Nature Reviews Neurology | Review

Mitotoxicity in distal symmetrical sensory peripheral neuropathies

Journal name:
Nature Reviews Neurology
Year published:
DOI:
doi:10.1038/nrneurol.2014.77
Published online

Abstract

Chronic distal symmetrical sensory peripheral neuropathy is a common neurological complication of cancer chemotherapy, HIV treatment and diabetes. Although aetiology-specific differences in presentation are evident, the clinical signs and symptoms of these neuropathies are clearly similar. Data from animal models of neuropathic pain suggest that the similarities have a common cause: mitochondrial dysfunction in primary afferent sensory neurons. Mitochondrial dysfunction is caused by mitotoxic effects of cancer chemotherapeutic drugs of several chemical classes, HIV-associated viral proteins, and nucleoside reverse transcriptase inhibitor treatment, as well as the (possibly both direct and indirect) effects of excess glucose. The mitochondrial injury results in a chronic neuronal energy deficit, which gives rise to spontaneous nerve impulses and a compartmental neuronal degeneration that is first apparent in the terminal receptor arbor—that is, intraepidermal nerve fibres—of cutaneous afferent neurons. Preliminary data suggest that drugs that prevent mitochondrial injury or improve mitochondrial function could be useful in the treatment of these conditions.

At a glance

Figures

First | 1-3 of 4 | Last
left
  1. Clinical symptoms and biomarkers of chronic distal symmetrical sensory peripheral neuropathy.
    Figure 1: Clinical symptoms and biomarkers of chronic distal symmetrical sensory peripheral neuropathy.

    Patients with distal symmetrical sensory peripheral neuropathy due to cancer chemotherapeutic treatment, HIV and nucleoside analogue reverse transcriptase inhibitor therapy, or diabetes complain of similar sensory disturbances: numbness combined with a dysaesthetic sensation of pins-and-needles and/or burning pain, along with allodynia and hyperalgesia. These sensory abnormalities appear in both of the feet, or in both the feet and the hands. Skin punch biopsy often reveals a significant loss of sensory axons from the epidermis (intraepidermal nerve fibres), even in cases where electrodiagnostic studies are normal.

  2. Underlying mechanisms in the development of distal symmetrical sensory peripheral neuropathy.
    Figure 2: Underlying mechanisms in the development of distal symmetrical sensory peripheral neuropathy.

    Distal neuropathy does not result from degeneration of the somatosensory primary afferent neuron, as indicated by a lack of ATF3+ nuclear signalling (a marker of axonal injury) and preservation of peripheral nerve axons. Instead, both preclinical and clinical stages of distal neuropathy are associated with mitochondrial dysfunction that leads to IENF degeneration and emergence of spontaneous discharges. Abbreviations: IENF, intraepidermal nerve fibre; RNS, reactive nitrogen species; ROS, reactive oxygen species.

  3. Contribution of nitro-oxidative stress to mitochondrial dysfunction.
    Figure 3: Contribution of nitro-oxidative stress to mitochondrial dysfunction.

    During mitochondrial respiration, the oxidative phosphorylation pathway produces the proton gradient required for ATP production. Electrons leaking from the electron transport chain react with molecular oxygen to produce potentially damaging O2−, which has the potential to generate other reactive oxygen species and—via interaction with NO—peroxynitrite. Under normal conditions, the antioxidant defence system (including MnSOD, catalase, glutathione and glutathione peroxidase) adequately reduces superoxide to water and molecular oxygen;81 however, if these mechanisms are overwhelmed, formation of peroxynitrite increases.89 In turn, peroxynitrite induces a bioenergetic deficit by disrupting the activities of metabolic enzymes, mitochondrial electron transport chain proteins, ATP synthase, and membrane transport proteins.80, 81 Notably peroxynitrite-induced damage to MnSOD creates a feed-forward mechanism for enhancing its own production, thus facilitating the hazardous accumulation of superoxide.80, 81 Blue lines indicate pathways for the formation of reactive oxygen and reactive nitrogen species, red lines indicate potential targets of peroxynitrite-induced mitochondrial dysfunction. Abbreviations: C, complex; MnSOD, manganese superoxide dismutase; NO, nitric oxide; O2−, superoxide ion.

