Gastrointestinal Diseases Research Unit, Kingston General Hospital, Queen's University, Kingston, Ontario K7L 2V7, Canada.
Department of Molecular Pathobiology, Department of Neuroscience and Physiology, Neuroscience Institute, New York University, New York, New York 10010.
J Neurosci. 2022 Apr 20;42(16):3316-3328. doi: 10.1523/JNEUROSCI.2098-21.2022. Epub 2022 Mar 7.
Opioid tolerance (OT) leads to dose escalation and serious side effects, including opioid-induced hyperalgesia (OIH). We sought to better understand the mechanisms underlying this event in the gastrointestinal tract. Chronic administration of morphine by intraperitoneal injection in male C57BL/6 mice evoked tolerance and evidence of OIH in an assay of colonic afferent nerve mechanosensitivity; this was inhibited by the δ-opioid receptor (DOPr) antagonist naltrindole when intraperitoneally injected in previous morphine administration. Patch-clamp studies of DRG neurons following overnight incubation with high concentrations of morphine, the µ-opioid receptors (MOPr) agonist [D-Ala, N-Me-Phe, Gly-ol]-Enkephalin (DAMGO) or the DOPr agonist [D-Ala, D-Leu]-Enkephalin evoked hyperexcitability. The pronociceptive actions of these opioids were blocked by the DOPr antagonist SDM25N but not the MOPr antagonist D-Pen-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH The hyperexcitability induced by DAMGO was reversed after a 1 h washout, but reapplication of low concentrations of DAMGO or [D-Ala, D-Leu]-Enkephalin restored the hyperexcitability, an effect mediated by protein kinase C. DOPr-dependent DRG neuron hyperexcitability was blocked by the endocytosis inhibitor Pitstop 2, and the weakly internalizing DOPr agonist ARM390 did not cause hyperexcitability. Bioluminescence resonance energy transfer studies in HEK cells showed no evidence of switching of G-protein signaling from G to a G pathway in response to either high concentrations or overnight incubation of opioids. Thus, chronic high-dose opioid exposure leads to opioid tolerance and features of OIH in the colon. This action is mediated by DOPr signaling and is dependent on receptor endocytosis and downstream protein kinase C signaling. Opioids are effective in the treatment of abdominal pain, but escalating doses can lead to opioid tolerance and potentially opioid-induced hyperalgesia. We found that δ-opioid receptor (DOPr) plays a central role in the development of opioid tolerance and opioid-induced hyperalgesia in colonic afferent nociceptors following prolonged exposure to high concentrations of MOPr or DOPr agonists. Furthermore, the role of DOPr was dependent on OPr internalization and activation of a protein kinase C signaling pathway. Thus, targeting DOPr or key components of the downstream signaling pathway could mitigate adverse side effects by opioids.
阿片类药物耐受(OT)导致剂量增加和严重的副作用,包括阿片类药物诱导的痛觉过敏(OIH)。我们试图更好地了解胃肠道中发生这种事件的机制。通过腹腔内注射吗啡,在雄性 C57BL/6 小鼠中进行慢性给药,诱发了对结肠传入神经机械敏感性的测定中的耐受和 OIH 的证据;当腹腔内注射先前给予吗啡时,δ-阿片受体(DOPr)拮抗剂纳曲吲哚抑制了这种作用。对 DRG 神经元进行的全夜孵育研究表明,高浓度吗啡、μ-阿片受体(MOPr)激动剂[D-Ala,N-Me-Phe,Gly-ol]-Enkephalin(DAMGO)或 DOPr 激动剂[D-Ala,D-Leu]-Enkephalin 可引起超兴奋性。这些阿片类药物的致痛作用被 DOPr 拮抗剂 SDM25N 阻断,但 MOPr 拮抗剂 D-Pen-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH 不阻断。DAMGO 诱导的超兴奋性在 1 小时冲洗后逆转,但再次应用低浓度的 DAMGO 或[D-Ala,D-Leu]-Enkephalin 可恢复超兴奋性,这种作用由蛋白激酶 C 介导。DOPr 依赖性 DRG 神经元超兴奋性被内吞抑制剂 Pitstop 2 阻断,弱内吞作用的 DOPr 激动剂 ARM390 不会引起超兴奋性。在 HEK 细胞中的生物发光共振能量转移研究中,没有证据表明 G 蛋白信号从 G 向 G 途径转换,以响应高浓度或过夜孵育阿片类药物。因此,慢性高剂量阿片类药物暴露导致结肠中的阿片类药物耐受和 OIH 的特征。这种作用是由 DOPr 信号介导的,并且依赖于受体内吞和下游蛋白激酶 C 信号。阿片类药物在治疗腹痛方面非常有效,但剂量增加可能导致阿片类药物耐受和潜在的阿片类药物诱导的痛觉过敏。我们发现,δ-阿片受体(DOPr)在长时间暴露于高浓度 MOPr 或 DOPr 激动剂后,在结肠传入伤害感受器中发挥核心作用,导致阿片类药物耐受和阿片类药物诱导的痛觉过敏。此外,DOPr 的作用取决于 OPr 的内化和蛋白激酶 C 信号通路的激活。因此,靶向 DOPr 或下游信号通路的关键组成部分可能通过阿片类药物减轻不良反应。