Medical Forum / Diseases and Disorders / Hepatitis / February 2009
LDN
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Chuck - 25 Feb 2009 13:48 GMT Does anyone know anything about the trials with low dose naltrexone? Is this just quackery or is it legit?
Thomas Wagner - 25 Feb 2009 22:26 GMT >Does anyone know anything about the trials with low dose naltrexone? Is >this just quackery or is it legit? Looks pretty fishy to me. Any substance that is supposed to cure that many diseases is not likely to actually cure anything. I might be wrong, but I doubt it.
Here's the list: Autoimmune diseases multiple sclerosis, systemic lupus erythematosus (SLE/LED), rheumatoid arthritis, ankylosing spondylitis, pemfigoidi, sarcoidosis, scleroderma, Crohn's disease, ulcerative colitis aka colitis ulcerosa, Celiac disease, psoriasis, Wegener's granulomatosis, transverse myelitis
Cancers bladder cancer, breast cancer, carcinoid tumor, colorectal cancer, glioblastoma, liver cancer, non-small cell lung cancer (NSLC), chronic lymphocytic leukemia, lymphoma (both Hodgkin's and non-Hodgkin's), melanoma, multiple myeloma, neuroblastoma, ovarian cancer, pancreatic cancer, prostate cancer, renal cell carcinoma, throat cancer, uterine cancer
Other illnesses HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis (ALS)/primary lateral sclerosis (PLS), autism, Alzheimer's disease, Parkinson's disease, Behcet's disease, chronic obstructive pulmonary disease (COPD, emphysema), endometriosis, fibromyalgia, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), irritated bowel syndrome (IBS)
Possible indications myasthenia gravis, eczema, asthma, allergies, narcolepsy, chronic Lyme disease/post Lyme syndrome, acne, rosacea, insomnia and some other sleep disorders, migraine, depression, chronic urticaria (hives), interstitial cystitis, obsessive compulsive disorder (OCD), type II diabetes, dementia, post-traumatic stress disorder (PTSD), schizophrenia
Impressive... but hard to believe. Thomas
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tom g. - 26 Feb 2009 03:30 GMT >>Does anyone know anything about the trials with low dose naltrexone? Is >>this just quackery or is it legit? [quoted text clipped - 34 lines] > > Impressive... but hard to believe. I've heard it makes a great desert topping also.........
Cactus Jammies - 26 Feb 2009 03:30 GMT > Does anyone know anything about the trials with low dose naltrexone? Is > this just quackery or is it legit? quack quack quack, it is a duck? so how does it walk? like a duck? well, LDN is an agent for releasing the addictive clutch that opiates have on the body, over a long term rather than the on-scene rescue agent used by paramedics on overdose victims. But it is a close cousin. It has been found to not only relieve addiction withdrawls, but also have beneficial effects on the autoimmune system. It was first cross-prescribed for control of Crohn's Disease, and it appears to work (study 2007, see abstract NIH.GOV)
I copied the files below from: http://neurotalk.psychcentral.com/thread46492.html There appear to be a lot more articles and discussions on LDN and potential benefits. Therefore I suspect a duck is indeed a duck. And this is not quackery, as it appears to be cross-precribed for Parkinson's Disease patients, the only limitation of beneficial effects appear to be receptor issues in individual patients (?).
Google this: Low Dose Naltrexone Hepatitis C?
This stuff has some kind of promise for people that are infected with Hep C and other killer bugs, but as yet sits parked because specialized medicine is so scattered all over the map and does not seem to understand teamwork on testing and symptoms issues. This may stay on the shelf, right next to the gizmo that can reduce viral load in the bloodstream. The only reason we see small molecule research for Hep C treatment now at this late stage is because of the high incidence of co-infection with HIV, where small molecule medicine was first investigated, and where they have a lot more grant money to experiment and prove treatments.
Hey chuck, thanks for bringing this up here. Where did you hear about LDN?
