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Pain Research: Product Guide - Edition 1
Pain Research: Product Guide - Edition 1
Chili plant
Capsicum annuum
A source of Capsaicin
Contents by Research Area:
• Nociception
• Ion Channels
• G-Protein-Coupled Receptors
• Intracellular Signaling
Tocris Product Guide Series
Pain Research
Contents
Page
Nociception 3
Ion Channels 4
G-Protein-Coupled Receptors 12
Intracellular Signaling 18
List of Acronyms 21
Related Literature 22
Pain Research Products 23
Further Reading 34
Introduction
Pain is a major public health problem with studies suggesting one fifth of the general population in both the USA and
Europe are affected by long term pain. The International Association for the Study of Pain (IASP) defines pain as ‘an
unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms
of such damage’.
Management of chronic pain in the clinic has seen only limited progress in recent decades. Treatment of pain has
been reliant on, and is still dominated by two classical medications: opioids and non-steroidal anti-inflammatory
drugs (NSAIDs). However, side effects such as dependence associated with opioids and gastric ulceration associated
with NSAIDs demonstrates the need for new drug targets and novel compounds that will bring in a new era of pain
therapeutics.
Pain has been classified into three major types: nociceptive pain, inflammatory pain and neuropathic or pathological
pain. Nociceptive pain involves the transduction of painful stimuli by peripheral sensory nerve fibers called nociceptors.
Neuropathic pain results from damage or disease affecting the sensory system, and inflammatory pain represents the
immunological response to injury through inflammatory mediators that contribute to pain. Our latest pain research
guide focuses on nociception and the transduction of pain to the spinal cord, examining some of the main classical
targets as well as emerging pain targets.
It is hoped that a thorough understanding of nociceptive pain will lead to the identification of key interventions most
likely to provide therapeutic benefit in the future. Tocris Bioscience provides a range of high performance life science
reagents that enable researchers to target the mechanisms that underlie pain. A selection of our key products are
highlighted within each section, and a full product listing can be found on pages 23-33.
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PAIN RESEARCH
Nociception
Nociception is a process involving transduction of intense ther- of sensory neurons and whether or not they are myelinated.
mal, chemical or mechanical stimuli that is detected by a sub- Most nociceptors are unmyelinated C-fibers that contribute
population of peripheral nerve fibers called nociceptors (also to a poorly-localized sensation of secondary pain, whilst
called pain receptors). Whilst neuropathic pain results from fast-onset, sharp pain is mediated by myelinated A-fibers.
damage or disease affecting the sensory system, nociceptive
The cell bodies of nociceptive neurons in the dorsal root gan-
pain is the normal response to noxious insult or injury of tissues
glion (DRG) send two processes: one axon to the peripheral
including: skin, muscle, organs, joints, tendons and bones.
tissue, and a second axon that synapses on second order neu-
Inflammatory pain, while not discussed in this guide, is charac-
rons in the dorsal horn of the spinal cord. The central axon of
terized by the mobilization of white blood cells and antibodies,
DRG neurons enters the spinal cord via the dorsal root and
leading to swelling and fluid accumulation. Noxious signals
branches to innervate multiple spinal segments in the rostral
can be enhanced or sensitized by inflammatory mediators,
and caudal direction (laminae I, II, IIA and V), from which the
during which pain fibers are activated by this lower intensity
ascending nociceptive pathways originate (Figure 1). Within
stimuli, and the pain generated can be more persistent. NSAIDs
these laminae, DRG neurons may interact with both excitatory
(such as aspirin (Cat. No. 4092), ibuprofen (Cat. No. 2796) and
and inhibitory interneurons that help to fine-tune the incoming
valdecoxib (Cat. No. 4206)) which inhibit cyclooxygenases, are
signals. Calcium channels play a key role in the transmission of
one of the most popular drug types used to prevent inflamma-
the pain signal, by triggering release of neuropeptides such as
tory pain in humans, but are not without severe side effects,
substance P, neurokinin 1 and calcitonin gene-related peptide
highlighting the need for new pain targets.
(CGRP), as well as neurotransmitters such as glutamate. The
Nociceptors are activated by noxious stimuli such as tis- ascending relay neurons then project to the medulla, mesen-
sue injury, exposure to an acid or irritant, or extreme tem- cephalon and thalamus in the brain, which in turn project to
peratures. They generate electrophysiological activity that is the somatosensory and anterior cingulate cortices to drive the
transmitted to the spinal cord. Nociceptors can be divided cognitive aspects of pain. Both local GABA-releasing inhibitory
functionally into three compartments: the peripheral terminal interneurons in the dorsal horn and descending noradrenergic
which detects painful stimuli; the axon which transduces the neurons originating in the brain can inhibit pain signaling.
signal; and the presynaptic terminal which transmits the sig- Signals relayed from nociceptors may act in combination to
nal, using glutamate as a primary neurotransmitter, across the produce changes that lead to hyperalgesia: an over-exaggerated
synapse to second order neurons. There are two major classes response to normally painful mechanical or thermal stimuli,
of nociceptor: myelinated A-fibers and unmyelinated C-fibers. or allodynia: a pain from a stimulus that would not normally
The speed of transmission is correlated to the axon diameter provoke pain.
i Unmyelinated C-fibers
ii
iii
iv
v Peripheral
vi tissues:
Nociceptors skin, muscle,
organs, joints,
Spinal cord segments
tendons or
Spinal cord bones
Myelinated A-fibers
The cell bodies of nociceptors are located in the dorsal root ganglion (DRG) and terminate as free endings in peripheral tissues. Pain signals
originating from the periphery pass through the dorsal root ganglion carried by C-fiber nerves (red) and myelinated A-fiber nerves (blue).
Inputs directed to the dorsal horn synapse on interneurons that modulate the transmission of nociceptive signals to higher CNS centres.
Signals are relayed to the brain via ascending pathways, and descending pathways from the brain send inhibitory signals. Highlighted in the
boxes are key mediators and drug targets that play important roles in pain processing and transmission.
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Tocris Product Guide Series
Ion Channels
signals encode the intensity of a noxious stimulus, leading to the
Products by Category Page transduction of pain signals (Figure 2). Recently, TRP (transient
receptor potential) channels have been pursued as pain targets
ASIC Channels........................................................................ . . 23
since they were identified at the genetic level and found to medi-
Calcium Channels. ................................................................ . . 23
ate the painful effects of capsaicin (via the TRPV1 channel), the
GABA A Receptors.................................................................... . 25
chemical responsible for the pungency of chili. A more classical
Glutamate (Ionotropic) Receptors...................................... . 26
understanding of the ion channels involved in pain implicates
HCN Channels. ....................................................................... . . 27
the sodium channels, these determine excitability of the neurons
Nicotinic Receptors............................................................... . 28
alongside the calcium channels that influence membrane poten-
Potassium Channels.............................................................. . 30
tial and neurotransmission. Potassium channels are important
Purinergic P2X Receptors. .................................................. . 31
in repolarizing neurons back to a resting state, and could be
Sodium Channels.................................................................... . 31
important targets in the future, alongside the emerging roles
TRP Channels.......................................................................... . 32
that the ASIC, HCN and P2X receptor ion channels play in pain.
