggested that PEMF might have direct corrective effects on injured nerves and would be a potentially promising non-invasive therapeutic tool for the treatment of DPN.     

Randomized,Double-Blind,Crossover Trial of Amitriptyline for Analgesia in Painful HIV-Associated Sensory Neuropathy

We conducted a randomized, double-blind, placebo-controlled, crossover study at a single center in South Africa, to ascertain whether amitriptyline is an effective analgesic for painful HIV-associated sensory neuropathy of moderate to severe intensity in: i) antiretroviral drug naive individuals, and ii) antiretroviral drug users. 124 HIV-infected participants (antiretroviral drug naive = 62, antiretroviral drug users = 62) who met the study criteria for painful HIV-associated sensory neuropathy were randomized to once-daily oral amitriptyline (titrated to a median: interquartile range of 50: 25-50 mg) or placebo for six weeks, followed by a three-week washout period and subsequent treatment crossover. The primary outcome measure was change from baseline in worst pain intensity of the feet (measured by participant self-report using an 11-point numerical pain rating scale) after six weeks of treatment. 122 of 124 participants completed all study visits and were included in the analysis of the primary outcome. In the antiretroviral drug-naive group (n = 61) there was no significant difference in the mean change in pain score from baseline after six weeks of treatment with placebo or amitriptyline [amitriptyline: 2.8 (SD 3.3) vs. placebo: 2.8 (3.4)]. Similarly, there was no significant difference in the change in pain score after six weeks of treatment with placebo or amitriptyline in the antiretroviral drug-user group (n = 61) [amitriptyline: 2.7 (3.3) vs. placebo: 2.1 (2.8)]. Controlling for period effects and treatment order effects did not alter the outcome of the analyses. Nor did analyzing the intention-to-treat cohort (missing data interpolated using baseline observation carried forward) alter the outcome of the analyses. In summary, amitriptyline, at the doses used here, was no more effective than an inactive placebo at reducing pain intensity in individuals with painful HIV-associated sensory neuropathy of moderate to severe intensity, irrespective of whether they were on antiretroviral therapy or not.

Trial Registration

ISRCTN 54452526     

糖尿病周围神经病变患者生活质量调查研究

目的:探讨糖尿病周围神经病变患者生活质量现状和影响因素.方法:采用自编问卷、抑郁自评量表(SDS)、焦虑自评量表(SAS)、社会支持评定量表(SSRS)、匹兹堡睡眠质量指数问卷(PSQI)和汉化版简明健康调查表(SF-36)量表对2010年10月～2012年10月在我院内分泌科住院治疗的50例糖尿病周围神经病变患者和同期50例在我院健康体检者进行测评,采用SPSS16.0软件进行分析找出糖尿病周围神经病变患者生活质量现状和影响因素.结果:糖尿病周围神经病变患者的生活质量明显低于健康体检者,有显著性差异(P＜0.05).多元线性逐步回归分析发现:文化程度高、患者对疾病了解多、社会支持评定量表总分高与糖尿病周围神经病变患者生活质量正相关,而慢性并发症种类多、有睡眠问题、焦虑抑郁标准分高与糖尿病周围神经病变患者生活质量负相关.结论:糖尿病周围神经病变患者生活质量较低,其生活质量受多方面因素的影响,我们应该采取针对性的干预措施来改善患者的生活质量.     

降纤酶联合甲钴胺治疗糖尿病周围神经病变的研究

目的 观察降纤酶联合甲钴胺治疗糖尿病周围神经病变的临床疗效.方法 选择60例糖尿病合并周围神经病变患者,随机分成治疗组和对照组各30例,治疗组用降纤酶首次剂量为10 u,第2天后改为5 u,每天1次,连续2周;同时应用甲钴胺500 μg肌肉注射,每天1次,连续2周.对照组用甲钴胺500 μg肌肉注射,每天1次,连续2周.两组进行疗效比较.结果 治疗2周后两组神经症状与检查评分均明显下降,但以治疗组下降显著,治疗后两组平均评分差异有统计学意义(P＜0.01).结论 降纤酶联合甲钴胺治疗糖尿病周围神经病变有较好的疗效.     

