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Okhuarobo A, Kreifeldt M, Gandhi PJ, Lopez C, Martinez B, Fleck K, Bajo M, Bhattacharyya P, Dopico AM, Roberto M, Roberts AJ, Homanics GE, Contet C. Ethanol's interaction with BK channel α subunit residue K361 does not mediate behavioral responses to alcohol in mice. Mol Psychiatry 2023:10.1038/s41380-023-02346-y. [PMID: 38135755 DOI: 10.1038/s41380-023-02346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Large conductance potassium (BK) channels are among the most sensitive molecular targets of ethanol and genetic variations in the channel-forming α subunit have been nominally associated with alcohol use disorders. However, whether the action of ethanol at BK α influences the motivation to drink alcohol remains to be determined. To address this question, we first tested the effect of systemically administered BK channel modulators on voluntary alcohol consumption in C57BL/6J males. Penitrem A (blocker) exerted dose-dependent effects on moderate alcohol intake, while paxilline (blocker) and BMS-204352 (opener) were ineffective. Because pharmacological manipulations are inherently limited by non-specific effects, we then sought to investigate the behavioral relevance of ethanol's direct interaction with BK α by introducing in the mouse genome a point mutation known to render BK channels insensitive to ethanol while preserving their physiological function. The BK α K361N substitution prevented ethanol from reducing spike threshold in medial habenula neurons. However, it did not alter acute responses to ethanol in vivo, including ataxia, sedation, hypothermia, analgesia, and conditioned place preference. Furthermore, the mutation did not have reproducible effects on alcohol consumption in limited, continuous, or intermittent access home cage two-bottle choice paradigms conducted in both males and females. Notably, in contrast to previous observations made in mice missing BK channel auxiliary β subunits, the BK α K361N substitution had no significant impact on ethanol intake escalation induced by chronic intermittent alcohol vapor inhalation. It also did not affect the metabolic and locomotor consequences of chronic alcohol exposure. Altogether, these data suggest that the direct interaction of ethanol with BK α does not mediate the alcohol-related phenotypes examined here in mice.
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Affiliation(s)
- Agbonlahor Okhuarobo
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Max Kreifeldt
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Pauravi J Gandhi
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Catherine Lopez
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Briana Martinez
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Kiera Fleck
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Michal Bajo
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | | | - Alex M Dopico
- University of Tennessee Health Science Center, Department of Pharmacology, Addiction Science, and Toxicology, Memphis, TN, USA
| | - Marisa Roberto
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Amanda J Roberts
- The Scripps Research Institute, Animals Models Core Facility, La Jolla, CA, USA
| | - Gregg E Homanics
- University of Pittsburgh, Department of Anesthesiology and Perioperative Medicine, Pittsburgh, PA, USA
| | - Candice Contet
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA.
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2
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Patel RR, Wolfe SA, Borgonetti V, Gandhi PJ, Rodriguez L, Snyder AE, D'Ambrosio S, Bajo M, Domissy A, Head S, Contet C, Dayne Mayfield R, Roberts AJ, Roberto M. Ethanol withdrawal-induced adaptations in prefrontal corticotropin releasing factor receptor 1-expressing neurons regulate anxiety and conditioned rewarding effects of ethanol. Mol Psychiatry 2022; 27:3441-3451. [PMID: 35668157 PMCID: PMC9708587 DOI: 10.1038/s41380-022-01642-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 04/22/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022]
Abstract
Prefrontal circuits are thought to underlie aberrant emotion contributing to relapse in abstinence; however, the discrete cell-types and mechanisms remain largely unknown. Corticotropin-releasing factor and its cognate type-1 receptor, a prominent brain stress system, is implicated in anxiety and alcohol use disorder (AUD). Here, we tested the hypothesis that medial prefrontal cortex CRF1-expressing (mPFCCRF1+) neurons comprise a distinct population that exhibits neuroadaptations following withdrawal from chronic ethanol underlying AUD-related behavior. We found that mPFCCRF1+ neurons comprise a glutamatergic population with distinct electrophysiological properties and regulate anxiety and conditioned rewarding effects of ethanol. Notably, mPFCCRF1+ neurons undergo unique neuroadaptations compared to neighboring neurons including a remarkable decrease in excitability and glutamatergic signaling selectively in withdrawal, which is driven in part by the basolateral amygdala. To gain mechanistic insight into these electrophysiological adaptations, we sequenced the transcriptome of mPFCCRF1+ neurons and found that withdrawal leads to an increase in colony-stimulating factor 1 (CSF1) in this population. We found that selective overexpression of CSF1 in mPFCCRF1+ neurons is sufficient to decrease glutamate transmission, heighten anxiety, and abolish ethanol reinforcement, providing mechanistic insight into the observed mPFCCRF1+ synaptic adaptations in withdrawal that drive these behavioral phenotypes. Together, these findings highlight mPFCCRF1+ neurons as a critical site of enduring adaptations that may contribute to the persistent vulnerability to ethanol misuse in abstinence, and CSF1 as a novel target for therapeutic intervention for withdrawal-related negative affect.
