Advertisement

The dual effect of morphine on tumor development

  • H. Tuerxun
  • J. CuiEmail author
Open Access
Review Article
  • 221 Downloads

Abstract

Morphine is a classic opioid drug used for reducing pain and is commonly prescribed as an effective drug to control cancer pain. Morphine has a direct role in the central nervous system to relieve pain, but because of its peripheral functions, morphine also has some side effects, such as nausea, constipation, and addiction (Gupta et al. in Sci World J 2015:10, 2015). In addition to its analgesic effect, the role of morphine in tumor development is an important question that has been investigated for many years with conflicting results. Numerous studies suggest that morphine has a role in both promoting and inhibiting tumor growth. In this extensive review, we attempt to comprehensively understand the effects of morphine and summarize both its positive and negative influences on various aspects of tumors, including tumor growth, angiogenesis, metastasis, inflammation, and immunomodulation.

Keywords

Morphine Tumor Apoptosis Metastasis Angiogenesis Inflammation Immunosuppression 

Introduction

One of the most common symptoms of cancer is pain, with 50–80% of cancer patients experiencing some degree of pain. As tumors develop, they can cause severe pain by invading the surrounding nervous tissue, organs, and bones. This can cause a series of pathophysiological changes in the body, including changes in immune function.

Studies suggest [2] that pain can increase the release of corticotrophin-releasing hormone (CRH), resulting in immunosuppression. CRH acts on the neuroendocrine system, which leads to the redistribution of lymphocytes from circulating blood to lymphatic tissue. This causes lymphocytes to respond less to mitogens. Furthermore, immune cells synthesize and release β-endorphin, an endogenous opioid peptide that is an important immunomodulator and can rapidly decrease CD3 + , CD4 + , and CD4 +/CD8 + expression in peripheral blood, thereby leading to immunosuppression. Neuropeptides and other factors produced by the body as a result of cancer pain can inhibit the production and release of Il-2, which also leads to immune hypofunction.

Morphine is an analgesic for cancer pain which improves the quality of life of patients. Besides its analgesic effect, the clinical utility of morphine is limited by several adverse effects, including addiction, tolerance, immunosuppression, and constipation [3]. However, morphine is still regarded as the most effective medicine for patients with severe pain. How morphine influences tumor growth has been debated for years. Some studies indicate that morphine promotes tumor progression, while others suggest that morphine inhibits tumor progression.

This review attempts to clarify the dual function of morphine on tumor progression, including growth, angiogenesis, metastasis, inflammation, and immunomodulation (Fig. 1).
Fig. 1

Morphine has dual effect on tumor development

Effect of morphine on tumor cell growth

Many studies have investigated how morphine influences tumor cell growth. Some studies [4] reported that when morphine is administered at a concentration greater than 10 μM, tumor cell proliferation is inhibited. One study found that high concentrations of morphine reduced MCF-7 cell growth in nude mice [4]. A similar result was obtained when morphine treatment prevented neuroblastoma SH-SY5Y cells from differentiating [5]. Although many studies have shown that high concentrations of morphine can inhibit the proliferation of tumors, the mechanism remains unclear. The involvement of opioid receptors remains debatable. It was shown that opioids inhibit T47D cell growth, the mechanism of which was mediated through κ- and δ-opioid receptors [6]. Another aspect of morphine which may contribute to its antigrowth effect is via apoptosis promotion. Morphine activates c-JunN-terminal kinase, which generates reactive oxygen species (ROS), inducing the release of cytochrome c and caspase-9/3 by enhancing the pro-apoptotic protein Bim and reducing the anti-apoptotic protein Bcl-2 [7]. In addition to this mitochondrial pathway, morphine can also promote Fas-mediated apoptosis [8]. Apoptosis of MCF-7 cells was shown to be mediated by a novel δ-2 receptor, p53, and caspase-independent pathway [9]. Activation of the κ-opioid receptor (KOR) promotes apoptosis via a phospholipase C pathway in the CNE2 human epithelial tumor cell line [10]. There are obvious differences in the number of necrotic cells induced by morphine between different cell lines. For example, the number of necrotic cells in an MCF-7 cell line is higher than that in HL-60 and A549 cell lines [11]. This difference is largely dependent on how the cell lines react to morphine.

