Opioids are powerful pain relievers, but also potent inducers of dependence and tolerance. Chronic morphine administration (via subcutaneous pellet) induces morphine dependence in the nucleus accumbens, an important dependence region in the brain, yet the cellular mechanisms are mostly unknown. Toll-like receptor 2 (TLR2) plays an essential function in controlling innate and inflammatory responses. Using a knockout mouse lacking TLR2, we assessed the contribution of TLR2 to microglia activation and development of morphine dependence. We report here that mice deficient in TLR2 inhibit morphine-induced the levels of microglia activation and proinflammatory cytokines. Moreover, in TLR2 knockout mice the main symptoms of morphine withdrawal were significantly attenuated. Our data reveal that TLR2 plays a critical role in morphine-induced microglia activation and dependence.

Toll-like receptor 2 (TLR2), a key immune receptor in the TLR family, is widely expressed in various systems, including the immune and nervous systems and plays a critical role in controlling innate and adaptive immune responses. We previously reported that opioids inhibit cell growth and trigger apoptosis. However, the underlying mechanism by which TLR2 mediates apoptosis in response to opioids is not yet known. Here we show that chronic morphine treatment in primary neurons dramatically increased the expression of TLR2 at both the messenger RNA and protein levels. In addition, TLR2 deficiency significantly inhibited chronic morphine-induced apoptosis in primary neurons. Activation of caspase-3 after morphine treatment is impaired in TLR2 deficient primary neurons. Moreover, morphine treatment failed to induce an increased level of phosphorylated glycogen synthase kinase 3 beta (GSK3β) in TLR2 deficient primary neurons, suggesting an involvement of GSK3β in morphine-mediated TLR2 signaling. These results thus demonstrate that opioids prime neurons to undergo apoptosis by inducing TLR2 expression. Our data suggest that inhibition of TLR2 is capable of preventing opioids-induced damage to neurons.

The present study was undertaken to evaluate the effects of ultra low concentrations (10-9 or 10-14 M) of morphine on neurite elongation in cultured neurons dissociated from rat spinal cords and cerebral cortex. In fetal serum (FS) or fetal serum-free supplemented with cAMP media, the length of longest neurite was significantly increased by 10-9 or 10-14 M morphine. For example, 10-14 M morphine increased neurite length by 24±0.5% and 27±0.3% in spinal cord neurons, and 18±0.2% and 17±0.6% in cortical neurons. Morphine (10-6 M) had no significant effect on neurite length of spinal and cortical neurons. The relative frequency distribution of neurite length revealed 61±2.7% of spinal neurons and 48±2.6% of cortical neurons are responsive to ultra low concentrations of morphine. In the responsive populations, morphine (10 -14 M) enhanced the neurite outgrowth in spinal neurons by 58±0.9% and 48±1.2% and in cortical neurons by 31±0.6% and 28±0.9% in FS and cAMP-supplemented media, respectively. Pretreatment with naloxone did not prevent the morphine effect. The result shows that morphine at ultra low concentrations enhances neurite outgrowth of spinal and cortical neurons via a naloxone-independent mechanism.

Experiments on the effects of drugs on behavior maintained by temporal-discrimination procedures have led to discrepant results. Recent experiments suggest that the effects of drugs may differ depending on whether the subject is timing some aspect of its own behavior or some other stimulus. The present experiment used a multiple-schedule procedure composed of a subject-produced and experimenter-imposed component. In the subject-produced component, pigeons categorized the duration of their most recently emitted interresponse time. In the experimenter-imposed component, pigeons categorized the duration of a key light. Morphine generally produced underestimation of time during the subject-produced component, a result in agreement with other recent experiments. Morphine had no systematic effects on accuracy during the experimenter-imposed component. These results are discussed in terms of procedural interactions and a morphine-induced disruption of stimulus control.

