Human Visceral Afferent Recordings: a Pre-Clinical Human Model of Visceral Pain
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HUMAN VISCERAL AFFERENT RECORDINGS: A PRE-CLINICAL HUMAN MODEL OF VISCERAL PAIN by Cian McGuire Submitted in partial fulfilment of the requirements of the Degree of Doctor of Philosophy 1 I, Cian McGuire, confirm that the research included within this thesis is my own work or that where it has been carried out in collaboration with, or supported by others, that this is duly acknowledged below and my contribution indicated. Previously published material is also acknowledged below. I attest that I have exercised reasonable care to ensure that the work is original, and does not to the best of my knowledge break any UK law, infringe any third party’s copyright or other Intellectual Property Right, or contain any confidential material. I accept that the College has the right to use plagiarism detection software to check the electronic version of the thesis. I confirm that this thesis has not been previously submitted for the award of a degree by this or any other university. The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author. Signature: Cian McGuire Date: 13.11.14 2 PUBLICATIONS: Publications: HOCKLEY, J. R., BOUNDOUKI, G., CIBERT-GOTON, V., MCGUIRE, C., YIP, P. K., CHAN, C., TRANTER, M., WOOD, J. N., NASSAR, M. A., BLACKSHAW, L. A., AZIZ, Q., MICHAEL, G. J., BAKER, M. D., WINCHESTER, W. J., KNOWLES, C. H. & BULMER, D. C. 2014. Multiple roles for NaV1.9 in the activation of visceral afferents by noxious inflammatory, mechanical, and human disease-derived stimuli. Pain, 155, 1962-75. (Hockley et al., 2014) Abstracts/Posters: British Pharmacology Society Conference, London, 2011. The effects of bradykinin and ATP on human visceral afferent fibre activity, a pilot study International Association for the Study of Pain, Milan, 2012. Mechanical and chemical stimulation of human visceral afferents Neurogastroenterology and Motility Conference, Bologna, 2012. Mechanical and chemical stimulation of human visceral afferents National Centre for the Replacement, Refinement, and Reduction of Animals in Research Conference, London, 2012. Mechanical and chemical stimulation of human visceral afferents Digestive Diseases Week, Orlando, 2013. Identification of a distinct population of human visceral nociceptors United European Gastroenterology Week, Berlin, 2013. Identification of a distinct population of human visceral nociceptors International Association for the Study of Pain, Buenos Aires, 2014 Human visceral afferents display mechanical hyposensitivity in tissue from patients with inflammatory bowel disease Talks: Digestive Disease Week, Orlando, 2013. Anatomical sensory nerve markers in human gut 3 ACKNOWLEDGEMENTS I am indebted to my supervisor Dr. David Bulmer for his input, encouragement, technical expertise and enthusiasm for my project. I would also like to thank Professor Charles Knowles and Professor Ashley Blackshaw for their advice throughout my PhD. I’d like to pay a special tribute to my parents for their continued encouragement and support over the last number of years. I would also like to thank my sisters Aoife and Nicola, and brother in law Paul for their support. I should also like to thank the following: Mr. George Boundouki for his commitment to human tissue collection, at the expense of his own time. Dr. Jim Hockley for his guidance when learning electrophysiology, and his answers to an uncountable number of questions. Dr. John Broad for his help with human tissue collection, data analysis, and the odd plastic pot. Mr. Victor Kung for his continuing endevor to collect every single piece of human tissue. The pathology team, especially Chris Evagora and Becky Carroll for their help in processing the tissue. Dr. David Reed for his company while doing human afferent recordings, and his help with watching countless of sport on a laptop. Michael Tranter for his presence in the lab, and his company on conference trips. Dr. Harween Dogra for her chat, energy, and her suggestions that its pub time. Dr. Vincent Cibert-Goton for his collaboration in many ongoing projects. Ann Rakpraja for her support, encouragement, and friendship. All my friends from football, my friends I’ve met in London, and my friends back home. 4 ABSTRACT Aim: We have recently developed electrophysiological recordings of human visceral afferent (HVA) activity in isolated gastrointestinal tissues. The aim of the this study was 1) test the mechano- and chemosensitivity of HVAs, 2) characterise subpopulations of HVAs based on their response to mechanical stimuli, 3) test the effect of drugs that have/are in clinical trials on the mechanosensitivity (von Frey hair (VFH) probing and appendix distension) of HVAs. Methods: All experiments were performed in accordance with UK human ethics regulations [NREC09/H0704/2]. Surgically resected human ileum, colon, and appendix were obtained from consenting patients undergoing bowel resection. Tissues were pinned in a tissue bath, or cannulated (appendix), and superfused with carbongenated Krebs buffer, at 6ml/min, 32-34°C. Mesenteric nerve bundles were carefully dissected and afferent activity was recorded using suction electrodes. Tissues were tested for mechanosensitivity (VFHs, stretching, mucosal stroking, distension) and chemosensitivity (bradykinin (BK), ATP (adenosine trisphosphate), PGE2 (prostaglandin E2), serotonin (aka 5-hydroxytryptamine (5-HT)), histamine, adenosine). The receptors involved in the activation of HVAs by BK, or ATP were also investigated. The response of HVAs to VFH probing or distension was tested before and after the application of tegaserod, STa endotoxin, or a transient receptor potential vanilloid 4 (TRPV4) agonist (GSK1016790A) or antagonist (HC067047). Results and Conclusion: HVAs were characterised as mesenteric, serosal, muscular, or muscular-mucosal. HVAs were chemosensitive to all mediators. Bradykinin B2 receptors are the most important receptors involved in the activation of HVAs by BK. P2Y receptors may play an important role in the activation of HVAs by ATP. Application of tegaserod, HC067047 or STa endotoxin reduced the HVA response to mechanical stimuli. HVA recordings are feasible and practical and are suitable for both basic scientific mechanistic studies, and could potentially be used as a pre-clinical model, in conjunction with animal experiments, to help predict the efficacy of novel compounds before clinical trials. 5 TABLE OF CONTENTS Page No. Title 1 Statement of originality 2 Publications 3 Acknowledgements 4 Abstract 5 Table of contents 6 Figures 21 Tables 25 Abbreviations 26 CHAPTER 1: GENERAL INTRODUCTION 1.1 ABDOMINAL PAIN IN GASTROINTESTINAL DISEASES 28 1.2 OVERVIEW OF THE EXTRINSIC INNERVATION OF THE GASTROINTESTINAL TRACT 30 1.2.1 Overview 30 1.2.2 Vagal afferents 31 1.2.3 Spinal afferents 32 1.2.4 Subtypes of vagal and spinal afferents innervating the gut 37 1.2.4.1 Vascular afferents 37 1.2.4.1.1 Splanchnic and pelvic 37 1.2.4.2 Silent afferents 39 1.2.4.3 Muscular afferents 40 1.2.4.3.1 Vagal 40 1.2.4.3.2 Splanchnic and pelvic 41 1.2.4.3.2.1 rIGLEs 41 6 1.2.4.4 Mucosal afferents 42 1.2.4.4.1 Vagal 42 1.2.4.4.2 Splanchnic and pelvic 43 1.2.4.5 Muscular-mucosal 43 1.2.4.5.1 Vagal tension-mucosal and pelvic muscular-mucosal afferents 43 1.3 OVERVIEW OF THE ENTERIC NERVOUS SYSTEM 48 1.3.1 Overview 48 1.4 NERVE FUNCTION 54 1.4.1 Ionotropic and metabotropic signalling 54 1.4.2 Membrane potential 55 1.4.3 Generation of action potentials in sensory nerves 56 1.5 VISCERAL PAIN 57 1.5.1 Mechanisms of visceral pain 58 1.5.1.1 Peripheral sensitisation 59 1.5.1.1.1 Neurogenic inflammation and sensitisation 60 1.5.1.1.2 Potential causes of peripheral sensitisation in bowel diseases 61 1.5.1.1.3 “Silent nociceptors in peripheral sensitisation 62 1.5.1.2 Central sensitisation 65 1.6 TRANSLATION 69 1.6.1 A pre-clinical model of visceral pain 71 1.7 AIMS 73 CHAPTER 2 PART 1: CHARACTERISATION OF SUBTYPES OF AFFERENTS INNERVATING THE HUMAN INTESTINE 7 2.1.1 INTRODUCTION 74 2.1.1.1 OVERVIEW OF THE EXTRINSIC INNERVATION OF THE GUT 74 2.1.1.2 GRADED RESPONSES TO VFH PROBING 76 2.1.1.3 SPONTANEOUS ACTIVITY 77 2.1.1.4 TRP CHANNELS 79 2.1.1.4.1 TRPV channels 80 2.1.1.4.1.1 TRPV4 channels 81 2.1.1.4.1.1.1 TRPV4 channels in visceral pain 82 2.1.1.5 AIMS 86 2.1.2 METHODS 87 2.1.2.1 PATIENTS 87 2.1.2.2 ELECTROPHYSIOLOGY RECORDINGS 89 2.1.2.3 MECHANOSENSITIVITY 91 2.1.2.3.1 VFH probing, circumferential and longitudinal stretch, and mucosal stroking 91 2.1.2.3.2 VFH time matched controls 92 2.1.2.4 MECHANOSENSITIVITY PROTOCOLS 95 2.1.2.4.1 VFH probing protocol 95 2.1.2.5 OFFLINE WAVEFORM ANALYSIS 97 2.1.2.6 DRUGS 97 2.1.3 RESULTS 99 2.1.3.1 OVERALL TISSUE COLLECTION – FLAT SHEET 99 2.1.3.2 TISSUE – FLAT SHEET CHARACTERISATION 101 2.1.3.3 TISSUE – TRPV4 VFH PROBING EXPERIMENTS 101 2.1.3.4 BASIC MECHANOSENSORY PROPERTIES OF HUMAN VISCERAL AFFERENTS 104 2.1.3.5 GRADED RESPONSES TO VFH PROBING IN SEROSAL/MESENTERIC AND 8 MUSCULAR AFFERENTS 109 2.1.3.6 SPONTANEOUS ACTIVITY 112 2.1.3.7 VFH TIME MATCHED CONTROLS 116 2.1.3.8 TRPV4 VFH PROBING PROTOCOL 118 2.1.3.9 SUMMARY OF RESULTS 124 2.1.4 DISCUSSION 125 2.1.4.1 MECHANOSENSITIVITY AND HVA CHARACTERISATION 125 2.1.4.2 SEROSAL AND MESENTERIC AFFERENTS 125 2.1.4.3 MUSCULAR, MUSCULAR-MUCOSAL AND MUCOSAL AFFERENTS 127 2.1.4.4 “SILENT” AFFERENTS 129 2.1.4.5 GRADED RESPONSES TO VFH PROBING 131 2.1.4.6 SPONTANEOUS ACTIVITY 133 2.1.4.7 TRPV4 135 2.1.5 CONCLUSION 138 CHAPTER 2 PART 2: CHARACTERISATION OF SUBTYPES OF AFFERENTS