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Role of macrophage–derived HMGB1 as an algogenic molecule ⁄ therapeutic target in visceral pain 巨噬细胞来源的HMGB1作为致痛分子/治疗靶点在内脏疼痛中的作用
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.24
Maho Tsubota, A. Kawabata
Accumulating evidence sheds light on the crucial role of a neuroimmune crosstalk in neurogenic inflammation and diverse neurological diseases associated with neuro inflammation. High mobility group box 1 (HMGB 1 ), one of damage–associated molecular patterns (DAMPs) ⁄ alarmins, is now considered a pro–inflammatory ⁄ pro– nociceptive molecule, and participates in the pathogenesis of neuropathic and inflammatory pain. In this review, we focus on the role of HMGB 1 in visceral pain signaling in the bladder, pancreas and colon. In rodent models for cystitis–related bladder pain, macrophage–derived HMGB 1 activates the receptor for advanced glycation end– products (RAGE), and induces NF– κ B–dependent overexpression of cystathionine– γ –lyase, an H 2 S–generating enzyme, resulting in excessive excitation of nociceptors through the H 2 S ⁄ Ca v 3 . 2 T–type calcium channel pathway and subsequent bladder pain. The macrophage–derived HMGB 1 also appears to play a role in the development of pancreatic pain accompanying acute pancreatitis and of colonic pain in a mouse model for irritable bowel syndrome (IBS). Thus, HMGB 1 is considered a key mediator for a neuroimmune crosstalk involved in visceral pain signaling in the bladder, pancreas and colon, and may serve as a novel therapeutic target for treatment of visceral pain in patients with interstitial cystitis ⁄ bladder pain syndrome, acute pancreatitis or IBS.
越来越多的证据揭示了神经免疫串扰在神经源性炎症和与神经炎症相关的多种神经系统疾病中的关键作用。高迁移率组框1 (hmgb1)是损伤相关分子模式(DAMPs) /警报器之一,目前被认为是一种促炎/促伤害性分子,参与神经性和炎症性疼痛的发病机制。在这篇综述中,我们主要关注hmgb1在膀胱、胰腺和结肠内脏疼痛信号传导中的作用。在膀胱炎相关膀胱疼痛的啮齿动物模型中,巨噬细胞来源的hmgb1激活晚期糖基化终产物受体(RAGE),诱导NF - κ b依赖性胱硫氨酸- γ -裂解酶(一种产生h2s的酶)的过度表达,通过h2s / cav 3导致伤害感受器过度兴奋。2 t型钙通道与随后的膀胱疼痛。在肠易激综合征(IBS)小鼠模型中,巨噬细胞来源的hmgb1似乎也在伴随急性胰腺炎的胰腺疼痛和结肠疼痛的发展中发挥作用。因此,hmgb1被认为是参与膀胱、胰腺和结肠内脏疼痛信号传导的神经免疫串音的关键介质,可能作为治疗间质性膀胱炎/膀胱疼痛综合征、急性胰腺炎或IBS患者内脏疼痛的新治疗靶点。
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引用次数: 0
Pattern of cortical activation encodes subjective phantom limb movement 皮层激活模式编码主观幻肢运动
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.39
R. Fukuma, T. Yanagisawa, Masataka Tanaka, B. Seymour, K. Hosomi, H. Kishima, T. Yoshimine, Y. Kamitani, Y. Saitoh
Subjective movability of phantom hand has been suggested to relate to phantom pain; however, cortical activities that represent the movement of phantom hand is unclear. Here, we recorded magnetoencephalographic signals while phantom limb patients moved their phantom hand and compared with the subjective movability of the phantom hand. During the experiment, the patients with phantom limb pain performed grasping and opening of phantom, and intact hands. Cortical potentials in the sensorimotor cortex contralateral to the tested hand were estimated from the magneto encephalographic signals, and used to infer movement type. Subjective movabili ty of the phantom hands were evaluated by duration of time required to perform grasping and opening. During movement of phantom hand, sensorimotor cortex contralateral to the phantom hand was activated similarly to the movement of intact hand. The decoding accuracy of movement type of phantom hand was deterio-rated in the patient who was not able to move his phantom hand fast. In conclusion, it was suggested that the decoding accuracy of phantom hand movement represented the subjective movability of the phantom hand.
