In vitro human plasma leucine(5)-enkephalin degradation is inhibited by a select number of drugs with the phenothiazine molecule in their chemical structure

A number of drugs with the phenothiazine molecule in their chemical structure inhibit in a dose-dependent manner human plasmatic aminopeptidase leucine(5)-enkephalin (LEU) metabolism. Half-life peptide degradation was significantly increased by thioridazine > fluphenazine > As-1397 [10-(alpha-diethylaminopropionyl)phenothiazine] >/= promethazine >/= chlorpromazine (final drug conc. 10(-4) M); t1/2 (+/- SD) 21.2 +/- 1.1, 19.6 +/- 1.0, 17.2 +/- 0.9, 17.1 +/- 1.0, and 17.1 +/- 1.1 min, respectively. Control and bacitracin (known aminopeptidase inhibitor) values were 11.8 +/- 1.0 and 31.3 +/- 1.7 min, respectively. These drugs significantly decreased (listed in the same order) LEU degradation initial velocity; Iv (+/- SD) 0.77 +/- 0.2, 0.82 +/- 0.2, 0.92 +/- 0.3, 0.93 +/- 0.2, 0.94 +/- 0.3 pg LEU/min, respectively. Control and bacitracin 1.10 +/- 0.3 and 0.20 +/- 0.1 pg LEU/min, respectively. Values represent results from 5 samples, each obtained by pooling 6 individual plasmas (4 male and 2 female; n = 30 healthy, drug-free volunteers). However, neither the phenothiazines ethopropazine, methotrimeprazine, prochlorperazine and trifluoperazine nor the various commonly used heterocyclic antipsychotics tested, e.g., molindone, loxapine, clozapine, haloperidol, sulpiride and thiothixene inhibited plasma LEU degradation kinetics. Our results failed to show correlations between chemical structure, antipsychotic properties and ability to inhibit plasmatic aminopeptidase LEU degradation. Whereas, presence of the phenothiazine molecule appears to be necessary for enzyme inhibition, only five out of nine substituted phenothiazines tested exhibited this effect. Furthermore, there was a lack of correlation between phenothiazines antipsychotic properties and their capacity to inhibit aminopeptidase activity, a property shown by promethazine (antihistaminic) and As-1397 (selective butyrylcholinesterase inhibitor) but lacking in prochlorperazine and trifluoperazine. Our results provide information which could lead to the rational design of agents capable to modulate the bioavailability of enkephalin and other endogenous aminopeptidase-degraded peptides believed to be involved in the etiology and/or pathophysiology associated with various disease conditions. Whether their development could find useful pharmacological applications remains to be explored.

[Met-enkephalin plasma concentration and content in liver tissue in patients with primary biliary cirrhosis]

Met-enkephalin is a pentapeptide belonging to the opioid system and like other opioid peptides is involved in phenomena associated with modulated pain perception, regulation of memory and emotional conditions, food and liquid consumption, regulation of immunological system and it has an impact upon digestive system motility, gastric and pancreatic secretion, metabolism of carbohydrates. Met-enkephalin concentration changes in liver tissue and plasma during liver disorders. It has been revealed that Met-enkephalin takes part in the etiopathogenesis of ascites and pruritus. Primary biliary cirrhosis (PBC) is a chronic inflammatory liver disease, its course involves the destruction of small and medium-sized bile ducts as a result of the process of granulation tissue growth developing in such diseases as fibrosis, liver cirrhosis development, and liver insufficiency. During the ending period of the PBC, clinical and biochemical symptoms of decompensation of liver cirrhosis occur. The objective of the study and paper was to make a comparison between the Met-enkephalin concentration rates in plasma and its content in liver tissue with the progress stage of PBC, which was assessed using clinical symptoms. The study was carried out in 40 female patients with PBC. PBC has been found by means of biochemical, serological investigations as well as histopathological liver bioptate estimation. The patietns with different causes of liver disorders have been excluded. Met-enkephalin concentration in plasma and content in liver tissue have been indicated in each patient. The control group consisted of 30 female patients treated in the Department of Gastroenterology with normal activity of indicative and cholestatic enzymes, and without any organic disorders. In the control group, the Met-enkephalin concentration rates in plasma were determined. Statistically significant difference has been indicated in Met-enkephalin plasma concentration between two patients groups: 23 patients with pruritus and 17 patients without it where (p = 0.0476). Statistically significant difference in Met-enkephalin concentration level in plasma and liver tissue in the group of 19 patients with liver failure symptoms (stadium IV and V according to Schaffner and Popper classification) and in the group of 21 patients without those symptoms (stadium I and II according to Schaffner and Popper classification) has been stated. For Met-enkephalin plasma concentration p = 0.002 and for Met-enkephalin liver tissue concentration p = 0.0214.

