Opioid and opiate immunoregulatory processes.

The discovery of the ability of the nervous system to communicate through "public" circuits with other systems of the body is attributed to Ernst and Berta Scharrer, who described the neurosecretory process in 1928. Indeed, the immune system has been identified as another important neuroendocrine target tissue. Opioid peptides are involved in this communication (i.e., neuroimmune) and with that of autoimmunoregulation (communication between immunocytes). The significance of opioid neuropeptide involvement with the immune system is ascertained from the presence of novel delta, mu, and kappa receptors on inflammatory cells that result in modulation of cellular activity after activation, as well as the presence of specific enzymatic degradation and regulation processes. In contrast to the relatively uniform antinociceptive action of opiate and opioid signal molecules in neural tissues, the presence of naturally occurring morphine in plasma and a novel mu3, opiate-specific receptor on inflammatory cells adds to the growing knowledge that opioid and opiate signal molecules may have antagonistic actions in select tissues. In examining various disorders (e.g., human immunodeficiency virus, substance abuse, parasitism, and the diffuse inflammatory response associated with surgery) evidence has also been found for the involvement of opiate/opioid signaling in prominent mechanisms. In addition, the presence of similar mechanisms in man and organisms 500 million years divergent in evolution bespeaks the importance of this family of signal molecules. The present review provides an overview of recent advances in the field of opiate and opioid immunoregulatory processes and speculates as to their significance in diverse biological systems.

Endothelin-receptor interactions. Role of a putative sulfhydryl on the endothelin receptor.

The mechanism of action of endothelin-receptor interactions was studied, using radioligand binding assays and SDS-PAGE, to investigate the possibility of disulfide interchange. Electrophoretic analysis suggested involvement of disulfide bond(s) in the receptor-ligand complex. Treatment of Et receptors with sulfhydryl-specific alkylating reagents (NEM or others) resulted in decreased ability to bind [125I]Et-1. [Dpr1-Asp15]Et-1, an antagonist homologous to Et but with an amide link replacing one of the disulfides, bound to Et receptors reversibly, but binding of Et-1 was less reversible. Preincubation of receptors with Et-1, but not with [Dpr1-Asp15]Et-1, protected receptors from alkylation with [14C]NEM. The data suggest that the Et receptor has a sulfhydryl group at or near the Et binding site. A model is proposed in which the role of the putative sulfhydryl group is discussed.

Myocardial expression of endothelin-1 in murine Trypanosoma cruzi infection.

Chagas' disease, caused by Trypanosoma cruzi, is an important cause of myocarditis and chronic cardiomyopathy and is accompanied by microvascular spasm and myocardial ischemia. We reported previously that infection of cultured endothelial cells with T. cruzi increased the synthesis of biologically active endothlein-1 (ET-1). In the present study, we examined the role of ET-1 in the cardiovascular system of CD1 mice infected with the Brazil strain of T. cruzi and C57BL/6 mice infected with the Tulahuen strain during acute infection. In the myocardium of infected mice myonecrosis and multiple pseudocysts were observed. There was also an intense vasculitis of the aorta, coronary artery, smaller myocardial vessels and the endocardial endothelium. Immunohistochemistry studies employing anti-ET-1 antibody revealed increased expression of ET-1 that was most intense in the endocardial and vascular endothelium. Elevated levels of mRNA for preproET-1, endothelin converting enzyme and ET-1 were observed in the same myocardial samples. Plasma ET-1 levels were significantly elevated in infected CD1 mice 10-15 days post infection. These observations suggest that increased levels of ET-1 are a consequence of the initial invasion of the cardiovascular system and provide a mechanism for infection-associated myocardial dysfunction.

Cryopreserved veins in myocardial revascularization: possible mechanism for their increased failure.

BACKGROUND: Cryopreserved veins are used as conduits for myocardial revascularization. However, a high failure rate associated with their use has been reported anecdotally. METHODS: To find an explanation for the poor performance of cryopreserved vein grafts, we conducted a retrospective 5-year study on all patients at a single institution in whom cryopreserved vein grafts were used. We further performed in vitro studies measuring cell adhesion, nitric oxide production, and contractile capacity of saphenous vein, internal thoracic artery, and cryopreserved veins. RESULTS; Forty-one patients were identified in whom one or more cryopreserved veins were used as a last resort. Sixteen had events (death or recatheterization). Seven deaths occurred (17%). Event-free survival was 50% at 12 months. Activated granulocyte/monocyte endothelial adherence could be lowered in internal thoracic arteries and saphenous veins with morphine incubation (50% and 57%, respectively), but not in cryopreserved veins. Simultaneous increases in nitric oxide release were also found in internal thoracic arteries and saphenous veins, but not cryopreserved veins. In addition, cryopreserved veins showed a diminished contractile capacity under experimental conditions. CONCLUSIONS: In this highly select group of patients, cryopreserved veins had a high early failure rate, which may be partially due to the inability of the endothelium to participate in immunovascular processes.

