- About this Journal
- Abstracting and Indexing
- Aims and Scope
- Annual Issues
- Article Processing Charges
- Articles in Press
- Author Guidelines
- Bibliographic Information
- Citations to this Journal
- Contact Information
- Editorial Board
- Editorial Workflow
- Free eTOC Alerts
- Publication Ethics
- Reviewers Acknowledgment
- Submit a Manuscript
- Subscription Information
- Table of Contents
Advances in Pharmacological Sciences
Volume 2011 (2011), Article ID 926361, 12 pages
Neurosteroid Binding Sites on the GABAA Receptor Complex as Novel Targets for Therapeutics to Reduce Alcohol Abuse and Dependence
1Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112-1393, USA
2Alcohol and Drug Abuse Research Center, LSU Health Sciences Center, New Orleans, LA 70112-1393, USA
3Department of Physiology, LSU Health Sciences Center, New Orleans, LA 70112-1393, USA
Received 10 May 2011; Accepted 17 July 2011
Academic Editor: Naheed R. Mirza
Copyright © 2011 Mary W. Hulin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Despite the prevalence of alcohol abuse and dependence in the US and Europe, there are only five approved pharmacotherapies for alcohol dependence. Moreover, these pharmacotherapeutic options have limited clinical utility. The purpose of this paper is to present pertinent literature suggesting that both alcohol and the neurosteroids interact at the GABAA receptor complex and that the neurosteroid sites on this receptor complex could serve as new targets for the development of novel therapeutics for alcohol abuse. This paper will also present data collected by our laboratory showing that one neurosteroid in particular, dehydroepiandrosterone (DHEA), decreases ethanol intake in rats under a variety of conditions. In the process, we will also mention relevant studies from the literature suggesting that both particular subtypes and subunits of the GABAA receptor play an important role in mediating the interaction of neurosteroids and ethanol.
The suggestion that neuroactive steroids could have potential as new pharmacotherapies for alcohol abuse and dependence followed shortly after the discovery that ethanol administration released specific neurosteroids. These same data also directly implicated the endogenous neurosteroids as potential contributors to the behavioral effects of ethanol [1, 2]. However, elucidating the interaction between the neuroactive steroids and ethanol has been especially difficult because both produce a wide variety of molecular and behavioral effects and both act at multiple receptors [3, 4]. Complicating matters even further, neurosteroids also have both genomic and nongenomic effects  that are often only dissociable in terms of their time course. Thus, the goal of this paper is to present pertinent literature regarding the interaction of ethanol and the neurosteroids while also highlighting research from our laboratory suggesting that one neurosteroid in particular, dehydroepiandrosterone (DHEA), may be a key to discovering promising new therapeutics for treating alcohol abuse and dependence. In this process, we also hope to provide compelling evidence for the involvement of the GABAA receptor complex and the role specific subunits of this complex may play in the effects of DHEA on ethanol intake.
If there is any doubt that new treatments for alcohol abuse and dependence are needed, one need only to review some of the most recent epidemiological data on excessive alcohol use. In 2009, an estimated 18.6 million persons aged 12 or older met criteria for alcohol dependence or abuse, representing 7.4 percent of the US population . Despite the prevalence of this problem, there are only five approved pharmacotherapies for alcohol dependence in the US and Europe . Furthermore, these pharmacotherapeutic options have limited clinical utility. For instance, the opioid antagonist naltrexone has been shown to have limited success apart from individuals with a family history of alcohol dependence, those with an enhanced opioid response to ingestion of alcohol, those who self-report enhanced alcohol cravings, and individuals with a specific μ-opioid receptor polymorphism [7–9]. Acamprosate, a synthetic homotaurine derivative, has been shown to decrease alcohol intake, purportedly via modulation of glutamate  and glycine  receptors. However, acamprosate had no direct effect on recombinant glutamate or glycine receptors expressed in Xenopus oocytes at low, clinically relevant concentrations , and therefore, the mechanism by which acamprosate modulates ethanol consumption is still undefined. Experiments involving acamprosate suggest that it is only fully effective in highly motivated subjects with a “goal of abstinence”  and that the combined experience of acamprosate with ethanol is necessary for decreasing ethanol intake .
2. Importance of the GABAA System in the Behavioral Effects of Ethanol
Although a variety of neurotransmitters and signaling pathways have been shown to be involved in the behavioral effects of ethanol (e.g., [14–16]), central GABAergic activity is widely accepted to be one of the most important components of ethanol’s effects as a CNS depressant [17, 18]. Behaviorally, this supposition is supported by research showing that benzodiazepines and barbiturates that positively modulate the GABAA receptor complex can substitute for ethanol in drug-discrimination procedures [19, 20]. Electrophysiological and genetic techniques have also furthered our understanding of the interaction between ethanol and the GABAA receptor complex by showing that it has both direct and indirect effects on the composition of this heteropentameric chloride ion channel. For example, in vitro studies with native and recombinant GABAA receptors indicate ethanol is able to enhance GABA-mediated currents at receptors containing a δ subunit (which are found almost exclusively extrasynaptically in vivo) and at doses of ethanol consistent with those achieved during typical episodes of social drinking in humans [18, 21, 22]. Studies with mice in which the δ subunit has been knocked out have shown the importance of δ subunit-containing GABAA receptor complexes in mediating many of the effects of ethanol. These knockout mice are less sensitive to the anticonvulsant effects of ethanol, demonstrate a decreased hyperexcitability during ethanol withdrawal, and show a lower preference for ethanol compared to wild-type controls. In contrast, δ subunit knockouts did not differ from controls in ethanol-induced anxiolysis, ataxia, hypnosis, or hypothermia .
Because δ subunits are only found in GABAA receptors that also contain an α4 or α6 subunit, the importance of these α subunit subtypes has been the subject of several investigations and debate. For instance, Hanchar et al.  found that cerebellar granule neurons from Sprague-Dawley rats with a naturally occurring mutation in the extrasynaptic α6 subunit (arginine (R) to glutamine (Q) in position 100) had an enhanced response to ethanol. Specifically, they reported an increased tonic current amplitude, tonic current noise, and spontaneous inhibitory postsynaptic current. However, using similar methods, Botta et al.  found that this mutation did not increase the sensitivity of GABAA receptors to ethanol; rather, they reported that ethanol modulated the currents of these channels indirectly via a presynaptic mechanism. The importance of the α4 subunit in mediating the effects of ethanol also remains to be determined, as α4 knockout mice had similar anxiolytic, hypothermic, ataxic, and hypnotic responses to ethanol compared to wild-type littermates .
