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The Journal of Neuroscience, March 1, 2001, 21(5):1779-1786
Pronociceptive Actions of Dynorphin Maintain Chronic
Neuropathic Pain
Zaijie
Wang1,
Luis R.
Gardell1,
Michael H.
Ossipov1,
Todd W.
Vanderah1,
Miles B.
Brennan4,
Ute
Hochgeschwender5,
Victor J.
Hruby2,
T. Phil
Malan Jr1, 3,
Josephine
Lai1, and
Frank
Porreca1, 3
Departments of 1 Pharmacology, 2 Chemistry,
and 3 Anesthesiology, University of Arizona Health Sciences
Center, Tucson, Arizona 85724, 4 Eleanor Roosevelt
Institute, Denver, Colorado 80206, and 5 Developmental
Biology Program, Oklahoma Medical Research Foundation, Oklahoma City,
Oklahoma 73104
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ABSTRACT |
Whereas tissue injury increases spinal dynorphin expression, the
functional relevance of this upregulation to persistent pain is
unknown. Here, mice lacking the prodynorphin gene were studied for
sensitivity to non-noxious and noxious stimuli, before and after
induction of experimental neuropathic pain. Prodynorphin knock-out (KO)
mice had normal responses to acute non-noxious stimuli and a mild
increased sensitivity to some noxious stimuli. After spinal nerve
ligation (SNL), both wild-type (WT) and KO mice demonstrated decreased
thresholds to innocuous mechanical and to noxious thermal stimuli,
indicating that dynorphin is not required for initiation of neuropathic
pain. However, whereas neuropathic pain was sustained in WT mice, KO
mice showed a return to baselines by post-SNL day 10. In WT mice, SNL
upregulated lumbar dynorphin content on day 10, but not day 2, after
injury. Intrathecal dynorphin antiserum reversed neuropathic
pain in WT mice at post-SNL day 10 (when dynorphin was upregulated) but
not on post-SNL day 2; intrathecal MK-801 reversed SNL-pain at both
times. Opioid (µ, , and ) receptor density and G-protein
activation were not different between WT and KO mice and were unchanged
by SNL injury. The observations suggest (1) an early,
dynorphin-independent phase of neuropathic pain and a later
dynorphin-dependent stage, (2) that upregulated spinal dynorphin is
pronociceptive and required for the maintenance of persistent
neuropathic pain, and (3) that processes required for the initiation
and the maintenance of the neuropathic pain state are distinct.
Identification of mechanisms that maintain neuropathic pain appears
important for strategies to treat neuropathic pain.
Key words:
prodynorphin; dynorphin; neuropathic pain; opioid
receptors; spinal nerve injury; nociception; gene deletion; gene
knockout; transgenic; mouse
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INTRODUCTION |
Peripheral nerve damage can elicit
abnormal pain characterized in part by hyperalgesia where noxious
stimuli are perceived as more painful, and allodynia where normally
innocuous stimuli elicit pain (Ossipov et al., 1999 ). The clinical
efficacy of local anesthetics, anti-arrhythmic, and anti-epileptic
drugs (Devor and Seltzer, 1999 ) supports the concept that such pain
critically depends on sustained afferent discharge of nerves. Data from
experimental models of neuropathic pain support the importance of
discharge of injured or adjacent nerve fibers as critical for eliciting the behavioral signs of nerve injury-induced pain (Kajander and Bennett, 1992 ; Malan et al., 2000 ). Recent studies have shown that the
rate of discharge of injured nerves declines significantly with time
after the injury (Han et al., 2000 ; C. Liu et al., 2000 ; X. Liu et al.,
2000 ). Although tonic discharge continues in the postinjury
state, the decreased firing rate of the afferents does not appear
consistent with many behavioral reports that demonstrate that nerve
injury-induced pain persists essentially unchanged for many weeks
(Chaplan et al., 1994 ; Bian et al., 1995 ). These findings raise the
possibility that although the pain state depends on some level of
abnormal afferent discharge, the processes that initiate neuropathic
pain state may differ from those that maintain such pain.
Neuropathic and other chronic (e.g., inflammatory) pain states are
associated with increased spinal dynorphin expression (Iadarola et al.,
1988 ; Dubner and Ruda, 1992 ; Bian et al., 1999 ; Malan et al., 2000 ).
Whereas dynorphin is an endogenous opioid with activity at opioid
receptors (Goldstein et al., 1979 ), many of its effects are blocked by
MK-801 but not naloxone, implicating direct or indirect interaction
with NMDA receptors (Massardier and Hunt, 1989 ; Skilling et al., 1992 ;
Lai et al., 1998 ; Tang et al., 1999 ). Intrathecal dynorphin injection
produces behavioral signs that mimic nerve injury-induced pain
(Vanderah et al., 1996 ; Laughlin et al., 1997 ) and that are blocked by
MK-801 pretreatment. The mechanisms of such acute activity of dynorphin
in vivo and the relevance of its upregulation in prolonged
pain states is not well understood. However, the observation that
intrathecal administration of an antiserum to dynorphin
A(1-17) reverses neuropathic pain in
nerve-injured rats (Malan et al., 2000 ) and mice (Ibrahim et al., 1999 )
has led us to hypothesize that upregulated or pathological levels of
spinal dynorphin may play a pronociceptive role by maintaining
"central sensitization" in the post-nerve injury state.
