Formalin- or adjuvant-induced peripheral inflammation increases neurokinin-1 receptor gene expression in the mouse

Substance P (SP) has been widely studied as a mediator of nociception. The release of SP from primary afferent neurons is increased during nociception, and SP activates neurokinin-1 (NK-1) receptors in the spinal cord and periphery. Nociception-evoked alterations in NK-1 receptor gene expression have been studied in rat models of persistent pain but have not been characterized in any murine models of peripheral inflammation. This study assessed behavioral responses and NK-1 receptor mRNA gene expression in mice receiving formalin or Freund's complete adjuvant (CFA) as an inflammatory stimulus. Mechanical withdrawal thresholds were measured before injection of formalin or CFA and hind paw licking/biting timed during the late-phase of the formalin response. Two and 24 hours after formalin or CFA injection, mechanical withdrawal thresholds were measured and the mice euthanized. Solution hybridization-nuclease protection assays were used to quantify NK-1 receptor mRNA levels. Results demonstrated that inflamed hind paws were edematous, and the withdrawal thresholds of the inflamed hind paws were significantly lower after formalin or CFA injection. Neurokinin-1 receptor mRNA levels in the ipsilateral dorsal spinal cords of mice were higher at 24 h after formalin injection or 4 days after CFA injection. These results confirm that mice are hyperalgesic at late time points after formalin or adjuvant injection when NK-1 receptor gene expression is elevated in the dorsal spinal cord. This supports the hypothesis that increased NK-1 receptor gene expression contributes to the development and maintenance of a hyperalgesic state.

Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study

Inflammatory responses are associated with cardiovascular disease and may be associated with dementing disease. We evaluated the long-term prospective association between dementia and high-sensitivity C-reactive protein, a nonspecific marker of inflammation. Data are from the cohort of Japanese American men who were seen in the second examination of the Honolulu Heart Program (1968-1970) and subsequently were reexamined 25 years later for dementia in the Honolulu-Asia Aging Study (1991-1996). In a random subsample of 1,050 Honolulu-Asia Aging Study cases and noncases, high-sensitivity C-reactive protein concentrations were measured from serum taken at the second examination; dementia was assessed in a clinical examination that included neuroimaging and neuropsychological testing and was evaluated using international criteria. Compared with men in the lowest quartile (<0.34mg/L) of high-sensitivity C-reactive protein, men in the upper three quartiles had a 3-fold significantly increased risk for all dementias combined, Alzheimer's disease, and vascular dementia. For vascular dementia, the risk increased with increasing quartile. These relations were independent of cardiovascular risk factors and disease. These data support the view that inflammatory markers may reflect not only peripheral disease, but also cerebral disease mechanisms related to dementia, and that these processes are measurable long before clinical symptoms appear.

The role of forced swim test on neutrophil leukocytosis observed during inflammation induced by LPS in rodents

Adult male rats were administered intrapleural (ipl) or intraperitoneal (i.p.) injection of lipopolysaccharide (LPS), 24 h after being submitted to forced swim test (FST). Four hours after LPS challenge, an increase in pleural and peritoneal leukocyte and neutrophil counts in animals not exposed to FST was noted. FST induced a marked increase in pleural, but not in peritoneal, neutrophil leukocytosis. The results suggest that lowered mood may increase inflammatory response to LPS.

Maternal behavior in F344/N and LEW/N rats. Effects on carrageenan-induced inflammatory reactivity and body weight

Inbred Fischer (F344/N) and Lewis (LEW/N) rats differ on a myriad of behavioral and physiological endpoints, such as inflammatory, startle and drug responsivity. These differences point to underlying genetic differences between the strains. However, genetic models of hypertension have shown the importance of the maternal environment in the development of high blood pressure, suggesting that maternal influences might also play a role in adult phenotypes of the LEW/N and F344/N strains. This was tested in the present series of experiments in which the effects of crossfostering on carrageenan-induced inflammation and on body weight were examined in the two strains. Following the demonstration that the two strains differed in maternal behavior (Experiment 1), which was independent of the pup being reared (Experiment 2), crossfostered and in-fostered pups from the LEW/N and F344/N strains were injected with carrageenan (at 60 days of age) and subsequently assessed for the accumulation of exudate in response to the injection. Body weights were also monitored from birth through 60 days of age. Although crossfostering affected body weight of the two strains, specifically, reducing weights in LEW/N pups reared by F344/N dams and increasing weights of F344/N pups reared by LEW/N dams, crossfostering did not affect inflammatory reactivity to carrageenan. Specifically, LEW/N pups had a greater level of exudate than F344/N pups, independent of the conditions under which they were reared, suggesting that differences in the inflammatory response between these two strains are under a high degree of genetic control. These results were discussed in terms of genetic factors mediating the early form of immune reactivity induced by carrageenan.

Fatigue is not associated with raised inflammatory markers in multiple sclerosis

BACKGROUND

The pathogenesis of fatigue in patients with MS is poorly understood.

OBJECTIVE

To test the hypothesis that fatigue in MS is related to inflammatory disease activity as measured by systemic markers of inflammation.

