Tissue Accumulation of Neutrophil Extracellular Traps Mediates Muscle Hyperalgesia in a Mouse Model

Abstract Background: Accumulation of uric acid during muscular trauma is potentially a causative factor of damage-associated molecular patterns (DAMPs) involved in the development of muscle hyperalgesia. Neutrophil extracellular traps (NETs), DNA-based reticular structures to capture DAMPs, play a central role in the onset of pain in gout attacks associated with hyperuricemia; however, their association with muscle hyperalgesia due to overuse injuries remains unknown. Therefore, the aim of this study was to investigate the involvement of NETs via the elevation of local uric acid level in muscle nociception.Methods: The triceps surae muscles (TSMs) in the unilateral hindlimb of mice were repeatedly stimulated with electrical pulses to induce excessive muscle contraction, and the contralateral TSM was used as a control. In addition to mechanical nociceptive thresholds, tissue uric acid levels, neutrophil recruitment, protein amount, and histological distribution of citrullinated histone 3 (citH3), a major marker of NETs, were investigated. Furthermore, whether neutrophil depletion, extracellular DNA cleavage (deoxyribonuclease I), and administration of the urate-lowering agent febuxostat, a xanthine oxidase inhibitor, improved muscle hyperalgesia due to NET accumulation was examined. Using a combination of multiphoton imaging analysis and intravital fluorescence staining, we also evaluated the intramuscular distribution of NET accumulation in stimulated TSMs.Results: CitH3 expression upon neutrophil recruitment significantly increased in the stimulated TSMs tissues with an increase in tissue uric acid levels. However, neutrophil depletion and extracellular DNA cleavage prevented the increase in uric acid levels in damaged muscle tissues. Furthermore, febuxostat administration significantly improved muscle hyperalgesia, with decreases not only in citH3 and tissue uric acid levels, but also in neutrophil recruitment. Interestingly, the intramuscular distribution of NETs in the stimulated TSM was predominantly observed in the myofascial region.Conclusions: Our findings suggest that NET accumulation caused by excessive muscle contraction was strongly associated with the pathogenesis of muscle hyperalgesia. Further, the mechanism underlying induction of locally recruited neutrophils forming NETs was increased tissue uric acid levels, which potentially plays a significant role in creating a vicious circle of muscle pain.