Innervation of the lumbar intervertebral disc by nerve growth factor-dependent neurons related to inflammatory pain.

STUDY DESIGN: We used anatomic tracers and immunoreactivity in rats to define dorsal root ganglion neuron populations innervating the lumbar discs in physiologic and inflammatory states. OBJECTIVES: To investigate the percentages of calcitonin gene-related peptide-immunoreactive (CGRP-ir) and isolectin B4 (IB4)-binding neurons innervating lumbar discs. SUMMARY OF BACKGROUND DATA: Small neurons are classified into two types. One contains CGRP and expresses the nerve growth factor receptor. The other binds IB4 and expresses the glial cell line-derived neurotrophic factor receptor. METHODS: A neurotracer, Fluoro-Gold, was applied to the L5-L6 disc in rats. Five days later, 50-microL saline (control group: n = 8) or Complete Freund's adjuvant (inflammatory group: n = 8) was applied to the disc. Seven days after the second operation, T13-L5 dorsal root ganglions were processed for double staining of CGRP and IB4. RESULTS: Of the Fluoro-Gold-labeled neurons, 50.1 +/- 4.6% (mean +/- SEM) were positive for CGRP and 0.7 +/- 0.6% positive for IB4 in the control group, while 65.6 +/- 4.7% were positive for CGRP and 1.0 +/- 1.0% positive for IB4 in the inflammatory group. The percentage of CGRP-ir neurons was significantly higher than that of IB4-binding neurons in both groups (P < 0.001, each). The percentage of CGRP-ir neurons in the inflammatory group was significantly higher than in the control group (P < 0.05). CONCLUSIONS: We found that most small neurons innervating the disc were CGRP-ir. Furthermore, disc inflammation caused an increase in CGRP-ir neurons but not IB4-binding neurons, suggesting that CGRP-ir, nerve growth factor-dependent neurons are more responsible for discogenic pain.

Sensory innervation of the lateral portion of the lumbar intervertebral disc in rats.

BACKGROUND CONTEXT: An annular tear extending to the outer one-third of the annulus is thought to be one of the causes of low back pain. However, some patients have bilateral low back symptoms, even if the annular tear is localized in the lateral disc. Because nociceptive information from the lateral disc is transmitted by the dorsal root ganglion (DRG) neurons innervating the lateral disc, we investigated the distribution of the DRG neurons innervating the lateral portion of the disc. PURPOSE: To clarify the distribution and pathway of the DRG neurons innervating the lateral portion of the L5-L6 disc in rats. STUDY DESIGN/SETTING: Using the retrograde tracing method, we studied the innervation pattern of the lateral portion of the L5-L6 intervertebral disc in rats. METHODS: The retrograde transport of Fluoro-Gold (F-G; Fluorochrome, Denver, CO) was used in 22 rats. Subjects included a nontreated group (n=16) and a sympathectomized group (n=6). Seven days after the application of F-G crystals to the left lateral portion of the L5-L6 disc, bilateral T12-L6 DRGs were observed by fluorescent microscopy. RESULTS: In the nontreated group, of all the F-G-labeled neurons, 93.1% were present in the left DRGs and 6.9% were in the right DRGs. The number of labeled neurons was largest in the left L2 DRGs. In the sympathectomized group, the numbers of labeled neurons in the T13, L1 and L2 DRGs were significantly lower than the numbers in the nontreated group. CONCLUSION: Results of this study indicate that DRG neurons innervating the lateral portion of the disc are distributed mainly in the ipsilateral side but also in the contralateral side. The DRG neurons in T13, L1 and L2 innervate the lateral portion of the L5-L6 disc through the paravertebral sympathetic trunks.

Calcitonin gene-related peptide immunoreactive neurons with dichotomizing axons projecting to the lumbar muscle and knee in rats.

Dorsal root ganglion (DRG) neurons with dichotomizing axons have been reported in several species and are thought to be related to referred pain. However, these neurons, which have dichotomizing axons to the lumbar muscles and to the knee, have not been investigated. Clinically, pain from the lumbar muscles is sometimes referred to the lower extremities. Two kinds of neurotracers [1,1'-dioctadecyl-3,3,3',3'-tetramethyl-indocarbocyanine perchlorate (DiI) and fluoro-gold (FG)] were used in the present double-labelling study. DiI crystals were placed in the left lower back muscle, and FG was applied to the medial side of the knee. Bilateral DRGs from L1 through L6 were immunoreacted with calcitonin gene-related peptide (CGRP) antibodies and observed under a fluorescence microscope. DRG neurons double-labelled with DiI and FG were recognized only in the ipsilateral DRGs from levels L1 to L6. Approximately 1% of DRG neurons innervating the low back muscles had other axons to the medial side of the knee. In double-labelled neurons, the ratio of CGRP-immunoreactive DRG neurons was 60%. This finding provides a possible neuroanatomical explanation for referred knee pain from the lower back since CGRP is a marker of sensory neurons typically involved with pain perception. However, these neurons are rare, and mechanisms of referred pain may be explained by the convergence-projection hypothesis.

