Peripheral opioid tolerance involves skin keratinocytes and platelet-derived growth factor type B signaling

Opioid analgesic tolerance drives dose escalation which hampers the therapeutic utility of opioids by increasing centrally mediated deleterious side-effects, including respiratory depression or addiction. Peripheral opioid delivery provides a safer, effective alternative to systemic delivery by avoiding centrally mediated opioid side-effects. However, tolerance still occurs peripherally via mechanisms that remain unknown. Centrally, activation of the mu-opioid receptor (MOPr) by opioids induces release of platelet-derived growth factor-B (PDGF-B); and inhibition of PDGF receptor beta (PDGFR{beta}) prevents opioid tolerance. In the periphery, MOPr and PDGF-B are expressed in keratinocytes, and PDGFR{beta} is expressed in peripheral sensory neurons (PSNs), which are involved in tolerance. Previous studies showed that optogenetic stimulation of keratinocytes modulates PSNs via release of keratinocyte-derived factors. Thus, we hypothesized that mechanisms of peripheral opioid tolerance involve keratinocytes and PDGFR{beta} signaling. Using behavioral pharmacology, optogenetics and imaging in mice, we found that selective inhibition of peripheral PDGFR{beta} prevents peripheral morphine tolerance caused by repeated intraplantar (i.pl.) morphine injections. In addition, we show that PDGF-B is both necessary and sufficient to cause peripheral morphine tolerance. Repeated peripheral morphine injections lead to an increase in PDGF-B mRNA in MOPr-expressing keratinocytes and induce changes in the biophysical properties of keratinocytes as measured by patch-clamp electrophysiology. In parallel, we discovered that repeated optogenetic activation of keratinocytes is sufficient to induce peripheral morphine tolerance in a PDGF-B/PDGFR{beta}-dependent manner. Together, we show a novel epithelial-neuronal communication mechanism that incorporates keratinocytes and PDGF-B/PDGFR{beta} to mediate peripheral opioid tolerance, opening the door to safer, more effective pain therapeutics. Significance StatementPeripheral opioids are a safer alternative to systemic opioids. However, peripheral tolerance leads to reduction of analgesia over time, hampering clinical use of peripheral opioids. Here, we highlight a novel epithelial-neuronal communication mechanism that mediates peripheral tolerance. We discovered that intraplantar (i.pl.) morphine injections in mice cause peripheral tolerance via release of platelet-derived growth factor type B (PDGF-B) and activation of platelet-derived growth factor beta (PDGFR{beta}). We find that morphine i.pl. increases PDGF-B in mu-opioid receptor-expressing keratinocytes, which could be released to activate PDGFR{beta} in cutaneous nociceptor endings to mediate peripheral tolerance. Moreover, we show that photostimulation of keratinocytes is sufficient to cause peripheral tolerance in a PDGF-B/PDGFR{beta}-manner. Thus, keratinocytes and PDGF-B are new promising targets for peripheral opioid tolerance.