Ketamine is an anesthetic,
analgesic, and antidepressant whose
secondary metabolite (2
R
,6
R
)-hydroxynorketamine
(HNK) has
N
-methyl-
d
-aspartate-receptor-independent
antidepressant activity in a rodent model. In humans, naltrexone attenuates
its antidepressant effect, consistent with opioid pathway involvement.
No detailed biophysical description is available of opioid receptor
binding of ketamine or its metabolites. Using molecular dynamics simulations
with free energy perturbation, we characterize the binding site and
affinities of ketamine and metabolites in μ and κ opioid
receptors, finding a profound effect of the protonation state. G-protein
recruitment assays show that HNK is an inverse agonist, attenuated
by naltrexone, in these receptors with IC
50
values congruous
with our simulations. Overall, our findings are consistent with opioid
pathway involvement in ketamine function.