[Role of endogenous opioids in heart failure]

The peptidergic, endogenous opioid system counteracts exogenous and endogenous stress factors. The system will be activated by stress, e.g., also in case of heart failure. The endogenous opioids endorphin, met-enkephalin, leu-enkephalin, dynorphin, casomorphin, and others split from precursor proteins (250-265 amino acids) by a specific proteolytic cleavage. In clinical and experimental heart failure the plasma levels of endorphin and lipotropin are changed as an evidence of the activated opioid system. In patients with chronic heart failure the plasma levels of endorphin and lipotropin are decreased, which is discussed as an exhaustion of the opioid system. In the case of experimentally induced right-heart failure in dogs the plasma levels of endorphin and lipotropin are increased. Morphine antagonists (naloxone hydrochloride) which penetrate into the cerebral system improve the disturbed hemodynamics in dogs with a right-heart failure. The improving effects results from central actions since opiate antagonists, which cannot penetrate the blood-brain-barrier (naloxone methobromide) have no effect. The actions of opioid peptides will be induced by inhibition of the depletion and the reabsorption of catecholamines in synaptic storages (isolated atria from guinea pig). In cultures from cardiac myocytes (chicken ventricle cells) enkephalins induced positive inotropic effects via receptor mediated mechanisms. The results showed modulating activities of endogenous opioids against the effect of activated sympathetic activity.