Mu- and delta-opioid receptor densities in respiratory-related brainstem regions of neonatal swine

Glial TLR4 signaling does not contribute to opioid-induced depression of respiration

Opioids activate glia in the central nervous system in part by activating the toll-like receptor 4 (TLR4)/myeloid differentiation 2 (MD2) complex. TLR4/MD2-mediated activation of glia by opioids compromises their analgesic actions. Glial activation is also hypothesized as pivotal in opioid-mediated reward and tolerance and as a contributor to opioid-mediated respiratory depression. We tested the contribution of TLR4 to opioid-induced respiratory depression using rhythmically active medullary slices that contain the pre-Bötzinger Complex (preBötC, an important site of respiratory rhythm generation) and adult rats in vivo. Injection with DAMGO (μ-opioid receptor agonist; 50 μM) or bath application of DAMGO (500 nM) or fentanyl (1 μM) slowed frequency recorded from XII nerves to 40%, 40%, or 50% of control, respectively. This DAMGO-mediated frequency inhibition was unaffected by preapplication of lipopolysaccharides from Rhodobacter sphaeroides (a TLR4 antagonist, 2,000 ng/ml) or (+)naloxone (1-10 μM, a TLR4-antagonist). Bath application of (-)naloxone (500 nM; a TLR4 and μ-opioid antagonist), however, rapidly reversed the opioid-mediated frequency decrease. We also compared the opioid-induced respiratory depression in slices in vitro in the absence and presence of bath-applied minocycline (an inhibitor of microglial activation) and in slices prepared from mice injected (ip) 18 h earlier with minocycline or saline. Minocycline had no effect on respiratory depression in vitro. Finally, the respiratory depression evoked in anesthetized rats by tail vein infusion of fentanyl was unaffected by subsequent injection of (+)naloxone, but completely reversed by (-)naloxone. These data indicate that neither activation of microglia in preBötC nor TLR4/MD2-activation contribute to opioid-induced respiratory depression.

Role of central and peripheral opiate receptors in the effects of fentanyl on analgesia, ventilation and arterial blood-gas chemistry in conscious rats

This study determined the effects of the peripherally restricted μ-opiate receptor (μ-OR) antagonist, naloxone methiodide (NLXmi) on fentanyl (25μg/kg, i.v.)-induced changes in (1) analgesia, (2) arterial blood gas chemistry (ABG) and alveolar-arterial gradient (A-a gradient), and (3) ventilatory parameters, in conscious rats. The fentanyl-induced increase in analgesia was minimally affected by a 1.5mg/kg of NLXmi but was attenuated by a 5.0mg/kg dose. Fentanyl decreased arterial blood pH, pO2 and sO2 and increased pCO2 and A-a gradient. These responses were markedly diminished in NLXmi (1.5mg/kg)-pretreated rats. Fentanyl caused ventilatory depression (e.g., decreases in tidal volume and peak inspiratory flow). Pretreatment with NLXmi (1.5mg/kg, i.v.) antagonized the fentanyl decrease in tidal volume but minimally affected the other responses. These findings suggest that (1) the analgesia and ventilatory depression caused by fentanyl involve peripheral μ-ORs and (2) NLXmi prevents the fentanyl effects on ABG by blocking the negative actions of the opioid on tidal volume and A-a gradient.

Effects of anesthetics, sedatives, and opioids on ventilatory control

This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.

Opioidergic and dopaminergic modulation of respiration

Opioids, dopamine and their receptors are present in many regions of the bulbar respiratory network. The physiological importance of endogenous opioids to respiratory control has not been explicitly demonstrated. Nonetheless, studies of opioidergic respiratory mechanisms are important because synthetic opiate drugs have respiratory side effects that in some situations pose health risks and limit their therapeutic usefulness. They can depress breathing depth and rate, blunt respiratory responsiveness to CO2 and hypoxia, increase upper airway resistance and reduce pulmonary compliance. The opiate respiratory disturbances are mainly due to agonist activation of mu- and delta-subtypes of receptor and involve specific types of respiratory-related neurons in the ventrolateral medulla and the dorsolateral pons. Endogenous dopaminergic modulation in the CNS and carotid bodies enhances CO2-dependent respiratory drive and depresses hypoxic drive. In the CNS, synthetic agonists with selectivity for D1-and D4-types of receptor slow respiratory rhythm, whereas D2-selective agonists modulate acute and chronic responses to hypoxia. D1-receptor agonists also act centrally to increase respiratory responsiveness to CO2, and counteract opiate blunting of CO2-dependent respiratory drive and depression of breathing. Cellular targets and intracellular mechanisms responsible for opioidergic and dopaminergic respiratory effects for the most part remain to be determined.

