Granulocyte defects and opioid receptors in chronic exposure to heroin or methadone in humans

Expression of Opioid Receptors in Cells of the Immune System

The observation of the immunomodulatory effects of opioid drugs opened the discussion about possible mechanisms of action and led researchers to consider the presence of opioid receptors (OR) in cells of the immune system. To date, numerous studies analyzing the expression of OR subtypes in animal and human immune cells have been performed. Some of them confirmed the expression of OR at both the mRNA and protein level, while others did not detect the receptor mRNA either. Although this topic remains controversial, further studies are constantly being published. The most recent articles suggested that the expression level of OR in human peripheral blood lymphocytes could help to evaluate the success of methadone maintenance therapy in former opioid addicts, or could serve as a biomarker for chronic pain diagnosis. However, the applicability of these findings to clinical practice needs to be verified by further investigations.

Effect of morphine sulfate on neonatal neutrophil chemotaxis

BACKGROUND

Opioids have been increasingly used for pain control in the neonatal intensive care unit. Data from adult human studies have demonstrated suppressive effects of morphine sulfate on the immune system, owing in part to its inhibition of chemotaxis.

OBJECTIVE

To study the effect of morphine exposure on chemotaxis of newborn neutrophils compared with adult neutrophils.

METHODS

Blood samples were collected from adult controls and from the umbilical cord of healthy full-term newborns. Neutrophils were isolated and then exposed to morphine sulfate. Chemotaxis assays were performed using interleukin (IL)-8 as the chemoattractant. The migrated neutrophils were quantitated by flow cytometry. IL-8 receptor expression was evaluated by staining with an anti-IL-8 receptor-specific antibody. Chemotaxis and IL-8 receptor expression were compared between newborn and adult neutrophils.

RESULTS

There was no difference in random migration between adult (n=10) and newborn neutrophils (n=14). IL-8 efficiently induced chemotaxis of both adult and newborn neutrophils, although newborn neutrophils exhibited significantly decreased chemotaxis compared with adult neutrophils: 389+/-197 newborn cells versus 731+/-190 adult cells (P=0.025). Exposure to morphine sulfate did not decrease chemotaxis of adult neutrophils but did modestly impair chemotaxis of newborn neutrophils. After exposure to morphine sulfate, adult neutrophils showed no difference in IL-8 receptor expression, whereas newborn neutrophils expressed fewer IL-8 receptors.

CONCLUSIONS

Newborn neutrophils had reduced chemotaxis toward IL-8. Exposure to morphine sulfate further decreased their chemotactic function. The differential effect may be explained in part by the reduction of IL-8 receptors of newborn neutrophils after morphine exposure.

Alteration in specific opioid-receptor labeling on peripheral blood leukocytes of bile duct-ligated rat

Cholestasis is associated with increased tonus and activity of opioidergic system. Opioid peptides have also immunomodulatory effects through stimulation of specific opioid receptors on the immune cells, or in an indirect fashion via the central nervous system. The combination of immunofluorescent technique and flow cytometry has proven to be sensitive method for the detection of leukocyte opioid receptors. This study was designed to examine the effect of cholestasis on the opioid-receptor labeling on the leukocytes from bile duct-ligated rats. Seven days after surgery, leukocytes were isolated from the peripheral blood of bile duct-ligated or sham-operated rats. The cells were incubated with naltrexone-fluorescein, in the absence or presence of unlabeled naltrexone, as a competitor and analysed by flow cytometry. Monocytes and granulocytes from bile duct-ligated rats showed an increase in the percentage of opioid-receptor labeling (29.6+/-2.08 for cholestatic versus 23+/-1.9 for sham, p<0.001; 50.6+/-3.18 for cholestatic versus 39.6+/-1.7 for sham, p<0.05; respectively). Furthermore, there was a decrease in the expression of opioid receptors on leukocytes due to cholestasis. In conclusion, changes in specific opioid-receptor labeling and percent of labeled leukocytes indicate that endogenous opioid-receptor interaction may be altered in peripheral blood leukocytes in acute cholestasis.

Effect of acupuncture on the neutrophil respiratory burst: a placebo-controlled single-blinded study

OBJECTIVES

Little is known about the influence of acupuncture treatment on the phagocytic immune system. This trial was performed to examine whether multiple acupuncture treatment affects the respiratory burst (RB) of neutrophils, a recognised measure of their cytotoxicity.

DESIGN

Placebo-controlled single-blinded study.

