Physical dependence of opiate-like peptides

Synthesis of the Mechanisms of Opioid Tolerance: Do We Still Say NO?

The use of morphine as a first-line agent for moderate-to-severe pain is limited by the development of analgesic tolerance. Initially opioid receptor desensitization in response to repeated stimulation, thought to underpin the establishment of tolerance, was linked to a compensatory increase in adenylate cyclase responsiveness. The subsequent demonstration of cross-talk between N-methyl-D-aspartate (NMDA) glutamate receptors and opioid receptors led to the recognition of a role for nitric oxide (NO), wherein blockade of NO synthesis could prevent tolerance developing. Investigations of the link between NO levels and opioid receptor desensitization implicated a number of events including kinase recruitment and peroxynitrite-mediated protein regulation. Recent experimental advances and the identification of new cellular constituents have expanded the potential signaling candidates to include unexpected, intermediary compounds not previously linked to this process such as zinc, histidine triad nucleotide-binding protein 1 (HINT1), micro-ribonucleic acid (mi-RNA) and regulator of G protein signaling Z (RGSZ). A further complication is a lack of consistency in the protocols used to create tolerance, with some using acute methods measured in minutes to hours and others using days. There is also an emphasis on the cellular changes that are extant only after tolerance has been established. Although a review of the literature demonstrates a lack of spatio-temporal detail, there still appears to be a pivotal role for nitric oxide, as well as both intracellular and intercellular cross-talk. The use of more consistent approaches to verify these underlying mechanism(s) could provide an avenue for targeted drug development to rescue opioid efficacy.

The Use of Psychotropic Medication for People with Severe Disabilities and Challenging Behavior: Current Status and Future Directions

People with severe disabilities who engage in challenging behavior are often prescribed psychotropic medication as a form of intervention. Although the goal of the medication is to reduce challenging behavior, limited empirical evidence is available to support the use of psychotropic intervention for people with severe disabilities. However, across a range of drug classes basic research suggests that many psychotropic medications selectively affect dimensions of behavior that could be of benefit in reducing challenging behavior. Currently, researchers cannot demonstrate whether most drugs prescribed to reduce challenging behavior are effective or predict when adverse side effects will emerge from their use. In this article we review the basic literature on behavioral pharmacology and integrate those findings with existing applied research to update JASH readers regarding the status of psychotropic medication. From this review, we present a set of suggestions that include: (a) improving research practices, (b) increasing the diversity of individuals involved in decision-making processes regarding medication use, and (c) developing consumer-friendly strategies for monitoring drug effects.

An emerging new paradigm in opioid withdrawal: a critical role for glia-neuron signaling in the periaqueductal gray

The chronic use of opiates (i.e., narcotics such as the natural derivatives of opium including morphine or codeine) or opioids (i.e., semisynthetic derivatives of opium and other molecules that activate opioid receptors) induces dependence, which is associated with various specific behavioral and somatic signs after their withdrawal or after the administration of an opioid antagonist. Among the brain regions implicated in opiate dependence and withdrawal, the periaqueductal gray area (PAG) appears to be critical in regulating the complex signs and symptoms of opioid withdrawal. Numerous neurochemical mechanisms in the PAG have been identified that may contribute to the opioid withdrawal syndrome. Accumulating evidence suggests that glial activation leading to the release of proinflammatory molecules acting on neurons is important in the complex syndrome of opioid dependence and withdrawal. This paper focuses on the recent advances in our understanding of the vital role that glia-neuron interactions play in opioid dependence and withdrawal within the PAG. We summarize those neurochemical mechanisms associated with opioid withdrawal including the recently defined importance of TNFα release from activated glial cells that communicate with TNF receptors on PAG neurons.

The role of TNFα in the periaqueductal gray during naloxone-precipitated morphine withdrawal in rats

Tolerance and dependence are common complications of long-term treatment of pain with opioids, which substantially limit the long-term use of these drugs. The mechanisms underlying these phenomena are poorly understood. Studies have implicated the midbrain periaqueductal gray (PAG) in the pathogenesis of morphine withdrawal, and recent evidence suggests that proinflammatory cytokines in the PAG may play an important role in morphine withdrawal. Here we report that chronic morphine withdrawal-induced upregulation of glial fibrillary acidic protein (GFAP), tumor necrosis factor alpha (TNFα) and phosphorylation of ERK1/2 (pERK1/2) in the caudal ventrolateral PAG (vlPAG). Microinjection of recombinant TNFα into the vlPAG followed by intraperitoneal naloxone resulted in morphine withdrawal-like behavioral signs, and upregulation of pERK1/2, expression of Fos, and phosphorylation of cAMP response element binding (pCREB) protein. We used a herpes simplex virus (HSV)-based vector expressing p55 soluble TNF receptor (sTNFR) microinjected into the PAG to examine the role of the proinflammatory cytokine TNFα in the PAG in the naloxone-precipitated withdrawal response. Microinjection of HSV vector expressing sTNFR into the PAG before the start of morphine treatment significantly reduced the naloxone-precipitated withdrawal behavioral response and downregulated the expression of GFAP and TNFα in astrocytes of the PAG. TNFR type I colocalized with neuronal pERK1/2. Microinjection of HSV vector expressing sTNFR into the PAG also significantly reduced the phosphorylation of both ERK1/2 and CREB, and reduced Fos immunoreactivity in neurons of the PAG following naloxone-precipitated withdrawal. These results support the concept that proinflammatory cytokines expressed in astrocytes in the PAG may play an important role in the pathogenesis of morphine withdrawal response.

