Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep. OSA leads to high cardiovascular morbidity and mortality. The pathogenesis of OSA has been linked to a defect in neuromuscular control of the pharynx. There is no effective pharmacotherapy for OSA. The objective of this study was to determine whether upper airway patency can be improved using chemogenetic approach by deploying designer receptors exclusively activated by designer drug (DREADD) in the hypoglossal motorneurons. DREADD (rAAV5-hSyn-hM3(Gq)-mCherry) and control virus (rAAV5-hSyn-EGFP) were stereotactically administered to the hypoglossal nucleus of C57BL/6J mice. In 6-8 weeks genioglossus EMG and dynamic MRI of the upper airway were performed before and after administration of the DREADD ligand clozapine-N-oxide (CNO) or vehicle (saline). In DREADDtreated mice, CNO activated the genioglossus muscle and markedly dilated the pharynx, whereas saline had no effect. Control virus treated mice showed no effect of CNO. Our results suggest that chemogenetic approach can be considered as a treatment option for OSA and other motorneuron disorders.Obstructive sleep apnea (OSA) is a common disorder affecting 25-30% of the adult population in the Western world 1 with the prevalence exceeding 50% in obese individuals 2 . It is caused by a loss of lingual motor tone, leading to recurrent upper airway obstruction during sleep, intermittent hypoxia and sleep fragmentation 3 and substantial cardiovascular morbidity and mortality 4 . Nasal continuous positive airway pressure can relieve upper airway obstruction, although poor adherence limits its therapeutic effectiveness 5 . Implantable hypoglossal nerve stimulators have been developed to maintain pharyngeal patency during sleep 6 by activating lingual muscles including the genioglossus (GG), a major pharyngeal dilator 7 . This device, however, had a therapeutic effect only in a subset OSA patients 6 . Similarly, pharmacological approaches had limited success 8 . Recent developments in chemo-and optogenetics suggest novel approaches for treating OSA. Optogenetics entails the expression of light sensitive proteins (i.e., channel rhodopsin-2 (ChR2)) in neurons 9 . Light-activated contraction of a variety of muscles has been demonstrated when ChR2 is deployed in the motor cortex, peripheral motorneurons or skeletal muscles 10 . However, this approach requires illumination of upper airway motorneurons and/or muscles, which is not practical for clinical application. An alternative approach is to deploy designer receptors exclusively activated by designer drug (DREADD) in motorneurons with subsequent activation by a unique ligand, clozapine-N-oxide (CNO) 11 . In this study we examined whether such chemogenetic stimulation of hypoglossal motorneurons can increase GG muscle tone and pharyngeal patency.
ResultsSix -eight weeks after infection with rAAV5-hSyn-hM3(Gq)-mCherry, all thirteen mice expressed DREADD throughout the hypoglossal nucleus (Fig. 1). All six rAAV-hSyn-EGFP trea...