靶向神经小胶质细胞的戒毒治疗策略

鸦片用于镇痛治疗有千余年历史, 其滥用导致药物成瘾, 带来严重的社会和医学问题。关于鸦片等精神活性物质的研究主要围绕 神经元,当前的戒毒药物作用于神经元的阿片受体或离子通道受体,然而其戒毒效果非常有限。神经元不是中枢神经系统中调节神经信号 转导的唯一组分,神经小胶质细胞占中枢神经系统的 10%~15%,然而其作用和功能在很长一段时间被忽视。鸦片、可卡因、冰毒及其他 精神活性物质激活 Toll 样受体 4 (TLR4),活化小胶质细胞,产生大量炎症因子,从而调节奖赏信号通路,增加神经元的兴奋性,导致药物 依赖和成瘾,因而 TLR4 是开发新型戒毒药物的靶点。综述药物成瘾的小胶质细胞分子机制以及靶向小胶质细胞的治疗药物成瘾的药物发现。     

阿尔茨海默病中Toll样受体与小胶质细胞的关系

阿尔茨海默病(Alzheimer’s disease,AD)是老年人常见的一种神经退行性疾病。目前AD的发病机制还不是很清楚,但大多数学者认为淀粉样蛋白沉积激活神经胶质细胞所导致的炎症反应是其核心病理机制,其中小胶质细胞是主要的炎症细胞。近期研究表明Toll样受体(Toll-like receptor,TLR)在小胶质细胞的激活过程中发挥着一定的作用。本文主要就近年来AD发病过程中TLR与小胶质细胞之间关系方面的研究进行综述。     

趋化因子CCL3在病理性疼痛和阿片耐受中的作用

趋化因子配体3[chemokine (C-C motif) ligand 3,CCL3]是趋化因子家族的一员,广泛表达于神经系统和免疫系统中。研究表明,CCL3可通过募集免疫细胞、激活细胞内的信号通路以及介导神经元与神经胶质细胞间的相互作用,从而参与神经病理性疼痛、炎性痛的发生及维持。此外,CCL3还可引起μ型阿片肽受体(mu opioid receptor,MOR)脱敏,从而影响吗啡等的镇痛作用,并参与阿片耐受的形成过程。该文综述了CCL3及其受体在病理性疼痛和阿片耐受中的作用。     

大鼠脊髓中的去甲肾上腺素在吗啡镇痛中的作用

本文报道中枢去甲肾上腺素(NE)能下行系统的脊髓末梢以及脊髓内的α受体在吗啡镇痛机制中的作用。结果显示,皮下注射6mg/kg 吗啡可使脊髓中的 NE 代谢终产物3-甲氧基4-羟基苯乙二醇硫酸盐(MHPG·SO_4)含量升高,提示脊髓 NE 的更新加速;反复多次注射吗啡引起吗啡镇痛耐受的动物,该反应消失。脊髓蛛网膜下腔注射α受体阻断剂酚妥拉明可部分对抗全身注射小剂量吗啡的镇痛作用,选择性的α_1受体阻断剂哌唑嗪或α_2受体阻断剂育亨宾有类似作用。阻断脊髓α_1或α_2受体对脊髓蛛网膜下腔直接注射微量吗啡的镇痛作用无显著影响,以上结果表明,下行 NE 能系统在吗啡镇痛机制中具有重要作用。     

大麻素受体2在吗啡耐受中的作用

吗啡在疼痛治疗中广泛应用,但其长期使用可以导致耐受,这大大影响了其临床应用价值,吗啡耐受是临床亟待解决的问题。研究发现大麻素受体2(cannabinoid receptor 2,CB2受体)参与吗啡耐受的发生与发展。CB2受体选择性激活剂与吗啡联合使用,可以减弱吗啡诱导产生的痛觉过敏和异常疼痛,抑制吗啡耐受的发生与发展。激活CB2受体抑制吗啡耐受的机制尚未明确,本文将就CB2受体在吗啡耐受中作用的研究现状作一综述。     

