Descending locus coeruleus noradrenergic signaling to spinal astrocyte subset is required for stress-induced pain facilitation

Reviewer #1 (Public review):

Summary

In this article, Kawanabe-Kobayashi et al., aim to examine the mechanisms by which stress can modulate pain in mice. They focus on the contribution of noradrenergic neurons (NA) of the locus coeruleus (LC). The authors use acute restraint stress as a stress paradigm and found that following one hour of restraint stress mice display mechanical hypersensitivity. They show that restraint stress causes the activation of LC NA neurons and the release of NA in the spinal cord dorsal horn (SDH). They then examine the spinal mechanisms by which LC→SDH NA produces mechanical hypersensitivity. The authors provide evidence that NA can act on alphaA1Rs expressed by a class of astrocytes defined by the expression of Hes (Hes+). Furthermore, they found that NA, presumably through astrocytic release of ATP following NA action on alphaA1Rs Hes+ astrocytes, can cause an adenosine-mediated inhibition of SDH inhibitory interneurons. They propose that this disinhibition mechanism could explain how restraint stress can cause the mechanical hypersensitivity they measured in their behavioral experiments.

Strengths:

(1) Significance. Stress profoundly influences pain perception; resolving the mechanisms by which stress alters nociception in rodents may explain the well-known phenomenon of stress-induced analgesia and/or facilitate the development of therapies to mitigate the negative consequences of chronic stress on chronic pain.

(2) Novelty. The authors' findings reveal a crucial contribution of Hes+ spinal astrocytes in the modulation of pain thresholds during stress.

(3) Techniques. This study combines multiple approaches to dissect circuit, cellular, and molecular mechanisms including optical recordings of neural and astrocytic Ca2+ activity in behaving mice, intersectional genetic strategies, cell ablation, optogenetics, chemogenetics, CRISPR-based gene knockdown, slice electrophysiology, and behavior.

Weaknesses:

(1) Mouse model of stress. Although chronic stress can increase sensitivity to somatosensory stimuli and contribute to hyperalgesia and anhedonia, particularly in the context of chronic pain states, acute stress is well known to produce analgesia in humans and rodents. The experimental design used by the authors consists of a single one-hour session of restraint stress followed by 30 min to one hour of habituation and measurement of cutaneous mechanical sensitivity with von Frey filaments. This acute stress behavioral paradigm corresponds to the conditions in which the clinical phenomenon of stress-induced analgesia is observed in humans, as well as in animal models. Surprisingly, however, the authors measured that this acute stressor produced hypersensitivity rather than antinociception. This discrepancy is significant and requires further investigation.

(2) Specifically, is the hypersensitivity to mechanical stimulation also observed in response to heat or cold on a hotplate or coldplate?

(3) Using other stress models, such as a forced swim, do the authors also observe acute stress-induced hypersensitivity instead of stress-induced antinociception?

(4) Measurement of stress hormones in blood would provide an objective measure of the stress of the animals.

(5) Results:

a) Optical recordings of Ca2+ activity in behaving rodents are particularly useful to investigate the relationship between Ca2+ dynamics and the behaviors displayed by rodents.

b) The authors report an increase in Ca2+ events in LC NA neurons during restraint stress: Did mice display specific behaviors at the time these Ca2+ events were observed such as movements to escape or orofacial behaviors including head movements or whisking?

c) Additionally, are similar increases in Ca2+ events in LC NA neurons observed during other stressful behavioral paradigms versus non-stressful paradigms?

d) Neuronal ablation to reveal the function of a cell population.

e) The proportion of LC NA neurons and LC→SDH NA neurons expressing DTR-GFP and ablated should be quantified (Figures 1G and J) to validate the methods and permit interpretation of the behavioral data (Figures 1H and K). Importantly, the nocifensive responses and behavior of these mice in other pain assays in the absence of stress (e.g., hotplate) and a few standard assays (open field, rotarod, elevated plus maze) would help determine the consequences of cell ablation on processing of nociceptive information and general behavior.

