Short-chain fatty acid, Butyrate prevents Morphine and Paclitaxel induced peripheral hypersensitivity

Peripheral hypersensitivity is a significant side effect with the chronic administration of opioids as well as chemotherapeutics. Both opioid-induced hypersensitivity (OIH) and chemotherapy induced hypersensitivity (CIH) are characterized by an increased sensitivity to painful stimuli which can significantly reduce the quality of life for individuals on either drug(s). Here we demonstrate the peripheral hypersensitivity associated with chronic morphine (opioid) and paclitaxel (chemotherapeutic) treatment can be reversed by oral supplementation with the short-chain fatty acid (SCFA) sodium butyrate. In two separate mouse behavioral models for peripheral hypersensitivity, we found that thermal hyperalgesia (for OIH) and cold allodynia (for CIH) were prevented by co-treatment with oral butyrate. Electrophysiological recordings of small diameter dorsal root ganglia (DRG) neurons from morphine and paclitaxel treated mice showed an increase in neuronal hyperexcitability in both drug models which was likewise prevented by oral butyrate treatment. Using colonic conditioned media obtained from excised colon segments we found that gut mediators of morphine treated mice can induce hyperexcitability in naïve DRG neurons, but such enhanced excitability is not present when animals are co-treated with butyrate suggesting gut derived mediators modulate neuronal hyperexcitability. In-vitro butyrate treatment did not prevent morphine induced excitability, suggesting an indirect role of sodium butyrate in modulating neuronal hypersensitivity. These data taken together suggest that gut derived mediators affect opioid and chemotherapeutic induced neuronal hypersensitivity that is prevented by the SCFA butyrate.


Introduction
Chronic pain continues to be a major unmet clinical challenge affecting up to 30% of patients throughout their life 1,2 . Chronic pain can arise from many sources and can range from post-surgical pain, pain brought on by underlying pathologies, or even pharmacological interventions 1 . Opioid-induced peripheral hypersensitivity (OIH) and paclitaxel-induced peripheral neuropathy (CIPN) are common side effects of chronic opioid use and paclitaxel chemotherapy, respectively 3,4 . These conditions are both characterized by an increased sensitivity to painful stimuli and other sensory changes, which can signi cantly reduce the quality of life for individuals on opioids or chemotherapy. Despite the prevalence of OIH and CIPN, the underlying mechanisms of these phenomena are not fully understood 5,6 . However, recent studies have suggested that the gut microbiome may play a role in the development of both OIH and CIPN 7,8 .
The microbiome is the broad collection of microorganisms (bacteria, viruses, fungi, etc.) that reside in the gut, skin, and other tissues, and changes in the gut microbiome have been associated with a number of conditions such as bromyalgia, rheumatoid arthritis, and irritable bowel syndrome 9 . Previous studies have shown that the gut microbiome can play a role in regulating pain by secreting or promoting the release of neurotransmitters, in ammatory cytokines, and other important messenger or regulatory signaling molecules 10 . We have previously demonstrated that the gastrointestinal microbiome is an important modulator of physiological and pharmacological effects induced by chronic morphine 11 . Mice treated with an antibiotic cocktail showed signi cantly reduced gut bacteria and did not develop chronic morphine induced increases in gut permeability, colonic mucosal destruction, in ammatory cytokine or antinociceptive tolerance. Similarly, chronic morphine (25mg pellet for 6 days) increased Gram-positive pathogenic bacteria and reduced bile-deconjugating bacterial strains in fecal samples resulting in an impairment of the gut barrier function and enhanced systemic in ammation 12 . These ndings were recapitulated in primary afferent neurons isolated from dorsal root ganglia (DRG) innervating the lower gastrointestinal tract, wherein in-vivo administration of antibiotics prevented tolerance to morphineinduced neuronal hypoexcitability 11,13 .
The link between chemotherapy and the microbiome is likewise becoming increasingly apparent. In a study by Shen et al., the authors found that oxaliplatin-induced mechanical hyperalgesia was reduced in germ-free mice and in mice pretreated with antibiotics, and that restoring the microbiota of germ-free mice resulted in restoring the hyperalgesia from oxaliplatin. The authors concluded that these effects were likely being mediated in part by TLR4 expressed on immune cells including macrophages 14 .
Similarly, a study by Ramakrishna et. al. 8 found that reciprocal gut microbiota transfers between a paclitaxel sensitive mouse strain (C57BL6/J) and a paclitaxel insensitive strain (129S6/SvEvTac) could confer the corresponding phenotype to paclitaxel-induced mechanical and cold hypersensitivity. The authors also found that paclitaxel decreased the abundance of certain bacterial species such as Akkermansia muciniphila, which was suggested to compromise gastrointestinal barrier integrity resulting in systemic exposure to bacterial metabolites and products that could then act upon the gut-immunebrain axis and alter neuronal function 8 .
