Chronic alcohol consumption produces a painful peripheral neuropathy for which there is no reliably successful therapy, attributable to, in great part, a lack of understanding of the underlying mechanisms. We tested the hypothesis that neuropathic pain associated with chronic alcohol consumption is a result of abnormal peripheral nociceptor function. In rats maintained on a diet to simulate chronic alcohol consumption in humans, mechanical hyperalgesia was present by the fourth week and maximal at 10 weeks. Thermal hyperalgesia and mechanical allodynia were also present. Mechanical threshold of C-fibers in ethanol fed rats was lowered, and the number of action potentials during sustained stimulation increased. The hyperalgesia was acutely attenuated by intradermal injection of nonselective protein kinase C (PKC) or selective PKC⑀ inhibitors injected at the site of nociceptive testing. Western immunoblot analysis indicated a higher level of PKC⑀ in dorsal root ganglia from alcohol-fed rats, supporting a role for enhanced PKC⑀ secondmessenger signaling in nociceptors contributing to alcohol-induced hyperalgesia.Key words: protein kinase C ⑀; alcoholic peripheral neuropathy; pain; hyperalgesia; allodynia; primary afferent nociceptor Ethanol consumption is the most common cause of peripheral nervous system, as well as CNS, neurotoxicity. Ethanol is thought to exert a direct neurotoxic action on the peripheral nervous system, resulting in a neuropathy that mostly involves smalldiameter fibers (Diamond and Messing, 1994;Monforte et al., 1995;Kielhorn, 1996;Ortiz-Plata et al., 1998;Tredici et al., 1999). The peripheral neuropathy is a potentially incapacitating complication of chronic consumption of ethanol, characterized by pain and dysesthesias, primarily in the lower extremities, and is poorly relieved by available therapies (Ratcliff, 1979;Monforte et al., 1995;Ortiz-Plata et al., 1998).Whereas enhanced nociception and primary afferent nociceptor hypersensitivity have been demonstrated in animal models of other neuropathic pain states, such as those induced by diabetes (Ahlgren and Levine, 1994), chemotherapy (Tanner et al., 1998; Authier et al., 1999), or trauma (Bennett andXie, 1988;Campbell et al., 1988;Seltzer et al., 1990;Xie and Xiao, 1990;Kim and Chung, 1992;Kim et al., 1993;Sheen and Chung, 1993;Yoon et al., 1996;Pedersen and Kehlet, 1998;Zahn and Brennan, 1999), an animal model for alcohol-induced neuropathy does not exist, nor has it even been demonstrated that primary afferent nociceptor function is altered by chronic exposure to alcohol.In animal models of other painful peripheral neuropathies, enhanced nociception involves alterations in intracellular signaling. Specifically, protein kinase C (PKC) (Ahlgren and Levine, 1994) [particularly the epsilon (⑀) isoform (Gerstin et al., 1998; Khasar et al., 1999] and protein kinase A (PKA) (Ahlgren and Levine, 1994) signaling pathways have been implicated in enhancing nociceptor function. Because alcohol has been shown to activate PKC and PKA (Coe et al., 1...

While altered activities in sensory neurons were noticed in neuropathic pain, caused by highly diverse insults to the peripheral nervous system, such as diabetes, alcohol ingestion, cancer chemotherapy and drugs used to treat AIDS, other infections and autoimmune diseases, as well as trauma, our understanding of how these various peripheral neuropathies manifest as altered neuronal activity is still rudimentary. The recent development of models of several of those neuropathies has, however, now made it possible to address their impact on primary afferent nociceptor function. We compared changes in mechanically-evoked C-fiber activity, in models of painful peripheral neuropathy induced by drinking ethanol (alcohol) or administering 2',3'-dideoxycytidine (ddC), a nucleoside reverse transcriptase inhibitor for AIDS therapy, two comorbid conditions in which pain is thought to be mediated by different second messenger signaling pathways. In C-fiber afferents, ddC decreased conduction velocity. In contrast, alcohol but not ddC caused enhanced response to mechanical stimulation (i.e., decrease in threshold and increase in response to sustained threshold and supra-threshold stimulation) and changes in pattern of evoked activity (interspike interval and action potential variability analyses). These marked differences in primary afferent nociceptor function, in two different forms of neuropathy that produce mechanical hyperalgesia of similar magnitude, suggest that optimal treatment of neuropathic pain may differ depending on the nature of the causative insult to the peripheral nervous system, and emphasize the value of studying co-morbid conditions that produce painful peripheral neuropathy by different mechanisms.