INTERVENTIONS

Eleven volunteers were treated bilaterally with standard needles (real) at acupoint LI11, 11 volunteers with placebo needles (placebo) at the same point. Treatments were performed for 30 min each twice a week for 4 weeks, eight times in all. The standard needles were manipulated until needle sensation (DEQI) developed. Before the treatment course (baseline), 48 h after the fourth (follow-up 1) and 48 h after the last treatment (follow-up 2) blood samples were drawn.

MAIN OUTCOME MEASURES

RB and plasma beta-endorphin at each time point.

RESULTS

In the real group there was a highly significant increase in the RB at follow-ups 1 (P=0.004) and 2 (P=0.007). Beta-endorphin levels decreased, but not significantly. In the placebo group there was a significant increase in the RB at follow-up 2 (P=0.048). In addition, at follow-up 2 a significant drop in beta-endorphin levels was observed (P=0.015).

CONCLUSIONS

The RB of neutrophils is significantly activated by a course of several acupuncture treatments. In addition, psychological effects and a placebo that was not totally inert may contribute to the findings in the placebo group which may be mediated by the opiate endorphin system.

Opioids, immunology, and host defenses of intravenous drug abusers

Overall, it is apparent that opioids do affect host defense mechanisms. Heroin users present with an altered and functionally impaired immune system and have a higher prevalence of infectious diseases than do nonaddicts. Individuals exposed to opioid treatment for pain management during surgical procedures or maintained on oral methadone for treatment of drug addiction show either no effect or a suppressed immune system, depending on dosage and, in the case of methadone-maintained patients, duration of drug treatment. Confounding factors in these studies undermine definitive conclusions about the mechanisms by which opioids induce their immunomodulatory effects. Animal models have provided the means by which investigators can study the effects of opioids in a complex, biologic system that is easily manipulated and controlled. Findings from these studies have confirmed human data associating a pathogenic susceptibility with opioid use. Animal models have shown the complexity of this association. Interaction of the CNS, the autonomic nervous system, and the HPA axis is required for the varied effects of opioids on the immune system. By implication, exogenous opioids may be mimicking pathways by which endogenous opioids are involved in regulating immune defenses. To minimize the increased incidence of infectious diseases in heroin users and individuals clinically exposed to opioids, it will be important to determine the individual and collective effects of the opioid-induced activation of these pathways and the consequences of that activation to the immune system.

Opioid receptors on white blood cells: effect of HIV infection and methadone treatment

Opioid receptors (OR) are involved in many physiological and pathological immune functions. During recent years, the treatment of opiate addiction with methadone in HIV-positive and HIV-negative patients has become widely accepted. However, little is known on the occurrence and course of OR on lymphocytes of these individuals. The objective of the study was to detect and quantify OR on peripheral white blood cells (WBC) by fluorescence-activated cell sorting using polyclonal antibodies and reverse transcriptase polymerase chain reaction, and to assess the influence of HIV infection and methadone treatment. We compared OR levels in 80 HIV-positive homosexuals, 18 HIV-positive intravenous drug users (IVDU) treated with methadone, 18 HIV-negative IVDU receiving methadone and 25 healthy controls. HIV infection was shown to decrease the amount of OR on WBC, especially of the delta-subtype on lymphocytes and granulocytes. The decrease correlated with the duration of HIV-infection (P<0.01), and inversely with the HIV viral load (P<0.01). In contrast, chronic methadone administration led to a significant increase of OR exclusively in HIV-negative IVDU. In particular the delta-OR was increased by 31-, 62- and 42-fold on lymphocytes, monocytes and granulocytes of HIV-negative patients (each P<0.005), respectively, which was not observed in HIV-positive IVDU. Therefore, HIV seems to reduce OR particularly on lymphocytes and granulocytes regardless of the mode of HIV transmission. The quantification of OR on immune cells may help to elucidate the effects of opioid analogues in health and drug addiction.

Changes in mu opioid receptors and rheological properties of erythrocytes among opioid abusers

Opioids, reported originally to bind to specific receptors in the brain, now also appear to bind to receptors on blood cells. The high prevalence of anemia among chronic opioid users leads us to propose that chronic opiate use results in elevated mu opioid receptor levels on human erythrocytes and that these receptor changes may affect erythrocyte membrane properties. Blood samples from 17 opioid-dependent subjects (based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or DSM-IV) and 15 drug-free controls were assayed for mu opioid receptors on erythrocytes using a flow cytometry immunoassay. Deformability and the hydration status of erythrocytes were studied by ektacytometry. Data were analyzed by independent t-tests, tests of correlation, chi square and cluster analyses. As expected, the percentage of erythrocytes from opioid-dependent subjects with opioid receptors (opioid receptor levels) was significantly higher (47.4 +/- 38.3%) than controls (22.8 +/- 30.1%) (t = 2.01, df = 30, p < 0.05). Also, the opioid-dependent patients showed a wide variation in the percentage of erythrocytes bearing opioid receptors and data analyses of these patients showed two strongly defined clusters. One subgroup consisted of nine individuals with very high receptor levels (mean = 81.5%) while the other had eight patients with low receptor levels (mean = 9.1%) that were not significantly different than the receptor levels of controls. Ektacytometry of opioid dependent patients with high opioid receptor levels showed changes in rheological parameters of erythrocytes, such as deformability index and cellular hydration. For example, a positive correlation was observed between opioid receptor levels and deformability indices among opioid-dependent patients (r = 0.74, p < 0.005). Our findings indicate that the mu opioid receptor is present on human erythrocytes, although with considerable variation in receptor levels, and that the levels of this receptor are significantly elevated with chronic opioid exposure. Moreover, erythrocytes with high opioid receptor levels from chronic opiate users seem to have high deformability. This study may offer clues to the biological properties of peripheral blood cells that may be mediated by mu opioid receptors and lead to a better understanding of some of the clinical effects of opioid use.

Opioid receptors on bone marrow neutrophils modulate chemotaxis and CD11b/CD18 expression

Opiates impair neutrophil-mediated host defense, but the involvement of kappa-opioid receptors in this action has not been defined. The selective kappa-opioid receptor agonist [trans-(+)3,4-dichloro-N-methyl-N[2-(1-pyrrolidinyl)-cyclohexyl]benzeneacetamide methanesulfonate inhibited macrophage inflammatory protein-2-induced chemotaxis of bone marrow neutrophils from C57BL/6 mice. Its effects were concentration-dependent (pIC(50)=10.40+/-0.61) and inhibited by naloxone (K(e)=0.27 nM). The kappa-opioid receptor agonists bremazocine and ICI-204, 488 also inhibited chemotaxis, as did the respective mu- and delta-opioid receptor agonists [D-Ala(2), N-methyl-Phe(4), Gly(5)-ol]enkephalin and [D-Pen(2,5)]enkephalin albeit with lower potencies. U-50,488H also decreased neutrophil expression of the beta(2) integrin CD11b/CD18 (Mac-1) and adhesion to plastic in a naloxone-reversible manner. The results indicate that kappa-opioid receptors expressed by neutrophils rapidly modulate chemotaxis and adhesion in vitro.

Morphine upregulates mu opioid receptors of human and monkey lymphocytes

Opioid receptors of subtypes delta, kappa, and mu similar to those found in brain cells have been identified in immune cells. The current study demonstrates by competitive polymerase chain reaction the treatment of human lymphocytic cells with morphine resulting in an increased amount of gene expression of mu opioid receptors. Antibodies against the MOR-1, the neuronal mu opioid receptor, were used in Western blot analysis of mu proteins and the results revealed a single band of approximately 50 kDa, the intensity of which was increased by morphine treatment. Similar results of mu opioid receptor activation were observed when monkey lymphocytes were treated with morphine. These studies suggest that in addition to causing an immune effect through communication with the neuroendocrine system, the psychoactive drug morphine may modulate immune functions by acting directly on the mu opioid receptors expressed on lymphocytes.

Morphine induces gene expression of CCR5 in human CEMx174 lymphocytes

All HIV-1 strains studied to date use CCR5, CXCR4, or both receptors to enter cells. Simian immunodeficiency virus (SIV) infection of non-human primates has served as a useful model for understanding AIDS pathogenesis in humans. Research on several genetically divergent SIV isolates has revealed that SIV uses CCR5, and not CXCR4, for entry. CEM x174, a human lymphoid cell line, has been routinely used to cultivate and maintain various SIV strains. However, questions have arisen about how CEM x174, which reportedly was unable to express detectable amounts of CCR5 transcripts, efficiently supports the growth of SIV. In searching for an answer, we resorted to a sensitive competitive reverse transcriptase-polymerase chain reaction procedure in an attempt to detect as well as quantify the amount of CCR5 expression. Here we present our findings, which indicate that CEM x174 indeed expresses CCR5 and that the amount of CCR5 is increased in cells pretreated with morphine. These results correlate well with our previous observations that morphine treatment causes CEM x174 cells to be more susceptible to SIV infection. Similar morphine effect was not observed on CEM x174 cells infected with simian retroviruses, which do not depend on CCR5 for entry. These findings suggest a plausible mechanism whereby opiate drug users render themselves more susceptible to HIV infection, thereby explaining the vast prevalence of HIV infection among endemic drug use populations.

Opioids suppress chemokine-mediated migration of monkey neutrophils and monocytes - an instant response

Opioid users having acquired human immunodeficiency syndrome (AIDS) are at a greater risk than non-users of contracting opportunistic infections. Opioid-administered and simian immunodeficiency virus (SIV)-infected rhesus monkeys have been an excellent model for studying AIDS and drug abuse in humans. In this study, chemotaxis of monkey leukocytes was evaluated using the chemokines interleukin-8 (IL-8) and regulated upon activation, normal T cell expressed (RANTES) as the chemoattractants, and the effects of various opioid agonists and antagonists on the efficiency of chemotaxis were examined. Opioids were either incubated with monkey leukocytes or added directly to chemokines, and the number of cells migrating toward IL-8 (for neutrophils) or RANTES (for monocytes) was scored. Inhibition of chemotaxis was seen with both assay conditions, and the inhibition was mediated by opioids binding to mu or kappa receptors. Binding to delta opiod receptors was rarely, if ever, observed. Although opioids themselves may act as weak chemoattractants for monkey leukocytes, addition of opioid agonists to chemokines would reduce the chemoattractant ability of the chemokines. Opioids did not cause the same inhibitory effect on the chemotactic migration of neutrophils when the complement component C5a or the chemotactic peptide N-formyl-MET-LEU-PHE (fMLP) was used as chemoattractant. These studies suggest that the presence of opioids during SIV infection immediately alters chemokine-mediated immune functions.

Neutrophil function and opioid receptor expression on leucocytes during chronic naltrexone treatment in humans

We report that neutrophil function was impaired in former heroin addicts on chronic naltrexone maintenance. Of the subjects, 62.5% had elevated plasma ACTH, 25% had elevated plasma cortisol and one subject had increased urinary cortisol. All subjects showed enhanced expression of opioid receptors on monocytes, neutrophils and lymphocytes. In vitro, incubation with therapeutically relevant concentrations of naltrexone induced a slow increase of neutrophil cytoplasmatic free Ca(2+)concentrations ([Ca(2+)]()E2>i) and slowed down the [Ca(2+)]()E2>i rise induced by N-formyl-methionyl-leucyl-phenylalanine. Neither naltrexone nor its metabolite beta-naltrexol affected human neutrophil function in vitro. We conclude that impairment of neutrophil function during chronic naltrexone may be related to opioid receptor overexpression. With this regard, the possible role of naltrexone-induced [Ca(2+)]()E2>i changes deserves further investigation. 1999 Academic Press.

Priming effect of met-enkephalin and beta-endorphin on chemiluminescence, chemotaxis and CD11b molecule expression on human neutrophils in vitro

The opioid peptides are widely distributed throughout the body, and they are generated during stress and inflammatory reaction. Opioids are involved in the communication between the immune and neuroendocrine systems. In the present study we have investigated the ability of both met-enkephalin and beta-endorphin to stimulate and prime the human neutrophils for enhanced chemiluminescence (CL) and chemotaxis induced with fMLP, OZ or PMA. We have also tested the effect of beta-endorphin and met-enkephalin on CD11a, CD11b, CD18 and CD16 molecule expression on PMN in vitro. PMN from ten healthy donors were incubated in vitro with different concentrations of beta-endorphin or met-enkephalin, and the CL response was evaluated with luminometer. To assess the effect of opioid peptides on CD11a, CD11b, CD18 and CD16 molecule expression the whole blood samples were incubated with different concentrations of the opioids, then the white cells were labelled with respective PE-conjugated MoAb and evaluated by flow cytometry. We have shown that: (1) met-enkephalin and beta-endorphin at physiological concentrations relevant to that of in vivo (10(-8) and 10(-6) M) enhanced fMLP, PMA or OZ stimulated chemiluminescence and induced chemotactic response, (2) High concentrations of beta-endorphin (10(-3) M) or met-enkephalin (10(-5) M) decreased the CL response of PMN in vitro, (3) The opioid peptides at lower concentrations resulted in CD11b and CD18 molecule up-regulation on neutrophils. We may conclude that opioid peptides in physiological concentration are involved in neutrophil priming whereas in higher concentration exert immunosuppressive potency. Opioid peptides like inflammatory cytokines may prime the neutrophils inflammatory response.

Peripheral benzodiazepine receptor expression on leukocytes and neutrophil function during anticonvulsant monotherapy

Epileptic patients on long-term therapy with a single anticonvulsant showed enhanced expression of peripheral benzodiazepine receptors (pBZrs) on neutrophils, monocytes and lymphocytes. N-Formyl-methionyl-leucyl-phenylalanine-induced chemotaxis was significantly impaired in neutrophils from patients on carbamazepine (p < 0.01 vs. controls). Neutrophils from patients on phenytoin had enhanced phorbol myristate acetate-stimulated O-2 production (p < 0. 01 vs. controls) and neutrophils from patients on valproic acid had impaired phagocytosis frequency and Staphylococcus aureus lethality index (p < 0.01 vs. controls). Overexpression of pBZrs on leukocytes may reflect the clinical response to anticonvulsants and may play a role in the immunological effects of some of these drugs.

Neutrophil adhesion molecules in HIV disease

Neutrophil dysfunction in HIV disease is well described. We examined the expression of neutrophil adhesion molecules amongst 72 HIV-infected subjects using a whole blood flow cytometric assay with FITC- and R-PE-labelled isotype-specific MoAbs. We report lesser expression of CD11a (LFA-1) and L-selectin (CD62L) on the circulating neutrophils of HIV+ subjects compared with HIV- controls. Expression of CD11b (Mac-1) was unchanged. Shedding of L-selectin and up-regulation of CD11b in response to in vitro stimulation with N-formyl-methionyl-leucyl-phenylalanine (fMLP) were less in HIV+ compared with HIV- subjects, most markedly in subjects with CD4 cell counts < 100 cells/mm3. These results suggest that neutrophil dysfunction in HIV disease, which increases with disease progression, may be attributable to dysregulated adhesion molecule expression.

Opiates and infection

This review on the effects of opiate use on infectious diseases discusses the complete spectrum of infections in the opiate user, including those of the lung, the GI tract, the skin, the skeletal system, and the CNS. There is both increased prevalence and increased severity of bacterial and viral infections in injection drug users with the outcome of increased morbidity and mortality. The experimental administration of opiates has lead to a greater understanding of the effects on susceptibility to and progression of infectious diseases. Animal models of opiate dependence and infection are reviewed with specific attention to cases in which the opiate-mediated effects are harmful and in which cases they are beneficial.

Carbamazepine affects neutrophil function through an action on peripheral benzodiazepine receptors

The aims of this study were to assess the possible role of peripheral benzodiazepine receptors (pBZrs)1 in mediating the in vitro effects of carbamazepine (CBZ) on some neutrophil functions in healthy volunteers and to investigate neutrophil function and pBZr expression in patients with epilepsia on CBZ monotherapy for at least 1 year. In vitro CBZ (42-168 microM) concentration-dependently inhibited chemotaxis induced by N-formyl-methionyl-leucyl-phenylalanine (FMLP) or lipopolysaccharide (LPS)-activated human serum. CBZ did not affect random migration, phagocytosis index, phagocytosis frequency, NBT reduction frequency, C. albicans lethality index and resting superoxide production. The pBZr antagonist PK 11195 (1 microM, per se ineffective) reversed the inhibitory effect of CBZ on chemotaxis induced by endotoxin-activated serum or FMLP. The pBZr agonist Ro 5-4864 (10-100 microM) mimicked the effect of CBZ on chemotaxis induced by endotoxin-activated serum or FMLP and had no effect on the other parameters. Neutrophils from epileptic patients on chronic CBZ monotherapy had impaired FMLP- and serum-induced chemotaxis and enhanced expression of pBZrs on neutrophils. These data strongly suggest an involvement of pBZrs in mediating the in vitro effects of CBZ on chemotaxis; furthermore, impairment of the same neutrophil function parameters and overexpression of pBZrs in patients are consistent with the hypothesis of an in vivo interaction of CBZ with pBZrs.

Positive and negative immunomodulation by opioid peptides

The data that follow review part of the existing evidence concerning the neuroimmune functions mediated by opioid peptides, with particular regard to dual immunomodulatory effects. Limited references to substances other than opioid peptides are included, mainly to emphasize the possible similarities in the mediation of neuroimmune interactions by different informational substances, while the interactions directed from the immune to the nervous system have deliberately been omitted.