In addition to modulating GABAA receptors directly, ethanol can also modulate them indirectly by altering the levels of GABA-modulating neurosteroids, such as 3α,5α-THP (allopregnanolone) and 3α,5α-THDOC (allotetrahydrodeoxycorticosterone) [1, 2, 27–29]. These neurosteroids are currently thought to contribute to the various behavioral effects of ethanol, including its sedative-hypnotic [30, 31], anxiolytic , and discriminative-stimulus effects [33–35]. For example, a reduction in the levels of 3α,5α-THP and 3α,5α-THDOC by the 5α-reductase inhibitor finasteride blocked the acquisition of ethanol drinking and the development of ethanol preference in male C57BL/6J mice . In healthy, adult social drinkers, finasteride also reportedly decreased the subjective effects of ethanol, leading some investigators to speculate that these neuroactive steroids were integral for producing ethanol’s subjective effects . In rats trained to discriminate ethanol from saline, 10 mg/kg of pregnanolone partially substituted (60%–70% drug-lever responding) for the discriminative-stimulus effects of 1 g/kg of ethanol subsequent to chronic administration of either saline or ethanol during adolescence . Similarly, in rats trained to discriminate 5.6 mg/kg of pregnanolone from saline, 1 g/kg of ethanol only partially substituted for this neurosteroid . Together, these symmetrical discrimination data indicate that the neurosteroid pregnanolone has overlapping, but not identical, discriminative-stimulus effects with ethanol.
In contrast to the partial substitution found with pregnanolone, Gurkovskaya and Winsauer  demonstrated that the discriminative-stimulus effects of DHEA, which comes from a common precursor pregnenolone, were unlike those of ethanol in rats trained to discriminate 1 g/kg of ethanol from saline. Furthermore, DHEA only modestly shifted the curve for ethanol-lever responding to the right when it was administered shortly before varying doses of ethanol (0.18–1.8 g/kg). Bienkowski and Kostowski  also reported a similar finding in that the sulfated derivative of DHEA, DHEAS, was ineffective at blocking the discriminative-stimulus effects of ethanol. Thus, the effects of DHEA on the discriminative-stimulus effects of ethanol are similar to those of RO15-4513, a partial inverse agonist at the benzodiazepine receptor site, which negatively modulates the GABAA receptor complex and has only been shown to modestly attenuate the subjective effects of ethanol (for review, see ). When these data are considered together, there seems to be little evidence to suggest that compounds that negatively modulate the GABAA receptor alter the discriminative-stimulus effects of ethanol even though these drugs can attenuate some of the other behavioral effects of ethanol.
Another mechanism by which ethanol enhances GABAergic activity indirectly is by increasing presynaptic GABA release [40–42]. Roberto et al.  found that direct infusion of 44 mM ethanol to slices of neurons from the central amygdala of rats reduced paired-pulse facilitation and increased the frequency of spontaneous inhibitory post-synaptic potentials and currents (IPSP/IPSCs), changes that the investigators concluded were indicative of increased presynaptic GABA release. In addition, studies have shown increases in the frequency of miniature ISPCs with 100 mM ethanol in Golgi cells from rat cerebellar slices and 70 mM ethanol in spinal motor neurons [40, 41].
Just as GABAergic activity contributes to ethanol’s CNS depressant and discriminative-stimulus effects, it is also thought to be integrally involved in mediating the reinforcing effects of ethanol. This notion has been strongly supported by studies showing that decreases in GABAA receptor activity can decrease ethanol intake. More specifically, GABAA receptor antagonists as well as inverse agonists at the benzodiazepine receptor site have been shown to decrease both ethanol preference and operant responding for ethanol [43–47]. For example, injection of 2 ng of the competitive GABAA receptor antagonist SR 95531 directly into the central nucleus of the amygdala decreased operant responding for ethanol in male rats, demonstrating a direct link between GABAA receptor modulation and the reinforcing effects of ethanol . These results were similar to those with RO15-4513 , which has been shown to decrease ethanol intake and to antagonize the intoxicating effects of ethanol [45, 50–52] when administered under an operant schedule of food- and ethanol-reinforced responding. In addition, RO15-4513 has been shown to reverse the memory-impairing effects of ethanol [53–55], and this reversal was attributed to both compounds’ interaction with ethanol at the GABAA receptor.
Although ethanol’s effects on the brain are pervasive, the role of GABA and dopamine in parts of the mesolimbic dopamine system, such as the ventral tegmental area, central nucleus of the amygdala, and nucleus accumbens, are of particular interest with regard to the reinforcing effects of ethanol. Ikemoto et al.  found that dopaminergic neurons in the anterior and posterior portions of the ventral tegmental area are differentially regulated by GABAA receptor modulators, as evidenced by a series of studies in which rats self-infused the GABAA receptor antagonist picrotoxin into the anterior, but not posterior, ventral tegmental area. Conversely, rats self-infused the GABAA receptor agonist muscimol into the posterior, but not anterior, ventral tegmental area [56, 57]. This was further clarified in a microdialysis study by Ding et al. , in which they found that the anterior ventral tegmental area was predominantly under GABA-mediated tonic inhibitory control, whereas the posterior tegmental area was predominantly under the control of dopamine-mediated inhibition. These data, therefore, suggested that the posterior ventral tegmental area may be of more importance than the anterior ventral tegmental area in the reinforcing effects of ethanol. The ventral tegmental area has direct projections to the nucleus accumbens, an area of the brain classically associated with the translation of “motivation to action,” or a link between areas of the brain associated with reward and those associated with drug seeking . Furthermore, ethanol consumption in alcohol-preferring rats has been shown to increase extracellular dopamine content in the nucleus accumbens .
3. Effects of DHEA on GABAA Receptors
The discovery of steroid synthesis in the brain quickly resulted in numerous studies into the physiological roles of these “neurosteroids,” with an emphasis on their apparent nongenomic effects [29, 61–64]. In 1990, Majewska et al.  demonstrated that the sulfated form of DHEA (DHEAS) bound to the GABAA receptor on rat neurosynaptosomes. Further, they showed that DHEAS binding decreased GABA-mediated current using a whole-cell voltage-clamp technique. Le Foll et al.  confirmed these findings using a whole-cell voltage-clamp technique in frog pituitary cells and also determined that 10 μM of DHEA and DHEAS were equally effective at decreasing GABA-induced currents. The next year, Imamura and Prasad investigated the effects of DHEA and DHEAS on GABA-mediated chloride influx in neurosynaptosomes derived from rat cortex, hippocampus, and cerebellum. These investigators determined the effects of multiple concentrations of DHEA and DHEAS on GABA-mediated chloride influx and concluded that DHEAS altered chloride influx with greater potency than DHEA . Park-Chung et al.  also found a difference in potency between DHEA and DHEAS, as 100 μM DHEAS was nearly twice as effective at decreasing GABA-induced current as an equal concentration of DHEA in Xenopus embryos expressing α1β2γ2 GABAA receptors.
Because multiple studies have shown that DHEAS is more potent than DHEA, the binding characteristics of DHEAS at the GABAA receptor have been more widely studied and characterized. Studies that have investigated the putative binding sites for DHEAS suggest that neurosteroids that are negative modulators of the GABAA receptor complex act at sites distinct from those that are positive modulators. For some neurosteroids, such as pregnanolone, the addition of a negatively charged sulfate group changes the GABA-modulating capacity of the neurosteroid from positive to negative. Substitution of a hemisuccinate group for the sulfate imparts the same effect on modulator activity, indicating that the negative charge of the compound influences its activity . These data support the suggestion that sulfated and unsulfated steroids modulate GABAA receptor activity through different sites [68, 69]. Unfortunately, similarities between DHEAS and DHEA binding are unknown, and additional research will be necessary to clarify these issues.
