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Abstract
Ingestion of alkaloid metabolites from the bark of Galbulimima (GB) sp. leads to psychotropic and excitatory effects in humans1-4. Limited, variable supply of GB alkaloids5, however, has impeded their biological exploration and clinical development6. Here we report a solution to the supply of GB18, a structural outlier and putative psychotropic principle of Galbulimima bark. Efficient access to its challenging tetrahedral attached-ring motif required the development of a ligand-controlled endo-selective cross-electrophile coupling and a diastereoselective hydrogenation of a rotationally dynamic pyridine. Reliable, gram-scale access to GB18 enabled its assignment as a potent antagonist of κ- and μ-opioid receptors-the first new targets in 35 years-and lays the foundation to navigate and understand the biological activity of Galbulimima metabolites.
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Affiliation(s)
- Stone Woo
- Department of Chemistry, Scripps Research, La Jolla, CA, USA
| | - Ryan A Shenvi
- Department of Chemistry, Scripps Research, La Jolla, CA, USA.
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2
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Zamora JC, Smith HR, Jennings EM, Chavera TS, Kotipalli V, Jay A, Husbands SM, Disney A, Berg KA, Clarke WP. Long-term antagonism and allosteric regulation of mu opioid receptors by the novel ligand, methocinnamox. Pharmacol Res Perspect 2021; 9:e00887. [PMID: 34713624 PMCID: PMC8554411 DOI: 10.1002/prp2.887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
Opioid overdose is a leading cause of death in the United States. The only treatment available currently is the competitive antagonist, naloxone (Narcan® ). Although naloxone is very effective and has saved many lives, as a competitive antagonist it has limitations. Due to the short half-life of naloxone, renarcotization can occur if the ingested opioid agonist remains in the body longer. Moreover, because antagonism by naloxone is surmountable, renarcotization can also occur in the presence of naloxone if a relatively larger dose of opioid agonist is taken. In such circumstances, a long-lasting, non-surmountable antagonist would offer an improvement in overdose treatment. Methocinnamox (MCAM) has been reported to have a long duration of antagonist action at mu opioid receptors in vivo. In HEK cells expressing the human mu opioid receptor, MCAM antagonism of mu agonist-inhibition of cAMP production was time-dependent, non-surmountable and non-reversible, consistent with (pseudo)-irreversible binding. In vivo, MCAM injected locally into the rat hindpaw antagonized mu agonist-mediated inhibition of thermal allodynia for up to 96 h. By contrast, antagonism by MCAM of delta or kappa agonists in HEK cells and in vivo was consistent with simple competitive antagonism. Surprisingly, MCAM also shifted the concentration-response curves of mu agonists in HEK cells in the absence of receptor reserve in a ligand-dependent manner. The shift in the [D-Ala2 ,N-MePhe4 ,Gly-ol5 ]-enkephalin (DAMGO) concentration-response curve by MCAM was insensitive to naloxone, suggesting that in addition to (pseudo)-irreversible orthosteric antagonism, MCAM acts allosterically to alter the affinity and/or intrinsic efficacy of mu agonists.
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Affiliation(s)
- Joshua C. Zamora
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
| | - Hudson R. Smith
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
| | | | | | - Varun Kotipalli
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
| | - Aleasha Jay
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
| | | | - Alex Disney
- Department of Pharmacy and PharmacologyUniversity of BathBathUnited Kingdom
| | - Kelly A. Berg
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
- Addiction ResearchTreatment & Training Center of ExcellenceUT Health San AntonioSan AntonioTexasUSA
| | - William P. Clarke
- Department of PharmacologyUT Health San AntonioSan AntonioTexasUSA
- Addiction ResearchTreatment & Training Center of ExcellenceUT Health San AntonioSan AntonioTexasUSA
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3
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Olanzapine/samidorphan (Lybalvi) for schizophrenia and bipolar disorder. Med Lett Drugs Ther 2021; 63:191-2. [PMID: 35085217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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4
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Gorur A, Patiño M, Shi T, Corrales G, Takahashi H, Rangel R, Gleber-Netto FO, Pickering C, Myers JN, Cata JP. Low doses of methylnaltrexone inhibits head and neck squamous cell carcinoma growth in vitro and in vivo by acting on the mu-opioid receptor. J Cell Physiol 2021; 236:7698-7710. [PMID: 34038587 DOI: 10.1002/jcp.30421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/06/2022]
Abstract
The Mu-opioid receptor (MOR) has been implicated in tumorigenesis and metastasis. Methylnaltrexone (MNTX), an antagonist of MOR, has shown to inhibit tumor growth and metastasis in lung cancer cell lines. The effect of MNTX on other cell lines such as head and neck squamous cell carcinoma (HNSCC) has not been investigated. We measured the expression and activity of the receptor in different HNSCC cell lines. Then, we evaluated the impact of modulating the expression MOR and the effect of MNTX on the proliferation, clonogenic activity, invasion, and migration of two HNSCC (FaDu and MDA686Tu) cell lines expressing MOR and one cell line (UMSCC47) not expressing the receptor. We also evaluated the impact of MNTX on tumor growth and metastasis formation in vivo. Activation of the receptor with [d-Ala2,N-Me-Phe4, Gly5-ol] (DAMGO) caused a significant reduction in cyclic adenosine monophosphate levels in FaDu cells. Knockdown of MOR inhibited in vitro aggressive cell behaviors on FaDu and MDA686Tu cells and correlated with a reduction in markers of epithelial-mesenchymal transition. In vitro studies showed that MNTX strongly inhibited the proliferation, clonogenic activity, invasion, and migration of FaDu and MDA686Tu cells but has no effect on UMSCC47 cells. In vivo experiments demonstrated that MNTX suppresses tumor growth in HNSCC cell tumor-bearing mice. Our studies indicate that MOR could be considered as a therapeutic target to treat HNSCC.
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Affiliation(s)
- Aysegul Gorur
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA
| | - Miguel Patiño
- Department of Anesthesiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Ted Shi
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA
| | - German Corrales
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hideaki Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roberto Rangel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederico O Gleber-Netto
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Curtis Pickering
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey N Myers
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA
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5
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Zhou J, Zhao L, Wei S, Wang Y, Zhang X, Ma M, Wang K, Liu X, Wang R. Contribution of the μ opioid receptor and enkephalin to the antinociceptive actions of endomorphin-1 analogs with unnatural amino acid modifications in the spinal cord. Peptides 2021; 141:170543. [PMID: 33794284 DOI: 10.1016/j.peptides.2021.170543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 01/20/2023]
Abstract
Endomorphin analogs containing unnatural amino acids have demonstrated potent analgesic effects in our previous studies. In the present study, the differences in antinociception and the mechanisms thereof for analogs 1-3 administered intracerebroventricularly and intrathecally were explored. All analogs at different routes of administration produced potent analgesia compared to the parent peptide endomorphin-1. Multiple antagonists and antibodies were used to explore the mechanisms of action of these analogs, and it was inferred that analogs 1-3 stimulated the μ opioid receptor to induce antinociception. Moreover, the antibody data suggested that analog 2 may induce the release of immunoreactive [Leu5]-enkephaline and [Met5]-enkephaline to produce a secondary component of antinociception at the spinal level and analog 3 may stimulate the the release of immunoreactive [Met5]-enkephaline at the spinal level. Finally, analogs 2 and 3 produced no acute tolerance in the spinal cord. We hypothesize that the unique characteristics of the endomorphin analogs result from their capacities to stimulate the release of endogenous antinociceptive substances.
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Affiliation(s)
- Jingjing Zhou
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Long Zhao
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Shuang Wei
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Yuan Wang
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China.
| | - Xianghui Zhang
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Mengtao Ma
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Kairong Wang
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Xin Liu
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China.
| | - Rui Wang
- Department of Pharmacology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China.
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6
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Abstract
In pharmacogenomics, variable receptor phenotypes, resulting from genetic polymorphisms, are often described as a change in protein function or regulation observed upon exposure to a drug. However, in some instances, phenotypes are defined using a class of medications rather than individual drugs. This paradigm assumes that a variation associated with a drug response phenotype will retain the magnitude and direction of the effect for other drugs with the same mechanism of action. However, nonsynonymous polymorphisms may have ligand-specific effects. The purpose of this study was to investigate the potential for point mutations to asymmetrically affect the binding of different drugs to a common target. Ligand binding data from site-directed mutagenesis studies on five G-protein coupled receptors (beta-1 and -2 adrenergic, dopamine D2, angiotensin II and mu-opioid receptor) were collected and analyzed. Binding data from 81 studies for 253 ligands with 447 mutant proteins, including 10 naturally occurring human variants, were analyzed, yielding 1989 mutation-ligand pairs. Fold change in binding affinity for mutant proteins, relative to the wild-type, for different drugs was examined for ligand-specific effects, with a fold-change difference of one or more orders of magnitude between agents considered significant. Of the mutations examined, 49% were associated with ligand-specific effects. One human variant (T164I, beta-2 adrenergic receptor) showed ligand-specific effects for antiasthmatic agents. These results indicate that ligand-specific changes in binding are a possible consequence of missense mutations. This implies that caution needs to be exercised when grouping drugs together during design or interpretation of genotype-phenotype association studies.
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MESH Headings
- Angiotensin Receptor Antagonists/pharmacology
- Genetic Association Studies
- Humans
- Ligands
- Mutagenesis, Site-Directed
- Pharmacogenomic Testing
- Polymorphism, Genetic/genetics
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Angiotensin/genetics
- Receptors, Dopamine D2/genetics
- Receptors, G-Protein-Coupled/antagonists & inhibitors
- Receptors, G-Protein-Coupled/genetics
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/genetics
- Signal Transduction/drug effects
- Silent Mutation/genetics
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Affiliation(s)
| | - Ian S Haworth
- Departments of Pharmacology and Pharmaceutical Sciences
| | - Scott A Mosley
- Departments of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, California, USA
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Nathan PJ, Bakker G. Lessons learned from using fMRI in the early clinical development of a mu-opioid receptor antagonist for disorders of compulsive consumption. Psychopharmacology (Berl) 2021; 238:1255-1263. [PMID: 31900526 DOI: 10.1007/s00213-019-05427-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/06/2019] [Indexed: 01/23/2023]
Abstract
Functional magnetic resonance imaging (fMRI) has been widely used to gain a greater understanding of brain circuitry abnormalities in CNS disorders. fMRI has also been used to examine pharmacological modulation of brain circuity and is increasingly being used in early clinical drug development as functional pharmacodynamic index of target engagement, and to provide early indication of clinical efficacy. In this short review, we summarize data from experimental medicine and early clinical development studies of a mu-opioid receptor antagonist, GSK1521498 developed for disorders of compulsive consumption including binge eating in obesity. We demonstrate how fMRI can be used to answer important questions of early clinical drug development relating to; (1) target engagement, (2) dose response relationships, (3) differential efficacy and (4) prediction of behavioural and clinically relevant outcomes. We also highlight important methodological factors that need to be considered when conducting fMRI studies in drug development given the challenges faced with small sample sizes in Phase 1 and early proof of mechanism studies. While these data highlight the value of fMRI as a biomarker in drug development, its use for making Go/No-go decisions is still faced with challenges given the variability of responses, interpretation of brain activation changes and the limited data linking drug induced changes in brain activity to clinical or behavioural outcome. These challenges need to be addressed to fulfil the promise of fMRI as a tool in clinical drug development.
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Affiliation(s)
- Pradeep J Nathan
- Experimental Medicine (Neuroscience), Sosei Heptares, Cambridge, UK
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
- The Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Geor Bakker
- Experimental Medicine (Neuroscience), Sosei Heptares, Cambridge, UK.
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, Netherlands.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
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Hou T, Xu F, Peng X, Zhou H, Zhang X, Qiu M, Wang J, Liu Y, Liang X. Label-free cell phenotypic study of opioid receptors and discovery of novel mu opioid ligands from natural products. J Ethnopharmacol 2021; 270:113872. [PMID: 33485984 DOI: 10.1016/j.jep.2021.113872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mu opioid receptor (MOR) is mainly a drug target for analgesia. Opioid-like agonists such as morphine have been clinically used for analgesia but have potential adverse effects. MOR antagonists have been demonstrated to alleviate these side effects. Plants (Carthamus tinctorius L, Cynanchum otophyllum C. K. Schneid., Coffea arabica L., Prinsepia utilis Royle and Lepidium meyenii Walp.) and Ganoderma fungi (Ganoderma hainanense J. D. Zhao, Ganoderma capense (Lloyd) Teng, Ganoderma cochlear (Blume et Nees) Bres., Ganoderma resinaceum Boud and Ganoderma applanatum (Pers.) Pat.) are traditional medicines with beneficial effects on immunoregulation, analgesia and the nervous system, but whether MORs are engaged in their effects remains unknown. AIM OF THE STUDY This work aimed to identify MOR ligands among compounds isolated from the above-mentioned 10 species, and to investigate selectivity against four opioid receptor subtypes. By analyzing the structure-activity relationship and off-target effects, we could provide a new direction for the future development of MOR drugs. MATERIALS AND METHODS Four opioid receptor subtype models, including MOR, delta (DOR), kappa (KOR) and nop (NOR), were established with a label-free phenotypic dynamic mass redistribution assay to systematically profile the pharmacological properties of known ligands. Then, 82 natural compounds derived from the 10 species were screened against MOR to identify new ligands. The selectivity of the new ligands was characterized against the four subtypes, and off-target effects were also investigated on eight G protein-coupled receptors (GPCRs). RESULTS The pharmacological properties of known ligands on transfected HEK293T-MOR, HEK293-DOR, HEK293-KOR and HEK293-NOR cell lines were characterized. Seven compounds purified from Ganoderma cochlear (Blume et Nees) Bres. and Carthamus tinctorius L were MOR antagonists with micromolar potency. Among them, compound 35 showed the strongest antagonistic activity on MOR with an IC50 value of 10.0 ± 3.0 μM. To a certain extent, these seven new antagonists, exhibited antagonistic activity on the other opioid receptor subtypes, and they had almost no effect on other GPCRs, including CB1, CB2, M2 and beta2AR. Additionally, a compound from Lepidium meyenii Walp. displayed MOR agonistic activity. CONCLUSIONS The established screening models opened new avenues for the discovery and evaluation of opioid receptor ligand selectivity. Together, the novel MOR antagonists and agonists will enrich the inventory of MOR ligands and benefit related therapies.
