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Harnett NG, Dumornay NM, Delity M, Sanchez LD, Mohiuddin K, Musey PI, Seamon MJ, McLean SA, Kessler RC, Koenen KC, Beaudoin FL, Lebois L, van Rooij SJ, Sampson NA, Michopoulos V, Maples-Keller JL, Haran JP, Storrow AB, Lewandowski C, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, McGrath ME, Hudak LA, Pascual JL, House SL, An X, Stevens JS, Neylan TC, Jovanovic T, Linnstaedt SD, Germine LT, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Luna B, Harte SE, Elliott JM, Ressler KJ. Prior differences in previous trauma exposure primarily drive the observed racial/ethnic differences in posttrauma depression and anxiety following a recent trauma. Psychol Med 2023; 53:2553-2562. [PMID: 35094717 PMCID: PMC9339026 DOI: 10.1017/s0033291721004475] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time. METHODS As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors. RESULTS Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants. CONCLUSIONS The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
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Affiliation(s)
- N. G. Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - N. M. Dumornay
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - M. Delity
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - L. D. Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - K. Mohiuddin
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - P. I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - M. J. Seamon
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - S. A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - F. L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, 02930, USA
| | - L. Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - S. J. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - V. Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - J. L. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - J. P. Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - A. B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - C. Lewandowski
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - P. L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - S. Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - C. W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - B. E. Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - M. C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, 35294, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - R. A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - M. E. McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - L. A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - J. L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - S. L. House
- Department of Emergency Medicine,, Washington University School of Medicine,, St. Louis, MO, 63130, USA
| | - X. An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - J. S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - T. C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - T. Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - S. D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - L. T. Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - E. M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - A. M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - C. Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - D. A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - R. C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - R. M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - N. K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - B. J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - P. Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, 77030, USA
| | - S. E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - M. W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - R. H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06510, USA
| | - J. Joormann
- Department of Psychology, Yale University, West Haven, CT, 06520, USA
| | - D. M. Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - D. A. Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - J. F. Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - J. W. Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - B. Luna
- Affiliation Laboratory of Neurocognitive Development, University of Pittsburgh Medical Center- Western Psychiatric Hospital, Pittsburgh, PA, 15213, USA
| | - S. E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - J. M. Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, 2006,, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - K. J. Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
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Schultebraucks K, Stevens JS, Michopoulos V, Maples-Keller J, Lyu J, Smith RN, Rothbaum BO, Ressler KJ, Galatzer-Levy IR, Powers A. Development and validation of a brief screener for posttraumatic stress disorder risk in emergency medical settings. Gen Hosp Psychiatry 2023; 81:46-50. [PMID: 36764261 PMCID: PMC10866012 DOI: 10.1016/j.genhosppsych.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Predicting risk of posttraumatic stress disorder (PTSD) in the acute care setting is challenging given the pace and acute care demands in the emergency department (ED) and the infeasibility of using time-consuming assessments. Currently, no accurate brief screening for long-term PTSD risk is routinely used in the ED. One instrument widely used in the ED is the 27-item Immediate Stress Reaction Checklist (ISRC). The aim of this study was to develop a short screener using a machine learning approach and to investigate whether accurate PTSD prediction in the ED can be achieved with substantially fewer items than the IRSC. METHOD This prospective longitudinal cohort study examined the development and validation of a brief screening instrument in two independent samples, a model development sample (N = 253) and an external validation sample (N = 93). We used a feature selection algorithm to identify a minimal subset of features of the ISRC and tested this subset in a predictive model to investigate if we can accurately predict long-term PTSD outcomes. RESULTS We were able to identify a reduced subset of 5 highly predictive features of the ISRC in the model development sample (AUC = 0.80), and we were able to validate those findings in the external validation sample (AUC = 0.84) to discriminate non-remitting vs. resilient trajectories. CONCLUSION This study developed and validated a brief 5-item screener in the ED setting, which may help to improve the diagnostic process of PTSD in the acute care setting and help ED clinicians plan follow-up care when patients are still in contact with the healthcare system. This could reduce the burden on patients and decrease the risk of chronic PTSD.
