Tetrodotoxin, a Potential Drug for Neuropathic and Cancer Pain Relief?

Tetrodotoxin, a Potential Drug for Neuropathic and Cancer Pain Relief?
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DOI:
10.3390/toxins13070483
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发表时间:
2021-07-12
期刊:
影响因子:
4.2
通讯作者:
Nieto FR
Nieto FR
中科院分区:
医学2区
文献类型:
--
作者:
González-Cano R;Ruiz-Cantero MC;Santos-Caballero M;Gómez-Navas C;Tejada MÁ;Nieto FR

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河豚毒素 (TTX) 是一种强效神经毒素,主要存在于河豚鱼和其他海洋和陆地动物中。 TTX 阻断电压门控钠通道 (VGSC),该通道通常被分类为 TTX 敏感通道或 TTX 抵抗通道。 VGSC 在疼痛信号传导中发挥关键作用,一些 TTX 敏感的 VGSC 在成人初级感觉神经元中高度表达。在病理性疼痛条件下,例如神经性疼痛,一些 TTX 敏感的 VGSC 上调,包括成人初级感觉神经元中胚胎 VGSC 亚型 NaV1.3 的大量重新表达,导致疼痛过敏。此外,具有 VGSC 亚型 NaV1.7 功能丧失突变的人表现出先天性对疼痛不敏感。 TTX 在几种啮齿动物神经性疼痛模型中显示出显着的镇痛作用。根据这一有希望的临床前证据,TTX 目前正在临床开发中,用于治疗化疗引起的神经性疼痛和癌症相关疼痛。本综述主要关注支持 TTX 在这些疼痛状态中具有潜在镇痛作用的临床前和临床证据。此外,我们还分析了这种神经毒素在以治疗剂量给药时产生的主要毒性作用,以及选择性阻断 TTX 敏感 VGSC 的其他天然毒素减轻神经病理性疼痛的治疗潜力。
Tetrodotoxin (TTX) is a potent neurotoxin found mainly in puffer fish and other marine and terrestrial animals. TTX blocks voltage-gated sodium channels (VGSCs) which are typically classified as TTX-sensitive or TTX-resistant channels. VGSCs play a key role in pain signaling and some TTX-sensitive VGSCs are highly expressed by adult primary sensory neurons. During pathological pain conditions, such as neuropathic pain, upregulation of some TTX-sensitive VGSCs, including the massive re-expression of the embryonic VGSC subtype NaV1.3 in adult primary sensory neurons, contribute to painful hypersensitization. In addition, people with loss-of-function mutations in the VGSC subtype NaV1.7 present congenital insensitive to pain. TTX displays a prominent analgesic effect in several models of neuropathic pain in rodents. According to this promising preclinical evidence, TTX is currently under clinical development for chemo-therapy-induced neuropathic pain and cancer-related pain. This review focuses primarily on the preclinical and clinical evidence that support a potential analgesic role for TTX in these pain states. In addition, we also analyze the main toxic effects that this neurotoxin produces when it is administered at therapeutic doses, and the therapeutic potential to alleviate neuropathic pain of other natural toxins that selectively block TTX-sensitive VGSCs.
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