Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain? A Systematic Literature Review.

BACKGROUND: Chronic pain (CP) is a major public health problem. Many patients with CP are increasingly prescribed opioids, which has led to an opioid crisis. Integrative medicine (IM), which combines pharmacological and complementary and alternative medicine (CAM), has been proposed as an opioid alternative for CP treatment. Nevertheless, the role of CAM therapies in reducing opioid use remains unclear. OBJECTIVES: To explore the effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients. METHODS: An online search of MEDLINE and Embase, CINAHL, PubMed supp., and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15, 2018, was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies. RESULTS: The electronic search yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design. CONCLUSIONS: There is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.

Histone demethylase KDM2B promotes triple negative breast cancer proliferation by suppressing p15INK4B, p16INK4A, and p57KIP2 transcription.

H3K4me3 and H3K36me2 histone demethylase KDM2B is an epigenetic regulatory factor involved in cell proliferation in numerous cells including breast cancer cells, however, the regulatory mechanism of KDM2B in cell proliferation of breast cancer cells, specifically in triple negative breast cancer (TNBC), remains largely unknown. In this study, we showed that higher expression level of KDM2B was associated with poor prognosis in TNBC. Using cell proliferation assay, we found that KDM2B promoted TNBC cell proliferation by suppressing the transcription of the cell cycle inhibitors p15INK4B, p16INK4A, and p57KIP2. Chromatin immunoprecipitation assay results showed that KDM2B bound to the promoters of these genes and thereby reduced the H3K4me3 and H3K36me2 levels, leading to the suppression of gene transcription in a histone demethylation activity-dependent manner. Silencing of p15INK4B, p16INK4A, and p57KIP2 in TNBC cells was shown to restore the promoting effect of KDM2B on TNBC cell proliferation. The present study reveals a novel cell regulatory mechanism through which KDM2B promotes TNBC cell proliferation by binding to the promoters of p15INK4B, p16INK4A, and p57KIP2, which reduces H3K4me3 and H3K36me2 levels to suppress gene transcription.

Exercise improves recovery after ischemic brain injury by inducing the expression of angiopoietin-1 and Tie-2 in rats.

Post-ischemia angiogenesis plays a critical part in the recovery of neural networks. Angiopoietin (Ang) has received much attention recently due to its key role in neurovascular remodeling. Exercise is proved to contribute to angiogenesis in normal or injured human skeletal muscle. The therapeutic effect of exercise on central angiogenesis after cerebral ischemia, however, has not been studied. In the present study, we investigated the relationship between exercise and the expression of Ang-1, Ang-2, and Tie-2 receptor tyrosine kinase in the brain using a rat model of stroke, with right middle cerebral artery occluded (MCAO). Male Sprague-Dawley rats were randomly grouped (n = 12): stroke-exercise (SE), stroke-no exercise (SNE) and sham-no exercise (SHAM). The SE group ran on a treadmill at a speed of 12 m/min, 30 min/day for 2 weeks. Functional recovery was assessed with neurological evaluation scores. Brain infarction was measured by Nissl staining. Expression of Ang-1, Ang-2, and Tie-2 were compared by immunohistochemical and real-time PCR analyses. The infarct volume in the SE group was significantly reduced compared with the SNE group (p < 0.05). Ang-1 (p < 0.05) and Tie-2 (p < 0.05) and their mRNA expression (p < 0.01 and p < 0.05, respectively) were increased in SE animals at 2 weeks, whereas Ang-2 expression remained unchanged. In conclusion, enhanced expression of Ang-1 and Tie-2 by exercise improves recovery of brain function in MCAO rats. Our results suggest the importance of angiogenesis in rehabilitation for post-ischemia brain injury and help to explain the underlying mechanism.

Pre-ischemic treadmill training affects glutamate and gamma aminobutyric acid levels in the striatal dialysate of a rat model of cerebral ischemia.

AIMS: Treadmill training has been shown to improve function in animal models and patients with cerebral ischemia. However, the neurochemical effects of this intervention on the ischemic brain have not been well studied. This study was designed to evaluate the effects of pre-ischemic treadmill training on the release of glutamate and gamma-aminobutyric acid (GABA) from the striatum in a rat middle cerebral artery occlusion (MCAO) model. MAIN METHODS: Rats were divided into five groups: sham control without MCAO, and 0, 1, 2 and 4 weeks pre-ischemic treadmill training. After training, cerebral ischemia was induced by MCAO for 120 min, followed by reperfusion. Microdialysis was used to collect dialysates from the striatum immediately before ischemia, and at 40, 80 and 120 min after ischemia, as well as at 40, 80, 120, 160, 200 and 240 min after reperfusion. KEY FINDINGS: Pre-ischemic treadmill training decreased glutamate release and increased GABA release during the acute phase of cerebral ischemia/reperfusion. Treadmill training for at least 2 weeks produced statistically significant changes in GABA/glutamate release. SIGNIFICANCE: The present study suggests that treadmill training inhibits the excessive release of glutamate, by stimulating GABA release during the acute phase of cerebral ischemia. This may be one of the important mechanisms to protect the striatal neurons from ischemic damage.

[Cloning and analysis of cDNA encoding key enzyme gene (dxr) of the non-MVA pathway in Taxus chinensis cells].

Two distinct routes (classical mevalonate pathway and a novel mevalonate-independent pathway) are utilized by plants for the biosynthesis of isopentenyl diphosphate, the universal precursor of isoprenoids (Fig. 1). Present researches indicated that taxol was synthesized mainly via non-mevalonate pathway, but not genetic evidence was showed. The second step in non-mevalonate pathway involves an intramolecular rearrangement and subsequent reduction of deoxyxylulose phosphate to yield 2-C-methyl-D-erythritol-4-phosphate, and 1-Deoxy-D-xylulose-5-phosphate reductoisomerase (DXR) with responsibility for this reaction was considered as a key enzyme. As a tool for the isolation of genes in terpenoid biosynthesis in plants, total RNA was prepared from Taxus chinensis suspension cells, a cell type highly specialized for diterpene (taxol). A reverse transcription-PCR strategy based on the design of degenerated oligonucleotides was developed for isolating the gene encoding a gymnosperm homolog of this enzyme from Taxus chinensis. Through sequence analysis by Blast P online, the resulting cDNA showed highly homologous to 1-deoxy-D-xylulose 5-phosphate reductoisomerases, with 95% identification compared with Arabidopsis thaliana (Q9XFS9), 94% with Mentha x piperita (Q9XESO), 80% with Synechococcus elongatus (Q8DK30), 78% with Synechocystis sp. PCC 6803 (Q55663) and Nostoc sp. PCC 7120 (Q8YP49), and 73% with Synechococcus leopoliensis (Q9RKT1). Deduced amino acid sequences were also analyzed by PROSITE, ClustalX (1.81) and Phylio (3.6 alpha), and data present evidence for the existence of this deoxyxyluose phosphate reductoisomerase in Taxus chinensis. This is the first report of the dxr gene cloned from gymnosperm.