A septo-hypothalamic-medullary circuit directs stress-induced analgesia

Reviewer #1 (Public Review):

The manuscript entitled "A septo-hypothalamic-medullary circuit directs stress-induced analgesia" by Shah et al., showed that the dLS-to-LHA circuit is sufficient and necessary for stress-induced analgesia (SIA), which is mediated by the rostral ventromedial medulla (RVM) in a opioid-dependent manner. This study is interesting and important and the conclusions are largely supported by the data. I have a few concerns as follows:

(1) The present data show that activation of dLS neurons produces SIA, however, this manipulation is non-specific. It may be better to see the effect of specific manipulation of stress-activated c-Fos positive neurons in the dLS using a combination of the Tet-Off system and chemogenetic/optogenetic tools.

(2) Depending on its duration, and intensity, stress can exert potent and bidirectional modulatory effects on pain, either reducing pain (SIA) or exacerbating it (stress-induced hyperalgesia, SIH). Is the circuit in the manuscript involved in SIH?

(3) It is well-accepted that opioid and cannabinoid receptors participate in the SIA, and the evidence is especially strong for the RVM endocannabinoid system. Given this, why did the authors focus their study on the opioid system?

(4) Does silencing of the dLS neurons affect stress-induced anxiety-like behaviors? Alternatively, what is the relationship between SIA and the level of stress-induced anxiety?

(5) Direct electrophysiological evidence should be provided to confirm the efficacy of the MP-CNO.

(6) Is the LHA a specific downstream target for SIA, and is the LHA involved in stress-induced anxiety-like behaviors?

(7) Do LHA neurons have direct projections to the RVM? If yes, what is its role in the SIA?

Reviewer #2 (Public Review):

Summary:

In this manuscript, Shah et al. explore the function of an understudied neural circuitry from the dLS -> LHA -> RVM in mediating stress-induced analgesia. They initially establish this neural circuitry through a series of intersectional tracings. Subsequently, they conduct behavioral tests, coupled with optogenetic or chemogenetic manipulations, to confirm the involvement of this pathway in promoting analgesia. Additionally, fiber photometry experiments are employed to investigate the activity of each brain region in response to stress and pain.

Strengths:

Overall, the study is comprehensive, and the findings are compelling.

Weaknesses:

One noteworthy concern arises regarding the overarching hypothesis that restrained-induced stress promotes analgesia. A more direct interpretation suggests that intense struggling, rather than stress per se, activates the dLS -> LHA -> RVM pathway that may drive analgesic responses.