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Vol. 282, Issue 1, 318-325, 1997
-Aminobutyric AcidA Receptor Complex and the
Neurosteroid Recognition Site1,2
Department of Psychology, Tufts University, Medford, Massachusetts
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Abstract |
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Agonists acting at benzodiazepine,
-aminobutyric acidA,
barbiturate and neurosteroid recognition sites were studied for their attenuation of separation-induced ultrasonic vocalizations (USV) in rat
pups. The behavioral effects of the neuroactive steroid 3
-hydroxy-5
-pregnan-20-one (allopregnanolone) were assessed when
the drug was administered alone and in combination with agonists and
antagonists acting at the
-aminobutyric acidA receptor
complex. At 7 days postpartum, male and female Long-Evans rat pups were separated from the dam and littermates, and placed on a 20°C surface for 2 min. Allopregnanolone (1-30 mg/kg s.c.), alprazolam (0.03-1 mg/kg s.c.), diazepam (0.1-3 mg/kg s.c.), muscimol (0.03-0.3 mg/kg s.c.) and pentobarbital (1-30 mg/kg s.c.) dose-dependently decreased USV. Pretreatment with flumazenil (0.1 mg/kg s.c.) antagonized alprazolam's and diazepam's USV-suppressive effects; bicuculline (2 mg/kg s.c.) reversed muscimol's USV-suppressive effects.
Allopregnanolone (3 mg/kg s.c.) produced a 4- to 7-fold leftward shift
in alprazolam's and diazepam's USV-suppressive effects, and also
produced a modest leftward shift in pentobarbital's USV dose-effect
function. Neither flumazenil, bicuculline, nor picrotoxin (1 mg/kg
s.c.) altered allopregnanolone's USV-suppressive effects. These
results suggest that the USV-suppressive effects of the neurosteroid
allopregnanolone are mediated at the
-aminobutyric acidA
receptor complex, and are independent from a direct action on the
benzodiazepine or
-aminobutyric acidA recognition sites
on this complex.
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Introduction |
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The existence of a neurosteroid
recognition site on the GABAA receptor complex has been
demonstrated (Baulieu, 1991
; Majewska, 1992
; Lambert et al.,
1995
). Neurosteroids such as allopregnanolone and 5
-THDOC
(allotetrahydrodeoxycorticosterone) are synthesized in brain but do not
interact with classical intracellular steroid receptors, rather they
bind stereoselectively and with high affinity to the membrane-bound
GABAA receptor complex (Paul and Purdy, 1992
).
Neurosteroids may serve an allosteric modulatory role at the
GABAA receptor complex (Lambert et al., 1995
).
In vitro, neurosteroids are similar to barbiturates in
enhancing BZ and GABAA function and binding resulting in
increased Cl
uptake (Majewska et al., 1986
;
Harrison et al., 1987
). At low concentrations, they enhance
the ability of BZs to potentiate muscimol-stimulated Cl
uptake (Morrow et al., 1990
) and displace the binding of the convulsant t-butylbicyclophosphorothionate (Orchinik and
McEwen, 1993
; Lambert et al., 1995
), whereas at high
concentrations, neurosteroids directly activate the GABAA
receptor in the absence of GABA (Morrow et al., 1990
).
In vivo, neurosteroids are anticonvulsant (Belelli et
al., 1989
), myorelaxant and sedative-hypnotic (Ramsay et
al., 1974
; Bukusoglu et al., 1993
), they share
discriminative stimulus properties with BZ receptor agonists (Ator
et al., 1993
), and they produce effects similar to BZs and
barbiturates in preclinical procedures sensitive to the effects of
anxiolytic drugs (Crawley et al., 1986
; Wieland et
al., 1991
). Recently, the neurosteroid allopregnanolone was found
to decrease rat pup USV while also producing motor incoordination
(Zimmerberg et al., 1994
).
