Mining the Na _v 1.7 interactome: Opportunities for chronic pain therapeutics

The peripherally expressed voltage-gated sodium Na _V 1.7 (gene SCN9A) channel boosts small stimuli to initiate firing of pain-signaling dorsal root ganglia (DRG) neurons and facilitates neurotransmitter release at the first synapse within the spinal cord. Mutations in SCN9A produce distinct human pain syndromes. Widely acknowledged as a “gatekeeper” of pain, Na _V 1.7 has been the focus of intense investigation but, to date, no Na _V 1.7-selective drugs have reached the clinic. Elegant crystallographic studies have demonstrated the potential of designing highly potent and selective Na _V 1.7 compounds but their therapeutic value remains untested. Transcriptional silencing of Na _V 1.7 by a naturally expressed antisense transcript has been reported in rodents and humans but whether this represents a viable opportunity for designing Na _V 1.7 therapeutics is currently unknown. The demonstration that loss of Na _V 1.7 function is associated with upregulation of endogenous opioids and potentiation of mu- and delta-opioid receptor activities, suggests that targeting only Na _V 1.7 may be insufficient for analgesia. However, the link between opioid-dependent analgesic mechanisms and function of sodium channels and intracellular sodium-dependent signaling remains controversial. Thus, additional new targets – regulators, modulators – are needed. In this context, we mine the literature for the known interactome of Na _V 1.7 with a focus on protein interactors that affect the channel's trafficking or link it to opioid signaling. As a case study, we present antinociceptive evidence of allosteric regulation of Na _V 1.7 by the cytosolic collapsin response mediator protein 2 (CRMP2). Throughout discussions of these possible new targets, we offer thoughts on the therapeutic implications of modulating Na _V 1.7 function in chronic pain.