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  Pharmaceutical Patents  

 

Title:  Method for preventing or treating neuropathic pain
United States Patent: 
7,943,588
Issued: 
May 17, 2011

Inventors:
 DeLeo; Joyce A. (Lebanon, NJ), Tanga; Flobert Y. (Medford, MA)
Assignee:
  Trustees of Dartmouth College (Hanover, NH)
Appl. No.:
 11/691,783
Filed:
 March 27, 2007


 

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Abstract

The present invention is a method for preventing or treating neuropathic pain. Using an agent to decrease the expression or activity of Toll-like receptor 4 (TLR4), behavioral hypersensitivity is attenuated thereby preventing or treating neuropathic pain in a subject in need of such treatment.

Description of the Invention

BACKGROUND OF THE INVENTION

Neuropathic pain remains a prevalent, persistent, and debilitating problem. Attempts to elucidate its mechanisms have focused principally on peripheral nerves, dorsal root ganglion, and central nervous system (CNS) neurons. Research efforts have expanded into the burgeoning field of glial/neuronal transmission and CNS immunologic responses to nerve injury. CNS glia display immune cell functions in both normal and pathologic conditions, and there is increasing evidence that neuropathic pain arising from nerve injury has a CNS neuroimmune component (DeLeo & Yezierski (2001) Pain 90:1-6; DeLeo, et al. (2004) Neuroscientist 10:40-52). Spinal glial activation triggers rapid, graded CNS expression of proinflammatory cytokines (including TNF-.alpha., IL-1.beta., and IL-6) that contributes to the initiation and maintenance of behavioral hypersensitivity after L5 nerve transection (DeLeo & Yezierski (2001) supra; Vuong, et al. (2004) Cell. Microbiol. 6:269-275; Raghavendra, et al. (2004) Neuropsychopharmacology 29:327-334). The onset of proinflammatory cytokine expression correlates with microglial activation and the initiation of behavioral hypersensitivity (Sommer, et al. (1993) J. Neuropathol. Exp. Neurol. 52:223-233; Sommer & Myers (1995) Acta Neuropathol. 90:478-485; Popovich, et al. (1997) J. Comp. Neurol. 377:443-464; Popovich, et al. (1997) J. Neuropathol. Exp. Neurol. 56:1323-1338), and neuroimmune activation in painful neuropathy has been established (Vuong, et al. (2004) supra; Bennett (1999) Proc. Natl. Acad. Sci. USA 96:7737-7738; Bennett (2000) Clin. J. Pain 16:S139-S143). However, the mechanistic links between nerve injury, microglial activation, and the genesis of behavioral hypersensitivity is unclear.

Cells of the innate immune system, including monocytes/macrophages, natural killer cells, neutrophils, and microglia recognize invariant molecular structures of pathogens (termed pathogen-associated molecular patterns, PAMP) by means of stable, genetically conserved, pattern-recognition receptors on the cell surface. The genes producing these receptors are homologous to the Toll gene in Drosophila and are therefore termed Toll-like receptors (Akira & Sato (2003) Scand J. Infect. Dis. 35:555-562). Toll-like receptor 4 (TLR4) is a transmembrane receptor protein with extracellular leucine-rich repeat domains and a cytoplasmic signaling domain. TLR4 expression has been demonstrated in the rodent CNS (Laflamme & Rivest (2001) FASEB J. 15:155-163; Eklind, et al. (2001) Eur. J. Neurosci. 13:1101-1106), where in vivo and in vitro studies show that TLR4 is expressed by microglia (Lehnardt, et al. (2002) J. Neurosci. 22:2478-2486; Lehnardt, et al. (2003) Proc. Natl. Acad. Sci. USA 100:8514-8519). Lipopolysaccharide (LPS, a well known exogenous ligand for TLR4) and potential endogenous ligands for TLR4 (e.g., members of the heat shock protein family and proteoglycans) lead to NF-.kappa.B activation and subsequent induction of proinflammatory cytokines (Vabulas, et al. (2002) J. Biol. Chem. 277:15107-15112; Tsan & Gao (2004) Am. J. Physiol. 286:C739-C744). TLR4 gene expression is also significantly increased during all phases of inflammation and is suggested to be related to nerve injury-induced behavioral hypersensitivity (Raghavendra, et al. 2004. Eur. J. Neurosci. 20:467-473). Moreover, increased spinal microglial TLR4 activation correlates with the onset of behavioral hypersensitivity in rats after injury to the L5 spinal nerve, even in the absence of exogenous TLR4 ligands such as LPS (Tanga, et al. (2004) Neurochem. Int. 45:397-407).