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Affiliation(s)
- K Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA; Department of Population Health, NYU Grossman School of Medicine, New York, USA.
| | - J S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans' Affairs Health Care System, Atlanta, GA, USA
| | - V Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lyu
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - R N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Behavioral, Social and Health Education Sciences, Emory University School of Public Health, Atlanta, GA, USA
| | - B O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - K J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - I R Galatzer-Levy
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - A Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Kovacs Balint Z, Raper J, Michopoulos V, Howell LH, Gunter C, Bachevalier J, Sanchez MM. Validation of the Social Responsiveness Scale (SRS) to screen for atypical social behaviors in juvenile macaques. PLoS One 2021; 16:e0235946. [PMID: 34014933 PMCID: PMC8136728 DOI: 10.1371/journal.pone.0235946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Primates form strong social bonds and depend on social relationships and networks that provide shared resources and protection critical for survival. Social deficits such as those present in autism spectrum disorder (ASD) and other psychiatric disorders hinder the individual’s functioning in communities. Given that early diagnosis and intervention can improve outcomes and trajectories of ASD, there is a great need for tools to identify early markers for screening/diagnosis, and for translational animal models to uncover biological mechanisms and develop treatments. One of the most widely used screening tools for ASD in children is the Social Responsiveness Scale (SRS), a quantitative measure used to identify individuals with atypical social behaviors. The SRS has been adapted for use in adult rhesus monkeys (Macaca mulatta)–a species very close to humans in terms of social behavior, brain anatomy/connectivity and development–but has not yet been validated or adapted for a necessary downward extension to younger ages matching those for ASD diagnosis in children. The goal of the present study was to adapt and validate the adult macaque SRS (mSRS) in juvenile macaques with age equivalent to mid-childhood in humans. Expert primate coders modified the mSRS to adapt it to rate atypical social behaviors in juvenile macaques living in complex social groups at the Yerkes National Primate Research Center. Construct and face validity of this juvenile mSRS (jmSRS) was determined based on well-established and operationalized measures of social and non-social behaviors in this species using traditional behavioral observations. We found that the jmSRS identifies variability in social responsiveness of juvenile rhesus monkeys and shows strong construct/predictive validity, as well as sensitivity to detect atypical social behaviors in young male and female macaques across social status. Thus, the jmSRS provides a promising tool for translational research on macaque models of children social disorders.
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Affiliation(s)
- Z. Kovacs Balint
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - J. Raper
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
| | - V. Michopoulos
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - L. H. Howell
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - C. Gunter
- Department of Pediatrics, Emory University, Atlanta, Georgia, United States of America
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
- Department of Human Genetics, Emory University, Atlanta, Georgia, United States of America
| | - J. Bachevalier
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Psychology, Emory University, Atlanta, Georgia, United States of America
| | - M. M. Sanchez
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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Grieb ZA, Ross AP, McCann KE, Lee S, Welch M, Gomez MG, Norvelle A, Michopoulos V, Huhman KL, Albers HE. Sex-dependent effects of social status on the regulation of arginine-vasopressin (AVP) V1a, oxytocin (OT), and serotonin (5-HT) 1A receptor binding and aggression in Syrian hamsters (Mesocricetus auratus). Horm Behav 2021; 127:104878. [PMID: 33148500 PMCID: PMC8889570 DOI: 10.1016/j.yhbeh.2020.104878] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
Dominance status in hamsters is driven by interactions between arginine-vasopressin V1a, oxytocin (OT), and serotonin 1A (5-HT1A) receptors. Activation of V1a and OT receptors in the anterior hypothalamus (AH) increases aggression in males, while decreasing aggression in females. In contrast, activation of 5-HT1A receptors in the AH decreases aggression in males and increases aggression in females. The mechanism underlying these differences is not known. The purpose of this study was to determine if dominance status and sex interact to regulate V1a, OT, and 5-HT1A receptor binding. Same-sex hamsters (N = 47) were paired 12 times across six days in five min sessions. Brains from paired and unpaired (non-social control) hamsters were collected immediately after the last interaction and processed for receptor binding using autoradiography. Differences in V1a, OT, and 5-HT1A receptor binding densities were observed in several brain regions as a function of social status and sex. For example, in the AH, there was an interaction between sex and social status, such that V1a binding in subordinate males was lower than in subordinate females and V1a receptor density in dominant males was higher than in dominant females. There was also an interaction in 5-HT1A receptor binding, such that social pairing increased 5-HT1A binding in the AH of males but decreased 5-HT1A binding in females compared with unpaired controls. These results indicate that dominance status and sex play important roles in shaping the binding profiles of key receptor subtypes across the neural circuitry that regulates social behavior.