CONCLUSIONS

1. The Met-enkephalin concentration rates in serum of patients with the PBC is higher than in the control group; 2. In PBC patients' pruritus appears together with the increase of Met-enkephalin plasma concentration. 3. In PBC patients, when liver failure symptoms appear Met-enkephalin concentration increases in plasma, and it decreases in the liver tissue.

Plasma levels of opioid peptides after sunbed exposures

BACKGROUND

Previous studies have indicated that solar and artificial ultraviolet (UV) radiation have a positive influence on psychological variables such as mood and emotional state. Circulating opioid peptides have been suggested as being important in this effect.

OBJECTIVES

To investigate in a controlled trial the influence of UVA radiation on opioid peptide levels.

METHODS

We determined plasma levels of beta-endorphin immunoreactive material (IRM) and met-enkephalin in UV-exposed (n = 35) and non-exposed (n = 9) healthy volunteers. On the first day of the study, blood samples were taken from the volunteers (time A). UVA irradiation was subsequently administered with an air-conditioned tanning device. During the UV exposures the volunteers wore opaque goggles. Twenty minutes after UV exposure, blood samples were collected again (time B). Within the following 3 weeks the volunteers had a series of five UV exposures. On the last day of the study (24 h after the sixth UV exposure) blood samples were collected (time C). The cumulative UVA doses were 96 J cm-2 for skin type II and 126 J cm-2 for skin type III. The controls had no UV exposures. Plasma beta-endorphin IRM and met-enkephalin levels were determined using radioimmunoassays.

RESULTS

At all times of blood collection (A, B, C), there were no significant differences in plasma levels of beta-endorphin IRM and met-enkephalin between UV-exposed and non-exposed volunteers (P > 0.05).

CONCLUSIONS

UVA irradiation does not significantly elevate plasma levels of beta-endorphin IRM and met-enkephalin. Therefore we suggest that psychological benefits claimed to occur after UV exposure are unlikely to be mediated by the types of circulating opioid peptides measured in this study.

Induction of antinociception and increased met-enkephalin plasma levels by cyclosporine and morphine in rats: implications of the combined use of cyclosporine and morphine and acute posttransplant neuropsychosis

BACKGROUND

Cyclosporine A (CsA) and morphine have neurotoxic and psychiatric side effects, respectively. Endogenous opiatelike peptides can elicit a number of behavioral responses that mimic the symptoms of psychiatric illness. The purpose of this study was to quantitiate the changes of Met-enkephalin (ME) and beta-endorphin (BE) after administration of CsA and morphine in surgery and to assess the antinociceptive effect.

PATIENTS AND MATERIALS

Pain sensitivity, an antinociceptive indicator in rats, was determined with the hotplate test. Plasma ME and BE levels were measured with radioimmunoassays.

RESULTS

In normal unoperated rats, CsA induced a profound analgesic effect concomitant with an increased plasma ME level on day 1. Morphine produced an analgesic effect on days 1 and 2, with decreased ME levels on days 2 and 3. Coadministration of CsA and morphine prolonged the analgesia from days 1 to 4 and increased the plasma ME level on day 1. No change in plasma BE level was found. In surgically operated rats, CsA induced an analgesic effect and higher ME levels than those in unoperated rats. Interestingly, the combined use of CsA and morphine prolonged the analgesia and increased plasma ME levels from days 1 to 4, with no significant change in plasma BE levels.