  4. Peroxynitrite decomposition catalysts.
    Figure 4: Peroxynitrite decomposition catalysts.

    These porphyrin-based agents, typified by MnTM-4-PyP5+, FeTM-4-PyP5+ and MnTE-2-PyP5+, act as dual MnSOD mimetics and peroxynitrite decomposition catalysts to eliminate peroxynitrite as well as potentially beneficial superoxide. The newer selective agents, SRI6 and SRI110, eliminate peroxynitrite while sparing superoxide. The charged metal centre of SRI6 is shielded by β-fused cyclohexenyl substituents, rendering it membrane-permeable and orally bioavailable.92 Moreover, the charged electron-withdrawing functionality of other agents such as FeTMPyP5+ is absent from SRI6, which reduces its MnSOD mimetic activity.92 SRI110 is also orally bioavailable owing to its electroneutrality.93 Through a two-electron reduction mechanism, SRI110 reacts with peroxynitrite to produce a manganese (V)–oxo intermediate with concomitant reduction of peroxynitrite to nitrite.93 The manganese (III) catalyst is then regenerated by endogenous reductants, completing a reductase-type cycle.93 Abbreviation: MnSOD, manganese superoxide dismutase.

right

References

  1. Quasthoff, S. & Hartung, H. P. Chemotherapy-induced peripheral neuropathy. J. Neurol. 249, 9–17 (2002).
  2. Argyriou, A. A., Iconomou, G. & Kalofonos, H. P. Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature. Blood 112, 1593–1599 (2008).
  3. Callaghan, B. C., Cheng, H. T., Stables, C. L., Smith, A. L. & Feldman, E. L. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 11, 521–534 (2012).
  4. Centner, C. M., Bateman, K. J. & Heckmann, J. M. Manifestations of HIV infection in the peripheral nervous system. Lancet Neurol. 12, 295–309 (2013).
  5. Lauria, G., Merkies, I. S. & Faber, C. G. Small fibre neuropathy. Curr. Opin. Neurol. 25, 542–549 (2012).
  6. Flatters, S. J. & Bennett, G. J. Studies of peripheral sensory nerves in paclitaxel-induced painful peripheral neuropathy: evidence for mitochondrial dysfunction. Pain 122, 245–257 (2006).
  7. Xiao, W. H. & Bennett, G. J. Effects of mitochondrial poisons on the neuropathic pain produced by the chemotherapeutic agents, paclitaxel and oxaliplatin. Pain 153, 704–709 (2012).
  8. Zheng, H., Xiao, W. H. & Bennett, G. J. Functional deficits in peripheral nerve mitochondria in rats with paclitaxel- and oxaliplatin-evoked painful peripheral neuropathy. Exp. Neurol. 232, 154–161 (2011).
  9. Zheng, H., Xiao, W. H. & Bennett, G. J. Mitotoxicity and bortezomib-induced chronic painful peripheral neuropathy. Exp. Neurol. 238, 225–234 (2012).
  10. Webster, R. G., Brain, K. L., Wilson, R. H., Grem, J. L. & Vincent, A. Oxaliplatin induces hyperexcitability at motor and autonomic neuromuscular junctions through effects on voltage-gated sodium channels. Br. J. Pharmacol. 146, 1027–1039 (2005).
  11. Loprinzi, C. L. et al. The Paclitaxel acute pain syndrome: sensitization of nociceptors as the putative mechanism. Cancer J. 13, 399–403 (2007).
  12. Kleggetveit, I. P. et al. High spontaneous activity of C-nociceptors in painful polyneuropathy. Pain 153, 2040–2047 (2012).
  13. Xiao, W. H. & Bennett, G. J. Chemotherapy-evoked neuropathic pain: abnormal spontaneous discharge in A-fiber and C-fiber primary afferent neurons and its suppression by acetyl-L-carnitine. Pain 135, 262–270 (2008).
  14. Xiao, W. H. et al. Mitochondrial abnormality in sensory, but not motor, axons in paclitaxel-evoked painful peripheral neuropathy in the rat. Neuroscience 199, 461–469 (2011).
  15. Erecinska, M. & Silver, I. A. Ions and energy in mammalian brain. Prog. Neurobiol. 43, 37–71 (1994).
