Opioid drugs can be efficacious in the treatment of chronic pain, but are plagued by the development of serious side effects such as tolerance and dependence that worsen with chronic use. Recent investigations into the pathology of chronic pain and the compensatory changes induced by chronic opioid treatment has revealed that upregulated receptor systems, including the cholecystokinin (CCK) and the kappa and delta opioid receptors (KOR, DOR), mediate many of the negative side effects of chronic opioid use, and may also dampen mu opioid (MOR) mediated analgesia. Based on these findings, we have developed three novel classes of bifunctional ligands with MOR agonist activity, and CCK, DOR, or KOR antagonist activity, respectively. Using CHO cell models containing the individual receptors and assays of receptor activity, including [35S]‐GTPγS coupling, ERK MAPK activation, and βarrestin2 recruitment, we present data characterizing these compounds and demonstrating that this approach yields compounds with the desired activity profiles at both receptor pairs. We also present in vivo data demonstrating that some of these compounds have an improved therapeutic index when compared to established opioids. Novel molecular strategies such as these which take advantage of a more complete biological understanding of the disease process hold much promise for the development of improved analgesics for human health.
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