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Affiliation(s)
- Tao Hou
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China.
| | - Fangfang Xu
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Xingrong Peng
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650201, China; Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650201, China.
| | - Han Zhou
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China.
| | - Xiuli Zhang
- College of Pharmaceutical Sciences, Soochow University, Suzhou, 215123, China.
| | - Minghua Qiu
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650201, China; Yunnan Key Laboratory of Natural Medicinal Chemistry, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650201, China.
| | - Jixia Wang
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China; Jiangxi Chinese Medicine Science Center of DICP, CAS, Nanchang, 330000, China.
| | - Yanfang Liu
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China; Jiangxi Chinese Medicine Science Center of DICP, CAS, Nanchang, 330000, China.
| | - Xinmiao Liang
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China; Jiangxi Chinese Medicine Science Center of DICP, CAS, Nanchang, 330000, China.
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Haas B, Ciftcioglu J, Jermar S, Weickhardt S, Eckstein N, Kaina B. Methadone-mediated sensitization of glioblastoma cells is drug and cell line dependent. J Cancer Res Clin Oncol 2021; 147:779-792. [PMID: 33315125 PMCID: PMC7872955 DOI: 10.1007/s00432-020-03485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE D,L-methadone (MET), an analgesic drug used for pain treatment and opiate addiction, has achieved attention from oncologists and social media as possible chemoensitizing agent in cancer therapy, notably brain cancer (glioblastoma multiforme, GBM). MET has been reported to enhance doxorubicin-induced cytotoxicity in GBM cells via activation of the µ-opioid receptor (MOR). Here, we extended this work and quantified the toxic effect of MET in comparison to other opioids alone and in combination with doxorubicin and the clinically more relevant alkylating drug temozolomide (TMZ), using a set of GBM cell lines and primary GBM cells. METHODS MOR expression in GBM cells was investigated by immunofluorescence and immunoblotting. Resistance to drugs alone and in combination with anticancer drugs was assessed by MTT assays. Concentration effect curves were fitted by nonlinear regression analysis and IC50 values were calculated. Apoptosis and necrosis rates were determined by annexin V/propidium iodide (PI)-flow cytometry. RESULTS MET alone was cytotoxic in all GBM cell lines and primary GBM cells at high micromolar concentrations (IC50 ~ 60-130 µM), observed both in the metabolic MTT assay and by quantifying apoptosis and necrosis, while morphine and oxycodone were not cytotoxic in this concentration range. Naloxone was not able to block MET-induced cytotoxicity, indicating that cell death-inducing effects of MET are not MOR-dependent. We recorded doxorubicin and TMZ concentration- response curves in combination with fixed MET concentrations. MET enhanced doxorubicin-induced cytotoxicity in only one cell line, and in primary cells it was observed only in a particular MET concentration range. In all assays, MET was not effective in sensitizing cells to TMZ. In two cell lines, MET even decreased the cell's sensitivity to TMZ. CONCLUSION MET was found to be cytotoxic in GBM cells in vitro only at high, clinically not relevant concentrations, where it was effective in inducing apoptosis and necrosis. Sensitizing effects were only observed in combination with doxorubicin, but not with TMZ, and are dependent on cell line and the applied drug concentration. Therefore, our findings do not support the use of MET in the treatment of GBM in combination with TMZ, as no sensitizing effect of MET was observed.
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MESH Headings
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Brain Neoplasms/drug therapy
- Brain Neoplasms/metabolism
- Brain Neoplasms/pathology
- Cell Line, Tumor
- Doxorubicin/administration & dosage
- Doxorubicin/pharmacology
- Drug Screening Assays, Antitumor
- Drug Synergism
- Glioblastoma/drug therapy
- Glioblastoma/metabolism
- Glioblastoma/pathology
- Humans
- Methadone/administration & dosage
- Methadone/pharmacology
- Morphine/pharmacology
- Naloxone/pharmacology
- Oxycodone/pharmacology
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/biosynthesis
- Tumor Cells, Cultured
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Affiliation(s)
- Bodo Haas
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.
| | - Janine Ciftcioglu
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
- Faculty of Applied Natural Sciences, Cologne University of Applied Sciences, Kaiser-Wilhelm-Allee, 51368, Leverkusen, Germany
| | - Sanja Jermar
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
- Faculty of Applied Natural Sciences, Cologne University of Applied Sciences, Kaiser-Wilhelm-Allee, 51368, Leverkusen, Germany
| | - Sandra Weickhardt
- Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Niels Eckstein
- Applied Pharmacy, University of Applied Sciences Kaiserslautern, Campus Pirmasens, Carl-Schurz-Str. 10-16, 66953, Pirmasens, Germany
| | - Bernd Kaina
- Institute of Toxicology, University Medical Center, Obere Zahlbacher Strasse 67, 55131, Mainz, Germany
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Lemos Duarte M, Trimbake NA, Gupta A, Tumanut C, Fan X, Woods C, Ram A, Gomes I, Bobeck EN, Schechtman D, Devi LA. High-throughput screening and validation of antibodies against synaptic proteins to explore opioid signaling dynamics. Commun Biol 2021; 4:238. [PMID: 33619305 PMCID: PMC7900253 DOI: 10.1038/s42003-021-01744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
Antibodies represent powerful tools to examine signal transduction pathways. Here, we present a strategy integrating multiple state-of-the-art methods to produce, validate, and utilize antibodies. Focusing on understudied synaptic proteins, we generated 137 recombinant antibodies. We used yeast display antibody libraries from the B cells of immunized rabbits, followed by FACS sorting under stringent conditions to identify high affinity antibodies. The antibodies were validated by high-throughput functional screening, and genome editing. Next, we explored the temporal dynamics of signaling in single cells. A subset of antibodies targeting opioid receptors were used to examine the effect of treatment with opiates that have played central roles in the worsening of the 'opioid epidemic.' We show that morphine and fentanyl exhibit differential temporal dynamics of receptor phosphorylation. In summary, high-throughput approaches can lead to the identification of antibody-based tools required for an in-depth understanding of the temporal dynamics of opioid signaling.
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Affiliation(s)
- Mariana Lemos Duarte
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York City, NY, 10029, USA
| | - Nikita A Trimbake
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York City, NY, 10029, USA
- Regeneron Pharmaceutical, 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Achla Gupta
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York City, NY, 10029, USA
| | | | - Xiaomin Fan
- AvantGen Inc., 6162 Nancy Ridge Dr #150, San Diego, CA, 92121, USA
| | - Catherine Woods
- AvantGen Inc., 6162 Nancy Ridge Dr #150, San Diego, CA, 92121, USA
| | - Akila Ram
- Department of Biology, Utah State University, Logan, UT, 84322, USA
| | - Ivone Gomes
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York City, NY, 10029, USA
| | - Erin N Bobeck
- Department of Biology, Utah State University, Logan, UT, 84322, USA
| | - Deborah Schechtman
- Department of Biochemistry, University of São Paulo, 748 Av Prof Lineu Prestes, room 1208 Cidade Universitaria, São Paulo, SP, 05508000, Brazil
| | - Lakshmi A Devi
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1603, New York City, NY, 10029, USA.
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Cleymaet AM, Berezin CT, Vigh J. Endogenous Opioid Signaling in the Mouse Retina Modulates Pupillary Light Reflex. Int J Mol Sci 2021; 22:ijms22020554. [PMID: 33429857 PMCID: PMC7826825 DOI: 10.3390/ijms22020554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 01/18/2023] Open
Abstract
Opioid peptides and their receptors are expressed in the mammalian retina; however, little is known about how they might affect visual processing. The melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs), which mediate important non-image-forming visual processes such as the pupillary light reflex (PLR), express β-endorphin-preferring, µ-opioid receptors (MORs). The objective of the present study was to elucidate if opioids, endogenous or exogenous, modulate pupillary light reflex (PLR) via MORs expressed by ipRGCs. MOR-selective agonist [D-Ala2, MePhe4, Gly-ol5]-enkephalin (DAMGO) or antagonist D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2 (CTAP) was administered via intravitreal injection. PLR was recorded in response to light stimuli of various intensities. DAMGO eliminated PLR evoked by light with intensities below melanopsin activation threshold but not that evoked by bright blue irradiance that activated melanopsin signaling, although in the latter case, DAMGO markedly slowed pupil constriction. CTAP or genetic ablation of MORs in ipRGCs slightly enhanced dim-light-evoked PLR but not that evoked by a bright blue stimulus. Our results suggest that endogenous opioid signaling in the retina contributes to the regulation of PLR. The slowing of bright light-evoked PLR by DAMGO is consistent with the observation that systemically applied opioids accumulate in the vitreous and that patients receiving chronic opioid treatment have slow PLR.
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Affiliation(s)
- Allison M. Cleymaet
- Department of Biomedical Sciences, Colorado State University, Ft. Collins, CO 80523, USA;
- Department of Clinical Sciences, Colorado State University, Ft. Collins, CO 80523, USA
| | - Casey-Tyler Berezin
- Cellular and Molecular Biology Graduate Program, Colorado State University, Ft. Collins, CO 80523, USA;
| | - Jozsef Vigh
- Department of Biomedical Sciences, Colorado State University, Ft. Collins, CO 80523, USA;
- Cellular and Molecular Biology Graduate Program, Colorado State University, Ft. Collins, CO 80523, USA;
- Correspondence: ; Tel.: +1-970-491-5758
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12
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Zhang YZ, Yang WJ, Wang XF, Wang MM, Zhang Y, Gu N, Wang CL. The spinal anti-allodynic effects of endomorphin analogs with C-terminal hydrazide modification in neuropathic pain model. Peptides 2020; 134:170407. [PMID: 32926948 DOI: 10.1016/j.peptides.2020.170407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022]
Abstract
The present study was undertaken to further investigate the spinal anti-allodynic effects of endomorphins (EMs) and their C-terminal hydrazide modified analogs EM-1-NHNH2 and EM-2-NHNH2 in the spared nerve injury (SNI) model of neuropathic pain in mice. Our results demonstrated that intrathecal (i.t.) administration of endomorphin-1 (EM-1), endomorphin-2 (EM-2), EM-1-NHNH2 and EM-2-NHNH2 produced potent anti-allodynic effects ipsilaterally in neuropathic pain model. Judging from the area under the curve (AUC) values, these two analogs exhibited higher antinociception than their parent peptides. Moreover, they also displayed significant antinociceptive effects in the contralateral paw administered intrathecally. Interestingly, EM-1 and its analog EM-1-NHNH2 displayed their antinociception probably by μ2-opioid receptor subtype since the μ1-opioid receptor antagonist naloxonazine didn't significantly block the anti-allodynia of EM-1 and EM-1-NHNH2, which implied a same opioid mechanism. However, the anti-allodynia induced by EM-2, but not EM-2-NHNH2 was significantly reduced by both μ1-opioid antagonist, naloxonazine and κ-antagonist, nor-binaltorphamine (nor-BNI), indicating multiple opioid receptors were involved in the anti-allodynic effects of EM-2. Most importantly, EM-1-NHNH2 decreased the antinociceptive tolerance, and EM-2-NHNH2 displayed non-tolerance-forming antinociception. Therefore, C-terminal amide to hydrazide conversion changed the spinal antinociceptive profiles of EMs in neuropathic pain. The present investigation is of great value in the development of novel opioid therapeutics against neuropathic pain.
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Affiliation(s)
- Yu-Zhe Zhang
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China
| | - Wen-Jiao Yang
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China
| | - Xiao-Fang Wang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Meng-Meng Wang
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China
| | - Yao Zhang
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China
| | - Ning Gu
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China.
| | - Chang-Lin Wang
- School of Life Science and Technology, Harbin Institute of Technology, 92 West Dazhi Street, Harbin, 150001, China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, 210009, China; State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China.