Beta-endorphin and drug-induced reward and reinforcement

Although drugs of abuse have different acute mechanisms of action, their brain pathways of reward exhibit common functional effects upon both acute and chronic administration. Long known for its analgesic effect, the opioid beta-endorphin is now shown to induce euphoria, and to have rewarding and reinforcing properties. In this review, we will summarize the present neurobiological and behavioral evidences that support involvement of beta-endorphin in drug-induced reward and reinforcement. Currently, evidence supports a prominent role for beta-endorphin in the reward pathways of cocaine and alcohol. The existing information indicating the importance of beta-endorphin neurotransmission in mediating the reward pathways of nicotine and THC, is thus far circumstantial. The studies described herein employed diverse techniques, such as biochemical measurements of beta-endorphin in various brain sites and plasma, and behavioral measurements, conducted following elimination (via administration of anti-beta-endorphin antibodies or using mutant mice) or augmentation (by intracerebral administration) of beta-endorphin. We suggest that the reward pathways for different addictive drugs converge to a common pathway in which beta-endorphin is a modulating element. Beta-endorphin is involved also with distress. However, reviewing the data collected so far implies a discrete role, beyond that of a stress response, for beta-endorphin in mediating the substance of abuse reward pathway. This may occur via interacting with the mesolimbic dopaminergic system and also by its interesting effects on learning and memory. The functional meaning of beta-endorphin in the process of drug-seeking behavior is discussed.

Nicotine attenuates place aversion induced by naloxone in single-dose, morphine-treated rats

RATIONALE

Acute physical dependence refers to the withdrawal syndrome precipitated by an opioid antagonist administered several hours after either a single dose or a short-term infusion of an opioid agonist.

OBJECTIVES

We examined the mechanism of nicotine-induced attenuation of naloxone-precipitated withdrawal syndrome when used to produce an aversive motivational state in a place-conditioning paradigm.

METHODS

The effect of nicotine was investigated through place aversion induced by naloxone in morphine-pretreated rats. Additionally, the mechanism of nicotine action in this model was explored specifically in relation to the dopaminergic system through the use of dopamine receptor antagonist and agonist.

RESULTS

Place avoidance behavior was potently elicited by naloxone (0.5 mg/kg s.c.) 24 h after a single exposure to morphine (10 mg/kg s.c.). Avoidance behavior was attenuated by pretreatment with a 0.2-mg/kg dose of nicotine 15 min prior to naloxone administration. The effect of nicotine was completely blocked by mecamylamine, but not hexamethonium. The dopamine receptor antagonists haloperidol (0.05, 0.1 mg/kg, s.c.), SCH23390 (0.1 mg/kg, s.c.), raclopride (1.0 mg/kg, s.c.) and eticlopride (0.1 mg/kg, s.c.) showed effects similar to mecamylamine. Additionally, the dopamine receptor agonist apomorphine (0.03, 0.1, 0.3 mg/kg, s.c.) inhibited naloxone-induced place aversion in morphine-treated rats.

CONCLUSION

The inhibitory effect of nicotine on place aversion induced by naloxone-precipitated morphine withdrawal may involve a dopaminergic portion of the central nervous system.

Effects of naloxone and post-tetanic stimulation on isolated guinea-pig ileum followed by long exposure to morphine and bestatin

This study was performed to compare the effects of naloxone (NLX) and post-tetanic stimulation on isolated guinea-pig ileum followed by prolonged exposure to morphine and bestatin. Morphine or bestatin alone did not induce any responses. In the presence of 1 microM morphine, the challenge with 1 microM naloxone caused quick contraction and post-tetanic contraction. A longer duration of these NLX-induced contraction and post-tetanic contractions was observed at the 6th stimulation compared to those after the 2nd stimulation. By contrast, the addition of bestatin, an aminopeptidase inhibitor, did not induce any NLX-induced contraction, although the same results for post-tetanic contraction as those of morphine were observed. These different effects of morphine and bestatin on NLX-induced contraction and post-tetanic contraction in the ileum may be due to different mechanisms of action in the opioid system. That in turn may suggest the possibility that bestatin has a physical dependence liability.

Acute opioid receptor desensitization and tolerance: is there a link?

1. Morphine, used long-term for the treatment of pain, results in drug tolerance. The therapeutic benefits, as well as side effects, of morphine are mediated predominantly via activation of mu-opioid receptors. Although the underlying mechanisms for opioid tolerance remains unclear, early adaptive processes, such as acute receptor desensitization and receptor downregulation, have been suggested to be crucial to the development of opioid tolerance. 2. Other neuroadaptations resulting from chronic opioid use include upregulation of the cAMP pathway, an increase in the cAMP response element-binding protein and Fos-related antigens. However, the connection between upregulation of these cellular elements and the mechanism behind the behavioural phenomenon remains unclear. 3. Acute receptor desensitization is thought to occur via uncoupling of the receptor and G-protein, which is followed by internalization of the receptor from the cell membrane. This process occurs after a few minutes of agonist exposure. Receptor-G-protein uncoupling is mediated via phosphorylation of putative sites on the intracellular loops of activated receptors. 4. Acute desensitization and downregulation of receptors both result in a reduction of agonist efficacy. These events occur early in the cascade of cellular adaptation; however, it is uncertain whether these processes contribute to the long-term changes in receptor sensitivity that occur after repeated exposure to opioids. 5. Acute desensitization may, in fact, be a protective mechanism whereby cells adapt to avoid the development of physiological drug tolerance by rapidly attenuating receptor-mediated signalling. Those drugs that do not cause receptor internalization, such as morphine, may have higher propensities to develop tolerance.

