Ethanol withdrawal (EtOHW) alters the pattern of neurohormonal and behavioral response toward internal and external stimuli, which mediates relapse to alcohol use even after a long period of abstinence. Increased noradrenergic signaling from the nucleus tractus solitarius (NTS) to the bed nucleus of the stria terminalis (BNST) during EtOHW underlies withdrawal-induced anxiety, while nitric oxide synthase (NOS) inhibitors injected into the periaqueductal area attenuate EtOHW-induced anxiety. Therefore, this study investigated the involvement of NOS within the NTS in anxiety and increased norepinephrine (NE) release in the BNST during protracted EtOHW in rats exposed to a mild stress. Rats were intraperitoneally administered 3 g/kg/day EtOH for 21 days followed by 28 days of withdrawal, and on the 28th day of withdrawal, the rats were subjected to restraint stress for 7 minutes. The elevated plus maze test was employed to evaluate anxiety-like behavior in rats, and in vivo microdialysis was used to measure the extracellular NE level in the BNST. In elevated plus maze tests, EtOHW rats but not EtOH-naive rats exhibited anxiety-like behavior when challenged with 7-minute mild restraint stress, which was, respectively, mitigated by prior intra-NTS infusion of the nitric oxide scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO), nonselective NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME), or selective neuronal NOS (nNOS) inhibitor 7-nitroindazole (7-NI). Each of these agents also decreased the plasma corticosterone levels in EtOHW rats. In in vivo microdialysis, prior intra-NTS infusion of carboxy-PTIO, L-NAME, or 7-NI attenuated the mild stress-induced NE release in the BNST of EtOHW rats. Additionally, EtOHW rats showed increased solitary nNOS gene and protein expression. Moreover, the anxiolytic effect of intra-NTS administration of 7-NI was abolished by subsequent intra-NTS administration of sodium nitroprusside. These results suggest that elevation of solitary nitric oxide signaling derived from nNOS mediates stress-precipitated anxiety and norepinephrine release in the BNST during protracted EtOHW.
1. Introduction
Relapse is a major barrier in alcoholism therapy [1]. Ethanol withdrawal (EtOHW) leads to adaptation of neurotransmission in the brain that often persists long after complete remission of EtOHW symptoms. This adaptation sensitizes physiological and behavioral responses to internal and external stimuli, characterized by exacerbated pathophysiological responses toward mild stress or even nonstress stimuli [2]. This phenomenon during EtOHW is a stress sensitization that mimics the allodynia in pain medicine in which innocuous stimuli provoke a painful sensation, resulting in relapse even after a long period of abstinence [3].
Elevated anxiety during EtOHW is the major negative emotional component for alcoholism relapse [4], and several lines of evidence indicate that a heightened norepinephrine (NE) signaling in the bed nucleus of the stria terminalis (BNST) is responsible for it. The BNST is a component of the extended amygdala; NE signaling in the BNST along with corticotrophin releasing factor (CRF) is the key factor mediating the anxiety associated with withdrawal of drugs of abuse [5]. NE triggers the extracellular release of CRF, and EtOHW increases the extracellular NE level in the central nucleus of the amygdala (another component of the extended amygdala) [6] and the CRF level in the BNST [7], which underlie EtOHW-induced anxiety. EtOH and morphine share many pharmacological similarities including induction of extracellular NE release in the BNST [8], and extracellular NE release is increased in the BNST in both spontaneous and naloxone-precipitated morphine withdrawal [9, 10]. Therefore, the extracellular NE level may be enhanced in the BNST during EtOHW in association with elevated anxiety. Moreover, Valdez et al. [11] reported that acute mild-restraint stress (AMRS) produced significant anxiety in rats during protracted EtOHW but not in their EtOH-naive counterparts, indicating an allodynia-like phenomenon. Taken together, these observations suggest that AMRS may induce sensitized NE release in the BNST, which is associated with anxiety in rats during protracted EtOHW.