Rudofsky, et al. ((2004) Diabetes Care 27:179-183) further teach that type II diabetics that are carriers of polymorphic forms of two TLR4 genes have a lower prevalence of diabetic neuropathy, wherein WO 2005/068442 discloses the use of certain compounds to treat pain in patients without TLR4 polymorphisms.

SUMMARY OF THE INVENTION

The present invention relates to a method of preventing or treating individuals suffering from neuropathic pain. The method involves administering to a subject in need of treatment an effective amount of an agent that decreases the expression or activity of TLR4 thereby preventing or treating neuropathic pain in the subject.

DETAILED DESCRIPTION OF THE INVENTION

It has now been found that modulators of TLR4 can be used to attenuate behavioral hypersensitivity associated with neuropathic pain. Functional links between TLR4, microglial activation, and the initiation of behavioral hypersensitivity were assessed by analyzing glial activation and behavioral hypersensitivity after spinal L5 nerve transection in wild-type mice and in genetically manipulated mice lacking normal TLR4 expression. Two mouse strains with distinct genetic defects at the TLR4 loci were used, namely a TLR4 knockout (KO) mouse (C57BL/10ScNJ), which has a complete deletion of the TLR4 gene and thus cannot synthesize TLR4 mRNA or protein, and the TLR4 point-mutant mouse (C3H/HeJ), which expresses only a mutated (nonfunctional) TLR4 protein because of an amino acid substitution at position 712 in the third exon of the TLR4 gene (Poltorak, et al. (1998) Science 282:2085-2088; Poltorak, et al. (2000) Proc. Natl. Acad. Sci. USA 97:2163-2167). Glial activation and behavioral hypersensitivity after L5 nerve transection were also assessed in normal rats and in rats injected intrathecally with antisense oligodeoxynucleotide (ODN) to decrease CNS expression of TLR4. Both series of experiments established a role for TLR4 and CNS innate neuroimmune activation in the onset of behavioral hypersensitivity.

To demonstrate that TLR4 was critical for pain induction, TLR4 KO mice (C57BL/10SCNJ; n=21) and point-mutant mice were analyzed. TLR4 KO mice (C57BL/10SCNJ; n=21) and point-mutant mice (C3H/HeJ; n=8) displayed significantly attenuated mechanical allodynia compared with their respective wild-type controls (C57BL10/ScSnJ; n=15 and C3H/HeN; n=7) for 0.008-g (P<0.001) and 0.015-g (P<0.001) von Frey filament stimulations beginning at day 1 after surgery (FIGS. 1A and 1B (see Original Patent)). FIG. 1C (see Original Patent) shows that TLR4 KO and point-mutant mice also displayed a significantly attenuated response to heat for days 1-7 (P<0.05) and 10-14 after surgery (P<0.001). FIG. 1D (see Original Patent) shows that the tail-flick response to immersion in 49.degree. C. water was also significantly attenuated for these mice for days 1-7 (P<0.05) and 10-14 after surgery (P<0.001).

To determine whether knockout of TLR4 could attenuate spinal glial activation, expression of CD11b and CD14 was analyzed. A 3- to 5-fold decrease in expression of mRNA for CD11b and CD14 was observed in TLR4 KO mice compared with the wild-type control group beginning at day 3 after surgery (P<0.001). A graded, significant up-regulation of TLR4 mRNA was observed in the wild-type control group (P<0.001). No TLR4 mRNA was detected in the TLR4 KO mice. Messenger RNA for the astrocytic activation marker glial fibrillary acid protein (GFAP) also decreased in TLR4 KO mice relative to the wild-type control group, starting at day 7 after surgery (P<0.001).

A link between innate immunity and spinal proinflammatory cytokine expression was also established. Significantly (3- to 5-fold) lower spinal expression of mRNA for IFN-.gamma., IL-1.beta., and TNF-.alpha. was observed after injury in the TLR4 KO mice as compared with the wild-type control group (P<0.001).

In injured wild-type mice, a robust immunoreactive staining of CD11b/CR3 throughout the dorsal horn ipsilateral to the L5 nerve transection (laminae I-IV) was observed on days 3, 7, and 14 after surgery. By contrast, CD11b/CR3 immunoreactivity was reduced almost to baseline levels in the ipsilateral dorsal horn of injured TLR4 KO mice. These immunohistochemical protein data support the mRNA findings for CD11b and establish a link between microglial activation and TLR4.