CONCLUSIONS

Our results showed that CsA can induce antinociception and increase plasma ME levels. This induction can be potentiated by the addition of morphine. Acute neuropsychiatric manifestations in the early posttransplant period might, therefore, be due to induction of ME after coadministration of CsA and morphine.

The role of met-enkephalin in silent myocardial ischemia in diabetic patients

Met-enkephalin plasma levels were evaluated in 20 cardioischemic diabetic patients. All the patients had ECG ischemic signs. Ten patients with diabetic autonomic neuropathy, experienced no pain during myocarial ischemia. Met-enkephalin levels in the diabetic patients with silent myiocardial ischemia were significantly lower compared to those in the symptomatic patients. This demonstrates that the absence of myocardial ischemic pain in neuropathic diabetic patients is not accounted for by met-enkephalin action.

beta-Endorphin modulation of pressor response to hyperventilation in hypertensive patients

After hyperventilation, systolic and diastolic blood pressure (BP) significantly decreased in 14 hypertensive patients (group 1), did not change in 9 (group 2) and increased in 8 (group 3). Basal BP, norepinephrine and dynorphin B levels were higher in group 1 than in groups 2 and 3. The decrease in BP after hyperventilation was associated with a decrease in plasma norepinephrine, Met-enkephalin and dynorphin B and an increase in beta-endorphin. Naloxone abolished the hyperventilation-induced BP and norepinephrine decreases. Our findings indicate that hyperventilation may select hypertensive patients with different sympatho-adrenergic activity and that the increase in beta-endorphin reduces BP response to hyperventilation in patients with high sympatho-adrenergic tone.

The presence of antibacterial and opioid peptides in human plasma during coronary artery bypass surgery

Antibacterial peptides, found in both invertebrates and vertebrates, represent a potential innate defense mechanism against microbial infections. However, it is unknown whether this process occurs in humans during surgery. We looked for evidence of release of antibacterial peptides during coronary artery bypass grafting (CABG). We used immunological techniques and antibacterial assays combined with high-performance gel-permeation chromatography, reverse-phase HPLC, N-terminal sequencing and comparison with synthetic standards to characterize the peptide B/enkelytin. We show the presence of anionic antibacterial peptide, the peptide B/enkelytin which correspond to the C-terminal part of proenkephalin A, from the plasma of patients undergoing CABG. Our studies show that peptide B/enkelytin is initially present at low levels in plasma and is then released in increased amounts just after skin incision. Antibacterial assays confirmed that the peptides specifically target gram-positive bacteria. We also demonstrate that peptide B/enkelytin is metabolized in vivo to the opioid peptides methionine-enkephalin-Arg-Phe and methionine-enkephalin, peptides that we show have granulocyte chemotactic activity. These findings suggest that in humans, surgical incision leads to the release of antibacterial peptides. Furthermore, these antibacterial peptides can be metabolized into compounds that have immune-activating properties.

Opioid peptide modulation of circulatory response to hyperventilation in humans

After hyperventilation, systolic blood pressure (SBP) significantly decreased in 10 subjects (group 1), did not change in eight (group 2) and increased in 15 (group 3). Diastolic blood pressure and heart rate increased in all groups. The decrease in SBP was associated with a decrease in plasma catecholamines and increase in beta-endorphin, whereas the increase in SBP was accompanied by an increase in catecholamine and Met-enkephalin levels. Naloxone abolished the hyperventilation-induced SBP and catecholamine decrease only in group 1. These findings show an activation of the endogenous opioid system after hyperventilation and the role of beta-endorphin in reducing SBP in response to the test.