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Affiliation(s)
- Z A Grieb
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America.
| | - A P Ross
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - K E McCann
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - S Lee
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - M Welch
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - M G Gomez
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - A Norvelle
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - V Michopoulos
- Yerkes National Primate Research Center, Atlanta, GA, United States of America; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - K L Huhman
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
| | - H E Albers
- Neuroscience Institute, Georgia State University, Center for Behavioral Neuroscience, Atlanta, GA, United State of America
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Maddox SA, Kilaru V, Shin J, Jovanovic T, Almli LM, Dias BG, Norrholm SD, Fani N, Michopoulos V, Ding Z, Conneely KN, Binder EB, Ressler KJ, Smith AK. Estrogen-dependent association of HDAC4 with fear in female mice and women with PTSD. Mol Psychiatry 2018; 23:658-665. [PMID: 28093566 PMCID: PMC5513798 DOI: 10.1038/mp.2016.250] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 10/10/2015] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
Women are at increased risk of developing post-traumatic stress disorder (PTSD) following a traumatic event. Recent studies suggest that this may be mediated, in part, by circulating estrogen levels. This study evaluated the hypothesis that individual variation in response to estrogen levels contributes to fear regulation and PTSD risk in women. We evaluated DNA methylation from blood of female participants in the Grady Trauma Project and found that serum estradiol levels associates with DNA methylation across the genome. For genes expressed in blood, we examined the association between each CpG site and PTSD diagnosis using linear models that adjusted for cell proportions and age. After multiple test correction, PTSD associated with methylation of CpG sites in the HDAC4 gene, which encodes histone deacetylase 4, and is involved in long-term memory formation and behavior. DNA methylation of HDAC4 CpG sites were tagged by a nearby single-nucleotide polymorphism (rs7570903), which also associated with HDAC4 expression, fear-potentiated startle and resting-state functional connectivity of the amygdala in traumatized humans. Using auditory Pavlovian fear conditioning in a rodent model, we examined the regulation of Hdac4 in the amygdala of ovariectomized (OVX) female mice. Hdac4 messenger RNA levels were higher in the amygdala 2 h after tone-shock presentations, compared with OVX-homecage control females. In naturally cycling females, tone-shock presentations increased Hdac4 expression relative to homecage controls for metestrous (low estrogen) but not the proestrous (high estrogen) group. Together, these results support an estrogenic influence of HDAC4 regulation and expression that may contribute to PTSD in women.
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Affiliation(s)
- S A Maddox
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - V Kilaru
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - J Shin
- Center for Advanced Brain Imaging (CABI), Georgia Institute of Technology, Atlanta, GA, USA
| | - T Jovanovic
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - L M Almli
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - B G Dias
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - S D Norrholm
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA,Atlanta VA Medical Center, Atlanta, GA, USA
| | - N Fani
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - V Michopoulos
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - Z Ding
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - K N Conneely
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - E B Binder
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - K J Ressler
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,McLean Hospital, Harvard Medical School, Belmont, MA, USA,Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA
| | - A K Smith
- Department of Psychiatry, School of Medicine, Emory University, Atlanta, GA, USA,Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA,Department of Gynecology and Obstetrics, School of Medicine, Emory University, 101 Woodruff Circle NE, Suite 4217, Atlanta, GA 30322, USA. E-mail:
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6
