Reciprocal Evolution of Opiate Science from Medical and Cultural Perspectives

Genomic and cell-specific regulation of benzylisoquinoline alkaloid biosynthesis in opium poppy

Opium poppy is a crop of great commercial value as a source of several opium alkaloids for the pharmaceutical industries including morphine, codeine, thebaine, noscapine, and papaverine. Most enzymes involved in benzylisoquinoline alkaloid (BIA) biosynthesis in opium poppy have been functionally characterized, and opium poppy currently serves as a model system to study BIA metabolism in plants. BIA biosynthesis in opium poppy involves two biosynthetic gene clusters associated respectively with the morphine and noscapine branches. Recent reports have shown that genes in the same cluster are co-expressed, suggesting they might also be co-regulated. However, the transcriptional regulation of opium poppy BIA biosynthesis is not well studied. Opium poppy BIA biosynthesis involves three cell types associated with the phloem system: companion cells, sieve elements, and laticifers. The transcripts and enzymes associated with BIA biosynthesis are distributed across cell types, requiring the translocation of key enzymes and pathway intermediates between cell types. Together, these suggest that the regulation of BIA biosynthesis in opium poppy is multilayered and complex, involving biochemical, genomic, and physiological mechanisms. In this review, we highlight recent advances in genome sequencing and single cell and spatial transcriptomics with a focus on how these efforts can improve our understanding of the genomic and cell-specific regulation of BIA biosynthesis. Such knowledge is vital for opium poppy genetic improvement and metabolic engineering efforts targeting the modulation of alkaloid yield and composition.

Natural products as a source of new anticancer chemotypes

INTRODUCTION

Exploring the chemical diversity and molecular mechanisms of natural products continues to be an important research area for identifying novel promising therapeutic approaches for fighting cancer. This is a complex disease and poses important challenges, which require not only targeted interventions to improve chemotherapy efficacy and tolerability, but also adjuvant strategies to counteract chemoresistance development and relapses.

AREAS COVERED

After a brief description of the recent literature on the anticancer potential of natural compounds, we searched for patents following the PRISMA guidelines, filtering the results published from 2019 onwards. In addition, some relevant publications from the overall scientific literature were also discussed.

EXPERT OPINION

This review comprehensively covers and analyzes the most recent advances on the anticancer mechanism of licensed natural compounds and their chemical optimization. Patentability of natural compounds was discussed according to the recent legislation in the U.S.A. and Europe.

Cardiovascular Complications of Opioid Use: JACC State-of-the-Art Review

Opioids are the most potent of all analgesics. Although traditionally used solely for acute self-limited conditions and palliation of severe cancer-associated pain, a movement to promote subjective pain (scale, 0 to 10) to the status of a "fifth vital sign" bolstered widespread prescribing for chronic, noncancer pain. This, coupled with rising misuse, initiated a surge in unintentional deaths, increased drug-associated acute coronary syndrome, and endocarditis. In response, the American College of Cardiology issued a call to action for cardiovascular care teams. Opioid toxicity is primarily mediated via potent μ-receptor agonism resulting in ventilatory depression. However, both overdose and opioid withdrawal can trigger major adverse cardiovascular events resulting from hemodynamic, vascular, and proarrhythmic/electrophysiological consequences. Although natural opioid analogues are devoid of repolarization effects, synthetic agents may be proarrhythmic. This perspective explores cardiovascular consequences of opioids, the contributions of off-target electrophysiologic properties to mortality, and provides practical safety recommendations.

The Potential of Traditional Knowledge to Develop Effective Medicines for the Treatment of Leishmaniasis

