阿片样物质与心脏缺血预处理

阿片肽和外源性阿片术物质如吗啡除了能缓解心肌梗塞造成的疼痛外,还具有减小梗塞范围和降低心律失常的发生等重要作用。心脏阿片受体参与了缺血预处理（IPC）对心脏的调节作用,阿片样物质激活心脏阿片受体还可模拟IPC对心脏的作用。心脏阿片受体的激活产生的急性即第一窗口期和延迟即第二窗口期的心脏保护作用的信号途径,与IPC相似,其信号通路涉及Gi/Go蛋白、蛋白激酶C、酪氨酸激酶和ATP敏感K^ 通道等途径。     

Opioids in neuropathic pain

Pain inhibition can be induced by immune-derived opioids interacting with opioid receptors on peripheral sensory nerves. These receptors are up-regulated in inflammation (1). Opioid peptides are synthesised in circulating immune cells which migrate to injured tissue. This is orchestrated by selectins and other adhesion molecules located on immunocytes and on vascular endothelium (2). In response to releasing stimuli the opioids are secreted, activate peripheral opioid receptors and produce analgesia by inhibiting the excitability of sensory nerves and/or the release of excitatory neuropeptides. These effects occur in the periphery and are devoid of central side-effects such as respiratory depression, sedation, dysphoria or dependence. Targeting of immune cells containing opioids to injured tissues is a novel concept of pain control and opens potential new therapeutic approaches.     

Opioids, feeding, and anorexias

This review summarizes recent work that focuses on the role of endogenous opioids (EOs) and opiate receptors in the control of food intake. Although the anorexic effect of opiate antagonists are now well accepted, the exact EO, site(s), and mechanism(s) of action remain to be established. However, accumulating evidence suggests that dynorphin, an endogenous ligand for kappa-type opiate receptors, is an important regulator (stimulant) of appetite. The roles of other EOs, such as beta-endorphin, are less clear. EOs appear to be involved in maintaining normal feeding behavior and are likely responsible for the overconsumption of fat in genetically obese and stressed subjects. Opiate antagonists block overconsumption of palatable foods, thus offering a promising approach to weight reduction for some overweight individuals. Anorexias may follow from a deficiency of kappa-type opioid activity, and surprisingly, can also result from excess opioid activity. Indeed, opiate antagonists of the mu type (naloxone) can enhance eating and weight gain in certain anorexic conditions. Therefore, it appears that excess opioid agonist activity may result in hyperphagia or anorexia (depending on the opiate receptor type). Finally, opiate antagonists may help normalize both types of pathological feeding states.     

Opioids for non-operable osteoarthritis and soft-tissue rheumatism

Reviews of oral opioid trials have shown that many side-effects need to be considered when treating patients with non-operable osteoarthritis and soft-tissue problems. European and American guidelines recommend their use with or without paracetamol. The controversy surrounding the use of non-steroidal anti-inflammatory drugs/cyclo-oxygenase-2 inhibitors is limiting physician and patient choices. There is a great need for alternative medication or ways of using current compounds.     

Fetal breathing and development of control of breathing

Technical advances during the last several decades have greatly facilitated research into fetal physiology and behavior, specifically fetal breathing (FB). Breathing movements have been demonstrated in the fetuses of every mammalian species investigated and appear to be part of normal fetal development. In this review we focus on the methods of measuring FB and on some of the problems associated with these measurements and their interpretation. We also review fetal behavior, the role of the peripheral and central chemoreceptors in spontaneous FB, the fetal respiratory response to hypercapnia and hypoxia, and the transition to continuous breathing at birth. It is clear that in many ways the control of breathing movements in utero differs from that after birth. In particular, inhibitory influences are much more prominent before than after birth. Possibly this is due to the unique fetal situation, in which conservation of energy may be more important than any advantage breathing activity imparts to the fetus.     

