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[医护心情] rextao的华西麻醉研究生成长历程—我也开博(就在这个麻醉的天堂)

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 楼主| 发表于 2009-4-18 15:13:52 | 只看该作者

Capsaicin-an effective topical treatment in pain

Capsaicin-an effective topical treatment in pain

Emanuel Markovirs, MD, and Amos Gilhar, MD



From the Department of Rehabilitation. Flieman Geriatric Hospital, and Skin Research Laboratory, The Bruce Rappaport Faculty of Medicine, Technion-lsrael lnstitute of Technology, Haifa, Israel

Correspondence

Amos Gilhar, MD, skin Research Laboratory, B. Rappaport Faculty of Medicine, Technion, PO Box 9649,31096 haifa, Israel



    A number of articles published in the past 5 years have focused on capsaicin - a pungent and irritating ingredient found in red hot peppers that has safely and successfully been used in the treatment of various painful conditions; e.g. postherpetic neuralagia, painful diabetic neuropathy, painful musculo-skeletal conditions like fibromyalgia and arthritis, hypersensitive bladder disease, postmastectomy pain syndrome, cluster headache ,and others.

This paper synthesizes data regarding the properties and the clinical use of capsaicin, obtained from Medline searches of original articles and review articles published in the past 5 years in North American and European publications.



    Pharmacology

    Capsaicin is a naturally occurring substance derived from plants of the Solanaceae family (red peppers),and has the chemical name 8-methyl-N-vanillyl-6-nonenamide.It is widely consumed as a food additive, particularly in South East Asia and Latin America It causes burning and inflammation upon contact with mucous membranes of the oral mucosa.

    Capsaicin exerts its major pharmacologic effects on the peripheral part of the sensory nervous system, particularly on the primary afferent neurons of C-fiber type. Capsaicin excites nociceptive C-afferents and causes the release of the neurotransmitter substance P from these sensory nerve fibers [1,2].

    Release of substance P then results in prolonged cutaneous pain transmission, histamine release, the "pathologic itch" sensation, and erythema because of axon reflex-mediated vasodilation. Prolonged repeat applications of capsaicin deplete the peripheral sensory C-fiber of substance P, resulting in inhibition of pain sensation. Capsaicin may work in pain syndromes by altering the balance between large and small fiber afferents, specifically by causing a reduction in small fiber input. Capsaicin does not interfere with the axonal transport of other neurotransmitters. local administration of capsaicin to the peripheral sensory nerve endings in the skin results in depletion of substance P from the whole neuron, both peripherally(nerve endings)and centrally.

    A recent study indicates that cutaneous injection of the capsaicin analogue NE-21610 produces analgesia to heat, but not to mechanical stimuli in man[3] The mechanism is supposed to be a selective action of the drug on heat transducers in nociceptors responive to both heat and mechanical stimuli. The long lasting(several weeks) hyperalgesia to heat stimuli may be clinically useful in burns.

    Another investigation has focused on capsaicin-evoked hyperalgesia, by injecting capsaicin intradermally into normal subjects. the injection of capsaicin adjacent to nociceptors receptive field failed to sensitize the nociceptors to mechanical stimuli.

    Capsaicin has been shown to have a role in preventing the development of thermal hyperalgesia in neonatal rats[5]. In capsaicin-treated rats there was no evidence of thermal hyperalgesia compared with a control group. Radioimmunoassay revealed that there was a significant depletion of substance P (43.8%) and calcitonin-gene-related peptide (72.6%) in the lumbal spinal cord of neonatal capsaicin-treated rats compared with vehicle-treated rats .Thermal hyperalgesia is mediated via the small diameter unmyelinated capsaicin-sensitive fibers.

    The role of capsaicin-sensitive small-diameter fibers in the development of thermal and mechanical allodynia (causalgia) in a rat model for neuropathic pain has also been investigated[6] The destruction of A, lamda and C nociceptive fibers by capsaicin, injected neonatally prior to the nerve injury, prevented activities induced in these fibers by the nerve injury from producing a central sensitization and, thus, allodynia (thermal and mechanical).

    It has been shown that capsaicin is effective in treating superficial pain (like burning, tingling, and allodynia) of patients with diabetic neuropathy.7This kind of pain is caused by increased firing of abnormally excitable or damaged nociceptive sprouting regenerating fibers. Capsaicin penetrates to the subdermal layer and can cause loss of unmyelinated nerve fibers, depletes nerves of substance P, inhibits axonal transport of substance P and reduces conduction in type C fibers. Continued use of topical capsaicin produces a densitization and raise the threshold for thermal, mechanical, and chemical stimuli by blocking the nociceptive afferents[7].

    Experimentally, capsaicin causes a dose- and species-dependent loss of unmyelinated fibers in sensory or mixed nerves and produces a selective degeneration of primary sensory neurons containing substance P, cholecystokinin, somatostatin, and vasoactive intestinal polypeptide in the cranial and spinal ganglia. These effects are prominent and irreversible in neonatal animals but are less striking in adults. When applied topically to the skin of experimental animals and humans, capsaicin initially lowers the threshold for thermal, chemical, and mechanical nociception possibly by direct stimulation of receptors, causing local warmth, redness, burning, and spontaneous pain. Continued application causes desensitization and raises the threshold for thermal, chemical, and mechanical stimuli, probably by blocking polymodal nociceptors, warm receptors, and conduction in nociceptive afferents[8].

The onset of action of capsaicin is up to 4 weeks from the beginning of application. The duration of action after every application is 3-6 h. The elimination is hepatic, via microsomal cytochrome P 450[9]



    General toxicity

    Ingestion of capsaicin in large doses has been reported to cause histopathologic and biochemical changes, including acute erosion of gastric mucosa and hepatic necrosis. The irreversible interaction of capsaicin with liver microsomal protein may account for its impact on hepatic drug metabolizing enzymes as well as hepatotoxicity.

Genotoxicity

    Capsaicin has been tested for mutagenicity in both bacterial and mammalian cells in culture, but the results are conflicting. Capsaicin causes chromosome aberrations in cultured human lymphocytes.



    Tumorigenicity

    A case-control study conducted in the Mexico City area, where hot chili peppers are heavily consumed, has shown a significant correlation between hot pepper consumption and the incidence of gastric cancer in the Mexican population.

    Recent data underlines the chemoprotective activities of capsaicin, due to its inhibitory effects on metabolism, DNA binding ,and mutagenicity of certain chemical carcinogens[10].

    Adverse manifestations of capsaicin application are burning, stinging, erythema, pruritus, and superficial ulcers of the skin.



    Preparation

    Capsaicin cream: 0.025%,in tubes of 0.7 oz, 1.5 oz, and 3 oz.

    Capsaicin cream: 0.075% in tubes of 1 oz and 2 oz.

