CA2524883C - Potassium-chloride cotransporter kcc2 modulation for treatment of pain - Google Patents

Abstract

Methods and products for the attenuation or treatment of pain and the reduction of nociception are described. The methods and products are based on the modulation of CNS intracellular chloride levels. The methods and products may also relate to modulation of the activity and/or expression of a chloride transporter, such as the KCC2 potassium-chloride cotransporter. Also described herein are commercial packages and uses based on such modulation. Related methods for identifying or characterizing a compound for the treatment of pain, the reduction of nociception and the diagnosis and prognostication of pain are also described.

Description

OF PAIN
FIELD OF THE INVENTION
The invention relates to the modulation of anion levels in a central nervous system (CNS) neural cell, and particularly relates to the modulation of CNS intracellular chloride levels and uses thereof for treating, preventing, diagnosing and prognosticating pain.
BACKGROUND OF THE INVENTION
The need for new and improved methods and agents for pain treatment is a significant ongoing concern in medicine. Acute pain, e.g. related to injury or disease, can be severe and have critical effects on patient recovery. An even greater concern is chronic pain, which affects a large proportion of the population, causing not only significant discomfort, but can result in low self-esteem, depression, anger, and can interfere with or completely prevent a sufferer from typical daily activities.
While a number of studies have been done in this area, many mechanisms and pathways involved in pain sensation remain poorly understood. As in the case of the sensation of various stimuli, it has been suggested that pain sensation is related to altered neuronal excitability.
Ion cotransport has in some cases been thought to play a role in the processing of certain stimuli. For example, Howard et al. (28) have demonstrated that mice In another aspect, the present invention provides a composition for the treatment or the prevention of neuropathic pain in a subject, said composition comprising:
(b) a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (ii); and (b) a pharmaceutically acceptable carrier.
In another aspect, the present invention provides a package comprising the compound defined above together with instructions for its use for the treatment or prevention of pain, or for decreasing nociception, in a subject.
In another aspect, the present invention provides a package comprising the composition defined above together with instructions for its use for the treatment or prevention of pain, or for decreasing nociception, in a subject.
In another aspect, the present invention provides a package comprising a container, the compound defined above and instructions for use of the compound for the treatment or prevention of neuropathic pain in a subject.
In another aspect, the present invention provides a package comprising a container, the composition defined above and instructions for use of the compound for the treatment or prevention of neuropathic pain in a subject.
In another aspect, the present invention provides the use of the composition defined above for the treatment or prevention of pain, or for decreasing nociception, in a subject.
In another aspect, the present invention provides the use of the composition defined above for the preparation of a medicament for the treatment or prevention of pain, or for decreasing nociception, in a subject.
2a In another aspect, the present invention provides the use of a compound capable of decreasing an intracellular chloride level in a CNS neural cell for the treatment or prevention of pain, or for decreasing nociception, in a subject, wherein said compound is (i) an anti-TrkB
antibody; (ii) an inhibitor of calmodulin-dependant kinase;
(iii) a KCC2 polypeptide; (iv) a nucleic acid encoding a KCC2 polypeptide; or (v) any combination of (i) to (iv).
In another aspect, the present invention provides the use of a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron for the treatment or prevention of neuropathic pain in a subject, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (ii).
In another aspect, the present invention provides the use of a compound capable of decreasing an intracellular chloride level in a CNS neural cell for the preparation of a medicament for the treatment or prevention of pain, or for decreasing nociception, in a subject, wherein said compound is (i) an anti-TrkB antibody; (ii) an inhibitor of calmodulin-dependant kinase; (iii) a KCC2 polypeptide; (iv) a nucleic acid encoding a KCC2 polypeptide; or (v) any combination of (i) to (iv).
In another aspect, the present invention provides the use of a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron for the preparation of a medicament for the treatment or prevention of neuropathic pain in a subject, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (IA).
In another aspect, the present invention provides a method of identifying or characterizing a compound for 2b treatment or prevention of pain, or for decreasing nociception, in a subject, said method comprising:
(a) contacting a test compound with a CNS-derived cell; and (b) determining whether intracellular chloride level is decreased in the presence of the test compound;
wherein said decrease is an indication that said test compound may be used for treatment or prevention of pain, or for decreasing nociception, in a subject.
In another aspect, the present invention provides a method of identifying or characterizing a compound for treatment or prevention of pain, or for decreasing nociception, in a subject, said method comprising:
(a) contacting a test compound with a cell expressing a CNS chloride transporter; and (b) determining whether activity or expression of said CNS
chloride transporter is modulated in the presence of the test compound relative to the absence of said test compound;
wherein a modulation in said activity of said CNS chloride transporter in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of pain, or for decreasing nociception, in a subject, and wherein (i) if said CNS chloride transporter is a chloride exporter, said modulation is an increase, and (ii) if said CNS chloride transporter is a chloride importer, said modulation is a decrease.
In another aspect, the present invention provides a method of identifying or characterizing a compound for treatment or prevention of neuropathic pain in a subject, said method comprising:
(a) contacting a test compound with a cell expressing a KCC2 polypeptide; and 2c (b) determining whether activity or expression of said KCC2 polypeptide is increased in the presence of the test compound relative to the absence of said test compound;
wherein an increase in said activity or expression of said KCC2 polypeptide in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of neuropathic pain in a subject.
In another aspect, the present invention provides a method of identifying or characterizing a compound for treatment or prevention of pain, or for decreasing nociception, in a subject, said method comprising:
(a) contacting a test compound with a cell comprising a first nucleic acid comprising a transcriptional regulatory element normally associated with a CNS chloride transporter gene, operably linked to a second nucleic acid comprising a nucleotide sequence encoding a reporter protein; and (b) determining whether reporter gene expression or reporter protein activity is modulated in the presence of said test compound relative to the absence of sais test compound;
wherein a modulation in reporter gene expression or reporter protein activity in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of pain, or for decreasing nociception, in a subject, and wherein (i) if said CNS chloride transporter is a chloride exporter, said modulation is an increase, and (ii) if said CNS chloride transporter is a chloride importer, said modulation is a decrease.
In another aspect, the present invention provides a method of identifying or characterizing a compound for treatment or prevention of pain in a subject, said method comprising:
2d (a) contacting a test compound with a cell comprising a first nucleic acid comprising a promoter normally associated with a KCC2gene, operably linked to a second nucleic acid comprising a nucleotide sequence of a reporter gene encoding a reporter protein; and (b) determining whether the expression of the reporter gene, or the activity of the reporter protein encoded by said reporter gene, is increased in the presence of said test compound relative to the absence of said test compound;
wherein an increase in reporter gene expression or reporter protein activity in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of neuropathic pain in a subject.
According to one aspect, the invention provides a method of treating or preventing pain in a subject, the method comprising decreasing an intracellular chloride level in a central nervous system (CNS) neural cell of the subject. In an embodiment, the method comprises modulating the activity or expression of a chloride transporter in the CNS cell, thereby to decrease the chloride level. In a further embodiment, the chloride transporter is KCC2 the method comprises increasing KCC2 activity or expression.
In another embodiment, the CNS neural cell is a spinal cord neural cell. In yet another embodiment, the signal of the pain originates in a peripheral nervous system (PNS) cell or sensory fiber 2e

2

3 transsynaptic to the CNS neural cell. In still another embodiment, the pain is neuropathic pain, and in further embodiments the neuropathic pain is associated with a nerve or tract injury or is selected from the group consisting of somatic and visceral pain. In yet another embodiment, the pain is selected from the group consisting of chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with diabetic neuropathy, phantom limb pain, spontaneous pain, chronic post-surgical pain, chronic temporomandibular pain, causalgia, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal neuralgia, chronic back pain, pain associated with spinal cord injury and recurrent acute pain.
In an embodiment, the method comprises administering to the subject a compound capable of decreasing the intracellular chloride level in the CNS cell. In yet another embodiment, the compound is capable of modulating the activity or expression of a chloride transporter in the CNS
cell. In yet a further embodiment, the chloride transporter is KCC2, and yet further, the compound is capable of increasing KCC2 activity or expression. In another embodiment, the compound is an inhibitor of TrkB, such as K-252a or an anti-TrkB antibody. In another embodiment, the compound is an inhibitor of cyclic AMP-dependent kinase (PKA) (e.g. H-89). In another embodiment, the compound is an inhibitor of calmodulin-dependant kinase (CAM kinase), and further, it is KN-93. In an embodiment, KCC2 comprises an amino acid sequence substantially identical to a sequence

4 selected from the group consisting of SEQ ID NO: 2, 4, 6 and a fragment thereof.
According to another aspect of the present invention, there is provided a composition for the treatment or the prevention of pain in a subject, the composition comprising a compound capable of decreasing an intracellular chloride level in a CNS neural 'cell; and a pharmaceutically acceptable carrier. In an embodiment, the compound is capable of modulating the activity or expression of a chloride transporter in the CNS neural cell. In a further embodiment, the chloride transporter is KCC2, and further, the compound is capable of increasing KCC2 activity or expression.
According to still another aspect of the, invention, there is provided a commercial package comprising the composition described herein together with instructions for its use in the treatment or prevention of pain.
According to yet another aspect of the invention, there is provided a commercial package comprising a compound capable of decreasing an intracellular chloride level in a CNS neural cell together with instructions for its use the treatment or prevention of pain. In an embodiment,- the compound is capable of modulating the activity or expression of a chloride transporter in said CNS neural cell. In a further embodiment, the chloride transporter is KCC2, and further, the compound is capable of increasing said KCC2 activity or expression.
According to a further aspect of the present invention, there is provided use of the composition described herein for the treatment or prevention of pain and/or for the 'preparation of a medicament for the treatment or prevention of pain.
=

According to yet a further aspect of the present invention, there is provided use of a compound capable of decreasing an intracellular chloride level in a CNS neural cell for the treatment or prevention of pain and/or for the

5 preparation of a medicament for the treatment or prevention of pain. In an embodiment, the compound is capable of modulating the activity or expression of a chloride transporter in said CNS cell. In a further embodiment, the chloride transporter is KCC2, and further, the compound is .
capable of increasing KCC2 activity or expression. In another embodiment, the compound is an inhibitor of TrkB, and . further, it is selected from the group consisting of K-252a and an anti-TrkB antibody. In another embodiment, the compound is an inhibitor of cyclic AMP-dependent kinase (PKA), and further, it is H-89. In another embodiment, the compound is an inhibitor of calmodulin-dependant kinase, and further, it is KN-93.
According to still a further aspect of the invention, there is provided a method of identifying or characterizing a compound for treatment or prevention of pain, the method comprising contacting a test compound with a CNS-derived cell; and determining whether the intracellular chloride level is decreased in the presence of the test compound; wherein the decrease is an indication that the test compound may be used for treatment or prevention of pain.
According to another aspect of the present invention, there is provided a method of identifying or characterizing a compound for treatment or prevention of pain, the method comprising contacting a test compound with a CNS-derived cell expressing a chloride transporter; and determining whether activity or expression of the chloride transporter is modulated in the presence of the test compound in such a way that the level intracellular chloride is

6 decreased; wherein the modulation is an indication that the test compound may be used for treatment or prevention of pain. In an embodiment, the chloride transporter is KCC2, and further, the method comprises determining whether said KCC2 expression or activity is increased in the presence of the test compound and the modulation is an increase. In another embodiment, KCC2 activity is determined by measuring a parameter selected from the group consisting of potassium transport, chloride transport, intracellular chloride level and anion reversal potential. In still another embodiment, the pain is selected from the group consisting of chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with diabetic neuropathy, phantom limb pain, spontaneous pain, , chronic post-surgical pain, chronic temporomandibular pain, causalgia, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal neuralgia, chronic back pain, pain associated with spinal cord injury and recurrent acute pain.
According to yet another aspect of the present invention, there is provided a method of identifying or characterizing a compound for treatment or prevention of pain, said method comprising contacting a test compound with.
a CNS-derived cell comprising a first nucleic acid comprising a transcriptionally regulatory element normally associated with a chloride transporter gene, operably linked to a second nucleic acid comprising a reporter gene capable of encoding a reporter protein; and determining whether reporter gene expression or reporter protein activity is modulated in the presence of the test compound; wherein the modulation in

7 reporter gene expression or reporter protein activity being an indication that the test compound may be used for treatment or prevention of pain. In a further embodiment, the chloride transporter is KCC2, and further, the reporter gene expression or reporter protein activity is increased in the presence of the test compound.
According to one aspect of the present invention, there is provided a method for decreasing nociception in a subject, the method comprising decreasing intracellular chloride in a CNS neural cell of the subject. In an embodiment, the method comprises modulating chloride transporter activity or expression in the CNS neural cell.
In a further embodiment, the chloride transporter is KCC2, and further, the method comprises increasing KCC2 activity or expression. In another embodiment, the method further comprises contacting the CNS neural cell with a compound capable of increasing KCC2 activity or expression. In yet another embodiment, the compound is an inhibitor of TrkB, and further, it is selected from the group consisting of K-252a and an anti-TrkB antibody. In still another embodiment, the compound is an inhibitor of cyclic AMP-dependent kinase (PKA), and further, it is H-89. In yet another embodiment, the compound is an inhibitor of calmodulin-dependant kinase, and further, it is KN-93. In still another embodiment, KCC2 comprises an amino acid sequence substantially identical to a sequence selected from the group consisting of SEQ ID NO: 2, 4, 6 and a fragment thereof.
According to another aspect of the invention, there is provided a method for diagnosing or prognosticating pain associated with CNS dysfunction in a subject experiencing pain, the method comprising determining whether a test CNS
intracellular chloride level is increased relative to a corresponding control chloride level; wherein the increase is

8 an indication that the subject is experiencing pain associated with CNS dysfunction.
In an embodiment, the method further comprises determining whether CNS chloride transporter activity or expression is moplulated relative to a control transporter activity or expression. In another embodiment, the chloride transporter is KCC2, and further, the method comprises determining whether KCC2 activity or expression is decreased relative to the control activity or expression.
In still another embodiment, the control intracellular chloride level is selected from the group consisting of an established standard; a corresponding intracellular chloride level determined in the subject at an earlier time; a corresponding intracellular chloride level determined in the subject when the subject is experiencing less pain or substantially no pain; and a corresponding intracellular chloride level determined in a control subject experiencing less pain or substantially no pain.
In yet another embodiment, the control activity or expression is selected from the group consisting of an established standard =of KCC2 activity or expression; a corresponding level of KCC2 activity or expression determined in the subject at an earlier time; a corresponding level of KCC2 activity or expression determined in the subject when the subject is experiencing less pain or substantially no pain; and a corresponding level of KCC2 activity or expression determined in a control subject experiencing less pain or substantially no pain.
In a further embodiment, KCC2 activity is determined by measuring a parameter selected from the group consisting of potassium transport, chloride transport, intracellular chloride level and anion reversal potential.
In still a further embodiment, the intracellular chloride level is determined by administering an indicator compound indicative of chloride level to the subject such that it is

9 contacted with a CNS neural cell of the subject; and assessing an in vivo signal associated with the indicator compound.
In yet another embodiment, the pain associated with CNS dysfunction is neuropathic pain.
In still yet another embodiment, the indicator compound is a radionuclide, and further, it is selected from the group consisting of 201T1, 99Tcm-tetrofosmin, 99Tcm-MIBI, 99Tcm-HMPAO and 3601.
In still another embodiment, the in vivo signal is assessed by an imaging technique. In yet still another embodiment, the in vivo signal is the retention index of the indicator compound. In a further embodiment, the imaging technique is selected from the group consisting of single photon emission computed tomography, positron emission tomography and magnetic resonance imaging. In yet a further embodiment, the indicator compound is indicative of KOC2 expression, and further, it is an antibody directed against K002.
According to yet another aspect of the invention, there is provided a method of treating pain associated with CNS dysfunction in a subject, the method comprising diagnosing or prognosticating, according to the methods described herein, pain associated with CNS dysfunction in the subject; and decreasing an intracellular chloride level in a CNS cell of the subject.
In an embodiment, the above-mentioned subject is a mammal, in a further embodiment, a human.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1: Peripheral nerve injury (PNI) induced a collapse of the Vanion in Lamina I (LI) neurons in the ipsilateral superficial dorsal horn (SDH). a) Chronic constriction injury of the sciatic nerve (n = 23), but not sham surgery (n = 11), caused a significant reduction in the 50% nociceptive withdrawal threshold to mechanical stimulation of the hindpaw in rats (p < 0.01). b) Ranges of Eanion recorded from LI
neurons of naive (A) and PNI (0) rats. Solid symbol = mean Eanion SEM. c) All classes of LI neurons (i.e. with phasic 5 (P), single-spike (SS) and tonic (T) firing properties [19]) showed a shift in Eanion in response to PNI. Scale bar is 50 mV
(y), 150 ms (x). d) Mean peak current measured in LI neurons from naive (A) and PNI (=) rats in response to applied GABA
at various Vm. Horizontal standard error bars represent

10 inter-neuron differences in recording pipette offset. Inset:
Representative traces from one neuron. Scale bar is 0.6 nA
(y), 1.0s (x).
Figure 2: Switch from GlyR(receptor)-only to mixed GABAAR- and GlyR-mediated miniature postsynaptic currents (mPSCs) following PNI in LI neurons. a) Raw traces of outward (left) and inward (right) miniature synaptic events from a naive rat LI neuron. All outward mPSCs were abolished by strychnine, while all inward mPSCs (recorded in the presence of strychnine and bicuculline) were abolished by the GluR
antagonist CNQX. HP - Holding Potential. Scale bar is 20 pA
(y), 300 ms (x). b) Raw traces of inward (left) and outward (right) miniature synaptic events recorded from a PNI rat LI
neuron. Unlike in naive rats, both strychnine and bicuculline were required to abolish all outward mPSCs. Inward mPSCs remained completely sensitive to CNQX. Scale bar is 20 pA
(y), 300 ms (x). c) left - Superimposed individual mPSCs recorded from PNI rat LI neurons. GlyR-only and GABAAR-only and mixed GABAAR/Glyr-mediated were clearly identifiable by their sensitivity to strychnine and/or bicuculline. Right -Averages of > 100 GlyR- and GABAAR-mediated mPSCs recorded from a PNI rat LI neuron. Scale bar is 15 pA (y), 20 ms (x).
d) Mean peak conductance of mPSCs recorded from naive (N; n =

11 for GlyR; n = 5 for GluR) and PNI (P; n = 9 for GlyR; n =
8 for GluR) LI neurons. P(B) indicates GlyR-mediated mPSCs recorded in PNI rat LI neurons (n = 12) at 0 mV in the presence of bicuculline. e) Net charge carried by G1yR-5 mediated mPSCs in naive rats (n = 6), by bicuculline-isolated GlyR-mediated mPSCs in PNI rats [PNI(Bic); n = 4], and by mixed GABAAR/GlyR-mediated mPSCs in PNI rat LI neurons (PNI; n = 12). f) Cumulative probability plot illustrating the difference between the GlyR-only mPSC inter-event interval 10 (I.E.I.) in naive LI neurons and that of bicuculline-isolated GlyR-only mPSCs in PNI rat LI neurons [PNI(Bic)], both recorded at Eanion= 0 mV. The addition of the GABAAR-mediated mPSCs (PNI) compensated the GlyR-only mPSC frequency decrease. Inset - No effect of PNI on .the frequency of G1uR-mediated mPSCs.
Figure 3: PNI-induced downregulation of KCC2 in SDH lamina I
neurons ipsilateral to PNI led to GlyR/GABAAR-mediated excitation. a) Brief GABA application (30 ms pressure puff) caused a tetrodotoxin (TTX) and bicuculline-sensitive rise in [Ca2+]1 in a LI neuron from a fura-2-am (Ca2+ indicator) loaded slices of a PNI rat. b) KC1 application, but not GABA
application (up to 250 ms-long pressure puffs) caused no change in [Ce]i in a naive rat LI neuron. In the presence of the KCC2-specific antagonist DIOA, GABA application did , elicit a rise in [Ca21]1 in a naive rat LI neuron. Scale bar is 0.02 (y), 10 s (x). c) Percentage of LI neurons displaying a GABA-evoked increase in [Ca2+]1. The proportion was significantly higher in PNI rats (7 = 2corrected = 3.91) and in the presence of DIOA in naive rats (7 N2corrected = 4.43). d) Representative trace confirming that exogenous GABA could repeatedly elicit action potentials in a lamina I neuron.
Upper scale bar is 5 mV (y), 200 ms (x). Lower scale bar is

12 30 mV (y), 4 s (x). Inset - response to a depolarizing pulse confirming this was a single-spike neuron (19). Scale bar is 20 mV (y), 300 ms (x). e) Similarly, focal stimuli (in the presence of glutamate receptor blockers) elicited bicuculline-sensitive monosynaptic depolarizing postsynaptic potentials thar could evoke action potentials in a lamina I
neuron from PNI rats. Scale bar is 5 mV (y), 250 ms (x).
Inset - response to a depolarizing pulse confirming this was a phasic neuron (19). Scale bar is 20 mV (y), 300 ms (x).
f) Left - Immunoblotting revealed that KCC2 levels were decreased in the lumbar SDH lying ipsilateral (Ipsi), but not contralateral (Con), to the site of the PNI. Right - Average intensities ( SEM) of KCC2 protein (normalized to actin) measured from immunoblots (n = 4) as in left (Ipsi normalized to Con).
Figure 4: Selective blockade or knock-down of the postsynaptic KCC2 exporter in the SDH significantly reduced nociceptive threshold. a) Tactile nociceptive withdrawal threshold as a function of time after intrathecal injections of DIOA (n = 5) or vehicle (n = 3). b) Thermal nociceptive withdrawal latency as a function of time after intrathecal injections of DIOA (n = 3) or vehicle (n = 3). Upon withdrawal, the rats also often licked their paw indicating nociception. c) Spontaneous mPSCs recorded with a CsC1 (cesium chloride) pipette (to clamp Eanion at OmV) in a LI
neuron in the presence and absence of DIOA. Scale bar is 20 pA (y), 300 ms (x). d) Cumulative probability plot (n = 4 neurons X 50 mPSCs) demonstrating that DIOA neither affected the peak conductance of synaptic events (p> 0.5), nor GABA-evoked responses (n = 5; p > 0.5, Inset) and therefore does not act on GlyRs nor GABAARs. Gp eak = peak conductance. e) Local lumbar spinal (intrathecal) administration of a KCC2

13 antisense oligodeoxynucleotide (each 12 h) caused a =
significant decrease in the tactile nociceptive withdrawal threshold in naive rats (n = 8), compared to those that received the scrambled oligodeoxynucleotide (n = 7). Inset, Decrease in spinal KCC2 protein levels (measured by immunoblots) following antisense (AS, 12h or 36h) or scrambled (S, 36h) oligodeoxynucleotide treatment. f) Lack of KCC2 immunoreactivity in dorsal root ganglia (DRG) in a naive rat, compared to SDH. g) Electron micrograph illustrating the selective expression of KCC2 in SDH
dendrites (D), but not synaptic boutons (B) (for quantitative details see Fig. 6). Arrows point to synapses. Scale bar is 0.2 pm.
Figure 5: Computer simulations of in vivo synaptic conditions confirmed that sensitization of Lamina I neurons occurred as a function of the shift in the Eanion= a) Left - Computer simulations using a model neuron (see Examples) demonstrate how PNI-induced changes to GlyR7 and GABAAR-mediated PSCs [PNI(GlyR+GABAAR)] affect the output firing frequency of LI
neurons as a function of GluR-mediated PSC frequency. Also shown is the result in LI neurons after PNI if only considering the effect of GlyR- mediated [PNI(GlyR-only)] or GABAAR-mediated [PNI(GABAAR-only)] synaptic events. Right -Same data as shown in the left panel, but expressed in terms of firing frequency ratio, which was calculated as the quotient of a specific data set divided by the No Inhibition data set (i.e., a firing frequency ratio of one is equivalent to no inhibition). While the normally hyperpolarizing G1yR-mediated PSCs (mean Eanion = -72.8 mV in naive rats) had a net inhibitory effect on the output firing frequency (fout), depolarizing GlyR-mediated PSCs (mean Eanion = -49.0 mV in PNI
rats), enhanced fmft beyond that predicted to result with no

14 inhibition, demonstrating a net excitatory effect. This excitatory effect was more prevalent when the GABAAR component was incorporated due to the increased charge carried by GABAAR-mediated PSCs. b) Left - Effect of different values of Eanion (over the range observed in our study) on the firing frequency of a LI neuron after PNI. Right - Same data as left panel expressed in terms of firing frequency ratio (as above).
Figure 6: KCC2 exporter expression is restricted to dorsal horn neurons, not sensory fibres. Although the KCC2 levels are below detection by immunoblotting from DRG (Fig. 4f), we verified whether KCC2 could be preferentially shuttled away from cell bodies to central terminals of primary afferents.
a) Electron micrograph illustrating the presence of KCC2 on dendrites (D) in lamina I of the dorsal horn. Membrane-delimited immunogold staining on the soma (S) of a lamina I
neuron is also shown (arrowheads). In contrast, no KCC2 immunostaining was observed in any of the randomly selected synaptic profiles examined (n = 171). b) KCC2 immunoreactivity was also absent from central boutons (n = 42 randomly selected central boutons) of synaptic glomeruli in laminae I and II (type I: CI; left; type II: cn; right;
arrows indicate excitatory synapses, D: dendrite) that unequivocally correspond to central terminals of primary afferents (A- and C- fibres [34,35]). Scale bars: a: 2 pm; b;
0.5 pm (left), 0.2 pm (right).
Figure 7: Effect of various treatments on anion (bicarbonate and chloride) reversal potential (Eanion) recorded from lamina I neurons of naive and PNI rats.

