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Edinoff AN, Wu NW, Nix CA, Bonin B, Mouhaffel R, Vining S, Gibson W, Cornett EM, Murnane KS, Kaye AM, Kaye AD. Historical Pathways for Opioid Addiction, Withdrawal with Traditional and Alternative Treatment Options with Ketamine, Cannabinoids, and Noribogaine: A Narrative Review. Health Psychol Res 2022; 10:38672. [PMID: 36628122 PMCID: PMC9817468 DOI: 10.52965/001c.38672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Even as prescription opioid dispensing rates have begun to decrease, the use of illicit opioids such as heroin and fentanyl has increased. Thus, the end of the opioid epidemic is not in sight, and treating patients that are addicted to opioids remains of utmost importance. Currently, the primary pharmacotherapies used to treat opioid addiction over the long term are the opioid antagonist naltrexone, the partial-agonist buprenorphine, and the full agonist methadone. Naloxone is an antagonist used to rapidly reverse opioid overdose. While these treatments are well-established and used regularly, the gravity of the opioid epidemic necessitates that all possible avenues of treatment be explored. Therefore, in this narrative review, we analyze current literature regarding use of the alternative medications ketamine, noribogaine, and cannabinoids in treating patients suffering from opioid use disorder. Beyond its use as an anesthetic, ketamine has been shown to have many applications in several medical specialties. Of particular interest to the subject at hand, ketamine is promising in treating individuals addicted to opioids, alcohol, and cocaine. Therapeutically administered cannabinoids have been proposed for the treatment of multiple illnesses. These include, but are not limited to epilepsy, Parkinson's disease, multiple sclerosis, chronic pain conditions, anxiety disorders, and addiction. The cannabinoid dronabinol has been seen to have varying effects. High doses appear to reduce withdrawal symptoms but this comes at the expense of increased adverse side effects such as sedation and tachycardia. Noribogaine is a weak MOR antagonist and relatively potent KOR agonist, which may explain the clinical anti-addictive effects. More research should be done to assess the viability of these medications for the treatment of OUD and withdrawal.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital; Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport; Louisiana Addiction Research Center
| | - Natalie W. Wu
- Department of Psychiatry and Behavioral Medicine,
Louisiana State University Health Shreveport
| | - Catherine A. Nix
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport; Louisiana Addiction Research Center
| | - Bryce Bonin
- School of Medicine,
Louisiana State University Health Shreveport
| | - Rama Mouhaffel
- School of Medicine,
Louisiana State University Health Shreveport
| | - Stephen Vining
- School of Medicine,
Louisiana State University Health Shreveport
| | - William Gibson
- School of Medicine,
Louisiana State University New Orleans
| | - Elyse M. Cornett
- Department of Anesthesiology,
Louisiana State University Shreveport
| | - Kevin S. Murnane
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport; Louisiana Addiction Research Center; Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Shreveport
| | - Adam M. Kaye
- Department of Pharmacy Practice,
Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D. Kaye
- Louisiana Addiction Research Center, Shreveport; Department of Anesthesiology, Louisiana State University Shreveport
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Zhang J, Song C, Dai J, Li L, Yang X, Chen Z. Mechanism of opioid addiction and its intervention therapy: Focusing on the reward circuitry and mu‐opioid receptor. MedComm (Beijing) 2022; 3:e148. [PMID: 35774845 PMCID: PMC9218544 DOI: 10.1002/mco2.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jia‐Jia Zhang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Chang‐Geng Song
- Department of Neurology Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ji‐Min Dai
- Department of Hepatobiliary Surgery Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ling Li
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Xiang‐Min Yang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Zhi‐Nan Chen
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
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Wille SMR, Elliott S. The Future of Analytical and Interpretative Toxicology: Where are We Going and How Do We Get There? J Anal Toxicol 2021; 45:619-632. [PMID: 33245325 DOI: 10.1093/jat/bkaa133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/02/2020] [Accepted: 11/18/2020] [Indexed: 01/26/2023] Open
Abstract
(Forensic) toxicology has faced many challenges, both analytically and interpretatively, especially in relation to an increase in potential drugs of interest. Analytical toxicology and its application to medicine and forensic science have progressed rapidly within the past centuries. Technological innovations have enabled detection of more substances with increasing sensitivity in a variety of matrices. Our understanding of the effects (both intended and unintended) have also increased along with determination and degree of toxicity. However, it is clear there is even more to understand and consider. The analytical focus has been on typical matrices such as blood and urine but other matrices could further increase our understanding, especially in postmortem (PM) situations. Within this context, the role of PM changes and potential redistribution of drugs requires further research and identification of markers of its occurrence and extent. Whilst instrumentation has improved, in the future, nanotechnology may play a role in selective and sensitive analysis as well as bioassays. Toxicologists often only have an advisory impact on pre-analytical and pre-interpretative considerations. The collection of appropriate samples at the right time in an appropriate way as well as obtaining sufficient circumstance background is paramount in ensuring an effective analytical strategy to provide useful results that can be interpreted within context. Nevertheless, key interpretative considerations such as pharmacogenomics and drug-drug interactions as well as determination of tolerance remain and in the future, analytical confirmation of an individual's metabolic profile may support a personalized medicine and judicial approach. This should be supported by the compilation and appropriate application of drug data pursuant to the situation. Specifically, in PM circumstances, data pertaining to where a drug was not/may have been/was contributory will be beneficial with associated pathological considerations. This article describes the challenges faced within toxicology and discusses progress to a future where they are being addressed.
