David Acton1, Xiangyu Ren2, Stefania Di Costanzo2, Antoine Dalet1, Steeve Bourane1, Ilaria Bertocchi3, Carola Eva3, Martyn Goulding4. 1. Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA. 2. Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA; Biology Graduate Program, Division of Biological Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. 3. Department of Neuroscience, University of Torino, Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, Regione Gonzole 1, 10043 Orbassano, Italy. 4. Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA 92037, USA. Electronic address: goulding@salk.edu.
Abstract
Acute itch can be generated by either chemical or mechanical stimuli, which activate separate pathways in the periphery and spinal cord. While substantial progress has been made in mapping the transmission pathway for chemical itch, the central pathway for mechanical itch remains obscure. Using complementary genetic and pharmacological manipulations, we show that excitatory neurons marked by the expression of the neuropeptide Y1 receptor (Y1Cre neurons) form an essential pathway in the dorsal spinal cord for the transmission of mechanical but not chemical itch. Ablating or silencing the Y1Cre neurons abrogates mechanical itch, while chemogenetic activation induces scratching. Moreover, using Y1 conditional knockout mice, we demonstrate that endogenous neuropeptide Y (NPY) acts via dorsal-horn Y1-expressing neurons to suppress light punctate touch and mechanical itch stimuli. NPY-Y1 signaling thus regulates the transmission of innocuous tactile information by establishing biologically relevant thresholds for touch discrimination and mechanical itch reflexes.
Acute itch can be generated by either chemical or mechanical stimuli, which activate separate pathways in the periphery and spinal cord. While substantial progress has been made in mapping the transmission pathway for chemical itch, the central pathway for mechanical itch remains obscure. Using complementary genetic and pharmacological manipulations, we show that excitatory neurons marked by the expression of the neuropeptide Y1 receptor (Y1Cre neurons) form an essential pathway in the dorsal spinal cord for the transmission of mechanical but not chemical itch. Ablating or silencing the Y1Cre neurons abrogates mechanical itch, while chemogenetic activation induces scratching. Moreover, using Y1 conditional knockout mice, we demonstrate that endogenous neuropeptide Y (NPY) acts via dorsal-horn Y1-expressing neurons to suppress light punctate touch and mechanical itch stimuli. NPY-Y1 signaling thus regulates the transmission of innocuous tactile information by establishing biologically relevant thresholds for touch discrimination and mechanical itch reflexes.
Itch is a protective cutaneous somatosensory modality that drives reflexive
scratching to remove harmful parasites and irritants from the skin. Itch is elicited
either by chemical pruritogens, including histamine and serotonin, or by light
mechanical stimuli, such as an insect crawling across the skin (Dong and Dong, 2018; Hachisuka et al., 2018; Han and Dong,
2014; Ikoma, 2013; Ikoma et al., 2006). Although chemical and mechanical
itch function in a complementary manner to protect against cutaneous tissue damage,
there is growing evidence that they are mediated by separate neural pathways in the
periphery and spinal cord.The transmission pathway for chemical itch has been characterized in some
detail (Bautista et al., 2014; Dong and Dong, 2018; Hachisuka et al., 2018; Ikoma, 2013). Chemical pruritogens activate pruriceptive Ad and C fibers
that display little or no mechanical sensitivity (Ringkamp et al., 2011; Schmelz et al.,
1997, 2003), and these convey the
itch signal from the skin to the superficial dorsal horn. Within the dorsal horn,
chemical itch is transmitted by neurons expressing the gastrin releasing peptide
receptor (GRPR) (Bautista et al., 2014; Hachisuka et al., 2018; Han and Dong, 2014; Mishra and Hoon, 2013; Sun et al.,
2009; Sun and Chen, 2007).
Thereafter, the signal is relayed to the thalamus (Davidson et al., 2007, 2012;
Johanek et al., 2008; Ma et al., 2012; Papoiu
et al., 2012; Simone et al., 2004)
and parabrachial nucleus (Campos et al.,
2018; Mu et al., 2017) by projection
neurons, including those marked by neurokinin-1 receptor (NK1R) expression (Akiyama et al., 2015). Much less is known about
mechanical itch, which is initiated by the activation of low-threshold
mechanoreceptors (LTMRs) in the skin (Fukuoka et
al., 2013; Han and Dong, 2014;
Koch et al., 2018). Recently, we showed
that mechanical itch is selectively gated by inhibitory interneurons in the dorsal
horn that are marked by the expression of Neuropeptide Y::Cre
(NPY::Cre interneurons [INs]). Ablation of NPY::Cre INs in mice leads to chronic
scratching in the absence of an external stimulus, as well as an increased tendency
to scratch in response to low-threshold mechanical stimulation of the nape,
consistent with disinhibited transmission of tactile information from the hairy skin
(Bourane et al., 2015a). This mechanical
itch phenotype is independent of the GRPR+ neuron-dependent chemical itch
pathway, providing strong evidence for a separate mechanical itch pathway in the
spinal cord. However, the excitatory spinal neurons that transmit the mechanical
itch signal and the mechanism by which the inhibitory NPY::Cre INs gate the flow of
information through this pathway remain wholly unknown.In this study, we delineate a central circuit for the processing of
mechanical itch that incorporates a peptidergic signaling mechanism to establish
normal touch discrimination. We show that neurons in the dorsal spinal cord
expressing Y1 and the transcription factor Lbx1, hereafter referred to as
Y1Cre neurons, are essential for the central transmission of light
punctate touch and mechanical but not chemical itch. Ablating the spinal
Y1Cre neurons abolishes the chronic spontaneous scratching that
occurs following removal of the NPY::Cre INs, while ablation or silencing spinal
Y1Cre neurons renders mice insensitive to mechanical but not chemical
stimulation. We go on to demonstrate that endogenous NPY acts on Y1+
dorsal horn neurons to suppress light punctate touch and mechanical itch.
Lbx1;
Y1 conditional knockout mice
exhibit spontaneous scratching and hypersensitivity to mechanical itch stimuli, as
well as reduced thresholds for hindpaw withdrawal from light punctate stimuli, but,
like Y1Cre neuron-ablated mice, they have normal responses to chemical
itch and pain stimuli. Conversely, selective activation of Y1 receptors or
activation of NPY::Cre INs to stimulate endogenous NPY release reduces mechanical
itch responses. These data show that the mechanical itch pathway is gated by NPY-Y1
signaling within the dorsal horn. These data also indicate that the previously
reported analgesic effects of NPY and Y1 signaling (Diaz-delCastillo et al., 2018; Duggan et
al., 1991; Hua et al., 1991; Intondi et al., 2008; Naveilhan et al., 2001; Solway et al., 2011; Taiwo and Taylor,
2002) are mediated by peripheral sensory neurons.
RESULTS
Y1 Expression Marks a Population of Excitatory Neurons within the
LTMR-RZ
Mechanical itch is mediated by light touch information transmitted to the
spinal cord by LTMRs innervating the hairy skin (Fukuoka et al., 2013); this information is then subject to
inhibitory gating by locally projecting NPY::Cre INs in the dorsal horn (Bourane et al., 2015a). We therefore
centered our search for the excitatory neurons that transmit the mechanical itch
signal on glutamatergic cells that are located within the LTMR recipient zone
(LTMR-RZ) of the dorsal horn (Abraira et al.,
2017). This zone (laminae IIi–IV) contains molecularly diverse
excitatory populations that are extensively innervated by LTMRs (Abraira et al., 2017; Abraira and Ginty, 2013; Koch et
al., 2018). Of particular interest was a subset of dorsal horn
excitatory neurons distinguished by expression of the inhibitory Y1 receptor
(NPYR1; Häring et al., 2018; Melnick, 2012; Miyakawa et al., 2005; Sathyamurthy et al., 2018). Y1
mRNA-positive neurons are distributed throughout the LMTR-RZ and are also
present in laminae I–IIo (Figure
1A). In the spinal cords of adult
Y1
(NPYR1) knockin mice (Padilla et al., 2016) carrying the
Ai14 reporter (Madisen et al., 2010),
Y1-derived cells were
enriched in laminae IIi/III, with additional cells present in laminae I, IIo,
and IV (Figures 1B and S1C). 88.8% ± 2.0% of
Y1+ cells in the dorsal horn co-expressed the
Y1-dependent tdTomato
reporter, with 62.5% ± 7.9% of tdTomato+ neurons showing
Y1 expression (Figures
1C and 1D). Likewise, when
Y1;
Ai14 mice were
crossed with a Y1::EGFP transgenic reporter line (Gene
Expression Nervous System Atlas [GENSAT]), 84.4% ± 4.6% of the
EGFP+ neurons co-expressed tdTomato (Figures S1A–S1C) and 53.8% ± 3.4% of the
tdTomato+ neurons co-expressed EGFP. These data suggest that
Y1 captures dorsal horn
neurons that exhibit transient or low-level Y1 gene expression
in addition to cells that show persistent expression, as has been noted for
other Cre drivers (e.g., Bourane et al.,
2015a; Duan et al., 2014;
Peirs et al., 2015).
Figure 1.
Y1Cre Marks a Population of Excitatory Neurons Concentrated in
Laminae II-III
(A) Transverse section through the lumbar spinal cord of a P21 mouse
showing Y1 mRNA expression in the dorsal horn.
(B) Section from a P42
Y1;
Ai14 mouse showing
laminar distribution of Y1-tdTomato neurons.
