The sodium channels Na v 1.7, Na v 1.8 and Na v 1.9 are critical for pain perception in peripheral nociceptors. Loss of function of Na v 1.7 leads to congenital insensitivity to pain in humans. Here we show that the spider peptide toxin called HpTx1, first identified as an inhibitor of K v 4.2, restores nociception in Na v 1.7 knockout (Na v 1.7-KO) mice by enhancing the excitability of dorsal root ganglion neurons. HpTx1 inhibits Na v 1.7 and activates Na v 1.9 but does not affect Na v 1.8. This toxin produces pain in wild-type (WT) and Na v 1.7-KO mice, and attenuates nociception in Na v 1.9-KO mice, but has no effect in Na v 1.8-KO mice. These data indicate that HpTx1-induced hypersensitivity is mediated by Na v 1.9 activation and offers pharmacological insight into the relationship of the three Na v channels in pain signalling.

Mutations in Nav1.9 encoded by SCN11A have been associated with episodic pain, small-fiber neuropathy, and congenital insensitivity to pain. In this study, we collected and characterized one Chinese family with episodic pain. The SCN11A mutation (c.664C>A/p.Arg222Ser) was identified and cosegregated with the episodic pain phenotype. In addition, we found that alcohol intake triggered intense pain attacks and detected the ALDH2 polymorphism (c.1510G>A/p.Glu504Lys) in 3 patients with episodic pain. The alcohol-aggravated pain symptom and this ALDH2 polymorphism were also reconfirmed in our previously reported episodic pain patient with the Nav1.9 mutation (p.Ala808Gly, patient III-2 in HBBJ family). To assess the pathogenicity of the Nav1.9 mutation and the new trigger, we introduced a mutation (p.Ala796Gly) into the mouse (orthologous mutation in human is p.Ala808Gly). The alteration hyperpolarized channel activation, increased the residual current through noninactivating channels, and induced hyperexcitability of dorsal root ganglion (DRG) neurons in Scn11a A796G/A796G mice. The Scn11a A796G/A796G mice showed increased sensitivity to mechanical, heat, and cold stimuli, and hypersensitivity to acetaldehyde and formalin, which could account for the alcohol intake-induced pain phenotype in patients. Moreover, acetaldehyde increased the mutant mNav1.9 channel current and excitability of Scn11a A796G/A796G mouse DRG neurons. Parecoxib (an anti-inflammatory medication) relieved the heat hypersensitivity in Scn11a A796G/A796G mice not receiving inflammatory stimuli and significantly decreased the hyperexcitability of DRG neurons in Scn11a A796G/A796G mice. These results indicated that Scn11a A796G/A796G mice recapitulated many clinical features of patients and suggested that Nav1.9 channel contributes significantly to the inflammatory pain state.

Congenital insensitivity to pain (OMIM 243000) is an extremely rare disorder caused by loss-of-function mutations in SCN9A encoding Nav1.7. Although the SCN9A mutations and phenotypes of painlessness and anosmia/hyposmia in patients are previously well documented, the complex relationship between genotype and phenotype of congenital insensitivity to pain remains unclear. Here, we report a congenital insensitivity to pain patient with novel SCN9A mutations. Functional significance of novel SCN9A mutations was assessed in HEK293 cells expressing Nav1.7, the results showed that p.Arg99His significantly decreased current density and reduced total Nav1.7 protein levels, whereas p.Trp917Gly almost abolished Nav1.7 sodium current without affecting its protein expression. These revealed that mutations in Nav1.7 in this congenital insensitivity to pain patient still retained partial channel function, but the patient showed completely painlessness, the unexpected genotypic-phenotypic relationship of SCN9A mutations in our patient may challenge the previous findings “Nav1.7 total loss-of-function leads to painlessness.” Additionally, these findings are helpful for understanding the critical amino acid for maintaining function of Nav1.7, thus contributing to the development of Nav1.7-targeted analgesics.

Human Na V 1.9 (hNa V 1.9), encoded by SCN11A, is preferentially expressed in nociceptors, and its mutations have been linked to pain disorders. Na V 1.9 could be a promising drug target for pain relief. However, the modulation of Na V 1.9 activity has remained elusive. Here, we identified a new candidate Na V 1.9-interacting partner, protein arginine methyltransferase 7 (PRMT7). Whole-cell voltage-clamp recordings showed that coelectroporation of human SCN11A and PRMT7 in dorsal root ganglion (DRG) neurons of Scn11a 2/2 mice increased the hNa V 1.9 current density. By contrast, a PRMT7 inhibitor (DS-437) reduced mNa V 1.9 currents in Scn11a 1/1 mice. Using the reporter molecule CD4, we observed an increased distribution of hLoop1 on the cell surface of PRMT7-overexpressing HKE293T cells. Furthermore, we found that PRMT7 mainly binds to residues 563 to 566 within the first intracellular loop of hNa V 1.9 (hLoop1) and methylates hLoop1 at arginine residue 519. Moreover, overexpression of PRMT7 increased the number of action potential fired in DRG neurons of Scn11a 1/1 mice but not Scn11a 2/2 mice. However, DS-437 significantly inhibited the action potential frequency of DRG neurons and relieved pain hypersensitivity in Scn11a A796G/A796G mice. In summary, our observations revealed that PRMT7 modulates neuronal excitability by regulating Na V 1.9 currents, which may provide a potential method for pain treatment.