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Affiliation(s)
- Reesha R Patel
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Sarah A Wolfe
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Vittoria Borgonetti
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università degli Studi di Firenze, 50139, Firenze (FI), Italy
| | - Pauravi J Gandhi
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Larry Rodriguez
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Angela E Snyder
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Shannon D'Ambrosio
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Michal Bajo
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Alain Domissy
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Steven Head
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Candice Contet
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - R Dayne Mayfield
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, 78712, USA
- Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Amanda J Roberts
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Marisa Roberto
- The Scripps Research Institute, 10550N. Torrey Pines Rd, La Jolla, CA, 92037, USA.
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3
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Shelkar GP, Gandhi PJ, Liu J, Dravid SM. Cocaine preference and neuroadaptations are maintained by astrocytic NMDA receptors in the nucleus accumbens. Sci Adv 2022; 8:eabo6574. [PMID: 35867797 PMCID: PMC9307248 DOI: 10.1126/sciadv.abo6574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Cocaine-associated memories induce cravings and interfere with the ability of users to cease cocaine use. Reducing the strength of cue-drug memories by facilitating extinction may have therapeutic value for the treatment of cocaine addiction. Here, we demonstrate the expression of GluN1/2A/2C NMDA receptor currents in astrocytes in the nucleus accumbens core. Selective ablation of GluN1 subunit from astrocytes in the nucleus accumbens enhanced extinction of cocaine preference memory but did not affect cocaine conditioning or reinstatement. Repeated cocaine exposure up-regulated GluN2C subunit expression and increased astrocytic NMDA receptor currents. Furthermore, intra-accumbal inhibition of GluN2C/2D-containing receptors and GluN2C subunit deletion facilitated extinction of cocaine memory. Cocaine-induced neuroadaptations including dendritic spine maturation and AMPA receptor recruitment were absent in GluN2C knockout mice. Impaired retention of cocaine preference memory in GluN2C knockout mice was restored by exogenous administration of recombinant glypican 4. Together, these results identify a previously unknown astrocytic GluN2C-containing NMDA receptor mechanism underlying maintenance of cocaine preference memory.
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Affiliation(s)
- Gajanan P. Shelkar
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
| | - Pauravi J. Gandhi
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
| | - Jinxu Liu
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
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Rodriguez L, Kirson D, Wolfe SA, Patel RR, Varodayan FP, Snyder AE, Gandhi PJ, Khom S, Vlkolinsky R, Bajo M, Roberto M. Alcohol Dependence Induces CRF Sensitivity in Female Central Amygdala GABA Synapses. Int J Mol Sci 2022; 23:7842. [PMID: 35887190 PMCID: PMC9318832 DOI: 10.3390/ijms23147842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 02/05/2023] Open
Abstract
Alcohol use disorder (AUD) is a chronically relapsing disease characterized by loss of control in seeking and consuming alcohol (ethanol) driven by the recruitment of brain stress systems. However, AUD differs among the sexes: men are more likely to develop AUD, but women progress from casual to binge drinking and heavy alcohol use more quickly. The central amygdala (CeA) is a hub of stress and anxiety, with corticotropin-releasing factor (CRF)-CRF1 receptor and Gamma-Aminobutyric Acid (GABA)-ergic signaling dysregulation occurring in alcohol-dependent male rodents. However, we recently showed that GABAergic synapses in female rats are less sensitive to the acute effects of ethanol. Here, we used patch-clamp electrophysiology to examine the effects of alcohol dependence on the CRF modulation of rat CeA GABAergic transmission of both sexes. We found that GABAergic synapses of naïve female rats were unresponsive to CRF application compared to males, although alcohol dependence induced a similar CRF responsivity in both sexes. In situ hybridization revealed that females had fewer CeA neurons containing mRNA for the CRF1 receptor (Crhr1) than males, but in dependence, the percentage of Crhr1-expressing neurons in females increased, unlike in males. Overall, our data provide evidence for sexually dimorphic CeA CRF system effects on GABAergic synapses in dependence.