This hypothesis has been tested in the present study using a transgenic
mouse strain in which the gene encoding prodynorphin has been deleted,
resulting in mice that do not produce dynorphin (Sharifi et al., 2001 ).
The responses of these prodynorphin knock-out (KO) mice to innocuous
stimuli and to acute and tonic nociception, were compared with those of
wild-type (WT) littermates before and after spinal nerve ligation
injury (SNL). Our findings demonstrate that although the actions of
dynorphin are not required for the initiation of the neuropathic pain
state, its presence is critical for the maintenance of such abnormal,
nerve injury-induced pain.
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MATERIALS AND METHODS |
Animals. Progeny of progenitor 129/SvEv-Tac mice were
used in this study. They were heterozygous at the prodynorphin gene with one wild-type allele (+) and one null allele ( ). In null allele
( ), the coding region and 1 kb of the 3' untranslated region of the
prodynorphin gene were deleted by the replacement of exons 3 and 4 with
a neomycin cassette pAB5 (Sharifi et al., 2001 ). Male mice that were
homozygous prodynorphin knock-out (KO) ( / ) and littermates that
were homozygous wild-type (WT) (+/+) were used. Both genotypes were
viable and showed normal growth and reproduction. Genotyping of litters
was initially performed with PCR and confirmed by Southern transblot.
Subsequently, mice were routinely genotyped by PCR using a set of
prodynorphin primers (5'-CAG GAC CTG GTG CCG CCC TCA GAG-3', 5'-CGC TTC
TGG TTG TCC CAC TTC AGC-3'; these yield a 500 bp product) and
neo primers (5'-ATC CAG GAA ACC AGC AGC GGC TAT-3', 5'-ATT
CAG ACA CAT CCC ACA TAA GGA CA-3'; these yield a 1200 bp product). Each
mouse was genotyped twice using DNA from two separate extractions from the tail tissue samples. The investigators performing the biochemical and behavioral tests were blind to the genotype of the mice. All breeding and testing procedures were performed in accordance with the
policies and recommendations of the International Association for the
Study of Pain and the National Institutes of Health guidelines for the
handling and use of laboratory animals and approved by the
Institutional Animal Care and Use Committee of the University of Arizona.
Immunohistochemistry. Tissue preparation and
immunohistochemical staining of spinal cord tissues from WT and KO mice
were performed according to that previously described (Vanderah et al.,
2001 ). Frontal frozen sections (30 µm) were prepared from the spinal
cord lumbar enlargement and immunostained for prodynorphin (guinea pig
anti-prodynorphin antiserum 1:40,000; gift from Dr. Robert Elde,
University of Minnesota, St. Paul, MN). In addition, groups of
three prodynorphin WT or KO mice were subjected to sham or SNL surgery
and killed at day 14 after surgery. The lumbar spinal cords from
these mice were immunolabeled with a rabbit anti-µ opioid receptor
antibody (1:20,000; gift from Dr. Robert Elde) or an antiserum for
PKC (rabbit anti-PKC , 1:10,000; Santa Cruz Biotechnology, Santa
Cruz, CA). The sections were processed with a biotinylated goat
anti-guinea pig (prodynorphin) or goat anti-rabbit (µ opioid receptor
and PKC ) IgG secondary antibody, followed by the avidin-biotin
horseradish peroxidase (HRP) complex (ABC kit; Vector Laboratories,
Burlingame, CA) and developed with diaminobenzidine (Fast DAB sets;
Sigma, St. Louis, MO). The sections were then mounted on glass slides
and coverslipped with DPX. Transmitted light images were acquired using
a Nikon E800 microscope outfitted with a plan apo 20× objective lens
and a Hamamatsu C5810 color CCD camera. The digitized output of the
camera was acquired with Adobe Photoshop.
Western analysis of the opioid
receptor. The ipsilateral (i.e., left) halves of the lumbar spinal
cord from sham or nerve-ligated mice were dissected and frozen on dry
ice. Tissues from three mice of the same experimental group were pooled
and homogenized with a glass homogenizer in RIPA buffer (1% NP-40,
0.5% sodium deoxycholate, 0.1% SDS, 5 mM
EDTA in PBS, pH 7.4) (3 ml/gm wet weight) in the presence of protease
inhibitors [0.05 mg/ml bestatin, 0.05 mg/ml leupeptin, 0.05 mg/ml
pepstatin, and 0.1 mg/ml phenylmethylsulfonylfluoride (PMSF)]. The
homogenates were incubated at 4°C for 2 hr, and the soluble fraction
was separated by centrifugation (45,000 × g, 60 min).
Protein content in the supernatant was determined by the Lowry method.
