Patient preference with respect to QoL and reduction in opioid-induced constipation (OIC) after treatment with prolonged-release (PR) oxycodone/naloxone compared with previous analgesic therapy [PREFER study].

OBJECTIVE: The aim of this study was to assess patient preference in terms of quality of life (QoL), analgesia and bowel function for patients with moderate to severe chronic non-malignant pain, when treated with oxycodone PR/naloxone PR compared with the previous WHO-step I and/or WHO-step II analgesic treatment . STUDY DESIGN: This was a 3-week open-label phase 3b study conducted in Belgium and the Netherlands, after 3 weeks patients could enter an extension phase. Patient preference with respect to QoL for oxycodone PR/naloxone PR treatment compared with previous WHO-step I and/or WHO-step II analgesics was assessed. A patient was considered a responder with respect to QoL if this assessment was 'better' or 'much better' compared with previous WHO-step I or II analgesics at any time point. RESULTS: Response rate with respect to QoL was 59.2% (95% CI: 51.7-66.8%) for the Full Analysis (FA)-population, for the Per Protocol-population response rate was 71.7% (95% CI: 63.1-80.3%). Explorative analysis showed that response rate with respect to QoL was highest in constipated patients pretreated with WHO-step II analgesics (73.8%). Mean ± SD pain score in the FA-population at start was 74.7 ± 16.6 decreasing to 53.9 ± 24.3 after a median (range) treatment period of 173.5 (31-771) days. For constipated subjects the significant reduction in constipation [improvement of the Bowel Function Index (BFI)], was -24.8 points (95% CI: -17.1 to -32.5). BFI for non-constipated subjects remained well below 28.8. Adverse events with oxycodone PR/naloxone PR treatment were well-known opioid-related adverse events. CONCLUSION: This study shows that the studied patients previously treated with WHO-step I and/or WHO-step II analgesics prefer treatment with oxycodone PR/naloxone PR with respect to QoL. Moreover, the study shows that treatment with oxycodone PR/naloxone PR significantly reduces OIC in constipated patients and that non-constipated patients do not develop OIC during treatment with oxycodone PR/naloxone PR.

Characterization of muscarinic receptors in rat kidney.

Muscarinic receptors in mammalian kidney seem to be involved in diuresis. In this study we give a detailed characterization of receptors in rat kidney. Specific binding of [3H](-)-quinuclidinylbenzilate ([3H]QNB) to membranes of rat kidney cortex was saturable and of high affinity. A dissociation constant of 0.063 +/- 0.003 nM and a receptor density of 1.46 +/- 0.07 pmol/g wet weight were obtained. The dissociation kinetics could be best described by assuming a mono-exponential function (k-1 = (0.52 +/- 0.1) x 10(-4) s-1). The binding of [3H]QNB reached a maximum in 60 min at 0.6 nM at 37 degrees C. Competition experiments with the enantiomers of benzetimide confirmed the muscarinic nature of the [3H]QNB binding sites. The inhibition constants of pirenzepine (0.23 +/- 0.02 microM), (+-)-hexahydrosiladifenidol (0.040 +/- 0.002 microM), AF-DX 116 (1.45 +/- 0.07 microM), methoctramine (1.67 +/- 0.02 microM) and gallamine (78 +/- 3 microM) classified this receptor as an M3 receptor. Inhibition of [3H]QNB binding by the agonists methylfurtrethonium, arecoline, isoarecoline methiodide, arecaidine propargyl ester and McN-A-343 displayed monophasic inhibition curves. With (+/-)-cis-2-methyl-4-dimethylaminomethyl-1,3- dioxolane methiodide in two out of four experiments a small (11%) population of high affinity agonist sites could be detected. The potassium sparing diuretic amiloride inhibited [3H]QNB binding (36 +/- 3 microM). Although in a way related to the amiloride binding site, the muscarinic receptors in rat kidney are unlikely to be the primary target of diuretic action of this drug.

Alterations of muscarinic acetylcholine receptors in the nasal mucosa of allergic patients in comparison with nonallergic individuals.

