Die Rolle von LRP1 in der Funktion des NMDA-Rezeptors

Ein funktionelles Zusammenspiel von LRP1, einem Mitglied der LDL-Rezeptorfamilie, mit dem NMDA-Rezeptor, einem Glutamat Rezeptor, wurde durch die Interaktion beider Proteine sowie eine tPa-vermittelte, LRP1-abhängige Signalübertragung durch den NMDA-Rezeptor belegt. Darüber hinaus zeigen Mäuse mit einem konditionellen neuronalen knock-out des Lrp1 Gens Verhaltensänderungen, die mit einer beeinträchtigten Signalübertragung durch NMDA-Rezeptoren assoziiert werden könnten. Die genaue Rolle von LRP1 in der NMDA-Rezeptor-Funktion bleibt allerdings noch unklar. In der vorliegenden Arbeit wurde die Rolle von LRP1 bei der Expression der NR2B-Untereinheit des NMDA-Rezeptors an der Zelloberfläche primärer kortikaler Neurone untersucht. Zu diesem Zweck wurde die knock-in Mauslinie LRP1ΔNPxY2, die sich durch eine Alanin Substitution im NPxY2 Motiv des LRP1 auszeichnet, eingesetzt. rnEs konnte gezeigt werden, dass diese knock-in Mutation in einer erhöhten Expression von LRP1 und der NMDA-Rezeptoruntereinheiten NR1 und NR2B an der Zelloberfläche primärer kortikaler Neurone resultiert. Der Effekt konnte durch eine reduzierte Endozytoserate von LRP1 und der NR1-und NR2B-Untereinheiten in primären LRP1ΔNPxY2 Neuronen erklärt werden. Darüber hinaus wurde ein verändertes Phosphorylierungsmuster der Internalisierungssignale der NR2B-Rezeptoruntereinheit Serin S1480 und Tyrosin Y1472 an der Zelloberfläche primärer LRP1ΔNPxY2 Neurone detektiert. Die verantwortlichen Kinasen Fyn und Kasein-Kinase II sind allerdings in LRP1ΔNPxY2 Neuronen im Vergleich zu den Wildtyp-Kontrollen nicht abweichend reguliert. In den Co-Immunopräzipitationsexperimenten wurde gezeigt, dass die Bindung von LRP1 mit NR2B durch die Phosphorylierung reguliert wird und dieser Regulationsmechanismus in LRP1ΔNPxY2 Neuronen beeinträchtigt ist. Dies resultiert in einer stärkeren Bindung von NR2B-Rezeptoruntereinheit an LRP1. Aufgrund reduzierter Internalisierungsraten von LRP1 in LRP1ΔNPxY2 Neuronen führt dieser Umstand zu einer Akkumulation beider Rezeptorproteine an der Zelloberfläche. Schließlich wurden die NMDA-Rezeptor-assoziierten Verhaltensänderungen wie die Hyperaktivität und die Defizite im direkten und umgekehrten räumlichen Lernvermögen in den LRP1ΔNPxY2 Tieren nachgewiesen. Zusammengefasst, demonstrieren diese Ergebnisse, dass LRP1 eine kritische Rolle in der Regulierung der NR2B-Expression an der Zelloberfläche spielt.