Elevated levels of opioid growth factor in the plasma of patients with pancreatic cancer

Opioid growth factor (OGF, [Met5]-enkephalin) is an endogenous peptide that regulates the growth of human pancreatic cancer. To evaluate whether human subjects with pancreatic cancer have alterations in plasma levels of OGF, fasting blood samples were obtained from 15 patients with histologically confirmed pancreatic adenocarcinoma. Forty-five subjects with other malignancies, 20 patients with acute pancreatitis, and 30 aged-matched patients without cancer served as control populations. Individuals with pancreatic cancer had OGF values, as determined by radioimmunoassay, that were up to 7.3-fold greater than control subjects. No differences were found between OGF values obtained from patients with other malignancies, acute pancreatitis, or subjects without cancer. The sensitivity and specificity of OGF for pancreatic cancer were greater than either CA 19-9 or CEA. These data indicate that pancreatic cancer is associated with a marked increase in plasma OGF levels and suggest that this peptide may serve as a useful diagnostic tool in the screening for this disease.

Decline of met-enkephalins concentration after interleukin-2 subcutaneous administration due to renal carcinoma

The authors have described the connections between nervous and immune systems. Endogenous opioids are one of the factors linking both systems. Endogenous and exogenous opioids can modify the function of interferons, humoral factors, antibody production and lymphocytes' activation. Concurrently, some cytokines can modify the endogenous opioid system. The aim of this study was to asses whether the subcutaneous administration of IL-2 influences the Met-Enkephalins concentration in serum after IL-2 single administration due to renal cancer. The Met-Enk level was estimated with RIA method. The IL-2 single administration results in a significant decrease of Met-Enk in serum.

Pituitary-adrenal-gonadal responses to high-intensity resistance exercise overtraining

Weight-trained men [OT; n = 11; age = 22.0 +/- 0.9 (SE) yr] resistance trained daily at 100% one-repetition maximum (1-RM) intensity for 2 wk, resulting in 1-RM strength decrements and in an overtrained state. A control group (Con; n = 6; age = 23.7 +/- 2.4 yr) trained 1 day/wk at a low relative intensity (50% 1 RM). After 2 wk, the OT group exhibited slightly increased exercise-induced testosterone (preexercise = 26.5 +/- 1.3 nmol/l, postexercise = 29.1 +/- 5.9 nmol/l) and testosterone-to-cortisol ratio (preexercise = 0. 049 +/- 0.007 nmol/l, postexercise = 0.061 +/- 0.006 nmol/l) and decreased exercise-induced cortisol (preexercise = 656.1 +/- 98.1 nmol/l, postexercise = 503.1 +/- 39.7 nmol/l). Serum concentrations for growth hormone and plasma peptide F [preproenkephalin (107-140)] were similar for both groups throughout the overtraining period. This hormonal profile is distinctly different from what has been previously reported for other types of overtraining, indicating that high-relative-intensity resistance exercise overtraining may not be successfully monitered via circulating testosterone and cortisol. Unlike overtraining conditions with endurance athletes, altered resting concentrations of pituitary, adrenal, or gonadal hormones were not evident, and exercise-induced concentrations were only modestly affected.

Opioid receptor ligands in human hepatic encephalopathy

BACKGROUND/AIMS

Opioid peptides may contribute to some of the manifestations of hepatic encephalopathy. To address the role of the opioid system in the pathogenesis of hepatic encephalopathy, three representative opioid ligands were measured in plasma and cerebrospinal fluid of patients with hepatic encephalopathy.

METHODS

Plasma and cerebrospinal fluid were obtained in three groups of patients: group 1: patients with hepatic encephalopathy; group 2: patients with lumbar back pain; group 3: healthy controls. Met-enkephalin, leu-enkephalin and beta-endorphin levels were measured in extracted plasma and cerebrospinal fluid samples by radioimmunoassay.

RESULTS

Plasma met-enkephalin levels were 656% (p<0.05) and 301% (p<0.05) and cerebrospinal fluid met-enkephalin levels were 1481% (p<0.01) and 645% (p<0.05) higher when compared to healthy control and pain control patients, respectively. Although plasma and cerebrospinal leu-enkephalin levels were elevated in patients with hepatic encephalopathy, the increases were not statistically significant. Plasma and cerebrospinal beta-endorphin levels were similar in the three study groups.

