Mesenchymal stem cell as salvage treatment for refractory chronic GVHD

Refractory chronic GVHD (cGVHD) is an important complication after allogeneic hematopoietic SCT and is prognostic of poor outcome. MSCs are involved in tissue repair and modulating immune responses in vitro and in vivo. From April 2005 to October 2008, 19 patients with refractory cGVHD were treated with MSCs derived from the BM of volunteers. The median dose of MSCs was 0.6 × 10(6) cells per kg body weight. Fourteen of 19 patients (73.7%) responded well to MSCs, achieving a CR (n=4) or a PR (n=10). The immunosuppressive agent could be tapered to less than 50% of the starting dose in 5 of 14 surviving patients, and five patients could discontinue immunosuppressive agents. The median duration between MSC administration and immunosuppressive therapy discontinuation was 324 days (range, 200-550 days). No patients experienced adverse events during or immediately after MSC infusion. The 2-year survival rate was 77.7% in this study. Clinical improvement was accompanied by the increasing ratio of CD5+CD19+/CD5-CD19+ B cells and CD8+CD28-/CD8+CD28+ T cells. In conclusion, transfusion of MSCs expanded in vitro, irrespective of the donor, might be a safe and effective salvage therapy for patients with steroid-resistant, cGVHD.

Tumor-derived mesenchymal stem cells enhance tumor development via nitric oxide (100.33)

Mesenchymal stem cells (MSCs) have been widely applied in treating immune disorders due to their immunosuppressive capacity. However, a major concern for the clinical application of MSCs is their risk to promote tumorigenesis. In the meantime, there are increasing reports about the identification of MSCs from various tumor tissues. In this study, we compared the tumor-derived MSCs with bone marrow-derived MSCs (BM-MSCs) in vitro and in vivo. We found that only tumor-derived MSCs, but not BM-MSCs enhance tumor development. In vitro, tumor-derived MSCs had a similar capacity to suppress T cell receptor-induced T cell proliferation via nitric oxide (NO), but exhibited a more vigorous inhibition on the differentiation and maturation of dendritic cells, compared to BM-MSCs. Moreover, co-culture with tumor-derived MSCs led bone marrow cells to differentiate into more CD11b+Gr-1+ myeloid-derived suppressor cells (MDSCs), another NO-producing immunosuppressive cell population. In vivo, more MDSCs were also detected after administration of tumor-derived MSCs, but not BM-MSCs in tumor-bearing mice. Furthermore, tumor-derived MSCs, but not BM-MSCs significantly enhanced tumor growth, which was partially dependent on NO. Therefore, NO-dependent tumor promoting effect is likely not mediated by MSCs themselves, but through the indirect action of MDSCs. Our findings indicate a novel role of MSCs in tumor progression and provide new information for the clinical application of MSCs.

Inflammatory cytokine-induced intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in mesenchymal stem cells are critical for immunosuppression

Cell-cell adhesion mediated by ICAM-1 and VCAM-1 is critical for T cell activation and leukocyte recruitment to the inflammation site and, therefore, plays an important role in evoking effective immune responses. However, we found that ICAM-1 and VCAM-1 were critical for mesenchymal stem cell (MSC)-mediated immunosuppression. When MSCs were cocultured with T cells in the presence of T cell Ag receptor activation, they significantly upregulated the adhesive capability of T cells due to the increased expression of ICAM-1 and VCAM-1. By comparing the immunosuppressive effect of MSCs toward various subtypes of T cells and the expression of these adhesion molecules, we found that the greater expression of ICAM-1 and VCAM-1 by MSCs, the greater the immunosuppressive capacity that they exhibited. Furthermore, ICAM-1 and VCAM-1 were found to be inducible by the concomitant presence of IFN-gamma and inflammatory cytokines (TNF-alpha or IL-1). Finally, MSC-mediated immunosuppression was significantly reversed in vitro and in vivo when the adhesion molecules were genetically deleted or functionally blocked, which corroborated the importance of cell-cell contact in immunosuppression by MSCs. Taken together, these findings reveal a novel function of adhesion molecules in immunoregulation by MSCs and provide new insights for the clinical studies of antiadhesion therapies in various immune disorders.

