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Margaret A. Naeser, Ph.D., Lic.Ac., Dipl. Ac. "Neurological Rehabilitation: Acupuncture and Laser Acupuncture To Treat Paralysis in Stroke and Other Paralytic Conditions and Pain in Carpal Tunnel Syndrome" Research Professor of Neurology Neuroimaging Section Boston University Aphasia Research Center Veterans Affairs Medical Center Boston, Massachusetts Lorenz K.Y. Ng, M.D. "What Is Acupuncture?" Clinical Professor of Neurology George Washington University School of Medicine Medical Director Pain Management Program National Rehabilitation Hospital Bethesda, Maryland Andrew Parfitt, Ph.D. "Nausea and Vomiting" Researcher Laboratory of Developmental Neurobiology National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland Bruce Pomeranz, M.D., Ph.D. "Summary of Acupuncture and Pain" Professor Departments of Zoology and Physiology University of Toronto Toronto, Ontario, Canada and proventil.
Increased neurotransmitter release, have also been reported Crain and Shen, 1990 ; . Opioids usually inhibit cAMP formation as confirmed here ; and have little or no effect on Ins 1, 4, 5 ; P3 formation Childers, 1991 ; , but opioid-induced stimulation of the production of both second messengers in neuronal tissues has recently been reported Olianas and Onali, 1993; Smart et al., 1994a ; . Noteably, in this study fentanyl, over the same dose range, stimulated one second messenger while inhibiting the other. Although dual excitatory and inhibitory effects of opioids in neuronal tissue have been reported previously Higashi et al., 1982; Jin et al., 1992 ; , the type of effect seen depended on the dose of opioid used. For example, in NG108-15 cells nanomolar concentrations of 6-opioids increased [Ca2l] while at micromolar concentrations they decreased [Ca2l], Jin et al., 1992 ; . Taken at face value our data showing stimulation of Ins l, 4, 5 ; P3 formation and inhibition of cAMP turnover suggest that the , t-opioid receptor on SH-SY5Y cells is exhibiting G-protein promiscuity. In a recent report Johnson et al. 1994 ; described in COS cells transiently expressing the cloned opioid receptor , aORl, that promiscuity may occur to cAMP inhibition and inhibition of Ins 1, 4, 5 ; P3 formation. However, our previous studies indicate that both events in SH-SY5Y cells are mediated by a pertussis toxin-sensitive G-protein Smart et al., 1994a ; , implying Gprotein fidelity. Clearly, further studies will be required to settle this issue, using titratable levels of cloned receptors at close to endogenous concentrations. There are two possible mechanisms for the stimulation of Ins 1, 4, 5 ; P3 formation caused bycu-opioids. First y subunits from Gi G. could activate PLC. Alternatively u-opioids could open a Ca2l channel, allowing Ca2 + -influx-dependent activation of PLC. Neither 6-opioid nor a2 agonists stimulated Ins 1, 4, 5 ; P3 formation, while the, -opioid agonist DAMGO did Table 1. ; . It worth noting that SH-SY5Y cells do not express K-opioid receptors Yu et al., 1986 ; . Furthermore, neither 1-opioid nor a2 agonists enhanced the Ins 1, 4, 5 ; P3 response to a submaximal dose of DAMGO, ruling out the possibility that insufficent , y subunits were liberated to have a stimulatory effect. Therefore, as all three of these receptors couple to Gi Yu al., 1986; Lambert and Nahorski, 1990a ; , this indicates that fl y-subunit activation of PLC, as seen in other cell types Birnbaumer, 1992 ; , is unlikely to occur in SH-SY5Y cells. However u- and 8-opioid receptors couple to different subtypes of Gi in SH-SY5Y cells Laugwitz et al., 1993 ; , and they may also couple differentially to Go, as in rat cortical membranes where the two receptor subtypes couple to different types of Go Moriaty et al., 1990; Georgoussi et al., 1993 ; . Thus, as the type of fl y subunit varies between G-protein subtypes Pronin and Gautam, 1992 ; , and some reports indicate that fl y-determined signal transduction is selective Kleuss et al., 1993 ; , there remains the possibility that f y subunits are involved in the stimulatory effects of , u-opioids in SH-SY5Y cells. Fentanyl did not increase Ins 1, 4, 5 ; P3 formation in Ca2 + -free conditions, as previously reported Smart et al., 1994a ; , but subsequent Ca2' replacement at 1 min restored the stimulatory effect. This suggests that, u-opioids may open a Ca2 + channel, and that the subsequent Ca2 + influx activates PLC Cockcroft and Thomas, 1992; Rhee and Choi, 1992 ; . Indeed, it has recently been shown that Ca2 + activates the PLC isoform 81 in transfected Chinese hamster ovary cells Banno et al., 1994 ; . While opioids generally close Ca2 + channels Porzig, 1990 ; , there is evidence that they can also open Ca2 + channels, as seen with &-opioids in NG108-15 cells Jin et al., 1992 ; . Furthermore, K-opioids open Ca2 + channels in both astrocytes and human B cells Heagy et al., 1992; Eriksson et al., 1993 ; . However, this putative opening of Ca2 + channels by , t-opioids was short-lived, with closing oc.
