Marchand J E, Cepeda M S, Carr D B, Wurm W H, Kream R M
Department of Anesthesiology, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Pain. 1999 Feb;79(2-3):187-200. doi: 10.1016/s0304-3959(98)00165-1.
Recent animal models of experimental nerve injury have proven useful in evaluating potential sympathetic involvement in neuropathic pain syndromes. We have employed a widely adopted unilateral L5/L6 spinal nerve ligation model to compare the development of mechanical allodynia with neurochemical changes both at the site of peripheral nerve injury and in the dorsal root ganglia (DRG). We have focused on the expression of neuropeptide Y (NPY), a well-studied regulatory peptide and phenotypic marker of sympathetic neurons, and functionally related Y-receptor binding sites following nerve injury. In sympathetic neurons, NPY is colocalized and coreleased with norepinephrine (NE) at peripheral sites of action. Furthermore, NPY gene expression is induced within the population of medium- and large-diameter DRG neurons of the A beta-fiber class after experimental nerve injury. We therefore hypothesized that concurrent alterations in NPY and NE expression by sympathetic and sensory neurons may be a contributing factor to sympathetically-maintained neuropathic conditions. Animals with unilateral L5/L6 spinal nerve ligation developed mechanical allodynia of the hind paw ipsilateral to the site of injury that persisted until sacrifice at postoperative day 10. A significant induction of preproneuropeptide Y-encoding (PPNPY) mRNA, as detected by in situ hybridization histochemistry (ISHH), occurred in populations of medium- and large-diameter DRG neurons ipsilateral to the site of injury. Immunohistochemical analysis indicated a marked decline in the number of labeled sympathetic axons positive for tyrosine hydroxylase-like and NPY-like immunoreactivities (TH-LI and NPY-LI, respectively) proximal to the site of nerve injury and almost complete elimination of immunopositive fibers distal to the site of ligation. Whereas, the extent of colocalization of NPY-LI to TH-LI-positive sympathetic axons in unaffected L4 or L5 nerve segments exceeded 80%, this figure declined to approximately 50% in regenerating axons of ligated spinal nerve L5. The portion of NPY-LI that was not colocalized to sympathetic TH-LI-positive fibers was most likely contributed by regenerating sensory axons, consistent with marked de novo synthesis of NPY by DRG neurons. In end bulb axon terminals, i.e. morphological profiles characteristic of neuromas, NPY-LI-positive elements that were not colocalized to TH-LI-positive sympathetic elements appeared to be spatially segregated from those of sympathetic origin with colocalized TH-LI and NPY-LI. Receptor autoradiography indicated that small- and medium-diameter DRG somata of the C-fiber class normally express both Y1 and Y2 receptor subtypes. The pattern of the distribution of Y-receptor binding sites appeared to be relatively unaffected by spinal nerve ligation. In contrast, there was a marked increase in the density of Y2 receptor binding sites in the proximal segment of ligated spinal nerve L5, consistent with previously published data indicating differential transport of the Y2 autoregulatory receptor subtype to nerve terminals. Induction of NPY gene expression in injured DRG neurons is consistent with appearance of NPY-LI-positive end bulbs derived from regenerating sensory axons that are found in developing neuromas containing a relatively high density of transported prejunctional Y2 receptors. Newly established functional interactions of spatially segregated sensory- and sympathetically-derived end bulbs in developing neuromas may enhance neuronal hyperexcitability engendered by aberrant electrical activity at the site of injury. Injury-related alterations in the regulatory activities of NPY released within the DRG at somally-distributed Y-receptors may also contribute to the development and/or persistence of symptoms characteristic of sympathetically-maintained pain. Finally, at later times NPY-mediated modulation of NE release from invading sympathetic axon terminals within the DRG may affect the extent of alpha2 rece
最近的实验性神经损伤动物模型已被证明在评估神经病理性疼痛综合征中潜在的交感神经参与方面很有用。我们采用了一种广泛应用的单侧L5/L6脊神经结扎模型,以比较机械性异常性疼痛的发展与外周神经损伤部位及背根神经节(DRG)中的神经化学变化。我们重点研究了神经肽Y(NPY)的表达,NPY是一种研究充分的调节肽和交感神经元的表型标志物,以及神经损伤后功能相关的Y受体结合位点。在交感神经元中,NPY与去甲肾上腺素(NE)在外周作用部位共定位并共同释放。此外,实验性神经损伤后,Aβ纤维类中、大直径DRG神经元群体中NPY基因表达被诱导。因此,我们假设交感神经元和感觉神经元中NPY和NE表达的同时改变可能是交感神经维持的神经病理性状况的一个促成因素。单侧L5/L6脊神经结扎的动物在损伤部位同侧的后爪出现机械性异常性疼痛,这种疼痛一直持续到术后第10天处死。原位杂交组织化学(ISHH)检测发现,损伤部位同侧中、大直径DRG神经元群体中前神经肽Y编码(PPNPY)mRNA有显著诱导。免疫组织化学分析表明,在神经损伤部位近端,酪氨酸羟化酶样和NPY样免疫反应性(分别为TH-LI和NPY-LI)阳性的标记交感轴突数量明显减少,而在结扎部位远端免疫阳性纤维几乎完全消失。在未受影响的L4或L5神经节段中,NPY-LI与TH-LI阳性交感轴突的共定位程度超过80%,而在结扎的L5脊神经再生轴突中,这一数字降至约50%。未与交感TH-LI阳性纤维共定位的NPY-LI部分很可能由再生的感觉轴突贡献,这与DRG神经元中NPY的显著从头合成一致。在终球轴突终末,即神经瘤的形态学特征,未与TH-LI阳性交感成分共定位且NPY-LI阳性的成分似乎在空间上与TH-LI和NPY-LI共定位的交感来源成分分开。受体放射自显影表明,C纤维类的小直径和中直径DRG胞体通常同时表达Y1和Y2受体亚型。Y受体结合位点的分布模式似乎相对不受脊神经结扎的影响。相比之下,结扎的L5脊神经近端节段中Y2受体结合位点的密度显著增加,这与先前发表的数据一致,表明Y2自调节受体亚型向神经终末的差异性转运。损伤的DRG神经元中NPY基因表达的诱导与源自再生感觉轴突的NPY-LI阳性终球的出现一致,这些终球存在于含有相对高密度转运的节前Y2受体的发育中的神经瘤中。发育中的神经瘤中空间上分离的感觉和交感来源终球新建立的功能相互作用可能会增强损伤部位异常电活动引起的神经元兴奋性过高。DRG中在胞体分布的Y受体处释放的NPY调节活性的损伤相关改变也可能导致交感神经维持性疼痛特征性症状的发展和/或持续。最后,在后期,NPY介导的对DRG内侵入的交感轴突终末释放NE的调节可能会影响α2受体的程度。