幻影手的主观活动性被认为与幻影疼痛有关;然而,代表幻手运动的皮层活动尚不清楚。在这里,我们记录了当幻肢患者移动他们的幻手时的脑磁图信号,并与幻手的主观活动性进行了比较。在实验过程中,有幻肢疼痛的患者进行了抓握和打开幻肢以及完整的手。根据脑磁图信号估计测试手对侧的感觉运动皮层的皮层电位,并用于推断运动类型。通过抓握和张开所需的时间来评估幻影手的主观活动性。在模拟手的运动过程中,模拟手对侧的感觉运动皮层被激活,类似于完整手的运动。在不能快速移动幻手的患者中,确定了幻手运动类型的解码准确性。结论表明,虚手运动的解码精度代表了虚手的主观活动性。
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引用次数: 0
Virtual reality (VR) treatment for phantom limb pain 虚拟现实(VR)治疗幻肢痛
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.19
M. Sumitani, M. Osumi, Kazunori Inomata, Y. Otake, R. Inoue, Rikuhei Tsuchida, Yaeko Yokoshima, K. Azuma, H. Abe
The brain monitors motor outputs and sensory inputs about limb movements and information communication of limb movements between the motor system and the sensory system all along the line. This information communication of limb move ments is called as the sensorimotor loop. In the normal condition, the sensorimotor loop maintains congruent. Recent advancement of cognitive neuroscience can propose that pathologic pain like as phantom limb pain can emerge and sustains and finally impairs patients’ quality of life when the loop becomes incongruent. We have treated phantom limb pain with the mirror visual feedback (MVF) and recently virtual reality (VR) treatment. The MVF and VR treatments can re–construct movement representations of a phantom limb and then improve phantom limb pain. We have successfully evaluated such movement representations of a phantom limb by assessing the intact upper limb movements on the basis of the bimanual coupling effect, which is physiologically equipped with the brain. The analgesic effect of the VR system is closely linked to the objectively–assessed reemergence of movement representations of a phantom limb.
大脑全程监控肢体运动的运动输出和感觉输入,以及肢体运动在运动系统和感觉系统之间的信息交流。肢体运动的这种信息交流被称为感觉运动回路。在正常情况下,感觉-运动回路保持一致。认知神经科学的最新进展表明,当神经回路变得不一致时,病理性疼痛如幻肢痛可以出现并维持并最终损害患者的生活质量。我们用镜像视觉反馈(MVF)和最近的虚拟现实(VR)治疗幻肢痛。MVF和VR治疗可以重建幻肢的运动表征,从而改善幻肢疼痛。我们已经成功地评估了幻肢的这种运动表征,通过评估完整的上肢运动,基于双手耦合效应,这是生理上配备的大脑。虚拟现实系统的镇痛效果与客观评估的幻肢运动表征的重新出现密切相关。
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引用次数: 0
Study of cortical motor representation and cortical excitability in refractory neuropathic pain 难治性神经性疼痛的皮质运动表征和皮质兴奋性研究
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.57
N. Mori, K. Hosomi, R. Takeuchi, Chanseok Lim, T. Mano, A. Matsugi, H. Kishima, Y. Saitoh
Objective: Repetitive transcranial magnetic stimulation over the primary motor cortex has been shown to provide an analgesic effect on refractory neuropathic pain. It is thought that the primary motor cortex may be involved in pain–related cognitive processing. In this study, navigation–guided transcranial magnetic stimulation (TMS) was applied to investigate cortical motor representation and cortical excitability related to pain. Methods: Subjects were seven patients with refractory neuropathic pain (60.4 ± 13.5 years; stroke, n=5 ; peripheral nerve injury, n=1 ; brachial plexus avulsion, n=1). Pain intensity was measured using a visual analog scale, a numeric rating scale and the short–form McGill Pain Questionnaire 2 (SF–MPQ–2). We measured motor representation and cortical excitability assessed by motor evoked potentials with navigation–guided TMS around the primary motor cortex. A resting motor threshold (RMT), and motor map area and extent were measured in the both hemispheres. The relations between pain assessment items and each measurement (the RMT ratio of affected hemisphere (AH) to unaffected hemisphere (UH), AH ⁄ UH area ratio, and AH ⁄ UH extent ratio) were examined. Results : The RMT of AH trended to be higher than that of UH (p=0.07). The AH ⁄ UH area ratio significantly correlated to SF–MPQ2 (rs=−0.85, p=0.02). The other analyses showed no significant correlations between pain assessment items and each measurement with TMS. Conclusions: This study suggested that refractory neuropathic pain might lead to changes of cortical motor representation and cortical excitability.
