Enhanced Analgesic Effects and Gastrointestinal Safety of a Novel, Hydrogen Sulfide-Releasing Anti-Inflammatory Drug (ATB-352): A Role for Endogenous Cannabinoids.

Aims: The covalent linking of nonsteroidal anti-inflammatory drugs to a hydrogen sulfide (H2S)-releasing moiety has been shown to dramatically reduce gastrointestinal (GI) damage and bleeding, as well as increase anti-inflammatory and analgesic potency. We have tested the hypothesis that an H2S-releasing derivative of ketoprofen (ATB-352) would exhibit enhanced efficacy without significant GI damage in a mouse model of allodynia/hyperalgesia. Results: ATB-352 was significantly more potent and effective as an analgesic than ketoprofen and did not elicit GI damage. Pretreatment with an antagonist of the CB1 cannabinoid receptor (AM251) significantly reduced the analgesic effects of ATB-352. The CB1 antagonist exacerbated GI damage when coadministered with ketoprofen, but GI damage was not induced by the combination of ATB-352 and the CB1 antagonist. In vitro, ATB-352 was substantially more potent than ketoprofen as an inhibitor of fatty acid amide hydrolase, consistent with a contribution of endogenous cannabinoids to the analgesic effects of this drug. Blood anandamide levels were significantly depressed by ketoprofen, but remained unchanged after treatment with ATB-352. Innovation: Ketoprofen is a potent analgesic, but its clinical use, even in the short term, is significantly limited by its propensity to cause significant ulceration and bleeding in the GI tract. Covalently linking an H2S-releasing moiety to ketoprofen profoundly reduces the GI toxicity of the drug, while boosting analgesic effectiveness. Conclusion: This study demonstrates a marked enhancement of the potency and effectiveness of ATB-352, an H2S-releasing derivative of ketoprofen, in part, through the involvement of the endogenous cannabinoid system. This may have significant advantages for the control and management of pain, such as in a postoperative setting.

A proof-of-concept, Phase 2 clinical trial of the gastrointestinal safety of a hydrogen sulfide-releasing anti-inflammatory drug.

BACKGROUND AND PURPOSE: ATB-346 is a hydrogen sulfide (H2 S)-releasing anti-inflammatory and analgesic drug. Animal studies demonstrated negligible gastrointestinal (GI) damage despite marked inhibition of COX activity and significant analgesic and anti-inflammatory effects. In humans, ATB-346 (250 mg once daily) was found to inhibit COX to the same extent as naproxen (550 mg twice daily). EXPERIMENTAL APPROACH: Two hundred forty-four healthy volunteers completed a 2-week, double-blind study, taking either ATB-346 (250 mg once daily) or naproxen (550 mg twice daily), with upper GI ulceration being examined endoscopically. KEY RESULTS: Forty-two per cent of the subjects taking naproxen developed at least one ulcer (≥3-mm diameter), while only 3% of the subjects taking ATB-346 developed at least one ulcer. The two drugs produced comparable and substantial (>94%) suppression of COX activity. Subjects in the naproxen group developed more ulcers per subject than ATB-346-treated subjects and a greater incidence of larger ulcers (≥5-mm diameter). The incidence of dyspepsia, abdominal pain, gastro-oesophageal reflux, and nausea was lower with ATB-346 than with naproxen. Subjects treated with ATB-346 had significantly higher plasma levels of H2 S than those treated with naproxen. CONCLUSIONS AND IMPLICATIONS: This Phase 2B study provides unequivocal evidence for a marked reduction of GI toxicity of the H2 S-releasing analgesic/anti-inflammatory drug, ATB-346, as compared to the conventional dose of naproxen that produced equivalent suppression of COX. LINKED ARTICLES: This article is part of a themed section on Hydrogen Sulfide in Biology & Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.4/issuetoc.

Redox Interactions of Tc(VII), U(VI), and Np(V) with Microbially Reduced Biotite and Chlorite.

