Role of Milk-Derived Opioid Peptides and Proline Dipeptidyl Peptidase-4 in Autism Spectrum Disorders.

Opioid peptides released during digestion of dietary proteins such as casein, were suggested to contribute to autism development, leading to the announcement of opioid excess hypothesis of autism. This paper examines role of enzyme proline dipeptidyl peptidase-4 (DPPIV; EC 3.4.14.5) and it is exogenous substrate, ß-casomorphin-7 (BCM7) in autism etiology. Our study included measurements of DPPIV and BCM7 concentrations in serum and urine, which were analyzed with ELISA assays and activity of DPPIV was measured by colorimetric test. The effect of opioid peptides from hydrolysed bovine milk on DPPIV gene expression in peripheral blood mononuclear cells (PBMC) in autistic and healthy children was determined using the Real-Time PCR (Polymerase Chain Reaction) method. Our research included 51 healthy children and 86 children diagnosed with autism spectrum disorder (ASD, ICDF84). We determined that the concentration of BCM7 in serum was significantly, 1.6-fold, higher in the ASD group than in controls (p < 0.0001). Concentration of DPPIV was found to also be significantly higher in serum from ASD children compared to the control group (p < 0.01), while we did not notice significant difference in enzymatic activity of serum DPPIV between the two study groups. We confirmed correlation according to the gender between analyzed parameters. The inspiration for this study emanated from clinical experience of the daily diet role in relieving the symptoms of autism. Despite this, we have concluded that milk-derived opioid peptides and DPPIV are potentially factors in determining the pathogenesis of autism; conducted studies are still limited and require further research.

Elevated endogenous opioids in obstructive jaundice: The possible skin mechanisms.

Obstructive jaundice disease is often accompanied by an increase in plasma endogenous opioids levels. Theses elevated endogenous opioids bring complications like pruritus, cardiac and vascular abnormalities in patients with cholestasis. However, little is known about the mechanism of increased endogenous opioids synthesis in cholestatic liver diseases. Different from the tradition view that the liver is the source of endogenous opioids peptides, recent researches give clues that skin may be another important organ in which endogenous opioid peptides were synthesized during cholestasis. Skin cells like keratinocytes, fibroblasts, macrophages and other inflammation cells had been reported to produce endogenous opioid peptides under certain physical and pathological conditions. In the course of obstructive jaundice, all these cells had the potential to be activated by different molecular mechanisms. And some cells like keratinocyte and inflammation cells had been proved to correlate with elevated plasma levels of enkephalin and beta-endorphin in patients with obstructive jaundice. Hence, we hypothesize that skin may be the site in which abundant endogenous opioid peptides been produced during the course of obstructive jaundice. These skin-cell related mechanisms should be further studied to resolve the puzzle of elevated peripheral opiate tone during obstructive jaundice.

Effects of transcranial direct current stimulation on pain, mood and serum endorphin level in the treatment of fibromyalgia: A double blinded, randomized clinical trial.

BACKGROUND: Recent studies have shown that novel neuro-modulating techniques can have pain-relieving effects in the treatment of chronic pain. The aim of this work is to evaluate the effects of transcranial direct current stimulation (tDCS) in relieving fibromyalgia pain and its relation with beta-endorphin changes. MATERIAL AND METHODS: Forty eligible patients with primary fibromyalgia were randomized to receive real anodal tDCS or sham tDCS of the left motor cortex (M1) daily for 10 days. Each patient was evaluated using widespread pain index (WPI), symptom severity of fibromyalgia (SS), visual analogue scale (VAS), and determination of pain threshold as a primary outcome. Hamilton depression and anxiety scales (HAM-D and HAM-A) and estimation of serum beta-endorphin level pre and post-sessions were used as secondary outcome. All rating scales were conducted at the baseline, after the 5th, 10th session, 15 days and 1 month after the end of the sessions. RESULTS: Eighteen patients from each group completed the follow-up schedule with no significant difference between them regarding the duration of illness or the baseline scales. A significant TIME × GROUP interaction for each rating scale (WPI, SS, VAS, pain threshold, HAM-A, HAM-D) indicated that the effect of treatment differed in the two groups with higher improvement in the experimental scores of the patients in the real tDCS group (P = 0.001 for WPI, SS, VAS, pain threshold, and 0.002, 0.03 for HAM-A, HAM-D respectively). Negative correlations between changes in serum beta-endorphin level and the changes in different rating scales were found (P = 0.003, 0.003, 0.05, 0.002, 0002 for WPI, SS, VAS, HAM-A, and HAM-D respectively). CONCLUSION: Ten sessions of real tDCS over M1 can induce pain relief and mood improvement in patients with fibromyalgia, which were found to be related to changes in serum endorphin levels. ClinicalTrials.gov Identifier: NCT02704611.

