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Therapeutic potential of bromhexine for acute itch in mice: Involvement of TMPRSS2 and kynurenine pathway. Int Immunopharmacol 2023; 117:109919. [PMID: 36842232 DOI: 10.1016/j.intimp.2023.109919] [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: 12/07/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/28/2023]
Abstract
Itching is an unpleasant sensation on the skin that could negatively impact the quality of life. Over the years, many non-pharmacological and pharmacological approaches have been introduced to mitigate this burdensome condition; However, the effectiveness of these methods remains questioned. Bromhexine, derived from the Adhatoda vasica plant, is a safe drug with minimal side effects. It has been widely used in managing respiratory symptoms over the years. The results of our study revealed that bromhexine has the potential to alleviate acute itch induced by Compound 48/80, a known mast cell destabilizer. According to our findings, bromhexine exerts its antipruritic effects primarily by inhibiting the Transmembrane Protein Serine Protease 2 (TMPRSS2) and, to a lesser extent, by decreasing the activation of the Kynurenine Pathway (KP). We further investigated the KP involvement by administrating 1-Methyl Tryptophan (1-MT), a known indoleamine-2,3-dioxygenase (IDO) inhibitor. 1-MT was found to be effective in reducing the itch itself. Moreover, co-administration of bromhexine and 1-MT resulted in synergistic antipruritic effects, suggesting that KP plays a role in acute itch. To conclude, we have presented for the first time a repositioning of bromhexine as a treatment for acute itch. In addition, we addressed the involvement of TMPRSS2 and KP in this process.
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Gazerani P. How Does Botulinum Toxin Inhibit Itch? Toxins (Basel) 2022; 14:toxins14100701. [PMID: 36287970 PMCID: PMC9610088 DOI: 10.3390/toxins14100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Two decades after reports of the anti-pruritic effects of botulinum neurotoxins (BoNTs), there is still no approved product for the anti-itch indication of BoNTs, and most clinical case reports still focus on the off-label use of BoNTs for various itchy conditions. Few randomized clinical trials have been conducted with controversial results, and the beneficial effects of BoNTs against itch are mainly based on case studies and case series. These studies are valuable in presenting the potential application of BoNTs in chronic pruritic conditions, but due to the nature of these studies, they are categorized as providing lower levels of evidence or lower grades of recommendation. To obtain approval for the anti-pruritic indication of BoNTs, higher levels of evidence are required, which can be achieved through conducting large-scale and well-designed studies with proper control groups and established careful and reliable primary and secondary outcomes. In addition to clinical evidence, presenting the mechanism-based antipruritic action of BoNTs can potentially strengthen, accelerate, and facilitate the current efforts towards further investments in accelerating the field towards the potential approval of BoNTs for itchy conditions. This review, therefore, aimed to provide the state-of-the-art mechanisms underlying the anti-itch effect of BoNTs from basic studies that resemble various clinical conditions with itch as a hallmark. Evidence of the neuronal, glial, and immune modulatory actions of BoNTs in reducing the transmission of itch are presented, and future potential directions are outlined.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg East, Denmark
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Sakamoto N, Haraguchi T, Kobayashi K, Miyazaki Y, Murata T. Automated scratching detection system for black mouse using deep learning. Front Physiol 2022; 13:939281. [PMID: 35936901 PMCID: PMC9352956 DOI: 10.3389/fphys.2022.939281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
The evaluation of scratching behavior is important in experimental animals because there is significant interest in elucidating mechanisms and developing medications for itching. The scratching behavior is classically quantified by human observation, but it is labor-intensive and has low throughput. We previously established an automated scratching detection method using a convolutional recurrent neural network (CRNN). The established CRNN model was trained by white mice (BALB/c), and it could predict their scratching bouts and duration. However, its performance in black mice (C57BL/6) is insufficient. Here, we established a model for black mice to increase prediction accuracy. Scratching behavior in black mice was elicited by serotonin administration, and their behavior was recorded using a video camera. The videos were carefully observed, and each frame was manually labeled as scratching or other behavior. The CRNN model was trained using the labels and predicted the first-look videos. In addition, posterior filters were set to remove unlikely short predictions. The newly trained CRNN could sufficiently detect scratching behavior in black mice (sensitivity, 98.1%; positive predictive rate, 94.0%). Thus, our established CRNN and posterior filter successfully predicted the scratching behavior in black mice, highlighting that our workflow can be useful, regardless of the mouse strain.