Cellular and synaptic adaptations mediating opioid dependence

Although opioids are highly effective for the treatment of pain, they are also known to be intensely addictive. There has been a massive research investment in the development of opioid analgesics, resulting in a plethora of compounds with varying affinity and efficacy at all the known opioid receptor subtypes. Although compounds of extremely high potency have been produced, the problem of tolerance to and dependence on these agonists persists. This review centers on the adaptive changes in cellular and synaptic function induced by chronic morphine treatment. The initial steps of opioid action are mediated through the activation of G protein-linked receptors. As is true for all G protein-linked receptors, opioid receptors activate and regulate multiple second messenger pathways associated with effector coupling, receptor trafficking, and nuclear signaling. These events are critical for understanding the early events leading to nonassociative tolerance and dependence. Equally important are associative and network changes that affect neurons that do not have opioid receptors but that are indirectly altered by opioid-sensitive cells. Finally, opioids and other drugs of abuse have some common cellular and anatomical pathways. The characterization of common pathways affected by different drugs, particularly after repeated treatment, is important in the understanding of drug abuse.

Endogenous opioids and reward

The discovery of endogenous opioids has markedly influenced the research on the biology of addiction and reward brain processes. Evidence has been presented that these brain substances modulate brain stimulation reward, self-administration of different drugs of abuse, sexual behaviour and social behaviour. There appears to be two different domains in which endogenous opioids, present in separate and distinct brain regions, are involved. One is related to the modulation of incentive motivational processes and the other to the performance of certain behaviours. It is concluded that endogenous opioids may play a role in the vulnerability to certain diseases, such as addiction and autism, but also when the disease is present, such as alcoholism.

The role of glutamate in physical dependence on opioids

The present review will evaluate the interactions between kappa-opioid receptors and glutamate within the locus coeruleus (LC) during the development of opioid dependence and on expression of withdrawal from dependence on opioids. Hyperactivity of noradrenergic neurons in the LC has been proposed to play a critical role in the physiological and behavioral responses that comprise opioid withdrawal. Several studies indicate that the excitatory amino acid system, in particular, glutamate and its receptors, participate in both the withdrawal-associated increase in LC neuronal activity and the expression of opioid withdrawal behaviors. Most studies on opioid dependence have focused on the prototypical opioid morphine, which produces its physical dependence through agonist actions at the mu-opioid receptor. Butorphanol (Stadol), which exhibits a markedly different profile of opioid receptor activity than does morphine, produces its physical dependence primarily through actions at the kappa-opioid receptor. Studies from our laboratories using a rodent model in which butorphanol administration induces dependence indicate further that the kappa-opioid receptor is an important regulator of glutamate release within the LC. Glutamate exerts actions within the LC that mediate expression of behavioral symptoms of butorphanol withdrawal.

Continuous and direct infusion of drug solutions in the brain of awake animals: implementation, strengths and pitfalls

One of the best strategies for understanding an animal's behavior is to study the function of the brain by experimentally modifying brain chemistry temporarily or on a long-term basis. This can be achieved by direct manipulation of neurochemistry of a targeted brain area with various drugs whose in vitro specificity and sensitivity are known. We assume that an animal's behavior is primarily controlled by the integrated performance of neural networks, rather than the action of a "superstar" single neuron which has narrowly tuned selectivity, in a specified brain region. Therefore, the former must be regulated by a large number of combinations of various transmitter/modulator receptors, hormones, growth factors, and other biochemically identifiable and yet unidentified substances. Under certain conditions, the activation of receptor-bound second messenger systems is thought to cause the enhanced expression of particular genes. Given the wide possibilities in manipulating brain chemistry, which may otherwise result in a variety of consequences, it is crucial to have a dependable means of sustaining the steady-state action of a drug for a sufficiently long time period at a targeted area in the brain of behaving animals. In most cases the continuous application of a drug is necessary to counteract its secondary mitigating effect, which is set in action through negative feedback loops and which in effect reduces the primary action of the drug in use. We have developed a technique to answer this need, using the Alzet osmotic minipump as the source of the continuous infusion force. A drug solution is continuously and directly infused, guided through a chronically implanted cannula, into a targeted area in the brain of behaving animals. The consequences of such an infusion are assessed, during as well as after the infusion, using various types of measurements in behavior, biochemistry, neurophysiology, pharmacology and morphology. The method has been successfully applied, for example, to the study of developmentally regulated neural plasticity in cat visual cortex. A few preconditions should be satisfied for the method to be properly applied to the brains of live animals. Those are: (1) manufacturing a suitable guide system, i.e., cannula-minipump assembly, for the infusion solution; (2) stereotaxic implantation of a cannula-minipump assembly into a selected brain region; and (3) estimating the concentration gradient of the continuously infused solution. This is crucial to assess the specificity and sensitivity of a drug for its assumed effects in vivo.

Social deprivation stress induces adaptative changes of opioid mechanisms in the rat tail artery

Brief (7-14 days) social deprivation stress has been found to increase blood pressure in Wistar rats, an effect dependent on activation of opioid function. The role of central opioids in this and other responses to stress has been repeatedly determined, but the possible involvement of modifications of peripheral opioid mechanisms is poorly understood. To further increase this knowledge, we have examined the opioid sensitivity of tail arteries taken from social deprived Wistar rats by studying the effect of beta-endorphin and DADLE "in vitro". Both opioids inhibited the electrically-induced constriction of the preparations in a dose-dependent manner, but these actions were significantly attenuated after 7-14 days of social deprivation. When the rats were isolated for 30-35 days, the hypertensive response was still present but the arteries from group-housed and isolated animals no longer showed differential sensitivity to opioids. This difference with respect to 7-14 days of isolation could be related to age-dependent changes of opioid function, which were observed among group-housed animals. The results suggest that social deprivation stress induces an adaptation of the tail arteries to the opioid effects on contractility. It is suggested that this endogenous adaptation could be contributing to the hypertensive response observed after social deprivation.

