Fentanyl binds to the mu-opioid receptor via the lipid membrane and transmembrane helices

Abstract

Overdose deaths from synthetic opioids, such as fentanyl, have reached epidemic proportions in the USA and are increasing worldwide. Fentanyl is a potent opioid agonist, that is less well reversed by naloxone than morphine. Due to fentanyls high lipophilicity and elongated structure we hypothesised that its unusual pharmacology may be explained by a novel binding mode to the -opioid receptor (MOPr). By employing coarse-grained molecular dynamics simulations and free energy calculations, we determined the routes by which fentanyl and morphine access the orthosteric pocket of MOPr. Morphine accesses MOPr via the aqueous pathway; first binding to an extracellular vestibule, then diffusing into the orthosteric pocket. In contrast, fentanyl takes a novel route; first partitioning into the membrane, before accessing the orthosteric site by diffusing through a ligand-induced gap between the transmembrane helices. This novel lipophilic route may explain the high potency and lower susceptibility of fentanyl to reversal by naloxone.