On 2021-06-08 02:58:38, user Cindy Liu wrote:
Review by Cindy Liu and Dominic Grisingher as part of the 2021 UCSF Peer Review minicourse with James Fraser.
Summary<br />
HIV/AIDS-associated peripheral neuropathy is a major problem that remains undertreated. Current treatments are to prescribe opioids or non-opioid analgesics; however, these have limited efficacy in relieving chronic pain for people living with HIV-1/AIDS. Therefore, there is a pressing need to develop effective therapies for HIV-1/AIDS patients. To accomplish this goal, the underlying pathogenic mechanism needs to be understood. Here, Liu et al. use transgenic mouse models and pharmacological manipulations to uncover a putative pathway of HIV-associated pain pathogenesis and suggest novel therapeutic targets.
The authors demonstrate that astrogliosis (astrocyte proliferation in response to damage in the nervous system) is 1) a consequence of intrathecal administration of gp120 (a spike protein required for HIV-1 infectivity that has previously been implicated in HIV-1/AIDS-associated pain), via 2) activation of neuron-to-astrocyte Wnt5a-ROR2 signaling; which 3) promotes pain pathogenesis by upregulating release of MMP2-activated IL-1?.
These results are demonstrated in a step-by-step fashion to propose a model of how gp120 might cause chronic pain in HIV-1/AIDS patients. Moreover, the authors introduce new transgenic mouse lines that can be used to further clarify the role of Wnt5a-ROR2 signaling in HIV-1/AIDS, and in normal and disease states. The proposed model identifies two proteins as novel therapeutic targets to help relieve chronic pain for patients living with HIV-1/AIDS.
Major points<br />
Intrathecal injection of gp120 is a well-validated model of chronic pain in rodents. Indeed, the authors report robust mechanical hypersensitivity (allodynia and hyperalgesia) that is clearly rescued by the pharmacologic and genetic manipulations performed throughout the manuscript. However, thermal hypersensitivity was neither reported nor addressed. This is a symptom that is commonly reported by HIV/AIDS patients, and has been demonstrated in previous studies, for example, with the Hargreaves test used in Milligan et al., 2001. It is possible that the Wnt5-ROR2 pathway described in the present work may only affect mechanical, but not thermal, hypersensitivity. If so, then it is unclear whether the proposed therapeutic targets of MMP2 and IL-1b for HIV/AIDS pain pathogenesis would be the most effective for future research and development. We would like the authors to demonstrate the role of thermal hypersensitivity in their present model. If it is already known that thermal hypersensitivity does not contribute to the authors' model, we would like the authors to cite this in their manuscript.
The authors demonstrate that gp120 induces increased excitability of excitatory-excitatory and decreased excitability of excitatory-inhibitory connections in spinal dorsal horn lamina II. This is referred to as “neural circuit polarization” in the manuscript and reveals a previously overlooked contribution of neuronal excitability to gp120-induced astrogliosis. However, it is unclear how this effect fits in with the existing literature of central sensitization, wind-up, or other known molecular mechanisms of chronic pain.
The authors do not record, or address, changes in IPSC frequency or amplitude. Although inhibitory neurons in lamina II receive less excitation from their excitatory presynaptic partners, what is the net effect of inhibition in the SDH?<br />
Because the authors use focal stimulation “in the vicinity” of the recorded neuron, the identities of the presynaptic neurons are unknown. Are they large fiber A-deltas (which would suggest central sensitization) or small diameter C-fibers (which should suggest wind-up) (Li et al., Pain, 1999)? Additionally, which other neurotransmitters and signaling proteins implicated in chronic pain pathogenesis exhibit gp120-induced changes in expression (e.g. Substance P, CGRP; Hao, Curr Neurophamacol, 2013)? Up- or downregulation of such molecules could readily be assayed by Western blots and presented alongside the existing data. Until this is addressed, we caution the authors against declaring neural circuit polarization as a novel mechanism of inducing chronic pain.
The authors use increased GFAP expression as a proxy for the presence of reactive (proliferating) astrocytes. However, GFAP is a general marker that also labels non-reactive astrocytes, and it is recommended to use at least another marker or functional assessment to confirm the presence of astrogliosis (Escartin et al., Nat Neurosci, 2021).
The authors conduct assays at 7 days post-injection of gp120 and use these data to demonstrate the pathway by which chronic pain persists. However, the term “chronic pain” in rodent models usually refers to hypersensitivity lasting 14 days or more; 7 days may be referred to as persistent pain that resolves. Since the authors are proposing IL-1b and MMP2 as new therapeutic targets, can they comment on whether their manipulations in Figure 6 resulted in analgesia lasting beyond 14 days, and for how long the effects persisted?
