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National Institute on Alcohol Abuse and Alcoholism |
No. 61 |
April 2004 |
Neuroscience Research and Therapeutic Targets
Alcoholism, like other addictions, is a brain disorder. Research has
shown that genes shape how an individual experiences alcohol—how
intoxicating, pleasant, or sedating it is—and how susceptible he
or she is to developing alcohol use disorders. Research has also shown
that chronic heavy drinking causes long–term—and perhaps permanent—changes
in the way the brain responds to alcohol. These parallel insights from
neuroscience research are paving the way for new medications that will
improve alcoholism treatment and relapse prevention.
Addiction science has benefited from rapid progress in cellular and molecular
research techniques, from the integration of scientific disciplines in
the study of addiction–related behavior, and from the development
of more appropriate animal models (1). Research in genetics is paying
off in the identification of genes that influence the risk of developing
alcoholism (2–7). Many of the genes being identified direct the
production of proteins involved in the complex process of signaling between
neurons in the brain. For example, genes that encode subunits of receptors
for neurotransmitters such as GABA, serotonin, and others have been identified
(see below for background on these neurotransmitters). Other genes related
to alcoholism risk encode enzymes that metabolize alcohol. Gene discovery
offers multiple benefits. Identification of risk–associated genes
may provide a means of identifying people at risk. As important, knowing
the genes and the proteins they encode is a key to understanding how alcohol
interacts with this part of the cell’s machinery, how variants of
the gene raise or lower risk, and how chronic exposure to alcohol can
change gene expression (the translation of genes into proteins) and set
the stage for addiction. Some of the genes being identified raise the
risk of both alcoholism and so–called comorbid disorders, like depression,
that often occur along with alcohol problems. Knowledge of these genes
should provide insight into the brain mechanisms that underlie these disorders.
Finally, identifying genes provides potential targets for medication development.
A recent Alcohol Alert on the genetics of alcoholism describes
some of the approaches being used to identify genes related to alcoholism
risk (8).
This Alcohol Alert provides a brief overview of what research
is revealing about how alcohol affects the brain and how the resulting
changes contribute to alcohol dependence. Also addressed is what research
is showing about the effect of stressful life experiences on the brain
and how they may contribute to risk of alcohol dependence and relapse
to drinking. Beyond understanding how alcohol affects the brain, the hoped–for
outcome of this work is the identification of neurologic targets for potential
medications. Some of the medications in clinical use or testing that have
come out of this work are reviewed below.
Alcohol Interferes with Brain Cell Communication
Large and often widespread networks of brain cells perform the brain’s
essential functions: storing information, regulating basic body functions,
and directing behavior. The basis of these brain networks is communication
from cell to cell by chemical messengers called neurotransmitters. Released
into narrow gaps, or synapses, between cells, neurotransmitters cross
the synapse and activate proteins called receptors. Receptor activation,
in turn, leads to a series of molecular interactions within the receiving
cell. Some of the molecular interactions are short–term and remain
localized to the area of the cell containing the receptors. Others result
in lasting changes, at multiple locations throughout the cell, in protein
expression, structure, and composition.
Intoxication and other short–term (acute) effects of alcohol are
caused largely by temporary, reversible changes in specific receptors
and associated molecules. With repeated (chronic) alcohol exposure, long–lasting
changes occur in receptors and in the series of chemical interactions
they signal. However, neuroscientists have found that receptor changes
are only one example of many permanent changes in the brain, collectively
referred to as “neuroadaptation,” caused by the presence of
alcohol. Strong evidence exists that neuroadaptation involves changes
at many different levels, from the genetically directed production of
critical proteins (9–12) to physical changes in the structure of
the cells on both sides of the synapse—that is, both the signaling
and the receiving cell.
Unraveling these different aspects of neuroadaptation may be the key
to understanding how addiction develops. Recent studies have linked neuroadaptation
with tolerance (the need to drink more alcohol to achieve the same level
of intoxication) (13,1) and with the symptoms of withdrawal (14). Neuroadaptation
also appears to underlie the persistent sense of discomfort, often described
as “craving,” that can lead to relapse even after long periods
of abstinence (14–17).
Medications from Neuroscience
Based on neuroscience research, scientists are developing medications
that potentially could target both the acute responses to alcohol and
the neuroadaptations that can accompany chronic drinking. Potential medications
may target specific receptor types, the series of chemical reactions set
off by receptor activation, or the production of critical protein enzymes
involved in these processes within cells. To use these strategies effectively
and safely, however, researchers must first understand in detail where
and how alcohol exerts its effects.
