Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain

Low-frequency electroacupuncture effectively alleviated recurrent pain in 10 patients. Basal levels of beta-endorphin and met-enkephalin in the lumbar cerebrospinal fluid (CSF) of these patients were not different from those in pain-free control subjects. After electroacupuncture in the patients with pain CSF beta-endorphin levels rose significantly in all subjects, but met-enkephalin levels were unchanged. These results suggest that the analgesia observed after electroacupuncture in patients with recurrent pain may be mediated by the release into the CSF of the endogenous opiate, beta-endorphin.

Acupuncture in heroin addicts; changes in Met-enkephalin and beta-endorphin in blood and cerebrospinal fluid

In heroin addicts showing features of heroin withdrawal basal beta-endorphin levels were elevated in both blood and cerebrospinal fluid (CSF) and did not change during electroacupuncture, although this therapy suppressed the clinical features of withdrawal. Met-enkephalin levels were not elevated in blood or CSF before treatment. However, successful electroacupuncture was associated with a rise in CSF met-enkephalin levels in all patients studied, although concentrations in blood did not alter.

Suppression of withdrawal symptoms by dynorphin in heroin addicts

The effectiveness of dynorphin-(1-13) in suppressing heroin withdrawal was studied. At a dose of 60 micrograms/kg body weight, dynorphin-(1-13) was effective in suppressing withdrawal symptoms. When saline was administered a strong placebo effect was noticed that, however, did not influence the outcome of the results. Only three out of the twelve patients receiving dynorphin-(1-13) experienced some mild side-effects such as feeling warm, dizziness and precordial formication.

Tetramethylpyrazine for treatment of experimentally induced stroke in Mongolian gerbils

Tetramethylpyrazine, a drug originally isolated from the rhizome of Ligusticum walliichi, has been used routinely in China for the treatment of stroke and angina pectoris. We evaluated this drug by testing its effectiveness in increasing the survival rate in a stroke model using Mongolian gerbils. Our results indicate that tetramethylpyrazine can increase survival rate only if it is administered before the induction of cerebral ischemia. Since we administered the drug intraperitoneally, it is possible that pretreatment was necessary to increase its effective concentration in the blood. Receptor binding studies indicated that tetramethylpyrazine was inactive against a variety of pharmacologically active receptors.

Opioid-like activity in the cerebrospinal fluid of pain patients treated by electroacupuncture

Thirteen patients with pain from various causes were treated by electroacupuncture for 30 min. Cerebrospinal fluid (CSF) was obtained before and after treatment. Opioid-like substances in the CSF were fractionated by high pressure liquid chromatography and assayed by competitive receptor binding using a mu-specific radioligand, [D-ala2, MePhe4, gly-ol5]-enkephalin (DAGO). Opioid activity, associated with a fraction, eluted at 18-20% acetonitrile, consistently showed an increase in level after acupuncture. Two other fractions eluted at larger concentrations of acetonitrile also increased significantly after acupuncture; however the increase was not consistently observed in every patient. Measurements of beta-endorphin and dynorphin by radioimmunoassay indicated that 80 and 60% of the patients, respectively, had a higher level of these peptides after acupuncture. The nature of the opioid activity, eluted at 18-20% acetonitrile is unknown; however a small amount of it could be found in various parts of the brain of rat.

Comparison of plasma hormonal levels between heroin-addicted and normal subjects

The serum concentrations of ACTH, cortisol, aldosterone, thyroxine, cyclic AMP and cholesterol were compared between normal and heroin-addicted subjects. Significantly lower ACTH, cyclic AMP and cholesterol levels were observed to be associated with the heroin addicts, but their plasma thyroxine level was significantly elevated. The possible physiopsychological effect resulting from these changes is discussed.

Immunoassayable beta-endorphin level in the plasma and CSF of heroin addicted and normal subjects before and after electroacupuncture

The present study was undertaken to evaluate if plasma or CSF beta-endorphin level can be induced to rise during the treatment of heroin addiction by electroacupuncture. Based on the examination of 30 addicts, we obtained no evidence indicating an increase of beta-endorphin level in either the plasma or the CSF after 30 min of acupuncture. In spite of this, the majority of the addicts experienced a reduction of withdrawal symptoms during treatment. Since electroacupuncture may only induce a highly localized secretion of beta-endorphin in the brain, our results cannot unequivocally exclude the possibility that this peptide is involved in mediating the action of acupuncture.