Beyond changes in the microbial composition, many studies have also been done to investigate the varied effects that microbial metabolites have on host physiology [15][16][17] . We previously reported that media conditioned with colon segments isolated from chronic morphine treated mice induced tolerance and hyperexcitability in naive DRG neurons, and this effect was inhibited by oral vancomycin treatment 18 demonstrating a link between pathogenic changes in the colonic microenvironment and neuronal outputs within the spinal cord. Perhaps the most well-established metabolites with the potential for therapeutic bene ts in this regard have been the short-chain fatty acids (SCFAs) produced as a product of fermentation from dietary bers by several species of gastrointestinal bacteria [19][20][21] . Propionate, acetate, and butyrate serve an essential role as an energy source for epithelial cells (enterocytes), modulate electrolyte and water absorption, and have been implicated as mediators of intestinal immune function, as well as various roles in neuronal function along the gut-brain-axis. Furthermore, loss of these ber fermenting bacteria (by dysbiosis) has been suggested to play a role in the dysregulation of these processes 20,22,23 . Indeed, butyrate in particular has emerged as a promising potential supplementary therapeutic in a number of in ammatory disease states [24][25][26][27][28] including CIPN and opioid related side effects 29 .
In a recent study Cristiano and colleagues reported that sodium butyrate (NaBut) restored paclitaxel induced altered gut barrier integrity, microbiota composition and food intake in a rodent model. Additionally, they reported that treatment with NaBut also ameliorated depressive-and anxiety-like behaviors induced by paclitaxel, and concluded the effects were associated with neuroprotective and anti-in ammatory mechanism. However, the investigators did not include a relevant NaBut with control treatment condition, limiting the scope of potential interpretations 30 . Similarly, Cruz-LeBron and colleagues found that patients on methadone maintenance treatment (MMT) had signi cantly reduced levels of fecal SCFAs, and reduced abundance of Akkermansia muciniphila resulting in increased intestinal permeability consistent with their opioid induced dysbiosis 31 .
Collectively these studies have led us to conclude that a plausible link between the behavioral and physiological consequences of both opioid use and chemotherapeutic treatment may be similarly alleviated by way of addressing the underlying gastrointestinal dysbiosis. However less is known about the underlying neuro-epithelial changes in the presence of either drug and SCFA supplementation. Therefore, the goal of our study was to investigate if oral butyrate supplementation could e caciously reduce both whole animal behavioral hypersensitivity as well as neuronal hypersensitivity at the level of the dorsal root ganglia of the spinal cord, and establish if these effects were the result of systemic effects or more localized to the gastrointestinal tract.
Various chemotherapeutics are known to cause profound peripheral hypersensitization in both human and rodents [35][36][37] . Paclitaxel has likewise been shown to induce peripheral hypersensitization through a number of sensory modalities including thermal 8, 25,38 . Therefore, we wanted to investigate if paclitaxel treated mice would similarly be responsive to oral butyrate treatment if given concurrently with paclitaxel. Male C57BL/6J mice received 8mg/kg paclitaxel + vehicle every other day for 7 days, and then assessed 7-days post nal injection with an acetone evaporation assay for cold allodynia ( Fig. 2A). Paclitaxel treatment induced a signi cant increase in total time animals spent engaging the stimulated paw (6.9s ± 0.6) (P < 0.001) when compared against animals that were treated with vehicle alone (2.5 ± 0.2). This enhanced cold hypersensitivity was signi cantly reduced by 250mM Na-butyrate treatment (2.5s ± 0.2) (P < 0.001) ( These data demonstrate that Na-butyrate is able to prevent nociceptive hypersensitivity when given concurrently in both an opioid and chemotherapeutic model of peripheral hypersensitivity. Chronic Morphine induced neuronal hyperexcitability is attenuated by Na-Butyrate Chronic morphine treatment has been shown to enhance neuronal excitability and increase sodium currents 13,32,39,40 . We have previously demonstrated opioid induced changes to the gut microenvironment can be linked with secondary changes to neuronal excitability in the DRG 13 . Therefore, we investigated if neuronal changes would be similarly attenuated in those animals that received chronic morphine and sodium butyrate. Animals received 4 days of a ramping dose of morphine outlined in Fig. 1A, and L4-S1 DRG collected on the 5th day for electrophysiological recordings in the current clamp con guration (See methods). Representative results obtained from the 500ms 10pA step pulse recording are shown in Fig. 3.
Relative to saline controls, DRG neurons isolated from chronic morphine treated mice produced signi cantly greater number of action potentials within the same recording period ( Fig. 3A and 3B left). However, this enhanced neuronal excitability was attenuated in neurons isolated from sodium butyrate treated mice (Fig. 3C left). Figure 3 also shows representative data from rate changes in membrane potential depolarization by phase plot analysis. Floating numbers on the pulse trace (Fig. 3B left) correspond to their associated phase plot trace, with the outermost trace being associated with the rst action potential in the recording on the left panel (Fig. 3B right). We found the most relevant feature to be the distinct drop in the rate of dV/dT seen during the rising phase of the action potential (associated with the peak rate of change on the graph) in the chronic morphine group (Fig. 3B right). Not only was this feature not seen in the saline control group, or the Na-butyrate treatment group (Fig. 3A right), but it did not appear to greatly change between successive action potentials after the rst evoked potential in a recording. This suggests that chronic morphine induces a change in ion channel kinetics speci c to the regenerating phase of the action potential, which is principally driven by voltage-gated sodium channels, and that Na-butyrate prevents this change when given concurrently with morphine.
