Greenwood-Van Meerveld B, Gardner C J, Little P J, Hicks G A, Dehaven-Hudkins D L
Gastrointestinal Research, Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK 72104, USA.
Neurogastroenterol Motil. 2004 Oct;16 Suppl 2:46-53. doi: 10.1111/j.1743-3150.2004.00555.x.
Opioid receptors in the gastrointestinal (GI) tract mediate the effects of endogenous opioid peptides and exogenously administered opioid analgesics, on a variety of physiological functions associated with motility, secretion and visceral pain. The studies reviewed or reported here describe a range of in vivo activities of opioid receptor antagonists upon GI function in rodents, focusing on mu receptors. Naloxone, and the peripherally acting mu-opioid receptor antagonists alvimopan and methylnaltrexone, reverse morphine-induced inhibition of GI transit in mice and rats, and morphine- or loperamide-induced inhibition of castor oil-induced diarrhoea in mice. At doses producing maximal reversal of morphine-induced effects upon GI transit, only the central nervous system (CNS) penetrant antagonist naloxone was able to reverse morphine-induced analgesia. Both central and peripheral opioid antagonists may affect GI function and/or visceromotor sensitivity in the absence of exogenous opioid analgesics, suggesting a constitutive role for endogenous opioid peptides in the control of GI physiology. Furthermore, in contrast to naloxone, alvimopan does not produce hypersensitivity to the visceromotor response induced by nociceptive levels of colorectal distension in a rodent model of post-inflammatory colonic hypersensitivity, suggesting that in the periphery endogenous mu-opioid receptor-mediated mechanisms do not regulate colonic sensitivity. The data support the hypothesis that peripherally acting opioid antagonists may be able to selectively block opioid receptors in the GI tract, thereby preserving normal GI physiology, while not blocking the effects of endogenous opioid peptides or exogenous opioid analgesics in the CNS. These findings suggest that the primary sites of action of mu-opioid agonists with respect to inhibition of GI function are in the periphery, whereas analgesic activity resides primarily in the CNS.
胃肠道(GI)中的阿片受体介导内源性阿片肽和外源性给予的阿片类镇痛药对与运动、分泌和内脏痛相关的多种生理功能的影响。此处综述或报道的研究描述了阿片受体拮抗剂在啮齿动物胃肠道功能方面的一系列体内活性,重点是μ受体。纳洛酮以及外周作用的μ阿片受体拮抗剂阿洛司琼和甲基纳曲酮可逆转吗啡对小鼠和大鼠胃肠道转运的抑制作用,以及吗啡或洛哌丁胺对小鼠蓖麻油诱导腹泻的抑制作用。在产生对吗啡诱导的胃肠道转运作用最大逆转的剂量下,只有能够穿透中枢神经系统(CNS)的拮抗剂纳洛酮能够逆转吗啡诱导的镇痛作用。在没有外源性阿片类镇痛药的情况下,中枢和外周阿片拮抗剂都可能影响胃肠道功能和/或内脏运动敏感性,这表明内源性阿片肽在胃肠道生理控制中具有组成性作用。此外,与纳洛酮不同,在炎症后结肠超敏反应的啮齿动物模型中,阿洛司琼不会对伤害性水平的结肠扩张诱导的内脏运动反应产生超敏反应,这表明在外周,内源性μ阿片受体介导的机制不调节结肠敏感性。这些数据支持这样的假设,即外周作用的阿片拮抗剂可能能够选择性地阻断胃肠道中的阿片受体,从而保持正常的胃肠道生理功能,同时不阻断内源性阿片肽或外源性阿片类镇痛药在中枢神经系统中的作用。这些发现表明,μ阿片激动剂抑制胃肠道功能的主要作用部位在外周,而镇痛活性主要存在于中枢神经系统。