CONCLUSIONS

The results of this study support accumulating data on the role of the delta opioid receptor ligand met-enkephalin in the pathogenesis of hepatic encephalopathy, and provide a rationale for the use of opioid receptor antagonists in the treatment of hepatic encephalopathy.

Met-enkephalin increase in patients with fibromyalgia under local treatment

Fibromyalgia is a chronic debilitating condition of unknown etiology. The clinical picture suggests increased activity and/or supersensitivity in nociceptive pathways or inadequate activity in endogenous pain attenuation mechanisms. One therapeutic approach in the treatment of this syndrome is the administration of serial local injections of lidocaine hydrochloride in the painful points. To evaluate the effect of this treatment on plasma met-enkephalin (ME) levels we studied 15 patients, all women with fibromyalgia under local treatment in the tender points, grouped as follows: 5 were treated with local injection of lidocaine hydrochloride, 5 were treated with local injection of saline and 5 treated with dry needling. Significant increases in plasma ME concentrations were observed in all groups in the last sampling of each session studied. These results show an increase in plasma ME levels 10 minutes after finishing each session, which is independent of the maneuver employed.

Methionine-enkephalin stimulates interleukin-6 mRNA expression: human plasma levels in coronary artery bypass grafting

Opioid peptides have the ability to regulate immunocompetent cells. The present study extends this phenomenon to include an interaction with interleukin (IL)-6. We demonstrate that methionine-enkephalin (met-enkephalin) stimulates IL-6 mRNA expression in mice as determined by RNA isolation and hybridization with IL-6 cDNA. In mice, met-enkephalin [0.1 and 1 mg/kg intraperitoneal exposure for 6 days] also enhanced serum IL-6 levels. The in vivo data demonstrate that met-enkephalin upregulates IL-6 levels via an increase in transcriptional activity. Further, pre- and postoperative IL-6 and met-enkephalin levels were determined in the plasma of seven patients. First an increase in met-enkephalin plasma levels occurred (8.9+/-2.9 to 135+/-18 pg/ml; P<0.005), and then an increase in plasma IL-6 levels (2.1+/-1.5 to 237+/-50 pg/ml; P<0.001), suggesting that, as in mice, met-enkephalin induces IL-6 production. Taken together, the data strongly suggest that opioid peptides may be important as one of the chemical signaling molecules initiating the diffuse inflammatory response associated with coronary artery bypass grafting.

Opioid peptides in response to mental stress in asymptomatic dilated cardiomyopathy

Fourteen asymptomatic dilated cardiomyopathy patients showing normal plasma levels of beta-endorphin, Met-enkephalin, dynorphin B, norepinephrine and endothelin-1 but elevated atrial natriuretic factor (ANF) levels underwent two Mental Arithmetic Tests (MAT), with placebo and naloxone hydrochloride infusion, respectively. MAT significantly (p < 0.01) increased blood pressure, heart rate, opioid peptides, norepinephrine, ANF, but not endothelin-1. Naloxone infusion significantly (p < 0.05) attenuated the increments produced by MAT in all measured parameters during placebo infusion. These results indicate that in asymptomatic dilated cardiomyopathy the endogenous opioid system, activated by stress-induced sympathoadrenergic hyperactivity, may further increase the sympathetic tone in a positive feedback that is interrupted by naloxone.

Endogenous opioid peptides and mental stress in congestive heart failure patients

Two groups of patients with acute congestive heart failure (CHF), New York Heart Association class III, presenting elevated plasma values of beta-endorphin, norepinephrine, atrial natriuretic factor (ANF) and endothelin-1, underwent the Mental Arithmetic Test (MAT) during placebo (n = 10) and naloxone hydrochloride (n = 10) infusion. The MAT during placebo significantly (p < 0.01) increased blood pressure, heart rate, plasma levels of Met-enkephalin, dynorphin B, beta-endorphin, norepinephrine, ANF and endothelin-1. The increases in norepinephrine, ANF and hemodynamics after the MAT during naloxone infusion were higher (p < 0.01) than those during placebo; thus, the transient upregulation of the endogenous opioid system during stress in CHF patients attenuates the hemodynamic response by reducing norepinephrine release.