35 to 70 kHz USV are emitted by neonatal rodents that are separated
from the dam and littermates (Gardner, 1985
; Mos and Olivier, 1989
;
Winslow and Insel, 1991
). These "distress vocalizations" or
"isolation calls," potentiated in environmental conditions such as
social isolation, reduced ambient temperature, hunger, rough handling,
novelty and threat (Okon, 1970
; Allin and Banks, 1971
; Bell, 1979
), are
an effective stimulus for maternal behavior. The emission of distress
vocalizations is not limited to rodents; they have been observed in
neonatal birds (Panksepp et al., 1978
), dogs (Panksepp
et al., 1978
) and primates (Kalin et al., 1987
; Miczek et al., 1995
). Because of the uniquely
"stressful" contexts in which distress vocalizations are emitted,
as well as their cross-species generality, these calls have provided an
attractive measure in the neurobiology of anxiety and in the evaluation
of anxiolytic compounds (Winslow and Insel, 1991
).
Not surprisingly, diverse drugs with clinical anxiolytic effects
suppress USV. GABA, acting on GABAA receptors, remains the most investigated neurotransmitter system with respect to USV (Insel
and Winslow, 1991
). Agonists acting at BZ and GABAA
receptor sites are very effective in reducing USV emitted by rat and
mouse pups. Specifically, chlordiazepoxide and diazepam decreased USV induced by rough handling in isolated rat pups in a
flumazenil-reversible manner and at doses that did not alter locomotor
behavior (Gardner, 1985
; Gardner and Budhram, 1987
). In addition, BZ
receptor inverse agonists such as FG 7142, DMCM and
-CCE, as well as
pentylenetetrazole, increased the production of USV and antagonized the
USV-suppressive effects of diazepam (Insel et al., 1986
;
Gardner and Budhram, 1987
; Nastiti et al., 1991
). The GABA
receptor agonists muscimol and baclofen were also found to decrease USV
(Gardner, 1985
; Nastiti et al., 1991
). These studies reveal
that separation-induced USV are sensitive to the effects of compounds
that influence GABAergic transmission through BZ, GABAA and
perhaps barbiturate receptor sites. The discovery that neurosteroids
allosterically modulate GABAergic function provided the impetus for our
investigation involving allopregnanolone and its behavioral effects
including USV emission and sedation in rat pups.
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Methods |
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Subjects. Seven-day-old (the date of parturition being designated as postnatal day 1) male and female Long-Evans rat pups weighing 6 to 18 g were bred on site from pairs (Charles River Laboratories, Wilmington, MA) in a vivarium with controlled temperature (21 ± 1°C), humidity (40-50%) and an inverted 12-hr light-dark cycle. All animals were housed in large 45.7 × 45.7 × 71.1 cm stainless steel breeding cages with pine shavings and free access to rodent food and water. Litters containing fewer than four pups were not tested, and each litter contributed not more than three pups to each treatment. All experiments were conducted during the dark phase of the light-dark cycle.
Apparatus. Ultrasonic vocalizations were detected using a condensor microphone (Bruel and Kjær model 4135) suspended 10 cm above a 22 × 22 × 4.5 cm aluminum pan. Signals were preamplified (Bruel and Kjær model 2633), filtered (Khron-Hite model 3550R) and passed through a measuring amplifier (Bruel & Kjær model 2610) which provided a flat frequency response between 20 to 60 kHz. The amplifier output was monitored with an oscilloscope (Goldstar model 9020A) and concurrently connected to a customized signal detection system. This MacIntosh II-based system digitized and frequency-filtered (band-pass: 32-52 kHz) the signal to determine the onset and offset of each sound pulse. Spurious signals (i.e., scratches on the aluminum pan and audible "squeals") were eliminated by using an additional algorithm that rejected signals less than 0.04 sec in duration or those that were separated by less than 0.06 sec. When correlating measurements from this automated sound detection system with taped playback of sound pulses, the reliability estimates exceeded r = 0.95.
Body temperature was recorded with a thermoprobe (Yellow Springs Instruments model 511) connected to a telethermometer (Yellow Springs Instruments model 2100).Procedure. Individual litters were separated from their mothers and placed in a 20 × 18 × 12 cm polycarbonate cage containing shavings from the home cage. Pups were brought to the experimental room with a heat source that maintained body temperature at approximately 33°C. After a 30-min adaptation period, pups were weighed, numbered and evaluated for ultrasound production by placing them individually onto the aluminum pan marked with a 5 × 5 cm grid and maintained at 20 ± 1°C. 70% of the pups emitted USV within 2 min and they were subsequently assigned randomly to the appropriate treatment. After the appropriate injection-test interval had elapsed (see "Drugs" below), pups were individually placed onto the 20°C surface for a 2-min observation period during which the rate and duration of USV were recorded concurrently with motor activity by direct observation of grid crossings (operationally defined as any traversing of a grid by the pup's head and both front paws). In addition, body temperature was measured before drug administration and immediately before the vocalization test, inserting the probe 1.5 cm into the rectum of the pup until the temperature had stabilized (approximately 10 sec).
