Inthe United States, at least 116 million adults suffer from chronic pain; the associated costs exceed $500 billion/yr. Neuropathic pain presents in 18% of chronic pain patients, and commonly arises from aberrant activity in the peripheral nervous system. chronic addiction, treatment Opioid analgesics are routinely prescribed for the treatment of pain but there are substantial risks involved with such therapy, including physical dependence, and fatal poisoning. The goal of this project is to develop a non-opioid antihyperalgesic for the of peripheral neuropathic pain. Neuronal hyperexcitability and spontaneous activity characterize neuropathic pain, properties associated with activity of hyperpolarization-activated, cyclic nucleotide-regulated (HCN1-4) channels, the source of the pacemaker current, Ih. Inhibition of HCN1-mediated Ih elicits marked antihyperalgesia in multiple animal models of neuropathic pain (including both direct nerve injury and chemotherapy-induced peripheral neuropathy, or CIPN), and does so with little or no disruption to either routine (normal) pain processing or baseline behaviors and activities. The overall objective is to develop a peripherally-restricted HCN1 inverse-agonist as a therapeutic for neuropathic pain. We have generated a novel small molecule (BP4L-18:1:1) that combines an antihyperalgesic HCN1 inhibitor with a motif that controls distribution and membrane presentation. Our immediate goal is to examine the behavior of BP4L-18:1:1 in detail and determine its efficacy and safety when administered orally as an antihyperalgesic in a rat model of nerve injury neuropathic pain. Our long-term goal is to determine if an injectable antibody-drug-conjugate (ADC)-derivative of BP4L-18:1:1, one that discretely targets peripheral HCN1 ion channels via association with an extracellular epitope on the channel, is safe and effective in relieving nerve injury and chemotherapy-induced neuropathic pain in appropriate rat models. Validation in these models will facilitate rapid transitioning to appropriate human studies. Successful completion of these goals will accelerate the development of an urgently needed, highly-effective, non-opioid, treatment for neuropathic pain.

Public Health Relevance

Neuropathic pain is a common clinical disorder for which treatment options are generally ineffective, and often dangerous. Degradation of an individual's quality of life, combined with substantial societal and monetary costs, make this condition a significant public health issue. The immediate goal of this project is to determine a orally; thereby if novel small-molecule alkylphenol that inhibits HCN1 channel function is antihyperalgesic when administered the long-term goal is the devlopment of an injectable version of this drug using a monoclonal antibody, creating anurgently needed, highly-effective, non-opioid, treatment for neuropathic pain.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
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Special Emphasis Panel (ZNS1)
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Skiadopoulos, Mario Hercules
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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