The Effects of Ultraviolet Eye Irradiation on Dextran Sodium Sulfate-Induced Ulcerative Colitis in Mice.

Ultraviolet (UV) eye irradiation denatures the cells of the intestine. This study examined the action of UVA and UVB on dextran sodium sulfate (DSS)-induced ulcerative colitis. We produced a mouse model of ulcerative colitis by administering DSS for 5 days and irradiated the eye with UVB or UVA for each day of the DSS treatment period. DSS-induced ulcerative colitis was deteriorated by the UVB eye irradiation. Conversely, the symptoms improved with UVA eye irradiation. The levels of adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), urocortin 2, interleukin (IL)-18, IL-6 and histamine in the blood increased after the UVB eye irradiation of DSS-treated mice (UVB/DSS-treated mice). In contrast, the ß-endorphin level in the blood of the UVA/DSS-treated mice increased and the levels of urocortin 2, tumor necrosis factor (TNF)-α and histamine decreased. Furthermore, in the colon, the expression of melanocortin-2 receptors (MC2R) increased in the UVB/DSS-treated mice, while the expression of µ-opioid receptors increased in the UVA/DSS-treated mice. When an ACTH inhibitor was administered, UVB eye irradiation caused the deterioration of DSS-treated ulcerative colitis, while the effect of UV eye irradiation disappeared with a µ-opioid receptor antagonist. These results suggested that UV eye irradiation plays an important role in DSS-induced ulcerative colitis.

Remote ischemic preconditioning does not increase circulating or effector organ concentrations of proopiomelanocortin derivates.

OBJECTIVES: The aim of the present study was to compare changes in circulating levels of proopiomelanocortin (POMC) derivates and lactate after remote ischemic preconditioning (IPC) and physical exercise. INTRODUCTION: Remote IPC (rIPC) is cardioprotective following acute myocardial infarction and major cardiac surgery. A blood-borne, transferable factor, released following not only rIPC but also vigorous exercise, mediates protection that is abolished by naloxone suggesting involvement of an opioid-receptor-dependent pathway. DESIGN: Eight healthy volunteers underwent rIPC by four cycles of 5-min inflation of a pneumatic tourniquet to 200 mmHg interrupted by 5 min of deflation. Subsequently, circulating plasma levels of POMC derivates, cortisol, and lactate were measured. After 3 days, the volunteers completed a vigorous exercise program, after which the same compounds were measured. RESULTS: While rIPC was not associated with any significant increase in circulating POMC derivates or lactate, exercise induced significant elevation of both compared with baseline. CONCLUSIONS: We were not able to demonstrate a detectable increase in circulating POMC derivates by a standard rIPC stimulus, suggesting that rIPC effect is not mediated by local or detectable central release of these derivates.

Effectiveness of electroacupuncture analgesia compared with opioid administration in a dog model: a pilot study.