Drugs.
Diazepam (Hoffman LaRoche, Nutley, NJ; 0.01, 0.03, 0.1, 0.3, 0.6, 1, 3, 6, 10 mg/kg suspended in a solution containing
85% distilled water, 14% propylene glycol and 1% Tween 80), muscimol (Sigma Chemical Co., St. Louis, MO; 0.003, 0.01, 0.03, 0.1, 0.3, 0.6, 1 mg/kg dissolved in 0.9% sodium chloride), and pentobarbital (Sigma;
0.3, 1, 3, 6, 10, 17, 30, 60 mg/kg dissolved in 0.9% sodium chloride)
were administered 30 min before the test. Alprazolam (Upjohn,
Kalamazoo, MI; 0.003, 0.01, 0.03, 0.1, 0.3, 0.6, 1, 3, 6 mg/kg
suspended in a solution containing 85% distilled water 14% propylene
glycol and 1% Tween 80) was administered 20 min before the test.
Allopregnanolone (Sigma; 1, 3, 10, 17, 30 mg/kg dissolved in a 20%
aqueous solution of 2-hydroxypropyl-
-cyclodextrin) was administered
10 min before the test.
Data analysis. The mean rate of grid crossings and changes in body temperature were transformed into percent of control; these transformed values and the mean rate and duration of USV were analyzed with individual one-factor (DRUG) between-subjects analysis of variances. Time course data were analyzed with a two-factor (DRUG, TIME) between-subjects analysis of variance. When comparisons were significant, posthoc Tukey t tests were performed. For analysis of the selectivity of the behavioral effects of the tested drugs, Pearson product moment correlation coefficients were calculated for USV rate, grid crossings and changes in body temperature. Alpha was 0.05, two-tailed. For analysis of the antagonism and interaction data, and after test for parallelism revealed no deviances from parallelism between dose-effect curves, ED50s (i.e., the dose at which USV were suppressed to 50% of vehicle control) and 95% confidence intervals for USV rate were calculated from first order regression equations. Nonoverlapping confidence intervals were accepted as significant.
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Results |
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USV were monotonic pulses, ranging from 35 to 45 kHz in frequency
and 0.04 to 0.3 sec in duration. During the 2-min vehicle isolation
tests, the rate of USV was 92.77 ± 1.53 (mean ± S.E.M.) calls/min, the total call duration was 10.88 ± 0.17 sec, the
pup's locomotor behavior was 6.84 ± 0.38 grid crosses/min, and
the pup's body temperature decreased by 1.46 ± 0.09°C
(base-line body temperature: 32.57 ± 0.08°C). These
observations remained consistent across different control vehicle
treatments (distilled water, saline, propylene glycol and Tween 80, 20% cyclodextrin vehicles). Because the suppressive effects of the
tested compounds on the duration of USV closely paralleled their
effects on the rate of USV, only the effects on USV rate will be
presented in detail. All agonist effects on the rate of USV are
summarized in figure 1.
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Allopregnanolone.
Allopregnanolone dose-dependently decreased
USV [10-30 mg/kg; F(5,60) = 19.66, P < .05), locomotor activity
[3-30 mg/kg; F(5,60) = 10.22, P < .05], and body temperature
[30 mg/kg; F(5,60) = 3.04, P < .05; fig. 2A].
Pretreatment with flumazenil (0.1 mg/kg), bicuculline (2 mg/kg) or
picrotoxin (1 mg/kg) failed to alter the suppressive effects of
allopregnanolone on USV (table 1) and locomotor activity (table 2). Pretreatment with these BZ-GABAA
receptor complex antagonists prevented the decrease in body temperature
due to allopregnanolone (table 3), although in general,
drug effects on body temperature were quite variable.
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Alprazolam and diazepam.
Alprazolam [0.1-1 mg/kg; F(6,99) = 8.01, P < .05] and diazepam [0.3-3 mg/kg; F(5,60) = 5.41, P < .05; fig. 3] dose-dependently decreased USV.