Naltrexone and acamprosate are two medications that act on receptor systems
in the brain on which alcohol is known to have an impact and that have
shown some success for treating alcoholism. Naltrexone binds with receptors
for endogenous opioids, naturally occurring opiate–like substances
that stimulate pleasurable feelings and suppress pain. Animal studies
suggest that opiate antagonists like naltrexone block some of alcohol’s
rewarding effects. Clinical studies have reported that alcohol–dependent
patients given naltrexone drink less frequently, and in smaller quantities,
than patients given a placebo (18). Naltrexone has been approved by the
U.S. Food and Drug Administration (FDA) for alcoholism treatment.
Acamprosate’s precise mechanism of action is not yet known, but
it is thought to affect activity of the neurotransmitter glutamate (18,19).
In clinical studies in Europe, patients on acamprosate experienced higher
abstinence rates, and for those who did relapse, longer periods of abstinence
(18). Clinical studies using acamprosate are ongoing in the United States,
but it has not yet been FDA approved.
Despite promising results for some patients using naltrexone or acamprosate,
not everyone responds. It is likely that different subtypes of alcoholics
have different genetically determined traits shaping their response to
alcohol and underlying their vulnerability to alcohol problems. For these
reasons, the need remains for new medications, with a variety of drugs
eventually providing a way to target treatment according to a person’s
individual biology.
Inhibitory and Excitatory Neurotransmitters: GABA and Glutamate
One of the most powerful actions of alcohol is to reduce the overall
level of brain activity by a combination of effects on two key neurotransmitters,
GABA (gamma–aminobutyric acid) and glutamate. Alcohol enhances the
activity of GABA, the brain’s chief inhibitory neurotransmitter.
At the same time, alcohol reduces the excitatory effects of glutamate.
These actions are the main reason that alcohol is often thought of as
a depressant.
GABA is the neurotransmitter–receptor system that has historically
received the most attention in alcohol research, but it remains difficult
to exploit therapeutically. Its major receptor type, the GABA–A
receptor, is involved in many of alcohol’s acute and chronic effects
(20–25). Medications that block GABA’s ability to bind at
the GABA–A receptor also block some of alcohol’s effects (1),
but because this receptor system plays a role in so many vital brain functions,
blocking it has side effects. Current GABA–A–blocking drugs
can cause convulsions, a side effect that must be eliminated before this
receptor system can be targeted for therapy.
Baclofen, a drug that activates another type of GABA
receptor (GABA–B), has recently been shown in a preliminary study
to be effective in inducing abstinence from alcohol and reducing alcohol
craving and consumption in alcoholics (26). Use of baclofen to treat alcohol–dependent
patients merits further investigation. Treatment for withdrawal commonly
involves drugs that act on GABA–A receptors. Investigators are searching
for new, safer drugs that increase GABA activity. One such drug—gabapentin—is
currently being tested (27).
Alcohol reduces the activity of the neurotransmitter glutamate by interacting
with NMDA receptors, one of several classes of receptor to which glutamate
binds. Preclinical data suggest that reducing NMDA neurotransmission may
be effective in treating alcoholism. Memantine, a drug
that reduces NMDA receptor function, looks promising as an anticraving
drug and in treating alcohol dependence. Clinical trials to establish
its efficacy are being contemplated (28). More recently, it has been shown
that the anticonvulsant drug, topiramate, which acts
on another class of glutamate receptors (AMPA–kainate receptors),
decreases glutamate activity while increasing GABA activity. A recent
study reported that alcohol–dependent patients on topiramate had
fewer drinking days and had fewer drinks on days they did drink (compared
with participants taking a placebo) (29). Topiramate reportedly reduced
craving. Additional studies are needed to confirm this work and provide
information on how best to use topiramate: on which groups of patients,
in what dosage, and with what types of psychosocial therapy.
Receptors Signaling Pleasure: Serotonin and Cannabinoids
Other candidates for drug treatment are aimed at brain receptors thought
to be involved with the mood–elevating, rewarding sensations associated
with alcohol. The neurotransmitter serotonin is involved in the regulation
of attention, emotion, and motivation. Alcohol alters serotonin neurotransmission
(30). In addition, depression is a common co–occurring disorder
with alcoholism. One class of drugs used to treat depression—selective
serotonin reuptake inhibitors (SSRIs)—increases the availability
of serotonin in the synapse. Studies examining whether SSRIs such as fluoxetine
(Prozac) and sertraline (Zoloft) might be helpful in treating alcoholism
co–occurring with depression have produced mixed results (31–33).