Morphine stimulates nitric oxide release from invertebrate microglia.

Morphine stimulates nitric oxide (NO) release in human endothelial cells. To determine whether this mechanism also occurs in invertebrates, the mussel Mytilus edulis was studied. Exposure of excised ganglia to morphine for 24 h resulted in a significant dose-dependent decrease in microglial egress that was naloxone sensitive. In coincubating the excised ganglia with morphine and the nitric oxide synthase inhibitor, N omega-nitro-L-arginine methyl ester (L-NAME), an increase in microglial egress was observed, suggesting that morphine may stimulate microglia to release NO. Morphine exposure to these cells in vitro resulted in NO release (39.4 +/- 4.9 nM), a phenomenon found to be naloxone sensitive (10(-6) M; NO level = 5.9 +/- 2.6 nM) and L-NAME sensitive (10(-4) M; NO level = 2.8 +/- 1.8 nM). Opioid peptides did not stimulate NO release, indicating that the process was mediated by the opiate alkaloid selective mu 3 receptor. Coincubation of microglia with L-arginine or the superoxide scavenger, superoxide dismutase, resulted in significantly higher NO levels observed following morphine stimulation. Taken together, the data demonstrate that morphine can stimulate NO release in cells obtained from an invertebrate that represents an animal 500 million years divergent in evolution from man, underscoring the significance of this process and further substantiating the critical importance of morphine as a naturally occurring signal molecule.

Expression of functional delta opioid receptors in vascular smooth muscle.

We evaluated smooth muscle from human internal mammary artery and rat aorta for the presence of delta opioid receptors. Radioligand receptor competition studies using the delta-receptor selective agonist, [3H]-[D-Ala2, Met5] enkephalinamide (DAMA) suggested the expression of a high affinity binding site in rat and human blood vessels that was consistent with the delta-2 opioid receptor subtype. Using RT-PCR with primers to the cloned delta opioid receptor (DOR), a cDNA fragment identical to the known DOR sequence was obtained from the smooth muscle cell line, A-10. Stimulation of A-10 cells with DAMA resulted in a significant mobilization of intracellular calcium and membrane depolarization. Exposure of aortic rings denuded of endothelium to DAMA induced a naltrindole-senstive increase in contractile tone. These data demonstrate the presence of a functional DOR in vascular smooth muscle and a direct impact of opioids on vascular contractile tone.

Protease activated receptors modulate aortic vascular tone.

The effect of agonists of the known protease activated receptors (PAR), the thrombin and the PAR-2 receptors, on vasoactive mediator release and vascular tone were studied using rings of rat aorta. Stimulation of aortic rings with the thrombin receptor agonist, Trap-14, or the PAR-2 agonist, SLIGRL, resulted in a rapid release of nitric oxide. Trap-14 and SLIGRL-induced nitric oxide release was reduced by pre-treatment with BQ-788, an ETB endothelin receptor-specific antagonist. Consistent with a role for endothelin-1 receptor activation in Trap-14 and SLIGRL-induced nitric oxide release, endothelin-1 levels were increased significantly following 5 min treatment of aortic rings with Trap-14 or SLIGRL. Cumulative addition of Trap-14 to aortic rings denuded of endothelium resulted in dose-dependent contraction with an EC50 value of 23 +/- 5 microM, whereas SLIGRL addition failed to induce aortic contraction. These data suggest that the known protease activated receptors are functionally coupled to nitric oxide release. In addition, the thrombin receptor appears to modulate both vasodilator and contractile responses, whereas the PAR-2 receptor is linked only to vasodilation.

Detection of endothelial cell-derived nitric oxide: current trends and future directions.