Alprazolam increased locomotor behavior at 0.03 mg/kg [F(6,99) = 4.55, P < .05]. At the doses tested, diazepam produced quite variable
effects on locomotor behavior (N.S.), and did not alter body
temperature. Alprazolam's effects on body temperature were not
measured.
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Muscimol.
Muscimol dose-dependently decreased USV [0.1-0.6
mg/kg; F(4,49) = 14.65, P < .05; fig. 4A].
Muscimol also dose-dependently decreased locomotor behavior [0.3-0.6
mg/kg; F(4,49) = 6.22, P < .05]. Body temperature was unaffected
by muscimol up to the highest dose tested.
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Pentobarbital. Pentobarbital produced biphasic effects of USV (fig. 4B) and locomotor behavior and dose-dependently decreased body temperature. Pentobarbital (1 mg/kg) tended to increase USV and locomotor behavior, although higher doses monotonically decreased USV [10-30 mg/kg; F(6,64) = 17.00, P <.05], locomotor behavior [30 mg/kg; F(6,64) = 10.06, P < .05], and body temperature [30 mg/kg; F(6,64) = 7.67, P < .05].
Pretreatment with picrotoxin (1 mg/kg) did not alter pentobarbital's suppressive effects on USV or locomotor behavior. Picrotoxin prevented the decreases in body temperature due to pentobarbital alone. A higher dose of picrotoxin (2 mg/kg) produced convulsions and was not examined further. Pentobarbital reduced USV with a 2-fold higher potency after allopregnanolone (3 mg/kg) administration than when pentobarbital was given alone. Pentobarbital dose-dependently decreased USV [6-10 mg/kg; F(5,55) = 8.67, P < .05]. In the presence of allopregnanolone, pentobarbital decreased locomotor behavior at 10 mg/kg [F(5,55) = 3.80, P < .05]. Administration of allopregnanolone prevented the reduction in body temperature observed after pentobarbital alone.| |
Discussion |
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Rat pup USV were sensitive to clinically effective anxiolytics and
compounds acting at various sites on the GABAA receptor complex. These effects were mediated by receptors at distinct sites of
the GABAA receptor complex because flumazenil, which acts
at the BZ site, antagonized the effects of alprazolam and diazepam, and
bicuculline, which acts at the GABAA site, antagonized the
effects of muscimol. Furthermore, the increased potencies to suppress
USV demonstrated with alprazolam, diazepam and pentobarbital in the
presence of allopregnanolone may involve the proposed positive allosteric modulation by neurosteroids at the GABAA
receptor complex (Orchinik and McEwen, 1993
; Lambert et al.,
1995
). Finally, the suppression of USV by allopregnanolone was not
influenced by the antagonists flumazenil, bicuculline or picrotoxin;
these results are consistent with the view that neurosteroids act at a
site distinct from BZ, GABAA and barbiturate receptor sites
on the GABAA receptor complex (Gee et al.,
1995
).
Allopregnanolone has been shown previously to possess sedative-hypnotic
effects (Crawley et al., 1986
; Bitran et al.,
1991
; Orchinik and McEwen, 1993
). In our experiments, allopregnanolone produced its USV-suppressive, myorelaxant and hypothermic effects in
the same dose range; it is therefore difficult to dissociate its
behavioral effects that might also influence USV. Although the current
knowledge of the behavioral effects and site of action of neurosteroids
is incomplete (Purdy et al., 1990
; Mellon, 1994
), the
USV-suppressive and sedative activity observed in our experiments parallel the anxiolytic-like and sedative-hypnotic effects demonstrated with preclinical methods sensitive to anxiolytic compounds (Britton et al., 1991
; Bitran et al., 1993
; Zimmerberg
et al., 1994
; Picazo and Fernandez-Guasti, 1995
).
Antagonists acting at BZ, GABAA and convulsant sites were
ineffective in altering allopregnanolone's USV-suppressive effects, and these effects are indicative of separate mechanisms or sites of
action for BZs and neurosteroids (Morrow et al., 1990
;
Lambert et al., 1995
). BZ antagonists were previously
ineffective in altering the in vitro and in vivo
effects of neurosteroids. Flumazenil failed to inhibit the potentiation
of GABA-elicited membrane currents and depolarizing responses by
alphaxolone (Cottrell et al., 1987
) and similarly failed to
inhibit the potentiation of muscimol-stimulated Cl
uptake
by THDOC (Morrow et al., 1990
). CGS 8216 failed to
antagonize allopregnanolone's anxiolytic-like activity in a light/dark
transition test (Wieland et al., 1991
), and flumazenil only
partially blocked the alphaxolone-induced increases in punished
behavior (Britton et al., 1991
).