Samples (15 µg of protein) were separated by 8% SDS-PAGE and
electrotransferred onto nitrocellulose membrane. The membrane was
preblocked in 5% nonfat milk in Tris (20 mM) buffer saline, pH 7.6, with 0.1% Tween 20 and incubated with a rabbit
anti- opioid receptor antibody (1:1500; Upstate Biotechnology, Lake
Placid, NY). The membrane was washed and incubated with a donkey
anti-rabbit IgG-HRP conjugate (1:1000), washed, and developed for
chemiluminescence detection (ECL; Amersham, Piscataway, NJ). The
membrane was then stripped and reprobed with a goat anti-actin antibody
(1:200; Santa Cruz Biotechnology) and anti-goat HRP-conjugated secondary antibody and developed as above. ECL-detected bands were
digitized and analyzed for relative intensity using MetaMorph (Universal Imagining, West Chester, PA).
Enzyme immunoassay for the quantitative analysis of
dynorphin. Spinal dynorphin content was assayed as previously
described (Malan et al., 2000 ) using the dorsal ipsilateral quadrant of the lumbar spinal cord from sham-operated or SNL mice. Content was
evaluated either 2 or 10 d after sham or SNL injury; the latter time point was chosen on the basis of peak SNL-induced spinal dynorphin
levels in rats (Malan et al., 2000 ). Tissue was extracted in 1 M acetic acid, and the dynorphin content in the
extracts was quantitated using a commercial enzyme immunoassay system
(Peninsula Laboratories, Belmont, CA) and a standard curve constructed
from known concentrations of dynorphin A(1-17).
The dynorphin antiserum used recognizes dynorphin
A(1-17) and a number of its fragments (as short
as dynorphin A(1-12)), but has no affinity for
-neoendorphin, dynorphin B,
-endorphin,[Leu5]- or
[Met5]enkephalin, or for dynorphin
fragments shorter than dynorphin A(1-12).
Protein content in the extracts was determined by the Coomassie Plus
Protein assay (Pierce, Rockford, IL).
Radioligand binding analysis for opioid receptors. Brain
membranes were prepared from the whole brains of three mice from the
same experimental group by homogenizing the tissues with the Polytron
in 50 mM Tris, pH 7.4, and centrifuging at
45,000 × g for 20 min at 4°C. The crude membrane
extracts were washed twice in the Tris buffer. Protein content was
determined by the Lowry method. Membrane protein (20 µg) was
incubated with 12 concentrations of
[3H]diprenorphine (59 Ci/mmol; NEN,
Boston, MA) in 50 mM Tris buffer, pH 7.4, containing 1 mM EDTA, 1 mM
dithiothreitol, 0.1 mM PMSF, and 0.5% bovine
serum albumin (BSA) at 25°C for 3 hr. Reaction was terminated by
rapid filtration through Whatman (Maidstone, UK) GF/B
filters presoaked in polyethylenimine and washed with 3 × 4 ml of
ice-cold PBS. Nonspecific binding was defined as that in the presence
of 10 µM naloxone. Radioactivity was
quantitated by liquid scintillation counting. The
KD and
Bmax values were calculated by
nonlinear least squares analysis (GraphPad Prism, San Diego, CA).
Opioid mediated
-[35S]GTP binding in
spinal cord. Determination of
-[35S]GTP binding in spinal cord
membranes prepared from naive or nerve-ligated mice was performed as
previously described with slight modifications (Porreca et al., 1998 ).
The ipsilateral half of the lumbar spinal cords from three mice in the
same group were pooled for membrane extraction as above. Membranes (20 µg of protein) were incubated with 0.1 nM
-[35S]GTP (1000-1500 Ci/mmol; NEN)
in a final volume of 1 ml of reaction buffer (50 mM HEPES, pH 7.4, 100 mM
NaCl, 1 mM EDTA, 5 mM
MgCl2, 20 µM GDP, 1 mM dithiothreitol, and 0.1% BSA) in the presence of opioid receptor subtype-specific agonists for 60 min at 25°C. The
agonists (concentration range, 0.1 pM to 100 µM) were:
[D-Ala2,NMePhe4-Gly-ol5]enkephalin
(DAMGO), SNC80 and U69,593 for µ, , and opioid receptors,
respectively. Basal level of binding was defined as the amount bound in
the absence of agonist. Nonspecific binding was determined in the
presence of 10 µM unlabeled GTP S. Reactions were terminated by rapid filtration through Whatman GF/B filters (presoaked in reaction buffer), followed by 4 × 4 ml of ice-cold wash buffer (50 mM Tris, 5 mM MgCl2, and 100 mM NaCl, pH 7.4). The membrane-bound
-[35S]GTP was determined by liquid
scintillation counting. The EC50 and
Emax values were calculated by
nonlinear least squares analysis (GraphPad Prism).