(C) Co-expression of tdTomato and Y1 mRNA in the dorsal
horn of a P21 Y1;
Ai14 mouse.
(D) Summary of Y1 mRNA expression (n = 3 mice).
(E and F) Transverse sections through the lumbar spinal cord of a P10
Y1;
Ai14 mouse stained with
antibodies against Lmx1b (E) and Pax2 (F).
(G) Quantification of co-expression of Y1-tdTomato with antibody-labeled
Lmx1b and Pax2 in P10
Y1;
Ai14 mice (n = 5 mice).
Roman numerals denote Rexed’s laminae.
Scale bars: 50 μm (A, B, E, and F) and 10 μm (C). Data:
mean ± SEM. See also Figures S1–S3.
The vast majority of
Y1-derived neurons are
excitatory, with 82.4% ± 6.9% expressing Lmx1b and only
0.4%± 0.2% expressing the inhibitory neuron marker Pax2
(Figures 1E–1G). Further-more, some tdTomato+ cells
co-expressed markers of excitatory neuron populations that have been implicated
in the transmission of mechanical stimuli, including cMaf+ neurons
(Wende et al., 2012),
retinoid-related orphan receptor alpha (RORα)+ neurons (Bourane et al., 2015b), and Somatostatin
(Sst)+ neurons (Christensen et
al., 2016; Duan et al., 2014;
Huang et al., 2018). Co-expression
was also seen in gastrin releasing peptide (GRP)-expressing neurons (Mishra and Hoon, 2013; Solorzano et al., 2015), as well as in
NK1R+ neurons in lamina I and laminae III– IV (Akiyama et al., 2013, 2015; Carstens et
al., 2010). By contrast, there was no overlap with neurons that
express GRPR, or cells expressing the astrocytic markers S100b or glial
fibrillary acidic protein (GFAP) (Figure S2).In keeping with this analysis, sparse labeling of Y1Cre
neurons in laminae I–IV with EnvA-pseudotyped ∆G-dsRed-Express
rabies virus revealed cell morphologies that are characteristic of excitatory
neurons. These include central-, vertical-, and radial-like cell types in lamina
II (Grudt and Perl, 2002), and projection
neurons in lamina I that likely correspond to NK1R+ projection
neurons (Akiyama et al., 2015; Brumovsky et al., 2006; Szabo et al., 2015). We also observed fusiform
neurons in lamina II and multipolar neurons in laminae III–IV, some of
which were previously shown to express Y1 (Figure S3; Brumovsky et al., 2006).To determine whether Y1Cre neurons receive direct LTMR
inputs, we performed injections of cholera toxin B (CTb) into either the hairy
skin of the thigh or the glabrous skin of the plantar hindpaw of adult
Y1;
Ai14 mice.
CTb-labeled boutons from fibers innervating either region were found in close
apposition to Y1Cre-tdTomato somata, and many of these displayed
immunoreactivity for vesicular glutamate transporter 1 (vGluT1), which labels
myelinated Aß and Aδ LTMRs in the LTMR-RZ (Figures 2A and 2B; n = 3 mice assessed per condition) (Todd et al., 2003).
Figure 2.
Y1 Neurons Receive Extensive
LTMR Input
(A and B) Examples of Y1Cre neurons in lamina IIi from
lumbarspinal cord sectionsof P42
Y1;
Ai14 mice injected with
CTb into: the hairy skin of the thigh (A) and the glabrous skin of the hindpaw
(B). Immunolabeled CTb+ contacts (blue) displayed vGluT1
immunoreactivity (green, arrowheads).
(C) Section through the lumbar dorsal horn of a P10
Y1;
Lbx1;
R26 mouse injected with EnvA
G-deleted rabies-mCherry virus. Arrowheads indicate infected Y1Cre
neurons. mCherry+/GFP— cells represent
transsynaptically labeled presynaptic neurons.
(D) Summary of antibody-labeled myelinated sensory afferent subtypes
that are presynaptic to the Y1Cre neurons, expressed as a percentage
of mCherry+ neurons (n = 4 mice).
(E–J) Sections from P10
Y1;
Lbx1;
R26 lumbar DRGs showing
presynaptically labeled sensory neurons(red) thatexpress c-Ret (E), TrkC but not
parvalbumin(PV; F), TrkB(G), calcitonin gene-related peptide (CGRP) and
neurofilament 200 (NF; H), and calbindin (CB; I), but not PV or calretinin (CR;
J). Arrowheads indicate co-labeled sensory afferents. CB, calbindin; CR,
calretinin; NF, neurofilament; PV, parvalbumin. Scale bars: 5 μm (B) and
100 μm (C and E–J). Data: mean ± SEM. See also Figure S4.
The LTMR subtypes that innervate Y1Cre neurons were further
analyzed by intersectional monosynaptic retrograde tracing with EnvA-pseudotyped
∆G-mCherry rabies virus (Figures
2C–2J) (Albisetti et al., 2017; Bourane et al., 2015a, 2015b; Wickersham et
al., 2007). Retrograde mCherry expression was observed in multiple
cutaneous LTMR subtypes, including c-Ret+/IB4—
Aß-LTMRs, TrkC+/parvalbumin—
Aß-LTMRs, TrkB+ Aδ-LTMRs, and putative LTMRs that
express calcitonin gene-related peptide (CGRP) and neurofilament 200 (NF200)
(Bourane et al., 2015b; Lawson et al., 2002). Dorsal root ganglion
(DRG) neurons expressing calbindin, which innervate Meissner corpuscles, were
also labeled (Figure 2I). Proprioceptors
marked by the expression of parvalbumin were largely spared, and Aß
fibers expressing calretinin, which innervate Pacinian corpuscles, were never
detected (Figure 2J). In summary, this
analysis provides clear evidence that the Y1Cre neurons are
extensively innervated by cutaneous LTMR fibers.
Y1Cre Neurons Are Essential Components of the Mechanical Itch
Pathway Gated by Inhibitory NPY:: Cre INs
NPY::Cre IN ablation causes a mechanical itch phenotype that is marked
by increased spontaneous hindlimb scratching (Figure 3A; Bourane et al.,
2015a). We therefore set about examining whether the Y1Cre
neurons in the dorsal horn transmit the mechanical itch signal using a genetic
epistasis strategy entailing diphtheria toxin (DT)-mediated ablation of both the
NPY::Cre/Lbx1 and
Y1/Lbx1
populations. Ablation of dorsal horn NPY::Cre INs alone significantly increased
spontaneous scratching 1 week after DT treatment, from 12 ± 2 scratch
episodes per 30-min observation period in FlpO— controls to
100 ± 17 episodes in ablated animals (Figures 3A, S4A, S4D,
and S4E). Strikingly,
this increase in spontaneous scratching was completely abolished following
ablation of both the Y1Cre and NPY::Cre populations in DT-treated
Y1; NPY::
Cre; Lbx1;
Tau;
Ai65 mice (Figures 3A, S4B, S4D, and S4E). These findings demonstrate
that the Y1Cre neurons are required for the expression of the
mechanical itch phenotype in mice lacking NPY::Cre-derived
inhibitory INs.
Figure 3.
Y1Cre Neurons within the Dorsal Horn Transmit Mechanical but Not
Chemical Itch
(A) Ablation of dorsal horn NPY::Cre INs increases spontaneous
scratching in NPY::Cre;
Lbx1;
Tau;
Ai65 mice (n = 16) compared
with DT-treated NPY::Cre;
Tau;
Ai65 controls that lack
DT-receptor expression (n = 11). Ablation of the Y1Cre and NPY::Cre
IN populations in Y1;
NPY::Cre; Lbx1;
Tau;
Ai65 mice abolishes
scratching (n = 11). Scratching is unaffected when Sst+ neurons are
ablated together with the NPY::Cre INs in
Sst; NPY::Cre;
Lbx1;
Tau;
Ai65 mice (n = 13). One-way
ANOVA and Bonferroni post hoc tests were used to assess statistical
differences.
(B and C) Reduced scratching in response to stimulation of the nape with
a 0.16-g von Frey hair in
Y1;
Lbx1;
Tau;
Ai65 mice treated with DT
(n = 14) compared with saline-treated controls (n = 11; B), and in
Y1;
Lbx1;
R26 mice treated with
clozapine N-oxide (CNO; n = 8) compared with
Y1;
R26 controls, which lack
FlpO-dependent hM4D expression (n = 8; C).
(D) Enhanced scratching in response to stimulation of the nape in
CNO-treated Y1;
Lbx1;
R26 mice (n = 6) compared
with Y1;
R26 controls (n = 6).
(E) Spontaneous scratching in CNO-treated
Y1;
Lbx1;
R26 mice (n = 8) is enhanced
over a 30-min period compared with control mice (n = 6).
(F) Scratching responses are unchanged in wild-type mice treated with
bombesin-saporin (BOM-SAP; n = 6) to ablate GRPR+ neurons compared
with controls injected with saporin (SAP; n = 8).
(G and H) Ablation of GRPR+ neurons in
Y1;
Lbx1;
R26 mice does not alter
evoked scratching (G; BOM-SAP, n = 8; SAP, n = 7) or spontaneous scratching (H;
BOM-SAP, n = 7; SAP, n = 7) following CNO injection.
(I) Scratching responses are unchanged in wild-type mice treated with
[Sar9, Met(O2)11]-substance P-SAP (SSP-SAP;
n = 10) to ablate NK1R+ neurons compared to SAP-injected controls (n
= 11).