Phosphoinositide 3-kinase mediates CD40 ligand-induced oxidative stress and endothelial dysfunction via Rac1 and NADPH oxidase 2

OBJECTIVES

CD40 ligand (CD40L) has been implicated as an inducer of reactive oxygen species (ROS) generation in endothelial cells, but definitive evidence for this and the in vivo relevance haves not been demonstrated fully. We thus investigated whether phosphoinositide 3-kinase (PI3K) was linked to ROS generation and endothelial reactivity in response to CD40L.

METHODS AND RESULTS

CD40L treatment activated PI3K activity by regulating the association between PI3K p85 and the CD40 receptor. CD40L exposure also stimulated the GTPase Rac1, which is known to activate NADPH oxidases, and enhanced ROS formation, whereas PI3K inhibition or depletion by small interfering RNA (siRNA) prevented these responses. Subsequently, PI3K overexpression activated Rac1 and increased ROS generation. These responses were not observed in the presence of inactive Rac1 or siRNA against the NADPH oxidase subunit NOX2. Protein kinase Czeta mediates PI3K-regulated NADPH oxidase activation by promoting cellular p47phox translocation. Importantly, PI3K inhibition prevented CD40L-mediated ROS generation and endothelial dysfunction in a mouse model. In summary, PI3K mediates CD40L-induced ROS production and subsequent endothelial dysfunction.

CONCLUSIONS

Targeting PI3K may provide a new therapeutic approach in diseases associated with oxidative stress and endothelial dysfunction.

Influence of humic substances on the migration of237Np,238Pu and241Am in a weak loess aquifer

The influence of humic substances on the migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer was investigated in situ with bisectional experimental columns. The experimental columns were constructed by connecting two undisturbed aquifer medium columns together, and inserted into the aquifer horizontally through holes pre-prepared in the wall of a vertical Experimental Shaft in an Underground Research Facility at the CIRP´s field test site. Quartz containing radionuclides3H,237Np,238Pu and241Am was introduced as point source and plane source at the central parts of the experimental columns, respectively. Outflow water of the experimental columns were collected and3H in the outflows were analyzed for calculating the water flow velocity in the experimental columns. When the experiment was completed, the experimental columns were dismounted and cut into slices and the activities of237Np,238Pu and241Am in the sliced samples were determined.

The water flow velocity in the point source experimental column and in the plane source experimental column was calculated as 1.15±0.05 cm/d and 1.06±0.05 cm/d, respectively. The concentration distribution of237Np,238Pu and241Am in the experimental columns indicate that, adjacent to the source, the concentration of each radionuclide is very large and decreases abruptly as the distance increases. In addition, some other high concentration regions/points were observed. This phenomenon may suggest that multiple species of these radionuclides with different mobility may exist in the in-situ aquifer condition. The calculated apparent distribution coefficients (Kd, ml/g) of the main specie of these radionuclides with and without additional humic substances are 8.90×101and 8.90×102for237Np, 1.93×102and 9.48×102for238Pu, 7.60×102and 9.79×102for241Am, respectively. These data suggest that the introduction of additional humic substances into the aquifer may enhance the mobility of237Np and238Pu, while it has no obvious influence on the migration of241Am.

The migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer: A field column experiment

The migration of radionuclides237Np,238Pu and241Am in a weak loess aquifer were investigated in-situ with a bisectional experimental column. The experimental column was constructed by connecting 2 undisturbed aquifer medium columns together and inserted into the aquifer horizontally through holes pre-prepared in the wall of a vertical experimental shaft in an Underground Research Facility at the CIRP´s field test site. Quartz containing radionuclides3H,237Np,238Pu and241Am was introduced as a point source at the center of the experimental column. Outflow water of the experimental column was collected and3H in the outflow was determined for calculating the water flow velocity through the experimental column. The experimental column was cut into slices of 0.3 cm long and the radioactivity of237Np,238Pu and241Am in the sliced soil samples was analyzed when the experiment was completed.

The water flow velocity in the experimental column was calculated as 1.15±0.05 cm/d. The activity distribution of237Np,238Pu and241Am in the experimental column indicate that each radionuclide has a very strong activity distribution region adjacent to the source introduction point and decreases abruptly as the distance increases. In addition there are other secondary activity distribution regions with different strength and widths. The calculated apparent distribution coefficients of the main specie of these radionuclides is (8.90±1.51)×102ml/g for237Np, (9.48±1.61)×102ml/g for238Pu and (9.79±1.66)×102ml/g for241Am.