Behavioral tests. High-threshold thermal nociception was
evaluated by the following methods: (1) tail immersion test by dipping the distal half of the tail into a water bath maintained at 48, 52, or
55°C and recording the latency to a rapid tail flick response. A 15, 12, and 10 sec cutoff was applied to 48, 52, or 55°C test, respectively, to prevent tissue injury; (2) paw withdrawal latency to a
radiant heat source applied to the plantar surface of the paw of mice
as previously described (Hargreaves et al., 1988 ). Naive wild-type mice
respond to lower and higher stimulus intensities with appropriate
changes in latency; the response at the lower intensity stimulation was
20 ± 0.42 sec whereas at the higher intensity stimulus the
response latency was 12 ± 0.32 sec. A maximal cutoff of 40 sec
was used to prevent tissue damage; (3) a hot-plate test by placing the
animal in a glass cylinder on a heated plate with temperature
controlled to 52 or 55°C and determining the latency to hindpaw
licking. A cutoff time was set at 45 sec for 52°C or 30 sec for
55°C hot plate to prevent injury. Non-noxious sensory thresholds of
the mice were determined by paw withdrawal latency to probing with a
series of calibrated (0.02-2.34 gm on a logarithmic scale) von Frey
filaments ("up and down" method) according to Chaplan et al. (1994)
and analyzed using a Dixon (1980) nonparametric test and expressed as
the mean withdrawal threshold.
Formalin test. Tonic inflammatory pain was induced in groups
of 14 mice by a subcutaneous injection of 20 µl of 2% formalin solution in the dorsal surface of the right hindpaw. Flinching of the
paw was counted in bins of 5 min each, starting with the formalin
injection and ending after 75 min. The formalin flinch test produces a
distinct biphasic response over time with flinching behavior appearing
in two phases. To quantify the flinch response over the first and
second phases, the total number of flinches occurring between 0 and 15 min and between 15 and 75 min were summed, respectively, giving a
cumulative distribution over time.
SNL. SNL was performed based on that previously described
for rats (Kim and Chung, 1992 ). Groups of eight WT or KO mice had the
L5 and L6 spinal nerve tightly ligated distal to the dorsal root
ganglion but before the fibers joined the sciatic nerve; sham operation
consisted of the same procedures but without the ligation. Mechanical
thresholds were determined by measuring the paw withdrawal threshold to
probing with a series of calibrated von Frey filaments as described
above. Thermal thresholds were determined with the radiant heat test as
described above. For the reversal of nerve injury-induced changes in
mechanical and thermal thresholds, separate groups of five to eight
mice were injected intrathecally with MK-801 (3.4 µg in 5 µl
saline), an antiserum against dynorphin A(1-17),
or a control nonimmune serum (150 µg in 5 µl) (Peninsula). This
antiserum recognizes dynorphin A(1-17) and a
number of its fragments and has no affinity for -neoendorphin,
dynorphin B, -endorphin, or [Leu5]-
or [Met5]enkephalin. Reversal
experiments were performed on days 2 and 14 after sham or SNL surgery.
The latter time point was chosen to insure that testing was done at a
time when behavioral baselines remained stable after return to
preinjury levels in the KO mice (see below).
Statistical analysis. Comparison between groups were
performed using Student's t test. Statistical significance
was established at 95% confidence limit.
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RESULTS |
Initial analysis of spinal cord tissues from the WT mice showed
that prodynorphin immunoreactivity is primarily located in the
superficial laminae of the dorsal horn but is entirely absent in spinal
cord tissues from the prodynorphin KO mice (Fig.
1). Enzyme immunoassay for the active
peptide dynorphin A(1-17) which is one of the
endogenous derivatives of prodynorphin, further confirmed the lack of
dynorphin expression in the KO mice (see Fig. 5 below). The KO mice
exhibited normal growth and development, feeding, motor function, and
weight that were indistinguishable from their WT littermates. When
these mice were evaluated for their nociceptive responsiveness, the WT
and KO mice displayed similar latency to innocuous mechanical
stimulation (Fig. 2A) as well as latencies to noxious input based on radiant heat and hot-plate tests (Fig. 2C,D). However, the KO mice
consistently showed a small, but significant decrease in the tail-flick
response latency when compared with the WT mice (Fig.
2B). WT and KO mice were tested using a model of
tonic nociceptive input by an injection of 2% formalin to the right
hindpaw. Both the WT and KO mice displayed a biphasic flinching
response over a 75 min period (Fig. 3).
No difference was detected in the amplitude and duration of the first phase of flinching between the WT and KO mice (Fig. 3A).
However, the KO mice showed a small, but significant enhancement of the second phase of flinching, indicated by the total number of flinches during the second phase compared with that exhibited by the WT mice
over the same period (Fig. 3B).

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Figure 1.
Prodynorphin immunostaining in spinal cord tissues
of wild-type (+/+) and prodynorphin knock-out ( / ) mice.
Prodynorphin immunoreactivity was primarily seen in the superficial
dorsal horn of wild-type mice, but was not detectable in prodynorphin
knock-out mice. Scale bar, 200 µm.
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Figure 2.
Response thresholds of wild-type (+/+) and
prodynorphin knock-out ( / ) mice to: innocuous mechanical
stimulation of the paw with von Frey filaments (n = 28, each group) (A); noxious thermal stimulus
elicited by immersion of the tail in water at 48, 52, and 55°C
(n = 32, each group) (B);
noxious thermal stimulus of the paw with low- or high-intensity radiant
heat (n = 28, each group)
(C); and hot plate latency at 52 or 55°C
(n = 28, each group) (D).
