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Cheung ST, Do Y, Kim E, Rella A, Goyarts E, Pernodet N, Wong YH. G Protein-Coupled Receptors in Skin Aging. J Invest Dermatol 2024:S0022-202X(24)01919-5. [PMID: 39186022 DOI: 10.1016/j.jid.2024.06.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 08/27/2024]
Abstract
Skin aging is a complex biological process affected by a plethora of intrinsic and extrinsic factors that alter cutaneous functions through the modulations of signaling pathways and responses. Expressed in various cell types and skin tissue layers, G protein-coupled receptors (GPCRs) play a vital role in regulating skin aging. We have cataloged 156 GPCRs expressed in the skin and reviewed their roles in skin aging, such as pigmentation, loss of elasticity, wrinkles, rough texture, and aging-associated skin disorders. By exploring the GPCRs found in the skin, it may be possible to develop new treatment regimens for aging-associated skin conditions using GPCR ligands.
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Affiliation(s)
- Suet Ting Cheung
- The Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; The Biotechnology Research Institute, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Yelim Do
- The Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; The Biotechnology Research Institute, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Eunah Kim
- The Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; The Biotechnology Research Institute, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Antonella Rella
- Research and Development, The Estée Lauder Companies, New York, New York, USA
| | - Earl Goyarts
- Research and Development, The Estée Lauder Companies, New York, New York, USA
| | - Nadine Pernodet
- Research and Development, The Estée Lauder Companies, New York, New York, USA; Estée Lauder Research Laboratories, Melville, New York, USA
| | - Yung Hou Wong
- The Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China; The Biotechnology Research Institute, The Hong Kong University of Science and Technology, Hong Kong, China; Molecular Neuroscience Center, State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Hong Kong, China; Center for Aging Science, The Hong Kong University of Science and Technology, Hong Kong, China.
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Bigliardi P, Junnarkar S, Markale C, Lo S, Bigliardi E, Kalyuzhny A, Ong S, Dunn R, Wahli W, Bigliardi-Qi M. The Opioid Receptor Influences Circadian Rhythms in Human Keratinocytes through the β-Arrestin Pathway. Cells 2024; 13:232. [PMID: 38334624 PMCID: PMC10854934 DOI: 10.3390/cells13030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
The recent emphasis on circadian rhythmicity in critical skin cell functions related to homeostasis, regeneration and aging has shed light on the importance of the PER2 circadian clock gene as a vital antitumor gene. Furthermore, delta-opioid receptors (DOPrs) have been identified as playing a crucial role in skin differentiation, proliferation and migration, which are not only essential for wound healing but also contribute to cancer development. In this study, we propose a significant association between cutaneous opioid receptor (OPr) activity and circadian rhythmicity. To investigate this link, we conducted a 48 h circadian rhythm experiment, during which RNA samples were collected every 5 h. We discovered that the activation of DOPr by its endogenous agonist Met-Enkephalin in N/TERT-1 keratinocytes, synchronized by dexamethasone, resulted in a statistically significant 5.6 h delay in the expression of the core clock gene PER2. Confocal microscopy further confirmed the simultaneous nuclear localization of the DOPr-β-arrestin-1 complex. Additionally, DOPr activation not only enhanced but also induced a phase shift in the rhythmic binding of β-arrestin-1 to the PER2 promoter. Furthermore, we observed that β-arrestin-1 regulates the transcription of its target genes, including PER2, by facilitating histone-4 acetylation. Through the ChIP assay, we determined that Met-Enkephalin enhances β-arrestin-1 binding to acetylated H4 in the PER2 promoter. In summary, our findings suggest that DOPr activation leads to a phase shift in PER2 expression via β-arrestin-1-facilitated chromatin remodeling. Consequently, these results indicate that DOPr, much like its role in wound healing, may also play a part in cancer development by influencing PER2.
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Affiliation(s)
- Paul Bigliardi
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA (C.M.)
- Stem Cell Institue, McGuire Translational Research Facility, University of Minnesota, Minneapolis, MN 55455, USA
| | - Seetanshu Junnarkar
- Agency for Science, Technology and Research, Singapore 138632, Singapore; (S.J.); (S.O.); (R.D.)
| | - Chinmay Markale
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA (C.M.)
- Stem Cell Institue, McGuire Translational Research Facility, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sydney Lo
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA (C.M.)
- Stem Cell Institue, McGuire Translational Research Facility, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elena Bigliardi
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA (C.M.)
- Stem Cell Institue, McGuire Translational Research Facility, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alex Kalyuzhny
- Department of Neuroscience, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Sheena Ong
- Agency for Science, Technology and Research, Singapore 138632, Singapore; (S.J.); (S.O.); (R.D.)
| | - Ray Dunn
- Agency for Science, Technology and Research, Singapore 138632, Singapore; (S.J.); (S.O.); (R.D.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
| | - Walter Wahli
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore;
- Unité Mixte de Recherche (UMR) 1331, Institut National de la Recherche Agronomique (INRA), ToxAlim, 31000 Toulouse, France
- Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland
| | - Mei Bigliardi-Qi
- Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA (C.M.)
- Stem Cell Institue, McGuire Translational Research Facility, University of Minnesota, Minneapolis, MN 55455, USA
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The Biological Role of Dead Sea Water in Skin Health: A Review. COSMETICS 2023. [DOI: 10.3390/cosmetics10010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Applying natural mineral water to skin care is a popular tendency and many cosmetics products based on thermal spring water have been developed. The special location and environmental conditions provide Dead Sea water (DSW) with unique ion composition and concentrations, which bring comprehensive positive effects on skin health. This article reviews two potential action modes of DSW, and the biological function of DSW and its related complex in dermatology and skin care. Previous studies have proved the functions of skin moisturization, anti-inflammation, skin barrier repair, and anti-pollution. Especially, the anti-aging effect of DSW and related complexes can act in three different ways: keratinocyte rejuvenation, photo-protection, and cellular energy elevation. Additionally, the issues that need further investigation are also discussed. We hope that this review will help to improve the understanding of DSW and its related complex, and further contribute to product development in the skincare industry.
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Xu X, Yu C, Xu L, Xu J. Emerging roles of keratinocytes in nociceptive transduction and regulation. Front Mol Neurosci 2022; 15:982202. [PMID: 36157074 PMCID: PMC9500148 DOI: 10.3389/fnmol.2022.982202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 01/07/2023] Open
Abstract
Keratinocytes are the predominant block-building cells in the epidermis. Emerging evidence has elucidated the roles of keratinocytes in a wide range of pathophysiological processes including cutaneous nociception, pruritus, and inflammation. Intraepidermal free nerve endings are entirely enwrapped within the gutters of keratinocyte cytoplasm and form en passant synaptic-like contacts with keratinocytes. Keratinocytes can detect thermal, mechanical, and chemical stimuli through transient receptor potential ion channels and other sensory receptors. The activated keratinocytes elicit calcium influx and release ATP, which binds to P2 receptors on free nerve endings and excites sensory neurons. This process is modulated by the endogenous opioid system and endothelin. Keratinocytes also express neurotransmitter receptors of adrenaline, acetylcholine, glutamate, and γ-aminobutyric acid, which are involved in regulating the activation and migration, of keratinocytes. Furthermore, keratinocytes serve as both sources and targets of neurotrophic factors, pro-inflammatory cytokines, and neuropeptides. The autocrine and/or paracrine mechanisms of these mediators create a bidirectional feedback loop that amplifies neuroinflammation and contributes to peripheral sensitization.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Catherine Yu
- Department of Pain Management, Anesthesiology Institute, Cleveland, OH, United States,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH, United States,Cleveland Clinic, Case Western Reserve University, Cleveland, OH, United States
| | - Li Xu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China,*Correspondence: Li Xu,
| | - Jijun Xu
- Department of Pain Management, Anesthesiology Institute, Cleveland, OH, United States,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, OH, United States,Cleveland Clinic, Case Western Reserve University, Cleveland, OH, United States,*Correspondence: Li Xu,
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Tominaga M, Takamori K. Peripheral itch sensitization in atopic dermatitis. Allergol Int 2022; 71:265-277. [PMID: 35624035 DOI: 10.1016/j.alit.2022.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023] Open
Abstract
Atopic dermatitis is a skin disorder caused by skin dryness and barrier dysfunction, resulting in skin inflammation and chronic itch (or pruritus). The pathogenesis of atopic dermatitis is thought to be initiated by a lowering of the itch threshold due to dry skin. This lowering of the itch threshold is at least partially due to the increase in intraepidermal nerve fibers and sensitization of sensory nerves by interleukin (IL)-33 produced and secreted by keratinocytes. Such skin is easily prone to itch due to mechanical stimuli, such as rubbing of clothing and chemical stimuli from itch mediators. In patients with atopic dermatitis, once itch occurs, further itch is induced by scratching, and the associated scratching breaks down the skin barrier. Disruption of the skin barrier allows entry into the epidermis of external foreign substances, such as allergens derived from house dust mites, leading to an increased induction of type 2 inflammatory responses. As a result, type 2 cytokines IL-4, IL-13, and IL-31 are mainly secreted by Th2 cells, and their action on sensory nerve fibers causes further itch sensitization. These sequences of events are thought to occur simultaneously in patients with atopic dermatitis, leading to a vicious itch-scratch cycle. This vicious cycle becomes a negative spiral that leads to disease burden. Therefore, controlling itch is essential for the treatment of atopic dermatitis. In this review, we summarize and discuss advances in the mechanisms of peripheral itch sensitization in atopic dermatitis, focusing on skin barrier-neuro-immune triadic connectivity.