(J and K) In Y1;
Lbx1;
R26 mice, ablation of
NK1R+ neurons does not alter evoked (J; SSP-SAP, n = 9; SAP, n =
7) or spontaneous (K; SSP-SAP, n = 10; SAP, n = 7) scratching following CNO
injection.
(L) Unchanged scratching in NPY::Cre;
Lbx1;
Tau;
Ai65 mice 2 weeks
after NK1R+ neuron ablation and 1 week following DT administration
(SSP-SAP, n = 9; SAP, n = 8).
(M) Unchanged scratching over a 30-min period in Y1Cre
neuron-ablated mice following injection of chloroquine (control, n = 9; ablated,
n = 11), histamine (control, n = 6; ablated, n = 8), compound 48/80 (control, n
= 6; ablated, n = 8), and SLIGRL (control, n = 7; ablated, n = 8).
*p < 0.05, **p < 0.01, ***p < 0.001, NS, not
significant. Data: mean ± SEM. See also Figures S4–S6.
Sst expression partially overlaps with Y1 expression in lamina II (Figures S2E–S2G; Zhang et al., 1999), and Sst signaling has been
implicated in chemical itch transmission (Christensen et al., 2016; Huang et
al., 2018; Kardon et al.,
2014). We therefore set out to test whether NPY::Cre IN-gated scratching
is mediated by Sst+ neurons in the dorsal horn. Strikingly, in
contrast to the negation of scratching that occurs upon Y1Cre neuron
depletion in NPY::Cre IN-ablated mice, simultaneous ablation of the NPY::Cre and
Sst+ populations did not reduce scratching as compared to
NPY::Cre IN-ablated controls (Figures 3A
and S4C–S4E; p > 0.05).
Furthermore, removing the Sst+ neurons alone did not alter
spontaneous scratching or responses to mechanical stimulation of the nape (Figure S5). These data
reveal that dorsal horn neurons expressing Y1, either transiently or
persistently, are necessary for transmitting the light touch modalities that
drive mechanical itch, whereas those that express Sst, including
Sst+/Y1+ neurons, are not.
Y1Cre Neurons Selectively Transmit the Mechanosensory Stimuli That
Drive Mechanical Itch
We next examined the function of the Y1Cre neurons in
transmitting the itch sensation that is generated by low-threshold mechanical
irritation of the hairy skin. Mechanical itch induction was assessed using a
modified alloknesis assay (Akiyama et al.,
2012) in which a low-force (0.16 g) von Frey hair was applied to the
hairy skin of the nape, and scratching responses were recorded over ten trials.
Whereas nape stimulation elicited scratching in 22.7% ± 4.7% of trials in
control mice, it did so in only 3.6% ± 2.3% of trials in which the
Y1Cre neurons were ablated (Figures
3B and S6A–S6B). A similar reduction in scratching was observed when the
Y1Cre neurons were silenced in
Y1;
Lbx1;
R26 mice treated
with clozapine N-oxide (CNO), as compared with CNO-treated
Y1;
R26 control mice
that lack FlpO-dependent expression of the hM4D receptor (Figure 3C). Conversely, scratching was greatly
enhanced when the Y1Cre neurons were activated in
Y1;
Lbx1;
R26 animals (Figure 3D), which is consistent with
heightened sensitivity to low-threshold tactile stimulation. There was also a
marked increase in the number of spontaneous hindlimb scratching bouts over a
30-min period following hM3D-mediated activation of the Y1Cre neurons
(Figure 3E).We then considered the possibility that the increases in spontaneous and
evoked scratching seen in Y1;
Lbx1;
R26 mice might be
attributable to the activation of the chemical itch pathway that is dependent on
GRPR+ neurons. As previously shown, chloroquine-induced chemical
itch was strongly reduced in wild-type mice following ablation of the
GRPR+ neurons by intrathecal (i.t.) injection of
saporin-conjugated bombesin (BOM-SAP; Figures S6C–S6E) (Bourane et al., 2015a; Huang et al., 2018; Sun et al., 2009). By contrast, scratching responses to nape
stimulation were unaffected (Figure 3F).
Consistent with these results, neither the evoked nor spontaneous scratching
seen following activation of Y1Cre neurons was affected by ablation
of the GRPR+ neurons (Figures 3G
and 3H). These data agree with our previous
report that spontaneous scratching induced by removal of NPY::Cre INs is not
affected by ablation of the GRPR+ neurons (Bourane et al., 2015a), despite our finding that the
Y1Cre neurons include some GRP-expressing neurons (Figures S2C, S2F, and S2G).We next considered whether the pathways for chemical and mechanical itch
transmission converge downstream of the GRPR+ neurons on lamina I
NK1R+ neurons, given that
Y1 and NK1R expression
partially overlap (Figures
S2D, S2F,
and S2G) and evidence
that NK1R+ projection neurons convey chemical itch sensation to key
supraspinal regions for the integration of aversive stimuli (Carstens et al., 2010; Akiyama et al., 2013, 2015).
Ablation of the NK1R+ neurons by injection of saporin conjugated to
the NK1R ligand [Sar9, Met(O2)11]-substance P
(SSP-SAP) significantly attenuated chloroquine-induced itch (Figures S6F–S6H) consistent with previous
reports (Carstens et al., 2010). However,
NK1R+ neuron ablation failed to modulate mechanically evoked itch
in wild-type mice (Figure 3I), nor did it
alter the rate of evoked or spontaneous scratching that occurs when the
Y1Cre neurons are activated (Figures 3J and 3K). Ablation of
the NK1R+ neurons also did not alleviate scratching induced by
ablation of NPY::Cre INs (Figure 3L).As a final test to exclude the possibility that Y1Cre neurons
are interposed in the chemical itch circuitry, we assessed scratching in
Y1Cre neuron-ablated mice following injection of chloroquine,
histamine, compound 48/80 or SLIGRL into the skin behind the ear. Scratching
responses to all four pruritogens remained intact in Y1Cre
neuron-ablated mice (Figure 3M), confirming
that these cells are not required for chemical itch, Together, these data
indicate that that the minority of Y1Cre neurons that co-express NK1R
are dispensable for mechanical itch sensation.Our demonstration that the Y1Cre neurons are essential for
mechanical itch led us to ask whether the Y1Cre neurons have a role
in transmitting low-threshold mechanical stimuli. Sensitivity to light punctate
touch, as assessed by von Frey hair stimulation of the glabrous skin, was
significantly reduced after ablating or silencing the Y1Cre neurons
(Figures 4A and 4B). Conversely, sensitivity was elevated by
activation of the Y1Cre neurons (Figure
4C). However, responses to light dynamic touch, as assessed by gentle
brushing, were unaffected (Figure 4D). This
finding is consistent with our observation that there is little, if any, overlap
between the Y1Cre and RORα+ neuronal populations
(Figures S2B, S2F, and S2G), the latter of which transmits
dynamic touch (Bourane et al., 2015b).
Sensitivity to acute pain, as assessed by the pinprick and Randall-Sellito
tests, was largely unchanged in Y1Cre neuron-ablated mice, as were
responses to pain chemically induced by intradermal injection of capsaicin or
formalin. Thermal pain, as assessed by the hot-plate and Hargreaves assays, was
likewise unaffected (Figures
4E–4J). Together, these
findings suggest that the Y1Cre population of neurons is largely
specialized for transmitting light touch information, and they play little or no
role in relaying chemical itch, noxious mechanical, or thermal information.
Figure 4.
Y1Cre Neurons Selectively Transmit Light Touch Information
(A and B) Sensitivity to von Frey hair stimulation of the hindpaw
glabrous skin is reduced following Y1Cre neuron ablation (A; control,
n = 6; ablated, n = 9) or silencing (B; control, n = 8; silenced, n = 8).
(C) Glabrous skin sensitivity to von Frey hair stimulation is elevated
following Y1Cre neuron activation (control, n = 6; activated, n =
6).
(D–F) Responses to dynamic touch (D; control, n = 11; ablated, n
= 13), pinprick (E; control, n = 11; ablated, n = 13), and Randall-Selitto (F;
control, n = 12; ablated, n = 9) are unchanged after Y1Cre neuron
ablation.
(G and H) Chemical pain responses following hindpaw injection of
capsaicin (G; control, n = 11; ablated, n = 9) or formalin (H; control, n = 9;
ablated, n = 7) are not altered following Y1Cre neuron ablation.
(I and J) Y1Cre neuron-ablated mice show normal heat
responses as assessed by the hot plate (I; control, n = 12; ablated, n = 9) and
Hargreaves (J; control, n = 12; ablated, n = 9) assays.
The underlying signaling mechanisms that contribute to the gating of
mechanical itch by the NPY::Cre INs have not been established. In
Y1::EGFP; NPY::Cre mice injected
intraspinally (T13-L1 levels) with an
AAV2/1-hSyn-DIO-SypHTomato virus, lamina II EGFP+ cell bodies
displayed tdTomato+ synaptic contacts from NPY::Cre INs (Figures 5A and 5B; n = 3 mice). These contacts colocalized with vesicular GABA
(gamma-aminobutyric acid) transporter (VGAT), indicating that NPY::Cre INs
provide inhibitory synaptic inputs to Y1+ neurons (Figure 5A). Strikingly, many puncta also had NPY
immunoreactivity (Figure 5B), with multiple
NPY immunoreactive puncta being co-localized with the postsynaptic marker
gephyrin on Y1-tdTomato+ somata in
Y1;
Ai14 mice (Figure 5C; n = 3).