    Application: three to five times a day, over one painful site.[9]



    Clinical applications of capsaicin

    Painful diabetic neuropathy

    An 8-week controlled study with topical 0.075% capsaicin in patients with chronic severe diabetic neuropathy proved that capsaicin was beneficial in the clinical improvement of pain status as measured by the physician's global evaluation, by the categorical pain severity scale, and by the visual analogue scale[8]. Capsaicin cream was applied to painful areas four times a day for 8 weeks. At a follow-up of 22 weeks, 50% of subjects had improvement of pain or were cured, 25% remained unchanged, and 25%worsened.[9]

    Another study by the same authors[10] deals with the safety of capsaicin application-possible impairment of "useful senses" in pin prick sensitivity, vibration, and touch-pressure sensations. After 8 weeks of treatment there were no significant changes in warm and vibration thresholds, but the cold threshold was significantly reduced by capsaicin and vehicle creams to an equal degree. there were no adverse effects on sensory function even in subjects with pre-existing neuropathic sensory impairment. The topical effects of capsaicin on cutaneous sensations depend on the concentration used and on the duration of treatment. At 0.1%-1%, topical capsaicin reduces or abolishes the flare response elicited by intradermal injections of substance P and histamine. However, the maximal concentration of topical capsaicin prescribed today is 0.075% cream.[10]

    Fifty diabetic patients suffering from "superficial pain"(burning, tingling, allodynia) were successfully treated by 0.075% capsaicin, four times a day, over 12 weeks.[7]



    Chronic postherpetic neuralgia

    This painful condition, manifested by dysaesthesia/paraesthesia and allodynia/hyperpathia, was treated using 0.025% capsaicin cream for 8 weeks, four times a day. After 8 weeks,48.7% of patients improved, 12.8% discontinued therapy due to side-effects (burning sensation, mastitis),and 38.5% reported no benefit. The onset of pain relief was noticed within the first 3 weeks of application, and the maximum pain relief was obtained after 5 weeks in most patients. Postherpetic pain may arise from uninhibited activity of unmyelinated afferents at hypersensitive neurons in the dorsal horn. Accordingly, decreased C-fiber input due to capsaicin-induced block or degeneration might produce pain relief in these patients.[11]

    Rheumatic diseases

    In a randomized, double-blind, placebo-controlled multicenter trial, involving 70 patients with knee osteoarthritis and 31 with rheumatoid arthritis with involvement of the knees, Deal et al.[12] used 0.025% capsaicin cream four times daily for 4 weeks. Significantly more relief of pain was reported by the capsaicin-treated patients than the placebo patients. After 4 weeks of treatment, rheumatoid arthritis patients and osteoarthritis patients demonstrated a mean reduction in pain of 57% and 33%, respectively.

    This topical treatment may be combined with other nonmedical and noninvasive therapies, like diathermy, exercise, acupuncture, transcutaneous electrical nerve stimulation, low energy laser, and pulsed electromagnetic fields.[13]

    Topical capsaicin may permit a substantial reduction in NSAID dosage in patients with osteoarthritis or rheumatoid arthritis, being an important addition to the treatment of these diseases.[14]

    Capsaicin 0.025% cream four times a day for 5 weeks was successfully used in the treatment of the painful neck and shoulder condition known as fibromyalgia and. It was applied over a maximum of five sites, by gently rubbing it into the skin for 30 s. Seventy-four percent of the patients reported mild burning associated with capsaicin use.

    The wrists and forearms of 40 patients with rheumatoid arthritis were injected intradermally with capsaicin[15]. The results showed a selective increase of capsaicin-induced vasodilatation in skin overlying joints, suggesting that the activity of a subpopulation of periarticular small sensory fibers is altered.



    Postmastectomy pain syndrome

    Postmastectomy pain syndrome caused mainly by intercostobrachial nerve injury during axillary clearing, has been successfully treated by 0.025% capsaicin cream, three times daily for 2 months. Sixty-eight per cent of patients have obtained good pain relief.[16]



    Cluster headache

    Cluster headache, whose pathogenesis is supposed to be linked to a subpopulation of trigeminal primary sensory neurons- C fibers - containing neuropeptides, has been treated by intranasal application of 10 mM capsaicin suspension once a day for 30 days. Seventy per cent of the patients treated on the ipsilateral-nostril showed a marked amelioration. The maximum period of amelioration lasted no more than 40 days.[17]

    Fifty microliters of capsaicin (50 nmol) were applied to the human nasal mucosa, once a day for 5-7 days[18]. The results - almost mucosa, once a day for 5-7 days[18]. The results - almost complete densitization - suggest that prolonged topical capsaicin treatment leads to selective desensitization to certain algesic stimuli as capsaicin itself and hydrogen ions.



    Hypersensitive vesical syndrome

    Hypersensitive vesical syndrome, defined as an abnormal increase of perceived sensation from the lower urinary tract in the absence of infection and/or detrusor contraction, has been treated by intravesical instillation of capsaicin (10 uM in saline) three times during 28 days (days 0,14,and 28).The results were beneficial for the patients. Capsaicin-sensitive sensory nerves are present in the human bladder and mediate pain and the regulation of bladder capacity [19].

    Irrigation of the bladder with capsaicin solution (1 mmol/L solution of capsaicin in 30% ethanol in saline) has been reported to be successful in modifying the detrusor reflex arc in paraplegics[20].



    The loin pain/hematuria syndrome

    The loin pain/hematuria syndrome, of unknown cause and pathology and manifested by lengthy episodes of pain with acute exacerbation, has been successfully treated by capsaicin instillation in the renal pelvis (1 mmol/L solution).The relief from pain lasted for 2-5 months after a single instillation[21].



    Psoriasis and PUVA-induced skin pain

    In psoriasis and PUVA-induced skin pain, application of capsaicin cream 0.075% four times a day for 10 days led to a complete resolution of pain and puritus. In the first 3 days of treatment there was an initial transient worsening of the burning sensation, probably due to initial release of substance P by capsaicin [22,23].



    Notalgia paresthetica

    Notalgia paresthetica is characterized by episodes of a localized itch or skin pain, close to the medial border of the scapula. Capsaicin cream 0.025% was used for 4 weeks, five times a day during the first week and three times a day during the three subsequent weeks [24]. Seventy per cent of the patients improved with this treatment, the main adverse reaction being burning and stinging at the site of application.



    Conclusions

    It may be concluded that capsaicin represents a valuable adjuvant therapy in various pain conditions, acting locally by topical application or instillation and being a safe and simple to use treatment, although a burning sensation or "itch" may accompany its application at the beginning of therapy.



References



1  Surh YJ, Lee SS. Capsaicin, a double-edged sword: toxicity, metabolism, and chemopreventive potential. Life Sci 1995;56:1845-1855.

2  Mathias BJ, Dillingham TR, Zeigler DN, et al, Topical capsaicin for chronic neck pain. Am J phys Med Rehabil 1995;74:39-44.