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Ádám D, Arany J, Tóth KF, Tóth BI, Szöllősi AG, Oláh A. Opioidergic Signaling-A Neglected, Yet Potentially Important Player in Atopic Dermatitis. Int J Mol Sci 2022; 23:4140. [PMID: 35456955 PMCID: PMC9027603 DOI: 10.3390/ijms23084140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common skin diseases, the prevalence of which is especially high among children. Although our understanding about its pathogenesis has substantially grown in recent years, and hence, several novel therapeutic targets have been successfully exploited in the management of the disease, we still lack curative treatments for it. Thus, there is an unmet societal demand to identify further details of its pathogenesis to thereby pave the way for novel therapeutic approaches with favorable side effect profiles. It is commonly accepted that dysfunction of the complex cutaneous barrier plays a central role in the development of AD; therefore, the signaling pathways involved in the regulation of this quite complex process are likely to be involved in the pathogenesis of the disease and can provide novel, promising, yet unexplored therapeutic targets. Thus, in the current review, we aim to summarize the available potentially AD-relevant data regarding one such signaling pathway, namely cutaneous opioidergic signaling.
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Affiliation(s)
- Dorottya Ádám
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.Á.); (J.A.); (K.F.T.); (B.I.T.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - József Arany
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.Á.); (J.A.); (K.F.T.); (B.I.T.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Kinga Fanni Tóth
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.Á.); (J.A.); (K.F.T.); (B.I.T.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Balázs István Tóth
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.Á.); (J.A.); (K.F.T.); (B.I.T.)
| | - Attila Gábor Szöllősi
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.Á.); (J.A.); (K.F.T.); (B.I.T.)
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Carano F, Teti G, Ruggeri A, Chiarini F, Giorgetti A, Mazzotti MC, Fais P, Falconi M. Assessment of the structural and functional characteristics of human mesenchymal stem cells associated with a prolonged exposure of morphine. Sci Rep 2021; 11:19248. [PMID: 34584173 PMCID: PMC8478991 DOI: 10.1038/s41598-021-98682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
The discovery of the expression of opioid receptors in the skin and their role in orchestrating the process of tissue repair gave rise to questions regarding the potential effects of clinical morphine treatment in wound healing. Although short term treatment was reported to improve tissue regeneration, in vivo chronic administration was associated to an impairment of the physiological healing process and systemic fibrosis. Human mesenchymal stem cells (hMSCs) play a fundamental role in tissue regeneration. In this regard, acute morphine exposition was recently reported to impact negatively on the functional characteristics of hMSCs, but little is currently known about its long-term effects. To determine how a prolonged treatment could impair their functional characteristics, we exposed hMSCs to increasing morphine concentrations respectively for nine and eighteen days, evaluating in particular the fibrogenic potential exerted by the long-term exposition. Our results showed a time dependent cell viability decline, and conditions compatible with a cellular senescent state. Ultrastructural and protein expression analysis were indicative of increased autophagy, suggesting a relation to a detoxification activity. In addition, the enhanced transcription observed for the genes involved in the synthesis and regulation of type I collagen suggested the possibility that a prolonged morphine treatment might exert its fibrotic potential risk, even involving the hMSCs.
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Affiliation(s)
- Francesco Carano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Gabriella Teti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Alessandra Ruggeri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Francesca Chiarini
- CNR-National Research Council of Italy, Institute of Molecular Genetics "Luigi Luca Cavalli-Sforza", Unit of Bologna, 40136, Bologna, Italy.,IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Arianna Giorgetti
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Maria C Mazzotti
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | - Mirella Falconi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
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8
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Komiya E, Tominaga M, Hatano R, Kamikubo Y, Toyama S, Sakairi H, Honda K, Itoh T, Kamata Y, Tsurumachi M, Kishi R, Ohnuma K, Sakurai T, Morimoto C, Takamori K. Peripheral endomorphins drive mechanical alloknesis under the enzymatic control of CD26/DPPIV. J Allergy Clin Immunol 2021; 149:1085-1096. [PMID: 34411589 DOI: 10.1016/j.jaci.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mechanical alloknesis (or innocuous mechanical stimuli-evoked itch) often occurs in dry skin-based disorders such as atopic dermatitis and psoriasis. However, the molecular and cellular mechanisms underlying mechanical alloknesis remain unclear. We recently reported the involvement of CD26 in the regulation of psoriatic itch. This molecule exhibits dipeptidyl peptidase IV (DPPIV) enzyme activity and exerts its biologic effects by processing various substances, including neuropeptides. OBJECTIVE The aim of the present study was to investigate the peripheral mechanisms of mechanical alloknesis by using CD26/DPPIV knockout (CD26KO) mice. METHODS We applied innocuous mechanical stimuli to CD26KO or wild-type mice. The total number of scratching responses was counted as the alloknesis score. Immunohistochemical and behavioral pharmacologic analyses were then performed to examine the physiologic activities of CD26/DPPIV or endomorphins (EMs), endogenous agonists of μ-opioid receptors. RESULTS Mechanical alloknesis was more frequent in CD26KO mice than in wild-type mice. The alloknesis score in CD26KO mice was significantly reduced by the intradermal administration of recombinant DPPIV or naloxone methiodide, a peripheral μ-opioid receptor antagonist, but not by that of mutant DPPIV without enzyme activity. EMs (EM-1 and EM-2), selective ligands for μ-opioid receptors, are substrates for DPPIV. Immunohistochemically, EMs were located in keratinocytes, fibroblasts, and peripheral sensory nerves. Behavioral analyses revealed that EMs preferentially provoked mechanical alloknesis over chemical itch. DPPIV-digested forms of EMs did not induce mechanical alloknesis. CONCLUSION The present results suggest that EMs induce mechanical alloknesis at the periphery under the enzymatic control of CD26/DPPIV.
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Affiliation(s)
- Eriko Komiya
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Ryo Hatano
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yuji Kamikubo
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sumika Toyama
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Hakushun Sakairi
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kotaro Honda
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Takumi Itoh
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Atopy (Allergy) Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yayoi Kamata
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Munehiro Tsurumachi
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryoma Kishi
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kei Ohnuma
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Sakurai
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Chikao Morimoto
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan.
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Takahashi N, Yoshizawa T, Kumagai J, Kawanishi H, Tsuchiya S, Moriishi M, Masaki T. Effectiveness of a treatment algorithm for hemodialysis-associated pruritus in terms of changes in medications. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00339-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Hemodialysis-associated pruritus (HAP) is a serious complication that occurs in 60–80% of hemodialysis patients, which not only decreases quality of life but also worsens prognosis. We have developed a treatment algorithm to take a comprehensive cause-specific approach to HAP and used it at our facility since June 2009. In this treatment algorithm, moisturizers and topical steroids are used depending on skin condition and severity of pruritus; administration of nalfurafine hydrochloride is considered in treatment-resistant cases. If pruritus improves, we attempt to taper topical steroids by switching to lower potency or by dose reduction or discontinuation. Here, we examined the effectiveness of the treatment algorithm over 9 years in terms of changes in medications.
Methods
Subjects were hemodialysis patients who received treatment for HAP at our facility: 89 in May 2009 before introduction of the algorithm, and 131 in April 2013, 164 in October 2014, 190 in October 2015, 181 in October 2016, 215 in October 2017, and 224 patients in October 2018 after its introduction. A questionnaire survey was conducted on the presence of pruritus, severity (using a visual analogue scale [VAS] and Shiratori severity scores), frequency, and insomnia due to pruritus. Changes in medications were investigated using medical records and compared.
Results
The proportion of patients with pruritus decreased significantly from 96.6% in 2009 to 66.8% in 2018 (p < 0.001). Median VAS score significantly decreased from 53.0 mm in 2009 to 24.5 mm in 2018 (p < 0.001), and the proportion of patients with insomnia due to pruritus also significantly decreased from 25.8% in 2009 to 2.2% in 2018 (p < 0.001). The proportion of patients who used moisturizers significantly increased from 34.8 to 89.7% (p < 0.001). The proportion of patients receiving topical steroids decreased from 47.2 to 35.7%, but the difference was not significant (p = 0.085).
Conclusions
The treatment algorithm was shown to be useful for improving HAP, but future challenges were identified, including promoting use of lower potency topical steroids or discontinuation. Further prospective studies are required to confirm the role of each treatment intervention in a comprehensive cause-specific approach to HAP.