The influence of electro-acupuncture on naloxone-induced morphine withdrawal. II. Elevation of immunoassayable beta-endorphin activity in the brain but not the blood

The effect of electro-acupuncture in the treatment of naloxone precipitated morphine withdrawal in mice was studied. Thirty minutes of acupuncture was enough to suppress withdrawal behaviors by more than 60%. Concomitant to the decrease of withdrawal behavior, there was a significant increase of brain beta-endorphin level in the acupunctured animals. Plasma beta-endorphin level of the treated and untreated group was not significantly different.

Intrathecal administration of beta-endorphin and dynorphin-(1-13) for the treatment of intractable pain

Seven cases of chronic pain were treated by intrathecal administration of 30 micrograms of beta-endorphin and dynorphin-(1-13). Compared with saline, both peptides were able to suppress pain for periods up to 4.5 and 7 hours on the average, respectively. No significant side reactions were noticed during the entire investigation.

Comparison of the effectiveness of different opioid peptides in suppressing heroin withdrawal

The effectiveness of beta-endorphin, dynorphin-(1-13), dynorphin-(1-10) amide, alpha-neoendorphin and [D-Ala2,D-Leu5]enkephalin in suppressing withdrawal in heroin addicts was compared in this study. Groups of six patients were stabilized overnight in the hospital and were treated with either saline or peptide when withdrawal symptoms began to appear the following morning. Withdrawal was scored before and after treatment by the patient himself and an independent observer. Peptides were administered in a bolus dose of 60 micrograms/kg body weight. The patient, the observer and the physician who administered the injection were all blind to the nature of the compound given. All treatments, including those with saline, produced an overall reduction of withdrawal score. However, by statistical analysis, only treatments with beta-endorphin, [D-Ala2,D-Leu5]enkephalin and dynorphin-(1-13) were effective in producing a significant decrease of withdrawal symptoms. The length of relief brought about by the different peptides varied from less than an hour to a maximum of 5 h in one case. The average period of relief brought about by beta-endorphin, dynorphin-(1-13) and [D-Ala2,D-Leu5]enkephalin was 44, 46 and 60 min, respectively. Of the five peptides administered [D-Ala2,D-Leu5]enkephalin produced the largest number of side-effects.

Treatment of pain in cancer patients by intrathecal administration of dynorphin

Dynorphin-(1-13) and -(1-10) were administered by intrathecal injection into six terminal cancer patients at doses of 7.5, 15, 30 and 60 micrograms. Compared with saline, both analogues of dynorphin were effective in suppressing pain. The duration of relief at doses of 15 micrograms and above was more than 4 hours on the average for both peptides. However, no proportional increase in response was observed when the dose applied was doubled. This lack of response might have been due to the development of tolerance.

Ontogenesis of multiple forms of monoamine oxidase in rat brain regions and liver

The postnatal development of total, type-A and type-B monoamine oxidase (MAO) in the brain stem, forebrain and cerebellum, determined with preferred substrates or selective inhibitors, were found to follow different patterns. In the brain regions, MAO-A activity reached adult levels in the brain stem first, followed by the forebrain and cerebellum, while MAO-B reached adult levels in these regions at about the same time and later in postnatal life. On the other hand, both MAO-A and B activities were almost fully developed in the newborn liver. Moreover, total and type-A, but not type-B, showed a caudal-to-rostral sequence of biochemical maturation in the brain. The spatiotemporal pattern of differentiation of type-A and type-B activities in the brain tends to support the classification of brain MAO into two distinct isoenzymic forms.

Met-enkephalin level in the cerebrospinal fluid of schizophrenic patients

The level of met-enkephalin in the cerebrospinal fluid of 18 schizophrenic and 18 non-mental patients were determined by radioimmunoassay. The concentration of this peptide in the schizophrenic patients ranged from 12 to 39 ng/l with a mean of 22.2 ng/l. The mean and range of the non-mental patients were 28 ng/l and 16 to 41 ng/l, respectively. The difference between the mean enkephalin level of the two groups was statistically significant by the t-test. However, this difference must be interpreted with caution since the data obtained from the non-mental patients cannot be regarded as normal. No significant correlation was observed between the severity of schizophrenic symptoms and cerebrospinal fluid met-enkephalin level.

Ventriculo-superior sagittal sinus shunt for hydrocephalus

Fifty-two children with hydrocephalus had ventriculo-superior sagittal sinus shunts installed. Hydrocephalus was communicating in 18 patients and noncommunicating in 34. Eleven patients died in the immediate postoperative period: 2 from intraventricular hemorrhage; 7 from midline tumors, who were moribund on admission; and 2 from postoperative infection. Forty-one patients recovered from the operation, but the 17 who had tumors eventually died from their disease. Of the 24 surviving patients, 7 were lost to follow-up. The remaining 17 patients were followed for one to six years (average, 4 years, 9 months). Of the 24 patients, 9 (37.5%) needed revision of the tube because of blockage, 6 in the intraventricular end and 3 in the sinus end.