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Affiliation(s)
- Larry Rodriguez
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Dean Kirson
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
- Department of Pharmacology, Addiction Science, and Toxicology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sarah A. Wolfe
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Reesha R. Patel
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Florence P. Varodayan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
- Department of Psychology, Binghamton University-SUNY, Binghamton, NY 13902, USA
| | - Angela E. Snyder
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Pauravi J. Gandhi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Sophia Khom
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
- Department of Pharmaceutical Sciences, University of Vienna Josef-Holaubek-Platz 2, A-1090 Vienna, Austria
| | - Roman Vlkolinsky
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Michal Bajo
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
| | - Marisa Roberto
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA; (L.R.); (S.A.W.); (R.R.P.); (F.P.V.); (A.E.S.); (P.J.G.); (S.K.); (R.V.); (M.B.)
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5
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Varodayan FP, Patel RR, Matzeu A, Wolfe SA, Curley DE, Khom S, Gandhi PJ, Rodriguez L, Bajo M, D'Ambrosio S, Sun H, Kerr TM, Gonzales RA, Leggio L, Natividad LA, Haass-Koffler CL, Martin-Fardon R, Roberto M. The Amygdala Noradrenergic System Is Compromised With Alcohol Use Disorder. Biol Psychiatry 2022; 91:1008-1018. [PMID: 35430085 PMCID: PMC9167785 DOI: 10.1016/j.biopsych.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a leading preventable cause of death. The central amygdala (CeA) is a hub for stress and AUD, while dysfunction of the noradrenaline stress system is implicated in AUD relapse. METHODS Here, we investigated whether alcohol (ethanol) dependence and protracted withdrawal alter noradrenergic regulation of the amygdala in rodents and humans. Male adult rats were housed under control conditions, subjected to chronic intermittent ethanol vapor exposure to induce dependence, or withdrawn from chronic intermittent ethanol vapor exposure for 2 weeks, and ex vivo electrophysiology, biochemistry (catecholamine quantification by high-performance liquid chromatography), in situ hybridization, and behavioral brain-site specific pharmacology studies were performed. We also used real-time quantitative polymerase chain reaction to assess gene expression of α1B, β1, and β2 adrenergic receptors in human postmortem brain tissue from men diagnosed with AUD and matched control subjects. RESULTS We found that α1 receptors potentiate CeA GABAergic (gamma-aminobutyric acidergic) transmission and drive moderate alcohol intake in control rats. In dependent rats, β receptors disinhibit a subpopulation of CeA neurons, contributing to their excessive drinking. Withdrawal produces CeA functional recovery with no change in local noradrenaline tissue concentrations, although there are some long-lasting differences in the cellular patterns of adrenergic receptor messenger RNA expression. In addition, postmortem brain analyses reveal increased α1B receptor messenger RNA in the amygdala of humans with AUD. CONCLUSIONS CeA adrenergic receptors are key neural substrates of AUD. Identification of these novel mechanisms that drive alcohol drinking, particularly during the alcohol-dependent state, supports ongoing new medication development for AUD.
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Affiliation(s)
- Florence P Varodayan
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California; Developmental Exposure Alcohol Research Center and Behavioral Neuroscience Program, Department of Psychology, Binghamton University, State University of New York, Binghamton, New York
| | - Reesha R Patel
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California; Systems Neurobiology Laboratory, Salk Institute for Biological Studies, La Jolla, California
| | - Alessandra Matzeu
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Sarah A Wolfe
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Dallece E Curley
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, Rhode Island
| | - Sophia Khom
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Pauravi J Gandhi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Larry Rodriguez
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Michal Bajo
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Shannon D'Ambrosio
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Hui Sun
- Clinical Core Laboratory, Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Tony M Kerr
- College of Pharmacy, Division of Pharmacology and Toxicology, University of Texas at Austin, Austin, Texas
| | - Rueben A Gonzales
- College of Pharmacy, Division of Pharmacology and Toxicology, University of Texas at Austin, Austin, Texas
| | - Lorenzo Leggio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland; Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Neuroscience, Georgetown University Medical Center, Washington, DC
| | - Luis A Natividad
- College of Pharmacy, Division of Pharmacology and Toxicology, University of Texas at Austin, Austin, Texas
| | - Carolina L Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Carney Institute for Brain Science, Brown University, Providence, Rhode Island; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland
| | - Rémi Martin-Fardon
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Marisa Roberto
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California.
