5-HT1B Receptors and aggression / impulsivity


Advertisement



Attention Valued Visitor: A Drug Reference Page for FDA Approved General Anesthetics is now available!
Shawn Thomas (Shawn@neurotransmitter.net) is working to summarize the mechanisms of action of every drug approved by the FDA for a brain- related condition. In addition, new pages with more automated content will soon replace some of the older pages on the web site. If you have suggestions about content that you would like to see, e-mail Shawn@neurotransmitter.net if you have anything at all to share.


 

Google
 
Web www.neurotransmitter.net

(Updated 4th quarter 2002)

Clark MS, Neumaier JF.
The 5-HT1B receptor: behavioral implications.
Psychopharmacol Bull. 2001 Autumn;35(4):170-85.
"5-HT1B receptors are expressed throughout the mammalian central nervous system. These receptors are located in the axon terminals of both serotonergic and nonserotonergic neurons, where they act as inhibitory autoreceptors or heteroreceptors, respectively. 5-HT1B receptors inhibit the release of a range of neurotransmitters, including serotonin, GABA, acetylcholine, and glutamate. These receptors have been difficult to study because of the diversity of their cellular localization and the absence of highly selective agonists and antagonists. There has been accumulating evidence, however, that 5-HT1B receptors modulate drug reinforcement, stress sensitivity, mood, anxiety, and aggression. The general results of a number of studies suggest that reduced 5-HT1B heteroreceptor activity may increase impulsive behaviors, whereas reduced 5-HT1B autoreceptor activity may have an antidepressant-like effect. This review focuses on the evidence from animal studies and human genetics that suggest that 5-HT1B receptors may be involved in the mechanism of action of antidepressants and may become important targets of drug therapy in the future." [Abstract]

Scearce-Levie K, Chen JP, Gardner E, Hen R.
5-HT receptor knockout mice: pharmacological tools or models of psychiatric disorders.
Ann N Y Acad Sci. 1999 Apr 30;868:701-15.
"The molecular diversity of cloned serotonin receptor subtypes in the brain makes it difficult to understand the specific modulatory roles played by different receptors. In order to understand the role of the 5-HT1B receptor subtype in behavior and neuropsychiatric disorders, we have been studying genetic knockout mice lacking the 5-HT1B receptor. The 5-HT1B knockout mice show evidence of increased aggression and impulsivity, behavioral patterns that are also associated with reduced 5-HT function. They also show reduced or absent locomotor stimulation to some serotoninergic drugs, indicating that the locomotor effects of these drugs require the 5-HT1B receptor. However, in some cases, data obtained with knockout mice conflicts with the pharmacological data. The 5-HT1B receptor knockout mice show a phenotype of increased vulnerability to drugs of abuse such as cocaine. However, pharmacological studies suggest that 5-HT1B stimulation enhances the effects of cocaine, while 5-HT1B blockade can attenuate some of the effects of cocaine. Compensations that enhance dopamine function appear to be responsible for the drug-vulnerable phenotype of 5-HT1B receptor knockout mice. By studying these compensations and changes in neural function, we can learn more about the fundamental mechanisms underlying addiction. The 5-HT1B knockout mice should be considered a model for the disease state of vulnerability to drugs of abuse, rather than a direct pharmacological model of 5-HT1B receptor function." [Abstract]

Huang YY, Oquendo MA, Friedman JM, Greenhill LL, Brodsky B, Malone KM, Khait V, Mann JJ.
Substance abuse disorder and major depression are associated with the human 5-HT1B receptor gene (HTR1B) G861C polymorphism.
Neuropsychopharmacology. 2003 Jan;28(1):163-9.
"The 5-HT(1B) receptor has been implicated in several psychopathologies, including pathological aggression, alcoholism and suicide. To test these and related potential genetic relationships in a single population, the human 5-HT(1B) receptor (h5-HTR(1B)) genotype for the G861C polymorphism was determined in 394 psychiatric patients and 96 healthy volunteers. Structured clinical interviews generated DSM III-R diagnoses. No significant association of the genotype or allele frequencies of the h5-HTR(1B) G861C locus was observed with diagnoses of alcoholism, bipolar disorder, schizophrenia or a history of a suicide attempt. Exploratory analyses indicated an association of the genotype and allele frequencies of the h5-HTR(1B) G861C locus with a history of substance abuse disorder (chi(2) = 9.51, df = 2, p = 0.009; chi(2) = 7.31, df = 1, p = 0.007, respectively) and with a diagnosis of a major depressive episode (chi(2) = 6.83, df = 2, p = 0.033; chi(2) = 5.81, df = 1, p = 0.016, respectively). Significant gene dose effects on the risk for substance abuse disorder and a major depressive episode were observed with the 861C allele (Armitage linearity tendency test: chi(2) = 7.20, df = 1, p = 0.008; chi(2) = 6.80, df = 1, p = 0.009, respectively). Substance abuse disorder and major depression appear to be associated with the h5-HTR(1B) G861C locus in the patient population, but other psychopathologies such as bipolar disorder, schizophrenia, alcoholism, and suicide attempts were not found to be associated with this polymorphism. This preliminary result will need replication, given the limitations of association studies." [Abstract]