The binding sites for neurosteroids that positively modulate the GABAA receptor complex, such as 3α,5α-THP and THDOC, have been more thoroughly investigated [62, 70, 71]. The results from these studies have indicated that these steroids act at one of two putative neurosteroid binding sites. The first site is thought to reside within the transmembrane domains of the α and β subunit interface, whereas the second site is thought to reside on the α subunit (for review, see ). The failure of DHEA to attenuate the pregnanolone-induced disruptions in behavior maintained under a differential-reinforcement-of-low-rate schedule  suggests that DHEA binds to a site on the GABAA receptor separate from pregnanolone. Therefore, DHEA is suspected to act at a site on the GABAA receptor distinct from the binding site of sulfated neurosteroids such as DHEAS and from neurosteroids that are positive modulators of the GABAA receptor such as pregnanolone.
Despite the differences in potency between DHEA and DHEAS, DHEA may have greater clinical utility because of its capacity to cross the blood-brain barrier. The sulfate group of DHEAS imparts greater hydrophilicity to the compound, largely limiting its capacity for diffusing into the central nervous system without first being hydrolyzed to the free steroid . The more lipophilic DHEA crosses the blood-brain barrier in large amounts, as evidenced by recent work in this laboratory. In this experiment, adult male Long-Evans rats were administered 56 mg/kg of DHEA and then sacrificed along with vehicle-treated control rats at time points ranging from 15 minutes to six hours after injection for brain steroid analysis. Steroids were extracted using the solid-phase technique established and validated by Newman et al.  and then analyzed using a commercially-available ELISA (DHEA Saliva ELISA kit, IBL International, Hamburg, Germany). As shown in Figure 1, DHEA levels in the hippocampus, hypothalamus, and frontal cortex of the brain were over twentyfold greater than in vehicle-treated controls. In fact, fifteen minutes following intraperitoneal (i.p.) injection, DHEA was present at concentrations shown by Majewska  to negatively modulate the GABAA receptor.
General support for the behavioral effects of DHEA as a negative modulator of the GABAA receptor complex comes from a study by Amato et al. , who demonstrated that the acute effects of DHEA administration on behavior were similar to other negative or neutral GABAA modulators under a differential-reinforcement-of-low-rates (DRL) schedule in rats. This study compared a variety of positive modulators to DHEA and the negative modulator β-CCM and the neutral modulator flumazenil across several dependent measures. Interestingly, DHEA was similar to β-CCM and flumazenil in producing little or no effect on response rate or the temporal pattern of responding. These findings directly contrast with the effects of the positive modulators ethanol, pregnanolone, lorazepam, and pentobarbital on behavior maintained under the same schedule, as these drugs increased response rate and disrupted the temporal pattern of responding.
The negative modulators of the GABAA receptor complex also contrast with the positive modulators in terms of their effects on anxiety. For instance, the benzodiazepines and barbiturates that positively modulate the GABAA receptor complex typically decrease anxiety in animal models as indicated by increases in suppressed behavior [78–80], time spent in open arms of the elevated plus maze [81, 82], and exploration in the open field test . In humans, benzodiazepines are prescribed clinically as anxiolytics. Unlike these drugs, the negative modulators such as the beta carbolines that are inverse agonists at the benzodiazepine binding site are anxiogenic . While one would expect all negative modulators of the GABAA receptor complex to be anxiogenic, this does not seem to be the case for DHEA as several studies have demonstrated that DHEA is anxiolytic in situations involving chronic stress [84–86]. Presumably, the anxiolytic effects of DHEA can be attributed to its antiglucocorticoid properties, especially considering most subjects under chronic stress have increased levels of cortisol. The DHEA/cortisol ratio is of particular significance, as the antiglucocorticoid effects of DHEA are postulated to be the means by which DHEA was able to reduce depression in humans [87, 88]. Charney  has also suggested that DHEA may be valuable for reducing the response to stress, particularly in patients with post-traumatic stress disorder.
In addition to the antiglucocorticoid effects of DHEA, the capacity of DHEA to modulate the release of other GABA-modulating neurosteroids may also be involved in its anxiolytic effects. DHEA administration has been shown to increase peripheral levels of 3α,5α-THP in postmenopausal women that received 25 mg/day for three months  and both peripheral and CNS levels of 3α,5α-THP in female rats that received 2 mg/kg for 14 consecutive days . Together with the finding that two weeks of DHEA administration decreased central levels of pregnenolone sulfate , another neurosteroid that negatively modulates the GABAA receptor [64, 66], these data suggest that long-term DHEA administration may increase overall GABAergic tone despite its capacity for negatively modulating the GABAA receptor complex acutely. Whether this is a direct effect of DHEA or a compensatory response to chronic DHEA remains an important question that will require further investigation.
As mentioned previously, the five subunits that comprise the GABAA receptor complex affect the responsiveness of these receptors to various endogenous and exogenous substances such as the neurosteroids and benzodiazepines [71, 92, 93]. Moreover, the repeated stimulation of GABAA receptor subtypes can induce changes in the subunits comprising these receptors. The α4 subunit, for example, has been shown to be particularly sensitive to changing levels of neurosteroids  and was upregulated following chronic administration of progesterone (a precursor to 3α,5α-THP) and following withdrawal of progesterone treatment. This particular subunit is also of interest because it was upregulated following chronic treatment with benzodiazepines, and its expression decreased the sensitivity of the GABAA receptor complex to benzodiazepines . For this reason, GABAA receptors containing an α4 subunit are often referred to as “benzodiazepine insensitive” receptors. The capacity of GABAA ligands to modify GABAA receptor subunit expression is, therefore, another putative mechanism by which DHEA treatment might alter ethanol intake and preference.
This notion led us to investigate the effect of DHEA administration on the expression of the α4 subunit of the GABAA receptor complex. In this study, twenty-four drug-naïve male Long-Evans hooded rats received either 56 mg/kg of DHEA () or vehicle () daily for a ten-day period. On the final day of treatment, subjects were sacrificed and the brains collected for analysis. Quantitative analysis of mRNA transcripts indicated that DHEA-treated rats had an approximately threefold increase in expression of α4 subunit mRNA in the hypothalamus compared to vehicle-treated controls, as shown in Figure 2. Interestingly, the expression of the α4 subunit mRNA in the frontal cortex did not differ between treatment groups. Together, these data suggested that the capacity of DHEA to alter α4 subunit expression is brain-region dependent, and this was further supported by Western-blot analysis showing that α4 subunit protein expression was increased in the hypothalamus following DHEA treatment compared to control (see Figure 3). In addition, expression of the δ subunit, which is expressed nearly exclusively in receptor complexes with either the α4 or α6 subunits, was not altered by DHEA treatment. More studies are certainly warranted to determine the implication of these findings.