What these studies suggest is that individuals vary not only in terms
of their risk of alcohol problems, but in how they respond to both pharmacologic
and behavioral treatment.
Research on other drugs that affect serotonin neurotransmission also
points to variability in individual responses to treatment. For example,
the drug ondansetron reduces the activity of a serotonin
receptor (5–HT3) on which alcohol is known to act and has been shown
to reduce the desire to drink in humans. A clinical trial demonstrated
that ondansetron was most effective in reducing the frequency and quantity
of drinking in early–onset (alcohol–dependent before age 25)
vs. late onset (alcohol–dependent after age 25) alcoholics (34).
Larger scale studies are needed to confirm these results. Continued research
on genetics and neurophysiology should help refine the understanding of
what shapes individual responses to drugs and how treatments can be tailored
accordingly (35).
Another recent candidate as a target for therapy is a brain receptor
(CB1) that responds to endocannabinoids, innate substances that interact
with the CB1 receptor in a manner similar to the active ingredients in
marijuana. Like serotonin, the endocannabinoid system is involved in the
rewarding effects of alcohol (36–40,12,41). A drug that blocks CB1
has been found to reduce alcohol consumption in rats (42–44), suggesting
the possibility of using such medications to help people undergoing alcohol
detoxification (45).
Cellular Enzymes
Another strategy for developing therapies focuses not on receptors but
on enzymes within the cell that are involved in the brain’s neuroadaptation
to alcohol. Chronic drinking alters the distribution of these enzymes
within cells and can change the way brain cells respond to alcohol (46–48,12).
An enzyme called protein kinase C (PKC) is the subject of much research
because it helps shape the level of sensitivity to alcohol’s behavioral
effects, at least in part through its interaction with the GABA–A
receptor. In a study looking at PKC and alcohol sensitivity, mutant mice
that lacked a form of PKC (PKC epsilon) were more sensitive than their
littermates to the behavioral effects of alcohol. Without alcohol, the
mutant mice did not appear sleepy or sedated, however (46). More recently,
the same team reported that the mice lacking PKC epsilon do not work as
hard for alcohol (by pressing a lever) as their littermates and do not
show the same increases in dopamine that are usually associated with the
reinforcing effects of alcohol. Withdrawal–associated seizures are
also less severe in these mutated mice (49,50). This suggests that medications
developed to inhibit PKC epsilon might reduce alcohol reward as well as
help treat seizures, but without the sedating effects of other drugs that
act on GABA neurotransmission.
Scanning the Genome
Using gene markers (known variations in genetic material spaced along
the DNA chains that make up chromosomes) scientists can scan the entire
genome for chromosomal stretches that are associated with alcoholism risk.
NIAAA’s Collaborative Study on the Genetics of Alcoholism (COGA)
has identified stretches on chromosomes 1, 2, 4, 7, 15, and 16 that are
associated with alcoholism risk (51–54). Work by other investigators
has also found confirming evidence for linkage to chromosome 1 (55), and
in American Indians, to chromosomes 1 and 4 (56,57). Recently COGA investigators
found evidence that variations in a gene on chromosome 4 encoding the
alpha subunit of the GABA–A receptor and, on chromosome 15, in the
GABA–A receptor gene GABRG3 influence alcoholism risk (5,4).
These findings bring the work full circle, tying risk associated with
a chromosomal location to a specific gene known to be involved in the
response to alcohol.
Other emerging methods can be used to assess the activities of thousands
of genes at once. This new technology (microarray gene analysis) promises
to expand the pool of target molecules for alcoholism researchers and
to help them zero in on the brain areas most affected by the disorder.
It is possible to compare the patterns of protein production in the brain
cells of animals bred to respond differently to alcohol or with different
exposure to alcohol; or, of people with and without alcohol addiction
(in this case, cells are obtained at autopsy). Comparisons of which genes
are active in different brain areas can direct attention to the regions
where alcohol exerts its greatest effects and to genes involved in the
alcohol response (9,58–61,12,11). A recent paper reported on the
identification of a gene that is differentially expressed in brain regions
of inbred alcohol–preferring and nonpreferring rats (62). The gene
codes for alpha synuclein, a protein that has been shown to be involved
in neurotransmission. Another recent study looked specifically at changes
in gene expression in mice shortly after a dose of alcohol. Out of about
24,000 genes, the screen identified 61 responding in a significant way
to alcohol, including sets of genes that have roles such as protecting
cells from injury and glucose metabolism, as well as being involved with
behavioral responses to alcohol (63). Further research will clarify the
roles of all these genes in the body’s response to alcohol.