Cholinergic nasal hyperresponsiveness in nasal allergy may be due to changes of the characteristics in muscarinic cholinergic receptors. Radioligand receptor binding and in vitro autoradiographic studies of nasal mucosa in nonallergic (NA) and allergic patients were performed to investigate this hypothesis. The heterogeneous NA group was subdivided into control individuals and patients with chronic sinusitis and vasomotor rhinitis. The 3H-(-)-Quinuclidinylbenzilate binding to muscarinic receptors in human nasal mucosa membranes was saturable and of high affinity in all groups. No significant differences could be demonstrated between the subgroups of the NA patients. In allergic patients the dissociation constants and receptor densities were significantly decreased in comparison with those of NA and with those of control individuals. No differences in agonist binding or coupling of the muscarinic receptor to the effector system via the G protein could be observed in allergic patients. In vitro autoradiographic experiments demonstrated specific 3H-(-)-Quinuclidinylbenzilate labeling of the glandular acini in NA and allergic patients. No specific labeling could be observed in the epithelium, blood vessels, or connective tissue. In conclusion, the increased sensitivity and decreased muscarinic receptor number may reflect the cholinergic-induced hypersecretion in nasal allergy but are probably too small to explain the complex allergic reaction.

Alterations of adrenoceptors in the nasal mucosa of allergic patients in comparison with nonallergic individuals.

Nasal hyperreactivity in nasal allergy may be due to changes of the characteristics in adrenergic receptors. Radioligand receptor-binding studies with the antagonists, 3H-prazosin (alpha 1-adrenoceptor), 3H-rauwolscine (alpha 2-adrenoceptor), and 125I-(-)-Cyanopindolol (beta-adrenoceptor) were performed in homogenates of nasal mucosa of allergic and nonallergic (NA) patients to investigate this hypothesis. The heterogeneous NA group was subdivided into control individuals and patients with chronic sinusitis and vasomotor rhinitis. No significant differences in affinities or densities of alpha 1- and alpha 2-adrenoceptors could be demonstrated in allergic patients in comparison with NA and control individuals. The beta-adrenoceptor density was significantly reduced in allergic patients in comparison with that of control individuals. Neither changes in agonist binding or in the effect of Gpp(NH)p on the agonist binding to beta-adrenoceptors could be observed in allergic patients. The subtype selective antagonist, LK203-030, demonstrated the presence of a homogeneous population of beta 2-adrenoceptors in human nasal mucosa of both NA and allergic patients. In vitro, autoradiography demonstrated specific 125I-(-)-Cyanopindolol labeling of the epithelium in NA and allergic patients. In conclusion, no changes in characteristics of alpha 1- or alpha 2-adrenoceptors in the nasal mucosa could be demonstrated in nasal allergy. However, a decreased number of beta-adrenoceptors may reflect a beta-adrenergic abnormality in nasal allergy.

Biochemical and autoradiographic analysis of beta-adrenoceptors in rat nasal mucosa.

The specific binding of 125I-(-)-cyanopindolol (125I-(-)-CYP) to homogenates and cryostat sections of rat nasal mucosa was saturable, stereoselective and of high affinity (Kd = 5.0 +/- 0.4 pM. Bmax = 204 +/- 12 fmol/mg protein and Kd = 7.2 +/- 0.7 pM; Bmax = 15 +/- 1 fmol/mg protein respectively). The subtype-selective antagonists, LK203-030 and ICI118,551, inhibited specific 125I-(-)-CYP binding according to a two-binding site model, indicating the presence of 57 and 45% beta 1-adrenoceptors in homogenates and cryostat sections, respectively. Competition of isoprenaline for antagonist binding to homogenates demonstrated 30 +/- 3% high-affinity agonist binding sites. A steepening of the curve was observed in presence of guanine nucleotides. In vitro labelling of cryostat sections of rat nasal mucosa was combined with autoradiography. The autoradiographs generated after incubation with 20 pM 125I-(-)-CYP showed specific labelling of the epithelium and glandular excretory ducts. It appeared from autoradiographs generated with subtype-selective antagonists in addition to the radioligand that beta 1- and beta 2-adrenoceptors were present in both structures.

Alpha 2-adrenoceptors in homogenates of rat nasal mucosa.

The specific binding of [3H]rauwolscine to rat nasal mucosa membranes was saturable, stereoselective and of high affinity. The Scatchard plot pointed to a homogeneous population of binding sites (Kd = 3.6 +/- 0.6 nM; Bmax = 5.1 +/- 0.7 pmol/g). The non-specific binding appeared to be non-linear, probably due to filter binding. Inhibition of [3H]rauwolscine binding with the subtype-selective antagonist, prazosin, suggested the presence of alpha 2-adrenoceptor subclasses in rat nasal mucosa. The (-)-epinephrine inhibition curves demonstrated high- and low-affinity agonist binding sites. A monophasic (-)-epinephrine inhibition curve was obtained in the presence of guanine nucleotides.

