Enhanced Excitability of Primary Sensory Neurons and Altered Gene Expression of Neuronal Ion Channels in Dorsal Root Ganglion in Paclitaxel-induced Peripheral Neuropathy

CHEMOTHERAPY-INDUCED peripheral neuropathy (CIPN) is a very common side effect of paclitaxel (Taxol^®; Bristol-Myers Squibb, New York, NY), a widely used chemotherapeutic agent, which severely limits its anticancer application.¹  Although the mechanisms are not well understood, the symptoms of paclitaxel CIPN include prominent numbness, tingling, and occasionally shooting/burning pain,^2–4  suggesting a polyneuropathy affecting both myelinated (Aβ and Aδ) and, less frequently, unmyelinated (C) fibers.²  Only a very low level of paclitaxel was detected in spinal cord and other parts of central nervous system after repeated administration, but a high concentration of paclitaxel was found in dorsal root ganglion (DRG),⁵  possibly due to the dense vascularization in DRG by highly permeable capillaries.⁶  The accumulation of paclitaxel in the peripheral nervous system imposes a greater risk for damage to these tissues.

Primary sensory neurons in DRG receive signals generated from peripheral nerve endings, integrate, and transfer these signals to spinal cord. Because DRG neurons play a critical role in transducing sensory signals including pain, numerous studies have focused on its involvement in the development of acute and chronic pain in various pathological conditions (for review, see the study by Gold and Gebhart⁷ ). Extensive studies have revealed that the intrinsic membrane properties of DRG neuronal soma, including both myelinated and unmyelinated cells, are significantly altered after peripheral nerve injury or inflammation and play important roles in the development of spontaneous pain, hyperalgesia, and allodynia. For example, an increased incidence of ectopic discharges originating from the soma of different populations of DRG neurons are commonly found after peripheral nerve injury,^8–11  direct compression of the ganglion,^12–20  and inflammation.^21,22  A substantial number of DRG neurons showed decreased rheobase and increased responses to either electrical or chemical stimulation applied to the soma.^{14,15,17,18,20,22–24}  More importantly, blocking such enhanced activities of DRG neurons attenuate chronic pain behavior including spontaneous pain and tactile allodynia.^22,25–30 

It is unknown whether the intrinsic membrane properties of primary sensory neurons in DRG are altered after exposure to paclitaxel chemotherapy. This gap in knowledge was addressed in the current study by using in vitro intracellular recordings from the somata of both myelinated and unmyelinated neurons in an intact DRG preparation using rats that had received paclitaxel or vehicle treatment. In addition, multiple-gene real-time polymerase chain reaction (rtPCR) array for neuronal ion channels was conducted to examine the changes in gene expression of neuronal ion channels in DRG from animals with paclitaxel CIPN.

Adult male Sprague–Dawley rats (8 to 12 weeks; Harlan, Houston, TX) housed in a 12-h light/dark cycle with free access to food and water were used in all experiments. The studies were approved by the Institutional Animal Care and Use Committee at The University of Texas MD Anderson Cancer Center and were performed in accordance with the National Institutes of Health Guidelines for Use and Care of Laboratory Animals.

Animals were treated with paclitaxel as previously described.^31–35  Paclitaxel (TEVA Pharmaceuticals, Inc., North Wales, PA) solution was given intraperitoneally at a dosage of 2 mg/kg in 0.9% saline every other day for a total of four injections (day 1, 3, 5, and 7). Control animals received an equivalent volume of vehicle (cremophor EL:ethanol, 1:1). Mechanical hypersensitivity is induced with this treatment protocol by day 7 and lasts at least several weeks (data not shown).^32,33,35,36 

Intracellular recordings were performed after mechanical hypersensitivity has established (usually on days 8 to 14 after chemotherapy).¹⁴  The L₄ and L₅ ganglia with attached sciatic nerve were removed and then incubated in 1 mg/ml Collagenase P (Roche, South San Francisco, CA) and 0.4 mg/ml Protease Type XIV (Sigma, St. Louis, MO) for 15 min at 37°C in oxygenated artificial cerebrospinal fluid. Artificial cerebrospinal fluid contains: 130 mM of NaCl, 24 mM of NaHCO₃, 3.5 mM of KCl, 1.25 mM of NaH₂PO4, 1.2 mM of MgCl₂, 1.2 mM of CaCl₂, and 10 mM of dextrose (pH = 7.3). After incubation, the ganglia were transferred to a recording chamber and superfused continuously with artificial cerebrospinal fluid bubbled with 95% O₂ plus 5% CO₂ at 37°C. The peripheral nerve was stimulated by a suction electrode. All chemicals were purchased from Sigma except where noted.