  16. Xiao, W. H., Zheng, H. & Bennett, G. J. Characterization of oxaliplatin-induced chronic painful peripheral neuropathy in the rat and comparison with the neuropathy induced by paclitaxel. Neuroscience 203, 194–206 (2012).
  17. Han, C. et al. The G1662S NaV1.8 mutation in small fibre neuropathy: impaired inactivation underlying DRG neuron hyperexcitability. J. Neurol. Neurosurg. Psychiatry http://dx.doi.org/10.1136/jnnp-2013-306095.
  18. Argyriou, A. A. et al. Voltage-gated sodium channel polymorphisms play a pivotal role in the development of oxaliplatin-induced peripheral neurotoxicity: results from a prospective multicenter study. Cancer 119, 3570–3577 (2013).
  19. Boyette-Davis, J. A. et al. Follow-up psychophysical studies in bortezomib-related chemoneuropathy patients. J. Pain 12, 1017–1024 (2011).
  20. Koskinen, M. J. et al. Intraepidermal nerve fibre density in cancer patients receiving adjuvant chemotherapy. Anticancer Res. 31, 4413–4416 (2011).
  21. Loseth, S., Stalberg, E., Jorde, R. & Mellgren, S. I. Early diabetic neuropathy: thermal thresholds and intraepidermal nerve fibre density in patients with normal nerve conduction studies. J. Neurol. 255, 1197–1202 (2008).
  22. Sumner, C. J., Sheth, S., Griffin, J. W., Cornblath, D. R. & Polydefkis, M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 60, 108–111 (2003).
  23. Polydefkis, M. et al. Reduced intraepidermal nerve fiber density in HIV-associated sensory neuropathy. Neurology 58, 115–119 (2002).
  24. Herrmann, D. N., Griffin, J. W., Hauer, P., Cornblath, D. R. & McArthur, J. C. Epidermal nerve fiber density and sural nerve morphometry in peripheral neuropathies. Neurology 53, 1634–1640 (1999).
  25. Nebuchennykh, M., Loseth, S., Lindal, S. & Mellgren, S. I. The value of skin biopsy with recording of intraepidermal nerve fiber density and quantitative sensory testing in the assessment of small fiber involvement in patients with different causes of polyneuropathy. J. Neurol. 256, 1067–1075 (2009).
  26. Bennett, G. J., Liu, G. K., Xiao, W. H., Jin, H. W. & Siau, C. Terminal arbor degeneration—a novel lesion produced by the antineoplastic agent paclitaxel. Eur. J. Neurosci. 33, 1667–1676 (2011).
  27. Siau, C., Xiao, W. & Bennett, G. J. Paclitaxel- and vincristine-evoked painful peripheral neuropathies: loss of epidermal innervation and activation of Langerhans cells. Exp. Neurol. 201, 507–514 (2006).
  28. Jin, H. W., Flatters, S. J., Xiao, W. H., Mulhern, H. L. & Bennett, G. J. Prevention of paclitaxel-evoked painful peripheral neuropathy by acetyl-L-carnitine: effects on axonal mitochondria, sensory nerve fiber terminal arbors, and cutaneous Langerhans cells. Exp. Neurol. 210, 229–237 (2008).
  29. Janes, K. et al. Bioenergetic deficits in peripheral nerve sensory axons during chemotherapy-induced neuropathic pain resulting from peroxynitrite-mediated post-translational nitration of mitochondrial superoxide dismutase. Pain 154, 2432–2440 (2013).
  30. Barriere, D. A. et al. Paclitaxel therapy potentiates cold hyperalgesia in streptozotocin-induced diabetic rats through enhanced mitochondrial reactive oxygen species production and TRPA1 sensitization. Pain 153, 553–561 (2012).
  31. Joseph, E. K. & Levine, J. D. Mitochondrial electron transport in models of neuropathic and inflammatory pain. Pain 121, 105–114 (2006).
  32. Kokotis, P. et al. Polyneuropathy induced by HIV disease and antiretroviral therapy. Clin. Neurophysiol. 124, 176–182 (2013).
  33. Dalakas, M. C., Semino-Mora, C. & Leon-Monzon, M. Mitochondrial alterations with mitochondrial DNA depletion in the nerves of AIDS patients with peripheral neuropathy induced by 2′3′-dideoxycytidine (ddC). Lab. Invest. 81, 1537–1544 (2001).