Methadone-induced respiratory depression in the neonatal guinea pig

Respiratory depression, the most serious side-effect of opioid treatment, is well documented for morphine, the most commonly used opioid in neonatal care. Less is known about methadone, a clinically relevant opioid analgesic, especially during neonatal development. This study was undertaken to determine the neonatal respiratory effects of methadone. We hypothesize that methadone is equipotent to morphine, compared to our previous morphine results in the same animal model, but has a much longer duration of action, due to its longer elimination half-life. Neonatal guinea pigs (3-14 days old) randomly received a single subcutaneous dose of methadone or saline. Using a non-invasive plethysmographic method, we measured ventilatory and metabolic parameters before injection and at intervals for 32 hr after injection while pups breathed "room air" or 5% CO(2) gas mixtures. Methadone-induced depression of ventilation was most evident during 5% CO(2) challenge. The onset of drug effects was within 15 min for all ages and doses, but the duration of action decreased with age. While the depth of methadone-induced respiratory depression did not depend on pup age, the control of breathing was different in 3-day-old pups, where inspiratory time increased fourfold; twice that of older pups. We conclude that methadone induces a naloxone reversible respiratory depression in guinea pig neonates and, in the very young, causes an abnormal breathing pattern due to changes in respiratory timing. Methadone is more potent than morphine with respect to neonatal respiratory depression, but surprisingly, the duration of methadone action was not longer than morphine.

Effects of leucine-enkephalin on potassium currents in neurons in the rat respiratory center in vitro

Experiments to identify the neuronal mechanisms underlying the respiratory activity of the opioid peptide leucine-enkephalin were performed on transverse slices of the rat brainstem in voltage-clamped conditions; studies addressed the effects of this peptide (10 nM-1 microM) on the potassium A current and the inward potassium current of neurons in two areas of the respiratory center: the ventrolateral area of the solitary tract nucleus and the pre-Bötzinger complex. The parameters of the A current assessed in all respiratory center neurons studied showed no change in the presence of leucine-enkephalin. At the same time, leucine-enkephalin produced reversible increases in the amplitude of the inward potassium current. These results provide evidence that the inhibitory effect of leucine-enkephalin at the level of respiratory center neurons is at least in part explained by its stimulatory action on the inward potassium current but is not associated with modulation of the potassium A current.

The effects of leucine-enkephalin on the membrane potential and activity of rat respiratory center neurons in vitro

Studies of transverse slices of Wistar rat brainstem using a patch clamp technique addressed the effects of the opioid peptide leucine-enkephalin (10 nM-1 microM) on the membrane potential and pattern of spontaneous activity of neurons in two parts of the respiratory center: the ventrolateral area of the solitary tract nucleus and the pre-Bötzinger complex. Leucine-enkephalin induced membrane hyperpolarization of respiratory center neurons and decreased the level of spike activity in spontaneously active cells. In pre-Bötzinger complex neurons showing a burst pattern of activity, leucine-enkephalin decreased the burst frequency, and two cells showed a transition from burst activity to tonic activity. These results provide evidence that the mechanism of the central respiratory activity of leucine-enkephalin results from its direct action on the membranes of respiratory center neurons.

Acute effects of fentanyl on breathing pattern in anaesthetized subjects

BACKGROUND

The predominant effect of opioids on respiratory pattern during anaesthesia is an increase in the duration of expiration (an effect on 'timing'), but there may also be changes in tidal volume (an effect on 'drive'). Timing and drive are controlled by separate neuronal systems, but are infrequently considered individually. The effects of opioids on breathing are not well characterized clinically because changes in carbon dioxide and anaesthetic levels usually occur at the same time, and can obscure the effects of the opioid.

METHODS

To study these effects in isolation, we established stable mild hypercapnia in female patients breathing spontaneously during sevoflurane anaesthesia, and then gave fentanyl 0.5 microg kg(-1) i.v. End-tidal carbon dioxide and sevoflurane concentrations were maintained constant, and the changes in timing of inspiration, expiration and tidal volume were measured.

