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Inhibition of Voltage-Gated Na+ Channels by the Synthetic Cannabinoid Ajulemic Acid

Foadi, Nilufar MD*; Berger, Christian MD*; Pilawski, Igor VMD*; Stoetzer, Carsten MD*; Karst, Matthias MD*; Haeseler, Gertrud MD*; Wegner, Florian MD; Leffler, Andreas MD*; Ahrens, Jörg MD*

doi: 10.1213/ANE.0000000000000188
Anesthetic Pharmacology: Research Report

BACKGROUND: The synthetic cannabinoid ajulemic acid has been demonstrated to alleviate pain in patients suffering from chronic neuropathic pain. Cannabinoids interact with several molecules within the pain circuit, including a potent inhibition of voltage-gated sodium channels. In this study, we closely characterized this property on neuronal and nonneuronal sodium channels.

METHODS: The inhibition of sodium inward currents by ajulemic acid was studied in vitro. Human embryonic kidney 293t cells were used as the expression system for Nav1.2, 1.3, 1.4, 1.5, 1.5N406K, 1.5F1760A, and 1.7; Nav1.8 was transiently expressed in ND7/23 cells. Nav1.2, Nav1.3, and Nav 1.8 were from rats, and Nav1.4, Nav1.5, and Nav1.7 were of human origin. Sodium currents were analyzed by means of the whole cell patch-clamp technique. The investigated concentrations of ajulemic acid were 0.1, 0.3, 1, 3, 10, and 30 μmol/L.

RESULTS: Ajulemic acid reversibly and concentration-dependently inhibited all voltage-gated sodium channel (Nav) isoforms investigated in this study, including Nav1.2, 1.3, 1.4, 1.5, 1.7, and 1.8. Tonic block of resting channels yielded half-maximal inhibitory concentration values between 2 and 9 μmol/L and was strongly enhanced on inactivated channels, suggesting state-dependent inhibition by ajulemic acid. Tonic block did not differ significantly when comparing Nav1.2 and Nav1.3, Nav1.4 and Nav1.5, and Nav1.7 and Nav1.8. Statistical analysis of other combinations of subunits (e.g., Nav1.2 and Nav1.4) by analysis of variance yielded a significant difference in block. Although we did not observe any relevant use-dependent block, ajulemic acid induced a strong hyperpolarizing shift of the voltage dependency of fast inactivation and modest shift of slow inactivation. The local anesthetic-insensitive Nav1.5 constructs N406K and F1760A displayed a preserved sensitivity to block by ajulemic acid. Finally, we found that low concentrations of ajulemic acid efficiently inhibited Navβ4 peptide-mediated resurgent currents in Nav1.5.

CONCLUSIONS: Our data suggest that block of sodium channels can be a relevant mechanism by which ajulemic acid alleviates neuropathic pain. The potent inhibition of resurgent currents and the preserved block on local anesthetic-insensitive channels indicates that ajulemic acid interacts with a conserved but yet unknown site of sodium channels.

Published ahead of print April 22, 2014

From the *Department of Anesthesia and Critical Care Medicine, and Department of Neurology and Clinical Neurophysiology, Medizinische Hochschule Hannover, Hannover, Germany.

Christian Berger, MD, is currently affiliated with Clinic for Cardiology, Herford Hospital, Herford, Germany.

Gertrud Haeseler, MD, is currently affiliated with Clinic for Anaesthesia and Critical Care Medicine, St. Elisabeth hospital Dorsten, Dorsten, Germany.

Accepted for publication December 18, 2013.

Published ahead of print April 22, 2014

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Jörg Ahrens, MD, Clinic for Anaesthesia and Critical Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Address e-mail to

© 2014 International Anesthesia Research Society