TRP Channels As Drug Targets to Relieve Itch Zili Xie Washington University School of Medicine in St
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Washington University School of Medicine Digital Commons@Becker Open Access Publications 2018 TRP channels as drug targets to relieve itch Zili Xie Washington University School of Medicine in St. Louis Hongzhen Hu Washington University School of Medicine in St. Louis Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Recommended Citation Xie, Zili and Hu, Hongzhen, ,"TRP channels as drug targets to relieve itch." Pharmaceuticals.11,4. 100. (2018). https://digitalcommons.wustl.edu/open_access_pubs/7299 This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. pharmaceuticals Review TRP Channels as Drug Targets to Relieve Itch Zili Xie and Hongzhen Hu * Department of Anesthesiology, The Center for the Study of Itch, Washington University School of Medicine, St. Louis, MO 63110, USA; [email protected] * Correspondence: [email protected]; Tel: +1-314-747-4317 Received: 4 September 2018; Accepted: 3 October 2018; Published: 6 October 2018 Abstract: Although acute itch has a protective role by removing irritants to avoid further damage, chronic itch is debilitating, significantly impacting quality of life. Over the past two decades, a considerable amount of stimulating research has been carried out to delineate mechanisms of itch at the molecular, cellular, and circuit levels. There is growing evidence that transient receptor potential (TRP) channels play important roles in itch signaling. The purpose of this review is to summarize our current knowledge about the role of TRP channels in the generation of itch under both physiological and pathological conditions, thereby identifying them as potential drug targets for effective anti-itch therapies. Keywords: TRP channels; itch; pain; TRPA1; TRPV1; TRPV3; TRPV4; TRPM8; TRPC4; agonists; antagonists 1. Introduction Itch, also known as pruritus, is an unpleasant sensation provoking the scratch reflex [1]. Itch is classified as acute or chronic, with the latter defined as pruritus lasting longer than six weeks [2]. Acute itch is often generated locally in the skin by pruritogens and the scratching behavior that is evoked has a protective role by removing irritants. Chronic itch, by contrast, may be maladaptive and leads to significant decrements in quality of life. It is associated with numerous conditions, including atopic eczema, psoriasis, urticaria, inflammatory skin diseases, chronic renal failure, cholestasis, lymphoma, and chronic liver diseases [3–6]. Chronic itch remains an unmet medical condition lacking universally effective treatments. Delineating itch mechanisms at the molecular, cellular, and circuit levels is critical to the development of new anti-itch therapeutic strategies. The transient receptor potential (TRP) channels comprise 28 members in mammals that can be divided into six subfamilies based on amino acid sequence homology, including TRPA, TRPC, TRPM, TRPML, TRPP, and TRPV [7]. TRP channels respond to a diverse array of thermal, chemical, and mechanical stimuli. They are implicated in many sensory functions including taste, smell, thermoception, touch, osmolarity, and pain [8–12]. In the past two decades, numerous studies have demonstrated that TRP channels are critically involved in itch sensation under both physiological and pathological conditions [13,14]. 2. Cellular Mechanisms of Itch Signaling in the Periphery Itch has long been considered a submodality of pain based on observations that local stimulation of the same skin sites at low intensities evokes itch, whereas high intensities cause pain [15]. Pain and itch are now clearly understood to be distinct sensory modalities [16–18]. Pruritogens evoke itch sensation by activating pruriceptors present on free nerve endings of cutaneous primary sensory neurons [19]. Primary sensory neurons are classified into four distinct types based on cell body size and axon myelination: (1) large-diameter, thickly myelinated proprioceptive neurons; (2) large-diameter, myelinated Aβ low-threshold mechanoreceptors which mediate touch; (3) medium-sized, lightly Pharmaceuticals 2018, 11, 100; doi:10.3390/ph11040100 www.mdpi.com/journal/pharmaceuticals Pharmaceuticals 2018, 11, x 2 of 21 distinct types based on cell body size and axon myelination: (1) large-diameter, thickly myelinated proprioceptive neurons; (2) large-diameter, myelinated Aβ low-threshold mechanoreceptors which mediate touch; (3) medium-sized, lightly myelinated Aδ nociceptive Pharmaceuticals 2018, 11, 100 2 of 20 neurons; and (4) small-diameter, unmyelinated C nociceptive neurons that detect noxious stimuli [19]. LaMotte et al. showed that