Insensitivity to pain induced by a potent selective closed-state Nav1.7 inhibitor

著者: M. Flinspach, Q. Xu, A. D. Piekarz, R. Fellows, R. Hagan, A. Gibbs, Y. Liu, R. A. Neff, J. Freedman, W. A. Eckert, M. Zhou, R. Bonesteel, M. W. Pennington, K. A. Eddinger, T. L. Yaksh, M. Hunter, R. V. Swanson & A. D. Wickenden

Pain places a devastating burden on patients and society and current pain therapeutics exhibit limitations in efficacy, unwanted side effects and the potential for drug abuse and diversion. Although genetic evidence has clearly demonstrated that the voltage-gated sodium channel, NaV1.7, is critical to pain sensation in mammals, pharmacological inhibitors of NaV1.7 have not yet fully recapitulated the dramatic analgesia observed in NaV1.7-null subjects. Using the tarantula venom-peptide ProTX-II as a scaffold, we engineered a library of over 1500 venom-derived peptides and identified JNJ63955918 as a potent, highly selective, closed-state NaV1.7 blocking peptide. Here we show that JNJ63955918 induces a pharmacological insensitivity to pain that closely recapitulates key features of the NaV1.7-null phenotype seen in mice and humans. Our findings demonstrate that a high degree of selectivity, coupled with a closed-state dependent mechanism of action is required for strong efficacy and indicate that peptides such as JNJ63955918 and other suitably optimized NaV1.7 inhibitors may represent viable non-opioid alternatives for the pharmacological treatment of severe pain.