Figure 8: Intrathecal administration of the receptor tyrosine kinase inhibitor K-252a (6 nM) resulted in an increase in the threshold for tactile nociceptive withdrawal.
5 Figure 9: DNA (SEQ ID NO: 1) and polypeptide (SEQ ID NO: 2) sequences of human KCC2.
Figure 10: DNA (SEQ ID NO: 3) and polypeptide (SEQ ID NO: 4) sequences of mouse KCC2.
Figure 11: DNA (SEQ ID NO: 5) and polypeptide (SEQ ID NO: 6) sequences of rat KCC2.
Figure 12: Comparison of the anion (chloride and bicarbonate) reversal potential (Eanion) measured from lamina I neurons in slices, taken from naive rats, perfused with BDNF, NGF or regular artificial cerebrospinal solution (ACSF; "control" in Figure). PNI - peripheral nerve injury.
Figure 13: Comparison of Eanion measured in slices containing lamina I neurons taken from PNI rats treated, by bath application, with an antibody directed against TrkB
(P/TrkBIgG), H-89 (P/H89), K-252a (P/K252a) and KN-93 (P/KN93). PNI - peripheral nerve injury.
Figure 14: Comparison between the nociceptive threshold for tactile stimulation of rats treated with an adenovirus transducing BDNF (M) and rats treated with an adenovirus transducing the green fluorescent protein (D).
Figure 15: Comparison between the nociceptive threshold for tactile stimulation of rats treated with human recombinant NGF (10 g/day x 6 days) (M) and rats treated with saline vehicle (0) Figure 16: Comparison between the nociceptive threshold for tactile stimulation of rats treated with the neutralizing anti-TrkB antibody (anti-TrkB-IgG 12 g/2 hrs x 3) (111) and rats treated with vehicle only (0).
Figure 17: Comparison between the nociceptive threshold for mechanical stimulation of rats treated with the PKA inhibitor, H-89 (380 nmol) (M) and rats treated with vehicle only (D).
DETAILED DESCRIPTION OF THE INVENTION
Described herein is a novel mechanism of disinhibition following peripheral nerve injury. It involves a transsynaptic disruption of anion homeostasis in neurons of lamina I of the superficial dorsal horn (SDH), one of the main spinal nociceptive output pathways (7). The resulting shift in the transmembrane anion gradient is shown herein to cause normally inhibitory anionic synaptic currents to be excitatory, substantially driving up the net excitability of lamina I neurons. As shown herein, peripheral nerve injury is sensed by transmission of a signal transynaptically resulting in an increase in intracellular chloride levels in central nervous system (CNS) neurons. Further, the studies described herein demonstrate that decreasing CNS neuronal chloride levels can reverse this phenomenon, as shown via local blockade or knock-down of the spinal KCC2 exporter in intact rats which markedly reduced nociceptive threshold, confirming that the reported disruption of anion homeostasis in lamina I
neurons was sufficient to cause neuropathic pain.

Therefore, the studies described herein have investigated the mechanism of pain sensation via the study of downstream events following peripheral nerve injury. As such, it is shown herein that such events are transmitted transsynaptically (e.g. by a peripheral nervous system (PNS
cell or a sensory fiber) to central nervous system (CNS) neurons, in an embodiment, to spinal cord neurons. Further studies herein demonstrate that transmission of the nociceptive signal and sensation of pain is ultimately effected by a modulation of intracellular chloride level (e.g. modulated by a chloride transporter such as the potassium-chloride cotransporter KCC2) in a CNS tissue.
KCC2 (see (37) for a review) is a potassium-chloride cotransporter which has been identified in rat, mouse and human (for human KCC2 see for example US Patent application Serial No. 20030027983 of Mount et al.; published February 6, 2003). Studies of homozygous and heterozygous disruptions of the KCC2 gene in mouse revealed a seizure phenotype, suggesting a possible role for KCC2 in epilepsy (38). The precise role of 1<002 in CNS function is not yet completely understood.
Applicants demonstrate herein a correlation between the intracellular chloride level (e.g. by virtue of the activity/expression of a chloride transporter such as KCC2) in a CNS cell or tissue, and the sensation of pain. As shown in the examples below, peripheral nerve injury (PNI) results in the hyperexcitation or sensitization of CNS neurons, e.g.
of the spinal cord, e.g. lamina I (LI) neurons of the superficial dorsal horn (SDH). Such hyperexcitability occurs transsynaptically (i.e. downstream from the injured peripheral neuron), a phenomenon which has not been described prior to applicants' studies herein. Such hyperexcitability results in a reduction of the nociceptive threshold.

As shown herein, the hyperexcitability noted above correlates with an increase in intracellular chloride levels (e.g. modulation [e.g. decrease] in chloride transporter [such as KCC2] activity and/or expression) in the SDH. The role of KCC2 in this regard was confirmed via administration of the KCC2 blocker DIOA or a KCC2 antisense oligonucleotide to spinal tissue, both resulting in a rapid decrease in the threshold for pain sensitivity. Therefore, a reduction in KCC2 activity and/or expression, if it results in increased CNS neuronal chloride levels, may result in a decrease in the threshold for pain sensitivity, and, conversely, an increase or induction of KCC2 activity and/or expression, if it results in a decrease in CNS neuronal chloride, may result in an increase in the threshold for pain sensitivity thus providing for prevention and treatment of pain. On the other hand, it has been reported that under certain pathophysiological conditions, e.g. where [1e]0 is elevated, KCC2 may accumulate Cl- in neurons, thereby enhancing neuronal excitability (42). Under such conditions, it is envisioned that KCC2 would have the opposite effect on CNS neuronal chloride, and thus result in an increase in CNS neuronal chloride and in turn decreased nociceptive threshold and increased pain sensation. As such, modulation of the activity and/or expression of KCC2 may, depending on the directionality of the flux of chloride ion, contribute to or alleviate a pain sensation.
Therefore, in a first aspect, the invention relates to methods and materials for the treatment of pain, based on the modulation of CNS intracellular chloride level and further the modulation of the activity and/or expression of a chloride transporter, e.g. the KCC2 potassium-chloride cotransporter. As used herein, a "chloride transporter" is defined as a polypeptide/protein or complex thereof associated with the cell membrane that is able to effect the passage of chloride anions across the cell membrane.
"Export(er)" refers to a net passage from the inside to the outside of the cell, and "import(er)" refers to a net passage from the outside to the inside of the cell.
Therefore, in an embodiment, the present invention relates to methods for treating pain by decreasing the intracellular chloride level in a cell, e.g. a CNS neural cell. In a further embodiment, modulators of a chloride transporter (e.g. KCC2) can be used to decrease intracellular chloride levels. In an embodiment, the invention relates to the application, systemic or local, of compounds or drugs that decrease the intracellular level of chloride in a CNS
neural cell as a means to attenuate pain. In order achieve this result, the above-mentioned compounds or drugs may modulate the function or expression of the chloride transporter (e.g. KCC2 cotransporter) in CNS neurons. In yet a further embodiment, the compounds or drugs may increase the expression or activity of the chloride transporter or KCC2.
In an embodiment, the CNS neural cell in which the intracellular chloride levels are being modulated can be located in the superficial dorsal horn or the spinal cord.
In addition, the cell may also be transsynaptic to a peripheral nerve cell or sensory fiber from which a signal for pain originates.
In an embodiment, the invention also relates to the treatment of acute and chronic pain, more specifically to the treatment of neuropathic pain. "Neuropathic pain", as used herein, refers to chronic pain associated with nerve injury (e.g. following crush, transection or compression of nerves or following nerve degeneration resulting from disease). In an embodiment, neuropathic pain is associated with a nerve or tract injury. In a further embodiment, the neuropathic pain is associated with visceral and/or somatic pain. The invention further relates to decreasing CNS neuronal chloride levels (e.g. via modulation of chloride transporter [such as KCC2] activity and/or expression) to reduce nociception.
5 "Nociception" as used herein refers to the sensory component of pain. Pain may be the result of various stimuli, including but not limited to pressure, injury, thermal stimuli or chemical (e.g. ionic) stimuli. In embodiments, the pain may be associated with many conditions such as 10 chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with