Molekulare Ursachen und therapeutische Intervention bei der Alzheimer-Demenz

Ein charakteristisches, neuropathologisches Merkmal der Alzheimer-Demenz (AD), der am häufigsten vorkommenden Demenz-Form des Menschen, ist das Auftreten von senilen Plaques im Gehirn der Patienten. Hierbei stellt das neurotoxische A-beta Peptid den Hauptbestandteil dieser Ablagerungen dar. Einen Beitrag zu der pathologisch erhöhten A-beta Generierung liefert das verschobene Expressionsgleichgewicht der um APP-konkurrierenden Proteasen BACE-1 und ADAM10 zu Gunsten der beta-Sekretase BACE-1. In der vorliegenden Dissertation sollten molekulare Mechanismen identifiziert werden, die zu einem pathologisch veränderten Gleichgewicht der APP-Spaltung und somit zum Entstehen und Fortschritt der AD beitragen. Des Weiteren sollten Substanzen identifiziert werden, die durch Beeinflussung der Genexpression einer der beiden Proteasen das physiologische Gleichgewicht der APP-Prozessierung wiederherstellen können und somit therapeutisch einsetzbar sind.rnAnhand eines „Screenings“ von 704 Transkriptionsfaktoren wurden 23 Faktoren erhalten die das Verhältnis ADAM10- pro BACE-1-Promotor Aktivität beeinflussten. Exemplarisch wurden zwei der molekularen Faktoren auf ihren Wirkmechanismus untersucht: Der TF „X box binding protein-1“ (XBP-1), der die so genannte „unfolded protein response“ (UPR) reguliert, erhöhte die Expression von ADAM10 in Zellkultur-Experimenten. Die Menge dieses Faktors war in AD-Patienten im Vergleich zu gesunden, Alters-korrelierten Kontrollen signifikant erniedrigt. Im Gegensatz dazu verminderte der Seneszenz-assoziierte TF „T box 2“ (Tbx2) die Menge an ADAM10 in SH-SY5Y Zellen. Die Expression des Faktors selbst war in post-mortem Kortexgewebe von AD-Patienten erhöht. Zusätzlich zu den TFs konnten in einer Kooperation mit dem Helmholtz Zentrum München drei microRNAs (miRNA 103, 107, 1306) bioinformatisch prädiziert und experimentell validiert werden, die die Expression des humanen ADAM10 reduzierten.rnIm Rahmen dieser Arbeit konnten damit körpereigene Faktoren identifiziert werden, die die Menge an ADAM10 regulieren und folglich potenziell an der Entstehung der gestörten Homöostase der APP-Prozessierung beteiligt sind. Somit ist die AD auch im Hinblick auf eine A-beta-vermittelte Pathologie als multifaktorielle Krankheit zu verstehen, in der verschiedene Regulatoren zur gestörten APP-Prozessierung und somit zur pathologisch gesteigerten A-beta Generierung beitragen können. rnEine pharmakologische Erhöhung der ADAM10 Genexpression würde zu der Freisetzung von neuroprotektivem APPs-alpha und gleichzeitig zu einer reduzierten A-beta Generierung führen. Deshalb war ein weiteres Ziel dieser Arbeit die Evaluierung von Substanzen mit therapeutischem Potenzial im Hinblick auf eine erhöhte ADAM10 Expression. Von 640 FDA-zugelassenen Medikamenten einer Substanz-Bibliothek wurden 23 Substanzen identifiziert, die die Menge an ADAM10 signifikant steigerten während die Expression von BACE-1 und APP unbeeinflusst blieb. In Zusammenarbeit mit dem Institut für Pathologie (Johannes Gutenberg Universität Mainz) wurde ein Zellkultur-basiertes Modell etabliert, um die Permeationsfähigkeit der potenziellen Kandidaten-Substanzen über die Blut-Hirn Schranke (BHS) zu untersuchen. Von den 23 Medikamenten konnten neun im Rahmen des etablierten Modells als BHS-gängig charakterisiert werden. Somit erfüllen diese verbleibenden Medikamente die grundlegenden Anforderungen an ein AD-Therapeutikum. rnADAM10 spaltet neben APP eine Vielzahl anderer Substrate mit unterschiedlichen Funktionen in der Zelle. Zum Beispiel reguliert das Zelladhäsionsmolekül Neuroligin-1 (NL-1), das von ADAM10 prozessiert wird, die synaptische Funktion exzitatorischer Neurone. Aus diesem Grund ist die Abschätzung potenzieller, Therapie-bedingter Nebenwirkungen sehr wichtig. Im Rahmen eines Forschungsaufenthalts an der Universität von Tokio konnte in primären, kortikalen Neuronen der Ratte bei einer Retinoid-induzierten Erhöhung von ADAM10 neben einer vermehrten alpha-sekretorischen APP-Prozessierung auch eine gesteigerte Spaltung von NL-1 beobachtet werden. Dies lässt vermuten, dass bei einer Behandlung mit dem Retinoid Acitretin neben einer vermehrten APP-Spaltung durch ADAM10 auch die Regulation glutamaterger Neurone durch die Spaltung von NL-1 betroffen ist. Anhand eines geeigneten Alzheimer-Tiermodells sollten diese Befunde weiter analysiert werden, um so auf einen sicheren therapeutischen Ansatz bezüglich einer vermehrten ADAM10 Genexpression schließen zu können.rn

