The effect of fentanyl and morphine on neurons in the dorsal raphe nucleus in the rat: an in vitro study

Unique Pharmacology, Brain Dysfunction, and Therapeutic Advancements for Fentanyl Misuse and Abuse

Fentanyl is a fully synthetic opioid with analgesic and anesthetic properties. It has become a primary driver of the deadliest opioid crisis in the United States and elsewhere, consequently imposing devastating social, economic, and health burdens worldwide. However, the neural mechanisms that underlie the behavioral effects of fentanyl and its analogs are largely unknown, and approaches to prevent fentanyl abuse and fentanyl-related overdose deaths are scarce. This review presents the abuse potential and unique pharmacology of fentanyl and elucidates its potential mechanisms of action, including neural circuit dysfunction and neuroinflammation. We discuss recent progress in the development of pharmacological interventions, anti-fentanyl vaccines, anti-fentanyl/heroin conjugate vaccines, and monoclonal antibodies to attenuate fentanyl-seeking and prevent fentanyl-induced respiratory depression. However, translational studies and clinical trials are still lacking. Considering the present opioid crisis, the development of effective pharmacological and immunological strategies to prevent fentanyl abuse and overdose are urgently needed.

Highlights in opioid agonists and antagonists

This review highlights new insights in to opioid agonists and antagonists, focusing on their mechanism of action with spinal and systemic administration, chronic use and main adverse effects. Short-cuts on some opioid agonists and antagonists of clinical interest are also presented, revealing potential clinical implications and future clinical directions as part of multimodal analgesia.

Contributions of serotonin in addiction vulnerability

The serotonin (5-hydroxytryptamine; 5-HT) system has long been associated with mood and its dysregulation implicated in the pathophysiology of mood and anxiety disorders. While modulation of 5-HT neurotransmission by drugs of abuse is also recognized, its role in drug addiction and vulnerability to drug relapse is a more recent focus of investigation. First, we review preclinical data supporting the serotonergic raphe nuclei and their forebrain projections as targets of drugs of abuse, with emphasis on the effects of psychostimulants, opioids and ethanol. Next, we examine the role of 5-HT receptors in impulsivity, a core behavior that contributes to the vulnerability to addiction and relapse. Finally, we discuss evidence for serotonergic dysregulation in comorbid mood and addictive disorders and suggest novel serotonergic targets for the treatment of addiction and the prevention of drug relapse.

Pro-epileptic effect of alfentanil in rats subjected to pilocarpine-induced chronic epilepsy

Pharmacological induction of epileptiform activity is a complementary method to study the epileptogenic area in drug-resistant epileptic patients. Among the different activation methods, fentanyl derivatives (e.g. alfentanil) provide one of the most efficient tools in triggering epileptiform abnormalities in surgical candidates. In this study, we tested the pro-epileptic effect of different concentrations of alfentanil in hippocampal slices obtained from control and pilocarpine-treated chronic epileptic rats. The pro-convulsant action of alfentanil was also studied in control and pilocarpine-treated epileptic rats implanted with subdural and hippocampal electrodes for electroencephalographic recordings. In 90% of slices from control animals, application of alfentanil (0.1-5 microM) induced a significant enhancement in amplitude and number of population spikes recorded in the hippocampal CA1 region. In contrast, alfentanil produced a significant reduction in the amplitude of population spikes in slices from pilocarpine-treated epileptic rats. These changes were accompanied by a significant increase in the number of population spikes in the form of epileptiform multispike responses of epileptic slices. Naloxone (20 microM) antagonized the effect of alfentanil in both control and epileptic slices, reducing the number of population spikes in slices from epileptic rats. In control rats, alfentanil induced epileptiform abnormalities in the hippocampal and cortical electroencephalographic recordings but only at concentrations higher than 200 microg/kg (e.g. 350 microg/kg). Lower doses of alfentanil (25 microg/kg) elicited epileptiform abnormalities only in chronic epileptic rats. The potent action of a minimal dose of alfentanil in inducing epileptiform activity suggests an enhancement of the pro-convulsant action of mu-receptor opioids in chronic temporal lobe epilepsy.