15 diabetic neuropathy, phantom limb pain, spontaneous pain, chronic post-surgical pain, chronic temporomandibular pain, causalgia, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal , neuralgia, chronic back pain, pain associated with spinal 20 cord injury and/or recurrent acute pain. The invention also relates to methods of diagnosis and prognostication to assess pain associated with CNS dysfunction. In an embodiment, such diagnosis/prognostication may be performed prior to the method of treatment described herein, or during a treatment regimen, to further characterize the nature of the pain or its progression, and thus provide information which may be used e.g. to select a course of treatment for such pain in accordance with the results obtained from such diagnosis/prognostication. As used herein, "pain associated with CNS dysfunction" relates to a pain sensation that is caused by an alteration in ion (e.g. anion) homeostasis in a CNS tissue. In an embodiment, the anion is a chloride ion.
In a further embodiment, the alteration is an increase in an intracellular chloride level in a CNS cell. In yet another embodiment, the activity or expression of a chloride transporter may be modulated (e.g. KCC2 activity or expression may be modulated [e.g. decreased]) when a subject experiences pain associated with a CNS dysfunction.
"KCC2" as used herein refers to a particular type of potassium-chloride cotransporter expressed in neurons. In embodiments, KCC2 comprises the sequence of the polypeptide of SEQ ID'NOs: 2 (human KCC2; see also Figure 9), 4 (mouse KCC2; see also Figure 10) or 6 (rat KCC2; see also Figure 11), fragments thereof or sequences substantially identical thereto. In further embodiments, KCC2 is encoded by the nucleic acid sequences capable of encoding the polypeptides of SEQ ID NO: 2, 4 or 6, or fragments thereof or sequences substantially identical thereto or related by hybridization criteria (see below). In further embodiments, such nucleic acid sequences comprise of SEQ ID NO: 1 (human KCC2 DNA; see also Figure 9), 3 (mouse KCC2 DNA; see also Figure 10) or 5 (rat KCC2 DNA; see also Figure 11), fragments thereof or sequences substantially identical thereto or related by hybridization criteria (see below).
"Chloride transport(er) activity" as used herein refers to the transport of chloride, across the cell membrane. Such transport activity may be measured by direct or indirect means using various methods known in the art, examples of which are described herein. "KCC2 activity" as used herein refers to any detectable phenotype associated with KCC2. In an embodiment, KCC2 activity includes, but is not limited to potassium transport, chloride transport, which may, for example, be determined by assessing levels (either directly or indirectly) of potassium and/or chloride inside and/or outside the cell using, for example, reversal potential measurements with patch clamping methods, chloride/potassium sensitive dyes (see for example Haugland, R.P., Handbook of Fluorescent Probes and Research Products, ninth ed., 2002, Molecular Probes, Inc., Eugene, OR, USA) electrodes, etc. In addition, KCC2 activity may also affect the neural cell's anion reversal potential (Eanion) = The anion reversal potential may be determined, for example, by using gramicidin-perforated patch clamp recording.
"Chloride transporter expression" (e.g. KCC2 expression) relates both to production of a chloride transporter transcript (e.g. a KCC2 transcript) or a chloride transporter polypeptide or protein (e.g. a KCC2 polypeptide or protein). Chloride transporter expression (e.g. KCC2 expression) may therefore, in embodiments, be determined by assessing protein levels directly (e.g., by immunocytochemistry and/or western analysis) or a level of a chloride transporter-encoding nucleic acid (e.g. chloride transporter-encoding nucleic acid such as chloride transporter mRNA levels) that may be determined by using, for example, methods such as reverse-transcriptase polymerase chain reaction [RT-PCR] methodsõ micro-array-based methods or by Northern analysis).
Compounds capable of decreasing intracellular chloride level in a CNS neural cell may, for example, modulate chloride transporter activity and expression (e.g.
KCC2 activity and expression). In an embodiment, the chloride transporter activity or expression (e.g. KCC2 activity or expression) may be increased. In an embodiment, these compounds can be administered in a way such that they contact a CNS tissue or a CNS cell. The compounds that can be used include, but are not limited to, those which directly or indirectly modify the activity of the protein and those which modulate the production and/or stability of the protein (e.g. at the level of transcription, translation, maturation, post-translationnal modification, phosphorylation and degradation).
One class of such compounds are those that act via modulation of phosphorylation of one or more sites on KCC2.
Upon cloning KCC2 (20), it has been reported that KCC2 does not contain consensus phosphorylation sites for PKA, yet does contain five for PKC (Thr34, Ser728, Thr787, Ser9" & Serl ") .
One consensus site was identified for tyrosine protein phosphorylation (Tyrl 81) in the carboxyl-terminal. This tyrosine kinase consensus phosphorylation site is not present in the KCC1 or KCC4 isoforms, yet it is conserved in the KCC3 protein (21). As such, compounds capable of upregulating or increasing KCC2 activity include, but are not limited to, protein kinases inhibitors (e.g. N-ethylmaleimide (23-25), staurosporine (29), and receptor tyrosine kinase inhibitors such as K-252a); antibodies or antibody fragments generated against certain kinases or kinase phosphorylation sites on KCC2, or compounds which interfere more directly (e.g.
oligopeptides capable of competing with phosphorylation sites oh KCC2) or less directly (e.g. compounds which modulate kinase activity and/or expression) with KCC2 phosphorylation.
In an embodiment, such a compound may act at the level of phosphorylation-mediated signaling pathways and ultimately affect KCC2 phosphorylation. In another embodiment, TrkB may be modulated to affect KCC2 phosphorylation and ultimately modulate KCC2 activity. Thus, In an embodiment, 'compounds that inhibit TrkB activity may, for example, be used in this regard. Such compounds may include, but are not limited to, K-252a (commercially available from Calbiochem) or a neutralizing antibody against TrkB (anti-TrkB antibody [e.g.
IgG])(commercially available from BD Transduction Laboratories). In yet another embodiment, modulation, e.g.
inhibition, of cyclic AMP-dependant kinase or PKA may be useful in modulating KCC2 phosphorylation and ultimately be used in the treatment or prevention of pain. For example, the PKA inhibitor H-89 (commercially available from EMD
Biosciences) may be used in this regard. In a further embodiment, modulation, e.g. inhibition, of calmodulin-dependant kinase (CAM kinase, e.g. II and IV) may alleviate or prevent pain in a subject by modulating KCC2 activity, e.g. phosphorylation. Compounds capable of inhibiting such a kinase include, but are not limited to, KN-93 (commercially available from EMD Biosciences). In yet another embodiment, modulators, e.g.inhibitors, of other members of the TrkB
pathway, e.g. phosphatidylinositol-specific phospholipase C
or phosphatidylcholine-specific phospholipase C, e.g.
phospholipase C gamma (PLC?), may be used to decrease intracellular chloride levels in a CNS neural cell. Such compounds include, but are not limited to, tricyclodecan-9-yl-xanthogenate, 1-0-octadecy1-2-0-methyl-rac-glycero-3-phosphorylcholine, neomycin sulfate, spermine tetrahydrochloride, 1-[6-((17beta-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl]-1H-pyrrole-2,5-dione, or 1-[6-((17beta-3-methoxyestra-1,3,5(10)-trien-17-yl)amino)hexyl]-2,5-pyrrolidinedione.
Further, modulation of KCC2 expression may also arise from modulation (e.g. mediated by phosphorylation) of transcription factors which regulate KCC2 expresion.
In a further aspect, the invention provides a method for treating pain or preventing/decreasing nociception in a subject or animal, comprising modulating, in embodiments reducing or decreasing, intracellular chloride levels in a CNS neuron or tissue. In an embodiment, such decrease in intracellular chloride levels is achieved by modulating, e.g.
decreasing, activity or expression of a chloride transporter (e.g. KCC2) in a CNS neuron or tissue of the subject. In a 25 =
further embodiment, the subject is a vertebrate. In another embodiment, the subject is a mammal, in a yet further embodiment, a human. In an embodiment, the CNS tissue is spinal cord tissue and the neural cell is a spinal cord neural cell.
Accordingly, the invention therefore provides methods of treating pain comprising administering a compound capable of modulating, in an embodiment, decreasing or reducing intracellular chloride levels in CNS tissue (e.g. a CNS neural cell) in a subject. In an embodiment, the modulation, e.g. increase, in chloride transporter (e.g.
KCC2) activity and/or expression effects the decrease in intracellular chloride level in the subject. In an embodiment, the =CNS tissue is spinal cord tissue and the neural cell is a spinal cord neural cell.
In an embodiment, KCC2 comprises an amino acid sequence substantially identical to a sequence *set forth in SEQ ID NO: 2, 4, 6 or a fragment thereof. In another embodiment, KCC2 may be encoded by a nucleic acid substantially identical to a nucleotide sequence capable of encoding SEQ ID NO: 2, 4, 6 or a fragment thereof, such as a sequence substantially identical to the sequence set forth in SEQ ID NO: 1, 3, 5 or a fragment thereof.
As noted above, a homolog, variant and/or fragment of a KCC2 which retains activity may also be used in the methods of the invention. Homologs include protein sequences which are substantially identical to the amino acid sequence of a KCC2, sharing significant structural and functional homology with a KCC2. Variants include, but are not limited to, proteins or peptides which differ from a KCC2 by any modifications, and/or amino acid substitutions, deletions or additions. Modifications can occur anywhere including the polypeptide backbone, (i.e. the amino acid sequence), the amino acid side chains and the amino or carboxy termini. Such substitutions, deletions or additions may involve one or more amino acids. Fragments include a fragment or a portion of a KCC2 or a fragment or a portion of a homolog or variant of a KCC2.
With regard to increasing or upregulating expression of KCC2 in a cell, various methods of introducing KCC2-encoding nucleic acids into the cell may be used, examples of which are described below. Methods such as the gene therapy methods discussed below may be used in this regard. Examples of KCC2-encoding nucleic acids include nucleic acids capable of encoding a polypeptide of SEQ ID NO:
2, 4 or 6 (e.g. the nucleic acids of SEQ ID NO: 1, 3 and 5), or nucleic acids substantially identical thereto. The method may also comprise administering to an area or neural tissue, e.g. CNS tissue, a cell comprising such a KCC2-encoding nucleic acid, via for example transplantation or introduction of a neural cell or precursor thereto (e.g. a stem cell) comprising such a KCC2-encoding nucleic acid. Further, the method may entail administering to the subject a compound capable of modulating, e.g. unpregulating or increasing, expression of a KCC2. Such a compound may for example be identified and characterized by the screening methods described below. Such a compound may further be provided as a composition comprising the compound and a pharmaceutically acceptable carrier. In an embodiment, the composition is formulated for or adapted for administration to the CNS.
Such a compound or composition may be provided in a commercial package together with instructions for its use.
"Homology" and "homologous" refers to sequence similarity between two peptides or two nucleic acid molecules. Homology.can be determined by comparing each position in the aligned sequences. A degree of homology between nucleic acid or between amino acid sequences is a function of the number of identical or matching nucleotides or amino acids at positions shared by the sequences. As the term is used herein, a nucleic acid sequence is "homologous"
to another sequence if the two sequences are substantially identical and the functional activity of the sequences is conserved (as used herein, the term "homologous" does not infer evolutionary relatedness). Two nucleic acid sequences are considered substantially identical if, when optimally aligned (with gaps permitted), they share at least about 50%
sequence similarity or identity, or if the sequences share defined functional motifs. In alternative embodiments, sequence similarity in optimally aligned substantially identical sequences may be at least 60%, 70%, 75%, 80%, 85%, 90% or 95%. As used herein, a given percentage of homology between sequences denotes the degree of sequence identity in optimally aligned sequences. An "unrelated" or "non-homologous" sequence shares less than 40% identity, though preferably less than about 25 % identity, with any of SEQ ID
NO: 1 to 6.
Substantially complementary nucleic acids are nucleic acids in which the "complement" of one molecule is substantially identical to the other molecule. Optimal alignment of sequences for comparisons of identity may be conducted using a variety of algorithms, such as the local homology algorithm of Smith and Waterman, 1981, Adv. Appl.
Math 2: 482, the homology alignment algorithm of Needleman and Wunsch, 1970, J. Mol. Biol. 48:443, the search for similarity method of Pearson and Lipman, 1988, Proc. Natl.
Acad. Sci. USA 85: 2444, and the computerised implementations of these algorithms (such as GAP, BESTFIT, FASTA and TFASTA
in the Wisconsin Genetics Software Package, Genetics Computer Group, Madison, WI, U.S.A.). Sequence identity may also be determined using the BLAST algorithm, described in Altschul et al., 1990, J. Mbl. Biol. 215:403-10 (using the published default settings). Software for performing BLAST analysis may be available through the National Center for Biotechnology Information. The BLAST algorithm involves first identifying high scoring sequence pairs (HSPs) by identifying short words of length W in the query sequence that either match or satisfy some positive-valued threshold score T when aligned with a word of the same length in a database sequence. T is referred to as the neighbourhood word score threshold.
Initial neighbourhood word hits act as seeds for initiating searches to find longer HSPs. The word hits are extended in both directions along each sequence for as far as the cumulative alignment score can be increased. Extension of the word hits in each direction is halted when the following parameters are met: the cumulative alignment score falls off by the quantity X from its maximum achieved value; the cumulative score goes to zero or below, due to the accumulation of one or more negative-scoring residue alignments; or the end of either sequence is reached. The BLAST algorithm parameters W, T and X determine the sensitivity and speed of the alignment. The BLAST program may use as defaults a word length (W) of 11, the BLOSUM62 scoring matrix (Henikoff and Henikoff, 1992, Proc. Natl. Acad. Sci.
USA 89: 10915-10919) alignments (B) of 50, expectation (E) of 10 (or 1 or 0.1 or 0.01 or 0.001 or 0.0001), M=5, N=4, and a comparison of both strands. One measure of the statistical similarity between two sequences using the BLAST algorithm is the smallest sum probability (P(N)), which provides an indication of the probability by which a match between two nucleotide or amino acid sequences would occur by chance. In alternative embodiments of the invention, nucleotide or amino acid sequences are considered substantially identical if the smallest sum probability in a comparison of the test sequences is less than about 1, preferably less than about 0.1, more preferably less than about 0.01, and most preferably less than about 0.001.
An alternative indication that two nucleic acid sequences are substantially complementary is that the two sequences hybridize to each other under moderately stringent, or preferably stringent, conditions. Hybridization to filter-bound sequences under moderately stringent conditions may, for example, be performed in 0.5 M NaHPO4, 7% sodium dodecyl sulfate (SDS), 1 mM EDTA at 65 C, and washing in 0.2.x SSC/0.1% SDS at 42 C (see Ausubel, et al. (eds), 1989, Current Protocols in Molecular Biology, Vol. 1, Green Publishing Associates, Inc., and John Wiley & Sons, Inc., New York, at p. 2.10.3). Alternatively, hybridization to filter-bound sequences under stringent conditions may, for example, be performed in 0.5 M NaHPO4, 7% SDS, 1 mM EDTA at 65 C, and washing in 0.1 x SSC/0.1% SDS at 68 C (see Ausubel, et al.
(eds), 1989, supra). Hybridization conditions may be modified in accordance with known methods depending on the sequence of interest (see Tijssen, 1993, Laboratory Techniques in Biochemistry and Molecular Biology -- Hybridization with Nucleic Acid Probes, Part I, Chapter 2 "Overview of principles of hybridization and the strategy of nucleic acid probe assays", Elsevier, New York). Generally, stringent conditions are selected to be about 5 C lower than the thermal melting point for the specific sequence at a defined ionic strength and pH.
According to a further aspect, the invention also provides a method for decreasing nociception in a subject.
In an embodiment, this method comprises modulating, e.g.
decreasing, intracellular chloride levels in a cell, e.g. a CNS cell, in a subject. In a further embodiment, the method also comprises modulating, e.g. increasing, chloride transporter activity or expression, e.g. KCC2 activity or expression. In yet another embodiment, the method also 5 comprises contacting the CNS neural cell with a compound capable of modulating chloride transporter activity. Such compounds include, but are not limited to a TrkB inhibitor (such as K-252a or anti-TrkB antibody), a PKA inhibitor (such as H-89) or a CAM kinase inhibitor (such as KN-93).
10 The invention further provides a composition for the prevention and/or treatment of pain comprising a compound capable of modulating, e.g. decreasing, intracellular chloride levels in admixture with a pharmaceutically acceptable carrier. In an embodiment, such composition may 15 modulate, e.g. increase or upregulate, chloride transporter activity, e.g. KCC2, 'activity and/or expression. In an embodiment, such a composition is suitable for or adapted for administration to a CNS neui.al cell or tissue, such as spinal cord tissue or cell. In yet a further embodiment, such a 20 composition may be an i.nducer of KCC2 expression or activity.
As used herein, an "inducer" is a compound that upregulates or enhances directly or indirectly the expression of the KCC2 gene, stability of the KCC2 mRNA, translation of the KCC2 mRNA, maturation of the KCC2 polypeptide, transport, e.g.
25 recycling, of the KCC2 polypeptide to the cell membrane, or transporter activity of the KCC2 polypeptide. In an embodiment, the "inducer" can also down-regulate or inhibit KCC2 inhibitors.
The invention further provides a use of the above-30 mentioned composition or the above-mentioned compound, capable of modulating, e.g. decreasing, intracellular chloride levels for the treatment or prevention of pain. The invention also provides a use of the above-mentioned composition or the above-mentioned compound, capable of modulating, e.g. decreasing, intracellular chloride levels for the preparation of a medicament for treatment or prevention of pain. In an embodiment, the compound or composition modulates, e.g. increases or upregulates, chloride transporter (e.g. KCC2) activity and/or expression.
In yet another embodiment, the compound or composition may comprise a TrkB inhibitor (such as K-252a or anti-TrkB
antibody), a PKA inhibitor (such as H-89) or a CAM kinase inhibitor (such as KN-93). In yet another embodiment, the medicament may be formulated for administration to a CNS
tissue, e.g. CNS cell, of a subject. Further, the compound may be, for example, an inducer of KCC2 expression or activity.
The invention further provides commercial packages comprising a compound capable of modulating, e.g. decreasing, intracellular chloride levels or the above-described composition together with instructions for its use in the treatment or prevention of pain. In an embodiment, the compound may modulate, e.g. increase or upregulate, chloride transporter or KCC2 activity and/or expression.
In various embodiments, a compound capable of modulating, e.g. decreasing, intracellular chloride levels in a CNS cell may be used therapeutically in formulations or medicaments to treat pain. The compound may, for example, modulate, e.g. increase or upregulate chloride transporter (e.g. KCC2) activity and/or expression. The invention also provides corresponding methods of medical treatment, in which a therapeutic dose of a compound capable of modulating, in an embodiment decreasing, intracellular chloride levels, is administered in a pharmacologically acceptable formulation.
Accordingly, the invention also provides therapeutic compositions comprising a compound capable of modulating, in an embodiment decreasing intracellular chloride levels, and a pharmacologically acceptable excipient or carrier. The therapeutic composition may be soluble in an aqueous solution at a physiologically acceptable pH.
In an embodiment, a compound of the invention is administered such that it comes into contact with.a CNS
tissue or a CNS neuron. As used herein, the "central nervous system" or CNS is the portion of the nervous system comprising the brain and the spinal cord (e.g. in the lumbar region). By contrast, the "peripheral nervous system" or PNS
is the portion of the nervous system other than the brain and the spinal cord. In an embodiment, the CNS tissue is the superficial dorsal horn, in a further embodiment, a lamina I
neuron. As such,. in embodiments a compound of the invention can be administered to treat CNS cells in vivo via direct intracranial or intrathecal injection or injection into the cerebrospinal fluid. Alternatively, the compound can be administered systemically (e.g. intravenously, or orally) in a form capable of crossing the blood brain barrier and entering the CNS. "Neural" and "neuronal" are used herein interchangeably and both relate to neurons and the nervous system.
The invention also provides pharmaceutical compositions (medicaments) comprising a compound capable of modulating, in an embodiment decreasing intracellular chloride levels in a CNS cell. In an embodiment, such compositions include the compound, in a therapeutically or prophylactically effective amount sufficient to treat or attenuate pain, and a pharmaceutically acceptable carrier. A
"therapeutically effective amount" refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired therapeutic result, such as reduction of pain. A therapeutically effective amount of a compound capable of modulating, in an embodiment decreasing, intracellular chloride levels in a CNS cell, may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the compound to elicit a desired response in the individual. Dosage regimens may be adjusted to provide the optimum therapeutic response.
A therapeutically effective amount is also one in which any toxic or detrimental effects of the compound are outweighed by the therapeutically beneficial effects. A
"prophylactically effective amount" refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired prophylactic result, such as preventing or inhibiting onset of pain or increases in the severity of pain. A prophylactically effective amount can be determined as described above for the therapeutically effective amount.
For any particular subject, specific dosage regimens may be adjusted over time according to the individual need and the professional judgement of the person administering or supervising the administration of the compositions.
As used herein "pharmaceutically acceptable carrier" or "excipient" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and dbsorption delaying agents, and the like that are physiologically compatible. In one embodiment, the carrier is suitable for parenteral administration.
Alternatively, the carrier can be suitable for intravenous, intraperitoneal, intramuscular, intracranial, intrathecal, sublingual or oral administration. Pharmaceutically acceptable carriers include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion.
The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active compound, use thereof in the pharmaceutical compositions of the invention is contemplated. Supplementary active compounds can also be incorporated into the compositions.
.
Therapeutic compositions typically must be sterile and stable under the conditions of manufacture and storage.
The composition can be formulated as a solution, microemulsion, liposome, or other ordered structure suitable to high drug concentration. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and suitable mixtures thereof. The proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants. In many cases, it will be preferable to include isotonic agents, for example, sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride in the composition. Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, monostearate salts and gelatin. Moreover, the compound capable of modulating, in an embodiment increasing or upregulating, KCC2 activity and/or expression, can be administered in a time release formulation, for example in a composition which includes a slow release polymer. The active compounds can be prepared with carriers that will protect the compound against rapid release, such as a controlled release formulation, including implants and microencapsulated delivery systems. Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, polylactic acid and polylactic, polyglycolic copolymers (PLG). Many methods for the preparation of such formulations are patented or generally known to those skilled in the art.
Sterile injectable solutions can be prepared by 5 incorporating the active compound (e.g. a compound capable of modulating, in an embodiment decreasing, intracellular chloride levels in a CNS cell) in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered 10. sterilization. Generally, dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable 15 solutions, the preferred methods of preparation are vacuum drying and freeze-drying which yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof. In accordance with an alternative aspect of the invention, a compound 20 capable of modulating, in an embodiment decreasing, intracellular chloride levels in a CNS cell, may be formulated with one or more additional compounds that enhance its solubility.
In accordance with another aspect of the invention, 25 therapeutic compositions of the present invention, comprising a compound capable of modulating, in an embodiment decreasing, intracellular chloride levels in a CNS cell, may be provided in containers or commercial packages which further comprise instructions for their use for the treatment 30 of pain.
Given that a decreased intracellular chloride level in a cell is associated with a modulation, e.g. an increase, in level/activity of chloride transporter (KCC2), which further correlates with a decrease in pain sensation as described herein, a further aspect of the present invention is the treatment of pain by administering to a subject (e.g.
to CNS tissue) a nucleic acid molecule encoding a KCC2, or a variant or fragment thereof which retains KCC2 activity.
Suitable methods of administration include gene therapy methods.
A nucleic acid of the invention may be delivered to cells in vivo using methods such as direct injection of DNA, receptor-mediated DNA uptake, viral-mediated transfection or non-viral transfection and lipid based transfection, all of which may involve the use of gene therapy vectors. Direct injection has been used to introduce naked DNA into cells in vivo (see e.g., Acsadi et al. (1991) Nature 332:815-818; Wolff et al. (1990) Science 247:1465-1468). A delivery .apparatus (e.g., a "gene gun") for injecting DNA into cells in vivo may be used. Such an apparatus may be commercially available (e.g., from BioRad).
Naked DNA may also be introduced into cells by complexing the DNA to a cation, such as polylysine, which is coupled to a ligand for a cell-surface receptor (see for example Wu, G.
and Wu, C. H. (1988) J. Biol. Chem. 263:14621; Wilson el al.
(1992) J. Biol. Chem. 267:963-967; and U.S. Pat. No.
5,166,320). Binding of the DNA-ligand complex to the receptor may facilitate uptake of the DNA by receptor-mediated endocytosis. A DNA-ligand complex linked to adenovirus capsids which disrupt endosomes, thereby releasing material into the cytoplasm, may be used to avoid degradation of the complex by intracellular lysosomes (see for example Curiel el al. (1991) Proc. Natl. Acad. Sci. USA 88:8850; Cristiano et = al. (1993) Proc. Natl. Acad. Sci. USA 90:2122-2126).
Defective retroviruses are well characterized for use as gene therapy vectors (for a review see Miller, A. D. (1990) Blood 76:271). Protocols for producing recombinant retroviruses and for infecting cells in vitro or in vivo with such viruses can be found in Current Protocols in Molecular Biology, Ausubel, F. M. et al. (eds.) Greene Publishing Associates, (1989), Sections 9.10-9.14 and other standard laboratory manuals.
Examples of suitable retroviruses include pLJ, pZIP, pWE and pEM which are well known to those skilled in the art.
Examples of suitable packaging virus lines include .psi.Crip, .psi.Cre, .psi.2 and .psi.Am. Retroviruses have been used to introduce a variety of genes into many different cell types, including epithelial cells, endothelial cells, lymphocytes, myoblasts, hepatocytes, bone marrow cells, in vitro and/or in vivo (see for example Eglitis, et al. (1985) Science 230:1395-1398; Danos and Mulligan (1988) Proc. Natl. Acad.
Sci. USA 85:6460-6464; Wilson et al. (1988) Proc. Natl. Acad.
Sci. USA 85:3014-3018; Armentano et al. (1990) Proc. Natl.
Acad. Sci. USA 87:6141-6145; Huber et al. (1991) Proc. Natl.
Acad. Sci. USA 88:8039-8043; Ferry et al. (1991) Proc. Natl.
Acad. Sci. USA 88:8377-8381; Chowdhury et al. (1991) Science 254:1802-1805; van Beusechem et al. (1992) Proc. Natl. Acad.
Sci. USA 89:7640-7644; Kay et al. (1992) Human Gene Therapy 3:641-647; Dai et al. (1992) Proc. Natl. Acad. Sci. USA
89:10892-10895; Hwu et al. (1993) J. Immunol. 150:4104-4115;
U.S. Pat. No. 4,868,116.; U.S. Pat. No. 4,980,286; PCT
Application WO 89/07136; PCT Application WO 89/02468; PCT
Application WO 89/05345; and PCT Application WO 92/07573).
For use as a gene therapy vector, the genome of an adenovirus may be manipulated so that it encodes and expresses a polypeptide compound of the invention, but is inactivated in terms of its ability to replicate in a normal lytic viral life cycle. See for example Berkner et al. (1988) BioTechniques 6:616; Rosenfeld et al. (1991) Science 252:431-434; and Rosenfeld et al. (1992) Cell 68:143-155. Suitable adenoviral vectors derived from the adenovirus strain Ad type d1324 or other strains of adenovirus (e.g., Ad2, Ad3, Ad7 etc.) are well known to those skilled in the art. Recombinant adenoviruses are advantageous in that they do not require 5 dividing cells to be effective gene delivery vehicles and can be used to infect a wide variety of cell types, including airway epithelium (Rosenfeld et al. (1992) cited supra), endothelial cells (Lemarchand et al. (1992) Proc. Natl. Acad.
Sci. USA 89:6482-6486), hepatocytes (Herz and Gerard (1993) Proc. Natl. Acad. Sci. USA 90:2812-2816) and muscle cells (Quantin el al. (1992) Proc. Natl. Acad. Sci. USA 89:2581-2584).
Adeno-associated virus (AAV) may be used as a gene therapy vector for delivery, of DNA for gene therapy purposes.
AAV is a naturally occurring defective virus that requires another virus, such as an adenovirus or a herpes virus, as a helper virus for efficient replication and a productive life cycle (Muzyczka et al. Curr. Topics in Micro. and Immunol.
(1992) 158:97-129). AAV may be used to integrate DNA into non-dividing cells (see for example Flotte et al. (1992) Am.
J. Respir. Cell. Mol. Biol. 7:349-356; Samulski et al. (1989) J. Virol. 63:3822-3828; and McLaughlin et al. (1989) J.
Virol. 62:1963-1973). An AAV vector such as that described in Tratschin et al. (1985) Mol. Cell. Biol. 5:3251-3260 may be used to introduce DNA into cells (see for example Hermonat et al. (1984) Proc. Natl. Acad. Sci. USA 81:6466-6470; Tratschin et al. (1985) Mol. Cell. Biol. 4:2072-2081; Wondisford et al.
(1988) Mol. Endocrinol. 2:32-39; Tratschin et al. (1984) J.
Virol. 51:611-619; and Flotte et al. (1993) J. Biol. Chem.
268:3781-3790). Lentiviral gene therapy vectors may also be .
adapted for use in the invention.
General methods for gene therapy are known in the art. See for example, U.S. Pat. No. 5,399,346 by Anderson et al. A biocompatible capsule for delivering genetic material is described in PCT Publication WO 95/05452 by Baetge et al.
Methods of gene transfer into hematopoietic cells have also previously been reported (see Clapp, D. W., et al., Blood 78:
1132-1139 (1991); Anderson, Science 288:627-9 (2000); and Cavazzana-Calvo et al., Science 288:669-72 (2000)).
The invention further relates to transplantation methods, to introduce into a subject a cell comprising a nucleic acid capable of encoding a KCC2, or to introduce into a subject a cell which has been treated in vitro or ex vivo with a compound capable of decreasing intracellular chloride levels (e.g. by culturing the cell in an appropriate medium comprising the compound). In an embodiment, such a cell is a neural cell or a precursor thereof, e.g. a stem cell capable of developing/differentiating into a neural cell (neuron progenitor.cell). Methods relating to neural stem cell isolation, proliferation, characterization and/or transplantation are described in for example US patents 5,851,832; 5,968,829; 5,411,883; 5,750,376; 6,040,180;
5,753,506 and 6,001,654. The nucleic acid may be present in a vector as described above, the vector being introduced into the cell in vitro, using for example.the methods described above. In an embodiment, the cell is autologous, and is obtained from the subject. In embodiments, the cell is allogeneic or xenogeneic.
Given the correlation between intracellular chloride levels in a CNS cell and pain, compounds which are capable of modulating, e.g. decreasing, intracellular chloride levels in a CNS cell can be used for the prevention and treatment of pain. In an embodiment, compounds that modulate, e.g. increase or upregulate, chloride transporter, such as KCC2, activity/expression can be used for decreasing intracellular chloride levels and ultimately prevent or treat pain. Therefore, the invention further relates to screening methods for the identification and characterization of compounds capable of modulating intracellular chloride levels and/or chloride transporter activity and/or expression.
5 Therefore, the invention further provides a method of determining whether a candidate compound is capable of modulating intracellular chloride levels in a cell, and in turn is useful for the prevention and treatment of pain. In an embodiment, the method comprises contacting a CNS-derived 10 cell with said candidate compound and determining whether the intracellular chloride level has decreased in the presence of the test compound. A decrease in intracellular chloride level is indicative that the test compound may be used for the treatment or the prevention of pain. As used herein, a 15 "CNS-derived cell" is a cell isolated or derived from a CNS
tissue, and in embodiments includes both primary neuronal cultures, immortalized neuronal cell lines, as well as accepted in vitro neuronal model systems (e.g. cells differentiated into neurons in vitro). In an embodiment, the 20 above-mentioned cell possesses a chloride transporter or KCC2 activity. In yet a further embodiment, the cell endogenously expresses a chloride transporter (e.g. KCC2). In a further embodiment the above-mentioned cell has been genetically engineered to express a chloride transporter gene or a KCC2 25 gene. In an embodiment, the cell may be an appropriate host cell comprising an exogenously introduced source of a chloride transporter, such as KCC2. Such a host cell may be prepared by the introduction of nucleic acid sequences encoding a chloride transporter or KCC2 into the host cell 30 and providing conditions for the expression of such nucleic acid. In an embodiment, such a nucleic acid is DNA. Such host cells may be eukaryotic, such as amphibian or mammalian cells. In an embodiment, such host cells are human.