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Riccio D, Andersen HH, Arendt-Nielsen L. Mild Skin Heating Evokes Warmth Hyperknesis Selectively for Histaminergic and Serotoninergic Itch in Humans. Acta Derm Venereol 2022; 102:adv00649. [PMID: 35083491 PMCID: PMC9558757 DOI: 10.2340/actadv.v102.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic itch can severely affect quality of life. Patients report that their chronic itch can be exacerbated by exposure to warm conditions (“warmth hyperknesis”). The aim of this mechanistic study was to investigate the effect of mild heating of the skin in humans on various experimental models of itch. A total of 18 healthy subjects were recruited to the study. Itch was provoked by histamine, serotonin, or cowhage in 3 different sessions. The provoked area was heated with an infrared lamp, and the skin temperature was either not altered, or was increased by 4°C or 7°C. Subsequent to induction of itch, the itch intensity was recorded for 10 min while the skin was heated continuously throughout the entire period of itch induction. Heating the skin resulted in a significant increase in itch intensity when provoked by histamine or serotonin. It is possible that thermoception and pruriception interact and selectively produce a higher itch intensity in histaminergic and serotoninergic itch.
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Affiliation(s)
| | | | - Lars Arendt-Nielsen
- Faculty of Medicine, Aalborg University, Fredrik Bajers Vej, D3-212, DK-9220 Aalborg East, Denmark.
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3'-O-Methylorobol Inhibits the Voltage-Gated Sodium Channel Nav1.7 with Anti-Itch Efficacy in A Histamine-Dependent Itch Mouse Model. Int J Mol Sci 2019; 20:ijms20236058. [PMID: 31805638 PMCID: PMC6928743 DOI: 10.3390/ijms20236058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023] Open
Abstract
An itch is a clinical complication that affects millions of patients. However, few treatment options are available. The voltage-gated sodium channel Nav1.7 is predominantly expressed in peripheral sensory neurons and is responsible for the rising phase of action potentials, thereby mediating nociceptive conduction. A gain-of-function mutation of Nav1.7 results in the hyperexcitability of sensory neurons and causes the inherited paroxysmal itch. Conversely, a monoclonal antibody that selectively inhibits Nav1.7 is able to effectively suppress the histamine-dependent itch in mice. Therefore, Nav1.7 inhibitors may possess the potential to relieve the itch. In the present study, using whole-cell voltage-clamp recordings, we demonstrated that 3’-O-methylorobol inhibited Na+ currents in Nav1.7-CHO cells and tetrodotoxin-sensitive Na+ currents in mouse dorsal root ganglion (DRG) neurons with IC50 (half-maximal inhibitory concentration) values of 3.46 and 6.60 μM, respectively. 3’-O-methylorobol also suppressed the tetrodotoxin-resistant Na+ currents in DRG neurons, though with reduced potency (~43% inhibition at 30 µM). 3’-O-methylorobol (10 µM) affected the Nav1.7 by shifting the half-maximal voltage (V1/2) of activation to a depolarizing direction by ~6.76 mV, and it shifted the V1/2 of inactivation to a hyperpolarizing direction by ~16.79 mV. An analysis of 3’-O-methylorobol activity toward an array of itch targets revealed that 3’-O-methylorobol was without effect on histamine H1 receptor, TRPV1, TRPV3, TRPV4, TRPC4 and TRPM8. The intrathecal administration of 3’-O-methylorobol significantly attenuated compound 48/80-induced histamine-dependent spontaneous scratching bouts and the expression level of c-fos in the nuclei of spinal dorsal horn neurons with a comparable efficacy to that of cyproheptadine. Our data illustrated the therapeutic potential for 3’-O-methylorobol for histamine-dependent itching, and the small molecule inhibition of Nav1.7 may represent a useful strategy to develop novel therapeutics for itching.
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Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. J Eur Acad Dermatol Venereol 2019; 34:239-250. [PMID: 31566796 PMCID: PMC7027518 DOI: 10.1111/jdv.15973] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.
