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Cole RH, Moussawi K, Joffe ME. Opioid modulation of prefrontal cortex cells and circuits. Neuropharmacology 2024; 248:109891. [PMID: 38417545 PMCID: PMC10939756 DOI: 10.1016/j.neuropharm.2024.109891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024]
Abstract
Several neurochemical systems converge in the prefrontal cortex (PFC) to regulate cognitive and motivated behaviors. A rich network of endogenous opioid peptides and receptors spans multiple PFC cell types and circuits, and this extensive opioid system has emerged as a key substrate underlying reward, motivation, affective behaviors, and adaptations to stress. Here, we review the current evidence for dysregulated cortical opioid signaling in the pathogenesis of psychiatric disorders. We begin by providing an introduction to the basic anatomy and function of the cortical opioid system, followed by a discussion of endogenous and exogenous opioid modulation of PFC function at the behavioral, cellular, and synaptic level. Finally, we highlight the therapeutic potential of endogenous opioid targets in the treatment of psychiatric disorders, synthesizing clinical reports of altered opioid peptide and receptor expression and activity in human patients and summarizing new developments in opioid-based medications. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".
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Affiliation(s)
- Rebecca H Cole
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA; Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience University of Pittsburgh, Pittsburgh, PA, USA
| | - Khaled Moussawi
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA; Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience University of Pittsburgh, Pittsburgh, PA, USA
| | - Max E Joffe
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA; Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience University of Pittsburgh, Pittsburgh, PA, USA.
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Casello SM, Flores RJ, Yarur HE, Wang H, Awanyai M, Arenivar MA, Jaime-Lara RB, Bravo-Rivera H, Tejeda HA. Neuropeptide System Regulation of Prefrontal Cortex Circuitry: Implications for Neuropsychiatric Disorders. Front Neural Circuits 2022; 16:796443. [PMID: 35800635 PMCID: PMC9255232 DOI: 10.3389/fncir.2022.796443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
Neuropeptides, a diverse class of signaling molecules in the nervous system, modulate various biological effects including membrane excitability, synaptic transmission and synaptogenesis, gene expression, and glial cell architecture and function. To date, most of what is known about neuropeptide action is limited to subcortical brain structures and tissue outside of the central nervous system. Thus, there is a knowledge gap in our understanding of neuropeptide function within cortical circuits. In this review, we provide a comprehensive overview of various families of neuropeptides and their cognate receptors that are expressed in the prefrontal cortex (PFC). Specifically, we highlight dynorphin, enkephalin, corticotropin-releasing factor, cholecystokinin, somatostatin, neuropeptide Y, and vasoactive intestinal peptide. Further, we review the implication of neuropeptide signaling in prefrontal cortical circuit function and use as potential therapeutic targets. Together, this review summarizes established knowledge and highlights unknowns of neuropeptide modulation of neural function underlying various biological effects while offering insights for future research. An increased emphasis in this area of study is necessary to elucidate basic principles of the diverse signaling molecules used in cortical circuits beyond fast excitatory and inhibitory transmitters as well as consider components of neuropeptide action in the PFC as a potential therapeutic target for neurological disorders. Therefore, this review not only sheds light on the importance of cortical neuropeptide studies, but also provides a comprehensive overview of neuropeptide action in the PFC to serve as a roadmap for future studies in this field.