We further quanti ed these changes in both the current pulse traces and phase plot analysis. Compared to the relevant controls, chronic morphine produced a signi cant increase (P < 0.001) in the number of action potentials elicited in the same pulse period at both two times (2x) (3.0 ± 0.4 AP in 500ms) and three times (3x) (4.4 ± 0.5 AP) the rheobase value (minimum current needed to illicit an action potential), and this enhanced neuronal excitability was signi cantly attenuated in the Na-butyrate treatment group at both 2x (1.50 ± 0.2 AP, P = 0.004) and 3x rheobase respectively (2.3 ± 0.4 AP, P < 0.001) (Fig. 4A).
We also analyzed secondary characteristics of enhanced neuronal excitability including rheobase, threshold potential, AP height, and quanti ed the decrease in peak rate change from the phase plot analysis. Threshold potential changes were observed in the chronic morphine treatment group relative to saline controls. Chronic morphine had a signi cantly hyperpolarized (more negative) threshold potential (-21.670mV ± 1.44) compared to saline controls (-10.60mV ± 1.23) (P < 0.001), that was attenuated in the presence of butyrate co-treatment in-vivo (-14.978mV ± 1.693) (P = 0.04) (Fig. 4B). Rheobase was similarly reduced in the chronic morphine group (69.44pA ± 13.90) (P = 0.007) relative to control (134.76pA ± 13.48), and recovered in the butyrate treatment group (124.29pA ± 12.95) (Fig. 4D). Quanti cation of the phase plot analysis revealed a signi cant drop in peak depolarization rate visualized in Fig. 3B. Compared to saline (11.734% loss ± 2.067), chronic morphine treated animals had a signi cantly greater percent loss in peak membrane depolarization rate (mV/ms) between the rst evoked potential and subsequent regenerative potentials (32.945% loss ± 4.537) (P = 0.003), but these kinetic changes were not seen in the butyrate treatment group (13.92% loss ± 2.98) (P = 0.01 vs Morphine) (Fig. 4B). Lastly, we observed a signi cant decrease in action potential height between the rst AP and the subsequent regenerative AP's in the chronic morphine treatment group. Compared to saline controls (3.9% decrease ± 0.9) chronic morphine had a signi cantly (P < 0.001) greater percent decrease (16.742% decrease ± 2.51) in action potential height from the rst evoked potential vs the second action potential (and subsequently equivalent regenerative potentials) in a pulse, however Na-butyrate prevented this change in AP dynamics as well (2.50% decrease ± 1.82) (P < 0.001 vs morphine) ( These data suggest that chronic morphine alters the electrical excitability of DRG neurons including changes in threshold, rheobase, and AP height resulting in enhanced ring frequency that is prevented by oral butyrate and likely related to underlying changes in those ion channels associated with the rising phase of the AP. Paclitaxel induced neuronal hyperexcitability is attenuated by Na-Butyrate As expected from its established effects on peripheral behavioral sensitivity, paclitaxel is known to cause neuronal hyperexcitability 41 . Therefore, much like with morphine we wanted to investigate if Na-butyrate would be able to prevent paclitaxel induced neuronal hyperexcitability in DRG neurons. Using the same treatment paradigm outlined in Fig. 2A, mice received 4 injections of 8mg/kg paclitaxel and their DRG isolated 7 days post-nal injection. Representative traces from the electrophysiological recordings of a 150ms pulse at 3x rheobase are shown in Fig. 5. Paclitaxel results bore a strong similarity to those obtained from chronic morphine. Relative to the saline group, DRG of mice treated with paclitaxel in-vivo elicited more action potentials within the same pulse period and Na-butyrate was effective at attenuating this enhanced neuronal excitability ( Fig. 5A-C, left). Phase plot analysis likewise indicated a signi cant drop in the mV/ms rate during the rising phase of subsequent regenerative action potentials ( Fig. 5A-C, right). Additionally, enhanced ring frequency and changes in rising phase kinetics appear to be similar between both chronic morphine and paclitaxel induced neuronal excitability. Paclitaxel signi cantly (P = 0.01 vs vehicle) enhanced the number of action potentials recorded in a 150ms pulse at 2x (2.65 AP's ± 0.35) and 3x rheobase (3.46 AP's ± 0.31) vs vehicle control (2x 1.3 Ap's ± 0.15, 3x 2.2 AP's ± 0.39), and Nabutyrate attenuated this hyperexcitability at 2x (1.462 ± 0.18 P = 0.01 vs Paclitaxel) and 3x rheobase (2.31 AP's ± 0.26 P = 0.01 vs Paclitaxel) (Three-way ANOVA, F (1, 132) = 16.4 P < 0.001) (Fig. 6A). Consistent with the effects we observed in chronic morphine (Fig. 4B), there was a similar reduction in depolarization rate (mV/ms) during the rising phase of the regenerative action potentials of neurons isolated from animals which were treated with paclitaxel (23.93% loss ± 3.88, P = 0.004 vs vehicle) (Fig. 6B). These changes in rising phase kinetics were not observed in either the vehicle controls (9.146% loss ± 0.74) or paclitaxel + Na-butyrate treatment conditions (8.779% loss ± 2.32, P = 0.003) However, further quanti cation of the hyperexcitability induced by paclitaxel highlights several key differences between the two models. Unlike the chronic morphine model where we only saw signi cant difference in AP height in successive and regenerative AP's, paclitaxel induced a signi cant increase (68.51mV ± 2.35, P = 0.006) vs vehicle (55.241mV ± 1.48) in AP height independent of repetitive ring events. This enhanced excitability was none-the-less attenuated by sodium butyrate treatment (52.37mV ± 3.108, P < 0.001 vs paclitaxel) (Two-way ANOVA, F (1, 36) = 4.31 P = 0.05) (Fig. 6C). Paclitaxel also induced a hyperpolarizing shift (F (1, 43) = 10.09 P = 0.0028) in the threshold potential which was not recovered by the Na-butyrate treatment, and was otherwise not signi cantly different from vehicle (Two-way ANOVA F (1, 43) = 0.5967 P = 0.4441) (Fig. 6D). Lastly, we did not see any signi cant difference in rheobases between any treatment condition with paclitaxel (Two-way ANOVA, F (1, 43) = 3.137 P = 0.0836) (Fig. 6E).