METHODS

Fatigue as assessed by the Fatigue Questionnaire Scale (FQS) and Krupp's Fatigue Severity Scale (KFSS) was correlated with several inflammatory markers in 38 patients with MS (16 relapsing-remitting [RR; 7 of whom had benign MS), 9 secondary progressive [SP], 13 primary progressive [PP]). The markers included daily urinary neopterin excretion, a marker of interferon-gamma-activated macrophage activity, and serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) levels. Urinary neopterin excretion was measured daily for 2 weeks.

RESULTS

No correlation was found between urinary neopterin excretion, CRP, or sICAM-1 and the fatigue scores. However, patients with a raised serum CRP level had higher KFSS, but not FQS, scores than patients with normal CRP levels (KFSS, 50 +/- 8 vs 41 +/- 14, p = 0.05; FQS, 13 +/- 4 vs 11 +/- 5, p = NS). When assessed using the FQS, patients with RR and SP MS were more fatigued than patients with PP MS (RR = 12.5 [4 to 23] vs SP = 13 [8 to 18] vs PP = 9 [7 to 14], p = 0.02). The patients with benign MS were as fatigued as patients with nonbenign disease.

CONCLUSION

The pathogenesis of fatigue in MS is complex and does not appear to be directly related to systemic markers of inflammatory disease activity. Interestingly, patients with PP MS were less fatigued than patients with RR disease.

Lack of peripheral analgesia mediated by intraplantar administration of neostigmine in carrageenan-injected rats

BACKGROUND AND OBJECTIVE

The aim of the study was to test the peripheral analgesic action of neostigmine. Intraplantar administration of neostigmine was studied in carrageenan-injected rats.

METHODS

After assessing baseline values (T0) for paw circumference and the paw withdrawal threshold on both hind paws, the right hind paw was injected with 0.2 mL of 1% carrageenan and the left hind paw with 0.2 mL of saline (0.9% NaCl). Two hours later (T1), both hindpaws were tested for inflammation (paw circumference) and for hyperalgesia (paw withdrawal threshold) and subsequently 20 microg of neostigmine was injected in the right hind paw. The paw withdrawal threshold was tested again 10 (T2), 20 (T3) and 60 min (T4) and paw circumference 60 min (T4) after neostigmine injection.

RESULTS

Carrageenan injection in the right hindpaw was associated with a decrease in the paw withdrawal threshold reflecting mechanical hyperalgesia (P < 0.001) and an increase in paw circumference reflecting oedema (P < 0.001) in the right hind paw when compared with the left side from T1 to T4. Neostigmine had no effect on paw circumference and the paw withdrawal threshold at measuring points T2, T3 and T4 when compared with T1 in the right hindpaw.

CONCLUSION

Our results support the lack of peripheral analgesic effect of neostigmine.

Acute sickness behaviour: an immune system-to-brain communication?

Over the past 20 years, psychoneuroimmunological research has produced a large body of evidence that challenges the historically dominant view that the immune system operates in an autonomous manner independent of other physiological systems. Today, there is little doubt that the brain and the immune system are intimately linked and capable of reciprocal communication (Ader et al. 1991). Despite the acknowledged bi-directional nature of the brain–immune system connection, the predominant focus of study has been on the effects of psychological and behavioural events (e.g. stress) on immune responses and disease processes, and the mechanisms underlying such effects (see Kusnekov & Rabin, 1994; Maier et al. 1994; Rozlog et al. 1999). However, considerable interest in the possibilities of immune-system-to-brain communication was initiated by a seminal paper considering the biological basis of behaviour in sick animals (Hart, 1988). Subsequently, the immunological determinants of the behavioural, cognitive and emotional changes associated with acute illness, as well as with more chronic psychopathological states (e.g. depression) have become the subject of rapidly expanding areas of research (e.g. Kent et al. 1992; Lloyd et al. 1992; Hickie & Lloyd, 1995; Maes et al. 1995a; Rothwell & Hopkins, 1995; Dantzer et al. 1996; Maier & Watkins, 1998; Vollmer-Conna et al. 1998; Maes, 1999).

The main objective of this editorial is to provide a succinct overview of current knowledge of the normal behavioural correlates of acute infective illness, their adaptive function and underlying mechanisms. Elucidation of the processes involved in the appearance, maintenance and inhibition of ‘normal’ sickness behaviour is important if extrapolations from this phenomenon to more chronic psychopathological conditions are to provide more than a new label for poorly understood non-specific symptom clusters.

Cytokine-induced sickness behavior: mechanisms and implications

Sickness behavior refers to a coordinated set of behavioral changes that develop in sick individuals during the course of an infection. At the molecular level, these changes are due to the brain effects of proinflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha). Peripherally released cytokines act on the brain via a fast transmission pathway involving primary afferent nerves innervating the bodily site of inflammation and a slow transmission pathway involving cytokines originating from the choroid plexus and circumventricular organs and diffusing into the brain parenchyma by volume transmission. At the behavioral level, sickness behavior appears to be the expression of a central motivational state that reorganizes the organism priorities to cope with infectious pathogens. There is evidence that the sickness motivational state can interact with other motivational states and respond to nonimmune stimuli probably by way of sensitization and/or classical conditioning. However, the mechanisms that are involved in plasticity of the sickness motivational state are not yet understood.