Premenstrual syndrome

Within the past decade, premenstrual syndrome (PMS) has become the subject of rigorous scientific scrutiny. As a result, diagnostic criteria have been developed, and the pathophysiology of the disorder has been partially elucidated. The preponderance of evidence suggests that the disorder is the result of the interaction of cyclic changes in estrogen and progesterone with specific neurotransmitters. Serotonin and gamma-amino butyric acid (GABA) appear to be especially important in this regard. Increased understanding of PMS has enabled the development of specific treatment modalities that, unlike previous prescriptions, have demonstrated efficacy in rigorous and reproducible studies.

Physical dependence produced by central morphine infusions: an anatomical mapping study

Morphine sulfate (1.5 nmoles/h) was chronically infused into various brain regions in rats. After 72 h of continuous infusions, an intraperitoneal injection of naloxone hydrochloride (5 mg/kg) was given to determine if physical dependence had developed. Various withdrawal signs were present following the naloxone challenge in rats chronically infused with morphine into the periventricular gray region. These withdrawal signs included escape behavior, wet-dog shakes, and teeth chattering. Several other brain regions (e.g., amygdala, caudate nucleus, lateral hypothalamus, nucleus accumbens, thalamus) were also tested, but morphine infusions into these areas produced only slight physical dependence. The magnitude of physical dependence produced by morphine infusions into the rostral aspect of the periventricular gray was comparable to that seen following repeated systemic morphine injections, while the physical dependence produced by caudal infusions into the vicinity of the locus coeruleus was considerably less. These data confirm the importance of the periventricular gray region in the development of physical dependence on morphine and reveal that a drug action in the more rostral aspect of this brain region produces the strongest signs of physical dependence.

Acupuncture as a detoxification treatment: an analysis of controlled research

The research literature on the use of acupuncture as a substance abuse treatment is reviewed. In recent years numerous descriptive reports have been published concerning the efficacy of acupuncture in alleviating withdrawal symptoms with substance abusers attempting abstinence. While a limited number of experimental design studies have been conducted in this area, results from controlled studies generally support that acupuncture can be effective in assisting active drug and alcohol users become abstinent. Controlled, experimental research on acupuncture and related techniques used as substance abuse treatments are reviewed. An overview regarding acupuncture and related procedures used as substance abuse treatments is first provided. Animal and human studies on acupuncture's usefulness in alleviating opiate withdrawal symptoms are presented, followed by studies concerning other substance abuse problems (i.e., alcohol, tobacco and cocaine). Possible physiological mechanisms related to acupuncture's effects are reviewed.

Physical dependence on morphine induced in dogs via the use of miniosmotic pumps

The difference between the development of physical dependence on morphine administered via Alzet miniosmotic pumps as well as syringe injection (twice a day) at fixed times was examined in conscious dogs. Physical dependence was quantified by polygraphically measuring naloxone-precipitated withdrawal signs on the day 8 after the subcutaneous implantation of miniosmotic pumps which supplied morphine at 1-5 mg/kg/day. Morphine plasma levels were maintained at 19-25 and 41-47 ng/mL during infusions of morphine at doses of 2.5 and 5 mg/kg/day, respectively. Morphine withdrawal was characterized by hyperactivity, biting, digging, tremors, nausea, hyperthermia, and increased wakefulness, and by electroencephalographic (EEG) activation in the amygdala and hippocampus, followed by dissociation of the EEG in the cortex (fast wave) from that in the limbic (slow wave) system, increased heart rates, and raised blood pressure. These morphine withdrawal signs seemed to be more severe than those exhibited in animals that had received syringe injections of morphine at the same doses. These results suggest that the use of miniosmotic pumps in dogs may be a very convenient and useful method for both evaluating drug dependence and studying its mechanisms.

Reduction of hibernation bout duration by intraventricular infusion of met-enkephalin

The potential of brain met-enkephalin (met-enk) systems to modulate central nervous system (CNS) activity during periods of general depression (modeled by the mammalian hibernation state) was studied in the ground squirrel (Citellus lateralis). Following entrance into hibernation, continuous met-enk infusion into the lateral ventricle (1 microliter/h; 0.2, 1 and 5 micrograms/microliter) produced a dose-dependent reduction in bout duration ranging from 1.2 to 3.9 days (13.8-44.6% of baseline bout duration). We suggest that the activity of met-enk-releasing neurons may serve to increase the excitability of the depressed CNS, thus accelerating the termination of the hibernation bout.

Development of tolerance to endogenous opiates activated by 24-h food deprivation

Four experiments assessed the effects of exposure to 24-h food deprivation on the tail-flick latency of rats exposed to a temperature stimulus. Confirming previous studies, Experiment 1 showed that food deprivation gave rise to analgesia, as indicated by increased tail-flick latencies, that was antagonized by naloxone. Experiment 2 found that analgesia was greatly reduced after five exposures to periods of 24-h food deprivation (alternating with 24-h free access to food), indicating the development of tolerance. Experiments 3 and 3a examined the development of tolerance to the analgesic effects of morphine following repeated morphine injections, saline injections, and exposure to 24-h food deprivation plus saline injections. The combined results of both experiments provided evidence that repeated exposures to either morphine or food deprivation, produced greater tolerance to morphine than did exposures to saline. That food deprivation was cross-tolerant with morphine indicated that tolerance to food deprivation-induced analgesia involved opioid mechanisms. The relevance of opioid tolerance to psychobiological models of feeding and to the development of an animal model of anorexia nervosa was discussed.