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Affiliation(s)
- Sanne M. Casello
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Rodolfo J. Flores
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Hector E. Yarur
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Huikun Wang
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Monique Awanyai
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Miguel A. Arenivar
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Rosario B. Jaime-Lara
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Hector Bravo-Rivera
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Hugo A. Tejeda
- Unit on Neuromodulation and Synaptic Integration, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Hugo A. Tejeda,
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Gupta A, Gomes I, Wardman J, Devi LA. Opioid receptor function is regulated by post-endocytic peptide processing. J Biol Chem 2014; 289:19613-26. [PMID: 24847082 DOI: 10.1074/jbc.m113.537704] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Most neuroendocrine peptides are generated in the secretory compartment by proteolysis of the precursors at classical cleavage sites consisting of basic residues by well studied endopeptidases belonging to the subtilisin superfamily. In contrast, a subset of bioactive peptides is generated by processing at non-classical cleavage sites that do not contain basic residues. Neither the peptidases responsible for non-classical cleavages nor the compartment involved in such processing has been well established. Members of the endothelin-converting enzyme (ECE) family are considered good candidate enzymes because they exhibit functional properties that are consistent with such a role. In this study we have explored a role for ECE2 in endocytic processing of δ opioid peptides and its effect on modulating δ opioid receptor function by using selective inhibitors of ECE2 that we had identified previously by homology modeling and virtual screening of a library of small molecules. We found that agonist treatment led to intracellular co-localization of ECE2 with δ opioid receptors. Furthermore, selective inhibitors of ECE2 and reagents that increase the pH of the acidic compartment impaired receptor recycling by protecting the endocytosed peptide from degradation. This, in turn, led to a substantial decrease in surface receptor signaling. Finally, we showed that treatment of primary neurons with the ECE2 inhibitor during recycling led to increased intracellular co-localization of the receptors and ECE2, which in turn led to decreased receptor recycling and signaling by the surface receptors. Together, these results support a role for differential modulation of opioid receptor signaling by post-endocytic processing of peptide agonists by ECE2.
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Affiliation(s)
- Achla Gupta
- From the Department of Pharmacology and Systems Therapeutics and
| | - Ivone Gomes
- From the Department of Pharmacology and Systems Therapeutics and
| | - Jonathan Wardman
- From the Department of Pharmacology and Systems Therapeutics and
| | - Lakshmi A Devi
- From the Department of Pharmacology and Systems Therapeutics and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
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Hong Y, Dai P, Jiang J, Zeng X. Dual effects of intrathecal BAM22 on nociceptive responses in acute and persistent pain--potential function of a novel receptor. Br J Pharmacol 2004; 141:423-30. [PMID: 14718254 PMCID: PMC1574218 DOI: 10.1038/sj.bjp.0705637] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bovine adrenal medulla 22 (BAM22) peptide is one of the cleavage products of proenkephalin A. It binds with high affinity to both opioid receptors and a newly discovered receptor in vitro. This latter receptor was first named sensory neuron-specific receptor and is here named BAM peptide-activated receptor with non-opioid activity (BPAR). BPAR is uniquely distributed in small-diameter DRG neurons, most of which are associated with the IB4 class of nociceptor afferent. The present study examined the effects of intrathecal administration of BAM22 on formalin-induced nocifensive behaviors and tail-withdrawal latency in the rat. Intrathecal (i.t.) administration of BAM22 decreased nocifensive behavior scores, measured as the sum of flinching and lifting/licking, in the first and second phases of the formalin test. This decrease was partially attenuated by systemic injection of naloxone. In the presence of naloxone, i.t. BAM22 produced a dose-dependent suppression of the nocifensive behaviors observed during the formalin test. The ratio of the efficacy of BAM22 (5 nmol) in the presence of naloxone over that in the absence of naloxone was 0.65 for flinching and 0.74 for lifting/licking in the second phase. BAM22 at a dose of 5 nmol increased the tail-withdrawal latency by 193 and 119% of baseline in the absence and presence of naloxone, respectively. Systemic administration of naloxone alone enhanced the nocifensive behaviors in the second, but not in the first phase of the formalin test. Naloxone treatment did not alter the tail-withdrawal latency. These data confirm earlier in vitro data showing that BAM22 has both opioid and non-opioid biological actions. The non-opioid action of BAM22 involves inhibition of acute and persistent nociceptive behaviors at the spinal level, presumably mediated via BPAR. The name suggested for this novel receptor, its potential physiological function and its ligand are discussed. British Journal of Pharmacology (2004) 141, 423-430. doi:10.1038/sj.bjp.0705637
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Affiliation(s)
- Yanguo Hong
- Department of Anatomy and Physiology, Bioengineering School, Fujian Normal University, 170 Chengpu Road, Fuzhou, People's Republic of China.
