All about pain pharmacology: what pain physicians should know

From the perspective of the definition of pain, pain can be divided into emotional and sensory components, which originate from potential and actual tissue damage, respectively. The pharmacologic treatment of the emotional pain component includes antianxiety drugs, antidepressants, and antipsychotics. The anti-anxiety drugs have anti-anxious, sedative, and somnolent effects. The antipsychotics are effective in patients with positive symptoms of psychosis. On the other hand, the sensory pain component can be divided into nociceptive and neuropathic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are usually applied for somatic and visceral nociceptive pain, respectively; anticonvulsants and antidepressants are administered for the treatment of neuropathic pain with positive and negative symptoms, respectively. The NSAIDs, which inhibit the cyclo-oxygenase pathway, exhibit anti-inflammatory, antipyretic, and analgesic effects; however, they have a therapeutic ceiling. The adverse reactions (ADRs) of the NSAIDs include gastrointestinal problems, generalized edema, and increased bleeding tendency. The opioids, which bind to the opioid receptors, present an analgesic effect only, without anti-inflammatory, antipyretic, or ceiling effects. The ADRs of the opioids start from itching and nausea/vomiting to cardiovascular and respiratory depression, as well as constipation. The anticonvulsants include carbamazepine, related to sodium channel blockade, and gabapentin and pregabalin, related to calcium blockade. The antidepressants show their analgesic actions mainly through inhibiting the reuptake of serotonin or norepinephrine. Most drugs, except NSAIDs, need an up-dose titration period. The principle of polypharmacy for analgesia in case of mixed components of pain is increasing therapeutic effects while reducing ADRs, based on the origin of the pain.

Luminescence properties of different Eu sites in LiMgPO4:Eu(2+), Eu(3+)

The effect of temperature on the luminescence properties of LiMgPO4 doped with Eu(3+) and Eu(2+) are presented. Depending on the excitation wavelength, luminescence spectra consist of two distinct broad emission bands peaking at 380 nm and 490 nm related to 4f(6)5d(1) → 4f(7) ((8)S7/2) luminescence of Eu(2+) and to europium-trapped exciton, respectively, and/or several sharp lines between the 580 nm and 710 nm region, ascribed to the (5)D0 → (7)FJ (J = 0, 1, 2, 3 and 4) transitions in Eu(3+). To explain all the features of the Eu(2+) and Eu(3+) luminescence we discussed the existence of two different Eu sites substituting for Li(+), with short and long distance compensation. The evident effect of increasing the intensity of the Eu(2+) luminescence with increasing temperature was observed. It was considered that the charge compensation mechanism for Eu(3+) and Li(+) as well as Eu(2+) replacing Li(+) in the LiMgPO4 is a long distance compensation that allows for the existence of some of the europium ions either as Eu(3+) at low temperature or as Eu(2+) at high temperature. We concluded that Eu(2+) in the Li(+) site with long distance compensation yields only 4f(6)5d(1) → 4f(7) luminescence, whereas Eu(2+) in the Li(+) site with short distance compensation yields 4f(6)5d(1) → 4f(7) luminescence and europium-trapped exciton emission.

Immunotherapy of experimental autoimmune encephalomyelitis by adoptive transfer of B cells stimulated with MOG (50.4)

The efficacy of adoptive transfer of activated B cells in an experimental autoimmune encephalomyelitis (EAE) model was investigated. B cells were prepared from C57BL/6 mice immunized with myelin oligodendrocyte glycoprotein (MOG 323-339) in CFA. Primary (1o) or secondary (2 o) stimulation of purified B cells was performed with MOG, LPS, and anti-CD40. EAE was induced by immunization with MOG plus M. tuberculosis and pertussis toxin. Adoptive transfer of 2 o B cells on day-1(D-1) of MOG immunization significantly prevented EAE development in a dose-dependent manner, but not 1o B cells. Adoptive transfer on D13 of immunization also suppressed EAE progress. At day 50, controls and treated mice were reimmunized with MOG and the results showed that adoptive transfer of activated 2o B cells induced long-term resistance to disease. 2o B cell treatment enhanced MOG-specific IgG1 but suppressed IgG2a antibody secretion. Cytokine profiles of splenic CD4+ T cells obtained on D21 of immunization clearly indicated that adoptively transferred 2o B cells drive Ag-specific TH2 responses. The fail of transfer of EAE with T cells from treated mice, but not control mice, supported that T cells polarized toward TH2 are responsible for the efficacy of 2o B cells. Neither regulatory T cells nor TH17 were likely to be involved in 2o B-mediated suppression of EAE. In conclusion, adoptive transfer of 2o B cells may be a promising strategy for immunotherapy of TH1-dominant autoimmune disorders.