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Agent: Rituxan rituximab, Genentech and Biogen Idec ; Purpose of study: To evaluate tolerability, effect on disease activity Possible mechanism: Binds to CD20 antigen on B cells and induces B-cell lysis Study description: Randomized, double blinded, placebo controlled Dose route: 1 g d day 1 and day 15 ; vs. PBO iv Outcome parameters: Frequency of relapse, scoring technique, MRI Type of MS: RR Number of Subjects: 104 Start date: December 2004 Observation period: 48 weeks Investigators: Multiple Sites: Multicenter, United States and Canada Results Publications: 91% reduction in gd + lesion count and reduced proportion of patients with relapses vs. PBO; with the exception of infusion-associated events, rates of adverse and serious adverse events were comparable Abstract #S12.003, AAN 2007; Genentech press release, May 1, 2007 ; Funding: Genentech, Inc. ClinicalTrials.gov Identifier: NCT00097188 Last update: 2007 * Agent: RTL1000 Purpose of study: To test safety Possible mechanism: Recombinant T-cell receptor ligands that bind to T cells, inducing a switch from inflammatory to anti-inflammatory Study description: Double blinded, placebo controlled, dose escalation Dose route: In each cohort of 6 subjects, 4 subjects will receive a single dose of RTL1000 2 mg, 6 mg, 20 mg, 60 mg, or 200 mg ; iv and 2 will receive PBO iv Outcome parameters: EDSS, 25-foot walk, 9-hole peg test, MRI Type of MS: RR, SP Number of Subjects: 36 Start date: January 2007 Observation period: 3 months Investigators: V. Yadav and others Sites: MS Center of Oregon, Oregon Health & Science University, Portland, and others, United States Results Publications: Not available Funding: Artielle ImmunoTherapeutics, Inc. Last update: 2007 ClinicalTrials.gov Identifier: NCT00411723, for example, procardia and pregnancy.
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When monitoring suggests the possibility that a GI event may have occurred or may be in process, study personnel respond using the practices articulated in section 6.3 of the ADAPT handbook. Specifically, personnel obtain further history as outlined in Section 6.3 of the Handbook ; . Adverse GI events should be reported carefully using standard terminology and should be carefully documented see 5.8 and 5.9 above ; . Subjects who develop severe vomiting, severe or persistent abdominal pain, hematemesis, melena, hematochezia rectal bleeding or any other symptoms that in the study physician's assessment require emergent evaluation, should immediately stop study drug and should be evaluated immediately by the primary care physician or by an emergency department section 6.3 of the study handbook ; . Subjects who develop significant symptoms or clinically significant Hb drops in the absence of symptoms, should be closely monitored by the study physician, ideally in conjunction with the primary care physician. Such subjects should immediately stop study drug see section 7.1 below ; and should see the primary care physician and or the study physician as soon as possible section 6.3 of the study handbook ; . Study personnel make decisions about stopping study drug and advise regarding further workup. They decide if study drug is terminated or restarted. Study personnel may involve the local GI consultant and or ADAPT GI consultant to assist in decision-making, and may interact with the subject's primary care physician if necessary!
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