The effect of stress on inflammation

Stress can either enhance or suppress aspects of the immune response, depending on the nature, duration, timing and intensity of the stressor. This paper focuses on the effects on inflammation of two behavioural stress paradigms: learned helplessness (La) and the open-field test (OF), and of the immunological stressor lipopolysaccharide (LPS). We have observed that the onset and severity of inflammation in adjuvant-induced arthritis (AA) in the rat can be altered by experience of the LH paradigm, or by priming with LPS, but not by OF.In the LH test, some rats escape (LH(-)) and others do not (LH(+)). Despite the LH(-) group demonstrating a greater corticosterone response to the LH stressor compared to the LH(+)rats, they exhibited earlier onset and greater seventy of AA. In contrast, intraperitoneal injection of LPS several weeks prior to induction of AA protected against inflammation. These results provide further evidence that environmental factors influence the etiology of at least one type of inflammation. The modulation of inflammation by a defined stressor suggests that understanding of the underlying mechanisms may provide a potential for novel therapies.

Inflammatory pain reduces correlated activity in the dorsal column nuclei

Persistent pain can result in sensitization of neurons in the spinal cord dorsal horn and produce physiological changes in sites such as the thalamus, that receive projections from the dorsal horn. Although the dorsal column nuclei receive both primary afferent input and projections from the dorsal horn, their participation in persistent pain states is relatively unexplored, perhaps because they play a limited role in acute, cutaneous nociception. We have used a model of inflammatory pain to examine the physiological properties of dorsal column nucleus neurons during persistent pain. We used this model in order to minimize direct damage to large myelinated primary afferents that project directly to the dorsal column nuclei. Inflammation was produced by injection of complete Freund's adjuvant into one hindpaw in rats, and neurons in the gracile nucleus were recorded 2-8 days later. Inflammation resulted in increased responsiveness to nociceptive (pinch) stimulation and increased incidence of afterdischarge firing 2-3 days after injection. Spontaneous activity was increased 6-8 days after injection. Inflammation decreased the strength of correlated firing in neuron pairs that shared common inputs, but did not affect the strength of monosynaptic interactions between neurons. These results suggest that the dorsal column nuclei can participate in persistent pain processes. Based on their anatomical connections, the dorsal column nuclei may contribute to thalamic changes during persistent pain as well as to supraspinal centers that modulate pain transmission in the spinal cord.

Effects of relaxation and stress on the capsaicin-induced local inflammatory response

OBJECTIVE

Although stress is known to modulate the inflammatory response, there has been little experimental examination of the effects of stress and stress reduction on inflammation in humans. In particular, the effects of stress and relaxation on neurogenic inflammation have been minimally studied. This study examines the effects of three experimental manipulations: mental stress, relaxation, and control on the local inflammatory response evoked by the intradermal injection of capsaicin, the active ingredient in chili peppers.

METHODS

Fifty subjects (28 men and 22 women) were pretrained in relaxation using an imagery-based relaxation tape and then randomized to experimental condition. Subjects participated in an evening reactivity session including 20 minutes of a stress (Stroop test), relaxation (tape), or control (video) manipulation, followed by a capsaicin injection in the forearm. Digitized flare measurements were taken for 1 hour postcapsaicin, and measurements of cardiovascular variables, cortisol, adrenocorticotrophic hormone, and norepinephrine were taken at regular intervals.

RESULTS

The size of the maximum capsaicin-induced flare was significantly smaller in the relaxation condition than in the stress or control conditions, which did not differ from each other. Increases in norepinephrine, heart rate, and systolic blood pressure during the experimental task, but not after capsaicin, significantly predicted size of maximum flare and total area under the curve of flare measurements.

CONCLUSIONS

These findings suggest that stress reduction may affect local inflammatory processes. Results are consistent with sympathetic modulation of the effects of relaxation on the flare response.

A behavioral test paradigm to measure the aversive quality of inflammatory and neuropathic pain in rats

The present experiment assessed the aversive quality of neuropathic and inflammatory pain in rats. Compared to sham-treated animals, L5 ligated (neuropathic) and complete Freund's adjuvant (inflammatory)-treated animals displayed an initial period of escape followed by avoidance of a preferred location of the test chamber that was associated with mechanical stimulation of the hyperalgesic paw. The onset of the avoidance behavior occurred during the first 10-15 min of behavioral testing and was maximal at 30 min. It is concluded that animals find mechanical stimulation of the hyperalgesic paw aversive and that this behavioral test paradigm is an additional method that may be used to assess nociception in rat neuropathic and inflammatory models.