Neurosystems—The Circuits and Networks of Stress
Neuroscience research is beginning to reveal how different brain regions
contribute to the complex process of addiction (64). The brain is subdivided
into many specialized regions, which set up connections, or “circuits,”
with other regions. These circuits, in turn, interact with other circuits
to form networks that integrate the functions of the brain.
The pleasurable effects of drugs of addiction, including alcohol, are
mediated by the so–called “reward” circuits of the brain
(65,16,1). Following short–term exposure to alcohol, these circuits
are able to return to their normal level of function. With repeated exposure
to alcohol, however, the responsiveness of these circuits changes. For
example, studies have demonstrated in rats that the function of neurotransmitters
involved in reward is reduced during withdrawal from alcohol, while at
the same time, stress–related systems are activated (1). Levels
of dopamine, a neurotransmitter associated with reward, are lower in rats
following withdrawal than before the rats were made dependent. The rats
also react with increased anxiety to stressful situations following withdrawal.
Research suggests that the discomfort and distress that result from these
persistent changes in brain reward and stress circuits underlie the compelling
motivation to drink by alcohol–dependent individuals.
The link between alcohol consumption and stress is complex. Studies suggest
that exposure to stress may lead to the initiation and continued use of
alcohol (17,66). In fact, many researchers believe that alcohol’s
stress–relieving effect is what prompts most people to drink (67).
While alcohol use may temporarily relieve the symptoms of stress, chronic
drinking not only can lead to alcohol–related problems, it may exacerbate
the adverse effects of stress, leaving the brain in a state of permanent
“physiological stress.” This effect may help explain why alcoholics
are likely to relapse during stressful life events, even after months
or years of abstinence (16,1).
Among the molecules involved in regulating physiological reactions to
stress, two in particular have drawn the attention of alcohol researchers.
Corticotropin–releasing factor (CRF) is a critical messenger in
the stress circuits that work primarily within the brain; neuropeptide
Y (NPY) is involved with processes ranging from appetite to memory and
stress responses (68–73). In a recent study, both alcohol and CRF
increased GABA neurotransmission in mice—except in mice missing
one of two types of CRF receptors (74). This suggests that the missing
receptors (CRF1) are a key link between the GABA–enhancing (and
rewarding) effects of alcohol and the neurobiology of stress.
Among NPY’s actions, it appears to counteract CRF effects. Research
has linked chronic alcohol intake to imbalances in CRF and NPY (68). Both
these molecules are logical targets for therapeutic research.
Through basic neuroscience research, scientists are gaining a better
understanding of how neuroadaptation sets the stage for alcohol addiction,
and how stress can influence both dependence and relapse. Development
of effective new medications for alcoholism requires a strategy that takes
into account the many different possible interactions of alcohol with
the brain, and the genetically determined variability among individuals.
Neuroscience Research and Therapeutic Target—A Commentary by NIAAA
Director Ting–Kai Li, M.D.
Alcohol interacts with the brain in complex ways. Its short–term
effects can transiently alter behavior, while long–term exposure
to alcohol can result in lasting changes in the brain, or neuroadaptation.
Each point in the course of alcohol’s interactions with cell surface
receptors, intracellular messenger molecules, genes, and brain circuits
offers a potential target for pharmacologic intervention. The promise
of interdisciplinary research in neuroscience is to link genetic, molecular,
cellular, anatomic, and behavioral data and provide both an understanding
of how individuals respond to alcohol and a guide for targeting prevention
and treatment.
References
(1) Koob, G.F. Alcoholism: Allostasis and beyond. Alcoholism:
Clinical and Experimental Research 27(2):232–243, 2003. (2)
Wernicke, C.; Samochowiec, J.; Schmidt, L.G.; et al. Polymorphisms
in the N–methyl–D–aspartate receptor 1 and
2B subunits are associated with alcoholism–related traits. Biological
Psychiatry 54:922–928, 2003. (3) Miyatake, R.;
Furukawa, A.; Matsushita, S.; et al. Functional polymorphisms in the Sigma1
receptor gene associated with alcoholism. Biological Psychiatry
55:85–90, 2004. (4) Dick, D.M.; Edenberg, H.J.;
Xuei, X.; et al. Association of GABRG3 with alcohol dependence.