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Affiliation(s)
- G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - T Berger
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M S Fassett
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. Pain 2019; 160:2661-2678. [DOI: 10.1097/j.pain.0000000000001678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Hawro T, Lehmann S, Deuring E, Weller K, Altrichter S, Church M, Maurer M, Metz M. Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage. J Eur Acad Dermatol Venereol 2019; 33:1755-1761. [DOI: 10.1111/jdv.15743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Hawro
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Lehmann
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - E. Deuring
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M.K. Church
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Itch induced by peripheral mu opioid receptors is dependent on TRPV1-expressing neurons and alleviated by channel activation. Sci Rep 2018; 8:15551. [PMID: 30341332 PMCID: PMC6195532 DOI: 10.1038/s41598-018-33620-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022] Open
Abstract
Opioids remain the gold standard for the treatment of moderate to severe pain. However, their analgesic properties come with important side effects, including pruritus, which occurs frequently after systemic or neuraxial administration. Although part of the opioid-induced itch is mediated centrally, recent evidence shows that the opioid receptor system in the skin also modulates itch. The goal of our study was to identify the peripherally located transducer mechanisms involved in opioid-induced pruritus. Scratching behaviors in response to an intradermal injection of the mu-opioid receptor (MOR) agonist [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO) was quantified in mast cell-, PAR2- and TRPV1-deficient mice or following ablation of TRPV1+ sensory neurons. We found that mast cells−/−, PAR-2−/−, or TRPV1−/− mice still exhibit DAMGO-induced itch responses. However, we show that ablation of TRPV1+ neurons or acute TRPV1 activation by capsaicin abolishes DAMGO-induced itch. Overall, our work shows that peripheral DAMGO-induced itch is dependent on the presence of TRPV1-expressing pruriceptors, but not the TRPV1 channel itself. Activation of these fibers by capsaicin prevents the opioid-induced itch.
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Mueller S, Fischer M, Herger S, Nüesch C, Egloff C, Itin P, Cajacob L, Brandt O, Mündermann A. Good vibrations: Itch induction by whole body vibration exercise without the need of a pruritogen. Exp Dermatol 2018; 28:1390-1396. [DOI: 10.1111/exd.13776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Simon Mueller
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
| | - Marilena Fischer
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
- Department of Orthopaedics and TraumatologyUniversity Hospital Basel Basel Switzerland
| | - Simon Herger
- Department of Orthopaedics and TraumatologyUniversity Hospital Basel Basel Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and TraumatologyUniversity Hospital Basel Basel Switzerland
- Department of Biomedical EngineeringUniversity of Basel Basel Switzerland
| | - Christian Egloff
- Department of Orthopaedics and TraumatologyUniversity Hospital Basel Basel Switzerland
| | - Peter Itin
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
| | - Lucian Cajacob
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
| | - Oliver Brandt
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and TraumatologyUniversity Hospital Basel Basel Switzerland
- Department of Biomedical EngineeringUniversity of Basel Basel Switzerland
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Nakamura T, Yoshida N, Anzawa K, Nishibu A, Mochizuki T. Itching in a trichophytin contact dermatitis mouse model and the antipruritic effect of antifungal agents. Clin Exp Dermatol 2018; 44:381-389. [PMID: 30187507 DOI: 10.1111/ced.13719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tinea is an infectious disease by dermatophytes, of which Trichophyton species accounts for the overwhelming majority of case. Tinea often causes itching with inflammation. In terms of pruritus by fungal infection, however, tinea has not been investigated sufficiently to date. AIM To evaluate itch caused by Trichophyton infection and the effect of antifungal agents on the infection, by measuring scratch behaviour and profiles of inflammatory cytokines and chemokines. METHODS We used a previously established mouse model of contact hypersensitivity induced by trichophytin, a crude extract from Trichophyton mentagrophytes. Scratching behaviour was recorded using a counting device that measured an electric current induced in a coil by movement of magnets that had been inserted into the hind paws of each animal. We investigated expression of various genes in lesional skin of mice and in normal human epidermal keratinocytes. We also investigated the antipruritic effects of the corticosteroid dexamethasone (DEX) and three antifungal agents: ketoconazole (KCZ), terbinafine (TBF) and liranaftate (LNF). RESULTS Biphasic peaks of scratching were observed at 1 h and at 6-7 h during an observation period of 14 h after trichophytin induction. For lesional skin, RNA was extracted 24 h after trichophytin challenge, and increased expression was seen in the genes for interleukin (IL)-17A, interferon-γ, tumour necrosis factor (TNF)-α, macrophage inflammatory protein (MIP)-2 and Dectin-1, whereas there was no obvious change in the genes for IL-31 and prostaglandin (PG)E2. Furthermore, KCZ inhibited histidine decarboxylase (HDC) expression in vitro and in vivo, and inhibited scratching in the very early phase. LNF inhibited expression of thymic stromal lymphopoietin (TSLP) and IL-8 in vitro, and TSLP, TNF-α, IL-1α and MIP2 in vivo, and also scratching in the early phase. TBF did not induce any significant alterations in either gene expression or scratching. DEX suppressed expression of all the chemical mediators except HDC in vitro and in vivo, and inhibited scratching. CONCLUSION Antifungals can inhibit itching induced by fungal infection through different mechanisms.