NK G
HCN nAChR P2Y G BK G i/o β
P2X ASIC TRP q/11 β γ
q/11 β γ
cAMP γ
Receptor potential
Cav
Kv
Nav
Action potential
propagation
Transduction
Peripheral terminals respond to noxious stimuli through ion channels such as TRP, ASIC, HCN and P2X receptors and GPCRs such as
bradykinin (BK), neurokinin (NK) and P2Y receptors which indirectly modulate ion channels and intracellular signaling pathways. When a
threshold depolarization is reached, voltage-gated sodium and calcium channels (NaV and CaV respectively) are activated, which generates
an action potential. At this point voltage-gated potassium channels (K V) open and repolarize the membrane, inactivating NaV channels and
returning the neuron to a resting state. The action potential then propagates along the axon in a process called transduction.
4 |
PAIN RESEARCH
their activity and can therefore bring about analgesia. TRP Figure 3 | TRP channels as temperature sensors
channels, named after the function they play in phototrans-
TRPA1 TRPV1,2,3
duction in Drosophila, are classified into six subfamilies in
TRPM8 TRPV4
mammals – TRPC, TRPM, TRPA1, TRPP, TRPML and TRPV.
They assemble as six transmembrane domains and generate Nociceptors
tetramers of cation-selective channels with varying degrees of Cold
calcium and sodium permeability. TRP channels respond to a receptors
Receptor type
range of stimuli including temperature (Figure 3), mechanical Cold receptors Warm receptors
Nociceptors
stress, changing osmolarity and intracellular and extracellular
messengers, and are weakly sensitive to voltage. Upon open-
ing, they depolarize cells from the resting membrane potential,
raising intracellular sodium and calcium concentration, and –10 0 10 20 30 40 50 60
exciting the cell.
Temperature (ºC)
The recent advancement of TRPV1 and TRPV3 channel blockers
to clinical trials, and TRPA1 blockers to preclinical develop Thermal activation profile of temperature-sensitive TRP channels.
Receptor type activated by particular temperatures is highlighted in
ment for the treatment of pain, has highlighted the emerging
the lower part of the figure, aligned to a temperature scale bar.
importance of the TRP channel as a key target in pain. Whilst
all six families have wide roles in many physiological and patho-
physiological processes, the TRPV1, TRPM8 and TRPA1 chan-
attenuation of painful symptoms in cancer models, underlying
nels are the most studied and are thought to play an integral
the importance of TRPV as a novel pain target. Other TRPV1
role in pain via sensory nerve activation in the DRG.
blockers including capsazepine (Cat. No. 0464) and A 784168
The TRPV1 channel, formerly known as the vanilloid recep- (Cat. No. 4319), have been shown to block acute pain induced by
tor, is the most extensively studied of the TRP channels and is capsaicin and BCTC (Cat. No. 3875) (Box 1). The multimodal
activated by noxious heat, acidic pH and pungent extracts from nature of TRPV1 channels offers the opportunity to design spe-
chilies, garlic, black pepper and cinnamon. TRPV1 expression cific drugs that are modality-specific, therefore activation by
is increased in several chronic human pain states and knockout distinct stimuli could be blocked whilst sparing TRPV1 chan-
animal models that lack a functional TRPV1 gene do not show nels’ sensitivity to other stimuli. The design of channel blockers
typical responses to painful stimuli. The recent generation of that inhibit TRPV1 activation by, for example, capsaicin but
selective TRPV blockers, such as the TRPV1-selective blocker not acid (e.g. SB 366791 (Cat. No. 1615)), and others that do not
JNJ 17203212 (Cat. No. 3361) and the TRPV4-selective differentiate between capsaicin and acid (e.g. AMG 9810 (Cat.
blocker RN 1734 (Cat. No. 3746), have demonstrated significant No. 2316)), has demonstrated the feasibility of this approach.
O
HN N O O O
OH
N HN
N N NH2
N S
O N
NO2
CF3 NH
N
HO H
H N O
N N N
HO O
S O SO2CF3
Cl
Capsazepine (0464) AMG 9810 (2316) A 784168 (4319)
Vanilloid receptor antagonist Competitive antagonist of TRPV1 Potent and selective TRPV1 antagonist
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Tocris Product Guide Series
Although most attention focuses on blocking the TRPV1 neuropathic pain and cold hypersensitivity without altering
channel in the treatment of pain, TRPV1 activators such as normal cold sensation, suggesting that these are useful tools
(E)-capsaicin (Cat. No. 0462) have also paradoxically been dem- to understand nociception. A structurally related compound,
onstrated to induce analgesia. Topical application of TRPV1 TCS 5861528 (Cat. No. 3938), also prevents the development of
activators (e.g. capsaicin creams) have been used clinically mechanical hyperalgesia in animal models of diabetes-induced
for many years to alleviate chronic painful conditions such as pain. The TRPM8 channel blocker AMTB (Cat. No. 3989)
diabetic neuropathy. It is thought that desensitization of the attenuates the bladder micturition reflex and nociceptive reflex
capsaicin receptor may mediate this analgesic effect. However, responses in the rat, and hence could represent a new therapeutic
it has also been hypothesized that capsaicin may reversibly avenue for overactive bladder and painful bladder syndrome.
deplete substance P, one of the body's main neurotransmitters
for pain and heat, from nerve endings, leading to a reduction in It is apparent that a growing number of TRP channels are of
the sensation of pain. Indeed resiniferatoxin (Cat. No. 1137), a potential therapeutic interest and may in the future result in
capsaicin analog, is being evaluated for long term analgesia in novel clinical drugs for the treatment of pain.
cancer patients who have chronic intractable pain.
Sodium Channels
The TRPA1 channel is the only member of the ankyrin family Excitability in neurons is dictated by the activity of voltage-
found in mammals and is predominantly expressed in C-afferent gated sodium channels (NaV). NaV channels are activated by
sensory nerve fibers. TRPA1 colocalizes with TRPV1 and is depolarization and allow the rapid influx of sodium ions,
also thought to play an important role in nociception. TRPA1 generating action potentials. Pain signals, in the form of action
is activated by sub-zero temperatures, mustard oil, cinnamon potentials are able to propagate along the axon of the noci
oil, raw garlic, onions and formalin, all of which elicit a pain- ceptor by activation of NaV channels. There are nine known
ful burning or prickling sensation. A super-cooling agent that subtypes of NaV channels, these are designated NaV1.1-1.9. They
activates both cold receptors, TRPM8 and TRPA1, is icilin (Cat. are composed of an alpha subunit that forms four homolo-
No. 1531). Icilin produces extreme sensations of cold in both gous domains (each with six-transmembrane helices) and two
human and animals and is almost 200 times more potent than auxiliary beta subunits that are involved in regulation.
menthol.