Localization of drug reward mechanisms by intracranial injections

Intracranial drug injections are useful in localizing brain areas where drugs of abuse initiate their habit-forming actions. However, serious methodological problems accompany such studies. Pharmacological controls are necessary to assess non-receptor-mediated local actions of the drug, anatomical controls are necessary to rule out drug efflux to distal sites of action, and behavioral controls are necessary to separate rewarding from general activating effects of drugs. Five brain sites have been advanced as sites of rewarding opiate actions: the ventral tegmental area (VTA), nucleus accumbens septi (NAS), lateral hypothalamus, periaqueductal gray, and hippocampus. Current evidence appears to confirm two of these--VTA and NAS; evidence is currently incomplete in the case of the hippocampus and is conflicting in the case of the lateral hypothalamus and periaqueductal gray. Two sites have been advanced as sites of rewarding psychomotor stimulant actions: NAS and the frontal cortex; each site seems implicated, but puzzling differences between amphetamine and cocaine findings remain to be resolved. Each of the clearly implicated sites is local to dopamine cell bodies or dopamine terminals that have been implicated in the rewarding effects of brain stimulation, food, and sex.

The physical dependence liability of butorphanol: a comparative study with morphine

In these studies, the physical dependence liability of butorphanol, a mixed 'agonist/antagonist' opioid analgesic, was compared to that of morphine. Male, Sprague-Dawley rats received i.c.v. infusions of saline (1 microliter/h), or an equimolar dose of butorphanol or morphine (52.3 nmol/h) for 3 days. The physical dependence liabilities of these two compounds were then compared by assessing both behavioral withdrawal signs and weight loss following naloxone-precipitated withdrawal. Body weight loss was also evaluated following abrupt (cessation of infusion) withdrawal from butorphanol or morphine. In animals receiving i.c.v. infusions of butorphanol or morphine, naloxone administration (5 mg/kg s.c.) induced an equivalent degree of body weight loss compared to saline-treated animals. In addition, the ED50 of naloxone to produce wet shakes, escape behavior, teeth chattering, urination and defecation was equivalent in rats receiving butorphanol or morphine. Infusions of butorphanol or morphine also produced an equivalent degree of weight loss in animals undergoing abrupt withdrawal. These results demonstrate then that a substantial degree of physical dependence had developed in rats which received a large dose of butorphanol.

Effect of naltrexone upon self-injurious behavior, learning and activity: a case study

Naltrexone significantly attenuated self-injurious behavior in a 20-year-old mildly retarded autistic male patient. The patient was videotaped daily and behavior was evaluated with a time-sampling procedure. Behavioral ratings of SIB frequency, SIB severity, and activity were collected automatically with a computerized system. Learning and memory were tested on a weekly basis with a modification of a paired associate learning test (PALT). Treatment with naltrexone resulted in (a) attenuation of SIB in the unstructured setting and (b) improvements in learning and memory without influencing activity levels.

Characteristics of mu and delta opioid binding sites in striatal slices of morphine-tolerant and -dependent mice

Previously, we demonstrated the enhanced affinity of opioid receptors for naloxone in striatal slices from morphine-dependent mice. In our present study, binding characteristics of the mu opioid receptor agonists, [D-Ala2,MePhe4,Gly-ol5]enkephalin (DAMGO) and dihydromorphine, the delta opioid receptor agonist, [D-Ala2, D-Leu5]enkephalin (DADLE), and the opioid antagonist, naloxone, were examined in striatal slices from morphine-tolerant and -dependent mice. Striatal slices from mice that were implanted with a morphine pellet for 3,7 and 21 days displayed significant decreases in Kd values (5.1, 4.6 and 5.5 nM, respectively) of [3H]DAMGO when compared to those in slices from control animals that were not implanted or implanted with placebo pellets (9.6 and 9.3 nM, respectively). Also, a significant increase in the binding affinity of naloxone, but not that of dihydromorphine, was observed in striatal slices of mice that were implanted with a morphine pellet for 3 days. Significant increases in the Bmax of delta binding sites in striatal slices of mice that were implanted with a morphine pellet for 3, 7 and 21 days (20.7, 18.1 and 17.7 pmol/mg tissue, respectively) were observed when compared to that in slices from control mice that were implanted with placebo pellets (11.4 pmol/mg tissue). The enhancement in the binding affinity of DAMGO and naloxone and the increased density of DADLE binding sites paralleled the development of morphine tolerance and dependence and [D-Pen2,D-Pen5]enkephalin cross-tolerance in whole animals. An antinociceptive potentiation between morphine and DAMGO was observed in morphine-tolerant and -dependent mice whereas in naive animals the effects of the two drugs were additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of delta opioid peptides as nonaddicting analgesics

Although much effort has been devoted to opioid research since the identification of enkephalins, understanding of the physiological importance and mechanisms of action of endogenous opioids lags behind understanding of opiate alkaloids such as morphine. In recent years, several novel approaches have been refined with promise for the successful development of the long-awaited nonaddicting analgesics that act at the opioid delta receptor. The present communication reviews these efforts.

Decrease of beta-endorphin in the brain of rats following nitrous oxide withdrawal

beta-Endorphin levels in the whole rat brain were not changed during acute (25 min) or chronic (48 h) exposure of rats to N2O. However, a significant decrease of beta-endorphin was found in the whole brain, brain stem and subcortex during the withdrawal from chronic exposure to N2O. It has been suggested that decrease of beta-endorphin levels during N2O withdrawal could be ascribed to unspecific stress accompanying drug withdrawal. Decrease of central beta-endorphin during N2O withdrawal might have a significant modulatory effect on transmitter balance, neuronal excitability and corresponding withdrawal behaviour. Furthermore, the decrease of beta-endorphin levels in the whole brain during N2O withdrawal might contribute to the postanaesthesia N2O-excitatory syndrome in humans. This might explain the known therapeutic effect of the opioid drug, meperidine on the excitatory N2O withdrawal phenomena during recovery from N2O anaesthesia in man.

