Identification of the NRF2 transcriptional network as a therapeutic target for trigeminal neuropathic pain.

Identification of the NRF2 transcriptional network as a therapeutic target for trigeminal neuropathic pain.
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DOI:
10.1126/sciadv.abo5633
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发表时间:
2022-08-05
期刊:
影响因子:
13.6
通讯作者:
--
中科院分区:
综合性期刊1区
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--
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三叉神经痛,历史上被称为“自杀疾病”,是一种非常痛苦的神经系统疾病,其特征是突然发作的剧烈面部疼痛。不幸的是,美国食品和药物管理局(FDA)唯一批准的治疗三叉神经痛的药物具有严重的副作用,许多患者需要手术。在这里,我们将NRF2转录网络确定为潜在的治疗靶点。我们报道了三叉神经痛患者的脑脊液中积累了活性氧,其中一些直接激活了疼痛传导通道TRPA1。与我们的患者队列相似,三叉神经病理性疼痛的小鼠模型也表现出显著的氧化应激。我们发现,刺激NRF2抗氧化转录网络与抑制TRPA1一样镇痛,部分是通过逆转潜在的氧化应激。使用转录组指导的药物发现策略,我们确定了两种NRF2网络调节剂作为潜在的治疗方法。这些候选药物之一,西司坦,已经被FDA批准,因此可能是三叉神经痛的一种有前途的替代治疗方法。药理学和遗传学招募NRF2转录网络减轻三叉神经痛。
Trigeminal neuralgia, historically dubbed the “suicide disease,” is an exceedingly painful neurologic condition characterized by sudden episodes of intense facial pain. Unfortunately, the only U.S. Food and Drug Administration (FDA)–approved medication for trigeminal neuralgia carries substantial side effects, with many patients requiring surgery. Here, we identify the NRF2 transcriptional network as a potential therapeutic target. We report that cerebrospinal fluid from patients with trigeminal neuralgia accumulates reactive oxygen species, several of which directly activate the pain-transducing channel TRPA1. Similar to our patient cohort, a mouse model of trigeminal neuropathic pain also exhibits notable oxidative stress. We discover that stimulating the NRF2 antioxidant transcriptional network is as analgesic as inhibiting TRPA1, in part by reversing the underlying oxidative stress. Using a transcriptome-guided drug discovery strategy, we identify two NRF2 network modulators as potential treatments. One of these candidates, exemestane, is already FDA-approved and may thus be a promising alternative treatment for trigeminal neuropathic pain. Pharmacologically and genetically recruiting the NRF2 transcriptional network alleviates trigeminal neuropathic pain.
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