Gabapentin loses efficacy over time after nerve injury in rats: role of glutamate transporter-1 in the locus coeruleus

Pain. 2016 Sep;157(9):2024-2032. doi: 10.1097/j.pain.0000000000000608.

Abstract

Despite being one of the first-choice analgesics for chronic neuropathic pain, gabapentin sometimes fails to provide analgesia, but the mechanisms for this lack of efficacy is unclear. Rats with nerve injury including L5-L6 spinal nerve ligation (SNL) respond uniformly and well to gabapentin, but many of these studies are performed within just a few weeks of injury, questioning their relevance to chronic neuropathic pain. In this study, intraperitoneal gabapentin showed a time-dependently reduction in antihypersensitivity after SNL, associated with downregulation of astroglial glutamate transporter-1 (GLT-1) in the locus coeruleus (LC). Consistently, SNL also time-dependently increased basal but masked gabapentin-induced noradrenergic neuronal activity in the LC. In rats 2 weeks after SNL, knock-down of GLT-1 in the LC reduced the antihypersensitivity effect of gabapentin. In rats 8 weeks after SNL, increasing GLT-1 expression by histone deacetylase inhibitor valproate restored the antihypersensitivity effect of gabapentin, associated with restored gabapentin-induced noradrenergic neuronal activity in the LC and subsequent spinal noradrenaline release. Knock-down of GLT-1 in the LC reversed the effect of valproate to restore gabapentin-induced antihypersensitivity. In addition, the antihypersensitivity effect of the intrathecal α2-adrenoceptor agonist clonidine also decreased with time after SNL injury. These results suggest that downregulation of GLT-1 in the LC and reduced spinal noradrenergic inhibition contribute to impaired analgesic efficacy from gabapentin in chronic neuropathic pain and that valproate can rescue this impaired efficacy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Amines / therapeutic use*
  • Analgesics / therapeutic use*
  • Animals
  • Antihypertensive Agents / pharmacology
  • Atropine / pharmacology
  • Bronchodilator Agents / pharmacology
  • CREB-Binding Protein / metabolism
  • Clonidine / pharmacology
  • Cyclohexanecarboxylic Acids / therapeutic use*
  • Disease Models, Animal
  • Excitatory Amino Acid Transporter 2 / genetics
  • Excitatory Amino Acid Transporter 2 / metabolism*
  • Gabapentin
  • Locus Coeruleus / drug effects
  • Locus Coeruleus / metabolism*
  • Male
  • Norepinephrine / metabolism
  • Pain Threshold / drug effects
  • Peripheral Nerve Injuries / drug therapy*
  • Peripheral Nerve Injuries / pathology*
  • RNA, Small Interfering / pharmacology
  • Rats
  • Rats, Sprague-Dawley
  • Spinal Cord Dorsal Horn / metabolism
  • Time Factors
  • gamma-Aminobutyric Acid / therapeutic use*

Substances

  • Amines
  • Analgesics
  • Antihypertensive Agents
  • Bronchodilator Agents
  • Cyclohexanecarboxylic Acids
  • Excitatory Amino Acid Transporter 2
  • RNA, Small Interfering
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Atropine
  • CREB-Binding Protein
  • Clonidine
  • Norepinephrine