  34. Lehmann, H. C., Chen, W., Borzan, J., Mankowski, J. L. & Höke, A. Mitochondrial dysfunction in distal axons contributes to human immunodeficiency virus sensory neuropathy. Ann. Neurol. 69, 100–110 (2011).
  35. Campenot, R. B. & Eng, H. Protein synthesis in axons and its possible functions. J. Neurocytol. 29, 793–798 (2000).
  36. Mocchetti, I., Bachis, A. & Avdoshina, V. Neurotoxicity of human immunodeficiency virus-1: viral proteins and axonal transport. Neurotox. Res. 21, 79–89 (2012).
  37. Herzberg, U. & Sagen, J. Peripheral nerve exposure to HIV viral envelope protein gp120 induces neuropathic pain and spinal gliosis. J. Neuroimmunol. 116, 29–39 (2001).
  38. Wallace, V. C. et al. Characterization of rodent models of HIV-gp120 and anti-retroviral-associated neuropathic pain. Brain 130, 2688–2702 (2007).
  39. Kamerman, P. R. et al. Pathogenesis of HIV-associated sensory neuropathy: evidence from in vivo and in vitro experimental models. J. Peripher. Nerv. Syst. 17, 19–31 (2012).
  40. Melli, G., Keswani, S. C., Fischer, A., Chen, W. & Hoke, A. Spatially distinct and functionally independent mechanisms of axonal degeneration in a model of HIV-associated sensory neuropathy. Brain 129, 1330–1338 (2006).
  41. Norman, J. P. et al. HIV-1 Tat activates neuronal ryanodine receptors with rapid induction of the unfolded protein response and mitochondrial hyperpolarization. PLoS ONE 3, e3731 (2008).
  42. Lecoeur, H. et al. HIV-1 Tat protein directly induces mitochondrial membrane permeabilization and inactivates cytochrome c oxidase. Cell. Death Dis. 3, e282 (2012).
  43. Deniaud, A., Brenner, C. & Kroemer, G. Mitochondrial membrane permeabilization by HIV-1 Vpr. Mitochondrion 4, 223–233 (2004).
  44. Huang, C. Y., Chiang, S. F., Lin, T. Y., Chiou, S. H. & Chow, K. C. HIV-1 Vpr triggers mitochondrial destruction by impairing Mfn2-mediated ER-mitochondria interaction. PLoS ONE 7, e33657 (2012).
  45. Kitayama, H. et al. Human immunodeficiency virus type 1 Vpr inhibits axonal outgrowth through induction of mitochondrial dysfunction. J. Virol. 82, 2528–2542 (2008).
  46. Leung, G. P. Iatrogenic mitochondriopathies: a recent lesson from nucleoside/nucleotide reverse transcriptase inhibitors. Adv. Exp. Med. Biol. 942, 347–369 (2012).
  47. Keswani, S. C., Jack, C., Zhou, C. & Hoke, A. Establishment of a rodent model of HIV-associated sensory neuropathy. J. Neurosci. 26, 10299–10304 (2006).
  48. Robinson, B., Li, Z. & Nath, A. Nucleoside reverse transcriptase inhibitors and human immunodeficiency virus proteins cause axonal injury in human dorsal root ganglia cultures. J. Neurovirol. 13, 160–167 (2007).
  49. Van Steenwinckel, J. et al. Role of spinal serotonin 5-HT2A receptor in 2′,3′-dideoxycytidine-induced neuropathic pain in the rat and the mouse. Pain 137, 66–80 (2008).
  50. Huang, W. et al. A clinically relevant rodent model of the HIV antiretroviral drug stavudine induced painful peripheral neuropathy. Pain 154, 560–575 (2013).
  51. Zhu, Y. et al. Didanosine causes sensory neuropathy in an HIV/AIDS animal model: impaired mitochondrial and neurotrophic factor gene expression. Brain 130, 2011–2023 (2007).
  52. Callaghan, B. C., Hur, J. & Feldman, E. L. Diabetic neuropathy: one disease or two? Curr. Opin. Neurol. 25, 536–541 (2012).
  53. Papanas, N., Vinik, A. I. & Ziegler, D. Neuropathy in prediabetes: does the clock start ticking early? Nat. Rev. Endocrinol. 7, 682–690 (2011).
  54. Sivitz, W. I. & Yorek, M. A. Mitochondrial dysfunction in diabetes: from molecular mechanisms to functional significance and therapeutic opportunities. Antioxid. Redox. Signal. 12, 537–577 (2010).
  55. Chowdhury, S. K., Smith, D. R. & Fernyhough, P. The role of aberrant mitochondrial bioenergetics in diabetic neuropathy. Neurobiol. Dis. 51, 56–65 (2013).
