Arpad Szallasi

The vanilloid receptor TRPV1: 10 years from channel cloning to antagonist proof-of-concept

The clinical use of TRPV1 (transient receptor potential vanilloid subfamily, member 1; also known as VR1) antagonists is based on the concept that endogenous agonists acting on TRPV1 might provide a major contribution to certain pain conditions. Indeed, a number of small-molecule TRPV1 antagonists are already undergoing Phase I/II clinical trials for the indications of chronic inflammatory pain and migraine. Moreover, animal models suggest a therapeutic value for TRPV1 antagonists in the treatment of other types of pain, including pain from cancer. We argue that TRPV1 antagonists alone or in conjunction with other analgesics will improve the quality of life of people with migraine, chronic intractable pain secondary to cancer, AIDS or diabetes. Moreover, emerging data indicate that TRPV1 antagonists could also be useful in treating disorders other than pain, such as urinary urge incontinence, chronic cough and irritable bowel syndrome. The lack of effective drugs for treating many of these conditions highlights the need for further investigation into the therapeutic potential of TRPV1 antagonists.

Transient receptor potential channels as therapeutic targets

Transient receptor potential (TRP) cation channels have been among the most aggressively pursued drug targets over the past few years. Although the initial focus of research was on TRP channels that are expressed by nociceptors, there has been an upsurge in the amount of research that implicates TRP channels in other areas of physiology and pathophysiology, including the skin, bladder and pulmonary systems. In addition, mutations in genes encoding TRP channels are the cause of several inherited diseases that affect a variety of systems including the renal, skeletal and nervous system. This Review focuses on recent developments in the TRP channel-related field, and highlights potential opportunities for therapeutic intervention.

Specific binding of resiniferatoxin, an ultrapotent capsaicin analog, by dorsal root anglion membranes

We have previously demonstrated that resiniferatoxin (RTX), an unusual phorbol-related diterpene, induces similar responses in rodents to those induced by capsaicin, the pungent constituent of hot peppers (the genus Capsicum). Strikingly, RTX was 3-4 orders of magnitude more potent than was capsaicin. We report here specific binding of [3H]RTX to particulate preparations from dorsal root ganglia (DRG), a target tissue of both RTX and capsaicin action. The Kd was 0.27 nM for DRG from the rat; the Bmax was 160 fmol/mg. The respective values for pig DRG were 2.2 nM and 730 fmol/mg. Typical phorbol esters did not inhibit [3H]RTX binding. Capsaicin inhibited binding with 10(4)-fold lower affinity than RTX, consistent with the relative in vivo potencies. The specific [3H]RTX binding appears to represent the postulated capsaicin receptor.

Vanilloid receptors : new insights enhance potential as a therapeutic target

&NA; Compounds related to capsaicin and its ultrapotent analog, resiniferatoxin (RTX), collectively referred to as vanilloids, interact at a specific membrane recognition site (vanilloid receptor), expressed almost exclusively by primary sensory neurons involved in nociception and neurogenic inflammation. Desensitization to vanilloids is a promising therapeutic approach to mitigate neuropathic pain and pathological conditions (e.g. vasomotor rhinitis) in which neuropeptides released from primary sensory neurons play a major role. Capsaicin‐containing preparations are already commercially available for these purposes. The use of capsaicin, however, is severely limited by its irritancy, and the synthesis of novel vanilloids with an improved pungency/desensitization ratio is an on‐going objective. This review highlights the emerging evidence that the vanilloid receptor is not a single receptor but a family of receptors, and that these receptors recognize not simply RTX and capsaicin structural analogs but are broader in their ligand‐binding selectivity. We further focus on ligand‐induced messenger plasticity, a recently discovered mechanism underlying the analgesic actions of vanilloids. Lastly, we give a brief overview of the current clinical uses of vanilloids and their future therapeutic potential. The possibility is raised that vanilloid receptor subtype‐specific drugs may be synthesized, devoid of the undesirable side‐effects of capsaicin.

Vanilloid (capsaicin) receptors in the rat: distribution in the brain, regional differences in the spinal cord, axonal transport to the periphery, and depletion by systemic vanilloid treatment.

Vanilloid (capsaicin) receptors were visualized by [3H]resiniferatoxin (RTX) autoradiography in the brain of newborn as well as adult (both control and colchicine-treated) rats. Specific labelling was seen in the brain stem only, in the nucleus of the solitary tract extending into the area postrema and the spinal sensory nucleus of the trigeminal nerve. Also, a strong signal was seen in the dorsal horn, dorsal root, trigeminal and nodose ganglia. Membranes obtained from the cervical, thoracic, and lumbar segments of the spinal cord showed similar affinities for RTX and likewise for capsaicin and capsazepine; maximal receptor density was similar in the cervical and thoracic segments (approximately 70 fmol/mg protein) but was twice as high in the lumbar segment. 24 h after ligation of the vagal or the sciatic nerves, a strong accumulation of specific RTX binding sites was observed mainly proximal to the ligature, implying intraaxonal receptor transport from the nodose and dorsal root ganglia, respectively, to the periphery. Systemic (s.c.) vanilloid treatment depleted specific [3H]RTX binding sites from the brain stem, the sensory (dorsal root as well as trigeminal) ganglia, and the spinal cord. RTX was approximately 200-fold more potent than capsaicin for eliminating vanilloid receptors from the spinal cord. The present results suggest a discrete expression of vanilloid receptors in the brain stem (sensory nuclei); although intrinsic vanilloid receptor-expressing neurons are though to exist in the rat brain, they remain undetected by the present [3H]RTX autoradiography methodology.

Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine

The large Trp gene family encodes transient receptor potential (TRP) proteins that form novel cation-selective ion channels. In mammals, 28 Trp channel genes have been identified. TRP proteins exhibit diverse permeation and gating properties and are involved in a plethora of physiologic functions with a strong impact on cellular sensing and signaling pathways. Indeed, mutations in human genes encoding TRP channels, the so-called “TRP channelopathies,” are responsible for a number of hereditary diseases that affect the musculoskeletal, cardiovascular, genitourinary, and nervous systems. This review gives an overview of the functional properties of mammalian TRP channels, describes their roles in acquired and hereditary diseases, and discusses their potential as drug targets for therapeutic intervention.

Euphorbium: Modern research on its active principle, resiniferatoxin, revives an ancient medicine

Resiniferatoxin, an ultrapotent capsaicin analog present in the latex of Euphorbia resinifera, interacts at a specific membrane recognition site (referred to as the vanilloid receptor), expressed by primary sensory neurons mediating pain perception as well as neurogenic inflammation. Desensitization to resiniferatoxin is a promising approach to mitigate neuropathic pain and other pathological conditions in which sensory neuropeptides released from capsaicin-sensitive neurons play a crucial role. Clinical trials to evaluate the potential of topical resiniferatoxin treatment to relieve pain associated with diabetic polyneuropathy and postherpetic neuralgia are in progress. Though resiniferatoxin was isolated only two decades ago, the dried latex of Euphorbia resinifera, called Euphorbium, has been in medicinal use since the time of recorded history. This review highlights the most important events in the history of this ancient medicine, from the first written record of the therapeutic potential of Euphorbium (at the time of the reign of the Roman Emperor Augustus) to the identification of its active principle as resiniferatoxin in 1975. A brief overview of the enormous contribution of resiniferatoxin to our current understanding of the anatomical localization, function, and pharmacology of vanilloid receptors is provided. Lastly, the mechanisms are summarized by which capsaicin and resiniferatoxin, despite sharing receptors, may have dissimilar biological actions.

Transient receptor potential (TRP) channels: a clinical perspective

Transient receptor potential (TRP) channels are important mediators of sensory signals with marked effects on cellular functions and signalling pathways. Indeed, mutations in genes encoding TRP channels are the cause of several inherited diseases in humans (the so‐called ‘TRP channelopathies’) that affect the cardiovascular, renal, skeletal and nervous systems. TRP channels are also promising targets for drug discovery. The initial focus of research was on TRP channels that are expressed on nociceptive neurons. Indeed, a number of potent, small‐molecule TRPV1, TRPV3 and TRPA1 antagonists have already entered clinical trials as novel analgesic agents. There has been a recent upsurge in the amount of work that expands TRP channel drug discovery efforts into new disease areas such as asthma, cancer, anxiety, cardiac hypertrophy, as well as obesity and metabolic disorders. A better understanding of TRP channel functions in health and disease should lead to the discovery of first‐in‐class drugs for these intractable diseases. With this review, we hope to capture the current state of this rapidly expanding and changing field.

Vanilloid (Capsaicin) Receptors in Health and Disease

The cloned vanilloid (capsaicin) receptor subtype 1 (VR1) integrates multiple noxious stimuli on peripheral terminals of primary sensory neurons. The initial excitation of these neurons is followed by a lasting refractory state, traditionally termed desensitization, that has clear therapeutic potential. Capsaicin is used to relieve neuropathic pain, uremic pruritus, and bladder overactivity. The ultrapotent vanilloid resiniferatoxin, now in phase 2 clinical trials, has improved tolerability. A less recognized human exposure to high capsaicin concentrations may occur by pepper sprays used in law enforcement. Evidence is mounting that VR1 expression is not restricted to sensory neurons. From the olfactory bulb to the cerebellum, VR1-expressing neurons are present in a number of brain nuclei, where they might be activated by anandamide. VR1 presence also was demonstrated in nonneuronal tissues. These discoveries place VR1 in a much broader perspective than pain perception and enhance the potential for unforeseen side effects, especially following prolonged vanilloid therapy. The expression of VR1 is plastic and down-regulated during vanilloid therapy, which might have a pivotal role in desensitization. Good evidence suggests altered VR1 expression in various disease states. This recognition not only may provide novel insights into pathogenesis but also may prove useful in diagnosis.

TRPV1 antagonists: the challenges for therapeutic targeting

The capsaicin receptor TRPV1 (transient receptor potential cation channel, subfamily V, member 1) is a polymodal nociceptor whose expression is upregulated in several painful disorders. At present, potent small molecule TRPV1 antagonists are undergoing clinical trials in patients with chronic pain. Clinical development of TRPV1 antagonists is, however, facing new challenges. Many drug candidates evoke a febrile reaction that varies among patients. We speculate that TRPV1 gene polymorphism might be an underlying cause of the inter-subject variability in pain sensation and response to TRPV1 antagonists. This newly understood and yet to be fully validated aspect of pain suggests that pain management based on regulating the TRPV1 receptor might require a personalized approach for effective clinical outcome. Here, we provide our perspectives on current progress in targeting TRPV1.