Repressor element 1-silencing transcription factor drives the development of chronic pain states.

Chronic pain is an unmet clinical problem with vast individual, societal and economic impact. Pathologic activity of the peripheral somatosensory afferents is one of the major drivers of chronic pain. This overexcitable state of somatosensory neurons is, in part, produced by the dysregulation of genes controlling neuronal excitability. Despite intense research, a unifying theory behind neuropathic remodelling is lacking. Here we show that transcriptional suppressor, repressor element 1-silencing transcription factor (REST, NRSF), is necessary and sufficient for the development of hyperalgesic state following chronic nerve injury or inflammation. Viral overexpression of REST in mouse DRG induced prominent mechanical and thermal hyperalgesia in vivo. Sensory neuron specific, inducible Rest knock-out prevented the development of such hyperalgesic state in three different chronic pain models. Genetic deletion of Rest reverted injury-induced hyperalgesia. Moreover, viral overexpression of REST in the same neurons in which its gene has been genetically deleted restored neuropathic hyperalgesia. Finally, sensory neuron specific Rest knockout prevented injury-induced downregulation of REST target genes in DRG neurons. This work identified REST as a major regulator of peripheral somatosensory neuron remodelling leading to chronic pain. The findings might help to develop a novel therapeutic approaches to combat chronic pain.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.