[PDF][PDF] Bias factor and therapeutic window correlate to predict safer opioid analgesics

CL Schmid, NM Kennedy, NC Ross, KM Lovell, Z Yue… - Cell, 2017 - cell.com
CL Schmid, NM Kennedy, NC Ross, KM Lovell, Z Yue, J Morgenweck, MD Cameron
Cell, 2017cell.com
Biased agonism has been proposed as a means to separate desirable and adverse drug
responses downstream of G protein-coupled receptor (GPCR) targets. Herein, we describe
structural features of a series of mu-opioid-receptor (MOR)-selective agonists that
preferentially activate receptors to couple to G proteins or to recruit βarrestin proteins. By
comparing relative bias for MOR-mediated signaling in each pathway, we demonstrate a
strong correlation between the respiratory suppression/antinociception therapeutic window …
Summary
Biased agonism has been proposed as a means to separate desirable and adverse drug responses downstream of G protein-coupled receptor (GPCR) targets. Herein, we describe structural features of a series of mu-opioid-receptor (MOR)-selective agonists that preferentially activate receptors to couple to G proteins or to recruit βarrestin proteins. By comparing relative bias for MOR-mediated signaling in each pathway, we demonstrate a strong correlation between the respiratory suppression/antinociception therapeutic window in a series of compounds spanning a wide range of signaling bias. We find that βarrestin-biased compounds, such as fentanyl, are more likely to induce respiratory suppression at weak analgesic doses, while G protein signaling bias broadens the therapeutic window, allowing for antinociception in the absence of respiratory suppression.
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