Species variation in the mechanisms of mesenchymal stem cell-mediated immunosuppression

Bone marrow-derived mesenchymal stem cells (MSCs) hold great promise for treating immune disorders because of their immunoregulatory capacity, but the mechanism remains controversial. As we show here, the mechanism of MSC-mediated immunosuppression varies among different species. Immunosuppression by human- or monkey-derived MSCs is mediated by indoleamine 2,3-dioxygenase (IDO), whereas mouse MSCs utilize nitric oxide, under the same culture conditions. When the expression of IDO and inducible nitric oxide synthase (iNOS) were examined in human and mouse MSCs after stimulation with their respective inflammatory cytokines, we found that human MSCs expressed extremely high levels of IDO, and very low levels of iNOS, whereas mouse MSCs expressed abundant iNOS and very little IDO. Immunosuppression by human MSCs was not intrinsic, but was induced by inflammatory cytokines and was chemokine-dependent, as it is in mouse. These findings provide critical information about the immunosuppression of MSCs and for better application of MSCs in treating immune disorders.

Species Variation in the Mechanisms of Mesenchymal Stem Cell-Mediated Immunosuppression (141.45)

Bone marrow derived mesenchymal stem cells (MSCs) hold great promise for treating immune disorders, although the immunoregulatory mechanisms remain largely controversial. Here we show that the mechanisms of MSC-mediated immunosuppression vary in different species. Under the same culture conditions, immunosuppression by MSCs derived from human or monkey was mediated by indoleamine 2, 3 dioxygenase (IDO), while immunosuppression by mouse MSCs depended on nitric oxide (NO). When the expression levels of inducible nitric oxide synthase (iNOS) and IDO were examined in mouse and human MSCs stimulated with their respective inflammatory cytokines, we found that human MSCs expressed high levels of IDO, but very low levels of iNOS, while mouse MSCs expressed high levels of iNOS and very little IDO. Except the executor molecules, moreover, the human and mouse MSCs shared some similarities. Like in mouse MSCs, immunosuppression by human MSCs was not intrinsic, but inducible by inflammatory cytokines. Additionally, IDO-mediated immunosuppression by human MSCs is also chemokine-dependent. These findings help to explain the apparently conflicting reports in the literatures and provide critical information to allow better application of human MSCs in treating immune disorders.

Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse

Changes in brain function during the initial weeks of abstinence from chronic methamphetamine abuse may substantially affect clinical outcome, but are not well understood. We used positron emission tomography with [F-18]fluorodeoxyglucose (FDG) to quantify regional cerebral glucose metabolism, an index of brain function, during performance of a vigilance task. A total of 10 methamphetamine-dependent subjects were tested after 5-9 days of abstinence, and after 4 additional weeks of supervised abstinence. A total of 12 healthy control subjects were tested at corresponding times. Global glucose metabolism increased between tests (P=0.01), more in methamphetamine-dependent (10.9%, P=0.02) than control subjects (1.9%, NS). Glucose metabolism did not change in subcortical regions of methamphetamine-dependent subjects, but increased in neocortex, with maximal increase (>20%) in parietal regions. Changes in reaction time and self-reports of negative affect varied more in methamphetamine-dependent than in control subjects, and correlated both with the increase in parietal glucose metabolism, and decrease in relative activity (after scaling to the global mean) in some regions. A robust relationship between change in self-reports of depressive symptoms and relative activity in the ventral striatum may have great relevance to treatment success because of the role of this region in drug abuse-related behaviors. Shifts in cortical-subcortical metabolic balance either reflect new processes that occur during early abstinence, or the unmasking of effects of chronic methamphetamine abuse that are obscured by suppression of cortical glucose metabolism that continues for at least 5-9 days after cessation of methamphetamine self-administration.