Therapeutic target validation of protein kinase C(PKC)-zeta for asthma using a mouse model

Protein kinase C (PKC) is a complex family consisting of many types of isoenzymes, of which PKC-zeta, an atypical isoform, has been reportedly implicated in the regulation of apoptosis and NF-kappaB, as well as control of T-dependent responses. Based on the recent report that PKC-zeta controls TH2 response, the current study was aimed to evaluate PKC-zeta as a potential therapeutic target for asthma using a mouse model. Mouse allergic asthma was induced by repeated sensitization followed by intranasal challenge with OVA and PKC-zeta pseudosubstrate inhibitor (PPI) was intratracheally instilled before each OVA challenge. Airway hyperreactivity (AHR) was measured by beta-methacoline-induced airflow obstruction. Cellular and cytokine profile in bronchoalveolar lavage fluid (BALF) and level of serum IgE as well as cytokine production by draining lymph node cells were compared. AHR and numbers of eosinophils in BALF were significantly lowered by PPI, indicating that blocking of PKC-zeta activation alleviates asthmatic manifestations. Additionally, PPI instillation decreased IL-5 and IL-13 levels in BALF to approximately 20% of controls, but not IFN-gamma level. Instillation of PPI also caused a marked fall in the level of TNF-alpha, another NF-kappaB-dependent, proinflammatory cytokine. Serum OVA-specific IgE level and ex vivo IL-4, IL-5 and IL-13, but not IFN-gamma, production by peribronchial lymph node cells was also considerably lower in PPI-treated mice. In conclusion, blockade of PKC-zeta signals by intratracheal instillation of PPI alleviates allergen-specific TH2 response as well as asthmatic manifestations and hence PKC-zeta is a promising target for treatment of asthma.

Oral Administration of Aqueous Extract ofCarthami FlosInduces Macrophage Activation and Preferentially Potentiates Type 1 Helper T-Cell ResponseIn Vivo

In vivo immunomodulatory activity of aqueous extract of Carthami Flos (AECF) was investigated using a mouse model immunized with keyhole limpet hemocyanin. Serum level of Ag-specific IgG2a was significantly elevated by oral administration of AECF but not IgG1. However, no selective B-cell proliferation by AECF was observed in vivo. Ag-specific proliferation and IFN-gamma and IL-5 production of draining lymph node T cells also was higher in AECF-treated mice when compared with water-treated control mice. However, AECF failed to enhance nonspecific T-cell response under CD3 stimulation. These results led us to hypothesize that AECF potentiates Ag-specific T-cell response, possibly through activation of antigen presenting cells (APC) other than B cells. Functional assessment of splenic macrophages showed that AECF administration significantly enhances IL-12 production as well as APC activity for IFN-gamma production and STAT-4 activation by T cells. Collectively, these data strongly support that AECF preferentially potentiates immune response polarized toward TH1 and for which increased activation of macrophages is most likely to be responsible. The present data implicate a possible application of AECF to potentiate cellular immunity and, we hope, prevent intracellular infections.