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Affiliation(s)
- T Nakamura
- Department of R&D Center, Ikeda Mohando Co. Ltd, Toyama, Japan.,Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - N Yoshida
- Department of R&D Center, Ikeda Mohando Co. Ltd, Toyama, Japan
| | - K Anzawa
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - A Nishibu
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - T Mochizuki
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
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Andersen HH, Akiyama T, Nattkemper LA, van Laarhoven A, Elberling J, Yosipovitch G, Arendt-Nielsen L. Alloknesis and hyperknesis—mechanisms, assessment methodology, and clinical implications of itch sensitization. Pain 2018; 159:1185-1197. [DOI: 10.1097/j.pain.0000000000001220] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Antipruritic Effects of Botulinum Neurotoxins. Toxins (Basel) 2018; 10:toxins10040143. [PMID: 29596343 PMCID: PMC5923309 DOI: 10.3390/toxins10040143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022] Open
Abstract
This review explores current evidence to demonstrate that botulinum neurotoxins (BoNTs) exert antipruritic effects. Both experimental and clinical conditions in which botulinum neurotoxins have been applied for pruritus relief will be presented and significant findings will be highlighted. Potential mechanisms underlying antipruritic effects will also be discussed and ongoing challenges and unmet needs will be addressed.
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Andersen HH, Lo Vecchio S, Elberling J, Yosipovitch G, Arendt-Nielsen L. UVB- and NGF-induced cutaneous sensitization in humans selectively augments cowhage- and histamine-induced pain and evokes mechanical hyperknesis. Exp Dermatol 2018; 27:258-267. [DOI: 10.1111/exd.13508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Hjalte H. Andersen
- Laboratory for Experimental Cutaneous Pain and Itch Research, SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Silvia Lo Vecchio
- Laboratory for Experimental Cutaneous Pain and Itch Research, SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Jesper Elberling
- The Allergy Clinic, Department of Dermato-Allergology; Copenhagen University Hospital; Gentofte, Copenhagen Denmark
| | - Gil Yosipovitch
- Department of Dermatology and Itch Center; University of Miami School of Medicine, Florida; Miami FL USA
| | - Lars Arendt-Nielsen
- Laboratory for Experimental Cutaneous Pain and Itch Research, SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
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Attenuation of serotonin-induced itch by sumatriptan: possible involvement of endogenous opioids. Arch Dermatol Res 2018; 310:165-172. [DOI: 10.1007/s00403-018-1809-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 02/03/2023]
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16
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Tarrasón G, Carcasona C, Eichhorn P, Pérez B, Gavaldà A, Godessart N. Characterization of the chloroquine-induced mouse model of pruritus using an automated behavioural system. Exp Dermatol 2017; 26:1105-1111. [DOI: 10.1111/exd.13392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Gema Tarrasón
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Carla Carcasona
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Peter Eichhorn
- Pharmacokinetics and Metabolism; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Bibiana Pérez
- Pharmacokinetics and Metabolism; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Amadeu Gavaldà
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Núria Godessart
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
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