Sex differences and phases of the estrous cycle alter the response of spinal cord dynorphin neurons to peripheral inflammation and hyperalgesia

The neuromodulatory interactions of sex steroids with the opioid system may result in sex differences in pain and analgesia. Dynorphin is an endogenous kappa-opioid peptide that is upregulated in an animal model of peripheral inflammation and hyperalgesia and is possibly regulated by circulating levels of sex steroids. The present study compared behavioral responses of male, cycling female, and gonadectomized Sprague-Dawley rats in a model of persistent pain. Cycling female rats were behaviorally tested over a 14-day period, and their estrous cycles were monitored by daily vaginal smears. Thermal hyperalgesia was measured by paw withdrawal latencies taken prior to and 24-72 h after rats received a unilateral hindpaw injection of complete Freund's adjuvant (CFA). Prior to CFA administration, there was no significant difference in paw withdrawal latencies between male rats, cycling female rats, and ovariectomized female rats. Following CFA administration, female rats in proestrus exhibited significantly increased hyperalgesia compared with male rats, ovariectomized female rats, and female rats in other estrous stages (P</=0.05). Levels of spinal preprodynorphin (PPD) mRNA induction in the L4-L5 segments were assessed by Northern blot analysis. PPD mRNA expression ipsilateral to the injected paw was significantly higher in female rats in diestrus (P</=0.05) and proestrus (P</=0.01) compared with rats in estrus and intact male rats. Ovariectomized rats had significantly higher levels of PPD mRNA expression compared with intact male rats (P</=0.05). However, castrated male rats had significantly lower levels of PPD mRNA expression than intact male rats (P</=0.05). PPD mRNA expression was not altered on the contralateral side of the spinal cord in any group. These results suggest a hormonal regulatory influence on the response of spinal cord dynorphin neurons to chronic inflammation and furthermore, that the association of the endocrine and opioid systems have the ability to influence an animal's sensitivity to pain.

Nociceptive and inflammatory effects of subcutaneous TNFalpha

Tumor necrosis factor alpha (TNF) is a potent pro-inflammatory cytokine that produces pain and hyperalgesia following injection. Its algesic effects are due to sensitizing actions on nociceptive primary afferents and to the upregulation of other pro-inflammatory and algesic proteins. In anesthetized rats, we investigated the effect of subcutaneously injected TNF on background activity and mechanical sensitivity of C nociceptors of the sural nerve, as well as its effects on cutaneous plasma extravasation. TNF sensitized C nociceptors dose-dependently; the optimal dose (5 ng) lowered threshold in 66.7% of the tested fibers. This sensitization occurred within 30 min and could last for 2 or more hours. Injected TNF had no effect on Abeta mechanoreceptive fibers. In addition, TNF evoked ongoing activity in 14% of C nociceptors and caused significant and dose-related increases in vascular permeability in glabrous skin. Our data suggest that TNF released during disease or after tissue injury participates in the generation of hyperalgesia and inflammation.

Tape-recorded hypnosis instructions as adjuvant in the care of patients scheduled for third molar surgery

As medical costs continue to escalate, there is willingness to consider the role played by nontraditional factors in health. We investigated the usefulness of tape-recorded hypnosis instruction on perioperative outcome in surgical patients in a prospective, randomized, and partially blinded study. Sixty patients scheduled for third molar surgery were studied. Patients were allocated to either an experimental group (E) or a control group (C). Group E received an audio tape to listen to daily for the immediate preoperative week, which guided the patients through a hypnotic induction and included suggestions on enhancement of perioperative well-being. Group C did not receive any tapes. The same surgeon administered local anesthesia and a standard regimen of sedation and performed the operation for all patients. The following variables were assessed 1 wk before surgery, immediately before and after surgery, and for 3 days after surgery by the indicated measurements: State anxiety by a Spielberger scale; nausea and pain by visual analog scales; number of tablets of the analgesics that were used; number of episodes of vomiting; and complications. In addition, the surgeon's assessment of ease of surgery was recorded. Two variables showed differences between the groups. First, Group C exhibited a mean increase of 11.7 points on the Spielberger scale from the screening to the presurgery period, while Group E showed only a mean increase of 5.5 points during the same period, P = 0.01. Second, the mean number of vomiting episodes was more in Group E, 1.3, than in Group C, 0.3, P = 0.02. In conclusion, anxiety was reduced before surgery by means of an audio tape containing hypnotic instructions; however, for no apparent reason, there was also an increase in the incidence of vomiting.

IMPLICATIONS

We administered hypnosis instructions to patients before third molar surgery. Anxiety was reduced, but there was an increase in the incidence of vomiting. Although an easy and cost-effective method, the value of this approach remains to be established.

The contribution of the cerebellum to mental and social functions in developmental age

Here are present the data concerning the intellectual, language and frontal performances of 24 children who had undergone surgery because of cerebellar hemispheric or vermis tumors and one girl with viral cerebellitis. The children with right cerebellar tumors presented auditory sequential memory and language processing disturbances; those with left cerebellar tumors showed deficits in spatial tests and visual sequential memory. The girl with cerebellitis showed a complex neuropsychological picture with impairment in processing language and in general sequential functions. Lesions of the vermis lead to two pictures: 1) a postsurgical mutism that could be subdivided into speech disorders (even to the extent of anarthria) and true language disturbances similar to frontal aphasia; and 2) behavioral disturbances ranging from irritability to a truly autistic response. These data seem to support the recently attributed role of the cerebellum as a modulator of the superior mental and social functions.

