Key words analgesic effect; clodronate; etidronate; phosphate transporter; ATP; glutamate Bisphosphonates (BPs) are used against various boneresorptive diseases, and the nitrogen-containing BPs (N-BPs) have much more powerful anti-bone-resorptive effects than the non-nitrogen-containing BPs (non-N-BPs) 1) (Fig. 1). However, N-BPs have inflammatory and/or necrotic effects, including fever, musculoskeletal pain, direct injuries to esophageal and gastric tissues, and osteonecrosis of the jaw.2) N-BPs, having entered cells (including osteoclasts), exhibit cytotoxicity due to inhibition of farnesyl pyrophosphate synthase in the mevalonate pathway of cholesterol biosynthesis, 1) reducing the prenylation of various proteins, including small guanosine 5′-triphosphatase (GTPases).
3)In contrast to N-BPs, the non-N-BPs etidronate and clodronate are almost devoid of inflammatory/necrotic effects.
4)Interestingly, they can reduce such side effects of N-BPs in mice. [5][6][7][8] Concerning the mechanisms by which clodronate (Clo) and etidronate (Eti) reduce the inflammatory/necrotic effects of N-BPs, our pharmacological studies have suggested that: (a) N-BPs may enter soft-tissue cells via phosphate transporters of the SLC20 and SLC34 families, (b) Clo and Eti may inhibit those families, possibly by competitive inhibition, and thereby inhibit the entry of N-BPs into soft-tissue cells, and (c) Clo and Eti may also inhibit phosphate transporters of the SLC17 family.
9)Pain is a cause of distress in many patients with osteoporosis. Fujita et al. found that in patients with osteoporosis and/ or osteoarthritis, Eti displayed an analgesic effect that was greater than those of N-BPs. 10) We recently reported that Clo and Eti exhibit analgesic effects in mice, possibly via direct interaction with neurons. 11) However, the mechanism underlying the analgesic effects of Clo and Eti remains unclear.Surprisingly, and very interestingly, the SLC17 family of transporters, initially characterized as phosphate carriers, was recently found to include neuronal vesicular transporters of glutamate and ATP. [12][13][14][15] The N-methyl-D-aspartate (NMDA) receptor (NMDA-R), an ionotropic receptor for glutamate, is distributed within the spinal cord and plays an important role in pain transmission. [16][17][18] In addition, nucleotides are released or leaked from non-excitable cells, as well as neurons, under both physiological and pathophysiological conditions, and recent studies indicate that ATP plays important roles during pain transmission through the ionotropic purinoceptor P2X-R. 19,20) There are as yet no reports describing relationships between BPs and neuronal transmitters. However, on the basis of the findings described above, we hypothesized that Clo and Eti may enter neurons through SLC20 and/or SLC34, and then act on neuronal vesicles to inhibit SLC17 transporter-mediated transport of glutamate and/or ATP (resulting in decrements in the levels of glutamate and ATP within the vesicles) (Fig.