Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients

Hamdy Awad, Motaz Abas, Haytham Elgharably, Ravi Tripathi, Tykie Theofilos, Sujatha Bhandary, Chittoor Sai Sudhakar, Chandan K. Sen, Sashwati Roy

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Postoperative pain management is a critical aspect of patient care. The inflammatory state of the post-sternotomy surgical wound sensitizes nerve endings, causing pain. Unrelieved or improperly managed pain compromises wound healing. Peripheral opioid receptors play a major role in analgesia, particularly under inflammatory conditions where both opioid receptor expression and efficacy are increased. Leukocytic opioid peptides include β-endorphin (END), met-enkephalin (ENK), and dynorphin-A (DYN), with END and ENK being predominant. Methodology/Principal Findings: This work represents the first study of inflammatory cells collected from post-sternotomy wounds of patients undergoing cardiac surgery including coronary artery bypass grafting (CABG). Wound fluid (WF) and cells were collected from sternal wounds using a JP Blake drain at 24, 48, and 72 hours post sternum closure. Anti-CD15 staining and flow cytometry revealed that polymorphonuclear neutrophils (PMN) are the predominant cells present in wound fluid collected post-surgery. Compared to peripheral blood (PB) derived PMN, significant increases in CD177+/CD66b+ PMN were observed suggesting activation of wound-site PMN. Such activation was associated with higher levels of opioid peptide expression in PMN derived from WF. Indeed, increased level of opioid peptides in sternal wound environment was noted 72 h post-surgery. We demonstrate that WF contains factors that can significantly induce POMC transcription in human PMNs. IL-10 and IL-4 were abundant in WF and both cytokines significantly induced POMC gene expression suggesting that WF factors such as IL-10 and IL-4 contribute towards increased opioid peptide expression in wound-site PMN. Conclusions/Significance: This approach provided a unique opportunity to study the cross-talk between inflammation and opioid peptides in PMN at a sternotomy wound-site. Wound-site PMN exhibited induction of END and ENK. In addition, sternal wound fluid significantly induced END expression in PMN. Taken together, these data constitute first clinical evidence that human wound-site PMNs are direct contributors of opioids at the sternal wound-site.

Original languageEnglish (US)
Article numbere47569
JournalPloS one
Volume7
Issue number10
DOIs
StatePublished - Oct 31 2012
Externally publishedYes

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Sternotomy
narcotics
animal injuries
Opioid Analgesics
neutrophils
Opioid Peptides
Neutrophils
Endorphins
Fluids
Wounds and Injuries
opioid peptides
Surgery
Pro-Opiomelanocortin
Enkephalins
endorphins
Opioid Receptors
Interleukin-4
Interleukin-10
Chemical activation
Dynorphins

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Awad, H., Abas, M., Elgharably, H., Tripathi, R., Theofilos, T., Bhandary, S., ... Roy, S. (2012). Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients. PloS one, 7(10), [e47569]. https://doi.org/10.1371/journal.pone.0047569

Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients. / Awad, Hamdy; Abas, Motaz; Elgharably, Haytham; Tripathi, Ravi; Theofilos, Tykie; Bhandary, Sujatha; Sai Sudhakar, Chittoor; Sen, Chandan K.; Roy, Sashwati.

In: PloS one, Vol. 7, No. 10, e47569, 31.10.2012.

Research output: Contribution to journalArticle

Awad, H, Abas, M, Elgharably, H, Tripathi, R, Theofilos, T, Bhandary, S, Sai Sudhakar, C, Sen, CK & Roy, S 2012, 'Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients', PloS one, vol. 7, no. 10, e47569. https://doi.org/10.1371/journal.pone.0047569
Awad H, Abas M, Elgharably H, Tripathi R, Theofilos T, Bhandary S et al. Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients. PloS one. 2012 Oct 31;7(10). e47569. https://doi.org/10.1371/journal.pone.0047569
Awad, Hamdy ; Abas, Motaz ; Elgharably, Haytham ; Tripathi, Ravi ; Theofilos, Tykie ; Bhandary, Sujatha ; Sai Sudhakar, Chittoor ; Sen, Chandan K. ; Roy, Sashwati. / Endogenous Opioids in Wound-Site Neutrophils of Sternotomy Patients. In: PloS one. 2012 ; Vol. 7, No. 10.
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