The vascular endothelium is a significant site of NO release that inhibits cellular adhesion and maintains a non-thrombogenic surface. Use of newly described technology suggests for the first time that the maximal release of NO induced by cNOS and iNOS activation may be quite similar, implying that it is the duration of NO release and not the concentration of NO produced from stimulated endothelial cells that accounts for the different biological activities of the enzymes. The respective roles of cNOS and iNOS must be carefully evaluated since both enzymes may have potent biological effects at local sites of production.

Potent mitogenic activity of staphylococcal enterotoxin A requires induction of interleukin 2.

Staphylococcal enterotoxin A (SEA), the most common cause of food poisoning, is capable of stimulating human T lymphocyte proliferation at concentrations as low as 10(-13) to 10(-16) M. SEA also induces the lymphokines interleukin 2 (IL 2) and interferon gamma (IFN gamma) at similarly low concentrations. HPL cultures were stimulated with SEA in the presence of antibodies to IL2 to determine the possible role of this lymphokine in its potent mitogenic effects. Polyclonal and monoclonal antibodies to human IL 2 blocked SEA-induced mitogenesis. Treatment of cultures with higher concentrations of SEA overcame the anti-IL 2 blockage, corresponding to induction of higher concentrations of IL 2. Blockage of HPL mitogenesis by anti-IL 2 antibodies also resulted in inhibition of IFN gamma production, which is dependent on IL 2. Neutralizing monoclonal antibody to IFN gamma failed to block SEA-induced proliferation. The data indicate that the induction of IL 2, but not IFN gamma, is a requirement for SEA induced lymphocyte proliferation. SEA food poisoning and IL 2 therapy for cancer result in similar toxic symptoms, characterized by malaise, fever, nausea or vomiting, and diarrhea. The similarity between SEA and IL2 toxic effects, the fact that SEA is a potent inducer of lymphokines such as IL 2, and the fact that IL 2 induction is a prerequisite for the mitogenic effects of SEA raises the intriguing question of the role of lymphokines such as IL 2 in SEA-induced food poisoning.

Characterization of a synthetic peptide corresponding to a receptor binding domain of mouse interferon gamma.

A receptor binding region of mouse interferon gamma (IFN gamma) has previously been localized to the N-terminal 39 amino acids of the molecule by use of synthetic peptides and monoclonal antibodies. In this report, a detailed analysis of the synthetic peptide corresponding to this region, IFN gamma (1-39), is presented. Circular dichroism (CD) spectroscopy indicated that the peptide has stable secondary structure under aqueous conditions and adopts a combination of alpha-helical and random structure. A peptide lacking two N-terminal amino acids, IFN gamma (3-39), had similar secondary structure and equivalent ability to compete for receptor binding, while peptides lacking four or more N-terminal residues had reduced alpha-helical structure and did not inhibit 125I-IFN gamma binding. Substitution of proline, a helix-destabilizing amino acid, for leucine (residue 8) of a predicted amphipathic alpha-helix (residues 3-12), IFN gamma (1-39) [Pro]8, resulted in a substantial reduction in the helical content of the peptide, supporting the presence of helical structure in this region. However, destabilization of the helix did not reduce the competitive ability of the peptide. A peptide lacking eight C-terminal residues, IFN gamma (1-31), did not block 125I-IFN gamma binding and had no detectable alpha-helical structure, suggesting a requirement of the predicted second alpha-helix (residues 20-34) for receptor interaction and helix stabilization. Substitution of phenylalanine for tyrosine at position 14, IFN gamma (1-39) [Phe]14, a central location of a predicted omega-loop structure, did not affect the secondary structure associated with the region yet resulted in a 30-fold increase in receptor competition.(ABSTRACT TRUNCATED AT 250 WORDS)

Thrombin receptor activation inhibits monocyte spreading by induction of ET(B) receptor-coupled nitric oxide release.

The effect of thrombin receptor activation on monocyte conformation was evaluated using the human monocyte cell line, THP-1, and the thrombin mimetic peptide, Trap-14. Treatment of THP-1 cells with Trap-14 induced rapid rounding of ameboid cells adherent to fibronectin-coated slides, whereas cell rounding was abrogated in the presence of the nitric oxide synthase inhibitor, NG-nitro-L-arginine or the endothelin B receptor antagonist, BQ-788. Endothelin-1 (ET-1) levels in the culture supernatant increased markedly within minutes of Trap-14 exposure with a concomitant loss in cellular ET-1 immunoreactivity. Importantly, loss of ET-1 immunoreactivity was blocked by pretreatment with the vesicle translocation inhibitor, nocodazole. Trap-14 potently induced the release of NO from THP-1 cells, whereas NO release was ablated by preincubation with BQ-788. These data demonstrate that thrombin receptor activation may inhibit cellular spreading as a result of autocrine ET-1 release and subsequent endothelin B receptor-dependent NO production, and suggest that initial exposure of inflammatory cells to thrombin may limit cellular activation and recruitment.

