Immunomodulation mediated by microinjection of morphine into the periaqueductal gray matter of the mesencephalon

Immunomodulatory properties of morphine and the hypothesised role of long-term opioid use in the immunopathogenesis of tuberculosis

Epidemiological studies have shown high tuberculosis (TB) prevalence among chronic opioid users. Opioid receptors are found on multiple immune cells and immunomodulatory properties of opioids could be a contributory factor for ensuing immunosuppression and development or reactivation of TB. Toll-like receptors (TLR) mediate an immune response against microbial pathogens, including Mycobacterium tuberculosis. Mycobacterial antigens and opioids co-stimulate TLRs 2/4/9 in immune cells, with resulting receptor cross-talk via multiple cytosolic secondary messengers, leading to significant immunomodulatory downstream effects. Blockade of specific immune pathways involved in the host defence against TB by morphine may play a critical role in causing tuberculosis among chronic morphine users despite multiple confounding factors such as socioeconomic deprivation, Human immunodeficiency virus co-infection and malnutrition. In this review, we map out immune pathways involved when immune cells are co-stimulated with mycobacterial antigens and morphine to explore a potential immunopathological basis for TB amongst long-term opioid users.

Role of hypothalamic-pituitary axis in morphine-induced alteration in thymic cell distribution using mu-opioid receptor knockout mice

Mu-opioid receptor knockout mice (MORKO), were used to address two questions: (1) if morphine induced decrease in thymic weight and cell distribution is mediated by the mu-opioid receptor and (2) the role of corticosteroids in morphine mediated alteration in thymic cell distribution. Our result show that morphine mediated increase in plasma corticosterone is mediated by the mu-opioid receptor since morphine at doses as high as 25 mg/kg-body weight does not increase plasma corticosterone levels in the MORKO. In addition, we have also shown that morphine treatment results in the differentiation of CD4+CD8+ (double positive cells) to single positive CD4+ cells while dexamethasone treatment results in the deletion of CD4+CD8+ (double positive) cells.

Suppression of splenic macrophage functions following acute morphine action in the rat mesencephalon periaqueductal gray

Morphine action in the periaqueductal gray (PAG) matter of the mesencephalon suppresses T cell proliferation and NK cell activity through actions at mu opioid receptors. We investigated the effect of acute microinjection of morphine in the rat PAG on macrophage function. We found that morphine injection in the PAG significantly (p <.01) suppressed nitric oxide production by untreated (82 +/- 23% suppression), IFN-gamma-primed (57 +/- 11% suppression), and LPS-activated (50 +/- 7% suppression) splenic macrophages and did not alter macrophage viability. In contrast, IFN-gamma- and LPS-activated macrophages from PAG-injected saline rats generated an increased output of nitric oxide, which was associated with significant (p <.01) reduction in cell viability. Morphine significantly (p <.01) inhibited TNF-alpha production by LPS-activated macrophages (28 +/- 8% inhibition compared with PAG-injected saline rats). In addition, morphine significantly (p <. 05) inhibited phagocytosis of Candida albicans by resident macrophages (40 +/- 20% inhibition compared with that of macrophages from PAG-injected saline rats). Responses of resident or activated macrophages from PAG-injected saline and untreated control groups did not differ significantly. The results of this ex vivo study suggest that suppressive effects of morphine on macrophage functions may contribute to increased susceptibility to infectious diseases and cancer associated with drug abuse.

Inhibition of interleukin-2 production and downregulation of IL-2 and transferrin receptors on rat splenic lymphocytes following PAG morphine administration: a role in natural killer and T cell suppression

We investigated the effects of acute injection of morphine into the rat mesencephalon periaqueductal gray (PAG), on splenic natural killer (NK) cell and lymphocyte functions, interleukin-2 (IL-2) production, expression of T cell (CD3), T helper cell (CD4), T suppressor cell (CD8), and NK cell (NKR-P1) surface markers, and expression of IL-2 (CD25) and transferrin (CD71) receptors. Bilateral microinjection of 10 nmol of morphine in the PAG significantly (p < 0.001) inhibited IL-2 (31%) production by activated splenic lymphocytes compared with that of PAG saline-injected control rats. In addition, morphine significantly (p < 0.01) suppressed splenic NK cell activity (14-33%) and T lymphocyte proliferative responses (25-48%) to various mitogens compared with controls. Furthermore, morphine did not alter the expression of CD3, CD4, CD8, and NKR-P1 surface markers, but significantly (p < 0.001) downregulated the expression of CD25 and CD71 receptors following in vitro activation. These results suggested that injection of morphine in the PAG suppresses NK and T cell functions by reducing the ability of T cells to produce IL-2 and downregulating the expression of CD25 and CD71 surface activation markers.