4. DHEA Decreases Ethanol Intake
Working under the hypothesis that negative modulators of the GABAA receptor complex generally decrease ethanol intake, we initiated a series of studies to determine if DHEA could produce the same effect. Using a relatively standard ethanol preference procedure, our first study compared the effects of DHEA and pregnanolone on home-cage ethanol intake and found that DHEA was more effective at reducing the intake of an 18% (v/v) ethanol solution than pregnanolone , which has been shown to positively modulate the GABAA receptor complex. These results were important for several reasons. First, they showed that the neurosteroids remain a relatively unexplored class of drugs with enormous therapeutic potential. Second, they showed that neurosteroids with the capacity to negatively modulate the GABAA receptor complex may be as valuable, or more valuable, as therapeutics for alcohol abuse and dependence than positive modulators, which could putatively serve as substitution therapies for alcohol. An important methodological detail in this study was that neurosteroid injections were administered daily until a criterion for stable ethanol intake was achieved; namely, each dose of neurosteroid was administered until ethanol intake did not vary by more than ±20% for 3 days or for a total of 8 days, in which case the last 3 of those 8 days were used for comparison purposes. This criterion was largely instituted because (1) the intake of low concentrations of ethanol (or low doses of other self-administered drugs) is inherently variable, (2) acute administration of a potential therapeutic may not always be representative of a drug’s capacity to reduce self-administration, and (3) therapeutics for drug dependence are generally administered chronically as opposed to acutely. However, using this criterion raised several critical questions regarding DHEA’s mechanism of action. First, were multiple injections necessary to achieve the effect on ethanol intake, and second, were the decreases in ethanol intake an effect of DHEA or one of several metabolites including the sex hormones testosterone and estradiol?
To address these questions, Worrel et al.  administered 7-keto DHEA, a metabolite of DHEA that is not metabolized to testosterone or estradiol , to the subjects from the Gurkovskaya et al.  preference study and found that this compound produced effects as large as DHEA. In fact, while 10 mg/kg of 7-keto DHEA produced an effect comparable to DHEA, 56 mg/kg of 7-keto DHEA produced a larger decrease in ethanol intake than DHEA. Another important aspect of this study was that 7-keto DHEA decreased ethanol intake after the initial injection, which occurred 15 minutes prior to the 30-minute preference session when ethanol and water were presented. Together, these data indicated that a major metabolite of DHEA might be responsible for the effect of DHEA, metabolism of DHEA to the sex hormones was not necessary to produce an effect on ethanol intake, and repeated administration was not necessary to produce an effect with 7-keto DHEA. Given the onset of the effect of 7-keto DHEA on ethanol intake, these data also suggest that a nonsteroidal, rather than steroidal, mechanism of action might be responsible for DHEA’s observed effects.
In more recent studies conducted in our laboratory, we have established ethanol self-administration under an operant schedule of reinforcement in order to compare the effects of DHEA (and 7-keto DHEA) on voluntary versus schedule-controlled ethanol intake. To establish ethanol-maintained behavior, rats were trained to respond under a fixed-ratio 10 schedule in which every 10 responses on a lever dispensed 0.1 mL of 18% ethanol to a concave spout located on the front wall of an operant chamber. After ethanol intake stabilized under these contingencies, the substitution of different ethanol concentrations was undertaken to compare the concentration-effect curve for ethanol under the FR-10 schedule with the curve established under the home-cage preference procedures. Interestingly, although intake of the lower concentrations of ethanol was more robust under the home-cage preference procedure than the operant procedure, the intake and dose of ethanol between the two procedures was more similar for the higher ethanol concentrations. In particular, substitution of a 32% ethanol concentration for the 18% ethanol concentration produced similar intake in milliliters and in the dose consumed (see Figure 4). More important, doses of DHEA that decreased ethanol intake under the home-cage preference procedure also decreased ethanol intake under an operant procedure (e.g., 56 mg/kg; Figure 5).
As a means of showing the potential developmental influence of DHEA on ethanol preference, we administered DHEA, lorazepam, or vehicle to three groups of male rats during adolescence and then assessed preference and intake of ethanol during adulthood . Lorazepam was included specifically as a comparison to DHEA, because it is well known as a positive allosteric modulator of the GABAA receptor complex. Briefly, each group of adolescent rats received a total of 15 injections (12 of one dose and 3 of a higher dose) on postnatal days (PND) 35–64, and then after a period of no treatment received 23-hours access to water, saccharin, or an ethanol/saccharin solution over several days on two separate occasions (PND 88 and again at PND 111). On the last occasion, the concentration of ethanol in the ethanol/saccharin solution was also increased to determine if the adolescent treatments altered the concentration-effect curves for each group. In general, this study demonstrated that lorazepam administration during adolescence increased adult preference for ethanol compared to vehicle or DHEA administration, whereas DHEA decreased adult preference for ethanol and saccharin compared to vehicle administration. These data were remarkable not only because they showed the long-term effect of positive allosteric modulation of GABAA receptors on later, adult ethanol intake, but they suggest the potential for endogenous levels of DHEA to play an integral role in shaping adult preference and intake either through its putative effects on the GABAA receptor complex or through other as yet unknown mechanisms .
5. Summary and Conclusions
Although the exact mechanism by which DHEA decreases ethanol intake is still under investigation, studies from both the literature and our laboratory strongly indicate that it can interact both directly and indirectly with the GABAA receptor complex and that its behavioral effects are very similar to those of several other negative GABAA receptor modulators. Consistent with data generated over the past several years [21, 22], our data also emphasize the potential role of extrasynaptic GABAA receptors in the interaction of the neurosteroid DHEA and alcohol. For instance, recent electrophysiological and biochemical data have indicated that GABAA receptors containing a δ subunit are potently affected by both ethanol and neurosteroids and that these “extrasynaptic” receptors likely contribute to tonic IPSP and IPSCs in many brain regions. Furthermore, GABAA receptors with δ subunits are thought to be associated exclusively with α4 and α6 subunits in vivo. If this is the case, the upregulation of the α4 subunit could then affect the responsiveness of δ-containing GABAA receptors, and ultimately, the behavioral effects of ethanol or the neurosteroids.
Similar to our molecular data pointing to a DHEA-ethanol interaction, our behavioral studies show that DHEA can dose dependently decrease ethanol intake in outbred rats. Interestingly, some of these data were gathered prior to definitively knowing whether peripherally administered DHEA crossed the blood brain barrier and whether DHEA or one of its hormonal metabolites was responsible for the effect. Since then, however, we have conducted studies showing that DHEA readily crosses the blood brain barrier after peripheral administration (data shown above) and that metabolism of DHEA to one of the sex hormones (i.e., either testosterone or estradiol) is not necessary to obtain the decrease in ethanol intake . Moreover, we have shown DHEA can decrease ethanol intake that is voluntary  or controlled by an operant schedule of reinforcement.
