1. ¹Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
2. ²Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
3. ³Center for Human Genetics, Duke University Medical Center, Durham, NC, USA

Correspondence: Dr GS Wand, Departments of Medicine and Psychiatry, The Johns Hopkins University School of Medicine, Ross Research Building, Room 863, 720 Rutland Avenue, Baltimore, MD 21205, USA. Tel: +1 410 955 7225; Fax: +1 410 955 0841; E-mail: gwand@jhmi.edu

Received 28 March 2005; Revised 13 June 2005; Accepted 13 June 2005; Published online 3 August 2005.

Abstract

A polymorphism in the mu-opioid receptor (MOR) (A118G) has been shown to increase -endorphin binding affinity, theoretically placing greater inhibitory tone on hypothalamic corticotropin-releasing hormone (CRH) neurons. We hypothesized that the minor allele (G) would predict cortisol responses to both pharmacological (naloxone) and psychological (stress) activation of the hypothalamic–pituitary–adrenal (HPA) axis. Healthy subjects (mean age 25.2 years, SD 9.2 years) completed a naloxone challenge (n=74) and/or the modified Trier Social Stress Test (TSST) (n=86). For the naloxone challenge, two baseline blood samples were obtained. Then, five increasing doses of i.v. naloxone were administered at 30-min intervals and 12 additional blood samples were collected at 15-min intervals. The TSST consisted of 5-min of public speaking and 5-min of mental arithmetic exercises. Three baseline and five post-TSST blood samples were drawn. Both the naloxone and TSST groups had significant adrenocorticotropin (ACTH) and cortisol responses to their respective challenges (P<0.001). There were no differences in baseline ACTH, baseline cortisol, or ACTH response by genotype in either the naloxone or the TSST group. Among subjects expressing a G allele, there was a higher cortisol response to naloxone (P=0.046), but a lower cortisol response to the TSST (P=0.044). In conclusion, the minor allele (G) was associated with a robust cortisol response to naloxone blockade, but a blunted response to psychosocial stress. We speculate that increased opioid avidity of the minor allele receptor contributes to the differential response to naloxone vs stress.