In search of the opiate receptor

Targeting G protein coupled receptors for alleviating neuropathic pain

Pain sensation is a normal physiological response to alert and prevent further tissue damage. It involves the perception of external stimuli by somatosensory neurons, then transmission of the message to various other types of neurons present in the spinal cord and brain to generate an appropriate response. Currently available analgesics exhibit very modest efficacy, and that too in only a subset of patients with chronic pain conditions, particularly neuropathic pain. The G protein-coupled receptors (GPCRs) are expressed on presynaptic, postsynaptic terminals, and soma of somatosensory neurons, which binds to various types of ligands to modulate neuronal activity and thus pain sensation in both directions. Fundamentally, neuropathic pain arises due to aberrant neuronal plasticity, which includes the sensitization of peripheral primary afferents (dorsal root ganglia and trigeminal ganglia) and the sensitization of central nociceptive neurons in the spinal cord or trigeminal nucleus or brain stem and cortex. Owing to the expression profiles of GPCRs in somatosensory neurons and other neuroanatomical regions involved in pain processing and transmission, this article shall focus only on four families of GPCRs: 1- Opioid receptors, 2-Cannabinoid receptors, 3-Adenosine receptors, and 4-Chemokine receptors.

New light on cortical neuropeptides and synaptic network plasticity

Neuropeptides, members of a large and evolutionarily ancient family of proteinaceous cell-cell signaling molecules, are widely recognized as extremely potent regulators of brain function and behavior. At the cellular level, neuropeptides are known to act mainly via modulation of ion channel and synapse function, but functional impacts emerging at the level of complex cortical synaptic networks have resisted mechanistic analysis. New findings from single-cell RNA-seq transcriptomics now illuminate intricate patterns of cortical neuropeptide signaling gene expression and new tools now offer powerful molecular access to cortical neuropeptide signaling. Here we highlight some of these new findings and tools, focusing especially on prospects for experimental and theoretical exploration of peptidergic and synaptic networks interactions underlying cortical function and plasticity.

Opioids and the Blood-Brain Barrier: A Dynamic Interaction with Consequences on Drug Disposition in Brain

Background:

Opioids are widely used in pain management, acting via opioid receptors and/or Toll-like receptors (TLR) present at the central nervous system (CNS). At the blood-brain barrier (BBB), several influx and efflux transporters, such as the ATP-binding cassette (ABC)

P-glycoprotein (P-gp, ABCB1), Breast Cancer Resistance Protein (BCRP, ABCG2) and multidrug resistance-associated proteins (MRP, ABCC) transporters, and solute carrier transporters (SLC), are responsible for the transport of xenobiotics from the brain into the bloodstream or vice versa.

Objective:

ABC transporters export several clinically employed opioids, altering their neuro-

pharmacokinetics and CNS effects. In this review, we explore the interactions between opioids

and ABC transporters, and decipher the molecular mechanisms by which opioids can modify their expression at the BBB.

Results:

P-gp is largely implicated in the brain-to-blood efflux of opioids, namely morphine and oxycodone. Long-term ex-posure to morphine and oxycodone has proven to up-regulate the expression of ABC transporters, such as P-gp, BCRP and MRPs, at the BBB, which may lead to increased tolerance to the antinociceptive effects of such drugs. Recent studies uncov-er two mechanisms by which morphine may up-regulate P-gp and BCRP at the BBB: 1) via a glutamate, NMDA-receptor and COX-2 signaling cascade, and 2) via TLR4 activation, subsequent development of neuro-

inflammation, and activation of NF-κB, presumably via glial cells.

Conclusion:

The BBB-opioid interaction can culminate in bilateral consequences, since ABC transporters condition the brain disposition of opioids, while opioids also affect the expression of ABC transporters at the BBB, which may result in increased CNS drug pharmacoresistance.

