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Heyns I, Faunce AF, Mumba MN, Kumar MNVR, Arora M. Nanotechnology-Enhanced Naloxone and Alternative Treatments for Opioid Addiction. ACS Pharmacol Transl Sci 2024; 7:2237-2250. [PMID: 39144549 PMCID: PMC11320732 DOI: 10.1021/acsptsci.4c00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 08/16/2024]
Abstract
Opioids are commonly prescribed to address intense, ongoing pain associated with cancer, as well as long-lasting noncancer-related pain when alternative methods have proven ineffective. Individuals who exhibit both chronic pain and misuse of opioids face a significant danger of experiencing adverse health outcomes and the potential loss of life related to opioid use. Thus, there is a current movement to prescribe naloxone to those considered high-risk for opioid overdose. Naloxone has been explored as an antidote to reverse acute respiratory depression. Conversely, naloxone can give rise to other problems, including hypertension and cardiac arrhythmias. Thus, the importance of nanotechnology-enabled drug delivery strategies and their role in mitigating naloxone side-effects are significant. In this review, we explore the latest advancements in nanotechnology-enabled naloxone and alternative methods for addressing the opioid crisis through the utilization of non-opioid natural alternatives for chronic pain management.
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Affiliation(s)
- Ingrid
Marie Heyns
- The
Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Department
of Translational Science and Medicine, College of Community Health
Sciences, The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Alabama
Life Research Institute, The University
of Alabama, Tuscaloosa, Alabama 35401, United States
| | - Alina Farah Faunce
- Research
Department, Alabama College of Osteopathic
Medicine, Dothan, Alabama 36303, United States
| | - Mercy Ngosa Mumba
- Center
for Substance Use Research and Related Conditions, Capstone College
of Nursing, The University of Alabama, Tuscaloosa, Alabama 35487, United States
| | - M. N. V. Ravi Kumar
- The
Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Department
of Translational Science and Medicine, College of Community Health
Sciences, The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Alabama
Life Research Institute, The University
of Alabama, Tuscaloosa, Alabama 35401, United States
- Department
of Biological Sciences, The University of
Alabama, Tuscaloosa, Alabama 35487, United States
- Chemical
and Biological Engineering, University of
Alabama, Tuscaloosa, Alabama 35487, United States
- Center for
Free Radical Biology, University of Alabama
at Birmingham, Birmingham, Alabama 35294, United States
- Nephrology
Research and Training Center, Division of Nephrology, Department of
Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, United States
| | - Meenakshi Arora
- The
Center for Convergent Bioscience and Medicine (CCBM), The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Department
of Translational Science and Medicine, College of Community Health
Sciences, The University of Alabama, Tuscaloosa, Alabama 35401, United States
- Alabama
Life Research Institute, The University
of Alabama, Tuscaloosa, Alabama 35401, United States
- Department
of Biological Sciences, The University of
Alabama, Tuscaloosa, Alabama 35487, United States
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Min X, Ma Y, Leng Y, Li X, Zhang J, Xu S, Wang X, Lv R, Guo J, Xing H. Effects of perioperative low-dose naloxone on the immune system in patients undergoing laparoscopic-assisted total gastrectomy: a randomized controlled trial. BMC Anesthesiol 2024; 24:172. [PMID: 38720250 PMCID: PMC11077871 DOI: 10.1186/s12871-024-02524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low immune function after laparoscopic total gastrectomy puts patients at risk of infection-related complications. Low-dose naloxone (LDN) can improve the prognosis of patients suffering from chronic inflammatory diseases or autoimmune diseases. The use of LDN during perioperative procedures may reduce perioperative complications. The purpose of this study was to examine the effects of LDN on endogenous immune function in gastric cancer patients and its specific mechanisms through a randomized controlled trial. METHODS Fifty-five patients who underwent laparoscopic-assisted total gastrectomy were randomly assigned to either a naloxone group (n = 23) or a nonnaloxone group (n = 22). Patients in the naloxone group received 0.05 µg/kg-1.h- 1naloxone from 3 days before surgery to 5 days after surgery via a patient-controlled intravenous injection (PCIA) pump, and patients in the nonnaloxone group did not receive special treatment. The primary outcomes were the rates of postoperative complications and immune function assessed by NK cell, CD3+ T cell, CD4+ T cell, CD8+ T cell, WBC count, neutrophil percentage, and IL-6 and calcitonin levels. The secondary outcomes were the expression levels of TLR4 (Toll-like receptor), IL-6 and TNF-α in gastric cancer tissue. RESULTS