3  Davis KK, Meyer RA, Turnquist JL, et al. Cutaneous injection of the capsaicin analogue,NE-21610,produces analgesia to heat but not to mechanical stimuli in man. Pain 1995;62:17-26.

4  Cervero F, Meyer RA, Campbell JN.A psychophysical study of secondary hyperalgesia: evidence for increased pain to input from nociceptors. Pain 1994;58;21-28.

5  Meller ST, Gebhart GF, Maves TJ. Neonatal capsaicin prevents the development of the thermal hyperalgesia produced in a model of neuropathic pain in the rat.Pain 1992;51:317-321.

6  Kim YI, Na HS, Han JS,et al. Critical role of the capsaicin-sensitive nerve fibers in the development of the causalgic symptoms produced by transecting some but not all of the nerves innervating the rat tail. J Neurosci 1995;15:4133-4139.

7  Pfeifer MA, Ross DR, Schrage JP, et al. A highly successful and novel model for treatment of chronic painful diabetic peripheral neuropathy. Diabetes Care 1993;16:1103-1114.

8  Tandan R, Lewis GA, Krusinsky PB, et al. Topical capsaicin in painful diabetic neuropathy. Controlled study with long-term follow-up. Diabetic Care 1992,15:8-14.

9  Omoigui S. The Pain Drugs Handbook. St Louis:Mosby Yearbook,1995;65-67.

10 Tandan R, Lewis GA, Badger GB, et al. Topical capsaicin in painful diabetic neuropathy. Effect of sensory function. Diabetic Care 1992;15:15-19.

11 Peikert A,Hentrich M, Ochs G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia:efficacy, predictors of response and long-term course. J Neurology 1991;238:452-456.

12 Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin; a double blind trial. Clin Tber 1991;13:383-395.

13 Puett DW, Griffin MR. Published trials of nonmedical and noninvasive therapies for hip and knee osteoarthritis. Ann Intern Med 1994;121:133-140.

14 Schnitzer RJ. Osteoarthritis treatment update. Postgrad Med 1993;93:89-96.

15 Jolliffe VA, Anand P, Kidd BL. Assessment of cutaneous sensory and autonomic axon reflexes in rheumatoid arthritis. Ann Rbeum Dis 1995;54:251-255.

16 Dini D, Bertelli G, Gozza A, et al. Treatment of the post-mastectomy pain syndrome with topical capsaicin. pain 1993;54:223-226.

17 Fusco BM, Marabini S, Maggi CA, et al. Preventive effect of repeated nasal applications of capsaicin in cluster headache. Pain 1994;59:321-325.

18 Geppetti P, Tramontana M, Del Bianco E, et al. Capsaicin - densitization to the human nasal mucosa selectively reduces pain evoked by citric acid. Br Clin Pbarmacol 1993;35:178-183.

19 Barbanti G, Maggi CA, B eneforti P, et al. Relief of pain following intravesical capsaicin in patients with hypersensitive disorders of the lower urinary tract. Br J Urol 1993;71:686-691.

20 Fowler CJ, Beck RO, Gerrard S, et al. Intravesical capsaicin for treatment of detrusor hyperreflexia. J Neurol Neurosurg Psycbiat 1994;57:169-173.

21 Bultitude MI. Capsaicin in treatment of loin pain/haematuria syndrome. Lancet 1995;345:921-922.

22 Burrows NP, Norris PG. Treatment of PUVA-induced skin pain with capsaicin.Br J Dermatol 1994;131:584-585.

23 Zhang WY, Lip WPA. The effectiveness of topically applied capsaicin. A meta-analysis. Eur J Clin Pbarmacol 1994;46:517-522.

24 Wallangren J, Klinker M. Successful treatment of notalgia paresthetica with topical capsaicin: Vehicle-controlled, double-blind, crossover study. J Am Acad Dermatol 1995;32:287-289.



From: International Journal of Dermatology 1997, 36, 401-404





译文:

辣椒碱——一种有效的外用镇痛药



    辣椒碱是从红辣椒中提取的一种具有辛辣和刺激性的成分,近五年的文献研究报导该药能安全而有效地用于治疗各种疼痛疾患。在临床上用于治疗带状疱疹后遗神经痛、糖尿病性神经痛、肌肉关节的疼痛(如纤维肌痛症)、丛集性头痛等疾患。本文综述了近五年北美和欧洲的相关文献,阐述辣椒碱的药理作用及其临床作用。



    1 药理作用

    辣椒碱是从茄科植物红辣椒中提取的天然成分,其化学名称为反-甲基-N-香草基-6-壬烯基酰胺。在东南亚和拉丁美洲,一直被广泛作为食品调味剂使用,如果接触眼和口腔粘膜能产生灼热感和局部炎症。

    作为镇痛药物,它主要作用于外周感觉神经系统,选择性地兴奋C型感觉神经元导致该神经纤维释放神经递质P物质。初期P物质的释放将出现一系列现象,如导致皮肤疼痛,组胺释放引起的皮肤局部发痒,神经反射性血管扩张导致的局部发红等。持续的反复使用辣椒碱将耗竭C型感觉神经纤维上的P物质,使神经失敏,疼痛的产生和传导明显抑制。局部使用辣椒碱不仅能耗竭外周感觉神经末梢的P物质,而且能导致整个神经元的P物质耗竭。所以,辣椒碱被认为是通过减少小直径感觉神经纤维的外周传入而起作用的。研究还发现辣椒碱对其他神经递质并无明显作用。

    最近一项研究表明,人体皮内注射辣椒碱拮抗剂NE-21610能阻断热刺激,但是对机械性刺激无阻断作用,提示辣椒碱选择性作用于相同的感受器中的温热觉传导部分的效应。这种持久的温热觉阻断效应提示该药可能使用于烧伤临床。另一项皮下注射辣椒碱的研究同样显示辣椒碱对机械性刺激感受器无明显影响。动物实验发现辣椒碱能阻止新生大鼠热过敏的形成;放免检测发现这种辣椒碱处理的新生大鼠腰椎脊髓背根神经节中有明显的P物质和降钙素基因相关多肽的耗竭现象。研究还发现新生鼠注射辣椒碱,能破坏辣椒碱敏感的小直径神经纤维Aδ和C型纤维,从而阻断热和化学性神经损伤产生的中枢敏感。

    辣椒碱能有效治疗糖尿病性神经痛患者浅表的疼痛(烧伤、刺痛等),这些疼痛的产生和再生的神经纤维异常兴奋有关。皮下组织辣椒碱给药能使无髓神经纤维的P物质耗竭从而阻断P物质介导的C型神经的痛觉传导。持续局部使用辣椒碱能诱导神经失敏,并且通过阻断伤害感受的传入提高热和化学性伤害刺激阈。