Naltrexone therapy of apnea in children with elevated cerebrospinal fluid beta-endorphin

Previous studies have indicated increased immunoreactivity of the endogenous opioid peptide beta-endorphin in the cerebrospinal fluid (CSF) of infants under 2 years of age with apnea. To assess the role of endogenous opioids in the pathogenesis of apnea in children, the effect of oral treatment with the opioid antagonist naltrexone was studied in apneic infants, as well as in older apneic children, with demonstrated increases in CSF immunoreactive beta-endorphin (i-BE). In the 8 apneic infants with elevated i-BE in lumbar CSF (range, 55-155 pg/ml; normal, 17-52 pg/ml), no further apnea occurred during naltrexone therapy (1 mg/kg/day, by mouth). Five children (2-8 years old) with apnea of unknown cause had elevated CSF i-BE (range, 74-276 pg/ml) compared to 6 age-matched nonapneic children (range, 15-48 pg/ml). No apneic events occurred during naltrexone therapy, except in 1 child during stressful events, but apnea recurred in some patients after attempts to discontinue naltrexone treatment. Adverse effects of naltrexone included complaints of headaches in 2 children and symptoms of a narcotic withdrawal syndrome during the first 3 days of treatment in 1 child. Three children with Leigh's syndrome had elevated CSF i-BE (range, 104-291 pg/ml) and their apnea also responded to naltrexone. We conclude that elevated endogenous opioids contribute to the pathogenesis of apnea in children and may even result in physical dependence.

Butorphanol precipitates abstinence in morphine dependent rats

Butorphanol precipitated a withdrawal syndrome in rats receiving continuous intracerebroventricular infusions of morphine for three days. However, the potency of butorphanol to induce defecation, urination, teeth chattering and escape behavior was one to two orders of magnitude less on a molar basis than that of naloxone. Wet shake behavior, a prominent feature of naloxone precipitated withdrawal, was absent in morphine dependent animals challenged with butorphanol. These data indicate qualitative as well as quantitative differences in the withdrawal syndromes induced by butorphanol and naloxone.

Opiate reward: sites and substrates

Opiates appear to have rewarding actions at more than one locus in the brain. Studies of the effects of dopaminergic lesions and dopamine receptor blockade indicate that intravenous heroin self-administration depends importantly on a dopaminergic substrate. Mapping of effective injection sites for morphine-conditioned place preference establishes one site of rewarding action near the dopamine cell bodies of the ventral tegmental area (VTA). Studies of the complex interactions of opiates, neuroleptics, and brain stimulation reward confirm that reward-related VTA opioid actions are dopamine-dependent. Opioid injections into the nucleus accumbens (NAS) also facilitate brain stimulation reward and serve as rewards in their own right, though these actions have not yet been localized by identification of negative sites in surrounding regions. The relation of this putative reward site to the dopamine system is not yet clear. Suggestions that the lateral hypothalamus or periaqueductal gray contain opioid reward sites remain to be confirmed. While opioid injections into these sites can be rewarding, these rewarding effects have not been localized to these sites, and opiate injections into each of these areas are reported not to facilitate brain stimulation reward. Intravenous heroin self-administration is not disrupted by kainic acid lesions of the bed nucleus of the lateral hypothalamus. Thus only the VTA and the NAS are firmly established as sites of opiate rewarding actions. Recent reports suggest that the kappa-opioid dynorphin may also have central rewarding actions and central and peripheral aversive actions; the CA3 region of the hippocampus is a possible site of the rewarding action.

Intraventricular self-administration of heroin in the rat: reward seems dissociated from analgesia and physical dependence

Experimentally naive rats were implanted with a cannula in the lateral ventricle of the brain and were allowed to self-administer heroin in doses of 0.125, 0.25, 0.5, 1 or 2 micrograms/infusion or placebo for five daily sessions of 3 h. The number of self-injections was related to the unit dose in an inverted U-shaped manner: the 0.5 microgram/infusion dose induced the highest infusion rate. The total heroin intake was proportionally related to the unit dose. A hot-plate test performed immediately after the fourth session revealed no analgesic effects in any of the groups that self-administered heroin. A naloxone (10 mg/kg) challenge given immediately after the fifth session induced very mild withdrawal signs only in the group that administered the highest dose of heroin. The results indicate that rats readily acquire intraventricular heroin self-administration behaviour and suggest that the rewarding effects of heroin can be dissociated from its analgesic and physical dependence-inducing effects.

Opioid peptides and primary biliary cirrhosis

Patients with liver disease have increased plasma concentrations of the endogenous opioid peptides methionine enkephalin and leucine enkephalin. As an initial investigation to determine whether opioid peptides contribute to any of the clinical manifestations of hepatic disease nalmefene, a specific opioid antagonist devoid of agonist activity, was given to 11 patients with cirrhosis. They all experienced a severe opioid withdrawal reaction on starting the drug. In the nine patients with primary biliary cirrhosis pruritus was greatly alleviated, fatigue seemed to improve, and plasma bilirubin concentration, which had been rising, showed a modest fall in all except one patient. These results indicate that blocking opioid receptors has an effect on some of the metabolic abnormalities of liver disease.

Are astroglial cells involved in morphine tolerance?

Morphine gives rise to a cascade of events in the nervous system affecting, among others, neurotransmitter metabolism. Tolerance develops for various effects shortly after administration of the drug. Also, physical dependence develops and can be demonstrated by precipitation of withdrawal reactions. Biochemical events in nervous tissue have been extensively studied during morphine treatment. This overview will focus upon brain protein metabolism since macromolecular events might be of importance for development of long-term effects, such as tolerance and physical dependence. Both dose- and time-dependent changes in brain protein synthesis and the syntheses of specific proteins have been demonstrated after morphine treatment, although methodological considerations are important. Different experimental models (animal and tissue culture models) are presented. It might be interesting to note that astroglial protein synthesis and the secretion of proteins to the extracellular medium are both changed after morphine treatment, these having been evaluated in astroglial enriched primary cultures and in brain tissue slices. The possibility is suggested that proteins released from astroglial cells participate in the communication with other cells, including via synaptic regions, and that such communication might of significance in modifying the synaptic membranes during morphine intoxication.