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Affiliation(s)
- Sarah M R Wille
- Department of Toxicology, National Institute for Criminalistics and Criminology, Brussels, Belgium
| | - Simon Elliott
- Elliott Forensic Consulting Ltd, Birmingham, UK.,Department Analytical, Environmental & Forensic Science, King's College London, London, UK
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Kuroda Y, Nonaka M, Kamikubo Y, Ogawa H, Murayama T, Kurebayashi N, Sakairi H, Miyano K, Komatsu A, Dodo T, Nakano-Ito K, Yamaguchi K, Sakurai T, Iseki M, Hayashida M, Uezono Y. Inhibition of endothelin A receptor by a novel, selective receptor antagonist enhances morphine-induced analgesia: Possible functional interaction of dimerized endothelin A and μ-opioid receptors. Biomed Pharmacother 2021; 141:111800. [PMID: 34175819 DOI: 10.1016/j.biopha.2021.111800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The misuse of opioids has led to an epidemic in recent times. The endothelin A receptor (ETAR) has recently attracted attention as a novel therapeutic target to enhance opioid analgesia. We hypothesized that endothelin A receptors may affect pain mechanisms by heterodimerization with μ opioid receptors. We examined the mechanisms of ETAR-mediated pain and the potential therapeutic effects of an ETAR antagonist, Compound-E, as an agent for analgesia. METHODS Real-time in vitro effect of Compound-E on morphine response was assessed in HEK293 cells expressing both endothelin A and μ opioid receptors through CellKey™ and cADDis cAMP assays. Endothelin A/μ opioid receptor dimerization was assessed by immunoprecipitation and live cell imaging. The in vivo effect of Compound-E was evaluated using a morphine analgesia mouse model that observed escape response behavior, body temperature, and locomotor activity. RESULTS In CellKey™ and cAMP assays, pretreatment of cells with endothelin-1 attenuated morphine-induced responses. These responses were improved by Compound-E, but not by BQ-123 nor by bosentan, an ETAR and endothelin B receptor antagonist. Dimerization of ETARs and μ opioid receptors was confirmed by Western blot and total internal reflection fluorescence microscopy in live cells. In vivo, Compound-E potentiated and prolonged the analgesic effects of morphine, enhanced hypothermia, and increased locomotor activity compared to morphine alone. CONCLUSION The results suggest that attenuation by endothelin-1 of morphine analgesia may be caused by dimerization of Endothelin A/μ opioid receptors. The novel ETAR antagonist Compound-E could be an effective adjunct to reduce opioid use.
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Affiliation(s)
- Yui Kuroda
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Miki Nonaka
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kamikubo
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruo Ogawa
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hakushun Sakairi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako Miyano
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan; Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, Japan
| | - Akane Komatsu
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsushi Dodo
- Strategy Planning & Operations, Medicine Development Center, Eisai Co., Ltd., Ibaraki, Japan
| | - Kyoko Nakano-Ito
- Global Drug Safety, Medicine Development Center, Eisai Co., Ltd., Ibaraki, Japan
| | - Keisuke Yamaguchi
- Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Sakurai
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masako Iseki
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Supportive and Palliative Care Research Support Office, National Center Hospital East, Chiba, Japan; Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan.