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Wojciechowski P, Andrzejewski K, Kaczyńska K. Intracerebroventricular Neuropeptide FF Diminishes the Number of Apneas and Cardiovascular Effects Produced by Opioid Receptors' Activation. Int J Mol Sci 2020; 21:ijms21238931. [PMID: 33255594 PMCID: PMC7728097 DOI: 10.3390/ijms21238931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023] Open
Abstract
The opioid-induced analgesia is associated with a number of side effects such as addiction, tolerance and respiratory depression. The involvement of neuropeptide FF (NPFF) in modulation of pain perception, opioid-induced tolerance and dependence was well documented in contrast to respiratory depression. Therefore, the aim of the present study was to examine the potency of NPFF to block post-opioid respiratory depression, one of the main adverse effects of opioid therapy. Urethane-chloralose anaesthetized Wistar rats were injected either intravenously (iv) or intracerebroventricularly (icv) with various doses of NPFF prior to iv endomorphin-1 (EM-1) administration. Iv NPFF diminished the number of EM-1-induced apneas without affecting their length and without influence on the EM-1 induced blood pressure decline. Icv pretreatment with NPFF abolished the occurrence of post-EM-1 apneas and reduced also the maximal drop in blood pressure and heart rate. These effects were completely blocked by the NPFF receptor antagonist RF9, which was given as a mixture with NPFF before systemic EM-1 administration. In conclusion, our results showed that centrally administered neuropeptide FF is effective in preventing apnea evoked by stimulation of μ-opioid receptors and the effect was due to activation of central NPFF receptors. Our finding indicates a potential target for reversal of opioid-induced respiratory depression.
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Sánchez-Blázquez P, Cortés-Montero E, Rodríguez-Muñoz M, Merlos M, Garzón-Niño J. The Sigma 2 receptor promotes and the Sigma 1 receptor inhibits mu-opioid receptor-mediated antinociception. Mol Brain 2020; 13:150. [PMID: 33176836 PMCID: PMC7659117 DOI: 10.1186/s13041-020-00676-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/22/2020] [Indexed: 01/10/2023] Open
Abstract
The Sigma-1 receptor (σ1R) has emerged as an interesting pharmacological target because it inhibits analgesia mediated by mu-opioid receptors (MOR), and also facilitates the development of neuropathic pain. Based on these findings, the recent cloning of the Sigma-2 receptor (σ2R) led us to investigate its potential role as a regulator of opioid analgesia and of pain hypersensitivity in σ2R knockout mice. In contrast to σ1R deficient mice, σ2R knockout mice developed mechanical allodynia following establishment of chronic constriction injury-induced neuropathic pain, which was alleviated by the σ1R antagonist S1RA. The analgesic effects of morphine, [D-Ala, N-MePhe, Gly-ol]-encephalin (DAMGO) and β-endorphin increased in σ1R-/- mice and diminished in σ2R-/- mice. The analgesic effect of morphine was increased in σ2R-/- mice by treatment with S1RA. However, σ2R-/- mice and wild-type mice exhibited comparable antinociceptive responses to the delta receptor agonist [D-Pen2,5]-encephalin (DPDPE), the cannabinoid type 1 receptor agonist WIN55,212-2 and the α2-adrenergic receptor agonist clonidine. Therefore, while σR1 inhibits and σ2R facilitates MOR-mediated analgesia these receptors exchange their roles when regulating neuropathic pain perception. Our study may help identify new pharmacological targets for diminishing pain perception and improving opioid detoxification therapies.
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MESH Headings
- Analgesics/pharmacology
- Animals
- Constriction, Pathologic
- Hyperalgesia/metabolism
- Hyperalgesia/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Morphine/pharmacology
- Nociception/drug effects
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
- Receptors, sigma/metabolism
- Sigma-1 Receptor
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Affiliation(s)
- Pilar Sánchez-Blázquez
- Neuropharmacology, Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Doctor Arce 37, 28002, Madrid, Spain.
| | - Elsa Cortés-Montero
- Neuropharmacology, Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Doctor Arce 37, 28002, Madrid, Spain
| | - María Rodríguez-Muñoz
- Neuropharmacology, Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Doctor Arce 37, 28002, Madrid, Spain
| | - Manuel Merlos
- Drug Discovery & Preclinical Development, Esteve, Barcelona, Spain
| | - Javier Garzón-Niño
- Neuropharmacology, Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Doctor Arce 37, 28002, Madrid, Spain
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Abstract
Chronic pruritus, defined as an unpleasant sensation resulting in a need to scratch that lasts more than 6 weeks, is a prevalent and bothersome symptom associated with both cutaneous and systemic conditions. Due to complex pathogenesis and profuse contributing factors, chronic pruritus therapy remains challenging. Regardless of the well-established antipruritic properties of classic pharmacotherapy (topical therapy, phototherapy and systemic therapy), these methods often provide insufficient relief for affected individuals. Owing to the growing interest in the field of pruritic research, further experimental and clinical data have emerged, continuously supporting the possibility of instigating novel therapeutic measures. This review covers the most relevant current modalities remaining under investigation that possess promising perspectives of approval in the near future, especially opioidergic drugs (mu-opioid antagonists and kappa-opioid agonists), neurokinin-1 receptor antagonists, biologic drugs, Janus kinase inhibitors, ileal bile acid transporter inhibitors, aryl hydrocarbon receptor agonists and histamine H4 receptor antagonists.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland
| | - Piotr Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 1 Chalubinskiego Street, 50-368, Wrocław, Poland.
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16
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Derouiche L, Pierre F, Doridot S, Ory S, Massotte D. Heteromerization of Endogenous Mu and Delta Opioid Receptors Induces Ligand-Selective Co-Targeting to Lysosomes. Molecules 2020; 25:molecules25194493. [PMID: 33007971 PMCID: PMC7583997 DOI: 10.3390/molecules25194493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Increasing evidence indicates that native mu and delta opioid receptors can associate to form heteromers in discrete brain neuronal circuits. However, little is known about their signaling and trafficking. Using double-fluorescent knock-in mice, we investigated the impact of neuronal co-expression on the internalization profile of mu and delta opioid receptors in primary hippocampal cultures. We established ligand selective mu–delta co-internalization upon activation by 1-[[4-(acetylamino)phenyl]methyl]-4-(2-phenylethyl)-4-piperidinecarboxylic acid, ethyl ester (CYM51010), [d-Ala2, NMe-Phe4, Gly-ol5]enkephalin (DAMGO), and deltorphin II, but not (+)-4-[(αR)-α-((2S,5R)-4-Allyl-2,5-dimethyl-1-piperazinyl)-3-methoxybenzyl]-N,N-diethylbenzamide (SNC80), morphine, or methadone. Co-internalization was driven by the delta opioid receptor, required an active conformation of both receptors, and led to sorting to the lysosomal compartment. Altogether, our data indicate that mu–delta co-expression, likely through heteromerization, alters the intracellular fate of the mu opioid receptor, which provides a way to fine-tune mu opioid receptor signaling. It also represents an interesting emerging concept for the development of novel therapeutic drugs and strategies.
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MESH Headings
- Animals
- Cells, Cultured
- Endocytosis
- Hippocampus/cytology
- Ligands
- Lysosomes
- Mice, Inbred C57BL
- Neurons/metabolism
- Piperidines/pharmacology
- Protein Multimerization
- Receptors, Opioid, delta/antagonists & inhibitors
- Receptors, Opioid, delta/metabolism
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
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Affiliation(s)
- Lyes Derouiche
- French National Centre for Scientific Research, Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, 67000 Strasbourg, France; (L.D.); (F.P.); (S.O.)
| | - Florian Pierre
- French National Centre for Scientific Research, Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, 67000 Strasbourg, France; (L.D.); (F.P.); (S.O.)
| | - Stéphane Doridot
- French National Centre for Scientific Research, Chronobiotron, 67200 Strasbourg, France;
| | - Stéphane Ory
- French National Centre for Scientific Research, Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, 67000 Strasbourg, France; (L.D.); (F.P.); (S.O.)
| | - Dominique Massotte
- French National Centre for Scientific Research, Institut des Neurosciences Cellulaires et Intégratives, University of Strasbourg, 67000 Strasbourg, France; (L.D.); (F.P.); (S.O.)
- Correspondence:
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17
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Gentzsch C, Seier K, Drakopoulos A, Jobin M, Lanoiselée Y, Koszegi Z, Maurel D, Sounier R, Hübner H, Gmeiner P, Granier S, Calebiro D, Decker M. Selective and Wash-Resistant Fluorescent Dihydrocodeinone Derivatives Allow Single-Molecule Imaging of μ-Opioid Receptor Dimerization. Angew Chem Int Ed Engl 2020; 59:5958-5964. [PMID: 31808251 PMCID: PMC7125027 DOI: 10.1002/anie.201912683] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 12/21/2022]
Abstract
μ-Opioid receptors (μ-ORs) play a critical role in the modulation of pain and mediate the effects of the most powerful analgesic drugs. Despite extensive efforts, it remains insufficiently understood how μ-ORs produce specific effects in living cells. We developed new fluorescent ligands based on the μ-OR antagonist E-p-nitrocinnamoylamino-dihydrocodeinone (CACO), that display high affinity, long residence time and pronounced selectivity. Using these ligands, we achieved single-molecule imaging of μ-ORs on the surface of living cells at physiological expression levels. Our results reveal a high heterogeneity in the diffusion of μ-ORs, with a relevant immobile fraction. Using a pair of fluorescent ligands of different color, we provide evidence that μ-ORs interact with each other to form short-lived homodimers on the plasma membrane. This approach provides a new strategy to investigate μ-OR pharmacology at single-molecule level.
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Affiliation(s)
- Christian Gentzsch
- Pharmaceutical and Medicinal ChemistryInstitute of Pharmacy and Food ChemistryJulius Maximilian University of WürzburgAm Hubland97074WürzburgGermany
| | - Kerstin Seier
- Institute of Pharmacology and ToxicologyJulius Maximilian University of WürzburgVersbacher Strasse 997078WürzburgGermany
| | - Antonios Drakopoulos
- Pharmaceutical and Medicinal ChemistryInstitute of Pharmacy and Food ChemistryJulius Maximilian University of WürzburgAm Hubland97074WürzburgGermany
| | - Marie‐Lise Jobin
- Institute of Pharmacology and ToxicologyJulius Maximilian University of WürzburgVersbacher Strasse 997078WürzburgGermany
| | - Yann Lanoiselée
- Institute of Metabolism and Systems Research & Centre of Membrane Proteins and ReceptorsUniversity of BirminghamIBR Tower, Level 2, EdgbastonBirminghamB152TTUK
| | - Zsombor Koszegi
- Institute of Metabolism and Systems Research & Centre of Membrane Proteins and ReceptorsUniversity of BirminghamIBR Tower, Level 2, EdgbastonBirminghamB152TTUK
| | - Damien Maurel
- ARPEGE (Pharmacology Screening Interactome) platform facilityInstitut de Génomique FonctionnelleUniversité de Montpellier, CNRS, INSERM141, rue de la Cardonille34094Montpellier Cedex 05France
| | - Rémy Sounier
- Institut de Génomique FonctionnelleUniversité de Montpellier, CNRS, INSERM141, rue de la Cardonille34094Montpellier Cedex 05France
| | - Harald Hübner
- Medicinal ChemistryDepartment of Chemistry and PharmacyFriedrich-Alexander University of Erlangen-Nuremberg91058ErlangenGermany
| | - Peter Gmeiner
- Medicinal ChemistryDepartment of Chemistry and PharmacyFriedrich-Alexander University of Erlangen-Nuremberg91058ErlangenGermany
| | - Sébastien Granier
- Institut de Génomique FonctionnelleUniversité de Montpellier, CNRS, INSERM141, rue de la Cardonille34094Montpellier Cedex 05France
| | - Davide Calebiro
- Institute of Pharmacology and ToxicologyJulius Maximilian University of WürzburgVersbacher Strasse 997078WürzburgGermany
- Institute of Metabolism and Systems Research & Centre of Membrane Proteins and ReceptorsUniversity of BirminghamIBR Tower, Level 2, EdgbastonBirminghamB152TTUK
| | - Michael Decker
- Pharmaceutical and Medicinal ChemistryInstitute of Pharmacy and Food ChemistryJulius Maximilian University of WürzburgAm Hubland97074WürzburgGermany
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18
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Abstract
With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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19
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Affiliation(s)
- Oussama Kebir
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
| | - Xavier Laqueille
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
| | - Fayçal Mouaffak
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
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20
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Takagi Y, Osawa G, Kato Y, Ikezawa E, Kobayashi C, Aruga E. Prevention and management of diarrhea associated with naldemedine among patients receiving opioids: a retrospective cohort study. BMC Gastroenterol 2020; 20:25. [PMID: 32005157 PMCID: PMC6995158 DOI: 10.1186/s12876-020-1173-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Naldemedine, a novel peripherally-acting mu-opioid receptor antagonist, has improved opioid-induced constipation in randomized controlled trials. The most frequent adverse event of naldemedine is diarrhea, which can cause abdominal pain and often leads to treatment discontinuation. We aimed to identify risk factors and appropriate management strategies for key adverse events including diarrhea associated with naldemedine, since those have not been extensively studied. METHODS We conducted a multi-center retrospective cohort study. Eligible patients had cancer, had undergone palliative care at participating centers, had been prescribed regular opioids, and had taken at least one dose of naldemedine between June 2017 and March 2018. The primary endpoint was the incidence of diarrhea according to baseline characteristics. Secondary endpoints included the duration of naldemedine administration, daily defecation counts before and after starting naldemedine, duration and severity of diarrhea as an adverse event of naldemedine, other adverse events, and the incidence of constipation within 7 days after recovery from diarrhea. We defined patients who started naldemedine within three days of starting a regularly prescribed opioid as the early group, and the remainder as the late group. RESULTS Among 103 patients who received naldemedine, 98 fulfilled the eligibility criteria. The median age was 68 years and 48% of the patients were female. Median performance status was 3, and the median oral intake was 50%. The median duration of naldemedine administration and overall survival were 25 and 64 days, respectively. The incidence of diarrhea in the early group (n = 26) was significantly lower than in the late group (n = 72) (3.9% vs. 22.2%, p = 0.02). Daily defecation counts increased after late (median 0.43 to 0.88, p < 0.001), but remained stable after early naldemedine administration (median 1.00 to 1.00, p = 0.34). Constipation after the diarrhea was resolved was common (53%), especially among patients who stopped naldemedine (78%). The diarrhea was improved within three days in 92% of patients who stopped other laxatives. CONCLUSIONS The early administration of naldemedine is beneficial because it reduces adverse events including diarrhea. Diarrhea caused by naldemedine can be effectively managed by stopping other laxatives while continuing naldemedine.