Figure 5.
Y1Cre Neurons Receive VGAT+ and NPY+
Synaptic Contacts from NPY::Cre Ins
(A and B) Examples of GFP-labeled cells from the lumbar spinal cord of
a P60 Y1::EGFP; NPY::Cre transgenic mouse. Presynaptic contacts
(red) from NPY::Cre INs onto Y1/EGFP+ cells were visualized with a
Cre-dependent AAV2/1-hSyn-DIO-SypHTom virus. Putative synaptic boutons marked by
VGAT (blue; A) and NPY (blue; B) immunoreactivity are indicated by
arrowheads.
(C) Examples of synaptic puncta labeled with antibodies against NPY
(green) and gephyrin (blue) on a Y1-tdTomato+ cell body in the lumbar
spinal cord of a P42 Y1;
Ai14 mouse (arrowheads).
(D) Schematic illustrating experimental conditions used to assess
synaptic connectivity between NPY::Cre INs and Y1Cre neurons.
(E) ReaChR-mediated activation of NPY::Cre IN generated monosynaptic
outward currents in lamina IIi Y1-EGFP+ neurons in P14–21
Y1::EGFP; NPY::Cre;
Lbx1;
R26 spinal cord slices in
the presence of kynurenic acid (KA; 1.5 mM) at a holding potential of —30
mV. These currents were abolished following application of 1 μM
strychnine and 60 μM picrotoxin (n = 7 cells from 5 mice). ***p <
0.001. The statistical difference was determined by the two-tailed, paired t
test.
(F) Traces recorded from a Y1-EGFP+ neuron showing a
monosynaptic inhibitory current elicited by NPY::Cre activation (purple trace)
and no response following bath application of strychnine and picrotoxin (black
trace).
Scale bars: 5 μm.
To confirm that the NPY::Cre INs form functional synapses onto
Y1+ neurons, we performed whole-cell patch-clamp recordings from
lamina IIi Y1-EGFP cells in spinal cord sections from Y1::EGFP;
NPY::Cre;
Lbx1;
R26 mice (Hooks et al., 2015). Following current
injection, the Y1-EGFP neurons displayed either single (20%) or phasic firing
patterns (80%; n = 32) that are characteristic of dorsal excitatory neurons
(Abraira et al., 2017; Grudt and Perl 2002; Koch et al., 2018). We then blocked glutamatergic transmission with
kynurenic acid and recorded from Y1-EGFP neurons at a holding potential of
—30 mV. Under these conditions, we observed inhibitory currents in 11/30
neurons following red-light excitable channelrhodopsin (ReaChR)-mediated
activation of the NPY::Cre INs (mean amplitude: 57.3 ± 15.6 pA). These
currents were abolished in 7/7 neurons following application of strychnine and
picrotoxin (Figures 5D–5F), demonstrating the NPY::Cre INs form
functional inhibitory synapses onto excitatory Y1+ neurons within the
dorsal horn.The intriguing finding that the Y1Cre neurons are contacted
by processes containing putative NPY+ dense core vesicles suggested
to us that NPY peptidergic signaling via the Y1Cre neurons might also
contribute to the gating of the mechanical itch pathway. To assess the role of
Gi-mediated inhibitory Y1 signaling within the dorsal horn, we
crossed Lbx1 (Sieber et al., 2007) with
Y1 mice (Bertocchi et al., 2011) to remove Y1
from dorsal horn neurons, sparing ventral, peripheral, and supraspinal neurons.
Lbx1;
Y1 mice exhibited
spontaneous scratching at P42, as well as elevated sensitivity to nape
stimulation (Figures 6A and 6B). Similarly, both spontaneous and evoked scratching
were elevated by the Y1 antagonist BIBP 3226 (Wang et al., 2016) acting at dorsal horn Y1 receptors (Figures 6C–6D and S7A–S7B). Likewise, elevated
spontaneous scratching was observed following administration of another Y1
antagonist, BMS 193885 (Antal-Zimanyi et al.,
2008), and in NPY knockout mice (Figure S7C) (Karl et al., 2008). Conditional knockout of
Y1 enhanced hindpaw sensitivity to light punctate touch but
did not modulate responses to dynamic touch (Figures 6E and 6F) or the
frequency of scratching in response to histaminergic and non-histaminergic
chemical itch stimuli (Figure 6G). The
duration and rate (duration/frequency) of scratching induced by compound 48/80
were also unchanged (Figures 6H and 6I; Gao et
al., 2018). Likewise, responses to mechanical, chemical, and thermal
pain stimuli were not affected (Figures
6J–6N). These data
indicate that NPY-Y1 signaling in the dorsal horn has a selective role in the
modulation of light punctate touch information from both the hairy and glabrous
skin and, as a consequence, functions to gate mechanical itch.
Figure 6.
NPY-Y1 Receptor Signaling within the Dorsal Horn Gates Mechanical Itch and
Light Punctate Touch
(A and B) Mice lacking the Y1 receptor in dorsal horn neurons exhibit
pronounced spontaneous scratching (A;
Lbx1;
Y1, n = 10;
Y1 control, n = 12) and
hypersensitivity to light punctate mechanical stimulation of the nape (B;
Lbx1;
Y1,n = 7;
Y1 control, n = 9).
(C) The Y1 antagonist BIBP 3226 (1 mg kg−1,
intraperitoneally [i.p.]) increases spontaneous scratching in control (n = 8)
but not conditional knockout mice (n = 12). Two-tailed, paired t tests were used
to assess statistical differences.
(D) BIBP 3226 causes hypersensitivity to nape stimulation (n = 12;
vehicle, n = 12).
(E and F) Lbx1;
Y1 mice have reduced hindpaw
von Frey thresholds (E;
Lbx1;
Y1,n= 8;
Y1 control, n = 8) but
responses to dynamic touch are unaltered (F;
Lbx1;
Y1,n= 8;
Y1 control, n = 9).
(G–I) Deletion of Y1 from dorsal horn neurons does not alter
scratching frequency in response to chloroquine
(Lbx1;
Y1, n = 11;
Y1 control, n = 9) or
scratching frequency (G), duration (H), or rate (duration/frequency; I) in
response to compound 48/80
(Lbx1;
Y1, n = 14;
Y1 control, n = 10).
(J–N) Deletion of Y1 from dorsal horn neurons does not affect
sensitivity to acute mechanical pain as assessed by pinprick (J;
Lbx1;
Y1,n = 9;
Y1 control, n = 9) or
the Randall-Selitto test (K;
Lbx1;
Y1,n= 8;
Y1 control, n = 6),
chemical nociception (L;
Lbx1;
Y1,n= 8;
Y1 control, n = 8), or
thermal pain as assessed by the hot plate (M;
Lbx1;
Y1,n = 9;
Y1 control, n = 9) or
Hargreaves tests (N;
Lbx1;
Y1,n = 8;
Y1 control, n = 6).
*p < 0.05 and ***p < 0.001. NS, not significant. Data:
mean ± SEM.
The role of Y1 signaling in the regulation of mechanical itch was
further assessed by administering NPY or the selective Y1 agonist
[Leu31, Pro34]-NPY (Gelfo et al., 2011) to NPY::Cre;
Lbx1;
Tau;
Ai65 mice 1 week after
ablating the NPY::Cre INs. Both agonists relieved spontaneous scratching in the
NPY:: Cre IN-ablated mice (Figures 7A and
S7D). Furthermore,
injection of NPY (Figure
S7E) or [Leu31, Pro34]-NPY reduced sensitivity
to nape stimulation, with this effect being abolished when [Leu31,
Pro34]-NPY was administered to
Lbx1;
Y1 mice, confirming the
dorsal horn as the site of NPY action (Figures
7B and S7F).
Figure 7.
NPY-Y1 Receptor Signaling Determines Sensitivity to Mechanical Itch
Stimuli
(A) Spontaneous scratching in NPY::Cre;
Lbx1;
Tau;
Ai65 mice 1 week after DT
treatment was reduced following injection of NPY (100 μg
kg−1, i.p.; n = 9) or the selective Y1 receptor agonist
[Leu31, Pro34]-NPY (100 μg
kg−1, i.p.; n = 6) when compared with vehicle.
(B) Evoked scratching is reduced when
Y1 mice (n = 8) but not
Lbx1;
Y1 mice (n = 9) are injected
with [Leu31, Pro34]-NPY (100 μg
kg−1, i.p., n = 8; vehicle, n = 8).
(C and D) hM3D-mediated activation of the NPY::Cre INs reduces
scratching in response to mechanical stimulation of the nape compared with
controls (NPY::Cre;
Lbx1;
R26, n = 13;
NPY::Cre; R26 controls,
n = 11; C) but not when Y1 receptors are inhibited by BIBP 3226 (n = 7;
controls, n = 9; D).
(E) Unchanged chloroquine-induced scratching following activation of
the NPY::Cre INs (n = 12; controls, n = 12).
(F–H) Activation of NPY::Cre INs reduces sensitivity to von Frey
hair (F), brush (G), and pinprick (H) stimulation of the plantar hindpaw (n =
13; controls, n = 11).
(I–K) Activation of NPY::Cre INs does not alter sensitivity to
von Frey hair (I), brush (J), and pinprick (K) stimulation following Y1 receptor
blockade by BIBP 3226 (n = 9; BIBP 3226-injected controls, n = 7).
Two-tailed, paired (A and B) or unpaired (C–K) t tests were used
to assess statistical differences. *p < 0.05, **p < 0.01, ***p
< 0.001. NS, not significant. Data: mean ± SEM (B–L). See
also Figure S7.