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6
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Kreifeldt M, Herman MA, Sidhu H, Okhuarobo A, Macedo GC, Shahryari R, Gandhi PJ, Roberto M, Contet C. Central amygdala corticotropin-releasing factor neurons promote hyponeophagia but do not control alcohol drinking in mice. Mol Psychiatry 2022; 27:2502-2513. [PMID: 35264727 PMCID: PMC9149056 DOI: 10.1038/s41380-022-01496-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
Abstract
Corticotropin-releasing factor (CRF) signaling in the central nucleus of the amygdala (CeA) plays a critical role in rodent models of excessive alcohol drinking. However, the source of CRF acting in the CeA during alcohol withdrawal remains to be identified. In the present study, we hypothesized that CeA CRF interneurons may represent a behaviorally relevant source of CRF to the CeA increasing motivation for alcohol via negative reinforcement. We first observed that Crh mRNA expression in the anterior part of the mouse CeA correlates positively with alcohol intake in C57BL/6J males with a history of chronic binge drinking followed by abstinence and increases upon exposure to chronic intermittent ethanol (CIE) vapor inhalation. We then found that chemogenetic activation of CeA CRF neurons in Crh-IRES-Cre mouse brain slices increases gamma-aminobutyric acid (GABA) release in the medial CeA, in part via CRF1 receptor activation. While chemogenetic stimulation exacerbated novelty-induced feeding suppression (NSF) in alcohol-naïve mice, thereby mimicking the effect of withdrawal from CIE, it had no effect on voluntary alcohol consumption, following either acute or chronic manipulation. Furthermore, chemogenetic inhibition of CeA CRF neurons did not affect alcohol consumption or NSF in chronic alcohol drinkers exposed to air or CIE. Altogether, these findings indicate that CeA CRF neurons produce local release of GABA and CRF and promote hyponeophagia in naïve mice, but do not drive alcohol intake escalation or negative affect in CIE-withdrawn mice. The latter result contrasts with previous findings in rats and demonstrates species specificity of CRF circuit engagement in alcohol dependence.
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Affiliation(s)
- Max Kreifeldt
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Melissa A Herman
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
- Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Harpreet Sidhu
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Agbonlahor Okhuarobo
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
- University of Benin, Faculty of Pharmacy, Department of Pharmacology & Toxicology, Benin City, Nigeria
| | - Giovana C Macedo
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Roxana Shahryari
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Pauravi J Gandhi
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Marisa Roberto
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA
| | - Candice Contet
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA.
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Gandhi PJ, Gawande DY, Shelkar GP, Gakare SG, Kiritoshi T, Ji G, Misra B, Pavuluri R, Liu J, Neugebauer V, Dravid SM. Dysfunction of Glutamate Delta-1 Receptor-Cerebellin 1 Trans-Synaptic Signaling in the Central Amygdala in Chronic Pain. Cells 2021; 10:2644. [PMID: 34685624 PMCID: PMC8534524 DOI: 10.3390/cells10102644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/02/2023] Open
Abstract
Chronic pain is a debilitating condition involving neuronal dysfunction, but the synaptic mechanisms underlying the persistence of pain are still poorly understood. We found that the synaptic organizer glutamate delta 1 receptor (GluD1) is expressed postsynaptically at parabrachio-central laterocapsular amygdala (PB-CeLC) glutamatergic synapses at axo-somatic and punctate locations on protein kinase C δ -positive (PKCδ+) neurons. Deletion of GluD1 impairs excitatory neurotransmission at the PB-CeLC synapses. In inflammatory and neuropathic pain models, GluD1 and its partner cerebellin 1 (Cbln1) are downregulated while AMPA receptor is upregulated. A single infusion of recombinant Cbln1 into the central amygdala led to sustained mitigation of behavioral pain parameters and normalized hyperexcitability of central amygdala neurons. Cbln2 was ineffective under these conditions and the effect of Cbln1 was antagonized by GluD1 ligand D-serine. The behavioral effect of Cbln1 was GluD1-dependent and showed lateralization to the right central amygdala. Selective ablation of GluD1 from the central amygdala or injection of Cbln1 into the central amygdala in normal animals led to changes in averse and fear-learning behaviors. Thus, GluD1-Cbln1 signaling in the central amygdala is a teaching signal for aversive behavior but its sustained dysregulation underlies persistence of pain. Significance statement: Chronic pain is a debilitating condition which involves synaptic dysfunction, but the underlying mechanisms are not fully understood. Our studies identify a novel mechanism involving structural synaptic changes in the amygdala caused by impaired GluD1-Cbln1 signaling in inflammatory and neuropathic pain behaviors. We also identify a novel means to mitigate pain in these conditions using protein therapeutics.
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Affiliation(s)
- Pauravi J. Gandhi
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Dinesh Y. Gawande
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Gajanan P. Shelkar
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Sukanya G. Gakare
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Takaki Kiritoshi
- Department of Pharmacology and Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.K.); (G.J.); (V.N.)
| | - Guangchen Ji
- Department of Pharmacology and Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.K.); (G.J.); (V.N.)
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Bishal Misra
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Ratnamala Pavuluri
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Jinxu Liu
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
| | - Volker Neugebauer
- Department of Pharmacology and Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (T.K.); (G.J.); (V.N.)
