A nontoxic pain killer designed by modeling of pathological receptor conformations

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Science  03 Mar 2017:
Vol. 355, Issue 6328, pp. 966-969
DOI: 10.1126/science.aai8636

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A pain killer without side effects

Opioids are very strong and effective pain killers. However, they also have a range of well-known side effects and can cause addiction. Painful conditions such as inflammation or trauma are often associated with localized tissue acidification. Spahn et al. designed a novel opioid receptor agonist that, unlike clinically used opioids, best activates the receptors in such acidified tissues. In rat models of inflammatory pain, the new drug exerted strong pain relief essentially without the side effects of standard opioids.

Science, this issue p. 966


Indiscriminate activation of opioid receptors provides pain relief but also severe central and intestinal side effects. We hypothesized that exploiting pathological (rather than physiological) conformation dynamics of opioid receptor-ligand interactions might yield ligands without adverse actions. By computer simulations at low pH, a hallmark of injured tissue, we designed an agonist that, because of its low acid dissociation constant, selectively activates peripheral μ-opioid receptors at the source of pain generation. Unlike the conventional opioid fentanyl, this agonist showed pH-sensitive binding, heterotrimeric guanine nucleotide–binding protein (G protein) subunit dissociation by fluorescence resonance energy transfer, and adenosine 3′,5′-monophosphate inhibition in vitro. It produced injury-restricted analgesia in rats with different types of inflammatory pain without exhibiting respiratory depression, sedation, constipation, or addiction potential.

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