Toll样受体4介导内毒素对内皮细胞NF-κB的激活

为探讨Toll样受体4(Toll-like receptor 4,TLR4)在内毒素(LPS)对内皮细胞NF-κB激活中的作用,以LPS刺激培养的ECV-304细胞为模型,运用RT-PCR和蛋白质印迹技术检测了内皮细胞TLR4的表达及LPS对其表达的影响.同时利用基因转染和抗体阻断方法进一步观察了TLR4在LPS对内皮细胞NF-κB激活中的作用.研究发现,LPS能明显上调内皮细胞TLR4的表达,呈一定的时间和剂量依赖性.转染TLR4的功能突变体和运用抗TLR4单抗能明显抑制LPS对内皮细胞NF-κB的激活.提示TLR4介导了LPS对内皮细胞NF-κB激活,可能在LPS对内皮细胞激活/损伤效应中具有重要的地位.     

Toll样受体4与肝损伤的研究进展

Toll样受体4((toll like receptor4,TLR4)是内毒素(LPS)的关键受体,为Toll蛋白家族中的一个成员,是联系固有免疫和适应性免疫的纽带。TLR4主要表达于髓源性细胞,其启动的胞内信号转导在肝损伤的发生和发展过程中发挥重要作用。这一信号转导途径主要通过NF-κB、p38、JNK等的激活,使细胞产生炎症转录因子,介导肝脏炎症。TLR4与氧化应激的相互作用,使得肝脏对TLR4的配体及细胞因子的敏感性增加,从而加重肝脏损伤。随着TLR4在肝损伤中的作用进一步阐明,其在肝脏疾病中的治疗作用将会产生广阔的应用前景。     

鞘内注射M受体和GDNF反义寡脱氧核苷酸抑制吗啡戒断大鼠蓝斑c-Fos表达

应用免疫组化方法观察鞘内注射毒蕈碱型乙酰胆碱(muscarinic acetylcholine receptor,M) 受体和胶质细胞源性神经营养因子(glial cell derived neurotrophic factor,GDNF)反义寡脱氧核苷酸对吗啡戒断大鼠蓝斑(locus coeruleus,LC)区内Fos表达的影响。结果显示,鞘内注射M_2受体和GDNF反义寡脱氧核苷酸明显减少大鼠吗啡戒断症状评分值(n=6,P<0.05)。正常大鼠LC区神经元Fos基础表达较低,吗啡依赖大鼠LC区神经元Fos表达增加,吗啡依赖大鼠纳酪酮(4mg/Kg,ip)催促戒断后,Fos表达进一步增加;鞘内注射M_2受体和GDNF反义寡脱氧核苷酸处理后均减少吗啡戒断大鼠LC区神经元Fos表达(n=5,P<0.05)。而鞘内注射M_1受体反义寡脱氧核苷酸处理组LC 区神经元Fos表达较吗啡戒断组没有显著差异(n=5,P>O.05)。结果提示:脊髓M_2受体调节吗啡戒断时LC区的神经元激活,而这种神经上行性激活涉及神经元与胶质细胞之间的适应性调节。     

新型镇痛药：神经元烟碱受体激动剂

从动物模型的研究中发现蛙皮素的镇痛效能与吗啡相当,而镇痛效价比吗啡高200多倍,ABT－594的镇痛效能与蛙皮素相当,而毒副作用明显低于后者,研究发现这两种化合物均是烟碱受体强激动剂,而ABT－594对烟碱受体亚型的选择性明显高于蛙皮素,烟碱受体激动剂激活受体后,引起中枢多种神经递质的释放,可能是其产生镇痛效应的关键所在,其中激活脑干下行性抑制通路起着更为重要的作用。     

