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Yi S, Cao H, Zheng W, Wang Y, Li P, Wang S, Zhou Z. Targeting the opioid remifentanil: Protective effects and molecular mechanisms against organ ischemia-reperfusion injury. Biomed Pharmacother 2023; 167:115472. [PMID: 37716122 DOI: 10.1016/j.biopha.2023.115472] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023] Open
Abstract
Opioids are widely used in clinical practice by activating opioid receptors (OPRs), but their clinical application is limited by a series of side effects. Researchers have been making tremendous efforts to promote the development and application of opioids. Fortunately, recent studies have identified the additional effects of opioids in addition to anesthesia and analgesia, particularly in terms of organ protection against ischemia-reperfusion (I/R) injury, with unique advantages. I/R injury in vital organs not only leads to cell dysfunction and structural damage but also induces acute and chronic organ failure, even death. Early prevention and appropriate therapeutic targets for I/R injury are crucial for organ protection. Opioids have shown cardioprotective effects for over 20 years, especially remifentanil, a derivative of fentanyl, which is a new ultra-short-acting opioid analgesic widely used in clinical anesthesia induction and maintenance. In this review, we provide current knowledge about the physiological effects related to OPR-mediated organ protection, focusing on the protective effect and mechanism of remifentanil on I/R injury in the heart and other vital organs. Herein, we also explored the potential application of remifentanil in clinical I/R injury. These findings provide a theoretical basis for the use of remifentanil to inhibit or alleviate organ I/R injury during the perioperative period and provide insights for opioid-induced human organ protection and drug development.
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Affiliation(s)
- Shuyuan Yi
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266021, China; Department of Anaesthesiology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China; School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Hong Cao
- Department of Anaesthesiology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China
| | - Weilei Zheng
- Department of Anaesthesiology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China
| | - Yin Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266021, China
| | - Peifeng Li
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266021, China.
| | - Shoushi Wang
- Department of Anaesthesiology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China.
| | - Zhixia Zhou
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266021, China.
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Kan T, Yoshikawa M, Watanabe M, Miura M, Ito K, Matsuda M, Iwao K, Kobayashi H, Suzuki T, Suzuki T. Sialorphin Potentiates Effects of [Met 5]Enkephalin without Toxicity by Action other than Peptidase Inhibition. J Pharmacol Exp Ther 2020; 375:104-114. [PMID: 32759368 DOI: 10.1124/jpet.120.266080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
This dose-response study investigated the effects of sialorphin on [Met5]enkephalin (ME)-induced inhibition of contractions in mouse vas deferens and antinociception in male rats. Differences were compared among combinations of three chemical peptidase inhibitors: amastatin, captopril, and phosphoramidon. The ratio of potencies of ME in mouse vas deferens pretreated with both sialorphin (100 µM) and a mixture of the three peptidase inhibitors (1 µM each) was higher than that with the mixture of peptidase inhibitors alone at any dose. Intrathecal administration of sialorphin (100-400 nmol) significantly and dose dependently increased ME (3 nmol)-induced antinociception with the mixture of three peptidase inhibitors (10 nmol each). The degree of antinociception with a combination of any two of the peptidase inhibitors (10 nmol each) in the absence of sialorphin was less than that in the presence of sialorphin (200 nmol). Pretreatment with both sialorphin (200 nmol) and the mixture of three peptidase inhibitors (10 nmol each) produced an approximately 100-fold augmentation in ME (10 nmol)-induced antinociception, but without signs of toxicity such as motor dysfunction in rats. Radioligand receptor binding assay revealed that sialorphin did not affect either binding affinity or maximal binding capacity of [d-Ala2,N-MePhe4,Gly-ol5]enkephalin. These results indicate that sialorphin potentiates the effects of ME without toxicity by a mechanism other than peptidase inhibition and with no effect on its affinity to µ-opioid receptors. SIGNIFICANCE STATEMENT: Sialorphin is regarded as an endogenous peptidase inhibitor that interacts with enkephalin-degrading enzymes. The results of these in vitro and in vivo studies confirm that sialorphin potentiates the effects of [Met5]enkephalin without toxicity by an action other than peptidase inhibition. This suggests that sialorphin offers the advantage of reducing or negating the side effects of opioid drugs and endogenous opioid peptides.