Intracellular recordings were obtained under current clamp (MultiClamp 700A; Axon Instruments, Sunnyvale, CA) by a glass sharp electrode (Sutter Instruments, Novato, CA) with impedances of 60 to 80 MΩ when filled with 3 M KCl. Electrophysiological signals were filtered at 5 kHz, digitized at 20 kHz via a Digidata 1320A interface, and analyzed offline with pClamp 10.0 software (Axon Instruments). All neuron accepted have resting membrane potentials more negative than −45 mV. Baseline activity was first monitored for 2 min without the delivery of any external stimuli to detect spontaneous activity (SA). Cells showing high levels of SA that would confound interpretation of responses to external stimuli were not further characterized. If there was either no or only low levels of SA, a series of electric stimuli (1 to 5 mA, duration 0.05 ms for A-fiber and 0.5 ms for C-fiber) was delivered to the nerve through the suction electrode to induce action potentials (APs) from the soma. The axonal conduction velocity (CV) was calculated by dividing the latency of the evoked AP into the distance between the stimulating electrode and the center of the ganglion (usually 12 to 15 mm). After the completion of peripheral nerve stimulation, the recorded cell was depolarized by a series of 40-ms injecting currents from −0.05 to 3 nA in increments of 0.025 nA to induce one or more APs. The current threshold (rheobase) was defined as the minimal current that evoked an AP through intracellular sharp electrode. The input resistance of each cell was measured based on the steady-state voltage changes at the end of the application of a series of hyperpolarizing/depolarizing currents (−50 pA to 50 pA, ΔI = 25 pA, duration 40 ms). Repetitive discharges of each neuron were measured by counting the spikes evoked by injecting a 1-s depolarizing current at two times the threshold.

Neurons with CV were divided into three groups as previously reported^14,15,37,38 : C-neurons with CV less than 1.3 m/s, Aδ neurons with CV 1.3 to 12 m/s, and Aα/β neurons with CV greater than 12 m/s. Additional characteristics of the AP including amplitude, duration, rise time, and fall time, amplitude and 50% duration (measured at an amplitude half-way between) of afterhyperpolarization were measured.

Dorsal root ganglion tissues used for rtPCR array were collected on day 7 after paclitaxel or vehicle treatment (12 rats were treated with paclitaxel and 4 rats were treated with vehicle) as previously described.³⁵  Animals were perfused transcardially with cold phosphate-buffered saline before tissue collection. L4 and L5 DRGs from both sides were collected (four ganglia per rat). DRG tissues from animals with the same treatment were pooled together (four rats per group) during tissue processing. Total RNA was extracted using TRIzol reagent (Invitrogen, Carlsbad, CA) and further purified using the RNeasey Mini Kit (Qiagen, Valencia, CA). The concentration and purity of RNA were detected by measuring the absorbance at 260 and 280 nm using a spectrophotometer (NanoDrop 2000; Thermo Scientific, Odessa, TX). Reverse transcription of complementary DNA from 2 μg of total RNA was performed in a thermal cycler (GeneAmp Polymerase Chain Reaction System 9700; Life Technologies, Carlsbad, CA) by RT² First Strand Kit (Qiagen) according to the manufacturer’s instruction (RT² Profiler PCR Array Handbook; Qiagen). The proprietary procedure effectively eliminated possible contaminating genomic DNA from RNA samples before reverse transcription. The amplification of complementary DNA was performed by using RT² SYBR Green ROX qPCR Mastermix (Cat. no. 330521; Qiagen). The neuronal ion channels array was performed using rat 384-well RT² Profiler PCR Array Kit (Cat. no. 330231, PARN-036ZA; Qiagen) on a 7900 Sequence Detection system (Life Technologies). Amplification steps consisted of one cycle of 50°C for 2 min plus 95°C for 10 min, 40 cycles of 95°C for 15 s, 60°C for 1 min, and one cycle of 95°C for 15 s, 60°C for 15 s, and 95°C for 15 s as a dissociation stage. The gene expression data were uploaded and analyzed using the online polymerase chain reaction array data analysis tool (version 3.0; Qiagen).^* The threshold cycle (Ct; the number of cycles to reach the threshold of detection) was determined for each gene, and the relative expression level of each gene was calculated using the following formula³⁹ : relative expression of messenger RNA = 2^{−Δ[(Ct sample − Ct control)}_paclitaxel^{−(Ct sample − Ct control)}_vehicle^], where Ct_sample is the Ct for the target gene and Ct_control is the average Ct for several housekeeping genes including β-actin, β-2 microglobulin, hypoxanthine phosphoribosyltransferase 1, lactate dehydrogenase A, and ribosomal protein P1. Positive and negative control wells were used to access reverse transcription efficiency, presence of genomic DNA, and positive rtPCR reactions according to the manufacturer’s instruction. To minimize the variance caused by sample handling and processing, all samples were processed by the same experimenter with the same experiment protocol, all complementary DNA were synthesized and amplified on the same plate at the same time.

