陳文佳,孟曉文,王麗娜,詹英,嵇富海,楊建平
(蘇州大學(xué)附屬第一醫(yī)院,江蘇蘇州215000)
蛛網(wǎng)膜下腔內(nèi)注射TSA對(duì)RTX誘導(dǎo)神經(jīng)病理性疼痛的影響及機(jī)制
陳文佳,孟曉文,王麗娜,詹英,嵇富海,楊建平
(蘇州大學(xué)附屬第一醫(yī)院,江蘇蘇州215000)
目的 探討蛛網(wǎng)膜下腔內(nèi)注射古菌素A(TSA)對(duì)樹酯毒素(RTX)誘導(dǎo)的神經(jīng)病理性疼痛的影響及機(jī)制。方法 雄性健康SD大鼠24只,用隨機(jī)數(shù)字表法均分成Vehicle組、RTX組、RTX+DMSO組、RTX+TSA組。除Vehicle組外均進(jìn)行神經(jīng)病理性疼痛造模處理,并于建模前1周對(duì)RTX+DMSO組及RTX+TSA組進(jìn)行蛛網(wǎng)膜下腔置管。Vehicle組單次腹腔注射RTX的溶媒1.5 mL;RTX組單次腹腔注射RTX 210 μg/kg; RTX+DMSO組建模前60 min及建模后每天蛛網(wǎng)膜下腔內(nèi)注射5%的DMSO 10 μL,連續(xù)注射7 d;RTX+TSA組建模前60 min及建模后每天蛛網(wǎng)膜下腔內(nèi)注射TSA 0.5 μg/kg,其溶媒為5%的DMSO。建模前各組大鼠采用von Frey絲檢測(cè)后肢足底基礎(chǔ)痛閾值,建模后第1、3、5、7天測(cè)定機(jī)械痛閾值。于最后1次蛛網(wǎng)膜下腔內(nèi)注射后2 h取材,采用qRT-PCR方法測(cè)定脊髓及脊神經(jīng)背根節(jié)腦源性神經(jīng)營(yíng)養(yǎng)因子(BDNF) mRNA的表達(dá)。結(jié)果 與Vehicle組相比,RTX組、RTX+DMSO組、RTX+TSA組在建模后第3、5、7天,機(jī)械痛閾值降低(P均<0.05);與RTX組和RTX+DMSO組相比,RTX+TSA組第5、7天建模機(jī)械痛閾值升高(P均<0.05);RTX組與RTX+DMSO組各時(shí)點(diǎn)相比,P均>0.05。與Vehicle組相比,RTX組和RTX+DMSO組脊髓及脊神經(jīng)背根節(jié) BDNF mRNA表達(dá)下調(diào)(P均<0.05);與RTX組和RTX+DMSO組比較,RTX+TSA組脊髓及脊神經(jīng)背根節(jié) BDNF mRNA表達(dá)上調(diào)(P均<0.05);RTX組與RTX+DMSO組相比,P均>0.05。結(jié)論 蛛網(wǎng)膜下腔內(nèi)注射TSA可通過上調(diào)BDNF的表達(dá)緩解RTX誘導(dǎo)的大鼠神經(jīng)病理性疼痛。
神經(jīng)病理性疼痛;曲古菌素A;腦源性神經(jīng)營(yíng)養(yǎng)因子;樹酯毒素;大鼠
帶狀皰疹后遺神經(jīng)痛(PHN)繼發(fā)于水痘帶狀皰疹病毒感染,是最常見和最嚴(yán)重的并發(fā)癥,嚴(yán)重影響患者的生活質(zhì)量,且其發(fā)病率近年隨人口老齡化增加而升高[1]。腦源性神經(jīng)營(yíng)養(yǎng)因子(BDNF)作為疼痛研究的靶點(diǎn)越來越得到關(guān)注。BDNF與表觀遺傳學(xué)的關(guān)系近年也得到驗(yàn)證。研究表明,曲古菌素A(TSA)是一種組蛋白去乙?;敢种苿?HDACI),可以通過抑制甲基化CpG結(jié)合蛋白2[2],進(jìn)而恢復(fù)細(xì)胞因子、趨化因子和BDNF的穩(wěn)態(tài)平衡,從而起到神經(jīng)修復(fù)與鎮(zhèn)痛作用?;跇漉ザ舅?RTX)誘導(dǎo)的神經(jīng)病理性疼痛模型模擬PHN得到世界認(rèn)可[3],2016年9月~2017年2月,本研究應(yīng)用該神經(jīng)病理性疼痛模型探討蛛網(wǎng)膜下腔內(nèi)注射TSA對(duì)該模型大鼠神經(jīng)病理性疼痛的影響及其機(jī)制,以期為PHN的治療提供理論依據(jù)。