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Affiliation(s)
- Takugi Kan
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Masanobu Yoshikawa
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Mariko Watanabe
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Masaaki Miura
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Kenji Ito
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Mitsumasa Matsuda
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Kayoko Iwao
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Kobayashi
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Suzuki
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
| | - Toshiyasu Suzuki
- Departments of Anesthesiology (T.K., M.W., M.Mi., K.I., M.Ma., Ta.S., To.S.) and Clinical Pharmacology (M.Y., H.K.) and Education and Research Support Center (K.I.), Tokai University School of Medicine, Kanagawa, Japan
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Utada K, Ishida K, Tohyama S, Urushima Y, Mizukami Y, Yamashita A, Uchida M, Matsumoto M. The combination of insulin-like growth factor 1 and erythropoietin protects against ischemic spinal cord injury in rabbits. J Anesth 2015; 29:741-8. [PMID: 26003536 DOI: 10.1007/s00540-015-2031-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Insulin-like growth factor 1 (IGF-1) and erythropoietin (EPO) have been reported to independently protect against ischemic spinal cord injury in rabbits. In the present study, we investigated whether the combination of IGF-1 and EPO protects against ischemic spinal cord injury in rabbits. METHODS Animals were assigned to 1 of 4 groups (n = 6 in each): a control group (saline), an IGF-1 group (IGF-1 0.3 mg/kg), an EPO group (EPO 800 U/kg), or an IGF-1 + EPO group (IGF-1 0.3 mg/kg + EPO 800 U/kg). Spinal cord ischemia was produced by occluding the abdominal aorta for 15 min. Saline, IGF-1, and EPO were administered intravenously just after the start of reperfusion. Hindlimb motor function was assessed daily for 7 days, after which histopathological evaluation was performed. To analyze phosphorylation of signal transduction molecules, animals were assigned to 1 of the 4 groups (n = 8 in each). Spinal cord ischemia and the treatment were the same as those described above. The spinal cords were removed at 15 or 30 min after reperfusion and used to analyze phosphorylation of signal transduction molecules. Four animals served as the preischemic control, and the spinal cord was removed just before the start of ischemia. RESULTS In the IGF-1 + EPO group, both neurological and histopathological outcomes were significantly improved as compared to the control group, which was consistent with the increase of Janus kinase-2 (JAK2) phosphorylation. CONCLUSIONS The combination of IGF-1 and EPO protects against ischemic spinal cord injury in rabbits. JAK2 might contribute to the protective effect.
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Affiliation(s)
- Kohji Utada
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Kazuyoshi Ishida
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Suguru Tohyama
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yutaka Urushima
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yoichi Mizukami
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Atsuo Yamashita
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Masato Uchida
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Mishiya Matsumoto
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
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Sedation and analgesia in intensive care: a comparison of fentanyl and remifentanil. PAIN RESEARCH AND TREATMENT 2011; 2011:650320. [PMID: 22110929 PMCID: PMC3197257 DOI: 10.1155/2011/650320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 04/18/2011] [Accepted: 05/01/2011] [Indexed: 12/19/2022]
Abstract
Optimal sedation and analgesia are of key importance in intensive care. The aim of this study was to assess the quality of sedoanalgesia and outcome parameters in regimens containing midazolam and either fentanyl or remifentanil. A prospective, randomized, open-label, controlled trial was carried out in the ICU unit of a large teaching hospital in Istanbul over a 9-month period. Thirty-four patients were randomly allocated to receive either a remifentanil-midazolam regimen (R group, n = 17) or a fentanyl-midazolam regimen (F group, n = 17). A strong correlation between Riker Sedation-Agitation Scale (SAS) and Ramsey Scale (RS) measurements was observed. Comparatively, remifentanil provided significantly more potent and rapid analgesia based on Behavioral-Physiological Scale (BPS) measurements and a statistically nonsignificantly shorter time to discharge. On the other hand, remifentanil also caused a significantly sharper fall in heart rate within the first six hours of treatment.
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