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Topical Treatments and Their Molecular/Cellular Mechanisms in Patients with Peripheral Neuropathic Pain-Narrative Review. Pharmaceutics 2021; 13:pharmaceutics13040450. [PMID: 33810493 PMCID: PMC8067282 DOI: 10.3390/pharmaceutics13040450] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/25/2022] Open
Abstract
Neuropathic pain in humans results from an injury or disease of the somatosensory nervous system at the peripheral or central level. Despite the considerable progress in pain management methods made to date, peripheral neuropathic pain significantly impacts patients' quality of life, as pharmacological and non-pharmacological methods often fail or induce side effects. Topical treatments are gaining popularity in the management of peripheral neuropathic pain, due to excellent safety profiles and preferences. Moreover, topical treatments applied locally may target the underlying mechanisms of peripheral sensitization and pain. Recent studies showed that peripheral sensitization results from interactions between neuronal and non-neuronal cells, with numerous signaling molecules and molecular/cellular targets involved. This narrative review discusses the molecular/cellular mechanisms of drugs available in topical formulations utilized in clinical practice and their effectiveness in clinical studies in patients with peripheral neuropathic pain. We searched PubMed for papers published from 1 January 1995 to 30 November 2020. The key search phrases for identifying potentially relevant articles were "topical AND pain", "topical AND neuropathic", "topical AND treatment", "topical AND mechanism", "peripheral neuropathic", and "mechanism". The result of our search was 23 randomized controlled trials (RCT), 9 open-label studies, 16 retrospective studies, 20 case (series) reports, 8 systematic reviews, 66 narrative reviews, and 140 experimental studies. The data from preclinical studies revealed that active compounds of topical treatments exert multiple mechanisms of action, directly or indirectly modulating ion channels, receptors, proteins, and enzymes expressed by neuronal and non-neuronal cells, and thus contributing to antinociception. However, which mechanisms and the extent to which the mechanisms contribute to pain relief observed in humans remain unclear. The evidence from RCTs and reviews supports 5% lidocaine patches, 8% capsaicin patches, and botulinum toxin A injections as effective treatments in patients with peripheral neuropathic pain. In turn, single RCTs support evidence of doxepin, funapide, diclofenac, baclofen, clonidine, loperamide, and cannabidiol in neuropathic pain states. Topical administration of phenytoin, ambroxol, and prazosin is supported by observational clinical studies. For topical amitriptyline, menthol, and gabapentin, evidence comes from case reports and case series. For topical ketamine and baclofen, data supporting their effectiveness are provided by both single RCTs and case series. The discussed data from clinical studies and observations support the usefulness of topical treatments in neuropathic pain management. This review may help clinicians in making decisions regarding whether and which topical treatment may be a beneficial option, particularly in frail patients not tolerating systemic pharmacotherapy.
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Akgün E, Lunzer MM, Tian D, Ansonoff M, Pintar J, Bruce D, Hawkinson JE, Wilcox GL, Portoghese PS. FBNTI, a DOR-Selective Antagonist That Allosterically Activates MOR within a MOR-DOR Heteromer. Biochemistry 2020; 60:1413-1419. [PMID: 32930576 DOI: 10.1021/acs.biochem.0c00498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This report describes the unique pharmacological profile of FBNTI, a potent DOR antagonist that acts as a MOR agonist via an allosteric mechanism. Binding of FBNTI to opioid receptors expressed in HEK 293 cells revealed a 190-fold greater affinity for DOR (Ki = 0.84 nM) over MOR (Ki = 160 nM). In mice, intrathecal FBNTI produced potent antinociception (ED50 = 46.9 pmol/mouse), which was antagonized by selective MOR antagonists (CTOP, β-FNA). Autoantagonism of the MOR agonism by FBNTI was observed above the ED75 dose, suggesting antagonism of activated MOR. That FBNTI is devoid of agonism in DOR knockout mice is consistent with allosteric activation of the MOR protomer via FBNTI bound to within a MOR-DOR heteromer. This proposed mechanism is supported by calcium mobilization assays, which indicate that FBNTI selectively activates the MOR-DOR heteromer and functionally antagonizes the MOR protomer at >ED75. The unprecedented mode of MOR activation by FBNTI may be responsible for the lack of tolerance after intrathecal (i.t.) administration. FBNTI was highly effective upon topical administration to the ipsolateral hind paw in the Hargreaves assay (EC50 = 0.17 ± 0.08 μM) and without significant contralateral activity, suggesting a lack of systemic exposure.
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Affiliation(s)
- Eyup Akgün
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Mary M Lunzer
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Defeng Tian
- University of Minnesota Institute for Therapeutics Discovery & Development (ITDD), 717 Delaware Street SE Room 519E, Minneapolis, Minnesota 55414, United States
| | - Michael Ansonoff
- Department of Neuroscience and Cell Biology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey 08854, United States
| | - John Pintar
- Department of Neuroscience and Cell Biology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey 08854, United States
| | - Daniel Bruce
- Department of Pharmacology, Medical School, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Jon E Hawkinson
- University of Minnesota Institute for Therapeutics Discovery & Development (ITDD), 717 Delaware Street SE Room 519E, Minneapolis, Minnesota 55414, United States
| | - George L Wilcox
- Departments of Neuroscience, Pharmacology and Dermatology, Medical School, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Philip S Portoghese
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Sanjel B, Shim WS. Recent advances in understanding the molecular mechanisms of cholestatic pruritus: A review. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165958. [PMID: 32896605 DOI: 10.1016/j.bbadis.2020.165958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
Cholestasis, a condition characterized by an abnormal decrease in bile flow, is accompanied by various symptoms such as pruritus. Although cholestatic pruritus is a prominent condition, its precise mechanisms have largely been elusive. Recently, advancements have been made for understanding the etiology and pathogenesis of cholestatic pruritus. The current review therefore focuses on summarizing the overall progress made in the elucidation of its molecular mechanisms. We have reviewed the available animal models on cholestasis to compare the differences between them, characterized potential pruritogens involved in cholestatic pruritus, and have summarized the receptor and ion channels implicated in the condition. Finally, we have discussed the available treatment options for alleviation of cholestatic pruritus. As our understanding of the mechanisms of cholestatic pruritus deepens, novel strategies to cure this condition are awaited.
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Affiliation(s)
- Babina Sanjel
- College of Pharmacy, Gachon University, Hambakmoero 191, Yeonsu-gu, Incheon 21936, Republic of Korea; Gachon Institute of Pharmaceutical Sciences, Hambakmoero 191, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Won-Sik Shim
- College of Pharmacy, Gachon University, Hambakmoero 191, Yeonsu-gu, Incheon 21936, Republic of Korea; Gachon Institute of Pharmaceutical Sciences, Hambakmoero 191, Yeonsu-gu, Incheon 21936, Republic of Korea.
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13
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Uhelski ML, Bruce D, Speltz R, Wilcox GL, Simone DA. Topical Application of Loperamide/Oxymorphindole, Mu and Delta Opioid Receptor Agonists, Reduces Sensitization of C-fiber Nociceptors that Possess Na V1.8. Neuroscience 2020; 446:102-112. [PMID: 32858141 DOI: 10.1016/j.neuroscience.2020.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
It was recently shown that local injection, systemic administration or topical application of the peripherally-restricted mu-opioid receptor (MOR) agonist loperamide (Lo) and the delta-opioid receptor (DOR) agonist oxymorphindole (OMI) synergized to produce highly potent anti-hyperalgesia that was dependent on both MOR and DOR located in the periphery. We assessed peripheral mechanisms by which this Lo/OMI combination produces analgesia in mice expressing the light-sensitive protein channelrhodopsin2 (ChR2) in neurons that express NaV1.8 voltage-gated sodium channels. These mice (NaV1.8-ChR2+) enabled us to selectively target and record electrophysiological activity from these neurons (the majority of which are nociceptive) using blue light stimulation of the hind paw. We assessed the effect of Lo/OMI on nociceptor activity in both naïve mice and mice treated with complete Freund's adjuvant (CFA) to induce chronic inflammation of the hind paw. Teased fiber recording of tibial nerve fibers innervating the plantar hind paw revealed that the Lo/OMI combination reduced responses to light stimulation in naïve mice and attenuated spontaneous activity (SA) as well as responses to light and mechanical stimuli in CFA-treated mice. These results show that Lo/OMI reduces activity of C-fiber nociceptors that express NaV1.8 and corroborate recent behavioral studies demonstrating the potent analgesic effects of this drug combination. Because of its peripheral site of action, Lo/OMI might produce effective analgesia without the side effects associated with activation of opioid receptors in the central nervous system.
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Affiliation(s)
- Megan L Uhelski
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Daniel Bruce
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - Rebecca Speltz
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA; Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA
| | - George L Wilcox
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA; Department of Pharmacology, University of Minnesota, Minneapolis, MN 55455, USA; Department of Dermatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Donald A Simone
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
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14
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Kahremany S, Hofmann L, Gruzman A, Cohen G. Advances in Understanding the Initial Steps of Pruritoceptive Itch: How the Itch Hits the Switch. Int J Mol Sci 2020; 21:ijms21144883. [PMID: 32664385 PMCID: PMC7402353 DOI: 10.3390/ijms21144883] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023] Open
Abstract
Pruritoceptive (dermal) itch was long considered an accompanying symptom of diseases, a side effect of drug applications, or a temporary sensation induced by invading pruritogens, as produced by the stinging nettle. Due to extensive research in recent years, it was possible to provide detailed insights into the mechanism of itch mediation and modulation. Hence, it became apparent that pruritus is a complex symptom or disease in itself, which requires particular attention to improve patients’ health. Here, we summarize recent findings in pruritoceptive itch, including how this sensation is triggered and modulated by diverse endogenous and exogenous pruritogens and their receptors. A differentiation between mediating pruritogen and modulating pruritogen seems to be of great advantage to understand and decipher the molecular mechanism of itch perception. Only a comprehensive view on itch sensation will provide a solid basis for targeting this long-neglected adverse sensation accompanying numerous diseases and many drug side effects. Finally, we identify critical aspects of itch perception that require future investigation.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan 5290002, Israel; (L.H.); (A.G.)
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada 86910, Israel;
- Correspondence:
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan 5290002, Israel; (L.H.); (A.G.)
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan 5290002, Israel; (L.H.); (A.G.)
