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Grade IV Sacral Sore Treated with an Ointment Rich in PUFAs, Ceramides, and Antimicrobial Peptides. Case Rep Dermatol Med 2022; 2022:4445055. [PMID: 35295787 PMCID: PMC8920691 DOI: 10.1155/2022/4445055] [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: 07/13/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
This report presents the case of a 57-year-old male patient with a history of hypertension, obesity, dyslipidemia, and coronary disease that after a prolonged postcoronary surgery hospitalization developed a sacral butterfly-shaped sore, with asymmetric involvement of the base of both buttocks, grade III on the left and grade IV on the right sides. The lesion was very painful and had a negative impact on the patient's sleep and mood. Following the initial surgical debridement and treatment with collagenase ointment, the wound showed delayed healing, an increase in necrotic tissue, and purulent discharge, requiring a second surgical debridement that revealed a deeper involvement of the wound. After a month with poor therapeutic response, it was decided to change the treatment to the application of gauzes embedded in an ointment rich in polyunsaturated fatty acids (PUFAs), ceramides, and antimicrobial peptides, Curefini® ointment. After 30 days of treatment, a 50% reduction of the initial wound diameter was obtained with a positive impact on the patient's quality of life, together with a reduction of incidental and spontaneous local pain resulting in better night rest and a return of appetite and strength. During the treatment course, the patient did not suffer any local or systemic infection in connection with the wound. After one month, the patient could discontinue the use of opioid analgesics. A 95% closure of the lesion was achieved in 45 days. This case highlights the therapeutic efficacy of the treatment of cavitated wounds with a product based on natural ingredients that helps reduce pain and promotes granulation and reepithelialization.
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Moussalem C, Ftouni L, Abou Mrad Z, Bsat S, Houshiemy M, Alomari S, Omeis I. Negative pharmacological effect on spine fusion: A narrative review of the literature of evidence-based treatment. Clin Neurol Neurosurg 2021; 207:106799. [PMID: 34304068 DOI: 10.1016/j.clineuro.2021.106799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Spine fusion surgery is commonly performed for diverse indications, the most frequent one being degenerative spine diseases. Despite the growing importance of this surgery, there is limited evidence concerning the effects of drugs on the process of spine fusion and healing. While asymptomatic sometimes, nonunion of the spine can have tremendous repercussions on the patients' quality of life and the healthcare system rendering it an "expensive complication". This literature review identifies the role of some perioperative drugs in spine fusion and reveals their potential role in pseudarthrosis of the spine. This review also benefits spine surgeons looking for current evidence-based practices. We reviewed the data related to nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, vancomycin, bisphosphonates, proton pump inhibitors (PPIs), pregabalin, and opioids. From the available experimental and clinical studies, we conclude that bisphosphonates might positively influence the process of spine fusion, while steroids and vancomycin have shown variable effects, and the remaining medications likely disturb healing and union of the spine. We recommend spine surgeons be cautious about the drugs they resort to in the critical perioperative period until further clinical studies prove which drugs are safe to be used.
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Affiliation(s)
- Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Louna Ftouni
- Faculty of Medicine, Beirut Arab University, P.O. Box 11-5020, Riad El Solh 1107 2809, Lebanon.
