Assessment of pioglitazone and proinflammatory cytokines during buprenorphine taper in patients with opioid use disorder.

BACKGROUND: Preliminary evidence suggested that the PPARγ agonist pioglitazone reduces opioid-withdrawal symptoms, possibly by inhibiting increases in proinflammatory cytokines. METHODS: A randomized, placebo-controlled clinical trial was conducted utilizing two different study designs (entirely outpatient, and a combination of inpatient and outpatient) to evaluate the safety and efficacy of pioglitazone as an adjunct medication for people with opioid physical dependence undergoing a buprenorphine taper. Participants were stabilized on buprenorphine/naloxone (sublingual, up to 16/4 mg/day), then randomized to receive oral pioglitazone (up to 45 mg/day) or placebo before, during, and after buprenorphine taper. Outcome measures included the Subjective Opiate Withdrawal Scale (SOWS) and Clinical Opiate Withdrawal Scale, use of rescue medications to alleviate opioid withdrawal symptoms, and opioid-positive urine specimens. Cerebrospinal fluid (CSF) and plasma were collected during the taper in a subset of participants for measurement of proinflammatory cytokines. RESULTS: The clinical trial was prematurely terminated due to slow enrollment; 40 participants per group were required for adequate statistical power to test study hypotheses. Twenty-four participants enrolled; 17 received at least one dose of study medication (6 pioglitazone, 11 placebo). SOWS scores were higher in the pioglitazone arm than in the placebo arm after adjusting for use of rescue medications; participants in the pioglitazone arm needed more rescue medications than the placebo arm during the post-taper phase. SOWS scores were positively correlated with monocyte chemoattractant protein-1 (MCP-1) in CSF (r = 0.70, p = 0.038) and plasma (r = 0.77, p = 0.015). Participants having higher levels of plasma MCP-1 reported higher SOWS, most notably after the buprenorphine taper ended. CONCLUSIONS: Results from this study provide no evidence that pioglitazone reduces opioid withdrawal symptoms during buprenorphine taper. High correlations between MCP-1 and opioid withdrawal symptoms support a role of proinflammatory processes in opioid withdrawal. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01517165.

Prefrontal and temporal gray matter density decreases in opiate dependence.

RATIONALE: There have been only a few structural brain-imaging studies, with varied findings, of opiate-dependent subjects. Voxel-based morphometry (VBM) is suitable for studying whole brain-wise structural brain changes in opiate-dependent subjects. OBJECTIVES: The objective of the current study is to explore gray matter density in opiate-dependent subjects. METHODS: Gray matter density in 63 opiate-dependent subjects and 46 age- and sex-matched healthy comparison subjects was compared using VBM. RESULTS: Relative to healthy comparison subjects, opiate-dependent subjects exhibited decreased gray matter density in bilateral prefrontal cortex [Brodmann areas (BA) 8, 9, 10, 11, and 47], bilateral insula (BA 13), bilateral superior temporal cortex (BA 21 and 38), left fusiform cortex (BA 37), and right uncus (BA 28). CONCLUSIONS: This study reports that opiate-dependent subjects have gray matter density decreases in prefrontal and temporal cortex, which may be associated with behavioral and neuropsychological dysfunction in opiate-dependent subjects.

[Effects of cerebrospinal fluid preparation from male and female patients with opiate dependence on rat open-field behavior]. / Vliianie preparata likvora patsientov s opiinoi zavisimost'iu muzhskogo i zhenskogo pola na povedenie krys-retsipientov v teste otkrytogo polia.

The effects of the intranasal administration of preparations made from the cerebrospinal fluid of male and female opiate users on the open-field rat behavior were studied. Behavioral differences were demonstrated in the effects of preparations from female and male cerebrospinal fluid. The administration of the "male" preparation produced a significant decrease in the locomotor activity and increase in the immobilization time and grooming duration, while the "female" preparation had the opposite effects. These differences may result from different content of endogenous and exogenous opiates and dopamine (and its metabolites) in the cerebrospinal fluid of male and female opiate users.

Characterization of N-terminal fragment of proopiomelanocortin in cerebrospinal fluid.

The molecular forms of the N-terminal fragment (hNT) of proopiomelanocortin were studied in cerebrospinal fluid (CSF) from normal subjects, methadone-addicted patients, patients with hydrocephalus, and a patient with Nelson's syndrome. The peptides were characterized by molecular sieving and Concanavalin A-Sepharose chromatography. Immunoreactivity was detected using antibodies directed against the N- and C-terminal portions of the hNT (hNT and gamma 3MSH antibodies, respectively). The mean immunoreactive hNT (IR-hNT) levels in samples of CSF from normal subjects, patients with hydrocephalus, methadone addicts, and the patient with Nelson's syndrome were 410 +/- 158 (+/- SE), 435 +/- 137, 328 +/- 183, and 85,700 pg/mL, respectively. Molecular sieving chromatography revealed one predominant species of IR-hNT and/or gamma 3MSH which coeluted with the authentic hNT-(1-76) marker. However, 10-16% of the total immunoreactivity eluted close to the void volume. No significant differences in the elution profiles were found among these groups. Most (61-69%) of the IR-hNT bound to Concanavalin A, and the elution patterns of samples from this column were similar to that of purified hNT-(1-76). These results support the view that the major molecular form of hNT in CSF is NT-(1-76) as it is in the pituitary gland.

Endorphin levels in opioid-dependent human subjects: a longitudinal study.

Endorphin levels were measured in 51 cerebrospinal fluid samples from 27 opioid-dependent or postdependent subjects. Radioreceptor assay showed the endorphin levels to be higher than those found in normal subjects. These high levels were found even while subjects were on methadone maintenance. The duration of opioid dependence was positively correlated with fraction I values. Both fractions tended to be lower during early withdrawal than late withdrawal. In naltrexone-maintained patients, radioreceptor assay showed FII to be greatly elevated, but electrophoresis and HPLC indicated that the elevations were not due to a peptide. Thus, the possibility of unextracted naltrexone metabolites remains at least a partial explanation for this apparent FII elevation.