Thrombin-induced vascular reactivity is modulated by ETB receptor-coupled nitric oxide release in rat aorta.

The role of endothelin (ET) receptors in thrombin-induced modulation of vascular tone was evaluated by direct measurement of ET-1 and ET receptor-coupled nitric oxide (NO) release and developed isometric tension in thrombin-treated aortic rings. Here we report that rapid release of ET-1 and subsequent ETB receptor activation are required for production of the potent vasodilator NO by thrombin-stimulated aorta. Thrombin-induced NO release is ablated by pretreatment with ETB receptor antagonists or after ET receptor desensitization by repeated stimulation with ET-1. Thrombin-induced relaxation of precontracted vessels was abrogated in the presence of ETB receptor antagonists and, in contrast, marked contraction to thrombin was observed. These data indicate that the endothelium-dependent vasodilator activity previously attributed to thrombin is indirect and requires ETB receptor-coupled NO release and suggest that ET receptor modulation of thrombin-induced vascular tone may contribute to the increased vasomotor tone observed in diseased and mechanically injured vessels.

Endothelin and nitric oxide release modulate aortic contraction to selected thrombin receptor agonists.

The contribution of endothelin-1 (ET-1) and nitric oxide (NO) release to vascular contraction induced by synthetic peptide agonists of the alpha-thrombin receptor, TRAP-14 and TRAP-6, was evaluated with the use of rings of rat aorta. TRAP-6 induced fourfold greater contraction than that induced by addition of TRAP-14. TRAP-14, but not TRAP-6, stimulation of aortic rings resulted in a rapid (in seconds) and dose-dependent increase in ET-1 levels detected in the vessel perfusate. Release of ET-1 in vessels denuded of endothelium was indistinguishable from that of intact vessels, suggesting that endothelial cells are not required for the observed ET-1 release. The contractile potency of TRAP-14 was reduced in the presence of BQ-123, a specific antagonist of the endothelin A subtype of ET receptors, whereas TRAP-14 potency was increased significantly by pretreatment with the NO synthetase inhibitor NG-nitro-L-arginine (L-NNA). The contractile potency of TRAP-6 was not altered in the presence of BQ-123 or L-NNA, suggesting that TRAP-14 but not TRAP-6 potency is modulated by ET-1 and NO release. These data indicate that TRAP-6 has limited function relative to TRAP-14 and that thrombin receptor activation is not sufficient to induce ET-1 and NO release from rat aorta.

Steric relationship of amino-terminal and carboxy-terminal domains of murine interferon-gamma as assessed by monoclonal antibodies.

Spleen cells from a hamster immunized with murine interferon-gamma (IFN-gamma) carboxy-terminal (95-133) synthetic peptide [IFN-gamma (95-133)] conjugated to keyhole limpet hemocyanin (KLH) were fused with mouse myeloma cells, resulting in the production of an anti-IFN-gamma (95-133) monoclonal antibody, which reacted with IFN-gamma. This monoclonal antibody bound [125I]IFN-gamma in a dose-dependent and reversible fashion, and neutralized the antiviral and macrophage priming activities of IFN-gamma. Antibody-antibody competition for [125I]IFN-gamma binding, using this carboxy-terminal-specific antibody and two previously described amino-terminal-specific monoclonal antibodies, indicated that the carboxy-terminal-specific monoclonal antibody competed only with itself and that the two amino-terminal-specific monoclonal antibodies similarly competed only with each other for [125I]IFN-gamma. The data suggest that the amino- and carboxy-terminal IFN-gamma domains important for function are sterically distant from one another, and suggest the intriguing possibility that interaction of IFN-gamma with its receptor may involve more than one binding site on the IFN-gamma molecule.

Acetylated endothelin-1 is a constrictor in guinea pig lung vasculature but not in isolated vascular strips.