CD30 supports lung inflammation

The physiological functions of CD30 have not been fully elucidated. Here we show that in CD30-deficient mice (CD30(-/-)), lung inflammation is significantly diminished in the ovalbumin (OVA) model of airway hyperreactivity. In CD30(-/-) mice, the recruitment of eosinophils into the airways after OVA-aerosol challenge of OVA-primed mice was significantly diminished when compared with wild-type (w.t.) mice. IL-13 levels were also significantly reduced in CD30(-/-) mice while levels of IFN-gamma, IL-4, IL-5 and IgE in bronchoalveolar lavage fluid, lung tissue and serum were comparable to w.t. mice. Peribronchial lymph node cells from CD30(-/-) mice, re-stimulated in vitro with OVA, secreted significantly lower levels of IL-13 than those from w.t. mice, but showed normal proliferative response and other cytokine production. Exogenous IL-13 reconstituted airway recruitment of leukocytes in OVA-challenged CD3O(-/-) mice. Adoptive transfer to naive w.t. mice of in vitro OVA-re-stimulated spleen cells from CD30(-/-) mice failed to induce eosinophilic pulmonary inflammation in contrast to transfer of primed cells from w.t. mice. These results indicate that CD30 is a regulator of T(h)2 responses in the effector-memory phase and a regulator of IL-13 production in memory cells in the lung.

Effective microorganism fermentation extract (EM-X) attenuates airway hyperreactivity and inflammation through selective inhibition of the TH2 response independently of antioxidant activity

The effective microorganism fermentation extract (EM-X) is an antioxidant cocktail derived from the fermentation of plant material with effective microorganisms, and its clinical application is being increasingly scrutinized. In the current study, the antiasthmatic effect of EM-X was investigated using a mouse model. Inhalation of EM-X during OVA challenge resulted in a significant reduction in airway hyperreactivity (AHR) and airway recruitment of leukocytes including eosinophils. However, the level of 8-isoprostane in bronchoalveolar lavage fluid (BALF), a marker of oxidative stress in asthmatic patients, was unaltered by EM-X inhalation. Instead, ELISA data showed that levels of IL-4, IL-5 and IL-13 in BALF or lung tissues were significantly lower in EM-X-inhaling mice than in the control mice, but not the IFN-gamma level. A considerably lower amount of Ag-specific IgE and IgG1 was detected in the serum of EM-X-inhaling mice than in the serum of the controls, whereas their IgG2a secretion was similar. In addition, Ag-specific ex vivo IL-4, IL-5 and IL-13 production of draining lymph node cells was markedly diminished by EM-X inhalation, but not IFN-gamma. These data clearly show that inhaled EM-X suppresses type 2 helper T (TH2), but not type 1 helper T (TH1), response. In conclusion, inhalation of EM-X attenuates AHR and airway inflammation which results from selective inhibition of the TH2 response to allergen, but independently of antioxidant activity. Our data also suggest that EM-X may be effectively applied for control of allergic asthma.

Multiple round of stimulation renders B cells capable to drive type 2 helper T (TH2) cell response (36.13)

Using hybrid mice of HEL-specific BCR Tg mice and OVA-specific TCR Tg mice, we investigated whether activated B cells may modulate T cell differentiation in addition to antigen presentation. Analysis of cytokine secretion has revealed that primarily stimulated (1°) B cells are more potent APC than naive B cells. However, second (2°) and further round of stimulation renders B cells capable to strongly drive polarization of naive CD4 T cells toward TH2 response, and concomitantly inhibitory to TH1 response. In the presence of 2° B cells as APC, activation of STAT-4 and T-bet was selectively inhibited during Ag-specific priming of T cells, whereas STAT-6 and GATA-3 were promoted, compared to 1° B cells. Altered MHC expression on 2° B cells was uncoupled with TH2 polarization, because they similarly work in nonspecific CD3 stimulation of T cells. Second round of stimulation regulates expression of costimulatory molecules on B cells, but not positively any TH2-related ones. Rather, 2° B cells were more likely to drive toward TH2 response via soluble mediators. 2° B cells produced much lower level of IFNγ and TNFα, but markedly higher levels of TH2 cytokines including IL-4 and IL-10, which largely contributed to 2° B-mediated TH2 polarization. This study suggests a possible therapeutic application of activated B cells against diseases caused by inappropriate TH1/2 polarization.