The BNST is a complex consisting of multiple nuclei, broadly divided into anterior and posterior, dorsal and ventral, and medial and lateral parts, and it is heavily innervated by noradrenergic projections arising from both A1/A2 in the nucleus tractus solitarius (NTS) and A6 (locus coeruleus) [12]. However, immunocytochemical and retrograde tracer analyses indicated that the noradrenergic inputs to the ventral BNST (vBNST) are derived mainly from the NTS-A2 [13, 14] and are critical for the negative emotions induced by withdrawal of drugs of abuse. For example, opiate withdrawal precipitated by opioid receptor antagonists was shown to increase NE release in the vBNST and to enhance c-Fos expression in both the vBNST and vBNST-projecting NTS-A2 neurons, whereas intra-vBNST infusion of β-adrenergic antagonists reduced the withdrawal-associated conditioned place aversion [14–16]. Neurochemical lesions of the noradrenergic bundle originating from the NTS-A2, but not from A6, attenuated the withdrawal aversion [14]. These observations suggest increased activity in the NTS-vBNST noradrenergic pathway during withdrawal of drugs of abuse, which is attributed to activation of NTS-A2 neurons. A wide range of neurotransmitters and neuropeptides, including glutamate, gamma-aminobutyric acid (GABA), nitric oxide (NO), galanin, and neuropeptide Y, are present in the NTS-A2 and regulate NE neuronal activities [17]. It is well documented that NO synthase (NOS) inhibiters have anxiolytic effects [18–20]; moreover, the NO system plays an important role in EtOHW anxiety and NE release induced by drug abuse. Bonassoli et al. [21] reported that EtOHW activated NO-producing neurons in the brainstem, while local infusion of NOS inhibitors into the brainstem regions such as the periaqueductal gray matter area and the dorsal raphe nucleus mitigates EtOHW anxiety [22, 23]. Our previous studies indicated that acute nicotine induces NE release in the hypothalamus and amygdala via the NTS NO pathway [24, 25]. These findings suggest that the NTS NO system may mediate the enhanced NTS-vBNST noradrenergic activities during protracted EtOHW.
Taken together, all the above observations lead to speculation that there may be abnormally heightened NTS-vBNST NE neuronal activities mediated by the NTS NO system during protracted EtOHW, which underlie anxiety in response to challenge with otherwise innocuous stimuli. To test this, in the present study, rats were exposed to a 7-minute AMRS during protracted EtOHW, and the effects of intra-NTS infusion of NOS inhibitors on anxiety-like behavior and NE release in the vBNST of EtOHW rats were examined.
2. Materials and Methods
2.1. Animals and Surgery
Eight-week-old male Sprague–Dawley rats (250-270 g) were provided by the Laboratory Animal Center at Qiqihar Medical University (Qiqihar, China) and housed in individual cages under standardized conditions (12 : 12 hour light/dark cycle, 21–23°C, free access to food and water). All rats were randomly assigned to the various experimental groups. All experimental procedures were approved by the Animal Care and Use Committee of Qiqihar Medical University (approval number: QMUAECC-2016-28) and were performed adhering to the National Institutes of Health guidelines.
After 7 days of acclimatization, the rats were stereotactically (Kopf Instruments, Tujunga, CA) implanted with bilateral microinjection guide cannulae targeting the NTS and/or a unilateral microdialysis probe guide cannula targeting the right ventral vBNST under sodium pentobarbital (50 mg/kg, intraperitoneally) anesthesia. In brief, after fixing the rat on the instrument, a longitudinal midline incision was made on the shaved and disinfected scalp, creating the surgical window by exposing the bregma and the lambda and clearing the skull surface using sterile cotton-tips dipped in 3% H2O2 solution. The coordinates of the bregma and the lambda were used to level the skull and act as the references, and the hydrogen peroxide solution (also a disinfectant) was used to eliminate the soft tissues to prevent a possible infection afterward. After the confirmation of a horizontally levelled skull, three small holes were drilled on the skull, respectively, targeting the right ventral vBNST and both sides of the NTS according to their coordinates, and guide cannulae were implanted through the holes and secured with two small screws and dental cement. The coordinates of the NTS and vBNST relative to bregma, according to the atlas of Paxinos and Watson [26], were as follows: anterior–posterior, −13.6 and−0.3 mm; medial–lateral, 0.8 and 1.4 mm; and dorsal ventral, 6.5 and 7.5 mm, respectively. The microinjection guide cannulae were positioned 1.5 mm above the targets. During the surgery, a small amount of lubricant eye ointment was applied to each rat to prevent corneal damage, and antibiotics and pain killers were also used for the postsurgery care. At the end of each experiment, the rats were euthanized and decapitated, the brain was extracted and stored at -80°C, and then coronal cryotome sections were made to observe the probe and injection positions, and if more accurate histological confirmation was desired, a Coomassie blue staining was used; finally, the rats with the correct targets were included for statistical analysis.
2.2. Experimental Protocols and Collection of Blood and NTS Tissues
After a 7-day recovery period after the surgery, the rats were intraperitoneally administered 3 g/kg/day EtOH (20% w/v) or saline for 21 days followed by 28 days of withdrawal. On the 28th day of EtOHW or saline withdrawal, the rats received 7-minute AMRS in a 6.4-cm-diameter plastic cylinder constructed from a 500 mL mineral water bottle and underwent in vivo microdialysis or a behavioral test in an elevated plus maze (EPM) (Figure 1).
(a) Schedule of EtOHW