Benzodiazepine self-administration in rhesus monkeys: estazolam, flurazepam and lorazepam

Cholangiocyte pathobiology

Cholangiocytes, the epithelial cells lining the intrahepatic and extrahepatic bile ducts, are highly specialized cells residing in a complex anatomic niche where they participate in bile production and homeostasis. Cholangiocytes are damaged in a variety of human diseases termed cholangiopathies, often causing advanced liver failure. The regulation of cholangiocyte transport properties is increasingly understood, as is their anatomical and functional heterogeneity along the biliary tract. Furthermore, cholangiocytes are pivotal in liver regeneration, especially when hepatocyte regeneration is compromised. The role of cholangiocytes in innate and adaptive immune responses, a critical subject relevant to immune-mediated cholangiopathies, is also emerging. Finally, reactive ductular cells are present in many cholestatic and other liver diseases. In chronic disease states, this repair response contributes to liver inflammation, fibrosis and carcinogenesis and is a subject of intense investigation. This Review highlights advances in cholangiocyte research, especially their role in development and liver regeneration, their functional and biochemical heterogeneity, their activation and involvement in inflammation and fibrosis and their engagement with the immune system. We aim to focus further attention on cholangiocyte pathobiology and the search for new disease-modifying therapies targeting the cholangiopathies.

Establishing performance characteristics for positive control article selection in drug self-administration studies

The selection of a controlled substance (CS) for use as the positive control article in a nonclinical drug abuse liability (DAL) assessment study should be contemplated carefully and with full understanding of the stated intent of the study design. Any CS that can maintain day-to-day stable baseline responding of voluntary intravenous intakes in animals may be selected under the current guidelines. Schedule I - IV CNS stimulants, depressants, and sedative/hypnotics can serve as maintenance drugs in these protocols, but not all of these compounds will provide comparatively efficient, robust, and stable daily intakes. Each Sponsor is directed to select a positive control article and training dose that will provide the most balanced, predictive, and scientifically-sound comparison consistent with the mechanism of action or therapeutic target of the test article. The SA study design is not a "one-size-fits-all" assay. This is a discussion of the critical design factors to be considered in selecting the most appropriate positive control article to use for a SA study.

Principles of drug abuse liability assessment in laboratory animals

This paper describes the rationale for use of preclinical assessments of abuse liability in laboratory animals, and then discusses "cross-cutting" methodological issues that apply to behavioral evaluations intended to contribute to an abuse liability evaluation package. Issues include use of: (1) positive and negative control conditions; (2) full dose-effect evaluations, (3) multiple dependent measures, (4) pharmacokinetic evaluations to guide choice of dose ranges, (5) a species for which good methodological and comparative data are available to aid interpretation of results, and (6) appropriate methods for the group or single-subject experimental design selected. The remainder of the paper describes basic methodology by which three core pieces of behavioral data required by the Food and Drug Administration for its use in the overall abuse liability analysis can be obtained preclinically. Reinforcing effects are assessed in study of drug self-administration; drug discrimination assesses degree of overlap of interoceptive stimulus effects with relevant comparison drugs; physical dependence potential is determined by assessing whether a withdrawal syndrome occurs after chronic drug administration. Background and methodological issues specific to each procedure are discussed. A key consideration for cross-cutting and specific methodological issues is that choices made enable confident interpretation of both positive and negative results.

Self-injection of barbiturates, benzodiazepines and other sedative-anxiolytics in baboons

Self-injection of 12 sedative-anxiolytics was examined in baboons. Intravenous injections and initiation of a 3-h time-out were dependent upon completion of a fixed-ratio schedule requirement, permitting eight injections per day. Before testing each dose of drug, self-injection performance was established with cocaine. Subsequently, a test dose was substituted for cocaine. At some doses, all five of the benzodiazepines examined (alprazolam, bromazepam, chlordiazepoxide, lorazepam, triazolam) maintained rates (number of injections per day) of drug self-injection above vehicle control in each of the baboons tested. Maximum rates of benzodiazepine self-injection were generally submaximal. Of the benzodiazepines examined, triazolam maintained the highest rates of self-injection. Among the three barbiturates tested, methohexital generally maintained high rates of self-injection in contrast to hexobarbital and phenobarbital, which only maintained low rates. Of the four non-benzodiazepine non-barbiturate sedatives examined, both chloral hydrate and methyprylon occasionally maintained high rates of self-injection. Although there were differences within and across animals, baclofen maintained intermediate rates of self-injection. The novel anxiolytic buspirone maintained only low rates of self-injection that were not different from vehicle. This study further validates the self-injection methodology for assessing sedative-anxiolytic abuse liability and provides new information about drug elimination rate as a determinant of drug self-administration.