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Affiliation(s)
- Yusuke Takagi
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
- Toda-chuo General Hospital, 1-19-3 Honcho, Toda City, Saitama, 335-0023, Japan.
| | - Gakuji Osawa
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yoriko Kato
- Toda-chuo General Hospital, 1-19-3 Honcho, Toda City, Saitama, 335-0023, Japan
- Saiseikai Kawaguchi General Hospital, 5-11-5 Nishi-kawaguchi, Kawaguchi City, Saitama, 332-8558, Japan
| | - Eri Ikezawa
- Toda-chuo General Hospital, 1-19-3 Honcho, Toda City, Saitama, 335-0023, Japan
| | - Chika Kobayashi
- Toda-chuo General Hospital, 1-19-3 Honcho, Toda City, Saitama, 335-0023, Japan
| | - Etsuko Aruga
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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21
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Zheng Y, Obeng S, Reinecke BA, Chen C, Phansalkar PS, Walentiny DM, Gerk PM, Liu-Chen LY, Selley DE, Beardsley PM, Zhang Y. Pharmacological characterization of 17-cyclopropylmethyl-3,14-dihydroxy-4,5-epoxy-6-[(3'-fluoro-4'-pyridyl)acetamido]morphinan (NFP) as a dual selective MOR/KOR ligand with potential applications in treating opioid use disorder. Eur J Pharmacol 2019; 865:172812. [PMID: 31743739 PMCID: PMC6914219 DOI: 10.1016/j.ejphar.2019.172812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 01/16/2023]
Abstract
For thousands of years opioids have been the first-line treatment option for pain management. However, the tolerance and addiction potential of opioids limit their applications in clinic. NFP, a MOR/KOR dual-selective opioid antagonist, was identified as a ligand that significantly antagonized the antinociceptive effects of morphine with lesser withdrawal effects than naloxone at similar doses. To validate the potential application of NFP in opioid addiction treatment, a series of in vitro and in vivo assays were conducted to further characterize its pharmacological profile. In calcium mobilization assays and MOR internalization studies, NFP showed the apparent capacity to antagonize DAMGO-induced calcium flux and etorphine-induced MOR internalization. In contrast to the opioid agonists DAMGO and morphine, cells pretreated with NFP did not show apparent desensitization and down regulation of the MOR. Though in vitro bidirectional transport studies showed that NFP might be a P-gp substrate, in warm-water tail-withdrawal assays it was able to antagonize the antinociceptive effects of morphine indicating its potential central nervous system activity. Overall these results suggest that NFP is a promising dual selective opioid antagonist that may have the potential to be used therapeutically in opioid use disorder treatment.
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MESH Headings
- Analgesics, Opioid/pharmacology
- Animals
- Biological Transport
- CHO Cells
- Caco-2 Cells
- Calcium/metabolism
- Cell Line, Tumor
- Cricetulus
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-/pharmacology
- Humans
- Ligands
- Male
- Mice, Inbred C57BL
- Morphinans/pharmacology
- Narcotic Antagonists/pharmacology
- Opioid-Related Disorders/drug therapy
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/metabolism
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Affiliation(s)
- Yi Zheng
- Department of Medicinal Chemistry, Virginia Commonwealth University, 800 E. Leigh Street, Richmond, VA, 23298, United States
| | - Samuel Obeng
- Department of Medicinal Chemistry, Virginia Commonwealth University, 800 E. Leigh Street, Richmond, VA, 23298, United States
| | - Bethany A Reinecke
- Department of Medicinal Chemistry, Virginia Commonwealth University, 800 E. Leigh Street, Richmond, VA, 23298, United States
| | - Chongguang Chen
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - Palak S Phansalkar
- Department of Pharmaceutics, Virginia Commonwealth University, 410 North 12th Street, Richmond, VA, 23298, United States
| | - David M Walentiny
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA, 23298, United States
| | - Phillip M Gerk
- Department of Pharmaceutics, Virginia Commonwealth University, 410 North 12th Street, Richmond, VA, 23298, United States
| | - Lee-Yuan Liu-Chen
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, United States
| | - Dana E Selley
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA, 23298, United States
| | - Patrick M Beardsley
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA, 23298, United States; Center for Biomarker Research and Precision Medicine, Virginia Commonwealth University, 1112 East Clay Street, Richmond, VA, 23298, United States
| | - Yan Zhang
- Department of Medicinal Chemistry, Virginia Commonwealth University, 800 E. Leigh Street, Richmond, VA, 23298, United States.
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22
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Überall MA, Müller-Schwefe GHH. [Lack of evidence for the inhibition of opioid-related analgesia through peripherally acting μ‑opioid-receptor antagonists]. Schmerz 2019; 34:84-85. [PMID: 31720791 DOI: 10.1007/s00482-019-00427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael A Überall
- Privates Institut für Neurowissenschaften, Algesiologie und Pädiatrie, Nordostpark 51, 90411, Nürnberg, Deutschland.
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23
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Corkrum M, Rothwell PE, Thomas MJ, Kofuji P, Araque A. Opioid-Mediated Astrocyte-Neuron Signaling in the Nucleus Accumbens. Cells 2019; 8:cells8060586. [PMID: 31207909 PMCID: PMC6628279 DOI: 10.3390/cells8060586] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 12/29/2022] Open
Abstract
Major hallmarks of astrocyte physiology are the elevation of intracellular calcium in response to neurotransmitters and the release of neuroactive substances (gliotransmitters) that modulate neuronal activity. While μ-opioid receptor expression has been identified in astrocytes of the nucleus accumbens, the functional consequences on astrocyte–neuron communication remains largely unknown. The present study has investigated the astrocyte responsiveness to μ-opioid signaling and the regulation of gliotransmission in the nucleus accumbens. Through the combination of calcium imaging and whole-cell patch clamp electrophysiology in brain slices, we have found that μ-opioid receptor activation in astrocytes elevates astrocyte cytoplasmic calcium and stimulates the release of the gliotransmitter glutamate, which evokes slow inward currents through the activation of neuronal N-methyl-D-aspartate (NMDA) receptors. These results indicate the existence of molecular mechanisms underlying opioid-mediated astrocyte–neuron signaling in the nucleus accumbens.
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Affiliation(s)
- Michelle Corkrum
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Patrick E Rothwell
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Mark J Thomas
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Paulo Kofuji
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Alfonso Araque
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
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24
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Dvorácskó S, Keresztes A, Mollica A, Stefanucci A, Macedonio G, Pieretti S, Zádor F, Walter FR, Deli MA, Kékesi G, Bánki L, Tuboly G, Horváth G, Tömböly C. Preparation of bivalent agonists for targeting the mu opioid and cannabinoid receptors. Eur J Med Chem 2019; 178:571-588. [PMID: 31220675 DOI: 10.1016/j.ejmech.2019.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022]
Abstract
In order to obtain novel pharmacological tools and to investigate a multitargeting analgesic strategy, the CB1 and CB2 cannabinoid receptor agonist JWH-018 was conjugated with the opiate analgesic oxycodone or with an enkephalin related tetrapeptide. The opioid and cannabinoid pharmacophores were coupled via spacers of different length and chemical structure. In vitro radioligand binding experiments confirmed that the resulting bivalent compounds bound both to the opioid and to the cannabinoid receptors with moderate to high affinity. The highest affinity bivalent derivatives 11 and 19 exhibited agonist properties in [35S]GTPγS binding assays. These compounds activated MOR and CB (11 mainly CB2, whereas 19 mainly CB1) receptor-mediated signaling, as it was revealed by experiments using receptor specific antagonists. In rats both 11 and 19 exhibited antiallodynic effect similar to the parent drugs in 20 μg dose at spinal level. These results support the strategy of multitargeting G-protein coupled receptors to develop lead compounds with antinociceptive properties.
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MESH Headings
- Analgesics, Opioid/chemical synthesis
- Analgesics, Opioid/chemistry
- Analgesics, Opioid/pharmacology
- Animals
- Dose-Response Relationship, Drug
- Enkephalins/chemistry
- Enkephalins/pharmacology
- Indoles/chemistry
- Indoles/pharmacology
- Mice
- Molecular Structure
- Naphthalenes/chemistry
- Naphthalenes/pharmacology
- Oxycodone/chemistry
- Oxycodone/pharmacology
- Rats
- Receptor, Cannabinoid, CB1/antagonists & inhibitors
- Receptor, Cannabinoid, CB1/metabolism
- Receptor, Cannabinoid, CB2/antagonists & inhibitors
- Receptor, Cannabinoid, CB2/metabolism
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
- Structure-Activity Relationship
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Affiliation(s)
- Szabolcs Dvorácskó
- A Laboratory of Chemical Biology, Institute of Biochemistry, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary
| | - Attila Keresztes
- A Laboratory of Chemical Biology, Institute of Biochemistry, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary
| | - Adriano Mollica
- Dipartimento di Farmacia, Università di Chieti-Pescara "G. d'Annunzio", Via dei Vestini 31, 66100, Chieti, Italy
| | - Azzurra Stefanucci
- Dipartimento di Farmacia, Università di Chieti-Pescara "G. d'Annunzio", Via dei Vestini 31, 66100, Chieti, Italy
| | - Giorgia Macedonio
- Dipartimento di Farmacia, Università di Chieti-Pescara "G. d'Annunzio", Via dei Vestini 31, 66100, Chieti, Italy
| | - Stefano Pieretti
- Istituto Superiore di Sanità, Centro Nazionale Ricerca e Valutazione Preclinica e Clinica dei Farmaci, Viale Regina Elena 299, 00161, Rome, Italy
| | - Ferenc Zádor
- Laboratory of Opioid Research, Institute of Biochemistry, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary
| | - Fruzsina R Walter
- Biological Barriers Research Group, Institute of Biophysics, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary
| | - Mária A Deli
- Biological Barriers Research Group, Institute of Biophysics, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary
| | - Gabriella Kékesi
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720, Szeged, Dóm tér 10., Hungary
| | - László Bánki
- Department of Traumatology, Faculty of Medicine, University of Szeged, 6725, Szeged, Semmelweis u. 6., Hungary
| | - Gábor Tuboly
- Department of Neurology, Faculty of Medicine, University of Szeged, 6725, Szeged, Semmelweis u. 6., Hungary
| | - Gyöngyi Horváth
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720, Szeged, Dóm tér 10., Hungary
| | - Csaba Tömböly
- A Laboratory of Chemical Biology, Institute of Biochemistry, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62., 6726, Szeged, Hungary.
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25
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Obeng S, Jali A, Zheng Y, Wang H, Schwienteck KL, Chen C, Stevens DL, Akbarali HI, Dewey WL, Banks ML, Liu-Chen LY, Selley DE, Zhang Y. Characterization of 17-Cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6α-(indole-7-carboxamido)morphinan (NAN) as a Novel Opioid Receptor Modulator for Opioid Use Disorder Treatment. ACS Chem Neurosci 2019; 10:2518-2532. [PMID: 30758946 PMCID: PMC6520168 DOI: 10.1021/acschemneuro.9b00038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The opioid crisis is a significant public health issue with more than 115 people dying from opioid overdose per day in the United States. The aim of the present study was to characterize the in vitro and in vivo pharmacological effects of 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6α-(indole-7-carboxamido)morphinan (NAN), a μ opioid receptor (MOR) ligand that may be a potential candidate for opioid use disorder treatment that produces less withdrawal signs than naltrexone. The efficacy of NAN was compared to varying efficacy ligands at the MOR, and determined at the δ opioid receptor (DOR) and κ opioid receptor (KOR). NAN was identified as a low efficacy partial agonist for G-protein activation at the MOR and DOR, but had relatively high efficacy at the KOR. In contrast to high efficacy MOR agonists, NAN did not induce MOR internalization, downregulation, or desensitization, but it antagonized agonist-induced MOR internalization and stimulation of intracellular Ca2+ release. Opioid withdrawal studies conducted using morphine-pelleted mice demonstrated that NAN precipitated significantly less withdrawal signs than naltrexone at similar doses. Furthermore, NAN failed to produce fentanyl-like discriminative stimulus effects in rats up to doses that produced dose- and time-dependent antagonism of fentanyl. Overall, these results provide converging lines of evidence that NAN functions mainly as a MOR antagonist and support further consideration of NAN as a candidate medication for opioid use disorder treatment.