The Western blots presented in the manuscript clearly depict changes in protein expression corresponding to the authors’ manipulations. However, the amount of tissue used in these assays makes it impossible to know whether these effects are lamina-specific and/or localized to the injection area. Because the lamina in spinal cord dorsal horn exhibit distinct cellular and molecular characteristics, we recommend that the authors include 1) images of injection, dissection, and recording sites to confirm locations of experiments and 2) include a discussion about the limitations of the methods used here . Due to the presence (and importance) of layers and laminae in the central nervous system, it is common practice to demonstrate that experiments were correctly localized. This is particularly important as vertebral L4-6 does not correspond to cord L4-6 (Harrison et al., NeuroImage, 2013).
Minor/confusing points<br />
Stylistic and formatting:<br />
-We believe that overall clarity of the manuscript would be improved by including a schematic of the experimental design, including a timeline of all experiments and locations of drug administration.<br />
-“Veh” is not clearly labeled as “vehicle” in Figure 1 legend. <br />
-Figure panel labels are misaligned in Figures 2-6, Supplementary Figures 1 and 3.<br />
-Figure panels are misaligned in Figures 3, 4, 6, and Supplementary Figures 1 and 3.<br />
-X axis labels of bar plots in Figure 4 are inconsistent with other plots.<br />
-Size of the scale bar in Figure 4A is missing from either the image or the figure legend.<br />
-Western blots shown in Figure 6 are too small; labeling text is almost illegible.<br />
-Figure 6 formatting is inconsistent between panels and other figures. B-E all show conditions in different ways; C is consistent with other figures. Colors of bars are not consistent between panels. Order of panels is confusing.<br />
-Blow-up of synaptic cleft in Figure 7C suggests that Wnt5a is being released from dendrites instead of axon terminals.
We ask that the authors provide immunohistochemical validation of the conditional knockout mice generated here.
We found that there was excessive use of acronyms in the manuscript. Examples include PLWHA (4 times, only in Introduction and Discussion), NRTI (used 2 times, only in Introduction) and PNS (used only once in Introduction). We suggest that the authors limit acronym use to those that will be used regularly throughout the manuscript.
We would like the authors to provide quantifications for all blots, especially given that all of them include beta-actin loading controls.
While the overall motivation for the study was compelling, we found that individual experiments were difficult to follow without clarifying explanations up front. Below are some terms that we feel would have benefitted from a more in-depth explanation.<br />
-Astrogliosis was defined as “reactive astrocytes” but there was no accompanying explanation of its significance in HIV/AIDS or chronic pain.<br />
-GFAP is only introduced in the context of the GFAP-TK mice, but GFAP itself is a standard astrocyte marker that is used outside of astrogliosis studies. <br />
-The choice to use Ganciclovar (an antiviral medication used to treat cytomegalovirus infections) to induce cell death in reactive astrocytes is unclear, because it is a cytotoxic antiviral that likely damages other cell types as well.<br />
-gp120 is a spike protein that is required for HIV-1 infectivity; however, this is unclear in the text.
The authors motivate the present study by pointing out that current analgesics, both opioidergic and non-opioidergic, are insufficient to relieve HIV/AIDS-associated pain in patients. How might the current findings explain this? We would like the authors to discuss how conventional therapies might interact with the proposed pathway to augment the suggestion that MMP2 and IL-1b are the best novel targets for therapy development.
It is unclear why the authors use GAD67-GFP mice in electrophysiological experiments in Figure 5 only when they identify inhibitory neurons by tonic spiking pattern in all other Figures. <br />
-Will the authors use these mice to identify inhibitory synapses and record IPSCs to confirm net inhibition in the spinal dorsal horn?<br />
-Do the authors find that there is a loss of inhibitory synapses, as has been described in previous studies using the gp120 model?
It is unclear why the number and intensity of bands in the MMP-2 blots are inconsistent between conditions.
Spelling and grammar errors:<br />
-“Rational-based” in Introduction is inconsistent with “rationale-based” in Abstract<br />
-“Post cART” vs “post-cART” in Introduction<br />
-“Only affects partially” should be “only partially affects” in Discussion section 2<br />
-“Indeed, gp120 appears to…” in Discussion section 2<br />
-“Pian” instead of “pain” in Discussion section 3<br />
-“We observe that IL-1b localization in astrocytes…” in Discussion section 6 is an incomplete sentence.<br />
-Figure 5 legend title reads “gp120-inudced pain”<br />
-Western blotting analysis section in Methods - the last sentence is missing a period. <br />
-Supplementary Figure 1 legend “5mice/group” is missing a space.
The proposed model relies on the Wnt5a-ROR2 signaling pathway. We cannot offer expert feedback on whether the authors sufficiently demonstrated the necessity of this ligand-receptor interaction to the model.