Leishmaniasis is a neglected tropical disease that affects people living in tropical and subtropical areas of the world. There are few therapeutic options for treating this infectious disease, and available drugs induce severe side effects in patients. Different communities have limited access to hospital facilities, as well as classical treatment of leishmaniasis; therefore, they use local natural products as alternative medicines to treat this infectious disease. The present work performed a bibliographic survey worldwide to record plants used by traditional communities to treat leishmaniasis, as well as the uses and peculiarities associated with each plant, which can guide future studies regarding the characterization of new drugs to treat leishmaniasis. A bibliographic survey performed in the PubMed and Scopus databases retrieved 294 articles related to traditional knowledge, medicinal plants and leishmaniasis; however, only 20 were selected based on the traditional use of plants to treat leishmaniasis. Considering such studies, 378 quotes referring to 292 plants (216 species and 76 genera) that have been used to treat leishmaniasis were recorded, which could be grouped into 89 different families. A broad discussion has been presented regarding the most frequent families, including Fabaceae (27 quotes), Araceae (23), Solanaceae and Asteraceae (22 each). Among the available data in the 378 quotes, it was observed that the parts of the plants most frequently used in local medicine were leaves (42.3% of recipes), applied topically (74.6%) and fresh poultices (17.2%). The contribution of Latin America to studies enrolling ethnopharmacological indications to treat leishmaniasis was evident. Of the 292 plants registered, 79 were tested against Leishmania sp. Future studies on leishmanicidal activity could be guided by the 292 plants presented in this study, mainly the five species Carica papaya L. (Caricaceae), Cedrela odorata L. (Meliaceae), Copaifera paupera (Herzog) Dwyer (Fabaceae), Musa × paradisiaca L. (Musaceae), and Nicotiana tabacum L. (Solanaceae), since they are the most frequently cited in articles and by traditional communities.

Endogenous Cardiotonics: Search And Problems

Medicinal preparations currently used for the treatment of patients with chronic cardiac failure involve those that reduce the heart load (vasodilators, diuretics, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors). Cardiotonic drugs with the cAMP-dependent mechanism are unsuitable for long-term administration due to the intensification of metabolic processes and an increase in the oxygen demand of the myocardium and all tissues of the body. For many years, digoxin has remained the only preparation enhancing the efficiency of myocardial performance. The detection of digoxin and ouabain in intact animals has initiated a search for other compounds with cardiotonic activity. The review summarizes current data on the effect exerted on the heart performance by endogenous compounds, from simple, such as NO and CO, to steroids, fatty acids, polypeptides, and proteins. Controversial questions and problems with the introduction of scientific achievements into clinical practice are discussed. The results obtained by the authors and their colleagues after many years of studies on the cardiotropic properties of serum lipoproteins are also reported. The experimentally established cardiotonic activity of apoprotein A-1, which is accompanied by a decrease in the relative consumption of oxygen, maybe of great interest.

Death from Poppy Tea Consumption

The historical practice of brewing poppy tea for its opioid-like effects is reoccurring with modern-day substance users. We present four postmortem cases with toxicology results that serve as case studies for the potential hazards of poppy tea ingestion. There is limited information regarding the risks of this practice due to the variability of the morphine content of the opium exuded from the plant. While internet tea recipes offer guidance, differences in poppy cultivation, washing, and infusing time are some of the reasons why the beverage may contain inconsistent and clinically significant alkaloid concentrations for each preparation. Variability in opioid tolerance along with additional drugs taken will impact the overall degree of toxicity experienced from the opiates in the tea. Advancements in the genetic modification of the poppy plant could greatly alter the ratio of alkaloids seen in biological fluids and will be highly dependent on the source of the poppy product. The blood concentrations of free morphine and free codeine in cases 1-3 where the toxicity from the tea was considered the primary cause of death were 0.94 and 0.11 mg/L, 0.62 and 0.034 mg/L, and 0.16 and 0.010 mg/L, respectively. The urine concentrations of morphine and codeine were 13 and 0.94 mg/L in case 1 and 16 and 1.6 mg/L in case 2, respectively. The opium alkaloids thebaine and laudanosine were identified qualitatively by our routine organic base/neutral drug detection procedure.

