diprenorphine and Pain

Ligand-PET studies are attracting increasing interest in experimental and clinical research. As the most elaborated of PET techniques, ligand-PET allows the demonstration of receptor distributions, and thus, the delineation of neurochemical pathologies in the disease state. Recent developments are promising that ligand-PET will even allow to characterize dynamic and short-term changes in neurotransmission and will tremendously add to the understanding of neurophysiology on the receptor level. In pain studies, mainly the mu-opioidergic agonist [(11)C]-carfentanil and the unspecific opioid receptor antagonist [(11)C]-diprenorphine are applied. Utilizing these ligands the thalamus, prefrontal and cingulate cortex, basal ganglia and midbrain structures have been shown to possess high amounts of opioidergic receptors in vivo and it is well accepted, that the receptor density is higher in projections of the medial than those of the lateral pain system. Changes in receptor availability were observed in patients suffering from chronic pain. Rheumatoid arthritis, trigeminal neuralgia and central poststroke pain (CPSP) all lead to decreased ligand binding in pain processing regions during the painful period in comparison to pain free intervals or healthy subjects. These decreases may either be the consequence of increased endogenous release or indicate receptor internalization/down-regulation or loss of neurons carrying these receptors. Recent studies also evidenced [(11)C]-carfentanil binding changes due to acute experimental pain. One possible interpretation of these changes is that the PET-ligand might be displaced by endogenous opioidergic ligands. One major region, where this "ligand displacement" was observed, was the thalamus. These findings highlight the importance of the opioidergic system in pain processing and the power of ligand-PET to advance the understanding of pain.

Topics: Analgesics, Opioid; Brain; Diprenorphine; Fentanyl; Humans; Ligands; Narcotic Antagonists; Pain; Positron-Emission Tomography; Receptors, Opioid

Topics: Animals; Anticonvulsants; Autonomic Nervous System; Blood Pressure; Brain; Diprenorphine; Drug Tolerance; Electroconvulsive Therapy; Electroencephalography; Endorphins; Enkephalin, Leucine; Enkephalin, Leucine-2-Alanine; Enkephalins; Heart Rate; Morphine; Naloxone; Pain; Pituitary Gland; Pressoreceptors; Rats; Receptors, Opioid; Sensory Thresholds; Tritium

MRI and PET provide complementary information for studying brain function. While the potential use of simultaneous MRI/PET for clinical diagnostic and disease staging has been demonstrated recently; the biological relevance of concurrent functional MRI-PET brain imaging to dissect neurochemically distinct components of the blood oxygenation level dependent (BOLD) fMRI signal has not yet been shown. We obtained sixteen fMRI-PET data sets from eight healthy volunteers. Each subject participated in randomized order in a pain scan and a control (nonpainful pressure) scan on the same day. Dynamic PET data were acquired with an opioid radioligand, [(11)C]diprenorphine, to detect endogenous opioid releases in response to pain. BOLD fMRI data were collected at the same time to capture hemodynamic responses. In this simultaneous human fMRI-PET imaging study, we show co-localized responses in thalamus and striatum related to pain processing, while modality specific brain networks were also found. Co-localized fMRI and PET signal changes in the thalamus were positively correlated suggesting that pain-induced changes in opioid neurotransmission contribute a significant component of the fMRI signal change in this region. Simultaneous fMRI-PET provides unique opportunities allowing us to relate specific neurochemical events to functional hemodynamic activation and to investigate the impacts of neurotransmission on neurovascular coupling of the human brain in vivo.

