neuropathic pain blocked by gene transfer technology and common virus

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Scientists use gene transfer technology and common virus to block

neuropathic pain

02 Jun 2005 Medical News Today

Remember how it felt the last time you burned your finger on a hot

stove? Imagine what it's like to have that burning pain in your hands

or feet all the time and know there's virtually nothing you can do

about it.

It's called neuropathic pain, and it's a common complication of many

diseases and medical conditions, especially diabetes. Drugs have

little effect on this type of pain, which is caused by damage to

sensory neurons that transmit pain, temperature and touch signals to

and from the brain.

Now, scientists at the VA Ann Arbor Healthcare System and the

University of Michigan Medical School have developed a way to block

the signals responsible for neuropathic pain. The secret to their

success is based on a virus called herpes simplex or HSV - the same

virus that causes cold sores and genital herpes. The scientists use a

disabled form of the virus, called a vector, to deliver genes to the

nucleus of neural cells.

A study published today in the June, 2005 of the ls of Neurology

describes how laboratory rats with nerve damage showed much less pain-

related behavior after receiving injections of the HSV-based vector,

which contained a gene called GAD, or glutamic acid decarboxylase.

The treatment's pain-killing effect lasted up to six weeks, and even

longer in rats that received additional injections.

The study is the first to demonstrate the successful use of gene

transfer technology, using a herpes viral vector, to treat peripheral

neuropathic pain in animals. Based on their success in related

studies with research animals, the scientists hope to conduct the

first clinical study in human patients soon.

" We use the vector to provide targeted gene delivery to the nervous

system, " says J. Fink, M.D., the W. Brear Professor of

Neurology in the U-M Medical School and staff neurologist at the VA

Ann Arbor Healthcare System, who co-directed the research study. " In

this case, we're not trying to correct a genetic defect. Our goal is

simply to deliver a gene to sensory nerve cells, so its product can

be used to block transmission of pain signals from damaged nerves to

the brain. "

After removing genes that make it possible for the herpes simplex

virus to infect a human host, VA/U-M scientists use it as a carrier

to deliver GAD to the nucleus of nerve cells in the dorsal root

ganglion near the spine. In previous studies, the researchers have

confirmed that the vector remains in the dorsal root ganglion, but an

enzyme expressed by the GAD gene moves to nerve terminals in the

spinal cord where it triggers production of a powerful

neurotransmitter called GABA.

" GABA is the main inhibitory neurotransmitter in the nervous system, "

Fink says. " It's like a hall monitor for the nervous system; it damps

down neurotransmission between cells to keep things quiet. You can't

have every neuron talking to every other neuron all the time or you'd

have chaos. "

Other scientists have shown that decreased GABA activity in the

spinal cord contributes to the development of neuropathic pain,

according to Fink.

Physicians have drugs that block neural transmission by mimicking the

actions of inhibitory agents like GABA, but it's difficult to give

these drugs in adequate doses, because the same drug that blocks pain

also interferes with brain activity, leaving people drowsy and unable

to think clearly.

" What we need is a way to release GABA in the spinal cord where it

can selectively block incoming pain signals from peripheral nerves, "

says Fink. " If we can block transmission of the signal at the first

neural synapse, it will never reach the brain and you won't feel

pain. "

That's where the herpes-based vector comes in. Although scientists

can use many kinds of vectors to transfer genes into living cells,

HSV has a natural ability to travel long distances along nerve fibers

to reach the neural cell's nucleus, which makes it the perfect gene

delivery vehicle for use in the nervous system.

" When we inject our HSV gene carrier under the skin of a laboratory

rat, the vector is taken up by sensory nerve terminals in the

animal's skin and carried through the axon back to the sensory

ganglia cell bodies next to the spinal cord, " says Shuanglin Hao,

M.D., Ph.D., a U-M research investigator and first author of the

study.

" Since the vector lacks essential viral genes for replication, it

remains in the nucleus expressing the GAD enzyme, which triggers

nerve terminals in the spinal cord to release GABA, " Fink adds. " As

long as the GAD gene remains active, GABA will continue to flood the

spinal cord and block the transmission of pain signals to the brain. "

In experiments reported in the ls of Neurology paper, VA/U-M

scientists tied off a nerve root in the sciatic nerve leading to the

left hind paw of eight rats in the study. Tying off the nerve root

makes the nerve degenerate and release substances that cause pain,

according to Fink. A second group of eight rats received sham

surgery, with no damage to their sciatic nerve. A third group served

as normal controls.

" When we study pain in people, we can ask them if it hurts, " says

Fink. " But you can't ask questions of a rat. So we study the animals'

behavior to discern whether they are experiencing pain using standard

models used to assess pain in rodents. "

One of the effects of neuropathic pain is called allodynia, which

means that even ordinary touch feels painful. In both rats and

people, scientists measure allodynia by touching the skin with a

series of filaments or exposing the skin to small amounts of moderate

heat. People with neuropathy perceive the filament's touch or heat as

a painful sensation. Rats with neuropathy will lift their paw if the

filament or heat produces pain. Rats without neuropathic pain don't

even notice. By monitoring whether rats lift their paw, and how long

it takes for them to do so, scientists can measure the degree of pain

the animal is feeling.

One week after surgery, some of the rats received injections of the

HSV vector with GAD, while control rats did not receive the vector.

Rats given the transgene vector had significantly lower pain

threshold responses to filament touch and heat exposure tests than

rats that did not receive the vector.

" We saw a sustained, continuous pain-suppressing effect that began

one week after inoculation with the vector and lasted for six weeks, "

says Marina Mata, M.D., staff neurologist at the VA Ann Arbor

Healthcare System, professor of neurology in the U-M Medical School

and co-director of the research team. " By seven weeks after

inoculation, the pain-blocking effect disappeared, but a second

inoculation into the same paw re-established the effect. "

In previous research, Mata and Fink have used their HSV vector to

deliver other neurotrophic factors and pain-suppressing drugs to

spinal ganglion cells. But Fink says the effect of the GAD-expressing

vector is substantially greater for neuropathic pain, because it

helps correct the reduction of GABA in the spinal cord. He also

emphasizes the excellent safety record of the HSV vector, which has

produced no side effects or complications in many animal studies.

" I am a clinical neurologist and I see patients with neuropathic

pain, " Fink says. " These patients suffer tremendously and the

treatments available to us now have limited effectiveness. Using our

herpes vector to provide targeted gene delivery to the nervous system

is a novel approach that shows tremendous promise for the treatment

of neuropathic pain. "

In future research, the scientists plan to conduct the first phase I

safety trial of a related HSV vector in patients with pain caused by

terminal cancer, which has spread to bone.

The research was supported by grants from the National Institute of

Neurological Disorders and Stroke and the Department of Veterans

Affairs. Additional collaborators in the study included Darren Wolfe,

Ph.D. and ph Glorioso, Ph.D., from the University of Pittsburgh.

The University of Michigan and the University of Pittsburgh hold

patents related to the herpes simplex virus-based vector.

Citation: ls of Neurology: 57(6), pp. 914-918.

University of Michigan Health Systems

http://www.umich.edu