Alterations of neuroreceptors in nasal hyperreactivity.

Cholinergic and adrenergic abnormalities have been observed in nasal allergy and may be due to changes in pharmacological characteristics of neuroreceptors. Radioligand receptor binding studies demonstrated no significant changes in affinities or densities of alpha-adrenoceptors, a decreased number of beta-adrenoceptors and a decreased affinity combined with a decreased number of muscarinic acetylcholine receptors.

Demonstration of alpha 1-adrenoceptors in rat nasal mucosa.

3H-Prazosin was used to demonstrate alpha 1-adrenoceptors in rat nasal mucosa. Specific binding is saturable and occurs to a homogeneous class of binding sites with high affinity (Kd = 0.07 +/- 0.01 nmol/l and with a receptor density of 0.36 +/- 0.02 pmol/g tissue or 14 +/- 1 fmol/mg protein. Kinetic experiments resulted in a Kd-value of 0.03 nmol/l. The binding is stereoselectively inhibited by epinephrine enantiomers. The antagonist prazosin inhibits 3H-Prazosin binding with high affinity, in contrast to yohimbine, classifying the binding sites as alpha 1-adrenoceptors. Inhibition experiments with WB4101 indicated the presence of alpha 1a- (31 +/- 9%) and alpha 1b-adrenoceptor subtypes in the rat nasal mucosa. The order of potencies of agonists determined in competition experiments was (-)epinephrine greater than (+)epinephrine greater than (-)phenylephrine.

Cholinergic muscarinic receptors in rat cochlea.

Specific 3H-1-quinuclidinylbenzilate (3H-1-QNB) binding to rat cochlea homogenates occurs to a homogeneous class of binding sites with Kd = 0.13 +/- 0.01 nM and Bmax = 0.57 +/- 0.07 fmol per cochlea. Binding is stereoselectively inhibited by benzetimide enantiomers. Dexetimide was more effective than levetimide in displacing 3H-1-QNB from its binding sites (Ki = 4 x 10(-10) M and 6.5 x 10(-6) M, respectively). Pirenzepine inhibits 3H-1-QNB binding with low affinity (Ki = 2 x 10(-6) M), classifying the binding sites as muscarinic M2 receptors.

Demonstration of beta-adrenergic receptors in rat nasal glands by an in vitro autoradiographic technique.

The distribution of beta-adrenergic receptors in rat nasal glands has been investigated with the use of an in vitro autoradiographic technique. Radioligand binding studies indicated that [125I]cyanopindolol binds specifically to beta-adrenergic receptors in cryostat sections of these glands. Autoradiograms generated after incubation with 0.02 nM [125I]cyanopindolol and dipping in nuclear K2 emulsion, showed specific labelling of the striated excretory ducts. These in vitro observations suggest a sympathetic control of the ion and water content of the glandular secretion.

Autonomic innervation of the nasal mucosa.

The nasal passages play a crucial role in the protection and functioning of the lower airways. Consequently the nerve supply of the nasal mucosa is extensive, which is related to an immediate and adequate reaction upon a variety of external and internal stimuli. A brief review of the present knowledge on nasal autonomic innervation and pharmacology will be given. There is special attention to more advanced methods, such as radioligand receptor binding techniques, which might augment our insight in the significance of the nervous system in nasal (patho)physiology. Furthermore data on the secretory activity of the nasal glands in the rat and its neural regulation will be accentuated.

Autoradiographic analysis of muscarinic receptors in rat nasal glands.

An in vitro method was developed for the biochemical and autoradiographic demonstration of low muscarinic receptor densities in peripheral tissue. Histological criteria point clearly to the necessity for fixation to preserve tissue quality. [3H]l-Quinuclidinylbenzilate bound specifically to a homogeneous class of binding sites in 0.5% glutardialdehyde-fixed cryostat sections (10 microns) of rat nasal glands with high affinity (Kd = 0.47 +/- 0.06 nM) and with a receptor density (Bmax) of 41 +/- 1 fmol/mg protein. This binding was linearly dependent on the thickness of the sections. Kinetic experiments resulted in a Kd value of 0.19 nM. Binding was stereoselectively inhibited by benzetimide enantiomers. Autoradiograms, generated after incubation with 0.6 nM [3H]l-quinuclidinylbenzilate and dipping in nuclear K2 emulsion, showed specific labelling of the glandular acini and excretory ducts. These in vitro observations provide conclusive evidence for the presence of acetylcholine receptors in the nasal glands of the rat.