模式识别受体激活状态对小胶质细胞p38-MAPK磷酸化水平的影响

为了探讨小胶质细胞模式识别受体（pattern recognition receptor,PRR）激活状态对Aβ42诱导下的细胞应激性p38丝裂原活化蛋白激酶（p38-mitogen activated protein kinase,p38-MAPK）磷酸化及细胞吞噬能力的影响,在不同模式识别受体（SRA,TRL2,SRB,CD36）的抗体存在的条件下用寡聚物Aβ42蛋白（oAβ42）孵育并活化小胶质细胞,测定细胞活化后的p38-MAPK激酶磷酸化水平和小胶质细胞模式识别受体TLR2的阻断对细胞Aβ42吞噬量的影响。结果发现,与正常小胶质细胞对比,模式识别受体SRA（scavenger receptor A）及TLR2受体（toll-like receptor 2）被相应抗体阻断的小胶质细胞在受到Aβ42蛋白激活时,p38-MAPK的磷酸化水平显著降低;TLR2受体被其抗体阻断后小胶质细胞对Aβ42的吞噬量降低,说明该模式识别受体激活状态影响胶质细胞吞噬能力,该过程与p38-MAPK的磷酸化水平相关。而受体内吞抑制剂对小胶质细胞的Aβ42蛋白的吞入量没有显著影响,说明上述细胞对寡聚物Aβ42的吞入过程并非经典的受体内吞过程。TLR家族受体有望成为阿尔茨海默病(Alzheimei Disease, AD)免疫治疗的潜在治疗靶标。     

Morphine enhances IL-1β release through toll-like receptor 4-mediated endocytic pathway in microglia

Morphine creates a neuroinflammatory response and enhances release of the proinflammatory cytokines like interleukin-1β (IL-1β), which compromises morphine analgesia as well as induces morphine tolerance. In this study, we attempted to investigate the mechanisms of morphine induced IL-1β synthesis and release. Microglial cells were treated with morphine (100 μM) once daily for 3 days. Control groups underwent the same procedure but received sterile saline injection instead of morphine. Toll-like receptor 4 (TLR4) and P2X4 receptor (P2X4R) signaling were analyzed using Western blot; immunofluorescence was used to detect the signaling of CD68; real-time RT-PCR and ELISA kit was used to measure the messenger RNA and protein synthesis and release level of IL-1β. Morphine enhanced IL-1β synthesis and P2X4R protein expression. TLR4 were responsible for morphine-induced IL-1β synthesis, while morphine-induced IL-1β release was via P2X4R. Morphine-induced IL-1β release is mediated by endocytosis of TLR4. These results indicated that TLR4 and P2X4R pathways mediated IL-1β synthesis and release in microglia followed chronic morphine. TLR4 internalization is the main mechanism of morphine-induced microglia activation and IL-1β release.     

Morphine and Fentanyl Repeated Administration Induces Different Levels of NLRP3-Dependent Pyroptosis in the Dorsal Raphe Nucleus of Male Rats via Cell-Specific Activation of TLR4 and Opioid Receptors

Morphine promotes neuroinflammation after NOD-like receptor protein 3 (NLRP3) oligomerization in glial cells, but the capacity of other opioids to induce neuroinflammation and its relationship to the development of analgesic tolerance is unknown. We studied the effects of morphine and fentanyl on NLRP3 inflammasome activation in glial and neuronal cells in the dorsal raphe nucleus (DRN), a region involved in pain regulation. Male Wistar rats received i.p. injections of morphine (10 mg/kg) or fentanyl (0.1 mg/kg) 3?×?daily for 7 days and were tested for nociception. Two hours after the last (19th) administration, we analyzed NLRP3 oligomerization, caspase-1 activation and gasdermin D-N (GSDMD-N) expression in microglia (CD11b positive cells), astrocytes (GFAP-positive cells) and neurons (NeuN-positive cells). Tolerance developed to both opioids, but only fentanyl produced hyperalgesia. Morphine and fentanyl activated NLRP3 inflammasome in astrocytes and serotonergic (TPH-2-positive) neurons, but fentanyl effects were more pronounced. Both opioids increased GFAP and CD11b immunoreactivity, caspase-1 and GSDMD activation, indicating pyroptotic cell death. The opioid receptor antagonist (?)-naloxone, but not the TLR4 receptor antagonist (+)-naloxone, prevented microglia activation and NLRP3 oligomerization. Only (+)-naloxone prevented astrocytes’ activation. The anti-inflammatory agent minocycline and the NLRP3 inhibitor MCC950 delayed tolerance to morphine and fentanyl antinociception and prevented fentanyl-induced hyperalgesia. MCC950 also prevented opioid-induced NLRP3 oligomerization. In conclusion, morphine and fentanyl differentially induce cell-specific activation of NLRP3 inflammasome and pyroptosis in the DRN through TLR4 receptors in astrocytes and through opioid receptors in neurons, indicating that neuroinflammation is involved in opioid-induced analgesia and fentanyl-induced hyperalgesia after repeated administrations.