Despite this, there is also accumulating evidence for the growth-promoting effect of morphine. Sergeeva et al. [12] reported that morphine activates the proliferation of myeloid K562 and T-lymphoma Yurkat cells. Sabrina et al. [13] reported that clinically relevant concentrations of morphine can increase breast cancer progression. Recently, it was reported that morphine can inhibit cisplatin-induced apoptosis [14]. Some studies have confirmed that taking low doses of morphine can increase the growth of the tumor cell; however, the mechanism is still unclear. Some researchers have indicated that the μ-opioid receptor (MOR) may have a significant role in this mechanism. Mathew et al. [15] showed that compared to wild-type controls, μ-opioid receptor-knockout (MORKO) mice did not have significant tumor growth when injected with Lewis lung cancer cells. Further, after infusion of methylnaltrexone, a MOR antagonist, wild-type mice treated with Lewis lung cancer cells had a significant reduction, up to 90%, in tumor growth [15]. It has been pointed out that morphine can stimulate the mitogen-activated protein kinase (MAPK) or Erk pathways to regulate cell cycle progression by binding to the MOR [16]. Morphine can also stimulate the degranulation of mast cells to promote the release of neuropeptide substance P (SP) [17, 18], which has been shown to enhance the proliferation of tumor cells through the tachykinin 1 (NK-1) receptor [19]. The anti-apoptosis effect of morphine is involved. As naloxone cannot reverse this effect, a non-opioid receptor-mediated signaling pathway is implicated. Further reports suggest that morphine inhibits the generation of ROS and prevents the DOX-mediated activation of caspase-3, release of cytochrome c, and changes in Bax and Bcl-2 protein expression [20]. In addition, several researchers have focused their research efforts on Survivin, a member of the inhibitor of apoptosis family. It was shown that morphine can enhance renal cell carcinoma (RCC) growth by promoting the expression of Survivin [21].

Effect of morphine on angiogenesis

The formation of new blood vessels is an essential part of tumor development. Because morphine is one of the most commonly used drugs for treating cancer pain, its effect on angiogenesis has attracted great attention from researchers. When a solid tumor grows, newly proliferating tumor cells are localized far away from their vascular supply. This low oxygen or hypoxic environmental stimulates tumor cells to secrete vascular endothelial growth factor (VEGF) [22], which promotes the formation of new blood vessels to sustain the tumor growth [23]. Balasubramanian et al. [24] reported that in rat cardiomyocytes and human umbilical vein endothelial cells, morphine inhibits the secretion of VEGF induced by hypoxia. Koodie et al. [25] observed that when morphine is administered at clinically relevant analgesic doses by continuous slow release implantation, tumor cell-induced angiogenesis is reduced. They also confirmed that this inhibitory effect was mediated by hypoxia-induced mitochondrial p38 MAPK pathway inhibition [25]. Others [26] have argued that morphine also inhibits angiogenesis by suppressing VEGF signaling via the KOR, as KOR knockout mice grafted with Lewis lung carcinoma or B16 melanoma had more proliferation and enhanced angiogenesis compared to wild type mice [26]. In addition to its direct effect, morphine can also suppress the migration of leukocytes and reduce angiogenesis [27].

Morphine not only inhibits angiogenesis, but also promotes the formation of new blood vessels. It was shown by Bimonte [13] that clinically relevant concentrations of morphine stimulates tumor angiogenesis. Singleton and Moss [28] found that morphine can transactivate the VEGF receptor and stimulate angiogenesis and further, angiogenesis was blocked after the application of a MOR antagonist [28]. The transactivation of the VEGF receptor by morphine may be mediated by adhesion molecules, such as ICAM-1 [29]. Another implicated pathway is the stimulation of the MAPK signaling pathway through G protein-coupled receptors and nitric oxide (NO). Chronic morphine therapy can increase the levels of nitric oxide synthase (NOS), NO, and cyclooxygenase-2 (COX-2) in mouse kidneys [30]. Similarly, 2 weeks of chronic morphine therapy stimulated COX-2, prostaglandin E2, and angiogenesis, which was accompanied by increased tumor weight and metastasis and reduced survival [31]. It could thus be postulated that morphine can upregulate COX-2, increase prostaglandin E2, and promote angiogenesis.