Alcoholism: Clinical and Experimental Research 28(1):4–9,
2004. (5) Edenberg, H.; Dick, D.M.; Xuei, X.; et al.
Variations in GABRA2, encoding the alpha2 subunit of the GABAA,
are associated with alcohol dependence and with brain oscillations. American
Journal of Human Genetics 74:705–714, 2004. (6) Herman,
A.I.; Philbeck, J.W.; Vasilopoulos, N.L.; and Depetrillo, P.B.
Serotonin transporter promoter polymorphism and differences in alcohol
consumption behaviour in a college student population. Alcohol and
Alcoholism 38:446–449, 2003. (7) Ozaki, N.:
Goldman: Kaye, W.H.; et al. Serotonin transporter missense mutation associated
with a complex neuropsychiatric phenotype. Molecular Psychiatry
8:933–936, 2003. (8) National Institute on Alcohol Abuse
and Alcoholism (NIAAA). The genetics of alcoholism. Alcohol
Alert No. 60. Rockville, MD: NIAAA, 2003. (9) Lewohl, J.M.;
Wang, L.; Miles, M.F.; et al. Gene expression in human alcoholism: Microarray
analysis of frontal cortex. Alcoholism: Clinical and Experimental
Research 24(12):1873–1882, 2000. (10) Heinz, A.,
and Mann, K. Neurodegeneration and neuroadaptation in alcoholism. In:
Agarwal, D.P., and Seitz, H.K., eds. Alcohol in Health and Disease.
New York: Marcel Dekker, 2001. pp. 225–241. (11) Crabbe,
J.C. Genetic contributions to addiction. Annual Review of
Psychology 53:435–462, 2002. (12) Hoffman, P.L.;
Miles, M.; Edenberg, H.J.; et al. Gene expression in brain: A window on
ethanol dependence, neuroadaptation, and preference. Alcoholism: Clinical
and Experimental Research 27(2):155–168, 2003. (13)
Kiianmaa, K.; Hyytiä, P.; Samson, H.H.; et al. New neuronal
networks involved in ethanol reinforcement. Alcoholism: Clinical and
Experimental Research 27(2):209–219, 2003. (14) Hoffman,
P.L.; Morrow, L.; Phillips, T.J.; and Siggins, G.R. Neuroadaptation
to ethanol at the molecular and cellular levels. In: Noronha, A.; Eckardt,
M.; and Warren, K., eds. Review of NIAAA’s Neuroscience and
Behavioral Research Portfolio. NIAAA Research Monograph No. 34. NIH
Pub. No. 00–4579. Bethesda, MD: National Institute on Alcohol Abuse
and Alcoholism, 2000. pp. 85–188. (15) Weiss, F.
Neuroadaptive changes in neurotransmitter systems mediating ethanol–induced
behaviors. In: Noronha, A.; Eckardt, M.; and Warren, K., eds. Review
of NIAAA’s Neuroscience and Behavioral Research Portfolio.
NIAAA Research Monograph No. 34. NIH Pub. No. 00–4579. Bethesda,
MD: National Institute on Alcohol Abuse and Alcoholism, 2000. pp. 261–313.
(16) Koob, G.F., and Le Moal, M. Drug addiction, dysregulation
of reward, and allostasis. Neuropsychopharmacology 24(2):97–129,
2001. (17) Kreek, M.J.; LaForge, K.S.; and Butelman,
E. Pharmacotherapy of addictions. Nature Reviews Drug Discovery
1:710–726, 2002. (18) National Institute on Alcohol Abuse
and Alcoholism (NIAAA). Tenth Special Report to
the U.S. Congress on Alcohol and Health. NIH Pub. No. 00–1583.
Bethesda, MD: NIAAA, 2000. (19) Johnson, B.A., and Ait–Daoud,
N. Medications to treat alcoholism. Alcohol Research & Health
23(2):99–106, 1999. (20) Mehta, A.K., and Ticku,
M.K. An update on GABAA receptors. Brain Research Reviews
29(2–3):196–217, 1999. (21) Buck, K.J., and
Finn, D.A. Genetic factors in addiction: QTL mapping and candidate gene
studies implicate GABAergic genes in alcohol and barbiturate withdrawal
in mice. Addiction 96(1):139–149, 2000. (22) Loh,
E.W., and Ball, D. Role of the GABAAβ2, GABAAα6,
GABAAα1, and GABAAγ2 receptor subunit
genes cluster in drug responses and the development of alcohol dependence.