Topics: Adult; Brain; Brain Mapping; Corpus Striatum; Diprenorphine; Female; Humans; Magnetic Resonance Imaging; Male; Narcotic Antagonists; Pain; Positron-Emission Tomography; Receptors, Opioid; Thalamus; Young Adult

The endogenous opioid system is involved in many body functions including pain processing and analgesia. To determine the role of basal opioid receptor availability in the brain in pain perception, twenty-three healthy subjects underwent positron emission tomography (PET) utilizing the subtype-nonselective opioid antagonist [(18)F]diprenorphine, quantitative sensory testing (QST) and the cold pressor test. Binding potentials (BPs) were calculated using a non-invasive reference tissue model and statistical parametric mapping was applied for t-statistical analysis on a voxelwise basis. We found that cold pain-sensitive subjects present a significantly lower BP in regions including the bilateral insular cortex and the left orbitofrontal cortex. In addition, correlation analysis revealed an inverse correlation between opioid BP in the bilateral motor and premotor region and perceptual wind-up. These findings indicate that interindividual differences in pain perception are partially accounted for by basal opioid receptor availability. A secondary aim of this study was to investigate the contribution of basal opioid receptor availability to the perception of non-nociceptive stimuli. The following negative correlations between regional opioid BP and scores of QST parameters were found: BP in the right premotor cortex and scores of alternating cold and warm stimuli, BP in the left midcingular cortex and scores of cold detection threshold, BP in the left insula and scores of mechanical detection threshold. These results suggest that the opioid receptor system is involved in the perception not only of pain but also of non-painful somatosensory stimuli.

Topics: Adult; Brain; Brain Chemistry; Cold Temperature; Data Interpretation, Statistical; Diprenorphine; Humans; Male; Middle Aged; Pain; Pain Threshold; Perception; Physical Stimulation; Positron-Emission Tomography; Pressure; Radiopharmaceuticals; Receptors, Opioid; Sensation; Sensory Thresholds; Somatosensory Cortex; Young Adult

To determine how opiate receptor distribution is co-localized with the distribution of nociceptive areas in the human brain, eleven male healthy volunteers underwent one PET scan with the subtype-nonselective opioidergic radioligand [(18)F]fluoroethyl-diprenorphine under resting conditions. The binding potential (BP), a parameter for the regional cerebral opioid receptor availability, was computed using the occipital cortex as reference region. The following regions of interest (ROIs) were defined on individual MR images: thalamus, sensory motor strip (SI/MI area), frontal operculum, parietal operculum, anterior insular cortex, posterior insular cortex, anterior cingulate cortex (ACC; peri- and subgenual part of "classical ACC" only), midcingulate cortex (MCC, posterior part of "classical ACC"), putamen, caudate nucleus and the amygdala. BP for [(18)F]fluoroethyl-diprenorphine was lowest in the sensory motor strip (0.30). Highest BP was found in thalamus (1.36), basal ganglia (putamen 1.22, caudate 1.16) and amygdala (1.21). In the cingulate cortex, ACC (1.11) had higher BP than MCC (0.86). In the operculo-insular region, we found high BPs in all ROIs: anterior insula (1.16), posterior insula (1.05), frontal operculum (0.99) and parietal operculum (0.77). Factor analysis of interindividual variability of opiate receptor BP revealed four factors (95% explained variance): (1) operculo-insular areas, ACC, MCC and putamen, (2) amygdala and thalamus, (3) caudate and thalamus, (4) SI/MI and MCC. Nociceptive areas of the lateral pain system (frontoparietal operculum and insula) have opiate receptor BPs significantly higher than SI/MI, comparable to anterior and midcingulate areas of the medial pain system. These findings suggest that the cortical anti-nociceptive effects of opiates are not only mediated by ACC and MCC, but also by the operculo-insular cortex, if it can be assumed that opioid binding mediates anti-nociception in those structures.

Topics: Adult; Brain; Diprenorphine; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nociceptors; Pain; Positron-Emission Tomography; Receptors, Opioid

