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Opioid Tolerance

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Endothelin has been reported to mediate inflammatory and cancer pain by acting on Endothelin-A (ET-A) receptors. Selective ET-A receptor antagonists have been found to attenuate nociception. Animal studies have demonstrated that ET-A receptor antagonists can potentiate morphine analgesia and prevent the development of tolerance.

PMZ-2123 is an ET-A receptor antagonist that potentiates analgesic effects of morphine and oxycodone, reduces the use of opioids, and maintains adequate pain relief. PMZ-2123 can reverse or avoid the development of opioid tolerance. Patients who have already developed tolerance to opioids can be treated with PMZ-2123 and adequate pain relief can be achieved with a lower dose of opioid.

The development of PMZ-2123 to potentiate analgesic effects of morphine and oxycodone and eliminate tolerance will have a major clinical impact in reducing the use of opioids and maintain adequate pain relief. It will reduce the risk of abuse, misuse, addiction, overdose, and deaths due to prescription opioid analgesics.

PMZ-2123 is in preclinical stage of development.

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Status of Opioid Tolerance

Product Pre-Clinical Clinical Market
Phase 1 Phase 2 Phase 3
Opioid Tolerance (PMZ-2123)
Publications
# Publication List
background Gulati, S., Briyal, S., Jones, S., Bhalla, S., and Gulati, A. (2017) Attenuation of opioid tolerance by ETB receptor agonist, IRL-1620, is independent of an accompanied decrease in nerve growth factor in mice. Heliyon 3, e00317
background Bhalla, S., Andurkar, S. V., and Gulati, A. (2016) Neurobiology of opioid withdrawal: Role of the endothelin system. Life Sci 159, 34-42
background Devarapalli, M., Leonard, M., Briyal, S., Stefanov, G., Puppala, B. L., Schweig, L., and Gulati, A. (2016) Prenatal Oxycodone Exposure Alters CNS Endothelin Receptor Expression in Neonatal Rats. Drug Res (Stuttg) 66, 246-250
background Bhalla, S., Pais, G., Tapia, M., and Gulati, A. (2015) Endothelin ETA receptor antagonist reverses naloxone-precipitated opioid withdrawal in mice. Can J Physiol Pharmacol 93, 935-944
background Bhalla, S., Zhang, Z., Patterson, N., and Gulati, A. (2010) Effect of endothelin-A receptor antagonist on mu, delta and kappa opioid receptor-mediated antinociception in mice. Eur J Pharmacol 635, 62-71
background Gulati, A., Bhalla, S., Matwyshyn, G., Zhang, Z., and Andurkar, S. V. (2009) Determination of adrenergic and imidazoline receptor involvement in augmentation of morphine and oxycodone analgesia by clonidine and BMS182874. Pharmacology 83, 45-58
background Matwyshyn, G. A., Bhalla, S., and Gulati, A. (2006) Endothelin ETA receptor blockade potentiates morphine analgesia but does not affect gastrointestinal transit in mice. Eur J Pharmacol 543, 48-53
background Puppala, B. L., Bhalla, S., Matwyshyn, G., and Gulati, A. (2006) Involvement of central endothelin receptors in neonatal morphine withdrawal. Exp Biol Med (Maywood) 231, 1157-1160
background Bhalla, S., Ciaccio, N., Wang, Z. J., and Gulati, A. (2006) Involvement of endothelin in morphine tolerance in neuroblastoma (SH-SY5Y) cells. Exp Biol Med (Maywood) 231, 1152-1156
background Puppala, B. L., Bhalla, S., Matwyshyn, G., and Gulati, A. (2006) Role of endothelin (ETA) receptors in neonatal morphine withdrawal. Peptides 27, 1514-1519
background Bhalla, S., Matwyshyn, G., and Gulati, A. (2005) Morphine tolerance does not develop in mice treated with endothelin-A receptor antagonists. Brain Res 1064, 126-135
background Puppala, B. L., Matwyshyn, G., Bhalla, S., and Gulati, A. (2004) Role of endothelin in neonatal morphine tolerance. J Cardiovasc Pharmacol 44 Suppl 1, S383-385
background Gulati, A., Bhalla, S., and Matwyshyn, G. (2004) A novel combination of opiates and endothelin antagonists to manage pain without any tolerance development. J Cardiovasc Pharmacol 44 Suppl 1, S129-131
background Puppala, B. L., Matwyshyn, G., Bhalla, S., and Gulati, A. (2004) Evidence that morphine tolerance may be regulated by endothelin in the neonatal rat. Biol Neonate 86, 138-144
background Bhalla, S., Matwyshyn, G., and Gulati, A. (2004) Central endothelin-B receptor stimulation does not affect morphine analgesia in rats. Pharmacology 72, 20-25
background Bhalla, S., Matwyshyn, G., and Gulati, A. (2002) Potentiation of morphine analgesia by BQ123, an endothelin antagonist. Peptides 23, 1837-1845
background Bhalla, S., Matwyshyn, G., and Gulati, A. (2003) Endothelin receptor antagonists restore morphine analgesia in morphine tolerant rats. Peptides 24, 553-56