Skip to main content
SpringerLink
Log in

Die Bedeutung der Opiatantagonisten bei der Behandlung des septischen Schocks

  • Chapter
Sepsis

Zusammenfassung

Die endogenen Opioide werden durch eine Gruppe von Peptidmolekülen repräsentiert, die sowohl in vitro als auch in vivo opiatähnliche Wirkungen hervorrufen. Im letzten Jahrzehnt hat die Erforschung der endogenen Opioide und deren Rezeptoren (zusammengefaßt als „endogene Opioidsysteme“ bezeichnet) eine Reihe wichtiger physiologischer, pharmakologischer und psychischer Funktionen erbracht, die von diesen beeinflußt werden. Von besonderer Bedeutung sind dabei Opiatantagonisten wie Naloxon, die sich als empfindliches Instrument beim Erarbeiten von Einblicken in die Wirkungsweise der endogenen Opioide erwiesen haben. Dieses Kapitel gibt einen Überblick über einige wichtige Ergebnisse, die darauf hindeuten, daß die endogenen Opioidsysteme in der Pathogenese des endotoxischen und septischen Schocks eine pathophysiologische Rolle spielen. Auch auf die klinische Bedeutung von Naloxon und anderen Opiatantagonisten soll eingegangen werden.

Die Meinungen und Thesen, die in diesem Aufsatz zum Ausdruck gebracht werden, entsprechen den privaten Ansichten der Autoren und dürfen nicht als offiziell angesehen werden; auch entsprechen sie nicht notwendigerweise den Ansichten des U.S. Army Medical Research Development and Command, der Uniformed Services University of the Health Sciences oder des Department of Defense. Gegen einen Vortrag und/oder eine Veröffentlichung bestehen keine Einwände. Der Autor möchte sich bei Mrs. M. Paige für ihre Unterstützung beim Erstellen dieses Manuskripts bedanken.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 64.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 84.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Adams HP Jr, Olinger CP, Barsan WG, et al. (1986) A dose-escalation study of large doses of naloxone for treatment of patients with acute cerebral ischemia. Stroke 17 (3): 404–409

    Article  PubMed  Google Scholar 

  2. Amir S (1986) Endorphins contribute to the loss of glucose homeostasis in anaphylactic shock. In: Progress in opioid research: proceedings of the international narcotics research conference. NIDA Research Monograph Series 75: 539–542

    Google Scholar 

  3. Bernton EW, Long JB, Holaday JW (1985) Opioids and neuropeptides: mechanisms in circulatory shock. Federation Proc 44: 290–299

    CAS  Google Scholar 

  4. Bhargava HN, Das S (1986) Evidence for opiate action at the brain receptors for thyrotropin-releasing hormone. Brain Research 368: 262–267

    Article  PubMed  CAS  Google Scholar 

  5. Bhargava HN, Yousif DJ, Matwyshyn GA (1983) Interactions of thyrotropin releasing hormone, its metabolites and analogues with endogenous and exogenous opiates. Gen Pharmac 14 (6): 565–570

    Article  CAS  Google Scholar 

  6. Brasch H (1986) Influence of the optical isomers (+)- and (—)-naloxone on beating frequency, contractile force and action potentials of guinea-pig isolated cardiac preparations. Br J Pharmac 88: 733–740

    Article  CAS  Google Scholar 

  7. Bryant HU, Bernton EW, Holaday JW (1987) Immunosuppressive effects of chronic morphine treatment in mice. Life Sciences 41: 1731–1738

    Article  PubMed  CAS  Google Scholar 

  8. Butler PD, Bodnar RJ (1984) Potentiation of foot shock analgesia by thyrotropin releasing hormone. Peptides 5: 635–639

    Article  PubMed  CAS  Google Scholar 

  9. Caffrey JL, Gaugl JF, Jones CE (1985) Local endogenous opiate activity in dog myocardium: receptor blockade with naloxone. Am J Physiol 248 (Heart Circ Physiol 17): H382 - H388

    PubMed  CAS  Google Scholar 

  10. Caffrey JL, Wooldridge B, Gaugl JF (1985) The interaction of endogenous opiates with autonomic circulatory control in the dog. Circ Shock 17: 233–242

    PubMed  CAS  Google Scholar 

  11. Caffrey JL, Wooldridge B, Gaugl JF (1986) Naloxone enhances myocardial responses to isoproterenol in dog isolated heart-lung. Am J Physiol 250 (Heart Circ Physiol 19): H749 - H754

    PubMed  CAS  Google Scholar 

  12. Chernow B, Lake CR, Teich S, et al (1986) Hemorrhagic hypotension increases plasma beta-endorphin concentrations in the nonhuman primate. Critical Care Medicine 14 (5): 505–507