Molecular Dynamics Simulations to Investigate How PZM21 Affects the Conformational State of the μ-Opioid Receptor Upon Activation

Opioid analgesics such as morphine have indispensable roles in analgesia. However, morphine use can elicit side effects such as respiratory depression and constipation. It has been reported that G protein-biased agonists as substitutes for classic opioid agonists can alleviate (or even eliminate) these side effects. The compounds PZM21 and TRV130 could be such alternatives. Nevertheless, there are controversies regarding the efficacy and G protein-biased ability of PZM21. To demonstrate a rationale for the reduced biasing agonism of PZM21 compared with that of TRV130 at the molecular level, we undertook a long-term molecular dynamics simulation of the μ-opioid receptor (MOR) upon the binding of three ligands: morphine, TRV130, and PZM21. We found that the delayed movement of the W293^6.48 (Ballesteros-Weinstein numbering) side chain was a factor determining the dose-dependent agonism of PZM21. Differences in conformational changes of W318^7.35, Y326^7.43, and Y336^7.53 in PZM21 and TRV130 explained the observed differences in bias between these ligands. The extent of water movements across the receptor channel was correlated with analgesic effects. Taken together, these data suggest that the observed differences in conformational changes of the studied MOR-ligand complexes point to the low-potency and lower bias effects of PZM21 compared with the other two ligands, and they lay the foundation for the development of G protein-biased agonists.

Receptor-centric solutions for the opioid epidemic: Making the opioid user impervious to overdose death

This mini-review presents the view that contemporary approaches to stem the tide of opioid overdose deaths are insufficient to make a significant impact. Instead, a focus on the opioid receptor as the ultimate molecular target to directly abolish opioid overdose death is explored. After identifying the key brainstem neurons that control respiration which are inhibited by opioid drugs, genetic techniques targeting the mu opioid receptor are detailed which prevent opioid overdose. This receptor-centric solution for the opioid overdose epidemic can be realized with existing technology and, with sufficient effort, could enter clinical trials within 5 to 10 years.

Comparing the efficacy of Morphine alone with Morphine and mgso4 in pain management after coronary artery bypass surgery

Objective:

To compare the effectiveness of Morphine alone and Morphine with MgSo4 in pain management after CABG surgery.

Methods:

This randomized control trial was conducted in the department of anesthesia and critical care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from November 2016 to June 2017. All collected data was entered and analyzed by using computer software SPSS version 23.1. Quantitative data like age, VAS score was analyzed and presented as mean and standard deviation. Similarly qualitative data like gender and ASA status was calculated and presented as frequency and percentages. Independent sample T-test was applied for significance of VAS score. P value ≤0.05 was considered as significant.

Results:

A total number of 150 patients of both genders were included in this study. The main outcome variables of our study were VAS score. It was observed that, in group (M), the mean VAS score after 4, 12 and 24 hours of operation was 5.24±1.61, 5.8±2.27 and 5.44±2.27 respectively. And in group (MM), the mean VAS score after 4, 12 and 24 hours of operation was 4.36±2.58, 3.48±2.10 and 4.12±1.05 respectively. It was noted that both groups had statically significant difference of VAS score, as group (M) had higher VAS score than group (MM).

Conclusion:

Morphine with Mgso4 has better efficacy as compared to morphine alone when used as analgesic agent after CABG surgery.

The Elevation of LC-ESI-Q-TOF-MS Response in the Analysis of Isoquinoline Alkaloids from Some Papaveraceae and Berberidaceae Representatives

Twenty-five methanol extracts obtained from various representatives of Papaveraceae and Berberidaceae botanical families (genera: Papaver, Argemone, Eschscholzia, Chelidonium, Glaucium, and Berberis) were screened for their alkaloid content in an optimized method suitable for the LC-ESI-Q-TOF-MS analysis. Twelve pharmacologically important isoquinoline alkaloids from four groups, aporphines, benzylisoquinolines, protoberberines, and benzophenanthridines, present in these traditionally used plant species were quantitatively determined in each studied sample, providing their alkaloid profile. A Zorbax Stable Bond RP-18 column and a mobile phase composed of 0.1% formic acid and 0.1% formic acid in acetonitrile (v/v) were used at the flow rate of 0.2 mL/min. A profound study on the optimization of MS response to four groups of isoquinoline alkaloids (validation of capillary voltage, gas flows, nebulizer pressure, skimmer, and fragmentor voltages), repeatability of results, and stability and linearity of measurements were described, showing, among others, 3000 V of capillary voltage, 350°C of gas temperature, 12 L/min of gas flows, nebulizer pressure of 35 psig, 65 V for skimmer voltage, and 30 V for collision energy as the most advantageous operation parameters.