BACKGROUND: Although opioid analgesics are the usual drugs to treat post-surgical pain, acupuncture has also been demonstrated to relieve various pain syndromes. The present pilot study aims to investigate the efficacy of electroacupuncture compared with a conventional opioid compound, butorphanol, for postoperative pain treatment in dogs undergoing elective ovariohysterectomy. METHODS: Twelve dogs were randomly allocated into two groups. Dogs received either electroacupuncture stimulation (16 and 43 Hz) at Shen Shu, Chang Shu, He Gu, Tai Yuan, Zu San Li, Yang Ling Quan, and Bai Hui acupoints, while control dogs were treated with butorphanol. Cardiovascular and respiratory parameters were recorded for both groups during operation. Plasma ß-endorphin concentrations were evaluated before surgery (baseline) and up to 24 h later. For each dog, pain was measured according to a dedicated subjective pain scoring system. RESULTS: Plasma ß-endorphin levels in dogs receiving electroacupuncture increased significantly against baseline values after 1 and 3 h after surgery. Moreover, the end-tidal isoflurane concentration needed for second ovary traction was significantly lower in acupuncture-treated dogs than control animals. All animals having electroacupuncture experienced prolonged analgesia, over 24 h at least, while four out of six dogs treated with butorphanol needed post-surgical ketorolac and tramadol supplementation to their pain relief. CONCLUSIONS: The results obtained from the present investigation showed some evidence for electroacupuncture as an alternative technique to provide postoperative analgesia in dogs.

The exogenous opioid peptides and DPPIV serum activity in infants with apnoea expressed as apparent life threatening events (ALTE).

Casein-derived peptides have been suggested to play a role in sudden infant death syndrome (SIDS). In this study, we have determined the content of bovine ß-casomorphin-7 (bBCM-7) and the activity of dipeptidyl peptidase-IV (DPPIV) in sera of infants with apparent life threatening events (ALTE syndromes, 'near miss SIDS'). We have found that the sera of some infants after an apnoea event contained more ß-casomorphin-7 than that of the healthy infants in the same age. In all the children after an apnoea event, however, a lowered DPPIV was detected. We suspect that the low activity of that peptidase may be responsible for opioid-induced respiratory depression, induced by bBCM-7 in the general circulation.

[Regulatory peptides and psychomotor development in infants].

Regulatory peptides (RP) are an important homeostatic factor. The maternal organism and placenta are substantial sources of RP for fetus during the prenatal period. Not only endogenous, but also exogenous RP play an important role during early postnatal period. In this study, the concentration of exogenous RP (casomorphins-7) and the activity of peptidases (enkephalinases) in the serum of breastfed and bottle-fed infants were estimated. Possible interrelation between these two parameters and the psychomotor development (PMD) of infants were evaluated. Using specially developed RIA, the investigators estimated the presence of human and bovine casomorphins immunoreactivity (CMir) in the serum of breastfed and bottle-fed infants. A distinct correlation of CMir with PMD was demonstrated. The activity of RP-degrading serum enzymes also correlated with PMD level. The role of endo- and exogenous peptides in normal PMD process and in the pathogenesis of early child autism is discussed in the article.

Changes of smoking behavior and serum adrenocorticotropic hormone, cortisol, prolactin, and endogenous opioids levels in nicotine dependence after naltrexone treatment.

This study was done to evaluate the therapeutic effects of naltrexone on smoking behaviors and to measure the changing of brain substances for elucidating the mode of action by naltrexone. Twenty-five voluntarily participated healthy male smokers were randomly assigned to naltrexone group or placebo group for 2 weeks. In this study, naltrexone group showed significant reduction in daily cigarette consumption amount, the expiratory CO levels, brief questionnaire for smoking urge (B-QSU) score, and FTQ score. However, only 2 subjects in naltrexone group quitted smoking completely at 4th week. Plasma levels of pituitary hormones (ACTH, cortisol, and prolactin) and endogenous opioids (beta-endorphin and dynorphin A) were checked weekly before and after the 'provocation and smoking coupled' stimulus once in a week for 3 weeks. In naltrexone group, pituitary hormones showed upward tendencies even though only the prolactin had statistical significance. However, beta-endorphin and dynorphin A were not significantly different between the two groups. It was suggested that naltrexone made effects on hypothalamo-pituitary-adrenocortical axis activity as well as smoking behavior. However, the meaning of these endocrinal changes by naltrexone is not conclusive, whether it is beneficial or aversive.