    Article  PubMed  CAS  Google Scholar 

  13. Curtis MT, Lefer AM (1980) Protective actions of naloxonc in hemorrhagic shock. Am J Physiol 239: H416–421

    PubMed  CAS  Google Scholar 

  14. D’Amato RJ, Holaday JW (1984) Multiple opiate receptors in endotoxic shock: evidence for S involvement and ji-6 interactions in vivo. Proc Natl Acad Sci 81: 2898–2901

    Article  PubMed  Google Scholar 

  15. DeMaria A, Heffernan JJ, Grindlinger GA, et al. (1985) Naloxone versus placebo in treatment of septic shock. Lancet June 15: 1363–1365

    Article  Google Scholar 

  16. Eiden LE, Ruth JA (1982) Enkephaline modulate the responsiveness of rat atria in vitro to norepinephrine. Peptides 3 (3): 475–478

    Article  PubMed  CAS  Google Scholar 

  17. Evans AGJ, Nasmyth PA, Steward HC (1952) The fall of blood pressure caused by intravenous morphine in the rat and cat. Br J Pharmacol 7: 542–552

    CAS  Google Scholar 

  18. Faden AI (1984) Opiate antagonists and thyrotropin-releasing hormone: potential role in the treatment of shock. JAMA 252 (9): 1177–1180

    Article  PubMed  CAS  Google Scholar 

  19. Faden AI (1984) Opiate antagonists and thyrotropin-releasing hormone: potential role in the treatment of central nervous system injury. JAMA 252 (11): 1452–1454

    Article  PubMed  CAS  Google Scholar 

  20. Faden AI, Holaday JW (1980) Naloxone treatment of endotoxin shock: stereospecificity of physiologic and pharmacologic effects in the rat. J Pharm Exp Ther 212: 441–447

    CAS  Google Scholar 

  21. Faden AI, Pilotte NS, Burt DR (1986) Experimental spinal cord injury: effects of trauma or ischemia on TRH and muscarinic receptors. Neurology 36: 723–726

    Article  PubMed  CAS  Google Scholar 

  22. Feuerstein G, Chiueh CC, Kopin IJ (1981) Effects of naloxone on the cardiovascular and sympathetic response to hypovolemic hypotension in the rat. Eur J Pharmacol 75: 65–69

    Article  PubMed  CAS  Google Scholar 

  23. Flamm ES, Young W, Collins WF, et al. (1985) A phase 1 trial of naloxone treatment in acute spinal cord injury. J Neurosurg 63: 390–397

    Article  PubMed  CAS  Google Scholar 

  24. Giuffre KA, Udelsman R, Listwak S, Chrousos GP (1988) Effects of immune neutralization of corticotropin-releasing hormone, adrenocorticotropin, and ß-endorphin in the surgically stressed rat. Endocrinology 122 (1): 306–310

    Article  PubMed  CAS  Google Scholar 

  25. Grevert P, Albert LH, Inturrisi CE, Goldstein A (1983) Effects of eight-hour naloxone infusions on human subjects. Biological Psychiatry 18 (12): 1375–1392

    PubMed  CAS  Google Scholar 

  26. Groeger JS (1986) Opioid antagonists in circulatory shock. Critical Care Medicine 14 (2): 170–171

    Article  PubMed  CAS  Google Scholar 

  27. Gurll NJ, Holaday JW, Reynolds DG et al. (1987) Thyrotropin releasing hormone: effects in monkeys and dogs subjected to experimental circulatory shock. Crit Care Med 15 (6): 574–581

    Article  PubMed  CAS  Google Scholar 

  28. Hamilton AJ, Carr DB, LaRovere JM, et al. (1986) Endotoxic shock elicits greater endorphin secretion than hemorrhage. Circ Shock 19: 47–54

    PubMed  CAS  Google Scholar 

  29. Higgins TL, Sivak ED, O’Neil DM et al. (1983) Reversal of hypotension by continuous naloxone infusion in a ventilator-dependent patient. Annals of Internal Medicine 98 (1): 47–48

    Article  PubMed  CAS  Google Scholar 

  30. Hinshaw LB, Archer LT, Beller BK, Ishida K, Chang AC, Brackett DJ, Flourney DJ, Passey RB, Wilson MF, Long JB, Holaday JW (in press) Further evaluation of naloxone therapy for E. coli sepsis in the baboon. Archives of Surgery

    Google Scholar 

  31. Hinshaw LB, Beller BK, Chang AC, et al. (1984) Evaluation of naloxone for therapy of Escherichia coli shock. Arch Surg 119: 1410–1418

    Article  PubMed  CAS  Google Scholar 

  32. Holaday JW (1983) Cardiovascular effects of the endogenous opiate system. In: Annual Review of Pharmacology 23: 541–594