     

The nitric oxide-cGMP signaling pathway plays a significant role in tolerance to the analgesic effect of morphine

Although the phenomenon of opioid tolerance has been widely investigated, neither opioid nor nonopioid mechanisms are completely understood. The aim of the present study was to investigate the role of the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) pathway in the development of morphine-induced analgesia tolerance. The study was carried out on male Wistar albino rats (weighing 180-210 g; n = 126). To develop morphine tolerance, animals were given morphine (50 mg/kg; s.c.) once daily for 3 days. After the last dose of morphine was injected on day 4, morphine tolerance was evaluated. The analgesic effects of 3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole (YC-1), BAY 41-2272, S-nitroso-N-acetylpenicillamine (SNAP), N(G)-nitro-L-arginine methyl ester (L-NAME), and morphine were considered at 15 or 30 min intervals (0, 15, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests (n = 6 in each study group). The results showed that YC-1 and BAY 41-2272, a NO-independent activator of soluble guanylate cyclase (sGC), significantly increased the development and expression of morphine tolerance, and L-NAME, a NO synthase (NOS) inhibitor, significantly decreased the development of morphine tolerance. In conclusion, these data demonstrate that the nitric oxide-cGMP signal pathway plays a pivotal role in developing tolerance to the analgesic effect of morphine.     

NMDA receptor antagonism disrupts the development of morphine analgesic tolerance in male, but not female C57BL/6J mice

Multiple studies demonstrate that coadministration of N-methyl-D-aspartate (NMDA) receptor antagonists with the opioid agonist morphine attenuates the development of analgesic tolerance. Sex differences in the effects of noncompetitive, but not competitive NMDA receptor antagonists on acute morphine analgesia, have been reported in mice, yet the role of sex in modulation of morphine tolerance by NMDA receptor antagonists has yet to be addressed. Therefore, we tested whether there is a sex difference in the effect of NMDA receptor antagonists on the development of morphine analgesic tolerance in C57BL/6J mice. Acutely, at a dose required to affect morphine tolerance in male mice, the noncompetitive NMDA receptor antagonist dizocilpine (MK-801) prolonged morphine analgesia similarly in both sexes in the hot plate and tail withdrawal assays. In the hot plate assay, coadministration of MK-801 or the competitive antagonist 3-(2-carboxpiperazin-4-yl)propyl-1-phosphanoic acid (CPP) with morphine attenuated the development of tolerance in male mice, while having no effect in females. Like normal and sham females, ovariectomized mice were similarly insensitive to the attenuation of morphine tolerance by MK-801 in the hot plate assay. Surprisingly, in the tail withdrawal assay, MK-801 facilitated the development of morphine-induced hyperalgesia and tolerance in males but not females. The results demonstrate that male mice are more sensitive to modulation of nociception and morphine analgesia after repeated coadministration of NMDA receptor antagonists. Furthermore, the underlying mechanisms are likely to be different from those mediating the sex difference in the modulation of acute morphine analgesia that has previously been reported.     