As a final test of the functional interaction between the NPY:: Cre and
Y1+ neurons, we assessed itch sensitivity following chemogenetic
activation of NPY::Cre INs. When NPY::Cre INs were selectively activated, evoked
scratching was reduced compared to controls (Figure 7C). This reduction in scratching was negated by co-injecting
BIBP 3226 with CNO, indicating that the inhibition of itch by NPY:: Cre INs is
in large part dependent on the actions of NPY on the Y1+ neurons
(Figure 7D). Importantly, the
inhibition of itch by NPY::Cre IN activation was specific to mechanical itch, as
chloroquine-induced scratching was unaffected (Figure 7E).The activation of NPY::Cre INs also caused a pronounced reduction in the
sensitivity of the glabrous skin to light punctate touch, as well as more
moderate reductions in responses to dynamic touch and acute pain (Figures 7F–7H). These effects were not observed when BIBP 3226 was administered
(Figures 7I–7K), implying that they were mediated by enhanced
release of NPY. Given that dorsal horn Y1+ neurons do not transmit
dynamic touch and acute pain, it is likely that the modulation of these
modalities following NPY::Cre IN activation results from ectopic activation of
Y1 receptors expressed by sensory neurons. Taken together, these data support a
model in which light punctate touch and mechanical itch are strongly regulated
by the actions of NPY on inhibitory Y1-bearing neurons in the dorsal horn.
DISCUSSION
In this study we have identified the population of excitatory neurons in the
dorsal spinal cord that are essential for transmitting the mechanosensory stimuli
that drive mechanical itch. These neurons are marked by Y1 receptor expression and
they define, together with NPY::Cre inhibitory INs in the dorsal horn, a central
pathway for mechanical itch transmission that is distinct from the well-described
GRP-GRPR chemical itch pathway (Figure 7L).
Scratching in response to mechanical stimulation is abolished when the
Y1Cre neurons are ablated, while activation of the Y1Cre
neurons increases scratching in response to mechanical stimulation. Our results also
reveal a prominent role for NPY peptidergic signaling in regulating light punctate
touch sensitivity and mechanical itch, which is mediated by Y1+ neurons
in the dorsal horn. We propose that NPY inhibitory signaling normally facilitates
the discrimination of light touch stimuli, and disrupting it promotes a chronic itch
phenotype and mechanical hyperknesis/alloknesis.
The light punctate touch and mechanical itch phenotypes we observe upon
manipulation of the Y1Cre neurons are consistent with their
innervation by mechanosensory LTMR afferents from both the glabrous and hairy
skin (Figure 2). Whereas the
Y1Cre neurons encompass multiple cell types within the LTMR-RZ
(Figures S2 and
S3), our findings
suggest that only a subset of these cells are required for mechanical itch
responses, and this subset appears to be distinct from those Y1Cre
neurons that express Sst or NK1R, as ablating the Sst+ or
NK1R+ neurons fails to disrupt the mechanical itch pathway (Figures 3 and S5).Touch information appears to be broadly distributed between overlapping
molecularly defined populations within the LTMRRZ that include Y1+,
RORa+, Sst+, vGlut3+, and
calretinin+ neurons (this study; Abraira et al., 2017; Abraira and
Ginty, 2013; Bourane et al.,
2015b; Duan et al., 2014;
Peirs et al., 2015). Interestingly,
the role of the Y1+ neurons in processing touch information appears
to be limited to punctuate touch, since they are dispensable for transmitting
dynamic light touch information (Figure 3),
which is instead largely transmitted by excitatory RORα+ INs
in laminae IIi/III (Bourane et al.,
2015b). The contribution that dynamic touch and the RORa+ INs
make to mechanical itch is still unclear.The possibility that the Y1Cre neurons may contribute to the
transmission of other cutaneous modalities is suggested by our observation that
some Y1Cre neurons reside in laminae I–IIo, subsets of which
are Sst+ neurons, which have been implicated in acute mechanical pain
and lamina I NK1R+ neurons, which transmit chemical pain (Brumovsky et al., 2002; Duan et al., 2014; Mantyh et al., 1997; Nichols et al.,
1999). Somewhat surprisingly, our functional analyses did not reveal
a role for the Y1Cre neurons in acute mechanical pain or responses to
noxious heat or chemical stimuli (Figure
4). Moreover, the absence of a pain phenotype following Y1Cre
neuron ablation or activation suggests the Y1Cre/SstCre
and Y1Cre/NK1R+ neurons are dispensable for pain
transmission.Chemical itch transmission was also unaffected following ablation of the
Y1Cre neurons (Figure 3),
with this study and our previous functional analysis of the NPY::Cre INs (Bourane et al., 2015a) providing strong
evidence that the pathways for mechanical and chemical itch are largely
segregated in the periphery and dorsal spinal cord (Figures 3 and 7L). Although the Y1Cre population partially overlaps with
NK1R+, Sst+, and GRP+ neurons that have
been implicated in chemical itch transmission (Albisetti et al., 2019; Christensen
et al., 2016; Fatima et al.,
2019; Huang et al., 2018;
Kardon et al., 2014; Mishra and Hoon, 2013), those embedded within the
Y1Cre population appear to be dispensable for chemical itch.Mechanical and chemical itch stimuli produce indistinguishable
sensations in humans, and both trigger scratching (Fukuoka et al., 2013). This suggests central
convergence of the mechanical and chemical itch pathways, a possibility
supported by observations that chemical pruritogens can cause alloknesis, a
condition in which normally innocuous mechanical stimuli cause itch (Akiyama et al., 2012; Gao et al., 2018; Wahlgren et al., 1991). Moreover, there is evidence that the
parabrachial nucleus (Campos et al.,
2018; Mu et al., 2017) to which
NK1R+ neurons project (Akiyama et
al., 2015) encodes both mechanical and chemical itch. Our results
show that the NK1R+ neurons are dispensable for mechanical itch,
which suggests that the chemical and mechanical itch pathways do not converge in
the spinal cord on ascending NK1R+ projection neurons.
NPY-Y1R Signaling Gates Mechanical Itch
Our analysis reveals a key role for NPY in regulating mechanical itch
and touch sensitivity. We propose that NPY-Y1 signaling functions in healthy
animals as a homeostatic mechanism to adjust the output of the LTMR circuitry,
thus ensuring the correct discrimination between itch and other innocuous light
touch sensations. Recently, it has been reported that NPY suppresses itch (Gao et al., 2018), although the site of
action and the cellular basis for this activity were not described. Our studies
show endogenous NPY acts on Y1+ neurons in the dorsal horn to
regulate mechanical itch, the same cells that are required for the chronic itch
phenotype in NPY::Cre IN ablated mice (Figure
3). We cannot completely exclude the possibility that NPY-Y1
signaling in sensory afferents also contributes to the modulation of
mechanosensory transmission; however, this is unlikely, as in these neurons Y1
is co-expressed with CGRP (Brumovsky et al.,
2002), a marker of high-threshold mechanoreceptors (Lawson et al., 2002).While our results show the inhibitory effects of NPY::Cre IN activation
are largely abolished by Y1 blockade, the present study does not eliminate a
role for GABA or glycine in the regulation of the mechanical itch pathway.
Rather, Y1-mediated inhibition may operate in conjunction with fast inhibitory
pathways (Akiyama et al., 2011; Ralvenius et al., 2018) to regulate the
sensitivity of the dorsal horn mechanosensory circuitry over longer time scales
than those controlled by ionotropic feedforward inhibition. It is also possible
that peptidergic signaling between NPY::Cre and Y1+ neurons
contributes to the inhibition of mechanical itch by counterstimuli, a role that
would be consistent with our observation that after-discharge spiking is
enhanced following brushing of the hairy skin in NPY::-Cre IN-ablated mice
(Bourane et al., 2015a).The central inhibition of mechanical itch by NPY::Cre INs parallels the
inhibitory regulation of chemical itch by the B5-I INs (Figure 7L) (Chiang et
al., 2016; Kardon et al.,
2014; Ross et al., 2010). B5-I INs
are a subset of lamina I-II inhibitory INs that express the transcription factor
Bhlhb5. These cells suppress activity in a tonic manner (Huang et al., 2018; Kardon et al., 2014; Ross et al.,
2010) and in response to counterstimuli (Hachisuka et al., 2016; Kardon et al., 2014). The B5-I INs include the spinal
INs that express the neuropeptide dynorphin, the endogenous agonist of kappa
opioid receptors, and as in mechanical itch, a neuropeptidergic mechanism is
proposed to regulate the chemical itch pathway in a tonic manner (Huang et al., 2018; Kardon et al., 2014; however, also see Duan et al., 2014).Several studies have found that NPY exerts analgesic effects via two of
the five identified mammalianNPY receptors, the Y1 and Y2 receptors, in
neuropathic, inflammatory, and some forms of acute pain (Diaz-delCastillo et al., 2018; Duggan et al., 1991; Hua et al., 1991; Intondi et al.,
2008; Naveilhan et al., 2001;
Solway et al., 2011; Taiwo and Taylor 2002). Y1 signaling is also required
for normal sensitivity to heat (Naveilhan et
al., 2001). However, it was previously unclear whether these effects
are mediated by central or peripheral mechanisms (Diaz-delCastillo et al., 2018; Gibbs et al., 2004; Moran et al., 2004). We find that ablation of Y1Cre
neurons or deletion of the Y1 gene within the dorsal horn has
no effect on acute, thermal, or chemical nociception (Figure 4), strongly indicating that they are instead
mediated by peptidergic Y1+ nociceptive afferents (Brumovsky et al., 2002), rather than Y1+
neurons in the dorsal horn. This finding further suggests that the mild
Y1-dependent inhibition of acute pain and dynamic touch observed following
activation of the NPY::Cre INs (Figure 7)
entails ectopic inhibition of Y1+ primary afferents, and that other
inhibitory neurons play a more prominent role in gating these modalities under
physiological conditions.In summary, this study demonstrates that Y1+ neurons form an
excitatory pathway within the dorsal horn for the transmission of mechanical
itch, and that the flow of information through this pathway is regulated by
inhibitory NPY-Y1 signaling to maintain normal touch discrimination. We propose
that dysregulation of this pathway following failure of the gating mechanism may
drive the development of neuropathic chronic itch. It has been suggested that
increases in mechanical itch sensitivity in mice following the loss of Merkel
cells due to aging or dry skin might be due to reduced cutaneous input to
inhibitory NPY-expressing INs, although this has not been tested (Feng et al., 2018). There is also evidence
that the disruption of NPY signaling in humans may contribute to chronic itch
(Reich et al., 2013). Notably,
psoriasispatients presenting with pruritus have reduced NPY serum levels, which
are negatively correlated with the intensity of itch (Reich et al., 2007). In view of the central
contribution NPY signaling makes to the inhibitory regulation of itch sensation,
Y1 signaling merits investigation as a therapeutic target for the treatment of
chronic itch, a condition that rivals chronic pain in the severity of its impact
on quality of life (Kini et al.,
2011).