P2X3-immunoreactive primary sensory neurons innervating lumbar intervertebral disc in rats.

The P2X(3) receptor is normally localized in a sub-population of small-diameter dorsal root ganglion (DRG) neurons, and is thought to be related to pain perception. The aim of this study in rats was to examine P2X(3)-immunoreactivity in DRG neurons innervating the lumbar disc and in DRG neurons innervating cutaneous tissues. Fluoro-Gold was applied to the L5-L6 disc, the plantar skin of the hind paw (L4-L5 dermatomes), and the back skin (L1-L2 dermatomes). It has been reported that the L5-L6 disc is innervated by T13-L5 DRG neurons. We performed immunostaining using antibodies against the P2X(3) receptor of T13-L5 DRGs to examine the L5-L6 disc, L4 and L5 DRGs to examine plantar skin and L1 and L2 DRGs to examine back skin. The P2X(3)-immunoreactivity was detected in 22.0 and 22.8% of neurons, labeled by Fluoro-Gold applied to plantar and back skin, respectively. However, P2X(3)-immunoreactivity was detected in only 4.0% of the neurons projecting to the L5-L6 disc. The proportion of P2X(3)-immunoreactive neurons was significantly larger in the DRG neurons innervating the plantar or the back skin, than in the DRG neurons innervating the lumbar disc. These results suggest that the P2X(3) receptors are abundant in DRG neurons innervating cutaneous tissues, but not in neurons innervating the lumbar disc. It is likely therefore that the P2X(3) receptor is less related to the mechanism of discogenic pain, than to cutaneous tissue pain.

Stereoscopic structure of sensory nerve fibers in the lumbar spine and related tissues.

STUDY DESIGN: Neurotracer was applied to various sites in the rat lumbar spine and related tissues. The segmental distribution of labeled neurons in dorsal root ganglia (DRG) was investigated. OBJECTIVES: To clarify the stereoscopic structure of afferent fibers innervating the lumbar spine and related tissues. SUMMARY OF BACKGROUND DATA: Afferent fibers in the rat L5-L6 lumbar intervertebral disc are reported to originate from neurons in L1 and L2 DRG. However, anatomic studies determined that each dorsal ramus of the spinal nerve sends nerves to dorsal elements of the corresponding lumbar vertebra. METHODS: Fluorescent neurotracer DiI (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate) was applied to various sites of the lumbar spine and related tissues in the L2, L5, and L6 levels in rats. DRG were sectioned 3 weeks after DiI application. Rostrocaudal distribution of DiI-labeled neurons was investigated. RESULTS: At L5, DiI-labeled neurons were prominent in DRG L3 for the lamina, L2 for the spinous process, L2 for the back muscle fascia, and L1 for the skin. Dorsal elements are therefore innervated by neurons in more rostral DRG. In the transverse plane, the more distant from the DRG a site was, the more rostral the DRG innervating the site. This structure suggested a concentric innervation pattern in the transverse plane. CONCLUSION: Stereoscopically, the peripheral innervation territory of a lumbar DRG is conical, with the apex at the ganglion and the base circumference located on the dermatome. The lumbar spine itself is involved in the conical innervation territories of DRG.

Anti-mechanical allodynic effect of intrathecal and intracerebroventricular injection of orexin-A in the rat neuropathic pain model.

Orexin-A has been reported to produce an analgesic effect in the hot plate test and in the inflammatory pain models. In the present study, the authors examined the effect of orexin-A on the mechanical allodynia induced by partial sciatic nerve ligation (a model of neuropathic pain) in the rat. Partial sciatic nerve ligation is created by tight ligation of one-third or one-half of the right sciatic nerve. Orexin-A was administered intrathecally or intracerebroventricularly 7 days after a partial sciatic nerve injury. Either intrathecal or intracerebroventricular injection of orexin-A attenuated the level of mechanical allodynia induced by partial sciatic nerve ligation. These data suggest that either intrathecal or intracerebroventricular injection of orexin-A is a new therapeutic approach to treating mechanical allodynia caused by nerve injury.

The dorsal portion of the lumbar intervertebral disc is innervated primarily by small peptide-containing dorsal root ganglion neurons in rats.

The intervertebral discs are innervated by the dorsal root ganglion (DRG) neurons. In the present study, we applied Fluoro-Gold (FG) to the dorsal portion of the L5-L6 intervertebral disc to label DRG neurons retrogradely, and then examined whether FG-labeled neurons were substance P (SP)-immunoreactive or isolectin B4 (IB4)-binding. Of the FG-labeled neurons, 44.0% were immunoreactive for SP, whereas only 0.6% were reactive for IB4. The rate of SP-immunoreactive neurons was significantly higher than that of IB4-binding neurons (P<0.001), suggesting that under physiological conditions the dorsal portion of the lumbar disc is mainly innervated by peptide-containing neurons.