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada 86910, Israel;
- Ben-Gurion University of the Negev, Eilat Campus, Eilat 8855630, Israel
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15
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Wieczorek A, Krajewski P, Kozioł-Gałczyńska M, Szepietowski JC. Opioid receptors expression in the skin of haemodialysis patients suffering from uraemic pruritus. J Eur Acad Dermatol Venereol 2020; 34:2368-2372. [PMID: 32170896 DOI: 10.1111/jdv.16360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uraemic pruritus is a common symptom in patients with chronic kidney disease undergoing haemodialysis (HD) treatment. Etiopathogenesis of uraemic pruritus is complex and not fully explained, but there are reports indicating a possible role of peripheral opioid system in its pathomechanism. OBJECTIVES This study was undertaken to analyse the expression of mu- and kappa-opioid receptors in the skin of HD patients with and without uraemic pruritus. METHODS Forty patients suffering from chronic kidney disease, treated with haemodialysis (21 pruritic and 19 non-pruritic), were included. The expression of mu- and kappa-opioid receptors in their skin was evaluated with immunohistochemistry. RESULTS The significant (P < 0.02) decrease in kappa-opioid receptor expression was shown in the skin of pruritic patients in comparison with the skin of those without itch (1.07 ± 0.62 and 1.66 ± 0.85, respectively). Moreover, there was a significant negative correlation between intensity of pruritus and expression of kappa-opioid receptors (r = -0.63, P = 0.002). There was no difference in the expression of mu-opioid receptor expression in the skin of pruritic and non-pruritic HD patients. CONCLUSIONS This study indicates that changes in peripheral opioid system may play an important role in the uraemic itch pathogenesis and that future studies are necessary to fully understand this mechanism.
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Affiliation(s)
- A Wieczorek
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - P Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - M Kozioł-Gałczyńska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Tamagawa-Mineoka R, Katoh N. Atopic Dermatitis: Identification and Management of Complicating Factors. Int J Mol Sci 2020; 21:E2671. [PMID: 32290423 PMCID: PMC7215488 DOI: 10.3390/ijms21082671] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease, associated with impaired skin barrier function and an atopic background. Various complicating factors, such as irritants, aeroallergens, food, microbial organisms, contact allergens, sweat, and scratching can induce the development of AD symptoms. Irritants, including soap/shampoo and clothes, can cause itching and eczematous lesions. In addition, young children with AD tend to become sensitized to eggs, milk, or peanuts, while older children and adults more often become sensitized to environmental allergens, such as house dust mites (HDM), animal dander, or pollen. Serum-specific IgE levels and skin prick test reactions to food tend to show high negative predictive values and low specificity and positive predictive values for diagnosing food allergy. On the other hand, AD adult patients tend to have severe skin symptoms and exhibit high HDM-specific IgE levels. Microbial organisms, e.g., Staphylococcus aureus and Malassezia furfur, might contribute to the pathogenetic mechanisms of AD. While sweat plays a major role in maintaining skin homeostasis, it can become an aggravating factor in patients with AD. Furthermore, scratching often exacerbates eczematous lesions. Several patient-specific complicating factors are seen in most cases. The identification and management of complicating factors are important for controlling AD.
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Affiliation(s)
- Risa Tamagawa-Mineoka
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan;
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17
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Ciałkowska-Rysz A, Dzierżanowski T. Topical morphine for treatment of cancer-related painful mucosal and cutaneous lesions: a double-blind, placebo-controlled cross-over clinical trial. Arch Med Sci 2019; 15:146-151. [PMID: 30697265 PMCID: PMC6348368 DOI: 10.5114/aoms.2018.72566] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Painful mucosal and cutaneous lesions are often less responsive or even refractory to systemic opioid analgesics. There is evidence suggesting that the effectiveness of topical morphine be restricted to inflammatory pain. The studied groups were small and the observation period relatively short. The aim of this study was to assess the effectiveness and safety of topical morphine for pain related to mucosal lesions and skin ulcers. MATERIAL AND METHODS The study was a 14-day randomized placebo-controlled cross-over trial (RCT) with a 28-day follow-up open phase (OP). The trial was conducted in adult patients with localized cancer-related pain and treated with systemic opioids in an oncology center or home hospice. The patients administered 0.2% gel on the mucosal lesion or 0.2% ointment on the skin lesion by themselves, without restrictions regarding the number of doses per day. The primary measurements were mean pain intensity (MPI) and mean pain relief (MPR) on the numeric rating scale (NRS 0-10), and ITT analysis was performed. RESULTS Thirty-five patients were randomized to the RCT, and all of them completed 14-day observation. The MPI before the treatment was NRS 5.9 and decreased to 2.5 after morphine (p < 0.0001 vs. placebo). The MPR was 57% after morphine, and 77% of the patients using topical morphine obtained clinically significant (at least 50% of the starting value) pain relief, statistically different from placebo. The analgesic effect was sustained over the 28-day OP period (p = 0.00001). There were only 2 cases of moderate pruritus, and no other side effects were reported. CONCLUSIONS Topical morphine was found to be a fast acting, highly effective, and safe medication for mucosal and skin lesions in palliative patients, with a sustainable pain relief effect over the 28-day observation period.
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18
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Jain N, Phillips FM, Weaver T, Khan SN. Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion. Spine (Phila Pa 1976) 2018; 43:1331-1338. [PMID: 29561298 DOI: 10.1097/brs.0000000000002609] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, economic analysis. OBJECTIVE To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. SUMMARY OF BACKGROUND DATA Chronic opioid use is associated with poor outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with COT in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors is important. METHODS Commercial insurance data from 2007 to Q3-2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications, ED visits, readmissions, 1-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications and adverse events. RESULTS A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost associated with increase resource use in these patients has been reported. CONCLUSION Preoperative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after one- or two-level PLF. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Nikhil Jain
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Frank M Phillips
- Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL
| | - Tristan Weaver
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Safdar N Khan
- The Ohio State University Wexner Medical Center, Columbus, OH
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Abstract
The process of recovery from skin wounding can be protracted and painful, and scarring may lead to weakness of the tissue, unpleasant sensations such as pain or itch, and unfavorable cosmetic outcomes. Moreover, some wounds simply fail to heal and become a chronic burden for the sufferer. Understanding the mechanisms underlying wound healing and the concomitant sensory disorders and how they might be manipulated for therapeutic benefit has attracted much interest in recent years, and here we discuss the latest developments in the field, focusing on the emergent roles of the peripheral opioid receptor (OPr) system.
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Affiliation(s)
- Mei Bigliardi-Qi
- Experimental Dermatology Group, Institute of Medical Biology, A*STAR, Singapore, Singapore, 138648.
| | - Paul Bigliardi
- NUH/NUS, National University Hospital/National University of Singapore, Singapore, Singapore, 119228
- Experimental Dermatology Group, Institute of Medical Biology, A*STAR, Singapore, Singapore, 138648
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20
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Leong C, Neumann C, Ramasamy S, Rout B, Yi Wee L, Bigliardi-Qi M, Bigliardi PL. Investigating endogenous µ-opioid receptors in human keratinocytes as pharmacological targets using novel fluorescent ligand. PLoS One 2017; 12:e0188607. [PMID: 29211767 PMCID: PMC5718609 DOI: 10.1371/journal.pone.0188607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/09/2017] [Indexed: 12/14/2022] Open
Abstract
Opioids in skin function during stress response, regeneration, ageing and, particularly in regulating sensation. In chronic pruritus, topical treatment with Naltrexone changes μ-opioid receptor (μ-OR) localization to relieve itch. The molecular mechanisms behind the effects of Naltrexone on μ-OR function in reduction of itching behavior has not been studied. There is an immediate need to understand the endogenous complexity of μ-OR dynamics in normal and pathological skin conditions. Here we evaluate real-time behavior of μ-OR-Endomorphine complexes in the presence of agonist and antagonists. The μ-OR ligand Endomorphine-1 (EM) was conjugated to the fluorescent dye Tetramethylrhodamine (TAMRA) to investigate the effects of agonist and antagonists in N/TERT-1 keratinocytes. The cellular localization of the EM-TAMRA was followed through time resolved confocal microscopy and population analysis was performed by flow cytometry. The in vitro analyses demonstrate fast internalization and trafficking of the endogenous EM-TAMRA-μ-OR interactions in a qualitative manner. Competition with Endomorphine-1, Naltrexone and CTOP show both canonical and non-canonical effects in basal and differentiated keratinocytes. Acute and chronic treatment with Naltrexone and Endomorphine-1 increases EM-TAMRA binding to skin cells. Although Naltrexone is clinically effective in relieving itch, the mechanisms behind re-distribution of μ-ORs during clinical treatments are not known. Our study has given insight into cellular mechanisms of μ-OR ligand-receptor interactions after opioid agonist and antagonist treatments in vitro. These findings potentially offer opportunities in using novel treatment strategies for skin and peripheral sensory disorders.
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Affiliation(s)
- Cheryl Leong
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
| | - Christine Neumann
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
| | - Srinivas Ramasamy
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
| | - Bhimsen Rout
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
| | - Lim Yi Wee
- Institute of Chemical and Engineering Sciences, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
| | - Mei Bigliardi-Qi
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
- * E-mail: , (PB); , (MB)
| | - Paul L. Bigliardi
- Institute of Medical Biology, Agency for Science Technology & Research (A*STAR), Singapore, Singapore
- National University Hospital, Division of Rheumatology, University Medicine Cluster, Singapore, Singapore
- * E-mail: , (PB); , (MB)
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21
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Tajiri K, Shimizu Y. Recent advances in the management of pruritus in chronic liver diseases. World J Gastroenterol 2017; 23:3418-3426. [PMID: 28596678 PMCID: PMC5442078 DOI: 10.3748/wjg.v23.i19.3418] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/13/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
Pruritus is a symptom found in patients with chronic liver diseases, especially cholestatic liver diseases such as primary biliary cholangitis. This symptom impairs patient quality of life by disturbing sleep and may lead to consideration of liver transplantation. Mechanisms implicated in pruritus have been associated with the peripheral and central nervous systems, leading to the development of various therapeutic options. Little evidence for the efficacy of most of these treatments is currently available, indicating a need for further investigations.
