Browsing by Author "Chamessian, Alexander"
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Item Open Access Differential expression of systemic inflammatory mediators in amputees with chronic residual limb pain.(Pain, 2017-01) Chamessian, Alexander; Van de Ven, Thomas; Buchheit, Thomas; Hsia, Hung-Lun; McDuffie, Mary; Gamazon, Eric R; Walsh, Colin; Bruehl, Stephen; Buckenmaier, Chester 'Trip'; Shaw, AndrewChronic postsurgical pain impacts most amputees, with more than half experiencing neuralgic residual limb pain. The transition from normal acute postamputation pain to chronic residual limb pain likely involves both peripheral and central inflammatory mechanisms. As part of the Veterans Integrated Pain Evaluation Research study, we investigated links between systemic inflammatory mediator levels and chronic residual limb pain. Subjects included 36 recent active duty military traumatic amputees with chronic residual limb pain and 40 without clinically significant pain. Blood samples were obtained and plasma concentrations of an array of inflammatory mediators were analyzed. Residual limb pain intensity and pain catastrophizing were assessed to examine associations with inflammatory mediators. Pro-inflammatory mediators including tumor necrosis factor (TNF)-α, TNF-β, interleukin (IL)-8, ICAM-1, Tie2, CRP, and SAA were elevated in patients with chronic residual limb pain. Across all patients, residual limb pain intensity was associated positively with levels of several proinflammatory mediators (IL-8, TNF-α, IL-12, TNF-β, PIGF, Tie2, SAA, and ICAM-1), and inversely with concentrations of the anti-inflammatory mediator IL-13, as well as IL-2 and Eotaxin-3. Pain catastrophizing correlated positively with IL-8, IL-12, TNF-β, PIGF, and ICAM-1, and inversely with IL-13. Significant associations between catastrophizing and residual limb pain intensity were partially mediated by TNF-α, TNF- β, SAA, and ICAM-1 levels. Results suggest that chronic postamputation residual limb pain is associated with excessive inflammatory response to injury or to inadequate resolution of the postinjury inflammatory state. Impact of pain catastrophizing on residual limb pain may be because of part to common underlying inflammatory mechanisms.Item Open Access Pain Phenotypes and Associated Clinical Risk Factors Following Traumatic Amputation: Results from Veterans Integrated Pain Evaluation Research (VIPER).(Pain medicine (Malden, Mass.), 2016-01) Buchheit, Thomas; Van de Ven, Thomas; Hsia, Hung-Lun John; McDuffie, Mary; MacLeod, David B; White, William; Chamessian, Alexander; Keefe, Francis J; Buckenmaier, Chester Trip; Shaw, Andrew DOBJECTIVE:To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain. DESIGN:Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury. SETTING:Military Medical Center. SUBJECTS:124 recent active duty military service members. METHODS:Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors. RESULTS:A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥ 3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter. CONCLUSIONS:Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.Item Open Access Pain regulation by non-neuronal cells and inflammation.(Science, 2016-11-04) Ji, Ru-Rong; Chamessian, Alexander; Zhang, Yu-QiuAcute pain is protective and a cardinal feature of inflammation. Chronic pain after arthritis, nerve injury, cancer, and chemotherapy is associated with chronic neuroinflammation, a local inflammation in the peripheral or central nervous system. Accumulating evidence suggests that non-neuronal cells such as immune cells, glial cells, keratinocytes, cancer cells, and stem cells play active roles in the pathogenesis and resolution of pain. We review how non-neuronal cells interact with nociceptive neurons by secreting neuroactive signaling molecules that modulate pain. Recent studies also suggest that bacterial infections regulate pain through direct actions on sensory neurons, and specific receptors are present in nociceptors to detect danger signals from infections. We also discuss new therapeutic strategies to control neuroinflammation for the prevention and treatment of chronic pain.Item Open Access The Cellular Determinants of Spinal and Peripheral Pain Processing(2018) Chamessian, AlexanderChronic pain is a major public health issue, affecting over 100 million people in costing over $600 million annually in the United States. The lack of effective therapies for chronic pain have directly contributed to the ongoing epidemic of opioid abuse and addiction. Deeper understanding the pathogenesis of chronic pain is a prerequisite for remedying the status quo. To that end, in this dissertation, I have undertaken two projects that aim to elucidate the key cellular elements of mechanical pain in the periphery and spinal cord.