-cactus jammies-
Clinical Studies demonstrating Naltrexone's Beneficial Effects to the Liver: The following are nine Clinical Studies which demonstrate the safety and very beneficial effects of Naltrexone to the liver for dosages below 300 mg a day. While the below are not specific to Low Dose Naltrexone (which is taken in much smaller dosages of approximately 1 to 4.5 mg a day), the below studies demonstrate the beneficial affect that opioid antagonists can have in liver disease in the following ways: 1.Reducing Liver Enzymes Levels, including Hepatitis (Studies 1 & 2) 2.Reducing Liver Damage in Hepatitis (Study 3) 3.Reducing Liver Injury in Cholestasis (Study 4) 4.Reducing Liver Enzymes in Cholestasis (Study 5) 5.Reducing Liver Fibrosis (Study 6) 6.Anti-inflammatory effects & improving hepatic dysfunction (Study 7) 7.Benefits in Cholestatic Pruritus (Studies 8 & 9) All of the below Clinical Studies / Articles are quoted from the National Institutes of Health / National Library of Medicine/Pub Med Website: (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed) **************************************** Study 1 - Benefit of reducing liver enzyme (ALT/AST) levels: Study of hepatotoxicity of naltrexone in the treatment of alcoholism. Alcohol. 2006 Feb;38(2):117-20. Links Yen MH, Ko HC, Tang FI, Lu RB, Hong JS. Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan. Since a black box warning was issued by the Food and Drug Administration regarding the use of the opiate antagonist naltrexone (NTX), many clinicians have been concerned about current labeling of the potential hepatotoxicity risk of NTX in the treatment of opiate dependence and alcoholism. Despite many reports that demonstrated that the use of NTX did not cause elevation of liver enzymes, controversy concerning whether NTX is hepatotoxic continues. The current study monitored 74 alcoholic patients who received 25mg of NTX daily in the first week and then 50mg of NTX daily for the rest of the 12-week period. After the 12-week treatment, levels of the hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) did not show any elevation, except in one subject, and the results strongly support that NTX did not induce abnormalities in liver function tests or elevate the liver enzymes. Instead, a statistical significance of decreasing levels of ALT and AST in the liver was shown throughout the study. These findings provide further support that NTX is not hepatotoxic at the recommended daily dose and may be beneficial for patients with elevated liver enzymes. PMID: 16839858 [PubMed - indexed for MEDLINE]
******************************************* Study 2 - Benefit of reducing liver enzyme levels in Hepatitis C patients: Effect of methadone or naltrexone on the course of transaminases in parenteral drug users with hepatitis C virus infection
[Article in Spanish] Lozano Polo JL, Gutiérrez Mora E, Martínez Pérez V, Santamaría Gutiérrez J, Vada Sánchez J, Vallejo Correas JA. Hospital Santa Cruz de Liencres,Servico de Medicina Interna, Cantabria.
A prospective study was conducted on the evolution of serum transaminases in 116 patients infected with hepatitis C virus (HCV), parenteral drug abusers, included for 6 months in treatment programs with methadone, naltrexone or "drug free" regimen. Treatment with methadone or naltrexone did not result in a transaminase increase in these patients. In contrast, patients included in the drug-free program appear to have a higher increase in serum transaminase levels than those treated with methadone or naltrexone (146.1 +/- 122.29 vs 91.88 +/- 81.96 and 86.99 +/- 64.26 Ul/ml, respectively). Such an increase originated mainly from patients who anytime during follow-up had a liver necrosis outbreak in the acute hepatitis range, and is offset if, instead of a given transaminase value, we consider a simplified liver necrosis index (1.28 +/- 0.74 vs 0.95 +/- 0.72 and 1.01 +/- 0.65, respectively; p > 0.05). HIV infected patients have serum transaminase values similar to those in HIV-negative patients (80.61 +/- 58.81 vs 113.63 +/- 99.59, respectively; p > 0.05). PMID: 9411543 [PubMed - indexed for MEDLINE] Note: Basically, the above study showed that ALT/AST levels of those with Hepatitis C who used Naltrexone, had liver enzymes significantly lower (86.99 +/- 64.26) than those patients who did not use Naltrexone (i.e. were `drug free' - 146.1 +/- 122.29) ************************* Study 3 - Benefit by reducing liver damage of hepatitis: Opioid receptor blockade reduces Fas-induced hepatitis in mice.