Plasma proenkephalin peptide F and human B cell responses to exercise stress in fit and unfit women

In vitro studies have connected immune cell function to Peptide F. The primary purpose of this investigation was to examine the responses of plasma Peptide F and epinephrine along with the changes in B cell antibody production in vivo in physically fit and unfit women in response to physical exercise on a cycle ergometer at 60% and 80% of peak oxygen consumption. Seven aerobically fit and eight untrained (i.e., unfit) women between the ages of 18 and 30 volunteered to participate in this investigation. Blood samples (analyzed for plasma Peptide F and epinephrine along with the number of antibody-producing B cells) were obtained 24 hours prior to the exercise session, pre-exercise, during each exercise intensity, and five minutes post-exercise. The fit group had a significantly higher plasma Peptide F concentration after the 80% exercise intensity along with significantly higher numbers of antibody producing B cells compared to the unfit group. The results of this investigation show that physically fit women have an enhanced secondary response of B cells to a specific antigen under conditions where Peptide F is increased. Such data demonstrate that physical fitness as promoted by the Public Health Service (e.g., Healthy People 2000) influences the underlying hormonal and immune cell responses when challenged by physical exercise stress.

Quantitative analysis of exogenous peptides in plasma using immobilized enzyme cleavage and gas chromatography-mass spectrometry with negative ion chemical ionization

A method is presented for the analysis of peptides in plasma at picomole to femtomole levels. Peptides are isolated from plasma by solid-phase extraction, the peptide of interest is purified by reversed-phase high-performance liquid chromatography (HPLC) and selectively digested using immobilized trypsin or chymotrypsin to yield specific di- or tripeptides. These di- and tripeptides are esterified using heptafluorobutyric anhydride, alkylated with pentafluorobenzyl bromide, then quantified by gas chromatography-mass spectrometry with negative ion chemical ionization. This method has been evaluated for a model synthetic heptapeptide, using a deuterium labeled analog as an internal standard. The half-life of the heptapeptide in human plasma was found to be 2 min. Extraction efficiencies of a tritiated peptide of similar size to the heptapeptide, [3H]DSLET, from plasma using either C18 or strong cation-exchange columns were 85+/-3 and 70+/-2%, respectively. Quantitation of fragments from the heptapeptide indicated that the analysis was linear from 1-50 ng of the heptapeptide per ml of plasma. This method was subsequently employed for pharmacokinetic studies of the biologically active peptide Met-enkephalin-Arg-Gly-Leu, where linearity was obtained from 50 to 1000 ng/ml in rat plasma. This method demonstrated negligible side reaction by-products due to autolysis, and has potential for extensive use given the wide availability of gas chromatography-mass spectrometry.

Hormonal (ACTH, cortisol, beta-endorphin, and met-enkephalin) and cardiovascular responses to hyperthermic stress in chronic alcoholics

Chronic alcohol drinking causes profound alterations in hypothalamic-pituitary function. In the present study, endocrine [corticotropin (ACTH), beta-endorphin, cortisol, and met-enkephalin] and cardiovascular (blood pressure) changes in response to hyperthermic stress (sauna at 90 degrees C for 30 min) were evaluated in 25 normal men (25 to 50 years old) and in 48 male alcoholic subjects (34 to 56 years old) after 5 weeks of abstinence. Significantly lower increments in systolic blood pressure were observed in alcoholics than in control subjects. Furthermore, alcoholics showed lower ACTH, beta-endorphin, and cortisol increments in response to sauna than normal controls. In contrast, sauna-induced hyperthermia did not change significantly the circulating met-enkephalin levels in either normal controls or chronic alcoholics. These data suggest that an impairment in the adaptive response to stress affects alcoholic men even after a few weeks of abstinence from alcohol.