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Affiliation(s)
- Samuel Obeng
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
| | - Abdulmajeed Jali
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Yi Zheng
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
| | - Huiqun Wang
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
| | - Kathryn L. Schwienteck
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Chongguang Chen
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania 19140, United States
| | - David L. Stevens
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Hamid I. Akbarali
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - William L. Dewey
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Mathew L. Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Lee-Yuan Liu-Chen
- Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania 19140, United States
| | - Dana E. Selley
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Yan Zhang
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
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26
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Obeng S, Wang H, Jali A, Stevens DL, Akbarali HI, Dewey WL, Selley DE, Zhang Y. Structure-Activity Relationship Studies of 6α- and 6β-Indolylacetamidonaltrexamine Derivatives as Bitopic Mu Opioid Receptor Modulators and Elaboration of the "Message-Address Concept" To Comprehend Their Functional Conversion. ACS Chem Neurosci 2019; 10:1075-1090. [PMID: 30156823 PMCID: PMC6405326 DOI: 10.1021/acschemneuro.8b00349] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Structure-activity relationship (SAR) studies of numerous opioid ligands have shown that introduction of a methyl or ethyl group on the tertiary amino group at position 17 of the epoxymorphinan skeleton generally results in a mu opioid receptor (MOR) agonist while introduction of a cyclopropylmethyl group typically leads to an antagonist. Furthermore, it has been shown that introduction of heterocyclic ring systems at position 6 can favor antagonism. However, it was reported that 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6β-[(2'-indolyl)acetamido]morphinan (INTA), which bears a cyclopropylmethyl group at position 17 and an indole ring at position 6, acted as a MOR agonist. We herein report a SAR study on INTA with a series of its complementary derivatives to understand how introduction of an indole moiety with α or β linkage at position 6 of the epoxymorphinan skeleton may influence ligand function. Interestingly, one of INTA derivatives, compound 15 (NAN) was identified as a MOR antagonist both in vitro and in vivo. Molecular modeling studies revealed that INTA and NAN may interact with different domains of the MOR allosteric binding site. In addition, INTA may interact with W293 and N150 residues found in the orthosteric site to stabilize MOR activation conformation while NAN does not. These results suggest that INTA and NAN may be bitopic ligands and the type of allosteric interactions with the MOR influence their functional activity. These insights along with our enriched comprehension of the "message-address" concept will to benefit future ligand design.
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MESH Headings
- Allosteric Regulation/drug effects
- Allosteric Regulation/physiology
- Analgesics, Opioid/chemistry
- Analgesics, Opioid/pharmacology
- Animals
- CHO Cells
- Cricetinae
- Cricetulus
- Dose-Response Relationship, Drug
- Male
- Mice
- Narcotic Antagonists/chemistry
- Narcotic Antagonists/pharmacology
- Protein Binding/drug effects
- Protein Binding/physiology
- Protein Structure, Secondary
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/physiology
- Structure-Activity Relationship
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Affiliation(s)
- Samuel Obeng
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
| | - Huiqun Wang
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
| | - Abdulmajeed Jali
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - David L. Stevens
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Hamid I. Akbarali
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - William L. Dewey
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Dana E. Selley
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298, United States
| | - Yan Zhang
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, 800 E Leigh Street, Richmond, Virginia 23298, United States
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27
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Corsetti M, Pannemans J, Whorwell P. Targeting mu opioid receptors to modulate gastrointestinal function: what have we learnt so far from the studies in functional bowel disorders? F1000Res 2019; 8:F1000 Faculty Rev-257. [PMID: 30863534 PMCID: PMC6402074 DOI: 10.12688/f1000research.15974.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Opioids have recently received much attention because of the epidemic in their use in some countries such as the USA and the UK. Concerns have been raised about the possibility that they can increase mortality in patients when used on a long-term basis. Moreover, they are known to induce paradoxical hyperalgesia as well as alterations of gut function. The analgesic properties of opioids are mediated by receptors located in the brain, but as opioid receptors are also expressed in the gastrointestinal tract, new drugs acting on these receptors have recently been developed to treat two functional disorders, namely irritable bowel syndrome with diarrhoea and opioid-induced constipation. The aim of this article is to highlight some interesting observations resulting from the development of these drugs in the field of functional gastrointestinal disorders.
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Affiliation(s)
- Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jasper Pannemans
- Catholic University of Leuven, KU Leuven, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - Peter Whorwell
- Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
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28
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Burke NN, Ferdousi M, Deaver DR, Finn DP, Roche M, Kelly JP. Locomotor and anti-immobility effects of buprenorphine in combination with the opioid receptor modulator samidorphan in rats. Neuropharmacology 2019; 146:327-336. [PMID: 30553825 DOI: 10.1016/j.neuropharm.2018.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
Modulation of the opioid system has re-emerged as a potential therapeutic avenue for treating depression, with efficacy of a fixed-dose combination of buprenorphine (BUP), a partial μ-opioid receptor (MOR) agonist and κ-opioid receptor (KOR) antagonist, and samidorphan (SAM), a potent MOR antagonist, as an adjuvant treatment in patients with major depressive disorder (MDD). To advance understanding of the mechanism of action underlying this combination, we examined BUP, SAM and their combination in a series of rat behavioural assays. We examined effects on locomotor activity in Sprague Dawley (SD) rats over an extended period of time in a home-cage tracking system, and behavioural despair (immobility) in the forced swim test (FST), a commonly-used test to study antidepressants, in SD and Wistar-Kyoto (WKY) rats. Strain differences in opioid receptor and prepropeptide mRNA expression in the brain (prefrontal cortex, amygdala, hippocampus and striatum) were examined using qRT-PCR. BUP produced locomotor hyperactivity in SD rats from 2 to 6 h following administration, which was attenuated by SAM. In SD rats, a low, but not a high, dose of SAM in combination with BUP counteracted swim-stress induced immobility. This effect was not seen with BUP alone. In contrast, BUP alone reduced immobility in WKY rats, and this effect was enhanced by a low, but not high, dose of SAM. In WKY rats, MOR mRNA expression was higher in the hippocampus and lower in the striatum vs. SD rats. KOR mRNA expression was higher in the amygdala and nociceptin receptor (NOP) mRNA expression was lower in the hippocampus vs. SD rats. Differences in opioid receptor expression may account for the differential behavioural profile of WKY and SD rats. In summary, administration of BUP, a MOR receptor agonist together with a MOR opioid-receptor antagonist, SAM, reduces behavioural despair in animal models traditionally used to study effects of antidepressants.
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MESH Headings
- Amygdala/metabolism
- Animals
- Behavior, Animal/drug effects
- Buprenorphine/pharmacology
- Depression/drug therapy
- Depression/metabolism
- Hippocampus/metabolism
- Male
- Motor Activity/drug effects
- Naltrexone/analogs & derivatives
- Naltrexone/pharmacology
- Opioid Peptides/metabolism
- RNA, Messenger/metabolism
- Rats
- Rats, Inbred WKY
- Rats, Sprague-Dawley
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, mu/agonists
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
- Swimming
- Nociceptin
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Affiliation(s)
- Nikita N Burke
- Pharmacology and Therapeutics, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland; Physiology, School of Medicine, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | - Mehnaz Ferdousi
- Pharmacology and Therapeutics, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | | | - David P Finn
- Pharmacology and Therapeutics, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | - Michelle Roche
- Physiology, School of Medicine, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland
| | - John P Kelly
- Pharmacology and Therapeutics, NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Ireland.
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29
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Maguire DR, Gerak LR, Woods JH, Husbands SM, Disney A, France CP. Long-Lasting Effects of Methocinnamox on Opioid Self-Administration in Rhesus Monkeys. J Pharmacol Exp Ther 2019; 368:88-99. [PMID: 30401680 PMCID: PMC11046729 DOI: 10.1124/jpet.118.252353] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/05/2018] [Indexed: 01/05/2023] Open
Abstract
Opioid abuse remains a serious public health challenge, despite the availability of medications that are effective in some patients (naltrexone, buprenorphine, and methadone). This study explored the potential of a pseudoirreversible mu-opioid receptor antagonist [methocinnamox (MCAM)] as a treatment for opioid abuse by examining its capacity to attenuate the reinforcing effects of mu-opioid receptor agonists in rhesus monkeys. In one experiment, monkeys responded for heroin (n = 5) or cocaine (n = 4) under a fixed-ratio schedule. Another group (n = 3) worked under a choice procedure with one alternative delivering food and the other alternative delivering the mu-opioid receptor agonist remifentanil. A third group (n = 4) responded for food and physiologic parameters were measured via telemetry. The effects of MCAM were determined in all experiments and, in some cases, were compared with those of naltrexone. When given immediately before sessions, naltrexone dose-dependently decreased responding for heroin and decreased choice of remifentanil while increasing choice of food, with responding returning to baseline levels 1 day after naltrexone injection. MCAM also decreased responding for heroin and decreased choice of remifentanil while increasing choice of food; however, opioid-maintained responding remained decreased for several days after treatment. Doses of MCAM that significantly decreased opioid-maintained responding did not decrease responding for cocaine or food. MCAM did not impact heart rate, blood pressure, body temperature, or activity at doses that decreased opioid self-administration. Because MCAM selectively attenuates opioid self-administration for prolonged periods, this novel drug could be a safe and effective alternative to currently available treatments for opioid abuse.
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Affiliation(s)
- David R Maguire
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
| | - Lisa R Gerak
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
| | - James H Woods
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
| | - Stephen M Husbands
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
| | - Alex Disney
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
| | - Charles P France
- Department of Pharmacology (D.R.M., L.R.G., J.H.W., C.P.F.), Department of Psychiatry (C.P.F.), and Addiction Research, Treatment & Training Center of Excellence (D.R.M., L.R.G., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)
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Affiliation(s)
- Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Hyunseok Kang
- Johns Hopkins University School of Medicine, Baltimore, MD
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Cao DN, Shi JJ, Wu N, Li J. Modulation of miR-139-5p on chronic morphine-induced, naloxone-precipitated cAMP overshoot in vitro. Metab Brain Dis 2018; 33:1501-1508. [PMID: 29916183 DOI: 10.1007/s11011-018-0257-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Chronic exposure to morphine can produce tolerance, dependence and addiction, but the underlying neurobiological basis is still incompletely understood. c-Jun, as an important component of the activator protein-1 transcription factor, is supposed to take part in regulating gene expression in AC/cAMP/PKA signaling. MicroRNA (miRNA) has emerged as a critical regulator of neuronal functions. Although a number of miRNAs have been reported to regulate the μ-opioid receptor expression, there has been no report about miRNAs to regulate chronic morphine-induced, naloxone-precipitated cAMP overshoot. Our results showed that chronic morphine pretreatment induced naloxone-precipitated cAMP overshoot in concentration- and time-dependent manners in HEK 293/μ cells. Chronic morphine pretreatment alone elevated both c-Jun protein and miR-139-5p expression levels, while dramatically artificial elevation of miR-139-5p inhibited c-Jun at the translational level. Furthermore, dramatically artificial upregulation of intracellular miR-139-5p limited chronic morphine-induced, naloxone-precipitated cAMP overshoot. These findings suggested that miR-139-5p was involved in regulating chronic morphine-induced, naloxone-precipitated cAMP overshoot in a negative feedback manner through its target c-Jun, which extends our understanding of neurobiological mechanisms underlying morphine dependence and addiction.
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Affiliation(s)
- Dan-Ni Cao
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
| | - Jing-Jing Shi
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
| | - Ning Wu
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China.
| | - Jin Li
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China.