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Shashank M. Dravid
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (P.J.G.); (D.Y.G.); (G.P.S.); (S.G.G.); (B.M.); (R.P.); (J.L.)
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8
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Kirson D, Khom S, Rodriguez L, Wolfe SA, Varodayan FP, Gandhi PJ, Patel RR, Vlkolinsky R, Bajo M, Roberto M. Sex Differences in Acute Alcohol Sensitivity of Naïve and Alcohol Dependent Central Amygdala GABA Synapses. Alcohol Alcohol 2021; 56:581-588. [PMID: 33912894 DOI: 10.1093/alcalc/agab034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Alcohol use disorder (AUD) is linked to hyperactivity of brain stress systems, leading to withdrawal states which drive relapse. AUD differs among the sexes, as men are more likely to have AUD than women, but women progress from casual use to binge and heavy alcohol use more quickly and are more likely to relapse into repetitive episodes of heavy drinking. In alcohol dependence animal models of AUD, the central amygdala (CeA) functions as a hub of stress and anxiety processing and gamma-Aminobutyric acid (GABA)ergic signaling within the CeA is involved in dependence-induced increases in alcohol consumption. We have shown dysregulation of CeA GABAergic synaptic signaling in alcohol dependence animal models, but previous studies have exclusively used males. METHODS Here, we used whole-cell patch clamp electrophysiology to examine basal CeA GABAergic spontaneous inhibitory postsynaptic currents (sIPSC) and the effects of acute alcohol in both naïve and alcohol dependent rats of both sexes. RESULTS We found that sIPSC kinetics differ between females and males, as well as between naïve and alcohol-dependent animals, with naïve females having the fastest current kinetics. Additionally, we find differences in baseline current kinetics across estrous cycle stages. In contrast to the increase in sIPSC frequency routinely found in males, acute alcohol (11-88 mM) had no effect on sIPSCs in naïve females, however the highest concentration of alcohol increased sIPSC frequency in dependent females. CONCLUSION These results provide important insight into sex differences in CeA neuronal function and dysregulation with alcohol dependence and highlight the need for sex-specific considerations in the development of effective AUD treatment.
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Affiliation(s)
- Dean Kirson
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Sophia Khom
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Larry Rodriguez
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Sarah A Wolfe
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Florence P Varodayan
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Pauravi J Gandhi
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Reesha R Patel
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Roman Vlkolinsky
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Michal Bajo
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
| | - Marisa Roberto
- The Scripps Research Institute, Department of Molecular Medicine, 10550 N Torrey Pines Rd, La Jolla, CA 92037, USA
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9
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Liu J, Shelkar GP, Gandhi PJ, Gawande DY, Hoover A, Villalba RM, Pavuluri R, Smith Y, Dravid SM. Striatal glutamate delta-1 receptor regulates behavioral flexibility and thalamostriatal connectivity. Neurobiol Dis 2020; 137:104746. [PMID: 31945419 PMCID: PMC7204410 DOI: 10.1016/j.nbd.2020.104746] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/19/2019] [Accepted: 01/12/2020] [Indexed: 10/31/2022] Open
Abstract
Impaired behavioral flexibility and repetitive behavior is a common phenotype in autism and other neuropsychiatric disorders, but the underlying synaptic mechanisms are poorly understood. The trans-synaptic glutamate delta (GluD)-Cerebellin 1-Neurexin complex, critical for synapse formation/maintenance, represents a vulnerable axis for neuropsychiatric diseases. We have previously found that GluD1 deletion results in reversal learning deficit and repetitive behavior. In this study, we show that selective ablation of GluD1 from the dorsal striatum impairs behavioral flexibility in a water T-maze task. We further found that striatal GluD1 is preferentially found in dendritic shafts, and more frequently associated with thalamic than cortical glutamatergic terminals suggesting localization to projections from the thalamic parafascicular nucleus (Pf). Conditional deletion of GluD1 from the striatum led to a selective loss of thalamic, but not cortical, terminals, and reduced glutamatergic neurotransmission. Optogenetic studies demonstrated functional changes at thalamostriatal synapses from the Pf, but no effect on the corticostriatal system, upon ablation of GluD1 in the dorsal striatum. These studies suggest a novel molecular mechanism by which genetic variations associated with neuropsychiatric disorders may impair behavioral flexibility, and reveal a unique principle by which GluD1 subunit regulates forebrain circuits.
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Affiliation(s)
- Jinxu Liu
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Gajanan P Shelkar
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Pauravi J Gandhi
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Dinesh Y Gawande
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Andrew Hoover
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA; UDALL Center of Excellence for Parkinson's Disease, Atlanta, GA 30329, USA
| | - Rosa M Villalba
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA; UDALL Center of Excellence for Parkinson's Disease, Atlanta, GA 30329, USA
| | - Ratnamala Pavuluri
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Yoland Smith
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA; UDALL Center of Excellence for Parkinson's Disease, Atlanta, GA 30329, USA; Dept. Neurology, Emory University, Atlanta, GA 30329, USA
| | - Shashank M Dravid
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA.