目的:重复经颅磁刺激初级运动皮质已被证明提供了一种镇痛效果难治性神经性疼痛。人们认为初级运动皮层可能参与疼痛相关的认知加工。本研究采用导航引导的经颅磁刺激(TMS)研究与疼痛相关的皮质运动表征和皮质兴奋性。方法:选取7例难治性神经性疼痛患者(60.4±13.5岁;笔画,n=5;周围神经损伤,n=1;臂丛撕脱,n=1)。疼痛强度采用视觉模拟量表、数字评定量表和简短的McGill疼痛问卷2 (SF-MPQ-2)进行测量。我们测量了运动表征和皮层兴奋性,用导航引导的TMS在初级运动皮层周围测量了运动诱发电位。在两脑半球测量静息运动阈值(RMT)和运动图面积和范围。检查疼痛评估项目与各测量指标(受影响半球(AH)与未受影响半球(UH)的RMT比、AH / UH面积比、AH / UH程度比)之间的关系。结果:AH的RMT有高于UH的趋势(p=0.07)。AH / UH面积比与SF-MPQ2显著相关(rs= - 0.85, p=0.02)。其他分析结果显示,疼痛评估项目与经颅磁刺激的各测量结果之间无显著相关性。结论:本研究提示顽固性神经性疼痛可能导致皮质运动表征和皮质兴奋性的改变。
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引用次数: 0
Imaging of microglia ⁄ macrophage in an animal model of peripheral inflammatory pain 外周炎性疼痛动物模型中的小胶质细胞/巨噬细胞成像
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.31
H. Uchida, M. Abe, Kazuki Tainaka, K. Sakimura
Microglia are parenchymal tissue–resident macrophage within the central nervous system (CNS) and originate from erythromyeloid precursor cells in the yolk sac. A growing body of evidence suggests that microglia engage in CNS development, homeostasis and diseases, including chronic pain. Peripheral nerve injury and inflammation produce persistent pain hypersensitivity via CNS sensitization, in which activated microglia have critical roles. Activation of microglia occurs at both spinal and supraspinal levels after nerve injury and inflammation; however, their spatial distribu-tion in the intact tissue remains poorly understood. Recently, tissue clearing methods and high–resolution imaging techniques have been greatly advanced, and these techniques will improve our understanding of pain mechanisms. Therefore, we attempted to clarify the three–dimensional localization of microglia in the intact CNS after peripheral inflammation by analyzing the reporter mouse line Iba– 1 (iCre/+); CAG– floxed STOP tdTomato with CUBIC (Clear, Unobstructed Brain ⁄ Body Imaging Cocktails and Computational analysis). In this review, we focus on recent advances in understanding of microglial activation under pathological pain conditions.
