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The Journal of Neuroscience, May 1993, 13(5): 1976-1992 Na+ Channel lmmunolocalization in Peripheral Mammalian Axons and Changes following Nerve Injury and Neuroma Formation Marshall Devor,’ Ruth Govrin-Lippmann,’ and Kimon Angelides* ‘Department of Cell and Animal Biology, Life Sciences Institute, Hebrew University of Jerusalem, Jerusalem 91904, Israel and 2Department of Cell Biology, Baylor College of Medicine, Houston, Texas 77030 Nerve injury frequently triggers hyperexcitability and the ec- channel-rich membrane patch that servesto encode integrated topic initiation of impulses in primary afferent axons. An im- depolarizations from dendritic and somatic inputs into an ap- portant consequence is neuropathic paresthesias and pain. propriate firing pattern. Usually this encoding region lies near Electrogenesis in normal afferents depends on appropriate the cell soma: the axon hillock or the first node of Ranvier Na+ channel concentrations. Therefore, we have asked (Dodge and Cooley, 1973; Waxman and Quick, 1978; Matsu- whether injury might trigger changes in axolemmal Na+ chan- moto and Rosenbluth, 1985; Wollner and Catterall, 1986). An nel distribution that could account for neuropathic hyper- exception is the primary afferent neuron, in which this zone is excitability. We used an Na+ channel-specific antibody, 7493, displaced to the far distal end of the peripheral axon, often to immunolocalize Na+ channels ultrastructurally in mem- centimeters or even meters from the cell soma. Here it serves branes of normal rat axons, and to assess remodeling fol- as a sensorytransducer ending. lowing nerve section and neuroma formation. Selective la- The sensory end of afferent axons is highly specialized for beling of nodal axolemma and, more weakly, of Schwann translating stimulus-evoked depolarizations (generator poten- cell membrane, confirmed the efficacy of our immunolabel- tial) into spike trains. This capability is absent over the rest of ing protocol. In neuromas at postoperative times associated the axon. For example, mechanical or thermal stimulation in with peak ectopic activity, we found clear evidence of Na+ mid-nerve, or even direct injection of depolarizing current channel accumulation. Specifically, soon after myelin was through an intracellular microelectrode, doesnot yield sustained stripped from large-diameter axons, the exposed, formerly firing (Ruiz et al., 198 1). internodal axolemma became immunopositive. Small-di- In contrast to the midnerve part of intact axons, many chron- ameter unmyelinated axons and axon sprouts in the neuroma ically injured afferents are able to sustain repetitive discharge. were also marked with 7493 IgG. Activated phagocytic mac- This ectopic rhythmic firing capability develops with time at rophages and endothelial cells were 7493 negative. Both formerly mid-nerve sites, yielding foci of abnormal evoked and large- and small-diameter axons in neuromas end in swollen, spontaneousafferent discharge(Koschorke et al., 1991; Devor, organelle-packed “end bulbs.” Most, but not all, of these 1993). In recent years a good deal of evidence hasaccumulated acquired Na+ channel immunolabeling. We propose that re- establishing activity originating at such ectopic neural pace- modeling results from a modification of the normal process maker sites as an important cause of neuropathic paresthesias of Na+ channel turnover in neural membranes. Na+ channel and pain in nerve injured patients (Nystrom and Hagbarth, protein accumulates in preterminal axolemma and neuroma 1981; Ochoa et al., 1982; Nordin et al., 1984; Devor, 1993). end bulbs due to a combination of permissive factors (es- These indications of a causal link between abnormal neural pecially myelin removal) and promotional factors (removal activity and neuropathic pain motivate a searchfor the cellular of normal downstream targets). This accumulation is a likely mechanism responsiblefor the development of ectopic firing precursor of afferent hyperexcitability in injured nerve. capability in afferents. Since impulse initiation at normal lo- [Key words: ectopic hyperexcitability, membrane remod- cations is dependent on Na+ channels, we have used an Na+ eling, nerve injury, neuroma, pain, sodium channels] channel-specific antibody to look for possiblechanges in Na+ channel distribution at sites of nerve injury associatedwith The ability of neurons to initiate trains of action potentials ectopic firing. dependson the presenceof transmembraneproteins that serve as regulated channelsfor ionic current flow. A uniquely impor- Materials and Methods tant one in this process is the voltage-sensitive Na+ channel Subjects and surgery.We usedadult (>300 gm) maleWistar-derived (Hille, 1984). Most vertebrate neurons have