These data show that Na-butyrate reduced hyperexcitability in neurons treated with paclitaxel. However, there were subtle differences between these changes and those induced by chronic morphine.
Na-butyrate prevents Morphine induced peripheral hypersensitivity through a gut mediated mechanism We next examined whether the effects of butyrate were mediated through a gut derived mechanism. For these studies, we investigated if conditioned media from colon tissues of morphine treated (as described above) mice enhance DRG neurons and if this was prevented by in-vivo treatment of oral butyrate.
A 0.5 cm section of the distal colon was dissected from mice treated with chronic morphine and placed in growth media overnight, allowing the colonic milieu to diffuse. The enriched media was collected the next day and stored at -80 o C. Following this, DRG neurons were isolated from naïve mice and incubated overnight with the colon condition media (CCM) media from chronic morphine treated mice, after which neuronal excitability was measured. Figure 7 shows that naïve neurons that were incubated in CCM media isolated from morphine treated cells showed a signi cant increase in ring frequency at increasing levels of stimulation (3.50 AP's ± 0.5 at 2x rheobase P = 0.04 vs saline, and 5.6 AP' s ± 0.73 at 3x rheobase P = 0.006 vs saline) compared to those naïve neurons (isolated from same animal) that were exposed to saline CCM (1.93 AP's ± 0.2 at 2x, and 2.47 AP's ± 0.46 at 3x rheobase). The enhanced neuronal excitability was not seen with naïve cells incubated with chronic morphine + Na-butyrate CCM media (2.91 AP's ± 0.5 at 3x rheobase, P = 0.03 vs morphine) (Fig. 7A) (data analyzed by Two-way ANOVA, F (4, 68) = 5.84 P < 0.001). The threshold potential was shifted consistent with our expected results from the in-vivo experiments seen in Fig. 4.
Chronic morphine CCM treated naïve neurons showed a signi cant (P = 0.004) hyperpolarizing shift in the threshold potential (-17.601 mV ± 1.3) vs saline CCM treated neurons (-11.06mV ± 1.1), this effect was attenuated in neurons treated with CCM isolated from chronic morphine + Na-butyrate treated animals (-12.47mV ± 1.29, P = 0.04 vs morphine) (Fig. 7B). Rheobase was similarly shifted towards a more excitable state by CCM media from morphine-treated mice, consistent with our ndings from the in-vivo treatment experiments. Chronic morphine CCM signi cantly reduced rheobase (52.7pA ± 8.64. P < 0.001 vs saline) of naïve isolated neurons when compared to naïve neurons incubated with saline treated CCM (153pA ± 16.9), and was not signi cantly shifted by CCM isolated from chronic morphine + Na-butyrate (112pA ± 11.6, P = 0.02) (Fig. 7C). Phase plot analysis of CCM treated cells revealed a similar pattern (compared to In-vivo data in Fig. 3) of rate (mV/ms) changes from the rst evoked potential to subsequent regenerative AP's during their rising phase from morphine CCM (16.77% decrease ± 3.81%, P = 0.02 vs saline), but not morphine + butyrate CCM treated naïve neurons (5.08% decrease ± 1.59%, P = 0.007) (Fig. 7D-E) (Data were analyzed by Two-Way ANOVA with Bonferroni's post-test). We thus found that naïve neurons incubated with chronic morphine treated CCM showed all the relevant electrophysiological outcomes we observed in the in-vivo treated experiments, which suggests that Nabutyrate's mechanism is at least in part emanating from its actions within the gastrointestinal tract.