Hepatology. 2004 Nov;40(5):1136-43. Jaume M, Jacquet S, Cavaillès P, Macé G, Stephan L, Blanpied C, Demur C, Brousset P, Dietrich G. INSERM U563, Institut Claude de Préval, IFR 30, Hôpital Purpan, Université Paul Sabatier Toulouse III, Toulouse, France. Fas (CD95)-induced hepatocyte apoptosis and cytotoxic activity of neutrophils infiltrating the injured liver are two major events leading to hepatitis. Because it has been reported that opioids, via a direct interaction, sensitize splenocytes to Fas-mediated apoptosis by upregulating Fas messenger RNA (mRNA) and modulated neutrophil activity, we assumed that opioids may participate in the pathophysiology of hepatitis. Using the hepatitis model induced by agonistic anti-Fas antibody in mice, we showed that opioid receptor blockade reduced liver damage and consequently increased the survival rate of animals when the antagonist naltrexone was injected simultaneously or prior to antibody administration. Treatment of mice with morphine enhanced mortality. Naloxone methiodide-a selective peripheral opioid antagonist-had a protective effect, but the absence of opioid receptors in the liver, together with lack of morphine effect in Fas-induced apoptosis of primary cultured hepatocytes, ruled out a direct effect of opioids on hepatocytes. In addition, the neutralization of opioid activity by naltrexone did not modify Fas mRNA expression in the liver as assessed with real-time quantitative polymerase chain reaction. Injured livers were infiltrated by neutrophils, but granulocyte-depleted mice were not protected against the enhancing apoptotic effect of morphine. In conclusion, opioid receptor blockade improves the resistance of mice to Fas-induced hepatitis via a peripheral mechanism that does not involve a down-modulation of Fas mRNA in hepatocytes nor a decrease in proinflammatory activity of neutrophils. PMID: 15389866 [PubMed - indexed for MEDLINE]
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Study 4 - Benefit of reducing liver injury: Opioid system blockade decreases collagenase activity and improves liver injury in a rat model of cholestasis.
J Gastroenterol Hepatol. 2007 Mar;22(3):406-13. Kiani S, Ebrahimkhani MR, Shariftabrizi A, Doratotaj B, Payabvash S, Riazi K, Dehghani M, Honar H, Karoon A, Amanlou M, Tavangar SM, Dehpour AR. Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. BACKGROUND: Following bile duct ligation (BDL) endogenous opioids accumulate in plasma and play a role in the pathophysiology and manifestation of cholestasis. Evidence of centrally mediated induction of liver injury by exogenous opioid agonist administration, prompts the question of whether opioid receptor blockade by naltrexone can affect cholestasis-induced liver injury. METHODS: Cholestasis was induced by BDL and cholestatic and sham-operated rats received either naltrexone or saline for 7 consecutive days. On the 7th day, liver samples were collected for determining matrix metalloproteinase-2 (MMP-2) activity, S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) content and blood samples were obtained for measuring plasma nitrite/nitrate and liver enzyme activities. RESULTS: Naltrexone-treated BDL animals had a significant reduction in plasma enzyme activity and nitrite/nitrate level. Liver SAM : SAH ratio and SAM level improved by naltrexone treatment in cholestatic animals compared to saline-treated BDL ones. Naltrexone treatment in BDL rats led to a decrease in the level of liver MMP-2 activity, which had already increased during cholestasis. CONCLUSION: Opioid receptor blockade improved the degree of liver injury in cholestasis, as assessed by plasma enzyme and liver MMP-2 activities. The beneficial effect of naltrexone may be due to its ability to increase liver SAM level and restore the SAM : SAH ratio. PMID: 17295775 [PubMed - indexed for MEDLINE]