Technetium, uranium, and neptunium are contaminants that cause concern at nuclear facilities due to their long half-life, environmental mobility, and radiotoxicity. Here we investigate the impact of microbial reduction of Fe(III) in biotite and chlorite and the role that this has in enhancing mineral reactivity toward soluble TcO4(-), UO2(2+), and NpO2(+). When reacted with unaltered biotite and chlorite, significant sorption of U(VI) occurred in low carbonate (0.2 mM) buffer, while U(VI), Tc(VII), and Np(V) showed low reactivity in high carbonate (30 mM) buffer. On reaction with the microbially reduced minerals, all radionuclides were removed from solution with U(VI) reactivity influenced by carbonate. Analysis by X-ray absorption spectroscopy (XAS) confirmed reductive precipitation to poorly soluble U(IV) in low carbonate conditions and both Tc(VII) and Np(V) in high carbonate buffer were also fully reduced to poorly soluble Tc(IV) and Np(IV) phases. U(VI) reduction was inhibited under high carbonate conditions. Furthermore, EXAFS analysis suggested that in the reaction products, Tc(IV) was associated with Fe, Np(IV) formed nanoparticulate NpO2, and U(IV) formed nanoparticulate UO2 in chlorite and was associated with silica in biotite. Overall, microbial reduction of the Fe(III) associated with biotite and chlorite primed the minerals for reductive scavenging of radionuclides: this has clear implications for the fate of radionuclides in the environment.

Redox interactions between Cr(VI) and Fe(II) in bioreduced biotite and chlorite.

Contamination of the environment with Cr as chromate (Cr(VI)) from industrial activities is of significant concern as Cr(VI) is a known carcinogen, and is mobile in the subsurface. The capacity of Fe(II)-containing phyllosilicates including biotite and chlorite to alter the speciation, and thus the mobility, of redox-sensitive contaminants including Cr(VI) is of great interest since these minerals are common in soils and sediments. Here, the capacity of bacteria, ubiquitous in the surface and near-surface environment, to reduce Fe(III) in phyllosilicate minerals and, thus, alter their redox reactivity was investigated in two-step anaerobic batch experiments. The model Fe(III)-reducing bacterium Geobacter sulfurreducens was used to reduce Fe(III) in the minerals, leading to a significant transformation of structural Fe(III) to Fe(II) of 0.16 mmol/g (∼ 40%) in biotite and 0.15 mmol/g (∼ 20%) in chlorite. The unaltered minerals could not remove Cr(VI) from solution despite containing a larger excess of Fe(II) than would be required to reduce all the added Cr(VI), unless they were supplied in a very high concentration (a 1:10 solid to solution ratio). By contrast, even at very low concentrations, the addition of bioreduced biotite and chlorite caused removal of Cr(VI) from solution, and surface and near surface X-ray absorption spectroscopy confirmed that this immobilization was through reductive transformation to Cr(III). We provide empirical evidence that the amount of Fe(II) generated by microbial Fe(III) reduction is sufficient to reduce the Cr(VI) removed and, in the absence of reduction by the unaltered minerals, suggest that only the microbially reduced fraction of the iron in the minerals is redox-active against the Cr(VI).

The impact of γ radiation on the bioavailability of Fe(III) minerals for microbial respiration.

Conservation of energy by Fe(III)-reducing species such as Shewanella oneidensis could potentially control the redox potential of environments relevant to the geological disposal of radioactive waste and radionuclide contaminated land. Such environments will be exposed to ionizing radiation so characterization of radiation alteration to the mineralogy and the resultant impact upon microbial respiration of iron is essential. Radiation induced changes to the iron mineralogy may impact upon microbial respiration and, subsequently, influence the oxidation state of redox-sensitive radionuclides. In the present work, Mössbauer spectroscopy and electron microscopy indicate that irradiation (1 MGy gamma) of 2-line ferrihydrite can lead to conversion to a more crystalline phase, one similar to akaganeite. The room temperature Mössbauer spectrum of irradiated hematite shows the emergence of a paramagnetic Fe(III) phase. Spectrophotometric determination of Fe(II) reveals a radiation-induced increase in the rate and extent of ferrihydrite and hematite reduction by S. oneidensis in the presence of an electron shuttle (riboflavin). Characterization of bioreduced solids via XRD indicate that this additional Fe(II) is incorporated into siderite and ferrous hydroxy carbonate, along with magnetite, in ferrihydrite systems, and siderite in hematite systems. This study suggests that mineralogical changes to ferrihydrite and hematite induced by radiation may lead to an increase in bioavailability of Fe(III) for respiration by Fe(III)-reducing bacteria.