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Yang DJ, Lee KS, Ko CM, Moh SH, Song J, Hur LC, Cheon YW, Yang SH, Choi YH, Kim KW. Leucine-enkephalin promotes wound repair through the regulation of hemidesmosome dynamics and matrix metalloprotease. Peptides 2016; 76:57-64. [PMID: 26763532 DOI: 10.1016/j.peptides.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/03/2015] [Accepted: 12/29/2015] [Indexed: 11/17/2022]
Abstract
The skin responds to environmental stressors by coordinated actions of neuropeptides and their receptors. An endogenous peptide for δ-opioid receptor (DOPr), Leu-enkephalin (L-ENK), is expressed in the skin and its expression is altered in pathological conditions. Although the importance of DOPr is rapidly gaining recognition, the molecular mechanisms underlying its effects on wound healing are largely undefined. We show here that L-ENK induced activation of Erk, P90(RSK), and Elk-1 and promoted the disruption of hemidesmosomes and the expression of matrix metalloprotease (MMP)-2 and MMP-9, important processes for wound healing. Treatment with Erk inhibitor blocked activation of P90(RSK) and Elk-1 and significantly blunted wound repair. Therefore, our results suggest that activation of Erk and its downstream effectors, P90(RSK) and Elk-1, are critical for DOPr-mediated skin homeostasis.
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Affiliation(s)
- Dong Joo Yang
- Department of Pharmacology, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea
| | - Kyung Suk Lee
- Department of Plastic and Reconstructive Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea
| | - Chang Mann Ko
- Department of Pharmacology, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea
| | - Sang Hyun Moh
- Anti-aging Research Institute of BIO-FD&C Co. Ltd., Incheon 21990, Republic of Korea
| | - Jihyeok Song
- Anti-aging Research Institute of BIO-FD&C Co. Ltd., Incheon 21990, Republic of Korea
| | - Lucia C Hur
- Derma-Lucia Skinceuticals LLC, 7500 Escala Drive, Austin, TX 78735, USA
| | - Young Woo Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University, School of Medicine, 1198 Guwol-Dong, Namdong-Gu, Incheon 21565, Republic of Korea
| | - Seung Ho Yang
- Department of Pharmacology, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea
| | - Yun-Hee Choi
- Anti-aging Research Institute of BIO-FD&C Co. Ltd., Incheon 21990, Republic of Korea.
| | - Ki Woo Kim
- Department of Pharmacology, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea.
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Fibroblast heterogeneity and its implications for engineering organotypic skin models in vitro. Eur J Cell Biol 2015; 94:483-512. [PMID: 26344860 DOI: 10.1016/j.ejcb.2015.08.001] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/19/2022] Open
Abstract
Advances in cell culture methods, multidisciplinary research, clinical need to replace lost skin tissues and regulatory need to replace animal models with alternative test methods has led to development of three dimensional models of human skin. In general, these in vitro models of skin consist of keratinocytes cultured over fibroblast-populated dermal matrices. Accumulating evidences indicate that mesenchyme-derived signals are essential for epidermal morphogenesis, homeostasis and differentiation. Various studies show that fibroblasts isolated from different tissues in the body are dynamic in nature and are morphologically and functionally heterogeneous subpopulations. Further, these differences seem to be dictated by the local biological and physical microenvironment the fibroblasts reside resulting in "positional identity or memory". Furthermore, the heterogeneity among the fibroblasts play a critical role in scarless wound healing and complete restoration of native tissue architecture in fetus and oral mucosa; and excessive scar formation in diseased states like keloids and hypertrophic scars. In this review, we summarize current concepts about the heterogeneity among fibroblasts and their role in various wound healing environments. Further, we contemplate how the insights on fibroblast heterogeneity could be applied for the development of next generation organotypic skin models.
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Brederson JD, Honda CN. Primary afferent neurons express functional delta opioid receptors in inflamed skin. Brain Res 2015; 1614:105-11. [PMID: 25911583 DOI: 10.1016/j.brainres.2015.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/01/2015] [Accepted: 04/13/2015] [Indexed: 11/16/2022]
Abstract
Peripherally-restricted opiate compounds attenuate hyperalgesia in experimental models of inflammatory pain, but have little discernable effect on nociceptive behavior in normal animals. This suggests that activation of opioid receptors on peripheral sensory axons contributes to decreased afferent activity after injury. Previously, we reported that direct application of morphine to cutaneous receptive fields decreased mechanical and heat-evoked responses in a population of C-fiber nociceptors in inflamed skin. Consistent with reported behavioral studies, direct application of morphine had no effect on fiber activity in control skin. The aim of the present study was to determine whether mechanical responsiveness of nociceptors innervating inflamed skin was attenuated by direct activation of delta opioid receptors (DORs) on peripheral terminals. An ex vivo preparation of rat plantar skin and tibial nerve was used to examine effects of a selective DOR agonist, deltorphin II, on responsiveness of single fibers innervating inflamed skin. Electrical recordings were made eighteen hours after injection of complete Freund's adjuvant into the hindpaw. Deltorphin II produced an inhibition of the mechanical responsiveness of single fibers innervating inflamed skin; an effect blocked by the DOR-selective antagonist, naltrindole. The population of units responsive to deltorphin II was identified as consisting of C fiber mechanical nociceptors.
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Affiliation(s)
| | - Christopher N Honda
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, USA.
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Neumann C, Bigliardi-Qi M, Widmann C, Bigliardi PL. The δ-opioid receptor affects epidermal homeostasis via ERK-dependent inhibition of transcription factor POU2F3. J Invest Dermatol 2014; 135:471-480. [PMID: 25178105 PMCID: PMC4291683 DOI: 10.1038/jid.2014.370] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 12/02/2022]
Abstract
Neuropeptides and their receptors are present in human skin, and their importance for cutaneous homeostasis and during wound healing is increasingly appreciated. However, there is currently a lack of understanding of the molecular mechanisms by which their signaling modulates keratinocyte function. Here, we show that δ-opioid receptor (DOPr) activation inhibits proliferation of human keratinocytes, resulting in decreased epidermal thickness in an organotypic skin model. DOPr signaling markedly delayed induction of keratin intermediate filament (KRT10) during in vitro differentiation and abolished its induction in the organotypic skin model. This was accompanied by deregulation of involucrin (IVL), loricrin, and filaggrin. Analysis of the transcription factor POU2F3, which is involved in regulation of KRT10, IVL, and profilaggrin expression, revealed a DOPr-mediated extracellular signal-regulated kinase (ERK)-dependent downregulation of this factor. We propose that DOPr signaling specifically activates the ERK 1/2 mitogen-activated protein kinase pathway to regulate keratinocyte functions. Complementing our earlier studies in DOPr-deficient mice, these data suggest that DOPr activation in human keratinocytes profoundly influences epidermal morphogenesis and homeostasis.
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Affiliation(s)
- Christine Neumann
- Experimental Dermatology Laboratory, Institute of Medical Biology, A*STAR, Singapore; Doctoral School Faculty of Biology and Medicine, University of Lausanne, Dorigny, Switzerland; These authors contributed equally to this work
| | - Mei Bigliardi-Qi
- Experimental Dermatology Laboratory, Institute of Medical Biology, A*STAR, Singapore.
| | - Christian Widmann
- Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Paul L Bigliardi
- Experimental Dermatology Laboratory, Institute of Medical Biology, A*STAR, Singapore; Division of Rheumatology, University Medicine Cluster, National University Hospital, Singapore.
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Immonen JA, Zagon IS, McLaughlin PJ. Featured Article: Selective blockade of the OGF–OGFr pathway by naltrexone accelerates fibroblast proliferation and wound healing. Exp Biol Med (Maywood) 2014; 239:1300-9. [DOI: 10.1177/1535370214543061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Naltrexone (NTX) is an opioid receptor antagonist that acts at classical and non-classical opioid receptors including the opioid growth factor receptor (OGFr). Animal models of type 1 and type 2 diabetes, as well as normal rodents, have shown that topical NTX enhances the healing rates of corneal epithelium and full-thickness cutaneous wounds. The mechanism of this general opioid antagonist on growth, and in particular the specific receptor pathway involved, is not understood. Tissue culture studies using NIH 3T3 fibroblasts and primary rat auricular fibroblasts were established to evaluate growth following opioid receptor antagonist treatment. Treatment of cells with CTOP, naltrindole, or nalmefene, selective antagonists for mu, delta, and kappa opioid receptors, respectively, did not accelerate cell replication. Addition of the classical opioid receptor peptides DAMGO, DPDPE, or EKC did not alter cell growth, suggesting that the classical opioid receptors were not involved in cutaneous wound healing. However, NTX (10−6 M) increased the growth of NIH 3T3 fibroblasts in culture over a 96-h period, and the specific ligand OGF decreased cell growth, supporting that the OGF-OGFr axis is tonically active and constitutively expressed in fibroblasts, the primary cell type in granulation tissue of the skin. Transfection of NIH 3T3 cells with OGFr siRNA reduced receptor protein; subsequent treatment with NTX did not accelerate cell proliferation. These data indicate that blockade of the OGFr pathway enhances proliferation of fibroblasts in vitro, and in a primary culture of auricular fibroblasts, suggesting that the effect of NTX on growth is mediated through the OGF-OGFr axis. Finally, antagonists for classical opioid receptors as well as NTX were topically applied to cutaneous wounds in type 1 diabetic rats; only NTX accelerated wound closure. These studies indicate that the mechanistic pathway underlying the effects of NTX to enhance cutaneous wound closure in diabetic and nondiabetic subjects is specific blockade of the OGF–OGFr regulatory axis.
