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14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management: An Experts' Roundtable
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

Inflammation Targeted Nanomedicine

A perspective on the promise and potential of biomedical technologies for pain diagnosis and management.
Pages 33-35
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In nerve injury (eg, sciatic nerve chronic constriction injury) preclinical models, we found that theranostic (NIRF labeled) nanoemulsions loaded with celecoxib (COX-2 inhibitor) led to reduction in mechanical hypersensitivity (as a measure of pain behavior) as well as reduced macrophage infiltration at the site of injury.7 This apparent pain relief in a preclinical model was achieved at a very low drug dose (0.24 mg/kg) of celecoxib delivered via targeted nanoemulsions.6 The change coincided with an intriguing trend of decreased signal in drug-loaded nanoemulsion treated animals vs control (not shown), as measured by 19F MRI, 19F NMR and NIR fluorescence which corresponds to lowered macrophage infiltration at the site of injury and reduced neuroinflammation.6 Histological data further confirmed that the number of CD68 positive cells (macrophages) decreased at the site of injury, which correlates to a reduction in mechanical hypersensitivity.6 These compelling results provide key supporting evidence of the potential these approaches hold for further development of effective and extended pain relief with macrophage-targeted drug delivery.

Implications of macrophage-targeted nanomedicine for pain treatment and diagnosis are potentially fairly broad. As driving engines of inflammation, macrophages have been implicated in many chronic diseases that lead to chronic pain, from rheumatoid arthritis, inflammatory bowel disease to trauma.22-24 However, considering the promise that this technology offers as it further develops, certain questions remain. For example, it is has been shown that the immune system and nervous system show sex dimorphism. Hence, it is possible that nanomedicine may hold a key to solving the differences in therapeutic responses between males and females that have been seen in clinical and preclinical models.25 Whether macrophage-targeted nanomedicine holds that specific key remains to be seen. Ongoing studies at Duquesne University are working to address these questions.

Conclusion

Overall, nanomedicine, powerfully multifaceted as it may be, needs work to streamline manufacturing, improve quality control, and reduce cost. If given adequate attention and support, it may become the solution to both the opioid crisis and the need for more effective, long-term pain management. Nanomedicine may also offer a way to directly address age and sex differences in pain medicine and to reach ultimate personalized pain treatment.

Last updated on: April 12, 2019
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