Roberto Ciccocioppo

Compulsive Drug‐Seeking Behavior and Relapse

Abstract: The development of addiction and vulnerability to relapse following withdrawal is proposed to be the result of neuroadaptive processes within the central nervous system that oppose the acute reinforcing actions of drugs of abuse. These changes lead to impairment in the mechanisms that mediate positive reinforcement and the emergence of affective changes such as anxiety, dysphoria, and depression during withdrawal. Considerable evidence exists implicating perturbations in DA and 5‐HT transmission in the nucleus accumbens—neurochemical systems that are activated by cocaine and ethanol self‐administration and deficient during withdrawal—as potential substrates for these affective changes. In addition, growing evidence suggests that enhanced CRF release in the central nucleus of the amygdala represents a mechanism underlying the anxiogenic and stress‐like consequences of withdrawal that are common to all drugs of abuse. A growing body of evidence also implicates dysregulation of the non‐neuroendocrine CRF stress system within the central nucleus of the amygdala as a common factor in the anxiogenic and aversive consequences of withdrawal from drugs of abuse. Moreover, a possible link may exist between long‐lasting abnormalities in CRF function in the CeA and vulnerability to relapse during protracted abstinence. Another presumably critical element contributing to the chronic relapsing nature of drug addiction is the learned responses to drug‐related stimuli. The long‐lasting efficacy of drug‐ and alcohol‐associated contextual stimuli in eliciting drug‐seeking behavior in animal models of relapse resembles the endurance of conditioned cue reactivity and cue‐induced cocaine craving in humans and confirms a significant role of learning factors in the long‐lasting addictive potential of cocaine. With cocaine, D1‐dependent neural mechanisms within the medial prefrontal cortex and basolateral amygdala may be important substrates for the motivating effects of drug‐related environmental stimuli. With ethanol, available data suggest a role for opioid receptors in the mediation of conditioned drug‐seeking behavior. Finally, conditioning factors (i.e., exposure to drug‐associated stimuli) and stress can interact to augment vulnerability to relapse. This finding emphasizes that it will be important to consider the simultaneous effects of multiple environmental triggers for relapse in the development of treatment and medication strategies.

3-(4-Chloro-2-Morpholin-4-yl-Thiazol-5-yl)-8-(1-Ethylpropyl)-2,6-Dimethyl-Imidazo[1,2-b]Pyridazine: A Novel Brain-Penetrant, Orally Available Corticotropin-Releasing Factor Receptor 1 Antagonist with Efficacy in Animal Models of Alcoholism

We describe a novel corticotropin-releasing factor receptor 1 (CRF1) antagonist with advantageous properties for clinical development, and its in vivo activity in preclinical alcoholism models. 3-(4-Chloro-2-morpholin-4-yl-thiazol-5-yl)-8-(1-ethylpropyl)-2,6-dimethyl-imidazo[1,2-b]pyridazine (MTIP) inhibited 125I-sauvagine binding to rat pituitary membranes and cloned human CRF1 with subnanomolar affinities, with no detectable activity at the CRF2 receptor or other common drug targets. After oral administration to rats, MTIP inhibited 125I-sauvagine binding to rat cerebellar membranes ex vivo with an ED50 of ∼1.3 mg/kg and an oral bioavailability of 91.1%. Compared with R121919 (2,5-dimethyl-3-(6-dimethyl-4-methylpyridin-3-yl)-7-dipropylamino-pyrazolo[1,5-a]pyrimidine) and CP154526 (N-butyl-N-ethyl-4,9-dimethyl-7-(2,4,6-trimethylphenyl)-3,5,7-triazabicyclo[4.3.0]nona-2,4,8,10-tetraen-2-amine), MTIP had a markedly reduced volume of distribution and clearance. Neither open-field activity nor baseline exploration of an elevated plus-maze was affected by MTIP (1–10 mg/kg). In contrast, MTIP dose-dependently reversed anxiogenic effects of withdrawal from a 3 g/kg alcohol dose. Similarly, MTIP blocked excessive alcohol self-administration in Wistar rats with a history of dependence, and in a genetic model of high alcohol preference, the msP rat, at doses that had no effect in nondependent Wistar rats. Also, MTIP blocked reinstatement of stress-induced alcohol seeking both in postdependent and in genetically selected msP animals, again at doses that were ineffective in nondependent Wistar rats. Based on these findings, MTIP is a promising candidate for treatment of alcohol dependence.

Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress

Alcoholism is a chronic relapsing disorder with substantial heritability. Uncovering gene–environment interactions underlying this disease process can aid identification of novel treatment targets. Here, we found a lowered threshold for stress-induced reinstatement of alcohol seeking in Marchigian–Sardinian Preferring (msP) rats genetically selected for high alcohol preference. In situ hybridization for a panel of 20 stress-related genes in 16 brain regions was used to screen for differential gene expression that may underlie this behavioral phenotype. An innate up-regulation of the Crhr1 transcript, encoding the corticotropin-releasing hormone receptor 1 (CRH-R1), was found in several limbic brain areas of msP rats genetically selected for high alcohol preference, was associated with genetic polymorphism of the Crhr1 promoter, and was accompanied by increased CRH-R1 density. A selective CRH-R1 antagonist (antalarmin, 10–20 mg/kg) was devoid of effects on operant alcohol self-administration in unselected Wistar rats but significantly suppressed this behavior in the msP line. Stress-induced reinstatement of alcohol seeking was not significantly affected by antalarmin in Wistar rats but was fully blocked in msP animals. These data demonstrate that Crhr1 genotype and expression interact with environmental stress to reinstate alcohol-seeking behavior.

Effect of Selective Blockade of μ1 or δ Opioid Receptors on Reinstatement of Alcohol-Seeking Behavior by Drug-Associated Stimuli in Rats ☆ ☆☆

This study examined the effects of a nonselective opiate antagonist and antagonists selective for the μ1 versus δ opioid receptor on ethanol-seeking behavior induced by alcohol-related environmental stimuli in an animal model of relapse. Rats were trained to self-administer ethanol (10% w/v) or water on an FR 1 schedule in 30-min daily sessions. The availability of ethanol was signaled by an olfactory discriminative stimulus (S+). A different olfactory stimulus (S−) signaled water availability. In addition, each lever-response resulting in delivery of ethanol was paired with illumination of a visual cue for 5 s (SC+), whereas a 5-s white noise (SC−) was associated with water. The rats were then subjected to a 20-day extinction phase where lever presses had no programmed consequences. Reexposure to the S+/CS+ stimulus condition in the absence of further ethanol availability elicited strong recovery of responding. No effect was observed following presentation of S−/CS−. Subsequentely, ethanol-seeking behavior associated with the S+/CS+ stimulus condition was studied in rats treated with the nonselective opiate antagonist naltrexone (0.25–1 mg/kg, SC), the δ selective antagonist naltrindole (1–5 mg/kg, IP), and the μ1 selective antagonist naloxonazine (1–15 mg/kg, IP). Naltrexone (1 mg/kg) and naltrindole (5 mg/kg) selectively inhibited alcohol-seeking behavior. Naloxonazine (15 mg/kg) also reduced ethanol-seeking behavior but produced some nonselective behavioral suppression as well. The results provide evidence that selective blockade of either μ1 or δ opioid receptors inhibits ethanol-seeking behavior elicited by drug-related environmental stimuli. Moreover, the data suggest that drugs aimed at the δ opioid receptor may offer advantages in the treatment and prevention of relapse compared with agents that also block the μ1 receptor.