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Affiliation(s)
- Jessica A Immonen
- Department of Neural & Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PY 17033, USA
| | - Ian S Zagon
- Department of Neural & Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PY 17033, USA
| | - Patricia J McLaughlin
- Department of Neural & Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PY 17033, USA
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Viet CT, Dang D, Ye Y, Ono K, Campbell RR, Schmidt BL. Demethylating drugs as novel analgesics for cancer pain. Clin Cancer Res 2014; 20:4882-4893. [PMID: 24963050 DOI: 10.1158/1078-0432.ccr-14-0901] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE In this study, we evaluated the analgesic potential of demethylating drugs on oral cancer pain. Although demethylating drugs could affect expression of many genes, we focused on the mu-opioid receptor (OPRM1) gene pathway, because of its role in pain processing. We determined the antinociceptive effect of OPRM1 re-expression in a mouse oral cancer model. EXPERIMENTAL DESIGN Using a mouse oral cancer model, we determined whether demethylating drugs produced antinociception through re-expression of OPRM1. We then re-expressed OPRM1 with adenoviral transduction and determined if, and by what mechanism, OPRM1 re-expression produced antinociception. To determine the clinical significance of OPRM1 on cancer pain, we quantified OPRM1 methylation in painful cancer tissues and nonpainful contralateral normal tissues of patients with oral cancer, and nonpainful dysplastic tissues of patients with oral dysplasia. RESULTS We demonstrated that OPRM1 was methylated in cancer tissue, but not normal tissue, of patients with oral cancer, and not in dysplastic tissues from patients with oral dysplasia. Treatment with demethylating drugs resulted in mechanical and thermal antinociception in the mouse cancer model. This behavioral change correlated with OPRM1 re-expression in the cancer and associated neurons. Similarly, adenoviral-mediated OPRM1 re-expression on cancer cells resulted in naloxone-reversible antinociception. OPRM1 re-expression on oral cancer cells in vitro increased β-endorphin secretion from the cancer, and decreased activation of neurons that were treated with cancer supernatant. CONCLUSION Our study establishes the regulatory role of methylation in cancer pain. OPRM1 re-expression in cancer cells produces antinociception through cancer-mediated endogenous opioid secretion. Demethylating drugs have an analgesic effect that involves OPRM1.
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Affiliation(s)
- Chi T Viet
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
| | - Dongmin Dang
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
| | - Yi Ye
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
| | - Kentaro Ono
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
| | - Ronald R Campbell
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
| | - Brian L Schmidt
- Department of Oral Maxillofacial Surgery, New York University, New York, NY, United States.,Bluestone Center for Clinical Research, New York University, NY, United States
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Ramot Y, Paus R. Harnessing neuroendocrine controls of keratin expression: A new therapeutic strategy for skin diseases? Bioessays 2014; 36:672-86. [DOI: 10.1002/bies.201400006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Yuval Ramot
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - Ralf Paus
- Dermatology Research Centre; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- Laboratory for Hair Research and Regenerative Medicine, Department of Dermatology; University of Münster; Münster Germany
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Stein C, Küchler S. Targeting inflammation and wound healing by opioids. Trends Pharmacol Sci 2013; 34:303-12. [PMID: 23602130 DOI: 10.1016/j.tips.2013.03.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/18/2013] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
Abstract
Opioid receptors are expressed on peripheral sensory nerve endings, cutaneous cells, and immune cells; and local application of opioids is used for the treatment of inflammatory pain in arthritis, burns, skin grafts, and chronic wounds. However, peripherally active opioids can also directly modulate the inflammatory process and wound healing. Here, we discuss the underlying mechanisms of opioid action and the conceivable therapeutic approaches for opioid treatment, as investigated in experimental and clinical studies. A large number of in vitro experiments and animal model investigations have produced evidence that peripherally active opioids can reduce plasma extravasation, vasodilation, proinflammatory neuropeptides, immune mediators, and tissue destruction. In contrast to currently available anti-inflammatory agents, opioids have not demonstrated organ toxicity, thus making them interesting candidates for drug development. Few clinical studies have tapped into this potential to date.
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Affiliation(s)
- Christoph Stein
- Department of Anesthesiology and Critical Care Medicine, Freie Universität Berlin, 12200 Berlin, Germany.
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Heilmann S, Küchler S, Wischke C, Lendlein A, Stein C, Schäfer-Korting M. A thermosensitive morphine-containing hydrogel for the treatment of large-scale skin wounds. Int J Pharm 2013; 444:96-102. [PMID: 23352858 DOI: 10.1016/j.ijpharm.2013.01.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/11/2013] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Topically applied opioids are an option to induce efficient analgesia in patients with severe skin wounds. For ongoing pain reduction, the vehicle should provide sustained drug release in order to increase the intervals during the regular wound dressing changes. In addition, the formulation should not impair wound healing. Hydrogels provide a moist wound environment, which is known to facilitate the healing process. METHODS AND RESULTS Investigating poloxamer hydrogels as a carrier system for morphine in terms of release behavior and (per-)cutaneous absorption, poloxamer 407 25wt.% hydrogel sustained morphine release up to 24h. The drug release rate decreased with increasing concentration of the gel forming triblock copolymer. Poloxamer 407 25wt.% hydrogel retarded morphine uptake into reconstructed human skin and percutaneous drug absorption compared to a hydroxyethyl cellulose reference gel. CONCLUSIONS The results of our in vitro study indicate that the thermosensitive poloxamer 407 25wt.% hydrogel is an appropriate carrier system for the topical application of morphine with regard to sustained drug release and ongoing analgesia.
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Affiliation(s)
- Sarah Heilmann
- Institute for Pharmacy, Freie Universität Berlin, Berlin, Germany
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Bao X, Liu D, Jin Y, Yang Y. A facile synthesis for novel loperamide analogs as potential μ opioid receptor agonists. Molecules 2012; 17:14288-97. [PMID: 23208464 PMCID: PMC6268526 DOI: 10.3390/molecules171214288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/21/2022] Open
Abstract
A facile synthesis for novel loperamide analogs as potential μ opioid receptors is described. The synthetic procedure for compound 5, which contains two 4-phenyl piperidine scaffolds, was optimized, and this compound was synthesized in excellent yield. We also describe a mild and highly efficient protocol for the synthesis of compounds 6 and 7.
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Affiliation(s)
- Xiaofeng Bao
- Department of Biochemical Engineering, Nanjing University Science & Technology, Chemical Engineering Building B302, 200 Xiaolinwei, Nanjing 210094, China.
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Heilmann S, Küchler S, Schäfer-Korting M. Morphine Metabolism in Human Skin Microsomes. Skin Pharmacol Physiol 2012; 25:319-22. [DOI: 10.1159/000342067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/19/2012] [Indexed: 02/04/2023]
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Charbaji N, Schäfer-Korting M, Küchler S. Morphine stimulates cell migration of oral epithelial cells by delta-opioid receptor activation. PLoS One 2012; 7:e42616. [PMID: 22900034 PMCID: PMC3416801 DOI: 10.1371/journal.pone.0042616] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/09/2012] [Indexed: 01/13/2023] Open
Abstract
Oral mucositis is one of the most common side effects of chemoradiation regimens and manifestation can be dose-limiting for the therapy, can impair the patient's nutritional condition and quality of life due to severe pain. The therapeutic options are limited; often only an alleviation of the symptoms such as pain reduction by using systemic opioids is possible. Stimulating opioid receptors on peripheral neurons and dermal tissue, potent analgesic effects are induced e.g. in skin grafted patients. Advantageous effects on the cell migration and, thus, on the wound healing process are described, too. In this study, we investigated whether opioid receptors are also expressed on oral epithelial cells and if morphine can modulate their cell migration behavior. The expression of the opioid receptors MOR, DOR and KOR on primary human oral epithelial cells was verified. Furthermore, a significantly accelerated cell migration was observed following incubation with morphine. The effect even slightly exceeded the cell migration stimulating effect of TGF-ß: After 14 h of morphine treatment about 86% of the wound area was closed, whereas TGF-ß application resulted in a closed wound area of 80%. With respect to morphine stimulated cell migration we demonstrate that DOR plays a key role and we show the involvement of the MAPK members Erk 1/2 and p38 using Western blot analysis.Further studies in more complex systems in vitro and in vivo are required. Nevertheless, these findings might open up a new therapeutic option for the treatment of oral mucositis.
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Affiliation(s)
- Nada Charbaji
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | | | - Sarah Küchler
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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Gabrilovac J, Čupić B, Zapletal E, Brozovic A. IFN-γ up-regulates kappa opioid receptors (KOR) on murine macrophage cell line J774. J Neuroimmunol 2012; 245:56-65. [DOI: 10.1016/j.jneuroim.2012.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 02/06/2012] [Accepted: 02/08/2012] [Indexed: 11/29/2022]
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Hong J, Buddenkotte J, Berger TG, Steinhoff M. Management of itch in atopic dermatitis. ACTA ACUST UNITED AC 2011; 30:71-86. [PMID: 21767767 DOI: 10.1016/j.sder.2011.05.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.
