The genetic architecture of fibromyalgia across 2.5 million individuals
A CELF4 DNA variation rs948440 showed up in patients with Myalgic encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) in this study (2):
Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome
Some patients with fibromyalgia and some patients with ME/CFS have Multiple Chemical Sensitivity (MCS). Could deficiency of the gene CELF4 be involved?
This study informs us about CELF4 (3):
Quote from reference 3:
"CELF4 is a powerful negative regulator of sensory neuron excitability and sensory thresholds to heat and mechanical stimuli resulting in thermal and mechanical hypersensitivity in uninjured mice and exacerbating hypersensitivity in injured mice."
"CELF4 expression is most highly enriched in small to medium diameter neurons that co-express the capsaicin receptor, TRPV1"
"Capsaicin-sensitive Celf4 KO neurons are robustly hyperexcitable"
(KO=Knock-Out)
This study also informs us about CELF4 (4):
Aberrant sodium channel activity in the complex seizure disorder of Celf4 mutant mice
Quote from reference 4:"
"In the present study we find that CELF4 deficiency results in a dramatic elevation in the expression of Nav1.6 protein at the AIS in both null and heterozygous neurons."
(AIS = axon initial segment. SCN8A encodes the protein Nav1.6.)
This study informs us about TRPV1 and TRPA1 (5):
The dual role of TRPV1 in peripheral neuropathic pain: pain switches caused by its sensitization or desensitization.
Quote from reference 5:
"TRPV1’s interaction with TRPA1 channels further influences chronic pain onset and progression."
- CELF4 is a negative regulator: The protein CELF4 functions as a brake on sensory neuron excitability.
- Loss of CELF4 increases sensitivity: When CELF4 is not functioning properly, sensory neurons become more "excitable," leading to heightened sensitivity to mechanical and heat stimuli.
- Evidence from studies: Experiments have demonstrated that mice lacking sufficient CELF4 display a greater response to stimuli like heat and pressure, showing clear mechanical and thermal hypersensitivity.
- Relevance to multiple chemical sensitivity: The hypersensitivity observed in these studies is relevant to conditions like multiple chemical sensitivity, which is characterized by an overreaction of the nervous system to various chemical triggers.
- Deltamethrin (DM) exposure: Studies have shown that DM can affect Nav1.6 channels in certain neurons, specifically in the nucleus accumbens (MSNs). This can lead to changes in both the persistent and tail current densities of these channels.
- Impact on neuronal excitability: By altering Nav1.6 function, DM may affect the overall excitability of these neurons. This could provide insights into the initial mechanisms of injury from toxin exposure, which could be relevant to MCS symptoms.
- Pain and touch: Nav1.6 is a key sodium channel in sensory neurons that are responsible for transmitting pain and touch signals.
- Pain signaling: Increased Nav1.6 activity can enhance responses to pain, while reducing Nav1.6 can alleviate pain in animal models of inflammation and nerve injury. This suggests that Nav1.6 plays a significant role in pain perception, which is a common symptom in MCS.
- CELF4 and Nav1.6: CELF4 negatively regulates the synthesis of the Nav1.6 sodium channel, meaning less CELF4 activity leads to more Nav1.6 protein available to the neuron.
- TRPV1 and Nav1.6: Activation of TRPV1 by agonists like capsaicin increases the amplitude of Nav1.6 currents. This suggests a direct functional interaction where TRPV1 activity can enhance the excitability of neurons that have Nav1.6 channels.
- CELF4 and TRPV1: CELF4 is enriched in sensory neurons and acts as a negative regulator of sensory neuron excitability. It also targets mRNAs involved in synaptic development, which would indirectly affect the function of other proteins like TRPV1, influencing sensory thresholds.
- When CELF4 is present and functional, it limits the amount of Nav1.6, which dampens overall neuronal excitability.
- When CELF4 is deficient, more Nav1.6 is synthesized, leading to increased neuronal excitability and sensory hypersensitivity.
- Activation of TRPV1 in a neuron with available Nav1.6 channels can further increase the neuron's excitability by boosting the sodium current.
- These interactions are crucial for the nervous system to finely tune sensory information and neuronal activity.
- Sensitization: The TRPV1 receptor, along with the TRPA1 receptor, appears to be sensitized in people with MCS. This means the receptors are more easily triggered than in non-sensitive individuals.
- Chemical activation: TRPV1 is activated by various substances involved in MCS, including capsaicin. Studies have shown that individuals with MCS exhibit a hyperresponsive TRPV1 receptor, which is consistent with the heightened chemical sensitivity they experience.
- Nitric oxide and NMDA receptors: Hyperresponsiveness of TRPV1 in MCS may contribute to increased nitric oxide (NO) levels and N-methyl-D-aspartate (NMDA) receptor activity, which are factors thought to play a central role in the condition.