The physiological role of APP in the activation of neuroprotective signaling mechanisms

Accumulating evidence indicates that loss of physiological amyloid precursor protein (APP) function leads to enhanced susceptibility of neurons to cellular stress during brain aging. This study investigated the neuroprotective function of the soluble APP ectodomain sAPPα. Recombinant sAPPα protected primary hippocampal neurons and neuroblastoma cells from cell death induced by trophic factor deprivation. This protective effect was abrogated in APP-depleted neurons, but not in APLP1-, APLP2- or IGF1-R-deficient cells, indicating that expression of holo-APP is required for sAPPα-dependent neuroprotection. Strikingly, recombinant sAPPα, APP-E1 domain and the copper-binding growth factor-like domain (GFLD) of APP were able to stimulate PI3K/Akt survival signaling in different wildtype cell models, but failed in APP-deficient cells. An ADAM10 inhibitor blocking endogenous sAPPα secretion exacerbated neuron death in organotypic hippocampal slices subjected to metabolic stress, which could be rescued by exogenous sAPPα. Interestingly, sAPPα-dependent neuroprotection was unaffected in neurons of APP-ΔCT15 mice which lack the intracellular C-terminal YENPTY motif of APP. In contrast, sAPPα-dependent Akt signaling was completely abolished in APP mutant cells lacking the C-terminal G-protein interaction motif and by specifically blocking Gi/o-dependent signaling with pertussis toxin. Collectively, the present thesis provides new mechanistic insights into the physiological role of APP: the data suggest that cell surface APP mediates sAPPα-induced neuroprotection via Go-protein-coupled activation of the Akt pathway.

Differential effect of elevated intralabyrinthine pressure on ocular vestibular evoked myogenic potentials elicited by air conducted sound and bone conducted vibration

Recently, ocular vestibular evoked myogenic potentials (oVEMP) have emerged as a tool for assessment of utricular function. They are short-latency myogenic potentials which can be elicited in response to vestibular stimulation, e.g. by air-conducted sound (ACS) or bone-conducted vibration (BCV) (reviewed in (Kantner and Gurkov, 2012)). Otolithic afferent neurons trigger reflexive electromyographic activity of the extraocular muscles which can be recorded beneath the eye contralateral to the stimulated ear by use of surface electrodes.

A new feature extraction method for signal classification applied to cat spinal cord signals

In the spinal cord of the anesthetized cat, spontaneous cord dorsum potentials (CDPs) appear synchronously along the lumbo-sacral segments. These CDPs have different shapes and magnitudes. Previous work has indicated that some CDPs appear to be specially associated with the activation of spinal pathways that lead to primary afferent depolarization and presynaptic inhibition. Visual detection and classification of these CDPs provides relevant information on the functional organization of the neural networks involved in the control of sensory information and allows the characterization of the changes produced by acute nerve and spinal lesions. We now present a novel feature extraction approach for signal classification, applied to CDP detection. The method is based on an intuitive procedure. We first remove by convolution the noise from the CDPs recorded in each given spinal segment. Then, we assign a coefficient for each main local maximum of the signal using its amplitude and distance to the most important maximum of the signal. These coefficients will be the input for the subsequent classification algorithm. In particular, we employ gradient boosting classification trees. This combination of approaches allows a faster and more accurate discrimination of CDPs than is obtained by other methods.

Neurotrophic factors [activity-dependent neurotrophic factor (ADNF) and basic fibroblast growth factor (bFGF)] interrupt excitotoxic neurodegenerative cascades promoted by a PS1 mutation

Although an excitotoxic mechanism of neuronal injury has been proposed to play a role in chronic neurodegenerative disorders such as Alzheimer’s disease, and neurotrophic factors have been put forward as potential therapeutic agents, direct evidence is lacking. Taking advantage of the fact that mutations in the presenilin-1 (PS1) gene are causally linked to many cases of early-onset inherited Alzheimer’s disease, we generated PS1 mutant knock-in mice and directly tested the excitotoxic and neurotrophic hypotheses of Alzheimer’s disease. Primary hippocampal neurons from PS1 mutant knock-in mice exhibited increased production of amyloid β-peptide 42/43 and increased vulnerability to excitotoxicity, which occurred in a gene dosage-dependent manner. Neurons expressing mutant PS1 exhibited enhanced calcium responses to glutamate and increased oxyradical production and mitochondrial dysfunction. Pretreatment with either basic fibroblast growth factor or activity-dependent neurotrophic factor protected neurons expressing mutant PS1 against excitotoxicity. Both basic fibroblast growth factor and activity-dependent neurotrophic factor stabilized intracellular calcium levels and abrogated the increased oxyradical production and mitochondrial dysfunction otherwise caused by the PS1 mutation. Our data indicate that neurotrophic factors can interrupt excitotoxic neurodegenerative cascades promoted by PS1 mutations.