f) Confirmation of LC NA neuron function with other methods that alter neuronal excitability or neurotransmission instead of destroying the circuit investigated, such as chemogenetics or chemogenetics, would greatly strengthen the findings. Optogenetics is used in Figure 1M, N but excitation of LC→SDH NA neuron terminals is tested instead of inhibition (to mimic ablation), and in naïve mice instead of stressed mice.

g) Alpha1Ars. The authors noted that "Adra1a mRNA is also expressed in INs in the SDH".

h) The authors should comprehensively indicate what other cell types present in the spinal cord and neurons projecting to the spinal cord express alpha1Ars and what is the relative expression level of alpha1Ars in these different cell types.

i) The conditional KO of alpha1Ars specifically in Hes5+ astrocytes and not in other cell types expressing alpha1Ars should be quantified and validated (Figure 2H).

j) Depolarization of SDH inhibitory interneurons by NA (Figure 3). The authors' bath applied NA, which presumably activates all NA receptors present in the preparation.

k) The authors' model (Figure 4H) implies that NA released by LC→SDH NA neurons leads to the inhibition of SDH inhibitory interneurons by NA. In other experiments (Figure 1L, Figure 2A), the authors used optogenetics to promote the release of endogenous NA in SDH by LC→SDH NA neurons. This approach would investigate the function of NA endogenously released by LC NA neurons at presynaptic terminals in the SDH and at physiological concentrations and would test the model more convincingly compared to the bath application of NA.

l) As for other experiments, the proportion of Hes+ astrocytes that express hM3Dq, and the absence of expression in other cells, should be quantified and validated to interpret behavioral data.

m) Showing that the effect of CNO is dose-dependent would strengthen the authors' findings.

n) The proportion of SG neurons for which CNO bath application resulted in a reduction in recorded sIPSCs is not clear.

o) A1Rs. The specific expression of Cas9 and guide RNAs, and the specific KD of A1Rs, in inhibitory interneurons but not in other cell types expressing A1Rs should be quantified and validated.

(6) Methods:

It is unclear how fiber photometry is performed using "optic cannula" during restraint stress while mice are in a 50ml falcon tube (as shown in Figure 1A).

Reviewer #2 (Public review):

Summary:

This study investigates the role of spinal astrocytes in mediating stress-induced pain hypersensitivity, focusing on the LC (locus coeruleus)-to-SDH (spinal dorsal horn) circuit and its mechanisms. The authors aimed to delineate how LC activity contributes to spinal astrocytic activation under stress conditions, explore the role of noradrenaline (NA) signaling in this process, and identify the downstream astrocytic mechanisms that influence pain hypersensitivity.

The authors provide strong evidence that 1-hour restraint stress-induced pain hypersensitivity involves the LC-to-SDH circuit, where NA triggers astrocytic calcium activity via alpha1a adrenoceptors (alpha1aRs). Blockade of alpha1aRs on astrocytes - but not on Vgat-positive SDH neurons - reduced stress-induced pain hypersensitivity. These findings are rigorously supported by well-established behavioral models and advanced genetic techniques, uncovering the critical role of spinal astrocytes in modulating stress-induced pain.

However, the study's third aim - to establish a pathway from astrocyte alpha1aRs to adenosine-mediated inhibition of SDH-Vgat neurons - is less compelling. While pharmacological and behavioral evidence is intriguing, the ex vivo findings are indirect and lack a clear connection to the stress-induced pain model. Despite these limitations, the study advances our understanding of astrocyte-neuron interactions in stress-pain contexts and provides a strong foundation for future research into glial mechanisms in pain hypersensitivity.