Prodynorphin knock-out mice display small, but significantly shorter
response latencies in the tail-flick test when compared with wild-type
mice (*p < 0.05), indicating mild
hyperalgesia.
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Figure 3.
Formalin (2%, s.c.)-induced
paw-flinching response in wild-type (+/+) and prodynorphin knock-out
( / ) mice. The time course of the formalin response is seen in
A, and the total number of flinches in the first (0-15
min) and second (15-75 min) phases are seen in B.
Prodynorphin knock-out mice exhibit a small but significantly greater
number of paw flinches in the second phase of the formalin response
when compared with wild-type mice (*p < 0.05),
suggesting mild hyperalgesia. Data represent the mean from 14 animals
in each group.
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The possible contribution of dynorphin in nerve injury-induced
neuropathic pain states was investigated by comparing the development of decreased latency to respond to a noxious thermal stimulus and
decreased response thresholds to innocuous mechanical stimulation after
L5/L6 SNL injury in the WT or KO mice. Figure
4 shows that within 2 d after SNL
injury, both the WT and KO mice developed pronounced increases in
sensitivity to innocuous mechanical and thermal stimulation when
compared with the sham-operated WT and KO mice. However, whereas the
SNL-injured WT mice maintained increased mechanical and thermal
sensitivity for the remaining time course (up to 14 d of
continuous monitoring) of the experiment, the KO mice exhibited a
progressive reversal of sensitivity to innocuous mechanical and noxious
thermal stimulation such that by day 10 after SNL injury, the paw
withdrawal threshold to radiant heat stimulus or von Frey filament
probing was not different from the preinjury level or that of the
sham-operated controls.

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Figure 4.
Response thresholds to innocuous mechanical (von
Frey filaments) (A) and noxious thermal (radiant
heat applied to the paw) (B) stimuli in wild-type
(WT, squares) and prodynorphin knock-out (KO,
circles) mice after sham (open symbols) or SNL
surgery (closed circles). Neither WT nor KO mice show
any change in the mechanical or thermal thresholds from preinjury
baselines after sham surgery throughout the 14 d test period.
After SNL, both WT and KO mice rapidly develop decreased innocuous
mechanical and noxious thermal thresholds by postsurgery day 2. Whereas
the decreased mechanical and thermal thresholds were maintained in WT
mice (closed squares), thresholds in KO mice showed a
progressive reversal to preinjury baseline levels (closed
circles). By day 10 after SNL, both mechanical and thermal
thresholds in KO mice were not significantly different from those
exhibited by sham-operated KO (or WT) mice done in parallel
(p > 0.5). Asterisk denotes
values that are significantly different from the corresponding
sham-operated mice. Data represent the mean from eight mice in each
experimental group.
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Quantitative analysis of spinal dynorphin content by enzyme immunoassay
showed that in the WT mice, spinal dynorphin at day 10 after SNL
(590 ± 76 pg/mg) was significantly elevated
(p < 0.05) when compared with sham-operated
controls (390 ± 74 pg/mg), whereas at day 2 after SNL (340 ± 110 pg/mg) spinal dynorphin was not different from the sham controls
(Fig. 5). The immunoreactivity found in extracts from KO mice (56 ± 3 pg/mg) was negligible when compared with that in the WT mice and likely represents the nonspecific activity of the antiserum. To substantiate the possible involvement of
spinal dynorphin in the observed neuropathic pain, WT and KO mice were
subjected to SNL, and at days 2 and 14 after surgery, they received a
bolus intrathecal injection of an antiserum to dynorphin and were then
monitored for paw withdrawal thresholds to von Frey filaments (Fig.
6A) or radiant heat
(Fig. 6B). Dynorphin antiserum had no effect on the
enhanced sensitivity to innocuous mechanical or noxious thermal stimuli
seen in the WT or KO mice 2 d after SNL, however, dynorphin
antiserum reversed these decreased thresholds in the WT mice 14 d
after SNL. Dynorphin antiserum had no effect on the responses of the KO
mice 14 d after SNL, at which time the paw withdrawal thresholds
for both innocuous and noxious stimuli had returned to preinjury level.
Control serum did not alter baseline responses in any treatment groups
(data not shown). The NMDA receptor antagonist, MK-801, was similarly used to evaluate the contribution of excitatory amino acid
neurotransmission to neuropathic pain states in these mice (Fig. 6). In
contrast to the data with intrathecal antiserum to dynorphin,
intrathecal MK-801 was effective in reversing the decreased thresholds
to innocuous mechanical and noxious thermal stimuli in WT and KO mice
at day 2 after SNL and in WT mice at day 14 after SNL. MK-801 had no
effect on the paw withdrawal thresholds to innocuous or noxious stimuli
in the KO mice at day 14 after SNL. Neither dynorphin antiserum nor
MK-801 altered paw withdrawal latencies in sham-operated WT or KO
mice.

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Figure 5.
