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Li KX, Fan L, Wang H, Tian Y, Zhang S, Hu Q, Liu F, Chen H, Hou H. A synonymous mutation of rs1137070 cause the mice Maoa gene transcription and translation to decrease. Front Mol Neurosci 2024; 17:1406708. [PMID: 39359688 PMCID: PMC11446106 DOI: 10.3389/fnmol.2024.1406708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/03/2024] [Indexed: 10/04/2024] Open
Abstract
The Monoamine Oxidase-A (MAOA) EcoRV polymorphism (rs1137070) is a unique synonymous mutation (c.1409 T > C) within the MAOA gene, which plays a crucial role in Maoa gene expression and function. This study aimed to explore the relationship between the mouse Maoa rs1137070 genotype and differences in MAOA gene expression. Mice carrying the CC genotype of rs1137070 exhibited a significantly lower Maoa expression level, with an odds ratio of 2.44 compared to the T carriers. Moreover, the wild-type TT genotype of MAOA demonstrated elevated mRNA expression and a longer half-life. We also delved into the significant expression and structural disparities among genotypes. Furthermore, it was evident that different aspartic acid synonymous codons within Maoa influenced both MAOA expression and enzyme activity, highlighting the association between rs1137070 and MAOA. To substantiate these findings, a dual-luciferase reporter assay confirmed that GAC was more efficient than GAT binding. Conversely, the synonymous mutation altered Maoa gene expression in individual mice. An RNA pull-down assay suggested that this alteration could impact the interaction with RNA-binding proteins. In summary, our results illustrate that synonymous mutations can indeed regulate the downregulation of gene expression, leading to changes in MAOA function and their potential association with neurological-related diseases.
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Affiliation(s)
- Kai Xin Li
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
- Institute of Technical Biology and Agricultural Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Lei Fan
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
- Institute of Technical Biology and Agricultural Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Hongjuan Wang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
| | - Yushan Tian
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
| | - Sen Zhang
- Department of Bioengineering, School of Chemical Engineering, Northwest University, Xi’an, China
| | - Qingyuan Hu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
- Institute of Technical Biology and Agricultural Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Fanglin Liu
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
- Institute of Technical Biology and Agricultural Engineering, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Huan Chen
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
| | - Hongwei Hou
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
- Key Laboratory of Tobacco Biological Effects, Zhengzhou, China
- Beijing Life Science Academy, Beijing, China
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Yang K, Du R, Yang Q, Zhao R, Fan F, Chen S, Luo X, Tan S, Wang Z, Yu T, Tian B, Le TM, Li CSR, Tan Y. Cortical thickness of the inferior parietal lobule as a potential predictor of relapse in men with alcohol dependence. Brain Imaging Behav 2024; 18:331-342. [PMID: 38078981 DOI: 10.1007/s11682-023-00838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Alcohol dependence is a disorder with a high recurrence rate that leads to a considerable public health burden. The risk of relapse appears to be related to a complex interplay of multiple factors. Herein, we aimed to explore the potential neural predictors of relapse in Chinese male patients with alcohol dependence. This study enrolled 58 male patients with alcohol dependence who had undergone acute detoxification. General demographic information and clinical features were collected. Magnetic resonance imaging data were used to measure cortical thickness across 34 regions of the brain. Patients were followed up at six months, and 51 patients completed the follow-up visit. These patients were divided into a relapser and an abstainer group. A binary logistic regression analysis was performed to investigate the potential risk factors of relapse. Compared to abstainers, relapsers showed higher inattention and non-planning impulsivity on the 11th version of the Barratt Impulsive Scale. The cortical thicknesses of the inferior-parietal lobules were significantly higher in abstainers compared with those in relapsers. Furthermore, binary logistic regression analysis showed that the thickness of the inferior parietal lobule predicted relapse, and lower non-planning impulse was a protective factor against relapse. Relapsers show poorer impulse control than abstainers, and structural magnetic resonance imaging revealed a decreased thickness of the inferior parietal lobule in relapsers. Our results indicate the thickness of the inferior parietal lobule as a potential relapse predictor in male patients with alcohol dependence.
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Affiliation(s)
- Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ruonan Du
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Qingyan Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Rongjiang Zhao
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Thang M Le
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China.