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10
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Shelkar GP, Pavuluri R, Gandhi PJ, Ravikrishnan A, Gawande DY, Liu J, Stairs DJ, Ugale RR, Dravid SM. Differential effect of NMDA receptor GluN2C and GluN2D subunit ablation on behavior and channel blocker-induced schizophrenia phenotypes. Sci Rep 2019; 9:7572. [PMID: 31110197 PMCID: PMC6527682 DOI: 10.1038/s41598-019-43957-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/25/2019] [Indexed: 12/18/2022] Open
Abstract
The GluN2C- and GluN2D-containing NMDA receptors are distinct from GluN2A- and GluN2B-containing receptors in many aspects including lower sensitivity to Mg2+ block and lack of desensitization. Recent studies have highlighted the unique contribution of GluN2C and GluN2D subunits in various aspects of neuronal and circuit function and behavior, however a direct comparison of the effect of ablation of these subunits in mice on pure background strain has not been conducted. Using knockout-first strains for the GRIN2C and GRIN2D produced on pure C57BL/6N strain, we compared the effect of partial or complete ablation of GluN2C and GluN2D subunit on various behaviors relevant to mental disorders. A large number of behaviors described previously in GluN2C and GluN2D knockout mice were reproduced in these mice, however, some specific differences were also observed possibly representing strain effects. We also examined the response to NMDA receptor channel blockers in these mouse strains and surprisingly found that unlike previous reports GluN2D knockout mice were not resistant to phencyclidine-induced hyperlocomotion. Interestingly, the GluN2C knockout mice showed reduced sensitivity to phencyclidine-induced hyperlocomotion. We also found that NMDA receptor channel blocker produced a deficit in prepulse inhibition which was prevented by a GluN2C/2D potentiator in wildtype and GluN2C heterozygous mice but not in GluN2C knockout mice. Together these results demonstrate a unique role of GluN2C subunit in schizophrenia-like behaviors.
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Affiliation(s)
- Gajanan P Shelkar
- Department of Pharmacology, Creighton University, Omaha, NE, 68178, USA
| | | | - Pauravi J Gandhi
- Department of Pharmacology, Creighton University, Omaha, NE, 68178, USA
| | | | - Dinesh Y Gawande
- Department of Pharmacology, Creighton University, Omaha, NE, 68178, USA
| | - Jinxu Liu
- Department of Pharmacology, Creighton University, Omaha, NE, 68178, USA
| | | | - Rajesh R Ugale
- Department of Pharmaceutical Sciences, R.T.M. Nagpur University, Nagpur, Maharashtra, 440033, India
| | - Shashank M Dravid
- Department of Pharmacology, Creighton University, Omaha, NE, 68178, USA.
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11
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Gandhi PJ, Shelkar GJ, Pavuluri R, Liu J, Dravid SM. Cell‐type specific expression of GluN2C and GluN2D subunits and their role in schizophrenic phenotypes. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.666.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Ravikrishnan A, Gandhi PJ, Shelkar GP, Liu J, Pavuluri R, Dravid SM. Region-specific Expression of NMDA Receptor GluN2C Subunit in Parvalbumin-Positive Neurons and Astrocytes: Analysis of GluN2C Expression using a Novel Reporter Model. Neuroscience 2018; 380:49-62. [PMID: 29559384 DOI: 10.1016/j.neuroscience.2018.03.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/26/2018] [Accepted: 03/09/2018] [Indexed: 12/12/2022]
Abstract
Hypofunction of NMDA receptors in parvalbumin (PV)-positive interneurons has been proposed as a potential mechanism for cortical abnormalities and symptoms in schizophrenia. GluN2C-containing receptors have been linked to this hypothesis due to the higher affinity of psychotomimetic doses of ketamine for GluN1/2C receptors. However, the precise cell-type expression of GluN2C subunit remains unknown. We describe the expression of the GluN2C subunit using a novel EGFP reporter model. We observed EGFP(GluN2C) localization in PV-positive neurons in the nucleus reticularis of the thalamus, globus pallidus externa and interna, ventral pallidum and substantia nigra. In contrast, EGFP(GluN2C)-expressing cells did not co-localize with PV-positive neurons in the cortex, striatum, hippocampus or amygdala. Instead, EGFP(GluN2C) expression in these regions co-localized with an astrocytic marker. We confirmed functional expression of GluN2C-containing receptors in the PV-neurons in substantia nigra and cortical astrocytes using electrophysiology. GluN2C was found to be enriched in several first-order and higher order thalamic nuclei. Interestingly, we found that a previous GluN2C β-gal reporter model excluded expression from PV-neurons and certain thalamic nuclei but exhibited expression in the retrosplenial cortex. GluN2C's unique distribution in neuronal and non-neuronal cells in a brain region-specific manner raises interesting questions regarding the role of GluN2C-containing receptors in the central nervous system.