NaV channels are largely blocked by nanomolar concentrations
Variation in TRPA1 gene expression can alter pain perception of tetrodotoxin (TTx) (Cat. No. 1078) (Figure 4), yet NaV1.5,
in humans, whilst the TRPM8 channel’s role in cold hyper- NaV1.8 and NaV1.9 are relatively resistant to TTx (also known
sensitivity, analgesia (in neuropathic pain) and inflammation, as TTx-R). Gain-of-function mutations in NaV channels have
suggest that it could represent a key therapeutic target. TRPA1 been shown to result in the hyperexcitability of nociceptors.
channel blockers such as HC 030031 (Cat. No. 2896) reduce Most sodium channels, excluding NaV1.4 and NaV1.5, have
OH
HO Me
HN O H
H O N
N OH
N+Et3
HN
HO OH O
Me
OH
Tetrodotoxin (1078) QX 314 bromide (1014)
Sodium channel blocker Sodium channel blocker
O
Cl
O
O N
Tyr-Cys-Gln-Lys-Trp-Met-Trp-Thr-Cys-Asp-
Ser-Glu-Arg-Lys-Cys-Cys-Glu-Gly-Met-Val- N N
H
Cys-Arg-Leu-Trp-Cys-Lys-Lys-Lys-Leu-Trp N
6 |
PAIN RESEARCH
Figure 4 | Tetraodontidae – a source of tetrodotoxin have been able to produce pain-specific local anesthesia in
TRPV1-expressing nociceptors without affecting other sensory
neurons. This represents an insightful strategy of how exploit-
ing ion channels as drug delivery ports can create specificity.
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Potassium Channels
Cys-Lys-Ser-Hyp-Gly-Ser-Ser-Cys-Ser-Hyp-
The principal function of potassium channels is to stabilize
Thr-Ser-Tyr-Asn-Cys-Cys-Arg-Ser-Cys-Asn- membrane potential by conducting hyperpolarizing outward
Hyp-Tyr-Thr-Lys-Arg-Cys-Tyr-NH2 potassium ion (K+) currents, thereby decreasing cellular excita
bility. The ability to re-establish electrical neutrality through
ω-Conotoxin GVIA (1085)
Ca2+ channel blocker (N-type) modulation of potassium channels makes them a potential
target to decrease nociceptor excitability, although there have
been limited studies in this field. There are four families of
NH2
potassium channels: voltage-gated (KV), inward rectifier (Kir),
CO2H calcium-activated (KCa) and two-pore (K2P). The diversity in the
structure and function of these channels allows them to ful-
Pregabalin (3775) fil a variety of roles in the membrane and for some, a role in
Selectively binds the α2δ subunit antinociception. Peripheral nerve injury markedly reduces the
of CaV channel
densities of KV channels, implicating them in the development
of pain. The DRG neurons express three distinct classes of K+
Figure 5 | Conus textile – a source of conotoxins currents, based on their sensitivities to their respective antago-
nists, tetraethylammonium (TEA) (Cat. No. 3068) that block
the slow-inactivating sustained K+ current carried by KV7.2/7.3
channels, 4-aminopyridine (4-AP) (Cat. No. 0940) that block
the fast-inactivating transient A-current carried by the KV1.4
channel and α-dendorotoxin (α-DTX) that blocks the slow-
inactivating transient D-current carried by KV1.1/1.2. channels.
KV channel openers, such as ML 213 (Cat. No. 4519), that dis-
play selectivity for a specific channel subtype (KV7.2 and KV7.4),
may be useful for identifying the role of K+ channel subtypes
in pain sensation (Box 4). The ATP-sensitive (K ATP) channel, a
member of the Kir family, is inhibited by glibenclamide (Cat.
No. 0911) and has also been implicated in the pathophysiology
of pain. Therefore Kir-selective tools such as tertiapin-Q (Cat.
No. 1316) may also be useful in the study of pain. Despite lim-
The marine cone snail (Conus textile) is a source of the neurotoxic ited understanding of the roles that potassium channels play
peptide known as conotoxin. Cone snails use a hypodermic-like tooth in pain modulation, they may become promising pain targets in
and a venom gland to attack and paralyze their prey before engulfing it. the future.
8 |
PAIN RESEARCH
OH
HN O
Cl N O
Me H
HO Me H
Me
N H H
Me
OH HO H
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Tocris Product Guide Series
GABA A Receptors
Box 6: P2X Receptor Products
Inhibitory control of nociceptive signals is attributed to A full list of targets and related products are listed on pages 23-33
γ-aminobutyric acid (GABA) (Cat. No. 0344). There are two
classes of GABA receptors: GABAA and GABAB. A third type of N
N
N
GABA receptor, insensitive to typical modulators of GABAA was N N Cl
designated as a GABAC receptor, however this has since been
described to be a variant within the GABA A receptor family. Cl
GABAA receptors are ligand-gated ion channels, or ionotropic
receptors, whereas GABA B receptors are G-protein-coupled A 438079 (2972)
receptors, or metabotropic receptors, and are discussed in the Competitve P2X7 antagonist
as THIP (Cat. No. 0807), and the positive allosteric modulator MeO N NH2
ganaxolone (Cat. No. 2531), have all evoked significant analgesia OMe
making GABAA receptors an interesting target for pain.
RO-3 (3052)
Selective P2X3 and P2X2/3 antagonist
P2X Receptors
Purinergic receptors have been implicated in pain. There are
NC OMe
two types of purinergic receptor: the adenosine receptor (also N O
classed as a P1 receptor) and P2 (ATP) receptor, which is further
HN N N OMe
divided into P2X and P2Y receptors (adenosine and P2Y recep- H H
10 |
PAIN RESEARCH
Figure 6 | Epipedobates tricolor – a source of epibatidine as an analgesic. It has demonstrated potent antinociceptive
effects in neuropathic pain models yet, despite its potency,
there are intolerable toxic side effects due to non-selectivity
that make it very unlikely to ever be of clinical use. The key
to the development of safe and effective nicotinic agonists as
analgesics is therefore to first understand which nAChR sub-
types are involved in modulating nociceptive transmission and
subsequently develop drugs with increased specificity for these
nAChR subtypes. The effect of nicotine on inhibitory currents
could be mimicked by the α4β2 nAChR agonist RJR 2403 (Cat.
No. 1053), and also by choline, an α7 nAChR agonist. However,
whilst the effect of nicotine could be completely blocked by the
nAChR antagonist mecamylamine (Cat. No. 2843) and the α4β2
nAChR antagonist dihydro-β-erythroidine (Cat. No. 2349), they
display differing effects on nAChR activity. α4β2 agonists such
as sazetidine A (Cat. No. 2736), the partial agonist varenicline
(Cat. No. 3754), and the α7 agonist LY 2087101 (Cat. No. 4141)
will help to elucidate of the role different receptor subtypes play
Epibatidine is an alkaloid found on the skin of the endangered in pain sensation (Box 7).