The invention also provides another method for the identification or characterization of compounds useful for the treatment and prevention of pain. In an embodiment, the method comprises contacting a CNS-derived cell with the candidate compound and determining whether chloride transporter activity has been modulated in the presence of the test compound. A modulation, e.g. increase, in chloride transporter activity is indicative that the test compound may be used for the treatment or the prevention of pain. In an embodiment, the chloride transporter is KCC2. KCC2 activity may be determined, for example, by measuring potassium transport, chloride transport, intracellular chloride levels and anion reversal potential.
The above-mentioned methods may be employed either with a single test compound or a plurality or library (e.g. a combinatorial library) of test compounds. In the latter case, synergistic effects provided by combinations of compounds may also be identified and characterized. The above-mentioned compounds may be used for prevention and/or treatment of pain, or may be used as lead compounds for the development and testing of additional compounds having improved specificity, efficacy and/or pharmacological (e.g.
pharmacokinetic) properties. In an embodiment the compound may be a prodrug which is altered into its active form at the appropriate site of action, e.g. in CNS tissue (e.g. in the spinal cord). In certain embodiments, one or a plurality of the steps of the screening/testing methods of the invention may be automated.
As noted above, the invention further relates to methods for the identification and characterization of compounds capable of modulating, in an embodiment increasing, chloride transporter , e.g. KCC2, gene expression. Such a method may comprise assaying chloride transporter, e.g. KCC2, gene expression in the presence versus the absence of a test compound. Such gene expression may be measured by detection of the corresponding RNA or protein, or via the use of a suitable reporter construct comprising a transcriptional regulatory element(s) normally associated with such chloride transporter or KCC2 gene, operably-linked to a reporter gene.
A first nucleic acid sequence may "operably-linked" with a second nucleic acid sequence when the first nucleic acid sequence is placed in a functional relationship with the second nucleic acid sequence. For instance, a promoter is operably-linked to a coding sequence if the promoter affects the transcription or expression of the coding sequences.
Generally, operably-linked DNA sequences are contiguous and, where necessary to join two =protein coding regions, in reading frame. However, since, for example, enhancers generally function when separated from the promoters by several kilobases and intronic sequences may be of variable lengths, some polynucleotide elements may be operably-linked but not contiguous. "Transcriptional regulatory element" is a generic term that refers to DNA sequences, such as initiation and termination signals, enhancers, and promoters, splicing signals, polyadenylation signals which induce or control transcription of protein coding sequences with which they are operably-linked. The expression of such a reporter gene may be measured on the transcriptional or translational level, e.g. by the amount of RNA or protein produced. RNA
may be detected by for example Northern analysis or by the reverse transcriptase-polymerase chain reaction (RT-PCR) method (see for example Sambrook et al (1989) Molecular Cloning: A Laboratory Manual (second edition), Cold Spring Harbor Laboratory Press, Cold Spring Harbor, New York, USA).
Protein levels may be detected either directly using affinity reagents (e.g. an antibody or fragment thereof [for methods, see for example Harlow, E. and Lane, D (1988) Antibodies: A
Laboratory Manual, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, NY]; a ligand which binds the protein) or by other properties (e.g. fluorescence in the case of green fluorescent protein) or by measurement of the protein's activity, which may entail enzymatic activity to produce a detectable product (e.g. with altered spectroscopic properties) or a detectable phenotype (e.g. alterations in cell growth). Suitable reporter genes include but are not limited to chloramphenicol acetyltransferase, beta-D
galactosidase, luciferase, or green fluorescent protein.
In an embodiment, a candidate compound may further be assayed to determine if it is capable of modulating a chloride transporter-mediated process (e.g. KCC2-mediated process) or chloride transporter activity (e.g. KCC2 activity). In an embodiment, such chloride transporter-mediated process is ion transport, e.g. potassium or chloride transport, as determined by for example by assessing potassium and/or chloride levels (e.g. intracellularly) or by measuring anion reversal potential (electrophysiologically), membrane potential, for example as described in the examples below.
The invention also relates to the diagnosis and prognostication of pain. In an embodiment, the pain is caused by an alteration in ion, e. g. anion or chloride, homeostasis in the nervous system, e.g. central nervous system, of a subject. Without wishing to being bound to any particular theory, a reduced capacity of potassium and chloride export from neurons in the central nervous system (CNS) may lead to persistent neuronal hyperexcitability and ultimately pain.
The invention thus provides a method for diagnosing or prognosticating pain associated with CNS dysfunction. As used herein, "CNS dysfunction" is an alteration in neuronal ionic homeostasis in the CNS.
In an embodiment, the pain associated with such CNS dysfunction is neuropathic pain. In an embodiment, the method comprises determining an intracellular chloride level in a CNS neural cell and comparing the chloride level to a corresponding control level.
In this particular method, an increase in the test level relative to a control level is an indication that the subject is experiencing pain associated with CNS dysfunction.
In an embodiment, the method may comprise determining whether CNS chloride transporter activity or expression (e.g. KCC2 activity or expression) is modulated, e.g. upregulated or increased, relative to a control activity or expression. In yet another embodiment, the control chloride level can be selected from an established standard, a corresponding chloride level determined in the subject at an earlier time;
a corresponding chloride level determined in said subject when the subject is experiencing less pain (relative to the current sensation of pain noted above) or substantially no pain; or a corresponding chloride level determined in a control subject experiencing less pain (relative to the current sensation of pain in the test subject noted above) or substantially no pain.
In an embodiment, a subject or control subject experiencing less pain or substantially no pain presents no evident .lesions to his central or peripheral nervous system (e.g. neuropathic pain) or persistent pain.
In yet another embodiment, the control activity or expression can be selected amongst an established standard of 1<002 activity or expression; a corresponding level of 1<002 activity or expression determined in the subject at an .30 earlier time; a corresponding level of KCC2 activity or expression determined in the subject when the subject is experiencing less pain (as above) or substantially no pain;
or a corresponding level of 1<002 activity or expression determined in a control subject experiencing less pain (as above) or substantially no pain. In an embodiment, the KCC2 activity may be determined as described above.
For example, intracellular chloride levels may be 5 determined by administering, to a subject, an indicator compound (such as a compound indicative of chloride level) that is capable of contacting a CNS neural cell of that subject. Following the administration of the indicator compound, assessment of the in vivo signal associated with 10 such indicator compound may be performed. In an embodiment, an indicator compound, such as a radionuclide (e.g. Thallium-201 (201Ti.
) "Tcm-tetrofosmin, "Tcm-MIBI or 99mTc-HMPAO or chloride conjugates thereof) or a compound indicative of KCC2 expression (such as an immunodetection-based reagent (e.g.
15 antibody, single chain antibody or Fab fragment directed against the KCC2 polypeptide)) may be employed. In yet another embodiment, the indicator compound, upon intravenous injection, may cross the blood-brain-barrier and accumulate in neurons of the CNS analogously to potassium, i.e. to 20 reflect potassium levels. In another embodiment, the dose of such radionuclide (e.g. 201T1) may be about 100 MBq (3mCi).
In yet another embodiment, the radionuclide (e.g. 201T1) may . be injected 15-20 minutes prior to SPECT imaging. Following injection of the indicator compound, an imaging technique may 25 be performed to assess the in vivo signal associated with the indicator compound. Such imaging techniques include, but are not limited to, single photon emission computed tomography (SPECT), positron emission tomography and/or magnetic resonance imaging. The imaging technique may enable the 30 ,assessment of the in vivo signal of the indicator Compound, such as the neural potassium gradient. Images can be obtained, for example, using gamma camera equipped with a high-resolution (5-7 mm) collimator and interfaced with a =

dedicated computer system. In an embodiment, serial projection images can be aquired over a 180 arc. In yet another embodiment, the radionuclide (e.g. 201T1) retention by' neurons can be expressed as a retention index (RI). The "retention index" as described herein is defined as:
Delayed retention-early retention x 100 Early retention =
In an embodiment, the "retention" of the retention index is herein defined as the amount of indicator compound (e.g. tracer or radionuclide) retained by a specific tissue at a certain time. In a further embodiment, the early retention is assessed before the delayed retention. In a further embodiment, the retention index is measured in a CNS
tissue.
In an embodiment, the methods of diagnosis/prognostication noted above may be performed in conjunction with the therapeutic/prophylactic methods noted above, for preventing or treating pain associated with CNS
dysfunction in a subject. Such a method thus comprises the diagnosis or prognostication of pain associated with CNS
dysfunction and, in accordance with the diagnosis/prognosis, decreasing intracellular chloride levels in a CNS cell of the subject thereby to prevent or treat pain.
Although various embodiments of the invention are disclosed herein, many adaptations and modifications may be made within the scope of the invention in accordance with the common general knowledge of those skilled in this art. Such modifications include the substitution of known equivalents for any aspect of the invention in order to achieve the same result in substantially the same way. Numeric ranges are inclusive of the numbers defining the range. In the claims, the word "comprising" is used as an open-ended term, substantially equivalent to the phrase "including, but not limited to". The following examples are illustrative of various aspects of the invention, and do not limit the broad aspects of the invention as disclosed herein.
Throughout this application, various references are referred to describe more fully the state of the art to which this invention pertains. The disclosures of these references are hereby incorporated by reference into the present disclosure.
EXAMPLES
Example 1: Methods Nerve Injury. Briefly, peripheral nerve injury was induced by surgically implanting a polyethylene cuff (-2 mm long, 0.7 mm inner diameter) around the sciatic nerve of adult, male, Spague-Dawley rats as previously described (16). A group of rats also received sham surgery. Only animals that showed a gradual decrease in mechanical threshold (over 14-17 days) down to 2.0 g or less were used for further experiments.
Behavioural Testing. Thermal and mechanical threshold for nociceptive withdrawal reflexes were tested as previously described (17).
Slice preparation. Parasagittal slices (300-350 pm) of spinal cord were prepared from adult (>50 days old) male rats as previously described (9). Slices were continually superfused (2-3 m1.min-1) with artificial cerebrospinal fluid (ACSF) containing (in mM): 126 NaC1, 26 NaHCO3, 10 glucose, 2.5 KC1, 2 CaCl2, 2 MgC12, 1.25 NaH2PO4, 0.001 TTX (bubbled with 95% 02 - 5% CO2, pH-7.4); when measuring GABAA/GlyR- mediated currents, 10 pM 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) and 40 pM D2-amino-5-phosphonovaleric acid (APV) were added to block fast glutamatergic transmission.
Recordings. For perforated patch recordings, the pipette tip was filled with a solution containing (in mM): 130 cesium gluconate (CsGluc), 5 CsCl, 2 MgCl2, 11 BAPTA Calcium chelator (buffer), 1 CaC12, 4 ATP, 0.4 GTP, 10 HEPES (pH-7.4). The pipette was back-filled with this same solution supplemented with 25 pg/ml gramicidin D (gramicidin stock was at 10 mg/ml in DMSO). Recordings in this mode were selected when access resistance was stable between 25-45 MO. For whole-cell voltage-clamp recordings, pipettes were filled with the above solution without gramicidin D. Similarly, whole-cell current-clamp recordings were performed using pipettes filled with the same intracellular solution as with voltage-clamp, except potassium methyl sulfate (KMeSO4) was used to replace CsGluc. To clamp Eanion at 0 mV, CsGluc was replaced with 110 mM CsC1 in the intracellular solution. All whole-cell recordings at Eanion = 0 mV were made at Vm = -60 mV in the presence of GluR-blockers. GABA was applied locally for 30-250 ms by pressure ejection through a patch micropipette.
Data acquisition and analysis of PSCs was performed as previously described (9). All measurements are given as means SEM, except where indicated. Statistical significance was tested using Student's t-tests for comparison of mean values, chi-square tests for contingency tables, and mixed design ANOVAs (post-hoc ¨ Tukey's HSD) for repeated measures.
Calcium Imaging. Slices were prepared from PNI and naive rats as detailed above for electrophysiological analysis.

After 15 min incubation in ACSF, slices were loaded with pM Fura-2-AM (a fluorometric calcium indicator, AM =
acetoxymethyl) in HEPES-buffered saline (+10% DMSO) for 1 hour. Slices were washed for -15 min with ACSF before being 5 mounted in the recording chamber, where they continued to be superfused by ACSF (2-3 ml.min-1). [Ca2-'] was fluorometrically measured using a Zeiss Axioscope equipped with epifluorescence optics. Images were acquired using a TILL , Photonics monochromator coupled to a CCD camera and regions 10 of interest (for ratioing) were drawn on clearly distinct neuronal cell bodies.
Immunoblotting. Horizontal slices (150 pm) of the SDH were made from the lumbar enlargement of both PNI and naive adult rats. Tissue extracts were prepared by homogenizing the slices with a Teflon pestle in a buffer containing 0.32 M
sucrose, 0.5 mM Tris-HC1, pH 7.5, 2 mM
ethylenediaminetetracetic acid (EDTA), 2.5 mM p-mercaptoethanol, and a cocktail of protease inhibitors (CompleteTM, Roche Diagnostics). Supernatants from 3,000 g (20 min) and 10,000 g (30 min) centrifugations were collected. Equal amounts of proteins (20 pg/lane) diluted in sample buffer were preheated at 37 C for 30 min, resolved by SDS-PAGE, and electroblotted onto nitrocellulose membranes.
Membranes were blocked 30 min in 5% nonfat dry milk in TBST
buffer *(150 mM NaC1, 10 mM Tris-HC1, pH 7.4, 0.05% Tween-20) and incubated overnight at 4 C with a rabbit anti-KCC2 antibody (1:1000, Upstate Biotechnology). After several washes in TBST, membranes were incubated for 30 min at room temperature with peroxidase-labeled goat anti-rabbit antibody (1:2000). Chemiluminescent bands were detected using Super Signal FemtoTM (Pierce Biotechnology). Digital images were captured with the VersaDocTM imaging system (BioRad) and data were analysed with Quantity OneTM software (BioRad).
Oligodeoxynucleotides. KCC2 antisense and scrambled 5 oligodeoxynucleotides, phosphorothioated at all positions were designed as previously described (18): antisense, 5'-TCTCCTTGGGATTGCCGTCA-3' (SEQ ID NO: 7; +59 relative to the ATG starting signal); scrambled, 5'-TCTTCTTGAGACTGCAGTCA-3' *
(SEQ ID NO: 8).
Intrathecal Injections. At least three days prior to drug administration, rats were anaesthetized with sodium pentobarbital (65 mg kg-1) and a lumbar spinal catheter was inserted into the intrathecal space, as previously described (11). Briefly, a small opening was created at the cisterna magna, and a catheter was inserted into the subarachnoid space and caudally directed -8 cm to the lumbar enlargement of the spinal cord. Upon recovery from surgery, lower body paralysis was induced via i.t. (intrathecal) lidocaine (2%, 30 pl) injection to confirm proper catheter localization.
Only animals exhibiting appropriate, transient paralysis to lidocaine, as well a lack of motor deficits were used for behavioural testing. Following drug/vehicle administration, animals were sacrificed and their vertebral column dissected to visually confirm correct placement of the catheter. Drugs included DIOA (10-30 pg, in 0.9% NaCl, 10 % DMSO) and oligodeoxynucleotides (single doses of 2 pg at Oh, 12h & 24h;
0.9% NaC1). Behavioural testing was performed as above;
normal (-15 g) mechanical threshold for withdrawal responses was confirmed in naive rats prior to receiving drug or vehicle. At the doses used, none of the compounds produced motor disturbances or sedation as assessed by grasping, righting and placing reflexes and behavioral observations (17).
Computer simulations. (see Figure 5) All simulations were performed with NEURON 4.3.1 using a compartment model of a generic spinal lamina I fusiform neuron with morphology and passive membrane properties based on (19). Dendrites bifurcated up to fourth order and an ax6n similar to that described in (19) were attached to the soma. Fast Na+ and delayed rectifier K.' currents based on (30) were inserted at 0.1 and 0.01 S/cm2, respectively, in the soma and axon initial segment and nodes; voltage threshold for spiking was -49 mV.
Two sets of inhibitory synapses were distributed randomly in the perisomatic region and four sets of excitatory synapses were more distal; each set was driven by an independent Poisson process at rates extrapolated from (31) and (32).
Electron microscopy. (see Figure 6) Tissue was prepared for ultrastructural analysis as previously described (35).
Briefly, rats were perfused through the aortic arch with 0.9%
NaC1 followed by a fixative solution containing 4%
paraformaldehyde (Sigma-Aldrich, Germany). After perfusion, spinal cords were removed, coronal blocks were dissected, 'then 60 pm thin sections were cut cryoprotected and freeze-thawed over 'liquid nitrogen and rinsed several times in phosphate buffer before incubation in the primary antiserum.
After incubation in blocking solution containing 2% bovine serum albumin (BSA), sections were incubated in rabbit anti-KCC2 (1:500, Upstate Biotechnology, USA) for 48 hours at 4 C.
After extensive washing, sections were incubated with 1 nm gold-conjugated anti-rabbit secondary antibody (1:250, Aurion) for 12 hours at 4 C followed by silver intensification (SE-EM, Aurion). Sections were treated with 0.5% 0s04 (20 min), dehydrated in graded ethanol, then in propylene oxide and embedded in Durcupan ACM (Fluka). After ultra-sectioning (UltracutTM UCT, Leica, Germany), specimens were examined using an electron microscope (Philips Tecnai 12, equipped with MegaViewTM CCD camera). Non-consecutive (spacing> 3 pm) ultrathin sections were analyzed in the electron microscope. Boutons with synaptic profiles were randomly selected and analyzed in laminae I & II and white matter for the expression of the KCC2 protein (36).
Intrathecal administration of K-252a. (see Figure 8) K-252a was prepared in 25 ul of 0.9% NaCl solution containing 10%
DMSO. Intrathecal catheterization was performed by creating a small opening at the cisterna magna, and inserting P10 polyethylene tubing into the subarachnoid space -- caudally directed -8 cm to the lumbar enlargement of the spinal cord.
Example 2: Results Peripheral neuropathy was induced in rats by chronically constricting the sciatic nerve (Fig. la). To test whether the hyperexcitability (sensitization) of SDH
neurons that follows peripheral nerve injury (PNI) is associated with modification of the anion gradient (Vanion)r anion reversal potential (Eanion) was measured using gramicidin-perforated patch clamp recording. This technique avoids disrupting the intracellular anion concentration (8).
Responses to exogenous GABA application showed that the anion reversal potential (Eanion) of lamina I (LI) neurons taken from PNI rats was ¨49.0 2.3 mV (range: -40 to -62.2 mV, n = 9) compared to -72.6 3.5 mV (range: -63.0 to -79.9 mV, n = 5;
p < 0.005) in LI neurons from naive rats (Fig. lb-d). Resting membrane potential was not significantly different between PNI (-62 4 mV, n = 7) and naive rat LI neurons (-61 2 mV, n = 16; p> 0.1). Spontaneous and evoked postsynaptic Currents (PSCs), recorded from PNI rat LI neurons in the presence of fast glutamate receptor (GluR) blockers were also inward (depolarizing from rest), their mean reversal potential increasing by 16.1 mV relative to that in lamina I
neurons from naive rats (n = 6, PNI; n =4, naive).
It was then investigated whether other properties of synaptic transmission were altered in the SDH after PNI. Inhibitory miniature PSCs (mPSCs) in LI neurons from naive rats are mediated by glycine receptors (GlyRs) alone despite GABA and glycine corelease from local inhibitory interneurons (9;
Fig.2a). While GluR-mediated mPSCs were unaffected by PNI
(Fig.2b), in all cells tested from PNI rats, a population of outward mPSCs at 0 mV persisted in the presence of the GlyR
antagonist strychnine (up to 1 pm; n = 4). These remaining mPSCs were mediated by GABAARs, as they were blocked by bicuculline (10 pM) and displayed prolonged decay kinetics compared to the GlyR-mediated component (TD(GABAAR) = 34.0 2.9 ms, n = 5, vs. TD(GlyR) = 11.3 1.3 ms, n = 6;p < 0.01; Fig.
2C).
Kinetic analysis further revealed that the decay phase of 36.9 2.3% of mPSCs followed a dual exponential function (Tin = 7.5 2.0 ms and TD2 = 51.3 7.9 ms; n = 6;
Fig.2c). These events possessed both a GABAAR and a GlyR-mediated component, as either strychnine or bicuculline could lead to the abolition of their respective components (n = 4).
Therefore, in parallel with the collapsed Vanionf PNI caused reorganization at LI synapses thereby unmasking GABAAR-only and mixed GARkR/GlyR-mediated mPSCs, in addition to those mediated by GlyRs alone. This synaptic organization is similar to that observed in immature LI-II neurons (9). The net effect of this synaptic switch is that it yielded a population of quantal synaptic events with significantly longer decay kinetics.
To examine the function of the PNI-induced GABAAR-mediated contribution to mPSCs, we analysed both the peak conductance and the frequency of mPSCs. This was performed using CsCl-filled pipettes to clamp the Eanion at 0 mV in both LI neurons taken from PNI and naive rats to prevent biased detection of mPSCs resulting from changes in driving force.
Peak conductance of GlyR-only mPSCs recorded in LI neurons taken from PNI rats was significantly smaller (-2-fold) than . that recorded from naive rat LI neurons (Fig. 2d). The addition of GABAAR-mediated events in the PNI condition, however, partially compensated the decrease in GlyR-only conductance. The peak conductance of GluR-mediated quantal events was not significantly different between LI neurons taken from naive and PNI rats (Fig.2d).
Factoring together the changes in peak conductance, kinetics, and driving force, the net charge carried by GlyR-only mPSCs at resting membrane potential in LI neurons taken from PNI rats was nearly 3-fold smaller than that in naive rats (Fig. 2e). With the contribution of GABAARs, however, the net charge carried by mPSCs in PNI rats rose back to that -mediated by GlyRs in naive rats. This result suggests that, although equivalent in magnitude, hyperpolarizing charge in naive LI neurons was carried by GlyR-mediated mPSCs alone, whereas depolarizing charge was transferred predominantly via GABAARs in PNI rat LI neurons, due to the prolonged decay kinetics of GABAAR-mediated mPSCs.
The frequency of GlyR-only mPSCs recorded in LI
neurons from PNI rats was observed to be significantly less (0.13 0.04 Hz, n = 5) than that for GlyR-only mPSCs in naive rat LI neurons (0.18 0.04 Hz, n =6;p <0.05; Fig.
2f). As with peak conductance, however, the addition of the GABAAR-mediated mPSCs compensated the PNI-induced decrease in frequency (0.22 0.10 Hz, n.= 4, for all GABAAR and/or GlyR-mediated events combined; p > 0.5): In contrast, there was no significant change in the frequency of GluR-mediated events 5 in LI neurons isolated from PNI rats (1.51 0.90 Hz, n = 9) compared to LI neurons from naive rats (0.82 0.40 Hz, n =
S; p> 0.3; Fig.2f).
If depolarizing GABAAR/GlyR-mediated postsynaptic currents exert a net excitatory influence in PNI LI neurons, 10 they should directly evoke action potentials, and consequently lead to Ca2+ influx . To test this hypothesis, we employed Ca2+-imaging using fura-2-am loaded LI neurons in slice to obtain a large data set. Administration of exogenous GABA to neuronal somata caused a significant increase in the 15 concentration of intracellular Ca2+ ([Ca2+]1) in 19% of LI
neurons (n = 53; Fig. 3a,c) lying ipsilateral to the site of PNI. This represents a seven-fold increase compared to LI
neurons found in naive and/or contralateral dorsal horn, where an increase in [Ca2+]i to GABA application was observed 20 in only 1 of 37 neurons tested (Fig. 3b,c). These responses were blocked by bicuculline (10 pM; n = 5) and by the voltage sensitive sodium channel blocker tetrodotoxin (TTX; 1 pM; n =
31). We then further confirmed electrophysiologically that applied GABA and synaptically elicited anionic postsynaptic 25 potentials can directly evoke action potentials (Fig. 3d,e).
These results indicate that postsynaptic anion fluxes can cause net excitation in lamina I neurons in PNI rats.
We then compared K002 protein levels by immunoblotting on horizontal slices of SDH. The KCC2 expression level in the 30 lumbar SDH ipsilateral to the PNI was significantly reduced (>2-fold) relative to the side contralateral to the injury (Fig. 3f). In naive rats, there was no significant difference between the two sides (n = 3).

