Towards Understanding Neuropathy from Cancer Chemotherapy and Pathophysiology of Pain Sensation: an Engineering Approach

Parul Verma, Purdue University

Abstract

This thesis addresses chemotherapy-induced peripheral neuropathy (CIPN)- a form of pain sensation and a prevalent dose-limiting side-effect of several chemotherapy agents such as vincristine, paclitaxel, and oxaliplatin. These agents are used for treating various cancers such as leukemia, brain tumor, lung cancer. Peripheral neuropathy is a numbing, tingling, and burning sensation felt in the palms and feet, which occurs due to damage to neurons (nerve cells). Prolonged CIPN can impact the quality of life of cancer patients. Occasionally, severe CIPN can result in termination of chemotherapy treatment altogether. Currently, there are no established strategies for treating CIPN due to a lack of understanding of its mechanisms. Moreover, different patients react differently to the same treatment; a subgroup of patient population may never experience CIPN, while another may experience severe CIPN for the same dose. In addition, there are no established strategies for predicting CIPN either. This thesis addresses both prediction and mechanisms of CIPN. The following paragraphs reflect the organization of this thesis. Each paragraph introduces a research problem, the approaches taken to investigate it, and states the key results. First, a metabolomics-based approach was used to investigate CIPN prediction. Blood samples of pediatric leukemic cancer patients who underwent treatment with a chemotherapy agent - vincristine were provided. These blood samples were analyzed at different treatment time points using mass spectrometry to obtain the metabolite profiles. Machine learning was then employed to identify specific metabolites that can predict overall susceptibility to peripheral neuropathy in those patients at specific treatment time points. Subsequently, selected metabolites were used to train machine learning models to predict neuropathy susceptibility. Finally, the models were deployed into an open-source interactive tool- VIPNp- that can be used by researchers to predict CIPN in new pediatric leukemic cancer patients. Second, the focus was shifted to the pathophysiology of pain and the pain-sensing neuron; specifically: (i) investigating pain sensation mutations and the dynamics of the pain-sensing neuron, and (ii) exploring chemotherapy-induced peripheral neuropathy mechanisms While pain is a common experience, genetic mutations in individuals can alter their experience of pain, if any at all (certain mutations yield individuals insensitive to pain). Despite its ubiquity, we do not have a complete understanding of the onset and/or mechanisms of pain sensation. Pain sensation can be broadly classified into three types: (i) nociceptive, (ii) neuropathic, and (iii) inflammatory. Nociceptive pain arises due to a noxious external stimulus (e.g., upon touching a hot object). Neuropathic pain (which is felt as a side-effect of the aforementioned chemotherapy agents) is the numbing and tingling sensation due to nerve damage. Inflammatory pain occurs due to damage to internal tissues. Pain in any form can be characterized in terms of electrical signaling by the pain-sensing neuron. Signal transmission regarding pain occurs through generation of an electrical signal called the action potential- a peak in neuron membrane potential. Excessive firing of action potentials by a pain-sensing neuron indicates pain of a specific form and intensity. In order to investigate this electrical signaling, a mathematical modeling approach was employed. The neuron membrane was assumed to be an electrical circuit and the potential across the membrane was modeled in terms of the sodium and potassium ions flowing across it via voltage-gated sodium and potassium channels, respectively.

Degree

Ph.D.

Advisors

Ramkrishna, Purdue University.

Subject Area

Health sciences|Medicine|Oncology|Therapy

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