| | - Zaki Abou Mrad
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Shadi Bsat
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Mohamad Houshiemy
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Safwan Alomari
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
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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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4
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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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5
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Shanmugam VK, Couch KS, McNish S, Amdur RL. Relationship between opioid treatment and rate of healing in chronic wounds. Wound Repair Regen 2017; 25:120-130. [PMID: 27865036 DOI: 10.1111/wrr.12496] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
Opioids are routinely used analgesics in patients with chronic wounds; however the impact of opioid exposure on wound healing is poorly understood. The purpose of this study was to investigate the association between opioid exposure and wound outcome in the Wound Etiology and Healing study. This longitudinal observational study was conducted on 450 subjects enrolled in the Wound Etiology and Healing biorepository. Data were collected prospectively including baseline characteristics, pain score, longitudinal opioid exposure, and total wound surface area (tWSA). Data were analyzed using static multivariate models, fixed-effects mixed models, and time to event analysis. Using fixed-effects models, opioid dose was significantly associated with tWSA after accounting for the effects of pain score and baseline co-variates (p < 0.0001). For each 1-unit increase in ln(opioid dose + 1) the ln(tWSA + 1) increased by 0.16 units (95% confidence interval 0.13-0.19, p < 0.0001). Visits where opioids were present had ln(tWSA + 1) 0.48 units larger (95% confidence interval 0.38-0.58, p < 0.0001) than visits with no opioid exposure. Using time-to-event analysis, patients who never received opioids healed faster than those who received opioids (log-rank chi-square 11.00, p = 0.0009). Using Cox regression analysis, patients with mean opioid dose ≥10 mg were significantly less likely to heal than those with no opioid (HR 0.67 [0.49-0.91], p = 0.011) after adjusting for wound size. Patients with opioid dose >0 to <10 mg had a similar hazard of not healing as those with no opioid exposure (HR 0.88 [0.65-1.19], p = 0.40). In conclusion, opioid analgesics are commonly prescribed to patients with chronic wounds; however, the data presented suggest that opioid exposure is associated with reduced likelihood of healing in patients with chronic wounds. Whether this is a causal relationship will require further study.
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Affiliation(s)
| | - Kara S Couch
- Division of Rheumatology, Ideas to Health Laboratory
| | - Sean McNish
- Division of Rheumatology, Ideas to Health Laboratory
| | - Richard L Amdur
- Department of Surgery, The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia
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6
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Bigliardi PL, Dancik Y, Neumann C, Bigliardi‐Qi M. Opioids and skin homeostasis, regeneration and ageing – What's the evidence? Exp Dermatol 2016; 25:586-91. [DOI: 10.1111/exd.13021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Paul L. Bigliardi
- YLL School of Medicine National University Singapore Singapore
- Division of Rheumatology University Medicine Cluster National University Hospital Singapore
- Experimental Dermatology Institute of Medical Biology Agency for Science Technology & Research (A*STAR) Singapore
| | - Yuri Dancik
- Experimental Dermatology Institute of Medical Biology Agency for Science Technology & Research (A*STAR) Singapore
| | - Christine Neumann
- Experimental Dermatology Institute of Medical Biology Agency for Science Technology & Research (A*STAR) Singapore
| | - Mei Bigliardi‐Qi
- Experimental Dermatology Institute of Medical Biology Agency for Science Technology & Research (A*STAR) Singapore
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Shanmugam VK, Fernandez SJ, Evans KK, McNish S, Banerjee AN, Couch KS, Mete M, Shara N. Postoperative wound dehiscence: Predictors and associations. Wound Repair Regen 2016; 23:184-90. [PMID: 25683272 DOI: 10.1111/wrr.12268] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 11/27/2022]
Abstract
The Agency for Healthcare Research and Quality patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI-14 measures postoperative wound dehiscence and specifically how often a surgical wound in the abdominal or pelvic area fails to heal after abdominopelvic surgery. Wound dehiscence is estimated to occur in 0.5-3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure as it impacts morbidity, length of stay, healthcare costs and readmission rates. Postoperative wound dehiscence cases from the Nationwide Inpatient Sample demonstrate 9.6% excess mortality, 9.4 days of excess hospitalization and $40,323 in excess hospital charges relative to matched controls. The purpose of the current study was to investigate the associations between PSI-14 and measurable medical and surgical comorbidities using the Explorys technology platform to query electronic health record data from a large hospital system serving a diverse patient population in the Washington, DC and Baltimore, MD metropolitan areas. The study population included 25,636 eligible patients who had undergone abdominopelvic surgery between January 1, 2008 and December 31, 2012. Of these cases, 786 (2.97%) had postoperative wound dehiscence. Patient-associated comorbidities were strongly associated with PSI-14, suggesting that this indicator may not solely be an indicator of hospital safety. There was a strong association between PSI-14 and opioid use after surgery and this finding merits further investigation.
