Ligand-induced regulation of the rat -opioid receptor (rKOR) was investigated in human embryonic kidney 293 cells stably expressing the FLAG-tagged rKOR. Incubation of rKOR cells with naltrexone for 24 h increased the B max Ͼ3-fold, with no change in the affinity of [ 3 H]diprenorphine. Two immunoreactive receptor species were present in cell lysates: naltrexone treatment caused a Ͼ3-fold increase in the 52-kDa species while decreasing the level of the 42-kDa species. Dynorphin(1-13), U69,593]pyran-7-carboxylic acid methyl ester] treatment did not alter the level of immunoreactive rKOR protein, whereas etorphine, cyclazocine, naloxone, and naloxone methiodide increased the 52-kDa and decreased the 42-kDa rKOR bands. Receptor up-regulation was associated with an increase in the number of cell surface receptors and a 2-fold increase in the E max for guanosine 5Ј-O-(3-[ 35 S]thio)triphosphate binding. Glycosidase digestion indicated that the 52-and 42-kDa receptors contained complex and high-mannose N-glycans, respectively, Pulse-chase analysis and glycosidase digestion sensitivities suggested that the 42-kDa rKOR species was a precursor of the 52-kDa species. Naltrexone did not alter rKOR mRNA levels or translational efficiency, and rKOR up-regulation was not inhibited by cycloheximide. Brefeldin A caused accumulation of intracellular rKOR intermediates, and coincubation with naltrexone increased the levels of the brefeldin-induced species significantly. These results suggest that select opioid ligands upregulate rKOR by enhancing the rate of receptor folding and maturation and by protecting the receptor from degradation, resulting in an increase in the number of rKOR binding sites, immunoreactive protein, and functional receptors.Chronic administration of morphine or other opioid agonists for pain relief results in tolerance to the analgesic effects and physical dependence (McQuay, 1999). In contrast, chronic blockade of opioid receptors with antagonists such as naloxone and naltrexone does not result in physical dependence and was shown nearly 30 years ago to be associated with supersensitivity to the analgesic actions of morphine (Tang and Collins, 1978). The enhanced analgesic effects of morphine following infusion of naloxone were correlated with an increase in the number of opioid receptor binding sites (Lahti and Collins, 1978). Antagonist-mediated opioid receptor up-regulation has been shown to occur in vivo for -opioid receptors (MORs), ␦-opioid receptors, and -opioid receptors (KORs) (Morris et al., 1988;Lesscher et al., 2003), highlighting its biological relevance; however, the underlying mechanisms remain unclear. The steady-state level of opioid receptor mRNAs did not change in response to chronic in vivo antagonist treatment; therefore, post-transcriptional mechanisms are apparently involved (for review, see Unterwald and Howells, 2008).A large number of human diseases, for example cystic fibrosis, are due to genetic mutations that cause protein misfolding (Thomas et al