Quantitative analysis of spinal dynorphin content
in prodynorphin KO and WT mice on days 2 and 10 after sham or SNL
surgery. Extract from the dorsal ipsilateral quadrant of the lumbar
spinal cord from each of five mice for each experimental group was used
for the enzyme immunoassay. Prodynorphin KO mice showed negligible
immunoreactivity. Similar levels of spinal dynorphin were seen in WT
mice at day 2 after SNL or at days 2 or 10 after sham surgery, whereas
spinal dynorphin was significantly increased in WT mice at day 10 after
SNL (*p < 0.05).
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Figure 6.
Effects of MK-801 and antiserum to dynorphin A
(dynorphin A/S) on the response threshold to innocuous mechanical
stimulation (von Frey filaments) (A) and noxious
thermal (radiant heat applied to the paw) stimulation
(B) in wild-type (WT) and
prodynorphin knock-out (KO) mice. SNL induced a decrease
in both mechanical and thermal thresholds in WT mice at days 2 and 14 after surgery and in KO mice at day 2, but not day 14, after SNL
surgery. At day 2 after SNL, intrathecal MK-801 reversed the decreased
mechanical and thermal response thresholds seen in both WT and KO mice
(hatched bars); intrathecal dynorphin A/S
(cross-hatched bars) had no effect at postsurgery day 2. At day 14 after SNL, both intrathecal MK-801 and dynorphin A/S reversed
the SNL-induced decrease in mechanical and thermal response thresholds
in WT mice. Prodynorphin KO mice no longer exhibit reduced thresholds
at day 14 (Fig. 4), and intrathecal MK-801 or dynorphin A/S did not
affect mechanical or thermal thresholds in these SNL-injured mice
(*p < 0.05). Data represent mean from five to
eight mice in each experimental group.
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It has been recognized that an alteration of function of a particular
gene in a transgenic organism could, during development, give rise to
compensatory phenotypic changes that may undermine the experimental
interpretation of the function of the gene in question. Pertinent to
the present study is any potential compensation to a loss of dynorphin
expression in the spinal cord that may influence sensory processing.
Dynorphin is an endogenous opioid, suggesting that a lack of this
peptide could elicit compensatory changes of opioid receptor expression
or function resulting in an enhancement of processes of inhibition in
sensory transmission. However, an evaluation of the total opioid
receptors in the brain (Table 1), as well
as the immunoreactivity of the opioid receptor (see Fig. 8) and µ opioid receptor in the spinal cord (see Fig. 9), indicates that the
density of opioid receptors, as well as their affinity to the opioid
antagonist diprenorphine in the KO mice were not significantly
different from that in the WT mice. The density of the opioid receptors
also did not change after SNL injury in the WT or KO mice. The potency
and efficacy of the selective opioid agonists for µ, , and receptors in stimulating -[35S]GTP
binding to spinal cord membranes argue against any functional difference in these receptors between the WT and KO mice after sham or
SNL surgery (Fig. 7). The expression and
distribution of protein kinase C (PKC ), which has been implicated
in the development of neuropathic pain (Malmberg et al., 1997 ), was
also found to be similar in sham or SNL-injured WT and KO mice (see Fig. 9). However, the potency and efficacy of selective opioid agonists
for µ, , and receptors in stimulating
-[35S]GTP binding to spinal cord
membranes argue against any functional difference in these receptors
between the WT and KO mice after sham or SNL surgery (Fig. 7).
Furthermore, an evaluation of the total opioid receptors in the brain
(Table 1), as well as (Fig. 8) and µ opioid receptor immunoreactivity in the spinal cord (Fig. 9) indicates that the density of opioid
receptors, as well as their affinity to the opioid antagonist,
diprenorphine, in the KO mice were not significantly different from
that in the WT mice. The density of the opioid receptors also did not
change after SNL injury in the WT or KO mice. The expression and
distribution of protein kinase C (PKC ), which has been implicated
in the development of neuropathic pain (Malmberg et al., 1997 ), was
also found to be similar in sham or SNL-injured WT and KO mice (Fig. 9).
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Table 1.
Saturation analysis of [3H]diprenorphine (a
nonselective opioid receptor antagonist that labels µ, and opioid receptors) in cortical brain membranes from WT and prodynorphin
KO mice
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Figure 7.
Stimulation of -[35S]GTP
binding by the opioid receptor agonist SNC80
(A), the opioid µ receptor agonist DAMGO
(B), and the opioid receptor agonist U69,593
(C) in spinal cord membranes prepared from WT
(squares) or KO (circles) mice 14 d
after sham (open symbols) or SNL surgery (closed
symbols). No significant change in opioid receptor-mediated
transduction was seen.
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Figure 8.
Western analysis of the opioid receptor
(KOR) in lumbar spinal cord from wild-type
(WT) and prodynorphin knock-out
(KO) mice 14 d after sham or SNL surgery. The KOR
antibody recognizes two bands of ~50-55 kDa, and the antibody for
actin recognizes a single band of 40 kDa. The integrated optical
densities for the KOR bands, normalized against that from the WT sham
(1.0), are 0.92 for WT SNL, 0.93 for KO sham, and 1.0 for KO SNL, after
correcting for loading based on the integrated optical density for
actin in each sample. The data are representative of three separate
analyses.