Microbial reduction of arsenic-doped schwertmannite by Geobacter sulfurreducens.

The fate of As(V) during microbial reduction by Geobacter sulfurreducens of Fe(III) in synthetic arsenic-bearing schwertmannites has been investigated. During incubation at pH7, the rate of biological Fe(III) reduction increased with increasing initial arsenic concentration. From schwertmannites with a relatively low arsenic content (<0.3 wt %), only magnetite was formed as a result of dissimilatory iron reduction. However, bioreduction of schwertmannites with higher initial arsenic concentrations (>0.79 wt %) resulted in the formation of goethite. At no stage during the bioreduction process did the concentration of arsenic in solution exceed 120 µgL(1), even for a schwertmannite with an initial arsenic content of 4.13 wt %. This suggests that the majority of the arsenic is retained in the biominerals or by sorption at the surfaces of newly formed nanoparticles. Subtle differences in the As K-edge XANES spectra obtained from biotransformation products are clearly related to the initial arsenic content of the schwertmannite starting materials. For products obtained from schwertmannites with higher initial As concentrations, one dominant population of As(V) species bonded to only two Fe atoms was evident. By contrast, schwertmannites with relatively low arsenic concentrations gave biotransformation products in which two distinctly different populations of As(V) persisted. The first is the dominant population described above, the second is a minority population characterized by As(V) bonded to four Fe atoms. Both XAS and XMCD evidence suggest that the latter form of arsenic is that taken into the tetrahedral sites of the magnetite. We conclude that the majority population of As(V) is sorbed to the surface of the biotransformation products, whereas the minority population comprises As(V) incorporated into the tetrahedral sites of the biomagnetite. This suggests that microbial reduction of highly bioavailable As(V)-bearing Fe(III) mineral does not necessarily result in the mobilization of the arsenic.

Atomistic simulations of calcium uranyl(VI) carbonate adsorption on calcite and stepped-calcite surfaces.

Adsorption of actinyl ions onto mineral surfaces is one of the main mechanisms that control the migration of these ions in environmental systems. Here, we present computational classical molecular dynamics (MD) simulations to investigate the behavior of U(VI) in contact with different calcite surfaces. The calcium-uranyl-carbonate [Ca(2)UO(2)(CO(3))(3)] species is shown to display both inner- and outer-sphere adsorption to the flat {101̅4} and the stepped {314̅8} and {31̅2̅16} planes of calcite. Free energy calculations, using the umbrella sampling method, are employed to simulate adsorption paths of the same uranyl species on the different calcite surfaces under aqueous condition. Outer-sphere adsorption is found to dominate over inner-sphere adsorption because of the high free energy barrier of removing a uranyl-carbonate interaction and replacing it with a new uranyl-surface interaction. An important binding mode is proposed involving a single vicinal water monolayer between the surface and the sorbed complex. From the free energy profiles of the different calcite surfaces, the uranyl complex was also found to adsorb preferentially on the acute-stepped {314̅8} face of calcite, in agreement with experiment.

The mechanism of the reduction of [AnO2]2+ (An = U, Np, Pu) in aqueous solution, and by Fe(II) containing proteins and mineral surfaces, probed by DFT calculations.

The fate of actinyl species in the environment is closely linked to oxidation state, since the reduction of An(VI) to An(IV) greatly decreases their mobility due to the precipitation of the relatively insoluble An(IV) species. Here we study the mechanism of the reduction of [AnO(2)](2+) (An = U, Np, Pu) both in aqueous solution and by Fe(II) containing proteins and mineral surfaces, using density functional theory calculations. We find a disproportionation mechanism involving a An(V)-An(V) cation-cation complex, and we have investigated how these complexes are formed in the different environments. We find that the behaviour of U and Pu complexes are similar, but the reduction of Np(V) to Np(IV) would seems to be more difficult, in line with the experimental finding that Np(V) is generally more stable than U(V) or Pu(V). Although the models we have used are somewhat idealised, our calculations suggest that there are strong similarities between the biotic and abiotic reduction pathways.

Investigation of ligand exchange reactions in aqueous uranyl carbonate complexes using computational approaches.

Carbonate anion exchange reactions with water in the uranyl-carbonate and calcium-uranyl-carbonate aqueous systems have been investigated using computational methods. Classical molecular dynamics (MD) simulations with the umbrella sampling technique were employed to determine potentials of mean force for the exchange reactions of water and carbonate. The presence of calcium counter-ions is predicted to increase the stability of the uranyl-carbonate species in accordance with previous experimental observations. However, the free energy barrier to carbonate exchange with water is found to be comparable both in the presence and absence of calcium cations. Possible implications of these results for uranyl adsorption on mineral surfaces are discussed. Density functional theory (DFT) calculations were also used to confirm the trends observed in classical molecular dynamics simulations and to corroborate the validity of the potential parameters employed in the MD scheme.

A review of the environmental corrosion, fate and bioavailability of munitions grade depleted uranium.

Depleted uranium (DU) is a by-product of nuclear fuel enrichment and is used in antitank penetrators due to its high density, self-sharpening, and pyrophoric properties. Military activities have left a legacy of DU waste in terrestrial and marine environments, and there have been only limited attempts to clean up affected environments. Ten years ago, very little information was available on the dispersion of DU as penetrators hit their targets or the fate of DU penetrators left behind in environmental systems. However, the marked increase in research since then has improved our knowledge of the environmental impact of firing DU and the factors that control the corrosion of DU and its subsequent migration through the environment. In this paper, the literature is reviewed and consolidated to provide a detailed overview of the current understanding of the environmental behaviour of DU and to highlight areas that need further consideration.

Optimizing Cr(VI) and Tc(VII) remediation through nanoscale biomineral engineering.

The influence of Fe(III) starting material on the ability of magnetically recoverable biogenic magnetites produced by Geobacter sulfurreducens to retain metal oxyanion contaminants has been investigated. The reduction/removal of aqueous Cr(VI) was used to probe the reactivity of the biomagnetites. Nanomagnetites produced by the bacterial reduction of schwertmannite powder were more efficient at reducing Cr(VI) than either ferrihydrite "gel"-derived biomagnetite or commercial nanoscale Fe(3)O(4). Examination of post-exposure magnetite surfaces indicated both Cr(III) and Cr(VI) were present. X-ray magnetic circular dichroism (XMCD) studies at the Fe L(2,3)-edge showed that the amount of Fe(III) "gained" by Cr(VI) reduction could not be entirely accounted for by "lost" Fe(II). Cr L(2,3)-edge XMCD spectra found Cr(III) replaced approximately 14%-20% of octahedral Fe in both biogenic magnetites, producing a layer resembling CrFe(2)O(4). However, schwertmannite-derived biomagnetite was associated with approximately twice as much Cr as ferrihydrite-derived magnetite. Column studies using a gamma-camera to image a (99)mTc(VII) radiotracer were performed to visualize the relative performances of biogenic magnetites at removing aqueous metal oxyanion contaminants. Again, schwertmannite-derived biomagnetite proved capable of retaining more (approximately 20%) (99)mTc(VII) than ferrihydrite-derived biomagnetite, confirming that the production of biomagnetite can be fine-tuned for efficient environmental remediation through careful selection of the Fe(III) mineral substrate supplied to Fe(III)-reducing bacteria.

Corrosion and transport of depleted uranium in sand-rich environments.