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Affiliation(s)
- Judith Hong
- Department of Dermatology, University of California San Francisco, San Francisco, CA 94143, USA
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Update on pruritic mechanisms of hypertrophic scars in postburn patients: the potential role of opioids and their receptors. J Burn Care Res 2011; 32:e118-25. [PMID: 21747328 DOI: 10.1097/bcr.0b013e3182223c32] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although itching (or pruritus) in a scar is a very common and distressing symptom and is increasingly being recognized as a significant obstacle in burn rehabilitation, the exact mechanisms underlying this symptom have not been elucidated; hence, a reliable therapy has not been established. Recent findings have suggested that itching caused by inflammatory dermatosis can be reduced by antihistamines, but histamine antagonists cannot block all types of pruritus (eg, neuropathic itch). This indicates the presence of a histamine-independent pathway for itch. Itch or pruritus may also be evoked by direct activation of opioid receptors, which have recently been identified in the skin. This article aims to assess the current state of knowledge regarding the role of opioids in the generation of itch in hypertrophic scars in postburn patients. To this end, the authors have reviewed the relevant literature and present some clinical data. The authors hope that this review will form the basis for future research to elucidate the mechanism and treatment of itch.
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McLaughlin PJ, Pothering CA, Immonen JA, Zagon IS. Topical treatment with the opioid antagonist naltrexone facilitates closure of full-thickness wounds in diabetic rats. Exp Biol Med (Maywood) 2011; 236:1122-32. [PMID: 21917593 DOI: 10.1258/ebm.2011.011163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A major problem associated with diabetes is the complication of chronic non-healing wounds that can lead to the formation of debilitating ulcers, and can progress to more serious problems including amputation. There is no fully effective prevention of these complications, constituting an unmet medical need to understand the pathophysiology and treatment of wound healing in diabetes. This study determined whether blockade of opioid receptors from opioid peptides, known to inhibit cell proliferation and be overexpressed in diabetes, by topical application of the opioid antagonist naltrexone (NTX) reverses delays in wound closure. Rats with streptozotocin-induced type 1 diabetes (T1D) received topical applications of NTX (10(-4)-10(-6) mol/L) or vehicle in a variety of carriers; DNA synthesis was evaluated 12 h later. DNA synthesis in the epithelium of T1D rats was significantly reduced from normal animals. Both systemic and topical application of NTX increased DNA synthesis (up to 2-fold higher) within 12 h of administration. In a second study, diabetic and normal rats received full-thickness cutaneous wounds and were treated three times daily with either 10(-5) mol/L NTX or vehicle in topical carriers. Wound sizes were analyzed, and BrdU (5-bromo-2'-deoxyuridine) labeling in the skin was evaluated to determine DNA synthesis. Application of NTX in a variety of carriers to rats with full-thickness wounds resulted in significantly smaller wound areas relative to T1D animals receiving vehicle, and comparable to that of normal rats. Wound contraction in T1D animals was 50% of that in normal rats, with NTX-treated wounds restoring wound contraction to that of normal cohorts. DNA synthesis was also enhanced in NTX-treated T1D animals compared with T1D vehicle controls. These data suggest that topical application of NTX is a non-toxic and efficacious facilitator for healing full thickness wounds in T1D, with wound contraction serving as a particular target of NTX action.
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Affiliation(s)
- Patricia J McLaughlin
- Department of Neural & Behavioral Sciences, MC H109, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Schramm CL, Honda CN. Co-administration of δ- and μ-opioid receptor agonists promotes peripheral opioid receptor function. Pain 2011; 151:763-770. [PMID: 20970925 DOI: 10.1016/j.pain.2010.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 08/18/2010] [Accepted: 09/08/2010] [Indexed: 11/15/2022]
Abstract
Enhancement of peripheral opioid analgesia following tissue injury or inflammation in animal models is well-documented, but clinical results of peripheral opioid therapy remain inconsistent. Previous studies in the central nervous system have shown that co-administration of μ- and δ-opioid receptor agonists can enhance analgesic outcomes; however, less is known about the functional consequences of opioid receptor interactions in the periphery. The present study examines the effects of intraplantar injection of the μ- and δ-opioid receptor agonists, morphine and deltorphin, alone and in combination on behavioral tests of nociception in naïve rats and on potassium-evoked release of CGRP from sciatic nerves of naïve rats. Neither drug alone affected nociceptive behaviors or CGRP release. Two separate measures of mechanical nociceptive sensitivity remained unchanged after co-administration of the two drugs. In contrast, when deltorphin was co-injected with morphine, dose-dependent and peripherally restricted increases in paw withdrawal latencies to radiant heat were observed. Similarly, concentration-dependent inhibition of CGRP release was observed when deltorphin and morphine were administered in sequence prior to potassium stimulation. However, no inhibition was observed when morphine was administered prior to deltorphin. All combined opioid effects were blocked by co-application of antagonists. Deltorphin exposure also enhanced the in vivo and in vitro effects of another μ-opioid receptor agonist, DAMGO. Together, these results suggest that under normal conditions, δ-opioid receptor agonists enhance the effect of μ-opioid receptor agonists in the periphery, and local co-administration of δ- and μ-opioid receptor agonists may improve results of peripheral opioid therapy for the treatment of pain.
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Affiliation(s)
- Cicely L Schramm
- Department of Neuroscience and Graduate Program in Neuroscience, University of Minnesota, Minneapolis, MN, USA
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Abstract
Skin responds to environmental stressors via coordinated actions of the local neuroimmunoendocrine system. Although some of these responses involve opioid receptors, little is known about cutaneous proenkephalin expression, its environmental regulation, and alterations in pathology. The objective of this study was to assess regulated expression of proenkephalin in normal and pathological skin and in isolated melanocytes, keratinocytes, fibroblasts, and melanoma cells. The proenkephalin gene and protein were expressed in skin and cultured cells, with significant expression in fibroblasts and keratinocytes. Mass spectroscopy confirmed Leu- and Met-enkephalin in skin. UVR, Toll-like receptor (TLR)4, and TLR2 agonists stimulated proenkephalin gene expression in melanocytes and keratinocytes in a time- and dose-dependent manner. In situ Met/Leu-enkephalin peptides were expressed in differentiating keratinocytes of the epidermis in the outer root sheath of the hair follicle, in myoepithelial cells of the eccrine gland, and in the basement membrane/basal lamina separating epithelial and mesenchymal components. Met/Leu-enkephalin expression was altered in pathological skin, increasing in psoriasis and decreasing in melanocytic tumors. Not only does human skin express proenkephalin, but this expression is upregulated by stressful stimuli and can be altered by pathological conditions.
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Kourosh AS, Harrington CR, Adinoff B. Tanning as a behavioral addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:284-90. [PMID: 20545604 DOI: 10.3109/00952990.2010.491883] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Persistent tanning despite potentially fatal consequences suggests a compulsive behavior similar to other addictive disorders. OBJECTIVES To review the literature supporting tanning addiction from an epidemiological, behavioral, and neurobiological perspective. METHODS A comprehensive review of the medical literature was conducted to assess the health consequences of tanning, behaviors and other psychiatric disorders associated with tanning, and central rewarding effects of ultraviolet light. RESULTS Many frequent tanners endorse signs and symptoms adapted from Diagnostic and Statistical Manual-IV (DSM IV) substance abuse or dependence criteria. Recent studies suggest biochemical mechanisms may reinforce ultraviolet light seeking behavior. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Frequent and persistent tanning may reveal itself to be a dermatologic-psychiatric disorder with carcinogenic sequelae. Multidisciplinary studies are required to determine the validity of an addiction diagnosis and to explore pharmacologic and cognitive therapeutic options for affected persons.
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Cafarchia C, Dell'Aquila ME, Traversa D, Albrizio M, Guaricci AC, de Santis T, Otranto D. Expression of the micro-opioid receptor on Malassezia pachydermatis and its effect in modulating phospholipase production. Med Mycol 2010; 48:73-8. [PMID: 19225979 DOI: 10.3109/13693780902718347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malassezia spp. may act as opportunistic skin pathogens in humans and animals. Malassezia pachydermatis proliferation and phospholipase production may play a pathogenic role in the occurrence of skin lesions in dogs. This study investigates the presence of mu-opioid receptor (MOR) in M. pachydermatis strains isolated from healthy dogs and dogs with skin lesions and its effects on phospholipase activity (p.a.). P.a. of 64 M. pachydermatis isolates was evaluated using different concentrations of naloxone (Nx), a MOR antagonist. Isolates were divided into Group A (i.e., 40 isolates from 26 dogs with dermatitis) and Group B (i.e., 24 isolates from 12 healthy dogs). The MOR expression was analyzed by Western blot and immunofluorescence. A statistically higher p.a. than that of the controls was found with isolates in Group A at a Nx concentration of 10(-6) M (P<0.05). No isolate in Group B displayed p.a. in either control samples or in the presence of any Nx concentration. Immunoblotting revealed two positive MOR immunoreactive bands of approximately 65 and 98 kDa. MOR expression and localization was also demonstrated by immunofluorescence in isolates from Groups A and B. This study provides the first evidence of MOR expression on M. pachydermatis cell membranes pointing to its possible role in modulating p.a. production in isolates from dogs with skin lesions.