All results are presented as means ± SEM (which only reaches a 68% CI) and analyzed with Prism GraphPad 6.0 (GraphPad Software, Inc., La Jolla, CA) or Sigma Plot 11.0 (Systat Software, Inc., San Jose, CA). For electrophysiological results, differences between means were tested for significance using one-way ANOVA with Turkey multiple comparison or Mann–Whitney U test (comparison was made across all six groups within the same family). The difference in incidence was analyzed with chi-square test. For rtPCR results, the difference between paclitaxel and vehicle treatment was expressed by fold changes (comparing with vehicle group) and analyzed using one-sample t test with the hypothesis that the actual fold change of each ion channel after paclitaxel treatment was not different from the hypothesized value of 1.0. The Bonferroni correction was later applied in the multiple testing. The difference is considered as statistically significant with an α value of P less than 0.05, and the term “significant” means statistically significant unless otherwise noted. The investigators were not blinded with the groups.

One hundred eighty DRG neurons, including 111 from paclitaxel-treated rats (23 rats) and 69 from vehicle-treated rats (11 rats), recorded with sharp electrode were included for further analysis. The neurons were first grouped according to their size as small-sized (≤30 um), medium-sized (31 to 44 um), and large-sized (≥45 um) cells. It has been shown by different studies that the classification of DRG neurons by the diameter of the soma yielded virtually the same groups of neurons as a classification by their axonal CV.^14,18,40  Seventy large-sized, 21 medium-sized, and 20 small-sized neurons were from paclitaxel-treated animals. Forty-two large-sized, 14 medium-sized, and 13 small-sized neurons were from vehicle-treated animals.

Spontaneous activity was observed in 26 neurons from paclitaxel-treated animals (26 of 111, 23.4%) but in only two neurons from vehicle-treated animals (2 of 69, 2.9%). SA was recorded in 19 of 70 (27.1%) large-sized neurons and in 7 of 21 (33.3%) medium-sized neurons in paclitaxel-treated animals. Two of 42 (4.8%) large neurons from vehicle-treated animals showed SA. No SA was observed in small neurons from either group. The incidence of SA was significantly increased after paclitaxel treatment (fig. 1A).

The patterns of SA were classified as irregular, regular-continuous, and bursting as previously described.^8,15,17  Of the 28 spontaneously discharging neurons (26 from paclitaxel- and 2 from vehicle-treated groups), 15 ells displayed irregular discharges, including 10 large- and 5 medium-sized neurons from paclitaxel-treated animals. Consistent with the previous reports on the study of peripheral nerve injury⁸  and compressed ganglion,^15,17  irregular SA was the most common pattern observed (53.6%) in paclitaxel CIPN. In this category, one cell displayed a mixture of doublet and single spikes (data not shown), whereas all others showed irregular interspike intervals (fig. 1B). Nine cells, including six large- and one medium-sized neurons from paclitaxel- and two large neurons from vehicle-treated animals, showed regular and continuous discharges which was the second most common discharge pattern in the study (32.1%) (fig. 1C). Bursting discharge, the least common discharge pattern (14.3%), was observed in four cells including three large- and one medium-sized neurons from paclitaxel-treated animals (fig. 1D).