Quantitative analysis of two opioid peptides in plasma by liquid chromatography-electrospray ionization tandem mass spectrometry

Quantitative analysis of two opioid peptides, DSLET [(D-Ser2)Leu-enkephalin-Thr6] and Met-enkephalin-Arg-Gly-Leu, was performed using microbore liquid chromatography interfaced to electrospray ionization tandem mass spectrometry. Validation of the methodology was demonstrated for each peptide in plasma. Quantitative analyses were performed through the use of a deuterium labelled peptide analog as an internal standard. Linearity was observed for the analysis of DSLET (5-1000 ng/ml) and Met-enkephalin-Arg-Gly-Leu (1-1000 ng/ml) in plasma with a limit of detection of 0.25 ng/ml for Met-enkephalin-Arg-Gly-Leu and 1.0 ng/ml for DSLET. In general, the observed concentrations showed good reproducibility with coefficients of variation of within 15%. In the concentration range studied, only 0.5 ml of plasma was required for optimal detection of Met-enkephalin-Arg-Gly-Leu and 0.25 ml for DSLET. Application of this method was demonstrated by studying the disposition of DSLET in a rat. DSLET administered to a rat exhibited a short half-life and a high clearance value.

Decreased patient analgesic requirements after liver transplantation and associated neuropeptide levels

BACKGROUND

Decreased morphine requirements have been reported after liver transplantation when compared with other types of major abdominal surgery. The aim of this study was to examine plasma concentrations of three neuropeptides involved in pain modulation-metenkephalin (ME), beta-endorphin (BE), and substance P (SP)-in patients undergoing orthotopic liver transplantation (OLT) and in control patients undergoing other liver operations. We then compared the postoperative analgesic requirements in these two groups of patients.

METHODS

Plasma levels of ME, BE, and SP were measured by radioimmunoassay at preincision, preemergence, and for 3 days after operation in 13 patients undergoing OLT and in 10 control patients. Patient-controlled analgesia morphine delivery was recorded for all patients postoperatively, and plasma morphine, its metabolites, and patient pain and sedation scores were also measured.

RESULTS

ME levels were elevated in all OLT patient samples when compared with control patient samples. BE levels were not significantly different at any time. SP levels were significantly decreased only in preincision and preemergence OLT patient samples. Total patient-controlled analgesia morphine delivered during the first 3 postoperative days was significantly less in OLT patients (70+/-8 mg) than in control patients (101+/-12 mg). Plasma morphine, morphine-3-glucuronide, and morphine-6-glucuronide levels were decreased in OLT patients, however, statistical significance was seen only in the morphine-6-glucuronide results.

CONCLUSIONS

We have shown that postoperative analgesic requirements are decreased in OLT patients, and we suggest that associated increased peripheral ME levels may be contributing to this decreased requirement. Based on our results, circulating BE and SP are less significant factors affecting postoperative analgesic requirements.

The role of the blood-brain barrier transporter PTS-1 in regulating concentrations of methionine enkephalin in blood and brain

Previous studies have suggested that peptide transport system (PTS)-1, a saturable efflux system from brain to blood, regulates the concentration in the brain of methionine enkephalin (Met-Enk), an opiate peptide related to the drinking of ethanol in mice. We determined the relationship of PTS-1 to concentrations of immunoreactive Met-Enk in plasma and whole brain in eight randomly selected strains of mice. An active PTS-1 system could be demonstrated in five of the eight strains. In those five strains, faster efflux rates due to PTS-1 correlated with higher concentrations of Met-Enk in brain and plasma. These concentrations of Met-Enk in brain and plasma were positively correlated in the five strains in which PTS-1 was demonstrable and were inversely correlated in the three strains in which PTS-1 was not demonstrable. The results are consistent with previous observations indicating that the chronic level of brain Met-Enk can set the level of activity of PTS-1 and that, once set, PTS-1 can play a major role in determining the concentrations of Met-Enk in brain and blood.