Multiple roles for Na(V)1.9 in the activation of visceral afferents by noxious inflammatory, mechanical, and human disease–derived stimuli

Chronic visceral pain affects millions of individuals worldwide and remains poorly understood, with current therapeutic options constrained by gastrointestinal adverse effects. Visceral pain is strongly associated with inflammation and distension of the gut. Here we report that the voltage-gated sodium channel subtype Na(V)1.9 is expressed in half of gut-projecting rodent dorsal root ganglia sensory neurons. We show that Na(V)1.9 is required for normal mechanosensation, for direct excitation and for sensitization of mouse colonic afferents by mediators from inflammatory bowel disease tissues, and by noxious inflammatory mediators individually. Excitatory responses to ATP or PGE(2) were substantially reduced in Na(V)1.9(−/−) mice. Deletion of Na(V)1.9 substantially attenuates excitation and subsequent mechanical hypersensitivity after application of inflammatory soup (IS) (bradykinin, ATP, histamine, PGE(2), and 5HT) to visceral nociceptors located in the serosa and mesentery. Responses to mechanical stimulation of mesenteric afferents were also reduced by loss of Na(V)1.9, and there was a rightward shift in stimulus–response function to ramp colonic distension. By contrast, responses to rapid, high-intensity phasic distension of the colon are initially unaffected; however, run-down of responses to repeat phasic distension were exacerbated in Na(V)1.9(−/−) afferents. Finally colonic afferent activation by supernatants derived from inflamed human tissue was greatly reduced in Na(V)1.9(−/−) mice. These results demonstrate that Na(V)1.9 is required for persistence of responses to intense mechanical stimulation, contributes to inflammatory mechanical hypersensitivity, and is essential for activation by noxious inflammatory mediators, including those from diseased human bowel. These observations indicate that Na(V)1.9 represents a high-value target for development of visceral analgesics.