    动物实验发现辣椒碱使无髓神经失敏和选择性诱导脑和脊髓中枢初级神经元退变这种作用呈现出剂量和个体依赖性;这些神经元含有某些特定物质,包括P物质、肠促胰酶肽、生长抑素、血管活性肠肽。在新生动物模型上这些作用明显而不可逆,但是在成年动物上作用并不显著。无论动物还是人类,初次皮肤局部使用辣椒碱将直接激活伤害感受器,从而使热和化学性刺激的痛阈降低,并产生局部发热、发红甚或灼痛。持续给药,则阻断刺激伤害感受器的反应性和传入神经对伤害性刺激的上传,导致神经神经元变得迟钝而失敏,最终使痛阈提高。

    辣椒碱在连续使用后第四周发挥最佳疗效,每次用药后作用时间达到3-6小时。辣椒碱通过肝脏内的微粒体细胞色素酶P450代谢清除。

    一般毒性

    有报导摄入大量辣椒碱能导致机体形态学和生化病理改变,如胃粘膜急性腐蚀和肝坏死。

    特殊毒性

    辣椒碱对培养的细菌和哺乳动物细胞均无诱导突变的作用。辣椒碱能使培养的人淋巴细胞染色体失常。墨西哥城一项研究显示红辣椒过量摄入的剂量和该地区胃癌发生率有明显相关性。最近一项研究强调辣椒碱具有染色体保护作用,因为它抑制某些致癌因子导致的DNA交链和诱变等。



    2 临床应用

    2.1糖尿病性神经痛

    一项观察周期为8周的对照研究发现,重度慢性糖尿病神经病变疼痛局部外用使用0.075%辣椒碱软膏有明显疗效。临床上能改善医生疼痛评价值、患者疼痛自我评价值、目测模拟表(VAS)等。使用方法为连续使用8周,每天4次局部外用。随访22周发现50%的受试者疼痛治愈或者明显改善,25%无明显改变,而其余25%加重。

    该研究者的另一项研究显示55例糖尿病的浅表疼痛在经过12周连续局部使用0.075%辣椒碱(每天4次外用)得到了成功治疗。该研究还发现局部使用0.1%-1%辣椒碱能减轻或者阻断皮内注射P物质和组胺诱导的炎症反应。

    2.2 带状疱疹后遗神经痛

    带状疱疹后神经痛患者主要是因为感觉不良/感觉异常和痛觉过敏导致。一项研究使用0.025%辣椒碱软膏连续治疗8周,每天4次治疗带状疱疹后神经痛患者。8周后,48.7%得到明显改善,12.8%因为副作用(烧灼感、乳腺炎)未中止治疗,38.5%无明显改善。前3周即能观察到缓解疼痛的疗效,大部分患者最佳疗效的时间为5周。

    2.3 类风湿关节炎和骨关节病等风湿免疫疾病

    一项随机、双盲、安慰剂对照的多中心临床研究,选取了70例膝骨关节炎患者和31例类风关膝关节累及的患者作为研究对象。治疗组连续4周使用0.025%辣椒碱软膏,每天4次。治疗组患者的疼痛显著改善,和对照组比较有明显差异。治疗4周后,类风关患者和骨关节炎患者疼痛改善率分别为57%和33%。

    辣椒碱软膏局部治疗建议联合其他康复和非创伤性治疗如透热疗法、运动治疗、针灸、经皮电刺激、低能激光治疗和电磁脉冲治疗等。局部辣椒碱治疗能减少OA和RA患者的NSAID药物的用量,是治疗这类疾病的重要联合用药。

    有报导连续使用0.025%辣椒碱软膏5周,每天5次,能有效治疗纤维肌痛症的颈部疼痛和肌筋膜疼痛综合征的肩部疼痛。因为使用部位超过5处,故74%患者反映有轻微的灼热感。

    2.4 乳腺切除术后疼痛

    乳腺切除术后疼痛主要是乳腺肿瘤腋窝淋巴结清扫损伤神经导致的。用0.025%辣椒碱软膏治疗2月,每天3次,能有效改善病情。一项研究发现68%的患者疼痛得到了明显的缓解。

    2.5 丛集性头痛

    丛集性头痛的发病机理和三叉神经中的含有P物质的初级感觉神经元病变有关。有报导,将10 mM辣椒碱悬液滴鼻(与头痛部位同侧鼻孔),每天一次,共治疗30天,70%患者有明显改善。疼痛改善最长持续时间保持了40天。

    2.6 神经源性膀胱过激综合症

    神经源性膀胱过激综合症是在无感染和逼尿肌收缩的情况下,下尿道感觉神经敏感性异常增高导致的。有报导将10 uM辣椒碱悬液(溶解于生理盐水)冲洗膀胱治疗该病,得到了满意疗效。用法为28天内冲洗3次(第1、14、28天)。尚有报导将1 mmol/L的辣椒碱溶液(溶解于含30%乙醇的生理盐水中)冲洗膀胱,能有效调节截瘫患者的逼尿肌反射弧。

    2.7 银屑病

    研究发现,用0.075%辣椒碱软膏治疗能完全缓解银屑病导致的皮肤疼痛和瘙痒。具体用法为连续使用10天,每天4次。在使用的前3天内可能有早期短暂的灼热感加剧,这和初期使用辣椒碱导致一过性P物质释放有关。



    结    语

    以上研究报导显示,辣椒碱是治疗各种疼痛的有效的药物。局部外用和冲洗治疗均显示出使用方便和安全性高的优势。副作用仅为部分患者在治疗初期有用药部位的热、痒感。

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 楼主| 发表于 2009-4-18 20:19:09 | 只看该作者

TRPV1 Antagonists Elevate Cell Surface Populations of Receptor Protein```

作者:Mark E. Johansen, Christopher A. Reilly and Garold S. Yost


【关键词】  capsaicin

    Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah 84112

    ABSTRACT

    TRPV1 mediates cell death and pro-inflammatory cytokine production in lung epithelial cells exposed to prototypical receptor agonists. This study shows that NHBE, BEAS-2B and TRPV1 over-expressing BEAS-2B cells pre-treated with various TRPV1 antagonists become sensitized to the prototypical TRPV1 agonist, nonivamide, via a mechanism that involves translocation of existing receptor from the endoplasmic reticulum to the plasma membrane. As such, typical cellular responses to agonist treatment, as measured by calcium flux, inflammatory cytokine gene induction, and cytotoxicity were exacerbated. These data were in contrast to the results obtained when TRPV1 antagonists were co-administered with nonivamide; conditions which inhibited TRPV1-mediated effects. The antagonists LJO-328, SC0030, and capsazepine increased the cytotoxicity of nonivamide by 20-fold and agonist-induced calcium flux by 6-fold. Inflammatory-cytokine gene induction by nonivamide was also increased significantly by pre-treatment with the antagonists. The enhanced responses were inhibited by the co-administration of antagonists with nonivamide, confirming that increases in sensitivity were attributable to increased TRPV1-associated activity. Sensitization was attenuated by brefeldin A (a golgi transport inhibitor), but not cycloheximide (a protein synthesis inhibitor), or actinomycin D (a transcription inhibitor). Sensitized cells exhibited increased calcium flux from extracellular calcium sources, while unsensitized cells exhibited calcium flux originating primarily from intracellular stores. These results demonstrate the presence of a novel mechanism for regulating the sub-cellular distribution of TRPV1 and subsequent control of cellular sensitivity to TRPV1 agonists.