Ecuadorian frog (Epipedobates tricolor). The frog uses the
compound to protect itself from predators, as it can kill animals Modulators of the α7 receptor such as the antagonists, methylly
many times larger than itself. caconitine (Cat. No. 1029) and α-bungarotoxin (Cat. No. 2133),
and the agonists, PNU 120596 (Cat. No. 2498), AR-R 17779
(Cat. No. 3964) and A 844606 (Cat. No. 4477), have been useful
(±)-epibatidine (Cat. No. 0684) is an alkaloid poison naturally in studies investigating acute pain, suggesting that subtype spe-
found on the skin of the Ecuadorian frog (Epipedobates tricolor) cificity may hold the key to understanding the role of nicotinic
(Figure 6), and is 100-200 times more potent than morphine receptors in pain.
H N Cl
N O N
N HN Cl
HN
N O HO N
H
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G-Protein-Coupled Receptors
and exciting area in pain research, building upon knowledge
Products by Category Page gained from studies into the more traditional targets such as
the opioid, glutamate and GABA receptors, which has greatly
Adenosine Receptors........................................................... . . 23
expanded the field of GPCRs in nociception. Bradykinin and
Bradykinin Receptors............................................................ . 23
neurokinin receptors have also been shown to play a role in
Cannabinoid Receptors........................................................ . . 24
nociception, as well as mediating neurotransmission in pain
Cannabinoid Modulation....................................................... . 25
pathways, making them useful targets for current research.
Cannabinoid Transport......................................................... . . 25
GABAB Receptors................................................................... . . 26 Cannabinoid Receptors
GABA Transport....................................................................... . 26
The analgesic properties of cannabinoids have been recognized
Glutamate (Metabotropic) Receptors............................... . . 26
for centuries. However it is only recently, since the characteriza-
Opioid Receptors............................................................... 28,29
tion of the metabotropic cannabinoid receptors – CB1 and CB2
Purinergic P2Y Receptors. .................................................. . 31
– that their mechanism of action has started to be understood.
Tachykinin Receptors........................................................... . . 32
CB1 and CB2 receptors inhibit adenylyl cyclase by coupling
Gα i/o. The CB1 receptor also modulates calcium and potas-
sium conductances and activates mitogen-activated protein
A variety of G-Protein-Coupled Receptors (GPCRs) have kinase (MAPK), leading to inhibition of cellular activity and
important roles in nociception. They modulate the function suppression of neuronal excitability (Figure 7). In contrast, the
of a wide variety of ion channels and signaling molecules in CB2 receptor appears not to gate ion channels but does activate
sensory neurons. The basic cycle of G-protein activation and MAPK. Additionally, an orphan G-protein-coupled receptor,
inactivation involves agonist binding and receptor activation. GPR55, has been recently described to bind cannabinoids.
This in turn induces a conformational change such that the
α-subunit binds GTP in exchange for GDP, thereby causing it Two major classes of lipids activate cannabinoid receptors –
to dissociate into a GTP-bound α-subunit and a βγ dimer. There N-acyl ethanolamines (NAE) and monoacylglycerols (MAGL).
are many classes of Gα subunits such as, Gαs (G stimulatory), Anandamide (AEA) (Cat. No. 1339), an NAE, was the first
Gαi (G inhibitory), Gαo (G other), Gαq/11, and Gα12/13 which can endocannabinoid to be isolated from the brain. This was closely
signal to downstream targets to stimulate or inhibit cellular followed by the monoacylglycerol, 2-Arachidonylglycerol
activity. Hydrolysis of GTP inactivates the G-protein, return- (2-AG) (Cat. No. 1298) (Box 8). AEA is synthesized from
ing it to its heteromeric state. Cannabinoids have become a new N-arachidonoyl phosphatidylethanolamine (NAPE) via multiple
O
Cl
Cl
Cl N
H AM 251 (1117)
Potent CB1 antagonist
NH
O ACEA (1319)
Potent, highly selective CB1 agonist Me Me
O
O H
O Me
OH
N O
H
N O N H
Me Me
12 |
PAIN RESEARCH
Synaptic cleft
mGluR1/5
Nociceptor Glutamate Second Order Neuron
Na+ (postsynaptic terminal)
(presynaptic terminal) AMPA AA
Exocytosis Et
Ca /Na
2+ +
2-AG
ECT
AEA
K+
GABA
KV CaV
CB1
Ca2+
Exocytosis
AC MAPK
cAMP
GABA
PKA vesicle
Inhibitory Interneuron
Gene expression
Pain signals from the nociceptor arrive at the presynaptic terminal where upon opening of voltage-gated calcium channels (CaV), elevates
intracellular calcium and stimulates exocytosis so that glutamatergic signaling can occur. Glutamate acts on two different types of receptors
on the postsynaptic neuron: ionotropic glutamate receptors (NMDA, AMPA and KA) and metabotropic glutamate receptors (mGluR).
Activation of these channels and receptors initiate a receptor potential in the postsynaptic neuron. Endocannabinoids (such as, anandamide
(AEA) and 2-arachidonoylglycerol (2-AG)) are synthesized in response to increased activity in the postsynaptic neuron. They exert their
effects by binding to specific G-protein-coupled receptors located on the presynaptic neuron. The CB1 receptor inhibits the AC-cAMP‑PKA
pathway and activates the mitogen-activated protein kinase (MAPK) cascade, both of which regulate gene expression. The CB1 receptor
modulates ion conductances, inhibiting voltage-sensitive Ca2+ channels, which blocks exocytosis and activates voltage-sensitive K+ channels
(K V), leading to suppression of the signals coming from the nociceptor – this is called retrograde signaling. Endogenous cannabinoids in
the synaptic cleft are taken up by endogenous cannabinoid transporters (ECT) into the cell whereby they are broken down by enzymes that
include, fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL). Inactivation of AEA (by FAAH) and 2-AG (by MAGL) occurs
via hydrolysis to arachidonic acid (AA) and ethanolamine (Et) or glycerol (Gl), respectively. GABAergic neurons also act on the postsynaptic
cell to decrease excitability. GABA A, a ligand-gated ion channel that conducts chloride ions and GABAB, a G-protein-coupled receptor that is
linked to K+ channels and that inhibits the AC-cAMP-PKA pathway, leads to inhibition of the postsynaptic neuron and a dampening down of
pain signals communicated to the brain.
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pathways which include enzymes such as phospholipase A 2, The CB1 receptor is found mainly in the CNS and has been iden-
phospholipase C and NAPE-PLD. 2-AG is synthesized from tified at the peripheral and central terminals of primary affer-
arachidonic acid-containing diacylglycerol (DAG) by the action ents. In neuropathic pain states, the levels of CB1 protein and
of diacylglycerol lipase (DAGL). Several other putative endo- mRNA are increased in DRG neurons projecting into the injured
cannabinoids have since been found including noladin ether nerve. In contrast, CB1 knockout studies have demonstrated
(Cat. No. 1411), virodhamine (Cat. No. 1569) and NADA (Cat. that these mice are hypersensitive to mechanical stimulation.