Unfortunately, the effect of DHEA on ethanol intake cannot be attributed exclusively to its capacity for negatively modulating GABAA receptor though there is a significant amount of data showing that this capacity may be its most prominent nongenomic effect [65, 67]. Without question, the difficulty identifying a binding site for DHEA on the GABAA receptor complex has made the investigation into DHEA’s mechanism of action more problematic. As indicated in this paper, the binding site for DHEA would seem to be different from the site for sulfated neurosteroids [68, 69] and from the site for positive GABAA modulators . From a behavioral perspective, however, DHEA produces effects similar to other negative modulators in rats responding under at least one operant schedule of reinforcement (i.e., a DRL schedule). The most notable exception to DHEA’s profile as a negative modulator seems to be its capacity for producing anxiolytic, rather than axiogenic, effects [84–86]. This could be viewed as a therapeutic benefit for a medication that is used to treat alcohol abuse and dependence. Furthermore, unlike negative modulators such as RO15-4513, there is very little evidence that DHEA or 7-keto DHEA have proconvulsant effects [49, 99]. By contrast, numerous small clinical trials with DHEA have shown adverse effects predominantly related to the androgenic effects of DHEA [100, 101]. For instance, common adverse effects in women taking 200 mg of DHEA per day include acne and hirsutism. These effects may be averted, however, by administering 7-keto DHEA, which is not converted to sex hormones  and reduces ethanol intake similarly to DHEA .
This work was supported by USPHS AA09803 (P. J. Winsauer) and AA019848 (M. E. W. Hulin) from the National Institute on Alcohol Abuse and Alcoholism. Special thanks to Ms. Conni Corll for her expert assistance in quantifying α-4 subunit mRNA.
- A. L. Morrow, M. J. VanDoren, S. N. Penland, and D. B. Matthews, “The role of GABAergic neuroactive steroids in ethanol action, tolerance and dependence,” Brain Research Reviews, vol. 37, no. 1–3, pp. 98–109, 2001.
- A. L. Morrow, G. C. Janis, M. J. VanDoren et al., “Neurosteroids mediate pharmacological effects of ethanol: a new mechanism of ethanol action?” Alcoholism, vol. 23, no. 12, pp. 1933–1940, 1999.
- F. T. Crews, A. L. Morrow, H. Criswell, and G. Breese, “Effects of ethanol on ion channels,” International Review of Neurobiology, no. 39, pp. 283–367, 1996.
- R. Rupprecht and F. Holsboer, “Neuroactive steroids: mechanisms of action and neuropsychopharmacological perspectives,” Trends in Neurosciences, vol. 22, no. 9, pp. 410–416, 1999.
- Substance Abuse and Mental Health Services Administration 2010, “Results from the 2009 national survey on drug use and health: volume I. Summary of national findings,” HHS Publication SMA 10-4586 Findings, Office of Applied Studies, Rockville, Md, USA, NSDUH Series H-38A.
- R. M. Swift, “Drug therapy for alcohol dependence,” The New England Journal of Medicine, vol. 340, no. 19, pp. 1482–1490, 1999.
- H. M. Pettinati and A. R. Rabinowitz, “Choosing the right medication for the treatment of alcoholism,” Current Psychiatry Reports, vol. 8, no. 5, pp. 383–388, 2006.
- D. W. Oslin, W. H. Berrettini, and C. P. O'Brien, “Targeting treatments for alcohol dependence: the pharmacogenetics of naltrexone,” Addiction Biology, vol. 11, no. 3-4, pp. 397–403, 2006.
- S. Ross and E. Peselow, “Pharmacotherapy of addictive disorders,” Clinical Neuropharmacology, vol. 32, no. 5, pp. 277–289, 2009.
- P. Chau, H. Hoifodt-Lido, E. Lof, B. Soderpalm, and M. Ericson, “Glycine receptors in the nucleus accumbens involved in the ethanol intake-reducing effect of acamprosate,” Alcoholism, vol. 34, pp. 39–45, 2009.
- M. T. Reilly, I. A. Lobo, L. M. McCracken et al., “Effects of acamprosate on neuronal receptors and ion channels expressed in Xenopus oocytes,” Alcoholism, vol. 32, no. 2, pp. 188–196, 2008.
- C. L. Czachowski, B. H. Legg, and H. H. Samson, “Effects of acamprosate on ethanol-seeking and self-administration in the rat,” Alcoholism, vol. 25, no. 3, pp. 344–350, 2001.
- S. M. Holter, R. Landgraf, W. Zieglgansberger, and R. Spanagel, “Time course of acamprosate action on operant ethanol self- administration after ethanol deprivation,” Alcoholism, vol. 21, no. 5, pp. 862–868, 1997.
- W. Kostowski and P. Bienkowski, “Discriminative stimulus effects of ethanol: neuropharmacological characterization,” Alcohol, vol. 17, no. 1, pp. 63–80, 1999.
- D. S. Choi, W. Wei, J. K. Deitchman et al., “Protein kinase Cdelta regulates ethanol intoxication and enhancement of GABA-stimulated tonic current,” Journal of Neuroscience, vol. 28, no. 46, pp. 11890–11899, 2008.
- C. W. Hodge, K. K. Mehmert, S. P. Kelley et al., “Supersensitivity to allosteric GABA(A) receptor modulators and alcohol in mice lacking PKCepsilon,” Nature Neuroscience, vol. 2, no. 11, pp. 997–1002, 1999.
- A. M. Allan and R. A. Harris, “Involvement of neuronal chloride channels in ethanol intoxication, tolerance, and dependence,” Recent Developments in Alcoholism, vol. 5, pp. 313–325, 1987.
- G. R. Breese, H. E. Criswell, M. Carta et al., “Basis of the gabamimetic profile of ethanol,” Alcoholism, vol. 30, no. 4, pp. 731–744, 2006.
- K. A. Grant, C. A. Waters, K. Green-Jordan, A. Azarov, and K. T. Szeliga, “Characterization of the discriminative stimulus effects of GABA(A) receptor ligands in Macaca fascicularis monkeys under different ethanol training conditions,” Psychopharmacology, vol. 152, no. 2, pp. 181–188, 2000.
- J. De Vry and J. L. Slangen, “Effects of training dose on discrimination and cross-generalization of chlordiazepoxide, pentobarbital and ethanol in the rat,” Psychopharmacology, vol. 88, no. 3, pp. 341–345, 1986.
- M. Wallner, H. J. Hanchar, and R. W. Olsen, “Ethanol enhances alpha 4 beta 3 delta and alpha 6 beta 3 delta gamma-aminobutyric acid type A receptors at low concentrations known to affect humans,” Proceedings of the National Academy of Sciences of the United States of America, vol. 100, pp. 15218–15223, 2003.
- V. Santhakumar, M. Wallner, and T. S. Otis, “Ethanol acts directly on extrasynaptic subtypes of GABAA receptors to increase tonic inhibition,” Alcohol, vol. 41, no. 3, pp. 211–221, 2007.
- R. M. Mihalek, B. J. Bowers, J. M. Wehner et al., “GABA(A)-receptor delta subunit knockout mice have multiple defects in behavioral responses to ethanol,” Alcoholism, vol. 25, no. 12, pp. 1708–1718, 2001.
- H. J. Hanchar, P. D. Dodson, R. W. Olsen, T. S. Otis, and M. Wallner, “Alcohol-induced motor impairment caused by increased extrasynaptic GABA(A) receptor activity,” Nature Neuroscience, vol. 8, no. 3, pp. 339–345, 2005.