We examined the relative importance of the two amino groups of endothelin-1 in mediating pulmonary vasoconstrictor activity. Complete acetylation of prefolded endothelin-1 (fAcET-1[AcK9]) yielded a product with vasoconstrictor properties (EC50 = 0.52 +/- 0.04 nM) in isolated Ringer-perfused guinea pig lungs similar to native endothelin-1 (EC50 = 0.31 +/- 0.05 nM). However, fAcET-1[AcK9] exhibited a marked reduction in potency when assessed by contraction of isolated guinea pig pulmonary artery strips or by contraction of carotid artery or aortic strip preparations. fAcET-1[AcK9] at concentrations up to 100 nM failed to induce appreciable contraction of any vascular strip preparation. In contrast, endothelin-1 had an EC50 of 1.46 +/- 0.32 to 1.88 +/- 0.19 nM in various vessel preparations. The differences in response to fAcET-1[AcK9] in the intact lung vs. strip preparation suggest different receptor populations in the two preparations. The importance of specific amino groups for contractile activity in the vascular strip preparation was explored by acetylation of individual sites (amino terminus or lysine sidechain) or both sites during peptide synthesis to produce AcET-1, ET-1[AcK9], and AcET-1[AcK9], respectively. The order of potency was endothelin-1 much greater than ET-1[AcK9] greater than AcET-1 greater than AcET-1[AcK9]. These results suggest that chemical modifications (e.g., biotinylation) should be made preferentially at the lysine-9 sidechain in order to retain maximal biological activity in vascular strip preparations.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphine-induced conformational changes in human monocytes, granulocytes, and endothelial cells and in invertebrate immunocytes and microglia are mediated by nitric oxide.

We evaluated the contribution of nitric oxide (NO) to morphine-induced rounding of spontaneously activated (mobile) ameboid human monocytes, granulocytes, or arterial endothelial cells and invertebrate immunocytes and microglia. Morphine induced significant rounding and inactivation of ameboid cells within 20 min except for arterial endothelial cells, which became rounded 24 h after morphine exposure. The effects of morphine on cell conformation were blocked in the presence of N-nitro-L-arginine, a nitric oxide synthase inhibitor. Treatment of cells with the NO donor, sodium nitroprusside, induced cell rounding similar to that observed following morphine exposure, suggesting that NO release may mediate morphine-induced changes in cell conformation. The contribution of NO release to morphine-induced cell rounding was determined by direct evaluation of NO concentration in real-time using a NO-specific amperometric probe. Significant increases in NO concentration were observed 2 min after morphine stimulation, whereas morphine-induced NO release was markedly impaired by pretreatment with N-nitro-L-arginine or the opiate alkaloid antagonist, naloxone. In contrast, opioid peptides failed to induce NO release, consistent with our previous observations that demonstrated the failure of opioid peptides to promote cell rounding. Taken together, these data suggest that morphine-induced NO release may be mediated by activation of the opiate alkaloid-selective, opioid peptide-insensitive micro3 receptor, and that functional coupling of morphine to NO production has been conserved during evolution and may modulate cellular activation.

Antagonism of LPS and IFN-gamma induction of iNOS in human saphenous vein endothelium by morphine and anandamide by nitric oxide inhibition of adenylate cyclase.

Nitric oxide (NO) production regulates vasodilation in many blood vessels. Additionally, constitutive NO release is being associated with positive biomedical phenomena, whereas inducible NO synthase (iNOS)-associated NO release with detrimental consequences in regard to endothelial inflammatory activities. As yet, an important link demonstrating why one is activated over the other is not available. Previous studies have demonstrated that morphine and anandamide effector processes are coupled to NO release in human endothelial cells (ECs). This study now extends this observation in that these endogenous signaling molecules may use NO directly to inhibit adenylate cyclase activity. Activation of human ECs, obtained from the saphenous vein, with morphine- or anandamide-stimulated NO release (35 nM and 28 nM, respectively) that peaked within 5 min and returned to basal levels within 10 min of agonist stimulation, consistent with constitutive NO synthase (cNOS) activation. Significant release of NO from ECs stimulated with lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma) occurred after 2 h after exposure and remained significantly increased over basal levels for 24-48 h (28 nM), consistent with iNOS activation. Preincubation of ECs with morphine or anandamide before, but not after, the addition of LPS + IFN, blocked iNOS activity. Exposure of ECs to the NO donor, SNAP, before the addition of LPS + IFN, blocked iNOS induction, whereas preincubation of ECs with inhibitors of NOS, before morphine or anandamide exposure, restored LPS + IFN induction of iNOS, suggesting a direct impact of NO on the regulation of iNOS activity. Morphine and anandamide stimulation of ECs did not stimulate cyclic adenosine monophosphate (cAMP) accumulation, whereas a marked increase in cAMP was observed in ECs treated with LPS + IFN (8.2 to 33 pmol/mg protein). Treatment of ECs with LPS + IFN did not induce cAMP accumulation in ECs treated with morphine, anandamide, or SNAP before LPS + IFN exposure. These data suggest that cAMP is required for the induction of iNOS in ECs and that NO may directly impair adenylate cyclase activity, preventing iNOS activation.