Lappalainen J, Long JC, Eggert M, Ozaki N, Robin RW, Brown GL, Naukkarinen H, Virkkunen M, Linnoila M, Goldman D.
Linkage of antisocial alcoholism to the serotonin 5-HT1B receptor gene in 2 populations.
Arch Gen Psychiatry. 1998 Nov;55(11):989-94.
"BACKGROUND: In mice, quantitative trait locus studies and behavioral evaluation of animals deleted for 5-HT1B have implicated this serotonin autoreceptor in alcohol consumption and aggressive behavior. We therefore investigated whether the 5-HT1B gene (HTR1B) is linked to alcoholism with aggressive and impulsive behavior in the human, as represented by 2 psychiatric diagnoses: antisocial personality disorder and intermittent explosive disorder comorbid with alcoholism. METHODS: Linkage was first tested in 640 Finnish subjects, including 166 alcoholic criminal offenders, 261 relatives, and 213 healthy controls. This was followed by a study in a large multigenerational family derived from a Southwestern American Indian tribe (n=418) with a high rate of alcoholism. All subjects were psychiatrically interviewed, blind-rated for psychiatric diagnoses, and typed for a HTR1B G861C polymorphism and for a closely linked short-tandem repeat locus, D6S284. Linkage was evaluated in sib pairs, and by using an association approach in which pedigree randomization corrects for nonindependence of observations on related subjects. RESULTS: In Finnish sib pairs, antisocial alcoholism showed significant evidence of linkage to HTR1B G861C (P=.04) and weak evidence with D6S284 (P=.06). By association analysis, the 183 Finnish antisocial alcoholics had a significantly higher HTR1B-861C allele frequency than the other 457 Finns we studied (P=.005). In the Southwestern American Indian tribe, significant sib pair linkage of antisocial alcoholism to HTR1B G861C (P=.01) was again observed, and there was also significant linkage to D6S284 (P=.01). CONCLUSION: These results suggest that a locus predisposing to antisocial alcoholism may be linked to HTR1B at 6q13-15." [Abstract]

Rujescu D, Giegling I, Sato T, Moller HJ.
Lack of association between serotonin 5-HT1B receptor gene polymorphism and suicidal behavior.
Am J Med Genet. 2003 Jan 1;116B(1):69-71.
"A genetic susceptibility to suicide attempts has been repeatedly suggested by family-, twin-, and adoption-studies. Because elevated impulsive aggression is one of the most prominent characteristics of suicide attempters and aggressive behavior has been reported in 5-HT1B receptor gene knockout mice, the serotonin receptor 1B gene (5-HT1B) is an attractive candidate. The distribution of a polymorphism (G861C) in the 5-HT1B gene was examined in 148 consecutively hospitalized German suicide attempters, and 327 German healthy volunteers randomly recruited from the general population. The controls and their first degree relatives had no history of mental disorders or suicidal behavior. We found no significant difference in allele or genotype frequency between patients and controls. The results did not differ when the patients were divided into several subgroups (gender, suicide attempters with a violent method or suicide attempters with unipolar-, bipolar-, borderline personality-, and schizophrenia spectrum disorders). These findings suggest that the 5-HT1B polymorphism is unlikely to play a major role in the genetic susceptibility to suicide attempts." [Abstract]