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Affiliation(s)
- Victoria K Shanmugam
- Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Stephen J Fernandez
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland
| | - Karen Kim Evans
- Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
| | - Sean McNish
- Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Anirban N Banerjee
- Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Kara S Couch
- Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Mihriye Mete
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland
| | - Nawar Shara
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland
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8
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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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9
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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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10
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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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11
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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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12
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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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13
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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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14
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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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15
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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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Cheng B, Liu HW, Fu XB, Sheng ZY, Li JF. Coexistence and upregulation of three types of opioid receptors, mu, delta and kappa, in human hypertrophic scars. Br J Dermatol 2008; 158:713-20. [DOI: 10.1111/j.1365-2133.2008.08449.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liang D, Shi X, Qiao Y, Angst MS, Yeomans DC, Clark JD. Chronic morphine administration enhances nociceptive sensitivity and local cytokine production after incision. Mol Pain 2008; 4:7. [PMID: 18294378 PMCID: PMC2279109 DOI: 10.1186/1744-8069-4-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/22/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The chronic use of opioids prior to surgery leads to lowered pain thresholds and exaggerated pain levels after these procedures. Several mechanisms have been proposed to explain this heightened sensitivity commonly termed opioid-induced hyperalgesia (OIH). Most of these proposed mechanisms involve plastic events in the central or peripheral nervous systems. Alterations in the abundance of peripheral mediators of nociception have not previously been explored. RESULTS In these experiments mice were treated with saline (control) or ascending daily doses of morphine to generate a state of OIH followed by hind paw incision. In other experiments morphine treatment was initiated at the time of incision. Both mechanical allodynia and peri-incisional skin cytokine levels were measured. Myeloperoxidase (MPO) assays were used to determine neutrophil activity near the wounds. The cytokine production inhibitor pentoxifylline was used to determine the functional significance of the excess cytokines in previously morphine treated animals. Mice treated chronically treated with morphine prior to incision were found to have enhanced skin levels of IL-1beta, IL-6, G-CSF, KC and TNFalpha after incision at one or more time points compared to saline pretreated controls. The time courses of individual cytokines followed different patterns. There was no discernable effect of chronic morphine treatment on wound area neutrophil infiltration. Pentoxifylline reduced cytokine levels and reversed the excess mechanical sensitization caused by chronic morphine administration prior to incision. Morphine treatment initiated at the time of incision did not lead to a generalized enhancement of cytokine production or nociceptive sensitization in excess of the levels observed after incision alone. CONCLUSION The enhanced level of nociceptive sensitization seen after incision in animals chronically exposed to morphine is associated with elevated levels of several cytokines previously reported to be relevant to this incisional pain model. The cytokines may be functional in supporting nociceptive sensitization because pentoxifylline reverses both peri-incisional skin cytokine levels and OIH. Opioid administration beginning at the time of incision does not seem to have the same cytokine enhancing effect. Approaches to postoperative pain control involving a reduction of cytokines may be an effective way to control excessive pain in patients chronically using opioids prior to surgical procedures.
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Affiliation(s)
- DeYong Liang
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
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Worrich S, Schuler G, Janicki PK. Effect of Local Administration of Transdermal Fentanyl on Peripheral Opioid Analgesia. PAIN MEDICINE 2007; 8:41-7. [PMID: 17244103 DOI: 10.1111/j.1526-4637.2007.00144.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Transdermal fentanyl is a commonly used analgesic for the treatment of severe chronic pain. Recent investigations have shown the presence of mu-opioid receptors in the skin and opioid analgesic efficacy with alternative routes of administration of narcotics. This placebo-controlled, double-blind prospective study assessed whether transdermal fentanyl administration produces local peripheral opioid analgesia at the site of application. DESIGN Baseline pain threshold and supra-threshold pain intensity assessments were measured using Quantitative Sensory Testing in 12 healthy volunteers. Placebo and fentanyl containing patches (Duragesic, 25 microg/h) were applied to opposite forearms for 2 h. After patch removal, pain threshold, supra-threshold pain response, and the area of secondary hyperalgesia were evaluated for both forearms. RESULTS No statistically significant differences in pain threshold, supra-threshold pain intensity, or area of hyperalgesia in fentanyl- versus placebo-treated forearms were detected in the study subjects. CONCLUSION These results suggest that the application of transdermal fentanyl patch for a period of 2 h does not produce local peripheral opioid analgesia at the site of patch application.