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Abstract
The opiate system is involved in a wide variety of neural functions including pain perception, neuroendocrine regulation, memory, drug reward, and tolerance. Such functions imply that endogenous opioid peptides should have anatomical interactions with limbic brain structures believed to be involved in the experience and expression of emotion. Using in situ hybridization histochemistry, the messenger RNA expression of the opioid precursors, prodynorphin and proenkephalin, was studied in whole hemisphere human brain tissue. Different components of the limbic system were found to be characterized by a high gene expression of either prodynorphin or proenkephalin messenger RNA. Brain regions traditionally included within the limbic system (e.g. amygdala, hippocampus, entorhinal cortex and cingulate cortex) as well as limbic-associated regions including the ventromedial prefrontal cortex and patch compartment of the neostriatum showed high prodynorphin messenger RNA expression. In contrast, high levels of proenkephalin messenger RNA were more widely expressed in the hypothalamus, periaqueductal gray, various mesencephalic nuclei, bed nucleus of the stria terminalis, and ventral pallidum; brain regions associated with endocrine-reticular-motor continuum of the limbic system. The marked anatomical dissociation between the expression of these two opioid peptide genes, seen clearly in whole hemisphere sections, indicates that distinct functions must be subserved by the prodynorphin and proenkephalin systems in the human brain.
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Affiliation(s)
- Y L Hurd
- Karolinska Institute, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Hospital, Stockholm, Sweden
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Abstract
The endogenous opioid peptides (EOP) are grouped in three families, each deriving from the posttranslational processing of a distinct precursor molecule and exhibiting high affinity for a specific opioid receptor. The genes of EOPs are expressed in a wide variety of sites, including many nerve, neurosecretory, and endocrine cells. In reviewing the vast literature on this subject, a few patterns begin to emerge. First, the distribution of EOPs in tissues appears to be a distinct characteristic of each family of opioids. Second, the EOP producing cells can be grouped into two broad categories: those expressing only one and those expressing multiple EOP genes. Most EOP-producing nerve and neurosecretory cells fall into the first category, that is, they express one EOP gene, whereas most nonneural cells fall into the second category, that is, they express multiple EOP genes. Third, it appears that there is a relationship between opioids, proliferation rate, and state of differentiation of cells, since it has been shown that (a) mitogenic factors may change the EOP profile of a cell, and that (b) opioids may inhibit the proliferation rate of normal or neoplastic cells. The physiologic implication of these observations is briefly discussed.
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Affiliation(s)
- A N Margioris
- Department of Clinical Chemistry, School of Medicine, University of Crete, Iraklion 71110, Greece
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Sato M, Morita Y, Saika T, Fujita M, Ohhata K, Tohyama M. Localization and ontogeny of cells expressing preprodynorphin mRNA in the rat cerebral cortex. Brain Res 1991; 541:41-9. [PMID: 1674222 DOI: 10.1016/0006-8993(91)91071-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The regional distribution of preprodynorphin (PPD) mRNA-containing cells (PPD cells) in the rat cerebral cortex was investigated by in situ hybridization histochemistry using a synthetic oligonucleotide probe. In the isocortex, PPD cells were small or medium-sized and were mainly located in layer V. While they were less numerous in the allocortex than in the isocortex. Only a few labeled cells were seen in the piriform and entorhinal cortices. In the hippocampal formation, labeled cells were observed in the granular layer of the dentate gyrus. An ontogenetic study revealed that PPD mRNA-containing cells appeared on postnatal day 7 in the isocortex and the allocortex and on day 14 in the dentate gyrus. Thereafter, they increased in number and signal intensity to reach a plateau on postnatal day 14 in both the isocortex and the allocortex and on day 35 in the dentate gyrus. The time-course of development of PPD mRNA-containing neurons in the cerebral cortex suggested that PPD-derived peptide has a neuromodulator and/or neurotransmitter role in these regions of the brain.