Intestinal transport and metabolism of glucose-conjugated kyotorphin and cyclic kyotorphin: metabolic degradation is crucial to intestinal absorption of peptide drugs.

Intestinal transport and metabolism of modified kyotorphin (KTP) were studied in rats. Modified KTPs studied were C-terminally modified KTP with p-aminophenyl-beta-D-glucoside (KTP-pAPbeta glc), N-terminally modified KTP-pAPbeta glc with t-butyloxycarbonyl group (Boc-KTP-pAPbeta glc) and the N- and C-terminally modified KTP by cyclization (cyclic KTP). KTP-pAPbeta glc was metabolized at a similar rate to that of KTP, and did not appear on the serosal side. Although Boc-KTP-pAPbeta glc was also metabolized, it was more stable than KTP and appeared on the serosal side. Cyclic KTP was also quite stable and appeared on the serosal side. The modified KTPs were evaluated kinetically for absorption consisting of membrane transport and metabolism. Absorption clearance (CL(abs)) of cyclic KTP, Boc-KTP-pAPbeta glc and Boc-KTP was higher than that of KTP (0.247 microl/min/cm) (Mizuma et al., Biochim. Biophys. Acta 1335 (1997) 111-119), which is the theoretical maximum by complete inhibition of peptidase activity, indicating that derivatization of KTP increases the membrane permeability. Furthermore, the data clearly showed that the greater the metabolic clearance (CL(met)) of KTP and the KTP derivatives, the lower the absorption clearance (CL(abs)). These results and further simulation study led to the conclusion that metabolic degradation in the intestinal tissues is more critical than membrane permeability (transport) for oral delivery of peptide drugs. Based on the stability of cyclic KTP in serum, this appears to be a good candidate analgesic peptide drug.

Neural monitoring of vasovagal syncope.

Head-up tilt testing has become a valuable and widely accepted diagnostic tool for evaluation of patients with vasovagal syncope. This test has afforded clinical researchers the opportunity to focus on the hemodynamic, humoral, and neural changes that accompany syncope. We review the animal and clinical studies that provide insight into the possible pathophysiological mechanisms involved in vasovagal syncope. Hemodynamic measurements in patients with vasovagal syncope suggest that a relative decrease in ventricular size and increase in cardiac contractility may be seen in many patients with vasovagal syncope. Patients with vasovagal syncope have also demonstrated numerous "exaggerated" neurohumoral responses to syncope. Differential changes in plasma levels of epinephrine, renin, endothelin, vasopressin, cortisol, prolactin, beta endorphins, and substance P have been reported by some investigators either prior to or during a syncopal episode in patients with vasovagal syncope. The precise pathophysiological significance of these measurements is unknown at the present time. Measurements of autonomic tone may be accomplished indirectly with analysis of heart rate variability or baroreflex slope, or directly by sympathetic neural recordings of the peroneal nerve. We have demonstrated decreased baroreflex slopes in patients with vasovagal syncope. Using microneurography, we and others have demonstrated decreased sympathetic nerve activity occurring 11 +/- 3 seconds prior to syncope during head-up tilt table testing. A variety of other abnormal reflexes, including blunted forearm blood flow responses during exercise, have been demonstrated by others. These observations suggest that pacing instituted after the event may not be as helpful as the use of a hemodynamic sensor that will result in the initiation of pacing prior to sympathetic withdrawal or modify the decrease in sympathetic tone that occurs prior to syncope.

Role of endogenous opioids and catecholamines in vasovagal syncope.