Both large- and medium-sized neurons with SA were depolarized compared with the quiescent cells (neurons that did not show SA) in the same size group in paclitaxel-treated animals (−51.6 ± 1.7, n = 19 vs. −57.3 ± 0.9, n = 51, P = 0.009 for large cells; −46.3 ± 0.9, n = 7 vs. −57.4 ± 1.6, n = 14, P = 0.003 for medium-sized cells, one-way ANOVA). For quiescent cells, AP was first induced by intracellular current injection to verify the ability of the recorded neuron to fire (fig. 2A). There were no statistically significant differences observed in resting membrane potential for large-sized, medium-sized, or small-sized neurons after paclitaxel treatment (fig. 2B and table 1).

The excitability of each quiescent cell was measured by current threshold (fig. 2A). The current threshold in each category, including large- (P < 0.0001, one-way ANOVA) and medium-sized (P < 0.001) neurons, was significantly lower in paclitaxel-treated animals compared with that in vehicle-treated animals (fig. 2C and table 1). No difference was observed in small cells (P = 0.067). DRG neurons often showed increased number of APs evoked by either peripheral nerve stimulation¹⁵  or a long depolarizing current injected intracellularly^14,23  after injury or inflammation. In the current study, the number of APs evoked by a 1-s current injection of two times current threshold through intracellular electrode was compared. Only cells that showed more than one AP to the stimulation were included in the analysis. Although there was no statistically significant difference in the number of evoked AP for any of the groups after paclitaxel treatment, medium-sized neurons tended to have more APs in response to the depolarizing current in paclitaxel-treated group (fig. 2D and table 1). This lack of difference is possibly due to the small number of samples collected. No significant difference was found in input resistance for any of the groups after paclitaxel treatment (fig. 2E).

An AP was evoked by delivering electric stimulation through peripheral nerve in 55 (including seven SA cells) of 111 cells (49.5%) from paclitaxel-treated animals and in 35 (including one SA cell) of 69 cells (50.7%) from vehicle-treated animals (fig. 3A). The proportion of neurons showing nerve stimulation-evoked AP was similar in paclitaxel- and vehicle-treated groups, which was consistent with the report that roughly half of the L4/L5 DRG neurons have axons in the sciatic nerve in rats.⁴¹  CV (fig. 3B) and some characteristics of evoked AP including amplitude (fig. 3C), duration (fig. 3D), rise time (fig. 3E), fall time (fig. 3F), afterhyperpolarization amplitude (fig. 3G) and 50% duration (fig. 3H) were measured from these neurons and listed in table 2. No significant difference was observed in CV or any of the characteristics of evoked AP between paclitaxel- and vehicle-treated groups for each size category, except that Aδ neurons showed shorter AP fall time after paclitaxel treatment (fig. 3F; P = 0.035, one-way ANOVA).

Many molecular and cellular factors, including expression and function of neuronal ion channels, may contribute to the excitability of DRG neurons in chronic pain condition.⁷  Changes in gene expression of neuronal ion channels in DRG (L4/L5) from animals with verified mechanical hypersensitivity after paclitaxel chemotherapy was detected using multiple-gene rtPCR array. The array detects 84 different neuronal ion channel genes including 43 potassium, 12 calcium, 9 sodium, 12 transient receptor potential, 3 chloride and 3 neuronal amiloride-sensitive cation channels, 1 potassium-chloride transporter, and bestrophin 1 (see appendix for the complete list). By using one-sample t test with Bonferroni correction (P = 0.05/84 = 0.0006), it has shown that none of the changes reached statistical significance. When Bonferroni correction was not performed, 10 genes were found to have significant changes after paclitaxel treatment, including seven potassium, one calcium, one sodium, and one transient receptor potential channels. Seven genes were up-regulated including K_v1.2, K_v11.3, K_ir3.1, hyperpolarization-activated cyclic nucleotide-gated channel 1 (HCN1), transient receptor potential vanilloid 3 (TRPV3), Na_v1.7, and brain ryanodine receptor–calcium release channel and three genes were down-regulated including K_ir1.1, K_ir3.4, and K_2P1.1 (table 3). We also highlighted the genes with fold change greater than 1.2 or less than 0.8 compared with vehicle-treated animals and the Ct value less than 33 (which is more conservative than the default cutoff value of 35 by manufacturer’s handbook) in both paclitaxel and vehicle groups because these genes were considered to have marginal changes and may have potential biological impacts in paclitaxel CIPN. By this criterion, another 21 genes were modified by paclitaxel treatment (table 3).