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Affiliation(s)
- M Sato
- Department of Anatomy, School of Medicine, Osaka University, Japan
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Gall C, Lauterborn J, Isackson P, White J. Seizures, neuropeptide regulation, and mRNA expression in the hippocampus. PROGRESS IN BRAIN RESEARCH 1990; 83:371-90. [PMID: 2203104 DOI: 10.1016/s0079-6123(08)61263-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recent studies have demonstrated that the regulation of neuropeptide expression in forebrain neurons is responsive to external influences including changes in physiological activity. This has been demonstrated most clearly in studies of hippocampus where the synthesis and resting levels of several neuropeptides, localized within well-characterized components of hippocampal circuitry, have been shown to be selectively influenced by seizure activity. In studies described here, we examined the influence of recurrent limbic seizures on the expression of enkephalin, dynorphin, cholecystokinin, and neuropeptide Y (NPY) in rat and mouse hippocampus using immunohistochemical, in situ hybridization and blot hybridization techniques. The data demonstrate that seizures differentially influence the expression of each peptide as a part of a broader cascade of changes in genomic expression within individual hippocampal neurons. In particular, seizures increase preproenkephalin mRNA and enkephalin peptide but decrease dynorphin peptide in the dentate gyrus granule cell/mossy fiber system. Seizure-induced decreases in the concentration of preprodynorphin mRNA in the granule cells have been reported by others. Immunoreactivity for CCK, which is codistributed with the opioid peptides in the mossy fiber system of mouse, is also dramatically reduced in the granule cell axons by seizure. Recurrent seizures induce two temporally distinct changes in NPY expression in hippocampus. First, there is an increase in hybridization to preproNPY mRNA within scattered, probable local circuit neurons in all subfields. This is followed by the seemingly novel appearance of preproNPY mRNA within the dentate gyrus granule cells and pyramidal cells of field CA1. Clues about mechanisms of neuropeptide regulation have come from observations of other, more rapid, transcriptional events induced by seizure. Most notably, our results and those of others demonstrate that seizures increase the expression of messenger RNAs from immediate-early genes (c-fos, c-jun, and NGFI-A) which encode proteins that may mediate neuropeptide gene regulation. In addition, mRNA for nerve growth factor is dramatically increased in the dentate gyrus granule cells by seizure; increased production of this trophic factor might mediate the more delayed changes in genomic expression and growth responses observed to occur in hippocampus and other forebrain areas following seizure activity.
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Affiliation(s)
- C Gall
- Department of Anatomy and Neurobiology, University of California, Irvine 92717
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Taquet H, Javoy-Agid F, Mauborgne A, Benoliel JJ, Agid Y, Legrand JC, Tramu G, Cesselin F, Hamon M. Biochemical mapping of cholecystokinin-, substance P-, [Met]enkephalin-, [Leu]enkephalin- and dynorphin A (1-8)-like immunoreactivities in the human cerebral cortex. Neuroscience 1988; 27:871-83. [PMID: 2472575 DOI: 10.1016/0306-4522(88)90190-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The distribution of immunoreactive cholecystokinin, substance P, [Met]enkephalin, [Leu]-enkephalin and dynorphin was determined in the cerebral cortex of the human brain post mortem. Peptide radioimmunoassays in three selected zones of the cortical gray mantle (frontal, temporal, occipital) revealed significant regional differences, prompting to the development of a new dissection procedure for the complete mapping of peptide-like materials throughout the entire cerebral cortex. For this purpose, frozen cerebral hemispheres were cut rostrocaudally in 21 verticofrontal serial sections, from which the cortical gray matter was divided into 4-5 distinct zones. The peptides could be measured in each of the 93 dissected pieces of tissue, but their distribution was uneven. The most abundant was cholecystokinin, particularly in the anterior part of the frontal lobe and in the temporal cortex, where its levels reached 0.5 ng/mg of tissue. The regional distribution of cholecystokinin resembled that of substance P with a decreasing gradient from the frontal to the occipital pole, but absolute levels of substance P were hardly one tenth of cholecystokinin levels. The mean concentrations of the three opioid peptides were even less than those of substance P, and their regional distributions were markedly different. [Met]Enkephalin was concentrated in the occipital cortex, and [Leu]enkephalin in the temporal cortex. Dynorphin was the least abundant, even in the temporal cortex where the highest levels were found. The widespread and heterogeneous distribution of these peptides strongly suggests that each of them exerts specific functions in the human cerebral cortex.