Sickness and behaviour in animals: a motivational perspective

Proinflammatory cytokines, produced by the activated immune system, induce a whole set of non-specific symptoms in the infected individual (i.e. hypophagia, adipsia, reduced social interest). However, evidence summarised in this review shows that behavioural changes induced by cytokines are not merely the consequence of a degraded state but reflect motivational reorganisation. If the set-up of these new priorities is expressed by a general decrease in behavioural activities (e.g. immobility, sleepiness), the sick individual remains nevertheless an open system still able to respond to environmental stimuli. If these cues are evaluated as relevant to the new priorities (e.g. cues from scattered pups or cues from nest material when ambient temperature is low), the sick individual interrupts sickness behaviour in order to respond specifically to the cues (e.g. retrieving of the pups or nest building). Once this is done, there is a return to recuperative behaviour. These findings represent a primary characterisation of biobehavioural action of immune stimuli, and they open new perspectives to facilitate further progress in our understanding of cytokine effects on behaviour.

Inflammation-induced up-regulation of protein kinase Cgamma immunoreactivity in rat spinal cord correlates with enhanced nociceptive processing

Activation of various second messengers contributes to long-term changes in the excitability of dorsal horn neurons and to persistent pain conditions produced by injury. Here, we compared the time-course of decreased mechanical nociceptive thresholds and the density of protein kinase Cgamma immunoreactivity in the dorsal horn after injections of complete Freund's adjuvant in the plantar surface of the rat hindpaw. Complete Freund's adjuvant significantly increased paw diameter and mechanical sensitivity ipsilateral to the inflammation. The changes peaked one day post-injury, but endured for at least two weeks. In these rats, we recorded a 75-100% increase in protein kinase Cgamma immunoreactivity in the ipsilateral superficial dorsal horn of the L4 and L5 segments at all time-points. Electron microscopy revealed that the up-regulation was associated with a significant translocation of protein kinase Cgamma immunoreactivity to the plasma membrane. In double-label cytochemical studies, we found that about 20% of the protein kinase Cgamma-immunoreactive neurons, which are concentrated in inner lamina II, contain glutamate decarboxylase-67 messenger RNA, but none stain for parvalbumin or nitric oxide synthase. These results indicate that persistent changes in protein kinase Cgamma immunoreactivity parallel the time-course of mechanical allodynia and suggest that protein kinase Cgamma contributes to the maintenance of the allodynia produced by peripheral inflammation. The minimal expression of protein kinase Cgamma in presumed inhibitory neurons suggests that protein kinase Cgamma-mediated regulation of excitatory interneurons underlies the changes in spinal cord activity during persistent nociception.

Reduction in peripheral inflammation by changes in attention

Peripheral inflammation in response to intra-articular injection of sodium urate was measured in birds showing pain-coping behaviour as well as in birds showing endogenous analgesia produced by changes in attention. Sixteen birds were injected with sodium urate into the left ankle joint. Eight birds were returned to their cages, and eight were placed in pairs into a novel pen. The birds placed into the novel pen showed significantly less pain coping behaviour in the 3-h period after injection than those birds returned to their cages. Both groups of birds showed elevated skin temperature over the inflamed joint, but in the birds in the novel pen this increase in temperature was significantly less than in the birds in cages. These results demonstrate that attentional shifts cannot only reduce the severe tonic pain of sodium urate arthritis, but also reduce peripheral inflammation.

Rapid sodium channel augmentation in response to inflammation induced by complete Freund's adjuvant

The mechanisms by which inflammation induces a chronic pain state are poorly understood. Following the induction of many painful conditions, an increase in the spontaneous firing rate of neurons is often observed in peripheral sensory ganglia. Since ion channels are essential mediators of spike generation and impulse conduction, it is reasonable to postulate that local changes in ion channel expression might underlie the changes in membrane excitability. Such alterations may serve to enhance the efficiency by which painful stimuli are transduced and then conducted to the central nervous system. In these studies, we employed immunocytochemical methods to investigate the changes in sodium channel expression in dorsal root ganglia of rats following a subcutaneous injection of complete Freund's adjuvant, an inducer of chronic inflammation. We find that sodium channel immunoreactivity within primary sensory neurons is dramatically increased within 24 h of the complete Freund's adjuvant injection. These changes persist in small neurons for at least 2 months and roughly parallel the time course of behaviorally measured changes in pain thresholds. Thus, the regulation of sodium channel synthesis may play a role in the generation and maintenance of the hyperesthetic state seen in chronic inflammation.