The firing of depleted uranium (DU) weapons during conflicts and military testing has resulted in the deposition of DU in a variety of sand-rich environments. In this study, DU-amended dune sand microcosm and column experiments were carried out to investigate the corrosion of DU and the transport of corrosion products. Under field-moist conditions, DU corroded to metaschoepite ((UO(2))(8)O(2)(OH)(12).(H(2)O)(10)) at a rate of 0.10+/-0.012 g cm(-2)y(-1). This loosely bound corrosion product detached easily from the coupon and became distributed heterogeneously within the sand. The corrosion of DU caused significant changes in the geochemical environment, with NO(3)(-) and Fe(III) reduction observed. Column experiments showed that transport of metaschoepite was mainly dependent on its dissolution and the subsequent interaction of the resulting dissolved uranyl (UO(2)(2+)) species with sand particles. The modelling results predict that the transport of U released from metaschoepite dissolution is retarded, due to a slowly desorbing surface species (first order desorption rate constant=5.0 (+/-1.0)x10(-8)s(-1)). The concentrations of U eluting from the metaschoepite column were orders of magnitude higher than the World Health Organisation's recommended maximum admissible concentration for U in drinking water of 15 microg L(-1). Therefore, a relatively high level of mobile U contamination would be expected in the immediate proximity of a corroding penetrator in a sand-rich environment.

Biogeochemical controls on the corrosion of depleted uranium alloy in subsurface soils.

Military activities have left a legacy of depleted uranium (DU) penetrator waste in the near-surface terrestrial environment. To understand the fate of this DU alloy, the mechanisms and controlling factors of corrosion need to be determined. In this study, field-moist and waterlogged microcosms were used to investigate the effect of redox conditions and soil water content on the corrosion and fate of DU in subsurface soil, and the impact of corroding DU on the soil microbial population. The mechanism of corrosion and the corrosion products formed were highly dependent on the water status of the soil. Under field-moist conditions, DU corroded at a rate of 0.49 +/- 0.06 g cm(-2) y(-1) and the main U input to surrounding soil was large metaschoepite [(UO2)8O2(OH)12 x (H2O)10] particles. However, underwaterlogged conditions the rate of corrosion was significantly slower at 0.01-0.02 g cm(-2) y(-1) and occurred with the release of dissolved species to the surrounding environment. Corrosion ceases under reducing conditions, thus redox conditions are important in determining the persistence of penetrators in the environment. Corroding DU alters the redox conditions in the surrounding environment and both mechanisms of corrosion impact the microbial community.

Corrosion and fate of depleted uranium penetrators under progressively anaerobic conditions in estuarine sediment.

The testing of armor-piercing depleted uranium (DU) "penetrators" has resulted in the deposition of DU in the sediments of the Solway Firth, UK. In this study, DU-amended, microcosm experiments simulating Solway Firth sediments under high (31.5) and medium (16.5) salinity conditions were used to investigate the effect of salinity and biogeochemical conditions on the corrosion and fate of DU, and the impact of the corroding DU on the microbial population. Under suboxic conditions, the average corrosion rates were the same forthe 31.5 and 16.5 salinity systems at 0.056 +/- 0.006 g cm(-2) y(-1), implying that complete corrosion of a 120 mm penetrator would take approximately 540 years. Under sulfate-reducing conditions, corrosion ceased due to passivation of the surface. Corroding DU resulted in more reducing conditions and decreased microbial diversity as indicated by DNA sequencing and phylogenetic analysis. The lack of colloidal and particulate DU corrosion products, along with measurable dissolved U and a homogeneous association of U with the sediment, suggest that U was transported from the penetrator surface into the surrounding environment through dissolution of U(VI), with subsequent interactions resulting in the formation of secondary uranium species in the sediment.

Experimental studies of the influence of grain size, oxygen availability and organic carbon availability on bioclogging in porous media.

Changes in the hydraulic properties of porous material due to bioclogging have been observed in many laboratory simulations and field studies. Because such changes in hydraulic properties influence the movement of fluids and contaminants, microbial ecology data are required for improved transport modeling. Here we investigate the effects of environmental variables previously shown to influence bioclogging, specifically oxygen availability, sediment grain size, and organic carbon (nutrient) concentration on the hydraulic properties of simulated subsurface environments. Our study provides evidence of a different clogging mechanism for aerobic and anaerobic microbial communities under high organic carbon concentrations (400 mg L(-1)). This work also suggests that the clogging mechanism operating in anaerobic microbial communities is more sensitive to carbon availability than that in the aerobic microbial communities. We found that grain size does have an effect on clogging, but it appears that there is a threshold carbon concentration, and therefore biomass, below which these effects are insignificant. Differences between the microbial communities that developed under different oxygenation conditions were detected using 16s rRNA analysis.

Microbial controls on metal mobility under the low nutrient fluxes found throughout the subsurface.

Laboratory simulations and field studies of the shallow subsurface have shown that microbes and their extracellular products can influence the mobility of toxic metals from waste disposal sites. Modelling the transport of contaminants in groundwater may, therefore, require the input of microbial ecology data in addition to geochemical data, thus increasing the costs and the uncertainty of predictions. However, whether microbial effects on contaminant mobility occur extensively in the natural subsurface is unknown because the conditions under which they have been observed hitherto are generally unrepresentative of the average subsurface environment. Here, we show that microbial activity affects the mobility of a toxic trace metal (Cu) under the relatively low nutrient fluxes that dominate subsurface systems. More particularly, we show that under these low nutrient conditions, microbes and microbial products can immobilize metal but may themselves be subject to subsequent mobilization, thus complicating the pattern of metal storage and release. Our results show that the capability of microbes in the subsurface to change both the capacity of porous media to store metal, and the behaviour of metal that is released, is not restricted to the well researched environments close to sites of waste disposal. We anticipate our simulations will be a starting point for generating input data for transport models, and specifying the mechanism of metal remobilisation in environments more representative of the subsurface generally.

Role of the G protein-coupled receptor kinase site serine cluster in beta2-adrenergic receptor internalization, desensitization, and beta-arrestin translocation.

There is considerable evidence for the role of carboxyl-terminal serines 355, 356, and 364 in G protein-coupled receptor kinase (GRK)-mediated phosphorylation and desensitization of beta(2)-adrenergic receptors (beta(2)ARs). In this study we used receptors in which these serines were changed to alanines (SA3) or to aspartic acids (SD3) to determine the role of these sites in beta-arrestin-dependent beta(2)AR internalization and desensitization. Coupling efficiencies for epinephrine activation of adenylyl cyclase were similar in wild-type and mutant receptors, demonstrating that the SD3 mutant did not drive constitutive GRK desensitization. Treatment of wild-type and mutant receptors with 0.3 nm isoproterenol for 5 min induced approximately 2-fold increases in the EC(50) for agonist activation of adenylyl cyclase, consistent with protein kinase A (PKA) site-mediated desensitization. When exposed to 1 mum isoproterenol to trigger GRK site-mediated desensitization, only wild-type receptors showed significant further desensitization. Using a phospho site-specific antibody, we determined that there is no requirement for these GRK sites in PKA-mediated phosphorylation at high agonist concentration. The rates of agonist-induced internalization of the SD3 and SA3 mutants were 44 and 13%, respectively, relative to that of wild-type receptors, but the SD3 mutant recruited enhanced green fluorescent protein (EGFP)-beta-arrestin 2 to the plasma membrane, whereas the SA3 mutant did not. EGFP-beta-Arrestin2 overexpression triggered a significant increase in the extent of SD3 mutant desensitization but had no effect on the desensitization of wild-type receptors or the SA3 mutant. Expression of a phosphorylation-independent beta-arrestin 1 mutant (R169E) significantly rescued the internalization defect of the SA3 mutant but inhibited the phosphorylation of serines 355 and 356 in wild-type receptors. Our data demonstrate that (i) the lack of GRK sites does not impair PKA site phosphorylation, (ii) the SD3 mutation inhibits GRK-mediated desensitization although it supports some agonist-induced beta-arrestin binding and receptor internalization, and (iii) serines 355, 356, and 364 play a pivotal role in the GRK-mediated desensitization, beta-arrestin binding, and internalization of beta(2)ARs.