STAR★METHODS
LEAD CONTACT AND MATERIALS AVAILABILITY
Further information and requests for resources and reagents should be
directed to and will be fulfilled by the Lead Contact, Martyn Goulding
(goulding@salk.edu).
EXPERIMENTAL MODEL AND SUBJECT DETAILS
All protocols for animal experiments were approved by the IACUC of the
Salk Institute for Biological Studies according to NIH guidelines for animal
experimentation. Male and female mice were used in all studies. Animals were
randomized to experimental groups and no sex differences were noted.The Y1 knockin mouse
line was generated by Padilla et al. (Padilla et
al., 2016). An FRT-flanked neomycin cassette was removed by crossing
with the FLPo-10 deleter strain (Wu et al., 2009), as described by Padilla et al.
(Padilla et al., 2016). The
Y1::eGFP transgenic reporter mouse line
(RRID:MMRRC_010554-UCD) was generated by the Gene Expression Nervous System
Atlas (GENSAT) project. The following mouse lines were also used in this study:
NPY::Cre (Bourane et al.,
2015a), Sst (Taniguchi et al., 2011),
Sst (He et al., 2016),
Lbx1 (Sieber et al., 2007),
Lbx1 (Bourane et al., 2015a),
Ai14 (Madisen et al., 2010),
Ai65 (Madisen et al., 2015),
R26 (Sciolino et al., 2016),
R26 (Bourane et al., 2015a),
R26 (Hooks et al., 2015),
Tau (Britz et al., 2015), NPY KO (Karl et al., 2008),
Y1 (Bertocchi et al., 2011), GRP::eGFP
(Mishra and Hoon, 2013),
R26 (Bourane et al., 2015b),
R26 (Seidler et al., 2008).
METHOD DETAILS
Immunohistochemistry
Mice were euthanized by a single intraperitoneal (i.p.) injection
(10 μl g−1 body weight) of ketamine (10 mg
ml−1) and xylazine (1 mg ml−1)
immediately prior to perfusion with 20 mL ice-cold 4% paraformaldehyde in
PBS. Spinal cords and DRG (lumbar levels L4 and L5)
were dissected and post-fixed for 1 h at RT, then washed 3 times in PBS and
cryoprotected in 30% sucrose-PBS (w/v) overnight at 4°C. Tissue was
embedded in Tissue-TekOCT Compound (Sakura Finetek) and cryosectioned at 40
μm. Sections were dried at RT and stored at —20°C.
Sections were washed once with PBS (5 min), blocked with a solution of 10%
donkey serum in PBT (PBS, 0.1% Triton X-100) for 1 h at RT and then
incubated overnight at 4°C with primary antibodies in a solution of
1% donkey serum in PBT. Sections were then washed 3 times (15 min each) in
PBT before being incubated for 2 h at RT with fluorophore–conjugated
secondary antibodies (1:1000; Jackson Laboratories) in a solution of 1%
donkey serum in PBT. Sections were again washed 3 times (15 min each) in PBT
before being mounted with Aqua-Poly/Mount (Polysciences). A Zeiss LSM 700
confocal microscope was used to capture images. 3–5 spinal cords were
analyzed for each condition. ImageJ software was used to assess
immunofluorescence, with thresholds set according to signal intensity (Jensen, 2013).The following primary antibodies were used in this study: rabbit
α-Calbindin (1:1,000; Swant), rabbit α-Calretinin (1:1,000;
Swant), sheep α-CGRP (1:1,000; Abcam), rabbit α-cMaf (1:5000;
C Birchmeier, MDC, Berlin), goat α-cRet (1:250; R&D Systems),
goat α-CTB (1:4000; List Laboratories), rabbit α-DsRed
(1:1000; Clontech), mouse α-Gephyrin (1:8000; Synaptic systems);
rabbit α-GFAP (1:500; Dako), chicken α-GFP (1:000; Aves), goat
α-GFP (1:1000; Abcam), rabbit α-GRPR (1:1000; Abcam), rabbit
α-GRPR (1:100; MBL), guinea pig α-Lmx1b (1:1000; M Goulding),
mouse α-NeuN (1:1000; Millipore), rabbit α-NK1R (1:500;
Advanced Targeting Systems), rabbit α-NPY (1:1000; Peninsula Lab),
rabbit α-Parvalbumin (1:1000; Swant), rabbit α-Pax2 (1:200;
Zymed), rat α-RFP (1:1000; Chromotek), rabbit α-PKCg (1:1000;
Santa Cruz), goat α-RORa (1:100; Santa Cruz), rabbit α-S100b
(1:500; Dako), goatTrkB (1:1000; R&D Systems), goat α-TrkC
(1:1000; R&D Systems), guinea pig α-VGAT (1:1000; Synaptic
Systems), guinea pig α-vGluT1 (1:1000; Millipore). In addition, Alexa
Fluor 647-conjugated isolectin GS-IB4 from Griffonia
simplicifolia (Invitrogen) was used at 1:500.
In Situ Hybridization
For in situ hybridization (ISH), mice were perfused
with 4% paraformaldehyde in a solution of 0.1% diethyl pyrocarbonate in PBS
(PBS-DEPC), post fixed for 1 h at RT, washed 3 times with PBS-DEPC and
cryopreserved overnight in 30% sucrose in PBS-DEPC. Spinal cords were
embedded in Tissue-Tek and stored at —80°C. Spinal cords were
then cryosectioned at 16 μm, and sections were hybridized with an
antisense RNA probe overnight at 64°C. Sections were washed twice in
a solution of 1 × saline-sodium citrate buffer, 50% formamide, and
0.1% Tween-20 at 64°C for 30 min and blocked with a solution of 0.1%
Tween 20 in maleic acid buffer (MABT) containing 2% blocking reagent and 10%
inactivated sheep serum for 2 h at RT. Sections were then incubated
overnight with sheep α-digoxigenin-alkaline-phosphatase Fab fragments
(1:2000; Roche), washed twice in MABT and revealed with a staining solution
of NBT (1:500, Roche) and BCIP (1:600, Roche). An Olympus VS-120 Virtual
Slde Scanning Microscope was used for imaging. For double staining analyses,
tdTomato fluorescence was imaged before ISH was performed. ISH images were
later pseudo-colored and superposed onto the tdTomato signal in Photoshop
(Adobe Systems). For quantification, three sections from each of three
spinal cords were analyzed per condition, and only cells with clearly
visible nuclei were scored.
Rabies Virus Tracing and Morphological Analyses
For the sparse labeling of
Y1 neurons required
for morphological reconstruction, EnvA-pseudotyped, ∆G-dsRed-Express
rabies virus (100 μl, 1.28 × 108 units
ml−1) was injected unilaterally into the lumbar spinal
cord of P10 Y1;
R26 mice (Bourane et al., 2015b). For the transsynaptic
tracing studies, bilateral injections of EnvA-pseudotyped, DG-mCherry (250
μl, 3.3 × 1010 units ml−1) were
made into the lumbar cord of
Y1;
Lbx1;
R26 animals at P5.Briefly, mice were anesthetized by administering 2.5% isoflurane via
a nose cone. The skin over the lumbar region of the dorsal spinal cord was
incised and a laminectomy was performed at the T13-L1
level. After removal of the dura mater with a fine needle to expose the
spinal cord, virus was injected via a fine glass capillary inserted into the
dorsal spinal cord. The needle was left in the cord for 1 min after
injection to prevent outflow. The skin was closed using Vetbond (3M) and
Reflex Skin Closure System (CellPoint Scientific). Mice were perfused 5 days
post-injection and processed for immunohistochemistry.
AAV Virus Tracing of Synaptic Connections
To visualize synaptophysin at presynaptic boutons, injections of
AAV2/1-hSyn-DIO-SypHTomato (0.5 μl, 1.6 × 1012
units ml−1) were made into the lumbar spinal cord of P37
Y1::eGFP mice as described above. Spinal cords were
then processed for immunohisto-chemistry at P60.