To demonstrate that behavioral hypersensitivity could be attenuated using a small molecule inhibitor, a TLR4 antisense oligodeoxynucleotide (ODN) was injected into the CNS of rats. It was initially confirmed that FITC-labeled random control ODN was incorporated into the spinal cord. Co-labeling with DAPI demonstrated the proximity of the FITC-labeled ODN to the nucleus, showing that the modified ODN was incorporated into the CNS parenchyma. Daily intrathecal injection of 10 .mu.g of TLR4 antisense ODN resulted in moderate but significant attenuation of both mechanical allodynia (FIG. 2A (see Original Patent)) and thermal hyperalgesia (FIG. 2B); more significant attenuation was observed with 20-.mu.g daily injections (P<0.001). Daily injections of saline or of 10 or 20 .mu.g of mismatch ODN did not alter mechanical or thermal hypersensitivity.

Because of the potential for TLR4 antisense ODN backbone toxicity, the maximum daily intrathecal administration of TLR4 antisense ODN was 20 .mu.g. This dosage provided a 56% decrease in spinal TLR4 mRNA expression (P<0.001). Decreased expression of TLR4 paralleled the decreased expression of the microglial activation markers CD11b (51%) and CD14 (44%) (P<0.001). The decrease in TLR4 also led to a significant decrease in proinflammatory cytokines, i.e., TNF-.alpha. (17%), IL-6 (52%), and IL-1.beta. (53%); P<0.001 in all cases in TLR4 antisense ODN-treated rats as compared with rats treated with saline or mismatch ODN.

The data presented herein demonstrate a key role for microglial TLR4 in the induction of behavioral hypersensitivity in rodent models of neuropathy. These data also show that the mRNA expression of the microglial activation markers, TLR4, CD11b/CR3, and CD14, were only elevated at the initiation phase of behavioral hypersensitivity (days 3 and 7). Conversely, the astrocytic activation marker GFAP showed an opposite pattern with a graded increase in the mRNA expression level at later time points (days 7 and 14). These results are consistent with findings suggesting that microglia are involved in the initiating phase of behavioral hypersensitivity, whereas astrocytes are involved in the maintenance phase (Tanga, et al. (2004) Neurochem. Int. 45:397-407; Raghavendra, et al. (2003) J. Pharmacol. Exp. Ther. 306:624-630). Many factors have been postulated to activate microglia after injury, but the finding that microglial TLR4 plays a crucial part as a receptor in the induction phase of behavioral hypersensitivity in rodent models of neuropathy has not been suggested in the art.

After L5 nerve transection injury, mediators are released or activated, causing secondary swelling and damage to neurons. Such mediators include ATP, glutamate, acidosis, free saturated or unsaturated fatty acids, high-extracellular potassium, serotonin, bradykinin, substance P, histamine, and products from the cyclooygenase and lipoxygenase pathway of the arachidonic acid metabolism (Kempski & Volk (1994) Acta Neurochir. Suppl. 60:7-11). At the spinal cord level, these alterations lead to a hyperexcitable state with intense nociceptive input to the dorsal horn and the chemical sensitization of high-threshold nociceptors to transmit low-intensity nonnoxious stimuli.

The findings presented herein indicate that TLR4 is a microglial sensor that triggers glial activation and the dynamic CNS immune response that ensues in response to nerve damage. Inhibition of TLR4 expression was found to produce a significant and dose-related attenuation of L5 nerve transection-induced tactile and thermal hypersensitivity, reduce expression of mRNA for microglial markers, and reduce expression of mRNA for spinal proinflammatory cytokine. These findings indicate a CNS role for TLR4 and innate immunity in the etiology of neuropathic pain. The ability of TLR4 to activate a pathway leading to central sensitization and nerve injury-induced behavioral hypersensitivity provides a means for regulating glial activation, and thus, alleviating chronic pain due to nerve damage. Accordingly, the present invention relates to methods for attenuating behavioral hypersensitivity associated with neuropathic pain and for preventing or treating neuropathic pain using an effective amount of an agent that decreases the expression or activity of TLR4. As used in the context of the present invention, neuropathic pain is pain that originates from a damaged nerve or nervous system.

Generally, an agent of the present invention is administered to an individual or patient identified as being in need of such prevention or treatment using routes (e.g., injection, infusion, or inhalation) and dosages that are determined to be appropriate by those of skill in this art. As used in the context of the present invention, an individual in need of treatment can include a human, zoo animal, companion animal, laboratory animal or livestock.

An effective amount of agent administered is defined as an amount which prevents, attenuates, or reduces behavioral hypersensitivity associated with neuropathic pain. Behavioral hypersensitivity of pain may include sensations that are sharp, aching, throbbing, gnawing, deep, squeezing, or colicky in nature and can be measured by, for example, exposure to thermal hyperalgesia or mechanical hyperalgesia.

As will be understood by those of skill in this art, the specific dose level for any particular patient will depend on a variety of factors, including the activity of the specific compound employed; the age, body weight, general health, and sex of the individual being treated; the time and route of administration; the rate of excretion; other drugs that have previously been administered; and the severity of the particular disease undergoing therapy.