The next frontier in the molecular biology of the opioid system. The opioid receptors

The analgesic and euphoric properties of some plant alkaloids such as morphine have been known and exploited for centuries. In contrast, only during the last twenty years have we begun to unravel the molecular basis by which opiates exert their effects, mechanisms important to our general understanding of the nervous system. The analgesic response to opiates is the result of a cascade of biochemical events that are triggered by the interaction of the opiate with specific macromolecular components found on the membranes of nervous system tissues, the opioid receptors. The endogenous ligands of these receptors are small peptides, the opioid peptides. Although much has been learned about the structures and the mode of synthesis of the opioid peptides, little is understood about the structure of their receptors. The application of molecular genetic techniques was of great importance to the studies of the opioid peptides. It is now expected that this same technology will unravel the physical mysteries of the opioid receptors.

Brain opioids and autism: an updated analysis of possible linkages

Considerable clinical evidence suggests that autistic children lack the normal ability or desire to engage others socially, as indicated by their poor social skills and inappropriate use of language for communicative purposes. Specifically, these children seem to lack normal amounts of social-emotional interest in other people, leading perhaps to a decreased initiative to communicate. This paper summarizes experimental evidence supporting a neurological theory, which posits that autism, at least partially, represents in the brain, such as brain opioids. These substances modulate social-emotional processes, and the possibility that blockade of opioid activity in the brain may be therapeutic for early childhood autism is discussed.

Effects of treatment with scopolamine and naloxone, singly and in combination, on amygdala kindling

Scopolamine and naloxone were administered singly and in combination to different groups of rats undergoing electrical kindling of the amygdala. Scopolamine significantly reduced the maximal seizure stage attained during 15 drug sessions and increased the total number of afterdischarges required to kindle a generalized convulsion. Naloxone had a similar but weaker and nonsignificant effect. The results confirm that antagonism of muscarinic receptors by scopolamine retards amygdala kindling.

The role of reward pathways in the development of drug dependence

In commenting on the discovery of "opiate" receptors, Goldstein (1976) said: "It seemed unlikely, a priori, that such highly stereospecific receptors should have been developed by nature to interact with alkaloids from the opium poppy" (p. 1081). Endogenous opioid peptides and opioid receptor systems have now been identified in invertebrates that are unlikely to have had ancestors exposed to opium poppies (Kavaliers et al., 1983; Kream et al., 1980; Leung and Stefano, 1984; Stefano et al., 1980). Moreover, endogenous opioids play a role in stress-induced feeding in the slug (Kavaliers and Hirst, 1986) just as they play a role in stress-induced feeding in rodents (Lowy et al., 1980; Morley and Levine, 1980). If we are to understand the actions of opiates and other drugs of abuse we must understand them in terms of their abilities to interact with neural systems that evolved in the service of primitive biological functions, long before any serious incidence of addiction itself. The most primitive axes of the biological substrates of behavior are the axes of approach and withdrawal. Addictive drugs appear to be able to activate the mechanisms of approach, which is termed "positive reinforcement" and to inhibit the mechanisms of withdrawal, which is termed "negative reinforcement." Anatomically distinct sets of pathways have evolved to serve these two forms of reward. Activation of the medial forebrain bundle and associated structures serves positive reinforcement and induces forward locomotion. Approach and forward locomotion are the unconditioned responses to positive reinforcing stimuli such as food and sex partners, and approach to environmental objects and positive reinforcement is induced by electrical stimulation of this structure. The locomotor stimulating effects and the positive reinforcing effects of opiates and psychomotor stimulants result from their activation of this mechanism; stimulants activate the mechanism at the level of dopaminergic synapses of the nucleus accumbens, frontal cortex, and perhaps other forebrain structures, while opiates activate the system at two points: at the level of the dopaminergic synapse and at the level of the afferents to the dopaminergic cell bodies. Ethanol, nicotine, caffeine and phencyclidine stimulate both locomotor activity and dopamine turnover, but their sites of interaction with reward pathways have not yet been identified. Benzodiazepines and barbiturates stimulate locomotor activity without stimulating dopamine turnover; they may interact with reward pathways at a synapse efferent to the dopaminergic link in the pathways.(ABSTRACT TRUNCATED AT 400 WORDS)

Changes in response rates and reinforcement thresholds for intracranial self-stimulation during morphine withdrawal

Rats were implanted with stimulating electrodes in the medial forebrain bundle-lateral hypothalamus and were trained in an auto-titration brain self-stimulation paradigm. When response rates and reinforcement thresholds were stable, the animals were implanted with subcutaneous osmotic minipumps (Alzet, 2ML1) which continually delivered morphine (1.2 mg/kg/hr as the base, n = 16) or saline (10.0 microliter/hr, n = 11). After one week the pumps were removed, and the animals were again tested in the auto-titration paradigm following the daily administration of either saline (spontaneous withdrawal) or 1.0 mg/kg naloxone (precipitated withdrawal). During the eight-day withdrawal phase there was a decrease in the rate of lever-pressing for the morphine dependent animals and this was greatest on the first day. The magnitude of the decrease was greater in the precipitated withdrawal group than in the spontaneous withdrawal group and an increase in the reinforcement threshold occurred only with precipitated withdrawal. Animals in both groups lost weight when measured each morning, but the precipitated group showed greater weight loss during the day. In addition, animals in the precipitated withdrawal group had diarrhea and showed a higher incidence of withdrawal signs than both the non-dependent (control) and spontaneous withdrawal groups. These experiments provide a detailed account of opiate withdrawal following the continuous subcutaneous infusion of a small dose of morphine for one week.