If a decrease in the expression of the KCC2 exporter leads to an increase in neuronal [Cl-]1 and, in turn, GABAAR-mediated depolarization, a pharmacological blockade of the KCC2 exporter in LI neurons from naive rats should have the same effect. To test for this possibility, we bath applied the selective KCC2 blocker DIOA (30 pM) to naive spinal slices. As in the PNI condition, GABA application in the presence of DIOA caused an increase in [Ca24-]1 in 30% of naive LI neurons tested (Fig. 3b,c).
To assess whether the empirically determined changes in GABAAR/GlyR-mediated postsynaptic control were sufficient to account for the central sensitization which follows PNI, we simulated in vivo conditions using a biophysically-realistic neuron model (Fig. 5). The simulation confirmed that, after PNI, the extent of LI neuronal sensitization varied as a function of their Eanion, ranging from slight disinhibition to a net hyperexcitation.
To test whether this hyperexcitability (sensitization) would result in a decrease in the stimulus threshold to evoke a nociceptive withdrawal reflex, we administered DIOA (15-30 pg) directly to the lumbar enlargement of the spinal cord in intact rats via an intrathecal catheter. DIOA caused a rapid and reversible decrease in nociceptive threshold to both mechanical and thermal stimuli (Fig. 4a-b). A similar decrease in nociceptive threshold was further obtained via selective knock-down of the exporter using spinal administration of an antisense oligodeoxynucleotide against KCC2 mRNA (Fig. 4e), , further confirming the functional impact of KCC2 dowregulation.
As shown in Figure 7, we demonstrate that in lamina I neurons taken from rats with peripheral neuropathy, the transmembrane anion reversal potential (Eanion) is significantly more depolarized than that in lamina I neurons taken from naive rats. The anion (bicarbonate and chloride) reversal potential (Eanion) of recorded from lamina I neurons taken from naïve rats was significantly less than that recorded from the lamina I neurons of rats that had received a peripheral nerve injury (PNI). Bath application of both BDNF (50 ng/ml; N/BDNF) and NGF (50 ng/ml; N/NGF) caused the Eanion recorded from naive rat lamina I neurons to become significantly depolarized, indicating a collapse of the transmembrane anion gradient. Alternatively, bath application of the TrkB antagonist K-252a (200 nM; P/K252a) to lamina I neurons taken from a PNI rat caused a hyperpolarization of the Eanion to a level similar to that observed in lamina I neurons taken from naive rats. All Eanion values were confirmed using gramicidin-D perforated-patch voltage-clamp recordings. This depolarized Eanion is the result of a decreased expression of the KCC2 cotransporter in the lamina I neurons taken from neuropathic rats, as noted above. In lamina I neurons from naive rats, it is further shown herein that the Eanion may be depolarized significantly via the perfusion of the growth factors NGF and BDNF, suggesting that these growth factors may decrease the function and/or expression of the KCC2 protein in the superficial dorsal horn. Alternatively, blocking the BDNF
receptor, TrkB, in lamina I neurons taken from neuropathic rats using the protein kinase inihibitor K-252a, is shown herein to reverse the depolarization of the F.
-anion, returning this value to a level similar to that observed in lamina I
neurons taken from naive rats. Further, as shown in Figure 8, intrathecal administration of the receptor tyrosine kinase inhibitor K-252a (6 nM) (but not vehicle injection alone) resulted in an increase in the threshold for tactile nociceptive withdrawal in rats that had received peripheral nerve injury. K-252a can thus reverse the hyperalgesia/allodynia after its development following peripheral nerve injury. K-252a did not produce any motor disturbances or sedation as assessed by grasping, righting and placing reflexes and behavioral observations. It is envisioned that this inhibitor reactivates the KCC2 cotransporter in lamina I neurons taken from neuropathic rats by blocking phosphorylation, perhaps at a protein tyrosine kinase site on the transporter or on its transcription factors (or other regulatory substrate).
The results herein show that the painful neuropathy that follows PNI can be explained by a downregulation of the KCC2 exporter and the resultant shift in the Vanion in spinal LI neurons. They also demonstrate that such a modification of Vanion in adult animals can occur in a neuron transsynaptic to an injury site. Previous efforts to identify a substrate underlying the hyperexcitability characteristic of peripheral neuropathy have focussed on measuring changes in number of GABAergic interneurons, GABA content or GABAAR expression. The results have been contradictory (3-6). The findings presented herein provide a new avenue to understand such mechanisms of disinhibition. The conversion of the GABAAR/GlyR-mediated postsynaptic action via a shift in Vanion provides a mechanistic basis for central sensitization, including increases in neuronal responsiveness and number of excitatory inputs.
A critical feature of the spinal cord is that it employs two very distinct GABAergic inhibitory mechanisms:
GABAergic control of the central terminals of sensory fibres already involves a depolarizing mechanism (39), in contrast to dorsal horn cells where GABAergic inhibition involves hyperpolarization. Thus, the change in KCC2 expression reported here affects the polarity of GABA action in only one of the two inhibitory mechanisms controlling sensory input.
This is confirmed by the fact that primary afferents lack ' expression of KCC2 (Fig.4f, g; see also Fig. 6).
GABA/glycine-mediated depolarization may also serve as a gating mechanism to enable excitation via voltage sensitive Ca2+ channels (VSCCs) and NMDA receptor/channels (10). Ca2+
influx via these channels is thought to be critical for the sensitization of spinal neurons (11). Indeed, blocking these Ca2+ channels in humans by drugs such as gabapentin and ketamine has proven highly efficacious in the treatment of neuropathic pain (12-14). However, use of Ca2+ channel blockers, particularly ketamine and other NMDA antagonists, is associated with many undesirable side effects (14, 15).
Example 3 - In vitro TrkB-dependent modulation of KCC2 Parasaggital slices (250-300 microm) were made from the dorsal horn of naive rats or PNI rats. Slices were continually iperfused with an oxygenated Ringer's solution and were permitted to equilibrate for at least 1.5 hours prior to manipulation. Unless otherwise specified, slices were further perfused with 10 microM CNQX, a blocker of non-NMDA
ionotropic glutamate receptors. Recordings were made from visually-identified lamina I neurons using gramicidin-D
perforated-patch or whole-cell voltage-clamp recordings. In both cases, pipettes were filled with an intracellular solution containing either potassium methyl sulphate or cesium gluconate as the major ionic species. Eanion was measured by applying a series of brief (5-10 ms) applications of exogenous GABA to the soma of the neurons of interest; by manipulating the membrane potential of the neuron, the point at which GABA elicited neither an inward nor an outward anion current was taken as Eanion= All measurements of membrane =

potential were corrected for liquid junction potential, pipette offset, and resistances.
As shown in Figure 12, both brain-derived neurotrophic factor- (BDNF; 50 ng/ml in bath) mediated 5 activation of TrkB and nerve growth factor- (NGF; 50 ng/ml in bath) mediated activation of TrkA caused a significant depolarization of the anion reversal potential (Eanion) in lamina I neurons taken from naive rats.
Using slices taken from peripheral nerve injured 10 (PNI) rats, where the Eanion is chronically depolarized, application of various inhibitors of components of an intracellular pathway coupled to TrkB receptors were shown to cause a significant hyperpolarization of the Eanion (bicarbonate and chloride), to levels similar to that 15 observed in slices taken from naive rats (Figure 13). Agents that rendered this effect included, but are not limited to, an antibody directed against TrkB, (anti-TrkB-IgG 1 g/ml in bath); K-252a, an inhibitor of TrkA/B autophosphorylation (200 nM in bath); H-89, a membrane-permeable inhibitor of 20 cyclic AMP-dependent kinase (PKA); 15 M in bath); and KN-93, a membrane permeable inhibitor of calmodulin-dependent kinase II and IV (5 M in bath).
Example 4 - TrkB-dependent modulation of nociceptive 25 threshold in vivo.
All drugs used for local spinal delivery via intrathecal catheter were dissolved in 0.9% NaC1 with or without 10% v/v DMSO. Intrathecal catheterization was 30 performed by creating a small opening at the cisterna magna, and inserting a short P10 polyethylene tube into the subarachnoid space, caudally directed - 8 cm to the lumbar enlargement (L4-5) of the spinal cord. No drug administered produced motor disturbances or sedation, as assessed via analysis of grasping, righting and placing reflexes and other behavioral observations. Von Frey testing was used to assess the 50% withdrawal threshold to mechanical stimulation as previously described (41). All experiments were performed on intact, adult Sprague-Dawley rats.
Local spinal delivery of various agents using an intrathecal catheter led to the identification of several compounds that either effect a reduction of nociceptive threshold for tactile stimulation in naive rats, or raise the nociceptive threshold in PNI rats.
Local spinal delivery of either an adenovirus transducing BDNF (Figure 14) or human recombinant BDNF
(10 jig/day x 6 days), but not of an adenovirus transducing the green-fluorescent protein, caused a significant decrease in the nociceptive threshold for mechanical stimulation in naive rats. Likewise, intrathecal delivery of human recombinant NGF (Figure 15; 10 gg/day x 6 days) to naive rats caused a very similar decrease in the said nociceptive threshold.
On the other hand, serial administration of antibody directed against TrkB (anti-TrkB-IgG 12 gg/2 hrs x 3) via intrathecal catheter to PNI rats effected a significant increase in nociceptive threshold to mechanical stimulation (Figure 16). Local spinal delivery of the PKA
inhibitor H-89 (380 nmol) also caused an increase in the nociceptive threshold (Figure 17).
Throughout this application, various references are cited, which describe more fully the state of the art to which this invention pertains.

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SEQUENCE LISTING
<110> Universite Laval De Koninck, Yves De Koninck, Paul Coull, Jeffrey <120> CNS chloride modulation and uses thereof <130> 85409-29 <150> US 60/470,885 <151> ,2003-05-16 <160> 8 <170> PatentIn version 3.2 <210> 1 -<211> 5907 <212> DNA
<213> Homo sapiens <220>
<221> CDS
,<222> (1)..(3351) <400> 1 atg coo aac aac ctg acg gac tgc .gag gac ggc gat ggg gga gcc aac 48 Met Pro Asn Asn Leu Thr Asp Cys Glu Asp Gly Asp Gly Gly Ala Asn ccg ggt gat ggc aac coo aag gaa ago agt ccc ttc atc aac agc acc 96 Pro Gly Asp Gly Asn Pro Lys Glu Ser Ser Pro Phe Ile Asn Ser Thr gac aca gag aag gga aag gag tat gat ggc aag aac atg gcc ttg ttt 144 Asp Thr Glu Lys Gly Lys Glu Tyr Asp Gly Lys Asn Met Ala Leu Phe gag gag gag atg gac acc ago cot atg gtg too too ttg ctc agt ggc 192 Glu Glu Glu Met Asp Thr Ser Pro Met Val Ser Ser Leu Leu Ser Gly =
ctg gcc aac tac acc aac ctg coo cag gga agt agg gag cat gaa gag 240 Leu Ala Asn Tyr Thr Asn Leu Pro Gln Gly Ser Arg Glu His Glu Glu gca gaa aac aat gag ggt gga aaa aag aag cog gtg cag gcc cca cgc 288 Ala Glu Asn Asn Glu Gly Gly Lys Lys Lys Pro Val Gin Ala Pro Arg 85 90 = 95 atg ggc acc ttc atg ggc gtg tac ctg cog tgc ctg cag .aac atc ttt 336 Met Gly Thr Phe Met Gly Val Tyr Leu Pro Cys Leu Gin Asn Ile Phe ggc gtc atc ctc ttc ctg cgg ctc acc tgg gtg gtg ggc att gca ggc 384 Gly Val Ile Leu Phe Leu Arg Leu Thr Trp Val Val Gly Ile Ala Gly atc atg gag tcc ttc tgc atg gtg ttc atc tgc tgc tcc tgt acg atg 432 Ile Met Glu Ser Phe Cys Met Val Phe Ile Cys Cys Ser Cys Thr Met ctc acg gcc atc tcc atg agt gca att gca acg aat ggt gtt gtg,cct 480 Leu Thr Ala Ile Ser Met Ser Ala Ile Ala Thr Asn Gly Val Val Pro 145 150 155 = 160 gct ggt ggc tcc tac tac atg att tcc agg tct ctg ggc cca gag ttt 528 Ala Gly Gly Ser Tyr Tyr Met Ile Ser Arg Ser Leu Gly Pro Glu Phe ggg ggt gcc gtg ggc ctc,tgc ttc tac ctg ggc act acc ttt gca gga 576 Gly Gly Ala Val Gly Leu Cys Phe Tyr Leu Gly Thr Thr Phe Ala Gly gcc atg tac atc ctg ggc acc atc gaa atc ctg ctg gct tac ctc ttc 624 Ala Met Tyr Ile Leu Gly Thr Ile Glu Ile Leu Leu Ala Tyr Leu Phe cca gcc atg gcc atc ttc aag gca gaa gat gcc agt ggg gag gca gca 672 Pro Ala Met Ala Ile Phe Lys Ala Glu Asp Ala Ser Gly Glu Ala Ala gcc atg ctg aac aac atg cgt gtt tac ggc acc tgt gtg ctc acc tgc 720 Ala Met Leu Asn Asn Met Arg Val Tyr Gly Thr Cys Val Leu Thr Cys atg gcc act gtg gtg ttt gtg ggt gtc aag tat gtc aac aag ttt gcc 768 Met Ala Thr Val Val Phe Val Gly Val Lys Tyr Val Asn Lys Phe Ala ctt gtc ttc ctg ggt tgt gtc atc ctc tcc atc ctg gcc atc tat gct 816 Leu Val Phe Leu Gly Cys Val Ile Leu Ser Ile Leu Ala Ile Tyr Ala 260 . 265 270 ggg gtc atc aag tct gcc ttc gac cca ccc aac ttc cog atc tgc ctc = 864 Gly Val Ile Lys Ser Ala Phe Asp Pro Pro Asn Phe Pro Ile Cys Leu ctg ggt aac cgc acg ctg tct cgc cat ggc ttt gat gtc tgt gcc aag 912 Leu Gly Asn Arg Thr Leu Ser Arg His Gly She Asp Val Cys Ala Lys ctg gct tgg gaa gga aat gag.acg gtg acc aca cgg cta tgg ggc ctt 960 Leu Ala Trp Glu Gly Asn Glu Thr Val Thr Thr Arg Leu Trp Gly Leu ttc tgc tcc tct cgc ttc ctc aac gcc acc tgt gat gaa tac ttc acc 1008 Phe Cys Ser Ser Arg Phe Leu Asn Ala Thr Cys Asp Glu Tyr She Thr cga aac aat gtc aca gag ate cag ggc ate cct ggt gct gcc agt ggc Arg Asn Asn Val Thr Glu Ile Gin Gly Ile Pro Gly Ala Ala Ser Gly =ctc atc aaa gag aac etc tgg age tcc tac ctg ace aag ggc gtg att Leu Ile Lys Glu Asn Leu Trp Ser Ser Tyr Leu Thr Lys Giy Val Ile 355 360' 365 gtg gag agg agt ggg atg ace tcg gtg ggc ctg gee gat ggc act cct = Val Glu Arg Ser Gly Met Thr Ser Val Gly Leu Ala Asp Gly Thr Pro ate gac atg gac cac cct tat gtc ttc agt gat atg ace tee tac ttc Ile Asp Met Asp His Pro Tyr Val Phe Ser Asp Met Thr Ser Tyr Phe ace ctg ctg gtt ggc ate tac ttc ccc tea gtc aca ggg ate atg get Thr Leu Leu Val Gly Ile Tyr Phe Pro Ser Val Thr Gly Ile Met Ala ggt tct aac cgc tot ggg gac ctg agg gat gee cag aag tea ate ccc Gly Ser Asn Arg Ser Gly Asp Leu Arg Asp Ala Gin Lys Ser Ile Pro act ggc ace ate ctg gee ate gee ace ace tct get gtc tac ate age Thr Gly Thr Ile Leu Ala Ile Ala Thr Thr Ser Ala Val Tyr Ile Ser tee gtt gtt ctg ttt ggg gee tgc att gag ggg gtc gtc ctg egg gac Ser Val Val Leu Phe Gly Ala Cys Ile Glu Gly Val Val Lou Arg Asp =