Head-up tilt testing demonstrates vasovagal mechanisms as a cause for syncope, but the pathophysiology underlying this condition remains unclear. The aim of this study was (i) to measure plasma beta-endorphins, adrenocorticotrophic hormone, cortisol, catecholamines, and brain natriuretic peptide during head-up tilt, and (ii) to assess the effect of naloxone infusion during head-up tilt in subjects with reproducible vasovagal syncope. During the assessment of unexplained syncope, 71 subjects underwent a total of 93 tilt tests (60-70 degrees head upwards for 40-45 min or until syncope occurred) during which frequent blood sampling was performed. Subjects with a positive tilt test (n = 56) (mean duration to syncope 23.6 min) showed a larger rise in beta-endorphin levels prior to syncope (baseline 4.7 +/- 2.2 vs syncope onset 6.9 +/- 3.2 pmol.l-1, P = 0.0001) than those with a negative test (n = 37) (baseline 3.9 +/- 3.9 vs end of test 4.9 +/- 2.3 pmol.l-1, P = 0.03). During tilting, adrenocorticotrophic hormone, cortisol, and noradrenaline increased; adrenaline and brain natriuretic peptide remained unchanged; and these responses were similar in positive and negative test groups. Naloxone (2.6 mg.kg-1 i.v. bolus followed by 20 micrograms.kg-1.min-1 infusion), administered in a double-blind fashion during head-up tilt in nine subjects, failed to modify either the time to syncope or the vasodepressor response. Thus, endogenous opioids appear not to be an important trigger for vasovagal syncope, and other pathophysiological mechanisms should be considered.

Lack of response of proenkephalin A and sympathetic nervous system in chronic pain associated with lung cancer.

Since the discovery of the link between peripheral endogenous opioid peptides and pain regulation, these substances have been studied in relation to certain pain conditions. In order to elucidate the effect of chronic pain on both peripheral opioid system and sympathetic nervous activity, we assayed plasma met-enkephalin (ME), neutrophil met-enkephalin containing peptides (NMECP) and plasma free and conjugated catecholamines (CA) in lung cancer patients with chronic pain related to bone metastases and without pain. No significant difference was found in ME levels when the pain cancer group (0.36 +/- 0.06 pmol/ml) was compared to the pain-free group (0.37 +/- 0.04 pmol/ml); results were similar for NMECP levels (14.1 +/- 1.66 pmol/mg prot and 18.41 +/- 1.93 pmol/mg prot, respectively). CA levels in both groups were also similar. These results differ from those we have reported previously for acute pain, suggesting that a non-permanent painful stimulus may be necessary for peripheral opioid system stimulation.

S.C.S. effectiveness in patients affected by peripheral chronic arterial disease: our 5 years experience.

Spinal cord stimulation (S.C.S.) showed a valid clinical effect in the treatment of chronic obliterative arteriopathy of the lower limbs at an advanced stage (III-IV stages) and of phantom limb pain syndrome (P.L.P.S.). Secretion patterns of various biochemical mediators were evaluated and mechanism, by which analgesic and vasodilatator actions occur, were thus accounted for. There is not agreement on this subject. We report our experience on 60 patients (age range 28-91), observed over the period 1987-92. Blood values of some chemical mediators (beta-endorphins, Kinins, Serotonin, PGE) were determined before and after stabilization of the S.C.S. implant (from 2 up to 6 months) and compared with the objective clinical and TCpO2 data. Statistical significance was checked of variations obtained (Student's "t" test). High significant increase of TCpO2, beta-endorphins, PGE, (p < 0.01) and the Kinins (p < 0.05) was found but there were no significant alteration of Serotonin. Results are explained and an S.C.S. effect at the spinal cord metamer level with a cortical integration (pointed out by the increase of the beta-endorphins) is suggested. Analgesic effectiveness and vasodilatator action of S.C.S. implant is stressed as long as it is carried out only when a correct indication is established in the absence of contraindications or important risk.

Endogenous opioid system modulation in anginal pain: demonstration of its central activity.

