Attenuation of postoperative adhesions using a modeled manual therapy

Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations. As such, they represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. We hypothesized that postoperative adhesions develop from a lack of movement of the abdominopelvic organs in the immediate postoperative period while rendered immobile by surgery and opiates, and tested whether manual therapy would prevent their development. In a modified rat cecal abrasion model, rats were allocated to receive treatment with manual therapy or not, and their resulting adhesions were quantified. We also characterized macrophage phenotype. In separate experiments we tested the safety of the treatment on a strictureplasty model, and also the efficacy of the treatment following adhesiolysis. We show that the treatment led to reduced frequency and size of cohesive adhesions, but not other types of adhesions, such as those involving intraperitoneal fatty structures. This effect was associated with a delay in the appearance of trophic macrophages. The treatment did not inhibit healing or induce undesirable complications following strictureplasty. Our results support that that maintained movements of damaged structures in the immediate postoperative period has potential to act as an effective preventive for attenuating cohesive postoperative adhesion development. Our findings lay the groundwork for further research, including mechanical and pharmacologic approaches to maintain movements during healing.

Modulation of breast cancer cell viability by a cannabinoid receptor 2 agonist, JWH-015, is calcium dependent

Introduction

Cannabinoid compounds, both nonspecific as well as agonists selective for either cannabinoid receptor 1 (CB₁) or cannabinoid receptor 2 (CB₂), have been shown to modulate the tumor microenvironment by inducing apoptosis in tumor cells in several model systems. The mechanism of this modulation remains only partially delineated, and activity induced via the CB₁ and CB₂ receptors may be distinct despite significant sequence homology and structural similarity of ligands.

Methods

The CB₂-selective agonist JWH-015 was used to investigate mechanisms downstream of CB₂ activation in mouse and human breast cancer cell lines in vitro and in a murine mammary tumor model.

Results

JWH-015 treatment significantly reduced primary tumor burden and metastasis of luciferase-tagged murine mammary carcinoma 4T1 cells in immunocompetent mice in vivo. Furthermore, JWH-015 reduced the viability of murine 4T1 and human MCF7 mammary carcinoma cells in vitro by inducing apoptosis. JWH-015-mediated reduction of breast cancer cell viability was not dependent on Gα_i signaling in vitro or modified by classical pharmacological blockade of CB₁, GPR55, TRPV1, or TRPA1 receptors. JWH-015 effects were calcium dependent and induced changes in MAPK/ERK signaling.

Conclusion

The results of this work characterize the actions of a CB₂-selective agonist on breast cancer cells in a syngeneic murine model representing how a clinical presentation of cancer progression and metastasis may be significantly modulated by a G-protein-coupled receptor.

Immunosuppressive effects of erythropoietin on human alloreactive T cells

Correction of anemia with erythropoietin (EPO) is associated with improved kidney transplant outcomes. Emerging evidence, predominantly from animal models, indicates that these observations may be erythropoiesis-independent and that EPO exhibits immunosuppressive properties. We examined the effects of EPO on human T-cell alloimmunity by first documenting that CD4(+) and CD8(+) T cells express EPO receptor (EPO-R) on their surfaces. In mixed lymphocyte reactions, EPO induced a dose-dependent decrease in allogeneic CD4(+) T-cell proliferation (EPO 1000 U/ml: 44.6%±22.9% of vehicle, P<0.05; 2000 U/ml: 11.1%±4% of vehicle, P<0.001) without inducing cell death. The effects required signals transmitted directly through the EPO-R expressed on T cells, resulting in diminished Th1 differentiation without effects on regulatory T-cell induction. Mechanistic studies revealed that EPO prevented IL-2-induced proliferation by uncoupling IL-2 receptor signaling, inhibiting phosphorylation of the intracellular intermediaries AKT and extracellular signal-regulated kinase that are known to mediate T-cell expansion. EPO treatment reduced expansion of human naïve CD4(+) T cells after adoptive transfer into NOD scid γc(null) mouse recipients, verifying the effects in vivo. Although activated T cells expressed CD131, an alternative EPO receptor, addition of a specific CD131 agonist peptide, ARA290, did not alter T-cell proliferation or cytokine production. Our findings link EPO-R signaling on T cells to inhibition of T-cell immunity, providing one mechanism that could explain the observed protective effects of EPO in kidney transplant recipients.

