Papers of the Week

Aberrations in spinal glycinergic signalling are a feature of pain chronification. Normalising these changes by inhibiting glycine transporter-2 (GlyT2) is a promising treatment strategy. However, existing GlyT2 inhibitors e.g. ORG25543 are limited by narrow therapeutic windows and severe dose-limiting side effects such as convulsions, and are therefore poor candidates for clinical development. Here, intraperitoneally administered oleoyl–lysine, a lipid-based GlyT2 inhibitor, was characterised in mouse models of acute (hotplate), inflammatory (CFA) and chronic neuropathic (CCI) pain. Side effects were also assessed on a numerical rating score, convulsions score, for motor incoordination (rotarod) and for respiratory depression (whole body plethysmography). Oleoyl–lysine produced near complete anti-allodynia for chronic neuropathic pain but no anti-allodynia/analgesia in inflammatory or acute pain. No side effects were seen at the peak analgesic dose, 30 mg/kg. Mild side effects were observed at the highest dose, 100 mg/kg, on the numerical rating score, but no convulsions. These results contrasted markedly with ORG25543, which reached less than 50% reduction in allodynia score only at the lethal/near-lethal dose of 50 mg/kg. At this dose, ORG25543 caused maximal side effects on the numerical rating score and severe convulsions. Oleoyl–lysine (30 mg/kg) did not cause any respiratory depression, a problematic side effect of opiates. These results show the safe and effective reversal of neuropathic pain in mice by oleoyl–lysine and provide evidence for a distinct role of glycine in chronic pain over acute or short-term pain conditions. Partially inhibiting GlyT2 can alleviate chronic pain by restoring lost glycinergic function. Novel lipid-based GlyT2 inhibitor, ol–lys, is safe and effective in alleviating neuropathic pain, but not inflammatory or acute pain. Clinical application of GlyT2 inhibitors may be better suited to chronic neuropathic pain over other pain aetiologies.