  56. Tomlinson, D. R. & Gardiner, N. J. Glucose neurotoxicity. Nat. Rev. Neurosci. 9, 36–45 (2008).
  57. Hinder, L. M., Vincent, A. M., Burant, C. F., Pennathur, S. & Feldman, E. L. Bioenergetics in diabetic neuropathy: what we need to know. J. Peripher. Nerv. Syst. 17 (Suppl. 2), 10–14 (2012).
  58. Zenker, J., Ziegler, D. & Chrast, R. Novel pathogenic pathways in diabetic neuropathy. Trends Neurosci. 36, 439–449 (2013).
  59. Eberhardt, M. J. et al. Methylglyoxal activates nociceptors through transient receptor potential channel A1 (TRPA1): a possible mechanism of metabolic neuropathies. J. Biol. Chem. 287, 28291–28306 (2012).
  60. Fernyhough, P., Roy Chowdhury, S. K. & Schmidt, R. E. Mitochondrial stress and the pathogenesis of diabetic neuropathy. Expert Rev. Endocrinol. Metab. 5, 39–49 (2010).
  61. Roy Chowdhury, S. K. et al. Impaired adenosine monophosphate-activated protein kinase signalling in dorsal root ganglia neurons is linked to mitochondrial dysfunction and peripheral neuropathy in diabetes. Brain 135, 1751–1766 (2012).
  62. Chowdhury, S. K. et al. Mitochondrial respiratory chain dysfunction in dorsal root ganglia of streptozotocin-induced diabetic rats and its correction by insulin treatment. Diabetes 59, 1082–1091 (2010).
  63. Akude, E. et al. Diminished superoxide generation is associated with respiratory chain dysfunction and changes in the mitochondrial proteome of sensory neurons from diabetic rats. Diabetes 60, 288–297 (2011).
  64. Urban, M. J. et al. Modulating molecular chaperones improves sensory fiber recovery and mitochondrial function in diabetic peripheral neuropathy. Exp. Neurol. 235, 388–396 (2012).
  65. Saleh, A. et al. Ciliary neurotrophic factor activates NF-κB to enhance mitochondrial bioenergetics and prevent neuropathy in sensory neurons of streptozotocin-induced diabetic rodents. Neuropharmacology 65, 65–73 (2013).
  66. Vincent, A. M. et al. Mitochondrial biogenesis and fission in axons in cell culture and animal models of diabetic neuropathy. Acta Neuropathol. 120, 477–489 (2010).
  67. Obrosova, I. G. Diabetic painful and insensate neuropathy: pathogenesis and potential treatments. Neurotherapeutics 6, 638–647 (2009).
  68. Golbidi, S., Badran, M. & Laher, I. Diabetes and alpha lipoic acid. Front. Pharmacol. 2, 69 (2011).
  69. Stevens, M. J., Obrosova, I., Cao, X., Van Huysen, C. & Greene, D. A. Effects of DL-α-lipoic acid on peripheral nerve conduction, blood flow, energy metabolism, and oxidative stress in experimental diabetic neuropathy. Diabetes 49, 1006–1015 (2000).
  70. Melli, G. et al. Alpha-lipoic acid prevents mitochondrial damage and neurotoxicity in experimental chemotherapy neuropathy. Exp. Neurol. 214, 276–284 (2008).
  71. Boulton, A. J., Kempler, P., Ametov, A. & Ziegler, D. Whither pathogenetic treatments for diabetic polyneuropathy? Diabetes Metab. Res. Rev. 29, 327–333 (2013).
  72. Trevisan, G. et al. Novel therapeutic strategy to prevent chemotherapy-induced persistent sensory neuropathy by TRPA1 blockade. Cancer Res. 73, 3120–3131 (2013).
  73. Gedlicka, C., Scheithauer, W., Schull, B. & Kornek, G. V. Effective treatment of oxaliplatin-induced cumulative polyneuropathy with alpha-lipoic acid. J. Clin. Oncol. 20, 3359–3361 (2002).
  74. Chiechio, S., Copani, A., Nicoletti, F. & Gereau, R. W. 4<sup>th</sup>. L-acetylcarnitine: a proposed therapeutic agent for painful peripheral neuropathies. Curr. Neuropharmacol. 4, 233–237 (2006).
  75. Sima, A. A., Calvani, M., Mehra, M., Amato, A. & Acetyl-L-Carnitine Study Group. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials. Diabetes Care 28, 89–94 (2005).