No. 1568). The endocannabinoids are thought to be synthe- Agonists for the CB1 receptor such as ACEA (Cat. No. 1319) and
sized on demand by activity-dependent or receptor-stimulated WIN 55,212-2 (Cat. No. 1038) have demonstrated success in
cleavage of membrane lipid precursors, and are released from alleviating mechanical allodynia, acute pain and hyperalgesia
postsynaptic cells immediately following their production. The in vivo, through both peripheral and central mechanisms. In
endocannabinoids can then regulate neurotransmitter release on the spinal cord, the non-selective cannabinoid receptor agonist
the presynaptic neuron through CB receptors, which influences CP 55,940 (Cat. No. 0949) has shown antinociceptive effects,
calcium influx driving exocytosis. Therefore they can control and application of the selective CB1 agonist ACEA (Cat. No.
GABAergic or glutamatergic transmission by retrograde signaling 1319) inhibited spinal nociceptive transmission.
(Figure 7).
The main hurdle in activating CB1 receptors in the CNS for
the alleviation of pain is the association with psychotropic side
effects, temporary memory impairment and dependence that
Box 9: Cannabinoid Modulation Products arise as an effect on forebrain circuits. Therefore, the clinical
A full list of targets and related products are listed on pages 23-33
exploitation of cannabinoids must first overcome their adverse
OH
side effects, without attenuating their analgesic properties.
O
The CB2 receptor was originally thought to be localized solely
N
H to the immune system, but has now also been identified in
the brain, DRG, spinal cord and sensory neurons. The CB2
AM 404 (1116)
agonists HU 308 (Cat. No. 3088), JWH 133 (Cat. No. 1343)
Anandamide transport inhibitor and GW 405833 (Cat. No. 2374) have provided direct support
for the hypothesis that CB2 produces antinociceptive effects
O
in persistent pain states. Importantly, CB2 selective agonists
H
lack the centrally-mediated side effects on motility, body tem-
N
N N N
CF3
perature or cognition typically observed with CB1 agonists.
O
Consequently, it has been proposed that CB2 agonists would be
PF 3845 (4175) unlikely to be psychoactive or addictive and therefore may be
Selective FAAH inhibitor
ideal candidates to provide analgesia independent of unwanted
side effects.
O O
Some biological effects reported for particular cannabinoids
N
NO2
have been found to be independent of CB1 or CB2 recep-
tor activity and have since been attributed to GPR55 such as
OH (-)-cannabidiol (Cat. No. 1570). GPR55 is also activated by the
O O cannabinoid ligand CP 55,940 (Cat. No. 0949) and a canna
bidiol analog O-1602 (Cat. No. 2797). The GPR55 receptor
O O
antagonist O-1918 (Cat. No. 2288) blocks nociceptive firing in
JZL 184 (3836) afferent C-fibers, suggesting that manipulation of GPR55 is a
Monoacylglycerol lipase (MAGL) inhibitor
valid therapeutic target for pain. A useful tool developed to
fluorescently label GPR55 receptors in vitro is Tocrifluor T1117
O (Cat. No. 2540), a 5-TAMRA fluorescently-labeled form of AM
251 (Cat. No. 1117), that fluoresces at 543 nm excitation and can
N N
H be used to help identify the neuronal expression of the GPR55
N N
receptor (Figure 8).
S N
Cannabinoid Modulation
JNJ 1661010 (3262)
Selective, reversible FAAH inhibitor In addition to treating pain states by targeting cannabinoid
receptors, a new approach is to target endogenous cannabinoids
14 |
PAIN RESEARCH
and their tonic influence over nociception in the CNS. Reuptake Figure 8 | Fluorescent ligand binding in the perivascular nerve
of endocannabinoids from the synaptic space, whereby they
are broken down within the cell, is reported to be facilitated
by a transporter that has yet to be identified (endogenous
cannabinoid transporter – ECT). However, pharmacological
inhibitors of this unidentified transporter have been devel-
oped, including AM 404 (Cat. No. 1116), OMDM-2 (Cat. No.
1797), UCM 707 (Cat. No. 1966) and VDM 11 (Cat. No. 1392).
These have shown antinociceptive effects in neuropathic and
inf lammatory rodent pain models. Systemic administra-
tion of these putative transport inhibitors increases levels
of naturally occurring endocannabinoids AEA and 2-AG
in the brain, providing a novel mechanism for alleviating
symptoms of pain.
Within the cell, endocannabinoids are degraded by enzymes
such as fatty acid amide hydrolase (FAAH) and monoacylg-
lycerol lipase (MAGL). FAAH hydrolyzes AEA to arachidonic
acid (AA), whereas 2-AG is metabolized to AA by MAGL
(Figure 7). Inhibitors for FAAH such as MAFP (Cat. No. 1421),
PF 750 (Cat. No. 3307), arachidonyl serotonin (Cat. No. 2836)
and JNJ 1661010 (Cat. No. 3262) (Box 9), have been shown to
possess antinociceptive properties and are effective in reduc-
Fluorescent ligand, Tocrifluor T1117 (Cat. No. 2540), shows
ing allodynia and hyperalgesia. Inhibitors for MAGL, such as GPR55 receptor (red/orange) expression in perivascular nerve
JZL 184 (Cat. No. 3836) and N-arachidonyl maleimide (Cat. cells and blood vessels, additional staining illustrates expression of
No. 3329), elevate levels of endocannabinoids in the body and α1‑adrenoceptors (green). Image kindly provided by Dr Craig Daly,
therefore may have a beneficial effect in boosting natural pain University of Glasgow (see Daly et al (2010), for further reference).
relief mechanisms (Box 9). Inhibition of DAGL, an enzyme that
catalyzes the conversion of 1,2-diacylglycerol (DAG) into 2-AG
using the inhibitor, RHC 80267 (Cat. No. 1842) may also be The term ‘opioid’ applies to any substance which produces
useful for examining the role of endogenous cannabinoids. morphine-like effects and can be blocked by antagonists such
as naloxone (Cat. No. 0599). Opioids have an unmatched
The proposed tonic influence of endocannabinoids in the CNS
effectiveness in easing pain yet they have serious side effects
could be targeted through inactivating FAAH, the enzyme
including nausea, constipation, respiratory depression, sleepi-
responsible for cannabinoid breakdown. Indeed this has been
ness, depression, hallucinations and dependence due to their
demonstrated in FAAH knockout mice that have reduced
highly addictive properties.
hyperalgesia. Whilst endocannabinoids appear to exert a mod-
erate influence on pain pathways, elevation of their endogenous Opioids inhibit adenylyl cyclase by binding to inhibitory
levels by inhibition of FAAH or manipulation of endocanna G-proteins (Gi/o), thereby reducing intracellular cAMP levels.
binoid transporters may present a therapeutic strategy for They also exert an analgesic effect through direct coupling
modulating endocannabinoid tone. This could have significant to ion channels, specifically by opening potassium channels
effects on analgesia in pain models, without the side effects and inhibiting calcium channel opening. The overall effect is
associated with CB1 agonists, making endocannabinoids a a reduced neuronal excitability and a decrease in the release of
potential target for modulating long term pain. pain neurotransmitters, resulting in analgesia.