Compared with the nonnaloxone group, the naloxone group exhibited a lower incidence of infection (in the incision, abdomen, and lungs) (P < 0.05). The numbers of NK cells and CD8+ T cells in the naloxone group were significantly greater than those in the nonnaloxone group at 24 h after surgery (P < 0.05) and at 96 h after surgery (P < 0.05). Compared with those in the nonnaloxone group, the CD3 + T-cell (P < 0.05) and CD4 + T-cell (P < 0.01) counts were significantly lower in the naloxone group 24 h after surgery. At 24 h and 96 h after surgery, the WBC count (P < 0.05) and neutrophil percentage (P < 0.05) were significantly greater in the nonnaloxone group. The levels of IL-6 (P < 0.05) and calcitonin in the nonnaloxone group were significantly greater at 24 h after surgery. At 24 h following surgery, the nonnaloxone group had significantly greater levels of IL-6 (P < 0.05) and calcitonin than did the naloxone group. Compared with those in the naloxone group, the expression levels of TLR4 (P < 0.05) in gastric cancer tissue in the naloxone group were greater; however, the expression levels of IL-6 (P < 0.01) and TNF-α (P < 0.01) in the naloxone group were greater than those in the nonnaloxone group. CONCLUSION Laparoscopic total gastrectomy patients can benefit from 0.05 ug/kg- 1. h- 1 naloxone by reducing their risk of infection. It is possible that LDN alters the number of cells in lymphocyte subpopulations, such as NK cells, CD3 + T cells, and CD4 + T cells, and the CD4+/CD8 + T-cell ratio or alters TLR4 receptor expression in immune cells, thereby altering immune cell activity. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 24/11/2023 (ChiCTR2300077948).
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Affiliation(s)
- Xiangzhen Min
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Yan Ma
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinanm, Shandong Province, China
| | - Yufang Leng
- Department of Anesthesiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
| | - Xiaoxi Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Jianmin Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Shoucai Xu
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Xiuqin Wang
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Jie Guo
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Huaixin Xing
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China.
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Nakada T, Ohtsuka T. Impact of opioids on postoperative prognosis in lung cancer. J Thorac Dis 2023; 15:5272-5274. [PMID: 37969287 PMCID: PMC10636488 DOI: 10.21037/jtd-23-1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/25/2023] [Indexed: 11/17/2023]
Affiliation(s)
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Han ZZ, Li M, Zhang Y. The effects of allogeneic and autologous blood transfusion on immune function in patients receiving total hip replacement. Am J Transl Res 2023; 15:4709-4717. [PMID: 37560247 PMCID: PMC10408532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To evaluate the effects of allogeneic and autologous blood transfusion on immune function and postoperative inflammation in patients after total hip replacement. METHODS In this retrospective study, the clinical data of 60 patients undergoing total hip arthroplasty through a posterolateral approach were analyzed. The patients were grouped into an autologous blood transfusion group (allo group) (n = 30) and an autologous blood transfusion group (auto-group) (n = 30) according to the treatment they received. All patients did not receive preoperative and intraoperative blood transfusion. The blood collected in the operation area was transfused to the patients in the auto-group with the autotransfusion device and the allogeneic blood was transfused to the patients in the allo-group after the operation. The average amount of blood transfusion was 400 ml. The immune function after blood transfusion was mainly evaluated by natural killer cell cytotoxicity (NKCC) and interleukin-2 (IL-2) using ELISA kits, meanwhile the changes of cellular immune factor levels (differentiation cluster of differentiation, CD) (CD3+, CD4+) and humoral immune factor levels (Immunoglobulin E, IgE) after blood transfusion were determined by flow cytometry. The secondary outcome was postoperative inflammatory response measured by white blood cell (WBC) count, neutrophil percentage (NP) and C-reactive protein (CRP). RESULTS The parameters of both groups of patients were comparable. The auto-group significantly outperformed the Allo-group in the following laboratory parameters: NKCC (%, E:T = 10:1) at day 2 [26.1 (Auto) vs 19.3 (Allo); P = 0.0025], NKCC (%, E:T = 5:1) at day 2 [20.0 (Auto) vs 17.3 (Allo); P = 0.0094], CD3+ (%) at day 2 [50.5 (Auto) vs 40.8 (Allo); P = 0.0233], CD4+ (%) at day 2 [41.2 (Auto) vs 26.3 (Allo); P = 0.0122], IgE (U/mL) at day 2 [157.8 (Auto) vs 319.8 (Allo); P = 0.0064]. CONCLUSION Autotransfusion can safely replace allogeneic blood transfusion and reduce the damage of postoperative immune function after total hip arthroplasty.