Neurochemistry International 37(5–6):413–423, 2000.
(23) Cagetti, E.; Liang, J.; Spigelman, I.; and Olson,
R.W. Withdrawal from chronic intermittent ethanol treatment changes subunit
composition, reduces synaptic function, and decreases behavioral responses
to positive allosteric modulators of GABAA receptors. Molecular
Pharmacology 63(1):53–64, 2003. (24) Blednov, Y.A.;
Jung, S.; Alva, H.; et al. Deletion of the α1 or β2 subunit
of GABAA receptors reduces actions of alcohol and other drugs.
Journal of Pharmacology and Experimental Therapeutics 304(1):30–36,
2003. (25) Kralic, J.E.; Wheeler, M.; Renzi, K.; et al.
Deletion of GABAA receptor a1 subunit–containing receptors
alters responses to ethanol and other anesthetics. Journal of Pharmacology
and Experimental Therapeutics 305(2):600–607, 2003. (26)
Addolorato, G.; Caputo, F.; Capiristo, E.; et al. Baclofen efficacy
in reducing alcohol craving and intake: A preliminary double–blind
randomized controlled study. Alcohol and Alcoholism 37(5):504–508,
2002. (27) Bonnet, U.; Banger, M.; Leweke, M.; et al.
Treatment of acute alcohol withdrawal with gabapentin: Results from a
controlled two–center trial. Journal of Clinical Psychopharmacology
23(5):514–519, 2003. (28) Bisaga, A., and Evans,
S.M. Acute effects of memantine in combination with alcohol in moderate
drinkers. Psychopharmacology 172:16–24, 2004. (29)
Johnson, B.A.; Ait–Daoud, N.; Bowden, C.L.; et al. Oral
topiramate for treatment of alcohol dependence: A randomized controlled
trial. Lancet 361(9370):1677–1685, 2003. (30) Lovinger,
D.M. Serotonin’s role in alcohol’s effects on the
brain. Alcohol Health & Research World 21(2):114–120,
1997. (31) Cornelius, J.R.; Salloum, I.M.; Ehler, J.G.;
et al. Fluoxetine in depressed alcoholics. A double–blind, placebo–controlled
trial. Archives of General Psychiatry 54(8):700–705, 1997.
(32) Moak, D.H.; Anton, R.F.; Latham, P.K.; et al. Sertraline
and cognitive behavioral therapy for depressed alcoholics: Results of
a placebo–controlled trial. Journal of Clinical Psychopharmacology
23(6):553–562, 2003. (33) Pettinati, H.M.; Volpicelli,
J.R.; Luck, G.; et al. Double–blind clinical trial of sertraline
treatment for alcohol dependence. Journal of Clinical Psychopharmacology
21(2)143–153, 2001. (34) Johnson, B.A.; Roache,
J.D.; Javors, M.A.; et al. Ondansetron for reduction of drinking among
biologically predisposed alcoholic patients. Journal of the American
Medical Association 284(8):963–971, 2000. (35) Kranzler,
H.R. Medications for alcohol dependence. Journal of the American
Medical Association 284:1016–1017, 2000. (36) Childers,
S.R., and Breivogel, C.S. Cannabis and endogenous cannabinoid
systems. Drug and Alcohol Dependence 51(1–2):173–187,
1998. (37) Basavarajappa, B.S., and Hungund, B.L. Neuromodulatory
role of the endocannabinoid signaling system in alcoholism: An overview.