Based on concepts that endogenous opioids participate in neural transmission of pain, the present study in central poststroke pain (CPSP) patients investigated changes in opioid receptor (OR) binding in neural structures centrally involved in the processing of pain. Five patients with central pain after lesions in the brain stem, thalamus or parietal cortex and twelve healthy volunteers underwent a [11C]diprenorphine positron emission tomography study. Binding potentials were calculated using a reference region model in all subjects. Statistical parametric mapping was applied for t-statistical analysis on voxel-basis. Binding potential values for each individual were extracted from a volume of interest at each identified significant peak. Spectral analysis was applied for quantification of global values. Significant regional reduced 11C-diprenorphine binding (corrected for multiple tests) was detected in contralateral thalamus, parietal, secondary somatosensory, insular and lateral prefrontal cortices, and along the midline in anterior cingulate, posterior cingulate and midbrain gray matter. Individual extracted binding values disclosed a reduced binding in these regions in all patients independent from the particular lesion site. The poststroke pain syndrome is associated with a characteristic pattern of reduced OR binding within the neural circuitry processing pain. It is suggested that an imbalance of excitatory-inhibitory mechanisms in certain brain structures, as evidenced in decreased [11C]diprenorphine binding, is one of the causes or the consequences of poststroke pain.

Topics: Aged; Brain Mapping; Carbon Radioisotopes; Central Nervous System; Diprenorphine; Female; Humans; Male; Middle Aged; Narcotic Antagonists; Pain; Radiopharmaceuticals; Receptors, Opioid; Stroke; Tomography, Emission-Computed

Using 18F-fluorodeoxyglucose and 11C-diprenorphine positron emission tomography (PET), we investigated alterations in glucose metabolism and opioid receptor binding in a patient with central poststroke pain, which developed after a small pontine hemorrhagic infarction. In comparison with normal databases, reduced 11C-diprenorphine binding was more accentuated than the hypometabolism on the lateral cortical surface contralateral to the symptoms, and a differential abnormal distribution between the tracers was seen in pain-related central structures. These results show that 11C-diprenorphine PET provides unique information for the understanding of central poststroke pain.

Topics: Adult; Aged; Carbon Radioisotopes; Cerebral Hemorrhage; Cerebral Infarction; Cerebrovascular Disorders; Diprenorphine; Fluorodeoxyglucose F18; Glucose; Humans; Male; Middle Aged; Narcotic Antagonists; Pain; Pons; Radiopharmaceuticals; Receptors, Opioid; Sensation Disorders; Tomography, Emission-Computed

A group of four patients with RA were examined to test the hypothesis that there is a change in the endogenous opioid system in the brain during inflammatory pain. Regional cerebral opioid receptor binding was quantified using the opioid receptor antagonist [11C] diprenorphine and positron emission tomography (PET). In the four patients studied in and out of pain, significant increases in [11C]diprenorphine binding were seen in association with a reduction in pain. Increases were seen in most of the areas of the brain that were sampled apart from the occipital cortex. Significant region-specific increases over and above the more generalized changes were also seen in the frontal, cingulate and temporal cortices in addition to the straight gyrus. These findings are consistent with the hypothesis that there are substantial increases in occupancy by endogenous opioid peptides during inflammatory pain.

Topics: Arthritis, Rheumatoid; Brain Chemistry; Diprenorphine; Humans; Pain; Receptors, Opioid; Severity of Illness Index; Tomography, Emission-Computed

With the aim of possibly studying the local activity of brain enkephalinergic pathways by autoradiography and positron emission tomography, preliminary competition experiments of [3H]diprenorphine binding in mouse brain were carried out after i.v. administration of the first systemically-active mixed inhibitor of enkephalin degrading enzymes RB 101 (N(R,S)-2-benzyl-3[(S)-(2-amino-4-methylthiobutyldithio]-1-oxoprop yl]- L-phenylalanine benzyl ester). Although devoid of affinity for the opioid binding sites, RB 101 inhibited the [3H]diprenorphine binding to the opioid receptors in a dose-dependent manner. This effect, very likely due to an RB 101-induced increase in extracellular levels of enkephalins, reached a plateau at a dose of 10 mg/kg, where almost 30% displacement was observed. Intravenous administration of either 5 or 20 mg/kg of RB 101 in mice submitted to warm-swim stress led to an additional [3H]diprenorphine displacement, which reached 45% compared to unstressed controls. This ceiling effect could account for the reported minimal morphine-like side effects induced by mixed inhibitors. A large increase in endogenous enkephalin levels induced by RB 101, associated or not with stress, was also indirectly demonstrated by the analgesic responses elicited by i.v. injection of the mixed inhibitor. This effect was blocked by naloxone but not by the delta antagonist naltrindole (NTI), supporting a preferential implication of mu receptors in supraspinal analgesia. Taken together, these results suggest that RB 101 could be used to determine the precise in vivo localization of enkephalinergic pathways recruited by various stimuli.