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Affiliation(s)
- Scott Worrich
- Department of Anesthesiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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Salemi S, Aeschlimann A, Reisch N, Jüngel A, Gay RE, Heppner FL, Michel BA, Gay S, Sprott H. Detection of kappa and delta opioid receptors in skin--outside the nervous system. Biochem Biophys Res Commun 2005; 338:1012-7. [PMID: 16263089 DOI: 10.1016/j.bbrc.2005.10.072] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 10/07/2005] [Indexed: 12/22/2022]
Abstract
Opioid receptors (OR) are widely expressed in the central nervous system (CNS). Opioid antinociception might be initiated by activation of OR outside the CNS, indicating targeting of peripheral OR could be useful in the treatment of chronic pain. This study was designed to detect OR in skin tissues of healthy volunteers at both mRNA and protein levels. Skin samples from 10 healthy individuals were investigated. Total isolated RNAs were reverse transcribed, amplified and quantified by real-time PCR. Tissue and skin fibroblast OR protein was detected by immunohistochemistry, Western blot, and immunofluorescence. All skin tissue samples expressed delta- (DOR) and kappa-OR (KOR) mRNAs. Using immunohistochemistry, DOR and KOR were localized in skin fibroblast-like and mononuclear cells. Skin fibroblasts in culture expressed DOR and KOR mRNA. Using immunofluorescence, both DOR and KOR proteins were expressed predominantly on the cell membrane with minor staining in the cytoplasm. We suggest that enhanced expression of DOR and KOR in skin justifies the exploration of selective novel delta and kappa agonists for local pain treatment.
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Affiliation(s)
- Souzan Salemi
- Center of Experimental Rheumatology, Department of Rheumatology, Institute of Physical Medicine, University Hospital, Gloriastrasse 25, Zurich, Switzerland
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Holló P, Bender T, Marschalkó M, Gonzalez R, Barna I, Horváth A. No significant change of plasma beta-endorphin levels of psoriasis patients after synchronous balneophototherapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2004; 20:205-9. [PMID: 15238099 DOI: 10.1111/j.1600-0781.2004.00105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Previous studies suggested that beta-endorphin has a pathogenic role in psoriasis: its increased plasma concentration may play a role in the neuroimmunological processes in the pathomechanism of the disease, and plasma beta-endorphin levels should reflect the changes in the patients' skin status. The purpose of this study was to investigate the changes of peripheral blood beta-endorphin levels in psoriatic patients in conjunction with changes in their skin symptoms after synchronous balneophototherapy. METHODS With synchronous balneophototherapy, 12 patients with extended skin symptoms of psoriasis were treated. The therapy followed the Regensburg protocol, consisting of a basic course of 35 sessions. Patients' skin status was characterized by evaluating the Psoriasis Area and Severity Index score before and after the therapy course. Blood samples were taken before treatment, and 1 day after the last session, with symptom-free skin. Plasma beta-endorphin levels were measured by a specific radioimmunoassay developed by the authors. RESULTS There was no significant change in plasma levels of beta-endorphin after clinical clearance of psoriatic skin symptoms. CONCLUSION In this non-randomized, uncontrolled study no significant difference could be detected between plasma beta-endorphin levels before and after a basic course of synchronous balneophototherapy in patients with psoriasis. Although beta-endorphin has many neuroimmunological effects, the changes of its plasma level do not consistently reflect the skin status. Inflammation in psoriatic skin lesions is probably not mediated directly by circulating beta-endorphin.
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Affiliation(s)
- P Holló
- Department of Dermatovenerology and Oncodermatology, Semmelweis University, Maria u.41, 1085 Budapest, Hungary.