Identification and characterization of a conserved family of protein serine/threonine phosphatases homologous to Drosophila retinal degeneration C (rdgC)

The Drosophila retinal degeneration C (rdgC) gene encodes an unusual protein serine/threonine phosphatase in that it contains at least two EF-hand motifs at its carboxy terminus. By a combination of large-scale sequencing of human retina cDNA clones and searches of expressed sequence tag and genomic DNA databases, we have identified two sequences in mammals [Protein Phosphatase with EF-hands-1 and 2 (PPEF-1 and PPEF-2)] and one in Caenorhabditis elegans (PPEF) that closely resemble rdgC. In the adult, PPEF-2 is expressed specifically in retinal rod photoreceptors and the pineal. In the retina, several isoforms of PPEF-2 are predicted to arise from differential splicing. The isoform that most closely resembles rdgC is localized to rod inner segments. Together with the recently described localization of PPEF-1 transcripts to primary somatosensory neurons and inner ear cells in the developing mouse, these data suggest that the PPEF family of protein serine/threonine phosphatases plays a specific and conserved role in diverse sensory neurons.

Glyceraldehyde-3-phosphate dehydrogenase: Nuclear translocation participates in neuronal and nonneuronal cell death

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) protein levels increase in particulate fractions in association with cell death in HEK293 cells, S49 cells, primary thymocytes, PC12 cells, and primary cerebral cortical neuronal cultures. Subcellular fractionation and immunocytochemistry reveal that this increase primarily reflects nuclear translocation. Nuclear GAPDH is tightly bound, resisting extraction by DNase or salt treatment. Treating primary thymocytes, PC12 cells, and primary cortical neurons with antisense but not sense oligonucleotides to GAPDH prevents cell death. Because cell-death-associated nuclear translocation of GAPDH and antisense protection occur in multiple neuronal and nonneuronal systems, we propose that GAPDH is a general mediator of cell death and uses nuclear translocation as a signaling mechanism.

Cocaine- and amphetamine-regulated transcript in the rat vagus nerve: A putative mediator of cholecystokinin-induced satiety

Cocaine- and amphetamine-regulated transcript (CART) is widely expressed in the central nervous system. Recent studies have pointed to a role for CART-derived peptides in inhibiting feeding behavior. Although these actions have generally been attributed to hypothalamic CART, it remains to be determined whether additional CART pathways exist that link signals from the gastrointestinal tract to the central control of food intake. In the present study, we have investigated the presence of CART in the rat vagus nerve and nodose ganglion. In the viscerosensory nodose ganglion, half of the neuron profiles expressed CART and its predicted peptide, as determined by in situ hybridization and immunohistochemistry. CART expression was markedly attenuated after vagotomy, but no modulation was observed after food restriction or high-fat regimes. A large proportion of CART-labeled neuron profiles also expressed cholecystokinin A receptor mRNA. CART-peptide-like immunoreactivity was transported in the vagus nerve and found in a dense fiber plexus in the nucleus tractus solitarii. Studies on CART in the spinal somatosensory system revealed strong immunostaining of the dorsal horn but only a small number of stained cell bodies in dorsal root ganglia. The present results suggest that CART-derived peptides are present in vagal afferent neurons sensitive to cholecystokinin, suggesting that the role of these peptides in feeding may be explained partly by mediating postprandial satiety effects of cholecystokinin.