Adenovirus E1A reverses the resistance of normal primary human lung fibroblast cells to TRAIL through DR5 upregulation and caspase 8-dependent pathway

Expression of the adenovirus serotype 5 (Ad5) E1A enhances tumor cells to apoptosis by TNF-alpha, Fas-ligand and TNF-related apoptosis-inducing ligand (TRAIL). In this study, we found that E1A expression reversed the resistance of normal primary human lung fibroblast cells (P-HLF) to TRAIL-induced apoptosis. Furthermore, TRAIL dramatically induced apoptosis of P-HLF cells that expressed E1A following either infection with Ad-E1A or transfection with pcDNA3-E1A. Further results demonstrated that E1A specifically upregulated DR5 levels but had nearly no effect on the levels of DR4. E1A dramatically upregulated the exogenous TRAIL, and then increased a substantial amount of TRAIL on the surface of P-HLF cells treated with the expression vectors, both Ad-TRAIL and pIRES-EGFP-TRAIL. The dominant negative FADD mutation (FADD-DN) results revealed that the apoptosis in Ad-E1A and Ad-TRAIL coinfected P-HLF cells was completely blocked following inhibition of the death receptors-associated apoptosis-inducing molecules FADD. Moreover, the caspase 8 inhibitor (Z-IETD-FMK) could efficiently block caspase 8 activation and resulted in inhibition of caspase 3 activation and cleavage. However, The caspase 9 specific inhibitor (Z-LEHD-FMK) could not counteract the synergistic effect of TRAIL-induced apoptosis in combination with E1A, and caspase 3 activation and cleavage were not inhibited by Z-LEHD-FMK. Thus, our results suggest that adenovirus E1A sensitizes P-HLF cells to TRAIL-induced apoptosis involving DR5 upregulation and the caspase 8-dependent pathway. These findings provide the first direct evidence for molecular mechanisms of adenovirus E1A gene products to sensitize normal cells to TRAIL-mediated apoptosis.

Enhanced TRAIL sensitivity by E1A expression in human cancer and normal cell lines: inhibition by adenovirus E1B19K and E3 proteins

TNF-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily of cytokines that induces apoptosis in a variety of cancer cells, but not in normal cells. However, more and more tumor cells remain resistant to TRAIL, which limited its application for cancer therapy. Expression of the adenovirus serotype 5 (Ad5) E1A sensitizes tumor cells to apoptosis by TNF-alpha, Fas-ligand, and TRAIL. Here we asked whether E1A overcomes this resistance and enhances TRAIL-induced apoptosis in the tumor cells. Our results revealed that the tumor cell lines, HeLa and HepG2, with infection by Ad-E1A, were highly sensitive to TRAIL-induced apoptosis. Importantly, we found that in normal primary human lung fibroblast cells (HLF) TRAIL is capable of inducing apoptosis in combination with E1A as efficiently as in some tumor cell lines. The adenovirus type 5 encoding proteins, E1B19K and E3 gene products, have been shown to inhibit E1A and TRAIL-induced apoptosis of HLF cells by using the recombinant adenovirus AdDeltaE1B55K, with mutation of E1B55K, containing E1B19K and complete E3 region. Further results demonstrated that the expression of DR5 and TRAIL was down-regulated in the AdDeltaE1B55K co-infected HLF cells. These findings suggest that TRAIL may play an important role in limiting virus infections and the ability of adenovirus to inhibit killing may prolong acute and persistent infections. The results from this study have also suggested the possibility that the combination of E1A with TRAIL could be used in the treatment of human malignancy, or in the selection of the optimal adenovirus mutant as effective delivering vector for cancer therapy.

LAAM maintenance vs methadone maintenance for heroin dependence

BACKGROUND

LAAM and methadone are both full mu opiate agonists and have been shown to reduce dependence on heroin when given continuously under supervised dosing conditions. LAAM has a long duration of action requiring dosing every two or three days compared to methadone which requires daily dosing. LAAM is not as widely available internationally as methadone, and may be withdrawn from the market following ten cases of life-threatening cardiac arrhythmias and an association with QT prolongation.

OBJECTIVES

To compare the efficacy and acceptability of LAAM maintenance with methadone maintenance in the treatment of heroin dependence.

SEARCH STRATEGY

We searched MEDLINE (January 1966 to August 2000), PsycINFO (1887 to August 2000), EMBASE (January 1985 to August 2000), and the Cochrane Controlled Trials Register (Issue 2 2000). In addition we hand searched NIDA monographs until August 2000 and searched reference lists of articles.