Strengths:

The study is built on a robust experimental design using a validated 1-hour restraint stress model, providing a reliable framework to investigate stress-induced pain hypersensitivity. The authors utilized advanced genetic tools, including retrograde AAVs, optogenetics, chemogenetics, and subpopulation-specific knockouts, allowing precise manipulation and interrogation of the LC-SDH circuit and astrocytic roles in pain modulation. Clear evidence demonstrates that NA triggers astrocytic calcium activity via alpha1aRs, and blocking these receptors effectively reduces stress-induced pain hypersensitivity.

Weaknesses:

Despite its strengths, the study presents indirect evidence for the proposed NA-to-astrocyte(alpha1aRs)-to-adenosine-to-SDH-Vgat neurons pathway, as the link between astrocytic adenosine release and stress-induced pain remains unclear. The ex vivo experiments, including NA-induced depolarization of Vgat neurons and chemogenetic stimulation of astrocytes, are challenging to interpret in the stress context, with the high CNO concentration raising concerns about specificity. Additionally, the role of astrocyte-derived D-serine is tangential and lacks clarity regarding its effects on SDH Vgat neurons. The astrocyte calcium signal "dip" after LC optostimulation-induced elevation are presented without any interpretation.

Reviewer #3 (Public review):

Summary

This is an exciting and timely study addressing the role of descending noradrenergic systems in nocifensive responses. While it is well-established that spinally released noradrenaline (aka norepinephrine) generally acts as an inhibitory factor in spinal sensory processing, this system is highly complex. Descending projections from the A6 (locus coeruleus, LC) and the A5 regions typically modulate spinal sensory processing and reduce pain behaviours, but certain subpopulations of LC neurons have been shown to mediate pronociceptive effects, such as those projecting to the prefrontal cortex (Hirshberg et al., PMID: 29027903).

The study proposes that descending cerulean noradrenergic neurons potentiate touch sensation via alpha-1 adrenoceptors on Hes5+ spinal astrocytes, contributing to mechanical hyperalgesia. This finding is consistent with prior work from the same group (dd et al., PMID:). However, caution is needed when generalising about LC projections, as the locus coeruleus is functionally diverse, with differences in targets, neurotransmitter co-release, and behavioural effects. Specifying the subpopulations of LC neurons involved would significantly enhance the impact and interpretability of the findings.

Strengths

The study employs state-of-the-art molecular, genetic, and neurophysiological methods, including precise CRISPR and optogenetic targeting, to investigate the role of Hes5+ astrocytes. This approach is elegant and highlights the often-overlooked contribution of astrocytes in spinal sensory gating. The data convincingly support the role of Hes5+ astrocytes as regulators of touch sensation, coordinated by brain-derived noradrenaline in the spinal dorsal horn, opening new avenues for research into pain and touch modulation.

Furthermore, the data support a model in which superficial dorsal horn (SDH) Hes5+ astrocytes act as non-neuronal gating cells for brain-derived noradrenergic (NA) signalling through their interaction with substantia gelatinosa inhibitory interneurons. Locally released adenosine from NA-stimulated Hes5+ astrocytes, following acute restraint stress, may suppress the function of SDH-Vgat+ inhibitory interneurons, resulting in mechanical pain hypersensitivity. However, the spatially restricted neuron-astrocyte communication underlying this mechanism requires further investigation in future studies.

Weaknesses

(1) Specificity of the LC Pathway targeting

The main concern lies with how definitively the LC pathway was targeted. Were other descending noradrenergic nuclei, such as A5 or A7, also labelled in the experiments? The authors must convincingly demonstrate that the observed effects are mediated exclusively by LC noradrenergic terminals to substantiate their claims (i.e. "we identified a circuit, the descending LC→SDH-NA neurons").

a) For instance, the direct vector injection into the LC likely results in unspecific effects due to the extreme heterogeneity of this nucleus and retrograde labelling of the A5 and A7 nuclei from the LC (i.e., Li et al., PMID: 26903420).

