Ion Channels in Pain Pathways; VGSCs Flashcards

1
Q

What mutations led to the ‘Human Pincushion’ phenomena?

A
  • Mutations in Families 1 - 3 of the NaV 1.7 VGSC
  • Via chromosome 2q24
  • Point mutations in gene SCN9A (sodium channel 9A) rendered it inactive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the general structure of a VGSC?

A
  • 2 subunits; α (large w/4 domains) and β (small; localisation of VGSCs)
  • 4 domains w/6TM helices per domain
  • Intracellular loops link helices and domains
  • P (pore-forming) loop between 5 and 6 acted as selectivity filter for Na+
  • 5 + 6 formed the pore whilst 1 - 4 faced the outside
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How did people with the NaV 1.7 mutation (SCN9A) not have any other abnormalities?

A

NaV1.7 is largely localised in the PNS; few CNS side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which VGSCs share similar AA sequence and where are they localised?

A
  • NaV1.1, 1.2, 1.3; CNS (+ PNS for 1.1)
  • NaV1.5, 1.8, 1.9; Heart, DRG, DRG.
  • NaV1.4; Skeletal muscle
  • NaV1.6; CNS, PNS
  • NaV1.7; PNS, Schwann cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is significant about Helix 4 of a VGSC?

A
  • Voltage sensor

- Senses membrane potential + transduces a change in membrane potential by opening up channel/pore

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What roles do the tetrodotoxin sensitive NaV1.1, 1.6 and 1.7 share and how does their localisation in tissue suggest this?

A
  • Acute noxious mechanical sensation

- Localised in the CNS/PNS, “ “, and PNS/Schwann cells respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What roles do the tetrodotoxin insensitive NaV1.8 and 1.9 perform and how does their localisation suggest this?

A
  • Highly expressed in nociceptors; both localised in the DRG

- Role in acute noxious mechanical sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is significant about NaV1.8 and its relationship to temperature?

A

It is important in acute cold sensation; does not inactivate at low temperatures whereas all the other NaVs do.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is NaV1.7 primarily expressed?

A
  • DRG and sympathetic ganglion neurons (PNS, Schwann cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the role of NaV1.7?

A
  • Amplifies the generator potential in neurons expressing it (including nociceptors) - one of the first channels to pick up changes in membrane potential after receptor activation
  • Threshold channel for firing action potentials
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is NaV1.7’s relationship with inflammation; can this be an analgesic target?

A
  • Upregulated in inflammation

- Removal of NaV1.7 gene = no inflammatory pain but neuropathic pain still existing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is NaV1.8 primarily expressed?

A
  • DRG and trigeminal ganglia (in the head)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the role of NaV1.8?

A

Contributes most of the sodium current underlying the action potential upstroke in neurons that express it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Can NaV1.8 be targeted for pain?

A
  • Removal of NaV1.8 gene yielded inflammatory/cold pain relief, but not neuropathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the modulated receptor hypothesis and how do VGSC inhibitors target it?

A

VGSC exists in several different states:

  • Closed (pore closed h gate open)
  • Open
  • Inactivated (pore open but h gate closed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are sodium channel blockers classified?

A
  • Selectivity for individual sodium channel isotypes (or lack of; most are non-specific)
  • State of the channel they target
  • Combination of the above
17
Q

How does carbamazepine exert its analgesic effect?

A
  • Anti-convulsant

- Stabilises inactivation state of the channel; prevents return to active state and re-opening of channel

18
Q

What indications in analgesia is carbamazepine used for?

A
  • Trigeminal neuralgia (neuropathic pain in face)

- Familial rectal pain syndrome in children (NaV1.7 mutation; permanently open)

19
Q

How does phenytoin exert its analgesic effect and when is it used?

A
  • Anticonvulsant
  • Stabilises inactivated state (100 fold weaker binding to resting state)
  • Second line for trigeminal neuralgia
20
Q

How does lidocaine exert its analgesic effect and when is it used?

A
  • Local anaesthetic
  • Inhibits open/inactivated channel
  • Used for local pain
21
Q

How is pain in trigeminal neuralgia triggered?

A

Chewing/speaking/brushing teeth etc.