RESULTS

The duration of inspiration increased by 30%, and the duration of expiration increased by 95%. Tidal volume increased in proportion to inspiratory duration, and the pattern of flow during the breath was recognizably changed, with a reduction in the rate of increase of flow at the onset of inspiration.

CONCLUSIONS

Small doses of opioid given when anaesthesia and carbon dioxide are stable affect respiratory timing predominantly, but in addition changes in the pattern of motor output can be detected.

Developmental expression of mu and delta opioid receptors in the rat brainstem: evidence for a postnatal switch in mu isoform expression

Opioid receptors are expressed in the brain during fetal and postnatal development, and the expression patterns vary with developmental age. To investigate the role of opioids in brain development, immunoblotting and immunohistochemical techniques were used to determine mu (MOR) and delta (DOR) opioid receptor expression levels and regional distributions in fetal, early postnatal and adult rat brainstem. Two immunoreactive bands were seen on Western blots of brainstem lysates for both MOR (50 and 70 kDa) and DOR (30 and 60 kDa). The expression levels of the isoforms changed dramatically between 6 and 15 days after birth. Total MOR protein was expressed at low levels in fetal and early postnatal animals with the 50-kDa band predominating. MOR expression then increased in the older animals and the 70-kDa isoform became dominant. Total DOR protein showed the opposite pattern, being high in the fetal and neonatal brainstem and low in the juvenile and adult. A postnatal switch in isoform expression for DOR was not evident in our study. In general, regional brainstem distributions in developing and adult animals were comparable to those reported in the literature, and both receptors were localized in the same areas where opioid receptor expression was high. It was concluded that MOR and DOR are developmentally regulated in the brainstem of the rat, that the isoform ratio switches postnatally from a fetal-neonatal pattern to a juvenile-adult pattern and that both receptors are generally expressed in the same brainstem regions from E16 to adult.

Central neuropeptide systems and respiratory control during development

The substance P/neurotachykinin-1 (NK-1) and the mu-opioid G protein-coupled receptor systems endow brainstem respiratory regions and display discrete developmental patterns. Hypoxia-induced neuropeptide release may increase receptor endocytosis, reducing receptor accessibility to ligands. We wondered whether the attenuated respiratory response to hypoxia of developing piglets after single (Respir. Physiol. 92 (1993a) 115) or repeated daily hypoxic exposure (J. Appl. Physiol. 83 (1997) 522) is influenced by differential endocytosis of NK-1 vs mu-opioid receptors. Whereas the long-term (24 h) response of both receptors to recurrent hypoxia in piglet brainstem is similar, i.e. upregulation, the short-term (5 min) response to single or recurrent hypoxia, albeit in rats, is different: radiolabelled NK-1 receptors are greatly reduced, suggesting enhanced endocytosis, but mu-opioid receptors remain unchanged, implying unaltered endocytosis. If confirmed in piglet brainstem, this difference would produce relatively more available mu-opioid receptors to opioid peptides in hypoxia that might contribute to the attenuated respiratory responses to single and repeated hypoxia during development.

Chronic in utero morphine exposure alters mu-agonist-stimulated [35S]-GTPgammaS binding in neonatal and juvenile guinea pig brainstem regions associated with breathing control

Narcotic analgesics act acutely upon opioid receptors in the brainstem to depress respiration in neonates, whereas withdrawal from chronic in utero exposure to morphine is associated with hyperventilation in the newborn. Because of the association between breathing and exposure to exogenous opioids, opioid-stimulated [35S]-guanylyl-5'-O-(gamma-thio)-triphosphate ([35S]-GTPgammaS) binding was examined in respiratory control areas of the brainstem in 3-, 7-, and 14-day-old guinea pigs who were exposed during the last 2 weeks of gestation by maternal subcutaneous injections of 7.5 mg/kg of morphine or an equal volume of saline twice daily. Ten micromolar D-ala(2), MePhe(4), Gly(ol)(5)-enkephalin (DAMGO), a mu-specific opioid receptor agonist, stimulated [35S]-GTPgammaS binding in the caudal and rostral ventral respiratory groups (cVRG and rVRG), nucleus tractus solitarius (NTS), and the parabrachial nucleus (PB). There were no statistically significant age-related changes in DAMGO-stimulated binding for any of the respiratory areas. However, morphine-exposed animals had decreased DAMGO-stimulated [35S]-GTPgammaS binding in these brainstem areas compared to saline-exposed animals. We hypothesize that this morphine-induced decrease in DAMGO activation of the mu-opioid receptor may be a partial explanation for the hyperventilation observed during neonatal morphine withdrawal.