Enduring Resistance to Extinction of Cocaine-Seeking Behavior Induced by Drug-Related Cues

The conditioning of cocaines pharmacological actions with environmental stimuli is thought to be a critical factor in long-lasting relapse risk associated with cocaine addiction. To study the significance of environmental stimuli in enduring vulnerability to relapse, the resistance to extinction of drug-seeking behavior elicited by a cocaine-related stimulus was examined. Male Wistar rats were trained to associate discriminative stimuli (SD) with the availability of intravenous cocaine (S+) vs. the availability of non-rewarding (S−) saline solution, and then placed on extinction conditions during which intravenous solutions and SD were withheld. The rats were then presented with the S+ or S− alone in 60-min reinstatement sessions conducted at 3-day intervals. To examine the long-term persistence of the motivating effects of the cocaine S+, a subgroup of rats was re-tested following an additional three months of abstinence during which time the rats remained confined to their home cages. Re-exposure to the cocaine S+ selectively elicited robust responding at the previously active lever. The efficacy and selectivity of this stimulus to elicit responding remained unaltered throughout a 34-day phase of repeated testing as well as following the additional extended abstinence period. In pharmacological tests, conducted in a separate group of rats, the dopamine (DA) D1 antagonist SCH 39166 (10 μg/kg), the D2/3 antagonist nafadotride (1 mg/kg), and the D2/3 agonist PD 128907 (0.3 mg/kg) suppressed the cue-induced response reinstatement while the D1 agonist SKF 81297 (1.0 mg/kg) produced a variable behavioral profile attenuating cue-induced responding in some rats while exacerbating this behavior in others. The results suggest that the motivating effects of cocaine-related stimuli are highly resistant to extinction. The undiminished efficacy of the cocaine S+ to induce drug-seeking behavior both with repeated testing and following long-term abstinence parallels the long-lasting nature of conditioned cue reactivity and cue-induced cocaine craving in humans, and confirms a significant role of learning factors in long-lasting vulnerability to relapse associated with cocaine addiction. Finally, the results support a role of DA neurotransmission in cue-induced cocaine-seeking behavior.

Nociceptin prevents stress-induced ethanol- but not cocaine-seeking behavior in rats.

This study examined whether nociceptin/orphanin FQ (NC), the endogenous ligand of the opioid receptor-like1 (ORL1) receptor, can block drug-seeking behavior induced by foot-shock stress. Male Wistar rats were trained to operantly self-administer ethanol or cocaine, and then subjected to daily extinction training until responding ceased. Subsequent exposure to 15 min of intermittent footshock elicited robust reinstatement of responding at the previously drug-paired lever. NC (0.1–2.0 μg; i.c.v.) significantly inhibited the effects of footshock stress on ethanol- but not cocaine-seeking behavior. The results support the hypothesis that the NC system participates in the regulation of behavioral responses to stress, and that drugs interacting with NC receptors may have therapeutic potential for the treatment of stress-induced alcohol-seeking behavior and relapse.

Effect of nociceptin on alcohol intake in alcohol-preferring rats.

Abstract The present study investigated the effect of nociceptin (NC), the endogenous ligand of the opioid-like orphan receptor ORL1, on ethanol intake in genetically selected Marchigian Sardinian alcohol-preferring (msP) rats. Acute intracerebroventricular (ICV) injection of 250 or 500 ng/rat of NC, just before access to 10% ethanol (offered 2 h/day), significantly increased ethanol intake. Subchronic (7 days) ICV injection of 500 ng/rat of NC, given just before access to 10% ethanol (for 30 min/day), resulted in a progressive decrease in ethanol consumption. After the end of NC treatment, rats progressively recovered their usual ethanol intake. When NC, 500 or 1000 ng/rat, was tested versus the effect of ethanol in the place conditioning paradigm, NC significantly reduced the increase in time spent in the ethanol-paired compartment after conditioning. This finding suggests that NC reduces the rewarding properties of ethanol in msP rats; thus, they may respond to the acute NC administration by increasing their ethanol intake in an attempt to achieve the usual reinforcing effect of ethanol, whereas subchronic NC treatment may result in extinction of ethanol drinking. The results of the present study suggest that the brain NC mechanisms may represent an interesting target of pharmacological interventions for the treatment of alcoholism.

Effect of nociceptin/orphanin FQ on the rewarding properties of morphine.