Nω-硝基-L-精氨酸甲酯抑制吗啡镇痛耐受大鼠中脑和脊髓一氧化氮合酶/N-甲基-D-天冬氨酸受体表达上调

采用热甩尾测痛法观察全身应用非特异性一氧化氮合酶（nitric oxide synthase,NOS）抑制剂——N^ω-硝基-L-精氨酸甲酯（L-NAME）对吗啡镇痛耐受形成的影响,并通过观察脊髓和中脑神经元型NOS（nNOS）和N-甲基-D-天冬氨酸（NMDA）受体亚单位表达的变化来阐释NO／NMDA受体在吗啡镇痛耐受形成中的作用。将36只健康成年Sprague-Dawley大鼠平均分为6组（每组6只）：1组为对照组,皮下注射生理盐水1ml;2、3、4、5和6组为处理组,分别皮下注射L-NAME10mg／kg、L-NAME20mg／kg、吗啡10mg／kg、L-NAME10mg／kg＋吗啡10mg／kg、L-NAME20mg／kg＋吗啡10mg／kg,每天2次。在注射前测量大鼠的热甩尾潜伏期（tail-flick latency,TFL）基础值,随后每天第一次给药50min后测量其TFL。第8天最后一次给药80min后（除2组和5组之外）断头取脊髓和中脑,采用RT-PCR技术测量nNOS以及NMDA受体1A（NR1A）和2A（NR2A）亚单位的表达。结果显示,2组大鼠第1天至第7天的TFL与基础值相比无显著差异;3组第7天时的TFL仍显著高于基础值;4组的TFL在第1天时最高,第2至第6天期间逐渐降低,第6天时与基础值相比无显著差异：5组的TFL在实验过程中呈下降趋势,虽然第7天时较第1天有所降低,但是仍然显著高于基础值;6组的TFL变化趋势与5组相同。PT—PCR分析结果显示,与1组相比,3组脊髓和中脑的nNOS mRNA表达显著降低,但NR1A mRNA和NR2A mRNA表达无显著改变;4组的nNOS mRNA、NR1A mRNA和NR2A mRNA表达均显著高于1组。与4组相比,6组的nNOS mRNA、NR1A mRNA和NR2A mRNA表达均显著降低。结果提示,吗啡镇痛耐受大鼠脊髓和中脑的nNOS和NMDA受体表达增加,联合应用L—NAME可抑制长期应用吗啡所致的nNOS表达增加和NMDA受体上调,延缓吗啡镇痛耐受的形成。本研究结果提示,脊髓和中脑的NO／NMDA受体与吗啡镇痛耐受形成密切相关。     

Regulation of opioid receptor trafficking and morphine tolerance by receptor oligomerization

The utility of morphine for the treatment of chronic pain is hindered by the development of tolerance to the analgesic effects of the drug. Morphine is unique among opiates in its ability to activate the mu opioid receptor (MOR) without promoting its desensitization and endocytosis. Here we demonstrate that [D-Ala(2)-MePhe(4)-Gly(5)-ol] enkephalin (DAMGO) can facilitate the ability of morphine to stimulate MOR endocytosis. As a consequence, rats treated chronically with both drugs show reduced analgesic tolerance compared to rats treated with morphine alone. These results demonstrate that endocytosis of the MOR can reduce the development of tolerance, and hence suggest an approach for the development of opiate analogs with enhanced efficacy for the treatment of chronic pain.     

Effects of stress and beta-funal trexamine pretreatment on morphine analgesia and opioid binding in rats