Finally, we investigated if Na-butyrate would reduce neuronal excitability when applied directly to the DRG cell bodies. We isolated naïve DRG neurons from male C-57/Bl6 mice and incubated them overnight in culture media containing either 10µM morphine or 10µM morphine + 3mM Na-butyrate. Naïve neurons incubated with 10µM morphine displayed signi cantly enhanced AP ring frequency in a 500ms pulse (5.125 AP's ± 1.109, P = 0.002 at 3x Rheobase vs Saline) when compared to naïve control neurons from the same donor animal (1.636 AP's. ± 0.364 at 3x rheobase). This enhanced neuronal excitability was not attenuated by additional incubation with 3mM Na-butyrate (5.00 AP's ± 1.00 at 3x rheobase, P > 0.99 vs morphine) (Fig. 8A). Furthermore, phase plot analysis revealed that 10µM morphine induced the familiar decrease in maximum mV/ms rate (29.11% loss ± 3.9, P = 0.003 vs naive) during the rising phase of the regenerative AP's relative to the naïve control (6.1% loss ± 3.5), a feature that was also observed in the Nabutyrate treatment group (30.9% loss ± 4.25, P = 0.98 vs Morphine). Representative phase plot are presented at the bottom of Fig. 8 (Fig. 8B-C) (data were analyzed by Two-way ANOVA F (1, 18) = 0.529 P = 0.48).
These data demonstrate that Na-butyrate's effects on neuronal hyperexcitability are associated with activity originating within the gastrointestinal tract rather than its potential effects directly at the level of the neuronal cell bodies.

Discussion
The goal of our study was to investigate if Na-butyrate supplementation could prevent drug induced peripheral hypersensitivity changes in both a chronic morphine model and a paclitaxel chemotherapy model. Through a combination of both whole animal behavioral assays and electrophysiological techniques, we determined that both chronic morphine and paclitaxel treatment induced peripheral hypersensitivity that can be prevented by cotreatment with Na-butyrate. These effects were also seen at the level of the dorsal root ganglia in the small diameter primary afferent nociceptors, where both in-vivo chronic morphine, and paclitaxel induced neuronal hyperexcitability was likewise attenuated by in-vivo butyrate cotreatment. Furthermore, both paclitaxel and chronic morphine produced biophysical changes in the rising phase of regenerative action potentials. Additionally, we found that when neurons isolated from a naïve animal were incubated with media conditioned with the colonic milieu of an animal treated In-vivo with chronic morphine, those naïve neurons take on the characteristic hyperexcitability. However, when naïve neurons were incubated with the colonic milieu of animals treated with chronic morphine and Na-butyrate, neuronal excitability was unchanged. Lastly, when we induced neuronal hyperexcitability invitro by way of incubating isolated naïve neurons with morphine, coincubation with Na-butyrate did not prevent morphine induced hyperexcitability, suggesting a gut-mediated rather than direct neuronal mechanism for Na-butyrate's underlying mechanism.
The anti-in ammatory properties of butyrate have been previously established by several studies over the last decade 9,42 . However, the mechanism(s) of action of how butyrate speci cally reduces in ammatory consequences across a broad range of pathologies is not fully understood, although several key molecular targets have been identi ed 43,44 . Butyrate is a short chain fatty acid (SCFA) byproduct of bacterial fermentation of dietary ber, and has been shown to engage several molecular targets and pathways that are known to reduce in ammation including gene expression, immune responses, oxidative stress pathways, and gut epithelial barrier function. Sodium butyrate's ability to act as a histone deacetylase (HDAC) inhibitor has been well established. Consequently, butyrate's role in altering gene expression and reducing pro-in ammatory cytokine production is an active area of research. Furthermore, butyrate has also been shown to modulate immune responses, speci cally the activation and differentiation of immune cells, including T cells and macrophages both through HDAC and other molecular mechanisms 45 . Sodium butyrate can also act as an antioxidant, reducing oxidative stress, which is a key driver of in ammation, particularly regarding paclitaxel which primarily achieves its cytotoxicity by microtubule toxicity thereby enhancing oxidative damage 46 . Several studies have implicated the importance of butyrate as an essential component of gut barrier function which prevents the passage of harmful substances and bacteria into the systemic circulation, thereby reducing systemic and local in ammation 45,46 . Speci cally, butyrate has been shown to increase the expression of tight junction proteins and stimulate the production of mucins 42,47 . Therefore, while the exact mechanism of how butyrate achieves its anti-in ammatory properties remains unclear, the existing evidence strongly suggests that these effects are primarily associated with the SCFAs interactions within the epithelium of the gut.