    Key Words: capsaicin; TRPV1; calcium; translocation; cytotoxicity; inflammation.

    INTRODUCTION

    The lung epithelium is the initial barrier that xenobiotics encounter upon inhalation and is a frequent target for toxicants (Burgel and Nadel, 2004). Damage to the respiratory epithelium compromises respiratory function by increasing the susceptibility of individuals to subsequent lung injury and infections, and ultimately contributes to hypersensitivity disorders such as asthma and COPD (Kasper and Haroske, 1996; Kuwano et al., 2001; Selman et al., 2001; Witschi, 1991). Activation of TRPV1 (the capsaicin receptor, VR1) in lung epithelial cells by certain types of airborne particulate pollutants and prototypical agonists initiates inflammatory responses and promotes cell death (Agopyan et al., 2003a,b, 2004; Oortgiesen et al., 2000; Reilly et al., 2003; Veronesi et al., 1999b).

    TRPV1 is a cation-selective channel that has been shown to be expressed by lung epithelial cells. It is a member of the Transient Receptor Potential (TRP) family of ion channels (Clapham, 2003) that detect and respond to many types of stimuli. There are five major subfamilies: TRPC (canonical), TRPV (vanilloid), TRPM (melastatin), TRPA (AnktM1), TRPP (polycystins), and TRPML (mucolipins). TRPV1, the founding member of the TRPV subfamily, is activated by low pH, noxious temperature, xenobiotics such as capsaicin and resiniferatoxin (RTX) (Caterina et al., 1997), as well as by the endogenous agonists anandamide (Szallasi and Di Marzo, 2000), N-arachidonoyl-dopamine (NADA) (Huang et al., 2002), N-oleoyldopamine (OLDA) (Chu et al., 2003), and 12-(S)-hydroperoxyeicosatetraenoic acid (12-(S)-HPETE) (Hwang et al., 2000).

    TRPV1 function is regulated by a variety of mechanisms, including desensitization by accumulation of excess intracellular calcium and subsequent calcium-dependent dephosphorylation (Dray et al., 1990; Marsh et al., 1987; Williams and Zieglgansberger, 1982; Wood et al., 1988), binding of calmodulin (Rosenbaum et al., 2004) and phosphatydylinositol-4,5,-bisphosphate (PiP2) (Chuang et al., 2001), direct phosphorylation by protein kinase A (PKA) (Di Marzo et al., 2002; Puntambekar et al., 2004) or protein kinase C (PKC) (Bhave et al., 2003; Premkumar and Ahern, 2000), and phosphorylation by CAM kinase II (Jung et al., 2004).

    Recently, the spatial-temporal regulation of TRP channels has been shown to be a control mechanism for TRP channel function. Regulated cell-surface expression of TRPV2 by insulin-like growth factor first indicated that changes in cellular location could impact TRP channel function (Kanzaki et al., 1999). TRPV2 has also been shown to be translocated to the cell surface of neurons by treating with neuropeptide head activator (Boels et al., 2001) and by forskolin in mast cells (Barnhill et al., 2004). In Drosophila photoreceptor cells, light induced the shuttling of TRPL receptors between the rhabdomeral photoreceptor membrane and an intracellular compartment controlling channel function (Bahner et al., 2002). The sub-cellular distribution and function of TRPM1 has also been shown to be regulated by translocation mechanisms (Xu et al., 2001). There have also been a number of studies that demonstrate the translocation of TRPC channels, including work which established that TRPC1 was translocated to the cell surface upon treatment with thrombin in endothelial cells (Mehta et al., 2003). Similarly, epidermal growth factor promoted the translocation and insertion of TRPC5 into the plasma membrane (Bezzerides et al., 2004), while the translocation of TRPC6 was initiated by muscarinic receptor activation or thapsigargin-induced endoplasmic reticulum (ER) calcium depletion (Cayouette et al., 2004). A Caenorhabditis elegans TRPC homologue, TRP-3, was suggested to translocate to spermatide cell surfaces in response to a store-operated calcium entry (SOCE) signal (Xu and Sternberg, 2003). In other studies, simply internalizing the channels through cytoskeletal disruption revealed a loss of function for TRP-3 (Lockwich et al., 2001) and several other TRPC channels (1, 2, and 4) (Itagaki et al., 2004), demonstrating further the functional importance of the cellular location of TRP channels.

    Additional studies have demonstrated the presence of multiple pools of TRPV1 in cells, including plasma membrane- and ER-associated populations (Karai et al., 2004; Olah et al., 2001). TRPV1 has been shown to increase at the cell surface, with no increase in mRNA, as a result of inflammation in dorsal root ganglion neurons (Ji et al., 2002), a process that appears to be controlled by protein kinase C, snapin, and synaptotagmin IX (Morenilla-Palao et al., 2004). It is not known whether similar control mechanisms exist in lung epithelial cells or whether this phenomenon affects prototypical responses to agonists.

    In the present study we show that prolonged treatment of cells with TRPV1 antagonists induced translocation of TRPV1 to the cell surface, significantly increasing typical responses to receptor agonists. Characterization of this unique mechanism provides new information on TRPV1 function and regulation in human lung epithelial cells and highlights the potential for side effects due to prolonged use of TRPV1 antagonists as therapeutic agents.

    MATERIALS AND METHODS

    Chemicals.

    Nonivamide (99%), capsazepine (CPZ), sulfinpyrazone, and ionomycin were purchased from Sigma Chemical Corporation (St. Louis, MO). Thapsigargin was purchased from Alexis Biochemicals (San Diego, CA). Fluo-4 (AM) was purchased from Molecular Probes (Eugene, OR). SC0030 (N-(4-tert-butylbenzyl)-N'-[3-fluoro-4-(methylsulfonylamino) benzyl]thiourea) (Wang et al., 2002) and LJO-328 (N-(4-tert-butylbenzyl)-N'-(1-[3-fluoro-4-(methylsulfonylamino)phenyl]ethyl)thiourea) were generously provided by Dr. Jeewoo Lee (Seoul National University, Seoul, Korea).

    Cell culture.