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Tocris Product Guide Series
HN
Et2N
NH2 H
O
OMe
N Me
N N N
O
Me N
O
OH Et
Phe-Gly-Gly-Phe-Thr-Gly-Ala-Arg-Lys-Ser-
Tyr-D-Ala-Gly-NMe-Phe-Gly-ol
Ala-Arg-Lys-Leu-Ala-Asn-Gln
and antidepressant effects in rodents, whereas endomorphin-1 effects in a rat model of neuropathic pain. The NOP novel
(Cat. No. 1055) and endomorphin-2 (Cat. No. 1056) are potent opioid receptor-like 1 (ORL1) receptor antagonists JTC 801
analgesic peptides that show the highest affinity and selectiv- (Cat. No. 2481) and (±)-J 113397 (Cat. No. 2598), demonstrate
ity for the µ opioid receptor. Additionally, the µ opioid agonist potent antinociceptive effects in animal models of acute pain
DAMGO (Cat. No. 1171) produces long lasting antinociceptive (Box 10).
16 |
PAIN RESEARCH
from firing. Hence they are considered inhibitory receptors. Substance P and Tachykinin Receptors
The GABAB receptor agonist (RS)-Baclofen (Cat. No. 0417) has The neuropeptide substance P (Cat. No. 1156) and its closely
been shown to have analgesic properties whereas the GABAB related neuropeptide, neurokinin A (Cat. No. 1152), are thought
antagonist CGP 55845 (Cat. No. 1248) blocks the antinocicep- to play an important physiological role in the modulation
tive actions of cholinergic agents (Box 11). Inhibition of GABA of nociception. They are involved in relaying the intensity of
uptake by the GABA transporter GAT-1 is also a target with noxious or painful stimuli, although can also be released from
NNC 711 (Cat. No. 1779), a GAT-1 inhibitor, demonstrating an the peripheral terminals of sensory nerve fibers in the skin,
ability to induce analgesia in a rat model of sciatic nerve injury. muscle and joints to initiate pain. Substance P is a ligand for
The evidence suggests that stimulation of GABA receptors at the tachykinin seven-transmembrane GPCR family and its
certain sites to offset the sedative side effects could be beneficial endogenous receptors are called neurokinin 1 (NK1) and NK2.
in the management of pain. Substance P coexists with glutamate in primary afferents that
respond to painful stimuli. Administration of NK1 antagonists
Adenosine and P2Y Receptors such as L-732,138 (Cat. No. 0868) and RP 67580 (Cat. No. 1635)
The adenosine receptor (also categorized as a purinergic P1 (Box 12) have been shown to attenuate hyperalgesia in rats,
receptor) is a G-protein-coupled receptor that has recently although this has not been proven clinically.
been associated with research into pain. Several adenosine
receptor agonists have progressed through clinical trials, dem- Bradykinin Receptors
onstrating that adenosine is a potential target for new drug Bradykinin, although considered to be a peripherally acting
development in pain. There are four types of adenosine recep- inflammatory mediator, has also been proposed to play a role
tors, A1, A 2A, A 2B and A 3, all of which couple to G-proteins. in pain transmission. Bradykinin is released from kininogen
In functional studies, peripheral administration of A1 and precursors at the site of tissue injury and inflammation and acts
A2A receptor agonists such as, N6 -Cyclopentyladenosine (Cat. on G-protein-coupled bradykinin receptor subtypes in primary
No. 1702) and CGS 21680 (Cat.No. 1063) respectively, lead to sensory neurons. The bradykinin 1 (B1) receptor is activated
antinociception against hyperalgesia. The role of A 2B and A3 by injury whilst the B2 receptor is constitutively active. B2 ago-
receptors seem to be largely associated with inflammatory nists including bradykinin (Cat. No. 3004), have been shown to
pain. It has also recently become apparent that the metabo- induce thermal hyperalgesia, whilst B2 antagonists such as HOE
tropic P2Y receptor can be found on sensory afferents and 140 (Cat. No. 3014) reduce pain sensation in the formalin test
may have a role in modulating pain transmission. P2Y recep- of pain hypersensitivity. The B1 receptor, usually absent from
tors are G-protein-coupled receptors that are in the same non-inflamed tissue and with a low affinity for bradykinin, is
family as the ionotropic P2X receptor. In vivo studies have thought to play a lesser role in pain transduction. However,
revealed that administration of the P2Y2/4 agonist UTPγS as demonstrated with B2 agonists, B1 receptor agonists such
(Cat.No. 3279) inhibits pain transmission and P2Y1 agonist as Lys-[Des-Arg 9]Bradykinin (Cat. No. 3225) also produce a
MRS 2500 (Cat. No. 2159) reduces hyperalgesia, suggesting nociceptive response and B1 receptor antagonists such as R 715
that the P2Y receptor could also potentially be an important (Cat. No. 3407) (Box 12) may be useful for investigating further
pain target. the role of the B1 receptor in nociception.
N
NH OMe
D-Arg-Arg-Pro-Hyp-Gly-Thi-Ser-D-Tic-Oic-Arg H
O
HOE 140 (3014) RP 67580 (1635)
Potent and selective B2 antagonist Potent and selective NK1 antagonist
H2N O
Phe-Phe-Pro-(Me)Leu-Met-NH2 Ac-Lys-Arg-Pro-Pro-Gly-Phe-Ser-DβNal-Ile
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Tocris Product Guide Series
Intracellular Signaling
shown to inhibit hyperalgesia (Box 13). Furthermore, H 89
Products by Category Page (Cat. No. 2910), also a PKA inhibitor, was able to block the
nociceptive response to an inflammatory agent in sensory
Guanylyl Cyclase.................................................................... . 27
pain fibers. Activation of PKA signaling pathways implicated
MAPK. . ..................................................................................... . . 27
in pain can also be achieved using drugs such as 8-Bromo-
MEK.. . . . ...................................................................................... . 27
cAMP (Cat. No. 1140) or cAMPS-Sp (Cat. No. 1333), which
mTOR.. . ...................................................................................... . 27
are membrane-permeable cAMP analogs that stimulate PKA
Nitric Oxide Synthase. ......................................................... . . 28
phosphorylation.