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Study 5- Reducing Liver Enzymes in Cholestatis Do endogenous opioids contribute to the bradycardia of rats with obstructive cholestasis? Fundam Clin Pharmacol. 2002 Aug;16(4):273-9. Gaskari SA, Mani AR, Ejtemaei-Mehr S, Namiranian K, Homayoun H, Ahmadi H, Dehpour AR. Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Endogenous opioids have nitric oxide (NO)-dependent cardiovascular actions. In the light of biological evidence of accumulation of endogenous opioids in cholestasis and also existence of NO-dependent bradycardia in cholestatic subjects, this study was carried out to evaluate the role of endogenous opioids in the generation of bradycardia in a rat model of cholestasis. Male Sprague-Dawley rats were used to induce cholestasis by surgical ligation of the bile duct, with sham-operated animals serving as a control. The animals were divided into six groups which received naltrexone [20 mg/kg/day, subcutaneously (s.c.)], N(G)-L-nitro-arginine methyl ester (L-NAME, 3 mg/kg/day, s.c.), aminoguanidine (200 mg/kg/day, s.c.), L-arginine (200 mg/kg/day, s.c.), naltrexone + L-NAME (20 and 3 mg/kg/day, s.c) or saline. One week after the operation, a lead II electrocardiogram (ECG) was recorded and the spontaneously beating atria of the animals were then isolated and the chronotropic responses to epinephrine evaluated. The plasma L-nitro-tyrosine level and alanine amino transferase and alkaline phosphatase activities were also measured. The heart rate of cholestatic animals was significantly lower than that of control rats in vivo and this bradycardia was corrected with daily adminstration of naltrexone or L-NAME. The basal spontaneous beating rate of atria in cholestatic animals was not significantly different from that of sham-operated animals in vitro. Cholestasis induced a significant decrease in the chronotropic effect of epinephrine. This effect was corrected by daily injection of naltrexone or L-NAME, or concurrent administration of naltrexone + L-NAME, and was not corrected by aminoguanidine. L-arginine had an equivalent effect to L-NAME and increased the chronotropic effect of epinephrine in cholestatic rats but not in control animals. Bile duct ligation increased the plasma activity of liver enzymes as well as the level of L-nitro-tyrosine. L-arginine and naltrexone treatment significantly decreased the elevation of liver enzymes in bile duct-ligated rats. Pretreatment of cholestatic animals with naltrexone or L-NAME decreased the plasma L-nitro-tyrosine level. The results suggest that either prevention of NO overproduction or protection against liver damage is responsible for recovery of bradycardia after naltrexone administration. PMID: 12570015 [PubMed - indexed for MEDLINE]
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Study 6- Benefit of reducing liver fibrosis:
Naltrexone, an opioid receptor antagonist, attenuates liver fibrosis in bile duct ligated rats. Gut. 2006 Nov;55(11):1606-16. Epub 2006 Mar 16. Ebrahimkhani MR, Kiani S, Oakley F, Kendall T, Shariftabrizi A, Tavangar SM, Moezi L, Payabvash S, Karoon A, Hoseininik H, Mann DA, Moore KP, Mani AR, Dehpour AR. The UCL Institute of Hepatology, Department of Medicine, Royal Free and University College Medical School, University College London, Rowland Hill St, London NW3 2PF, UK. AIM: The aim of this study was to investigate the hypothesis that the opioid system is involved in the development of hepatic fibrosis. METHODS: The effect of naltrexone (an opioid receptor antagonist) on hepatic fibrosis in bile duct ligated (BDL) or sham rats was assessed by histology and hepatic hydroxyproline levels. Liver matrix metalloproteinase 2 (MMP-2) was measured by zymography, and alpha smooth muscle actin (alpha-SMA) and CD45 (leucocyte common antigen) by immunohistochemistry. The redox state of the liver was assessed by hepatic glutathione (GSH)/oxidised glutathione (GSSG) and S-nitrosothiol