Huang YY, Grailhe R, Arango V, Hen R, Mann JJ.
Relationship of psychopathology to the human serotonin1B genotype and receptor binding kinetics in postmortem brain tissue.
Neuropsychopharmacology. 1999 Aug;21(2):238-46.
"Knockout of the 5-HT1B gene in mice results in increased aggression, as well as alcohol and cocaine consumption. Given the clinical association of aggression, suicide, alcoholism, and substance abuse, we studied relationship of psychopathology to the human 5-HT1B receptor gene (N = 178) and postmortem human 5-HT1B receptor binding (N = 96) in the brain. The sample comprised: 71 suicide victims, 107 nonsuicides, 45 with a history of major depression and 79 without, 64 with a history of a alcoholism or substance abuse and 60 without, as well as 36 with a history of pathological aggression and 42 without. Single-strand conformational polymorphism (SSCP) analysis and DNA sequencing techniques were used to screen the coding region of the human 5-HT1B receptor gene in genomic DNA isolated from postmortem human brain tissue. Two common polymorphisms were identified in the 5-HT1B receptor gene, involving a silent C to T substitution at nucleotide 129 and a silent G to C substitution at nucleotide 861 of the coding region. These polymorphisms were found with the same frequency in the suicide and the nonsuicide groups and in those with and without a history of major depression, alcoholism, or pathological aggression. The binding indices (Bmax and KD of the 5-HT1B receptor in prefrontal cortex also did not differ in suicides and controls, major depression, alcoholism, and cases with a history of pathological aggression. The C129 or G861 allele had 20% fewer 5-HT1B receptor compared to the 129T or 861C allele. We did not identify a relationship between suicide, major depression, alcoholism, or pathological aggression with 5-HT1B receptor binding indices or genotype." [Abstract]

de Almeida RM, Miczek KA.
Aggression escalated by social instigation or by discontinuation of reinforcement ("frustration") in mice: inhibition by anpirtoline: a 5-HT1B receptor agonist.
Neuropsychopharmacology. 2002 Aug;27(2):171-81.
"Experiments with social instigation or the omission of scheduled reinforcement show that serotonergic mechanisms may be involved in escalated aggression in animals. 5-HT1B receptor agonists have anti-aggressive effects in individuals who show moderate as well as high levels of aggression. The present study compared the effects of the 5-HT1B agonist anpirtoline (0.125-1.5 mg/kg) on (1) species-typical aggressive behavior in male mice, (2) aggression "instigated" or primed by prior exposure to the opponent, and (3) aggression heightened by "frustration" caused by omission of scheduled reinforcement. The effects of anpirtoline on species-typical behavior were also assessed after pretreatment with the 5-HT1B/1D receptor antagonist GR127935 (10 mg/kg). Anpirtoline, like other 5-HT1B agonists (CP-94,253, zolmitriptan), decreased both instigated and frustration-heightened aggression, while motor behavior was unaffected. The aggression-inhibiting effects of anpirtoline were blocked by pretreatment with GR127935. The current results indicate that the 5-HT(1B) receptor is critically involved in the modulation of escalated aggression." [Abstract]

Miczek KA, de Almeida RM.
Oral drug self-administration in the home cage of mice: alcohol-heightened aggression and inhibition by the 5-HT1B agonist anpirtoline.
Psychopharmacology (Berl). 2001 Oct;157(4):421-9.
"RATIONALE: In order to model heightened aggression after alcohol consumption and to study the inhibitory influence of 5-HT1B receptors on drinking and fighting, an experimental procedure should enable self-administration of precise amounts of alcohol in a limited period of time before an aggressive confrontation. OBJECTIVES: To design a new device that can reinforce operant responding by the delivery of sweet alcohol in the resident mouse home cage, where aggressive behavior toward an intruder can subsequently be examined, and to demonstrate inhibition of alcohol-heightened aggression by 5-HT1B receptor agonist treatment. METHODS: Within one experimental session, all singly housed CFW male mice (n=26) performed a nose-poke response that was reinforced by 0.05 ml sucrose. Using the sucrose fading technique, eventually the mice consumed a 6% ethanol/4% sucrose solution after each fifth nose poke during daily 15-min experimental sessions. The number of ethanol reinforcements was adjusted so that 0.6, 1.0, 1.7, and 3.0-g/kg doses were consumed in 15 min or less. Assays confirmed blood alcohol levels at 68.1 mg/dl for intake of 1.0 g/kg. After consuming a specific dose of ethanol in the form of a fixed number of response-dependent deliveries, the response panel was removed from the home cage and, 15 min later, the resident confronted a male intruder. Anpirtoline was administered either before alcohol self-administration or before the aggressive confrontation. RESULTS: After being reinforced with 1.0 g/kg or 1.7 g/kg sweet ethanol, the mice significantly increased attack and threat behavior relative to their aggressive behavior following sucrose or water consumption only. Treatment with the 5-HT1B receptor agonist anpirtoline (0.125, 0.25, 0.5 mg/kg, i.p.) before the confrontation decreased alcohol-heightened aggression and species-typical aggression in the absence of changes in other elements of the behavioral repertoire. Anpirtoline affected ethanol-reinforced behavior only at doses that were 5-10 times higher than those producing anti-aggressive effects. CONCLUSIONS: Self-administration of alcohol in the home cage of mice is readily accomplished with the aid of a simple, removable panel. The effective inhibition of high levels of aggressive behavior due to alcohol consumption after anpirtoline treatment confirm the 5-HT1B receptor as a critical site in the termination of aggression." [Abstract]