- P. Botta, M. Mameli, K. L. Floyd, R. A. Radcliffe, and C. F. Valenzuela, “Ethanol sensitivity of GABAergic currents in cerebellar granule neurons is not increased by a single amino acid change (R100Q) in the alpha6 GABAA receptor subunit,” Journal of Pharmacology and Experimental Therapeutics, vol. 323, no. 2, pp. 684–691, 2007.
- D. Chandra, D. F. Werner, J. Liang et al., “Normal acute behavioral responses to moderate/high dose ethanol in GABAA receptor alpha4 subunit knockout mice,” Alcoholism, vol. 32, no. 1, pp. 10–18, 2008.
- M. L. Barbaccia, D. Affricano, M. Trabucchi et al., “Ethanol markedly increases “GABAergic” neurosteroids in alcohol-preferring rats,” European Journal of Pharmacology, vol. 384, no. 2-3, pp. R1–R2, 1999.
- A. C. Grobin, D. B. Matthews, L. L. Devaud, and A. L. Morrow, “The role of GABA(A) receptors in the acute and chronic effects of ethanol,” Psychopharmacology, vol. 139, no. 1-2, pp. 2–19, 1998.
- M. D. Majewska, N. L. Harrison, R. D. Schwartz, J. L. Barker, and S. M. Paul, “Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor,” Science, vol. 232, no. 4753, pp. 1004–1007, 1986.
- M. J. VanDoren, D. B. Matthews, G. C. Janis, A. C. Grobin, L. L. Devaud, and A. L. Morrow, “Neuroactive steroid 3alpha-hydroxy-5alpha-pregnan-20-one modulates electrophysiological and behavioral actions of ethanol,” Journal of Neuroscience, vol. 20, no. 5, pp. 1982–1989, 2000.
- R. T. Khisti, M. J. VanDoren, T. O'Buckley, and A. L. Morrow, “Neuroactive steroid 3 alpha-hydroxy-5 alpha-pregnan-20-one modulates ethanol-induced loss of righting reflex in rats,” Brain Research, vol. 980, no. 2, pp. 255–265, 2003.
- K. Hirani, A. N. Sharma, N. S. Jain, R. R. Ugale, and C. T. Chopde, “Evaluation of GABAergic neuroactive steroid 3alpha-hydroxy-5alpha-pregnane-20-one as a neurobiological substrate for the anti-anxiety effect of ethanol in rats,” Psychopharmacology, vol. 180, no. 2, pp. 267–278, 2005.
- P. Bienkowski and W. Kostowski, “Discriminative stimulus properties of ethanol in the rat: effects of neurosteroids and picrotoxin,” Brain Research, vol. 753, no. 2, pp. 348–352, 1997.
- C. A. Bowen, R. H. Purdy, and K. A. Grant, “Ethanol-like discriminative stimulus effects of endogenous neuroactive steroids: effect of ethanol training dose and dosing procedure,” Journal of Pharmacology and Experimental Therapeutics, vol. 289, no. 1, pp. 405–411, 1999.
- N. A. Ator, K. A. Grant, R. H. Purdy, S. M. Paul, and R. R. Griffiths, “Drug discrimination analysis of endogenous neuroactive steroids in rats,” European Journal of Pharmacology, vol. 241, no. 2-3, pp. 237–243, 1993.
- M. M. Ford, J. D. Nickel, and D. A. Finn, “Treatment with and withdrawal from finasteride alter ethanol intake patterns in male C57BL/6J mice: potential role of endogenous neurosteroids?” Alcohol, vol. 37, no. 1, pp. 23–33, 2006.
- A. Pierucci-Lagha, J. Covault, R. Feinn et al., “GABRA2 alleles moderate the subjective effects of alcohol, which are attenuated by finasteride,” Neuropsychopharmacology, vol. 30, no. 6, pp. 1193–1203, 2005.
- O. V. Gurkovskaya and P. J. Winsauer, “Discriminative stimulus effects of ethanol, pregnanolone, and dehydroepiandrosterone (DHEA) in rats administered ethanol or saline as adolescents,” Pharmacology Biochemistry and Behavior, vol. 93, no. 1, pp. 82–90, 2009.
- L. R. Gerak, J. M. Moerschbaecher, and P. J. Winsauer, “Overlapping, but not identical, discriminative stimulus effects of the neuroactive steroid pregnanolone and ethanol,” Pharmacology Biochemistry and Behavior, vol. 89, no. 3, pp. 473–479, 2008.
- M. Carta, M. Mameli, and C. F. Valenzuela, “Alcohol enhances GABAergic transmission to cerebellar granule cells via an increase in Golgi cell excitability,” Journal of Neuroscience, vol. 24, no. 15, pp. 3746–3751, 2004.
- L. Ziskind-Conhaim, B. X. Gao, and C. Hinckley, “Ethanol dual modulatory actions on spontaneous postsynaptic currents in spinal motoneurons,” Journal of Neurophysiology, vol. 89, no. 2, pp. 806–813, 2003.
- M. Roberto, S. G. Madamba, S. D. Moore, M. K. Tallent, and G. R. Siggins, “Ethanol increases GABAergic transmission at both pre- and postsynaptic sites in rat central amygdala neurons,” Proceedings of the National Academy of Sciences of the United States of America, vol. 100, no. 4, pp. 2053–2058, 2003.
- A. Balakleevsky, G. Colombo, F. Fadda, and G. L. Gessa, “Ro 19-4603, a benzodiazepine receptor inverse agonist, attenuates voluntary ethanol consumption in rats selectively bred for high ethanol preference,” Alcohol and Alcoholism, vol. 25, no. 5, pp. 449–452, 1990.
- S. Rassnick, E. D'Amico, E. Riley, and G. F. Koob, “GABA antagonist and benzodiazepine partial inverse agonist reduce motivated responding for ethanol,” Alcoholism, vol. 17, no. 1, pp. 124–130, 1993.
- H. H. Samson, G. A. Tolliver, and A. O. Pfeffer, “Oral ethanol reinforcement in the rat: effect of the partial inverse benzodiazepine agonist RO15-4513,” Pharmacology Biochemistry and Behavior, vol. 27, no. 3, pp. 517–519, 1987.
- K. Wegelius, A. Honkanen, and E. R. Korpi, “Benzodiazepine receptor ligands modulate ethanol drinking in alcohol-preferring rats,” European Journal of Pharmacology, vol. 263, no. 1-2, pp. 141–147, 1994.
- A. E. Boyle, R. Segal, B. R. Smith, and Z. Amit, “Bidirectional effects of GABAergic agonists and antagonists on maintenance of voluntary ethanol intake in rats,” Pharmacology Biochemistry and Behavior, vol. 46, no. 1, pp. 179–182, 1993.
- P. Hyytia and G. F. Koob, “GABAA receptor antagonism in the extended amygdala decreases ethanol self-administration in rats,” European Journal of Pharmacology, vol. 283, no. 1–3, pp. 151–159, 1995.
- W. Sieghart, “Structure and pharmacology of gamma-aminobutyric acidA receptor subtypes,” Pharmacological Reviews, vol. 47, no. 2, pp. 181–234, 1995.