Opioids and neuropeptides: mechanisms in circulatory shock

Endogenous opioid systems are activated in stressful situations such as circulatory shock. The opiate antagonist naloxone improves cardiovascular function in several models of shock caused by endotoxemia, hypovolemia, anaphylaxis, and spinal trauma. The ergotropic neuropeptide, thyrotropin-releasing hormone, in supraphysiological doses, also improves cardiovascular function in these shock models, but this effect does not result from action at the opiate receptor. For both these agents a central nervous system (CNS) site of action has been partially characterized. A variety of neuropeptides, including the opioids, seem capable of modulating autonomic function through their CNS actions. In addition, they may play a role in peripheral integration and transmission of autonomic nervous activity by actions at the ganglia and/or at nerve endings. Some neuropeptides also have direct autacoid effects on cells, including those of the microvasculature. This raises new questions concerning possible peripheral functions of neuropeptides during circulatory shock, and the nature of their interactions with other potential shock mediators such as monokines and arachidonic acid derivatives.     

Salt Appetite,and the Influence of Opioids

Due to the biological importance of sodium and its relative scarcity within many natural environments, ‘salt appetite’ has evolved whereby dietary salt is highly sought after and palatable when tasted. In addition to peripheral responses, salt depletion is detected within the brain via circumventricular organs and 11β-hydroxysteroid dehydrogenase type 2 (HSD2) neurons to increase salt appetite. Salt appetite is comprised of two main components. One component is the incentive salience or motivation for salt (i.e. how much salt is ‘wanted’). Incentive salience is dynamic and largely depends on internal homeostatic conditions in combination with the detection of relevant cues. It involves the mesolimbic system and structures such as the central amygdala, and opioid signalling within these regions can increase salt intake in rodents. A second key feature is the hedonic palatability of salt (i.e. how much it is ‘liked’) when it is tasted. After detection on the tongue, gustatory information passes through the brainstem nucleus of the solitary tract and thalamus, before being consciously detected within the gustatory cerebral cortex. The positive or negative hedonic value of this stimulus is also dynamic, and is encoded by a network including the nucleus accumbens, ventral pallidum, and lateral parabrachial nucleus. Opioid signalling within these areas can alter salt intake, and ‘liking’. The overconsumption of dietary salt likely contributes to hypertension and associated diseases, and hence further characterising the role played by opioid signalling has important implications for human health.     

Cytokines and resistive breathing

This review summarizes and analyzes the results of the present experimental studies indicating immune system involvement in control of breathing. The hypothesis about the role of cytokines in the mechanisms of respiratory muscle fatigue and reduced ventilatory sensitivity to hypercapnia during respiration with the added resistive loading is justified. The possible ways of implementing of respiratory cytokine effects are discussed.     

Cytokines and resistive breathing

The results of recent experimental studies indicating the involvement of the immune system in the control of breathing are analyzed and summarized. The hypothesis on the role of cytokines in the mechanisms of respiratory muscle fatigue and a decrease in the ventilatory sensitivity to hypercapnia during respiration with the added resistive load is justified. Possible ways of implementation of the respiratory cytokine effects are discussed.     

Opioids in the regulation of food intake and energy expenditure

This paper and the following four papers summarize a symposium on the role of opioids in regulation of feeding, body weight, and energy expenditure. The central sites of opioid action are discussed, as is opioid activity in invertebrates, large animals, and humans. This paper provides a historical review of developments in the field from the early concepts of an endogenous opioid system to the current understanding of multiple receptor types and their interaction in regulating ingestive behavior. Opioids from all three opioid families may stimulate food intake, and some evidence exists that opioids may stimulate energy expenditure. Eating and drinking behavior is very complex and involves a number of components. Our understanding of the role of opioids in this process is shallow, and future research must be designed carefully to evaluate individual components of ingestive behavior.     

Hypoxia, hyperoxia and breathing

Conclusions This short Commentary has been limited to a few of several studies. They clearly indicate that the mechanisms involved in the effects of hypoxia and hyperoxia on the ventilatory control and particularly on theintegrative respiratory centres are far from being completely understood and are now believed to be more complex than what was postulated 40 years ago. Other mechanisms, which are beyond the scope of this short review, are currently the subjects of numerous studies which suggest that mediators or modulators are involved not only at the periphery but also at the level of the central nervous system. It must be emphasized that all these recent studies do not contradict at all, but rather help to explain, the early findings of Pierre Dejours concerning the participation of the peripheral chemoreceptors in the regulation and control of breathing.