Central and peripheral neoangiogenesis in paclitaxel-induced painful peripheral neuropathy

Neurotoxicity is the most debilitating non-haematological adverse effect of paclitaxel (PTX) in cancer patients. Symptoms are typical of a sensory peripheral neuropathy and the incidence and degree are dependent on the cumulative dose. The symptoms include paraesthesia, disaesthesia, tingling, and numbness. Moreover, many patients develop allodynia and hyperalgesia, experiencing a severe neuropathic pain (NP). NP can originate from a peripheral sensitization then transmitted to upper centers in the central nervous system where it can determine structural and functional changes (altered neuronal discharge patterns). Preliminary evidences in other NP models showed an abundant microvascular neoangiogenesis in the primary somatosensory cortex, specifically on the hindlimb projection. The aim of this work is to investigate the microstructural vascular anomalies both in the central somatosensory pathway and peripheral (dorsal root ganglia, DRG) compartments in rats exposed to chronic PTX treatment. We treated 24 rats with PTX 10 mg/kg once a week for 4 weeks to induce a painful peripheral neuropathy. Animals were tested for neurophysiological abnormalities and behavioral NP before and after treatment. Then animals were sacrificed and perfused with fixative and/or indian-ink before collecting samples. Samples have been analyzed at synchrotron radiation resources by X-ray Phase-Contrast Tomography (XPCT) Imaging (Diamond, Didcot, UK and ESRF, Grenoble, France). Volume rendering allowed for a detailed visualization of vasculature at the sub micrometric scale. Quantitative and morphological analyses of micro-vascular structures with comparative comparisons between control and NP rats. Histochemical and histological evaluations have been performed to validate the results obtained by XPCT. A significant increased number of vessels has been found in NP samples, suggesting a neoangiogenesis at the capillary level in NP condition. The effect was larger (about +173%) on central stations, still relevant (+91%) in L4-L5 spinal cord and noticeable (+56%) in related DRG. Specifical analyses indicated that neo-formed vessels were smaller than 15 micron. NP samples were accompanied by significant decrement of the number of branch points and the tortuosity, factors showed to furtherly compromise normal microcirculation and neuronal activity. These events have been confirmed by the positivity to vessel neogenesis made by tomato lectin staining in all compartments and by morphological-histological observations at light and confocal microscopy. Evidences of vascular neo-genesis at capillary level have been found in neuropathic rats treated with PTX. These findings could shed light on new pathogenetic mechanisms and potential novel therapeutic approaches.