PI 3-Kinase............................................................................. . . 29
Protein Kinase A. ................................................................... . 30 Protein Kinase C
Protein Kinase C .................................................................. . . 30
PKC consists of 15 isozymes that can be divided into three
Protein Kinase G. ................................................................... . 30
groups, conventional, novel and atypical. The conventional
Protein Synthesis.................................................................. . . 31
isozymes are activated by a process requiring phospholipase
C (PLC), diacylglycerol (DAG) and calcium. In contrast, the
novel forms do not require calcium and atypical forms do not
The transition between ‘acute’ and ‘chronic’ pain is largely arbi- require DAG or calcium. Activation of PKC has been shown
trary, with temporal cut-offs after which point acute pain is to enhance the TTx-R sodium currents and TRPV1 channel
renamed chronic pain. Understanding the cellular mechanisms currents. In particular, PKCε can translocate to the plasma
underlying chronic pain states will be crucial for the develop- membrane of nociceptors in response to inflammatory media-
ment of new long-term therapeutic strategies. Neuronal plastic- tors such as bradykinin and substance P. PKCε activity has
ity at multiple sites in the pain pathway is now widely accepted also been linked to maintaining the ‘primed’ state whereby
as critical in the maintenance of chronic pain. The cellular nociceptors have increased sensitivity to noxious stimuli,
mechanisms that underlie this plasticity are not well known, characteristic of chronic pain. PKC inhibitors, GF 109203X
although are likely to involve changes in gene expression and (Cat. No. 0741) and chelerythrine (Cat. No. 1330) have dem-
regulation of protein synthesis. In the nociceptor, changes in onstrated significant reductions in rat models of mechanical
synaptic strength and efficacy can trigger increases in the trans-
duction of pain signals. Plasticity can also occur at peripheral
terminals of nociceptors, where changes in receptor and chan- Figure 9 | Intracellular signaling in chronic pain states
nel expression, distribution, and activation thresholds can
generate hypersensitivity. It is through multiple intracellular Noxious stimuli
pathways that these changes occur; for example, protein kinase
A (PKA), PKC and PKG cascades can generate posttranslational
modifications on target proteins that affect their activation and GPCRs NO
trafficking. The regulation of gene transcription and translation
that controls expression of proteins has been suggested to occur
primarily through the ERK and PI 3-K/mTOR signaling cas- PI 3-K/mTOR MAPK PKA PKC PKG
cades (Figure 9) which have been highlighted as potential areas
that will generate future therapeutic pain targets.
Transcription/translation Receptor/channel phosphorylation
Protein Kinase A
PKA exerts a profound modulatory role on sensory nociceptor
physiology. Activation of PKA by cAMP is sufficient to pro-
Expression Function, trafficking, recycling, distribution
duce hyperalgesia in nociceptors. It may mediate some of these
effects through direct phosphorylation of TTx-R sodium chan-
nels such as NaV1.8 or TRPV1 channels, both of which have
been shown to induce pain in a neuropathic pain model. PKA Nociceptor hyperalgesia Persistent pain
also interacts with MEK, a component of the MAPK pathway,
leading to activation of further downstream targets. This can MAPK and PI 3-K/mTOR signaling pathways are thought to be the
regulate gene expression, affecting neuronal plasticity. Opioid primary pathways involved in chronic pain and the regulation of
gene transcription and translation in nociceptors. PKC, PKA and
receptors, meanwhile, produce analgesia by inhibiting adeny-
PKG pathways control posttranslational regulation of receptor and
lyl cyclase, thereby blocking PKA activation, hence making channel proteins, and also have influences on gene expression.
it a key therapeutic pain target. Injection of a PKA inhibitor, Long term modulation of nociceptor plasticity in this way can lead to
cAMPS-Rp (Cat. No. 1337), before a painful stimulus was hyperalgesia and persistent pain states.
18 |
PAIN RESEARCH
hyperalgesia, therefore it will be interesting to see how inhib- has been linked to pain plasticity upstream of ERK. The ERK
itors of PKCε and other isoforms advance in the current pathway involves a sequential cascade including Ras, Raf, and
research field. MEK. MEK inhibitors such as PD 98059 (Cat. No. 1213) and
U0126 (Cat. No. 1144) demonstrate an ability to block acute
Protein Kinase G and Nitric Oxide pain behavior after formalin injection, suggesting that ERK
In contrast, less is known about the role of cGMP/PKG signal- must play a role in short term nociception given the short-time
ing and nitric oxide (NO)-mediated modulation of pain. NO involved. However, ERK produces not only short-term func-
stimulates guanylyl cyclase which activates cGMP and PKG. tional changes by non-transcriptional mechanisms but has
Studies have shown that intracutaneous injections of NO pre- also been suggested to generate long-term adaptive changes by
cursors evoke pain, implicating it as a pronociceptive media- modification of gene transcription and translation. Direct ERK
tor. However, NO has been shown to mediate the analgesic inhibitors have been useful in blocking this pathway such as
effects of opioids and other analgesic substances, suggesting its the selective ERK inhibitor, FR 180204 (Cat. No. 3706). p38 is
role in nociception is complex and diverse. Classical inhibitors typically activated by MKK4 protein kinases and can be inhib-
such as L-NAME (Cat. No. 0665) will help to define the role ited by SB 203580 (Cat. No. 1202), demonstrating an ability to
of NO in pain. Newer products such as the soluble guanylyl reduce mechanical allodynia and reverse the pain associated
cyclase inhibitor, NS 2028 (Cat. No. 4517), may offer increased with arthritis. p38 MAPK activation has also been implicated
selectivity in targeting the cGMP/PKG pathway. in increasing TRPV1 channel expression at the plasma mem-
brane and contributes to pain hypersensitivity and the early
MAPK Signaling development of mechanical allodynia. Less is known about
MAPK is a critical kinase in cell signaling pathways. It trans- the role of JNK in pain, yet SP 600125 (Cat. No. 1496) a JNK
duces extracellular stimuli into intracellular translational and inhibitor attenuates pain after repeated injection over several
transcriptional responses. Stimulation of nociceptive DRG days, demonstrating an accumulated analgesic effect in a rat
neurons increases phosphorylation of various types of MAPK cancer-induced bone pain model (Box 13).
which initiate changes in short term acute pain or long term
transcription. The three major MAPK family members – ERK, PI 3-K/Akt/mTOR Pathway
p38 and c-Jun N-terminal kinase (JNK) – represent three The PI 3-K/mTOR pathway appears to play a key role in plas-
different MAPK signaling cascades. Whilst inhibition of all ticity. PI 3-kinase (PI 3-K) is a lipid kinase that generates PIP3
three MAPK pathways has been shown to attenuate persistent from membrane phosphoinositides, thereby activating the
pain after nerve injury, increased ERK and / or p38 activity serine/threonine kinases Akt and mTOR, which regulate gene
N
N NH
H N
N O N
H2N
S
N Me
N
N
N N
F H O
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Tocris Product Guide Series
expression. Increased activation of Akt and mTOR is observed role in phosphorylation of a protein, 4E-BP that controls the
in DRG and dorsal horn neurons following nerve injury, there- initiation of protein translation. Direct inhibition of protein
fore inhibition of this pathway is an important target in pain translation can be achieved by targeting the downstream bind-
research. Selective PI 3-kinase inhibitors, such as LY 294002 ing protein, eIF4E, with 4E1RCat (Cat. No. 4215), a small mol-
(Cat. No. 1130) and 740 Y-P (Cat. No. 1983), have demonstrated ecule inhibitor that prevents assembly of the regulatory protein
an ability to block downstream phosphorylation of Akt and complex. Therefore the multiple roles of mTOR in transcrip-
the initiation of hyperalgesia. Inhibition of mTOR activity in tion, translation and posttranslational modifications make it an
the spine by rapamycin (Cat. No. 1292) shows antinociceptive important target in pain research, provided specificity or direct
effects in animal models of pain. Systemic administration of targeting of peripheral nociceptors can be achieved.