itch-initiating neurons are predominantly C-type myelinatedneurons Awithδ nociceptive an additional neurons; small and population (4) small-diameter, of Aδ neurons unmyelinated [20]. Thus, C both nociceptive pain and neurons itch are that detecttransduced noxious stimuliby small [19-diameter]. LaMotte dorsal et al. root showed ganglion that itch-initiating (DRG) neurons neurons. However, are predominantly the two C-typemodalities neurons are with transduced an additional separately small population by pain-selective of Aδ neurons (nociceptive) [20]. Thus, and both itch pain-selective and itch are(pruriceptive) transduced by neuronal small-diameter subpopulations dorsal root in ganglionthe skin. This (DRG) is firmly neurons. supported However, by thethe twofinding modalities that arethe transduced ablation separatelyof Mas-related by pain-selective G protein-coupled (nociceptive) receptor and itch-selectivemember A3 (pruriceptive)(MrgprA3) neurons neuronal subpopulationssubstantially inreduc the skin.es scratching This is firmly evoked supported by multiple by the findingpruritogens that the and ablation under ofchronic Mas-related itch G protein-coupledconditions, leaving receptor pain member sensitivity A3 (MrgprA3) intact [21]. neurons substantially reduces scratching evoked by multipleIn pruritogens addition to and sensory under neurons, chronic itchmany conditions, other cell leavingtypes are pain also sensitivity involved intactin itch [21 pathways]. [22]In. additionFor instance to sensory, stimulated neurons, keratinocytes many other cellrelease types numerous are also involved inflammatory in itch pathwaysmediators [22 ]. Forincluding instance, thymic stimulated stromal keratinocytes lymphopoietin release (TSLP), numerous ATP, inflammatoryendothelins, prostaglandins, mediators including histamine, thymic stromalnitric lymphopoietin oxide, and serotonin (TSLP), which ATP, endothelins, can directly prostaglandins, activate or sensitize histamine, primary nitric sensory oxide, neurons and serotonin to whichinitiate can directlyitch [22] activate. Similarly, or sensitizeinnate immune primary cells sensory (such neurons as mast tocell initiates, neutrophil itch [22s]., macrophage Similarly, innates, immuneand dendritic cells (such cell ass) mastrelease cells, a versatile neutrophils, ensemble macrophages, of pruritogenic and dendritic inflammatory cells) releasemediators a versatile [23]. ensembleThe interplay of pruritogenic between inflammatory adaptive immune mediators cells and [23]. neurons The interplay also plays between an important adaptive role immune in itch cells andsensation neurons also(Figure plays 1) an[24 important–26]. role in itch sensation (Figure1)[24–26]. FigureFigure 1. Transient1. Transient receptor receptor potential potential (TRP) (TRP channels) channels and itch and signaling. itch signaling. Six TRP Six channelsTRP arechannels implicated are in implicated itch signaling, in itch including signaling, TRPA1, including TRPV1, TRPA1, TRPV3, TRPV4,TRPV1, TRPM8,TRPV3, andTRPV4, TRPC4. All itch-relatedTRPM8, and TRP TRPC4. channels All are expresseditch-related in keratinocytes TRP channels and/or are primary expressed sensory in keratinocytes neurons. TRPA1 is requiredand/or for primary itch evoked sensory by chloroquine neurons. TRPA1 (CQ), bovineis required adrenal for medulla itch evoked 8–22 peptideby chloroquine (BAM8-22), 5-hydroxytryptamine(CQ), bovine adrenal (5-HT), medulla bile acid, 8–22 and peptide thymic (BAM8 stromal-22 lymphopoietin), 5-hydroxytryptamine (TSLP) which (5-HT can), be releasedbile fromacid, keratinocytes and thymic through stromal protease-activated lymphopoietin receptor (TSLP 2) (PAR2)which activation.can be released These pruritogens from bindkeratinocytes to their respective through G protein-coupled protease-activated receptors (GPCRs):receptor Mas-related 2 (PAR2 G) protein-coupledactivation. These receptor member A3 (MrgprA3), MrgprC11, 5-hydroxytryptamine receptor 7(HTR7), G protein-coupled bile pruritogens bind to their respective G protein-coupled receptors (GPCRs): Mas- acid receptor Gpbar1 (TGR5), and thymic stromal lymphopoietin receptor (TSLPR). Phospholipase C related G protein-coupled receptor member A3 (MrgprA3), MrgprC11, 5- (PLC) and Gβγ signaling downstream from these receptors contribute to TRPA1 activation. TRPA1 also hydroxytryptamine receptor 7(HTR7), G protein-coupled bile acid receptor Gpbar1 mediates miR-711-induced itch through direct activation. TRPV1 is required for histamine-evoked (TGR5), and thymic stromal lymphopoietin receptor (TSLPR). Phospholipase C (PLC) itch, whereby histamine receptor 1 (H1R) and histamine receptor 4 (H4R) activate TRPV1 through theand PLC Gβγ signaling signaling