Our electrophysiological characterization of both morphine and paclitaxel demonstrated the expected increase in basal excitability in both animal models, consistent with the established literature, and this enhanced neuronal excitability was reduced by oral butyrate treatment. However, the speci c mechanisms underlying both the enhanced excitability and the subsequent extinction of this effect by SCFA treatment may signi cantly differ between both morphine and paclitaxel. For example, previous studies by Li et. al. 48 have demonstrated a strong association with voltage gated calcium channel (CaV3.2) changes induced by paclitaxel treatment. However, both drug models showed a similar increase in ring frequency and subsequent changes in regenerative action potential rising phase rates, both of which were attenuated by butyrate. This strongly suggests that both paclitaxel and morphine may (by potentially differential mechanisms) alter underlying sodium channel kinetics particularly those involved in the rising phase kinetics. In DRG neurons the predominating voltage gated sodium channel is NaV1.8 a TTX-R sodium channel, however NaV1.9 is also expressed ubiquitously in small diameter nociceptors and has been known to be involved in regenerative non-inactivating currents 49,50 . Future directions should include investigating speci c changes in sodium channel conductance and kinetic changes, associated with both paclitaxel and chronic morphine, including investigating speci c sodium channel subtypes that may be driving the regenerative currents as well as the mechanism by which butyrate is attenuating these changes.
Our data also demonstrated that Na-butyrate appears to achieve this reduced neuronal excitability through a gut mediated mechanism. The CCM experiments showed that the treatment condition the animal was exposed to (i.e Chronic morphine, chronic morphine + butyrate) de ned the electrophysiological phenotype of the naïve neurons cultured in the colonic conditioned media.
Conversely, when we incubated morphine and butyrate in-vitro, we found that morphine still produced enhanced neuronal excitability that was not responsive to cotreatment with Na-butyrate. Taken together these data suggest that the SCFA does not directly affect somatic properties to such a degree as to attenuate the enhanced neuronal excitability. It is worth mentioning that we used a Na-butyrate concentration which was previously established to induce HDAC inhibition (3mM) for the in-vitro experiments 44,51 . There are several limitations to these interpretations, principally that the exact contents of the colonic milieu enriching the media were not characterized in this study. Furthermore, we also acknowledge that CCM experimental models were generated by injecting animals in-vivo, while the direct application of butyrate to morphine treated neurons was generated by an in-vitro approach, which raises the question of whether or not the excitability generated in-vivo is mechanistically the same or potentially induced by different mechanism, and therefore may not be responsive to SCFA treatment as a result. We feel that while that is valid, and the data should be taken with the proper context, chronic morphine's effects on neuronal excitability have been well characterized utilizing both in-vivo and in-vitro approaches and these studies have found similar excitability changes to those reported previously 13,32 , and so we feel con dent that while the underlying mechanisms may differ between in-vivo and in-vitro morphine the fact that such a high dose of Na-butyrate had no effect on the underlying excitability strongly suggests a lack of direct e cacy on the neuronal physiology. However, we also acknowledge that our ex-vivo isolation technique removes any contributions secondary cells such as glia that may contribute to the in ammatory microenvironment within the DRG, and previous literature particularly with paclitaxel has strongly implicated a glial component in the mechanism of CIPN 37,52 . Furthermore, a more thorough characterization of the morphological and histological changes that underlie both pre and post treatment in both drug models would greatly expand our understanding of the underlying mechanisms of Nabutyrate's therapeutic potential.
In conclusion, these data demonstrate that oral Na-butyrate supplementation can prevent the peripheral hypersensitivity induced by both chronic morphine and paclitaxel. Additionally, our data suggests that preserving barrier function, butyrate may systematically affect neuronal function, and prevent damage of neuronal terminals exposed to the mucosal environment. Future studies into potential sex differences, different treatment models and more robust behavioral assays (i.e prophylaxis vs treatment vs cotreatment) will greatly strengthen our understanding of the therapeutic value of SCFA treatment as an emerging and potentially valuable clinical tool for extending the already profound bene ts of both opioids and chemotherapeutic drugs.

Animals Models:
Adult male and female 8-weeks old C57BL/6J mice (Jackson Lab, Bar Harbor, ME) were used in this study. Mice were acclimatized at least 7 days before use and maintained throughout in standard housing conditions with access to food and water (24 ± 2°C temperature; 50 ± 10% relative humidity). Mice receiving morphine were injected with a ramping dose for four days starting at day one with 20mg/kg i.p b.i.d, followed by two days of 40mg/g i.p b.i.d, and a nal day of 80mg/kg i.p b.i.d morphine. Sodium butyrate (25mM-800 mM wt/v) was given by oral gavage twice daily for 4 days starting on the rst day of morphine i.p injection. For the studies on paclitaxel induced hypersensitivity, adult male mice received 8 mg/kg, i.p.of paclitaxel or 1:1:18 vehicle (1 volume cremophor EL, 1 volume ethanol, 18 volume saline) i.p. injections on alternating days (days 1, 3, 5, 7) to a cumulative dose of 32 mg/kg as described previously 53 . Paclitaxel cohorts receiving the butyrate treatment were treated twice daily with a 250mM oral gavage of sodium butyrate for 14 days starting on the rst day of paclitaxel i.p injection. Mice in the naloxone cohort were injected with a ramping dose for four days starting at day one with 2mg/kg i.p b.i.d, followed by two days of 4mg/g i.p b.i.d, and a nal day of 8mg/kg i.p b.i.d naloxone. Animals were excluded from the study if they lost more than 20% of body weight, or developed an adverse reaction to injections over the course of treatment period. Investigators were blinded to the animal's treatment condition during data collection for behavioral experiments.