By using the similar paclitaxel CIPN animal models, recordings from peripheral nerve fibers have found that paclitaxel treatment induces increased SA of both myelinated (A-) and unmyelinated (C-) fibers⁴²  and enhanced responses of C-fibers to peripheral mechanical stimulation.³⁴  Because both studies used teased fiber recordings of peripheral nerve (sural and saphenous nerves) with transected central end but intact skin innervation, the recorded axonal activities originated from periphery. The data shown here provided evidence that increased excitability of soma of DRG neurons is induced as well in paclitaxel CIPN and hyperexcitability measured by the intrinsic membrane properties is observed in both myelinated (Aβ and Aδ) and unmyelinated (C) cells.

Around one third of myelinated neurons displayed SA when recorded from the soma after paclitaxel chemotherapy, which is higher than the incidence of SA recorded from peripheral A-fibers.⁴²  Because patients with paclitaxel CIPN often complain about spontaneous numbness and tingling which indicate myelinated fiber neuropathy,^2–4  the prominent hyperexcitability of Aβ and Aδ neurons in DRG may well account for those major sensory dysfunctions in patients with paclitaxel CIPN, as well as tactile allodynia which is consistently observed in paclitaxel CIPN animal models. The increased incidence of SA (ectopic discharges or ectopia) originated from the soma of DRG neurons, especially myelinated cells, has been found across various models of peripheral nerve injury.^8–20  Because the degree of allodynia correlates with the degree of ectopia^8,25,43,44  and blocking the increased activities of DRG neurons attenuate chronic pain behavior including spontaneous pain and allodynia,^22,25–30  it has been thought that the hyperexcitability of DRG neurons, particularly myelinated cells, plays a critical role in the initiation of spontaneous pain and tactile allodynia.⁴⁵  In addition to the increased incidence of SA, we also found a robust decrease in the rheobase of DRG non-SA neurons, which is similar to the observation after peripheral nerve injury.^{11,14,15,17,18,20,23,24,46} 

The rheobase of DRG small neurons also decreased after paclitaxel treatment, but such a decrease did not reach statistically significant. Although we did not observe SA from soma of nociceptive neurons in our study, the possibility of such activity could not be excluded. Due to the large heterogeneity of DRG neurons, it is possible that the important effects of paclitaxel may be restricted to particular subclasses of small neurons which were not sampled in the current study. It seems that the incidence of SA originated from the soma of C-cells is quite variable and may depend on different animal models. For example, no or only minimal level of SA in C-cells was observed after spinal nerve axotomy.^8,47,48  A low level of SA from C-cells was found after chronic compression of DRG.^{13–16,18,19,24,49}  A robust increase in such activity was observed after modified spinal nerve ligation^11,21  or paw inflammation induced by intraplantar Complete Freund Adjuvant injection.²¹ 

Similar to previous studies,^34,42  we did not find any change in axonal CV of either myelinated or unmyelinated neurons after paclitaxel chemotherapy. Although it has been reported that paclitaxel induces a reduction of CV in peripheral nerve in experimental animals, these changes seem to depend on the cumulative dosage of paclitaxel because such a reduction only occurred in animals receiving 80 mg/kg but not 16 mg/kg paclitaxel⁵⁰  or in mice receiving more than 200 mg/kg.⁵¹  The impact of chemotherapy may also be variable on different types of peripheral nerves because no reduction of CV was found in digital nerve even from mice receiving 200 mg/kg paclitaxel.⁵¹  Finally, the changes in CV may be more prominent closer to the peripheral terminals where die-back occurs because a large increase in CV of muscle afferents after paclitaxel was observed in a recent study.⁵²  Nevertheless, the lack of change in axonal CV reported here, along with previous studies, may correlate with the observation that low dose of paclitaxel did not induce any axonal degeneration at the mid-axon level⁵³  but was still sufficient to induce distal terminal degeneration.^33,54 

No changes were found in other intrinsic membrane properties including input resistance, AP and afterhyperpolarization amplitude and duration, except that medium-sized neurons had shorter AP fall time in paclitaxel group compared with that in the same-sized cells in vehicle group. Such a difference could be due to sampling variance because the total duration and rise time of AP in the same group were not changed.