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Nylocks KM, Michopoulos V, Rothbaum AO, Almli L, Gillespie CF, Wingo A, Schwartz AC, Habib L, Gamwell KL, Marvar PJ, Bradley B, Ressler KJ. An angiotensin-converting enzyme (ACE) polymorphism may mitigate the effects of angiotensin-pathway medications on posttraumatic stress symptoms. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:307-15. [PMID: 25921615 DOI: 10.1002/ajmg.b.32313] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/23/2015] [Indexed: 11/06/2022]
Abstract
Angiotensin, which regulates blood pressure may also act within the brain to mediate stress and fear responses. Common antihypertensive medication classes of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) have been associated with lower PTSD symptoms. Here we examine the rs4311 SNP in the ACE gene, previously implicated in panic attacks, in the relationship between ACE-I/ARB medications and PTSD symptoms. Participants were recruited from outpatient wait rooms between 2006 and March 2014 (n= 803). We examined the interaction between rs4311 genotype and the presence of blood pressure medication on PTSD symptoms and diagnosis. PTSD symptoms were lower in individuals taking ACE-Is or ARBs (N = 776). The rs4311 was associated with PTSD symptoms and diagnosis (N = 3803), as the T-carriers at the rs4311 SNP had significantly greater likelihood of a PTSD diagnosis. Lastly, the rs4311 genotype modified the effect of ACE-Is or ARBs on PTSD symptoms (N = 443; F1,443 = 4.41, P < 0.05). Individuals with the CC rs4311 genotype showed lower PTSD symptoms in the presence of ACE-Is or ARBs. In contrast, T- carriers showed the opposite, such that the presence of ACE-Is or ARBs was associated with higher PTSD symptoms. These data suggest that the renin-angiotensin system may be important in PTSD, as ACE-I/ARB usage associates with lower symptoms. Furthermore, we provide genetic evidence that some individuals are comparatively more benefitted by ACE-Is/ARBs in PTSD treatment. Future research should examine the mechanisms by which ACE-Is/ARBs affect PTSD symptoms such that pharmaco-genetically informed interventions may be used to treat PTSD.
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Affiliation(s)
- K M Nylocks
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - V Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Yerkes National Primate Research Center, Atlanta, Georgia
| | - A O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - L Almli
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - C F Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - A Wingo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - A C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - L Habib
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - K L Gamwell
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - P J Marvar
- Department of Pharmacology & Physiology, Institute of Neuroscience, George Washington University, Washington, District of Columbia
| | - B Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Mental Health Services, Atlanta, Georgia
| | - K J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Yerkes National Primate Research Center, Atlanta, Georgia
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7
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Johnson ZP, Lowe J, Michopoulos V, Moore CJ, Wilson ME, Toufexis D. Oestradiol differentially influences feeding behaviour depending on diet composition in female rhesus monkeys. J Neuroendocrinol 2013; 25:729-41. [PMID: 23714578 PMCID: PMC4427903 DOI: 10.1111/jne.12054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 05/03/2013] [Accepted: 05/26/2013] [Indexed: 12/18/2022]
Abstract
In females, cyclical changes in the ovarian hormone oestradiol are known to modulate feeding behaviour. However, what is less clear is how these behavioural effects of oestradiol are modified by the macronutrient content of a diet. In the present study, we report data showing that oestradiol treatment results in both significantly smaller meals and a reduced total calorie intake in ovariectomised, socially-housed female rhesus macaques when only chow diet is available. Conversely, during a choice dietary condition where both palatable and chow options are available, oestradiol treatment had no observable, attenuating effect on calorie intake. During this choice dietary phase, all animals consumed more of the palatable diet than chow diet; however, oestradiol treatment appeared to further increase preference for the palatable diet. Finally, oestradiol treatment increased snacking behaviour (i.e. the consumption of calories outside of empirically defined meals), regardless of diet condition. These findings illustrate how oestradiol differentially influences feeding behaviour depending on the dietary environment and provides a framework in which we can begin to examine the mechanisms underlying these observed changes.
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Affiliation(s)
- Z P Johnson
- Division of Developmental & Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.
