Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
J Neuroimmune Pharmacol. 2011 Dec;6(4):442-65. doi: 10.1007/s11481-011-9292-5. Epub 2011 Jul 26.
Infection rate among intravenous drug users (IDU) is higher than the general public, and is the major cause of morbidity and hospitalization in the IDU population. Epidemiologic studies provide data on increased prevalence of opportunistic bacterial infections such as TB and pneumonia, and viral infections such as HIV-1 and hepatitis in the IDU population. An important component in the intravenous drug abuse population and in patients receiving medically indicated chronic opioid treatment is opioid withdrawal. Data on bacterial virulence in the context of opioid withdrawal suggest that mice undergoing withdrawal had shortened survival and increased bacterial load in response to Salmonella infection. As the body of evidence in support of opioid dependency and its immunosuppressive effects is growing, it is imperative to understand the mechanisms by which opioids exert these effects and identify the populations at risk that would benefit the most from the interventions to counteract opioid immunosuppressive effects. Thus, it is important to refine the existing animal model to closely match human conditions and to cross-validate these findings through carefully controlled human studies. Better understanding of the mechanisms will facilitate the search for new therapeutic modalities to counteract adverse effects including increased infection rates. This review will summarize the effects of morphine on innate and adaptive immunity, identify the role of the mu opioid receptor in these functions and the signal transduction activated in the process. The role of opioid withdrawal in immunosuppression and the clinical relevance of these findings will also be discussed.
静脉药物滥用者（IDU）的感染率高于普通人群，是 IDU 人群发病和住院的主要原因。流行病学研究提供了数据，表明 IDU 人群中机会性细菌感染（如结核病和肺炎）和病毒感染（如 HIV-1 和肝炎）的患病率增加。在静脉药物滥用人群和接受医学指示的慢性阿片类药物治疗的患者中，阿片类药物戒断是一个重要组成部分。关于阿片类药物戒断背景下细菌毒力的数据表明，接受戒断的小鼠对沙门氏菌感染的存活时间缩短，细菌负荷增加。随着支持阿片类药物依赖及其免疫抑制作用的证据越来越多，了解阿片类药物发挥这些作用的机制以及确定最受益于干预措施以对抗阿片类药物免疫抑制作用的风险人群至关重要。因此，有必要完善现有的动物模型，使其更接近人类的情况，并通过精心控制的人类研究来交叉验证这些发现。更好地了解这些机制将有助于寻找新的治疗方法来对抗包括感染率增加在内的不良反应。本文综述了吗啡对固有和适应性免疫的影响，确定了 μ 阿片受体在这些功能中的作用以及在该过程中激活的信号转导。还讨论了阿片类药物戒断在免疫抑制中的作用以及这些发现的临床相关性。