The interactions of neurosteroids with the GABA antagonist bicuculline
are more complex. In vitro, bicuculline inhibited the displacement of TBPS and reversed the membrane current elicited by high
concentrations of alphaxolone (Cottrell et al., 1987
; Olsen
and Sapp, 1995
); in contrast, bicuculline-insensitive augmentation of
TBPS binding has also been demonstrated with lower concentrations of
alphaxolone. The results from in vivo investigations are
equivocal. Whereas bicuculline and the convulsant picrotoxin reduced
the anxiolytic-like effects of 3
-hydroxy-4-pregnan-20-one in
response to a predator odor (Kavaliers et al., 1994
), these
GABAA receptor complex antagonists failed to suppress the
alphaxolone-induced increases in punished behavior (Britton et
al., 1991
). These latter results and the failure of bicuculline
and picrotoxin to alter allopregnanolone's USV-suppressive effects in
our experiments are consistent with separate sites of action for
neurosteroids, GABAA and convulsants on the
GABAA receptor complex, and should prompt future in
vivo investigations of this receptor complex using selective
neurosteroid antagonists. It must also be noted that the results from
our set of experiments involving picrotoxin are less compelling, as
this antagonist failed to alter pentobarbital's and
allopregnanolone's USV-suppressive effects.
The BZ receptor full agonists alprazolam and diazepam suppressed USV in
a behaviorally specific manner, i.e., the suppression of USV
was not secondary to the sedative or myorelaxant properties of these
compounds (Gardner, 1985
). The reversal of alprazolam's and
diazepam's suppressive effects on USV by flumazenil suggests that
central BZ receptors were the site of action for this effect. Of
particular interest was the interaction between allopregnanolone and
the BZ agonists. Allopregnanolone enhanced alprazolam's and diazepam's USV-suppressive effects and this increase in potency was
not secondary to allopregnanolone's sedative or hypothermic properties, as neither the rate of grid crossings nor body temperature were altered. In vitro, neurosteroids have been found to
enhance GABAA receptor function at a site distinct from the
BZ receptor (Macdonald and Olsen, 1994
). At low concentrations,
neurosteroids stimulated [3H]flunitrazepam binding,
increased the duration of the Cl
channel opening and
increased the likelihood of longer open-channel burst durations
(Harrison et al., 1987
); these effects are further augmented
by BZs, revealing a separate site of action for each (Gee et
al., 1988
; Morrow et al., 1990
). In our experiments,
the increased potency of the BZ agonists to suppress USV is consistent with the proposal that neurosteroids serve as positive allosteric modulators at the GABAA receptor complex; it is also true
that this leftward shift in BZ function may reflect an additive
relationship.
The GABAA receptor agonist muscimol suppressed USV and
locomotor behavior, and similar to allopregnanolone, suggests that the
reduction in USV by muscimol might have been secondary to its sedative
effects (Nastiti et al., 1991
). Pretreatment with the
GABAA receptor antagonist bicuculline reversed muscimol's suppressive effects on USV and locomotor activity and confirms the
involvement of central GABAA receptors in the
USV-suppressive, muscle relaxant or sedative effects of muscimol
(Gardner, 1985
; Shephard, 1987
; Benton and Nastiti, 1988
; Nastiti
et al., 1991
). The results from the interaction experiments
with allopregnanolone and muscimol were unexpected. In
vitro, muscimol-stimulated Cl
uptake was robustly
enhanced with a variety of neurosteroids, including allopregnanolone,
alphaxolone, THDOC, THDOC 21-mesylate, and
3
-hydroxy-pregn-4-en-20-one; neurosteroids increased muscimol binding to GABAA receptor sites (Turner et al.,
1989
; Morrow et al., 1990
). In contrast, allopregnanolone
failed to potentiate the USV-suppressive effects of muscimol in our set
of experiments and should prompt future in vivo
investigations of the interaction between neurosteroid and
GABAA receptor agonists. One explanation for the
discrepancy between the in vitro and current in
vivo results may be in the use of a relatively immature system.