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Jia Y, Tian Y, Wang H, Lei X. Functional connectivity from dorsolateral prefrontal cortex mediates the impact of social jetlag on depressive tendency in young adults. Chronobiol Int 2023; 40:824-833. [PMID: 37190780 DOI: 10.1080/07420528.2023.2212755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/16/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
Social jetlag (SJL), a form of circadian rhythm disturbance, is linked to depressive symptoms; however, it is unclear what role the brain network, particularly the reward and cognitive control circuits, plays in this association. To address this issue, employing the ventral striatum (VS) and dorsolateral prefrontal cortex (DLPFC) as seeds, we used voxel-level whole-brain functional connectivity (FC) to determine the neural basis of the association between SJL and depressive tendency. Behavioral results indicated that SJL was positively associated with depression scores. Functional connection results showed that higher SJL was linked with decreased FC between the inferior orbitofrontal cortex and the VS. For DLPFC, we discovered changed FC in frontal, parietal, and occipital lobes related to SJL. More importantly, the mediation analysis revealed that the DLPFC-cuneus FC significantly mediated the relationship between SJL and depression scores. According to our study, higher SJL showed abnormal FC from the VS and DLPFC, which may involve attention impairments, cognitive control and reward function. Our results suggest that brain FC involving visual attention may explain the relationship between SJL and depressive tendency. This may offer new insights into the neural underpinnings of how circadian misalignment leads to mood issues.
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Affiliation(s)
- Yan Jia
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Yun Tian
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Haien Wang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
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Qiu X, Han X, Wang Y, Ding W, Sun Y, Lei H, Zhou Y, Lin F. Reciprocal modulation between cigarette smoking and internet gaming disorder on participation coefficient within functional brain networks. Brain Imaging Behav 2022; 16:2011-2020. [PMID: 36018530 DOI: 10.1007/s11682-022-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
Many reports indicated that cigarette smoking was associated with internet gaming disorder (IGD). However, the underlying mechanism of comorbidity between smoking and IGD and whether they had interaction effects on topological organization of brain functional network are still unknown. Therefore, we investigated the interaction between smoking and IGD in resting-state brain functional networks for 60 healthy controls, 46 smokers, 38 IGD individuals and 34 IGD comorbid with smoking participants. The modular structures of functional networks were explored and participation coefficient (Pc) was used to characterize the importance of each brain region in the communication between modules. Significant main effect of IGD was found in the left superior frontal gyrus, bilateral medial part of superior frontal gyrus and bilateral posterior cingulate gyrus with lower Pc in IGD group than in non-IGD group. Significant interaction effects between smoking and IGD were found in the left posterior orbital gyrus, right lateral orbital gyrus, left supramarginal gyrus, left middle temporal gyrus and left inferior temporal gyrus. The interaction in these brain regions was characterized by no significant difference or significantly decreased Pc in smokers or IGD individuals while significantly increased Pc in IGD comorbid with smoking group under the influence of IGD or smoking. Our findings provide valuable information underlying the neurophysiological mechanisms of smoking and IGD, and also offer a potential target for future clinical treatment of smoking and IGD comorbidity.
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Affiliation(s)
- Xianxin Qiu
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, People's Republic of China
- University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China
| | - Xu Han
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Yao Wang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Weina Ding
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Hao Lei
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, People's Republic of China
- University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China.
| | - Fuchun Lin
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, People's Republic of China.
- University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China.
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Brain Magnetic Resonance Imaging Features of Nicotine-Dependent Individuals and Its Correlation with Polymorphisms of Dopamine D Receptor Gene. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2296776. [PMID: 36082055 PMCID: PMC9433208 DOI: 10.1155/2022/2296776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
The aim of this research was developed to provide a scientific basis for individualized prevention, clinical diagnosis, and corrective treatment of nicotine addiction. The objects were 214 cases in the smoke group and 43 cases in the control group. According to the Fagerstrom Nicotine Dependence Test (FTND), the smokers were divided into mild nicotine dependence group (FTND < 6 points, 138 cases) and nicotine severe dependence group (≥6 points, 76 cases). The brain structure in long-term smokers was evaluated by using magnetic resonance imaging (MRI). The nicotine dependence was further analyzed by grouping the included individuals, and some candidate genes related to nicotine addiction were screened by combining with bioinformatics analysis. The family research strategy was adopted to detect nicotine addiction susceptibility genes and their polymorphisms. The MRI imaging results showed that the bilateral thalamus, right parietal, and left lens gram-molecule volume (GMV) were negatively correlated with smoking index and smoking years in the smoking group. The GMV of the posterior cingulate cortex in the severe nicotine dependence group was lower than that of the control group, and the GMVs of bilateral thalamus and bilateral superior limbic gyrus in the mild nicotine dependence group were lower than those of the control group. The gene polymorphism detection showed that rs6275 was highly polymorphic in the target population and the frequency of rs6275-C allele was 53.26%. Therefore, the MRI imaging characteristics suggested that the affected brain regions of smokers and people with varying degrees of nicotine dependence were mainly concentrated in response-related pathways and the limbic system and had cumulative effects on the central nervous system. In addition, the M6275 polymorphism of DRD2 gene was associated with susceptibility to nicotine addiction in Chinese population, and the M6275-C allele had a protective effect on susceptibility to nicotine addiction and smoking initiation.