SELECTION CRITERIA

All randomised controlled trials, controlled clinical trials and controlled prospective studies comparing LAAM and methadone maintenance for the treatment of heroin dependence and measuring outcomes of efficacy or acceptability were included.

DATA COLLECTION AND ANALYSIS

Data on retention in treatment, heroin use, side-effects and mortality were collected by two reviewers independently. A meta-analysis was performed using RevMan. Discrepancies were resolved by consensus.

MAIN RESULTS

Eighteen studies, (15 RCTs, 3 Controlled prospective studies) met the inclusion criteria for the review. Three were excluded from the meta-analysis due to lack of data on retention, heroin use or mortality. Cessation of allocated medication (11 studies, 1473 participants) was greater with LAAM than with methadone, (RR 1.36, 95%CI 1.07-1.73, p=0.001, NNT=7.7 (or 8)). Non-abstinence was less with LAAM (5 studies, 983 participants; RR 0.81, 95%CI 0.72-0.91, p=0.0003, NNT=9.1 (or 10)). In 10 studies (1441 participants) there were 6 deaths from a range of causes, 5 in participants assigned to LAAM (RR 2.28 (95%CI 0.59-8.9, p=0.2). other relevant outcomes, such as quality of life and criminal activity could not be analysed because of lack of information in the primary studies.

REVIEWER'S CONCLUSIONS

LAAM appears more effective than methadone at reducing heroin use. More LAAM patients than methadone ceased their allocated medication during the studies, but many transferred to methadone and so the significance of this is unclear. There was no difference in safety observed, although there was not enough evidence to comment on uncommon adverse events.

Risperidone pre-treatment reduces the euphoric effects of experimentally administered cocaine

Pre-clinical research implicates dopaminergic neurotransmission as critical in producing the effects of stimulants. Previous stimulant challenge studies using volunteers treated with dopaminergic antagonists have generally failed to demonstrate reduction of subjective effects. We performed this study to determine whether repeated dosing with risperidone reduced the subjective effects of experimentally administered cocaine. Nine non-treatment seeking hospitalized cocaine-dependent volunteers received 40 mg cocaine IV before and following 5 days of treatment with risperidone, 2 mg per day. Risperidone pre-treatment reduced the self-rated 'high' produced by cocaine. Repeated, rather than single, dosing with a D2 antagonist may be necessary to reduce the subjective effects produced by cocaine. The degree of D2 receptor blockade produced by risperidone appears to be greater than the reduction in euphoric effects produced by cocaine, suggesting that mechanisms other than those involving D2 receptors may be important in drug-induced euphoria.

Pain intolerance in opioid-maintained former opiate addicts: effect of long-acting maintenance agent

Patients on methadone maintenance therapy are relatively intolerant of pain, a finding hypothesized to reflect a hyperalgesic state induced by chronic opioid administration. To explore if the intrinsic activity of the opioid maintenance agent might affect expression of hyperalgesia in this population, withdrawal latency for cold-pressor (CP) pain was compared between small groups of methadone-maintained (n = 18), buprenorphine-maintained (n = 18), and matched control (n = 18) subjects. The opioid-maintained groups had equal and significantly shorter withdrawal latencies than controls, however it is possible that high rates of continued illicit opioid use precluded finding differences between methadone and buprenorphine groups. Differential effects of maintenance agent were found for the few subjects without illicit opioid use, such that withdrawal latencies for methadone-maintained (n = 5) were less than for buprenorphine-maintained (n = 7) which were less than controls (n = 18). Diminished pain tolerance in patients receiving opioid maintenance treatment has significant clinical implications. More research is needed to determine if buprenorphine offers advantages over methadone in this regard.