aag ttt ggc gaa get gtg aat ggc aac etc gtg gtg ggc act ctg gee Lys Phe Gly Glu Ala Val Asn Gly Asn Leu Val Val Gly Thr Leu Ala tgg cca tct cca tgg gta att gtc ate gga tee ttc ttc tee ace tgt Trp Pro Ser Pro Trp Val Ile Val Ile Gly Ser Phe Phe Ser Thr Cys ggg get ggg ctg cag age etc acg ggg gee cca cgc ctg ctg cag gee Gly Ala Gly Leu Gin Ser Leu Thr Gly Ala Pro Arg Leu Leu Gin Ala ate tcg agg gat ggc att gtg ccc ttc ctg cag gtc ttt ggc cat ggc Ile Ser Arg Asp Gly Ile Val Pro Phe Leu Gin Val Phe Gly His Gly aag gee aat gga gag ccg ace tgg gee ctg etc ctg act gee tgc ate Lys Ala Asn Gly Glu Pro Thr Trp Ala Leu Leu Leu Thr Ala Cys Ile tgc gag att ggc ate etc att gca tee etc gac gag gtg gee ccc ate Cys Glu Ile Gly Ile Leu Ile Ala Ser Leu Asp Glu Val Ala Pro Ile ctc tct atg ttc ttc ctg atg tgc tac atg ttt gtg aat ctg gcc tgt 1728 Leu Ser Met Phe Phe Leu Met Cys Tyr Met Phe Val Asn Leu Ala Cys gca gtg cag acg ctg ctg agg aca ccc aac tgg agg cca cgc ttt cga 1776 Ala Val Gin Thr Leu Leu Arg Thr Pro Asn Trp Arg Pro Arg Phe Arg tat tac cac tgg acc ctc tcc ttc ctg ggc atg ago ctc tgc ctg gcc 1824 . Tyr Tyr His Trp Thr Leu Ser Phe Leu Gly Met Ser Leu Cys Leu Ala ctc atg ttc atc tgc tcc tgg tat tat gca ctg gta gcc atg ctc att 1872 Leu Met Phe Ile Cys Ser Trp Tyr Tyr Ala Leu Val Ala Met Leu Ile gct gga ctc atc tac aag tac att gag tac cgt ggg gca gag aag gag 1920 Ala Gly Leu Ile Tyr Lys Tyr Ile Glu Tyr Arg Gly Ala Glu Lys Glu tgg ggc gat ggg ata cga ggt ctg tct ctc agt gcg got cgc tat gcc 1968 Trp Gly Asp Gly Ile Arg Gly Leu Ser Leu Ser Ala Ala Arg Tyr Ala ctc tta cgc ctg gag gaa ggg ccc cca cac acc aag aac tgg agg cca 2016 Leu Leu Ar Leu Glu Glu Gly Pro Pro His Thr Lys Asn Trp Arg Pro cag ctg.ctg gtg ctg gtg cgt gtg gac caa gac cag aat gtg gtg cac 2064 Gin Leu Leu Val Leu Val Arg Val Asp Gln Asp Gin Asn Val Val His = 675 680 685 ccc cag ctg ctc tca ctg acc tcc cag ctg aag gca ggg aag ggc ctg 2112 Pro Gin Leu Leu Ser Leu Thr Ser Gin Leu Lys Ala Gly Lys Gly Leu acc atc gtg ggc tct gtc ctt gag ggc acc ttt ctg gaa aat cat cca 2160 Thr Ile Val Gly Ser Val Leu Glu GlY Thr'Phe Leu Glu Asn His Pro cag gcc cag cgg gca gaa gag tct atc agg cgc ctg atg gag gca gag 2208 Gin Ala Gin Arg Ala Glu Glu Ser Ile Arg Arg Leu Met Glu Ala Glu aag gtg aag ggc ttc tgc cag gtg gtg atc tcc tcc aac ttg cgt gat 2256 Lys Val Lys Gly Phe Cys Gin Val Val Ile Ser Ser Asn Leu Arg Asp ggc gtg tcc cat ctg atc cag tcc ggg ggc ctc ggg ggg ctg cag cac 2304 Gly Val Ser His Leu Ile Gin Ser Gly Gly Leu Gly Gly Leu Gin His aac act gtg ctt gtt ggc tgg ccc cgc aac tgg cgc cag aag gaa gat 2352 .
Asn Thr Val Leu Val Gly Trp Pro Arg Asn Trp Arg Gin Lys Glu Asp 5/36 .
cat cag acg tgg agg aac ttc att gag ctg gtc cgg gaa acc aca gct 2400 His Gin Thr Trp Arg Asn Phe Ile Glu Leu Val Arg Glu Thr Thr Ala ggc cac tta gcc ctg ctg gtc acc aag aac gtt tcc atg ttt cct ggg '2448 Gly His Leu Ala Leu Leu Val Thr Lys Asn Val Ser Met Phe Pro Gly aac cct gag cgc ttc tct gag ggc agc atc gac gtt tgg tgg att gtg 2496 Asn Pro Glu Arg Phe Ser Glu Gly Ser lie Asp Val Trp Trp Ile Val cac gat gga ggc atg ctc atg ctg ctg ccc ttc ctg ctg cgg cac cac 2544 His Asp Gly Gly Met Leu Met Leu Leu Pro Phe Leu Leu Arg His His aag gtc tgg cgg aag tgc aag atg cgt atc ttc act gtg gcc cag atg 2592 Lys Val Trp Arg Lys Cys Lys Met Arg Ile Phe Thr Val Ala Gin Met gat gac aat agc atc cag atg aag aag gat ctg acc aca ttt ctg tat 2640 Asp Asp Asn Ser Ile Gin Met Lys Lys Asp Leu Thr Thr Phe Leu Tyr cat tta cgc atc act gcg gag gtc gag gtg gtg gag atg cat gag agc 2688 His Leu Arg Ile Thr Ala Glu Val Glu Val Val Glu Met His Glu Ser 885 . 890 895 gac atc tca gct tac acc tat gag aag acg ttg gtg atg gag cag cgt 2736 Asp Ile Ser Ala Tyr Thr Tyr Glu Lys Thr Leu Val Met Glu Gin Arg tcc cag atc ctc aaa cag atg cat tta acc aag aat gag cgg gag cgg 2784 Ser Gin Ile Leu Lys Gin Met His Leu Thr Lys Asn Glu Arg Glu Arg gag atc cag agt atc aca gat gag tca cga ggc tca atc cgg aga aag 2832 Glu Ile Gin Ser Ile Thr Asp Glu Ser Arg Gly Ser Ile Arg Arg Lys aat cca gcc aac acg cgg ctc cgc ctg aac gtc cca gaa gag acg gct 2880 Asn Pro Ala Asn Thr Arg Leu Arg Leu Asn Val Pro Glu Glu Thr Ala ggt gac agt gaa gag aag cca gag gag gag gtg cag ctg atc cac gat 2928 Gly Asp Ser Glu Glu Lys Pro Glu Glu Glu Val Gin Leu Ile His Asp cag agt gct ccc agc tgc ccc agc agc tcc ccg tcc cca ggg gag gag 2976 Gin Ser Ala Pro Ser Cys Pro Ser Ser Ser Pro Ser Pro Gly Glu Glu cct gag ggg gaa ggg gag aca gat ccg gag aag gtg cat ctc acc tgg 3024 Pro Glu Gly Glu Gly Glu Thr Asp Pro Glu Lys Val His Leu Thr Trp acc aag gac aag tcg gtg gca gag aag aat aag ggc ccc agt cct 3069 Thr Lys Asp Lys Ser Val Ala Glu Lys Asn Lys Gly Pro Ser Pro gtc tcc tct gag ggc atc aag gac ttc ttc agc atg aag ccg gag 3114 Val Ser Ser Glu Gly Ile Lys Asp Phe Phe Ser Met Lys Pro Glu tgg gag aac ttg aac cag tcc aac gtg cgg cgc atg cac acg gcc 3159 Trp Glu Asn Leu Asn Gin Ser Asn Val Arg Arg Net His Thr Ala gtg cgg ctg aac gag gtc atc gtg aag aaa tcc cgg gac gcc aag 3204 Val Arg Leu Asn Glu Val Ile Val Lys Lys Ser Arg Asp Ala Lys ctt gtt ttg ctc aac atg cct ggg cct ccc cgc aac cgc aat ggt 3249 Leu Val Leu Leu Asn Met Pro Gly Pro Pro Arg Asn Arg Asn Gly gat gaa aac tac atg gag ttt ctc gag gtc ctc aca gag cac ctg 3294 Asp Glu Asn Tyr Met Glu Phe Leu Glu Val Leu Thr Glu His lieu gac cgg gtg atg ctg gtc cgc ggt ggt ggc cga gag gtc atc acc 3339 Asp Arg Val Met Leu Val Arg Gly Gly Gly Arg Glu Val Ile Thr atc tac tcc tga gaaccaggtc ctgccacccg ggcccgagcg cgcccggccc 3391 Ile Tyr Ser gcggctccgg agccctcgcc gOgccccccg ccgctgtcac cgtttacata cagaccctgt 3451 gcccgtgtcc tggcccctta ccccgctgcc tgaagcccgg aggccacgcc tgttggggct 3511 ' gattcggaga gggcgccccg ccgcgcagag accagagctc ctcagtgcca gtttggcccc 3571 tgggtcttcg ctgccctttt tctaagcccg gcctcgtctc gccggaggag acgctgcaat 3631 aaaggttggg agaaggcgcg gaaaggagag gagctggggc cttggggacc cccaggtagt 3691 ccatgcggcc cattcctccc cttcccactc ccgccgcggt cctcgctctg cgctcctccg 3751 gcgctgctcc ctggctcccg gcggcccgga ggcccgcggg gtgggaaggc cgcgcttgcC 3811 gtctccgccg ccccttctcg ccgagccgtg gggcgcgggc ggccgagcct atacatagtg 3871 tacaggagac atcgcgtgta tttttaacgt ccccatattt atgtgactag aagcgcaaca 3931 gacttctcgc catagtcgag ctctcccgct gggggcactg cggggaggcg aggcctcggg 3991 aagctgaatt ttccttgacg tccaagagtt tgagagcgaa agtgctttag gcccaggcgg 4051 gggtcgtggc ctcgttccct cgacacctcc gtcctgctct cgcctcttcg ccctttccgc 4111 gcgcccttgg cttcccaccc tcctctccag tccttttccg agatgaggtg agacaagggt 4171 ccaacttttc ctggattcgc ctcccagcgg acgtgagctt ccactgcggc tgcagagacg 4231 , cgagcaacct cttctcatcg gctcttatgc aagttggggc caggataggg gaggggtgct 4291 cctcaagagg aagaaaccga gaggcccgcg ccccaccgag gaagccccgc cccggtgcct 4351 tcgctgggga gcaggcgtct ctcctcagtc ggcttgtcgc ctgctccccg tatcccatgg 4411 ctcctcgcca aagactgaaa ttgtggagct ggagggcgcc ccctccccgg agtttcctcc 4471 ctgggacaag tgagggagga gggggccgat tctggtttag gggccggacc cactgagagg 4531 ccccagagcc gcccgtgatg ttcctccccc gtccccatct ggcagctcct gtctcgcctg 4591 .agggacccag ccgccttctc cgtgctctgg ggccgggcct cgctgcttag cagcggcctc 4651 tagctccgtc tcccggggac ctgggcctga gggagggctg gagtcagcac gcgctttgtc 4711 cttagcgcct gtctgctctc ctctaactag gacccagggc ctttggcttc cccagctcat 4771 ccttggccct tccgctccac cagcctggtc tgaggcgtgc tctgtcctta gagaaggcgc 4831.
ggtggccggg ttcccttccc ctagggcaca ttactaaggg ggtcaggcac tgcatgctcg 4891 ttccagcacc atctgggact gggtacagta cctccagccc cagggccctg acctgcgcac 4951 ctagcttgac atctcacgca cctcccagag ctggcgccac tgagtaatcc ggacctcacc 5011 acctcttttc ctttgagccc aaggcagagc tagagctgga gctggcgcca cccagacagc 5071 gtcaggtgtg gctggggtag gtttggaggt ctgccagtta cgccaagtcc cctctgagat 5131 tcgatcaggg gactggatag attctttcag gtactcaatc aggaagctgg aggtgttaga 5191 caccagcccc ctgcatcctt cagtagacct ccctctgaac accacagcca ggtcctgcct 5251 tctgggggcc tgaatattcc agagctgatg tgatgggctg tgcagaaggg ggctgtatca 5311 acatcaatta gggaaccaaa gttgcactat ctgggcccag attgtctggt tggcaagagc 5371 aaagtttccg ttgatgaaac,agacatccca caacaaaaac ccaagttttc tgtgctacat 5431 gtgcaatatt tgttatgaat gttatcacaa gtcattcatc aagttatctt tataatcact 5491 gtagttagat gtttcatgtc cattcaagtg acttttattc tgagtgcaat atttcaatag 5551 ccttgtagtg ataactagtg ttgcttttgt ttagatgatc tatgtgcagg gcaatgcaat 5611 gaagttgaaa ccccttggta ataggagagg ttgcaaacca aatcaagagt atttattact 5671 attactgcta ttattattag gcctgccttt aattttcagt gtaagtgttc agtatgccgc 5731 atcctgcctc agtattgatc ttgtgttctt tgtgccaata tgaaaaggag agggttggtt 5791 ctttccttta ttgttgaatg ctcccattta atgctttatg gcttttactg tattactttt 5851 VIM) 2004/101072 ttagactccc gtctgcacaa aatgcaataa aaataatttt attataaaaa aaaaaa <210> 2 <211> 1116 <212> PRT
<213> Homo sapiens <400> 2 Met Pro Asn Asn Leu Thr Asp Cys Glu Asp Gly Asp Gly Gly Ala Asn Pro Gly Asp Gly Asn Pro Lys Glu Ser Ser Pro Phe Ile Asn Ser Thr 20 . 25 30 Asp Thr Glu Lys Gly Lys Glu Tyr Asp Gly Lys Asn Met Ala Leu Phe Glu Glu Glu Met Asp Thr Ser Pro Met Val Ser Ser Leu Leu Ser Gly Leu Ala Asn Tyr Thr Asn Leu Pro Gin Gly Ser Arg Glu His Glu Glu Ala Glu Asn Asn Glu Gly Gly Lys Lys Lys Pro Val Gin Ala Pro Arg Met Gly Thr Phe Met Gly Val Tyr Leu Pro Cys Leu Gin Asn Ile Phe Gly Val Ile Leu Phe Leu Arg Leu Thr Trp Val Val Gly Ile Ala Gly Ile Met Glu Ser Phe Cys Met Val Phe Ile Cys Cys Ser Cys Thr Met Leu Thr Ala Ile Ser Met Ser Ala Ile Ala Thr Asn Gly Val Val Pro Ala Gly Gly Ser Tyr Tyr Met Ile Ser Arg Ser Leu Gly Pro Glu Phe Gly Gly Ala Val Gly Leu Cys Phe Tyr Leu Gly Thr Thr Phe Ala Gly Ala Met Tyr Ile Leu Gly Thr Ile Glu Ile Leu Leu Ala Tyr Leu Phe Pro Ala Met Ala Ile Phe Lys Ala Glu Asp Ala Ser Gly Glu Ala Ala Ala Met Leu Asn Asn Met Arg Val Tyr Gly Thr Cys Val Leu Thr Cys Met Ala Thr Val Val Phe Val Gly Val Lys Tyr Val Asn Lys Phe Ala .
245 . 250 255 Leu Val Phe Leu Gly Cys Val Ile Leu Ser Ile Leu Ala Ile Tyr Ala Gly Val Ile Lys Ser Ala Phe Asp Pro Pro Asn Phe Pro Ile Cys Leu Leu Gly Asn Arg Thr Leu Ser Arg His Gly Phe Asp Val Cys Ala Lys Leu Ala Trp Glu Gly Asn Glu Thr Val Thr Thr Arg Leu Trp Gly Leu Phe Cys Ser Ser Arg Phe Leu Asn Ala Thr Cys Asp Glu Tyr Phe Thr Arg Asn Asn Val Thr Glu Ile Gin Gly Ile Pro Gly Ala Ala Ser Gly .340 345 350 Leu Ile Lys Glu Asn Leu Trp Ser Ser Tyr Leu Thr Lys Gly Val Ile Val Glu Arg Ser Gly Met Thr Ser Val Gly Leu Ala Asp Gly Thr Pro 370 . 375 380 Ile Asp Met Asp His Pro Tyr Val Phe Ser Asp Met Thr Ser Tyr Phe 385 390 395 400' Thr Leu Leu Val Gly Ile Tyr Phe Pro Ser Val Thr Gly Ile Met Ala Gly Ser Asn Arg Ser Gly Asp Leu Arg Asp Ala Gin Lys Ser Ile Pro Thr Gly Thr Ile Leu Ala Ile Ala Thr Thr Ser Ala Val Tyr Ile Ser 435 , 440 445 Ser Val Val Leu Phe Gly Ala Cys Ile Glu Gly Val Val Leu Arg Asp Lys Phe Gly Glu Ala Val Asn Gly Asn Leu Val Val Gly Thr Leu Ala Trp Pro Ser Pro Trp Val Ile Val Ile Gly Ser Phe Phe Ser Thr Cys Gly Ala Gly Leu Gin Ser Leu Thr Gly Ala Pro Arg Leu Leu Gin Ala Ile Ser Arg Asp Gly Ile Val Pro Phe Leu Gln Val Phe Gly His Gly Lys Ala Asn Gly Glu Pro Thr Trp Ala Leu Leu Leu Thr Ala Cys Ile Cys Glu Ile Gly Ile Leu Ile Ala Ser Leu Asp Glu Val Ala Pro Ile Leu Ser Met Phe Phe Leu Met Cys Tyr Met Phe Val Asn Leu Ala Cys Ala Val Gin Thr Leu 'Leu Arg Thr Pro Asn Trp Arg Pro Arg Phe Arg Tyr Tyr His Trp Thr Leu Ser Phe Leu Gly Met Ser Leu Cys Leu Ala Leu Met Phe Ile Cys Ser Trp Tyr Tyr Ala Leu Val Ala Met Leu Ile Ala Gly Leu Ile Tyr Lys Tyr Ile Glu.Tyr Arg Gly Ala Glu Lys Glu Trp Gly Asp Gly Ile Arg Gly Leu Ser Lou Ser Ala Ala Arg Tyr Ala Leu Leu Arg Leu Glu Glu Gly Pro Pro His Thr Lys Asn Trp Arg Pro Gin Leu Leu Val Leu Val Arg Val Asp Gin Asp Gin Asn Val Val His Pro Gin Leu Leu Ser Leu Thr Ser Gin Leu Lys Ala Gly Lys Gly Leu Thr Ile Val Gly Ser Val Leu Glu Gly Thr Phe Leu Glu Asn His Pro Gin Ala Gin Arg Ala Glu Glu Ser Ile Arg Arg Leu Met Glu Ala Glu Lys Val Lys Gly Phe Cys Gin Val Val Ile Ser Ser Asn Leu Arg Asp Gly Val Ser His Lou Ile Ser Gly Gly Leu Gly Gly Lou Gin His Asn Thr Val Leu Val Gly Trp Pro Arg Asn Trp Arg Gin Lys Glu Asp His Gin Thr Trp Arg Asn Phe Ile Glu Leu Val Arg Glu Thr Thr Ala 785 790 795 ' 800 Gly His Leu Ala Leu Leu Val Thr Lys Asn Val Ser Met Phe Pro Gly Asn Pro Glu Arg Phe Ser Glu Gly Ser Ile Asp Val Trp Trp Ile Val His Asp Gly Gly Met Lou Met Leu Lou Pro Phe Lou Leu Arg His His Lys Val Trp Arg Lys Cys Lys Met Arg Ile Phe Thr Val Ala Gin Met Asp Asp Asn Ser Ile Gin Met Lys Lys Asp Leu Thr Thr Phe Leu Tyr His Leu Arg Ile Thr Ala Glu Val Glu Val Val Glu Met His Glu Ser Asp Ile Ser Ala Tyr Thr Tyr Glu Lys Thr Leu Val Met Glu Gin Arg Ser Gin Ile Leu Lys Gin Met His Leu Thr Lys Asn Glu Arg Glu Arg Glu Ile Gin Ser Ile Thr Asp Glu Ser Arg Gly Ser Ile Arg Arg Lys Asn Pro Ala Asn Thr Arg Leu Arg Leu Asn Val Pro Glu Glu Thr Ala Gly Asp Ser Glu Glu Lys Pro Glu Glu Glu Val Gin Leu Ile His Asp Gin Ser Ala Pro Ser Cys Pro Ser Ser Ser Pro Ser Pro Gly Glu Glu Pro Glu Gly Glu Gly Glu Thr Asp Pro Glu Lys Val His Leu Thr Trp Thr Lys Asp Lys Ser Val Ala Glu Lys Asn Lys Gly Pro Ser Pro Val Ser Ser Glu Gly Ile Lys Asp Phe Phe Ser Met Lys Pro Glu Trp Glu Asn Leu Asn Gin Ser Asn Val Arg Arg Met His Thr Ala Val Arg LeU Asn Glu Val Ile Val Lys Lys Ser Arg Asp Ala Lys 1055 1060. 1065 Leu Val Leu Leu Asn Met Pro Gly Pro Pro Arg Asn Arg Asn Gly Asp Glu Asn Tyr Met Glu Phe Leu Glu Val Leu Thr Glu His Leu Asp Arg Val Met Leu Val Arg Gly Gly Gly Arg Glu Val Ile Thr Ile Tyr Ser <210> 3 <211> 3656 <212> DNA
<213> Mus musculus . <220>
<221> CDS
<222> (86)..(3433) <400> 3 ' gagcaagcga gcgagcggag aaggcgggca gaggggcgcg ggcgaagcgg cgcagccatc 60 ccgagcccgg cgccgcgcag ccacc atg ctc aac aac ctg acg gac tgc gag 112 Met Leu Asn Asn Leu Thr Asp Cys Glu gac ggc gat ggg gga gcc aac ccc ggt gat ggc aac ccc aaa gag age 160 Asp Gly Asp Gly Gly Ala Asn Pro Gly Asp Gly Asn Pro Lys Glu Ser agt ccc ttc ate aac age acg gac acg gag aag ggc aga gag tac gat 208 Ser Pro Phe Ile Asn Ser Thr Asp Thr Glu Lys Gly Arg Glu Tyr Asp 30 35 40 ' ggc agg aac atg gcc ctg ttt gag gag gag atg gac acc agc ccc atg 256 Gly Arg Asn Met Ala Leu Phe Glu Glu Glu Met Asp Thr Ser Pro Met gta tcc tcc ctg etc agt ggg ctg gcc aac tac ace aac eta ccc cag 304 Val Ser Ser Leu Leu Ser Gly Leu Ala Asn Tyr Thr Asn Leu Pro Gin gga agt aga gag cat gaa gaa gca gaa aat aat gag ggt gga aaa aag 352 Gly Ser Arg Glu His Glu Glu Ala Glu Asn Asn Glu Gly Gly Lys Lys aag cog gtg cag get cct cga atg ggc ace ttc atg ggt gtg tac ctg 400 Lys Pro Val Gin Ala Pro Arg Met Gly Thr Phe Met Gly Val Tyr Leu ccg tgc ctg cag aac ate ttt ggt gtc ate etc ttc ctg egg etc acg 448 Pro Cys Leu Gin Asn Ile Phe Gly Val Ile Leu Phe Leu Arg Leu Thr tgg gtg gtg ggc atc gcg ggc atc atg gag tcc tie tgt atg gtc tte 496 Trp Val Val Gly Ile Ala Gly Ile Met Glu Ser Phe Cys Met Val Phe =

att tgc tgc tcc tgt acg atg ctc aca gcc att tcc atg agt gca atc 544 Ile Cys Cys Ser Cys Thr Met Leu Thr Ala Ile Ser Met Ser Ala Ile gca acc aat ggt gtt gtg cct gct ggt ggc tcg tac tac atg att tcc 592 Ala Thr Asn Gly Val Val Pro Ala Gly Gly Ser Tyr Tyr Met Ile Ser =
agg tct ctg ggc cog gag ttt ggg ggc gcc gtg ggc ctc tgc ttc tac 640 Arg Ser Leu Gly Pro Glu Phe Gly Gly Ala Val Gly Leu Cys Phe Tyr ctg ggc acc acc ttt gct ggg gct atg tac atc ctt ggc acg atc gag 688 Leu Gly Thr Thr Phe Ala Gly Ala Met Tyr Ile Leu Gly Thr Ile Glu atc ctg ctg gct tat ctc tic cca gct atg gcc atc ttc aag gca gaa 736 Ile Leu Leu Ala Tyr Leu The Pro Ala Met Ala Ile Phe Lys Ala Glu gat gcc agt ggg gag gcg gcc gcc atg ctg aac aac atg egg gtg tat 784 Asp Ala Her Gly Glu Ala Ala Ala Met Leu Asn Asn Met Arg Val Tyr ggc acc tgt gtg ctc acc tgc atg gcc acc gtt gtc ttt gtg ggt gtc 832 Gly Thr Cys Val Leu Thr Cys Met Ala Thr Val Val Phe Val Gly Val aag tac gtc aac aag ttt gcc ttg gtc tie ctg ggt tgc gtc atc ctg 880 Lys Tyr Val Asn Lys Phe Ala Leu Val Phe Leu Gly Cys Val Ile Leu tcc atc ctg .gcc atc tat gca ggg gtc atc aag tct gcc ttc gac cca 928 Ser Ile Leu Ala Ile Tyr Ala Gly Val Ile Lys Ser Ala Phe Asp Pro ccc aat ttc ccg atc tgc ctc ctg ggg aac cgc acg ctg tct cgc cat 976 Pro Asn Phe Pro Ile Cys Leu Leu Gly Asn Arg Thr Leu Ser Arg His 285 290 295 =
ggc ttt gat gtc tgt gcc aag ctg gct tgg gaa gga aat gag aca gtg 1024 Gly Phe Asp Val Cys Ala Lys Leu Ala Trp Glu Gly Asn Glu Thr Val acc aca egg ctc tgg ggc ctt ttC tgc tcc tcc cgc ctc ctc aat gcc 1072 Thr Thr Arg Leu Trp Gly Leu Phe Cys Ser Ser Arg Leu Leu Asn Ala acc tgt gat gag tac tie acc cga aac aat gtc aca gag atc cag ggc 1120 Thr Cys Asp Glu Tyr Phe Thr Arg Asn Asn Val Thr Glu Ile Gin Gly =
att cct ggt gct gcc agt ggt ctc atc aaa gag aac ctg tgg agt tct 1168 Ile Pro Gly Ala Ala Ser Gly Leu Ile Lys Glu Asn Leu Trp Ser Ser tac ctg acc aaa ggg gtg. att gtc gag agg cgt ggg atg ccc tct gtg 1216 .
Tyr Leu Thr Lys Gly Val Ile Val Glu Arg Arg Gly Met Pro Ser Val ggc ctg gca gac ggt acc ccc gta gac atg gac cac ccc tat gtc ttc 1264 Gly Leu Ala Asp Gly Thr Pro Val Asp Met Asp His Pro Tyr Val Phe agt gat atg acc tcc tac ttc acc ctg ctc gtt ggt atc tac ttc ccc 1312 Ser Asp Met Thr Ser Tyr Phe Thr Leu Leu Val Gly Ile Tyr Phe Pro tca gtc aca ggg atc atg gct ggc tca aac cga tct gga gac ctg cgg 1360 Ser Val Thr Gly Ile Met Ala Gly Ser Asn Arg Ser Gly Asp Leu Arg gat gcc cag aag tct atc cct act gga act atc ctg gcc att gct acc 1408 = Asp Ala Gin Lys Ser Ile Pro Thr Gly Thr Ile Leu Ala Ile Ala Thr acc tct gct gtc tac atc agc tct gtt gtt ctg ttt gga gcc tgc atc 1456 Thr Ser Ala Val Tyr Ile Ser Ser Val Val Leu Phe Gly Ala Cys Ile gag ggg gtc gtc tta cgg gac aag ttt ggg gaa gct gtg aat ggc aac 1504 Glu Gly Val Val Leu Arg Asp Lys Phe Gly Glu Ala Val Asn Gly Asn ttg gtg gtg ggc acc ctg gcc tgg cct tct ccc tgg gtc atc gtc ata 1552 Leu Val Val Gly Thr Leu Ala Trp Pro Ser Pro Trp Val Ile Val Ile . 475 480 485 ggc tct ttc ttc tct acc tgt ggg gct gga tta cag agc ctc aca ggg 1600 Gly Ser Phe Phe Ser Thr Cys Gly Ala Gly Leu Gin Ser Leu Thr Gly gcc cca cgt ctg ctg cag gcc atc tcc cgg gat ggc ata gtg ccc ttc 1648 Ala Pro Arg Leu Leu Gin Ala Ile Ser Arg Asp Gly Ile Val Pro Phe ctg cag gtc ttt ggc cat ggc aaa gct aat gga gag cca acc tgg gcg 1696 Leu Gin Val Phe Gly His Gly Lys Ala Asn Gly Glu Pro Thr Trp Ala ctg ctg ctg act gcc tgc atc tgt gag atc ggc atc ctc ata gcc tcc 1744 Leu Leu Leu Thr Ala Cys Ile Cys Glu Ile Gly Ile Leu Ile Ala Ser ctg gat gag gtc gcc cct ata ctt tcc atg ttc ttc cta atg tgt tac 1792 Leu Asp Glu Val Ala Pro Ile Leu Ser Met Phe Phe Leu Met Cys Tyr atg ttt gtg aac ttg gct tgt gcg gtg cag acg ctg ctg agg aca ccc 1840 Net Phe Val Asn Leu Ala Cys Ala Val Gin Thr Leu Leu Arg Thr Pro 570 575 .580 585 aac tgg agg cca cga ttt cgc tat tac cac tgg act ctc tcc ttc ctg 1888 Asn Trp Arg Pro Arg Phe Arg Tyr Tyr His Trp Thr Leu Ser Phe Leu ggc atg agc ctc tgc ctg gcc ctc atg ttc att tgc tcc tgg tac tac 1936 Gly Net Ser Leu Cys Leu Ala Leu Net Phe Ile Cys Ser Trp Tyr Tyr gca ctg gtg gcc atg ctc att gcc gga ctc att tat aag tac atc gag 1984 =
Ala Leta Val Ala Met Leu Ile Ala Gly Leu Ile Tyr Lys Tyr Ile Glu 620 625 630 ' tac cgg ggg gcg gag aag gag tgg ggg gat gga atc cga ggc ctg tot 2032 Tyr Arg Gly Ala Glu Lys Glu Trp Gly Asp Gly Ile Arg Gly Leu Ser 635 . 640 645 ctc agt gca gca Cgc tat got ctc ttg cgc ctg gag gaa gga cot cog 2080 Leu Ser Ala Ala Arg Tyr Ala Leu Leu Arg Leu Glu Glu Gly Pro Pro cat acg aag aac tgg agg coo cag ctg ctg gtg ctg gtg cgt gtg gac 2128 His Thr Lys Asn Trp Arg Pro Gin Leu Leu Val Leu Val Arg Val Asp ' cag gat cag aac gtg gtg cat cog cag ctg ctc tcc ctg acc tcc cag 2176 Gin Asp Gin Asn Val Val His Pro Gin Leu Leu Ser Leu Thr Ser Gin ctc aag gca ggg aag ggc ctg acc att gtg ggc tcc gtc ctt gag'ggc 2224 Leu Lys Ala Gly Lys Gly Leu Thr Ile Val Gly Ser Val Lau Glu Gly acc ttt ctg gac aac cat cca cag got cag cgg gca gag gag tot atc 2272 Thr Phe Leu Asp Asn His Pro Gin Ala Gin Arg Ala Glu Glu Ser Ile agg cgc ctg atg gag got gag aag gtg aag ggc ttc tgc cag gta gtg 2320 Arg Arg Leu Met Glu Ala Glu Lys Val Lys Gly Phe Cys Gin Val Val atc tcc tcc aac ctg cgt gat ggt gtg tcc cac ctg atc cag tot ggg 2368 Ile Ser Ser Asn Leu Arg Asp Gly Val Ser His Leu Ile Gin Ser Gly ggc ctc ggg gga ttg caa cac aat acc gtg ctg gtg ggc tgg cot cgc 2416 Gly Leu Gly Gly Leu Gin His Asn Thr Val Leu Val Gly Trp Pro Arg aac tgg agg cag aag gag gat cat cag aca tgg agg aac ttc atc gaa 2464 Asn Trp Arg Gin Lys Glu Asp His Gln Thr Trp Arg Asn Phe Ile Glu ctg gtc cgg gaa act aca gcc ggc cac ctc gcc ctg ctg gtc acc aag 2512 Leu Val Arg Glu Thr Thr Ala Gly His Leu Ala Leu Leu Val Thr Lys aat gtt tcc atg ttt ccc ggg aac cct gag cgc ttc tog gag ggc agc 2560 Asn Val Ser Met Phe Pro Gly Asn Pro Glu Arg Phe Ser Glu Gly Ser 810 , 815 820 825 att gac gtg tgg tgg att gtg cac gac ggg ggc atg ctc atg ctg ctg 2608 Ile Asp Val Trp Trp Ile Val His Asp Gly Gly Met Leu Met Leu Leu ccc ttc ctg ctg cga cac cac aag gtc tgg agg aaa tgc aaa atg cgg 2656 Pro Phe Leu Leu Arg His His Lys Val Trp Arg Lys Cys Lys Met Arg atc ttc acc gtg gcc cag atg gac gat aac agt atc cag atg aag aag 2704 Ile Phe Thr Val Ala Gin Met Asp Asp Asn Ser Ile Gin Met Lys Lys gac ctg acc acg ttt ctg tac cac tta cgc att act gca gag gtg gag 2752 Asp Leu Thr Thr Phe Leu Tyr His Leu Arg Ile Thr Ala Glu Val Glu ,875 880 885 gtg gtg gag atg cat gag agc gac atc tog gca tac acc tac gag aag 2800 Val Val Glu Met His Glu Ser Asp lie Ser Ala Tyr Thr Tyr Glu Lys aca tta gta atg gag caa cga tot cag atc ctc aaa cag atg cac ctc 2848 Thr Leu Val Met Glu Gin Arg Ser Gin Ile Leu Lys Gin Met His Leu acc aag aac gag cgg gaa cgg gag atc cag agc atc aca gac gag tct 2896 Thr Lys Asn Glu Arg Glu Arg Glu Ile Gin Ser Ile Thr Asp Glu Ser cgg ggc too att cgg agg aag aat cca gcc aac ccc cgg ctc cgc ctc 2944 Arg Gly Ser Ile Arg Arg Lys Asn Pro Ala Asn Pro Arg Leu Arg Leu aat gtt ccc gaa gag aca gcg tgt gac aat gag gag aag cca gag gag 2992 Asn Val Pro Glu Glu Thr Ala Cys Asp Asn Glu Glu Lys Pro Glu Glu gag gtg cag ctg atc cat gac cag agt got ccc agc tgc cot agc agc 3040 Glu Val Gin Leu Ile His Asp Gin Ser Ala Pro Ser Cys Pro Ser Ser tog cca tot cca, ggg gag gag ccc gag ggg gag agg gag aca gac cca 3088 Ser Pro Ser Pro Gly Glu Glu Pro Glu Gly Glu Arg Glu Thr Asp Pro gag gtg cat ctt acc tgg acc aag gat aag tca gtg gca gag aag 3133 Glu Val His Leu Thr Trp Thr Lys Asp Lys Ser Val Ala Glu Lys aat aaa ggc ccc agt ccc gtc tcc tcc gag ggc atc aag gac ttc 3178 Asn Lys Gly Pro Ser, Pro Val Ser Ser Glu Gly Ile Lys Asp Phe ttc agc atg aag ccg gag tgg gaa aac ttg aac cag tcc sat gta 3223 Phe Ser Met Lys Pro Glu Trp Glu Asn Leu Asn Gin Ser Asn Val cgg cgc atg cac aca gct gtg cgg ctg aac gag gtc atc gtg sat 3268 Arg Arg Met His Thr Ala Val Arg Leu Asn Glu Val Ile Val Asn ass tct cgg gat gcc aag cta gtt ttg ctc aac atg ccc ggg cct 3313 Lys Ser Arg Asp Ala Lys Leu Val Leu Leu Asn Met Pro Gly Pro ccc cgc aac cgc sat ggg gat gas aac tac atg gaa ttc ttg gag 3358 Pro Arg Asn Arg Asn Gly Asp Glu Asn Tyr Met Glu Phe Leu Glu gtc ctc act gag caa ctg gac cgg gtg atg ctg gtccgc ggt ggc 3403 Val Leu Thr Glu Gin Leu Asp Arg Val Met Leu Val Arg Gly Gly ggc cga gag gtc atc acc atc tac tcc tga aggccaggac ctgccactcc 3453 Gly Arg Glu Val Ile Thr Ile Tyr Ser ggcccgagcg cgcccggccc gcggccccca gagccctcgc cgcgcctccc cgccgctgtc 3513 accgtttaca taagacccag ttgcccatgc cctggcccct ttccttcccg ctgcctgcag 3573 ccctgaggcc ttgcccgtcg gggctgaccc gcagggcggc ccgtgaggcc ccttttctga 3633 gcctggcctc gccccgccgg agc 3656 <210> 4 <211> 1115 <212> PRT
<213> Mus musculus <400> 4 Met Leu Asn Asn Leu Thr Asp Cys Glu Asp Gly Asp Gly Gly Ala Asn Pro Gly Asp Gly Asn Pro Lys Glu Ser Her Pro Phe Ile Asn Ser Thr Asp Thr-Glu Lys Gly Arg Glu Tyr Asp Gly Arg Asn Met Ala Leu Phe Glu Glu Glu Met Asp Thr Ser Pro Met Val Ser Ser Leu Leu Ser Gly Leu Ala Asn Tyr Thr Asn Leu Pro Gin Gly Ser Arg Glu His Glu Glu Ala Glu Asn Asn Glu Gly Gly Lys Lys Lys Pro Val Gin Ala Pro Arg Met Gly Thr Phe Met Gly Val Tyr Leu Pro Cys Leu Gin Asn Ile Phe Gly Val Ile Leu Phe Leu Arg Leu Thr Trp Val Val Gly Ile Ala Gly 115 . 120 125 Ile Met Glu Ser Phe Cys Met Val Phe Ile Cys Cys Ser Cys Thr Met Leu Thr Ala Ile Ser Met Ser Ala Ile Ala Thr Asn Gly Val Val Pro Ala Gly Gly Ser Tyr Tyr Met Ile Ser Arg Ser Leu Gly Pro Glu Phe Gly Gly Ala Val Gly Leu Cys Phe Tyr Leu Gly Thr Thr Phe Ala Gly Ala Met Tyr Ile Leu Gly Thr Ile Glu Ile Leu Leu Ala Tyr Leu Phe Pro Ala Met Ala Ile Phe Lys Ala Glu Asp Ala Ser Gly Glu Ala Ala Ala Met Leu Asn Asn Met Arg Val Tyr Gly Thr Cys Val Leu Thr Cys Met Ala Thr Val Val Phe Val Gly Val Lys Tyr Val Asn Lys Phe Ala Leu Val Phe Leu Gly Cys Val Ile Leu Ser Ile Leu Ala Ile Tyr Ala Gly Val Ile Lys Ser Ala Phe Asp Pro Pro Asn Phe Pro Ile Cys Lou Leu Gly Asn Arg Thr Lou Ser Arg His Gly Phe Asp Val Cys Ala Lys 290 . 295 300 Leu Ala Trp Glu Gly Asn Glu Thr Val Thr Thr Arg Leu Trp Gly Leu Phe Cys Ser Ser Arg Leu Leu Asn Ala Thr Cys Asp Glu Tyr Phe Thr . Arg Asn Asn Val Thr Glu Ile Gin Gly Ile Pro Gly Ala Ala Ser Gly Lou Ile Lys Glu Asn Leu Trp Ser Ser Tyr Lou Thr Lys Gly Val Ile 355 360 ,365 Val Glu Arg Arg Gly Met Pro Ser Val Gly Leu Ala Asp Gly Thr Pro Val Asp Met Asp His Pro Tyr Val Phe Ser Asp Met Thr Ser Tyr Phe Thr Lou Leu Val Gly Ile Tyr Phe Pro Ser Val Thr Gly Ile Met Ala Gly Ser Asn Arg Ser Gly Asp Leu Arg Asp Ala Gin Lys Ser Ile Pro .