Characterization of Mayven, a Novel Actin-binding Protein Predominantly Expressed in Brain

The cytoskeleton plays an important role in neuronal morphogenesis. We have identified and characterized a novel actin-binding protein, termed Mayven, predominantly expressed in brain. Mayven contains a BTB (broad complex, tramtrack, bric-a-brac)/POZ (poxvirus, zinc finger) domain-like structure in the predicted N terminus and “kelch repeats” in the predicted C-terminal domain. Mayven shares 63% identity (77% similarity) with the Drosophila ring canal (“kelch”) protein. Somatic cell-hybrid analysis indicated that the human Mayven gene is located on chromosome 4q21.2, whereas the murine homolog gene is located on chromosome 8. The BTB/POZ domain of Mayven can self-dimerize in vitro, which might be important for its interaction with other BTB/POZ-containing proteins. Confocal microscopic studies of endogenous Mayven protein revealed a highly dynamic localization pattern of the protein. In U373-MG astrocytoma/glioblastoma cells, Mayven colocalized with actin filaments in stress fibers and in patchy cortical actin-rich regions of the cell margins. In primary rat hippocampal neurons, Mayven is highly expressed in the cell body and in neurite processes. Binding assays and far Western blotting analysis demonstrated association of Mayven with actin. This association is mediated through the “kelch repeats” within the C terminus of Mayven. Depolarization of primary hippocampal neurons with KCl enhanced the association of Mayven with actin. This increased association resulted in dynamic changes in Mayven distribution from uniform to punctate localization along neuronal processes. These results suggest that Mayven functions as an actin-binding protein that may be translocated along axonal processes and might be involved in the dynamic organization of the actin cytoskeleton in brain cells.

Nerve growth factor rapidly suppresses basal, NMDA-evoked, and AMPA-evoked nitric oxide synthase activity in rat hippocampus in vivo

In adult forebrain, nerve growth factor (NGF) influences neuronal maintenance and axon sprouting and is neuroprotective in several injury models through mechanisms that are incompletely understood. Most NGF signaling is thought to occur after internalization and retrograde transport of trkA receptor and be mediated through the nucleus. However, NGF expression in hippocampus is rapidly and sensitively regulated by synaptic activity, suggesting that NGF exerts local effects more dynamically than possible through signaling requiring retrograde transport to distant afferent neurons. Interactions have been reported between NGF and nitric oxide (NO). Because NO affects both neural plasticity and degeneration, and trk receptors can mediate signaling within minutes, we hypothesized that NGF might rapidly modulate NO production. Using in vivo microdialysis we measured conversion of l-[14C]arginine to l-[14C]citrulline as an accurate reflection of NO synthase (NOS) activity in adult rat hippocampus. NGF significantly reduced NOS activity to 61% of basal levels within 20 min of onset of delivery and maintained NOS activity at less than 50% of baseline throughout 3 hr of delivery. This effect did not occur with control protein (cytochrome c) and was not mediated by an effect of NGF on glutamate levels. In addition, simultaneous delivery of NGF prevented significant increases in NOS activity triggered by the glutamate receptor agonists N-methyl-d-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA). Rapid suppression by NGF of basal and glutamate-stimulated NOS activity may regulate neuromodulatory functions of NO or protect neurons from NO toxicity and suggests a novel mechanism for rapidly mediating functions of NGF and other neurotrophins.

Sodium channels and pain

Although it is well established that hyperexcitability and/or increased baseline sensitivity of primary sensory neurons can lead to abnormal burst activity associated with pain, the underlying molecular mechanisms are not fully understood. Early studies demonstrated that, after injury to their axons, neurons can display changes in excitability, suggesting increased sodium channel expression, and, in fact, abnormal sodium channel accumulation has been observed at the tips of injured axons. We have used an ensemble of molecular, electrophysiological, and pharmacological techniques to ask: what types of sodium channels underlie hyperexcitability of primary sensory neurons after injury? Our studies demonstrate that multiple sodium channels, with distinct electrophysiological properties, are encoded by distinct mRNAs within small dorsal root ganglion (DRG) neurons, which include nociceptive cells. Moreover, several DRG neuron-specific sodium channels now have been cloned and sequenced. After injury to the axons of DRG neurons, there is a dramatic change in sodium channel expression in these cells, with down-regulation of some sodium channel genes and up-regulation of another, previously silent sodium channel gene. This plasticity in sodium channel gene expression is accompanied by electrophysiological changes that poise these cells to fire spontaneously or at inappropriate high frequencies. Changes in sodium channel gene expression also are observed in experimental models of inflammatory pain. Thus, sodium channel expression in DRG neurons is dynamic, changing significantly after injury. Sodium channels within primary sensory neurons may play an important role in the pathophysiology of pain.