    Google Scholar 

  33. Holaday JW (1984) Neuropeptides in shock and trauma injury: sites and mechanisms of action. Neuroendocrine Perspectives 3: 161–199

    CAS  Google Scholar 

  34. Holaday JW (1985) Endogenous opioids and their receptors. In: Current concepts, Kalamazoo MI, Scope Publications, Upjohn

    Google Scholar 

  35. Holaday JW, Bernton EW (1984) Thyrotropin releasing hormone: a potent neuromodulator with therapeutic potential. Arch Int Medicine 144: 1138–1140

    Article  CAS  Google Scholar 

  36. Holaday JW, D’Amato RJ (1983) Multiple opioid receptors: evidence for p-6 site interactions in endotoxic shock. Life Sci 33: 703–706

    Article  PubMed  CAS  Google Scholar 

  37. Holaday JW, D’Amato RJ, Faden AI (1981) Thyrotropin releasing hormone improves cardiovascular function in experimental endotoxic and hemorrhagic shock. Science 213: 216–218

    Article  PubMed  CAS  Google Scholar 

  38. Holaday JW, Faden AI (1978) Naloxone reversal of endotoxin hypotension suggests role of endorphins in shock. Nature 275: 450–451

    Article  PubMed  CAS  Google Scholar 

  39. Iloladay JW, Faden AI (1983) TRH: Autonomic effects upon cardiorespiratory function in endotoxic shock. Reg Peptides 7: 111–125

    Google Scholar 

  40. Holaday JW, Kenner JR, Clatt CE, et al (1984) Dynorphin: cardiovascular consequences of opioid receptor interactions in normal and endotoxemic rats. Proc West Pharmacol Soc 27: 429–433

    PubMed  CAS  Google Scholar 

  41. Holaday JW, Long JB, Tortella FC (1985) Evidence for kappa, mu and delta opioid binding site interactions in vivo. Federation Proceedings 44: 2860–2862

    CAS  Google Scholar 

  42. Holaday JW, O’Hara M, Faden AI (1981) Hypophysectomy alters cardiorespiratory variables: central effects of pituitary endorphins in shock. Am J Physiol 241 (Heart & Circ Physiol) 10: H479 — H495

    Google Scholar 

  43. Holaday JW, Pasternak GW, D’Amato RJ, et al. (1983) Naloxazone lacks therapeutic effects in endotoxic shock yet blocks the effects of naloxone. Eur J Pharmacol 89: 293–296

    Article  PubMed  CAS  Google Scholar 

  44. Holaday JW, Ruvio BA, Faden AI (1981) Thyrotropin releasing hormone improves blood pressure and survival in endotoxic shock. Eur J Pharmacol 74: 101–105

    Article  PubMed  CAS  Google Scholar 

  45. Holaday JW, Ruvio BA, Robles LE, et al. (1982) ICI MI54,129, a putative delta antagonist, reverses endotoxic shock without altering morphine analgesia. Life Sci 31: 2209–2212

    Article  PubMed  CAS  Google Scholar 

  46. Holaday JW, Tortella FC (1984) Multiple opioid receptors: Possible physiological functions of, u and a binding sites in vivo. In: Mueller EE, Genazzani AR (eds) Central and peripheral endorphins. Raven, New York, pp 237–250

    Google Scholar 

  47. Holaday JW, Tseng LF, Loh HH, et al. (1978) Thyrotropin releasing hormone antagonizes ß-endorphin hypothermia and catalepsy. Life Sci 22: 1537–1544

    Article  PubMed  CAS  Google Scholar 

  48. Horita A, Carino MA, Lai H (1986) Pharmacology of thyrotropin-releasing hormone. Ann Rev Pharmacol Toxicol 26: 311–332

    Article  CAS  Google Scholar 

  49. Horton JW, Tuggle DW, Kiser RS (1984) Effect of temperature on naloxone treatment in canine hemorrhagic shock. Circ Shock 14: 251–265

    PubMed  CAS  Google Scholar 

  50. Hughes GS (1984) Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life Sci 35 (23): 2319–2326

    Article  PubMed  CAS  Google Scholar 

  51. Jansen HF, Lutherer LO (1980) Ventriculocisternal administration of naloxone protects against severe hypotension during endotoxin shock. Brain Res 194: 608–612

    Article  Google Scholar 

  52. Koyama S, Santiesteban HL, Ammons WS, et al. (1983) The effects of naloxone on the peripheral sympathetics in cat endotoxin shock. Circ Shock 10: 7–13

    PubMed  CAS  Google Scholar 

  53. Krumins SA, Faden AI, Feuerstein G (1985) Opiate binding in rat hearts: modulation of binding after hemorrhagic shock. Biochem and Biophys Res Comm 127 (1): 120–128