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Figure 9.
Opioid µ receptor (MOR; A-D) and
protein kinase C (PKC ;
E-H) immunoreactivity in the ipsilateral dorsal
horn of the lumbar spinal cord of wild-type (WT, left
column) and prodynorphin knock-out (KO, right
column) mice, after sham surgery (A,
B; E, F) or at day
14 after SNL (C, D; G,
H). No qualitative difference in immunoreactivity
was seen in tissues from WT and KO mice after sham or SNL surgery.
Scale bar, 200 µm.
|
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 |
DISCUSSION |
The generation of a transgenic mouse strain that does not express
dynorphin allows for an assessment of the possible contributions of
this peptide in normal sensory thresholds as well as in pathological pain states. When compared with WT controls, the KO mice showed normal
behavior and development as well as normal sensitivity to non-noxious
stimulation. Only slightly altered nocifensive thresholds to some
noxious stimuli were observed, suggesting that spinal reflex and pain
transmission pathways are intact. A consistent observation was mild,
but significant hyperalgesia in the KO mice as shown by the decrease
observed in tail-flick response latencies and the enhancement of
flinching in the second phase of the formalin response. These
observations suggest the possibility that constitutive levels of the
products of prodynorphin produce a modest and limited tonic inhibition
of nociceptive input, likely through opioid actions, as previously
suggested with studies using dynorphin antiserum (Ossipov et al.,
1996 ). The mild endogenous tone suggested by these observations is also
consistent with the relatively low levels of dynorphin normally
expressed in the spinal cord (Dubner and Ruda, 1992 ). However, it
should be noted that in the initial characterization of these
prodynorphin KO animals, Sharifi et al. (2001) found evidence
for a reduced level of transcripts for proopiomelanocortin (POMC). The
degree to which this change might affect peptide production remains to
be determined, but the possibility that the mild hyperalgesia observed
could also reflect a decrease in the expression of products of POMC,
such as -endorphin, cannot be excluded.
After SNL, both WT and KO mice demonstrated reliable signs of
neuropathic pain within 2 d, suggesting that the initiation of the
postinjury state does not depend on the action of the products of
prodynorphin. However, the WT mice exhibited a significant upregulation
of spinal dynorphin at day 10 after SNL, which is similar to that
previously observed in SNL-injured rats (Malan et al., 2000 ). This
overexpression of spinal dynorphin notably correlates with the presence
of sustained neuropathic pain in the SNL-injured WT mice, because in
the SNL-injured KO mice in which spinal dynorphin is absent, a full
recovery of increased sensitivity to innocuous mechanical and noxious
thermal stimuli was observed by day 10 after injury. These findings
support the possibility of a causal relationship between upregulated
spinal dynorphin and the abnormal pain state. This possibility was
tested further by spinal administration of dynorphin antiserum.
Dynorphin antiserum has previously been shown to reverse SNL-induced
neuropathic pain in rats (Malan et al., 2000 ) and in mice (Ibrahim et
al., 1999 ). Consistent with the earlier observation in rats and mice, intrathecal dynorphin antiserum had no effect on sensory thresholds in
sham-operated WT or KO mice (Ibrahim et al., 1999 ; Malan et al., 2000 ).
When tested at day 2 after SNL injury, intrathecal dynorphin antiserum
also did not affect sensory thresholds in WT or KO mice. When tested
14 d after SNL injury, however, intrathecal administration of
antiserum to dynorphin completely reversed the increased sensitivity to
innocuous mechanical and noxious thermal stimuli induced by SNL in WT
mice (no pain or effects of dynorphin antiserum were seen in SNL KO
mice at day 14). The time-related activity of dynorphin antiserum
against SNL-induced pain contrasts sharply with the activity of
intrathecal MK-801; this compound was effective in reversing
SNL-induced pain when tested at either 2 or 14 d after injury.
Critically, it should be noted that the reversal by dynorphin antiserum
was to, but not above, preinjury baseline levels, indicating blockade
of a pronociceptive effect rather than production of
"analgesia."
The lack of sustained SNL-induced pain in the prodynorphin KO mice,
together with the increased mechanical and thermal sensitivity of the
SNL WT mice to dynorphin antiserum as well as MK-801 on day 14, have
led us to conclude that the products of prodynorphin, and specifically
dynorphin, are essential in the maintenance of the neuropathic pain
state. The specific involvement of dynorphin in the SNL-induced pain,
rather than that of other products of the prodynorphin gene, is
supported by the specificity of the antiserum used as well as the
demonstrated increases in expression of spinal dynorphin at day 10 after SNL. In this regard, it should be emphasized that the potential
reduction of POMC products such as -endorphin in these KO mice would
be expected to increase sensitivity to pain, rather than promote the
decrease in sensitivity to noxious or non-noxious stimuli observed in
the current experiments. These data, together with the activity of
dynorphin antiserum only at a time when spinal dynorphin is
upregulated, strongly suggests that unlike dynorphin, potential
deficiencies in the expression of POMC products do not play a role in
the observed consequences of SNL injury.
