A rodent model of HIV protease inhibitor indinavir induced peripheral neuropathy

Pain. 2017 Jan;158(1):75-85. doi: 10.1097/j.pain.0000000000000727.

Abstract

HIV-associated sensory neuropathy (HIV-SN) is the most frequent manifestation of HIV disease. It often presents with significant neuropathic pain and is associated with previous exposure to neurotoxic nucleoside reverse transcriptase inhibitors. However, HIV-SN prevalence remains high even in resource-rich settings where these drugs are no longer used. Previous evidence suggests that exposure to indinavir, a protease inhibitor commonly used in antiretroviral therapy, may link to elevated HIV-SN risk. Here, we investigated whether indinavir treatment was associated with the development of a "dying back" axonal neuropathy and changes in pain-relevant limb withdrawal and thigmotactic behaviours. After 2 intravenous injections of indinavir (50 mg/kg, 4 days apart), adult rats developed hind paw mechanical hypersensitivity, which peaked around 2 weeks post first injection (44% reduction from baseline). At this time, animals also had (1) significantly changed thigmotactic behaviour (62% reduction in central zone entries) comparing with the controls and (2) a significant reduction (45%) in hind paw intraepidermal nerve fibre density. Treatment with gabapentin, but not amitriptyline, was associated with a complete attenuation of hind paw mechanical hypersensitivity observed with indinavir treatment. Furthermore, we found a small but significant increase in microglia with the effector morphology in the lumbar spinal dorsal horn in indinavir-treated animals, coupled with significantly increased expression of phospho-p38 in microglia. In summary, we have reported neuropathic pain-related sensory and behavioural changes accompanied by a significant loss of hind paw skin sensory innervation in a rat model of indinavir-induced peripheral neuropathy that is suitable for further pathophysiological investigation and preclinical evaluation of novel analgesics.

MeSH terms

  • Amines / therapeutic use
  • Analgesics / therapeutic use
  • Animals
  • Calcitonin Gene-Related Peptide / metabolism
  • Calcium-Binding Proteins / metabolism
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Disease Models, Animal
  • Exploratory Behavior / drug effects
  • Gabapentin
  • Ganglia, Spinal / drug effects
  • Ganglia, Spinal / metabolism
  • Ganglia, Spinal / pathology
  • Gene Expression Regulation / drug effects
  • Glial Fibrillary Acidic Protein / metabolism
  • HIV Infections / chemically induced*
  • HIV Infections / complications*
  • HIV Protease Inhibitors / toxicity*
  • Hyperalgesia / etiology
  • Indinavir / toxicity*
  • Male
  • Metacarpus / drug effects
  • Metacarpus / innervation
  • Microfilament Proteins / metabolism
  • Microglia / drug effects
  • Microglia / metabolism
  • Neuralgia / complications
  • Neuralgia / drug therapy
  • Neuralgia / etiology*
  • Neuralgia / pathology
  • Pain Measurement
  • Pain Threshold / drug effects*
  • Physical Stimulation / adverse effects
  • Rats
  • Rats, Wistar
  • Spinal Cord / drug effects
  • Spinal Cord / metabolism
  • Spinal Cord / pathology
  • Statistics, Nonparametric
  • gamma-Aminobutyric Acid / therapeutic use

Substances

  • Aif1 protein, rat
  • Amines
  • Analgesics
  • Calcium-Binding Proteins
  • Cyclohexanecarboxylic Acids
  • Glial Fibrillary Acidic Protein
  • HIV Protease Inhibitors
  • Microfilament Proteins
  • gamma-Aminobutyric Acid
  • Indinavir
  • Gabapentin
  • Calcitonin Gene-Related Peptide