    Article  CAS  Google Scholar 

  54. Lechner RB, Gurll NJ, Reynolds DG (1985) Intercoronary naloxone in hemorraghic shock: dose-dependent stereospecific effects. Am J Physiology 249: H272–277

    CAS  Google Scholar 

  55. Lechner RB, Gurll NJ, Reynolds DG (1985) Naloxone potentiates the cardiovascular effects of catecholamines in canine hemorrhagic shock. Circ Shock 16: 347–361

    PubMed  CAS  Google Scholar 

  56. Lechner RB, Gurll NJ, Reynolds DG (1985) Role of the autonomic nervous system in mediating the response to naloxone in canine hemorrhagic shock. Circ Shock 16: 279–295

    PubMed  CAS  Google Scholar 

  57. Long JB, Lake CR, Reid AA, et al. (1986) Effects of naloxone and thyrotropin releasing hormone on plasma catecholamines, corticosterone, and arterial pressure in normal and endotoxemic rats. Circ Shock 18: 1–10

    PubMed  CAS  Google Scholar 

  58. Long JB, Ruvio BA, Glatt CE, et al. (1984) ICI 174864, a putative 1 opioid antagonist, reverses endotoxemic hypotension: pretreatment with dynorphin 1–13, a x agonist, blocks this action. Neuropeptides 5: 291–294

    Article  PubMed  CAS  Google Scholar 

  59. Malcolm DS, Zaloga GP, Willey SC, et al. (1988) Naloxone potentiates epinephrine’s hypertensive effects in endotoxemic rats. Circ Shock, submitted

    Google Scholar 

  60. Manaker S, Winokur A, Rhodes CH, et al. (1985) Autoradiographic localization of thyrotropin-releasing hormone ( TRH) receptors in human spinal cord. Neurology 35: 328–332

    Google Scholar 

  61. McIntosh TK, Faden AI (1986) Thyrotropin-releasing hormone ( TRH) and circulatory shock. Circ Shock 18: 241–258

    Google Scholar 

  62. McIntosh TK, Palter M, Grasberger R, et al. (1985) Effect of an opiate antagonist (naloxone) and an agonist/antagonist (nalbuphine) in primate hemorrhagic shock. Circ Shock 17: 313–325

    PubMed  CAS  Google Scholar 

  63. McMenamin DV, Smith EM, Blalock JE (1985) Endotoxin induction of leukocyte-derived proopiomelanocortin-related peptides. Infect Immun 48: 813–817

    Google Scholar 

  64. Miller RR, Menke JA, Hansen NB, Zwick DL, Bickers RG, Nowicki PT (1986) The effect of naloxone on the hemodynamics of the newborn piglet with septic shock. Pediatric Research 20 (8): 707–710

    Article  PubMed  CAS  Google Scholar 

  65. Putterman C, Halpern P, Leykin Y, et al. (1986) Early use of naloxone in shock — a clinical trial. Resuscitation 13: 185–190

    Article  PubMed  CAS  Google Scholar 

  66. Reynolds DG, Gurll NJ, Vargish T, et al. (1980) Blockade of opiate receptors with naloxone improves survival and cardiac performance in canine endotoxic shock. Circ Shock 7: 39–48

    PubMed  CAS  Google Scholar 

  67. Riggs TR, Yano Y, Vargish T (1986) Morphine depression of myocardial function. Circ Shock 19: 31–38

    PubMed  CAS  Google Scholar 

  68. Schadt JC, York DH (1981) The reversal of hemorrhagic hypotension by naloxone in conscious rabbits. Can J Physiol Pharmacol 59: 1208–1213

    Article  PubMed  CAS  Google Scholar 

  69. Van DeMeer K, Valkenburg PW, Bastiaans AC, et al. (1986) Effect of naloxone on blood pressure and survival in different shock models in rats. Eur J Pharmacol 124: 299–308

    Article  Google Scholar 

  70. Weld JM, Kamerling SG, Combie JD, et al. (1984) The effects of naloxone on endotoxic and hemorrhagic shock in horses. Res Comm in Chem Pathol Pharmacol 44 (2): 227–238

    CAS  Google Scholar 

Download references

Authors
  1. J. W. Holaday
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Universitätsklinikum Steglitz Klinik für Anästhesiologie und operative Intensivmedizin, Freie Universität Berlin, Hindenburgdamm 30, D-1000, Berlin 45, Deutschland

    K. Reinhart  & K. Eyrich  & 

Rights and permissions

Reprints and permissions

Copyright information

© 1989 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Holaday, J.W. (1989). Die Bedeutung der Opiatantagonisten bei der Behandlung des septischen Schocks. In: Reinhart, K., Eyrich, K. (eds) Sepsis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-09869-1_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-09869-1_30

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-09870-7

  • Online ISBN: 978-3-662-09869-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation