Investigating Opioid‐induced Respiratory Depression and Analgesia Using Larval Zebrafish

Abstract

Introduction Opioid drugs produce both analgesia and severe respiratory depression which can be lethal. In 2019, over 50,000 North Americans died of an opioid overdose. Our understanding on how to differentiate between these two effects is limited due to a lack of simple animal models. Therefore, we aim to understand respiratory depression and analgesia by opioids using novel zebrafish models, allowing for drug screening. Using these models, we tested a variety of drugs including serotoninergic agonists, glutamatergic modulators, and calcium channel activators, for their ability to reverse opioid-induced respiratory depression. Methods We have established phenotype-based approaches using in-vivo zebrafish models of respiratory depression and analgesia by fentanyl. To quantify respiratory depression, we measured respiratory activity by quantifying mandible movements in 12-14 day post-fertilization larvae. To quantify analgesia, we measured the escape swimming response to nociceptive stimuli such as formalin or allyl isothiocyanate (AITC) combined with fentanyl to induce analgesia. We then introduced various candidate drugs to measure their effects on respiratory depression and analgesia. Results Respiratory rate was normalized to each fish's baseline (baseline=100%). Zebrafish strains were found to be differentially sensitive to opioids, where Tübingen (TU) fish did not respond to fentanyl (1µM, p=0.4240, n=9) and AB fish showed significant respiratory rate depression (p<0.001, n=11). AB and TU crosses did not show respiratory depression (n=7). In AB zebrafish, a dose-dependent decrease in respiratory rate was observed with 1μM and 3µM fentanyl (p=0.01, n=11 and p<0.001, n=27, respectively). The opioid antagonist naloxone (20µM) and selective antagonist CTAP (4μM) reversed respiratory depression by fentanyl (p<0.001, n=9 and p=0.049, n=11, respectively). Respiratory depression by 1μM fentanyl was reversed by the AMPA receptor positive allosteric modulator CX614 (5μM, p<0.001, n=9) but not the serotoninergic 5-HT4 agonist BIMU8 (10μM, n=21). Calcium channel activators nefiracetam (1µM) and FLP-64176 (1µM) reversed respiratory depression by fentanyl (1µM, p=0.005, n=11 and3µM, p<0.001, n=15, respectively). Formalin (0.075%) and AITC (100µM) significantly increased swimming velocity (p=0.005, n=21 and p<0.001, n=23, respectively), which was reduced by fentanyl (4μM, p<0.001, n=12and 6µM, p=0.004, n=14, respectively). FLP-64176 reversed fentanyl analgesia when administered with formalin (p<0.001, n=10). Discussion: Our models show that respiratory depression and analgesia by opioids can be measured in zebrafish larvae. The strain differences point to a potential genetic protection which we are investigating using quantitative real-time polymerase chain reaction (qPCR). Our novel zebrafish models can be used to investigate the effects of opioids, as well as for drug screening to find ways to treat respiratory depression while preserving analgesia.