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Affiliation(s)
| | - Pauravi J Gandhi
- Department of Pharmacology, Creighton University, Omaha, NE 68178, USA
| | - Gajanan P Shelkar
- Department of Pharmacology, Creighton University, Omaha, NE 68178, USA
| | - Jinxu Liu
- Department of Pharmacology, Creighton University, Omaha, NE 68178, USA
| | | | - Shashank M Dravid
- Department of Pharmacology, Creighton University, Omaha, NE 68178, USA.
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13
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Micallef INM, Ho AD, Klein LM, Marulkar S, Gandhi PJ, Calandra G, McSweeney PA. Plerixafor (Mozobil) for stem cell mobilization in patients with multiple myeloma previously treated with lenalidomide. Bone Marrow Transplant 2010; 46:350-5. [PMID: 20479709 DOI: 10.1038/bmt.2010.118] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lenalidomide and other new agents have considerable activity in multiple myeloma (MM) and have changed the landscape of treatment. Data suggest that lenalidomide therapy before autologous hematopoietic stem cell transplantation has a detrimental effect on stem cell mobilization. This retrospective study examined the efficacy of plerixafor in combination with G-CSF among patients with MM previously treated with lenalidomide (median, 4 cycles; range, 1-20 cycles). Data were analyzed for 60 patients who received plerixafor plus G-CSF for frontline mobilization in a phase 3 clinical trial or an expanded access program (n=20) or for remobilization in a compassionate use program (n=40). The overall median number of CD34+ cells collected was 5.6 × 10(6) per kg (range, 0.45 × 10(6)-37.2 × 10(6)). The minimum number of CD34+ cells (2 × 10(6) per kg) was collected from 86.7% of patients in a median of 1 day. This minimum was collected from 100% of patients who underwent frontline mobilization and 80% of patients who underwent remobilization. These data suggest that CD34+ hematopoietic stem cells can be successfully and predictably collected with combination plerixafor plus G-CSF for primary or secondary mobilization in the majority of patients with MM who have been previously treated with lenalidomide.
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Affiliation(s)
- I N M Micallef
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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14
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Silva MA, Gandhi PJ. Selection of glycoprotein IIb/IIIa inhibitors for upstream use in patients with diabetes experiencing unstable angina or non-ST segment elevation myocardial infarction. What have we learned in the last 10 years? J Clin Pharm Ther 2005; 29:497-510. [PMID: 15584937 DOI: 10.1111/j.1365-2710.2004.00594.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronary disease accounts for the majority of deaths among patients with diabetes and the thrombotic milieu accelerated by diabetes results in unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) or death. Upstream use of a glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor with percutaneous coronary intervention (PCI) as part of an early invasive approach is preferred. However substantial numbers of patients present to rural or non-teaching hospitals without immediate access to a catheterization laboratory. Enhanced GP IIb/IIIa receptor mobilization, TXA2 production and platelet activation together present an extensive thrombotic challenge that may not be overcome with current doses of GP IIb/IIIa inhibitors when used without PCI. Heterogeneity of platelet aggregometric analysis may have identified GP IIb/IIIa doses used in clinical trials that may not fully overcome the thrombotic challenge in patients with diabetes. GUSTO-IV ACS failed to demonstrate a difference in mortality when used without PCI. The PURSUIT trial provided evidence that eptifibatide decreases death or non-fatal myocardial infarction (MI) in the main group and in the diabetic subgroup. Reductions in this primary endpoint were driven by the reduction in non-fatal MI. The PRISM and PRISM-PLUS trials demonstrated a reduction in death, MI or refractory ischaemia at 48 h or 7 days in the main cohort but not specifically in patients with diabetes. Data supporting use of GP IIb/IIIa inhibitors are inconsistent, raising the question of whether these agents should be used at all without PCI. Variability in experimental methodology of platelet aggregometry and selection of anticoagulant used during dose finding studies may have generated doses that are insufficient to overcome the thrombotic burden. A new marker of active inflammation, sCD40L is found to be upregulated at subtherapeutic doses of GP IIb/IIIa inhibitors, suggesting that rebound inflammatory processes may partially account for absence of clear evidence of benefit with some GP IIb/IIIa inhibitors in patients with diabetes experiencing UA/NSTEMI.