    BEAS-2B human bronchial epithelial cells (CRL-9609) were purchased from ATCC (Rockville, MD). TRPV1-overexpressing cells were generated by transfecting BEAS-2B cells with human TRPV1 cDNA cloned into the pcDNA 3.1D-V5/His6 mammalian expression vector (InVitrogen, Carlsbad, CA) and selecting for stably transformed cells, as previously described (Reilly et al., 2003). BEAS-2B and TRPV1-overexpressing BEAS-2B cells were cultured in LHC-9 media (BioSource, Camarillo, CA). Normal human bronchial epithelial (NHBE) cells, a primary cell line, were purchased from Cambrex (Walkersville, MD) and cultured in BEGM media. Culture flasks for BEAS-2B and TRPV1-overexpressing BEAS-2B cells were coated with LHC basal media fortified with collagen (30 μg/ml), fibronectin (10 μg/ml), and bovine serum albumin (10 μg/ml). Cells were maintained between 3090% confluency and were passaged every 24 days by trypsinization.

    Cytotoxicity assays.

    Cells were sub-cultured into coated multi-well cell culture plates and allowed to reach 95% confluence within 2448 h. The cells were treated for 24 h with the various agonists and antagonists prepared in the appropriate culture media. Cell viability was assessed using the Dojindo Cell Counting Kit-8 (Dojindo Laboratories, Gaithersburg, MD), according to the supplier recommendations. Briefly, WST-8, a tetrazolium salt, is reduced by cellular NAD+- and NADP+-dependent dehydrogenases to an orange formazan product that is soluble in tissue culture medium. The amount of formazan produced (max = 450 nm) is directly proportional to the number of living cells. Data are expressed as the percentage of viable cells relative to untreated control cells, calculated using the absorbance ratio. All experiments were performed in triplicate.

    Fluorometric calcium assays.

    Cells were sub-cultured into coated 96-well culture plates and grown to 95% confluence within 2448 h. Prior to analysis, the cells were loaded with membrane-permeable fluorogenic calcium indicator, Fluo-4 (AM) (2.5 μM), for 90 min at room temperature (22°C) in LHC-9 media containing 200 μM sulfinpyrazone. Cells were washed with media and incubated at room temperature for an additional 20 min to permit methyl ester hydrolysis and activation of Fluo-4 (AM) within the cells. Changes in cellular fluorescence in response to agonist and antagonist treatments were assessed microscopically (10X objective) on cell populations ( 500 cells/field) using a Nikon Diaphot inverted microscope equipped with a fluorescence filter set designed to visualize green fluorescent protein. Fluoromicrographs were captured at high resolution using a SPOT Insight QE digital camera interfaced with the SPOT data system software (Diagnostic Instruments, Inc., Sterling Heights, MI). Images were collected immediately prior to the addition of the various substances and 30 s after treatment. All agonist and antagonist solutions were prepared in culture media and were added to the cells in 50 μl volumes at room temperature. Image quantitation was achieved using the NIH Image J software package. Briefly, the brightness of the images was normalized, the background fluorescence subtracted, and the mean fluorescence intensity of the images determined. Data was normalized to maximize fluorescence values obtained by treating cells with ionomycin (15 μM).

    RT-PCR analysis of cytokine gene expression.

    Cells were sub-cultured into coated 25 cm2 cell culture flasks and grown to a density of 8090% followed by the procedure to enhance TRPV1 responses by antagonists. Cells were washed with PBS and then treated with nonivamide for 4 h at 37°C. Total RNA was extracted from the cell pellets using the RNeasy mini RNA isolation kit (Qiagen, Valencia, CA) and 5 μg of total RNA was transcribed into cDNA using Poly T and Superscript II (Invitrogen, Carlsbad, CA). IL-6, IL-8, and -actin cDNA was selectively amplified by PCR from 2.5 μl of the cDNA synthesis reaction using the following primers: IL-6 sense 5'-CTTCTCCACAAGCGCCTTC-3' and antisense 5'-GGCAAGTCTCCTCATTGAATC-3' (325 nt), IL-8 sense 5'-TGGCTCTCTTGGCAGCCTTC-3' and antisense 5'-CAGGAATCTTGTATTGCATCTG-3' (410 nt), and -actin sense 5'-GACAACGGCTCCGGCATGTGCA-3' and antisense 5'-TGAGGATGCCTCTCTTGCTCTG-3' (183 nt). The PCR program consisted of an initial 2 min incubation at 94°C and 28 cycles of 94°C (30 s), 55°C (30 s), and 72°C (30 s). A final extension period of 10 min at 72°C was also included. PCR products were resolved on a 1% SB agarose gel and images were collected using a Bio-Rad Gel-Doc imaging system. Product quantification was achieved by determining the band intensities for each PCR product relative to -actin, the internal PCR control, using the Gel Doc density analysis tools.

    Cellular sensitization and inhibition assays.

    Characteristic TRPV1-mediated calcium responses were established using nonivamide as the agonist. Enhanced calcium responses were initiated by treating cells up to 24 h with antagonists prior to loading with Fluo-4 (AM). Brefeldin A, actinomycin D, and cycloheximide were co-incubated with antagonists at various concentrations to identify cellular processes that controlled cell sensitization. Inhibition of normal and enhanced responses to nonivamide was achieved by addition of TRPV1 antagonists 30 s prior to the addition of nonivamide. For enhanced cytotoxicity, cells were treated with the antagonist up to 24 h, washed once with sterile phosphate-buffered saline (PBS), and treated with nonivamide for an additional 24 h. Brefeldin A, actinomycin D, and cycloheximide were co-incubated with the antagonists during the pre-treatment period to assess mechanisms that controlled sensitization. Inhibition of enhanced cytotoxicity was achieved by co-treating cells with nonivamide and LJO-328 (5 μM) for 24 h.

    Intracellular/extracellular calcium flux determination.

    Depletion of ER calcium was accomplished by treating cells with thapsigargin (1.5 μM) for  5 min or until the baseline fluorescence intensity returned to basal levels. This was followed by addition of nonivamide to observe the influx of calcium from extracellular sources. Inhibition of calcium flux due to cell surface TRPV1 was accomplished using a solution of the calcium chelator, EGTA (100 μM) and the calcium channel blocker, ruthenium red (10 μM), both of which are plasma membrane impermeable. This was followed by treatment with nonivamide to observe calcium flux originating from the ER. Differences in fluorescence responses observed between the treatments were used to assess the relative contribution of ER-bound and cell surface TRPV1 in total calcium flux initiated by nonivamide.

    Statistical analysis of data.

    EC50 and LD50 values were obtained by non-linear regression analysis (Prism 4, GraphPad Software, Inc., San Diego, CA) using the sigmoidal dose-response (variable slope) equation. Statistical testing utilized ANOVA and Dunnett's multiple comparison post-test to determine significance. The unpaired t-test was also used where appropriate.

