Meperidine, remifentanil and tramadol but not sufentanil interact with α2-adrenoceptors in α2A-, α2B- and α2C-adrenoceptor knock out mice brain

Intra-articular remifentanil on postoperative pain in knee arthroscopic surgery; a double blind randomized clinical trial

BACKGROUND

We aimed to assess the efficacy of intra-articular remifentanil in relieving postoperative pain after knee arthroscopy.

METHODS

We conducted a double-blind randomized clinical trial study on 60 patients. Patients were divided into two equal groups. The control group received 25 ml of intra-articular normal saline, and the intervention group received 200 μg of remifentanil dissolved in 25 ml of saline. We evaluated at rest postoperative pain at 1, 3, 6, 12, 18, and 24 h after the surgery using the Visual Analog Scale (VAS). Patients with VAS scores of 4 or more received meperidine (pethidine). The first time meperidine was requested and the total amount of meperidine consumed was recorded.

RESULTS

Out of 60 patients, 49 were male (81.6%), and the mean age of participants was 32.71 (7.02) years. An hour after the surgery, the control group showed a mean VAS score of 8.66 (1.26), and decreased to 2.53 (1.67) at the end of 24 h. The intervention group started with a mean VAS score of 2.23 (1.81) and ended at 0.10 (0.305). All patients in the control group and 11 (36.7%) patients in the intervention group asked for analgesics during follow-up. The mean total meperidine dose in the control and intervention groups was 108.33 (23.97) mg and 13.33 (19.40) mg, respectively (P < 0.001; 95% confidence interval of the difference 83.72 to 106.27).

CONCLUSIONS

Intra-articular remifentanil may decrease postoperative pain and analgesic requirements in patients undergoing knee arthroscopy.

Anxiolytic and antidepressant-like effects of monoterpene tetrahydrolinalool and in silico approach of new potential targets

INTRODUCTION- The drugs currently available for treatment of anxiety and depression act through modulation of the neurotransmission systems involved in the neurobiology of the disorder, yet they of-ten present side effects, which can impair patient adherence to treatment. METHOD- This, has driven the search for new molecules with anxiolytic and antidepressant potential. Aromatic plants are rich in essential oils, and their chemical constituents, such as monoterpenes, are be-ing studied for these disorders. This study aims to evaluate the anxiolytic and antidepressant-like poten-tial of the monoterpene tetrahydrolinalool in in vivo animal models, and review pharmacological targets with validation through molecular docking. Male Swiss mice (Mus musculus) were treated with THL (37.5-600 mg kg-1 p.o.) and submitted to the elevated plus maze, open field, rota rod, and forced swim tests. In the elevated plus-maze, THL at doses of 37.5 and 75 mg kg-1 induced a significant increase in the percentage of entries (72.7 and 64.3% respectively), and lengths of stay (80.3 and 76.8% respective-ly) in the open arms tests. RESULT- These doses did not compromise locomotor activity or motor coordination in the animals. In the open field, rota rod tests, and the forced swimming model, treatment with THL significantly reduced immobility times at doses of 150, 300, and 600 mg kg-1, and by respective percentages of 69.3, 60.9 and 68.7%. CONCLUSION- In molecular docking assay, which investigated potential targets, THL presented sat-isfactory energy values for: nNOs, SGC, IL-6, 5-HT1A, NMDAr, and D1. These demonstrate the po-tential of THL (a derivative of natural origin) in in vivo and in silico models, making it a drug candidate.

Biased, Bitopic, Opioid-Adrenergic Tethered Compounds May Improve Specificity, Lower Dosage and Enhance Agonist or Antagonist Function with Reduced Risk of Tolerance and Addiction

This paper proposes the design of combination opioid-adrenergic tethered compounds to enhance efficacy and specificity, lower dosage, increase duration of activity, decrease side effects, and reduce risk of developing tolerance and/or addiction. Combinations of adrenergic and opioid drugs are sometimes used to improve analgesia, decrease opioid doses required to achieve analgesia, and to prolong the duration of analgesia. Recent mechanistic research suggests that these enhanced functions result from an allosteric adrenergic binding site on opioid receptors and, conversely, an allosteric opioid binding site on adrenergic receptors. Dual occupancy of the receptors maintains the receptors in their high affinity, most active states; drops the concentration of ligand required for full activity; and prevents downregulation and internalization of the receptors, thus inhibiting tolerance to the drugs. Activation of both opioid and adrenergic receptors also enhances heterodimerization of the receptors, additionally improving each drug's efficacy. Tethering adrenergic drugs to opioids could produce new drug candidates with highly desirable features. Constraints-such as the locations of the opioid binding sites on adrenergic receptors and adrenergic binding sites on opioid receptors, length of tethers that must govern the design of such novel compounds, and types of tethers-are described and examples of possible structures provided.