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Graduation date: 1995

Les modifications physiopathologiques induites par l’obésité sont susceptibles de modifier la pharmacocinétique d’un grand nombre de médicaments. Toutes les étapes peuvent-être touchées : modification des compartiments de l’organisme, de la fonction rénale et de l’expression des protéines du métabolisme. L’intensité des variations induites reste difficile à anticiper en l’absence d’études spécifiques, ce qui pose également la question du choix du meilleur estimateur de poids dans l’expression du schéma posologique du médicament chez le sujet obèse. Nous avons évalué l’impact de différents descripteurs de poids sur les variabilités inter-individuelles de trois médicaments couramment utilisés en diabétologie, dans la douleur et en cancérologie. Une modélisation a été faite en pharmacocinétique de population (Monolix®) avec une évaluation des descripteurs de poids (poids de masse maigre, poids idéal, poids total, surface corporelle…). Pour la metformine (n=105 patients), molécule fortement hydrophile, CL/F et V/F augmentent avec le poids. Le poids de masse maigre est le meilleur descripteur de poids pour les deux paramètres et permet d’abaisser de manière importante la variabilité inter-individuelle. Dans le cas de la morphine (n=31), aucun descripteur n’est corrélé à CL/F ou V/F dans une population de sujets atteints d’obésité morbide. L’analyse de l’imatinib (n=54), de lipophilie plus importante, et de son métabolite actif montre que le poids idéal est la covariable la plus performante. Son impact n’explique cependant qu’une part minime de la variabilité de CL/F et ne remet pas en cause le principe d’une dose fixe. Les résultats confirment l’intérêt des méthodes de pharmacocinétique de population dans l’évaluation des covariables morphologiques, et indiquent qu’il n’existe pas de descripteur de poids universel. Ces résultats doivent nous encourager à évaluer systématiquement l’impact de l’obésité avec des modèles de population. Dans certains cas, des études de confirmation comparant différents schémas devraient-être mises en place. / Pharmacokinetic of drugs may be altered by pathophysiological changes associated with obesity: renal function, body compartments, expression of metabolism proteins. Real impact may be difficult to appreciate due to small number of specific studies. What is the best size-descriptor for optimal dosing in obesity remains a question of importance. Impact of different size descriptors was studied for three drugs currently used in diabetology, pain and oncology. Population pharmacokinetic modeling was done using Monolix® software to evaluate different covariates (LBW, TBW, BSA, …). CL/F and Vd/F of metformin, highly hydrophilic drug, increases positively with body weight (n=105). LBW was the best size-descriptor leading to substancial decrease in the between-subject variability BSV. No size-descriptors showed significant impact for morphine (n=31). Ideal body weight is the best size-descriptor for imatinib and its main metabolite (n=54), lipophilic drug. It explains only a small part of BSV and fixed dosing stays justified. Population PK analysis are the most formal assessment of morphological covariates and no single size descriptor can described all variabilities. Results must lead us to more systematic population PK analysis. Confirmation studies comparing different dosing regimens have to be done.

L’objectif de cette thèse a été d’explorer l’association entre des variants génétiques impliqués dans la variabilité interindividuelle de la réponse au traitement par les opioïdes et la survenue d’effets secondaires. Nous avons recherché si des facteurs génétiques influençaient la réponse à la morphine dans le traitement de la douleur aigüe. L’allèle T du polymorphisme c.3435C>T d’ABCB1 est significativement associé aux doses de morphine et à la survenue de nausées dans une étude pilote chez des patients libanais en post-opératoire. Ensuite, l’étude de la réponse à la morphine chez des patients présentant une obésité morbide a montré que la fréquence de l’allèle 118G d’OPRM1 et le seuil de sensibilité à la douleur sont plus élevés que chez les patients à poids normal. La recherche des facteurs influençant la variabilité de la réponse à la méthadone chez des patients toxicomanes traités pour substitution a mis en évidence deux polymorphismes (TaqIA de DRD2/ANKK1 et c.118A>G d’OPRM1) significativement associés à la dose maximale de méthadone administrée. Trois facteurs sont associés au phénotype CYP3A, impliqué dans le métabolisme de la méthadone: la prise de benzodiazépines, l’infection par le VIH et un polymorphisme de POR, gène qui code une oxydoréductase. De plus, le travail mené sur les effets secondaires cardiaques de la méthadone a permis de mettre en évidence trois facteurs corrélés à l’allongement de l’espace QT : la dose, l’infection par le VIH et le polymorphisme p.Lys897Thr de KCNH2 codant pour le canal potassique hERG. Ces travaux contribuent à démontrer l’intérêt d’intégrer des données cliniques et génétiques dans la prescription personnalisée des opioïdes. / The main objective of this thesis was to explore the association between genetic variants potentially involved in inter-individual variability of opioids’ response and side effects in the treatment of pain and opiate substitution treatment. Initially, we investigated whether genetic factors influence the response to morphine in the treatment of acute pain. The T allele of the polymorphism ABCB1 c.3435C>T was significantly associated with doses of morphine and the outcome of nausea in a pilot study in Lebanese postoperative patients. Next, we examined the response to morphine in patients with morbid obesity (BMI>40); in these patients, the frequency of the 118G OPRM1 allele and the pain threshold appeared to be higher than in patients with normal BMI. The search for factors influencing the variability in response to methadone in patients treated for drug substitution showed that two polymorphisms (DRD2/ANKK1 TaqIA and OPRM1 c.118A>G) were significantly associated with the maximum doses of methadone. In addition, three factors were associated with the CYP3A phenotype, involved in the metabolism of methadone: the use of benzodiazepines, HIV infection and a polymorphism in POR gene, which encodes an oxidoreductase. Finally, the exploration of the cardiac side effects of methadone has highlighted three factors significantly correlated with QT prolongation: methadone doses, HIV infection and the polymorphism p.Lys897Thr in KCNH2 encoding a cardiac potassium ion channel. This work demonstrates the importance of integrating both clinical and genetic data in the personalized prescription of opioids.