b) It is difficult to believe that the intersectional approach described in the study successfully targeted LC→SDH-NA neurons using AAVrg vectors. Previous studies (e.g., PMID: 34344259 or PMID: 36625030) demonstrated that similar strategies were ineffective for spinal-LC projections. The authors should provide detailed quantification of the efficiency of retrograde labelling and specificity of transgene expression in LC neurons projecting to the SDH.

c) Furthermore, it is striking that the authors observed a comparably strong phenotypical change in Figure 1K despite fewer neurons being labelled, compared to Figure 1H and 1N with substantially more neurons being targeted. Interestingly, the effect in Figure 1K appears more pronounced but shorter-lasting than in the comparable experiment shown in Figure 1H. This discrepancy requires further explanation.

d) A valuable addition would be staining for noradrenergic terminals in the spinal cord for the intersectional approach (Figure 1J), as done in Figures 1F/G. LC projections terminate preferentially in the SDH, whereas A5 projections terminate in the deep dorsal horn (DDH). Staining could clarify whether circuits beyond the LC are being ablated.

e) Furthermore, different LC neurons often mediate opposite physiological outcomes depending on their projection targets-for example, dorsal LC neurons projecting to the prefrontal cortex PFCx are pronociceptive, while ventral LC neurons projecting to the SC are antinociceptive (PMIDs: 29027903, 34344259, 36625030). Given this functional diversity, direct injection into the LC is likely to result in nonspecific effects.

Conclusion on Specificity: The authors are strongly encouraged to address these limitations directly, as they significantly affect the validity of the conclusions regarding the LC pathway. Providing more robust evidence, acknowledging experimental limitations, and incorporating complementary analyses would greatly strengthen the manuscript.

(2) Discrepancies in Data

a) Figures 1B and 1E: The behavioural effect of stress on PWT (Figure 1E) persists for 120 minutes, whereas Ca²⁺ imaging changes (Figure 1B) are only observed in the first 20 minutes, with signal attenuation starting at 30 minutes. This discrepancy requires clarification, as it impacts the proposed mechanism.

b) Figure 4E: The effect is barely visible, and the tissue resembles "Swiss cheese," suggesting poor staining quality. This is insufficient for such an important conclusion. Improved staining and/or complementary staining (e.g., cFOS) are needed. Additionally, no clear difference is observed between Stress+Ab stim. and Stress+Ab stim.+CPT, raising doubts about the robustness of the data.

c) Discrepancy with Existing Evidence: The claim regarding the pronociceptive effect of LC→SDH-NAergic signalling on mechanical hypersensitivity contrasts with findings by Kucharczyk et al. (PMID: 35245374), who reported no facilitation of spinal convergent (wide-dynamic range) neuron responses to tactile mechanical stimuli, but potent inhibition to noxious mechanical von Frey stimulation. This discrepancy suggests alternative mechanisms may be at play and raises the question of why noxious stimuli were not tested.

(3) Sole reliance on Von Frey testing

The exclusive use of von Frey as a behavioural readout for mechanical sensitisation is a significant limitation. This assay is highly variable, and without additional supporting measures, the conclusions lack robustness. Incorporating other behavioural measures, such as the adhesive tape removal test to evaluate tactile discomfort, the needle floor walk corridor to assess sensitivity to uneven or noxious surfaces, or the kinetic weight-bearing test to measure changes in limb loading during movement, could provide complementary insights. Physiological tests, such as the Randall-Selitto test for noxious pressure thresholds or CatWalk gait analysis to evaluate changes in weight distribution and gait dynamics, would further strengthen the findings and allow for a more comprehensive assessment of mechanical sensitisation.

Overall Conclusion

This study addresses an important and complex topic with innovative methods and compelling data. However, the conclusions rely on several assumptions that require more robust evidence. Specificity of the LC pathway, experimental discrepancies, and methodological limitations (e.g., sole reliance on von Frey) must be addressed to substantiate the claims. With these issues resolved, this work could significantly advance our understanding of astrocytic and noradrenergic contributions to pain modulation.