Spontaneous activity in pain patient stem cell–derived sensory neurons arises from one functional subclass

Spontaneous activity of peripheral sensory nerve fibers is one of the main drivers of neuropathic pain. It can be assessed in microneurography recordings of patients' C fibers and in patch-clamp recordings of dissociated dorsal root ganglia from humans and rodents. In microneurography of human C fibers, a distinct subgroup of neurons, the so-called mechano-insensitive (CMi) or sleeping nociceptors, shows spontaneous activity during neuropathic pain. It was shown before that sensory neurons from patient-derived induced pluripotent stem cells (iSNs) can be used to model this increased spontaneous activity in vitro, suggesting that a disease relevant cell type is generated with this approach. The origin of the spontaneous activity in human C fibers is not fully understood. Derived sensory neurons offer the unique possibility to study patient-derived, single-cell function, allowing for identification of potential mechanisms underlying spontaneous C-fiber activity. Here, we identify 4 distinct functional subtypes of iSNs from healthy donors and a patient suffering from the neuropathic pain syndrome inherited erythromelalgia using patch-clamp recordings. Similar to microneurography recordings from the same patient, spontaneous activity is restricted to 1 functional subgroup that shows tonic firing behavior and seems to be especially prone to develop neuronal hyperexcitability. We demonstrate that spontaneous activity correlates with a reduced voltage threshold of action potential generation and increased spontaneous depolarizing fluctuations of the membrane potential. Our findings reveal that only the tonically firing functional subclass of iSNs shows spontaneous activity and suggest that these neurons may be related to the pathologically active CMi fibers identified during microneurography recordings in patients with pain.