Discovery, Structure-Activity Relationship, and Mechanistic Studies of 1-((3R,4S)-3-((Dimethylamino)methyl)-4-hydroxy-4-(3-methoxyphenyl)piperidin-1-yl)-2-(2,4,5-trifluorophenyl)ethan-1-one as a Novel Potent Analgesic

Management of moderate to severe pain relies heavily on opioid analgesics such as morphine, oxycodone, and fentanyl in clinics. However, their prolonged use was associated with undesirable side effects. Many new strategies to reduce side effects have been proposed, but not without disadvantages. Using a hot plate model as a phenotypic screening method, our studies identified (3R,4S)-9d with a new scaffold as a potent analgesic with ED₅₀ values of 0.54 mg/kg and 0.021 mg/kg in hot plate and antiwrithing models, respectively. Mechanistic studies showed that it elicited its analgesic effect via the active metabolite (3R,4S)-10a. The mechanism of (3R,4S)-10a-induced activation of the μ opioid receptor (MOR) was proposed by means of molecular dynamics (MD) simulation.

Remifentanil infusion during desflurane anesthesia reduces tissue blood flow while maintaining blood pressure and tissue oxygen tension in the masseter muscle and mandibular bone marrow

The aim of this study was to compare changes in tissue blood flow and tissue oxygen tension in the masseter muscle and mandibular bone marrow induced by remifentanil under desflurane or sevoflurane anesthesia. Eleven male tracheotomized Japan White rabbits were anesthetized with desflurane or sevoflurane under mechanical ventilation. The order of the inhalation of desflurane or sevoflurane was randomized. Desflurane or sevoflurane was administered at 1.0 minimum alveolar concentration and remifentanil was infused at 0.4 µg/kg/min. Observed variables included heart rate (HR), blood pressure (BP), common carotid artery blood flow (CCBF), mandibular bone marrow tissue blood flow (BBF), masseter muscle tissue blood flow (MBF), mandibular bone marrow tissue oxygen tension (PbO₂), and masseter muscle tissue oxygen tension (PmO₂). Two way repeated measures ANOVA showed no interaction between volatile anesthetics and remifentanil infusion except for MBF. There were significant differences in HR, SBP, DBP, MAP and CCBF between desflurane and sevoflurane groups. There were also significant differences in HR, SBP, DBP, MAP, CCBF, BBF and PbO₂ before, during and after remifentanil infusion. Desflurane reduced tissue blood flow in the masseter muscle and mandibular bone marrow while better maintained HR and BP than sevoflurane. Under remifentanil infusion, although both anesthetics reduced tissue blood flow, tissue oxygen tension was maintained in masseter muscle and mandibular bone marrow.

Structural Insight into the Mechanism of 4-Aminoquinolines Selectivity for the alpha2A-Adrenoceptor

Background

α_2A-adrenoceptor (AR) is a potential target for the treatment of degenerative diseases of the central nervous system, and α_2A-AR agonists are effective drugs for this condition. However, the lack of high selectivity for α_2A-AR subtype of traditional drugs greatly limits their clinic usage.

Methods

A series of homobivalent 4-aminoquinolines conjugated by two 4-aminoquinoline moieties via varying alkane linker length (C2-C12) were characterized for their affinities for each α₂-AR subtype. Subsequently, docking, molecular dynamics and mutagenesis were applied to uncover the molecular mechanism.

Results

Most 4-aminoquinolines (4-aminoquinoline monomer, C2-C6, C8-C10) were selective for α_2A-AR over α_2B- and α_2C-ARs. Besides, the affinities are of similar linker length-dependence for each α₂-AR subtype. Among all the compounds tested, C10 has the highest affinity for α_2A-AR (pKi=−7.45±0.62), which is 12-fold and 60-fold selective over α_2B-AR and α_2C-AR, respectively. Docking and molecular dynamics suggest that C10 simultaneously interacts with orthosteric and “allosteric” sites of the α_2A-AR. The mutation of F205 decreases the affinity by 2-fold. The potential allosteric residues include S90, N93, E94 and W99.

Conclusion

The specificity of C10 for the α_2A-AR and the potential orthosteric and allosteric binding sites proposed in this study provide valuable guidance for the development of novel α_2A-AR subtype selective compounds.