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Candy B, Jones L, Vickerstaff V, Larkin PJ, Stone P. Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care. Cochrane Database Syst Rev 2018; 6:CD006332. [PMID: 29869799 PMCID: PMC6513061 DOI: 10.1002/14651858.cd006332.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid-induced bowel dysfunction (OIBD) is characterised by constipation, incomplete evacuation, bloating, and gastric reflux. It is one of the major adverse events of treatment for pain in cancer and in palliative care, resulting in increased morbidity and reduced quality of life.This is an update of two Cochrane reviews. One was published in 2011, Issue 1 on laxatives and methylnaltrexone for the management of constipation in people receiving palliative care; this was updated in 2015 and excluded methylnaltrexone. The other was published in 2008, Issue 4 on mu-opioid antagonists (MOA) for OIBD. In this updated review, we only included trials on MOA (including methylnaltrexone) for OIBD in people with cancer and people receiving palliative care. OBJECTIVES To assess the effectiveness and safety of MOA for OIBD in people with cancer and people receiving palliative care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science to August 2017. We also searched clinical trial registries and regulatory websites. We contacted manufacturers of MOA to identify further data. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed the effectiveness and safety of MOA for OIBD in people with cancer and people at a palliative stage irrespective of the type of terminal disease they experienced. DATA COLLECTION AND ANALYSIS Two review authors assessed risk of bias and extracted data. The appropriateness of combining data from the trials depended upon sufficient homogeneity across the trials. Our primary outcomes were laxation, impact on pain relief, and adverse events. Impact on pain relief was a primary outcome because a possible adverse effect of MOAs is a reduction in pain relief from opioids. We assessed the evidence on these outcomes using GRADE. MAIN RESULTS We identified four new trials for this update, bringing the total number included in this review to eight. In total, 1022 men and women with cancer irrespective of stage or at a palliative care stage of any disease were randomised across the trials. The MOAs evaluated were oral naldemedine and naloxone (alone or in combination with oxycodone), and subcutaneous methylnaltrexone. The trials compared with MOA with a placebo or with the active intervention administered at different doses or in combination with other drugs. The trial of naldemedine and the two of naloxone in combination with oxycodone were in people with cancer irrespective of disease stage. The trial on naloxone alone was in people with advanced cancer. The four trials on methylnaltrexone were undertaken in palliative care where most participants had cancer. All trials were vulnerable to biases; four were at a high risk as they involved a sample of fewer than 50 participants per arm.In the trial of naldemedine compared to placebo in 225 participants, there were more spontaneous laxations over the two-week treatment for the intervention group (risk ratio (RR) 1.93, 95% confidence intervals (CI) 1.36 to 2.74; moderate-quality evidence). In comparison with higher doses, lower doses resulted in fewer spontaneous laxations (0.1 mg versus 0.2 mg: RR 0.73, 95% CI 0.55 to 0.95; 0.1 mg versus 0.4 mg: RR 0.69, 95% CI 0.53 to 0.89; moderate-quality evidence). There was moderate-quality evidence that naldemedine had no effect on opiate withdrawal. There were five serious adverse events. All were in people taking naldemedine (low-quality evidence). There was an increase in the occurrence of other (non-serious) adverse events in the naldemedine groups (RR 1.36, 95% CI 1.04 to 1.79, moderate-quality evidence). The most common adverse event was diarrhoea.The trials on naloxone taken either on its own, or in combination with oxycodone (an opioid) compared to oxycodone only did not evaluate laxation response over the first two weeks of administration. There was very low-quality evidence that naloxone alone, and moderate-quality evidence that oxycodone/naloxone, had no effect on analgesia. There was low-quality evidence that oxycodone/naloxone did not increase the risk of serious adverse events and moderate-quality evidence that it did not increase risk of adverse events.In combined analysis of two trials of 287 participants, we found methylnaltrexone compared to placebo induced more laxations within 24 hours (RR 2.77, 95% CI 1.91 to 4.04. I² = 0%; moderate-quality evidence). In combined analysis, we found methylnaltrexone induced more laxation responses over two weeks (RR 9.98, 95% CI 4.96 to 20.09. I² = 0%; moderate-quality evidence). The proportion of participants who had a rescue-free laxation response within 24 hours of the first dose was 59.1% in the methylnaltrexone arms and 19.1% in the placebo arm. There was moderate-quality evidence that the rate of opioid withdrawal was not affected. Methylnaltrexone did not increase the likelihood of a serious adverse event; there were fewer in the intervention arm (RR 0.59, 95% CI 0.38 to 0.93; I² = 0%; moderate-quality evidence). There was no difference in the proportion of participants experiencing an adverse event (RR 1.17, 95% CI 0.94 to 1.45; I² = 74%; low-quality evidence). Methylnaltrexone increased the likelihood of abdominal pain and flatulence.Two trials compared differing methylnaltrexone schedules of higher doses with lower doses. For early laxation, there was low-quality evidence of no clear difference between doses on analgesia and adverse events. Both trials measured laxation response within 24 hours of first dose (trial one: RR 0.82, 95% CI 0.41 to 1.66; trial two: RR 1.07, 95% CI 0.81 to 1.42). AUTHORS' CONCLUSIONS In this update, the conclusions for naldemedine are new. There is moderate-quality evidence to suggest that, taken orally, naldemedine improves bowel function over two weeks in people with cancer and OIBD but increases the risk of adverse events. The conclusions on naloxone and methylnaltrexone have not changed. The trials on naloxone did not assess laxation at 24 hours or over two weeks. There is moderate-quality evidence that methylnaltrexone improves bowel function in people receiving palliative care in the short term and over two weeks, and low-quality evidence that it does not increase adverse events. There is a need for more trials including more evaluation of adverse events. None of the current trials evaluated effects in children.
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Affiliation(s)
- Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry6th Floor, Maple House149 Tottenham Court RoadLondonUKW1T 7NF
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry6th Floor, Maple House149 Tottenham Court RoadLondonUKW1T 7NF
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry6th Floor, Maple House149 Tottenham Court RoadLondonUKW1T 7NF
| | - Philip J Larkin
- UCD College of Health SciencesUCD School of Nursing, Midwifery and Health Systems and Our Lady's Hospice and Care ServicesDublinIreland
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryDivision of PsychiatryRoom 119, First Floor, Charles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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Cornelissen JC, Obeng S, Rice KC, Zhang Y, Negus SS, Banks ML. Application of Receptor Theory to the Design and Use of Fixed-Proportion Mu-Opioid Agonist and Antagonist Mixtures in Rhesus Monkeys. J Pharmacol Exp Ther 2018; 365:37-47. [PMID: 29330156 PMCID: PMC5830633 DOI: 10.1124/jpet.117.246439] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/09/2018] [Indexed: 01/17/2023] Open
Abstract
Receptor theory predicts that fixed-proportion mixtures of a competitive, reversible agonist (e.g., fentanyl) and antagonist (e.g., naltrexone) at a common receptor [e.g., mu-opioid receptors (MORs)] will result in antagonist proportion-dependent decreases in apparent efficacy of the agonist/antagonist mixtures and downward shifts in mixture dose-effect functions. The present study tested this hypothesis by evaluating behavioral effects of fixed-proportion fentanyl/naltrexone mixtures in a warm-water tail-withdrawal procedure in rhesus monkeys (n = 4). Fentanyl (0.001-0.056 mg/kg) alone, naltrexone (0.032-1.0 mg/kg, i.m.) alone, and fixed-proportion mixtures of fentanyl/naltrexone (1:0.025, 1:0.074, and 1:0.22) were administered in a cumulative-dosing procedure, and the proportions were based on published fentanyl and naltrexone Kd values at MOR in monkey brain. Fentanyl alone produced dose-dependent antinociception at both 50 and 54°C thermal intensities. Up to the largest dose tested, naltrexone alone did not alter nociception. Consistent with receptor theory predictions, naltrexone produced a proportion-dependent decrease in the effectiveness of fentanyl/naltrexone mixtures to produce antinociception. The maximum effects of fentanyl, naltrexone, and each mixture were also used to generate an efficacy-effect scale for antinociception at each temperature, and this scale was evaluated for its utility in quantifying 1) efficacy requirements for antinociception at 50 and 54°C and 2) relative efficacy of six MOR agonists that vary in their efficacies to produce agonist-stimuated GTPγS binding in vitro (from lowest to highest efficacy: 17-cyclopropylmethyl-3,14β-dihyroxy-4,5α-epoxy-6α-[(3'-isoquinolyl)acetamindo]morphine, nalbuphine, buprenorphine, oxycodone, morphine, and methadone). These results suggest that fixed-proportion agonist/antagonist mixtures may offer a useful strategy to manipulate apparent drug efficacy for basic research or therapeutic purposes.
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Affiliation(s)
- Jeremy C Cornelissen
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Samuel Obeng
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Kenner C Rice
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Yan Zhang
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Matthew L Banks
- Department of Pharmacology and Toxicology, School of Medicine (J.C.C., S.S.N., M.L.B.), and Department of Medicinal Chemistry, School of Pharmacy (S.O., Y.Z.), Virginia Commonwealth University, Richmond, Virginia; and Drug Design and Synthesis Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
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Moerke MJ, Banks ML, Cheng K, Rice KC, Negus SS. Maintenance on naltrexone+amphetamine decreases cocaine-vs.-food choice in male rhesus monkeys. Drug Alcohol Depend 2017; 181:85-93. [PMID: 29040826 PMCID: PMC5683900 DOI: 10.1016/j.drugalcdep.2017.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cocaine use disorder remains a significant public health issue for which there are no FDA-approved pharmacotherapies. Amphetamine maintenance reduces cocaine use in preclinical and clinical studies, but the mechanism of this effect is unknown. Previous studies indicate a role for endogenous opioid release and subsequent opioid receptor activation in some amphetamine effects; therefore, the current study examined the role of mu-opioid receptor activation in d-amphetamine treatment effects in an assay of cocaine-vs-food choice. METHODS Adult male rhesus monkeys with double-lumen intravenous catheters responded for concurrently available food pellets and cocaine injections (0-0.1mg/kg/injection) during daily sessions. Cocaine choice and overall reinforcement rates were evaluated during 7-day treatments with saline or test drugs. RESULTS During saline treatment, cocaine maintained a dose-dependent increase in cocaine-vs.-food choice. The mu-opioid receptor agonist morphine (0.032-0.32mg/kg/h) dose-dependently increased cocaine choice and decreased rates of reinforcement. A dose of the mu-selective opioid receptor antagonist naltrexone (0.0032mg/kg/h) that completely blocked morphine effects had no effect on cocaine choice when it was administered alone, but it enhanced the effectiveness of a threshold dose of 0.032mg/kg/h amphetamine to decrease cocaine choice without also enhancing nonselective behavioral disruption by this dose of amphetamine. Conversely, the kappa-selective opioid antagonist norbinalorphimine did not enhance amphetamine effects on cocaine choice. CONCLUSIONS These results suggest that amphetamine maintenance produces mu opioid-receptor mediated effects that oppose its anti-cocaine effects. Co-administration of naltrexone may selectively enhance amphetamine potency to decrease cocaine choice without increasing amphetamine potency to produce general behavioral disruption.
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Affiliation(s)
- Megan J Moerke
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
| | - Matthew L Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
| | - Kejun Cheng
- Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852, USA; Office of Pharmaceutical Quality, The Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Kenner C Rice
- Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852, USA.
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
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Journigan VB, Polgar WE, Tuan EW, Lu J, Daga PR, Zaveri NT. Probing ligand recognition of the opioid pan antagonist AT-076 at nociceptin, kappa, mu, and delta opioid receptors through structure-activity relationships. Sci Rep 2017; 7:13255. [PMID: 29038479 PMCID: PMC5643385 DOI: 10.1038/s41598-017-13129-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022] Open
Abstract
Few opioid ligands binding to the three classic opioid receptor subtypes, mu, kappa and delta, have high affinity at the fourth opioid receptor, the nociceptin/orphanin FQ receptor (NOP). We recently reported the discovery of AT-076 (1), (R)-7-hydroxy-N-((S)-1-(4-(3-hydroxyphenyl)piperidin-1-yl)-3-methylbutan-2-yl)-1,2,3,4-tetrahydroisoquinoline-3-carboxamide, a pan antagonist with nanomolar affinity for all four subtypes. Since AT-076 binds with high affinity at all four subtypes, we conducted a structure-activity relationship (SAR) study to probe ligand recognition features important for pan opioid receptor activity, using chemical modifications of key pharmacophoric groups. SAR analysis of the resulting analogs suggests that for the NOP receptor, the entire AT-076 scaffold is crucial for high binding affinity, but the binding mode is likely different from that of NOP antagonists C-24 and SB-612111 bound in the NOP crystal structure. On the other hand, modifications of the 3-hydroxyphenyl pharmacophore, but not the 7-hydroxy Tic pharmacophore, are better tolerated at kappa and mu receptors and yield very high affinity multifunctional (e.g. 12) or highly selective (e.g. 16) kappa ligands. With the availability of the opioid receptor crystal structures, our SAR analysis of the common chemotype of AT-076 suggests rational approaches to modulate binding selectivity, enabling the design of multifunctional or selective opioid ligands from such scaffolds.
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MESH Headings
- Humans
- Narcotic Antagonists/chemistry
- Narcotic Antagonists/pharmacology
- Opioid Peptides/chemistry
- Receptors, Opioid/chemistry
- Receptors, Opioid, delta/antagonists & inhibitors
- Receptors, Opioid, delta/chemistry
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, kappa/chemistry
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/chemistry
- Structure-Activity Relationship
- Nociceptin
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Affiliation(s)
- V Blair Journigan
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA
- Marshall University School of Pharmacy, Department of Pharmaceutical Sciences, One John Marshall Drive, Huntington, WV 25755, USA
| | - Willma E Polgar
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA
| | - Edward W Tuan
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA
| | - James Lu
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA
| | - Pankaj R Daga
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA
| | - Nurulain T Zaveri
- Astraea Therapeutics, 320 Logue Avenue, Suite 142, Mountain View, CA, 94043, USA.
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Drug Enforcement Administration, Department of Justice. Schedules of Controlled Substances: Removal of Naldemedine From Control. Final rule. Fed Regist 2017; 82:45436-8. [PMID: 28990740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
With the issuance of this final rule, the Drug Enforcement Administration removes the substance naldemedine (4R,4aS,7aR,12bS)-3-(cyclopropylmethyl)-4a,7,9-trihydroxy-N-(2-(3-phenyl-1,2,4-oxadiazol-5-yl)propan-2-yl)-2,3,4,4a,5,7a-hexahydro-1H-4,12-methanobenzofuro[3,2-e]isoquinoline-6-carboxamide) including its salts from the schedules of the Controlled Substances Act. Prior to the effective date of this rule, naldemedine was a schedule II controlled substance because it can be derived from opium alkaloids. This action removes the regulatory controls and administrative, civil, and criminal sanctions applicable to controlled substances, including those specific to schedule II controlled substances, on persons who handle (manufacture, distribute, reverse distribute, dispense, conduct research, import, export, or conduct chemical analysis) or propose to handle naldemedine.