Building a better analgesic: multifunctional compounds that address injury-induced pathology to enhance analgesic efficacy while eliminating unwanted side effects

The most highly abused prescription drugs are opioids used for the treatment of pain. Physician-reported drug-seeking behavior has resulted in a significant health concern among doctors trying to adequately treat pain while limiting the misuse or diversion of pain medications. In addition to abuse liability, opioid use is associated with unwanted side effects that complicate pain management, including opioid-induced emesis and constipation. This has resulted in restricting long-term doses of opioids and inadequate treatment of both acute and chronic debilitating pain, demonstrating a compelling need for novel analgesics. Recent reports indicate that adaptations in endogenous substance P/neurokinin-1 receptor (NK1) are induced by chronic pain and sustained opioid exposure, and these changes may contribute to processes responsible for opioid abuse liability, emesis, and analgesic tolerance. Here, we describe a multifunctional mu-/delta-opioid agonist/NK1 antagonist compound [Tyr-d-Ala-Gly-Phe-Met-Pro-Leu-Trp-NH-Bn(CF3)2 (TY027)] that has a preclinical profile of excellent antinociceptive efficacy, low abuse liability, and no opioid-related emesis or constipation. In rodent models of acute and neuropathic pain, TY027 demonstrates analgesic efficacy following central or systemic administration with a plasma half-life of more than 4 hours and central nervous system penetration. These data demonstrate that an innovative opioid designed to contest the pathology created by chronic pain and sustained opioids results in antinociceptive efficacy in rodent models, with significantly fewer side effects than morphine. Such rationally designed, multitargeted compounds are a promising therapeutic approach in treating patients who suffer from acute and chronic pain.

Disease modification of breast cancer-induced bone remodeling by cannabinoid 2 receptor agonists

Most commonly originating from breast malignancies, metastatic bone cancer causes bone destruction and severe pain. Although novel chemotherapeutic agents have increased life expectancy, patients are experiencing higher incidences of fracture, pain, and drug-induced side effects; furthermore, recent findings suggest that patients are severely undertreated for their cancer pain. Strong analgesics, namely opiates, are first-line therapy in alleviating cancer-related pain despite the severe side effects, including enhanced bone destruction with sustained administration. Bone resorption is primarily treated with bisphosphonates, which are associated with highly undesirable side effects, including nephrotoxicity and osteonecrosis of the jaw. In contrast, cannabinoid receptor 2 (CB(2) ) receptor-specific agonists have been shown to reduce bone loss and stimulate bone formation in a model of osteoporosis. CB(2) agonists produce analgesia in both inflammatory and neuropathic pain models. Notably, mixed CB(1) /CB(2) agonists also demonstrate a reduction in ErbB2-driven breast cancer progression. Here we demonstrate for the first time that CB(2) agonists reduce breast cancer-induced bone pain, bone loss, and breast cancer proliferation via cytokine/chemokine suppression. Studies used the spontaneously-occurring murine mammary cell line (66.1) implanted into the femur intramedullary space; measurements of spontaneous pain, bone loss, and cancer proliferation were made. The systemic administration of a CB(2) agonist, JWH015, for 7 days significantly attenuated bone remodeling, assuaged spontaneous pain, and decreased primary tumor burden. CB(2) -mediated effects in vivo were reversed by concurrent treatment with a CB(2) antagonist/inverse agonist but not with a CB(1) antagonist/inverse agonist. In vitro, JWH015 reduced cancer cell proliferation and inflammatory mediators that have been shown to promote pain, bone loss, and proliferation. Taken together, these results suggest CB(2) agonists as a novel treatment for breast cancer-induced bone pain, in which disease modifications include a reduction in bone loss, suppression of cancer growth, attenuation of severe bone pain, and increased survival without the major side effects of current therapeutic options.

