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Ramirez JM, Burgraff NJ, Wei AD, Baertsch NA, Varga AG, Baghdoyan HA, Lydic R, Morris KF, Bolser DC, Levitt ES. Neuronal mechanisms underlying opioid-induced respiratory depression: our current understanding. J Neurophysiol 2021; 125:1899-1919. [PMID: 33826874 DOI: 10.1152/jn.00017.2021] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Opioid-induced respiratory depression (OIRD) represents the primary cause of death associated with therapeutic and recreational opioid use. Within the United States, the rate of death from opioid abuse since the early 1990s has grown disproportionally, prompting the classification as a nationwide "epidemic." Since this time, we have begun to unravel many fundamental cellular and systems-level mechanisms associated with opioid-related death. However, factors such as individual vulnerability, neuromodulatory compensation, and redundancy of opioid effects across central and peripheral nervous systems have created a barrier to a concise, integrative view of OIRD. Within this review, we bring together multiple perspectives in the field of OIRD to create an overarching viewpoint of what we know, and where we view this essential topic of research going forward into the future.
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Affiliation(s)
- Jan-Marino Ramirez
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Nicholas J Burgraff
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Aguan D Wei
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Nathan A Baertsch
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Adrienn G Varga
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - Helen A Baghdoyan
- Department of Psychology, University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - Ralph Lydic
- Department of Psychology, University of Tennessee, Knoxville, Tennessee.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - Kendall F Morris
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Donald C Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Erica S Levitt
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, Department of Physical Therapy, University of Florida, Gainesville, Florida
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Torralva R, Eshleman AJ, Swanson TL, Schmachtenberg JL, Schutzer WE, Bloom SH, Wolfrum KM, Reed JF, Janowsky A. Fentanyl but not Morphine Interacts with Nonopioid Recombinant Human Neurotransmitter Receptors and Transporters. J Pharmacol Exp Ther 2020; 374:376-391. [PMID: 32513839 DOI: 10.1124/jpet.120.265561] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Synthetic opioids, including fentanyl and its analogs, have therapeutic efficacy in analgesia and anesthesia. However, their illicit use in the United States has increased and contributed to the number one cause of death for adults 18-50 years old. Fentanyl and the heroin metabolite morphine induce respiratory depression that can be treated with the μ opioid receptor (MOR) antagonist naloxone. With higher or more rapid dosing, fentanyl, more than morphine, causes chest wall rigidity and can also induce rapid onset laryngospasm. Because non-MORs could mediate differing clinical manifestations, we examined the interactions of fentanyl and morphine at recombinant human neurotransmitter transporters, G protein-coupled receptors, and the N-methyl-D-aspartate glutamate receptor. Both drugs were agonists at MOR, κ, and δ opioid receptors. Morphine had little or no affinity at other human receptors and transporters (K i or IC50 value >100 µM). However, fentanyl had K i values of 1407 and 1100 nM at α 1A and α 1B adrenoceptor subtypes, respectively, and K i values of 1049 and 1670 nM at dopamine D4.4 and D1 receptor subtypes, respectively; it also blocked [3H]neurotransmitter uptake by the vesicular monoamine transporter 2 (IC50 = 911 nM). Pharmacokinetic models indicate that these Ki and IC50 values are pharmacologically relevant. Fentanyl had little affinity for other receptors or transporters. Thus, noradrenergic disposition at specific receptor subtypes in relevant organs may play a role in respiratory and cardiothoracic effects of fentanyl. Data suggest that less selective fentanyl receptor pharmacology could play a role in the different clinical effects of morphine compared with fentanyl, including fentanyl-induced deaths after illicit use. SIGNIFICANCE STATEMENT: The synthetic opioid fentanyl induces different clinical effects, including rapid onset muscular rigidity, vocal cord closure, and rapid death, than the heroin metabolite morphine. Our data indicate for the first time that the two drugs have very different effects at recombinant human neurotransmitter receptors and transporters that might explain those clinical differences.
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Affiliation(s)
- Randy Torralva
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Amy J Eshleman
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Tracy L Swanson
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Jennifer L Schmachtenberg
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - William E Schutzer
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Shelley H Bloom
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Katherine M Wolfrum
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - John F Reed
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Aaron Janowsky
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
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