Abstract

The rates of opioid overdose in the United States quadrupled between 1999 and 2017, reaching a staggering 130 deaths per day. This health epidemic demands innovative solutions that require uncovering the key brain areas and cell types mediating the cause of overdose- opioid-induced respiratory depression. Here, we identify two primary changes to murine breathing after administering opioids. These changes implicate the brainstem's breathing circuitry which we confirm by locally eliminating the µ-Opioid receptor. We find the critical brain site is the preBötzinger Complex, where the breathing rhythm originates, and use genetic tools to reveal that just 70-140 neurons in this region are responsible for its sensitivity to opioids. Future characterization of these neurons may lead to novel therapies that prevent respiratory depression while sparing analgesia.

Highlights

  • 400,000 people in the United States died from a drug overdose involving a prescription or illicit opioid between 1999 and 2017 [1]

  • We show that two small brainstem sites are sufficient to rescue opioid induced respiratory depression

  • Characterization of these neurons and their molecular response to opioids may reveal a strategy for separating respiratory depression from analgesia and enable the development of novel opioids or related compounds that relieve pain without risk of overdose

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Summary

Introduction

400,000 people in the United States died from a drug overdose involving a prescription or illicit opioid between 1999 and 2017 [1]. This epidemic is not unique to the United States and with the increasing distribution of highly potent synthetic opioids like fentanyl, it has become a global public health emergency [2]. In both the central and peripheral nervous systems, including sites that could modulate breathing such as: the cerebral cortex, brainstem respiratory control centers, primary motor neurons, solitary nucleus, and oxygen sensing afferents [5,6]. Either one or multiple sites could be mediating the depressive effects of opioids on breathing

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