Developmental changes of (3)H-labelled mu-opioid receptors in brainstems of intra-uterine growth-restricted rats

The opioid mu-system is involved in brainstem-mediated respiratory control. Infants with intra-uterine growth restriction (IUGR) have more respiratory disorders in the early postnatal period. Using [(3)H]DAGO, a mu-selective ligand, and a computer-based image analysis of autoradiography, we compared the ontogeny and distribution of mu-opioid binding sites in the brainstem of IUGR and control rats in utero (E21), at birth (P0) and on postnatal days 1 (P1), P7, P10, P14 and P21. The ontogeny pattern was found to be similar in both groups. The density of the binding sites, which was low in E21, increased at P0, slightly declined at P1 and remained relatively constant thereafter. The distribution of DAGO-binding sites, also similar in both groups, was heterogeneous and was much denser in the dorsal areas of medulla and pons. In particular, binding sites were highly concentrated in nuclei involved in the cardio-respiratory function. However, DAGO-binding density was higher at all ages (except for P0 and P1) in IUGR than in control rats. Taken together, these results give at least a partial explanation for the effects of IUGR which lowers the Apgar score at birth and raises the incidence of respiratory disorders in infants.

Endogenous opiates: 1999

This paper is the twenty-second installment of the annual review of research concerning the opiate system. It summarizes papers published during 1999 that studied the behavioral effects of the opiate peptides and antagonists, excluding the purely analgesic effects, although stress-induced analgesia is included. The specific topics covered this year include stress; tolerance and dependence; learning, memory, and reward; eating and drinking; alcohol and other drugs of abuse; sexual activity, pregnancy, and development; mental illness and mood; seizures and other neurologic disorders; electrical-related activity; general activity and locomotion; gastrointestinal, renal, and hepatic function; cardiovascular responses; respiration and thermoregulation; and immunologic responses.

Respiratory responses to single and episodic hypoxia during development: mechanisms of adaptation

The respiratory responses of the developmental subject to single and repeated episodes of hypoxia are distinct. During a single exposure, the fetus responds with an arrest of breathing activity, and the neonate, with excitation followed by depression (the biphasic response). Mechanisms under active consideration include chemosensory resetting, hypometabolism, prevalence of inhibitory neurotransmitter/modulator influence, and supramedullary regulation of control functions. When exposed to recurrent episodic hypoxia, neonates respond with relative hypoventilation, i.e. tolerance to a subsequent hypoxic stimulus. Whereas the investigation of processes responsible for this tolerance is at its infancy, studies using chronic hypoxia appear to be a useful guide. So far, altered interstitial neuromodulator levels and central markers of programmed neuronal death are harbingers of future research in this field. The clarification of the mechanisms involved in response to recurrent episodic hypoxia during development will be of fundamental value and may be useful for the eventual treatment and/or prevention of harmful central respiratory-related processes.

Prenatal cocaine raises mu-opioid receptor density in piglet cardiorespiratory medulla

Repeated prenatal exposure to cocaine attenuates arousal and cardiorespiratory functions in neonates. This study explored the possible role of brainstem mu- and delta-opioid systems in these effects. Medullary sections were obtained from 6 to 7 (young) and 20 to 21-day-old (older) piglets either unexposed or exposed prenatally to a 2-mg/kg intravenous cocaine hydrochloride dose, injected to the pregnant sow four times a day during the last third of gestation. Mu- and delta-opioid receptor binding was assessed by quantitative autoradiography using, respectively, 125I-DAMGO (Tyr-D-Ala-Gly-N-Me-Phe-Gly-ol) and 125I-DPDPE (Tyr-D-Pen-Gly-pCl-Phe-D-Pen). At control, delta-, but not mu-opioid, receptor density increased with postnatal age. In contrast, cocaine-induced mu-, but not delta-opioid, receptor density increased 1) in the dorsal motor vagal (dmnX) and facial (nF) nuclei, and, at borderline significance level, in the cardiorespiratory-related gigantocellular reticular nucleus (nRG) of the young, and 2) in the spinal trigeminal nucleus and tract (nSp5), and in the cardiorespiratory-related medial solitary tract (nTSm) and lateral reticular (nRL) nuclei of both age groups. These findings support a possible participation of the mu-opioid system in the attenuation of arousal and cardiorespiration after repeated prenatal exposure to cocaine.