Introduction
Itch is an uncomfortable sensation and emotional experience that strongly evokes a desire to scratch [
1]. Itch is caused by not only skin disease but also systemic, neuropathic, psychogenic and cutaneous disorders [
2]. It is well known that itch can be induced through histamine dependent and histamine-independent pathways [
3,
4], and both types of itch have been found to activate spinothalamic tract neurons [
5,
6]. Neuroimaging studies in humans have confirmed the anterior cingulate cortex (ACC), along with other cortical structures, are activated by itch [
7,
8]. Moreover, Descalzi et al. showed that itching enhanced spontaneous excitatory post-synaptic currents in ACC pyramidal neurons [
9].
Itch can be classified as either acute or chronic according to the course duration. Acute itch is a daily experience that can usually be abolished by briefly scratching near the area of itching. Chronic itch can be debilitating, and local scratching often provides little relief and can even exacerbate the problem instead [
10]. To the best of our knowledge, few studies have focused on itch-related cortical changes in chronic itch.
It is generally known that glutamate-mediated 2-amino-3-(3-hydroxy-5-methyl-isoxazol-4-yl) propanoic acid receptor (AMPAR) functions contribute to excitatory post synaptic transmission. Membrane trafficking of AMPARs is dynamic, and such dynamic trafficking is important for the expression of synaptic plasticity [
11,
12]. The electrophysiological characteristics of AMPARs have been investigated using conventional methods that assess the changes in synaptic plasticity.
In the present study, we combined behavioral and electrophysiological approaches to investigate whether there are changes in synaptic plasticity in the ACC during chronic itch. Furthermore, we sought to determine the underlying mechanisms of such changes in synaptic plasticity.
Discussion
Chronic itch can be induced by peripheral neuropathy or nerve irritation [
26]. According to previous studies, itch and pain share similar mechanisms [
3]. These conditions can result from immune dysfunction because inflammatory mediators can directly activate or sensitize nociceptive and pruriceptive neurons in the peripheral and central nervous systems, leading to pain and itch hypersensitivity [
27]. DCP acts as a local irritant, triggering a local sensitization, and it triggers an immune response that opposes the action of autoreactive cells [
28]. In our study, we found that DCP application can induce chronic itch in a rat model.
The ACC is critical for cognitive functions, including decision making, trace memory, attention, and persistent pain [
29,
30]. It has been well documented that the ACC is important for pain-related perception, and there are both presynaptic and postsynaptic changes in ACC synapses after nerve injury [
17,
31]. Long-term changes in synaptic transmission, occurring in sensory synapses located along the somatosensory pathway or pain-processing brain regions, contribute to chronic inflammatory and neuropathic pain [
32‐
35]. Therefore, we explored the synaptic transmission of the ACC in a chronic itch model. Our results showed that the enhanced excitatory synaptic transmission in the ACC after chronic itch can be attributted to increases in the probability of presynaptic neurotransmitter release and postsynaptic responsiveness.
AMPA receptors are heteromultimers assembled from GluR1, GluR2, GluR3 and GluR4 subunits [
36,
37]. AMPA receptors without GluR2 are Ca
2+ permeable (CP-AMPA receptors) and inwardly rectifying, which are always GluR1 heteromultimer [
38]. Therefore, an alteration in the rectification index could reflect the subunit composition of AMPA receptors. In previous studies, the number of synaptic GluR1 subunits in the ACC of rats increased with nerve injury and chronic inflammation pain [
17,
39]. The trafficking of AMPA receptor subunits has been proposed to contribute to synaptic plasticity underlying hyperalgesia [
32]. In our study, we found an intensified function of CP-AMPARs in ACC neurons after the development of chronic itch. This result indicates that, similar to neuropathic pain, the dynamic membrane trafficking of CP-AMPAR in ACC is also induced by chronic itch.
Long-term synaptic plasticity often results in a change in the number of functional synaptic modules connecting pre- and postsynaptic neurons, conversion of silent synapses to functional synapses (unsilencing), and conversion of functional synapses to silent synapses (silencing), which should occur frequently in the brain [
22]. Our data suggest that silent synapses were unsilenced by recruiting AMPARs in ACC neurons after chronic itch. Although evidence indicates that AMPA-silent synapses are largely confined to the prepubescent developmental period [
22], some AMPA-silent synapses may exist among mature synapses and ageing animals [
40]. In the current study, the presence of silent synapses in the ACC of young adult rats (3-5 weeks old) is supported by the reduced failure rate of eEPSCs at depolarized holding potentials. Furthermore, in DCP group, the failure rate of eEPSCs did not differ between positive and negative holding potentials, indicating that silent synapses were unsilenced postsynaptically.
In addition to postsynaptically silent synapses, presynaptically silent synapses also exist. Presynaptically silent synapses do not release neurotransmitter in response to presynaptic action potentials, and they are silent when receiving low-frequency stimulation but begin releasing neurotransmitters, and are therefore not silent, when they receive high-frequency stimulation [
41]. We found that there was an increase in the frequency of mEPSCs in ACC pyramidal neurons after chronic itch was induced. Moreover, the PPR of ACC neurons in the chronic itch group was smaller than those in the control group at 50-ms intervals. These results indicate that presynaptically silent synapses were unsilenced as well.
There are some limitations in this study that should be noted. First, NMDAR is another type of major glutamate receptor, and it has been considered a potential target for the treatment of itch [
42]. Moreover, NMDAR, especially NR2B, in the ACC plays an important role in the induction and expression of persistent inflammatory and neuropathic pain [
43,
44]. The contribution of NMDARs was not estimated in the current study. Second, the rectifying properties of AMPARs can only reveal the function of CP-AMPARs. Whether other subtypes of AMPARs contributed to the chronic itch need to be investigated in the future work. Third, Descalzi et al. showed that the acute scratching corresponds with enhanced excitatory transmission in the ACC through kainate receptor modulation of inhibitory circuitry [
9]. However, we found that the GABAergic transmission was not affected by chronic itch. It has been well known that kainate receptors are rare in pyramidal neurons. We therefore never considered the contribution of kainate currents in the electrophysiology experiments. However, kainate receptor GluK1 is considered to be incorporated into the silent synapses in CA1 pyramidal neurons [
45]. Thus, whether the redistribution of kainate receptors on ACC pyramidal neurons under the chronic itch condition is curious.
Abbreviations
ACC, anterior cingulate cortex; ACSF, artificial cerebrospinal fluid; AMPA, 2-amino-3-(3-hydroxy-5-methyl-isoxazol-4-yl) propanoic acid; AP5, 2-amino-5-phosphonopentanoate; DCP, diphenylcyclopropenone; DNQX, 6,7-dinitroquinoxaline-2,3(1H,4H)-dione; EPSCs excitatory postsynaptic currents; GABA, γ-aminobutyric acid; mEPSCs, miniature excitatory postsynaptic currents; mIPSCs, miniature inhibitory postsynaptic currents; NMDA, N-methyl-D-aspartate; PPR, paired-pulse ratio; TTX, tetrodotoxin
Acknowledgements
The authors are grateful to Dr. Ying-Wei Wang (Professor of Anesthesiology at Huashan Hospital, Fudan University, Shanghai, China) for his constructive suggestions.