Topics: Analgesics; Animals; Brain; Cell Membrane; Diprenorphine; Disulfides; Enkephalins; Hot Temperature; Kinetics; Male; Mice; Mice, Inbred Strains; Neprilysin; Pain; Phenylalanine; Receptors, Opioid; Stress, Psychological; Tritium

The influence of Met-enkephalin on mitogenic stimulation of mouse splenocytes was investigated. Met-enkephalin (ME) was shown to suppress proliferation induced by Concanavalin A and activate proliferation induced by Staphylococcus enterotoxin A. Both effects were revealed at low (down to 10(-14) M) concentration of pentapeptide. Naloxone reversed ME influence on cell activation. The number of receptors for naloxone was shown to increase up to 2.5-fold during mitogenic activation. The difference in expression of various types of opioid receptors at mitogenic stimulation was demonstrated by ligand displacement experiments.

Topics: Animals; Binding, Competitive; Concanavalin A; Diprenorphine; Enkephalin, Methionine; Enterotoxins; Female; Lymphocyte Activation; Mice; Mice, Inbred C57BL; Mice, Inbred CBA; Naloxone; Pain; Receptors, Opioid; Receptors, Opioid, delta; Receptors, Opioid, mu; Sensory Thresholds; Spleen

In vivo opioid receptor binding in the cortical projections of the medial (cingulate and prefrontal cortex) and lateral pain system (primary somatosensory cortex) in male volunteers has been quantitated using [11C]diprenorphine and positron emission tomography. High levels of opioid receptor binding were seen in the cortical projections of the medial pain system in the cingulate and prefrontal cortex as has previously been observed in post-mortem studies. However, a focal reduction of opioid receptor binding was observed and quantitated in the primary motor/sensory strip when compared to surrounding parietal cortex. This new finding suggests that the medial pain system is likely to be more susceptible to exogenous and endogenous opioid neuromodulation than the so-called lateral pain system.

Topics: Adult; Carbon Radioisotopes; Cerebral Cortex; Diprenorphine; Humans; Male; Organ Specificity; Pain; Receptors, Opioid; Reference Values; Tomography, Emission-Computed

Chronic arthritic pain was induced by intradermally inoculating rats at the tail-base with Mycobacterium butyricum, which results in swelling, inflammation, and hyperalgesia of the joints. These symptoms peak at 3 weeks after inoculation and disappear by 10 weeks. The following changes were seen at 3 weeks. Immunoreactive dynorphin (ir-Dyn) and ir-alpha-neo-endorphin (alpha-NE) manifested comparable patterns of change. Their levels were increased in the anterior, but not neurointermediate, pituitary. The thalamus showed a rise in ir-Dyn and ir-alpha-NE, but no alterations were seen in other brain regions. In each case, cervical, thoracic, and lumbosacral sections of the spinal cord showed a rise in ir-Dyn and ir-alpha-NE: This was most pronounced in the lumbosacral region, where the magnitude of these shifts correlated with the intensity of arthritic symptoms. In addition, a moderate elevation in ir-methionine-enkephalin (ME) was seen in lumbosacral spinal cord. In brain, ir was not changed. The level of ir-beta-endorphin (beta-EP) was elevated both in the plasma and the anterior, but not the neurointermediate, pituitary. In addition, the content of messenger RNA encoding the beta-EP precursor, proopiomelanocortin (POMC), was enhanced in the anterior lobe. Thus, there was a selective activation of synthesis of beta-EP in, and its secretion from, the anterior lobe. In no brain tissue did levels of ir-beta-EP change. At 10 weeks postinoculation, the above changes were no longer apparent, indicating their reversibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Arthritis; Arthritis, Experimental; beta-Endorphin; Brain; Brain Chemistry; Chronic Disease; Diprenorphine; Disease Models, Animal; Dynorphins; Endorphins; Hypothalamus; Male; Mesencephalon; Pain; Rats; Rats, Inbred Strains; Receptors, Opioid; Spinal Cord; Thalamus

