Probing the Cellular Basis of Spinal Kappa Opioid Receptor Inhibition of Itch

The kappa opioid receptor (KOR, encoded by Oprk1) is an extremely attractive target for the treatment of chronic itch. The KOR agonist nalfurafine is used to treat chronic itch associated with kidney and liver disease in Japan, with additional KOR agonists in development for atopic dermatitis and neuropathic itch. Despite the clinical promise of KOR agonists, the cellular basis of KOR inhibition of itch remains unknown. Previous work from our lab demonstrated that KOR inhibition of itch occurs – at least in part – at the level of the spinal cord, raising the question: how does KOR signaling inhibit itch spinal circuits? We are addressing this fundamental gap in knowledge through a combination of molecular, genetic, behavioral, and physiological approaches in mice. First, we used fluorescent in situ hybridization to determine which spinal neuron populations express Oprk1. We show that Oprk1 is expressed within a heterogenous population of spinal neurons, but primarily those that express the neuropeptide substance P or the neurokinin-1 receptor, which drive itch behavior. Moreover, retrograde viral labeling revealed that Oprk1 is expressed in spinoparabrachial neurons that relay itch input from the spinal cord to the brain. Next, we tested whether Oprk1 spinal neurons contribute to itch behaviors. We selectively expressed excitatory chemogenetic tools in Oprk1-Cre spinal neurons and found that chemogenetic activation of these neurons potentiated itch behaviors. Finally, we used ex vivo two-photon calcium imaging of the spinal cord to visualize the neuron networks activated by spinal itch neuropeptides and investigated how KOR agonists inhibit these networks. Notably, these data are the first in-depth look into the cellular basis of spinal KOR inhibition of itch and provide fundamental mechanistic insights into KOR agonists that are clinically effective in alleviating chronic itch. Supported by NIH grants F32NS110155 (TDS) and R01NS0967905 (SER).