- Brain imaging: Functional brain imaging studies have provided further support for the role of TRPV1 by showing that its activation in MCS patients leads to brain-region-specific neuronal variations not seen in controls.
Me: Is TRPA1 involved in Multiple Chemical Sensitivity?
- Sensitization of TRP receptors: TRPA1, along with TRPV1, is part of a group of sensory receptors that appear to be overactive in people with MCS.
- Exaggerated responses: This sensitization means that TRPA1 receptors can trigger a stronger inflammatory and irritative response to chemicals that would normally not cause such a strong reaction.
- Contribution to symptoms: The activation of TRPA1 by irritants can lead to symptoms like respiratory irritation and headaches, which are common in MCS, notes ScienceDirect and the National Institutes of Health.
- Role in inflammation: The activation of TRPA1 can trigger a cascade of events, including the release of inflammatory neuropeptides, which contributes to symptoms like neurogenic inflammation.
- Growing scientific consensus: Research is increasingly supporting the biological basis for MCS, moving away from the view that it is purely psychological.
References:
1) The genetic architecture of fibromyalgia across 2.5 million individuals
Isabel Kerrebijn, Gyda Bjornsdottir, Keon Arbabi, Lea Urpa, Hele Haapaniemi, Gudmar Thorleifsson, Lilja Stefansdottir, Stephan Frangakis, Jesse Valliere, Lovemore Kunorozva, Erik Abner, Caleb Ji, Bitten Aagaard, Henning Bliddal, Søren Brunak, Mie T Bruun, Maria Didriksen, Christian Erikstrup, Arni J Geirsson, Daniel F Gudbjartsson, Thomas F Hansen, Ingileif Jonsdottir, Stacey Knight, Kirk U Knowlton, Christina Mikkelsen, Lincoln D Nadauld, Thorunn A Olafsdottir, Sisse R Ostrowski, Ole BV Pedersen, Saedis Saevarsdottir, Astros T Skuladottir, Erik Sørensen, Hreinn Stefansson, Patrick Sulem, Olafur A Sveinsson, Gudny E Thorlacius, Unnur Thorsteinsdottir, Henrik Ullum, Arnor Vikingsson, Thomas M Werge, Chronic Pain Genomics Consortium, FinnGen, DBDS Genomic Consortium, Estonian Biobank Research Team, Genes & Health Research Team, Richa Saxena, Kari Stefansson, Chad M Brummett, Bente Glintborg, Daniel J Clauw, Thorgeir E Thorgeirsson, Frances MK Williams, Nasa Sinnott-Armstrong, Hanna M Ollila, Michael Wainberg
medRxiv 2025.09.18.25335914; doi: https://doi.org/10.1101/2025.09.18.25335914
https://www.medrxiv.org/content/10.1101/2025.09.18.25335914v1
This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
2) Schlauch KA, Khaiboullina SF, De Meirleir KL, Rawat S, Petereit J, Rizvanov AA, Blatt N, Mijatovic T, Kulick D, Palotás A, Lombardi VC. Genome-wide association analysis identifies genetic variations in subjects with myalgic encephalomyelitis/chronic fatigue syndrome. Transl Psychiatry. 2016 Feb 9;6(2):e730. doi: 10.1038/tp.2015.208. PMID: 26859813; PMCID: PMC4872418.
https://pubmed.ncbi.nlm.nih.gov/41089293/
4) Sun W, Wagnon JL, Mahaffey CL, Briese M, Ule J, Frankel WN. Aberrant sodium channel activity in the complex seizure disorder of Celf4 mutant mice. J Physiol. 2013 Jan 1;591(1):241-55. doi: 10.1113/jphysiol.2012.240168. Epub 2012 Oct 22. PMID: 23090952; PMCID: PMC3630783.
https://pubmed.ncbi.nlm.nih.gov/23090952/
5) Gao N, Li M, Wang W, Liu Z, Guo Y. The dual role of TRPV1 in peripheral neuropathic pain: pain switches caused by its sensitization or desensitization. Front Mol Neurosci. 2024 Sep 9;17:1400118. doi: 10.3389/fnmol.2024.1400118. PMID: 39315294; PMCID: PMC11417043.
https://www.frontiersin.org/journals/molecular-neuroscience/articles/10.3389/fnmol.2024.1400118/full
6) Molot J, Sears M, Marshall LM, Bray RI. Neurological susceptibility to environmental exposures: pathophysiological mechanisms in neurodegeneration and multiple chemical sensitivity. Rev Environ Health. 2021 Sep 16;37(4):509-530. doi: 10.1515/reveh-2021-0043. PMID: 34529912.
https://pubmed.ncbi.nlm.nih.gov/34529912/
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