Safety of estazolam. The United States clinical experience

The safety profile of estazolam, a new triazolobenzodiazepine hypnotic medication, has been developed in 1,320 normal volunteers and patients with insomnia. No clinically significant effects of estazolam on vital signs or laboratory values were detected. Drug-specific adverse effects such as somnolence, dizziness, hypokinesia, and abnormal coordination occurred, but these are expected extensions of benzodiazepine pharmacologic activity. No consistent effects on psychomotor performance, including memory, were seen at the recommended hypnotic doses in insomniac subjects. These data, combined with the evidence for hypnotic activity, indicate that estazolam is a safe and effective treatment for insomnia.

Schedule-induced chlordiazepoxide intake: differential effect of cocaine and ethanol histories

Groups of rats were given differential histories of drinking either water, cocaine (0.15 mg/ml), or ethanol (2.5%) solutions under fixed-time (FT) 1-min schedule-induced polydipsia conditions in daily, 3-hr sessions. The session solution for all groups was then changed to chlordiazepoxide (0.25 mg/ml), and after daily session intakes had stabilized, FT values of 3 and 5 min were probed for single sessions. Probe-session chlordiazepoxide intakes were greater for the Ethanol History Group than for Cocaine History and Water History Groups. Previous research showed that probe conditions elevated intakes for agents with abuse potential (cocaine, ethanol, midazolam), but not for those lacking such potential (water, chlordiazepoxide, flurazepam). The present study demonstrated that a history of ethanol overindulgence yielded elevated probe intakes for chlordiazepoxide, while a history of cocaine or water overindulgence did not. This is consistent with animal and human evidence indicating that a history of either alcohol or sedative abuse increases the probability that benzodiazepines will function as reinforcers and/or be abused.

Reinforcing and subjective effects of diazepam in nondrug-abusing volunteers

Preference for diazepam was assessed in 18 light and 12 moderate social drinkers using a cumulative dosing procedure. The 7-session procedure consisted of: 1) four sampling sessions, during which participants ingested color-coded capsules containing either diazepam (five 4-mg capsules administered at 30-min intervals; total dose 20 mg) or placebo, and 2) three choice sessions, during which they could ingest up to 7 capsules of their preferred color of capsule, each separated by 30 min. Subjective (mood) and behavioral (performance) measures were obtained throughout the 4-hour sessions. The light social drinkers chose diazepam over placebo on 66% of the choice sessions, and ingested a mean dose per session of about 16 mg. The moderate drinkers chose diazepam on 100% of the choice sessions, and ingested an average dose of 25 mg per session. Diazepam produced sedation in both groups, but in the moderate drinkers it also increased measures of subjective effects suggestive of "euphoria." The results indicate that diazepam can serve as a positive reinforcer under laboratory conditions in nondrug-abusing individuals who are moderate users of alcohol and other drugs. Greater reinforcing efficacy may be indicative of higher risk of abuse. The results illustrate the usefulness of the cumulative dosing procedure to measure both drug preference and dose preference.

Self-administration of barbiturates and benzodiazepines: a review

Studies of barbiturate and benzodiazepine self-administration are categorized by species and route of administration. Reinforcement, defined as self-administration of drug greater than of a non-drug control, has been demonstrated most often in studies employing the IV route, and there has been greater reliability in this result for a given drug among barbiturates rather than among benzodiazepines. Most studies of PO self-administration in rodents have not demonstrated reinforcement, despite a number of behavioral manipulations to induce drug intake. Studies of PO barbiturate self-administration in monkeys have demonstrated reinforcement but recent studies of PO benzodiazepine self-administration in baboons have not, although physical dependence was demonstrated. Reinforcement via the IG route has not been reliably demonstrated. Behavioral variables, including interreinforcement interval and drug self-administration history, appear to be important determinants of whether or not reinforcement will be demonstrated, particularly among the benzodiazepines; but the range of conditions under which behavioral and pharmacological variables interact to promote or lessen the likelihood of self-administration of these drugs remains to be determined experimentally.