Dermatomes and the central organization of dermatomes and body surface regions in the spinal cord dorsal horn in rats.

Dermatomes and the associated central projection fields were studied with the application of fluorescent neurotracer, 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI), to 21 reference points on rat trunk and hindlimb skin. Segmental distribution and rostrocaudal central level of dorsal root ganglion (DRG) neurons innervating reference points were examined and DiI-induced fluorescent areas were mapped in the horizontal plane through lamina II of the dorsal horn. Segmental levels of DRG neurons innervating reference points were generally identical to the level determined using dye-extravasation methods. However, innervation of the first digit was situated in the L4 dermatome, not the L3 reported previously using those methods. Generally, afferents from a reference point projected to a single field in the ipsilateral dorsal horn. Reference points on ventral and dorsal median lines of the trunk were represented bilaterally. Afferents from reference points located on the ventral median line of the hindlimb projected to two separate fields: one on the medial margin of spinal cord segments L2-L5 and the other on the medial half of spinal cord segment L5. From the distribution of central projection fields of reference points, central projection fields of dermatomes were revealed as even in shape and located within corresponding spinal cord segments. The arrangement of peripheral and central fields of dermatomes and body surface regions suggests that peripheral and central projection fields of cutaneous afferent fibers are reshaped from the common prototypical pattern that exhibits an orderly and evenly sequenced arrangement.

Analgesic effect of intrathecally administered orexin-A in the rat formalin test and in the rat hot plate test.

1. Orexin-A and orexin-B (also known as hypocretin-1 and hypocretin-2) are hypothalamic peptides and regulate feeding behaviour, energy metabolism and the sleep-wake cycle. Orexin-A binds equally to both orexin-1 and orexin-2 receptors, while orexin-B has a preferential affinity for orexin-2 receptors. 2. Orexins are also known to be concentrated in superficial laminae of the spinal dorsal horn, and orexin-A and orexin-1 receptors are found in the dorsal root ganglion cells. 3. In the present study, the authors examined the effect of intrathecal injection of either orexin-A or orexin-B in the rat formalin test (a model of inflammatory pain) and in the rat hot plate test. The paw formalin injection induces biphasic flinching (phase 1: 0-6 min; phase 2: 10-60 min) of the injected paw. 4. Intrathecal injection of orexin-A, but not orexin-B, decreased the sum of flinches in phases 1 and 2 in the formalin test and increased the hot plate latency. These effects of orexin-A were completely antagonized by pre-treatment with SB-334867, a selective orexin-1 receptor antagonist. Intrathecal injection of SB-334867 alone had no effect in the formalin test or in the hot plate test. 5. Intrathecal injection of orexin-A suppressed the expression of Fos-like immunoreactivity (Fos-LI), induced by paw formalin injection, in laminae I-II of L4-5 of the spinal cord. 6. These data suggest that the spinal orexin-1 receptor is involved in the nociceptive transmission and that the activation of the spinal orexin-1 receptor produces analgesic effects in the rat formalin test and in the rat hot plate test.

The origin of sensory innervation of the peritoneum in the rat.

The distribution of sensory neurons innervating the peritoneum was studied using axonal transport of fluoro-gold. The tracer was injected into parietal peritoneum, diaphragm, mesentery, mesocolon, visceral peritoneum covering the stomach, small intestine, colon, liver, spleen, kidney, urinary bladder or uterus. After ten days of survival bilateral dorsal root ganglia from C2 to S6, and the nodose ganglia were dissected. The cryostat sections of these ganglia were mounted on glass slides and observed with a fluorescence microscope. In cases where the tracer was placed on the peritoneum covering the abdominal wall, labeled neurons were observed only in the ipsilateral dorsal root ganglia. A small number of neurons in nodose and cervical dorsal root ganglia of both sides were labeled after placing the tracer on the central part of the diaphragm. When fluoro-gold was applied to the peripheral part of the diaphragm, nodose ganglion was negative, and dorsal root ganglia from T6 to T12 were positive. Many neurons in the nodose ganglia in addition to somata in the dorsal root ganglia from T4 to T13 were labeled when the tracer was placed on the peritoneum lining the stomach, small intestine or caecum. After applying the tracer onto the colon, labeled neurons were observed in the dorsal root ganglia from T13 to L2 and L5 to S1. Ganglion cells in the nodose and dorsal root ganglia from T5 to T13 were positive when fluoro-gold was placed on the mesentery. No labeled neurons were observed in any ganglia when the tracer was applied to the peritoneum covering the spleen, kidney, uterus, urinary bladder and liver. These results suggest that most of the parietal peritoneum receives sensory nerves from dorsal root ganglia and the visceral peritoneum from both spinal nerves and the vagus nerve.