Relationship of body energy status to inflammation-induced anorexia and weight loss

The response to acute inflammation of rats at two levels of prior weight reduction were compared with normal-weight rats to examine how prior alterations in body energy status influence inflammation-induced anorexia and weight loss. Specifically, body weights were either reduced by 6%, the level of weight loss expected in normal-weight rats following induction of acute inflammation, or by 12%, a level 6% below that expected of the normal-weight rats. Rats were either allowed to eat ad lib. on postinflammation Day 1 or were kept on food restriction until Day 5, when anorexia was no longer expected to be present. As predicted, normal-weight rats allowed to eat ad lib. beginning Day 1 displayed the most severe anorexia. Total food intake of this group over the first 5 days following inflammation induction was 33% less than the control (CON) group. Rats with 6% prior weight reduction displayed a milder anorexia, eating only 15% less than the CON group over the first 5 days. In contrast, rats with 12% prior weight reduction ate the same amount of food as the CON group. Interestingly, similar feeding patterns were observed in rats that resumed ad lib. feeding on Day 5. The outcome of these various feeding patterns was to bring body weights of all the inflammation groups to the same level, approximately 6% below CON group weights. These results provide further evidence that proinflammatory mediators induce a temporary reduction in the amount of body tissue (weight) spontaneously maintained that is directly proportionate to the magnitude of insult.

The effect of genotype on sensitivity to inflammatory nociception: characterization of resistant (A/J) and sensitive (C57BL/6J) inbred mouse strains

The important role of genetic factors in the mediation of sensitivity to pain and pain inhibition is being increasingly appreciated. In an attempt to systematically study the genotypic influences on inflammatory nociception, we conducted a survey of the nociceptive responsivity of three common outbred mouse strains and 11 inbred mouse strains on the formalin test. The formalin test is known to display a biphasic temporal pattern of behavioral and electrophysiological activity, defined by an acute/early phase and a tonic/late phase. Nociceptive sensitivity (licking/biting of the affected area) to a subcutaneous injection of 5% formalin (25 microl volume) into the plantar surface of the right hindpaw displayed moderate heritability in both phases (0.38 and 0.46, respectively). One strain, A/J, was identified as extremely resistant to formalin nociception, displaying total licking in the acute and tonic phases that was 60% and 87% lower, respectively, than the grand mean of all strains. A subsequent series of experiments were performed to characterize the difference between A/J and C57BL/6J mice. The findings establish this inbred strain comparison as a useful genetic model of nociceptive sensitivity.

Role of caffeine in combined analgesic drugs from the point of view of experimental pharmacology

The interactions of caffeine (CAS 58-08-2) with acetylsalicylic acid (CAS 50-78-2, ASA) and paracetamol (CAS 103-90-2) were investigated with regard to the analgesic, antiphlogistic, antipyretic and other properties. The inhibitory effect of paracetamol and ASA on the prostaglandin biosynthesis in a cyclooxygenase preparation from bovine brain in vitro was not affected by the addition of caffeine. Caffeine additively increases the antinociceptive effect of paracetamol with regard to the heat-induced pain in the mouse, as does aminophenazone. The antinociceptive effect of aminophenazone on the mechanically induced pain in the mouse is also additively increased by caffeine. In contrast to the effect of aminophenazone on the inflammatory pain in the rat, the effect of ASA is not increased by caffeine and that of paracetamol only negligibly. The antipyretic effect of paracetamol is additively increased by caffeine in the normothermic rat. The antipyretic effect of ASA and paracetamol on the yeast-induced pyrexia of the rat is not affected by caffeine. Caffeine additively increases the acute antiexudative effect of ASA and aminophenazone on the carageenin-induced oedema of the hind paw of the rat. The increase in locomotor activity caused by caffeine in mouse and rat is neutralised or diminished when the caffeine is given in combination with paracetamol. This effect is maintained even if the rats are pretreated with the combination of active ingredients for 3 weeks. The ulcerogenic effect of ASA in the stomach of the rat is not increased by caffeine. The protective effect of ASA against the hepatotoxic effect of paracetamol in the mouse is not influenced by the addition of caffeine. The plasma levels after the oral administration of 20 mg/caffeine/ kg and 80 mg paracetamol/kg in the rat are not significantly changed when the substances are given in combination. The toxicological advantages resulting from combining ASA and paracetamol with caffeine are discussed.

Hypersensitivity of lurcher mutant mice to the depressing effects of lipopolysaccharide and interleukin-1 on behaviour

Lurcher mutant mice are characterized by a fast and almost total loss of olivocerebellar neurones during the first postnatal month, associated with a chronic inflammatory state. To test their brain sensitivity to proinflammatory cytokines, we assessed the behavioural responses of adult male Lurcher and wild type to an i.p. or i.c.v. injection of rat recombinant IL-1 beta, and lipopolysaccharide (LPS). IL-1 beta (15 micrograms kg-1, i.p. or 1 ng i.c.v.) decreased social exploration measured 2, 4 and 6 h later, and this decrease was significantly more pronounced in Lurcher than in wild type mice. LPS (60 micrograms kg-1, i.p. or 5 ng i.c.v.) decreased social exploration measured 2 and 4 h later, and this effect was also significantly more marked in Lurcher than in wild type mice. These results suggest that the chronic inflammatory state which characterizes Lurcher mice renders these animals more sensitive to the effects of cytokines such as IL-1 beta and LPS. This difference may be due to the higher reactivity of brain macrophages and glial cells to LPS and IL-1 in Lurcher mice than in wild type.