Abstract P1-11-23: Cannabinoid Receptor 2 Compounds in the Attenuation of Breast Cancer Cell Proliferation: Mechanisms of Action

Cannabinoids have been well established as mediators of tumor cell proliferation in several cancer models. The activity of cannabinoid receptor 1 (CB1) agonists as well as cannabinoid receptor 2 (CB2) agonists have been extensively studied over the last decade, though their mechanisms of action have yet to be defined in the context of attenuating tumor proliferation. CB1 is abundant in the central nervous system with a low level of expression in the periphery, while CB2 exists primarily on cells of the immune system. Due to the lack of neuronal expression of CB2 receptors, compounds acting at CB2 receptors do not produce the psychotropic effects associated with CB1 receptor compounds. Although CB1 and CB2 compounds have yielded similar antiproliferative results in some tumor cells in vitro, CB2 receptors are markedly upregulated in many tumor cell lines for unknown reasons. Therefore, we focused on compounds selective for the CB2 receptor, including the CB2 selective agonists JWH-015 and AM1241. We show here that CB2 agonists and antagonists alike attenuate the proliferation of mouse and human breast cancer cells in a concentration dependent manner. CB2 agonist induced breast cancer anti-proliferation is not blocked by pretreatment with pertussis toxin, the CB1 cannabinoid receptor antagonist SR141716, or the transient receptor potential cation channel subfamily V member 1 (TRPV1) antagonist capsazepine. The CB1 and CB2 receptors are classified as G-protein coupled receptors (GPCRs) that are generally linked to Gai or Gaq. Agonists and antagonists of G protein coupled receptors are typically defined based on their Ga mediated effect on intracellular cAMP levels. This method of classification is not entirely effective: it ignores the possibility of differential effects on alternative kinases and the bg subunit activity. The anti-proliferative activity of both JWH-015 and SR144528 may be explained by alternative receptor coupling pathways, changes in constitutive activity, or activity at a separate receptor. Here, we show a dose and time dependent decrease in phosphorylated ERK in cells treated with either JWH-015 (CB2 agonist) or SR144528 (CB2 antagonist). Together, these data along with the absence of a pertussis toxin effect suggest that the CB2 compounds are acting in a non-Gai coupled manner, and are attenuating a pro-survival pathway. Further studies are necessary to identify the binding partner responsible for the antiproliferative effects of CB2 compounds. We advance the idea that CB2 receptors on breast cancer cells constitutively activate the MAP/ERK pro-survival pathway and that by preventing constituitive activity of the CB2 receptor, CB2 compounds downregulate phosphorylation of the MAPK/ERK pathway to promote apoptosis of breast cancer cells.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-11-23.

Development of potent μ and δ opioid agonists with high lipophilicity

An SAR study on the Dmt-substituted enkephalin-like tetrapeptide with a N-phenyl-N-piperidin-4-ylpropionamide moiety at the C-terminal was performed and has resulted in highly potent ligands at μ and δ opioid receptors. In general, ligands with the substitution of D-Nle(2) and halogenation of the aromatic ring of Phe(4) showed highly increased opioid activities. Ligand 6 with good biological activities in vitro demonstrated potent in vivo antihyperalgesic and antiallodynic effects in the tail-flick assay.

Constitutive activity at the cannabinoid CB(1) receptor and behavioral responses

The cannabinoid receptor type 1, found mainly on cells of the central and peripheral nervous system, is a major component of the endogenous cannabinoid system. Constitutive and endogenous activity at cannabinoid receptor type 1 regulates a diverse subset of biological processes including appetite, mood, motor function, learning and memory, and pain. The complexity of cannabinoid receptor type 1 activity is not limited to the constitutive activity of the receptor: promiscuity of ligands associated with and the capability of this receptor to instigate G protein sequestration also complicates the activity of cannabinoid receptor type 1. The therapeutic use of cannabinoid receptor type 1 agonists is still a heavily debated topic, making research on the mechanisms underlying the potential benefits and risks of cannabinoid use more vital than ever. Elucidation of these mechanisms and the quest for agonists and antagonists with greater specificity will allow a greater control of the side effects and risks involved in utilizing cannabinoids as therapeutic agents. In this chapter, we review a small subset of techniques used in the pharmacological application of and the behavioral effects of molecules acting at the paradoxical cannabinoid receptor type 1.