Effect of morphine on tumor invasion and metastasis

The most common reason why a patient fails to respond to cancer treatment is not because of the original tumor itself, but instead, because of metastasis from the primary one. The activation of urokinase plasminogen activator (uPA) and matrix metalloproteinases (MMPs) play an important role in the degradation of the extracellular matrix (ECM), which is regarded as an indispensable step in tumor migration [32, 33]. MMP is a type of endopeptidase which can remodel the constituents of the ECM [32]. It was reported that morphine reduces the migration and invasion of breast cancer cells by inhibiting MMPs [34]. The findings from Katarzyna et al. [35] indicate that morphine exerts its inhibitory effect on MMP-2 and MMP-9 by inhibiting the NO/NOS system. Adhesion is also important for metastasis. Min et al. [36] clarified that morphine can weaken endothelial cell adhesion molecules induced by LPS-stimulated colon cancer cells and reduce metastasis.

However, conflicting data on the effects of morphine on tumor metastasis were simultaneously published. As mentioned before, uPA plays a crucial role in the degradation of the ECM [33]. Gach et al. [37] reported that in MCF-7 breast cancer cells, morphine significantly increases the secretion of uPA. Similarly, Nylund et al. [38] showed that in HT-29 colon cancer cells, morphine induces the secretion of uPA. Naloxone can reverse this morphine-induced upregulation, proving that opioid receptors were involved in the process. Recently, it has been found that over-expressing Survivin can promote tumors to metastasize and increase genomic instability, thereby promoting tumor invasion and metastasis [39, 40]. It was also shown that morphine can enhance RCC growth by promoting Survivin expression [39, 40].

Effect of morphine on inflammation

The inflammatory response plays a crucial role in the different stages of tumor development and mainly affects the tumor through two direct pathways: (1) adjusting the antitumor immunity of the host and (2) creating a pro-tumorigenic microenvironment. Boettger et al. [41] reported that morphine can reduce the inflammatory response in the chronic antigen-induced arthritis model. Further research showed that morphine can modulate inflammatory cytokines to inhibit inflammation [42]. In addition, morphine can induce the activation of KOR to exert its anti-inflammatory response [43]. As such, morphine can prevent inflammation, inhibit tumor growth, and ameliorate addiction.

In contrast to its inhibiting effects on inflammation, morphine can also stimulate the degranulation of mast cells to promote the release of the neuropeptide SP [17, 18]. This then aggravates the inflammatory response, helps the tumor escape from the immune surveillance, induces addiction, and increases the infection rate.

Effect of morphine on the immune system

A number of mechanisms for the effects of morphine on immunity have been described. Morphine regulates immune function by directly acting on immune cells and via indirect actions, which include interacting with the central nervous system (CNS) and promoting its release of immune mediators (Table 1).
Table 1

Morphine modules immune function by direct and indirect actions

 

The effects of morphine

Immune cells

 Innate cells

  Macrophages

Reduce the proliferation of macrophage progenitor cells

Reduce recruitment

Reduce Fcg R mediated phagocytosis

Reduce the release of NO

  NK cells

Suppress the activity of NK cells

 Adaptive cells

  B cells

Inhibit the function of macrophages and polymorphonuclear leukocytes

  T cells

Interfere with transcriptional activation of the IL-2 gene

Inhibit IFN-γ

CNS

 Acute administration

  PAG

Suppress NK cell cytotoxicity and lymphocyte proliferaiton

  NAS

Inhibit NK cell cytotoxicity

 Chronic administration

  HPA axis

Decrease NK cell cytotoxicity

Direct effects

Morphine induces immune suppression by directly regulating adaptive and innate cells, including macrophages, natural killer (NK) cells, B cells, and T cells.

For morphine to exert its direct effects on an immune cell, either the immune cell must express opioid receptors or morphine must be capable of working through non-opioid receptors [44].

Macrophages/phagocytic cells, together with NK cells, constitute the major part of innate immunity. Morphine reduces the number of macrophages that can be used to respond to infection by reducing the proliferation of macrophage progenitor cells [45] and inhibiting the recruitment of these cells [46]. In addition, macrophage phagocytosis can be inhibited [47] and macrophage bactericidal activity can be disrupted by reducing the release of NO [48]. Further studies have shown that deletion of the MOR gene completely eliminates the inhibitory effect of morphine on phagocytosis and bactericidal activity. Morphine substantially decreases the activity of NK cells. It is thought that morphine suppresses the activity of NK cells as a result of the activation of opioid receptors in the CNS [49].

Similar to its effect on the innate immune system, prolonged morphine treatment attenuates the adaptive immune response. T lymphocytes are the main cells involved in cellular immunity. They also regulate the activity of other cells through neuroendocrine mechanisms or cytokines. Chronic morphine treatment results in a decrease in cell viability, proliferative responses, T-helper cell function, and CD4/CD8 cell populations [50]. In addition, morphine has been shown to significantly reduce the production of IL-2, TNF-α, and IFN-γ in mouse spleen cell cultures [51]. Mechanistically, morphine can impair the proliferation of lymphocytes by interfering with the transcriptional activation of the IL-2 gene [52], as well as interfering with the activity of the IFN-γ promoter through two distinct cAMP-dependent pathways [50]. These effects are absent in MORKO mice, further demonstrating that the activation of MOR can lead to immunosuppressive effects. Contrary to T cell research, the effect of morphine on B-cell function is limited. B lymphocytes are involved in humoral immunity mainly by producing antibodies and memory cells. Morphine inhibits the function of macrophages and polymorphonuclear leukocytes via the neural immune circuit, thereby indirectly regulating B cell function [53].

Indirect effects

The indirect action of morphine on the immune system via the CNS is also supported by conflicting evidence [54]. Acute morphine administration releases biological amines into the periaqueductal gray to suppress NK cell cytotoxicity and lymphocyte proliferation [54, 55, 56]. Additionally, morphine releases neuropeptide γ via D1 receptors into the nucleus accumbens shell to inhibit splenic NK cell cytotoxicity [57]. Chronic morphine administration increases the activity of the hypothalamic–pituitary–adrenal axis and the release of immunosuppressive glucocorticoids, both of which decrease the cytotoxicity of NK cells [58, 59].

Conclusions and perspectives

Current research shows that morphine plays a dual role in the regulation of tumors, including its effect on tumor growth, angiogenesis, metastasis, inflammation, and immunity. However, the mechanisms remain unclear. The expression of MOR in tumors may be the key to these mechanisms. Morphine has a role in tumor growth and metastasis by modulating apoptosis and VEGF signaling. Thus, opioid antagonists might become novel therapeutic options for tumor treatment.

The major factors responsible for the dual role of morphine in tumors is the dose of morphine and type of tumor. Generally speaking, at high concentrations, morphine inhibits tumor cell growth, angiogenesis, invasion, and metastasis. However, low daily doses of morphine stimulates tumor cell proliferation, angiogenesis, and immunosuppression. The mechanism of the concentration-dependent effect of morphine is not clear. In addition, the effect of morphine is dependent on the type of cancer, since different cancer cells overexpress different opioid receptors.