Phenylpiperidine opioid effects on isoflurane minimum alveolar concentration in cats

Different structurally related phenylpiperidine opioids exhibit different isoflurane-sparing effects in cats. Because minimum alveolar concentration (MAC) in cats is affected only by very high plasma concentrations of some phenylpiperidine opioids, we hypothesized these effects are caused by actions on nonopioid receptors. Using a prospective, randomized, crossover design, six cats were anesthetized with isoflurane, intubated, ventilated, and instrumented. Isoflurane MAC was measured in triplicate using a tail-clamp and bracketing technique. A computer-controlled intravenous infusion using prior pharmacokinetic models targeted plasma concentrations of 60 ng/ml fentanyl, 10 ng/ml sufentanil, or 500 ng/ml alfentanil, and isoflurane MAC was measured in duplicate. Next, naltrexone 0.6 mg/kg was administered to cats hourly during the opioid infusion, and isoflurane MAC was measured in duplicate. Blood was collected during MAC determinations to measure opioid concentrations. Responses were analyzed using repeated measures ANOVA with significance at p < .05. Alfentanil and sufentanil decreased isoflurane MAC by 16.4% and 6.4%, respectively, and these effects were completely reversed by naltrexone. Fentanyl had no significant effect on isoflurane MAC. Alfentanil and sufentanil modestly reduce isoflurane MAC via agonist effects on opioid receptors. However, these effects are too small to justify clinical use of phenylpiperidine opioids as single agents to reduce MAC in cats.

Decreases in Oral Tissue Blood Flow Induced by Remifentanil Are Not Accompanied by Deterioration of Oral Tissue Oxygen Tension in Rabbits

PURPOSE

The purpose of this study was to investigate the effects of remifentanil infusion on tissue blood flow and tissue oxygen tension in the mandibular bone marrow and masseter muscle in rabbits. In addition, changes in tissue oxygen consumption in those tissues during remifentanil infusion were investigated.

MATERIALS AND METHODS

Sixteen male tracheotomized Japanese White rabbits were anesthetized with sevoflurane under mechanical ventilation. Under oxygen and air inhalation, fraction of inspiratory oxygen was set at 0.4 and remifentanil was infused at a rate of 0.4 μg ∙ kg^-1 ∙ min^-1. Measurements were performed before remifentanil infusion, 20 minutes after the start of remifentanil infusion, and 20 and 60 minutes after the completion of remifentanil infusion (n = 8). The observed variables included heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), mandibular bone marrow tissue blood flow (BBF), masseter muscle tissue blood flow (MBF), mandibular bone marrow tissue oxygen tension (PbO₂), and masseter muscle tissue oxygen tension (PmO₂). Another 8 rabbits were observed for arterial pH, lactate, base excess (BE), and tissue oxygen consumption in the region from which the retromandibular vein received venous blood. Measurements were performed before remifentanil infusion and 20 minutes after the start of remifentanil infusion.

RESULTS

HR, SBP, DBP, MAP, BBF, and MBF decreased during remifentanil infusion. PbO₂ increased 20 minutes after remifentanil infusion and returned to almost the baseline value 60 minutes after remifentanil infusion. PmO₂ did not change throughout the experiment. The difference between the arterial oxygen content of the femoral artery and the venous oxygen content of the retromandibular vein decreased during remifentanil infusion. Arterial pH, lactate, and BE did not change during remifentanil infusion.

CONCLUSIONS

Remifentanil decreased BBF and MBF but did not decrease PbO₂ and PmO₂. It is suggested that tissue oxygen consumption decreased during remifentanil infusion.

Effect of prenatal tramadol on postnatal cerebellar development: Role of oxidative stress

BACKGROUND AND AIM

The adverse neurological effects of tramadol have recently raised attention. The literature pertaining to studying postnatal cerebellar changes induced by prenatal tramadol is very scanty, thus the current study has been designed to improve understanding of the cerebellar oxidative stress-related alterations associated with tramadol administration during pregnancy in this critical period of neuronal differentiation and synaptic development, thereby highlighting the importance of controlling prenatal prescription of opioids and optimizing care for opioid-dependent pregnant women and their infants.

MATERIAL AND METHODS

Twenty pregnant female rats of Sprague Dawley strains were used in the study. Their offspring were divided into two groups: group I (control group) offspring of mothers given saline; group II offspring of mothers given tramadol from the 10th day (D10) of gestation till D21. The pups were sacrificed on the 7^th, 14^th and 21^st postnatal days. Cerebellar specimens were processed for histomorphometric, immunohistochemical and electron microscopic assessment and were evaluated for various oxidative stress parameters.

RESULTS

Tramadol administration during pregnancy caused profound structural abnormalities on the post-natal cerebellar cortex and was associated with oxidative stress evidenced by elevation of lipid peroxidation products and inhibition of antioxidant enzyme activities.

Does tramadol affect coagulation status of patients with malignancy?

AIM

The study investigated the direct effects of tramadol on the coagulation status of women with gynecologic malignancies in vitro.

MATERIALS AND METHODS

Citrated whole-blood samples from 21 patients with gynecologic tumors were spiked ex vivo with 2 or 6 μl/ml tramadol. Thrombelastography (TEG) analysis was performed using ROTEM(®) to assess clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF).