1.1 動(dòng)物、試劑、儀器及其來源 成年雄性SD大鼠24只,體質(zhì)量180~200 g,由昭衍(蘇州)新藥研究中心有限公司提供,許可證號(hào)SCXK(蘇)2013-0003。實(shí)驗(yàn)室光照時(shí)間8:00~20:00,溫度18~22 ℃,濕度40%~60%,單籠喂養(yǎng),自由充分飲食。主要試劑和儀器:TSA(Sigma公司,美國(guó)),RTX(LC Labs公司,美國(guó));LightCycler?480 模塊式高通量實(shí)時(shí)熒光定量PCR(Roche公司,瑞士),von Frey針刺觸覺測(cè)量?jī)x(Stoelting公司,美國(guó))。
1.2 分組與模型建立 大鼠適應(yīng)實(shí)驗(yàn)環(huán)境1周后,采用隨機(jī)數(shù)字表法均分成4組(n=6):Vehicle組、RTX組、RTX+DMSO組和RTX+TSA組。于造模前1周對(duì)RTX+DMSO組及RTX+TSA組進(jìn)行蛛網(wǎng)膜下腔置管:大鼠俯臥位于操作臺(tái),背部皮膚備皮后消毒,大鼠L3~4椎間隙作一豎直切口,長(zhǎng)度2 cm左右,逐層暴露,鈍性分離豎脊肌,充分暴露3~4椎間隙。用25號(hào)穿刺針行腰椎穿刺,感覺有突破感,則說明穿刺針頭端已挑破椎間孔。緩慢退針,從椎間孔破口沿著穿刺針的徑路插入PE-10導(dǎo)管,導(dǎo)管向大鼠頭端置入約2 cm,大鼠出現(xiàn)甩尾,且有清亮的腦脊液流出,說明導(dǎo)管已經(jīng)置入蛛網(wǎng)膜下腔。將PE導(dǎo)管的近端用手術(shù)縫線與韌帶結(jié)扎,逐層縫合肌肉、筋膜。妥善固定,用碘伏消毒皮膚傷口,縫皮。于第6天用利多卡因驗(yàn)證是否置管成功,如出現(xiàn)肢體癱瘓、感染或?qū)Ч苊摮鰟t剔除實(shí)驗(yàn)。在蛛網(wǎng)膜下腔內(nèi)置管1周大鼠損傷恢復(fù)后,測(cè)定各組大鼠基礎(chǔ)痛閾值,除Vehicle組外,其余三組均建模處理,建模方式為每只大鼠在氟烷(2%氧)麻醉下接受單次RTX腹腔注射210 μg/kg建立神經(jīng)病理性疼痛模型。Vehicle組建模方式為單次腹腔注射RTX的溶媒,其成分為10% Tween 80、10%乙醇與生理鹽水組成的混合液[3];RTX組單次腹腔注射RTX;RTX+TSA組在RTX腹腔注射建模前60 min以及建模后每天予大鼠蛛網(wǎng)膜下腔內(nèi)注射TSA,并持續(xù)到建模后7 d。TSA蛛網(wǎng)膜下腔內(nèi)注射劑量為0.5 μg/kg,TSA的溶劑為5%的DMSO。RTX+DMSO組在單次RTX腹腔注射前60 min與建模后蛛網(wǎng)膜下腔內(nèi)注射5% DMSO,同樣持續(xù)至建模后7 d。
1.3 機(jī)械痛閾值測(cè)定 建模前測(cè)定各組大鼠基礎(chǔ)痛閾值,建模后第1、3、5、7天測(cè)定機(jī)械痛閾值,測(cè)定時(shí)間為蛛網(wǎng)膜下腔內(nèi)給藥后2 h。測(cè)量時(shí)將大鼠置于底部為鐵絲網(wǎng)的有機(jī)玻璃籠中,待其適應(yīng)后采用序貫法進(jìn)行實(shí)驗(yàn)。機(jī)械痛閾值的測(cè)量采用Chaplan等(1994)報(bào)道的“up and down”方法[4]:將大鼠放在鐵絲網(wǎng)架子上,待動(dòng)物適應(yīng)測(cè)試環(huán)境并能保持安靜開始測(cè)量。將一系列校準(zhǔn)的von Frey毛針垂直作用于后肢足底表面中部,注意避開不敏感的足墊位置,以不同強(qiáng)度(1.0、1.4、2、4、6、8、10、15、26、60、100 g)的力量彎曲6 s,大鼠輕快地撤回爪子或縮足則認(rèn)為是陽(yáng)性反應(yīng)。連續(xù)測(cè)量5次取平均值。
1.4 脊髓及脊神經(jīng)背根節(jié) BDNF mRNA表達(dá)的測(cè)定 于最后一次蛛網(wǎng)膜下腔內(nèi)給藥后,隨機(jī)取6只大鼠,腹腔注射4%水合氯醛400 mg/kg麻醉后,取L4~6脊髓組織,采用TRIzol Reagent提取總RNA。逆轉(zhuǎn)錄條件:42 ℃ 60 min,70 ℃ 5 min,4 ℃ 5 min終止反應(yīng)。引物序列由上海生工公司合成。BDNF上游引物:5′-TGGCAAGACTTCAACTCAGC-3′,下游引物:5′-CTCCATCATCAAAAAGCCCCA-3′,產(chǎn)物長(zhǎng)度146 bp;β-actin上游引物:5′-CCCATCTATGAGGGTTACGC-3′,下游引物:5′-TTTAATGTCACGCACGATTTC-3′,產(chǎn)物長(zhǎng)度150 bp。建立如下反應(yīng)體系:Eva green 5 μL,上游引物 1 μL,下游引物 1 μL,DEPC水 1.5μL,cDNA模版 1.5 μL。擴(kuò)增條件為95 ℃變性30 s,58 ℃退火30 s,72 ℃延伸20 s,共40個(gè)循環(huán)。采用2-ΔΔCT法計(jì)算目的基因的相對(duì)表達(dá)水平。
2.1 四組各時(shí)點(diǎn)機(jī)械痛閾值比較 見表1。
表1 四組各時(shí)點(diǎn)機(jī)械痛閾值比較±s)
注:與Vehicle組比較,aP<0.05;與RTX組或RTX+DMSO組比較,bP<0.05。
2.2 四組不同部位BDNF mRNA相對(duì)表達(dá)比較 Vehicle組、RTX組、RTX+DMSO組、RTX+TSA組脊髓中BDNF mRNA分別為1.01±0.03、0.20±0.04、0.23±0.02、0.54±0.03;脊神經(jīng)背根節(jié)中BDNF mRNA分別為1.00±0.03、0.33±0.02、0.35±0.03、0.61±0.03。RTX組與RTX+DMSO組脊髓與脊神經(jīng)背根節(jié)中BDNF mRNA呈低表達(dá),兩組比較,P>0.05。RTX組和RTX+DMSO組脊髓及脊神經(jīng)背根節(jié)中BDNF mRNA較Vehicle組表達(dá)下降(P均<0.01);與RTX組和(或)RTX+DMSO組比較,RTX+TSA組脊髓及脊神經(jīng)背根節(jié)BDNF mRNA表達(dá)升高(P均<0.05)。
PHN以老年患者多見,疼痛頑固而劇烈,常持續(xù)數(shù)月甚至數(shù)年,治療困難,其發(fā)生機(jī)制復(fù)雜。由于臨床研究納入標(biāo)準(zhǔn)不一致、缺乏嚴(yán)格的對(duì)照使其影響因素較多,試驗(yàn)結(jié)果差異很大。因此動(dòng)物實(shí)驗(yàn)的基礎(chǔ)研究尤為重要。傳統(tǒng)的PHN模型應(yīng)用水痘-帶狀皰疹病毒誘導(dǎo),其結(jié)果是造成機(jī)械痛超敏與熱痛過敏,而臨床上PHN患者多數(shù)為機(jī)械痛超敏而無(wú)熱痛過敏[3]。本文應(yīng)用的神經(jīng)病理性疼痛模型即給大鼠單次腹腔注射辣椒素受體激動(dòng)劑RTX,模擬病毒對(duì)脊神經(jīng)節(jié)感覺神經(jīng)元的損毀,有效地去除了表達(dá)熱敏感通道辣椒素受體的脊神經(jīng)節(jié)小直徑神經(jīng)元和無(wú)髓傳入C纖維,故出現(xiàn)熱痛失敏現(xiàn)象;同時(shí)僅損傷部分Aβ有髓傳入神經(jīng)纖維,引起有髓神經(jīng)纖維軸突腫脹和髓鞘變形,并向脊髓背角淺層長(zhǎng)芽,引起機(jī)械痛覺超敏,這兩種痛行為的改變很好地模擬了PHN患者的臨床癥狀[3]。
近期研究[5]顯示,BDNF可能參與了神經(jīng)病理性疼痛和炎性痛的發(fā)生過程。在慢性疼痛等異常狀態(tài)下,由非神經(jīng)細(xì)胞(主要是小膠質(zhì)細(xì)胞)合成和分泌的較正常狀態(tài)下高出數(shù)十倍乃至上千倍BDNF,可促使痛覺過敏的發(fā)生和發(fā)展。也有研究顯示,BDNF的合成增加,可作用于脊髓神經(jīng)元的酪氨酸激酶受體B,從而抑制鉀氯轉(zhuǎn)運(yùn)體表達(dá),使得細(xì)胞內(nèi)氯離子的內(nèi)穩(wěn)態(tài)破壞,造成抑制性神經(jīng)遞質(zhì)的異常去極化,出現(xiàn)神經(jīng)病理性疼痛[6]。另一方面,BDNF在中樞可以通過增加自由基清道夫的活性減少氧自由基誘導(dǎo)的神經(jīng)元凋亡;并通過調(diào)節(jié)細(xì)胞外鈣流入或釋放細(xì)胞內(nèi)儲(chǔ)存鈣維持細(xì)胞內(nèi)鈣濃度,從而抑制氨基酸中毒[7],促進(jìn)神經(jīng)干細(xì)胞的分化和神經(jīng)細(xì)胞生長(zhǎng),對(duì)神經(jīng)起保護(hù)作用??梢夿DNF在神經(jīng)系統(tǒng)中具有雙重作用。目前,BDNF在PHN中作用的研究較少,其作用機(jī)制尚不明確。
BDNF在中樞的來源主要為膠質(zhì)細(xì)胞,在外周為中小直徑的神經(jīng)元,已知在某些疾病中,盡管存在膠質(zhì)細(xì)胞的激活,但BDNF的表達(dá)卻是減少的,因此BDNF的減少在其疾病的發(fā)生發(fā)展中可能發(fā)揮重要作用[8]。本試驗(yàn)發(fā)現(xiàn),BDNF在PHN疼痛模型中的中樞脊髓與外周脊神經(jīng)背根節(jié)的表達(dá)降低。國(guó)內(nèi)外研究中也指出,PHN患者中樞神經(jīng)系統(tǒng)BDNF等神經(jīng)因子表達(dá)降低[9,10],本研究結(jié)果與其一致。有學(xué)者應(yīng)用恩再適及普瑞巴林治療PHN患者,結(jié)果外周血BDNF的表達(dá)水平上升,患者疼痛減輕,且恩再適或普瑞巴林應(yīng)用后BDNF的表達(dá)上升,其水平與VAS呈正相關(guān),提示BDNF的增加與PHN患者疼痛減輕具有相關(guān)性[10]。
TSA作為一種HDACI對(duì)多種炎癥反應(yīng)起到調(diào)節(jié)作用,由于不同的HDACs具有不同的乙?;J?,調(diào)節(jié)不同的基因,所以HDACI在免疫性疾病中通過調(diào)節(jié)不同的免疫因子而起作用[11]。TSA在疼痛中應(yīng)用的研究較少,目前基于多發(fā)性硬化癥所致的中樞神經(jīng)病理性疼痛研究顯示,TSA在神經(jīng)修復(fù)與鎮(zhèn)痛中發(fā)揮重要作用[2]。Hasan等[12]的研究也指出,TSA增強(qiáng)BDNF的表達(dá)在神經(jīng)保護(hù)和受損神經(jīng)系統(tǒng)恢復(fù)中起重要作用,而一定濃度的BDNF也會(huì)增加脊神經(jīng)節(jié)神經(jīng)元的存活數(shù)量。BDNF在表觀遺傳學(xué)上調(diào)控途徑的實(shí)現(xiàn)還可以通過其他途徑。有試驗(yàn)表明,RE1沉默轉(zhuǎn)錄因子(REST)和CoREST是兩個(gè)轉(zhuǎn)錄抑制因子,參與BDNF基因轉(zhuǎn)錄抑制,REST和CoREST可能是髓鞘再生和(或)髓鞘修復(fù)潛在的生物學(xué)靶點(diǎn)[13]。無(wú)論基于何種理論基礎(chǔ),BDNF的表達(dá)在癌性疼痛、神經(jīng)病理性疼痛等疼痛相關(guān)疾病的發(fā)病機(jī)理與治療中發(fā)揮重要作用。
PHN發(fā)病過程中存在外周中小神經(jīng)元的損傷[14],某些PHN模型證實(shí)在中樞神經(jīng)系統(tǒng)中,存在星形膠質(zhì)細(xì)胞的活化[15]?;谏鲜隼碚?,我們推測(cè),在外周神經(jīng)系統(tǒng),比如脊神經(jīng)節(jié)中,中小直徑神經(jīng)元的減少或者破壞導(dǎo)致BDNF表達(dá)降低,而中樞星形膠質(zhì)細(xì)胞雖然廣泛活化表達(dá),但該模型膠質(zhì)細(xì)胞源性BDNF的表達(dá)卻減少。有研究者認(rèn)為TSA可以作用于星形膠質(zhì)細(xì)胞,從而在中樞增加星形膠質(zhì)細(xì)胞源性的BDNF增加,在RTX誘導(dǎo)的神經(jīng)痛模型中起到中樞神經(jīng)保護(hù)作用,促進(jìn)RTX組大鼠感覺器官的恢復(fù)[16]。而在外周,在脊神經(jīng)節(jié)中TSA增加BDNF的表達(dá),可能使得神經(jīng)細(xì)胞存活增多[17],神經(jīng)纖維功能得以恢復(fù)從而減輕疼痛或者延緩疼痛的產(chǎn)生。另外,在諸多PHN模型及臨床病例中顯示,PHN大鼠或者患者在中樞或外周存在炎癥反應(yīng),基于TSA調(diào)節(jié)免疫反應(yīng)的特性,在本模型中,TSA可能降低了中樞與外周的炎性反應(yīng),從而達(dá)到鎮(zhèn)痛的效應(yīng),但其具體機(jī)制還需進(jìn)一步探究。
綜上所述,TSA作為HDACI可能通過調(diào)節(jié)中樞及外周BDNF的表達(dá),緩解RTX誘導(dǎo)的神經(jīng)病理性疼痛。
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Effects of subarachnoid injection of TSA on RTX-induced neuropathic pain and its mechanism
CHENWenjia,MENGXiaowen,WANGLina,ZHANYing,JIFuhai,YANGJianping
(TheFirstAffiliatedHospitalofSoochowUniversity,Suzhou215000,China)
Objective To study the effects of subarachnoid injection of trichostatin A (TSA) on resiniferatoxin (RTX)-induced neuropathic pain in rats and its mechanism.Methods Twenty-four male SD rats were randomly divided into four groups (n=6): Vehicle group, RTX group, RTX+DMSO group, and RTX+TSA group. The models of neuropathic pain were established in the remaining three groups except Vehicle group. Subarachnoid catheterization was performed in the RTX+DMSO group and RTX+TSA group one week prior to modeling. Before the establishment of the models, the rats were sacrificed with von Frey filaments to detect the basal value of the pain, and the mechanical pain threshold was measured on the 1st, 3rd, 5th, and 7th days after modeling. Vehicle group was treated with a single peritoneal RTX solvent 1.5 mL; rats in the RTX group