Prostaglandins, Leukotrienes and Essential Fatty Acids 66(2–3):287–299,
2002. (38) Hungund, B.L.; Basavarajappa, B.S.; Vadasz,
C.; et al. Ethanol, endocannabinoids, and the cannabinoidergic signaling
system. Alcoholism: Clinical and Experimental Research 26(4):565–574,
2002. (39) González, S.; Cascio, M.G.; Fernándo–Ruiz,
J.; et al. Changes in endocannabinoid contents in the brain of rats chronically
exposed to nicotine, ethanol, or cocaine. Brain Research 954:73–81,
2002. (40) Schmidt, L.G.; Samochowiec, J.; Finckh, U.;
et al. Association of a CB1 cannabinoid receptor gene (CNR1) polymorphism
with severe alcohol dependence. Drug and Alcohol Dependence 65(3):221–224,
2002. (41) Wang, L.; Liu, J.; Harvey–White, J.;
et al. Endocannabinoid signaling via cannabinoid receptor 1 is involved
in ethanol preference and its age–dependent decline in mice. Proceedings
of the National Academy of Sciences U.S.A. 100(3):1393–1398,
2003. (42) Hungund, B.L., and Basavarajappa, B.S. Role
of brain’s own marijuana, anandamide and its cannabinoid receptors
(CB1) in alcoholism. Recent Research Developments in Neurochemistry
3(Part 1):9–26, 2000. (43) Freedland, C.S.; Sharpe,
A.L.; Samson, H.H.; and Porrino, L.J. Effects of SR141716A on ethanol
and sucrose self–administration. Alcoholism: Clinical and Experimental
Research 25(2):277–282, 2001. (44) Vacca, G.;
Serra, S.; Brunetti, G.; et al. Boosting effect of morphine on alcohol
drinking is suppressed not only by naloxone but also by the cannabinoid
receptor antagonist, SR 141716. European Journal of Pharmacology
445(1–2):55–59, 2002. (45) Lallemand, F.;
Soubrié, P.H.; and De Witte, P.H. Effects of CB1 cannabinoid receptor
blockade on ethanol preference after chronic ethanol administration. Alcoholism:
Clinical and Experimental Research 25(9):1317–1323, 2001.
(46) Hodge, C.W.; Mehmert, K.K.; Kelley, S.P.; et al. Supersensitivity
to allosteris GABAA receptor modulators and alcohol in mice
lacking PKCε. Nature Neuroscience 2(11):997–1002,
1999. (47) Nuwayhid, S.J., and Werling, L.L. σ1receptor
agonist–mediated regulation of N–methyl–D–aspartate–stimulated
[3H]dopamine release is dependent upon protein kinase C. Journal
of Pharmacology and Experimental Therapeutics 304(1):364–369,
2003. (48) Proctor, W.R.; Poelchen, W.; Bowers, B.J.;
et al. Ethanol differentially enhances hippocampal GABAA receptor–mediated
responses in protein kinase Cγ (PKCγ) and PKCε null mice.
Journal of Pharmacology and Experimental Therapeutics 305(1):264–270,
2003. (49) Olive, M.F.; Mehmert, K.K.; Messing, R.O.;
and Hodge, C.W. Reduced operant ethanol self–administration and
in vivo mesolimbic dopamine responses to ethanol in PKCε–deficient
mice. European Journal of Neuroscience 12:4131–4140, 2000.
(50) Olive, M.F.; Mehmert, K.K.; Nannini, A.; et al.
Reduced ethanol withdrawal severity and altered withdrawal–induced
c–fos expression in various brain regions of mice lacking protein
kinase C–epsilon. Neuroscience 103:171–179, 2001.
(51) Foroud, T.; Bucholz, K.K.; Edenberg, H.J.; et al.
Linkage of an alcoholism–related severity phenotype to chromosome
16. Alcoholism: Clinical and Experimental Research 22(9):2035–2042,
1998. (52) Foroud, T.; Edenberg, H.J.; Goate, A.; et
al. Alcoholism susceptibility loci: Confirmation studies in a replicate
sample and further mapping. Alcoholism: Clinical and Experimental
Research 24(7):933–945, 2000. (53) Reich, T.;
Edenberg, H.J.; Goate, A.; et al. A genome–wide search for genes
affecting the risk for alcohol dependence. American Journal of Medical
Genetics (Neuropsychiatric Genetics) 81:207–215, 1998. (54)
Song, J.; Koller, D.L.; Foroud, T.; et al. Association of GABAA
receptors and alcohol dependence and the effects of genetic imprinting.
American Journal of Medical Genetics Part B (Neuropsychiatric Genetics)
117B:39–45, 2003. (55) Lappalainen, J.; Kranzler,
H.R.; Petrakis, I.; et al. Confirmation and fine mapping of the chromosome
1 alcohol dependence risk locus. Molecular Psychiatry 9:312–319,
2004. (56) Ehlers, C.L.; Gilder, D.A.; Wall, T.L.; et
al. Genomic screen for loci associated with alcohol dependence in Mission
Indians. American Journal of Medical Genetics Part B (Neuropsychiatric
Genetics). Early View, published online (www3.interscience.wiley.com),
June 7, 2004. (57) Long, J.C.; Knowler, W.C.; Hanson,
R.L.; et al. Evidence for genetic linkage to alcohol dependence on chromosome
4 and 11 from an autosome–wide scan in an American Indian population.