In vivo down-regulation of rat striatal opioid receptors by chronic enkephalin

Administration of methionine enkephalin (ICV) to rats for 5 days resulted in the development of physical dependence as exemplified by a hypothermic response which peaked 2-8 hours after initiation of withdrawal. Twenty-four hours post-withdrawal, opioid receptor binding was determined in the striatum using a selective delta receptor ligand. These studies revealed a decreased in the number of receptors. Bmax decreased from 193 +/- 20.4 fmoles/mg protein in controls to 136 +/- 9.7 fmoles/mg protein in enkephalin treated rats. This difference is significant at p less than 0.001. Existing evidence suggests that this decrease in binding is predominantly due to a decrease in delta receptors. Hence, the present findings indicate that delta receptor down-regulation in vivo may be an important mechanism in the adaptive response to chronic exposure to an endogenous opioid peptide.

D-phenylalanine: a putative enkephalinase inhibitor studied in a primate acute pain model

D-Phenylalanine, along with morphine, acetylsalicylic acid and zomepirac sodium were evaluated for their antinociceptive actions in monkeys (M. fascicularis) trained to autoregulate nociceptive stimulation using a discrete-trials, aversive-threshold paradigm. Morphine sulfate produced dose-related increases in aversive threshold which were reversible after administration of naloxone (12.5 or 25 micrograms/kg i.m.). D-Phenylalanine (500 mg/kg p.o.) produced a small increase in aversive threshold which was not statistically significant and not naloxone reversible. Acetylsalicylic acid (200 mg/kg p.o.) but not zomepirac sodium (200 mg/kg p.o.) in combination with D-phenylalanine (500 mg/kg) produced a small statistically significant increase in aversive threshold. Our results argue against the hypothesis that D-phenylalanine is responsible for increasing aversive thresholds via opiate receptor mechanisms involving increased activity of enkephalins at synaptic loci. Previous studies by others in rats and mice showed that D-phenylalanine and acetylsalicylic acid produced increases in nociceptive thresholds which were naloxone reversible. Our failure to find opiate receptor mediated analgesia in a primate model with demonstrated opiate receptor selectivity and sensitivity is discussed in terms of previous basic and clinical research indicating an analgesic role for D-phenylalanine. Possible species difference in drug action is discussed in terms of inhibition by D-phenylalanine of carboxy-peptidase-like enkephalin processing enzymes as well as inhibition of carboxypeptidase-like enkephalin degrading enzymes.

Opiate dependence and withdrawal--a new synthesis?

There is a growing body of evidence to suggest that adrenocorticotropin (ACTH) may have a physiological role as an endogenous contra-opioid agonist. In addition to having appreciable affinity for opiate receptors and inducing many behavioural and intracellular effects opposite to those observed following opioid administration, ACTH may interact with endorphins in a mutually antagonistic manner. On the basis of these data a model of opiate dependence is proposed whereby several aspects of the opiate abstinence syndrome may be attributed to the excitatory actions of ACTH acting at opiate receptors. Thus, it may be predicted that opiate antagonist administration during primary abstinence should significantly attenuate many aspects of this behavioural syndrome. The present study was conducted in order to investigate this hypothesis. Results indicated that whilst naloxone (1.5 mg/kg) exerted little influence in non-dependent animals, it significantly attenuated abstinence-exacerbated grooming, body shaking, teeth chattering and sneezing, in addition to completely antagonizing withdrawal hyperalgesia in post-dependent animals. These data are consistent with the proposed existence of an endogenous contra-opioid ligand, the antagonism of which markedly reduces the severity of the morphine withdrawal syndrome.

Beta-endorphin suppression of acute morphine abstinence in morphine dependent monkeys: effective given intraventricularly but ineffective given intravenously

Six female adult Macaca mulatta monkeys were made dependent upon morphine sulfate and were implanted with a chronic indwelling needle in the lateral ventricle of the brain for sterile intraventricular injections. Both beta-endorphin and morphine, in a dose dependent manner given intraventricularly suppressed the signs of 14 hour acute morphine abstinence. On a molar basis, beta-endorphin was more active than morphine in suppressing the signs of morphine abstinence. When given intravenously in much larger doses, beta-endorphin was ineffective in contrast to morphine which was effective in suppressing abstinence.

Physical dependence produced by chronic intracerebroventricular infusion of [D-Arg]kyotorphin or thiorphan to rats

Two compounds, [D-Arg]kyotorphin and thiorphan, unique in their mechanisms for producing an opioid-like analgesic response, were infused for six days into the lateral cerebral ventricle of rats. [D-Arg]kyotorphin (62.5 micrograms/microliter per h) and thiorphan (75 micrograms/5 microliter per h), but not vehicle infused animals, displayed certain behaviors characteristic of precipitated morphine withdrawal upon naloxone (10 mg/kg i.p.) challenge. Acute intracerebroventricular (i.c.v.) administration of [D-Arg]kyotorphin (62.5 micrograms/5 microliter) or thiorphan (75 micrograms/5 microliter) and subsequent challenge with naloxone resulted in no abnormal behavior. These data indicate that compounds which produce their analgesic effect through the modulation of endogenous opioids can cause physical dependence.

Chronic pain: an addiction

Chronic pain is distinguished from persistent pain and it is proposed that chronic pain involves addiction to the endogenous opioid system. Even when the organic lesions responsible for pain are removed, chronic pain can be maintained as an internal state preventing the withdrawal or abstinence syndrome associated with endorphins and enkephalins.