Retrograde Cholera Toxin-b Labeling of Cutaneous Sensory Neurons
Postnatal day (P) 39 Y1Cre;
Ai14 mice were
anesthetized with 2.5% isoflurane in O2, and Alexa Fluor 647-conjugated
cholera toxin subunit B (CTb) (0.5 μl, 2.5 μg
μl−1 in 0.9% sterile saline; Molecular Probes)
was injected into either the hairy skin of the hindlimb or the glabrous skin
of the plantar hindpaw with a fine glass capillary. Mice were perfused at 3
days post injection and processed for immunohistochemistry.
Cell Ablation
For ablation of neurons expressing Cre and FlpO drivers in addition
to Tau, mice were
injected with diphtheria toxin (DT; 50 ng kg−1 in 0.9%
sterile saline, i.p.; List Biological Laboratories) at P28 and P31 (Bourane et al., 2015a). Analysis of
spontaneous scratching in mice expressing NPY::Cre (and
relevant controls) was performed at P35, 7 days following the first DT
injection. For the double-Cre ablation experiment, controls were positive
for Cre and Tau alleles
but lacked the Lbx1 allele
and did not therefore express the diphtheria toxin receptor; however, all
mice received DT. All other behavioral testing was performed 14–21
days following the first injection; controls were littermates of
experimental animals and had identical genotypes but received injections of
0.9% sterile saline instead of DT.To ablate cells cell populations with saporin-conjugated receptor
ligands, P28mice were given a single intrathecal (i.t.) injection of either
bombesin-saporin (400 ng in 5 μL 0.9% sterile saline; Advanced
Targeting Systems) (Bourane et al.,
2015a) to ablate GRPR+ cells or [Sar9,
Met(O2)11]-substance P-saporin neurons (100 ng in
5 mL 0.9% sterile saline; Advanced Targeting Systems) to ablate
NK1R+ neurons (Wiley and
Lappi, 1999). Littermate controls received blank saporin (equal
mass in 5 μL 0.9% sterile saline; Advanced Targeting Systems).
Behavioral testing and assessment of ablation efficiency by
immunohistochemistry were performed 14 days later at P42.For i.t. injections, mice were anesthetized with 2.5% isoflurane in
O2, delivered via a nose cone. The caudal paralumbar region
was then secured between the thumb and index finger, and a 30-gauge needle
was inserted into the fifth intervertebral space until it elicited a tail
flick. To prevent outflow, the needle was held in place for 10 s and turned
90° prior to withdrawal.
Drug Administration
Synthesis of the selective Y1 receptor agonist [Leu31,
Pro34]-Neuropeptide Y ([Leu31,
Pro34]-NPY; YPSKPDNPGEDAPAEDMARYYS ALRHYINLLTRPRY-NH2)
(Fuhlendorff et al., 1990) was
performed on a Gyros Protein Technologies, Inc. Tribute peptide synthesizer
equipped with real-time UV monitoring, using standard Fmoc chemistry, in the
Salk’s Peptide Synthesis Core. The resultant crude peptide was
purified by the Salk’s Proteomics Core to > 98% using HPLC.
The final, purified product gave a single peak of predicted mass (4240.7 Da)
by MS analysis. The peptide was administered in solution at pH 7.Neuropeptide Y (NPY; Tocris) and [Leu31,
Pro34]-NPY were dissolved in 0.9% sterile saline. Clozapine
N-oxide (CNO; Sigma) and the Y1 receptor antagonist
BIBP 3226 (Tocris) (Jacques et al.,
1995) were dissolved in DMSO, which was then diluted with 0.9%
sterile saline such that the concentration of DMSO did not exceed 1% in
injected solutions. The Y1 receptor antagonist BMS 193885 (Tocris) (Poindexter et al., 2002) was dissolved
in sterile water, which was then rendered isotonic with glucose (5%
w/v).CNO was administered by i.p. injection at 2 mg kg-1.
Other drugs were administered as indicated.CNO, NPY, [Leu31, Pro34]-NPY, and BIBP 3226
were injected 15 min prior to behavioral testing. BMS 193885 was observed to
cause inactivity for ~30 min following i.p. injection, as previously
reported (Antal-Zimanyi et al., 2008);
behavioral testing in BMS 193885-injected mice and vehicle-injected controls
was therefore conducted from 30 to 60 min post injection. WT mice injected
with NPY, [Leu31, Pro34]-NPY, BIBP 3226 or BMS 193885
were compared to vehicle-injected littermate controls.To take into account differences in phenotype severity between
NPY::Cre; Lbx1;
Tau mice treated with DT and
between Lbx1;
Y1 mice, paired t tests were
conducted to assess the effects of Y1 drugs. Recordings were made at 4 h
intervals on the same day.For chemogenetic silencing and activation experiments, all mice
received CNO. Control mice were positive for the Cre and
R26 or
R26 alleles but
lacked the Lbx1 allele and
did not therefore express the hM4D or hM3D receptor.
Electrophysiology
For slice preparations, P14–28 mice were anaesthetized by
i.p. injection of urethane (10 ml/g) and transcardially perfused with
oxygenated ice-cold dissecting/recovery artificial cerebrospinal fluid
(ACSF; NaCl, 95 mM; KCl, 2.5 mM; NaHCO3, 26 mM;
NaH2PO4H2O, 1.25 mM; MgCl2,
6 mM; CaCl2, 1.5mM; glucose, 20 mM; sucrose, 50 mM; Kynurenic
Acid, 1 mM; ethyl pyruvate, 5 mM). The spinal cords were then isolated in
ice-cold dissecting/recovery ACSF before being embedded in low-melting
agarose at 33°C. A vibratome (Leica VT1000S) was used to cut 300
μm transverse slices from lumbar segments L1-5
in ice cold dissecting/recovery ACSF. Slices were then allowed to recover in
dissecting/recovery ACSF at ~34°C for 1 h before being secured in a
recording chamber continuously perfused with recording aCSF (NaCl, 125 mM;
KCl, 2.5 mM; NaHCO3, 26 mM;
NaH2PO4H2O, 1.25 mM; MgCl2,
1 mM; CaCl2, 2 mM; glucose, 20 mM; ethyl pyruvate, 5 mM) at RT.
At all stages, ACSF was equilibrated with carbogen (95% O2; 5%
CO2). Experiments were performed at RT.Patch-clamp electrodes (3–5 MU) were pulled on a horizontal
puller (Sutter Instrument, Novato, CA) from borosilicate glass (World
Precision Instruments, Sarasota, FL). Signals were amplified and filtered (4
kHz low-pass Bessel filter) with a MultiClamp 700B amplifier (Molecular
Devices) and acquired at 50 kHz with a Digidata 1440A A/D board and pCLAMP
software (Molecular Devices). Neuronal firing was elicited by injecting
depolarizing currents ranging from 0 to 200 pA in 20 pA increments for 1 s
at intervals of 10 s. For ReaChR-mediated stimulation of NPY::Cre INs, a
single LED optic fiber source (~2 mW output at 591 nm) was positioned ~10 mm
from the surface of the slice, illuminating its entire surface. Stimulation
was delivered at a pulse width of 5–20 ms. All drugs were bath
applied. Kynurenic acid (1.5 μM; Sigma) and strychnine (1 mM; Sigma)
were dissolved in water. Picrotoxin (60 μM; Sigma) was dissolved in
DMSO such that the concentration of DMSO in recording solution did not
exceed 0.1% (v/v). A liquid junction potential of 14 mV was corrected
offline.
Behavioral Testing
Littermate controls were used for behavioral tests, and the
experimenter was blinded to genotype/treatment. Animals were habituated to
the behavioral testing apparatus for 1 h on each of the two days preceding
data collection. Tests were conducted at P42-P49, or at P35 (7 days
following the first injection of DT) in experiments to assess spontaneous
scratching induced by ablation of NPY::Cre neurons.
Spontaneous Itch
To quantify scratching induced in the absence of an experimental
mechanical stimulus (spontaneous itch), mice were placed in a plastic
chamber and video recorded for a period of 30 min; bouts of hindlimb
scratching were counted offline (Bourane
et al., 2015a).
Nape Stimulation Assay
To quantify itch-related scratching behaviors induced by
mechanical stimulation of the hairy skin, mice were placed in a plastic
chamber and a 0.16 g von Frey hair was applied to the nape for 3 s (as
per Bourane et al., 2015a).
Hindlimb scratching responses over 10 trials were counted and reported
as a percentage.
von Frey Assay
To assess the sensitivity of the glabrous skin to light punctate
mechanical stimulation, mice were placed in a plastic chamber on an
elevated wire grid and the lateral plantar surface of the hindpaw was
stimulated with calibrated von Frey monofilaments (0.008–4 g).
The paw withdrawal threshold for the von Frey assay was determined by
Dixon’s up-down method (Chaplan
et al., 1994).
Dynamic Touch Test
To assess the sensitivity of the glabrous skin to light dynamic
touch, mice were placed in a plastic chamber on an elevated wire grid
and the plantar surface of the hindpaw was stimulated by light stroking
with a fine paintbrush in a heel-to-toe direction (Bourane et al., 2015b). The test was repeated
10 times at 10 s intervals between trails, and the percentage of
positive paw withdrawal trials was calculated.