Ion channels gated by heat

All animals need to sense temperature to avoid hostile environments and to regulate their internal homeostasis. A particularly obvious example is that animals need to avoid damagingly hot stimuli. The mechanisms by which temperature is sensed have until recently been mysterious, but in the last couple of years, we have begun to understand how noxious thermal stimuli are detected by sensory neurons. Heat has been found to open a nonselective cation channel in primary sensory neurons, probably by a direct action. In a separate study, an ion channel gated by capsaicin, the active ingredient of chili peppers, was cloned from sensory neurons. This channel (vanilloid receptor subtype 1, VR1) is gated by heat in a manner similar to the native heat-activated channel, and our current best guess is that this channel is the molecular substrate for the detection of painful heat. Both the heat channel and VR1 are modulated in interesting ways. The response of the heat channel is potentiated by phosphorylation by protein kinase C, whereas VR1 is potentiated by externally applied protons. Protein kinase C is known to be activated by a variety of inflammatory mediators, including bradykinin, whereas extracellular acidification is characteristically produced by anoxia and inflammation. Both modulatory pathways are likely, therefore, to have important physiological correlates in terms of the enhanced pain (hyperalgesia) produced by tissue damage and inflammation. Future work should focus on establishing, in molecular terms, how a single ion channel can detect heat and how the detection threshold can be modulated by hyperalgesic stimuli.

Brain-derived neurotrophic factor is an endogenous modulator of nociceptive responses in the spinal cord

The primary sensory neurons that respond to noxious stimulation and project to the spinal cord are known to fall into two distinct groups: one sensitive to nerve growth factor and the other sensitive to glial cell-line-derived neurotrophic factor. There is currently considerable interest in the ways in which these factors may regulate nociceptor properties. Recently, however, it has emerged that another trophic factor—brain-derived neurotrophic factor (BDNF)—may play an important neuromodulatory role in the dorsal horn of the spinal cord. BDNF meets many of the criteria necessary to establish it as a neurotransmitter/neuromodulator in small-diameter nociceptive neurons. It is synthesized by these neurons and packaged in dense core vesicles in nociceptor terminals in the superficial dorsal horn. It is markedly up-regulated in inflammatory conditions in a nerve growth factor-dependent fashion. Postsynaptic cells in this region express receptors for BDNF. Spinal neurons show increased excitability to nociceptive inputs after treatment with exogenous BDNF. There are both electrophysiological and behavioral data showing that antagonism of BDNF at least partially prevents some aspects of central sensitization. Together, these findings suggest that BDNF may be released from primary sensory nociceptors with activity, particularly in some persistent pain states, and may then increase the excitability of rostrally projecting second-order systems. BDNF released from nociceptive terminals may thus contribute to the sensory abnormalities associated with some pathophysiological states, notably inflammatory conditions.

Distinct neurochemical features of acute and persistent pain

To address the neurochemistry of the mechanisms that underlie the development of acute and persistent pain, our laboratory has been studying mice with deletions of gene products that have been implicated in nociceptive processing. We have recently raised mice with a deletion of the preprotachykinin-A gene, which encodes the peptides substance P (SP) and neurokinin A (NKA). These studies have identified a specific behavioral phenotype in which the animals do not detect a window of “pain” intensities; this window cuts across thermal, mechanical, and chemical modalities. The lowered thermal and mechanical withdrawal thresholds that are produced by tissue or nerve injury, however, were still present in the mutant mice. Thus, the behavioral manifestations of threshold changes in nociceptive processing in the setting of injury do not appear to require SP or NKA. To identify relevant neurochemical factors downstream of the primary afferent, we are also studying the dorsal horn second messenger systems that underlie the development of tissue and nerve injury-induced persistent pain states. We have recently implicated the γ isoform of protein kinase C (PKCγ) in the development of nerve injury-induced neuropathic pain. Acute pain processing, by contrast, is intact in the PKCγ-null mice. Taken together, these studies emphasize that there is a distinct neurochemistry of acute and persistent pain. Persistent pain should be considered a disease state of the nervous system, not merely a prolonged acute pain symptom of some other disease conditions.