Ethics Declarations:
All procedures and methodologies were conducted in accordance with the procedures reviewed and approved by the Institutional Animal Care and Use committee at Virginia Commonwealth University (VCU IACUC). All methods are reported in accordance with ARRIVE guidelines 54 .
Hot plate thermal hyperalgesia assay Animals receiving morphine were tested on day 5, 18 hours after the last injection of morphine for the development of thermal hyperalgesia by utilizing a hot plate assay. The hot plate was set to 50 and animals were placed in the center of the heated area and allowed to engage in the assay for 30s. During the assay if the animals engaged in hind paw licking, hind paw shaking, or jumping behaviors the assay was ended and the total time spent on the hot plate was recorded.
Acetone evaporation assay: Animals received 8mg/kg paclitaxel or vehicle (1:1:18, cremophor, ethanol, saline) every other day for 7 days, and were subsequently tested for the development of cold allodynia by acetone evaporation. Acetone evaporation produces a non-noxious sensation of coolness approximately equivalent to 15-21°C when applied to the skin 55 . Animals were tested at Day 7 and Day 14 postpaclitaxel treatment using a clear Plexiglas box with wire bottom to allow for access to the plantar surface of the animal's hind paw. Animals were acclimated for approximately 1 hour prior to testing after which time acetone was applied via a gavage needle to produce a drop (approximately 100µl) onto the plantar surface of the left or right paw. Animal behavior was recorded for 30s and the behavioral response graded on a scale of 0-3 in increasing intensity for both paws (i.e 0, no response; 1, brisk withdrawal or ick of the paw; 2, licking of the paw; 3, prolonged licking/biting of the hind paw) 55 .
Animals are then left undisturbed for 10 minutes and the trial repeated on the other paw. Scores were averaged across all trials to produce a single allodynia score. For comparison, 30°C water was used as a control and applied to the paw and behaviors scored as above with acetone. the cumulative time spent engaging ( icking, shaking, grooming, licking etc.) the stimulated paw after acetone application was also quanti ed.

DRG Isolation
Isolation of DRG neurons was carried out as described in previous studies 13,32 . Following sacri ce by cervical dislocation, DRG were harvested from spinal levels L5-S1 (those supplying the lower gastrointestinal tract) and immediately placed in cold (4°C) Hanks' Balanced Salt Solution (HBSS). Ganglia were then incubated (37°C) for 18 min in HBSS with 36.6 ug/mL papain, washed with HBSS, and incubated for 1hr in HBSS with 1.5 mg/mL collagenase. Tissues were gently triturated and centrifuged for 5 min at 1,000 rpm. The colonic media is decanted, and cells resuspended in neurobasal A medium containing 1% FBS, 1x B-27 supplement, 2 mM L-glutamine, 10 ng/mL GDNF, and penicillin/streptomycin/amphotericin B. The suspension was plated on poly-D-lysine/laminin coated coverslips and incubated (37°C) for at least 24 hr. Recordings were made using a Axopatch 200B ampli er and Clampex/Clamp t 11.0 data acquisition software was used for analyses. Action potential (AP) threshold and rheobase estimates were measured from resting current, a 10pA stimulus pulse is applied in 10pA steps starting from − 30pA for 10ms. For assessing multiple action potential ring events, a 500ms (150ms for paclitaxel) pulse period was used. Phase plots were generated by plotting the rst derivative of the AP against membrane potential, maximum rate changes between successive potentials were measured during the rising phase of the AP Colon tissue conditioned media collection In order to demonstrate whether in ammatory mediators released within the colon enhance neuronal excitability, we tested the effect of colon conditioned media (CCM) on DRG neuronal excitability, similar to previous studies 13 . Following sacri ce by cervical dislocation, full circumference colon segments 5 mm in length are resected and placed in 250 µL of neurobasal A medium containing 1% FBS, 1x B-27 supplement, 2 mM L-glutamine, 10 ng/mL GDNF, and penicillin/streptomycin/amphotericin B. The samples were incubated (37°C) for 24h and then the colon conditioned media was collected and either frozen in liquid nitrogen or transferred to freshly isolated naïve DRG neuron cultures. An additional 200 µL of fresh medium is added to the culture, which is then incubated (37°C) for 24 h before performing electrophysiology experiments.
Data analysis. Sample sizes were determined using G*Power to detect 80% power for a medium effect size (Cohen's d = 0.5) and an alpha level of 0.05. Data were analyzed using Graphpad Prism 9 (La Jolla, CA). Data were analyzed via a two-way ANOVA that included relevant drug treatment, and butyrate treatment as independent variables. Bonferroni's post hoc test was used for those analyses which indicated a signi cant interaction (p < 0.05). A three-way ANOVA with Tukey's post-hoc test was utilized when analyzing excitability data comparing increasing levels of stimulation against relevant drug treatment and butyrate treatment respectively on the number of evoked potentials. 54. Cummins, T. R., Sheets, P. L. & Waxman, S. G. The roles of sodium channels in nociception: Implications for mechanisms of pain.  Chronic morphine induced neuronal hyperexcitability is attenuated by Na-Butyrate A)-C) Representative neuronal action potential traces from isolated DRG neurons from Saline, morphine, and morphine + Na-Butyrate treated animals. The left shows the actional potential trace taken at 3x rheobase stimulation in a 500ms pulse protocol, the right shows the associated phase plane analysis which is derived from the 1 st derivative of the trace on the left, plotted against membrane potential.