Plasma beta-endorphin levels provide controversial results on the role of endogenous opioid system in modulation of anginal pain. As an alternative, the action of plasmatic luteinizing hormone after administration of naloxone was investigated: naloxone blocks the tonic endogenous opioid system inhibition of gonadotropin release; thus, the level of luteinizing hormone after naloxone administration is an index of central endogenous opioid system activity. Twenty patients with coronary artery disease and positive results of stress tests were selected: 10 had angina (group I) and 10 did not (group II). Ten healthy subjects were also studied as a control group (group III). In all patients basal plasma beta-endorphin levels, basal luteinizing hormone plasma levels (every 15 minutes for 1 hour) and luteinizing hormone plasma levels after administration of 0.1 mg/kg naloxone over 4 minutes (every 15 minutes for 2 hours) were determined. In 15 patients the test was performed after luteinizing hormone releasing hormone was given. The integral concentration time of luteinizing hormone plasma level during baseline (LHiB) and after administration of naloxone (LHiN) or luteinizing hormone releasing hormone (LHiRH), the ratio (LHiN:LHiB and LHiRH:LHiB) and the differences (LHiN-LHiB and LHiRH-LHiB) between the postinfusion period and baseline were calculated. No difference was found in beta-endorphin plasma levels and luteinizing hormone response after luteinizing hormone releasing hormone infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endogenous opioid peptides in cattle during pregnancy, birth and the newborn period]. / Endogene opioide Peptide beim Rind während Trächtigkeit, Geburt und Neugeborenenphase.

The concentrations of beta-endorphin and met-enkephalin in plasma were investigated in cows in different stages of gestation, during parturition and in the early postpartum period as well as in their newborn calves. Plasma beta-endorphin concentrations were low in the early stages of pregnancy. In the last month of gestation beta-endorphin levels almost as high as during parturition were found. Therefore in cattle the antepartum increase in plasma beta-endorphin concentration is not linked to the onset of labour. Met-enkephalin levels in plasma of calving cows were higher than those in cows in the last month of gestation. For met-enkephalin a relation to the stress of parturition is more likely than for beta-endorphin. In conjunction with a cesarean section the concentrations of beta-endorphin and met-enkephalin in plasma increased during surgery. This increase is likely to be caused by surgery-related stress. Calves showed highest beta-endorphin concentrations immediately after delivery. One hour post natum beta-endorphin levels were markedly decreased and showed only minor changes thereafter. In calves born at term highest met-enkephalin concentrations were found immediately post natum with levels decreasing continuously over the first two days of life. Preterm calves showed lower met-enkephalin concentrations in plasma than those born at term. During the first hour post natum in preterm animals met-enkephalin levels in plasma even increased. A highly significant correlation existed between met-enkephalin levels and the degree of acidosis in calves. An antagonism between endogenous opioids and catecholamines in newborns is suggested.

Hyperendorphinemia in obesity is not related to the affective state.

In seventy-two patients affected by hyperphagic obesity and forty age-matched, normal weight volunteers we performed a psychological assessment, through various mental tests, and evaluated the beta-endorphin (B-Ep), ACTH and cortisol circulating levels, in basal condition and following an overnight short dexamethasone suppression test (DST). The hormones were measured by radioimmunoassay either directly in the serum (cortisol) and the plasma (ACTH), or after affinity gel column chromatography (B-Ep). In obese subjects B-Ep levels in basal conditions were four times greater than in normal weight controls and showed significantly less reduction after DST. ACTH and cortisol levels, in contrast, were in the normal range and were suppressed following dexamethasone as was also true in the control group. Psychological evaluation on M.M.P.I. (Minnesota Multiphasic Personality Inventory) revealed a trend toward hypochondria, depression, hysterias, psychoasthenia and schizophrenia. However, no significant correlation has been found between M.M.P.I. clinical scale scores and circulating levels of B-Ep and cortisol either in basal conditions or after DST. In conclusion, these data do not support the hypothesis that abnormalities of the hypothalamus-pituitary-adrenal axis in hyperphagic obesity are related to affective disorders.