Reviewer #3 (Public Review):
In this article, Gregory Grecco and colleagues developed a novel translational mouse model of prenatal methadone exposure (PME) that closely resembles the opioid exposure experienced by pregnant women living with opioid use disorder and treated with methadone maintenance pharmacotherapy. The article delineates the impact of prenatal methadone exposure on physical development and motor behavior of the next generation male and female progeny. The authors also relied on a combination of electrophysiological, immunohistochemical and volumetric MRI imaging approaches to investigate the mechanisms underlying PME-derived phenotypes in male and female offspring. Overall, PME produced changes in motor function, motor coordination and growth in progeny. These phenotypes were accompanied by changes in the electrophysiological properties and density of neurons in the primary motor cortex of offspring raised by opioid-exposed dams.
One of the stated goals by the authors was to develop a mouse model that closely mirrored exposure and dosing regimens in clinical populations living with opioid use disorder in order to increase the translational value of the findings outlined in this report. One of the strengths of the article is the experimental design and the longitudinal nature of the studies. The dams were first treated with oxycodone, a commonly abused pain killer to mimic this condition in patients living with SUD. 5 days prior to mating, the animals were switched to methadone to model maintenance pharmacotherapy that is commonly used in SUD patients. The doses of oxycodone and methadone were carefully selected to mimic as closely as possible the suspected exposure experienced by pregnant women and their unborn offspring. The authors demonstrated that the concentrations of methadone and related metabolites were present in the plasma, brain and placentas of dams and offspring in the opioid-treated group during gestation, parturition and up to one week after birth. Another strength of the study was the fact that the authors convincingly demonstrated a lack of change in maternal behavior in the opioid-treated dams, which could have been a major confounding factor. The dams exposed to oxycodone and methadone did develop dependence to opioids as expected, however the amount and nature of maternal care delivered to their offspring was not affected by oxycodone and methadone exposure. This critical finding enabled the authors to delve further into the biological underpinnings of the observed phenotypes. The offspring produced by opioid-exposed dams showed some phenotypes consistent with neonatal opioid withdrawal syndrome (NOWS) in humans, including hyperthermia and twitches or jerks. Together, these findings demonstrate that the authors were successful in creating a novel model of prenatal opioid use and methadone maintenance in mice.
Overall, both males and females produced by opioid-treated dams had lower body weight and length during development and through adolescence. Bone volume was also lower in PME offspring compared to controls at 1 week of age, an effect that dissipated by adolescence in PME progeny. Locomotor activity was reduced at P1 and increased at P7 and P21. Interestingly, ultra sonic vocalization emitted by pups when separated from their mothers, was highest for PME females compared to all groups and this increase in calls also coincided with increased activity. PME offspring also had delays in demonstrated coordinated motor behaviors such as acquisition of surface righting, forelimb grasp and cliff aversion during the early stages of development. Prepulse inhibition, a measure of sensorimotor gating was not disrupted by PME.
At the anatomical level, the largest impact of PME was found in the primary motor region of the cortex, where cell density was reduced particularly in the upper cortical layers. Next, the authors probed the properties of cells and circuits in primary motor cortex and found reduced firing rates in response to injected currents in PME animals compared to controls. The input resistance of these cells was also diminished in the PME group. Together, these findings suggest that the number of cells may be reduced by PME in primary motor cortex and that the remaining neurons are not able to fire as effectively, resulting in blunted transmission within this brain region. Lastly, the authors stimulated local synaptic inputs to M1 using glutamate uncaging and found that the neural circuits connecting the top layers of M1 to layer 5 are enhanced in PME animals.
Overall, the authors identified some electrophysiological correlates of altered motor function and coordination produced by a novel prenatal opioid exposure model and regimen. This article had several strengths highlighted above but also included some areas of potential improvement. The authors included both sexes in many of their analyses but it is not always clear when the sex of the offspring were combined in the analyses and/or whether sex was always included as a factor in the many endpoints described in the paper. The authors acknowledge some of the limitations of their model in better understanding OUD in pregnant women. Including the caveat that many women do not switch to maintenance therapy prior to conception would be worth mentioning. Moreover the use of buprenorphine has increased in recent years and methadone is not the only maintenance therapy available. Lastly, the electrophysiological recordings do not exactly coincide with some of the overt phenotypes reported: at P21, the PME animals are hyperactive but the time window does not match with the coordination deficits reported. Overall, these minor weaknesses detracted only slightly from the overall impact and value of the reported findings.