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La douleur chronique articulaire dans la polyarthrite rhumatoïde : rôle des canaux ASIC3 dans l'athralgie induite par les ACPA et des voies de signalisation NGF/TrkA dans la douleur chronique inflammatoire

Abstract : Rheumatoid arthritis is an autoimmune disease that affects nearly 1% people worldwide and is characterized by joint inflammation, cartilage and bone damages, associated with chronic joint pain, often resistant to current therapies. Whether at a preclinical stage, where we talk about arthralgia, or at an established stage of the pathology, pain constitutes a real burden for the patients with more than 60% rating their pain management has unsatisfactory. The presence of synovitis is necessary for the diagnosis of established RA, therefore, no real therapeutic strategy is used at a preclinical stage. In addition, at an established stage, the current strategy aimed primarily at reducing the activity of the pathology without an actual management of the pain as such.Among the actors of synovitis in RA, Nerve Growth Factor plays a critical role in the establishment and maintenance of painful symptoms. Anti-NGF are known as promising analgesic drugs. Nevertheless, due to pleiotropic effects of NGF, targeting this neurotrophin leads to significant adverse effects. In the first part of this work, we sought to better characterize the specific involvement of intracellular signaling pathways of the high affinity tyrosine kinase A (TrkA) receptor of NGF in a context of inflammatory joint pain (arthritis), but also of somatic and visceral pain. Since a total knockout of TrkA receptor in mice is not viable, we performed a multimodal study in TrkA/C knock-in mice, expressing a chimeric receptor composed of the native extracellular part of TrkA receptor and, the transmembrane and intracellular functional parts of the neurotrophin 3 receptor: TrkC receptor, which is not really involved in inflammatory pain. Thus, NGF can bind normally to the TrkA/C receptor but activates the intracellular signaling pathways downstream of TrkC receptor. Our results have shown that a lack of activation of certain TrkA pathways (i.e. c-Jun and p38 MAPK) in the DRGs of TrkA/C mice, has a significant impact on the development of painful symptoms, especially mechanical hypersensitivity in a context of articular, somatic, or visceral pain, without affecting heat thermal hyperalgesia. These effects result, on one hand, from the decrease of CGRP+ nerve sprouting and in another hand, from the transcriptional changes of some neurotransmitters and mechanotransducers including the proton-sensitive ion channel: ASIC3. In addition, our studies highlight a direct link between NGF/TrkA and bone remodeling, in particular, osteoclastic activity, suggesting a beneficial role of the inhibition of some specific TrkA-associated pathways, in both mechanical hypersensitivity and bone erosion found in RA.In a second part of our work, we investigated the mechanisms involved in arthralgia induced by the injection of autoantibodies against citrullinated peptides (ACPA). The majority of RA patients is positive for ACPA that can be produced months to years before RA diagnosis and appear to be directly associated with the development of pain. Arthralgia is one of the first signs of an emerging RA and can persist even following RA treatment. First, we confirmed that monoclonal ACPA IgG1 subtypes differ in their pronociceptive and bone erosive properties certainly link to their reactivity patterns against citrullinated epitopes on different targets especially those engaging osteoclast activity. Thus, the combination of B02/B09 ACPA clones induced pain like behaviour without any inflammation, but is associated with an alteration of bone homeostasis in injected mice. We suggest that as a result of ACPA-induced osteoclast activation, certain factors (e.g. protons and/or lipids) are released, which sensitize ASIC3, ultimately leading to pain.
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Lauriane Delay. La douleur chronique articulaire dans la polyarthrite rhumatoïde : rôle des canaux ASIC3 dans l'athralgie induite par les ACPA et des voies de signalisation NGF/TrkA dans la douleur chronique inflammatoire. Neurosciences [q-bio.NC]. Université Clermont Auvergne, 2018. Français. ⟨NNT : 2018CLFAS017⟩. ⟨tel-02918095⟩

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