  76. Youle, M., Osio, M. & ALCAR Study Group. A double-blind, parallel-group, placebo-controlled, multicentre study of acetyl L-carnitine in the symptomatic treatment of antiretroviral toxic neuropathy in patients with HIV-1 infection. HIV Med. 8, 241–250 (2007).
  77. Bianchi, G. et al. Symptomatic and neurophysiological responses of paclitaxel- or cisplatin-induced neuropathy to oral acetyl-L-carnitine. Eur. J. Cancer 41, 1746–1750 (2005).
  78. Hershman, D. L. et al. Randomized double-blind placebo-controlled trial of acetyl-L-carnitine for the prevention of taxane-induced neuropathy in women undergoing adjuvant breast cancer therapy. J. Clin. Oncol. 31, 2627–2633 (2013).
  79. Xiao, W. H., Zheng, F. Y., Bennett, G. J., Bordet, T. & Pruss, R. M. Olesoxime (cholest-4-en-3-one, oxime): analgesic and neuroprotective effects in a rat model of painful peripheral neuropathy produced by the chemotherapeutic agent, paclitaxel. Pain 147, 202–209 (2009).
  80. Cassina, A. & Radi, R. Differential inhibitory action of nitric oxide and peroxynitrite on mitochondrial electron transport. Arch. Biochem. Biophys. 328, 309–316 (1996).
  81. Radi, R., Cassina, A., Hodara, R., Quijano, C. & Castro, L. Peroxynitrite reactions and formation in mitochondria. Free Radic. Biol. Med. 33, 1451–1464 (2002).
  82. Drose, S. & Brandt, U. Molecular mechanisms of superoxide production by the mitochondrial respiratory chain. Adv. Exp. Med. Biol. 748, 145–169 (2012).
  83. Fidanboylu, M., Griffiths, L. A. & Flatters, S. J. Global inhibition of reactive oxygen species (ROS) inhibits paclitaxel-induced painful peripheral neuropathy. PLoS ONE 6, e25212 (2011).
  84. Toyama, S. et al. Characterization of acute and chronic neuropathies induced by oxaliplatin in mice and differential effects of a novel mitochondria-targeted antioxidant on the neuropathies. Anesthesiology 120, 459–473 (2014).
  85. Kamboj, S. S., Vasishta, R. K. & Sandhir, R. N-acetylcysteine inhibits hyperglycemia-induced oxidative stress and apoptosis markers in diabetic neuropathy. J. Neurochem. 112, 77–91 (2010).
  86. Lin, P. C. et al. N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data. Support. Care Cancer 14, 484–487 (2006).
  87. Cascinu, S. et al. Neuroprotective effect of reduced glutathione on oxaliplatin-based chemotherapy in advanced colorectal cancer: a randomized, double-blind, placebo-controlled trial. J. Clin. Oncol. 20, 3478–3483 (2002).
  88. Doyle, T. et al. Targeting the overproduction of peroxynitrite for the prevention and reversal of paclitaxel-induced neuropathic pain. J. Neurosci. 32, 6149–6160 (2012).
  89. Beckman, J. S., Beckman, T. W., Chen, J., Marshall, P. A. & Freeman, B. A. Apparent hydroxyl radical production by peroxynitrite: implications for endothelial injury from nitric oxide and superoxide. Proc. Natl Acad. Sci. USA 87, 1620–1624 (1990).
  90. Payne, J. E. et al. Discovery of dual inducible/neuronal nitric oxide synthase (iNOS/nNOS) inhibitor development candidate 4-((2-cyclobutyl-1H-imidazo[4,5-b]pyrazin-1-yl)methyl)-7, 8-difluoroquinolin-2(1H)-one (KD7332) Part 2: identification of a novel, potent, and selective series of benzimidazole-quinolinone iNOS/nNOS dimerization inhibitors that are orally active in pain models. J. Med. Chem. 53, 7739–7755 (2010).
  91. Latremoliere, A. & Woolf, C. J. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J. Pain 10, 895–926 (2009).
  92. Rausaria, S. et al. Retooling manganese(III) porphyrin-based peroxynitrite decomposition catalysts for selectivity and oral activity: a potential new strategy for treating chronic pain. J. Med. Chem. 54, 8658–8669 (2011).
  93. Rausaria, S. et al. Manganese(III) complexes of bis(hydroxyphenyl)dipyrromethenes are potent orally active peroxynitrite scavengers. J. Am. Chem. Soc. 133, 4200–4203 (2011).