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Pergolizzi JV, Raffa RB, Rosenblatt MH. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. J Clin Pharm Ther 2020; 45:892-903. [PMID: 31986228 DOI: 10.1111/jcpt.13114] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 01/05/2020] [Indexed: 01/07/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Opioid use in the United States has reached unprecedented-some would even say crisis-levels. Although many individuals use opioid drugs as part of legitimate pain management plans, a significant number misuse prescription or illicit opioids. With regular opioid use, individuals develop tolerance and physical dependence; both are predictable, physiologic responses to repeated opioid exposure. However, a substantial number of individuals who misuse opioids will develop opioid use disorder (OUD), a complex, primary, chronic, neurobiological disease rooted in genetic, environmental and psychosocial factors. This article discusses OUD, opioid receptor physiology, and opioid withdrawal symptomatology and pathophysiology, as well as current treatment options available to reduce opioid withdrawal symptoms in individuals with physical dependence and/or OUD. METHODS The research articles regarding OUD and its management have been reviewed thoroughly based on a PubMed literature search using keywords related to opioid dependence, its pathophysiology and current treatment strategies. RESULTS AND DISCUSSION Tolerance/physical dependence and the behavioural characteristics associated with OUD reflect complex neurobiologic adaptations in several major systems of the brain, including the locus ceruleus and mesolimbic systems. Physical dependence is responsible for the distressing withdrawal symptoms individuals experience upon abrupt cessation or rapid dose reduction of exogenous opioids. Opioid withdrawal symptoms are a key driver behind continued opioid use, and a barrier to opioid discontinuation. Several opioid-based medications are available to treat patients with OUD; these treatments can diminish opioid withdrawal symptoms and cravings as well as block opioid effects in the event of relapse. Additionally, non-opioid drugs may be used during acute detoxification to help alleviate opioid withdrawal symptoms. WHAT IS NEW AND CONCLUSION The opioid crisis has produced many challenges for physicians, one being the need to determine which patients would benefit most from maintenance therapy and which may be candidates for opioid discontinuation. In addition to summarizing current understanding of OUD, we provide a new algorithm for determining the need for continued opioid use as well as examples of situations where management of opioid withdrawal symptoms is indicated.
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Affiliation(s)
| | - Robert B Raffa
- Neumentum, Palo Alto, California.,University of Arizona College of Pharmacy, Tucson, Arizona.,Temple University School of Pharmacy, Philadelphia, Pennsylvania
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Koraćević M, Lalić J, Nedeljković S, Koraćević G. REBOUND PHENOMENON – IMPORTANT AND UBIQUITOUS IN PHARMACOTHERAPY. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ujcikova H, Hlouskova M, Cechova K, Stolarova K, Roubalova L, Svoboda P. Determination of μ-, δ- and κ-opioid receptors in forebrain cortex of rats exposed to morphine for 10 days: Comparison with animals after 20 days of morphine withdrawal. PLoS One 2017; 12:e0186797. [PMID: 29053731 PMCID: PMC5650167 DOI: 10.1371/journal.pone.0186797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic exposure of mammalian organism to morphine results in adaption to persistent high opioid tone through homeostatic adjustments. Our previous results indicated that in the frontal brain cortex (FBC) of rats exposed to morphine for 10 days, such a compensatory adjustment was detected as large up-regulation of adenylylcyclases I (8-fold) and II (2.5-fold). The other isoforms of AC (III-IX) were unchanged. Importantly, the increase of ACI and ACII was reversible as it disappeared after 20 days of morphine withdrawal. Changes of down-stream signaling molecules such as G proteins and adenylylcyclases should respond to and be preceded by primary changes proceeding at receptor level. Therefore in our present work, we addressed the problem of reversibility of the long-term morphine effects on μ-, δ- and κ-OR protein levels in FBC. METHODS Rats were exposed to increasing doses of morphine (10-40 mg/kg) for 10 days and sacrificed either 24 h (group +M10) or 20 days (group +M10/-M20) after the last dose of morphine in parallel with control animals (groups -M10 and -M10/-M20). Post-nuclear supernatant (PNS) fraction was prepared from forebrain cortex, resolved by 1D-SDS-PAGE under non-dissociated (-DTT) and dissociated (+DTT) conditions, and analyzed for the content of μ-, δ- and κ-OR by immunoblotting with C- and N-terminus oriented antibodies. RESULTS Significant down-regulation of δ-OR form exhibiting Mw ≈ 60 kDa was detected in PNS prepared from both (+M10) and (+M10/-M20) rats. However, the total immunoblot signals of μ-, δ- and κ-OR, respectively, were unchanged. Plasma membrane marker Na, K-ATPase, actin and GAPDH were unaffected by morphine in both types of PNS. Membrane-domain marker caveolin-1 and cholesterol level increased in (+M10) rats and this increase was reversed back to control level in (+M10/-M20) rats. CONCLUSIONS In FBC, prolonged exposure of rats to morphine results in minor (δ-OR) or no change (μ- and κ-OR) of opioid receptor content. The reversible increases of caveolin-1 and cholesterol levels suggest participation of membrane domains in compensatory responses during opioid withdrawal. GENERAL SIGNIFICANCE Analysis of reversibility of morphine effect on mammalian brain.