Antiasthmatic activity and selective inhibition of type 2 helper T cell response by aqueous extract of semen armeniacae amarum

Semen armeniacae amarum (SAA) has long been used to control asthma in Korean traditional medicine. However, its antiasthmatic action still remains poorly understood. In the current study, effective mechanism of SAA was investigated in a mouse model of allergic asthma induced by repeated sensitization and intranasal challenge with OVA. Airway hyperreactivity (AHR) measured by beta-methacholine-induced airflow obstruction and airway recruitment of leukocytes including eosinophils were significantly reduced by oral treatment of SAA water extract. Level of interleukin (IL)-4, but not Interferon gamma (IFN-gamma), in the bronchoalveolar lavage fluid (BALF) also appeared considerably lower in SAA-treated mice than in controls. Collectively, these data show that SAA suppresses type 2 helper T cell (Th2), but not type 1 helper T cell (Th1), response. This hypothesis was supported further by the data of ex vivo cytokine production of peribronchial lymph node cells. Thus, oral administration of SAA attenuates asthmatic manifestations including AHR and airway inflammation, which possibly result from selective inhibition of Th2 response to allergen. Our data strongly suggest that SAA may be effectively applied to control other Th2-related diseases as well as allergic asthma.

Characterization of N-acetylmuramidase M-1 of Streptomyces globisporus produced by Escherichia coli BL21(DE3)pLysS

A gene of Streptomyces globisporus encoding N-acetylmuramidase M-1 was cloned into the pET26b vector and expressed in Escherichia coli BL21(DE3)pLysS. Maximal activity for the purified enzyme was observed at 55 degrees C with an optimal pH of 5.3, and N-bromosuccinimide strongly inhibited lytic activity even at a concentration of 0.01 mM. The enzyme showed N,O-diacetylmuramidase activity.

Cortical excitability during prolonged antiepileptic drug treatment and drug withdrawal

OBJECTIVE

Previous reports characterized the effects of administration of single oral doses of antiepileptic drugs (AED) on cortical excitability. However, AED effects on cortical excitability, and their relationship to plasma blood levels, during chronic drug administration at therapeutic doses are not known. The objective of the study was to determine whether plasma blood levels during chronic administration at therapeutic doses would accurately predict changes in corticomotor excitability.

METHODS

We used transcranial magnetic stimulation (TMS) to measure cortical excitability during 5 weeks administration of carbamazepine (CBZ) and lamotrigine (LTG), and subsequent AED withdrawal in 20 healthy volunteers. Data were analyzed using ANOVA(RM) and regression analysis.

RESULTS

Resting motor thresholds (r-MT) increased with increasing total and free CBZ and LTG levels during drug administration, but not drug withdrawal. After acute AED withdrawal, r-MT elevation persisted in most individuals with CBZ despite undetectable plasma levels, compared to a rapid normalization with LTG. In contrast, acute drug withdrawal resulted in a transient decrease in r-MT in 3/10 individuals with CBZ and 2/10 with LTG.

CONCLUSIONS

Plasma levels provide information on motor cortical function during active treatment phases but not during AED withdrawal.

SIGNIFICANCE

The transient decrease in r-MT associated with acute AED withdrawal could represent a physiological substrate contributing to AED withdrawal seizures.

Eupatilin, a pharmacologically active flavone derived from Artemisia plants, induces apoptosis in human promyelocytic leukemia cells

Extracts of the whole herb of Artemisia asiatica Nakai (Asteraceae) have been used in traditional oriental medicine for the treatment of inflammation, cancer and other disorders. In the present work, we have evaluated the apoptosis-inducing capability of eupatilin (5,7-dihydroxy-3,4,6-trimethoxyflavone), a pharmacologically active ingredient of A. asiatica, in cultured human promyelocytic leukemia (HL-60) cells. Thus, eupatilin exhibited concentration-dependent inhibitory effects on viability and DNA synthesis capability of HL-60 cells. The anti-proliferative effect of eupatilin was attributable to its apoptosis-inducing activity as determined by characteristic nuclear condensation, in situ terminal end-labeling of fragmented DNA (TUNEL), release of mitochondrial cytochrome c into cytoplasm, proteolytic activation of caspases-9, -3, and -7, and cleavage of poly(ADP-ribose)polymerase. Eupatilin-induced HL-60 cell apoptosis does not appear to be mediated via alteration in Bcl-2/Bax-2. Taken together, the above findings suggest that eupatilin has chemopreventive and cytotoxic effects.

