Opioid tolerance and bowel dysfunction

描述(申请人提供)：吗啡仍然是治疗中度到重度疼痛最常用的处方药物之一，包括癌症或手术引起的疼痛。然而，这种优秀的止痛药在人类身上的长期使用受到副作用的限制，这些副作用包括止痛耐受性和阿片类药物引起的肠道功能障碍，便秘是最常见的和虚弱的症状。这项研究的长期目标是阐明导致对阿片类药物许多影响的耐受的机制，包括减慢胃肠转运，但不包括便秘。需要检验的主要假设是，吗啡细胞信号特性的差异决定了回肠耐受性的发展，而不是结肠。初步数据表明，回肠对吗啡的耐受与去偶联？阿片受体来自其下游的信号蛋白。与回肠不同，结肠是便秘的主要部位，不会对重复注射吗啡产生耐受性。具体目标1的主要目标是检验这样一种假设：下调？阻滞素2与回肠对吗啡的耐受有关。具体的目标是刻画集中和时间关系？Arrestin 2下调和耐受性发展。功能和生化研究将被用来关联慢性吗啡在体外和体内利用？-arrestin 2基因敲除小鼠的效果。《特定目标2》将检验这一假设？Arrestin2作为脚手架蛋白调节下游信号，包括MAP、Src、Akt和蛋白激酶C。初步研究结果表明，与吗啡诱导的抗伤害耐受不同，在回肠中，磷酸化ERK的下调与耐受的形成有关，这表明中枢神经系统在胃肠道阿片类药物耐受的机制上存在根本差异。这一目标还将审查是否下调监管？Arrestin 2是通过改变泛素化来调节的。具体目标3将探讨长期吗啡对成年小鼠肌间神经丛分离的肠神经细胞的影响。为此，我们将对来自结肠和回肠的单个肠神经细胞进行表征和测试，以确定吗啡引起的电兴奋性的变化以及对野生型和？逮捕2只基因敲除的小鼠。从这些研究中获得的信息将增加我们对阿片类药物耐受机制的了解，并最终在胃肠道和大脑中产生身体依赖。

DESCRIPTION (provided by applicant): Morphine remains one of the most frequently prescribed drugs for the treatment of moderate to severe pain, including pain due to cancer or surgery. However, the long-term use of this excellent pain reliever in man is limited by side-effects that include analgesic tolerance and opioid-induced bowel dysfunction, with constipation being the most common and debilitating symptom. The long-term goals of this study are to elucidate the mechanisms that lead to tolerance to many of the effects of opioids, including slowing of gastrointestinal transit but not constipation. The main hypothesis to be tested is that differences in the cellular signaling properties of morphine determine the development of tolerance in the ileum but not the colon. Preliminary data suggest that morphine tolerance in the ileum is associated with an uncoupling of the ? opioid receptor from its downstream signaling proteins. Unlike the ileum, the colon which is the major site for constipation does not develop tolerance to repeated administration of morphine. The major objective of specific aim 1 is to test the hypothesis that down-regulation of ? arrestin2 is associated with morphine tolerance in the ileum. The specific goals are to characterize the concentration and temporal relationship for ? arrestin 2 downregulation and tolerance development. Functional and biochemical studies will be utilized to correlate the effect of chronic morphine in-vitro and in-vivo utilizing ?-arrestin2 knock-out mice. Specific Aim 2 will test the hypothesis that ? arrestin2 acts as a scaffolding protein to regulated downstream signaling including MAP kinase, Src kinase, Akt and protein kinase C. Preliminary findings suggest that unlike morphine induced antinociceptive tolerance, in the ileum downregulation of phospho-ERK correlates with tolerance development suggesting fundamental differences in the mechanism for opioid tolerance in the gastrointestinal tract from CNS. This aim will also examine if downregulation of ? arrestin 2 is mediated via altered ubiquitination. Specific Aim 3 will explore the effect of long-term morphine on isolated enteric neurons from the adult mouse myenteric plexus. In this aim, single enteric neurons from the colon and ileum will be characterized and tested to determine morphine- induced changes in electrical excitability and effects on sodium, calcium and potassium channels in wild-type and ? arrestin2 knock-out mice. The information obtained from these studies will increase our understanding of the mechanisms of opioid tolerance and ultimately physical dependence in the gastrointestinal tract and in the brain.