Neurogenic inflammation: with additional discussion of central and perceptual integration of nonneurogenic inflammation

The Working Group on Neurogenic Inflammation proposed 11 testable hypotheses in the three domains of neurogenic inflammation, perceptual and central integration, and nonneurogenic inflammation. The working group selected the term people reporting chemical sensitivity (PRCS) to identify the primary subject group. In the domain of neurogenic inflammation, testable hypotheses included: PRCS have an increased density of c-fiber neurons in symptomatic tissues; PRCS produce greater quantities of neuropeptides and prostanoids than nonsensitive subjects in response to exposure to low-level capsaicin or irritant chemicals; PRCS have an increased and prolonged response to exogenously administered c-fiber activators such as capsaicin; PRCS demonstrate augmentation of central autonomic reflexes following exposure to agents that produce c-fiber stimulation; PRCS have decreased quantities of neutral endopeptidase in their mucosa; exogenous neuropeptide challenge reproduces symptoms of PRCS. In the domain of perceptual and central integration, testable hypotheses included: PRCS have alterations in adaptation, habituation, cortical representation, perception, cognition, and hedonics compared to controls; the qualitative and quantitative interactions between trigeminal and olfactory systems are altered in PRCS; higher integration of sensory inputs is altered in PRCS. In the domain of nonneurogenic inflammation, testable hypotheses included: increased inflammation is present in PRCS in symptomatic tissues and is associated with a heightened neurosensory response; PRCS show an augmented inflammatory response to chemical exposure. The working group recommended that studies be initiated in these areas.

Formalin- and carrageenan-induced inflammation attenuates place preferences produced by morphine, methamphetamine and cocaine

Morphine-, methamphetamine- and cocaine-induced place preferences under inflammation produced by unilateral injections of 2.5% formalin (50 microliters) and 1% carrageenan (100 microliters) into the hind paw were examined in rats. Formalin and carrageenan reduced the paw pressure threshold, and this hyperalgesia lasted for 9 and 13 days, respectively. Morphine-, cocaine- and methamphetamine-induced place preferences were significantly attenuated in inflamed groups as compared with the respective noninflamed groups. However, indomethacin failed to produce a place preference in either group. Furthermore, the morphine-induced place preference in the inflamed group gradually recovered to the respective control level as the inflammation healed. These results suggest that the rewarding effects of morphine, cocaine and methamphetamine are attenuated in the presence of inflammatory nociception.

A nitric oxide synthesis inhibitor (L-NAME) reduces licking behavior and Fos-labeling in the spinal cord of rats during formalin-induced inflammation

Formalin injected subcutaneously into the hindpaw of the rat produces an animal model of inflammation that exhibits a phasic component and a tonic component of pain. We evaluated the effects of a nitric oxide synthase inhibitor, N omega-nitro-L-arginine methyl ester (L-NAME), on a formalin-induced behavior, hindpaw licking, and on Fos-labeling of nuclei in the fifth lumbar spinal segment. Our results demonstrated that pretreatment with intrathecal doses of 0.3 and 1.0 mg of L-NAME significantly reduced licking behavior associated with injection of formalin into the left hindpaw of the rat. In addition, these same doses of L-NAME reduced formalin-induced Fos-labeling in the ipsilateral dorsal gray matter (as compared to the contralateral gray matter). Qualitative assessment suggested that the reduction in labeling occurred primarily in the superficial dorsal horn. The stereoisomer, D-NAME, administered at the same doses had little to no effect on either formalin-induced licking or Fos-labeling. Finally, our results revealed that total licking time was related to Fos-labeling. Rats that spent less time licking the hindpaw exhibited a smaller increase in Fos-labeling. Our results suggest that the production of nitric oxide is associated with licking behavior resulting from formalin injection into the hindpaw of rats. Our results also suggest that the production of nitric oxide and Fos are associated. Indeed, these substances may be involved in spinal pathways associated with nociception.

Endotoxin-induced local inflammation and hyperalgesia in rats and mice: a new model for inflammatory pain

Lipopolysaccharide, also known as endotoxin (ET), is a major constituent of the outer membrane of the cell wall of most gram negative bacteria. ET is known to cause a number of pathophysiological changes associated with illness including inflammatory pain. The aim of this study is to characterize the peripheral hyperalgesia induced by ET in rats and mice. Different groups of rats and mice received different doses of ET ranging from 0.6 microgram to 40 micrograms dissolved in 50 microliters saline and injected in the plantar area of the left hind legs. All animals were subjected to tail immersion (TF), hot plate (HP) and paw pressure (PP) tests, 2-3 days prior to ET injection and during the following 1-2 days. ET injections produced a dose-dependent decrease in the latencies of the HP and PP tests of the injected leg reaching a maximum decrease of 50-60% of the control with 20-40 micrograms ET at 9 h (rats) and 24 h (mice) after the injection. Almost complete recovery was observed after 24 h in rats and 48 h in mice. TF latencies showed a less but a significant decrease while PP of the opposite leg and all tests in saline-injected animals did not elicit significant variations and served as additional controls. Our results indicate that the use of ET-produced hyperalgesia is a valid model for local and reversible inflammatory pain, with minimal distress to the animal. This model can also be used to study the efficacy of various anti-inflammatory and analgesic drugs and the molecular mechanisms of inflammation induced by bacterial invasion.