a localized, Na+ Sabrastrain rats.Work followedethical guidelines of the International Associationfor the Study of Pain(IASP), and university and national regulationson humaneuse of researchanimals. Under Nembutalan- esthesia (50 mg/kg, i.p.), the sciatic nerve was exposed in the popliteal Received Mar. 9, 1992; revised Nov. 6, 1992; accepted Nov. II, 1992. fossaand tightly ligatedwith 5-Osilk. The nerve wasthen cut across We acknowledge the helpful comments of S. G. Waxman, J. A. Black, and M. about 1 mm distal to the ligature, andabout 5 mm of the distal stump H. Ellisman. This work was supported by grants from the United States-Israel Binational Science Foundation (BSF), the Hebrew University Center for Research wasexcised. Alternatively, the L4 and L5 dorsalroots (DRs) were ex- on Pain, the (U.S.) National Multiple Sclerosis Society, and the U.S. National posed in a lumbar laminectomy, tightly ligated with 6-O silk -3-5 mm Institutes of Health (NIH Grant CNS28072). from their point of entry into the spinal cord, and cut between the Correspondence should he addressed to Prof. Marshall Devor at the above ligatureand the cord. In somerats both lesionswere carried out. In- address. cisions were closed in layers, and topical and systemic antibiotics ad- Copyright @ 1993 Society for Neuroscience 0270-6474/93/131976-17.SO5.00/0 ministered. Recovery was uneventful. This net-ve/DR injury, designed The Journal of Neuroscience, May 1993, 73(5) 1977 to suppress regeneration and promote neuroma formation, is identical axons was disrupted and undergoing active phagocytosis,while to that used in our prior electrophysiological and anatomical studies of in others new myelin was being laid down. This zone was rich experimental neuromas (reviewed in Devor, 1993). The rats were maintained postoperatively under standard colony con- in demyelinated preterminal axon segments,swollen organelle- ditions. At appropriate times they were deeply anesthetized and perfused packed terminal “end bulbs,” and at later survival times, nu- transcardially with saline followed by 4% paraformaldehyde in 0.1 M merous preterminal axon branches and fine unmyelinated PO, buffer (37°C pH 7.4). After ~230 min postfixation in situ, tissue sprouts. (3) In the 300 pm nearest the ligature was a “zone of was removed and postfixed for an additional 2-3 hr at 4°C. In addition demyelination” in which myelin was removed without renewal. to neuromas and proximal nerve and DR segments, control samples of intact contralateral nerves and DRs were also taken. Most axon end bulbs occurred within this region, which also Immunostaining. The results are based primarily on DR and sciatic had many demyelinated axons, and a gradually increasingpop- nerve neuromas from rats that survived 7 and 13 d postoperatively, the ulation of axons sprouts. (4) Finally, under the ligature, was a interval corresponding to the peak of neuroma A-fiber hyperexcitability “compression zone” that contained few, if any, neuronal pro- (Pauir-Kricheli and Devor. 1988). Short seaments of fixed nerve, DR. and neuroma segments were quartered longytudinally using a fresh #l 1 cesses.In the present study we focused on Na+ channel im- blade, and desheathed. They were then rinsed (3 x 5 min buffer, 3 x munolocalization within the zones of dys- and demyelination 5 min buffer with 0.1 M glycine, 4”C), transferred to blocking medium in the distal 3 mm of the injured nerve. [ 1 x 10 min glycinejbuffer containing 2% normal goat serum (Sigma), 20°C], and incubated overnight in primary antibody in blocking medium Immunolabel specificity and the heterogeneousdistribution of (20°C, gentle agitation). Na+ channel epitopesin normal axons The following day tissue was rinsed in glycine/buffer and then buffer alone (both 5 x 3 min, 20°C) incubated for l-2 hr (20°C) in biotinylated Specificity. Immunolabeling using 7493 IgG occurred consis- goat anti-rabbit IgG, buffer rinsed (5 x 10 min), and reacted in ABC tently on some cell types and membrane locations, avoiding reagent (Elite kit, Vector Labs) followed by NiCl-intensified diamino- others completely (see below). There was no intracellular la- benzidine (DAB). Tissue was then postfixed in 3% glutaraldehyde, buffer rinsed overnight (4”C), osmicated (1% OsO,, 4°C) dehydrated in as- beling. Primary 7493 IgG yielded the most intense immuno- cending alcohols (4°C) and then propylene oxide (20”(Z), and embedded labeling of membranes,although with this material there was in LX-araldite. Longitudinal thin sections were picked up on copper always some decoration of basal lamina (e.g., open arrow in grids and viewed in a JEOL 1 OOCX. We usually avoided counterstaining Figs. 3A, 6A). Most ofthis can be attributed to antibodiespresent and instead used a small (40 pm) aperture and low accelerating voltage