The dorsal root ganglion (DRG) is a highly vulnerable site in
diabetic neuropathy. Under diabetic conditions, the DRG is subjected to tissue
ischemia or lower ambient
oxygen tension that leads to aberrant metabolic functions. Metabolic dysfunctions have been documented to play a crucial role in the pathogenesis of diverse
pain hypersensitivities. However, the contribution of diabetes-induced metabolic dysfunctions in the DRG to the pathogenesis of
painful diabetic neuropathy remains ill-explored. In this study, we report that
pyruvate dehydrogenase kinases (PDK2 and PDK4), key regulatory
enzymes in
glucose metabolism, mediate glycolytic metabolic shift in the DRG leading to
painful diabetic neuropathy.
Streptozotocin-induced diabetes substantially enhanced the expression and activity of the PDKs in the DRG, and the genetic ablation of Pdk2 and Pdk4 attenuated the
hyperglycemia-induced
pain hypersensitivity. Mechanistically, Pdk2/4 deficiency inhibited the diabetes-induced
lactate surge, expression of
pain-related
ion channels, activation of satellite glial cells, and infiltration of macrophages in the DRG, in addition to reducing central sensitization and
neuroinflammation hallmarks in the spinal cord, which probably accounts for the attenuated
pain hypersensitivity. Pdk2/4-deficient mice were partly resistant to the diabetes-induced loss of peripheral nerve structure and function. Furthermore, in the experiments using DRG neuron cultures,
lactic acid treatment enhanced the expression of the
ion channels and compromised cell viability. Finally, the pharmacological inhibition of DRG PDKs or
lactic acid production substantially attenuated diabetes-induced
pain hypersensitivity. Taken together, PDK2/4 induction and the subsequent
lactate surge induce the metabolic shift in the diabetic DRG, thereby contributing to the pathogenesis of
painful diabetic neuropathy.