Methadone maintenance treatment (
MMT) is the major tapering
therapy for
morphine addictive patients. There have gender differences reported in response to
MMT. This study discovered that the
estrogen-response element single nucleotide polymorphism (ERE-SNP; rs16974799, C/T) of
cytochrome 2B6 gene (
cyp2b6;
methadone catabolic
enzyme) responded differently to
MMT dosing.
Oestradiol was associated with high
MMT dosing, high enantiomer (R- or S-) of 2-ethylidene-1,5-dimethyl-3,3-dipheny-pyrrolidine (EDDP;
methadone metabolite) to
methadone ratio and increased
drug-seeking behaviour, implicating
oestradiol-CYP-EDDP/
methadone axis decreasing
MMT efficacy. In mouse model, oestrogen mitigates
methadone antinociceptive response, facilitates
methadone catabolism and up-regulates
methadone-associated metabolizing
enzymes. Oestrogen also ablates chronic
methadone administration-induced rewarding response. Mechanism dissection revealed the CC genotype of CYP2B6-ERE-SNP exerts higher ERE sequence alignment score, higher estrogenic response as compared to TT genotype. At last, preclinical study via targeting
estrogen signal that
tamoxifen (TMX;
selective estrogen receptor modulator,
SERM) could facilitate the tolerance phase rewarding response of
methadone. Strikingly, TMX also reduces tapering/abstinence phases
methadone liability in mice. In conclusion, this study demonstrates altering
methadone metabolism through targeting
estrogen signals might be able to free
morphine addictive patients from the addiction of
opioid replacement therapy. Therefore, the add-on
therapy clinical trial introducing
SERM in
MMT regimen is suggested.