Torin 1 (Cat. No. 4247), also an mTOR inhibitor, reduces the
response to mechanical and cold stimuli in mice experiencing Investigations of these complex intracellular pathways using
neuropathic pain (Box 13). KU 0063794 (Cat. No. 3725) is a selective inhibitors and activators will help deepen our under-
selective mTOR inhibitor which shows no activity at PI 3-kinase standing of the genesis of both acute and long-term chronic pain,
and maybe be useful in investigating the physiological role of whilst also helping to identify new targets for pharmacological
mTOR in nociception. mTOR has been shown to play a key intervention.
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PAIN RESEARCH
List of Acronyms
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Further Reading
Nociception
Basbaum et al (2009) Cellular and molecular mechanisms of pain. Cell. 139 267.
Berg et al (2012) Receptor and channel heteromers as pain targets. Pharmaceuticals. 5 249.
Binshtook et al (2007) Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers. Nature.
449 607.
Brooks and Tracey (2005) From nociception to pain perception: imaging the spinal and supraspinal pathways. J. Anat. 207 19.
Dubin and Patapoutian (2010) Nociceptors: the sensors of the pain pathway. J. Clin. Invest. 120 3760.
Gold and Gebhart (2010) Nociceptor sensitization in pain pathogenesis. Nat Med. 16 1248.
Raouf et al (2010) Pain as a channelopathy. J. Clin. Invest. 120 3745.
Trescot et al (2008) Opioid pharmacology. Pain Physician. 11 133.
Vanegas et al (2010) NSAIDs, opioids, cannabinoids and the control of pain by the central nervous system. Pharmaceuticals. 3 1335.
Ion Channels
Cao (2006) Voltage-gated calcium channels and pain. Pain. 126 5.
Chizh and Illes (2000) P2X receptors and nociception. Pharm. Rev. 53 553.
Cummins et al (2008) The roles of sodium channels in nociception: implications for mechanisms of pain. Pain. 131 243.
Daly et al (2010) Fluorescent ligand binding reveals heterogeneous distribution of adrenoceptors and ‘cannabinoid-like’
receptors in small arteries. Br. J. Pharmacol. 159 787.
Donnelly-Roberts et al (2007) Painful purinergic receptors. J. Pharmacol. Exp. Ther. 324 409.
Emery et al (2012) HCN2 ion channels: an emerging role as the pacemakers of pain. Trends Pharmacol. Sci. 33 456.
Gu and Lee (2010) Acid-sensing ion channels and pain. Pharmaceuticals. 3 1411.
Holzer (2008) The pharmacological challenge to tame the transient receptor potential vanilloid-1 (TRPV1) nocisensor.
Br. J. Pharmacol. 155 1145.
Moran et al (2011) Transient receptor potential channels as therapeutic targets. Nat. Rev. Drug. Discov. 10 601.
Nilius et al (2007) Transient receptor potential cation channels in disease. Physiol. Rev. 87 165.
Ocaña et al (2004) Potassium channels and pain: present realities and future opportunities. Eur. J. Pharmacol. 500 203.
Rasband et al (2001) Distinct potassium channels on pain-sensing neurons. PNAS. 98 13373.
Rashid et al (2003) Novel expression of vanilloid receptor 1 on capsaicin-insensitive fibers accounts for the analgesic effect of
capsaicin cream in neuropathic pain. J. Pharmacol. Exp. Ther. 304 940.
G-Protein-Coupled Receptors
Bleakman et al (2006) Glutamate receptors and pain. Semin. Cell Dev. Biol.17 592.
Dray (1995) Inflammatory mediators of pain. Br. J. Anaesth. 75 125.
Enna and McCarson (2006) The role of GABA in the mediation and perception of pain. Adv. Pharmacol. 54 1.
Fowler (2012) Monoacylglycerol lipase - a target for drug development? Br. J. Pharmacol. 166 1568.
Guindon and Hohmann (2009) Endocannabinoid system and pain. CNS Neurol. Disord. Drug Targets. 8 403.
Hohmann and Suplita (2006) Endocannabinoid mechanism of pain modulation. AAPS J. 8 693.
Kress and Kuner (2009) Mode of action of cannabinoids on nociceptive nerve endings. Exp. Brain Res. 196 79.
Roques et al (2012) Inhibiting the breakdown of endogenous opioids and cannabinoids to alleviate pain. Nat. Rev. Drug Discov.
11 292.
Schuelert and McDougall (2011) The abnormal cannabidiol analogue O-1602 reduces nociception in a rat model of acute
arthritis via the putative cannabinoid receptor GPR55. Neurosci. Lett. 500 72.
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PAIN RESEARCH
Staton et al (2008) The putative cannabinoid receptor GPR55 plays a role in mechanical hyperalgesia associated with
inflammatory and neuropathic pain. Pain. 99 532.
Stone and Molliver (2009) In search of analgesia: emerging roles of GPCRs in pain. Mol. Interv. 9 234.
Wang et al (2005) Bradykinin produces pain hypersensitivity by potentiating spinal cord glutamatergic synaptic transmission.
J. Neurosci. 25 7986.
Intracellular Signaling
Aley et al (1998) Nitric oxide signaling in pain and nociceptor sensitization in the rat. J. Neurosci. 18 7008.
Cheng and Ru-Rong (2008) Intracellular signaling in primary sensory neurons and persistent pain. Neurochem. Res. 33 1970.
Obata and Noguchi (2004) MAPK activation in nociceptive neurons and pain hypersensitivity. Life Sci. 74 2643.
Price and Geranton (2009) Translating nociceptor sensitivity: the role of axonal protein synthesis in nociceptor physiology.
Eur. J. Neurosci. 29 2253.
Reichling and Levine (2009) Critical role of nociceptor plasticity in chronic pain. Trends Neurosci. 32 611.
White et al (2011) Extracellular signal-regulated kinases in pain of peripheral origin. Eur. J. Pharmacol. 650 8.
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