Evidence for an immune response in major depression: a review and hypothesis

1. This paper reviews recent findings on cellular and humoral immunity and inflammatory markers in depression. 2. It is shown that major depression may be accompanied by systemic immune activation or an inflammatory response with involvement of phagocytic (monocytes, neutrophils) cells, T cell activation, B cell proliferation, an "acute" phase response with increased plasma levels of positive and decreased levels of negative acute phase proteins, higher autoantibody (antinuclear, antiphospholipid) titers, increased prostaglandin secretion, disorders in exopeptidase enzymes, such as dipeptidyl peptidase IV, and increased production of interleukin (IL)-1 beta and IL-6 by peripheral blood mononuclear cells. 3. It is hypothesized that increased monocytic production of interleukins (Il-1 beta and Il-6) in severe depression may constitute key phenomena underlying the various aspects of the immune and "acute" phase response, while contributing to hypothalamic-pituitary-adrenal-axis hyperactivity, disorders in serotonin metabolism, and to the vegetative symptoms (i.e. the sickness behavior) of severe depression.

Neuroendocrine factors in susceptibility to inflammatory disease: focus on the hypothalamic-pituitary-adrenal axis

Communication between the central components of the stress response and the immune system plays an important role in susceptibility to inflammatory disease. This communication occurs through hormonal and neuronal mechanisms. Hormonal mechanisms involve activation of the hypothalamic-pituitary-adrenal (HPA) axis by immune system products, e.g. cytokines. The stimulated HPA axis regulates immune responses through the immunosuppressive effects of glucocorticoids. Neuronal mechanisms include direct innervation of immune organs. Cytokine activation of the HPA axis and the resultant glucocorticoid-induced suppression of immune and inflammatory responses represent an important mechanism whereby the central stress response modulates peripheral inflammation. Interruption of this communication is associated with exacerbation of inflammatory disease. Conversely, intracerebroventricular transplantation of hypothalamic tissue from inflammatory resistant rats into susceptible rats reduces peripheral inflammation by more than 85%.

[User knowledge and attitude in relation to drug use for pain, fever or inflammation]

OBJECTIVE

To find how users identified non-steroidal analgesic/antipyretic/anti-inflammatory drugs (NSAID) and their adverse reactions, as well as where the prescriptions were obtained and where users inquired when in doubt.

DESIGN

An observation study carried out by means of a structured questionnaire administered to 174 residents in our basic health area.

SETTING

Cerro del Aguila Basic Health Area in Sevilla.

PARTICIPANTS

The 174 residents, chosen at random, by quotas corresponding to the Census' demographic characteristics. People under 15 were excluded.

MEASUREMENTS AND MAIN RESULTS

32.2% had no spontaneous memory of having taken any NSAID: 86.8% did not remember any possible adverse reaction to medication. Only 49.3% of the NSAID declared were prescribed by a doctor. 17.8% took NSAID daily and 5.7% took more than one medicine containing NSAID every day.

CONCLUSIONS

In our health area, health education, both to identify NSAID as a pharmacological group and any possible adverse reactions, needs to be strengthened.

Central monoaminergic changes induced by morphine in hypoalgesic and hyperalgesic strains of domestic fowl

The present research examined morphine dose-response effects on both the formalin test and on CNS monoamine (MA) levels and the metabolites dihydroxyphenylacetic acid (DOPAC) and 5-hydroxyindoleacetic acid (5-HIAA) in hypoalgesic (76) and hyperalgesic (SN) strains of domestic fowl. Morphine produced a significant hypoalgesic response in the 76 strain at 15-45 mg/kg and a significant hyperalgesic response in the SN strain at 5-10 mg/kg. In subsequent experiments, analyses of whole brain (minus tectum), brainstem, and spinal cord MA, DOPAC, and 5-HIAA via high-performance liquid chromatography with electrochemical detection (HPLC-EC) were performed following morphine administration in both the 76 and SN strains. Morphine produced a significant elevation of brain dopamine (DA) and a significant elevation of brain, brainstem, and spinal cord serotonin (5-HT) in both the 76 and SN strains. Morphine elevated brain norepinephrine (NE) in the 76 strain. However, morphine failed to affect brain NE in the SN strain. This distinct morphine effect on brain NE differentiates strain-dependent hypoalgesia and hyperalgesia in domestic fowl.

[Anxiety, inflammation and duration of operation: is there a relationship?]

Pain, facial swelling and trismus evolution after removal of impacted lower third molar were studied in 34 patients obtained from a random sample. A significantly longer length of surgery and facial swelling were observed at 24 hours postoperatively patients with a high anxiety level.