We have modeled the transition from acute to chronic pain in the rat. In this model (termed hyperalgesic priming) a chronic state develops after a prior inflammatory process or exposure to an inflammatory mediator, in which response to subsequent exposure to prostaglandin E2 (PGE2) is characterized by a protein kinase Cε-dependent marked prolongation of mechanical hyperalgesia. To assess the effect of priming on the function of the nociceptor, we have performed in vitro patch clamp and in vivo single fiber electrophysiology studies using tumor necrosis factor to induce priming. In vitro, the only change observed in nociceptors cultured from primed animals, was a marked hyperpolarization in resting membrane potential (RMP); prolonged sensitization, measured at 60 minutes, could not be tested in vitro. However, complimentary with behavioral findings, in vivo baseline mechanical nociceptive threshold was significantly elevated compared to controls. Thirty minutes after injection of PGE2 into the peripheral receptive field, both primed and control nociceptors showed enhanced response to mechanical stimulation. However, sixty minutes after PGE2 administration the response to mechanical stimulation was further increased in primed but not in control nociceptors. Thus, at the level of the primary afferent nociceptor, it is possible to demonstrate both altered function at baseline and prolonged PGE2-induced sensitization. Intrathecal antisense to Kv7.2, which contributes to RMP in sensory neurons, reversibly prevented the expression of priming in both behavioral and single-fiber electrophysiology experiments, implicating these channels in the expression of hyperalgesic priming.

Background: There are few detailed consensus and guidelines on perioperative clinical characteristics of liver transplantation (LT) in patients with methylmalonic acidemia (MMA). This retrospective study investigated details of the clinical course and individualized treatment plan of the center with largest experience in China.Methods: A total of 7 MMA patients undergoing LT in Beijing Friendship Hospital from June 2013 to December 2017 were enrolled in the study, whose clinical data (clinical characteristics, laboratory findings, chronological changes in urine MMA levels, treatment, etc.) during perioperative period were analyzed retrospectively. All the patients received strict postoperative management.Results: All the 7 cases were confirmed to have isolated MMA, among which, 3 cases received living donor liver transplantation (LDLT), 4 cases received deceased donor liver transplantation (DDLT). A wild fluctuate of metabolic condition was observed within the first few days after surgery and two weeks after LT, the mean base excess of blood value (BE-B) restored to normal whereas plasma bicarbonate (HCO 3 − ) was still below normal value even with intermittent sodium bicarbonate correction. It also showed marked reduction in propionylcarnitine (C3) and C3/C2 level and the mean urine MMA by gas chromatographymass spectrometry (GC-MS) was reduced by 81.7% (P<0.01) but remained >72× higher than upper limit of normal. The metabolism-correcting medications were administered as before. The renal function of one case with renal insufficiency before LT (serum creatinine rising) maintained stable by adjusting the immunosuppressive regimen during the observation period. All patients survive to date. Conclusions:LT is an effective treatment to prevent metabolic crisis, but patients with MMA tend to be metabolically fragile even after surgery. During perioperative period, close monitoring should be given for acidosis episodes so as to implement sodium bicarbonate correction. Metabolism-correcting medications are still needed. Special immunosuppressive regimen is an effective way of maintaining renal function for those with kidney dysfunction.