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Takahashi N, Tominaga M, Kosaka R, Kamata Y, Umehara Y, Matsuda H, Sakaguchi A, Ogawa H, Takamori K. Involvement of µ-opioid Receptors and κ-opioid Receptors in Itch-related Scratching Behaviour of Imiquimod-induced Psoriasis-like Dermatitis in Mice. Acta Derm Venereol 2017; 97:928-933. [PMID: 28512665 DOI: 10.2340/00015555-2704] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pathogenesis of psoriatic itch is poorly understood. The aim of this study was to investigate the involvement of opioid receptors in scratching behaviour of imiquimod-induced psoriasis-like dermatitis model mice. Topical application of 5% imiquimod cream to the rostral back skin of mice induced antihistamine-resistant scratching behaviour. The expression of µ-opioid receptor (MOR) protein increased in the epidermis, dorsal root ganglia (DRG) and spinal cord of imiquimod-treated mice. In contrast, the expression of κ-opioid receptor (KOR) protein decreased in the DRG and spinal cord of imiquimod-treated mice, and was undetectable in the epidermis of both groups. Topical or intraperitoneal administration of the MOR antagonist naloxone and oral administration of the centrally acting KOR agonist ICI-199,441 inhibited scratching behaviour, whereas oral administration of the peri-pherally-selective KOR agonist asimadoline did not. These results suggest that peripheral and central MOR and central KOR may be involved in the modulation of scratching behaviour in imiquimod-treated mice.
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MESH Headings
- Aminoquinolines
- Animals
- Behavior, Animal/drug effects
- Disease Models, Animal
- Drug Eruptions/etiology
- Drug Eruptions/metabolism
- Drug Eruptions/prevention & control
- Drug Eruptions/psychology
- Imiquimod
- Male
- Mice, Inbred C57BL
- Narcotic Antagonists/pharmacology
- Psoriasis/chemically induced
- Psoriasis/metabolism
- Psoriasis/prevention & control
- Psoriasis/psychology
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, Opioid, mu/metabolism
- Signal Transduction/drug effects
- Skin/drug effects
- Skin/innervation
- Skin/metabolism
- Spinal Cord/drug effects
- Spinal Cord/metabolism
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Affiliation(s)
- Nobuaki Takahashi
- Institute for Environmental and Gender Specific Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Elaine G Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
- Hull and East Yorkshire NHS Trust, Hull, UK
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Hale M, Wild J, Reddy J, Yamada T, Arjona Ferreira JC. Naldemedine versus placebo for opioid-induced constipation (COMPOSE-1 and COMPOSE-2): two multicentre, phase 3, double-blind, randomised, parallel-group trials. Lancet Gastroenterol Hepatol 2017; 2:555-564. [PMID: 28576452 DOI: 10.1016/s2468-1253(17)30105-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid-induced constipation is a frequent side-effect of opioid treatment, and standard interventions have limited or inconsistent efficacy. This study assessed the efficacy and safety of naldemedine, a peripherally acting μ-opioid receptor antagonist, for the treatment of opioid-induced constipation in patients with chronic non-cancer pain. METHODS We report two double-blind, randomised, placebo-controlled trials in adults with chronic non-cancer pain and opioid-induced constipation. The first (COMPOSE-1) was done in 68 outpatient sites in seven countries and the second (COMPOSE-2) at 69 outpatient sites in six countries; both studies were done in Europe and the USA. Eligible patients were aged 18-80 years, did not use laxatives, and had a stable opioid regimen for treatment of chronic non-cancer pain with a total daily dose averaging at least 30 mg (morphine equivalent) for at least 1 month before screening. Patients were randomly assigned (1:1) to receive either oral naldemedine 0·2 mg or matching placebo once a day for 12 weeks. Randomisation was stratified by average total daily opioid dose (30-100 mg and >100 mg equivalents of oral morphine sulphate). The primary endpoint was proportion of responders. A responder had at least three spontaneous bowel movements (SBMs) per week with an increase from baseline of at least one SBM per week for at least 9 weeks of the 12-week treatment period including at least three of the last 4 weeks. Efficacy endpoints were analysed by intention to treat and the safety population included all patients who received at least one dose of study drug. These trials have both been completed and are registered with ClinicalTrials.gov, numbers NCT01965158 and NCT01993940. FINDINGS In COMPOSE-1, 547 patients were recruited between Aug 29, 2013, and Jan 22, 2015, and were randomly assigned to receive naldemedine (n=274) or placebo (n=273). Patients for COMPOSE-2 were recruited between Nov 4, 2013, and June 9, 2015; 553 patients were randomly assigned to receive naldemedine (n=277) or placebo (n=276). Five patients were enrolled at more than one site, so were excluded from the intention-to-treat population (COMPOSE-1: one per group; COMPOSE-2: one in the naldemedine group, two from the placebo group), with intention-to-treat group sizes of 273 in the naldemedine group and 272 in the placebo group in COMPOSE-1, and 276 in the naldemedine group and 274 in the placebo group in COMPOSE-2. The proportion of responders in both trials was significantly higher with naldemedine than with placebo in COMPOSE-1 (130 responders [47·6%] of 273 in the naldemedine group vs 94 responders [34·6%] of 272 in the placebo group, difference 13·0% [95% CI 4·8-21·3]; p=0·002) and in COMPOSE-2 (145 [52·5%] of 276 vs 92 [33·6%] of 274, difference 18·9% [10·8-27·0]; p<0·0001). Incidence of adverse events with naldemedine was similar to placebo (COMPOSE-1: 132 [49%] of 271 in the naldemedine group vs 123 [45%] of 272 in the placebo group; COMPOSE-2: 136 [50%] of 271 vs 132 [48%] of 274). Treatment-related adverse events were noted in 59 (22%) of 271 patients in the naldemedine group and 45 (17%) of 272 in the placebo group in COMOPOSE-1, and in 54 (20%) of 271 patients in the naldemedine group and 31 (11%) of 274 in the placebo group of COMPOSE-2; the between-group differences were largely due to gastrointestinal disorders, which were more common with naldemedine than placebo (COMPOSE-1: 40 [15%] patients in the naldemedine group vs 18 [7%] in the placebo group; COMPOSE-2: 42 [16%] vs 20 [7%]). INTERPRETATION Naldemedine treatment led to a significantly higher responder rate than did placebo and was generally well tolerated. These results support that naldemedine could be a new option for the treatment of opioid-induced constipation in patients with chronic non-cancer pain. FUNDING Shionogi & Co, Ltd.
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Affiliation(s)
- Martin Hale
- Gold Coast Research LLC, Plantation, FL, USA
| | - James Wild
- Upstate Clinical Research Associates, Williamsville, NY, USA
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Wang Y, Zhou J, Liu X, Zhao L, Wang Z, Zhang X, Wang K, Wang L, Wang R. Structure-constrained endomorphin analogs display differential antinociceptive mechanisms in mice after spinal administration. Peptides 2017; 91:40-48. [PMID: 28363796 DOI: 10.1016/j.peptides.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022]
Abstract
We previously reported a series of novel endomorphin analogs with unnatural amino acid modifications. These analogs display good binding affinity and functional activity toward the μ opioid receptor (MOP). In the present study, we further investigated the spinal antinociceptive activity of these compounds. The analogs were potent in several nociceptive models. Opioid antagonists and antibodies against several endogenous opioid peptides were used to determine the mechanisms of action of these peptides. Intrathecal pretreatment with naloxone and β-funaltrexamine (β-FNA) effectively inhibited analog-induced analgesia, demonstrating that activity of the analogs is regulated primarily through MOP. Antinociception induced by analog 2 through 4 was not reversed by δ opioid receptor (DOP) or κ opioid receptor (KOP) antagonist; antibodies against dynorphin-A (1-17), dynorphin-B (1-13), and Leu5/Met5-enkephalin had no impact on the antinociceptive effects of these analogs. In contrast, antinociceptive effects induced by a spinal injection of the fluorine substituted analog 1 were significantly reversed by KOP antagonism. Furthermore, intrathecal pretreatment with antibodies against dynorphin-B (1-13) attenuated the antinociceptive effect of analog 1. These results indicate that the antinociceptive activity exerted by intrathecally-administered analog 1 is mediated, in part, through KOP with increased release of dynorphin-B (1-13). The chemical modifications used in the present study may serve as a useful tool to gain insight into the mechanisms of endomorphins activity.
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MESH Headings
- Analgesia
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/antagonists & inhibitors
- Analgesics, Opioid/chemistry
- Analgesics, Opioid/pharmacology
- Analysis of Variance
- Animals
- Antibodies/immunology
- Dynorphins/administration & dosage
- Dynorphins/antagonists & inhibitors
- Dynorphins/chemistry
- Dynorphins/pharmacology
- Enkephalin, Leucine/administration & dosage
- Enkephalin, Leucine/antagonists & inhibitors
- Enkephalin, Leucine/chemistry
- Enkephalin, Leucine/pharmacology
- Enkephalin, Methionine/administration & dosage
- Enkephalin, Methionine/antagonists & inhibitors
- Enkephalin, Methionine/chemistry
- Enkephalin, Methionine/pharmacology
- Fluorine/chemistry
- Injections, Spinal
- Male
- Mice
- Naloxone/administration & dosage
- Naloxone/pharmacology
- Naltrexone/administration & dosage
- Naltrexone/analogs & derivatives
- Naltrexone/pharmacology
- Narcotic Antagonists/pharmacology
- Oligopeptides/administration & dosage
- Oligopeptides/antagonists & inhibitors
- Oligopeptides/chemistry
- Oligopeptides/pharmacology
- Opioid Peptides/administration & dosage
- Opioid Peptides/antagonists & inhibitors
- Opioid Peptides/chemistry
- Opioid Peptides/pharmacology
- Pain/drug therapy
- Pain/metabolism
- Pain Measurement
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, mu/antagonists & inhibitors
- Receptors, sigma/antagonists & inhibitors
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Affiliation(s)
- Yuan Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Jingjing Zhou
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Xin Liu
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Long Zhao
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Zhaojuan Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Xianghui Zhang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Kezhou Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Linqing Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China
| | - Rui Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, Department of Pharmacology, Institute of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China.
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Li J, Fu C, Liu H, Fu R, Zuo W, Kang S, Chen P, Gregor D, Paulose R, Bekker A, Ye JH. Electroacupuncture Attenuates Hyperalgesia in Rats Withdrawn from Chronic Alcohol Drinking via Habenular Mu Opioid Receptors. Alcohol Clin Exp Res 2017; 41:637-643. [PMID: 28166603 PMCID: PMC5500232 DOI: 10.1111/acer.13332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hyperalgesia or increased sensitivity to pain is often found in alcoholics during alcohol withdrawal and may contribute to relapse drinking. Alternative therapies such as acupuncture and electroacupuncture (EA), through mechanisms involving opioid receptors, may reduce pain and substance dependence and withdrawal syndromes. The lateral habenula (LHb), an epithalamic structure rich in mu opioid receptors (MORs), is a critical target for both drugs of abuse and pain. We previously observed hyperalgesia in rats withdrawn from chronic ethanol (EtOH) drinking and found that EA at the acupoint Zusanli (ST36) reduced EtOH intake. This raised question of whether EA can alleviate hyperalgesia during alcohol withdrawal and, if so, whether the mechanism involves MORs in the LHb. METHODS We trained male rats to drink EtOH using the intermittent access 20% EtOH 2-bottle free-choice drinking paradigm for 8 weeks, after which the alcohol supply was discontinued. We measured pain sensitivity using radiant heat (a light beam directed at the hind paw of rats) and compared the paw withdrawal latencies (PWLs) with and without EA at ST36. RESULTS The PWLs were significantly shorter in rats at 24, 48, and 72 hours and 7 days after the discontinuation of EtOH when compared to EtOH-naïve rats. After a single administration of 2-Hz EA for 20 minutes at ST36, the PWLs at 24 hours after the withdrawal of EtOH were significantly greater than those of the sham group (2-Hz EA at the tail). Furthermore, the effect of EA on PWLs was significantly attenuated by bilateral intrahabenula infusion of the MOR antagonist naltrexone. CONCLUSIONS These results suggest that EA can alleviate hyperalgesia during EtOH withdrawal through a mechanism involving MORs in the habenula. Based on this, EA could be of potential value as a therapy for hyperalgesia in alcohol dependence.