- W. J. McBride, J. M. Murphy, L. Lumeng, and T. K. Li, “Effects of Ro 15-4513, fluoxetine and desipramine on the intake of ethanol, water and food by the alcoholpreferring (P) and -nonpreferring (NP) lines of rats,” Pharmacology Biochemistry and Behavior, vol. 30, no. 4, pp. 1045–1050, 1988.
- P. D. Suzdak, J. R. Glowa, and J. N. Crawley, “A selective imidazobenzodiazepine antagonist of ethanol in the rat,” Science, vol. 234, no. 4781, pp. 1243–1247, 1986.
- P. D. Suzdak, S. M. Paul, and J. N. Crawley, “Effects of Ro15-4513 and other benzodiazepine receptor inverse agonists on alcohol-induced intoxication in the rat,” Journal of Pharmacology and Experimental Therapeutics, vol. 245, no. 3, pp. 880–886, 1988.
- C. Castellano and R. Populin, “Effect of ethanol on memory consolidation in mice: antagonism by the imidazobenzodiazepine Ro 15-4513 and decrement by familiarization with the environment,” Behavioural Brain Research, vol. 40, no. 1, pp. 67–72, 1990.
- C. L. Melchior and R. F. Ritzmann, “Neurosteroids block the memory-impairing effects of ethanol in mice,” Pharmacology Biochemistry and Behavior, vol. 53, no. 1, pp. 51–56, 1996.
- T. Nabeshima, K. Tohyama, and T. Kameyama, “Reversal of alcohol-induced amnesia by the benzodiazepine inverse agonist Ro 15-4513,” European Journal of Pharmacology, vol. 155, no. 3, pp. 211–217, 1988.
- S. Ikemoto, J. M. Murphy, and W. J. McBride, “Self-infusion of GABA(A) antagonists directly into the ventral tegmental area and adjacent regions,” Behavioral Neuroscience, vol. 111, no. 2, pp. 369–380, 1997.
- S. Ikemoto, J. M. Murphy, and W. J. McBride, “Regional differences within the rat ventral tegmental area for muscimol self-infusions,” Pharmacology Biochemistry and Behavior, vol. 61, no. 1, pp. 87–92, 1998.
- Z. M. Ding, W. Liu, E. A. Engleman, Z. A. Rodd, and W. J. McBride, “Differential effects of dopamine D2 and GABAA receptor antagonists on dopamine neurons between the anterior and posterior ventral tegmental area of female Wistar rats,” Pharmacology Biochemistry and Behavior, vol. 92, no. 3, pp. 404–412, 2009.
- G. F. Koob, “The neurobiology of addiction: a neuroadaptational view relevant for diagnosis,” Addiction, vol. 101, supplement 1, pp. 23–30, 2006.
- R. J. Thielen, E. A. Engleman, Z. A. Rodd et al., “Ethanol drinking and deprivation alter dopaminergic and serotonergic function in the nucleus accumbens of alcohol-preferring rats,” Journal of Pharmacology and Experimental Therapeutics, vol. 309, no. 1, pp. 216–225, 2004.
- M. D. Majewska, “Neurosteroids: endogenous bimodal modulators of the GABAA receptor. Mechanism of action and physiological significance,” Progress in Neurobiology, vol. 38, no. 4, pp. 379–395, 1992.
- N. L. Harrison, M. D. Majewska, J. W. Harrington, and J. L. Barker, “Structure-activity relationships for steroid interaction with the gamma-aminobutyric acidA receptor complex,” Journal of Pharmacology and Experimental Therapeutics, vol. 241, no. 1, pp. 346–353, 1987.
- K. W. Gee, M. B. Bolger, R. E. Brinton, H. Coirini, and B. S. McEwen, “Steroid modulation of the chloride ionophore in rat brain: structure-activity requirements, regional dependence and mechanism of action,” Journal of Pharmacology and Experimental Therapeutics, vol. 246, no. 2, pp. 803–812, 1988.
- M. D. Majewska and R. D. Schwartz, “Pregnenolone-sulfate: an endogenous antagonist of the gamma-aminobutyric acid receptor complex in brain?” Brain Research, vol. 404, no. 1-2, pp. 355–360, 1987.
- M. D. Majewska, S. Demirgoren, C. E. Spivak, and E. D. London, “The neurosteroid dehydroepiandrosterone sulfate is an allosteric antagonist of the GABAA receptor,” Brain Research, vol. 526, no. 1, pp. 143–146, 1990.
- F. Le Foll, E. Louiset, H. Castel, H. Vaudry, and L. Cazin, “Electrophysiological effects of various neuroactive steroids on the GABA(A) receptor in pituitary melanotrope cells,” European Journal of Pharmacology, vol. 331, no. 2-3, pp. 303–311, 1997.
- M. Imamura and C. Prasad, “Modulation of GABA-gated chloride ion influx in the brain by dehydroepiandrosterone and its metabolites,” Biochemical and Biophysical Research Communications, vol. 243, no. 3, pp. 771–775, 1998.
- M. Park-Chung, A. Malayev, R. H. Purdy, T. T. Gibbs, and D. H. Farb, “Sulfated and unsulfated steroids modulate gamma-aminobutyric acidA receptor function through distinct sites,” Brain Research, vol. 830, no. 1, pp. 72–87, 1999.
- A. K. Mehta and M. K. Ticku, “Unsulfated and sulfated neurosteroids differentially modulate the binding characteristics of various radioligands of GABA(A) receptors following chronic ethanol administration,” Neuropharmacology, vol. 40, no. 5, pp. 668–675, 2001.
- A. M. Hosie, M. E. Wilkins, and T. G. Smart, “Neurosteroid binding sites on GABA(A) receptors,” Pharmacology and Therapeutics, vol. 116, no. 1, pp. 7–19, 2007.
- J. J. Lambert, D. Belelli, S. C. Harney, J. A. Peters, and B. G. Frenguelli, “Modulation of native and recombinant GABA(A) receptors by endogenous and synthetic neuroactive steroids,” Brain Research Reviews, vol. 37, no. 1–3, pp. 68–80, 2001.
- R. J. Amato, P. B. Lewis, H. He, and P. J. Winsauer, “Effects of positive and negative modulators of the gamma-aminobutyric acid A receptor complex on responding under a differential-reinforcement-of-low-rate schedule of reinforcement in rats,” Behavioural Pharmacology, vol. 21, no. 8, pp. 727–735, 2010.
- Y. Kishimoto and M. Hoshi, “Dehydroepiandrosterone sulphate in rat brain: incorporation from blood and metabolism in vivo,” Journal of Neurochemistry, vol. 19, no. 9, pp. 2207–2215, 1972.
- A. E. M. Newman, E. H. Chin, K. L. Schmidt, L. Bond, K. E. Wynne-Edwards, and K. K. Soma, “Analysis of steroids in songbird plasma and brain by coupling solid phase extraction to radioimmunoassay,” General and Comparative Endocrinology, vol. 155, no. 3, pp. 503–510, 2008.