Opioid administration following spinal cord injury: implications for pain and locomotor recovery

Approximately one-third of people with a spinal cord injury (SCI) will experience persistent neuropathic pain following injury. This pain negatively affects quality of life and is difficult to treat. Opioids are among the most effective drug treatments, and are commonly prescribed, but experimental evidence suggests that opioid treatment in the acute phase of injury can attenuate recovery of locomotor function. In fact, spinal cord injury and opioid administration share several common features (e.g. central sensitization, excitotoxicity, aberrant glial activation) that have been linked to impaired recovery of function, as well as the development of pain. Despite these effects, the interactions between opioid use and spinal cord injury have not been fully explored. A review of the literature, described here, suggests that caution is warranted when administering opioids after SCI. Opioid administration may synergistically contribute to the pathology of SCI to increase the development of pain, decrease locomotor recovery, and leave individuals at risk for infection. Considering these negative implications, it is important that guidelines are established for the use of opioids following spinal cord and other central nervous system injuries.

Antinociceptive and nociceptive actions of opioids

Although the opioids are the principal treatment options for moderate to severe pain, their use is also associated with the development of tolerance, defined as the progressive need for higher doses to achieve a constant analgesic effect. The mechanisms which underlie this phenomenon remain unclear. Recent studies revealed that cholecystokinin (CCK) is upregulated in the rostral ventromedial medulla (RVM) during persistent opioid exposure. CCK is both antiopioid and pronociceptive, and activates descending pain facilitation mechanisms from the RVM enhancing nociceptive transmission at the spinal cord and promoting hyperalgesia. The neuroplastic changes elicited by opioid exposure reflect adaptive changes to promote increased pain transmission and consequent diminished antinociception (i.e., tolerance).

Nufenoxole, a new antidiarrhoeal agent, inhibits fluid secretion in the human jejunum

Nufenoxole is an orally active antidiarrhoeal agent which binds to opioid receptors in the brain and myenteric plexus of the intestine. A perfusion technique has been used to investigate the effect of nufenoxole (1 mg/kg intrajejunally) on water and solute transport stimulated by the secretagogue, dioctyl sodium sulphosuccinate, in the human jejunum in vivo. Nufenoxole reversed the direction of jejunal transport of salt and water from net secretion to net absorption. These changes in water and electrolyte transport were inhibited by intravenous naloxone, the opioid antagonist. Nufenoxole possesses potent antisecretory properties, which are mediated via opioid receptors and may contribute to its antidiarrhoeal action in man.

Methadone detection in rat myenteric plexus: comparison with findings in the central nervous system by the immunofluorescence method

Nonpregnant and pregnant rats were given methadone for varying time periods. Myenteric plexus was then examined for methadone by immunofluorescence and the results compared to similar studies of the central nervous system. Nonpregnant animals showed positive ganglion cells 2 weeks before methadone was detected in the brain. Additionally, maternal ganglion cells were more frequently positive than those of their offspring. These findings indicate fundamental differences in the response of peripheral and central neurons to methadone. Thus, studying the effects of opiates on isolated strips of bowel may be of little value in furthering understanding of the action of narcotics upon the brain.

Binding of the opiate-like pentapeptide methionine-enkephalin to a particulate fraction from rat brain

The characteristics of stereospecific binding of [3H] met-enkephalin (15 Ci/mmole) were studied in a particulate fraction from rat brain. The binding assay was performed for 70 min at degrees C and the bound radioactivity separated by filtration through glass fiber filters (Whatman, GF/C). In the absence of sodium, binding of [3H] met-enkephalin could be described on the basis of two independent binding sites with apparent KDs of 2.1 and 53 nM, respectively. The data are also consistent with one class of binding sites showing negative cooperativity. In the presence of 100 mM NaCl, binding of [3H] met-enkephalin was 90-95% reduced, thus indicating the agonist properties of the peptide. The highly stereospecific binding of [3H] met-enkephalin was evidenced by the 10,000-fold greater potency of levorphanol than its analgesically inactive enantiomer dextrorphan to compete for [3H] met-enkephalin binding. Similar conclusions could be reached using levallorphan, (+)-3-hydro-N-allyl-morphinan, (-) methadone and (+) methadone. The apparent affinity of various opiate agonists and antagonists for the binding sites was closely correlated with their known pharmacological activity.