The opioid growth regulatory system and naltrexone in diabetes: One side makes you taller and the other side makes you smaller

Abstract

This article provides an overview of research into the inhibitory role of the Opioid Growth Regulatory System (OGRS), which is characterized by its mediator, Opioid Growth Factor (OGF), [Met 5 ]-enkephalin, and its specific receptor (OGFr), in the pathobiology of diabetic complications involving the ocular surface. Additionally, involvement of the OGRS in systemic diabetic complications is illustrated by its role in poor diabetic cutaneous wound healing. The title of this paper is derived from Lewis Carroll’s Alice’s Adventures in Wonderland in which Alice is invited by the caterpillar to eat either side of a mushroom with powerful growth inducing characteristics. In the context of this review, this metaphor highlights the antagonistic relationship between the OGRS and naltrexone (NTX), which blocks the binding of OGF to OGFr thereby preventing or reversing the deleterious effects of the OGRS in the pathobiology of diabetic complications such as dry eye, keratopathy (delayed corneal epithelial wound healing and decreased corneal sensitivity) and delayed cutaneous wound healing in animal models of type 1 and type 2 diabetes. In addition, we will show that topical NTX treatment has been demonstrated to be safe in early phase studies performed in humans. We believe these data support further clinical trials of NTX in the treatment of diabetic ocular surface disease and delayed cutaneous wound healing. Finally, our findings may have implications for the evaluation of the OGRS in the pathobiology of other systemic diabetic complications.