RESULTS

In the INTEM assay, CT (P < 0.05) and CFT (P < 0.01) were significantly prolonged with tramadol at a 6 μl/ml concentration compared with baseline. There were no significant differences in MCF values between the baseline and the tramadol-treated samples (P > 0.05). Blood medicated with tramadol (6 μl/ml) clotted slowly (increased CT and CFT).

CONCLUSION

The changes observed by TEG demonstrated that tramadol impairs hemostasis in a concentration-dependent manner in the whole blood of women with gynecologic malignancies in vitro.

Mild, Pd-catalyzed stannylation of radioiodination targets

Trialkylstannanes are versatile precursors for chemical transformations, including radiolabeling with a variety of halogens, particularly iodine. In the present work a convenient, Pd-mediated stannylation method is presented that can be performed in an open flask. The method is selective for aryl iodides allowing selective stannylations in the presence of other halogen atoms. The reaction conditions are mild, making the method compatible with chemically sensitive bioactive compounds.

Interaction of morphine but not fentanyl with cerebral α2-adrenoceptors in α2-adrenoceptor knockout mice

Objectives

α2-Adrenergic and μ-opioid receptors belong to the rhodopsin family of G-protein coupled receptors and mediate antinociceptive effects via similar signal transduction pathways. Previous studies have revealed direct functional interactions between both receptor systems including synergistic and additive effects. To evaluate underlying mechanisms, we have studied whether morphine and fentanyl interacted with α2-adrenoceptor-subtypes in mice lacking one individual α2-adrenoceptor-subtype (α2-adrenoceptor knockout).

Methods

Opioid interaction with α2-adrenoceptors was investigated by quantitative receptor autoradiography in brain slices of α2A-, α2B- or α2C-adrenoceptor deficient mice. Displacement of the radiolabelled α2-adrenoceptor agonist [125I]paraiodoclonidine from α2-adrenoceptors in different brain regions by increasing concentrations of morphine, fentanyl and naloxone was analysed. The binding affinity of both opioids to α2-adrenoceptor subtypes in different brain regions was quantified.

Key findings

Morphine but not fentanyl or naloxone provoked dose-dependent displacement of [125I]paraiodoclonidine from all α2-adrenoceptor subtypes in the brain regions analysed. Binding affinity was highest in cortex, medulla oblongata and pons of α2A-adrenoceptor knockout mice.

Conclusions

Our results indicated that morphine interacted with α2-adrenoceptors showing higher affinity for the α2B and α2C than for the α2A subtype. In contrast, fentanyl and naloxone did not show any relevant affinity to α2-adrenoceptors. This effect may have an impact on the pharmacological actions of morphine.

Endogenous opiates and behavior: 2008

This paper is the 31st consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2008 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).

Nefopam but not physostigmine affects the thermoregulatory response in mice via alpha(2)-adrenoceptors

Nefopam, a non-opioid, centrally acting benzoxazocine analgesic, proved to be as efficient in treatment of postanaesthetic thermoregulatory shivering as clonidine or meperidine. However, its exact mechanism of action is still unclear. Potent anti-shivering activity was also demonstrated for physostigmine primarily based on cholinergic but probably also different additional mechanisms of action. Hypothesizing an involvement of alpha(2)-adrenoceptors we studied their role in nefopam- and physostigmine-mediated thermoregulation in a mouse model of nonshivering thermogenesis. To differentiate possible alpha(2)-adrenoceptor subtype-specific interactions, we analysed wildtype mice and mice with deletion of the alpha(2A)-, alpha(2B)- or alpha(2C)-adrenoceptor (knock out). Ten mice of each genotype (n = 40) were administered saline, saline plus atipamezole, 1 mg/kg nefopam, 25 mg/kg nefopam, 25 mg/kg nefopam plus atipamezole, physostigmine and physostigmine plus atipamezole intraperitoneally. Each mouse was randomly subjected to each of the seven different treatments. Afterwards, the mice were positioned into a plexiglas chamber where rectal temperature and mixed expired carbon dioxide were measured during following whole body cooling. Thermoregulatory threshold temperature of nonshivering thermogenesis and maximum response intensity were analysed. Nefopam decreased the thermoregulatory threshold temperature in wildtype, alpha(2B)- and alpha(2C)-adrenoceptor mice. This effect was partially abolished by additional administration of the alpha(2)-adrenoceptor antagonist atipamezole. In alpha(2A)-adrenoceptor knock out mice, nefopam did not affect the thermoregulatory threshold. In contrast, physostigmine decreased the thermoregulatory threshold in wildtype and all alpha(2)-adrenoceptor knock out mice independently from additional atipamezole administration. Our results indicate an important role of the alpha(2A)-adrenoceptor in the thermoregulatory response induced by nefopam but not by physostigmine in mice.