    RESULTS

    Calcium flux, induced by the prototypical TRPV1 agonist, nonivamide, was significantly increased following a 24 h pre-treatment with the antagonists LJO-328, SC0030, and capsazepine in a dose-dependent manner (Figs. 1a and 1b). Increases in sensitivity were observed at 0.5 h and were maximized at 6 h (data not shown). EC50 values for the enhancement of calcium flux by LJO-328, SC0030, and capsazepine were 0.07 μM ± 0.01, 0.095 μM ± 0.004, and 1.8 μM ± 0.4, respectively (Fig. 1a). Pre-treatment with concentrations of LJO-328, SC0030, and capsazepine that produced maximum increases in sensitivity (from Fig. 1a) amplified calcium flux by 70% and shifted the EC50 value for nonivamide-induced calcium flux from 3 μM ± 1 to 0.44 μM ± 0.09, 0.5 μM ± 0.2, and 0.44 μM ± 0.04, respectively (Fig. 1b).

    TRPV1-overexpressing BEAS-2B cells pre-treated with TRPV1 antagonists for 24 h also exhibited greater cytotoxicity when treated with nonivamide (Figs. 1c and 1d). All three antagonists (i.e., LJO-328, SC0030, and capsazepine) enhanced TRPV1-mediated cell death. Sensitization was observed at 0.5 h, reached a maximum at 2 h, and persisted for greater than 72 h (data not shown). The approximate EC50 values for exacerbation of nonivamide toxicity by LJO-328, SC0030, and capsazepine were 0.30 μM ± 0.08, 0.37 μM ± 0.05, and 1.25 μM ± 0.09, respectively (Fig. 1c). Pre-treatment with concentrations of LJO-328, SC0030, and CPZ that produced maximum increases in sensitivity (from Fig. 1c) decreased the LD50 of nonivamide from 0.89 μM ± 0.03 to 0.045 ± 0.004 μM, 0.053 ± 0.003 μM, and 0.041 ± 0.004 μM, respectively (Fig. 1d).

    Previous studies showed that treatment of cells with nonivamide, or other TRPV1 agonists, increased the expression of IL-6 and IL-8 mRNA and cytokine secretion via a process that was dependent upon influx of extracellular calcium via TRPV1 (Oortgiesen et al., 2000; Reilly et al., 2003, 2005; Veronesi et al., 1999b). Pre-treatment of cells with LJO-328 for 24 h markedly increased the degree of IL-6 and IL-8 gene induction produced by nonivamide treatment, relative to cells that were not pre-treated with the antagonist (Figs. 2a and 2b). Quantitation of the magnitude of this response demonstrated significant 1.2 (IL-6) and 1.7-fold (IL-8) increases, relative to responses induced by nonivamide alone (Fig. 2b).

    Previous work has also shown that LJO-328 is a potent competitive inhibitor of calcium flux and cell death initiated by nonivamide when co-administered to cells (Reilly et al., 2005). Addition of LJO-328 to cells during treatment with nonivamide prevented both basal and enhanced cell death (Fig. 3a) and calcium flux (Fig. 3b) in response to nonivamide treatment. Similarly, both normal and antagonist-induced increases in calcium flux were blocked by SC0030 and CPZ (Fig. 3b), consistent with inhibition of TRPV1.

    The increases in cytotoxicity and calcium flux due to antagonist pre-treatment could occur from an elevation in TRPV1 expression, changes in cellular distribution, post-translational modifications, or combinations of the three. Increased sensitivity was not attenuated by cycloheximide or actinomycin D (Figs. 4a and 4b). RT-PCR analysis of TRPV1 expression levels demonstrated no change in mRNA concentrations following 24 h antagonist pre-treatment (data not shown). Co-treatment with brefeldin A, a Golgi transport inhibitor, significantly reduced the ability of the antagonists to sensitize cells (Figs. 4a and 4b) suggesting that sensitization was related to protein export to the cell surface. Accordingly, calcium flux in unsensitized cells was only slightly attenuated by ruthenium red/EGTA ( 5%), yet was completely inhibited by prior depletion of intracellular ER calcium stores with thapsigargin (Fig. 5). Conversely, sensitized cells exhibited calcium flux that was only partially attenuated by ruthenium red/EGTA (20%) or thapsigargin (20%). Only when ruthenium red/EGTA was used in conjunction with thapsigargin, conditions which would prevent calcium flux originating from both intracellular stores and the media, was a near complete block (66%) of calcium flux observed (Fig. 5). Collectively, these data suggested that translocation of TRPV1 from the ER to the cell surface was responsible for sensitization of the cells.

    NHBE and BEAS-2B cells, primary and immortalized cell lines from which the TRPV1-overexpressing cells were derived, were also assessed for antagonist-induced sensitization. Pre-treatment with LJO-328 (30 and 50 μM in BEAS-2B and NHBE cells) for 24 h increased the cytotoxicity of nonivamide by 50% in BEAS-2B cells (Fig. 6a) and 68% in NHBE cells, with some cytotoxicity to BEAS-2B (16%) and NHBE cells (28%) due to LJO-328 itself (Fig. 6b). Similarly, inflammatory cytokine gene induction by nonivamide treatment was markedly increased in BEAS-2B cells 24 h pre-treatment with LJO-328 (Figs. 6c and 6d).

    DISCUSSION

    The lung epithelium is a frontline barrier to inhaled xenobiotics and pathogens. This important cell layer is often subject to damage, possibly causing airway inflammation, pulmonary edema, various systemic responses, and respiratory dysfunction (Barnes, 2002; Cohn et al., 2004; Morrison and Bidani, 2002). It has been shown that several xenobiotics selectively damage the lung epithelium by interacting with specific receptors on the cellular surface. One such receptor is TRPV1 which has been shown to produce inflammatory responses and cell death when activated by certain types of particulate materials (Agopyan et al., 2003a,b, 2004; Oortgiesen et al., 2000; Veronesi et al., 1999a) or the prototypical TRPV1 agonist, capsaicin (Reilly et al., 2003). Therefore, the identification and characterization of specific factors that modulate the sensitivity of these cells to specific toxicants, either via inhibition of responses or by sensitizing cells, is an important task. Here we demonstrate that TRPV1 antagonists enhanced typical responses to nonivamide in lung epithelial cells via a novel mechanism that correlated to an increase in cell-surface receptor function.