Pinprick Test
To assess the sensitivity of the glabrous skin to acute painful
stimuli, mice were placed in a plastic chamber on an elevated wire grid
and the plantar surface of the hindpaw was stimulated with an Austerlitz
insect pin (Tip diameter: 0.02 mm; Fine Science Tools). The pin was
gently applied to the plantar surface of the hindpaw without moving the
paw or penetrating the skin. The pin stimulation was repeated 10 times
on different paw areas with a 1–2 min interval between trails,
and the percentage of trials in which mice responded with paw withdrawal
was calculated.
Randall-Selitto Test
Prior to testing, mice were placed in a plastic restraining tube
and allowed 5 min to acclimatize. A Randall-Selitto device (IITC, USA)
was used to apply slowly increasing pressure to a point midway along the
tail until the animal showed clear signs of discomfort. This pressure
was recorded as the pain threshold. Three trials taken at 2 min
intervals were performed to calculate the average threshold for each
animal.
Chemical Nociception Tests
To assess pain induced by chemical agents, a 30-gauge needle was
used to inject 6 mL of either capsaicin (1 mg in 10 mL 9% saline
containing 7% Tween-80) or formalin (2% in 9% saline) subcutaneously
into the plantar hindpaw. The time spent licking, flinching, and biting
the injected hindpaw was recorded for 15 min (capsaicin) or 1 h
(formalin) post-injection. Phase I was defined as the first 10 min post
injection and phase II was defined as the period 10–60 min post
injection.
Hot Plate Test
Mice were placed on a hot plate (IITC, USA) set at 46°C,
50°C or 54°C and the latencies to hindpaw flinching and
licking were measured. All animals were tested sequentially with a
minimum of 5 min between each test. To prevent tissue damage, a cutoff
time was set at 60 s for assays at 46°C and 50°C, and 30 s
for 54°C.
Hargreaves Test
To measure radiant heat pain, mice were placed in a plastic
chamber and the plantar hindpaw surface was exposed to a beam of radiant
heat (IITC, USA). The latency to paw withdrawal was determined in one
trial per hindpaw and averaged per animal, with a 10 min interval
between trials. A cutoff time of 30 s was set to prevent tissue
damage.
Chemical Itch Test
The pruritogens chloroquine (200 mg; Sigma), histamine (100
μg; Sigma), compound 48/80 (100 μg; Sigma) and
SLIGRL-NH2 (SLIGRL; 100 nM; Abcam) were dissolved in 0.9%
sterile saline and injected intradermally behind the ear in a volume of
50 μl. The behavior of each animal was video-recorded over the
following 30 min, and the number of hindpaw scratch bouts was
counted.
QUANTIFICATION AND STATISTICAL ANALYSIS
Data were analyzed in GraphPad Prism 6 for Windows, Version 6.01
(Graphpad Software) or Excel 2016 (Microsoft) by two-tailed, unpaired t tests,
unless otherwise indicated. See figure legends for details of statistical
analyses. p < 0.05 was considered to be statistically significant. All
data are presented as the mean ± standard error of the mean (SEM).All tdTomato signals were enhanced by RFP antibody staining prior to
analysis.
KEY RESOURCES TABLE
REAGENT or RESOURCE
SOURCE
IDENTIFIER
Antibodies
Rabbit α-Calbindin
(1:1000)
Swant
Cat# 300; RRID:AB_10000347
Rabbit α-Calretinin
(1:1000)
Swant
Cat# 7699/3H; RRID:AB_10000321
Sheep α-CGRP
(1:1000)
Abcam
AB22560; RRID:AB_725809
Rabbit α-cMaf
(1:5000)
C Birchmeier, MDC, Berlin
N/A
Goat α-cRet
(1:250)
R&D Systems
Cat# AF482; RRID:AB_2301030
Goat α-CTb
(1:4000),
List Laboratories
Cat# 703; RRID:AB_10013220
Sheep
α-Digoxigenin-AP, Fab fragments (1:2000)
Roche
Cat# 11093274910; RRID:AB_514497
Rabbit α-DsRed
(1:1000)
Clontech
Cat# 632496; RRID: AB_10013483
Mouse α-Gephyrin
(1:8000)
Synaptic Systems
Cat# 147 011; RRID:AB_887717
Rabbit α-GFAP
(1:500)
Dako
Cat# Z0334; RRID:AB_10013382
Chicken α-GFP
(1:000)
Aves
Cat # GFP-1020; RRID:AB_10000240
Goat α-GFP
(1:1000)
Abcam
Cat# ab6673; RRID:AB_305643
Rabbit α-GRPR
(1:100)
MBL
Cat# LS-A831; RRID:AB_591750
Rabbit α-GRPR
(1:1000)
Abcam
Cat# ab39883; RRID:AB_880315
Guinea pig α-Lmx1b
(1:1000)
M Goulding
N/A
Rabbit α-MafA
(1:5000)
C Birchmeier, MDC, Berlin
N/A
Mouse α-NeuN
(1:1000)
Millipore
Cat# MAB377; RRID:AB_2298772
Rabbit
α-Neuropeptide Y1 Receptor (1:100)
Alomone Labs
Cat# ANR-021: RRID:AB_2040030
Rabbit α-NF200
(1:1000)
Sigma
Cat# N4142; RRID:AB_477272
Rabbit α-NK1R
(1:500)
Advanced Targeting Systems
Cat# AB-N33ap; RRID:AB_458739
Rabbit α-NPY
(1:1000)
Peninsula Lab
Cat# T-4070.0050; RRID:AB_518504
Rabbit α-Pax2
(1:200)
Zymed
Cat# 71–6000; RRID:AB_2533990
Rabbit
α-Parvalbumin (1:2000)
Swant
Cat# PV-25; RRID:AB_10000344
Rabbit
α-PKCγ (1:1000)
Santa Cruz
Cat# SC-211; RRID:AB_632234
Rat α-RFP
(1:1000)
Chromotek
Cat#5F8; RRID: AB_2336064
Goat
α-RORα (1:100)
Santa Cruz
Cat# sc-6062; RRID:AB_655755
Rabbit
α-S100β (1:500)
Dako
Cat# Z0311; RRID:AB_10013383
Chicken α-TrkB
(1:1000)
R&D Systems
Cat# AF1494; RRID:AB_2155264
Goat α-TrkC
(1:1000)
R&D Systems
Cat# AF1404; RRID:AB_2155412
Guinea pig α-VGAT
(1:1000)
Synaptic Systems
Cat# 131004; RRID:AB_887873
Guinea pig α-vGluT1
(1:1000)
Millipore
Cat# AB5905; RRID: AB_2301751
Bacterial and Virus
Strains
EnvA-pseudotyped, ∆G-mCherry
Janelia Viral Core/HHMI
Wickersham
et al., 2007
EnvA-pseudotyped,
∆G-dsRed-Express
Janelia Viral Core/HHMI
Wickersham
et al., 2007
AAV2/1-hSyn-DIO-SypHTom
Koch et
al., 2017
N/A
Chemicals, Peptides, and
Recombinant Proteins
Isolectin GS-IB4 From Griffonia simplicifolia,
Alexa Fluor 647 Conjugate (1:500)
Invitrogen
Cat# I32450; RRID:SCR_014365
Cholera Toxin Subunit b (Recombinant), Alexa
Fluor 647 Conjugate
Invitrogen
Cat# C34778
Diphtheria Toxin, Unnicked, from
Corynebacterium diphtheria
Authors: Sarah E Ross; Alan R Mardinly; Alejandra E McCord; Jonathan Zurawski; Sonia Cohen; Cynthia Jung; Linda Hu; Stephanie I Mok; Anar Shah; Erin M Savner; Christos Tolias; Roman Corfas; Suzhen Chen; Perrine Inquimbert; Yi Xu; Roderick R McInnes; Frank L Rice; Gabriel Corfas; Qiufu Ma; Clifford J Woolf; Michael E Greenberg Journal: Neuron Date: 2010-03-25 Impact factor: 17.173
Authors: Cedric Peirs; Sean-Paul G Williams; Xinyi Zhao; Claire E Walsh; Jeremy Y Gedeon; Natalie E Cagle; Adam C Goldring; Hiroyuki Hioki; Zheng Liu; Paulina S Marell; Rebecca P Seal Journal: Neuron Date: 2015-08-19 Impact factor: 17.173
Authors: Linda Madisen; Aleena R Garner; Daisuke Shimaoka; Amy S Chuong; Nathan C Klapoetke; Lu Li; Alexander van der Bourg; Yusuke Niino; Ladan Egolf; Claudio Monetti; Hong Gu; Maya Mills; Adrian Cheng; Bosiljka Tasic; Thuc Nghi Nguyen; Susan M Sunkin; Andrea Benucci; Andras Nagy; Atsushi Miyawaki; Fritjof Helmchen; Ruth M Empson; Thomas Knöpfel; Edward S Boyden; R Clay Reid; Matteo Carandini; Hongkui Zeng Journal: Neuron Date: 2015-03-04 Impact factor: 17.173
Authors: William T Ralvenius; Elena Neumann; Martina Pagani; Mario A Acuña; Hendrik Wildner; Dietmar Benke; Nina Fischer; Ana Rostaher; Simon Schwager; Michael Detmar; Katrin Frauenknecht; Adriano Aguzzi; Jed Lee Hubbs; Uwe Rudolph; Claude Favrot; Hanns Ulrich Zeilhofer Journal: Nat Commun Date: 2018-08-13 Impact factor: 14.919