Cerebrospinal fluid [Met5]enkephalin level in schizophrenics during treatment with naloxone

The effect of naloxone on CSF [Met5]enkephalin level and on the suppression of psychotic symptoms associated with schizophrenia was studied. Seven patients were treated with naloxone at a dose of 0.4 mg/day for seven days and six were treated with saline for the same period. Of the seven patients receiving naloxone, three showed signs of improvement. In the saline group, only one case of obvious improvement was observed. The mean CSF [Met5]enkephalin level before and after treatment in both the naloxone and saline group did not change significantly. However, there was a highly significant correlation (r = -0.73, P less than 0.01) between the increase of [Met5]enkephalin level and the decrease in psychotic symptoms.

Fast detoxification of heroin addicts by acupuncture and electrical stimulation (AES) in combination with naloxone

Detoxification can be accomplished more rapidly by first "flushing" the opiates from the receptor sites. Naloxone, a short acting antagonist displaces opiates from the receptor sites and such displacement precipitates an abstinence syndrome. Recently, a method of using acupuncture and electrical stimulation (AES) in combination with naloxone for fast detoxification was reported. This technique was applied to 50 cases of heroin addicts. Forty-one were detoxified. There were nine failures. Of the 41 cases, 18 patients were sent to rehabilitation centres and did not experience abstinence symptoms. Six were sent out of Hong Kong where heroin is not available, and two others did not go to a rehabilitation centre but still abstained. The other 15 were presumed to be on the drug. It is advocated that AES increases endorphin and relieves abstinence syndrome, but also at the same time inhibits the autonomic nervous system, mainly the parasympathetic nervous system. The technique does not stop the craving, therefore after detoxification, the patients should be sent for psycho-social rehabilitation, or alternatively be put on long acting antagonist.

Ellipticine inhibits the proliferation and induces apoptosis in rheumatoid arthritis fibroblast-like synoviocytes via the STAT3 pathway

OBJECTIVE

Ellipticine (5,11-dimethyl-6H-pyrido[4,3-b]carbazole) is an alkaloid isolated from Apocyanaceae plants. This study was designed to investigate the effects of ellipticine on the proliferation and apoptosis of fibroblast-like synoviocytes (FLSs) from patients with rheumatoid arthritis (RA).

METHODS

RA-FLSs were exposed to different concentrations of ellipticine (i.e., 0.5, 1, 2, 4 and 8 μM) for 24-72h and measured for viability, proliferation and apoptosis. The involvement of signal transducer and activators of transcription 3 (STAT3) signaling in the action of ellipticine was determined by Western blot analysis, luciferase reporter assay and rescue experiments.

RESULTS

Ellipticine treatment significantly inhibited the viability and proliferation of RA-FLSs in a concentration-dependent manner. In contrast, ellipticine exposure did not alter the viability of normal human FLSs. Moreover, ellipticine triggered significant apoptosis and increased caspase-3 activity in RA-FLSs. Mechanistically, ellipticine reduced the phosphorylation of STAT3 and downregulated the expression of Mcl-1, cyclin D1 and Bcl-2. Luciferase reporter assay demonstrated that ellipticine treatment led to a significant inhibition of STAT3-mediated transcriptional activity in RA-FLSs. Overexpression of constitutively active STAT3 reversed the suppressive effects of ellipticine on RA-FLSs, which was accompanied by restoration of Mcl-1, cyclin D1 and Bcl-2.

DISCUSSION AND CONCLUSIONS

Ellipticine shows anti-proliferative and pro-apoptotic effects on RA-FLSs through inhibition of the STAT3 pathway and may have therapeutic potential in RA.

Clinical experience and mechanism of acupuncture and electrical stimulation (AES) in the treatment of drug abuse

Three hundred cases were treated by AES in an out-patient detoxification setting. Seventy-seven cases completed 14 days of treatment and of these 30 were detoxified. One hundred and twenty-six cases came back for retreatment and another 19 cases (19/300 = 6.3% or 19/126 = 15.5%) were detoxified. It was found that the ACTH, cortisol (corticosterone), c-AMP were elevated during abstinence and these compounds were reduced after AES treatment. Fraction I of the opiate activity in the brains of mice was found to be increased after AES. It has been suggested that this could be a beta-endorphin. Recently it was found that during abstinence the plasma beta-lipoprotein and and beta-endorphin were elevated but not reduced after AES. However, the CSF met-enkephalin was within normal limits during abstinence but greatly elevated after half an hour of AES. It is suggested that acupuncture affects not only the somatosensory nervous system but also the autonomic nervous system, as well as the neuro-endocrine system in drug abusers.