American Journal of Medical Genetics (Neuropsychiatric Genetics)
81:216–221, 1998. (58) Thibault, C.; Lai, C.; Wilke,
N.; et al. Expression profiling of neural cells reveals specific patterns
of ethanol–responsive gene expression. Molecular Pharmacology
58(6):1593–1600, 2000. (59) Mayfield, R.D.; Lewohl,
J.M.; Dodd, P.R.; et al. Patterns of gene expression are altered in the
frontal and motor cortices of human alcoholics. Journal of Neurochemistry
81(4):802–813, 2002. (60) Rimondini, R.; Arlinde,
C.; Sommer, W.; and Heilig, M. Long–lasting increase in voluntary
ethanol consumption and transcriptional regulation in the rat brain after
intermittent exposure to alcohol. FASEB Journal 16(1):27–35,
2002. (61) Saito, M.; Smiley, J.; Toth, R.; and Vadasz,
C. Microarray analysis of gene expression in rat hippocampus after chronic
ethanol treatment. Neurochemical Research 27(10):1221–1229,
2002. (62) Liang, T.; Spence, J.; Liu, L.; et al. Alpha–synuclein
maps to a quantitative trait locus for alcohol preference and is differentially
expressed in alcohol–preferring and nonpreferring rats. Proceedings
of the National Academy of Sciences of the U.S.A. 100(8):4690–4695,
2003. (63) Treadwell, J.A., and Singh, S.M. Microarray
analysis of mouse brain gene expression following acute ethanol treatment.
Neurochemical Research 29:357–369, 2004. (64) Roberts,
A.J., and Koob, G.F. The neurobiology of addiction. Alcohol
Health & Research World 21(2):101–106, 1997. (65)
Hernandez–Avila, C.A.; Oncken, C.; Van Kirk, J.; et al.
Adrenocorticotropin and cortisol responses to a naloxone challenge and
risk of alcoholism. Biological Psychiatry 51(8):652–658,
2002. (66) Kreek, M.J., and Koob, G.F. Drug dependence:
Stress and dysregulation of brain reward pathways. Drug and Dependence
51:23–47, 1998. (67) Sayette, M.A. An appraisal–disruption
model of alcohol’s effects on stress responses in social drinkers.
Psychological Bulletin 114:459–476, 1993. (68)
Slawecki, C.J.; Somes, C.; and Ehlers, C.L. Effects of chronic
ethanol exposure on neurophysiological responses to corticotropin–releasing
factor and neuropeptide Y. Alcohol and Alcoholism 34(3):289–299,
1999. (69) Thiele, T.E.; Miura, G.I.; Marsh, D.J.; et
al. Neurobiological responses to ethanol in mutant mice lacking neuropeptide
Y or the Y5 receptor. Pharmacology, Biochemistry and Behavior
67(4):683–691, 2000. (70) Caberlotto, L.; Thorsell,
A.; Rimondini, R.; et al. Differential expression of NPY and its receptors
in alcohol–preferring AA and alcohol–avoiding ANA rats. Alcoholism:
Clinical and Experimental Research 25(11):1564–1569, 2001.
(71) Lappalainen, J.; Kranzler, H.R.; Malison, R.; et
al. A functional neuropeptide Y Leu7Pro polymorphism associated with alcohol
dependence in a large population sample from the United States. Archives
of General Psychiatry 59(9):825–831, 2002. (72) Thorsell,
A.; Rimondini, R.; and Heilig, M. Blockade of central neuropeptide
Y (NPY) Y2 receptors reduces ethanol self–administration in rats.
Neuroscience Letters 332(1):1–4, 2002. (73) Pandey,
S.C.; Carr, L.G.; Heilig, M.; et al. Neuropeptide Y and alcoholism:
Genetic, molecular, and pharmacological evidence. Alcoholism: Clinical
and Experimental Research 27(2):149–154, 2003. (74)
Nie, Z.; Schweitzer, P.; Roberts, A.J.; et al. Ethanol augments
GABAergic transmission in the central amygdale via CRF1 receptors. Science
303:1512–1514, 2004.
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