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Neuronal Dysfunction Associated with Colorectal Cancer Augments Sensitivity to Chemotherapy-induced Neuropathic Pain

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      Neuropathic pain is a common and debilitating side effect of many cancer treatments. The platinum-based chemotherapeutic agent oxaliplatin is widely used in treatment regimens for colorectal cancer, but its side effects (including numbness, tingling or sharp, stabbing, 'electrical' pain) are so severe as to become dose limiting in a subset of patients. We set out to determine if the systemic immune system alterations in colon cancer could influence subsequent sensitivity to oxaliplatin therapy. Using two orthotopic mouse models of colon cancer, we perform immunohistochemistry, behavioral analysis, functional calcium imaging, plasma cytokine/chemokine array analysis and mitochondrial functional capacity to determine the extent to which cancer-associated inflammation drives neuronal dysfunction in response to chemotherapy. We found that two distinct colorectal cancer cell lines in two immunocompetent mouse strains induced impaired mitochondrial function in dorsal root ganglion neurons in vitro. This was accompanied by a significant reduction in intra-epidermal nerve fiber density in the plantar hindpaw skin. Multi-electrode array and ratiometric calcium imaging show abnormalities in spontaneous firing and cytosolic calcium concentration in dorsal root ganglion neurons. Finally, we show that tumor-bearing mice show a greater degree of tactile and cold sensitivity in response to a sub-maximal dose of oxaliplatin, despite there being no overt symptoms of neuropathy in tumor-bearing mice that did not receive oxaliplatin. We conclude that colorectal cancer induces 'sub-clinical' neuronal injury that predisposes to neuropathic pain hypersensitivity upon subsequent treatment with oxaliplatin. Future experiments will focus on identifying the soluble factor(s) responsible, and the generalizability of this phenomenon. Grant support from Rita Allen Foundation.
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