Cochrane Drugs and Alcohol Group: the development of systematic reviews of treatment outcome

- The aim of the Cochrane Collaboration is to promote review processes which address all aspects of health care and which can be viewed by clinicians to guide their day-to-day clinical practice. Recently, a Cochrane review group on drugs and alcohol has been developed. The Cochrane Review Group Editorial base is in Rome, Italy. There is an international editorial board with editors in the UK, Italy, France, Australia and the USA. So far, the group has published five reviews addressing treatment for opioid, cocaine and alcohol dependence. Additional reviews and protocols are in progress. A growing number of titles are registered with the group. Interested readers and potential reviewers and/or referees can contact the Cochrane Drugs and Alcohol Group Coordinator in Rome at the e-mail address: dacochrane@asplazio.it

Cognitive impairment in individuals currently using methamphetamine

Although there are increasing reports of methamphetamine use, studies examining the cognitive consequences of methamphetamine have not been performed on a population currently using the drug. To characterize this population, 65 people currently using MA regularly and 65 non-users were given a battery of cognitive tests. The battery included recall, recognition, Digit Symbol, Trail Making A & B, Stroop, Wisconsin Card Sort, backward digit span, and the FAS test of verbal fluency. The methamphetamine users were significantly more impaired on recall tasks, digit symbol, Stroop color words, and Trail Making B, but scores fell within the normal ranges on the other measures.

Interferon-gamma inhibits in situ expression of PDGF-beta mRNA by smooth muscle cells in injured rabbit arteries after transluminal balloon angioplasty

OBJECTIVE

To elucidate the mechanism of interferon-gamma (IFN-gamma) to inhibit the restenosis after successful percutaneous transluminal angioplasty (PTA).

METHODS

A rabbit vascular restenotic model was constructed and the proliferation of intimal smooth muscle cells (SMCs) were observed by monitoring their expression of proliferating cell nuclear antigen (PCNA) and platelet-derived growth factor beta chain mRNA (PDGF-beta mRNA) at the indicated time points.

RESULTS

IFN-gamma could significantly inhibit the expression of PCNA by intimal SMCs one week after denudation, when counting 200 intimal cells for PCNA-positive reactions with an inhibitory rate of 88.50% (P < 0.001). IFN-gamma could downregulate in situ expression of PDGF-beta mRNA by these cells as we calculated the average number of PDGF-beta mRNA positive cells per square millimetre area at x 400 magnification with reduced rates of 86.85% in 1 week group (P < 0.001), of 93.66% in 2 week group (P < 0.001) and of 52.92% in 4 week group (0.02 < P < 0.05), respectively.

CONCLUSIONS

The local production of PDGF-beta by vascular intimal SMCs via an autocrine mechanism may be responsible for continuous proliferation of these cells and the formation of neointima after injury. This could be inhibited by IFN-gamma through downregulating the expression of PDGF-beta mRNA. These results provide an in vivo basis for IFN-gamma to be used clinically for the management of restenosis after percutaneous transluminal angioplasty.

Hyperalgesic responses in methadone maintenance patients

Opioid substitution treatment for dependence may alter sensitivity to pain. Previous studies on pain sensitivity in methadone maintenance patients have yielded contradictory results. This study compared nociceptive responses between 16 patients on stable, once daily, doses of methadone and 16 matched control subjects. Two types of nociceptive stimuli were used: (1) electrical stimulation; and (2) a cold pressor test. Two parameters were measured: detection for onset of pain, and pain tolerance. Methadone patients were tested over an inter-dosing period: at the time of trough plasma methadone concentration (0 h), and 3 h after their daily dose. Control subjects were tested twice 3 h apart. Blood samples were collected to determine plasma methadone concentration. In methadone patients, trough to peak increases in mean R-(-)- and S-(+)-methadone concentrations (118 and 138 ng/ml to 185 and 259 ng/ml, respectively) resulted in significant increases in pain detection and tolerance values for both nociceptive stimuli. Using electrical stimulation, methadone patients' pain tolerance values were lower than controls at 0 h, but higher than controls at 3 h; no significant differences in pain detection values were found. For the cold pressor test, methadone patients detected pain significantly earlier than controls at 0 h, and were also substantially less pain tolerant than controls at both 0 and 3 h. There were no significant differences in pain detection values between the two groups at 3 h. Pain tolerance to pain detection ratios for methadone patients were significantly lower than controls for the cold pressor test at 0 and 3 h, and for electrical stimulation at 0 h only. In summary, the relative pain sensitivity of methadone maintenance patients is determined by the nature of the nociceptive stimulus (e.g. cold pressor test versus electrical stimulation), the plasma methadone concentration (trough versus peak plasma concentration), and whether thresholds are determined for detection of pain or pain tolerance. Although responding to changes in plasma methadone concentration, maintenance patients are markedly hyperalgesic to pain induced by the cold pressor test.