This study was essentially an in vivo protection experiment designed to test further the hypothesis that stress induces release of endogenous opioids which then act at opioid receptors. Rats that were either subjected to restraint stress for 1 hr or unstressed were injected ICV with either saline or 2.5 micrograms of beta-funaltrexamine (beta-FNA), an irreversible opioid antagonist that alkylates the mu-opioid receptor. Twenty-four hours later, subjects were tested unstressed for morphine analgesia (tail-flick assay) or were sacrificed and opioid binding in brain was determined. [3H]D-Ala2NMePhe4-Gly5(ol)enkephalin (DAGO) served as a specific ligand for mu- opioid receptors, and [3H]-bremazocine as a general ligand for all opioid receptors. Rats injected with saline while stressed were significantly less sensitive to the analgesic action of morphine 24 hr later than were their unstressed counterparts. Beta-FNA pretreatment attenuated morphine analgesia in an insurmountable manner. Animals pretreated with beta-FNA while stressed were significantly more sensitive to the analgesic effect of morphine than were animals that received beta-FNA while unstressed, consistent with the hypothesis that stress induces release of endogenous opioids that would protect opioid receptors from alkylation by beta-FNA. beta-FNA caused small and similar decreases in [3H]-DAGO binding in brain of both stressed and unstressed animals. Stressed rats injected with saline tended to have increased levels of [3H]DAGO and [3H]-bremazocine binding compared to the other groups. This outcome may be relevant to the tolerance to morphine analgesia caused by stress.     

Analgesic activity of spiradoline mesylate (U-62,066E), a kappa opioid agonist in mice

The present study was undertaken to evaluate the analgesic potency of spiradoline mesylate, a k(kappa) opioid agonist, in comparison with that of morphine, by hot plate, tail-pinch and acetic acid-induced writhing assay. The ED50 values of spiradoline in hot plate, tail-pinch and acetic acid-induced writhing assay were 0.46, 0.26 and 0.20 mg/kg, respectively. The analgesic potency of spiradoline was 1.5-7.0 times higher than that of morphine. Repeated treatment with spiradoline as well as morphine developed tolerance to the analgesic effect in hot plate assay. In mice developed tolerance to one analgesic, response to the other analgesic did not alter compared to saline-treated mice. Single administration of spiradoline (1.5 and 3 mg/kg, s.c.) did not inhibit morphine-induced analgesia. These results suggest that spiradoline has more potent analgesic activity than morphine, presumably mediated through stimulation of receptors different from morphine.     

Prostaglandins and opioids.

In guinea-pig small intestine, rat brain in vitro and neuroblastomaXglioma hybrid cells, opioids specifically inhibit the action of E prostaglandins. In the whole rat, E prostaglandins, administered centrally, antagonize the antinociceptive action of morphine. E prostaglandins also antangonize the induction of opioid tolerant/dependence. In turn, tolerance/dependent preparations respond with added intensity to E prostaglandins. The antagonism between opioids and E prostaglandins does not occur at the opioid receptor; but, certainly in some preparations and probably in others, this antagonism occurs at the coupling or catalytic unit of a neuronal adenylate cyclase that opioids inhibit and E prostaglandins stimulate. The proposition that antagonism of E prostaglandin at appropriate neurons in the brain is part of the natural mechanism of opioid analgesia remains possible, but unproven, and is worth continued investigation.     

The effects of pituitary adenylate cyclase-activating polypeptide on acute and chronic morphine actions in mice

The effects of pituitary adenylate cyclase-activating polypeptide (PACAP) on pain sensitivity, on morphine analgesia, on morphine tolerance and withdrawal were investigated in mice. The heat-radiant tail-flick test was used to assess antinociceptive threshold. Intracerebroventricular (i.c.v.) administration of PACAP alone had no effect on pain sensitivity but in a dose of 500 ng, it significantly diminished the analgesic effect of a single dose of morphine (2.25 mg/kg, s.c.). PACAP (500 ng, i.c.v.) significantly increased the chronic tolerance to morphine and enhanced the naloxone (1 mg/kg, s.c.)-precipitated withdrawal jumping. Theophylline (1 mg/kg, i.p.) pretreatment significantly enhanced the effect of PACAP on morphine analgesia but the effects of PACAP on tolerance and withdrawal were unaffected upon theophylline administration. On the grounds of our previous studies with vasoactive intestinal polypeptide (VIP), it appears that different receptors are involved in the effects of PACAP in acute and chronic morphine actions. Our results indicate that PACAP-induced actions likely participate in acute and chronic effects of morphine and suggest a potential role of PACAP in opioid analgesia, tolerance and withdrawal.