Although present and functional at birth, BZ, GABAA and
convulsant recognition sites increase in number and change in their
central distribution up to 3 to 4 wk postnatally (Aldinio et
al., 1980
; Palacios and Kuhar, 1981
). Additionally, it has been
discovered that the subunit composition of the GABAA
receptor complex changes early in postnatal development (Gambarana
et al., 1990
; Frostholm et al., 1992
).
Neurosteroids have been most often compared to barbiturates on the
basis of their in vitro and in vivo activity.
Both of these allosteric modulators of the GABAA receptor
complex increase GABA-stimulated Cl
flux by increasing
the duration of channel opening (Allan and Harris, 1986
), they
stimulate muscimol binding, and at higher concentrations they directly
elicit a membrane current from chromaffin cells (Peters et
al., 1988
; Turner et al., 1989
). Additionally, barbiturates, as with neurosteroids, have anticonvulsant properties and
produce anxiolytic-like effects in preclinical methods sensitive to
anxiolytics (Meert and Colpaert, 1986
). Neurosteroid augmentation of
barbiturate effects is well documented (Turner et al., 1989
; Paul and Purdy, 1992
; Macdonald and Olsen, 1994
). Similar to the results from the BZ-neurosteroid experiments (described above), the
presently observed enhancement of the USV-suppressive effects of
pentobarbital by allopregnanolone is consistent with the proposal that
neurosteroids serve as positive allosteric modulators at the
GABAA receptor complex; this enhancement is also consistent with an additive relationship.
In summary, rat pup USV were sensitive to BZ, GABAergic, barbiturate and neurosteroid compounds acting at the GABAA receptor complex. The USV-suppressive effects of alprazolam, diazepam and pentobarbital were augmented in the presence of allopregnanolone and supports the proposal that neurosteroids serve as positive allosteric modulators at the GABAA receptor complex. These results may also indicate an additive relationship between these compounds and should prompt further in vivo research involving multiple combinations of doses (i.e., alprazolam and allopregnanolone) and the use of a selective neurosteroid antagonist to more fully characterize allopregnanolone's effects at the GABAA receptor complex. Finally, allopregnanolone's USV-suppressive effects were not altered by the GABAA receptor complex antagonists flumazenil, bicuculline and picrotoxin; these results are indicative of a separate neurosteroid site of action on this receptor complex.
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Footnotes |
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Accepted for publication March 24, 1997.
Received for publication July 23, 1996.
1 This work was supported by United States Public Health Service Grants AA5122 and DA02632 (K.A.M.) and by research fellowship CNPQ 201736/92-6 (H.M.T.B.).
2 Animals used in these studies were maintained in accordance with the Tufts University Committee on Animal Care, and Guidelines of the Committee on the Care and Use of Laboratory Animal Resources, National Health Council (Department of Health, Education and Welfare, Publication No. (NIH) 85-23, revised 1983).
3 Current address: Department of Pharmacology, University of Michigan Medical School, 1301 MSRB III, Ann Arbor, MI 48109-0632.
4 Current address: Division of Pharmacology, Funcacao Faculdade Federal Ciencias Medicas, Porto Alegre, Brazil.
Send reprint requests to: Dr. K. A. Miczek, Tufts University, Research Building, 490 Boston Avenue, Medford, MA 02155.
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Abbreviations |
|---|
BZ, benzodiazepine;
Cl, 95% confidence
interval;
ED50, 50% effective dose;
GABA,
-aminobutyric
acid;
USV, ultrasonic vocalization;
allopregnanolone, 3
-hydroxy-5
-pregnan-20-one;
THDOC, 5
-pregnane-3
-21-diol-20-one.
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K. E. Vanover, S. Rosenzweig-Lipson, J. E. Hawkinson, N. C. Lan, J. D. Belluzzi, L. Stein, J. E. Barrett, P. L. Wood, and R. B. Carter Characterization of the Anxiolytic Properties of a Novel Neuroactive Steroid, Co 2-6749 (GMA-839; WAY-141839; 3alpha , 21-Dihydroxy-3beta -trifluoromethyl-19-nor-5beta -pregnan-20-one), a Selective Modulator of gamma -Aminobutyric AcidA Receptors J. Pharmacol. Exp. Ther., October 1, 2000; 295(1): 337 - 345. [Abstract] [Full Text] |
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