小胶质细胞是中枢神经系统(CNS)实质组织内的巨噬细胞,起源于卵黄囊内的红髓前体细胞。越来越多的证据表明,小胶质细胞参与中枢神经系统的发育、体内平衡和疾病,包括慢性疼痛。周围神经损伤和炎症通过中枢神经系统致敏产生持续的疼痛超敏反应,激活的小胶质细胞在其中起关键作用。神经损伤和炎症后,小胶质细胞的激活发生在脊柱和脊柱上水平;然而,它们在完整组织中的空间分布仍然知之甚少。最近,组织清理方法和高分辨率成像技术取得了很大的进步,这些技术将提高我们对疼痛机制的理解。因此,我们试图通过分析报告小鼠系Iba - 1 (iCre/+)来阐明外周炎症后完整中枢神经系统中小胶质细胞的三维定位;CAG - floxed STOP tdTomato with CUBIC(清晰,无阻碍的脑/身体成像鸡尾酒和计算分析)。在这篇综述中,我们重点介绍了病理性疼痛条件下小胶质细胞激活的最新进展。
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引用次数: 0
第40回 日本疼痛学会  印象記  臨床部門 第40回 日本疼痛学会  印象記  臨床部門
Pub Date : 2018-12-28 DOI: 10.11154/pain.33.325
晃一 細見
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引用次数: 0
第40回 日本疼痛学会  印象記  基礎部門 第40回 日本疼痛学会  印象記  基礎部門
Pub Date : 2018-12-28 DOI: 10.11154/pain.33.323
英二 金銅
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引用次数: 0
Neuromodulation therapy for post–stroke pain 脑卒中后疼痛的神经调节治疗
Pub Date : 2018-12-28 DOI: 10.11154/PAIN.33.294
Takamitsu Yamamoto, Mitsuru Watanabe, Kazutaka Kobayashi, H. Oshima, C. Fukaya, A. Yoshino
We have reported that 5 Hz cervical spinal cord stimulation (SCS) increased cerebral blood flow and induced muscle twitches in the upper extremities, and minimally conscious state patients showed a remarkable recovery of consciousness and motor function in the upper extremities compared with that in the lower extremities. From the findings of our previous study, we have applied 5 Hz cervical SCS in combination with conventional 20 Hz cervical SCS to induce paresthesia over the painful area in poststroke pain patients. We report a new SCS technique for post– stroke pain and motor weakness. Twenty–two poststroke pain patients underwent pharmacological evaluation and dual–lead SCS trials or implantation. For the pharmacological evaluation, ketamine, morphine, and thiopental tests were carried out. Using a Touhy needle, a four or eight–contact flexible cylinder–type electrode was inserted into the epidural space of the cervical or thoracic vertebrae. The patients received 5 Hz cervical SCS to induce muscle twitches for five minutes in one session, and five sessions per day were carried out. In addition, patients underwent 20Hz cervical SCS to induce paresthesia as much as they required. During the 20 Hz SCS test period in the 22 patients, pain relief was estimated as excellent (≧60% VAS score reduction) in six patients, good (30 – 59% reduction) in nine patients, fair (10 – 29% reduction) in four patients, and poor (<10% reduction) in three patients. Three patients with poor estimated pain relief were not treated with chronic SCS. Twenty–four months after chronic SCS in 19 patients, pain relief was estimated as excellent in three patients, good in nine patients, and fair in seven patients. The %VAS score reduction 24 months after chronic SCS and the results of the ketamine test showed a significant correlation (r=0.670, p=0.001) by Pearson’s correlation coefficient test. However, the %VAS score reduction and the thiopental (r=0.291, p=0.227) and morphine (r=0.327, p=0.172) tests showed no significant cor relation. In patients treated with a combination of cervical 5 Hz and 20 Hz SCS, the motor function of the upper extremities recovered remarkably. The pharmacological evaluation of poststroke pain is a useful tool for the selection of candidates for SCS, and low–dose ketamine drop infusion method is useful for increasing the effect of SCS. The combination of 5 Hz and 20 Hz SCS is a new neuro-