Oxaliplatin Modulates the Characteristics of Voltage-Gated Calcium Channels and Action Potentials in Small Dorsal Root Ganglion Neurons of Rats

Oxaliplatin is important for treating colorectal cancer. Although oxaliplatin is highly effective, it has severe side effects, of which neurotoxicity in dorsal root ganglion (DRG) neurons is one of the most common. The key mechanisms of this neurotoxicity are still controversial. However, disturbances of calcium homeostasis in DRG neurons have been suggested to mediate oxaliplatin neurotoxicity. By using whole-cell patch-clamp and current-clamp techniques, as well as immunocytochemical staining, we examined the influence of short- and long-term exposure to oxaliplatin on voltage-gated calcium channels (VGCC) and different VGCC subtypes in small DRG neurons of rats in vitro. Exposure to oxaliplatin reduced VGCC currents (I_Ca(V)) in a concentration-dependent manner (1–500 μM; 13.8–63.3%). Subtype-specific measurements of VGCCs showed differential effects on I_Ca(V). While acute treatment with oxaliplatin led to a reduction in I_Ca(V) for P/Q-, T-, and L-type VGCCs, I_Ca(V) of N-type VGCCs was not affected. Exposure of DRG neurons to oxaliplatin (10 or 100 μM) for 24 h in vitro significantly increased the I_Ca(V) current density, with a significant influence on L- and T-type VGCCs. Immunostaining revealed an increase of L- and T-type VGCC protein levels in DRG neurons 24 h after oxaliplatin exposure. This effect was mediated by calcium-calmodulin-protein kinase II (CaMKII). Significant alterations in action potentials (AP) and their characteristics were also observed. While the amplitude increased after oxaliplatin treatment, the rise time and time-to-peak decreased, and these effects were reversed by treatment with pimozide and nimodipine, which suggests that VGCCs are critically involved in oxaliplatin-mediated neurotoxicity.     

Thalidomide Promotes Morphine Efficacy and Prevents Morphine-Induced Tolerance in Rats with Diabetic Neuropathy

Opioid analgesics have less efficacy in diabetic neuropathy treatment, and tolerance often occurs after chronic usage. Given that thalidomide can potentiate the morphine efficacy in diabetic neuropathy treatment, we investigated the effects of intrathecal administrations of thalidomide on morphine tolerance during the treatment of diabetic neuropathy. We found that intrathecal administrations of thalidomide (25 mg/kg/ml) potentiated the analgesic effects of morphine on mechanical hyperalgesia and prevented the development of morphine tolerance. While this treatment regimen did not alter the protein levels of μ-opioid receptor (MOR) in the spinal cord of diabetic rats, chronic morphine treatment robustly increased MOR binding density in the synaptic plasma membranes fraction, but decreased it in the microsomal fraction. Furthermore, thalidomide was able to reverse the distribution of MOR altered by chronic morphine treatment. Finally, STZ-induced diabetes promoted PKC activation and enhanced TNFα level in the spinal cord, which were attenuated by intrathecal administrations of thalidomide. Taken together, these results suggested that thalidomide may potentiate morphine efficacy on diabetic neuropathy and prevent the development of morphine tolerance by suppressing PKC activation and TNFα level in the spinal cord.     

前列地尔联合丹红注射液治疗糖尿病周围神经病变的疗效分析

目的：探讨前列地尔联合丹红注射液治疗糖尿病周围神经病变的效果,为治疗糖尿病周围神经病变提供临床依据。方法：采用回顾性调查的方法,选取我院2011年1月-2012年12月收治的糖尿病周围神经病变150例,分为前列地尔联合丹红注射液组（联合治疗组）,前列地尔组和丹红组,每组各50例。结果：联合治疗组总有效率为94．00％（47／50）,高于丹红组86．00％（43／50）和前列地尔组88．00％（44／50）（P〈0．05）;联合治疗组显效率为68．00％（34／50）,高于丹红组60．00％（30／50）和前列地尔组60．00％（30／50）;联合治疗组无效率为9．00％（3／50）,低于丹红组14．00％（7／50）和前列地尔组12．00％（6／50）（P〈0．05）;三组治疗后正中神经和腓总神经MNCV和SNCV均高于治疗前,差异有统计学意义（P〈0．05）;联合治疗组治疗后均高于丹红组和前列地尔组治疗后,差异有统计学意义（P〈0．05）。结论：前列地尔联合丹红注射液可有效提高正中神经和腓总神经MNCV和SNCV,对改善糖尿病周围神经病变效果较好。