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Affiliation(s)
- H Taquet
- INSERM U. 288, Faculté de Médecine Pitié-Salpêtrière, Paris, France
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Lamour Y, Epelbaum J. Interactions between cholinergic and peptidergic systems in the cerebral cortex and hippocampus. Prog Neurobiol 1988; 31:109-48. [PMID: 2840687 DOI: 10.1016/0301-0082(88)90029-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Harlan RE, Shivers BD, Romano GJ, Howells RD, Pfaff DW. Localization of preproenkephalin mRNA in the rat brain and spinal cord by in situ hybridization. J Comp Neurol 1987; 258:159-84. [PMID: 3584538 DOI: 10.1002/cne.902580202] [Citation(s) in RCA: 309] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To determine the localization in rat brain and spinal cord of individual neurons that contain the messenger RNA coding for the opioid peptide precursor preproenkephalin, we performed in situ hybridization with a tritiated cDNA probe complementary to a protion of preproenkephalin mRNA. We observed autoradiographic signal over the cytoplasm of neurons of many regions of the central nervous system. Several types of controls indicated specificity of the labeling. Neurons containing preproenkephalin mRNA were found in the piriform cortex, ventral tenia tecta, several regions of the neocortex, nucleus accumbens, olfactory tubercle, caudate-putamen, lateral septum, bed nucleus of the stria terminalis, diagonal band of Broca, preoptic area, amygdala (especially central nucleus, with fewer labeled neurons in all other nuclei), hippocampal formation, anterior hypothalamic nucleus, perifornical region, lateral hypothalamus, paraventricular nucleus, dorsomedial and ventromedial hypothalamic nuclei, arcuate nucleus, dorsal and ventral premamillary nuclei, medial mamillary nucleus, lateral geniculate nucleus, zona incerta, periaqueductal gray, midbrain reticular formation, ventral tegmental area of Tsai, inferior colliculus, dorsal and ventral tegmental nuclei of Gudden, dorsal and ventral parabrachial nuclei, pontine and medullary reticular formation, several portions of the raphe nuclei, nucleus of the solitary tract, nucleus of the spinal trigeminal tract (especially substantia gelatinosa), ventral and dorsal cochlear nuclei, medial and spinal vestibular nuclei, cuneate and external cuneate nuclei, gracile nucleus, superior olive, nucleus of the trapezoid body, some deep cerebellar nuclei, Golgi neurons in the cerebellum, and most laminae of the spinal cord. In most of these brain regions, the present results indicate that many more neurons contain preproenkephalin mRNA than have been appreciated previously on the basis of immunocytochemistry.
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Abstract
The neuroanatomical distribution of dynorphin B-like immunoreactivity (DYN-B) was studied in the adult male and female albino rat. The distribution of DYN B in colchicine- and noncolchicine-treated animals was also compared to that of another opioid peptide derived from the prodynorphin precursor dynorphin A (1-8) (DYN 1-8), and an opioid peptide derived from the proenkephalin precursor met-enkephalin-arg-gly-leu (MERGL). DYN B cell bodies were present in nonpyramidal cells of neo- and allocortices, medium-sized cells of the caudate-putamen, nucleus accumbens, lateral part of the central nucleus of the amygdala, bed nucleus of the stria terminalis, preoptic area, and in sectors of nearly every hypothalamic nucleus and area, medial pretectal area, and nucleus of the optic tract, periaqueductal gray, raphe nuclei, cuneiform nucleus, sagulum, retrorubral nucleus, peripeduncular nucleus, lateral terminal nucleus, pedunculopontine nucleus, mesencephalic trigeminal nucleus, parabigeminal nucleus, dorsal nucleus of the lateral lemniscus, lateral superior olivary nucleus, superior paraolivary nucleus, medial superior olivary nucleus, ventral nucleus of the trapezoid body, lateral dorsal tegmental nucleus, accessory trigeminal nucleus, solitary nucleus, nucleus ambiguus, paratrigeminal nucleus, area postrema, lateral reticular nucleus, and ventrolateral region of the reticular formation. Fiber systems are present that conform to many of the known output systems of these nuclei, including major descending pathways (e.g., striatonigral, striatopallidal, reticulospinal, hypothalamospinal pathways), short projection systems (e.g., mossy fibers in hippocampus, hypothalamo-hypophyseal pathways), and local circuit pathways (e.g., in cortex, hypothalamus). The distribution of MERGL was, with a few notable exceptions, in the same nuclei as DYN B. From these neuroanatomical data, it appears that the dynorphin and enkephalin peptides are strategically located in brain regions that regulate extrapyramidal motor function, cardiovascular and water balance systems, eating, sensory processing, and pain perception.
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