Rate-independent inhibition by norepinephrine of 5-HT release from the somadendritic region of serotonergic neurons

Endogenous adrenergic drive regulates the firing rate of serotonergic neurons. However, advocates of feedback theory assert that 5-hydroxytryptamine (5-HT) released in the somatodendritic region of raphe neurons regulates both rate and release of 5-HT. Experiments were done to determine if the somatodendritic region might have receptors for norepinephrine that inhibit release of 5-HT independently of rate, as this would allow for discrete effects of norepinephrine on rate and release, even in the presence of functional feedback by 5-HT. The release of 5-HT at fixed frequencies of stimulation was substantially reduced when norepinephrine (1 and 3 x 10(-7) M) was present. Norepinephrine also inhibited the release of 3H-5-HT with delivery of a single stimulation pulse ruling out a remote action of the catecholamine. The alpha(1) antagonist prazosin did not modify the profile of norepinephrine inhibition. Further, the alpha(1) agonist phenylephrine had no effect on 3H-5-HT efflux. The alpha(2) antagonist yohimbine antagonized almost entirely the inhibition by norepinephrine at 1 Hz, and reduced it substantially at 3 Hz. Blockade of 5-HT(1) receptor sites with methiothepin did not reduce the inhibitory effect of norepinephrine on 3H-5-HT efflux. It is proposed that release of endogenous norepinephrine at synapses with 5-HT neurons could activate 5-HT neuron firing rate through alpha(1) receptors located at the soma and simultaneously short-circuit ongoing 5-HT feedback inhibition by inhibiting release through adrenergic alpha two receptors likely located at the dendrites.

Developmental changes in the localization of the transplasma membrane NADH-dehydrogenases in the rat brain

The function of transplasma membrane oxidoreductases (PMO's) has been further studied by means of investigating the postnatal (PN) developmental changes in the tissue localization of six isoenzymes previously characterized (see accompanying paper). The changes were followed in the midbrain for PMO-I, -II, and -V and in the brainstem for PMO-III, -IV and -VI. PMO-I is not observed before PN5 and develops as long vertical fibers located mainly in the pontine nucleus and in the dorsal raphe nucleus until it merges all over the midbrain except for the aqueduct and the superior colliculus after PN10. At that stage it is highly expressed in the trigeminal nucleus and the dorsal raphe, but its expression then strongly decreases and PMO-I disappears almost completely later on. Similarly PMO-II only develops around PN5, first in the dorsal and caudal linear raphe and later on (at PN7) also in the pontine nucleus and in the median raphe; at PN10 PMO-II gradually had vanished from these areas and strongly developed in the dorsal raphe and in the mesencephalic trigeminal nucleus. Later on PMO-II also decreases from these areas. PMO-III slowly develops within the gigantocellular reticular nucleus from PN1 to PN5 and later on reaches the facial nucleus (after PN5), the density of PMO-III in these regions at PN10 being much higher than in the adult. PMO-IV follows a similar developmental pattern in the midbrain, with an optimal density around PN10 also. PMO-V appears only at about PN5, first within the dorsal raphe in parallel fibers and in multipolar neurons. It disappears from the fibers around PN10 and remains present in neurons up to adulthood. PMO-VI appears at early stages within the gigantocellular reticular nucleus and after PN5 within the central gray in vertical fibers. At later stages PMO-VI is found in the spinal trigeminal nucleus, at first within the neuropil then in multipolar neurons that remain present up to adulthood. These datas suggested that the different isoenzymes are expressed at various stages in specific areas. The role of PMO's in neuronal development is discussed.

Activity changes in rat raphe magnus neurons at different concentrations of fentanyl in vitro

The nucleus raphe magnus (NRM) is an important descending pain inhibitory system. We postulated that the analgesic action of supraspinally administered opiates results from increased descending inhibitory control of the NRM. We tested whether fentanyl activates NRM neurons in the rat slice preparation using extra-cellular recording. Eighty-seven percent of NRM neurons (total number = 68) tested were spontaneously active with firing frequencies of 0.2-4 spikes/s in artificial cerebrospinal fluid. Application of fentanyl (0.25, 0.5, and 1 mumol/L) increased firing frequencies in 12 of 59 (20%) spontaneously active neurons. In 6 of 9 (67%) silent neurons, fentanyl induced firing activities. Naloxone (1-2 mumol/L) antagonized the increased or induced activities by fentanyl in three neurons. In 13 of 59 (22%) spontaneously active neurons, fentanyl decreased the firing frequencies. Although fentanyl was associated with increased activity in a total of 18 NRM neurons, fentanyl at a higher concentration significantly increased the number of inhibited neurons. The results indicate that fentanyl partly activates the descending inhibitory system originating from the NRM; however, at higher concentrations, it appears also to inhibit this same system.