Sulfide species as a sink for mercury in lake sediments.

The interaction between two contrasting examples of lake sediments and small concentrations of mercury added to the sediments in solution has been studied using X-ray absorption spectroscopy. Whereas one lake (Esthwaite Water) is biologically productive, with a seasonal cycle of phytoplankton activity, including stratification and Fe(III) reduction, and a mineralogy involving quartz, muscovite, and clinochlore, the other (Botany Pond) remains oxic throughout the year. In the latter case, the sediment is predominantly quartz and calcite. Chemical analyses of these two lake sediments reflectthe differences in mineralogy and showthat both contain significant organic carbon (approximately 10-12 wt %) and smaller amounts of S (approximately 0.2-1.7 wt %) and Cl (approximately 0.4-1.1 wt %). Despite the substantial amounts of organic matter in both sediments, the spectroscopic data show that the mercury occurs as a sulfide phase with a local structural environment akin to that in cinnabar. Parallel spectroscopic studies conducted on Hg either coprecipitated or sorbed onto FeS (mackinawite), and on oxidized mackinawite, provide supporting information; the possibility of Hg forming a chloride was eliminated by careful mapping of the relevant elements by an electron microprobe. It appears, therefore, that the high affinity of Hg for S predominates even in substantially oxic environments.

A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine.

OBJECTIVES: The long-term use of strong opioid analgesics among chronic noncancer pain (CNCP) patients remains controversial because of concerns over problematic drug use. However, previous surveys suggest that this is not necessarily the case. Therefore, we designed a controlled study to generate evidence in support of these findings. PATIENTS/SETTING: Ten CNCP patients attending the pain clinic in a district general hospital had been taking an average daily dose of 40 mg controlled-release morphine sulphate (mean 40, range 10-90, SD 21 mg), for an average of 2 years (mean 2.175, range 2-2.25, SD 0.2 years). DESIGN: Randomized, double-blind, placebo controlled cross-over study. The study was based on the premise that abrupt cessation of opioid drugs is most likely to highlight problematic use and the consequent inability to stop using opioids. Morphine was substituted with placebo for 60-hour periods to compare the effects of abstinence with those of continued use. Assessment of morphine cessation and abstinence effects was through direct observation, physiological measurements, questionnaire responses, and Brief Pain Inventory scores. RESULTS: Following cessation and abstinence, there were no indications of psychological dependence or drug craving, but there was evidence of the detrimental effects of pain intensity on activity, mood, relationships, sleep, and enjoyment of life. Three patients (30%) reported opioid drug withdrawal symptoms. Pharmacokinetic data demonstrated compliance with abstinence by all patients. CONCLUSION: The results suggest the existence of a group of CNCP patients whose long-term opioid consumption can be beneficial and remain moderate without them suffering from the consequences of problematic opioid drug use.

X-ray absorption spectroscopy studies of reactions of technetium, uranium and neptunium with mackinawite.

Technetium, uranium and neptunium may all occur in the environment in more than one oxidation state (IV or VII, IV or VI and IV or V respectively). The surface of mackinawite, the first-formed iron sulfide phase in anoxic conditions, can promote redox changes so a series of laboratory experiments were carried out to explore the interactions of Tc, U and Np with this mineral. The products of reaction were characterised using X-ray absorption spectroscopy. Technetium, added as TcO4(-), is reduced to oxidation state IV and forms a TcS(2)-like species. On oxidation of the mackinawite in air to form goethite, Tc remains in oxidation state IV but in an oxide, rather than a sulfide environment. At low concentrations, uranium forms uranyl surface complexes on oxidised regions of the mackinawite surface but at higher concentrations, the uranium promotes surface oxidation and forms a mixed oxidation state oxide phase. Neptunium is reduced to oxidation IV and forms a surface complex with surface sulfide ions. The remainder of the Np coordination sphere is filled with water molecules or hydroxide ions.