Three antagonists at the mu opiate receptor site: naloxone, naltrexone and diprenorphine, and one agonist-antagonist compound nalorphine, at doses usually not analgesic elicited analgesia in rats when administered after non-naloxone-reversible shock-induced analgesia had disappeared. The chi receptor antagonist, MR 2266, and the delta antagonist, ICI 154129, were all ineffective. This effect was no longer present when non-naloxone-reversible shock-induced analgesia was inhibited by the administration of the chi receptor antagonist, MR 2266. These results suggest that the mu opiate receptor may change its conformation under particular conditions such as continuous inescapable shock.

Topics: Analgesics; Animals; Diprenorphine; Electroshock; Male; Nalorphine; Naloxone; Naltrexone; Pain; Rats; Rats, Inbred Strains; Receptors, Opioid; Receptors, Opioid, mu; Stress, Physiological

The analgesic activity of the opiate agonists etorphine and sufentanil and the antagonistic effects of diprenorphine and naloxone have been related to the occupancy of 3 classes of opiate binding sites previously defined in vivo in order to establish their pharmacological significance. Sufentanil binds specifically in vivo to the first type of site (site 1), exhibiting approximately 1100-fold selectivity over site 2, whereas etorphine displays approximately 20-fold selectivity for site 1 over site 2. Neither agonist has a measurable affinity to the third type of binding site. The binding data suggest that site 1 is analogous to the mu site previously identified in vitro. Both agonists produce analgesia in the rat tail flick test at the same low fractional occupancy of site 1 (approximately 2% at the ED50) while they display much lower and quite different occupancies at site 2. Both of the opiate antagonists naloxone and diprenorphine reduce the potency of sufentanil and etorphine by a factor of 2 at 50% occupancy of site 1 alone. These results provide strong evidence that these 4 drugs exert their effects by interaction with site 1 (mu sites) which therefore may be regarded as the receptor responsible for analgesic action in this test. The assumption of a direct relationship between antagonistic effect and fractional occupancy appears to be valid for naloxone and diprenorphine at site 1, while the agonists exert their action at a very low fractional occupancy implying a non-linear binding-effect process.

Topics: Animals; Brain; Diprenorphine; Drug Interactions; Etorphine; Fentanyl; Morphinans; Naloxone; Pain; Rats; Receptors, Opioid; Sufentanil

A method of in vivo autoradiography was utilized which allows the visualization of local changes in opiate receptor occupation in the intact rat brain. The method is based on the exclusion of [3H]diprenorphine binding in areas in which the release of endogenous opiate peptides is increased by behavioral manipulation. The technique lends itself to the use of film autoradiography, allowing the mapping of relative levels of functional receptor occupancy throughout the whole brain. Prolonged intermittent footshock and forced swims in cold water (two stress-inducing manipulations which are known to release endogenous opiates) were found to cause highly significant decreases in specific high-affinity [3H]diprenorphine binding, as measured by liquid scintillation counting. These changes were unaccompanied by corresponding changes in non-specific binding and were not related to local changes in blood flow. A prolonged non-stressful swim in warm water caused no changes in [3H]diprenorphine binding. The use of tritium-sensitive film autoradiography allowed the resolution of these decreases to the level of individual nuclei. Differences in specific binding were found to be greatest in the periaqueductal gray, the reticular formation, and in midline-intralaminar thalamic nuclei, all of which have been implicated in the modulation of pain sensation.

Topics: Animals; Autoradiography; Brain; Cold Temperature; Diprenorphine; Electroshock; Male; Pain; Physical Exertion; Rats; Rats, Inbred Strains; Receptors, Opioid; Stress, Physiological