Chronic morphine treatment increased regenerative action potentials in the 500ms pulse relative to saline indicating an enhanced neuronal excitability phenotype. This enhanced excitability is attenuated in the Na-butyrate treatment group. Phase plane analysis of the action potential traces reveal a signi cant loss in maximum rate of membrane potential change during the rising phase of the action potential in the chronic morphine group relative to saline controls, this change in maximum dV/dT is attenuated in the chronic morphine + Na-butyrate group implicating voltage gated sodium channels in the potentiation of regenerative action potentials. Floating numbers (1,2) indicate which action potential corresponds to which portion of the phase plane plots (which overlay one another), it should be noted that maximum rate of change (max dV/dT) occurs during the rising phase of the AP, and before the AP peak. Chronic morphine induces a hyperexcitable phenotype by altering threshold potential and rising phase kinetics of the neuronal action potential in DRG nociceptors A) Number of action potentials produced by isolated neurons at increasing levels of stimulation (1x Rheobase, 2x Rheobase, 3x Rheobase). Chronic morphine treatment signi cantly increases the number of action potentials seen in a 500ms pulse period at 2x and 3x rheobase stimulation compared to saline controls (2x Rh P=0.002, 3x Rh P<0.001), In-vivo treatment with Na-butyrate attenuated these changes and reduced the number of action potentials signi cantly compared to chronic morphine in the same pulse period (2x Rh P= 0.01, 3x Rh P<0.001). B) Threshold potential changes seen in isolated DRG neurons after chronic morphine treatment. Chronic morphine induced a signi cant (P<0.001) hyperpolarizing shift in the threshold potential relative to saline controls, In-vivo Na-Butyrate prevented this shift (P=0.04). C) Percentage loss of peak dV/dT in the phase plane analysis seen in Figure 3.
Chronic morphine shows a signi cant (P=0.003) loss in peak dV/dT between the rst action potential and the subsequent regenerated AP's in the trace. D) Chronic morphine lowers neuronal rheobase signi cantly (P=0.007) but is recovered by the in-vivo treatment with Na-butyrate (P=0.05). E) Percent loss in the AP peak measured in the phase plane analysis seen in Figure 2. Chronic morphine shows a signi cant (P<0.001) loss in AP peak between the rst action potential and the subsequent regenerated AP's in the trace, this decrease in action potential peak is signi cantly attenuated in the Na-butyrate treatment group (P<0.001). Data were analyzed by Three-way ANOVA (F (1, 174) = 22.3 P<0.001) in panel A, and by Twoway ANOVA with Bonferroni's correction in panels B-E. All data were collected using a 500ms pulse protocol, N=5-6, and n=15-18 per treatment group.

Figure 5
Paclitaxel induced neuronal hyperexcitability is attenuated by Na-Butyrate A)-C) Representative neuronal action potential traces from isolated DRG neurons from saline, paclitaxel, and paclitaxel + Na-butyrate treated animals. The left shows the actional potential trace taken at 3x rheobase stimulation in a 150ms pulse protocol, the right shows the associated phase plane analysis Page 27/31 which is derived from the 1 st derivative of the trace on the left, plotted against membrane potential.
paclitaxel treatment increased regenerative action potentials in the 150ms pulse relative to saline indicating an enhanced neuronal excitability phenotype. This enhanced excitability is attenuated in the Na-butyrate treatment group. Floating numbers (1,2) indicate which action potential corresponds to which portion of the phase plane plots, which overlay one another.  Chronic morphine alters neuronal excitability through a gut mediated mechanism A) Number of action potentials produced by isolated neurons from a naïve animal. Neurons were treated with colonic conditioned media (CCM) which conveyed the corresponding phenotype seen in Figure 3.
Chronic morphine treatment signi cantly increases the number of action potentials seen in a 500ms pulse period at 3x rheobase stimulation compared to saline (P<0.001), this enhanced excitability was not observed in the naïve neurons treated with CCM from Na-Butyrate treated animals (P=0.007 vs Morphine). Panels B-D) show the expected changes in rheobase and threshold potential, and relevant kinetic changes observed in from Figure 4 are likewise conveyed to the naïve neurons by morphine treated CCM but not in the presence of Na-Butyrate treated CCM. Panel E) shows representative traces of Morphine, and Morphine + Na-Butyrate CCM treated naïve neurons, note the similarity in AP morphology to those representative traces in Figure 2. All data were generated from naïve neurons recorded 24 hours after adding CCM fractions to the cells. Data were analyzed by Two-Way ANOVA with Bonferroni's posttest (P=0.05) (N=4 n=10-15 per group). Figure 8