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Yosipovitch G. Dry skin and impairment of barrier function associated with itch - new insights. Int J Cosmet Sci 2004; 26:1-7. [DOI: 10.1111/j.0142-5463.2004.00199.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bigliardi PL, Sumanovski LT, Büchner S, Rufli T, Bigliardi-Qi M. Different expression of mu-opiate receptor in chronic and acute wounds and the effect of beta-endorphin on transforming growth factor beta type II receptor and cytokeratin 16 expression. J Invest Dermatol 2003; 120:145-52. [PMID: 12535211 DOI: 10.1046/j.1523-1747.2003.12018.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is evidence that neuropeptides, especially the opiate receptor agonists, are involved in wound healing. We have previously observed that beta-endorphin, the endogenous ligand for the mu-opiate receptor, stimulates the expression of cytokeratin 16 in a dose-dependent manner in human skin organ cultures. Cytokeratin 16 is expressed in hyperproliferative epidermis such as psoriasis and wound healing. Therefore we were interested to study whether epidermal mu-opiate receptor expression is changed at the wound margins in acute and chronic wounds. Using classical and confocal microscopy, we were able to compare the expression level of mu-opiate receptors and the influence of beta-endorphin on transforming growth factor beta type II receptor in organ culture. Our results show indeed a significantly decreased expression of mu-opiate receptors on keratinocytes close to the wound margin of chronic wounds compared to acute wounds. Additionally beta-endorphin upregulates the expression of transforming growth factor beta type II receptor in human skin organ cultures. These results suggest a crucial role of opioid peptides not only in pain control but also in wound healing. Opioid peptides have already been used in animal models in treatment of wounds; they induce fibroblast proliferation and growth of capillaries, and accelerate the maturation of granulation tissue and the epithelization of the defect. Furthermore opioid peptides may fine-tune pain and the inflammatory response while healing takes place. This new knowledge could potentially be used to design new locally applied drugs to improve the healing of painful chronic wounds.
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Affiliation(s)
- P L Bigliardi
- Department of Dermatology, University of Basel and Kantonsspital Schauffhausen, Switzerland.
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Southall MD, Li T, Gharibova LS, Pei Y, Nicol GD, Travers JB. Activation of epidermal vanilloid receptor-1 induces release of proinflammatory mediators in human keratinocytes. J Pharmacol Exp Ther 2003; 304:217-22. [PMID: 12490594 DOI: 10.1124/jpet.102.040675] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During dermal injury and the associated trauma a number of compounds are released that can mediate the inflammatory response. Determining the cellular mechanisms that initiate the inflammatory responses to acute keratinocyte damage is important for understanding the regulation of epidermal inflammation. The recently cloned vanilloid receptor-1 (VR1) is a polymodal receptor, responding to thermal, pH, or vanilloids such as capsaicin stimulation. Although VR1 has been localized only on sensory neurons and within the central nervous system, recent evidence suggests a functional VR1 is expressed in human skin and epidermal cells. Using reverse transcription-polymerase chain reaction and immunoblotting we report that human keratinocytes and the human keratinocyte cell line HaCaT express VR1. Consistent with neuronal VR1, activation of epidermal VR1 by capsaicin induced a calcium influx. Treating HaCaT cells with capsaicin resulted in a dose-dependent expression of cyclooxygenase-2 (COX-2), whereas pretreatment with the VR1 receptor antagonist capsazepine abolished the capsaicin-stimulated increase in COX-2 expression. Furthermore, the capsaicin-induced expression of COX-2 was dependent on extracellular calcium. Activation of the epidermal VR1 by capsaicin also resulted in an increased release of interleukin-8 and prostaglandin E2, and the stimulated release was attenuated by capsazepine. The finding that VR1 is expressed by keratinocytes is of great importance because it expands the putative role of VR1 beyond that of pain perception. Our results suggest that VR1 expression in keratinocytes may have a role in the inflammation that occurs secondary to epidermal damage or insult, and thus may function as a sensor for noxious cutaneous stimulation.
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Affiliation(s)
- Michael D Southall
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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