levels. Subtypes of opioid receptors in cultured hepatic stellate cells (HSCs) were characterised by reverse transcriptase-polymerase chain reaction, and the effects of selective delta opioid receptor agonists on cellular proliferation, tissue inhibitor of metalloproteinase 1 (TIMP-1), and procollagen I expression in HSCs determined. RESULTS: Naltrexone markedly attenuated the development of hepatic fibrosis as well as MMP-2 activity (p<0.01), and decreased the number of activated HSCs in BDL rats (p<0.05). The development of biliary cirrhosis altered the redox state with a decreased hepatic GSH/GSSG ratio and increased concentrations of hepatic S-nitrosothiols, which were partially or completely normalised by treatment with naltrexone, respectively. Activated rat HSCs exhibited expression of delta1 receptors, with increased procollagen I expression, and increased TIMP-1 expression in response to delta(1) and delta(2) agonists, respectively. CONCLUSIONS: This is the first study to demonstrate that administration of an opioid antagonist prevents the development of hepatic fibrosis in cirrhosis. Opioids can influence liver fibrogenesis directly via the effect on HSCs and regulation of the redox sensitive mechanisms in the liver. PMID: 16543289 [PubMed - indexed for MEDLINE]
******************************** Study 7- Benefit of anti-inflammatory effects & improving hepatic dysfunction: Effects of naltrexone on lipopolysaccharide-induced sepsis in rats. J Biomed Sci. 2005;12(2):431-40. Links Lin SL, Lee YM, Chang HY, Cheng YW, Yen MH. Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan.
Naltrexone, an opioid antagonist, has been reported to possess an anti-inflammatory effect via blockade of opioid receptor. The aim of this study is to evaluate the protective effect of naltrexone on LPS-induced septic shock in rats. Sepsis was induced by administration of LPS (10 mg/kg, i.v.) in anesthetized rats. Results demonstrated that pretreatment with naltrexone (10 mg/kg, i.v.) significantly ameliorated hypotension and bradycardia of rats 6 h after LPS administration. In isolated blood vessel, study showed that pretreatment with naltrexone significantly improved norepinephrine-induced vasoconstriction and ACh-induced vasorelaxation in aorta of endotoxemic animals. Naltrexone significantly reduced the elevation of serum glutamate-oxalacetate transaminase and glutamate-pyruvate transaminase (as index of hepatic function) induced by LPS. The infiltration of polymorphonuclear neutrophils into liver 48 h after LPS treatment in mice was also reduced by naltrexone. On the other hand, naltrexone significantly decreased the levels of plasma TNF-alpha and inhibited overproduction of superoxide anions in aortic rings. However, naltrexone did not suppress the overproduction of NO (measured by its metabolites nitrite/nitrate in plasma) and iNOS expression in lungs induced by LPS. In in vitro study, naltrexone did not attenuate non-enzymatic iron-induced lipid peroxidation in rat brain homogenates. In conclusion, pretreatment with naltrexone significantly improved circulatory failure and hepatic dysfunction in sepsis. These effects were associated with reduction of TNF-alpha levels and superoxide anion formation, which may be attributed to antagonism of opioid receptors. PMID: 15917999 [PubMed - indexed for MEDLINE] *********************************
Chuck - 26 Feb 2009 13:08 GMT I first heard about it from a colleague at work with MS. He too has been suffering with Interferon Tx, albeit a different variety of Interferon. In any case it's supposed to show some promise in his case as well.
>> Does anyone know anything about the trials with low dose naltrexone? Is >> this just quackery or is it legit? [quoted text clipped - 368 lines] > PMID: 15917999 [PubMed - indexed for MEDLINE] > *********************************
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