intraperitoneal injection of RTX (210 μg/kg); from 60 min before RTX injection, 5% DMSO (10 μL) was injected into rats of the RTX+DMSO group intrathecally once a day for 7 days; from 60 min before RTX injection, TSA (0.5 μg/kg) with solvent of 5% DMSO was injected into rats of the RTX+TSA group intrathecally once a day. The expression of BDNF mRNA in the spinal cord (SC) and dorsal root ganglion (DRG) was measured by qRT-PCR at 2 h after last time of TSA injection.Results Compared with the Vehicle group, the RTX group, RTX+DMSO group, and RTX+TSA group displayed a significantly decrease in mechanical allodynia on the 3th, 5th, and 7th days (P<0.05). Compared with the RTX group and RTX+DMSO group, the RTX+TSA group had significantly higher mechanical pain threshold on 5th and 7th days (allP<0.05). There was no statistically significant difference between the RTX group and RTX+DMSO group (P>0.05). Compared with the Vehicle group, the expression of BDNF mRNA was down-regulated in the spinal cord and DRG in the RTX group and RTX+DMSO group (P<0.05). Compared with the RTX group and RTX+DMSO group, the expression of BDNF mRNA in the spinal cord was up-regulated in the RTX+TSA group (P<0.05). There was no statistically significant difference between the RTX+DMSO group and RTX group (P>0.05).Conclusion The subarachnoid injection of TSA can relieve RTX-induced neuropathic pain by up-regulating the expression of brain-derived neurotrophic factor (BDNF).
neuropathic pain; trichostatin A; brain-derived neurotrophic factor; resiniferatoxin; rats
國(guó)家自然科學(xué)基金資助項(xiàng)目(81471136);江蘇省青年醫(yī)學(xué)人才基金資助項(xiàng)目(QNRC2016740)。
陳文佳(1990-),男,碩士,主要研究方向?yàn)橥从X信息的傳遞與調(diào)控。E-mail:653377045@qq.com
王麗娜(1979-),女,副主任醫(yī)師,主要研究方向?yàn)橥从X信息的傳遞與調(diào)控。E-mail:wangln@suda.edu.cn
10.3969/j.issn.1002-266X.2017.29.004
R741
A
1002-266X(2017)29-0012-04
2017-04-12)