The method of the present invention is particularly useful for preventing and/or treating pain associated with neuropathies, polyneuropathies (e.g., as in diabetes and trauma), neuralgias (e.g., post-zosterian neuralgia, postherpetic neuralgia, trigeminal neuralgia, algodystrophy, and HIV-related pain); musculo-skeletal pain such as osteo-traumatic pain, arthritis, osteoarthritis, spondylarthritis as well as phantom limb pain, back pain, vertebral pain, post-surgery pain; cancer-related pain; vascular pain such as pain resulting from Raynaud's syndrome, Horton's disease, arteritis, and varicose ulcers; as well as pain associated with multiple sclerosis, Crohn's Disease, and endometriosis.

Agents for decreasing the expression or activity of TLR4 can be selected from a variety of compound classes including small organic molecules, antisense oligonucleotides (including siRNA and the like), ribozymes, anti-TLR4 antibodies or fragments thereof. In particular embodiments, the instant agent decreases the expression or activity of TLR4 receptor by 10% to 100% (e.g., 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or 100%) relative to a control level of TLR4 expression or activity such as that found in a subject with neuropathic pain and has not received treatment.

Agents known in the art to antagonize the activity of TLR4 include, but are not limited to, E5564 (also known as compound 1287 or SGEA) (Mullarkey et al. (2003) J. Pharmacol. Exp. Ther. 304(3):1093-1102, 2003). This agent is also described in U.S. Pat. No. 5,681,824. A cell-permeable TLR4 inhibitory peptide is also known in the art for blocking TLR4 activity (see Huang, et al. (2005) Cancer Research 65:5009-5014). Antagonistic antibodies such as monoclonal antibody MTS510 to mouse TLR4 (commercially available from eBioscience, San Diego, Calif.) can also be used. See, e.g., Qi & Shelhamer (2005) J. Biol. Chem. 280:38969-38975. For therapeutic use in species such as humans, such an antibody can be humanized or fragmented to improve efficacy.

Agents which inhibit the expression of TLR4 include, e.g., TLR4 antisense ODN as well as TLR4 short interfering RNAs (siRNAs). Antisense ODN molecules are commercially available to the skilled artisan from sources such as Biognostik (Gottingen, Germany), whereas suitable siRNA molecules are disclosed by Huang, et al. (2005) supra or Qi & Shelhamer (2005) supra (e.g., sense, gat ccG TTC CAT TGC TTG GCG AAT TTC AAG AGA ATT CGC CAA GCA ATG GAA CTT TTT Tg (SEQ ID NO:1) and antisense, aat tcA AAA AAG TTC CAT TGC TTG GCG AAT TCT CTT GAA ATT CGC CAA GCA ATG GAA Cg (SEQ ID NO:2)). As will be appreciated by the skilled artisan, antisense ODN, siRNA, or ribozymes can be readily generated based on the known nucleic acid sequence encoding TLR4. Examples of known TLR4 sequences are found in GENBANK, including those having the following Accession Nos. (listed by species): cow (Bos taurus; NM.sub.--174198, AB056444, and AF310952); pig (Sus scrofa; AY289532); chicken (Gallus gallus; AY064697); horse (Equus caballus; AY005808); dog (Canis farniliaris; AB080363); cat (Felis catus; BAB43947); human (Homo sapiens; NM.sub.--138557, NM.sub.--138556, NM.sub.--138554, NM.sub.--003266, AF177765, AF172171, AF172170, AF172169, AH009665, AF177766, and U88880); mouse (Mus musculus; NM021297, AL805946, AF177767, AF222309, AF185285, AF110133, and AF095353); rat (Rattus norvegicus; NM.sub.--019178); Chinese hamster (Cricetulus griseus; AF153676); gorilla (Gorilla gorilla; AF497565, AF497564, AF497563, and AH011592); orangutan (Pongo pygmaeus; AF497562, AF497561, AF497560, and AH011591); olive baboon (Papio hamadryas anubis; AH008378, AF180964, AF180963, and AF180962); pygmy chimpanzee (Pan paniscus; AH008351, AF179220, AF179219, and AF179218); and rhesus monkey (Macaca rnulatta; AF162474).

It is contemplated that the agents of the present invention can be used alone or in combination with other treatments known to alleviate pain.


Claim 1 of 1 Claim

1. A method of preventing or treating neuropathic pain comprising administering intrathecally to a subject in need of treatment an effective amount of an agent that decreases the expression or activity of TLR4, wherein said agent comprises a TLR4 antisense oligonucleotide, MTS510, or E5564, thereby preventing or treating neuropathic pain in the subject.

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