Abstract 7496: The piritramide-based perioperative analgesia can affect the cancer dissemination in colorectal cancer patients
Authors: Srovnal Josef , Berta Emil , Vidlarova Monika , Rehulkova Alona , Jecmenova Katerina , Popper Miroslav , Srovnalova Alzbeta , Prasil Petr , Skalicky Pavel , Gabrhelik Tomas , Maca Jan , Michalek Pavel , Hajduch Marian 
Published: March 2024

Abstract
Introduction: Colorectal cancer (CRC) stands as a prominent contributor to global cancer-related mortality. Post-surgical management of CRC patients often involves the administration of opioid analgesics. These analgesics operate through opioid and cannabinoid receptors, pathways implicated in tumor progression and metastasis, potentially impacting patient survival adversely. This investigation delves into the influence of piritramide and morphine on cancer dissemination, encompassing in vitro and in vivo assessments, cytotoxicity analyses, and elucidation of their mode of action.
Methods: The presence of circulating tumor cells (CTCs) in the blood of 131 CRC patients was quantitatively assessed using the real-time polymerase chain reaction (qPCR) method. Cytotoxic effects of morphine and piritramide were evaluated via colony-forming assays (CFA) utilizing HCT116 and HT29 cell lines. The impact of piritramide and morphine on opioid receptor activity was gauged through transfected reporter cell lines and fluorescence imaging plater reader (FLIPR) calcium assays. In vivo models involving subcutaneous and intrasplenic administration in SCID and BALB mice, respectively, utilizing HCT116 and HT29 cell lines, were conducted. Morphological profiling, employing the cell painting assay, facilitated high-content image-based analysis on both cell lines.
Results: Perioperative analgesia with piritramide exhibited a tendency towards longer time to recurrence (TTR) survival in CRC patients (HR=1.8, p=0.104). Conversely, morphine-treated patients demonstrated a twofold increase in TTR events (HR=4.7, p=0.011). Piritramide, but not morphine, significantly inhibited colony growth in HCT116 and HT-29 cell lines in the CFA, consistent with cytotoxicity test results. Functional assays revealed agonistic effects of both piritramide and morphine on opioid receptor kappa 1 (OPRK1) and mu 1 (OPRM1), with piritramide exhibiting greater potency as an OPRK1 agonist. In the SCID mice model, subcutaneous application of HT29 cell lines resulted in significantly reduced tumor growth in piritramide-treated mice. In the intrasplenic model utilizing BALB mice, mice treated with piritramide exhibited diminished tumor growth and a reduction in both the number and size of metastases. Comparative analysis with reference compounds revealed a distinct phenotypic profile of piritramide affecting the endoplasmic reticulum.
Conclusion: Piritramide, as opposed to morphine, demonstrated cytotoxic effects on both in vitro and in vivo CRC cell lines, resulting in reduced tumor growth and dissemination. Perioperative analgesia with piritramide exhibited potential in improving time to recurrence survival in CRC patients.
Acknowledgement: This study received support from the European Union - Next Generation EU (LX22NPO5102) and Palacky University Olomouc (LF 2023_006).
Citation Format: Josef Srovnal, Emil Berta, Monika Vidlarova, Alona Rehulkova, Katerina Jecmenova, Miroslav Popper, Alzbeta Srovnalova, Petr Prasil, Pavel Skalicky, Tomas Gabrhelik, Jan Maca, Pavel Michalek, Marian Hajduch. The piritramide-based perioperative analgesia can affect the cancer dissemination in colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7496.