In vitro and animal studies are principally used to explore these mechanisms, because the environment can be carefully controlled. However, the findings from these studies cannot be completely extrapolated to humans, as the internal environment of the human body is complex. As a result, further research is necessary to fully understand the effects of morphine on the development of tumors in a human physiological environment. A small number of studies have found that greater morphine requirement are associated with shorter progression-free and shorter survival rate [60, 61]. Thus, further studies are needed to determine how to utilize the advantages of morphine and minimize the negative effects. Until there is more reliable evidence, it is currently necessary to use the adequate dose of morphine needed to relieve pain in cancer patients.

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No informed consent is required.

References

  1. 1.
    Gupta M, Msambichaka L, Ballas SK, Gupta K. Morphine for the treatment of pain in sickle cell disease. Sci World J. 2015;2015:10.CrossRefGoogle Scholar
  2. 2.
    Shen LD, Yang J, Li YX, et al. Correlation between senile cancer pain and depression and its effect on immune function[J]. J Kunming Med Coll. 2011;2(3):31–4.Google Scholar
  3. 3.
    Grace Peter M, Maier Steven F, Watkins Linda R. Opioid-induced central immune signaling: implications for opioid analgesia. Headache. 2015;55(4):475–89.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Tegeder I, Grosch S, Schmidtko A, Haussler A, Schmidt H, Niederberger E, Scholich K, Geisslinger G. G protein-independent G1 cell cycle block and apoptosis with morphine in adenocarcinoma cell:involvement of p53 phosphorylation. Cancer Res. 2003;63(8):1846–52.PubMedGoogle Scholar
  5. 5.
    Gonzalez-Nunez Veronica, Noriega-Prieto Jose Antonio, Rodríguez Raquel E. Morphine modulates cell proliferation through mir133b & mir128 in the neuroblastoma SH-SY5Y cell line. Biochim Biophys Acta Mol Basis Dis. 2014;1842(4):566–72.CrossRefGoogle Scholar
  6. 6.
    Hatzoglou A, Bakogeorgou E, Castanas E. The antiproliferative effect of opioid receptor agonists on the T47D human breast cancer cell line, is partially mediated through opioid receptors. Eur J Pharmacol. 1996;296(2):199–207.PubMedCrossRefGoogle Scholar
  7. 7.
    Lin X, Wang YJ, Li Q, Hou YY, Hong MH, Cao YL, Chi ZQ, Liu JG. Chronic high-dose morphine treatment promotes SH-SY5Y cell apoptosis via c-Jun N-terminal kinase-mediated activation of mitochondria-dependent pathway. FEBS J. 2009;276(7):2022–36.PubMedCrossRefGoogle Scholar
  8. 8.
    Yin D, Mufson RA, Wang R, Shi Y. Fas-mediated cell death promoted by opioids. Nature. 1999;397(6716):218.PubMedCrossRefGoogle Scholar
  9. 9.
    Pati ML, Hornick JR, Niso M, Berardi F, Spitzer D. Sigma-2 receptor agonist derivatives of 1-Cyclohexyl-4-[3-(5-methoxy-1,2,3,4-tetrahydronaphthalen-1-yl)propyl]piperazine (PB28) induce cell death via mitochondrial superoxide production and caspase activation in pancreatic cancer. BMC Cancer. 2017;17(1):51.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Diao CT, Li L, Lau SY, Wong TM, Wong NS. kappa-Opioid receptor potentiates apoptosis via a phospholipase C pathway in the CNE2 humanepithelial tumor cell line. Biochim Biophys Acta. 2000;1499(1–2):49–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Hatsukari Ikusuke, Hitosugi Naoko, Ohno Rie, Hashimoto Ken, Nakamura Shinichi, Satoh Kazue, Nagasaka Hiroshi, Matsumoto Isao, Sakagami Hiroshi. Induction of apoptosis by morphine in human tumor cell lines in vitro. Anticancer Res. 2007;27(2):857–64.PubMedGoogle Scholar
  12. 12.
    Sergeeva MG, Grishina ZV, Varfolomeyev SD. Morphine effect on proliferation of normal and tumor cells of immune origin. Immunol Lett. 1993;36(2):215–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Bimonte Sabrina, Barbieri Antonio, Rea Domenica, Palma Giuseppe, Luciano Antonio, Cuomo Arturo, Arra Claudio, Izzo Francesco. Morphine Promotes Tumor Angiogenesis and Increases Breast Cancer Progression. Biomed Res Int. 2015;2015:161508.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Cao LH, Li HT, Lin WQ, et al. Morphine, a potential antagonist of cisplatin cytotoxicity, inhibits cisplatin induced apoptosis and suppression of tumor growth in nasopharyngeal carcinoma xenografts. Sci Rep. 2016;6:18706.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Mathew B, Lennon FE, Siegler J, Mambetsariev N, et al. The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation. Anesth Analg. 2011;112(3):558–67.PubMedCrossRefGoogle Scholar
  16. 16.
    Fujioka N, Nguyen J, Chen C, Li Y, Pasrija T, Niehans G, Johnson K, Gupta V, Kratzke R, Kalpna G. Morphine-induced epidermal growth factor pathway activation in non-small cell lung cell. Anesth Analg. 2011;113(6):1353–64.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Vincent L, Vang D, Nguyen J, et al. Mast cell activation contributes to sickle cell pathobiology and pain in mice. Blood. 2013;122:1853–62.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Aich A, Afrin LB, Gupta K. Mast cell-mediated mechanisms of nociception. Int J Mol Sci. 2015;16:29069–92.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Muñoz M, Coveñas R. Involvement of substance P and the NK-1 receptor in cancer progression. Peptides. 2013;48:1–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Lin X, Li Q, Wang YJ, Ju YW, Chi ZQ, Wang MW, Liu JG. Morphine inhibits doxorubicin-induced reactive oxygen species generation and nuclear factor kappaB transcriptional activation in neuroblastoma SH-SY5Y cells. Biochem J. 2007;406(2):215–21.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Ma Y, Ren Z, Ma S, Yan W, He M, Wang D, Ding P. Morphine enhances renal cell carcinoma aggressiveness through promotes survivin level. Ren Fail. 2017;39(1):258–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Folkman J, D’Amore PA. Blood vessel formation: what is its molecular basis? Cell. 1996;87(7):1153–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Brekken RA, Thorpe PE. Vascular endothelial growth factor and vascular targeting of solid tumors. Anticancer Res. 2001;21(6b):4221–9.PubMedGoogle Scholar
  24. 24.
    Balasubramanian S, Ramakrishnan S, Charboneau R, Wang J, Barke RA, Roy S. Morphine sulfate inhibits hypoxia-induced vascular endothelial growth factor expression in endothelial cells and cardiac myocytes. J Mol Cell Cardiol. 2001;33:2179–87.PubMedCrossRefGoogle Scholar
  25. 25.
    Koodie L, Ramakrishnan S, Roy S. Morphine suppresses tumor angiogenesis through a HIF-1alpha/p38MAPK pathway. Am J Pathol. 2010;177(2):984–97.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Yamamizu K, Hamada Y, Narita M. j Opioid receptor ligands regulate angiogenesis in development and in tumours. Br J Pharmacol. 2015;172(2):268–76.PubMedCrossRefGoogle Scholar
  27. 27.
    Koodie L, Yuan H, Pumper JA, et al. Morphine inhibits migration of tumor-infiltrating leukocytes and suppresses angiogenesis associated with tumor growth in mice. Am J Pathol. 2014;184:1073–84.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Singleton PA, Moss J. Effect of perioperative opioids on cancer recurrence: a hypothesis. Future Oncol. 2010;6(8):1237–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Kevil CG, Orr AW, Langston W, Mickett K, Murphy-Ullrich J, Patel RP, et al. Intercellular adhesion molecule-1 (ICAM-1) regulates endothelial cell motility through a nitric oxide-dependent pathway. J Biol Chem. 2004;279(18):19230–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Leo S, Nuydens R, Meert TF. Opioid-induced proliferation of vascular endothelial cells. J Pain Res. 2009;2:59–66.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Farooqui M, Li Y, Rogers T, Poonawala T, Griffin RJ, Song CW, et al. COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia. Br J Cancer. 2007;97(11):1523–31.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Yamamoto Kazuhiro, Murphy Gillian, Troeberg Linda. Extracellular regulation of metalloproteinases. Matrix Biol. 2015;44–46:255–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Gouri Adel, Dekaken Aoulia, El Bairi Khalid, Aissaoui Arifa, Laabed Nihad, Chefrour Mohamed, Ciccolini Joseph, Milano Gérard, Benharkat Sadek. Plasminogen activator system and breast cancer: potential role in therapy decision making and precision medicine. Biomarker Insight. 2016;11:105–11.CrossRefGoogle Scholar
  34. 34.
    Xie Nan, Khabbazi Samira, Nassar Zeyad D, Gregory Kye, Vithanage Tharindu, Anand-Apte Bela, Cabot Peter J, Sturgess David, Shaw Paul N, Parat Marie-Odile. Morphine alters the circulating proteolytic profile in mice: functional consequences on cellular migration and invasion. FASEB J. 2017;31(12):5208–16.PubMedCrossRefGoogle Scholar
  35. 35.
    Gach Katarzyna, Szemraj Janusz, Wyrębska Anna, Janecka Anna. The influence of opioids on matrix metalloproteinase-2 and -9 secretion and mRNA levels in MCF-7 breast cancer cell line. Mol Biol Rep. 2011;38(2):1231–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Min Too Jae, Park Sang-Hee, Ji Yi-Hwa, Lee Yoon-Sook, Kim Tae Woo, Kim Jae Hwan, Kim Woon-Young, Park Young-Cheol. Morphine attenuates endothelial cell adhesion molecules induced by the supernatant of LPS-stimulated colon cancer cells. J Korean Med Sci. 2011;26(6):747–52.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Gach K, Szemraj J, Fichna J, Piestrzeniewicz M, Delbro DS, Janecka A. The influence of opioids on urokinase plasminogen activator on protein and mRNA level in MCF-7 breast cancer cell line. Chem Biol Drug Des. 2009;74(4):390–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Nylund G, Pettersson A, Bengtsson C, Khorram-Manesh A, Nordgren S, Delbro DS. Functional expression of mu-opioid receptors in the human colon cancer cell line, HT-29, and their localization in human colon. Dig Dis Sci. 2008;53(2):461–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Liu S, Qi L, Yu Q, et al. Survivin and HLA-I expression predicts survival of patients with clear cell renal cell carcinoma. Tumour Biol. 2014;35:8281–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Chen X, Chen XG, Hu X, et al. MiR-34a and miR-203 inhibit survivin expression to control cell proliferation and survival in human osteosarcoma cells. J Cancer. 2016;7:1057–65.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Boettger MK, Weber K, Gajda M, Brauer R, Schaible HG. Spinally applied ketamine or morphine attenuate peripheral inflammation and hyperalgesia in acute and chronic phases of experimental arthritis. Brain Behav Immun. 2010;24(3):474–85.PubMedCrossRefGoogle Scholar
  42. 42.
    Cabot PJ, Carter L, Gaiddon C, Zhang Q, Schafer M, Loeffler JP, Stein C. Immune cell-derived beta-endorphin. Production, release, and control of inflammatory pain in rats. J Clin Invest. 1997;100(1):142–8.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Finley MJ, Happel CM, Kaminsky DE, Rogers TJ. Opioid and nociceptin receptors regulate cytokine and cytokine receptor expression. Cell Immunol. 2008;252(1–2):146–54.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Sabita R, Jinghua W, Jennifer K, Lisa K, Josephine M. Modulation of immune function by morphine: implications for susceptibility to infection. J Neuroimmun Pharmacol. 2006;1:77–89.CrossRefGoogle Scholar