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Affiliation(s)
- M A Silva
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA 01608, USA.
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15
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Abstract
Argatroban, a direct thrombin inhibitor, has been used in Japan since the early 1980's and was recently approved for use in the United States for patients with heparin-induced thrombocytopenia. However, its use has been studied in other clinical settings including, myocardial infarction, percutaneous coronary intervention and cerebral thrombosis. The doses used in the different clinical situations vary, but argatroban offers the advantage of not requiring renal adjustment. Because of its small molecular weight, argatroban has the ability to inhibit both clot bound and soluble thrombin. This paper provides a comprehensive review of both indicated and off label uses of argatroban. Pharmacology, pharmacokinetics, adverse events and drug interactions with argatroban are also discussed.
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Affiliation(s)
- M Moledina
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences--Worcester, 19 Foster Street, Worcester, MA 01608, USA
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16
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Abstract
The impact of clinical pharmacy services on direct drug costs in a coronary care unit (CCU) was studied. An observational, nonrandomized study was conducted on all patients admitted to the CCU to evaluate the impact of clinical pharmacy services on direct drug costs. Clinical pharmacy services were introduced into the CCU in July 1998. Patient characteristics, mean drug costs per admission, mean drug category costs per admission, and total hospital costs per admission were determined for October 1997 to June 1998 (nonintervention period), July 1998 to March 1999 (intervention period 1), and April 1999 to December 1999 (intervention period 2). The Clini-Trend program was used to estimate the total reduction in drug costs associated with documented pharmacist interventions from January to December 1999. Mean patient age, sex, admitting diagnosis-related group, Medicare case-mix index, ventilator days, length of stay, and number of deaths did not differ significantly among the three study periods. Mean +/- S.D. drug costs per admission for the nonintervention period were $374.05 +/- $75.51. With the introduction of clinical pharmacy services, mean +/- S.D. drug costs per admission were $381.94 +/- $66.16 (p > 0.1 for intervention period 1 compared with the nonintervention period) and $233.74 +/- $84.16 (p = 0.002 for intervention period 2 compared with the nonintervention period). From January to December 1999, 4151 pharmacist interventions were documented. The estimated reduction in drug costs associated with the interventions totaled $372,384. A pharmacist's clinical services in the CCU allowed for significant estimated reductions in total drug costs.
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Affiliation(s)
- P J Gandhi
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Avenue, Boston, MA 02115, USA.
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17
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Smith BS, Gandhi PJ. Pharmacokinetics and pharmacodynamics of low-molecular-weight heparins and glycoprotein IIb/IIIa receptor antagonists in renal failure. J Thromb Thrombolysis 2001; 11:39-48. [PMID: 11248789 DOI: 10.1023/a:1008904310194] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Data regarding the use of low-molecular-weight heparins (LMWHs) and glycoprotein (GP) IIb/IIIa receptor antagonists in patients with renal failure are limited. Renal failure has the potential to increase the risk of adverse drug events associated with LMWHs and GP IIb/IIIa receptor antagonists. This is due to changes in the pharmacokinetic and pharmacodynamic profiles of these agents in patients with renal failure. Until more data are available, clinicians should consider alternative therapies in this patient population.
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Affiliation(s)
- B S Smith
- Clinical Pharmacy Specialist, Critical Care, UMass Memorial Medical Center, Worcester, MA 01655, USA.
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18
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Abstract
Drug-induced thrombocytopenia is a phenomenon that causes significant morbidity and mortality among patients. Practitioners should be able to recognize the clinical manifestations of drug-induced thrombocytopenia, differentiate it from other causes, and manage it appropriately. Numerous case reports have documented drug-induced causes of thrombocytopenia. The following article focuses on the characteristics and management of drug-induced thrombocytopenia secondary to medications commonly encountered in the coronary care unit. Pharmacotherapeutic agents that are most commonly implicated in this setting include ticlopidine, unfractioned heparin, glycoprotein (GP)IIb/IIIa inhibitors, H(2)-receptor antagonists, quinidine and antibiotics. Case reports were obtained through a comprehensive search of the Medicine database and subsequently complemented by bibliographic reviews of the agents just specified. Reports that exhibited possible, probable, and definite associations with drug-induced thrombocytopenia are included in the article.
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Affiliation(s)
- N M Patnode
- University of Massachusetts Memorial Health Care, Worcester, Massachusetts, USA
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19
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Meisheri YV, Nadkar MY, Mathew CM, Gandhi PJ, Dhungat AJ. A common poison--unusual complications (a case of organo-phosphorus poisoning with seizures and acidosis). J Assoc Physicians India 1990; 38:499-501. [PMID: 2292559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Y V Meisheri
- Department of Medicine, TN Medical College, Bombay
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