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8
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Michopoulos V, Embree M, Reding K, Sanchez MM, Toufexis D, Votaw JR, Voll RJ, Goodman MM, Rivier J, Wilson ME, Berga SL. CRH receptor antagonism reverses the effect of social subordination upon central GABAA receptor binding in estradiol-treated ovariectomized female rhesus monkeys. Neuroscience 2013; 250:300-8. [PMID: 23856065 DOI: 10.1016/j.neuroscience.2013.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 01/22/2023]
Abstract
Persistent exposure to environmental stressors causes dysregulation of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis and alters GABAA receptor (GABAAR) levels throughout the brain. Social subordination in socially housed female rhesus results in distinctive stress-related physiological and behavioral phenotypes that are dependent on the ovarian hormone estradiol (E2). In the present study, we utilized ovariectomized adult female rhesus monkeys undergoing hormone replacement with E2 to test the hypothesis that the chronic psychosocial stress of subordination alters GABAAR binding potential (GABAAR BPND) in limbic regions implicated in emotional processing including the prefrontal cortex, temporal lobe (amygdala and hippocampus), and hypothalamus. Furthermore, we tested the hypothesis that peripheral administration of a corticotropin-releasing hormone (CRH) receptor antagonist (astressin B) would reverse the alterations in GABAAR binding within these regions in subordinate females. After subjects received astressin B or saline for three consecutive days, GABAAR BPND was determined by positron emission tomography (PET) using (18)F-flumazenil as a radioligand. T1-weighted structural magnetic resonance imaging scans were also acquired for PET scan co-registration, in order to perform a region of interest analysis using the pons as a reference region. Compared to socially dominant females, subordinate females exhibited increased GABAAR BPND in the prefrontal cortex but not in the temporal lobe or the hypothalamus. Administration of astressin B eliminated the status difference in GABAAR BPND in the prefrontal cortex, suggesting that the chronic stressor of social subordination modulates GABAergic tone via effects on CRH and the LHPA axis, at least in prefrontal regions.
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Affiliation(s)
- V Michopoulos
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States; Division of Developmental & Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
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9
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Embree M, Michopoulos V, Votaw JR, Voll RJ, Mun J, Stehouwer JS, Goodman MM, Wilson ME, Sánchez MM. The relation of developmental changes in brain serotonin transporter (5HTT) and 5HT1A receptor binding to emotional behavior in female rhesus monkeys: effects of social status and 5HTT genotype. Neuroscience 2012; 228:83-100. [PMID: 23079633 DOI: 10.1016/j.neuroscience.2012.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 01/21/2023]
Abstract
The goal of the present study was to examine how social subordination stress and 5HTT polymorphisms affect the development of brain serotonin (5HT) systems during the pubertal transition in female rhesus monkeys. We also examined associations with developmental changes in emotional reactivity in response to a standardized behavioral test, the Human Intruder (HI). Our findings provide the first longitudinal evidence of developmental increases in 5HT1A receptor and 5HTT binding in the brain of female primates from pre- to peripuberty. The increase in 5HT1A BP(ND) in these socially housed female rhesus monkeys is a robust finding, occurring across all groups, regardless of social status or 5HTT genotype, and occurring in the left and right hemispheres of all prefrontal regions studied, as well as the amygdala, hippocampus, hypothalamus, and raphe nuclei. 5HTT BP(ND) also showed an increase with age in raphe, anterior cingulate cortex, and dorsolateral prefrontal cortex. These changes in brain 5HT systems take place as females establish more adult-like patterns of social behavior, as well as during the HI paradigm. Indeed, the main developmental changes in behavior during the HI (increase in freezing and decrease in submission/appeasement) were related to neurodevelopmental increases in 5HT1A receptors and 5HTT, because the associations between these behaviors and 5HT endpoints emerge at peripuberty. We detected an effect of social status on 5HT1A BP(ND) in the hypothalamus and on 5HTT BP(ND) in the orbitofrontal cortex, with subordinates showing higher BP(ND) than dominants in both cases during the pubertal transition. No main effects of 5HTT genotype were observed for 5HT1A or 5HTT BP(ND). Our findings indicate that adolescence in female rhesus monkeys is a period of central 5HT reorganization, partly influenced by exposure to the social stress of subordination, that likely functions to integrate adrenal and gonadal systems and shape the behavioral response to emotionally challenging social situations.
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Affiliation(s)
- M Embree
- Division of Developmental & Cognitive Neuroscience, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.