  45. 45.
    Roy S, Wang J, Kelschenbach J, Koodie L, Martin J. Modulation of immune function by morphine: implications for susceptibility to infection. J Neuroimmune Pharmacol. 2006;1:77–89.PubMedCrossRefGoogle Scholar
  46. 46.
    Grimm MC, Ben-Baruch A, Taub DD, Howard OM, Resau JH, Wang JM, Ali H, Richardson R, Snyderman R, Oppenheim JJ. Opiates transdeactivate chemokine receptors: delta and mu opiate receptor-mediated heterologous desensitization. J Exp Med. 1998;188:317–25.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Ninkovic J, Roy S. Role of the mu-opioid receptor in opioid modulation of immune function. Amino Acids. 2013;45:9–24.PubMedCrossRefGoogle Scholar
  48. 48.
    Menzebach A, Hirsch J, Nost R, Mogk M, Hempelmann G, Welters ID. Morphine inhibits complement receptor expression, phagocytosis and oxidative burst by a nitric oxide dependent mechanism. Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;39:204–11.PubMedCrossRefGoogle Scholar
  49. 49.
    Tabellini G, Borsani E, Benassi M, et al. Effects of opioid therapy on human natural killer cells. Int Immunopharmacol. 2014;18:169–74.PubMedCrossRefGoogle Scholar
  50. 50.
    Ninković Jana, Roy Sabita. Role of the mu-opioid receptor in opioid modulation of immune function. Amino Acids. 2013;45(1):9–24.PubMedCrossRefGoogle Scholar
  51. 51.
    Machelska H, Cabot PJ, Mousa SA, Zhang Q, Stein C. Pain control in inflammation governed by selectins. Nat Med. 1998;4:1425–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Roy S, Chapin RB, Cain KJ, Charboneau RG, Ramakrishnan S, Barke RA. Morphine inhibits transcriptional activation of IL-2 in mouse thymocytes. Cell Immunol. 1997;179:1–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Liang Xuan, Liu Renyu, Chen Chunhua, Ji Fang, Li Tianzuo. Opioid system modulates the immune function: a review. Trans Perioperat Pain Med. 2016;1(1):5–13.Google Scholar
  54. 54.
    Weber RJ, Pert A. The periaqueductal gray matter mediates opiate-induced immunosuppression. Science. 1989;245:188–90.PubMedCrossRefGoogle Scholar
  55. 55.
    Irwin M, Hauger RL, Brown M, Britton KT. CRF activates autonomic nervous system and reduces natural killer cytotoxicity. Am J Physiol. 1988;255(5 Pt 2):R744–7.PubMedGoogle Scholar
  56. 56.
    Hernandez MC, Flores LR, Bayer BM. Immunosuppression by morphine is mediated by central pathways. J Pharmacol Exp Ther. 1993;267:1336–41.PubMedGoogle Scholar
  57. 57.
    Saurer TB, Ijames SG, Lysle DT. Neuropeptide Y Y1 receptors mediate morphine-induced reductions of natural killer cell activity. J Neuroimmunol. 2006;177:18–26.PubMedCrossRefGoogle Scholar
  58. 58.
    Fecho K, Maslonek KA, Dykstra LA, Lysle DT. Evidence for sympathetic and adrenal involvement in the immunomodulatory effects of acute morphine treatment in rats. J Pharmacol Exp Ther. 1996;277:633–45.PubMedGoogle Scholar
  59. 59.
    Mellon RD, Bayer BM. Role of central opioid receptor subtypes in morphine-induced alterations in peripheral lymphocyte activity. Brain Res. 1998;789:56–67.PubMedCrossRefGoogle Scholar
  60. 60.
    Zylla D, Gourley BL, Vang D, et al. Opioid requirement, opioid receptor expression, and clinical outcomes in patients with advanced prostate cancer. Cancer. 2013;119:4103–10.PubMedCrossRefGoogle Scholar
  61. 61.
    Zylla D, Ma Kuskowski, Gupta K, Gupta P. Association of opioid requirement and cancer pain with survival in advanced non-small cell lung cancer. Br J Anaesth. 2014;113:1–8.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  1. 1.The First Hospital of Jilin UniversityJilin CityChina

Personalised recommendations