The excitability of DRG neurons is fundamentally determined by the functional activities of neuronal ion channels which could be modulated by many intracellular and extracellular factors in various conditions of chronic pain.⁷  In a recent study, multiple-gene rtPCR array has been used to largely confirm the gene changes in both DRG and spinal cord after peripheral nerve injury and inflammation detected by microarray method.⁵⁵  This array has also been successfully used to detect robust changes in gene expression of neurotrophin and proinflammatory cytokine in various tissues including DRG after paw plantar incision.⁵⁶ 

With multiple-gene rtPCR array, we have found prominent changes in gene expression of some neuronal ion channels in DRG after paclitaxel chemotherapy. Although the changes in expression of these genes did not reach statistical significance after Bonferroni correction, each did show a statistical significance when Bonferroni correction was not performed. Considering the increased probability of false negatives after Bonferroni correction and the high chance of reaching statistical significance when individual rtPCR was performed, we presented these data here.

Although it is impossible to tell which particular channel plays a major role, the robust down-regulation of voltage-gated potassium channels such as inwardly rectifying potassium channels (K_ir 1.1 and K_ir 3.4) and up-regulation of HCN1 and voltage-gated sodium channel Na_v1.7 suggest the possible involvement of these channels in paclitaxel CIPN. The hyperpolarization-activated current (I_h) medicated by HCN1 is expressed on DRG myelinated neurons.^57,58  The increase of HCN1 may facilitate the increased SA in these neurons observed in the current study. Another striking observation is the increased expression of Na_v1.7 in DRG after paclitaxel. Na_v1.7 is expressed in both large- and small-diameter DRG neurons and in most functionally identified nociceptors.^59,60  Studies have shown that gain-of-function mutations of Na_v1.7 are strongly linked to some inherited pain disorders such as inherited erythromelalgia.^61–63  Recent studies have established a link between the gain-of-function mutation of Na_v1.7 and painful peripheral neuropathy.^64,65  Interestingly, loss-of-function of Na_v1.7 has been found being related to insensitivity to pain.^66–68  In addition, animal studies have found that the Na_v1.7 expression level in DRG neurons is increased in response to various stimulation and knockdown of Na_v1.7 attenuates some pathological pain (for review, see the study by Dib-Hajj et al.⁶⁹ ). The specific role of these neuronal ion channels revealed by the current rtPCR study in paclitaxel CIPN remains to be fully established. The ongoing work in the laboratory is focused on addressing these issues.

There are certainly many limitations to interpret the changes of ion channel gene expression with rtPCR array. For example, the function of these channels depends on multiple factors, such as the rates of protein translation and degradation, post-translational modification, and the number of channels expressed on the plasma membrane. Tying the gene expression of these channels to their ultimate function and their specific role in paclitaxel CIPN will need further investigation. Some discrepancies between our study and previous studies have also been noticed. A recent study has shown that TRPV1 mRNA in DRG was increased after paclitaxel and blocking TRPV1 prevented or attenuated mechanical and thermal hypersensitivity of paclitaxel CIPN.⁷⁰  A marginal increase in DRG TRPV1 expression was also found in our study, but the difference did not reach statistically significant (appendix). Another example is that Nav1.2 has been found to be expressed predominantly in brain⁷¹  and only at a very low level in DRG.^72,73  Our data showed that the level of Nav1.2 expression in DRG was comparative with that of Nav1.1, Nav1.9, and Nav1.6 as judged by Ct values (appendix). These discrepancies could be contributed by several factors such as the variance in the efficiency of RNA extraction or complementary DNA synthesis between different laboratories, and the different design of probes.

In conclusion, we show that paclitaxel chemotherapy induces increased excitability of primary sensory neurons in DRG, which is demonstrated by the increased incidence of SA originated from the soma of myelinated cells and decreased rheobase in both myelinated and unmyelinated cells. These alterations in the intrinsic membrane properties of DRG neurons, along with increased activities of peripheral nerve fibers reported by other studies, suggest that the pathology of peripheral nervous system may play critical roles in the development of paclitaxel CIPN. The prominent changes in gene expression of some neuronal ion channels in DRG such as up-regulation of HCN1 and Na_v1.7 channels and down-regulation of K_ir channels suggest the possible roles of these channels in paclitaxel CIPN. Our data suggest the underlying channelopathy mechanism of paclitaxel CIPN and provide potential therapeutic targets.

This work was supported by grants from National Institutes of Health, Bethesda, Maryland (NS 046606), and National Cancer Institute, Bethesda, Maryland (CA 124787).

The authors declare no competing interests.