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Affiliation(s)
- C Cafarchia
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, University of Bari, Valenzano, Bari, Italy
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Changes in the expression of the μ-opioid receptor in the mare oviduct during oestrus and anoestrus. Anim Reprod Sci 2010; 119:40-9. [DOI: 10.1016/j.anireprosci.2009.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 11/23/2022]
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Pain S, Dezutter C, Reymermier C, Vogelgesang B, Delay E, André V. Age-related changes in pro-opiomelanocortin (POMC) and related receptors in human epidermis. Int J Cosmet Sci 2010; 32:266-75. [PMID: 20384899 DOI: 10.1111/j.1468-2494.2009.00569.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SYNOPSIS Much effort has been placed in cosmetic research for better understanding of the effects of ageing on skin's appearance, structure, mechanical properties and function. It is now of common knowledge that UV radiations induce pre-mature skin ageing notably in the epidermis where UV radiations induce keratinocyte differentiation. As UV radiations have also been shown to regulate the pro-opiomelanocortin (POMC) peptide family in the skin and because no study has been conducted so far to investigate the age-related changes in POMC and related receptors, we analysed POMC, MC-1R, MC-2R and MOR-1 at mRNA level and MC-1R, MC-2R and MOR-1 at protein level too in primary cultures of normal human keratinocytes obtained from female donors aged from 17 to 75 years old. Regarding the gene expressions, we observed that MC-1R, MC-2R and MOR-1 suffered a dramatic decrease after 50 years of age, whereas POMC increased five-fold. Western blot analysis confirmed these results except for MOR-1 whose expression appeared to decrease at older age, around 70 years old. Immunostainings specific to MC-1R, MC-2R and MOR-1 performed on full-thickness skin biopsies also revealed an intense staining in the basal and spinous layers of a 30-year-old donor, whereas no reactivity could be observed in a 60-year-old one. We conclude that POMC and POMC-related receptors suffer a dramatically disturbed balance with ageing and that this may be implicated in the general process of skin ageing.
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Affiliation(s)
- S Pain
- BASF Beauty Care Solutions, 32 rue Saint Jean de Dieu, 69007 Lyon, France.
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Küchler S, Wolf NB, Heilmann S, Weindl G, Helfmann J, Yahya MM, Stein C, Schäfer-Korting M. 3D-wound healing model: influence of morphine and solid lipid nanoparticles. J Biotechnol 2010; 148:24-30. [PMID: 20138929 DOI: 10.1016/j.jbiotec.2010.01.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/11/2009] [Accepted: 01/06/2010] [Indexed: 11/28/2022]
Abstract
For efficient pain reduction in severe skin wounds, topically applied opioids may be a new option. Moreover, by stimulating keratinocyte migration opioids may also accelerate wound healing. Yet, conventional formulations failed to consistently provide sufficient pain control in patients which may be due to local drug degradation or insufficient concentrations at the target site. After having excluded major morphine glucuronidation by keratinocytes and fibroblasts, we next aimed for an optimised formulation. Since long intervals for painful wound dressing changes are intended, the formulations should allow for prolonged opioid release and should not impair the healing process. We developed morphine-loaded solid lipid nanoparticles (SLN, mean size about 180 nm), and tested improvement of wound closure in a new human-based 3D-wound healing model. Standardised wounds were induced by CO(2)-laser irradiation of reconstructed human full-thickness skin equivalents (EpiDermFT). Morphine, morphine-loaded and unloaded SLN accelerated reepithelialization. Keratinocytes almost completely covered the dermis equivalent after 4 days, which was not the case when applying the vehicle. In conclusion, acceleration of wound closure, low cytotoxicity and irritation as well as possible prolonged morphine release make SLN an interesting approach for innovative wound management.
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Affiliation(s)
- Sarah Küchler
- Institut für Pharmazie, Freie Universität Berlin, Königin-Luise-Str. 2-4, D-14195 Berlin, Germany
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Lintner K, Mas-Chamberlin C, Mondon P, Peschard O, Lamy L. Cosmeceuticals and active ingredients. Clin Dermatol 2009; 27:461-8. [PMID: 19695477 DOI: 10.1016/j.clindermatol.2009.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cosmetic ingredients previously considered "inert" have potential to provide a biologic effect to skin. In a cosmeceutical formulation, the boundary between an "active" and "inert" ingredient may be obscured. For this reason, the cosmeceutical distributor must find a nonambiguous method to demonstrate the efficacy of a new ingredient. For a product to be successful in the marketplace, the benefits of the product must clearly be communicated to the consumer, and the consumer must be satisfied with product performance.
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Affiliation(s)
- Karl Lintner
- Sederma S.A.S., F-78612 Le Perray en Yvelines, BP 33, 29 rue du Chemin Vert, Cedex, France.
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Kumagai H, Ebata T, Takamori K, Muramatsu T, Nakamoto H, Suzuki H. Effect of a novel kappa-receptor agonist, nalfurafine hydrochloride, on severe itch in 337 haemodialysis patients: a Phase III, randomized, double-blind, placebo-controlled study. Nephrol Dial Transplant 2009; 25:1251-7. [PMID: 19926718 DOI: 10.1093/ndt/gfp588] [Citation(s) in RCA: 222] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pruritus in haemodialysis patients is an intractable disease and substantially impairs their quality of life. Based on the results of our earlier clinical study, we hypothesized that the micro-(mu) opioid system is itch-inducible, whereas the kappa (kappa) system is itch-suppressive. METHODS The efficacy and safety of nalfurafine hydrochloride (a novel kappa-receptor agonist) were prospectively investigated by randomly (1:1:1) administering 5 or 2.5 microg of the drug or a placebo orally for 14 days using a double-blind design in 337 haemodialysis patients with itch that was resistant to currently available treatments, such as antihistamines. RESULTS The mean decrease in the visual analogue scale (VAS) from baseline, the study's primary endpoint, was significantly larger in the 5-microg nalfurafine hydrochloride group (n = 114) than in the placebo group (n = 111, P = 0.0002, one-sided test at 2.5% significance level). The decrease in the VAS in the 2.5-microg group (n = 112) was also significantly larger than that in the placebo group (P = 0.0001). The incidence of adverse drug reactions (ADRs) was 35.1% in the 5-microg group, 25.0% in the 2.5-microg group and 16.2% in the placebo group. Moderate to severe ADRs were observed in 10 of the 226 patients. The most common ADR was insomnia (sleep disturbance), seen in 24 of the 226 nalfurafine patients. CONCLUSIONS This Phase III, randomized, double-blind, placebo-controlled, parallel-group, prospective study based on VAS evaluations clearly showed that orally taken nalfurafine hydrochloride effectively reduced itches that were otherwise refractory to currently available treatments in maintenance haemodialysis patients, with few significant ADRs. This novel drug was officially approved for clinical use in January 2009 by the Ministry of Health, Labour and Welfare of Japan.
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Affiliation(s)
- Hiroo Kumagai
- Department of Nephrology, National Defense Medical College, Japan.
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Bigliardi PL, Tobin DJ, Gaveriaux-Ruff C, Bigliardi-Qi M. Opioids and the skin - where do we stand? Exp Dermatol 2009; 18:424-30. [DOI: 10.1111/j.1600-0625.2009.00844.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oyoshi MK, He R, Kumar L, Yoon J, Geha RS. Cellular and molecular mechanisms in atopic dermatitis. Adv Immunol 2009; 102:135-226. [PMID: 19477321 DOI: 10.1016/s0065-2776(09)01203-6] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Atopic dermatitis (AD) is a pruritic inflammatory skin disease associated with a personal or family history of allergy. The prevalence of AD is on the rise and estimated at approximately 17% in the USA. The fundamental lesion in AD is a defective skin barrier that results in dry itchy skin, and is aggravated by mechanical injury inflicted by scratching. This allows entry of antigens via the skin and creates a milieu that shapes the immune response to these antigens. This review discusses recent advances in our understanding of the abnormal skin barrier in AD, namely abnormalities in epidermal structural proteins, such as filaggrin, mutated in approximately 15% of patients with AD, epidermal lipids, and epidermal proteases and protease inhibitors. The review also dissects, based on information from mouse models of AD, the contributions of the innate and adaptive immune system to the pathogenesis of AD, including the effect of mechanical skin injury on the polarization of skin dendritic cells, mediated by keratinocyte-derived cytokines such as thymic stromal lymphopoietin (TSLP), IL-6, and IL-1, that results in a Th2-dominated immune response with a Th17 component in acute AD skin lesions and the progressive conversion to a Th1-dominated response in chronic AD skin lesions. Finally, we discuss the mechanisms of susceptibility of AD skin lesions to microbial infections and the role of microbial products in exacerbating skin inflammation in AD. Based on this information, we discuss current and future therapy of this common disease.
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Affiliation(s)
- Michiko K Oyoshi
- Division of Immunology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Lauria G, Lombardi R, Camozzi F, Devigili G. Skin biopsy for the diagnosis of peripheral neuropathy. Histopathology 2008; 54:273-85. [PMID: 18637969 DOI: 10.1111/j.1365-2559.2008.03096.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin biopsy has become an accepted tool for investigating small nerve fibres, which are invisible to conventional neurophysiological tests even though they are affected early on in peripheral neuropathies of varying aetiology. Morphometric analysis of epidermal and dermal nerves has proved to be reliable, reproducible and unaffected by the severity of neuropathy, making skin biopsy useful for diagnosing small fibre neuropathy (SFN) in clinical practice. The possibility of obtaining skin biopsy specimens from different sites of the body, to repeat them within the area of the same sensory nerve, to distinguish between somatic and autonomic nerves and to investigate the expression of nerve-related proteins has widened the potential applications of this technique to clinical research. Skin biopsy performed using a minimally invasive disposable punch is a safe and painless procedure. Using specific antibodies with bright-field immunohistochemistry or immunofluorescence technique, it is possible to investigate unmyelinated fibres innervating the epidermis of hairy and glabrous skin, large myelinated fibres supplying specialized corpuscles in glabrous skin, and autonomic fibres innervating sweat glands, blood vessels and arrector pilorum muscles. This review discusses the features of skin innervation in hairy and glabrous skin, the functional properties of skin nerve fibres and their changes in peripheral neuropathies.
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Affiliation(s)
- G Lauria
- Neuromuscular Diseases Unit, National Neurological Institute Carlo Besta, Milan, Italy.
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