Capsaicin suppresses phorbol ester-induced activation of NF-kappaB/Rel and AP-1 transcription factors in mouse epidermis

Capsaicin, the principal pungent ingredient of hot chili peppers, has anti-inflammatory and analgesic properties and is currently used as a topical cream for the management of various neuropathic conditions. In the present study, topical application of capsaicin onto dorsal skin of female ICR mice strongly suppressed phorbol ester-stimulated activation of NF-kappaB via blockade of IkappaB-alpha degradation with subsequent inhibition of nuclear translocation of the functionally active NF-kappaB subunit, p65. Likewise, phorbol ester-induced activation of activator protein-1 (AP-1) was abolished by capsaicin pretreatment. Since altered transactivation of NF-kappaB and AP-1 has been implicated for neoplastic transformation and progression, the suppression of these transcription factors by capsaicin may account for its previously reported chemopreventive effects on mouse skin tumorigenesis as well as inflammation.

Inhibitory effects of curcumin and capsaicin on phorbol ester-induced activation of eukaryotic transcription factors, NF-kappaB and AP-1

Recently, considerable attention has been focused on identifying dietary and medicinal phytochemicals that can inhibit, retard or reverse the multi-stage carcinogenesis. Spices and herbs contain phenolic substances with potent antioxidative and chemopreventive properties. Curcumin, a yellow colouring agent from turmeric and capsaicin, a pungent principle of red pepper exhibit profound anticarcinogenic and antimutagenic activities. Two well-defined eukaryotic transcription factors, nuclear factor-kappa B (NF-kappaB) and activator protein 1 (AP-1) have been implicated in pathogenesis of many human diseases including cancer. These transcription factors are known to be activated by a wide array of external stimuli, such as tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA), tumor necrosis factor, reactive oxygen species, bacterial lipopolysaccharide, and ultraviolet. In the present study, we found that topical application of TPA onto dorsal skin of female ICR mice resulted in marked activation of epidermal NF-kappaB and AP-1. Curcumin and capsaicin, when topically applied prior to TPA, significantly attenuated TPA-induced activation of each transcription factor in mouse skin. Likewise, both compounds inhibited NF-kappaB and AP-1 activation in cultured human promyelocytic leukemia (HL-60) cells stimulated with TPA. Based on these findings, it is likely that curcumin and capsaicin exert anti-tumor promotional effects through suppression of the tumor promoter-induced activation of transcription factors, NF-kappaB and AP-1.

Site-directed mutagenesis of the amino acid residues in beta-strand III [Val30-Val36] of D-amino acid aminotransferase of Bacillus sp. YM-1

The beta-strand III formed by amino acid residues Val30-Val36 is located across the active site of the thermostable D-amino acid aminotransferase (D-AAT) from thermophilic Bacillus sp. YM-1, and the odd-numbered amino acids (Tyr31, Val33, Lys35) in the strand are revealed to be directed toward the active site. Interestingly, Glu32 is also directed toward the active site. We first investigated the involvement of these amino acid residues in catalysis by alanine scanning mutagenesis. The Y31A and E32A mutant enzymes showed a marked decrease in k(cat) value, retaining less than 1% of the wild-type enzyme activity. The k(cat) values of V33A and K35A were changed slightly, but the Km of K35A for alpha-ketoglutarate was increased to 35.6 mM, compared to the Km value of 2.5 mM for the wild-type enzyme. These results suggested that the positive charge at Lys35 interacted electrostatically with the negative charge at the side chain of alpha-ketoglutarate. Site-directed mutagenesis of the Glu32 residue was conducted to demonstrate the role of this residue in detail. From the kinetic and spectral characteristics of the Glu32-substituted enzymes, the Glu32 residue seemed to interact with the positive charge at the Schiff base formed between the aldehyde group of pyridoxal 5'-phosphate (PLP) and the epsilon-amino group of the Lys145 residue.