Fentanyl blockade of K+channels contribute to Wooden Chest Syndrome

Abstract Fentanyl is a potent synthetic opioid widely used perioperatively and illicitly as a drug of abuse 1,2. It is well established that fentanyl acts as a μ-opioid receptor agonist, signaling through Gαi/o intracellular pathways to inhibit electrical excitability, resulting in analgesia and respiratory depression 3,4. However, fentanyl uniquely also triggers muscle rigidity, including respiratory muscles, hindering the ability to execute central respiratory commands or to receive external resuscitation. This potentially lethal condition is termed Wooden Chest Syndrome (WCS), the mechanisms of which are poorly understood 5–7. Here we show that fentanyl directly blocks a subset of EAG-class potassium channels 8. Our results also demonstrate that these channels are widely expressed in cervical spinal motoneurons, including those innervating the diaphragm. A significant fraction of these motoneurons is excited by fentanyl, concomitant with blockade of voltage-dependent non-inactivating K+ currents. In vivo electromyography revealed a persistent tonic component of diaphragmatic muscle activity elicited by fentanyl, but not morphine. Taken together our results identify a novel off-target mechanism for fentanyl action, independent of μ-opioid receptor activation, with a paradoxical excitatory effect that may underlie WCS. We anticipate these findings may inform the design of safer analgesics and generalize to other neuronal circuits implicated in fentanyl-related maladaptive behaviors. Competing Interest Statement The authors have declared no competing interest.