据我们报道,5Hz颈脊髓刺激(SCS)增加了大脑血流量,并诱导了上肢肌肉抽搐,与下肢相比,轻度意识状态患者的上肢意识和运动功能显著恢复。根据我们之前的研究结果,我们已经将5 Hz的颈脊髓刺激与传统的20 Hz的颈神经刺激相结合,在卒中后疼痛患者的疼痛区域诱导感觉异常。我们报道了一种治疗中风后疼痛和运动无力的新SCS技术。22名卒中后疼痛患者接受了药物评估和双导联脊髓刺激系统试验或植入。为了进行药理学评价,进行了氯胺酮、吗啡和硫喷妥钠试验。使用Touhy针,将四或八触点柔性圆柱形电极插入颈椎或胸椎的硬膜外间隙。患者接受5 Hz的颈脊髓刺激,在一次治疗中诱导肌肉抽搐5分钟,每天进行5次治疗。此外,患者接受了20Hz的颈部脊髓刺激,以根据需要诱发感觉异常。在22名患者的20 Hz SCS测试期间,6名患者的疼痛缓解被评估为优秀(VAS评分降低≥60%),9名患者的良好(降低30-59%),4名患者的尚可(降低10-29%),3名患者的较差(降低<10%)。三名估计疼痛缓解不佳的患者未接受慢性脊髓刺激治疗。19名患者在慢性脊髓刺激24个月后,疼痛缓解估计为3名患者疼痛缓解良好,9名患者疼痛减轻良好,7名患者疼痛尚可。通过Pearson相关系数检验,慢性脊髓刺激后24个月VAS评分的%降低与氯胺酮测试结果显示出显著相关性(r=0.670,p=0.001)。然而,%VAS评分降低与硫喷妥钠(r=0.291,p=0.227)和吗啡(r=0.327,p=0.172)测试无显著相关性。在接受5赫兹和20赫兹脊髓刺激联合治疗的患者中,上肢运动功能显著恢复。卒中后疼痛的药理学评估是选择脊髓刺激候选药物的有用工具,低剂量氯胺酮滴注法有助于提高脊髓刺激的效果。5 Hz和20 Hz SCS的组合是一种新的神经-
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引用次数: 0
Development of a macaque model of central post–stroke pain and challenges to understand the mechanisms 猕猴中枢性卒中后疼痛模型的建立及其机制的研究
Pub Date : 2018-12-28 DOI: 10.11154/PAIN.33.275
N. Higo, K. Nagasaka
Central post–stroke pain (CPSP) is a central neuropathic pain characterized by pain and sensory abnormalities due to central nervous system lesion following a cerebro vascular accident. Developing therapeutic interventions for CPSP is difficult because its pathophysiology is unclear. In recent years, rodent models of CPSP have been developed to address this problem. In these models, a lesion of the thalamus including the ventral posterolateral nucleus (VPL) was made by inducing a focal stroke. Using these models, cellular and molecular mechanisms that underlie pathogenesis of CPSP have been discovered. Moreover, some drugs have been suggested to ameliorate the symptoms of the rodent CPSP models. In addition to the rodent models, a primate model of CPSP might also contribute to overcoming CPSP because it is more com-patible with humans in regard to the structures and functions of brain regions which is suggested to be involved in pain in humans. Aside from humans, the macaque monkeys are the most widespread primate genus, ranging from Japan to North Africa. Since the macaque monkeys are the animal species closest to humans among those which can be used for invasive experiments, they are widely used to understand the mechanisms of the human brain. Therefore, we developed a nonhuman primate model of CPSP using macaque monkeys. Because there were individual differences among macaque monkeys, the location of the VPL in each monkey was determined by magnetic resonance imaging (MRI) and extracellular recording of neuronal activity during tactile stimulation. Thereafter, a hemorrhagic lesion was induced by injecting collagenase type IV. Histological analysis using Nissl staining revealed that most of the lesion was localized within the VPL. Several weeks after the injection, the macaques displayed behavioral changes that were interpreted as reflecting the development of both mechanical allodynia and thermal hyperalgesia. functional magnetic resonance imaging is performed to detect brain activity changes underlying CPSP using the established macaque model. The combination of the homology of pain–related cortical areas between macaques and humans with relative-ly large macaque brain enables acquisition of imaging data on par with those examined in clinical research. Therefore, the brain imaging studies using the macaque monkey provide an advantage for the translation of the findings to human patients. We believe that animal models of CPSP will contribute not only to full understanding of pathophysiology but also to the development of therapeutic interventions for it.