Substance P and calcitonin gene-related peptide immunoreactive sensory DRG neurons innervating the lumbar intervertebral discs in rats.

The rat L5/6 disc is innervated from T13 to L6 dorsal root ganglia (DRGs) multisegmentally. Sensory fibers from T13, L1 and L2 DRGs have been reported to innervate through the paravertebral sympathetic trunks, whereas those from L3 to L6 DRGs innervate directly through sinuvertebral nerves on the posterior longitudinal ligament (PLL). The presence of substance P (SP)- and calcitonin gene-related peptide (CGRP)-immunoreactive (ir) nerve fibers has been demonstrated in the lumbar intervertebral discs, but their percentages in DRG neurons have not been studied. Fluoro-gold (F-G) labeled neurons innervating the L5/6 disc were distributed throughout DRGs from T13 to L6 levels. Of F-G labeled neurons innervating the L5/6 disc, the percentage of SP-ir T13 to L6 DRG neurons was 30%, and that of CGRP-ir neurons was 47%. The mean cross-sectional area of the cell of SP-ir neurons was 696+/-66 microm2 (mean +/- S. E.), and that of CGRP-ir neurons was 695+/-72 microm2 (mean +/- S. E.). SP- and CGRP-ir were mainly observed in small neurons. The percentages of SP- or CGRP-ir neurons in L1 and L2 DRGs innervating the L5/6 disc were not different from those in L3, L4 or L5 DRGs. In the physiological condition in rats, DRG neurons at all levels may have the same significant role in pain sensation of the disc.

Up-regulation of substance P and NMDA receptor mRNA in dorsal horn and preganglionic sympathetic neurons during adjuvant-induced noxious stimulation in rats.

Substance P (SP) and glutamate-containing terminals are found in the dorsal horn and preganglionic sympathetic neurons (PSNs) in the intermedio-lateral nucleus of the spinal cord. SP receptor (SPR) and N-methyl-D-aspartate type glutamate receptor (NMDAR) were also recognized in portions of the dorsal horn and PSNs. Primary sensory nerve fibers containing SP and glutamate terminated around PSNs, or partly on PSNs directly as well as on dorsal horn neurons (DHNs). The present study was performed to investigate the changes in SPR and NMDAR mRNA expressions during nociception in rats. Upon the injection of complete Freund's adjuvant (CFA) into the front paw, edema and hyperalgesia occurred immediately, with the difference in latency score between injected and non-injected paws continuing to day 10. The up-regulation of SPR and NMDAR mRNAs in DHNs and PSNs was recognized using in situ hybridization and northern blot techniques. CFA injection increased SPR mRNA expression in PSNs at days 1 and 4, and NMDAR mRNA expression at days 1, 4 and 7. At day 14, the mRNA expression of both receptors decreased to the control level. These changes in the amount of receptor mRNAs in DHNs and PSNs may cause hyperalgesia and sympathetically mediated pain.

Organization of cutaneous ventrodorsal and rostrocaudal axial lines in the rat hindlimb and trunk in the dorsal horn of the spinal cord.

The somatotopic organization of cutaneous primary afferents projecting to the dorsal horn of the rat spinal cord was investigated. The fluorescent neurotracer, 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) was applied to cutaneous incisions made along ventrodorsal axial lines (VDALs) or rostrocaudal axial lines (RCALs) of the trunk and hindlimb. DiI-induced fluorescent zones appeared in laminae I-III of the dorsal horn in the transverse section. Several fluorescent zones appeared at different mediolateral portions after tracer application to VDALs. After tracer was applied to RCALs, a single zone of fluorescence was observed. Serial transverse sections were used to reconstruct fluorescent zones in lamina II and to illustrate the rostrocaudally elongated band-like projection fields in a horizontal plane. In the horizontal plane, the fluorescent zones of VDALs were reconstructed to band-like projection fields. These fields were arranged mediolaterally and extended rostrocaudally for approximately the length of one spinal cord segment or less. The fluorescent zones of RCALs were reconstructed to one band-like projection field. This field extended rostrocaudally over several spinal cord segments. Cutaneous afferents from the ventral median line of the trunk, tail, hindlimb, sole, and ventral side of the digits projected to the medial margin of the dorsal horn. Cutaneous afferents from the dorsal median lines projected to the lateral margin of the dorsal horn. By analyzing the pattern of the body surface regions and the VDALs and RCALs, the central projection fields of body surface regions could be hypothesized, based on the central projection fields of the individual VDAL and RCAL afferents. Thus, we established a detailed dorsal view map of the central projection fields of cutaneous primary afferents.