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MESH Headings
- Animals
- Blotting, Western
- Electrophoresis, Gel, Two-Dimensional
- Electrophoresis, Polyacrylamide Gel
- Male
- Morphine/administration & dosage
- Morphine/adverse effects
- Prosencephalon/metabolism
- Rats
- Rats, Wistar
- Receptors, Opioid, delta/metabolism
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, mu/metabolism
- Substance Withdrawal Syndrome
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Affiliation(s)
- Hana Ujcikova
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Hlouskova
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Kristina Cechova
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Biochemistry, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Katerina Stolarova
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Lenka Roubalova
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Petr Svoboda
- Department of Biomathematics, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
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Cheppudira BP, Trevino AV, Petz LN, Christy RJ, Clifford JL. Anti-nerve growth factor antibody attenuates chronic morphine treatment-induced tolerance in the rat. BMC Anesthesiol 2016; 16:73. [PMID: 27596139 PMCID: PMC5011970 DOI: 10.1186/s12871-016-0242-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022] Open
Abstract
Background Nerve growth factor (NGF) is known to induce inflammation and pain; however its role in opioid-induced tolerance has not been studied. This study investigated the effects of an anti-NGF neutralizing antibody on the development of tolerance following chronic morphine treatment in naïve rats. Methods Four groups of rats were used in this study; one treated with saline alone, one with 10 mg/kg of morphine, one with 10 μg of anti-NGF and the other with 10 mg/kg of morphine + 10 μg of anti-NGF, twice per day for 5 days. The route of treatment was subcutaneous (S.C.) for morphine and saline, and intraperitoneal (i.p.) for anti-NGF. Response to a noxious thermal stimulus during the course of drug treatment was assessed (Hargreaves’ test). Further, the change in the NGF levels in the lumbar spinal cord was measured by ELISA. Results Our results showed that repeated administration of morphine produced an apparent tolerance which was significantly attenuated by co-administration of anti-NGF (P < 0.001). Additionally, the area under the curve (AUC) of the analgesic effect produced by the combination of morphine and anti-NGF was significantly (P < 0.001) greater than for saline controls and chronic morphine treated rats. Moreover, the level of NGF in the spinal cord of chronic morphine treated rats was significantly higher (P < 0.05) than in both the saline control group and the group receiving simultaneous administration of anti-NGF with morphine. These results indicate that anti-NGF has the potential to attenuate morphine-induced tolerance behavior by attenuating the effects of NGF at the spinal level. Conclusion Taken together, our study strongly suggests that the NGF signaling system is a potential novel target for treating opioid-induced tolerance.
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Affiliation(s)
- Bopaiah P Cheppudira
- Burn Injuries Task Area, United States Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, 78234, USA.
| | - Alex V Trevino
- Burn Injuries Task Area, United States Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, 78234, USA
| | - Lawrence N Petz
- Department of Clinical Investigation, United States Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, 78234, USA
| | - Robert J Christy
- Burn Injuries Task Area, United States Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, 78234, USA
| | - John L Clifford
- Burn Injuries Task Area, United States Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, 78234, USA
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