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Affiliation(s)
- Zong-Zheng Han
- Graduate School of Jinzhou Medical UniversityJinzhou 121000, Liaoning, China
- Blood Transfusion Department, Hanchuan People’s HospitalHanchuan 431600, Hubei, China
| | - Miao Li
- Blood Transfusion Department, Hanchuan People’s HospitalHanchuan 431600, Hubei, China
| | - Yong Zhang
- Clinical Laboratory, Huangshi Fifth HospitalHuangshi 420204, Hubei, China
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Hamad AS, Edward EA, Sheta E, Aboushleib HM, Bahey-El-Din M. Iron Acquisition Proteins of Pseudomonas aeruginosa as Potential Vaccine Targets: In Silico Analysis and In Vivo Evaluation of Protective Efficacy of the Hemophore HasAp. Vaccines (Basel) 2022; 11:vaccines11010028. [PMID: 36679873 PMCID: PMC9864456 DOI: 10.3390/vaccines11010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is a Gram-negative pathogen responsible for fatal nosocomial infections worldwide. Iron is essential for Gram-negative bacteria to establish an infection. Therefore, iron acquisition proteins (IAPs) of bacteria are attractive vaccine targets. METHODOLOGY A "Reverse Vaccinology" approach was employed in the current study. Expression levels of 37 IAPs in various types of PA infections were analyzed in seven previously published studies. The IAP vaccine candidate was selected based on multiple criteria, including a high level of expression, high antigenicity, solubility, and conservation among PA strains, utilizing suitable bioinformatics analysis tools. The selected IAP candidate was recombinantly expressed in Escherichia coli and purified using metal affinity chromatography. It was further evaluated in vivo for protection efficacy. The novel immune adjuvant, naloxone (NAL), was used. RESULTS AND DISCUSSION HasAp antigen met all the in silico selection criteria, being highly antigenic, soluble, and conserved. In addition, it was the most highly expressed IAP in terms of average fold change compared to control. Although HasAp did excel in the in silico evaluation, subcutaneous immunization with recombinant HasAp alone or recombinant HasAp plus NAL (HasAP-NAL) did not provide the expected protection compared to controls. Immunized mice showed a low IgG2a/IgG1 ratio, indicating a T-helper type 2 (Th2)-oriented immune response that is suboptimal for protection against PA infections. Surprisingly, the bacterial count in livers of both NAL- and HasAp-NAL-immunized mice was significantly lower than the count in the HasAp and saline groups. The same trend was observed in kidneys and lungs obtained from these groups, although the difference was not significant. Such protection could be attributed to the enhancement of innate immunity by NAL. CONCLUSIONS We provided a detailed in silico analysis of IAPs of PA followed by in vivo evaluation of the best IAP, HasAp. Despite the promising in silico results, HasAp did not provide the anticipated vaccine efficacy. HasAp should be further evaluated as a vaccine candidate through varying the immunization regimens, models of infection, and immunoadjuvants. Combination with other IAPs might also improve vaccination efficacy. We also shed light on several highly expressed promising IAPs whose efficacy as vaccine candidates is worthy of further investigation.
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Affiliation(s)
- Abdelrahman S. Hamad
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria P.O. Box 25435, Egypt
| | - Eva A. Edward
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria P.O. Box 25435, Egypt
| | - Eman Sheta
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria P.O. Box 21131, Egypt
| | - Hamida M. Aboushleib
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria P.O. Box 25435, Egypt
| | - Mohammed Bahey-El-Din
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria P.O. Box 25435, Egypt
- Correspondence:
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Research progress of opioid growth factor in immune-related diseases and cancer diseases. Int Immunopharmacol 2021; 99:107713. [PMID: 34426103 DOI: 10.1016/j.intimp.2021.107713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
Methionine enkephalin (MENK) has an important role in both neuroendocrine and immune systems. MENK was known as an opioid growth factor (OGF) for its growth regulatory characteristics. OGF interacts with the OGF receptor (OGFr) to inhibit DNA synthesis by upregulating p16 and/or p21, which delays the cell cycle transition from G0/G1 to S phase, and inhibits cell proliferation. In addition, OGF combines with OGFr in immune cells to exert its immunomodulatory activity and regulate immune function. OGF has been studied as an immunomodulator in a variety of autoimmune diseases, including multiple sclerosis, inflammatory bowel disease, diabetes and viral infections, and has been proven to relieve symptoms of certain diseases in animal and in vitro experiments. Also, OGF and OGFr have various anti-tumor molecular mechanisms. OGF can be used as the primary therapy alone or combined with other drugs to treat tumors. This article summarizes the research progress of OGF in immune-related diseases and cancer diseases.