Evaluation of endothelin receptor populations using endothelin-1 biotinylated at lysine-9 sidechain.

Optimal conditions for biotinylation of endothelin-1 (Et-1) were determined using biotinylating reagents of variable linker arm length and mono- vs dual-biotinylated Et-1. Specific modification of lysine-9 sidechain with NHS-LC-biotin (Et-1[BtK9]) produced a derivative with maximal binding and retention of vascular smooth muscle contractile activity. The Et-1[BtK9] probe bound to Chinese hamster ovary cells transfected with EtA receptor cDNA (CHO[EtR]), but not untransfected cells. Binding to rat vascular smooth muscle cells (VSMC) was detectable at 0.01 nM with maximal binding at 1 nM. Displacement of 1 nM Et-1 [BtK9] binding by Et-1 indicated an IC50 value of 6 +/- 3 nM. Et-1 displaced Et-1[BtK9] binding to VSMC and CHO[EtR] to a greater extent than endothelin-3, indicating predominant expression of EtA receptor sub-type. Thus, biotinylation of Et-1 at the lysine-9 sidechain may be of general use for localization and typing of Et-receptor populations.

Rebound from nitric oxide inhibition triggers enhanced monocyte activation and chemotaxis.

Exposure of human peripheral blood monocytes to the NO donor S-nitroso-N-acetyl-DL-penicillamine (SNAP) resulted in a rapid shift in cellular conformation of spontaneously activated cells from ameboid to round. The population of activated cells, approximately 7. 1 +/- 1.2%, was reduced 7-fold to 1.1 +/- 0.4% following 0.5 h exposure to SNAP. Observation of monocytes for 6 h demonstrated a gradual release from NO inhibition initiating at 2.5 h following SNAP treatment and a period of hyperactivity that was maximal at approximately 5 h following SNAP exposure. During the rebound from the NO inhibition phase, there was a significant increase in the population of activated monocytes and an increased responsiveness to chemotactic agents such as IL-1, IL-8, and fMLP relative to that of cells treated with the chemotactic agents alone. Conformational changes induced by SNAP were associated with a reduction in F-actin and loss of filopodial extension. The loss and recovery of F-actin staining paralleled changes in cell activity, suggesting that NO may alter cellular activity by modulation of cytoskeletal actin. These data taken together suggest that inhibition of monocyte activity by NO results in an excitatory phase observed subsequent to release from NO inhibition and increased sensitivity to chemotactic agents. We propose that this rebound from NO inhibition may provide increased immunosurveillance to rectify immunological problems that have been encountered during the period of inhibition.

Ischemic preconditioning - an opiate constitutive nitric oxide molecular hypothesis.

Coronary artery disease is the number one cause of adult mortality due to a medical illness in the United States. Exciting new studies are looking at the role transient ischemia may play in preconditioning the myocardium to reduce the degree of infarction following a sustained ischemic insult. In this speculative review, we surmise ischemic preconditioning and the resulting protection afforded by it in response to abnormal insults arises from an already existing physiological process that may be associated with exercise. A brief ischemic episode mimics the cells response to normal dips in ATP levels caused by metabolic demand. In so doing, via constitutive nitric oxide synthase derived nitric oxide, it temporarily down regulates a cells excitatory state, thus protecting it from the next insult. Within this context, opiate and opioid actions can be incorporated into the protection scenario, as can other signal molecules since they may release nitric oxide. Instead of ischemia inducing nitric oxide release via a drop of ATP levels, various signal molecules, such as opiate alkaloids, have their cell surface receptors coupled to constitutive nitric oxide synthase thereby releasing nitric oxide, initiating associated cell activity dampening action. In conclusion, it appears as though endogenous nitric oxide stimulators offer their selective preconditioning protection by joining an already existing process that limits activation following normal physical exertion.