    Cytotoxicity, inflammatory cytokine gene induction, and calcium flux induced by the TRPV1 agonist, nonivamide, were used to evaluate the effects of low-dose, long-term pre-treatment of TRPV1 antagonists on basal TRPV1 functions. Previously, we demonstrated that the antagonists LJO-328 and SC0030 attenuated the cytotoxicity of TRPV1 agonists when co-administered (Reilly et al., 2005). Similarly, LJO-328, SC0030, and the prototypical TRPV1 antagonist, capsazepine, inhibited TRPV1-mediated calcium flux and calcium-dependent cytokine gene induction and secretion (Reilly et al., 2003, 2005). In this study, we found that TRPV1 antagonists were able to enhance the sensitivity of these cells to subsequent agonist exposures when applied for extended periods of time prior to agonist treatment. LJO-328 was the most potent sensitizing agent, followed by SC0030 and CPZ. Co-treatment of cells with these antagonists and nonivamide attenuated both basal and enhanced responsiveness to agonist treatment, indicating that modulation of TRPV1 was responsible for the changes in sensitivity observed with antagonist pre-treatment. Increased cellular sensitivity was observed within 0.5 h of antagonist treatment and was maximized at 26 h, depending upon the endpoint used. Elevated sensitivity remained for >72 h (data not shown). Overlapping kinetics for the enhancement of cytotoxicity and calcium flux suggested that these two TRPV1-mediated processes were augmented through the same mechanism.

    A potential explanation for the observed increases in sensitivity produced by antagonist pre-treatment was that the TRPV1 antagonists promoted increases in TRPV1 expression by inhibiting basal TRPV1 functions in the cells. Previous studies that characterized the TRPV1-overexpressing cell line demonstrated that increased levels of receptor expression selectively promoted cytotoxicity and inflammatory cytokine responses similar to the enhanced responses observed in this study (Reilly et al., 2003). However, we found that neither cycloheximide (a protein synthesis inhibitor), nor actinomycin D (and transcription inhibitor), prevented sensitization by the antagonists. Analysis of TRPV1 mRNA abundance by RT-PCR following 24 h antagonist treatments supported this conclusion (data not shown).

    Brefeldin A, a Golgi transport inhibitor, drastically reduced cellular sensitization produced by antagonists pre-treatment. These data suggested that translocation of TRPV1 from the intracellular locations (ER) to the plasma membrane caused sensitization. Quantification of calcium flux originating from intracellular stores and extracellular sources provided compelling evidence that the abundance of TRPV1 at the cell surface was increased by antagonist pre-treatment. These data confirmed the existence of two distinct populations of TRPV1 which can be dynamically regulated by long-term inhibition of basal TRPV1-mediated processes. How translocation initiation signals are processed in cells remains unclear, but modifications to extracellular calcium content (± calcium, EDTA) alone had no effect on sensitivity (data not shown).

    It is significant to note that the BEAS-2B cells, as well as a primary lung epithelial cell line, NHBE, (neither of which artificially over-express TRPV1) also responded to TRPV1 antagonist pre-treatment in a similar manner, albeit the degree of sensitization observed was much lower. We presume that the subtle changes in cell sensitivity produced by antagonists pre-treatment in these cells was the result of lower basal expression levels of TRPV1 (compared to the TRPV1-overexpressing cells) and thus, less protein was available to redistribute between the ER and cell surface over the duration of the assay. The fact that a maximum effect was attainable in all cell types, including the over-expressing line, suggests that the rate and degree of sensitization was ultimately dependent upon the level of TRPV1 expression, the duration of the agonist treatment, and the rate of translocation relative to protein recycling and degradation.

    These intriguing results highlight potential negative effects that may be encountered with therapeutic use of TRPV1 antagonists to treat various malaise including chronic pain, bladder dysfunction, or lung inflammatory diseases. Similarly, substances such as DHEA and aminoglycoside antibiotics, which have also been shown to inhibit TRPV1 (Chen et al., 2004; Raisinghani and Premkumar, 2005), may also promote sensitization, although this possibility was not investigated. A more detailed investigation of the precise biochemical mechanisms and cellular pathways that govern TRPV1 translocation will ultimately provide additional understanding of how this receptor is regulated to control threshold responses to endogenous and foreign agonists. Such knowledge may ultimately provide insights into individual variability to toxicant susceptibility and uncover potential unanticipated drug interactions. Collectively, these data add to our current understanding of how TRPV1 influences respiratory cell toxicities by providing novel insights into biological factors that control TRPV1-mediated processes in respiratory epithelial cells.

    ACKNOWLEDGMENTS

    We thank Dr. Jeewoo Lee of Seoul National University for providing the LJO-328 and SC0030 compounds. We also acknowledge Dr. Micheal Caterina of Johns Hopkins University for helpful suggestions and Dr. Alan R. Light and Ron W. Hughen of the University of Utah for assistance with the calcium flux assays. This work was supported by a grant from the National Heart, Lung, and Blood institute (HL069813). Conflict of interest: none declared.

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[ 本帖最后由 rextao 于 2009-4-18 20:20 编辑 ]

活动公告:做任务得积分和权限(新手奖励计划) (←点击查看详情)

133#
 楼主| 发表于 2009-5-4 19:46:29 | 只看该作者

好久没有过来论坛了

最近一段时间一直在做实验 关于器官保护的实验 我的辣椒素是高浓度的很难容 头痛的很····
实验就是这样 总会碰到各种问题。

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134#
 楼主| 发表于 2009-5-13 22:28:56 | 只看该作者
论坛改版了 我们的校园网终于可以畅通无阻的点击!庆祝一下!

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135#
发表于 2009-6-6 00:38:45 | 只看该作者
楼主好久没更新了,进来坐一下。:)

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136#
 楼主| 发表于 2009-6-11 00:37:54 | 只看该作者
是啊 最近在实验室做实验 预实验就要结束了···才知道实验的艰辛啊!

论坛公告:2013年论坛版主火热招聘中!! (←点击查看详情

137#
 楼主| 发表于 2009-6-21 19:13:24 | 只看该作者
准备复出了 试验做到一半了 又被抓上来上临床 没有办法···这样我就要回来论坛畅游了 呵呵!

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138#
 楼主| 发表于 2009-6-22 19:57:40 | 只看该作者
如何掌握好拔管时机:
要根据患者的实际情况和手术的要求掌握好拔管的时机,应避免在浅麻醉下拔管(即在深麻醉和清醒之间),因为浅麻醉拔管有增加喉痉挛的危险。
深麻醉和浅麻醉的区别在口咽吸引的时候会很明显,任何对吸引有反应的患者(比如屏气,呛咳)为浅麻醉状态,而没有反应为深麻醉状态。
如果患者呼喊能睁眼或者有反应的体动 提示患者清醒。

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139#
发表于 2009-7-6 12:51:18 | 只看该作者
楼主好久不更新了。。。特来催稿。。。表把博客荒废了哈。。。广大人民等着拜读呢。。。
麻醉怎么这么难。。。我以前一直以为麻醉就是把病人搞睡着就成了。。。失败啊失败啊。。。难啊难啊。。。

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140#
 楼主| 发表于 2009-7-6 20:46:57 | 只看该作者
这阵子在做实验 周末骑行去北川了 缓解一下压力!我会逐步更新的 谢谢楼上的支持!

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