- J. Glowinski and L. L. Iversen, “Regional studies of catecholamines in the rat brain. I. The disposition of [3H]norepinephrine, [3H]dopamine and [3H]dopa in various regions of the brain,” Journal of Neurochemistry, vol. 13, no. 8, pp. 655–669, 1966.
- M. M. Bradford, “A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein dye binding,” Analytical Biochemistry, vol. 72, no. 1-2, pp. 248–254, 1976.
- C. M. Filipeanu, F. Zhou, W. C. Claycomb, and G. Wu, “Regulation of the cell surface expression and function of angiotensin II type 1 receptor by Rab1-mediated endoplasmic reticulum-to-Golgi transport in cardiac myocytes,” Journal of Biological Chemistry, vol. 279, no. 39, pp. 41077–41084, 2004.
- T. C. McCloskey, B. K. Paul, and R. L. Commissaris, “Buspirone effects in an animal conflict procedure: comparison with diazepam and phenobarbital,” Pharmacology Biochemistry and Behavior, vol. 27, no. 1, pp. 171–175, 1987.
- B. Soderpalm, “The SHR exhibits less “anxiety” but increased sensitivity to the anticonflict effect of clonidine compared to normotensive controls,” Pharmacology and Toxicology, vol. 65, no. 5, pp. 381–386, 1989.
- J. M. Witkin and L. A. Perez, “Comparison of effects of buspirone and gepirone with benzodiazepines and antagonists of dopamine and serotonin receptors on punished behavior of rats,” Behavioural Pharmacology, vol. 1, no. 3, pp. 247–254, 1989.
- S. Pellow and S. E. File, “Anxiolytic and anxiogenic drug effects on exploratory activity in an elevated plus-maze: a novel test of anxiety in the rat,” Pharmacology Biochemistry and Behavior, vol. 24, no. 3, pp. 525–529, 1986.
- M. M. Savic, D. I. Obradovic, N. D. Ugresic, J. M. Cook, W. Yin, and D. R. Bokonjic, “Bidirectional effects of benzodiazepine binding site ligands in the elevated plus-maze: differential antagonism by flumazenil and beta-CCt,” Pharmacology Biochemistry and Behavior, vol. 79, no. 2, pp. 279–290, 2004.
- A. Rex, D. N. Stephens, and H. Fink, “‘Anxiolytic’ action of diazepam and abecarnil in a modified open field test,” Pharmacology Biochemistry and Behavior, vol. 53, no. 4, pp. 1005–1011, 1996.
- D. S. Charney, “Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress,” American Journal of Psychiatry, vol. 161, no. 2, pp. 195–216, 2004.
- Y. Hu, A. Cardounel, E. Gursoy, P. Anderson, and M. Kalimi, “Anti-stress effects of dehydroepiandrosterone: protection of rats against repeated immobilization stress-induced weight loss, glucocorticoid receptor production, and lipid peroxidation,” Biochemical Pharmacology, vol. 59, no. 7, pp. 753–762, 2000.
- A. Prasad, M. Imamura, and C. Prasad, “Dehydroepiandrosterone decreases behavioral despair in high- but not low-anxiety rats,” Physiology and Behavior, vol. 62, no. 5, pp. 1053–1057, 1997.
- O. M. Wolkowitz, V. I. Reus, A. Keebler et al., “Double-blind treatment of major depression with dehydroepiandrosterone,” American Journal of Psychiatry, vol. 156, no. 4, pp. 646–649, 1999.
- O. M. Wolkowitz, V. I. Reus, E. Roberts et al., “Dehydroepiandrosterone (DHEA) treatment of depression,” Biological Psychiatry, vol. 41, no. 3, pp. 311–318, 1997.
- A. D. Genazzani, M. Stomati, F. Bernardi, M. Pieri, L. Rovati, and A. R. Genazzani, “Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids,” Fertility and Sterility, vol. 80, no. 6, pp. 1495–1501, 2003.
- F. Bernardi, E. Casarosa, N. Pluchino et al., “Effect of dehydroepiandrosterone on central and peripheral levels of allopregnanolone and beta-endorphin,” Fertility and Sterility, vol. 83, supplement 1, pp. 1161–1168, 2005.
- J. Young, C. Corpechot, M. Haug, S. Gobaille, E. E. Baulieu, and P. Robel, “Suppressive effects of dehydroepiandrosterone and 3 beta-methyl-androst-5-en-17-one on attack towards lactating female intruders by castrated male mice. II. Brain neurosteroids,” Biochemical and Biophysical Research Communications, vol. 174, no. 2, pp. 892–897, 1991.
- H. Shen, Q. H. Gong, M. Yuan, and S. S. Smith, “Short-term steroid treatment increases delta GABAA receptor subunit expression in rat CA1 hippocampus: pharmacological and behavioral effects,” Neuropharmacology, vol. 49, no. 5, pp. 573–586, 2005.
- S. S. Smith, H. Shen, Q. H. Gong, and X. Zhou, “Neurosteroid regulation of GABAA receptors: focus on the alpha4 and delta subunits,” Pharmacology and Therapeutics, vol. 116, no. 1, pp. 58–76, 2007.
- R. A. Holt, A. N. Bateson, and I. L. Martin, “Chronic treatment with diazepam or abecarnil differentially affects the expression of GABAA receptor subunit mRNAs in the rat cortex,” Neuropharmacology, vol. 35, no. 9-10, pp. 1457–1463, 1996.
- O. V. Gurkovskaya, S. T. Leonard, P. B. Lewis, and P. J. Winsauer, “Effects of pregnanolone and dehydroepiandrosterone on ethanol intake in rats administered ethanol or saline during adolescence,” Alcoholism, vol. 33, no. 7, pp. 1252–1264, 2009.
- M. E. Worrel, O. V. Gurkovskaya, S. T. Leonard, P. B. Lewis, and P. J. Winsauer, “Effects of 7-keto dehydroepiandrosterone on voluntary ethanol intake in male rats,” Alcohol, vol. 45, pp. 349–354, 2011.
- H. Lardy, N. Kneer, Y. Wei, B. Partridge, and P. Marwah, “Ergosteroids II: biologically active metabolites and synthetic derivatives of dehydroepiandrosterone,” Steroids, vol. 63, no. 3, pp. 158–165, 1998.
- M. W. Hulin, R. J. Amato, and P. J. Winsauer, “GABAA receptor modulation during adolescence alters adult ethanol intake and preference in rats,” Alcoholism. In press.
- M. K. Ticku and S. K. Kulkarni, “Molecular interactions of ethanol with GABAergic system and potential of RO15-4513 as an ethanol antagonist,” Pharmacology Biochemistry and Behavior, vol. 30, no. 2, pp. 501–510, 1988.
- A. Hartkamp, R. Geenen, G. L. R. Godaert et al., “Effect of dehydroepiandrosterone administration on fatigue, well-being, and functioning in women with primary Sjogren syndrome: a randomised controlled trial,” Annals of the Rheumatic Diseases, vol. 67, no. 1, pp. 91–97, 2008.
- R. F. van Vollenhoven, J. L. Park, M. C. Genovese, J. P. West, and J. L. McGuire, “A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus,” Lupus, vol. 8, no. 3, pp. 181–187, 1999.