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Sved AF, Weeks JJ, Grace AA, Smith TT, Donny EC. Monoamine oxidase inhibition in cigarette smokers: From preclinical studies to tobacco product regulation. Front Neurosci 2022; 16:886496. [PMID: 36051642 PMCID: PMC9424897 DOI: 10.3389/fnins.2022.886496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Monoamine oxidase (MAO) activity is reduced in cigarette smokers and this may promote the reinforcing actions of nicotine, thereby enhancing the addictive properties of cigarettes. At present, it is unclear how cigarette smoking leads to MAO inhibition, but preclinical studies in rodents show that MAO inhibition increases nicotine self-administration, especially at low doses of nicotine. This effect of MAO inhibition develops slowly, likely due to plasticity of brain monoamine systems; studies relying on acute MAO inhibition are unlikely to replicate what happens with smoking. Given that MAO inhibition may reduce the threshold level at which nicotine becomes reinforcing, it is important to consider this in the context of very low nicotine content (VLNC) cigarettes and potential tobacco product regulation. It is also important to consider how this interaction between MAO inhibition and the reinforcing actions of nicotine may be modified in populations that are particularly vulnerable to nicotine dependence. In the context of these issues, we show that the MAO-inhibiting action of cigarette smoke extract (CSE) is similar in VLNC cigarettes and cigarettes with a standard nicotine content. In addition, we present evidence that in a rodent model of schizophrenia the effect of MAO inhibition to enhance nicotine self-administration is absent, and speculate how this may relate to brain serotonin systems. These issues are relevant to the MAO-inhibiting effect of cigarette smoking and its implications to tobacco product regulation.
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Affiliation(s)
- Alan F. Sved
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Alan F. Sved,
| | - Jillian J. Weeks
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony A. Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tracy T. Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Eric C. Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, United States
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7
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Grodin EN, Burnette E, Towns B, Venegas A, Ray LA. Effect of alcohol, tobacco, and cannabis co-use on gray matter volume in heavy drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:760-768. [PMID: 34435833 PMCID: PMC8484037 DOI: 10.1037/adb0000743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Alcohol, tobacco, and cannabis are the three most frequently used drugs in the United States and co-use is common. Alcohol, tobacco, and cannabis use has been separately associated with altered brain structure, and alcohol and tobacco co-use results in decreases in gray matter volume. Less is known about the effect of alcohol and cannabis co-use, and alcohol, tobacco, and cannabis tri-use. Therefore, this study examined the effect of co- and tri-use on gray matter volume, a measure of brain cell density, in heavy drinkers. METHOD Heavy drinkers (n = 237; 152m/85f; age = 32.52; white = 111; black = 28; Latino = 9; American Indian = 2; Pacific Islander = 4; Asian = 59; mixed = 15; other = 9) were classified into four groups based on their alcohol, tobacco, and cannabis use: alcohol only users (n = 70), alcohol and tobacco co-users (n = 90), alcohol and cannabis co-users (n = 35), and alcohol, tobacco, and cannabis tri-users (n = 42). All participants completed a structural MRI scan. Voxel-based morphometry was conducted to evaluate the effect of co-use on gray matter volume, with alcohol only users as the reference group. Age, sex, and scanner were included as covariates. RESULTS Alcohol and tobacco co-users had significantly decreased left orbitofrontal gray matter volume relative to alcohol only users (Cohen's d = .79). There were no differences in gray matter volume between the alcohol only and alcohol and cannabis co-users, or between the alcohol only and tri-user groups. CONCLUSION The additive effect of tobacco co-use on gray matter volumes in heavy drinkers was limited and localized. The effect of tri-use of alcohol, tobacco, and cannabis may have interacted, such that overlapping cannabis and tobacco use masked volume differences present in separate co-using groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Elizabeth Burnette
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Neuroscience Interdepartmental Program, University of California at Los Angeles, Los Angeles, CA
| | - Brandon Towns
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Alexandra Venegas
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
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Goldstein RZ, Barrot M, Everitt BJ, Foxe JJ. Addiction in focus: molecular mechanisms, model systems, circuit maps, risk prediction and the quest for effective interventions. Eur J Neurosci 2020; 50:2007-2013. [PMID: 31502353 DOI: 10.1111/ejn.14544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Rita Z Goldstein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, The Leon and Norma Hess Center for Science and Medicine, New York, NY, USA
| | - Michel Barrot
- Centre National de la Recherche Scientifique, Institut des Neurosciences Cellulaires et Intégratives, Université de Strasbourg, Strasbourg, France
| | - Barry J Everitt
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, University of Cambridge, Cambridge, UK
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Department of Neuroscience, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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