Download references

Author information
Affiliations
  1. Department of Anaesthesia, Faculty of Dentistry, and The Alan Edwards Centre for Research on Pain, McGill University, 3655 Promenade Sir William Osler, Montréal, QC H3G 1Y6, Canada.
    • Gary J. Bennett
  2. Department of Pharmacological and Physiological Sciences, Saint Louis University School of Medicine, 1402 South Grand Boulevard, St Louis, MO 63104, USA.
    • Timothy Doyle &
    • Daniela Salvemini
ContributionsAll three authors provided substantial contributions to discussions of the content of the manuscript, researched the literature, and participated in writing, editing and revision of the manuscript.
Competing interests statementD.S. and the Saint Louis University School of Medicine have patents concerning the use of superoxide dismutase mimetics and peroxynitrite decomposition catalysts for the treatment and prevention of neuropathic pain (WO 2012033916 A1 20120315; US 20080318917 A1 20081225; WO 2005060437 A2 20050707; US 6214817 B1 20010410; WO 9858636 A1 19981230). G.J.B and T.D. declare no competing interests.
Corresponding author

Correspondence to:

Author details
  • Gary J. Bennett
    Gary Bennett is Professor and Canada Senior Research Chair in the Department of Anesthesia and the Faculty of Dentistry at McGill University, Montreal, QC, Canada and Adjunct Professor in the Department of Anesthesiology at the University of California, San Diego, CA, USA. He received his PhD in psychology from Virginia Commonwealth University in Richmond, VA, USA, and spent 20 years as a staff scientist at the Neurobiology and Anesthesiology Branch, National Institute of Dental Research, NIH, Bethesda, MD, USA). For the past 35 years his research has focused on neuropathic pain syndromes and the development of new analgesics.
    Contact Gary J. Bennett
    Search for this author in:
  • Timothy Doyle
    Timothy Doyle is Research Assistant Professor in the Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO, USA. He received his PhD from Saint Louis University for studying the inflammatory and biochemical mechanisms of septic shock, before his postdoctoral fellowship in the laboratory of Professor Daniela Salvemini researching the mechanisms underlying pain and pain therapeutics. His current research focuses on understanding the molecular, biochemical and inflammatory signaling pathways involved in the development and maintenance of chronic neuropathic pain.
    Search for this author in:
  • Daniela Salvemini
    Daniela Salvemini is Professor in the Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO, USA. She received her BSc in pharmacology from King's College, London, UK and her PhD in pharmacology under the mentorship of Nobel Laureate Sir John R. Vane at the William Harvey Research Institute in London. She spent over a decade in the private sector, leading drug discovery efforts. Her research focuses on the cellular and molecular changes that underlie chronic pain and opioid-induced analgesic tolerance. Her research is highly translational and stresses cross-fertilization with discovery chemistry.
    Search for this author in: