Intrathecal 6-hydroxydopamine or cervical spinal hemisection reduces norepinephrine content, but not the density of alpha 2-adrenoceptors, in the cat lumbar spinal enlargement

Targeted inactivation of spinal α2 adrenoceptors promotes paradoxical anti-nociception

Noradrenergic drive from the brainstem to the spinal cord varies in a context-dependent manner to regulate the patterns of sensory and motor transmission that govern perception and action. In sensory networks, it is traditionally assumed that activation of spinal α2 receptors is anti-nociceptive, while spinal α2 blockade is pro-nociceptive. Here, however, we demonstrate in vivo in rats that targeted blockade of spinal α2 receptors can promote anti-nociception. The anti-nociceptive effects are not contingent upon supraspinal actions, as they persist below a chronic spinal cord injury and are enhanced by direct spinal application of antagonist. They are also evident throughout sensory-dominant, sensorimotor integrative, and motor-dominant regions of the gray matter, and neither global changes in spinal neural excitability nor off-target activation of spinal α1 adrenoceptors or 5HT 1A receptors abolished the anti-nociception. Together, these findings challenge the current understanding of noradrenergic modulation of spinal nociceptive transmission.

Pharmacological profiles of alpha 2 adrenergic receptor agonists identified using genetically altered mice and isobolographic analysis

Endogenous, descending noradrenergic fibers impose analgesic control over spinal afferent circuitry mediating the rostrad transmission of pain signals. These fibers target alpha 2 adrenergic receptors (alpha(2)ARs) on both primary afferent terminals and secondary neurons, and their activation mediates substantial inhibitory control over this transmission, rivaling that of opioid receptors which share a similar pattern of distribution. The terminals of primary afferent nociceptive neurons and secondary spinal dorsal horn neurons express alpha(2A)AR and alpha(2C)AR subtypes, respectively. Spinal delivery of these agents serves to reduce their side effects, which are mediated largely at supraspinal sites, by concentrating the drugs at the spinal level. Targeting these spinal alpha(2)ARs with one of five selective therapeutic agonists, clonidine, dexmedetomidine, brimonidine, ST91 and moxonidine, produces significant antinociception that can work in concert with opioid agonists to yield synergistic antinociception. Application of several genetically altered mouse lines had facilitated identification of the primary receptor subtypes that likely mediate the antinociceptive effects of these agents. This review provides first an anatomical description of the localization of the three subtypes in the central nervous system, second a detailed account of the pharmacological history of each of the six primary agonists, and finally a comprehensive report of the specific interactions of other GPCR agonists with each of the six principal alpha(2)AR agonists featured.

Low doses of alpha 2-adrenoceptor antagonists augment spinal morphine analgesia and inhibit development of acute and chronic tolerance

BACKGROUND AND PURPOSE

Ultra-low doses of opioid receptor antagonists augment spinal morphine antinociception and block the induction of tolerance. Considering the evidence demonstrating functional and physical interactions between the opioid and alpha(2)-adrenoceptors, this study investigated whether ultra-low doses of alpha(2)-adrenoceptor antagonists also influence spinal morphine analgesia and tolerance.

EXPERIMENTAL APPROACH

Effects of low doses of the competitive alpha(2)-adrenoceptor antagonists-atipamezole (0.08, 0.8 ng), yohimbine (0.02, 2 ng), mirtazapine (0.02 ng) and idazoxan (0.08 ng) were investigated on intrathecal morphine analgesia, as well as acute and chronic morphine antinociceptive tolerance using the rat tail flick and paw pressure tests.

KEY RESULTS

At doses markedly lower than those producing alpha(2)-adrenoceptor blockade, atipamezole, yohimbine, mirtazapine and idazoxan, prolonged the antinociceptive effects of morphine. When co-administered with repeated acute spinal injections of morphine, all four agents blocked the induction of acute tolerance. Co-injection of atipamezole with morphine for 5 days inhibited the development of tolerance in a chronic treatment paradigm. Spinal administration of atipamezole also reversed established antinociceptive tolerance to morphine as indicated by the restoration of morphine antinociceptive potency. The effects of atipamezole on spinal morphine tolerance were not influenced by treatment with 6-hydroxydopamine.

CONCLUSIONS AND IMPLICATIONS

Low doses of competitive alpha(2)-adrenoceptor antagonists can augment acute morphine analgesia and block or reverse tolerance to spinal administration of morphine. These actions are interpreted in terms of their interaction with an opioid-alpha(2)-adrenoceptor complex, whose activity may have a function in the genesis of analgesic tolerance.

Differential distribution of alpha2A and alpha2C adrenergic receptor immunoreactivity in the rat spinal cord

alpha2-Adrenergic receptors (alpha2-ARs) mediate a number of physiological phenomena, including spinal analgesia. We have developed subtype-selective antisera against the C termini of the alpha2A-AR and alpha2C-AR to investigate the relative distribution and cellular source or sources of these receptor subtypes in the rat spinal cord. Immunoreactivity (IR) for both receptor subtypes was observed in the superficial layers of the dorsal horn of the spinal cord. Our results suggest that the primary localization of the alpha2A-AR in the rat spinal cord is on the terminals of capsaicin-sensitive, substance P (SP)-containing primary afferent fibers. In contrast, the majority of alpha2C-AR-IR was not of primary afferent origin, not strongly colocalized with SP-IR, and not sensitive to neonatal capsaicin treatment. Spinal alpha2C-AR-IR does not appear to colocalize with the neurokinin-1 receptor, nor is it localized on astrocytes, as evidenced by a lack of costaining with the glial marker GFAP. However, some colocalization was observed between alpha2C-AR-IR and enkephalin-IR, suggesting that the alpha2C-AR may be expressed by a subset of spinal interneurons. Interestingly, neither subtype was detected on descending noradrenergic terminals. These results indicate that the alpha2-AR subtypes investigated are likely expressed by different subpopulations of neurons and may therefore subserve different physiological functions in the spinal cord, with the alpha2A-AR being more likely to play a role in the modulation of nociceptive information.

The hypothalamus-pituitary-ovary and hypothalamus-pituitary-thyroid axes in spinal cord-injured women

Sixteen women with spinal cord injury (SCI) underwent studies of the hypothalamus-pituitary-ovary (HPO) and hypothalamus-pituitary-thyroid (HPT) axes with luteinizing hormone (LH) releasing hormone (LHRH) and thyrotropin (TSH) releasing hormone (TRH) stimulation tests during the early follicular phase. The mean interval from injury to participation in this study was 7.5 years (range, 1.5 to 13.1). All subjects were menstruating regularly. Five (35.7%) SCI subjects who were menstruating before injury had postinjury amenorrhea for 1 to 12 months, and the other nine (64.3%) SCI subjects had no interruption of menstruation after injury. Two SCI subjects whose injury occurred in preadolescence proceeded to menarche without any delay. The amount of menstrual flow was noted to be reduced in nine (64.3%) SCI subjects. Two and three SCI subjects had elevated follicle-stimulating hormone (FSH) and prolactin (PRL) levels, respectively. LH responses to LHRH were significantly higher in the SCI group (P < .001). Ten (62.6%) SCI subjects had enhanced LH responses to LHRH. The mean TSH, PRL, and FSH responses to TRH and LHRH of the SCI group were not significantly different from those of age-matched controls. However, five (31.2%), four (25.0%), and five (31.2%) SCI subjects had enhanced TSH, PRL, and FSH responses to TRH and LHRH, respectively. Six (37.5%) SCI subjects had a delayed FSH response to LHRH. In total, 13 (81.2%) SCI subjects had at least one axis abnormality. These findings are consistent with the hypothesis that changes of central neurotransmitters may occur after SCI.

Pituitary-testicular and pituitary-thyroid axes in spinal cord-injured males

Thirty spinal cord-injured (SCI) males were studied for evaluation of their pituitary-testicular and pituitary-thyroid axes using combined luteinizing hormone-releasing hormone (LHRH) and thyrotropin-releasing hormone (TRH) tests and electroejaculated semen analyses. Thirty age-matched normal male volunteers served as controls. There were four subjects with low serum triiodothyronine (T3) levels, one with elevated serum follicle-stimulating hormone (FSH) level, eight with elevated serum testosterone levels, and 11 with elevated serum prolactin levels. There were significantly elevated luteinizing hormone (LH) responses to LHRH in SCI subjects when compared with normal controls. There were 16 (53.3%) SCI subjects who had exaggerated and/or prolonged LH responses. Among them, six subjects also had elevated FSH responses. There were eight and four subjects whose thyrotropin (TSH) and prolactin responses to TRH were exaggerated, respectively. Marked impaired motility was observed in 56 electroejaculated semen samples from 16 SCI subjects. There was a significant correlation between LH and total sperm count. Our data suggest that there is a reduced central dopaminergic tone in SCI subjects.

Antagonism of stimulation-produced antinociception from ventrolateral pontine sites by intrathecal administration of alpha-adrenergic antagonists and naloxone

Focal electrical stimulation of the ventrolateral pontine tegmentum in conscious rats induced antinociception in approximately one-half of the animals screened, as indicated by a marked suppression of the thermally evoked tail-flick flexion reflex. The effectiveness of ventrolateral pontine stimulation in elevating tail-flick latency was significantly reduced by intrathecal microinjection of 30 micrograms of the non-selective alpha-adrenergic antagonist phentolamine, and was largely abolished by a 60-micrograms dose of this drug. The blockade of ventrolateral pontine stimulation-produced antinociception by phentolamine was maximal by 15 min postinjection, and was still evident 60 min after drug microinjection. Ventrolateral pontine stimulation-produced antinociception was also attenuated by intrathecal administration of the alpha 2-selective antagonist yohimbine (37 micrograms) and the opioid antagonist naloxone (30 micrograms), but not the alpha 1 antagonist WB-4101 (37 micrograms), the beta-adrenergic antagonist propranolol (111.6 micrograms) nor the serotonergic antagonist methysergide (30 micrograms). However, the antagonism of pontine stimulation-produced antinociception by naloxone was unlike that of phentolamine and yohimbine, in that it developed slowly and was only evident at 60 min postinjection. Hence naloxone's site of action may be distant from the injection site. These data indicate that the thermal antinociception produced by stimulation of the ventrolateral pons is mediated through spinal alpha 2-receptors and opioid receptors of uncertain location. The close proximity of many of the effective electrode placements to the rostral A5 and ventral subcoerulear A7 noradrenergic cell groups suggests that noradrenergic spinopetal projections arising from these groups are involved in mediating the antinociception induced by stimulating these sites.

Effects of iontophoresis of noradrenaline and stimulation of the periaqueductal gray on single-unit activity in the rat superficial dorsal horn

Recordings were made with a new form of low-noise carbon fibre microelectrode from 75 units in the superficial laminae of the lumbar dorsal horn of the anaesthetized rat. The response of each unit to adequate stimulation of its peripheral receptive field, to noradrenaline (NA) applied iontophoretically, and to electrical stimulation of the periaqueductal gray (PAG) was investigated. Only units that could be excited by iontophoresis of glutamate (10-100 nA) were analyzed. Recording sites in the spinal cord and stimulation sites in the brainstem were identified histologically at the end of each experiment. Forty-six units with low-threshold receptive fields and small spike amplitudes were found, mainly located in laminae II and III. Both stimulation of the PAG and NA iontophoresis excited the majority (32/46) of these units. The rest were unaffected. Eight high-threshold (HT) units were located in the region of lamina I. Twenty-one wide-dynamic-range (WDR) units were found mainly in deeper laminae. Both WDR and HT units were inhibited by NA and PAG stimulation. This inhibition affected both glutamate-evoked activity and responses to nociceptive stimuli. We suggest that the small LT units are inhibitory interneurones of the substantia gelatinosa (SG), which act on the WDR and HT units to produce nociceptive-specific inhibition. The inhibition can be modality-specific without necessarily being presynaptic because of the laminar arrangement of the dorsal horn. The PAG could thus exert its known antinociceptive effects at least partly via descending noradrenergic axons that excite these SG cells.

Alpha 2-adrenoceptors mediate inhibition of cyclic AMP production in the spinal cord after stimulation of cyclic AMP with forskolin but not after stimulation with capsaicin or vasoactive intestinal peptide

In slices obtained from the ventral and the dorsal guinea pig spinal cord both forskolin and vasoactive intestinal peptide (VIP) caused a dose-dependent stimulation of the production of cyclic AMP. By contrast capsaicin stimulated cyclic AMP formation only in the dorsal cord; no effect was observed in the ventral cord. The alpha 2-adrenergic agonist UK-14,304 dose-dependently inhibited the production of cyclic AMP in both the dorsal and ventral aspects of the cord when the formation of cyclic AMP had been stimulated with 3 microM forskolin, the maximal inhibition amounting to 25-32%. Also the basal (i.e., unstimulated) production of cyclic AMP was inhibited, the inhibition amounting to about 16-18%. However, after stimulation of cyclic AMP formation in the dorsal cord with capsaicin, UK-14,304 was virtually ineffective in inhibiting the accumulation of cyclic AMP. Also, when the formation of cyclic AMP was stimulated with VIP, UK-14,304 was virtually ineffective in inhibiting the formation of cyclic AMP both in the ventral and the dorsal parts of the cord. When cyclic AMP production had been stimulated with forskolin the ability of UK-14,304 to inhibit the formation of cyclic AMP was not attenuated by capsaicin, either in the ventral or in the dorsal cord. The results are discussed with the notion that cyclic AMP inhibitory spinal cord alpha 2-adrenoceptors are located on cells accessible to stimulation of cyclic AMP with forskolin but not with capsaicin or VIP.

Intrathecal bradykinin acts presynaptically on spinal noradrenergic terminals to produce antinociception in the rat

In the awake restrained rat the intrathecal (i.th.) administration of 8.1 pmol-8.1 nmol of bradykinin (BK) and kallidin (KD) enhanced the reaction time (RT) to a noxious radiant heat stimulus in a dose-dependent manner. The fragments BK-(1-8) and BK-(1-7) were active only at doses higher than 10 nmol and the following rank order of potency was observed: BK greater than KD much greater than BK-(1-8) greater than BK-(1-7). The increment of tail-flick latency was greatest at 1 (BK) or 6 (KD) min and the RT returned to basal levels within 15 min post-administration. The effect of BK (81 pmol) was unaffected by the prior i.th. administration of propranolol and naloxone but was significantly potentiated by prazosin (P less than 0.05). In contrast, the response to BK was significantly blocked (P less than 0.001) by phentolamine, idazoxan and yohimbine as well as by treatment with 6-hydroxydopamine (6-OHDA) at a dose of 20 micrograms (i.th.) 1 week earlier. The latter pretreatment reduced the antinociceptive effect of i.th. tyramine (7 mumol) and potentiated that to noradrenaline (NA) (0.6 nmol) (P less than 0.01) while it preserved both the antinociceptive effect of neurokinin B (8 nmol) and the hyperalgesic effect of substance P (6.5 nmol). A biochemical analysis revealed that 6-OHDA treatment reduced the NA content in the lumbar spinal cord by 60% without affecting the levels of serotonin, dopamine, adrenaline or their main metabolites. There were also significant reductions in NA content in cervical (44%) and thoracic (55%) spinal cord. Pretreatment with 6-OHDA for a longer survival period (2 weeks) caused a further decrease of NA in the lumbar spinal cord (88%); however, the serotonin and dopamine levels were reduced in all regions examined. These results suggest that BK (kinins) may inhibit spinal nociceptive sensory transmission and produce analgesia by acting presynaptically on terminals of bulbospinal NA-containing fibers.

The effect of unilateral dorsal root ganglionectomies or ventral rhizotomies on alpha 2-adrenoceptor binding to, and the substance P, enkephalin, and neurotensin content of, the cat lumbar spinal cord

The density of alpha 2-adrenoceptor binding sites and the content of substance P, enkephalins, and neurotensin were determined in quadrants of the lumbar spinal enlargement of control cats and of cats upon which either unilateral dorsal root ganglionectomies or unilateral ventral rhizotomies had been performed. The performance of unilateral dorsal root ganglionectomies resulted in a significant decrease (45-55%) of substance P content in the ipsilateral dorsal horn 7 and 21 days postoperatively. The concentration of alpha 2-adrenoceptor binding sites ([3H]rauwolscine Bmax) in the ipsilateral dorsal horn was consistently and significantly decreased at these same postganglionectomy times (20% reduced relative to the contralateral dorsal horn). Enkephalin content 7 and 21 days after ganglionectomies was not significantly different from control, whereas the neurotensin content of the ipsilateral dorsal horn was significantly increased in the 21-day survival cats. The performance of unilateral ventral rhizotomies did not produce any statistically significant changes in the density of alpha 2-adrenoceptor binding sites or in the substance P or enkephalin content of any spinal quadrant. The neurotensin content of both the ipsilateral dorsal and ipsilateral ventral quadrants of the ventral rhizotomized cats was significantly increased. The significant decrease of alpha 2-adrenoceptor binding site concentration in the ipsilateral dorsal horn after unilateral dorsal root ganglionectomies suggests that approximately 20% of the alpha 2-adrenoceptors present within the cat lumbar spinal dorsal gray are located on the axons or terminals of primary sensory afferents. Consistent with this interpretation of the ganglionectomy results, we found significant levels of saturable [3H]rauwolscine binding to homogenates of the cat L4-Sl spinal dorsal root ganglia. Because alpha 2-adrenoceptor binding sites in the ipsilateral ventral lumbar spinal gray were not significantly reduced after unilateral ventral rhizotomies, our results provide no evidence for the location of alpha 2-adrenoceptor on lumbar spinal motoneurons.