The differential sensitivity to reversal of SNL-induced pain by MK-801,
but not dynorphin antiserum at postinjury day 2, also indicates that
the processes that initiate neuropathic pain differ from those that are
critical to its maintenance. The activity of MK-801 underscores the
likely importance of repetitive discharge originating from the injured
or adjacent primary afferent neurons to initiate SNL-induced
neuropathic pain (Seltzer et al., 1991 ). Ectopic discharge is known to
occur and to peak within 16 hr after SNL in rats but decreases over
time to <50% of its initial discharge rate by day 5 after injury (Han
et al., 2000 ). Although the discharge rate of the injured nerve fibers
depends on fiber type, it is clear that discharge rate diminishes with
time after nerve injury (C. Liu et al., 2000 ; X. Liu et al., 2000 ).
However, the magnitude of the observed signs of neuropathic pain are
maintained essentially unchanged for many weeks (Chaplan et al., 1994 ;
Bian et al., 1995 ; X. Liu et al., 2000 ). These findings suggest that
mechanisms required to maintain the presence of the neuropathic pain
state extend beyond afferent input to the CNS. Our data support
this possibility and suggest that whereas ectopic activity is likely to
drive the neuropathic pain state at early stages after nerve injury,
afferent discharge is necessary but not sufficient to maintain the
neuropathic pain state in the absence of an upregulation of spinal
dynorphin. Thus, the data provide support for the concept that the
processes which maintain the neuropathic pain state depend on the
presence of increased levels of spinal dynorphin.
Dynorphin appears to maintain the neuropathic pain state ultimately
through an NMDA-dependent mechanism. It might be speculated that
elevated levels of dynorphin act to increase the release of excitatory
transmitters from presynaptic and/or postsynaptic spinal sites, an idea
that awaits experimental validation. However, the des-Tyr fragments of
dynorphin (i.e., non-opioid fragments) have been demonstrated to
enhance capsaicin-evoked release of calcitonin gene-related
peptide from primary afferent fibers in spinal cord preparations
(Claude et al., 1999 ; T. Vanderah and F. Porreca, unpublished
observations) and in DRG cells in culture (J. Lai, Z. Wang, and F. Porreca, unpublished observations). Des-Tyr dynorphin also activates
PKC in spinal cord (Z. Wang, F. Porreca, and J. Lai, unpublished
observations) and stimulates an increase in intracellular
calcium in neuronal cells (Tang et al., 2000 ). Additionally, it is
known that dynorphin and its fragments may directly bind to the NMDA
receptor (Tang et al., 1999 ) although the physiological relevance of
such binding is unclear. An interesting and plausible hypothesis is
that SNL-induced afferent discharge may initiate the consequences of
nerve injury, including an upregulation of spinal dynorphin that
ultimately acts to sustain the SNL-induced pain. This would be in line
with an early, dynorphin-independent, and a later, dynorphin-dependent,
neuropathic pain state as a result of SNL.
An alternate explanation may relate to the possibility that SNL injury
results in an upregulation of inhibitory transmitter-receptor systems.
Using a model of sustained inflammatory pain, Dubner and colleagues
have suggested that inhibitory receptors (such as opioid receptors)
may be upregulated in opioid µ receptor-deficient mice (Qiu et al.,
2000 ). An examination of opioid receptor expression and transduction in
the post-SNL injury state revealed no changes, suggesting that such
compensations were not responsible for the progressive reversal of
neuropathic pain in the KO mice.
The present study supports the concept that an upregulation of
dynorphin results in a pathological action that is pronociceptive and
acts to maintain the chronic pain state. These findings offer a
potentially important alternative to the development of NMDA antagonists as treatments for neuropathic pain. Whereas the latter are
likely to be limited by a broad spectrum of severe side effects (Blanchet et al., 1997 ), approaches that may selectively limit the
increased expression or activity of dynorphin may offer pain relief
without associated side effects. The findings from this study reveal a
previously unknown role of dynorphin to promote pain. Dynorphin may
also participate in other pathological states associated with injuries
to peripheral or central nerves, including the consequences of
ischemia, stroke, and central trauma (Faden, 1996 ). Critically, our
data suggest that a blockade of an overexpression of dynorphin or its
actions may represent a new modality to interfere with the maintenance
of chronic pain, which remains one of the most important challenges to
clinical medicine.
 |
FOOTNOTES |
Received Sept. 22, 2000; revised Dec. 6, 2000; accepted Dec. 19, 2000.
This study was supported by National Institute on Drug Abuse DA
11823. We thank Drs. Shou-wu Ma, En-Tan Zhang, and Chengmin Zhong for
their technical assistance.
J.L. and F.P. contributed equally to this work.
Correspondence should be addressed to Dr. Frank Porreca, Department of
Pharmacology, University of Arizona Health Sciences Center, Tucson, AZ
85724. E-mail: FRANKP{at}U.ARIZONA.EDU.
 |
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