中枢性脑卒中后疼痛(CPSP)是一种以脑血管意外后中枢神经系统损伤引起的疼痛和感觉异常为特征的中枢神经性疼痛。由于其病理生理机制尚不清楚,因此开发针对CPSP的治疗干预措施很困难。近年来,为了解决这一问题,开发了啮齿动物CPSP模型。在这些模型中,通过诱导局灶性中风造成丘脑包括腹侧后外侧核(VPL)的病变。利用这些模型,发现了CPSP发病机制的细胞和分子机制。此外,一些药物已被建议改善啮齿动物CPSP模型的症状。除了啮齿类动物模型外,灵长类动物的CPSP模型也可能有助于克服CPSP,因为它在与人类疼痛有关的大脑区域的结构和功能方面与人类更相容。除了人类,猕猴是分布最广的灵长类动物,从日本到北非都有。由于猕猴是可用于侵入性实验的动物中最接近人类的物种,因此它们被广泛用于了解人类大脑的机制。因此,我们以猕猴为研究对象,建立了非人类灵长类动物CPSP模型。由于猕猴之间存在个体差异,因此通过核磁共振成像(MRI)和触觉刺激时神经元活动的细胞外记录来确定每只猕猴VPL的位置。随后,注射IV型胶原酶诱导出血性病变。尼氏染色组织学分析显示,大部分病变位于VPL内。注射几周后,猕猴表现出行为变化,这被解释为反映了机械性异常性痛和热痛觉过敏的发展。使用已建立的猕猴模型进行功能性磁共振成像以检测CPSP导致的脑活动变化。猕猴与人类大脑相对较大的猕猴之间疼痛相关皮质区域的同源性,使得获得的成像数据与临床研究中检查的数据相当。因此,使用猕猴的脑成像研究为将研究结果转化为人类患者提供了优势。我们相信CPSP的动物模型不仅有助于对病理生理学的充分理解,而且有助于治疗干预措施的发展。
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引用次数: 0
Chronic itch by neuron–glia interactions in the spinal dorsal horn 脊髓背角神经元-胶质细胞相互作用引起的慢性瘙痒
Pub Date : 2018-12-28 DOI: 10.11154/PAIN.33.302
M. Tsuda
Itch sensation is a defense system that responds rapidly to a wide range of harmful internal and external stimuli. Recent progress in our understanding of the neuronal basis for itch sensation in the nervous systems has been made, but the mechanism underly ing how itch turns into a pathological chronic state, such as atopic dermatitis, remains poorly understood. It is becoming clear that chronic itch is not simply a con-sequence of the continuity of acute itch signals, but rather of maladaptive function in the nervous system that is caused by long–term structural and functional alterations following skin inflammation. Recent studies have uncovered the causal role of glial cells in the spinal dorsal horn using mouse models of chronic itch including atopic dermatitis. Understanding the key roles of neuron–glia interactions may provide us with exciting insights into the mechanisms for the chronicity of itch and clues to develop novel therapeutic agents for treating chronic itch.
瘙痒感是一种防御系统,对各种有害的内部和外部刺激做出快速反应。最近,我们在理解神经系统中瘙痒感的神经元基础方面取得了进展,但对瘙痒如何转变为病理性慢性状态(如特应性皮炎)的机制仍知之甚少。越来越清楚的是,慢性瘙痒不仅仅是急性瘙痒信号连续性的问题,而是皮肤炎症后长期结构和功能改变引起的神经系统适应不良。最近的研究使用包括特应性皮炎在内的慢性瘙痒小鼠模型揭示了脊髓背角神经胶质细胞的因果作用。了解神经元-神经胶质细胞相互作用的关键作用,可以为我们深入了解瘙痒的慢性机制提供令人兴奋的见解,并为开发治疗慢性瘙痒的新型治疗剂提供线索。
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引用次数: 0
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Pain Research
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