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Affiliation(s)
- Jing Li
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Caihong Fu
- Department of Neurology, Dong-Zhi-Men Hospital, Beijing University of Chinese Medicine, Key Laboratory for Internal Chinese Medicine of Ministry of Education, Beijing, China
| | - Hongwei Liu
- Department of Neurology, Dong-Zhi-Men Hospital, Beijing University of Chinese Medicine, Key Laboratory for Internal Chinese Medicine of Ministry of Education, Beijing, China
| | - Rao Fu
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Wanhong Zuo
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Seungwoo Kang
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Pei Chen
- Department of Neurology, Dong-Zhi-Men Hospital, Beijing University of Chinese Medicine, Key Laboratory for Internal Chinese Medicine of Ministry of Education, Beijing, China
| | - Danielle Gregor
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Rose Paulose
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Alex Bekker
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Jiang-Hong Ye
- Department of Anesthesiology, Rutgers, New Jersey Medical School, Newark, NJ, USA
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Lawson R, Ryan J, King F, Goh JW, Tichy E, Marsh K. Cost Effectiveness of Naloxegol for Opioid-Induced Constipation in the UK. Pharmacoeconomics 2017; 35:225-235. [PMID: 27663572 DOI: 10.1007/s40273-016-0454-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Opioid-induced constipation (OIC) is the most common adverse effect reported in patients receiving opioids to manage pain. Initial treatment with laxatives provides inadequate response in some patients. Naloxegol is a peripherally acting µ-opioid receptor antagonist used to treat patients with inadequate response to laxative(s) (laxative inadequate responder [LIR]). A cost-effectiveness model was constructed from the UK payer perspective to compare oral naloxegol 25 mg with placebo in non-cancer LIR patients receiving opioids for chronic pain, and a scenario analysis of naloxegol 25 mg with rescue laxatives compared with placebo with rescue laxatives in the same patient population. METHODS The model comprised a decision tree for the first 4 weeks of treatment, followed by a Markov model with a 4-week cycle length and the following states: 'OIC', 'non-OIC (on treatment)', 'non-OIC (untreated)' and 'death'. Two phase III trials with a follow-up period of 12 weeks provided data on treatment efficacy, transition probabilities, adverse event frequency and patient utility. Resource utilisation data were sourced from a UK-based burden of illness study and physician surveys. A UK National Health Service and Personal Social Service perspective was adopted; costs and health-related quality of life gains were discounted at a rate of 3.5 %. The model was run over a time horizon of 5 years, reflecting the average period of opioid use. RESULTS Naloxegol has an incremental cost-effectiveness ratio of £10,849 per quality-adjusted life-year gained versus placebo, and £11,179 when rescue laxatives are made available in both arms (2014 values). Model outcomes were only sensitive to variations in utility inputs. However, the probabilistic sensitivity analyses indicate that naloxegol has a 91 % probability of being cost effective at a £20,000 threshold when compared with placebo. CONCLUSIONS Naloxegol is likely a cost-effective treatment option for LIR patients with OIC. This assessment should be supported by further work on the utility of patients with OIC, including how utility varies with more granular measures of OIC.
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Affiliation(s)
- Richard Lawson
- AstraZeneca Global Payer and Pricing (GPEP), 101 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA
| | - James Ryan
- AstraZeneca Global Payer and Pricing (GPEP), Da Vinci Building, Melbourn Science Park, Hertfordshire, SG8 6EE, UK
| | - Frederic King
- AstraZeneca Global Payer and Pricing (GPEP), 101 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA
| | - Jo Wern Goh
- Evidera Inc., 7101 Wisconsin Ave, Suite 1400, Bethesda, MD, 20814, USA
| | - Eszter Tichy
- Evidera Inc., Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK
| | - Kevin Marsh
- Evidera Inc., Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
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Corder G, Tawfik VL, Wang D, Sypek EI, Low SA, Dickinson JR, Sotoudeh C, Clark JD, Barres BA, Bohlen CJ, Scherrer G. Loss of μ opioid receptor signaling in nociceptors, but not microglia, abrogates morphine tolerance without disrupting analgesia. Nat Med 2017; 23:164-173. [PMID: 28092666 PMCID: PMC5296291 DOI: 10.1038/nm.4262] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022]
Abstract
Opioid pain medications have detrimental side effects including analgesic tolerance and opioid-induced hyperalgesia (OIH). Tolerance and OIH counteract opioid analgesia and drive dose escalation. The cell types and receptors on which opioids act to initiate these maladaptive processes remain disputed, which has prevented the development of therapies to maximize and sustain opioid analgesic efficacy. We found that μ opioid receptors (MORs) expressed by primary afferent nociceptors initiate tolerance and OIH development. RNA sequencing and histological analysis revealed that MORs are expressed by nociceptors, but not by spinal microglia. Deletion of MORs specifically in nociceptors eliminated morphine tolerance, OIH and pronociceptive synaptic long-term potentiation without altering antinociception. Furthermore, we found that co-administration of methylnaltrexone bromide, a peripherally restricted MOR antagonist, was sufficient to abrogate morphine tolerance and OIH without diminishing antinociception in perioperative and chronic pain models. Collectively, our data support the idea that opioid agonists can be combined with peripheral MOR antagonists to limit analgesic tolerance and OIH.
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Affiliation(s)
- Gregory Corder
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
| | - Vivianne L. Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
| | - Dong Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
| | - Elizabeth I. Sypek
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford University Neuroscience Graduate Program, Stanford, CA 94305, USA
| | - Sarah A. Low
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
| | - Jasmine R. Dickinson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford University Biology Graduate Program, Stanford, CA 94305, USA
| | - Chaudy Sotoudeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
| | - J. David Clark
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Anesthesiology Service, Veteran’s Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Ben A. Barres
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
- Department of Neurobiology, Stanford University, Stanford, CA 94305, USA
| | - Christopher J. Bohlen
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
- Department of Neurobiology, Stanford University, Stanford, CA 94305, USA
| | - Grégory Scherrer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California, USA
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
- Stanford Neurosciences Institute, Stanford, CA 94305, USA
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Abstract
Itch is a global clinical problem and finding effective treatment remains a therapeutic challenge because of the complex pathophysiology of itch. The key component of treating itch should be directed at the underlying etiologies when possible. However, without eradication of the underlying diseases, treatment is often palliative at best. Treatment with systemic therapies can vary according to the etiology of the chronic itch. The aim of this article is to review the major systemic anti-itch agents and give a summary on the possible systemic treatments for different types of itch.
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Abstract
Like pain, itch is a challenging condition that needs to be managed. Within this setting, the first principle of itch management is to get an appropriate diagnosis to perform an etiology-oriented therapy. In several cases it is not possible to treat the cause, the etiology is undetermined, there are several causes, or the etiological treatment is not effective enough to alleviate itch completely. This is also why there is need for symptomatic treatment. In all patients, psychological support and associated pragmatic measures might be helpful. General principles and guidelines are required, yet patient-centered individual care remains fundamental.
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Affiliation(s)
- Laurent Misery
- Department of Dermatology, University Hospital of Brest, and Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France
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Abstract
Characterized by the clinical presentation of individual to multiple symmetrically distributed, hyperkeratotic, and intensely itchy papules and nodules, prurigo nodularis (PN) is a rare disease that emerges in patients with chronic pruritus due to continuous scratching over a long period of time. The itching and scratching of the lesions contribute to the vicious cycle that makes this disease difficult to treat, thus reducing the quality of life of affected patients. The pathogenesis of PN is ambiguous, although immunoneuronal crosstalk is implicated. Its etiology was found to be heterogenous. It can emerge as the symptom of various dermatological, neurological, psychiatric, and systemic diseases. There is currently no approved therapy for PN. However, contemporary therapies consist of calcineurin inhibitors, capsaicin, topical steroids, UV therapy, and a systemic application of antihistamines, anticonvulsants, μ-opioid receptor antagonists, and immunosuppressants. Multimodal therapy should be utilized in order to achieve optimal results, including topical and systemic symptomatic therapies.
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Abstract
Uremic itch is a frequent and sometimes very tormenting symptom in patients with advanced or end-stage renal failure, with a strong negative impact on the quality of life. According to a representative study, the point prevalence of chronic itch is 25% in hemodialysis patients but may reach more than 50% in single cohorts depending on the country and dialysis efficacy. Not much is known regarding the pathogenesis of uremic itch. Besides parathyroid hormone, histamine, tryptase, and alteration of the calcium-phosphate metabolism have been suspected. More recently, derangements in the opioid system and an inflammatory condition have been investigated as suspected players in the pathogenesis of uremic itch, but remain unproven so far. Treatment of chronic itch in dialysis patients remains difficult. Besides topical application of rehydrating or immunomodulating compounds, such as γ-linolenic acid or tacrolimus treatment with nalfurafine may be helpful. Apart from that, gabapentin and pregabalin are promising drugs to alleviate uremic itch. In many cases, UVB phototherapy is effective in reducing the intensity of itch. When treating patients, one should take into account that most of the drugs available are not licensed for the treatment of itch. Therefore, a deliberate use of therapeutic options aiming for a good risk-benefit relation should be adopted. In very severe and refractory cases, patients suitable for renal transplantation might be switched to 'high urgency' status, as successful renal transplantation cures uremic pruritus in most of the cases.
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Grechko OY, Shtareva DM, Spasov AA, Litvinov LA, Rashchenko AI. STUDYING THE PHYSICAL DEPENDENCE ON AND TOLERANCE TO THE ANTINOCICEPTIVE EFFECT OF RU-1205 SUBSTANCE. Eksp Klin Farmakol 2016; 79:8-11. [PMID: 29949697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We have studied the physical dependence on and tolerance to the analgesic activity of compound RU-1205. It is established that this compound does not cause side effects typical of morphine and butorphanol including the development of withdrawal syndrome upon naloxone provocation and tolerance to analgesic activity upon 14-day administration.
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Zhou D, Bui K, Sostek M, Al‐Huniti N. Simulation and Prediction of the Drug-Drug Interaction Potential of Naloxegol by Physiologically Based Pharmacokinetic Modeling. CPT Pharmacometrics Syst Pharmacol 2016; 5:250-7. [PMID: 27299937 PMCID: PMC4879473 DOI: 10.1002/psp4.12070] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/15/2016] [Indexed: 12/16/2022] Open
Abstract
Naloxegol, a peripherally acting μ-opioid receptor antagonist for the treatment of opioid-induced constipation, is a substrate for cytochrome P450 (CYP) 3A4/3A5 and the P-glycoprotein (P-gp) transporter. By integrating in silico, preclinical, and clinical pharmacokinetic (PK) findings, minimal and full physiologically based pharmacokinetic (PBPK) models were developed to predict the drug-drug interaction (DDI) potential for naloxegol. The models reasonably predicted the observed changes in naloxegol exposure with ketoconazole (increase of 13.1-fold predicted vs. 12.9-fold observed), diltiazem (increase of 2.8-fold predicted vs. 3.4-fold observed), rifampin (reduction of 76% predicted vs. 89% observed), and quinidine (increase of 1.2-fold predicted vs. 1.4-fold observed). The moderate CYP3A4 inducer efavirenz was predicted to reduce naloxegol exposure by ∼50%, whereas weak CYP3A inhibitors were predicted to minimally affect exposure. In summary, the PBPK models reasonably estimated interactions with various CYP3A modulators and can be used to guide dosing in clinical practice when naloxegol is coadministered with such agents.
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Affiliation(s)
- D Zhou
- AstraZeneca PharmaceuticalsWalthamMassachusettsUSA
| | - K Bui
- AstraZeneca PharmaceuticalsWalthamMassachusettsUSA
| | - M Sostek
- AstraZeneca PharmaceuticalsGaithersburgMarylandUSA
| | - N Al‐Huniti
- AstraZeneca PharmaceuticalsWalthamMassachusettsUSA
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Lechner WV, Knopik VS, McGeary JE, Spillane NS, Tidey JW, McKee SA, Metrik J, Leventhal AM, Rohsenow DJ, Kahler CW. Influence of the A118G Polymorphism of the OPRM1 Gene and Exon 3 VNTR Polymorphism of the DRD4 Gene on Cigarette Craving After Alcohol Administration. Nicotine Tob Res 2016; 18:632-6. [PMID: 26092968 PMCID: PMC5896808 DOI: 10.1093/ntr/ntv136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/10/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The current study examined whether the presence of the G allele of the A118G polymorphism of the OPRM1 gene (rs1799971) and the long allele of exon 3 VNTR polymorphism of the DRD4 gene moderate the effect of alcohol administration on urge to smoke. These polymorphisms have been associated with greater alcohol induced-urge to drink. Urge to drink and alcohol consumption increase urge to smoke. Therefore, these polymorphisms may also sensitize urge to smoke after alcohol consumption. METHODS Individuals smoking 10-30 cigarettes per day and reporting heavy drinking were recruited from the community. Caucasians (n = 62), 57.3% male, mean age 39.2, took part in a three-session, within-subjects, repeated-measures design study. Participants were administered a placebo, 0.4 g/kg, or 0.8 g/kg dose of alcohol. A118G genotype, exon 3 VNTR genotype, and urge to smoke (baseline and three times after receiving alcohol) were assessed. RESULTS G allele carriers showed greater urge to smoke across all assessments. Additionally, a significant interaction indicated that G carriers, compared to homozygotes (AA), evinced a significantly greater increase in urge to smoke after high dose alcohol relative to placebo. The interaction between condition, DRD4 polymorphism, and time was not significant. CONCLUSIONS Presence of G allele of the A118G polymorphism of the OPRM1 gene may lead to greater increases in urge to smoke after a high dose of alcohol. Pharmacotherapies targeted to opiate receptors (eg, naltrexone) may be especially helpful in aiding smoking cessation among G carriers who are heavy drinkers.
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Affiliation(s)
- William V Lechner
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI;
| | - Valerie S Knopik
- Division of Behavioral Genetics, Rhode Island Hospital, Providence, RI; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - John E McGeary
- Division of Behavioral Genetics, Rhode Island Hospital, Providence, RI; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Nichea S Spillane
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | | | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI; Providence Veterans Affairs Medical Center, Providence, RI
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Damaris J Rohsenow
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI; Providence Veterans Affairs Medical Center, Providence, RI
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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