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Abstract
PURPOSE OF REVIEW Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes. RECENT FINDINGS To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research. SUMMARY The biologic perturbation of the perioperative period, compounded by the effects of anesthetic agents, renders patients with cancer particularly vulnerable to enhanced viability of minimal residual disease, with long-term outcome consequences. However, low level and often conflicting clinical evidence equipoise currently exists with regards to optimal oncoanesthesia techniques. Large, prospective, randomized control trials are urgently needed to inform evidence-based clinical practice guidelines.
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Identification of Novel Biomarkers and Candidate Drug in Ovarian Cancer. J Pers Med 2021; 11:jpm11040316. [PMID: 33921660 PMCID: PMC8073701 DOI: 10.3390/jpm11040316] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/13/2022] Open
Abstract
This paper investigates the expression of the CREB1 gene in ovarian cancer (OV) by deeply excavating the gene information in the multiple databases and the mechanism thereof. In short, we found that the expression of the CREB1 gene in ovarian cancer tissue was significantly higher than that of normal ovarian tissue. Kaplan–Meier survival analysis showed that the overall survival was significantly shorter in patients with high expression of the CREB1 gene than those in patients with low expression of the CREB1 gene, and the prognosis of patients with low expression of the CREB1 gene was better. The CREB1 gene may play a role in the occurrence and development of ovarian cancer by regulating the process of protein. Based on differentially expressed genes, 20 small-molecule drugs that potentially target CREB1 with abnormal expression in OV were obtained from the CMap database. Among these compounds, we found that naloxone has the greatest therapeutic value for OV. The high expression of the CREB1 gene may be an indicator of poor prognosis in ovarian cancer patients. Targeting CREB1 may be a potential tool for the diagnosis and treatment of OV.
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Yuan M, Men Y, Kang J, Sun X, Zhao M, Bao Y, Yang X, Sun S, Ma Z, Wang J, Deng L, Wang W, Zhai Y, Liu W, Zhang T, Wang X, Bi N, Lv J, Liang J, Feng Q, Chen D, Xiao Z, Zhou Z, Wang L, Hui Z. Postoperative radiotherapy for pathological stage IIIA-N2 non-small cell lung cancer with positive surgical margins. Thorac Cancer 2020; 12:227-234. [PMID: 33247556 PMCID: PMC7812075 DOI: 10.1111/1759-7714.13749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to evaluate the efficacy of postoperative radiotherapy (PORT) in stage pIIIA‐N2 non‐small cell lung cancer (NSCLC) patients with positive surgical margins. Methods Between January 2003 and December 2015, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were retrospectively reviewed. Those with pIIIA‐N2 NSCLC and positive surgical margins were enrolled into the study. The Kaplan‐Meier method was used for survival analysis, and the log‐rank test was used to analyze differences between the groups. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate potential prognostic factors for OS. Statistically significant difference was set as P < 0.05. Results Of all the 1547 patients with pIIIA‐N2 NSCLC reviewed, 113 patients had positive surgical margins, including 76 patients with R1 resection and 37 with R2 resection. The median overall survival (OS) was 28.3 months in the PORT group and 22.6 months in the non‐PORT group (P = 0.568). Subset analysis showed that for patients with R1 resection, the median OS was 52.4 months in the PORT group which was nonsignificantly longer than that of 22.6 months in the non‐PORT group (P = 0.127), whereas PORT combined with chemotherapy could significantly improve OS, with a median OS of 52.4 months versus 17.2 months (P = 0.027). For patients with R2 resection, PORT made no significant difference in OS (17.6 vs. 63.8 months, P = 0.529). Conclusions For pIIIA‐N2 NSCLC patients with positive surgical margins, PORT did not improve OS, but OS was improved in those patients who underwent R1 resection combined with chemotherapy. Key points Significant findings of the study Significant findings of the study: Postoperative radiotherapy (PORT) has been recommended to treat patients with positive surgical margins. However, the existing evidence is controversial and high‐level evidence is lacking. What this study adds What this study adds: The PORT group had markedly, but not statistically significant, longer median OS compared with the non‐PORT group in patients with R1 resection. OS was significantly longer in the patients with R1 resection receiving adjuvant CRT than the surgery alone group.
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Affiliation(s)
| | - Yu Men
- Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xin Sun
- Department of Radiation Oncology
| | | | | | - Xu Yang
- Department of Radiation Oncology
| | | | | | | | - Lei Deng
- Department of Radiation Oncology
| | | | | | | | | | - Xin Wang
- Department of Radiation Oncology
| | - Nan Bi
- Department of Radiation Oncology
| | - Jima Lv
- Department of Radiation Oncology
| | | | | | | | | | | | | | - Zhouguang Hui
- Department of Radiation Oncology.,Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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