The present study investigated the effect of nociceptin/orphanin FQ, the endogenous ligand of the opioid receptor-like 1 (ORL1) receptor, on the rewarding properties of morphine in the place conditioning paradigm. Intracerebroventricular (i.c.v.) injections of nociceptin/orphanin FQ, 500 or 1000 (but not 250) ng/rat, abolished conditioned place preference induced by subcutaneous (s.c.) injections of morphine (3 mg/kg). These doses of nociceptin/orphanin FQ induced neither place aversion nor preference per se. The same doses did not modify the rat performance in the Morris water test, suggesting that they do not disrupt spatial learning and memory. Moreover, these doses of nociceptin/orphanin FQ did not modify the development of morphine-induced locomotor sensitization, suggesting that they do not interfere with sensitization processes to morphine. The present results confirm and extend previous reports that nociceptin/orphanin FQ is able to abolish morphine-induced conditioned place preference, and raise interest for the possible role of nociceptin/orphanin FQ and ORL1 receptors in the control of opiate abuse.

Genetically selected Marchigian Sardinian alcohol-preferring (msP) rats: an animal model to study the neurobiology of alcoholism.

The present article provides an up‐to‐date review summarizing almost 18 years of research in genetically selected Marchigian Sardinian alcohol‐preferring (msP) rats. The results of this work demonstrate that msP rats have natural preference for ethanol characterized by a spontaneous binge‐type of drinking that leads to pharmacologically significant blood ethanol levels. This rat line is highly vulnerable to relapse and presentation of stimuli predictive of alcohol availability or foot‐shock stress can reinstate extinguished drug‐seeking up to 8 months from the last alcohol experience. The msP rat is highly sensitive to stress, shows an anxious phenotype and has depressive‐like symptoms that recover following ethanol drinking. Interestingly, these animals have an up‐regulated corticotrophin releasing factor (CRF) receptor 1 system. Clinical studies have shown that alcoholic patients often drink ethanol in the attempt to self‐medicate from negative affective states and to search for anxiety relief. We propose that msP rats represent an animal model that largely mimics the human alcoholic population that due to poor ability to engage in stress‐coping strategies drink ethanol as a tension relief strategy and for self‐medication purposes.

The Effects of Acamprosate and Neramexane on Cue-Induced Reinstatement of Ethanol-Seeking Behavior in Rat

This study examines, for the first time, the effects of acamprosate and the non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist neramexane on ethanol-seeking induced by alcohol-related environmental stimuli in an animal model of relapse. Wistar rats were trained to operantly self-administer ethanol (10% w/v) or water on a fixed-ratio 1 schedule in a 30-min daily session. Ethanol availability was signaled by an olfactory discriminative stimulus of orange extract (S+). In addition, each lever press was accompanied by a 5-s illumination of the operant chambers house light (CS+). Water availability was signaled by anise odor (S−) and 5-s white noise stimulus (CS−). After completion of the conditioning phase, indicated by stable levels of responding, operant behaviors were extinguished. Prior to reinstatement tests, animals were divided into groups according to either treatment with acamprosate (100, 200 mg/kg given twice), neramexane (1.0, 2.0, 4.0 mg/kg), or vehicle. In vehicle-treated rats, re-exposure to the S+/CS+ in the absence of further ethanol availability elicited strong recovery of responding. No effect was observed following presentation of water-paired cues (S−/CS−). Acamprosate dose-dependently attenuated recovery of responding elicited by ethanol-paired cues (S+/CS+), whereas responding under S−/CS− was not modified by drug administration. Treatment with 1.0 and 2.0 mg/kg of neramexane did not significantly modify responding under both S+/CS+ and S−/CS− conditions. However, a slight reduction of cue-induced reinstatement of alcohol seeking was observed. At the dose of 4.0 mg/kg, neramexane elicited a marked inhibition of responding following presentation of both ethanol- and water-paired cues. In conclusion, acamprosate significantly and selectively reduced alcohol-seeking elicited by environmental stimuli predictive of alcohol availability. Treatment with neramexane that shares part of the pharmacological effects of acamprosate on NMDA receptors, however, resulted in a nonselective reduction of lever responding.