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β-Endorphin, Met-enkephalin and corresponding opioid receptors within synovium of patients with joint trauma, osteoarthritis and rheumatoid arthritis
  1. Shaaban A Mousa1,
  2. Rainer H Straub2,
  3. Michael Schäfer1,
  4. Christoph Stein1
  1. 1Klinik für Anaesthesiologie und Operative Intensivmedizin, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
  2. 2Laboratory of Experimental Rheumatology and Neuroendocrino-Immunology, Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
  1. Correspondence to:
    Professor Dr S A Mousa
    Klinik für Anaesthesiologie und Operative Intensivmedizin, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany; shaaban.mousa{at}charite.de

Abstract

Objective: Intra-articularly applied opioid agonists or antagonists modulate pain after knee surgery and in chronic arthritis. Therefore, the expression of β-endorphin (END), Met-enkephalin (ENK), and μ and δ opioid receptors (ORs) within synovium of patients with joint trauma (JT), osteoarthritis (OA) and rheumatoid arthritis (RA) were examined.

Methods: Synovial samples were subjected to double immunohistochemical analysis of opioid peptides with immune cell markers, and of ORs with the neuronal markers calcitonin gene-related peptide (CGRP) and tyrosine hydroxylase (TH).

Results: END and ENK were expressed by macrophage-like (CD68+) and fibroblast-like (CD68) cells within synovial lining layers of all disorders. In the sublining layers, END and ENK were mostly expressed by granulocytes in patients with JT, and by macrophages/monocytes, lymphocytes and plasma cells in those with OA and RA. Overall, END- and ENK-immunoreactive (IR) cells were more abundant in patients with RA than in those with OA and JT. ORs were found on nerve fibres and immune cells in all patients. OR-IR nerve fibres were significantly more abundant in patients with RA than in those with OA and JT. μORs and δORs were coexpressed with CGRP but not with TH.

Conclusions: Parallel to the severity of inflammation, END and ENK in immune cells and their receptors on sensory nerve terminals are more abundant in patients with RA than in those with JT and OA. These findings are consistent with the notion that, with prolonged and enhanced inflammation, the immune and peripheral nervous systems upregulate sensory nerves expressing ORs and their ligands to counterbalance pain and inflammation.

  • ABC, avidin–biotin–peroxidase complex
  • ANOVA, analysis of variance
  • CGRP, calcitonin gene-related peptide
  • DAB, 3′,3′-diaminobenzidine tetrahydrochloride
  • DPX, distrene, tricresyl phosphate and xylene
  • END, endorphin
  • ENK, enkephalin
  • IA, intra-articular
  • IR, immunoreactive
  • JT, joint trauma, OA, osteoarthritis
  • OR, opioid receptor
  • PBS, phosphate buffered saline
  • RA, rheumatoid arthritis
  • TH, tyrosine hydroxylase

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Footnotes

  • Published Online First 23 February 2007

  • Competing interests: None declared.

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