Thr Gly Thr Ile Leu Ala Ile Ala Thr Thr Ser Ala Val Tyr Ile Ser Ser Val Val Leu Phe Gly Ala Cys Ile Glu Gly Val Val Leu Arg Asp Lys Phe Gly Glu Ala Val Asn Gly Asn Leu Val Val Gly Thr Lou Ala Trp Pro Ser Pro Trp Val Ile Val Ile Gly.Ser Phe Phe Ser Thr Cys Gly Ala Gly Leu Gin Ser Leu Thr Gly Ala Pro Arg Leu Leu Gin Ala Ile Ser Arg Asp Gly Ile Val Pro Phe Lou Gin Val Phe Gly His Gly Lys Ala Asn Gly Glu Pro Thr Trp Ala Lou Leu Leu Thr Ala Cys Ile 530 535 540 =
Cys Glu Ile Gly Ile Leu Ile Ala Ser Leu Asp Glu Val Ala. Pro Ile Leu Ser Met. Phe Phe Leu Met Cys Tyr Met Phe Val Asn Leu Ala Cys ) Ala Val Gin Thr Leu Leu Arg Thr Pro Asn Trp Arg Pro Arg Phe Arg Tyr Tyr His Trp Thr Leu Ser Phe Lou Gly Met Ser Leu,Cys Leu Ala Leu Met Phe Ile Cys Ser Trp Tyr Tyr Ala Lou Val Ala Met Lou Ile 610 615 ' 620 Ala Gly Lou Ile Tyr Lys Tyr Ile Glu Tyr Arg Gly Ala Glu Lys Glu Trp Gly Asp Gly Ile Arg Gly Leu Ser Leu Ser Ala Ala Arg Tyr Ala Leu Leu Arg Leu Glu Glu Gly Pro Pro His Thr Lys Asn Trp Arg Pro 660 665 670.
Gin Lou Leu Val Leu 'Val Arg Val Asp Gin Asp Gin Asn Val Val His Pro Gin Lou Leu Ser Lou Thr Ser Gin Lou Lys Ala Gly Lys Gly Lou Thr Ile Val Gly Ser Val Leu Glu Gly Thr Phe Leu Asp Asn His Pro Gin Ala Gin Arg Ala Glu Glu Ser Ile Arg Arg Leu Met Glu Ala Glu Lys Val Lys Gly Phe Cys Gin Val Val Ile Ser Ser Asn Leu Arg Asp 740 745 750 .
Gly Val Ser His Leu Ile Gin Ser Gly Gly Leu Gly Gly Leu Gin His 755 760 . 765 Asn Thr Val Leu Val Gly Trp Pro Arg Asn Trp Arg Gin Lys Glu Asp His Gin Thr Trp Arg Asn Phe Ile Glu Leu Val Arg Glu Thr Thr Ala Gly His Leu Ala Leu Leu Val Thr Lys Asn Val Ser Met Phe Pro Gly Asn Pro Glu Arg Phe Ser Glu Gly Ser Ile Asp Val Trp Trp Ile Val His Asp Gly Gly Met Leu Met Leu Leu Pro She Leu Leu Arg His His Lys Val Trp Arg Lys Cys Lys Met Arg Ile Phe Thr Val Ala Gin Met Asp Asp Asn Ser Ile Gin Met Lys Lys Asp Leu Thr Thr She Leu Tyr His Leu Arg Ile Thr Ala Glu Val Glu Val Val Glu Met His Glu Ser Asp Ile Ser Ala Tyr Thr Tyr Glu Lys Thr Leu Val Met Glu Gin Arg Ser Gin Ile Leu Lys Gin Met His Leu Thr Lys Asn Glu Arg Glu Arg Glu Ile Gin Ser lie ThrAsp Glu Ser Arg Gly Ser Ile Arg Arg Lys ' Asn Pro Ala Asn Pro Arg Leu Arg Leu Asn Val Pro Glu Glu Thr Ala Cys Asp Asn Glu Glu Lys Pro Glu Glu Glu Val Gin Leu Ile His Asp Gin Ser Ala Pro Ser Cys Pro Ser Ser Ser Pro Ser Pro Gly Glu Glu Pro Glu Gly Glu Arg Glu Thr Asp Pro Glu Val His Leu Thr Trp Thr Lys Asp Lys Ser Val Ala Glu Lys Asn Lys Gly Pro Ser Pro Val Ser. Ser Glu Gly Ile Lys Asp Phe Phe Ser Met Lys Pro Glu Trp Glu Asn Leu Asn Gin Ser Asn Val Arg Arg Met His Thr Ala Val Arg Leu Asn Glu Val Ile Val Asn Lys Ser Arg Asp Ala Lys Leu Val Leu Leu Asn Met Pro Gly Pro Pro Arg Asn Arg Asn Gly Asp Glu Asn Tyr Met Glu Phe Leu Glu Val Leu Thr Glu Gin Leu Asp Arg Val Met Leu Val Arg Gly Gly Gly Arg Glu Val Ile Thr Ile Tyr Ser <210> 5 <211> 5566 <212> DNA
<213> Rattus norvegicus <220>
<221> CDS
<222> (116)..(3466) <400> 5 ccgctccacg gagagcaagc gacagagctc gagcaagcga gcgagcggcg aaggcgggca 60 gaggggcgcg ggcgaagagg cgcagccatc ccgagcccgg cgccgcgcag ccacc atg 118 . Met ctc aac aac ctg acg gac tgc gag gac ggc gat ggg gga gcc aac ccg 166 Leu Asn Asn Leu Thr Asp Cys Glu Asp Gly Asp Gly Gly Ala Asn Pro ggt gac ggc aat ccc aag gag agc agc ccc ttc atc aad agc acg gac 214 Gly Asp Gly Asn Pro Lys Glu Ser Ser Pro Phe Ile Asn Ser Thr Asp acg gag aag ggg aga gag tat gat ggc agg aac atg gcc ctg ttt gag 262 Thr Glu Lys Gly Arg Glu Tyr Asp Gly Arg Asn Met Ala Leu Phe Glu gag gag atg gac acc agc ccc atg gta tcc tcc ctg ctc agt ggg ctg 310 Glu Glu Met Asp Thr Ser Pro Met Val Ser Ser Leu Leu Ser Gly Leu gcc aac tac acc aac ctg cct cag gga agc aaa gag cac gaa gaa gca 358 Ala Asn Tyr Thr Asn Leu Pro Gin Gly Ser Lys Glu His Glu Glu Ala gaa aac aat gag ggc gga aag aag aag ccg gtg cag gcc cca cgc atg 406 Glu Asn Asn Glu Gly Gly Lys Lys Lys Pro Val Gin Ala Pro Arg Met ggc acc ttc atg ggc gtg tac ctc ccg tgc ctg cag aac atc ttt ggt 454 Gly Thr Phe Met Gly Val Tyr Leu Pro Cys Leu Gin Asn Ile Phe Gly gtt atc ctc ttt ctg cgg ctc act tgg gtg gtg gga atc gca ggc atc 502 = Val Ile Leu Phe Leu Arg Leu Thr Trp Val Val Gly Ile Ala Gly Ile atg gag tcc ttc tgc atg gtc ttc atc tgc tgc too tgc acg atg etc 550 Met Glu Ser Phe Cys Met Val Phe Ile Cys Cys Ser Cys Thr Met Leu aca gcc att tcc atg agc gca att gca acc aat ggt gtt gtg cct gct 598 Thr Ala Ile Ser Met Ser Ala Ile Ala Thr Asn Gly Val Val Pro Ala ggt ggc tcc tac tac atg att tcc agg tot ctg ggc ccg gag ttt ggg 646 Gly Gly Ser Tyr Tyr Met Ile Ser Arg Ser Leu Gly Pro Glu Phe Gly 165 170 . 175 ggc gcc gtg ggc ctc tgc ttc tac ctg ggc act acc ttt gct ggg gct 694 Gly Ala Val Gly Leu Cys Phe Tyr Leu Gly Thr Thr Phe. Ala Gly Ala atg tac atc ctg ggc acc atc gag atc ctg ctg gct tac ctc ttc cca 742 Met Tyr Ile Leu Gly Thr Ile Glu Ile Leu Leu Ala Tyr Leu Phe Pro gcg atg gcc atc ttc aag gca gaa gat gcc agt ggg gag gca gcc gcc 790 Ala Met Ala Ile Phe Lys Ala Glu Asp Ala Ser Gly Glu Ala Ala Ala 210 215 ' 220 225 atg ttg aat aac atg egg gtg tat ggc acc tgt gtg ctc acc tgc atg 838 Met Leu Asn Asn Met Arg Val Tyr Gly Thr Cys Val Leu Thr Cys Met 230 235 = 240 gcc accigta gtc ttt gtg ggc gtc aag tac gtg aac aag ttt gcc ctg 886 Ala Thr Val Val Phe Val Gly Val Lys Tyr Val Asn Lys Phe Ala Leu 245 '250 255 gtc ttc ctg ggt tgc gtg atc ctc tcc atc ctg gcc atc tac gca ggg 934 Phe Leu Gly Cys Val Ile Leu Ser Ile Let Ala Ile Tyr Ala Gly gtc atc aag tct gcc ttc gat cca ccc aat ttc ccg att tgc ctc ctg 982 Val Ile Lys Ser Ala Phe Asp Pro Pro Asn Phe Pro Ile Cys Leu Leu ggg aac cgc acg ctg tct cgc cat ggc ttt gat gtc tgt gcc aag ctg 1030 Gly Asn Arg Thr Leu Ser Arg His Gly Phe Asp Val Cys Ala 'Lys Leu ' 290 295 300 305 gct tgg gaa gga aat gag aca gtg acc aca cgg ctc tgg ggc eta ttc 1078 Ala Trp Glu Gly Asn Glu Thr Val Thr Thr Arg Leu Trp Gly Leu Phe tgt tcc tcc cgc ctc ctc aat gcc acc tgt gat gag tac ttc acc cga 1126 Cys Ser Ser Arg Leu Leu Asn Ala Thr Cys Asp Glu Tyr Phe Thr Arg 325 330 335.
=
aac aat gtc aca gag atc cag ggc att cct ggt gct gca agt ggc ctc 1174 Asn Asn Val Thr Glu Ile Gin Gly Ile Pro Gly Ala Ala Ser Gly Leu atc=aaa gag aac ctg tgg agt tcc tac ctg acc aag ggg gtg atc gtg 1222 Ile Lys Glu Asn Leu Trp Ser Ser Tyr Leu Thr Lys Gly Val Ile Val gag agg cgt ggg atg ccc tct gtg ggc ctg gca gat ggt acc ccc gtt 1270 Glu Arg Arg Gly Met Pro Ser Val Gly Leu Ala Asp Gly Thr Pro Val , 370 375 380 385 gac atg gac cac ccc tat gtc ttc agt gat atg acc tcc tac ttc acc 1318 Asp Met Asp His Pro Tyr Val Phe Ser Asp Met Thr Ser Tyr Phe Thr ctg ctt gtt ggc ate tat ttc ccc tea gtc aca ggg-atc atg get ggc 1366 Lou Leu Val Gly Ile Tyr Phe Pro Ser Val Thr Gly Ile Met Ala Gly tcg aac egg tee gga gac ctg egg .gat gee cag aag tct ate cct act 1414 Ser Asn Arg Ser Gly Asp Leu Arg Asp Ala Gin Lys Ser Ile Pro Thr 420 425 430 .
gga act ate ttg gee att get acg ace tct get gtc tae ate age tct 1462 Gly Thr Ile Leu Ala Ile Ala Thr Thr Ser Ala Val Tyr Ile Ser Ser gtt gtt ctg ttc gga gee tgc ate gaa ggg gtc gtc eta egg gac aag 1510 Val Val Leu Phe Gly Ala Cys Ile Glu Gly Val Val Lou Arg Asp Lys 450 45,5 460 465 ttt ggg gaa get gtg aat ggc aat ctg gtg gtg ggc ace ctg gee tgg 1558 Phe Gly Glu Ala Val Asn Gly Asn Leu Val Val Gly Thr Leu Ala Trp cct tct cct tgg gtc att gtc ata ggc tct ttc ttc tct ace tgc gga 1606 Pro Ser Pro Trp Val Ile Val Ile Gly Ser Phe Phe Ser Thr Cys Gly get gga eta cag age etc aca ggg gee cca cgc ctg ctg cag gee ate 1654 Ala Gly Lou Gin Ser Leu Thr Gly Ala Pro Arg Leu Leu Gin Ala Ile .

