Targeting peroxynitrite driven nitroxidative stress with synzymes: A novel therapeutic approach in chronic pain management

Morphine sulfate and other opiate/narcotic analgesics are the most effective treatments for acute and chronic severe pain. However, their clinical utility is often hampered by the development of analgesic tolerance. This complex pathophysiological cycle contributes significantly to decreased quality of life in the growing population of subjects with chronic pain due to oversedation, reduced physical activity, respiratory depression, constipation, potential for addiction, and other side-effects. Accordingly, there is growing interest in new approaches that would maintain opiate efficacy during repetitive dosing without engendering tolerance or unacceptable side-effects. Considerable evidence implicates nitroxidative stress in the development of pain of several etiologies and importantly in opiate antinociceptive tolerance, caused by the presence of superoxide, O₂^?, (SO) nitric oxide, NO (NO) and more recently peroxynitrite, ONOO^? or its conjugate acid ONOOH, (PN) that is the product of their interaction. To this end, several antioxidant synthetic enzymes (synzymes) have been developed to effectively prevent the formation of PN (superoxide dismutase mimetics, SODms) or to decompose PN once it is formed (PN decomposition catalysts). The objectives of this mini-review written on PN and morphine antinociceptive tolerance are to 1) summarize recent advances made in the development of novel synzymes as therapeutics, 2) discuss the importance of nitroxidative stress in opiate anatinociceptive tolerance and 3) argue that PN is a rational target for therapeutic intervention in pain management. These concepts provide a pharmacological basis for developing inhibitors of PN biosynthesis as novel non-narcotic analgesics, thus addressing a large and currently unmet medical need with major socioeconomic consequences.