Mechanical allodynia is a cardinal feature of pathological pain in which innocuous mechanical stimulation such as light touch produces a painful sensation. Recent work has demonstrated the necessity of cutaneous Aβ low-threshold mechanoreceptors (Aβ-LTMRs) for mechanical allodynia-like behaviors in mice, but its remains unclear whether activation of these neurons alone is sufficient to produce pain behaviors in pathological settings. To address this question, in the first part of this dissertation, I generated and characterized a transgenic mouse line that expresses the optogenetic actuator channelrhodopsin-2 (ChR2) conditionally in Vesicular Glutamate Transporter 1 (Vglut1)-expressing sensory neurons(Vglut1-ChR2). I show that the Vglut1-ChR2 comprises a heterogeneous population of Neurofilament 200-positive, large-sized sensory neurons with cutaneous projections that terminate in Merkel Cell-Neurite Complexes, Meissner Corpuscles and Hair Follicles and with spinal projections that terminate in the deep dorsal horn (Lamina IIi-V) and ventral horn in the spinal cord. In naive Vglut1-ChR2 mice, acute transdermal photostimulation of the plantar hindpaw with blue (470nm) light produced paw withdrawal behaviors in an intensity- and frequency-dependent manner that were abolished by selective pharmacological A-fiber blockade. light-evoked nocifensive behaviors such as licking, biting, jumping and vocalization were virtually absent in Vglut1-ChR2, even at the highest stimulation intensity and frequency. Plantar photostimulation of Vglut1-ChR2 mice in a Real-Time Place-Escape/Avoidance (RT-PEA) assay did not produce aversion, in contrast to the strong aversion elicited in mice that conditionally express ChR2 in Nav1.8-positive and Npy2r-positive nociceptors. Surprisingly, in the Spared Nerve Injury model of neuropathic pain, Vglut1-ChR2 mice did not show significant differences in light-evoked withdrawal behaviors or real-time aversion despite hypersensitivity to natural mechanical stimuli. Thus, I conclude that optogenetic activation of Vglut1-ChR2 neurons alone is not sufficient to produce pain-like behaviors in neuropathic mice.
In the second part of this dissertation, I investigated the cellular determinants of mechanical pain processing in the spinal dorsal horn (SDH), which is comprised of distinct neuronal populations that process different somatosensory modalities. Somatostatin (SST)-expressing interneurons in the SDH have been implicated specifically in mediating mechanical pain. Identifying the transcriptomic profile of SST neurons could elucidate the unique genetic features of this population and enable selective analgesic targeting. To that end, I combined the Isolation of Nuclei Tagged in Specific Cell Types (INTACT) method and Fluorescence Activated Nuclei Sorting (FANS) to capture tagged SST nuclei in the SDH of adult male mice. Using RNA-sequencing (RNA-seq), I uncovered more than 13,000 genes. Differential gene expression analysis revealed more than 900 genes with at least 2-fold enrichment. In addition to many known dorsal horn genes, I identified and validated several novel transcripts from pharmacologically tractable functional classes: Carbonic Anhydrase 12 (Car12), Phosphodiesterase 11A (Pde11a), and Protease-Activated Receptor 3 (F2rl2). In situ hybridization of these novel genes showed differential expression patterns in the SDH, demonstrating the presence of transcriptionally distinct subpopulations within the SST population. Overall, my findings provide new insights into the gene repertoire of SST dorsal horn neurons and reveal several novel targets for pharmacological modulation of this pain-mediating population and pathological pain.