tee egg gat ggc ata gtg ccc ttc ctg cag gtc ttt ggc cat ggc aaa 1702 Ser Arg Asp Gly Ile Val Pro Phe Leu Gin Val Phe Gly His Gly Lys gee aac gga gag cca ace tgg gcg ctg ctg ctg act gee tgc ate tgt 1750 Ala Asn Gly Glu Pro Thr Trp Ala Leu Leu Leu Thr Ala Cys Ile Cys gag ate ggc ate etc ate gee tee ctg gat gag gtc gee cct ate ctt 1798 Glu Ile Gly Ile Leu Ile Ala Ser Leu Asp Glu Val Ala Pro Ile Leu tee atg ttc ttc ctg atg tgt tae atg ttt gtg aac ttg get tgc gcg 1846 Ser Met Phe Phe Lou Met Cys Tyr Met Phe Val Asn Leu Ala Cys Ala gtg cag aca ctg ctg agg acg ccc aac tgg agg cca cgc ttc cga tat 1894 Val Gin Thr Leu Leu Arg Thr Pro Asn Trp Arg Pro Arg Phe Arg Tyr tac cac tgg ace etc tee ttc ctg ggc atg age etc tgc ctg gee ctg 1942 Tyr His Trp Thr Lou Ser Phe Leu Gly Met Ser Leu Cys Leu Ala Leu atg ttc att tgc tee tgg tat tat gcg ctg gta get atg etc ate get 1990 Met Phe Ile Cys Ser Trp Tyr Tyr Ala Leu Val Ala Met Leu Ile Ala 610 615 . 620 625 ggc etc atc tat aag tac atc gag tac cgg ggg gca gag aag gag tgg 2038 Gly Leu Ile Tyr Lys Tyr Ile Giu Tyr Arg Gly Ala Glu Lys Glu Trp ggg gat ggg atc cga ggc ctg tct ctc agt gca gct cgc tat get ctc 2086 Gly Asp Gly Ile Arg Gly Leu Ser Leu Ser Ala Ala Arg Tyr Ala Leu ttg cgt ctg gag gaa gga ccc ccg cat aca aag aac tgg agg ccc cag 2134 Leu Arg Leu Glu Glu Gly Pro Pro His Thr Lys Asn Trp Arg Pro Gin eta ctg gtg ctg gtg cgt gtg gac cag gac cag aac gtg gtg cac ccg 2182 Leu Leu Val Leu Val Arg Val Asp Gin Asp Gin Asn Val Val His Pro cag ctg ctg tee ttg acc tee cag etc aag gca ggg aag ggc ctg ace 2230 Gin Leu Leu Ser Leu Thr Ser Gin Leu Lys Ala Gly Lys Gly Leu Thr 690 695 700 , 705 att gtg ggc tct gtc ctt gag ggc ace ttt ctg gac aac cac cct cag 2278 Ile Val Gly Ser Val Leu Glu Gly Thr Phe Leu Asp Asn His Pro Gin get cag egg gca gag gag tct atc egg cgc ctg atg gag get gag aag 2326 Ala Gin Arg Ala Glu Glu Ser Ile Arg Arg Leu Met Glu Ala Glu Lys gtg aag ggc ttc tgc cag gta gtg atc tee tee aac ctg cgt gac ggt 2374 Val Lys Gly Phe Cys Gin Val Val Ile Ser Ser Asn Leu Arg Asp Gly gtg tee cac ctg atc caa tee ggg ggc etc ggg ggc ctg caa cac aac 2422 Val Ser His Leu Ile Gin Ser Gly Gly Leu Gly Gly Leu Gin His Asn act gtg eta gtg ggc tgg cct cgc aac tgg cga cag aag gag gat cat 2470 Thr Val Leu Val Gly Trp Pro Arg Asn Trp Arg Gin Lys Glu Asp His cag aca tgg agg aac ttc atc gaa etc gtc egg gaa act aca get ggc 2518 Gin Thr Trp Arg Asn Phe Ile Glu Leu Val Arg Glu Thr Thr Ala Gly cac etc gee ctg ctg gtc ace aag aat gtt tee atg ttc ccc ggg aac 2566 His Leu Ala Leu Leu Val Thr Lys Asn Val Ser Met She Pro Gly Asn cct gag cgt ttc tct gag ggc age att gac gtg tgg tgg atc gtg cac 2614 Pro Glu Arg She Ser Glu Gly Ser Ile Asp Val Trp Trp Ile Val His gac ggg ggc atg etc atg ctg ttg ccc ttc etc ctg egt cac cac aag 2662 Asp Gly Gly Met Leu Met Leu Leu Pro Phe Leu Leu Arg His His Lys gtc tgg agg aaa tgc aaa atg cgg atc ttc acc gtg gcg cag atg gat 2710 Val Trp Arg Lys Cys Lys Met Arg Ile Phe Thr Val Ala Gin Met Asp gac aac agc att cag atg aag aaa gac ctg acc acg ttt ctg tac cac 2758 Asp Asn Set Ile Gin Met Lys Lys Asp Leu Thr Thr Phe Leu Tyr His tta cga att act gca gag gtg gaa gtc gtg gag atg cac gag agc gac 2806 Leu Arg Ile Thr Ala Glu Val Glu Val Val Glu Met His Glu Set Asp atc tca gca tac acc tac gag aag aca ttg gta atg gaa caa cgt tct 2854 Ile Ser Ala Tyr Thr Tyr Glu Lys Thr Leu Val Met Glu Gin Arg Set cag atc ctc aaa cag atg cac ctc acc aag aac gag cgg gaa cgg gag 2902 Gin Ile Leu Lys Gin Met His Leu Thr Lys Asn Glu Arg Glu Arg Glu atc cag agc atc aca gat gaa tct cgg ggc tcc att cgg agg aag aat 2950 Ile Gin Set Ile Thr Asp Glu Set Arg Gly Set Ile Arg Arg Lys Asn cca gcc aac act cgg ctc cgc ctc aat gtt ccc gaa gag aca gct tgt 2998 Pro Ala Asn Thr Arg Leu Arg Leu Asn Val Pro Glu Glu Thr Ala Cys gac aac gag gag aag cca gaa gag gag gtg cag ctg atc cat gac cag 3046 Asp Asn Glu Glu Lys Pro Glu Glu Glu Val Gin Leu Ile His Asp Gin agt gct ccc agc tgc cct agc agc tcg ccg tct cca ggg gag gag cct 3094 Set Ala Pro Set Cys Pro Set Set Set Pro Set Pro Gly Glu Glu Pro gag ggg gag ggg gag aca gac cca gag aag gtg cat ctc acc tgg acc 3142 Glu Gly Glu Gly Glu Thr Asp Pro Glu Lys Val His Leu Thr Trp Thr aag gat aag tca gcg gct cag aag aac aaa ggc ccc agt ccc gtc ,3187 Lys Asp Lys Ser.Ala Ala Gin Lys Asn Lys Gly Pro Set Pro Val tcc tcg gag ggg atc aag gac ttc ttc agc atg aag ccg gag tgg 3232 Sex. Set Glu Gly Ile Lys Asp Phe Phe Set Met Lys Pro Glu Trp gaa aac ttg aac cag tcc aac gtg cgg cgc atg cac aca gct gtg 3277 Glu Asn Leu Asn Gin Set Asn Val Arg Arg Met His Thr Ala Val cgg ctg aac gag gtc atc gtg aat aaa tcc cgg gat gcc aag ttg 3322 Arg Leu Asn Glu Val Ile Val Asn Lys Set Arg Asp Ala Lys Leu 1055 1060 . 1065 gtg ttg ctc aac atg ccc ggg cct ccc cgc aac cgc aat gga gat 3367 Val Leu Leu Asn Met Pro Gly Pro Pro Arg Asn Arg Asn Gly Asp gaa aac tac atg gaa ttc ctg gag gtc ctc act gag caa ctg gac 3412 Glu Asn Tyr Met Glu Phe Leu Glu Val Leu Thr Glu Gin Leu Asp cgg gtg atg ctg gtc cgc ggt ggt ggc cga gag gtc atc acc atc 3457 Arg Val Met Leu Val Arg Gly Gly Gly Arg Glu Val Ile Thr Ile tac tcc tga aggccaggac ctgccactcc ggcccgagcg agcccggccc 3506 Tyr Ser gcggccccgg agccctcgcc gcgcctcccc gccgctgtca ccgtttacat aagaccccgt 3566 tgcccgtgcc ctggccctct tccctcccgc tgcctgcggc ccggaggcct tgcccgtcgg 3626 ggctgacccg gagggcggcc cgtgggcccc ttttctgagc ccggcctcgc cctgccggag 3686 tagacgttgc aataaaggtg gcgaggcggc gtggagagga goggaaccgt ggtcccgggc 3746 cggggagccc cgagcccgtc cctccccacg ccccgccgcg ctccccccgg accctggtcg , 3806 ctgagcccgg gcgccgctcg gctgcgctat.acatagtgta caggagacat cgagtgtatt 3866 tttaatgtcc ccatatttct gtaaactaga aacgcaacgg actcctcgcc acggccgcgc 3926 tctccccgct gcgggcgccc aggaaggcgg agacccggga agccagggtt ccctgcgctc 3986 ccgagctgag agccaagtgc tttaaggccg gcgctctcct ttccctttcc tgtccacggc 4046 ccgggcttcc ctctcttccc tccagttctt ggcgaacaca ggtgaagccc tgcccggtgc 4106 cttcgtggag gagcaggcgt ctctcctctg ttggcttgcc gcctgctccc cctgtcccgt 4166 ggctcctcgc caaagactga atttgtggag ctggagggca caccctcccc actttccttc 4226 ctgggacagg tgaggggcca atgccagtct aggggccgac tcacaggagg cctcgcgcag 4286 cctcttggtc cccactctgc aagtcctgcc tggggaccca gcccccctgg tggttctggg 4346 gcggagcttt gctgcctagc agcaagtcct tagttactgt ctccagatac caggacctgg 4406 agtagggaat ggagtcatat gggttcagtt gttcctggcg cttctctgcc ccctgctccc 4466 cctctccccc tctcgtagga cacaaggact ttggctttct taactCatcc ttggcgcttc 4526 cgctccacca cgcccacctg tggggaggag ccctcagccc tagagaggcg tttggctggt 4586 tcccttcccc cagggcacgt tactaagagg acaggcactg catgctcctt taagcgccct 4646 ctgggactgg gtacagtgcc tccagcccca gggccctggt ctgcgcacct agttagacat 4706 cattgcccac tccagggcca gggccactag ctgacctcac cacctttttc cttgagccca 4766 aggcagagag agctgcagct ggtgccatct agacaggctc aagtgtggcc agtggcaggg 4826 ctcgagggcc actgccctgt tgcttggctc aggacctctc tgagatttga tggggactgg 4886 atattcttcc aggtagtagc catcaagtcg gaagtgttgg acccaggacc tgacattcct 4946 tcaagactgc cctcccttgc tgtggttttg ccttttgggg caagagaggg gctgggcaaa 5006 cggggaggag gcagtatcaa caccgattag ggaaccaaag ttgcactacc tgggcccagc 5066 ctctggttgg caagagcaaa gtttctgttg atgaaaacaa acagcccaca acaacacccc 5126 cccccccgtt ttctgtgctc catgtgcaat atttgttatg aaccttgtgt cgttcaagtc 5186 acctttataa tcactgtagc tagatgttcc atgtccatcc aggtgacttt actctgagtg 5246 caatatttca atagcctggt agtgagaaga gtgttgcttt tgtttcagcc gacctatgtg 5306 cagggcaatg caatgcagtc caaaaccctt gtaaatagga gaggttgcaa gccaaatcaa 5366 gagtatttat cgttattact attattatta ggcctgcctt taattttagt gtttcggtat 5426 ttcgcatcct gcctcggtat tgatcgtgtg ttctctgtgc caatatgcaa aggagaggat 5486 cagttctttc ctttactgtt gaatgctccc atttactgct ttaaggcttt tactgtgttc 5546 attttttaga tacctgtctg 5566 <210> 6 <211> 1116 <212> PRT
<213> Rattus norvegicus <400> 6 Met Leu Asn Asn Leu Thr Asp Cys Glu Asp Gly Asp Gly'Gly Ala Asn Pro Gly Asp Gly Asn Pro Lys Glu Ser Ser Pro Phe Ile Asn Ser Thr Asp Thr Glu Lys Gly Arg Glu Tyr Asp Gly Arg Asn Met Ala Leu Phe Glu Glu Glu Met Asp Thr Ser Pro Met Val Ser Ser Leu Leu Ser Gly Leu Ala Asn Tyr Thr Asn Leu Pro Gin Gly Ser Lys Glu His Glu Glu Ala Glu Asn Asn Glu Gly Gly Lys Lys Lys Pro Val Gin Ala Pro Arg Met Gly Thr Phe Met Gly Val Tyr Leu Pro Cys Leu Gin Asn Ile Phe ,100 105 110 Gly Val Ile Leu Phe Leu Arg Leu Thr Trp Val Val Gly Ile Ala Gly Ile Met Glu Ser Phe Cys Met Val Phe Ile Cys Cys Ser Cys Thr Met Leu Thr Ala Ile Ser Met Ser Ala Ile Ala Thr Asn Gly Val Val Pro Ala Gly Gly Ser Tyr Tyr Met Ile Ser Arg Ser Leu Gly Pro Glu Phe Gly Gly Ala Val Gly Leu Cys Phe Tyr Leu Gly Thr Thr Phe Ala Gly Ala Met Tyr Ile Leu Gly Thr Ile Glu Ile Leu Leu Ala Tyr Leu Phe Pro Ala Met Ala Ile Phe Lys Ala Glu Asp Ala Ser Gly Glu Ala Ala Ala Met Leu Asn Asn Met Arg Val Tyr Gly Thr Cys Val Leu Thr Cys Met Ala Thr Val Val Phe Val Gly Val Lys Tyr Val Asn Lys Phe Ala Leu Val Phe Leu Gly Cys Val Ile Leu Ser Ile Leu Ala Ile Tyr Ala Gly Val Ile Lys Ser Ala Phe Asp Pro Pro Asn Phe Pro Ile Cys Leu Leu Gly Asn Arg Thr Leu Ser Arg His Gly Phe Asp Val Cys Ala Lys Leu Ala Trp Glu Gly Asn Glu Thr Val Thr Thr Arg Leu Trp Gly Leu Phe Cys Ser Ser. Arg Leu Leu Asn Ala Thr Cys Asp Glu Tyr Phe Thr Arg Asn Asn Val Thr Glu Ile Gin Gly Ile Pro Gly Ala Ala Ser Gly 340. 345 350 Leu Ile Lys Glu Asn Leu Trp Ser Ser Tyr Leu Thr Lys Gly Val Ile 355 360 365 ' Val Glu Arg Arg Gly Met Pro Ser Val Gly Leu Ala Asp Gly Thr Pro Val Asp Met Asp His Pro Tyr Val Phe Ser Asp Met Thr Ser Tyr Phe 385 390 395. 400 Thr Leu Leu Val Gly Ile Tyr Phe Pro Ser Val Thr Gly Ile Met Ala Gly Ser Asn Arg Ser Gly Asp Leu Arg Asp Ala Gin Lys Ser Ile Pro Thr Gly Thr Ile Leu Ala Ile Ala Thr Thr Set Ala Val Tyr Ile Ser Ser Val Val Leu Phe Gly Ala Cys Ile Glu Gly Val Val Leu Arg Asp Lys Phe Gly Glu Ala Val Asn Gly Asn Leu Val Val Gly Thr Leu Trp Pro Ser Pro Trp Val lie Val Ile Gly Ser Phe Phe Ser Thr Cys Gly Ala Gly Leu Gin Ser Leu Thr Gly Ala Pro Arg Leu Leu Gin Ala Ile Ser Arg Asp Gly Ile Val Pro Phe Leu Gin Val Phe Gly His Gly 33/36 .
Lys Ala Asn Gly Glu Pro Thr Trp Ala Leu Leu Leu Thr Ala Cys Ile Cys Glu Ile Gly Ile Leu Ile Ala Ser Leu Asp Glu Val Ala Pro Ile Leu Ser Met .Phe Phe Leu Met Cys Tyr Met: She Val Asn Leu Ala Cys Ala Val Gin Thr Leu Leu Arg Thr Pro Asn Trp Arg Pro Arg She Arg Tyr Tyr His Trp Thr Leu Ser Phe Leu Gly Met Ser Leu Cys Leu Ala Leu Met Phe Ile Cys Ser Trp Tyr Tyr Ala Leu Val Ala Met Leu Ile Ala Gly Leu Ile Tyr Lys Tyr Ile Glu Tyr Arg Gly Ala Glu Lys Glu 625 630 635 640 .
Trp Gly Asp Gly Ile Arg Gly.Leu Ser Leu Ser Ala Ala Arg Tyr Ala Leu Leu Arg Leu Glu Glu Gly Pro Pro His Thr Lys Asn Trp Arg Pro 660 . 665 670 Gin Leu Leu Val Leu Val Arg Val Asp Gin Asp Gin Asn Val Val HiS

Pro Gin Leu Leu Ser Leu Thr Ser Gin Leu Lys Ala Gly Lys Gly Leu Thr Ile Val Gly Ser Val Leu Glu Gly Thr She Leu Asp Asn His Pro Gin Ala Gin Arg Ala Glu Glu Ser Ile Arg Arg Leu Met Glu Ala Glu . Lys Val Lys Gly Phe Cys Gin Val Val Ile, Ser Ser Asn Leu Arg Asp Gly Val Ser His Leu Ile Gin Ser Gly Gly Leu Gly Gly Leu Gin His Asn Thr Val Leu Val Gly Trp Pro Arg Asn Trp Arg Gin Lys Glu Asp His Gin Thr Trp Arg Asn Phe Ile Glu Leu Val Arg Glu Thr Thr Ala Gly His Leu Ala Leu Leu Val Thr Lys Asn Val Ser Met Phe Pro Gly Asn Pro Glu Arg Phe Ser Glu Gly Ser Ile Asp Val Trp Trp Ile Val His Asp Gly Gly Met Leu Met Leu Leu Pro Phe Leu Leu Arg His His 835 , 840 845 Lys Val Trp Arg Lys Cys Lys Met Arg Ile Phe Thr Val Ala Gin Met Asp Asp Asn Ser Ile Gin Met Lys Lys Asp Leu Thr Thr Phe Leu Tyr His Leu Arg Ile Thr Ala Glu Val Glu Val Val Glu Met His Glu Ser Asp Ile Ser Ala Tyr Thr Tyr Glu Lys Thr Leu Val Met Glu Gin Arg Ser Gin Ile Leu Lys Gin Met His Leu Thr Lys Asn Glu Arg Glu Arg , 915 920 925 Glu Ile Gin Ser Ile Thr Asp Glu Ser Arg Gly Ser Ile Arg Arg Lys Asn Pro Ala Asn Thr Arg Leu Arg Leu Asn Val Pro Glu Glu Thr Ala Cys Asp Asn Glu Glu Lys Pro Glu Glu Glu Val Gin Leu Ile His Asp Gin Ser Ala Pro Ser Cys Pro Ser Ser Ser Pro Ser Pro Gly Glu Glu Pro Glu Gly Glu Gly Glu Thr Asp Pro Glu Lys Val His Leu Thr Trp Thr Lys Asp Lys Ser Ala Ala Gin Lys Asn Lys Gly Pro Ser Pro Val Ser Ser Glu Gly Ile Lys Asp She She Ser Met Lys Pro Glu Trp Glu Asn Leu Asn Gin Ser Asn Val Arg Arg Met His Thr Ala Val Arg Leu Asn Glu Val Ile Val Asn Lys Ser Arg Asp Ala Lys Leu Val Leu Leu Asn Met Pro Gly Pro Pro Arg Asn Arg Asn Gly Asp Glu Asn Tyr Met Glu She Leu Glu Val Leu Thr Glu Gin Leu Asp Arg Val Met Leu Val Arg Gly Gly Gly Arg Glu Val Ile Thr Ile Tyr Ser <210> 7 <211> 20 <212> DNA
<213> Artificial sequence <220>
<223> Synthetic oligonucleotide <400> 7 tctocttggg attgccgtca 20 . <210> 8 <211> 20 <212> DNA

<213> Artificial sequence <220>
<223> Synthetic oligonucleotide <400> 8 tcttcttgag actgcagtca 20

Claims (26)

WHAT IS CLAIMED IS:

1. A composition for the treatment or the prevention of neuropathic pain in a subject, said composition comprising:
(a) a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (ii); and (b) a pharmaceutically acceptable carrier.

2. The composition of claim 1, wherein said KCC2 polypeptide comprises an amino acid sequence having at least 90% identity with the amino acid sequence of SEQ ID NO: 2, 4 or 6 and having potassium-chloride cotransporter activity.

3. The composition of claim 2, wherein said KCC2 polypeptide comprises the amino acid sequence of SEQ ID NO: 2.

4. The composition of claim 1 or 2, wherein said nucleic acid encoding a KCC2 polypeptide comprises the nucleotide sequence of SEQ ID NO: 1, 3 or 5.

5. The composition of any one of claims 1-3, wherein said neuropathic pain is associated with a nerve or tract injury.

6. The composition of any one of claims 1-3, wherein said neuropathic pain is visceral pain.

7. The composition of any one of claims 1-3, wherein said neuropathic pain is chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with diabetic neuropathy, phantom limb pain, spontaneous pain, chronic post-surgical pain, chronic temporomandibular pain, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal neuralgia, chronic back pain, pain associated with spinal cord injury or recurrent acute pain.

8. A package comprising a container, the compound defined in any one of claims 1-3 and instructions for use of the compound for the treatment or prevention of neuropathic pain in a subject.

9. A package comprising a container, the composition of any one of claims 1-3 and instructions for use of the compound for the treatment or prevention of neuropathic pain in a subject.

10. Use of a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron for the treatment or prevention of neuropathic pain in a subject, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (ii).

11. Use of a compound capable of increasing KCC2 expression or activity in a superficial dorsal horn (SDH) neuron for the preparation of a medicament for the treatment or prevention of neuropathic pain in a subject, wherein said compound is (i) a KCC2 polypeptide; (ii) a nucleic acid encoding a KCC2 polypeptide; or (iii) a combination of (i) and (ii).

12. The use of claim 10 or 11, wherein said KCC2 polypeptide comprises an amino acid sequence having at least 90% identity with the amino acid sequence of SEQ ID NO: 2, 4 or 6 and having potassium-chloride cotransporter activity.

13. The use of claim 12, wherein said KCC2 polypeptide comprises the amino acid sequence of SEQ ID NO: 2.

14. The use of any one of claims 10-12, wherein said nucleic acid encoding a KCC2 polypeptide comprises the nucleotide sequence of SEQ ID NO: 1, 3 or 5.

15. The use of any one of claims 10-14, wherein said neuropathic pain is associated with a nerve or tract injury.

16. The use of any one of claims 10-14, wherein said neuropathic pain is visceral pain.

17. The use of any one of claims 10-14, wherein said neuropathic pain is chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with diabetic neuropathy, phantom limb pain, spontaneous pain, chronic post-surgical pain, chronic temporomandibular pain, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal neuralgia, chronic back pain, pain associated with spinal cord injury or recurrent acute pain.

18. A method of identifying or characterizing a compound for treatment or prevention of neuropathic pain in a subject, said method comprising:
(a) contacting a test compound with a cell expressing a KCC2 polypeptide; and (b) determining whether activity or expression of said KCC2 polypeptide is increased in the presence of the test compound relative to the absence of said test compound;

wherein an increase in said activity or expression of said KCC2 polypeptide in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of neuropathic pain in a subject.

19. The method of claim 18, wherein said KCC2 activity is determined by measuring potassium transport, chloride transport, intracellular chloride level or anion reversal potential.

20. The method of claim 18 or 19, wherein said KCC2 polypeptide comprises an amino acid sequence having at least 90% identity with the amino acid sequence of SEQ ID NO: 2, 4 or 6 and having potassium-chloride cotransporter activity.

21. The method of claim 20, wherein said KCC2 polypeptide comprises the amino acid sequence of SEQ ID NO: 2.

22. The method of any one of claims 18-21, wherein said neuropathic pain is chronic inflammatory pain, pain associated with arthritis, fibromyalgia, back pain, cancer-associated pain, pain associated with digestive disease, pain associated with Crohn's disease, pain associated with autoimmune disease, pain associated with endocrine disease, pain associated with diabetic neuropathy, phantom limb pain, spontaneous pain, chronic post-surgical pain, chronic temporomandibular pain, post-herpetic neuralgia, AIDS-related pain, complex regional pain syndromes type I and II, trigeminal neuralgia, chronic back pain, pain associated with spinal cord injury or recurrent acute pain.

23. A method of identifying or characterizing a compound for treatment or prevention of pain in a subject, said method comprising:
(a) contacting a test compound with a cell comprising a first nucleic acid comprising a promoter normally associated with a KCC2gene, operably linked to a second nucleic acid comprising a nucleotide sequence of a reporter gene encoding a reporter protein; and (b) determining whether the expression of the reporter gene, or the activity of the reporter protein encoded by said reporter gene, is increased in the presence of said test compound relative to the absence of said test compound;
wherein an increase in reporter gene expression or reporter protein activity in the presence relative to in the absence of said test compound is an indication that said test compound may be used for treatment or prevention of neuropathic pain in a subject.

24. A method for diagnosing or prognosticating neuropathic pain associated with CNS dysfunction in a subject experiencing pain, said method comprising determining whetherKCC2 expression or activity is decreased in a superficial dorsal horn (SDH) neuron from said subject relative to a control KCC2 expression or activity, wherein said decrease is an indication that said subject is experiencing pain associated with CNS dysfunction.

25. The method of claim 24, wherein said control KCC2 activity or expression is:
(a) an established standard of KCC2 activity or expression;
(b) a corresponding level of KCC2 activity or expression determined in said subject at an earlier time;

(c) a corresponding level of KCC2 activity or expression determined in said subject when said subject is experiencing less pain or substantially no pain; or (d) a corresponding level of KCC2 activity or expression determined in a control subject experiencing less pain or substantially no pain.

26. The method of claim 24 or 25, wherein said KCC2 activity is determined by measuring potassium transport, chloride transport, intracellular chloride level or anion reversal potential.