Releviate Therapeutics focuses on treating pain at its source by removing specific matrix metalloproteinases (MMP-14 and MMP-9) that cause neuropathic and, possibly, nociceptive pain. Releviate offers a potentially first-in-class therapy that treats pain at its source, unlike opioids and anti-depressants, that mask the pain.
Despite a variety of causes of neuropathic pain, there is one thing in common: the mechanism of such pain development.
Table I depicts the most current classification of pain.
| NEUROPATHIC = nerve injury | NOCICEPTIVE = tissue injury | NOCIPLASTIC | MIXED | ||
|---|---|---|---|---|---|
| PERIPHERAL | CENTRAL | SOMATIC | VISCERAL | ||
| Peripheral neuropathy (1-3%) |
Central post-stroke pain (8%) |
Arthritis (25-40% in people > 40 years) |
Endometriosis (10% in women of reproductive age) | Irritable bowel syndrome (5-15%) |
Headache (15% for migraine, 20-30% for tension-type) |
| Postherpetic neuralgia (annual incidence 0.1-0.2%) |
Spinal cord injury (30-50%) | Myofascial pain (5%-10%) | Interstitial cystitis3 (0.2-1% of women) |
Fibromyalgia (3-6%) |
Cancer5 (lifetime prevalence 30-40%) |
| Chronic postsurgical pain (2-10% after surgery) |
Multiple sclerosis (25%) |
Connective tissue disorders (0.2-0.5%) | Ulcers/ gastritis/ esophagitis (3-9%) | Complex regional pain syndrome type I (0.006-0.05%, 3%-20% after orthopedic surgery) | Low back pain6 (annual prevalence rate 20-40%) |
| Phantom limb pain (30-60%) |
Parkinson’s disease (10%) |
Burn pain2 (annual incidence of burns requiring hospitalization 0.01%) | Cholecystitis/ appendicitis | Temporomandibular disorder (5-12%) | Neck pain7 (annual prevalence rate 20-40%) |
| Trigeminal neuralgia (0.01%) | Seizure disorder (1-3%) | Ischemic pain6 | |||
| Radiculopathy/ spinal stenosis (3%-10%) | |||||
| Nerve entrapment syndromes (e.g. carpal tunnel, thoracic outlet, meralgia paresthetica; 2-4%) | |||||
Table I. Pain Classification.
Pain can be classified into four categories: neuropathic, nociplastic, and mixed. Neuropathic pain is divided into peripheral neuropathic pain, such as phantom pains, and central pain, such as multiple sclerosis-related pain. Nociplastic pain is related to irritable bowel syndrome, and mixed pain includes cancer or low-back pain.
Neuropathic pain was not clearly defined mechanistically until 2008. Between 2006 and 2012, scientists and clinicians — currently associated with Releviate and UC San Diego, Duke University, Sanford Burnham Institute, and UC Riverside — discovered the molecular mechanism of neuropathic pain.
Before 2000, neuropathic pain was considered more of a psychiatric disorder. It was referred to as “psychotic pain” by many physicians, largely due to the misunderstood nature of the pain.
It wasn’t until 2008 that neuropathic pain was clearly defined by the International Association for the Study of Pain (IASP) as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory nervous system.”
Releviate is pursuing three indications in neuropathic pain: Small Fiber Neuropathy (SFN), Diabetes-induced Neuropathic Pain (DNP) , and prevention of chemotherapy induced neuropathic pain (CIPN).