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10
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Wilson M, Michopoulos V. Psychosocial influence on diet preference and caloric intake in female monkeys. Appetite 2010. [DOI: 10.1016/j.appet.2010.04.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Michopoulos V, Shepard K, Arce M, Whitley J, Wilson M. Food history and social status affect food intake in monkeys. Appetite 2009. [DOI: 10.1016/j.appet.2009.04.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Keen-Rhinehart E, Michopoulos V, Toufexis DJ, Martin EI, Nair H, Ressler KJ, Davis M, Owens MJ, Nemeroff CB, Wilson ME. Continuous expression of corticotropin-releasing factor in the central nucleus of the amygdala emulates the dysregulation of the stress and reproductive axes. Mol Psychiatry 2009; 14:37-50. [PMID: 18698320 PMCID: PMC2652696 DOI: 10.1038/mp.2008.91] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increase in corticotropin-releasing factor (CRF) is a putative factor in the pathophysiology of stress-related disorders. As CRF expression in the central nucleus of the amygdala (CeA) is important in adaptation to chronic stress, we hypothesized that unrestrained synthesis of CRF in CeA would mimic the consequences of chronic stress exposure and cause dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, increase emotionality and disrupt reproduction. To test this hypothesis, we used a lentiviral vector to increase CRF-expression site specifically in CeA of female rats. Increased synthesis of CRF in CeA amplified CRF and arginine vasopressin peptide concentration in the paraventricular nucleus of the hypothalamus, and decreased glucocorticoid negative feedback, both markers associated with the pathophysiology of depression. In addition, continuous expression of CRF in CeA also increased the acoustic startle response and depressive-like behavior in the forced swim test. Protein levels of gonadotropin-releasing hormone in the medial preoptic area were significantly reduced by continuous expression of CRF in CeA and this was associated with a lengthening of estrous cycles. Finally, sexual motivation but not sexual receptivity was significantly attenuated by continuous CRF synthesis in ovariectomized estradiol-progesterone-primed females. These data indicate that unrestrained CRF synthesis in CeA produces a dysregulation of the HPA axis, as well as many of the behavioral, physiological and reproductive consequences associated with stress-related disorders.Molecular Psychiatry (2009) 14, 37-50; doi:10.1038/mp.2008.91; published online 12 August 2008.
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Affiliation(s)
- E Keen-Rhinehart
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA
| | - V Michopoulos
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA
| | - DJ Toufexis
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA,School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - EI Martin
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - H Nair
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA
| | - KJ Ressler
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA,School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - M Davis
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA,School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - MJ Owens
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - CB Nemeroff
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - ME Wilson
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA,Center for Behavioral Neuroscience, Emory University, Atlanta, GA, USA
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13
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Kudwa AE, Michopoulos V, Gatewood JD, Rissman EF. Roles of estrogen receptors α and β in differentiation of mouse sexual behavior. Neuroscience 2006; 138:921-8. [PMID: 16338079 DOI: 10.1016/j.neuroscience.2005.10.018] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 09/13/2005] [Accepted: 10/09/2005] [Indexed: 10/25/2022]
Abstract
Sex differences in brain and behavior are ubiquitous in sexually reproducing species. Developmental differences in circulating concentrations of gonadal steroids underlie many sexual dimorphisms. During the late embryonic and early perinatal periods, the testes produce androgens, thus, male brains are exposed to testosterone, and in situ testosterone is aromatized to estradiol. In contrast, females are not exposed to high concentrations of testosterone or estradiol until puberty. In many species, neural sex differences and sexually dimorphic behaviors in adults are initiated primarily by estradiol exposure during early development. In brain, estradiol activates two independent processes: masculinization of neural circuits and networks that are essential for expression of male-typical adult behaviors, and defeminization, the loss of the ability to display adult female-typical behaviors. Here, data for the roles of each of the known estrogen receptors (estrogen receptor alpha and estrogen receptor beta) in these two processes are reviewed. Based on work done primarily in knockout mouse models, separate roles for the two estrogen receptors are suggested. Estrogen receptor alpha is primarily involved in masculinization, while estrogen receptor beta has a major role in defeminization of sexual behaviors. In sum, estradiol can have selective effects on distinct behavioral processes via selective interactions with its two receptors, estrogen receptor alpha and estrogen receptor beta.
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Affiliation(s)
- A E Kudwa
- Program in Neuroscience, University of Virginia Medical School, Charlottesville, 22908, USA
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