Ask the Pharmacist

Q) I heard on the news that a couple of American researchers were awarded a prize. What was that all about?

A) The Nobel prizes are awarded by the Swedish Foundation that shares the same name, as they have been since 1901. There are the original five prizes in the fields of Physics, Chemistry, Peace, Literature & Physiology or Medicine as well as a sixth in the field of economics which was first presented in 1968. The Nobel Prizes are widely regarded as the most prestigious awards available in their respective fields.

Not surprisingly given the scope of this column, let’s focus on the award for physiology and medicine. There are many times that awards are given out to original creations that perhaps appeal to the experts in that particular field but have no widespread impact on the greater population. This is not the case with the Nobel award for Medicine. Past winners’ research has paved the way for the discovery of MRIs and many other ground-breaking medical interventions. Viruses such as the human immunodeficiency virus and the human papilloma viruses have also been discovered which in turn lead to our ability to treat and prevent HIV and cervical cancer respectively.

This year’s award was presented to two American scientists; Dr. David Julius who is a physiologist from the University of California and Dr. Ardem Patapoutian who is a molecular biologist and neuroscientist at Scripps Research in La Jolla California. Interestingly enough, they were announced as co-winners even though they worked independently of each other despite the proximity of their labs and the similarity of their research. These break-throughs started, as do many inventions, with the simple asking of a question. Apparently, as Dr Julius was browsing the aisles of his local supermarket, he came upon an aisle dedicated to chilli pepper sauces. He turned to his wife, also a scientist and stated that he thought it was time someone finally solved how some chemicals cause the sensation of heat. Her response, demonstrating the well-known practicality of wives everywhere was all the stimulus he would need, was a straight-forward “Well then, you should get on it.” At this point in time (most of this research by both men was conducted in the late 1990’s and 2000’s), science knew that capsaicin, the active ingredient found in chilli peppers, stimulated neurons involved in the sensation of pain, but no one knew the mechanism behind this phenomenon.

To solve this dilemma, Julius and his team created essentially a library of DNA, with literally millions of bits of DNA and figured that, when tested, eventually one of them would react to capsaicin. After a very long search, they discovered what is now known as TRPV1, a vanilloid receptor that is involved in our ability to feel noxious stimuli, such as pain and heat, from not only chilli peppers but from other sources as well. This receptor kicks into action when we experience temperatures that we perceive as painful which is approximately 43C for most of us.

At the same time, in another lab down the road, Patapoutian was spending his time trying to figure out how our nerves sense pressure. How do we know when our fingers find a door in the dark or that someone has tapped us on our shoulder? How do we instinctively know where our limbs are without having to look to locate them? Their process was incredibly rigorous and time consuming.

They basically created a cell line that produced an electric signal when prodded by a tiny instrument, which is what was theorized that our nerve cells (neurons) do. They then, one by one, turned off different genes within these cells until they found the one that allowed the cells to become numb to the pressure of the instrument. This was a painstaking process that initially produced a year of nothing but negative responses (which is the reality of research for all those who are debating a future in a lab; dogged determination is a must!) until, on the 72nd candidate success was achieved. Patapoutian and his team had discovered Piezo 1 and later on Piezo 2, electrical channels that are essential to how we translate a force upon our skin into electrical impulses that allow our brain to experience touch.

The area of medicine that this research is expected to impact is the one that is perhaps most in dire need of a new approach, the treatment of chronic pain. Our lack of good alternatives has propelled us into two simultaneous crises at once. The first is the opioid crisis that was fuelled, in part, by our over-reliance on narcotics to help those affected with pain.

The second is a much less well-publicized emergency since it doesn’t directly lead to mortality and that involves people that live their lives in constant pain. The options available for alleviating this chronic pain haven’t changed in well over a decade and for many people, they were also not adequate enough. Chronic pain can be the result of back disc injuries or trauma from car accidents among many other causes. If this pain is left unmanaged, it may eventually affect sleep, mental health, careers and, unfortunately all too often, their families.

At this point, capsaicin is being used in a large number of creams that are used for more chronic pains such as arthritic knees or nerve pain secondary to shingles or diabetes. Systemic drugs are apparently on the way but are proving challenging when it comes to providing pain relief without an unacceptable level of side effects. Still, these drugs are expected to be “game-changers” when they do arrive at pharmacies worldwide and will hopefully provide relief for 100s of millions of people everywhere. For more information about this or any other health related questions, contact your pharmacist.