Ferris CF, Melloni RH Jr, Koppel G, Perry KW, Fuller RW, Delville Y.
Vasopressin/serotonin interactions in the anterior hypothalamus control aggressive behavior in golden hamsters.
J Neurosci. 1997 Jun 1;17(11):4331-40.
"Studies in several species of rodents show that arginine vasopressin (AVP) acting through a V1A receptor facilitates offensive aggression, i.e., the initiation of attacks and bites, whereas serotonin (5-HT) acting through a 5-HT1B receptor inhibits aggressive responding. One area of the CNS that seems critical for the organization of aggressive behavior is the basolateral hypothalamus, particularly the anterior hypothalamic region. The present studies examine the neuroanatomical and neurochemical interaction between AVP and 5-HT at the level of the anterior hypothalamus (AH) in the control of offensive aggression in Syrian golden hamsters. First, specific V1A and 5-HT1B binding sites in the AH are shown by in vitro receptor autoradiography. The binding for each neurotransmitter colocalizes with a dense field of immunoreactive AVP and 5-HT fibers and putative terminals. Putative 5-HT synapses on AVP neurons in the area of the AH are identified by double-staining immunocytochemistry and laser scanning confocal microscopy. These morphological data predispose a functional interaction between AVP and 5-HT at the level of the AH. When tested for offensive aggression in a resident/intruder paradigm, resident hamsters treated with fluoxetine, a selective 5-HT reuptake inhibitor, have significantly longer latencies to bite and bite fewer times than vehicle-treated controls. Conversely, AVP microinjections into the AH significantly shorten the latency to bite and increase biting attacks. The action of microinjected AVP to increase offensive aggression is blocked by the pretreatment of hamsters with fluoxetine. These data suggest that 5-HT inhibits fighting, in part, by antagonizing the aggression-promoting action of the AVP system." [Abstract]

Rilke O, Will K, Jahkel M, Oehler J.
Behavioral and neurochemical effects of anpirtoline and citalopram in isolated and group housed mice.
Prog Neuropsychopharmacol Biol Psychiatry. 2001 Jul;25(5):1125-44.
"Acute effects of serotonergic drugs acting via different mechanisms were investigated by a social interaction test and subsequent determination of serotonin and dopamine metabolisms in mice housed in groups or isolated for 6 weeks. A resident/intruder test was performed with anpirtoline (5-HT1B receptor agonist in rodents; 1 mg/kg), citalopram (SSRI; 0.5 mg/kg) and saline treatment before animals were decapitated and different brain regions were frozen for subsequent HPLC-analyses. Behavioral investigations indicated a strong increase of aggressive behavior after 6 weeks of isolation housing. Acute citalopram treatment did not influence behavioral parameters of isolated and group housed mice. In contrast, anpirtoline antagonized isolation induced aggressive behavioral components in a specific manner. Analysis of dopamine and serotonin metabolism revealed that citalopram treatment did not affect dopamine metabolism, but reduced serotonin metabolism in the striatum, hippocampus, cortex and midbrain independent of housing conditions. In contrast, anpirtoline treatment increased dopamine metabolism in cortex, striatum and midbrain as well as influenced serotonin metabolism in a structure- and state-specific manner. Whereas anpirtoline decreased serotonin metabolism in the cortex, the midbrain and the hippocampus independent of housing conditions, in the striatum anpirtoline abolished the isolation induced decrease of serotonin metabolism. These results indicate that anpirtoline might induce antiaggressive effects via postsynaptic receptor- and structure-specific activation of serotonergic but also dopaminergic processes, whereas structure independent increase of synaptic serotonin via citalopram was ineffective to reverse aggressivity in isolated mice." [Abstract]

 

 

 

 

 

->Back to Home<-



Recent 5-HT1B and Aggression/Impulsivity Research

1) Dennis RL, Chen ZQ, Cheng HW
Serotonergic mediation of aggression in high and low aggressive chicken strains.
Poult Sci. 2008 Apr;87(4):612-20.
Serotonin (5-HT) regulates aggressive behavior via binding to its receptors, such as 5-HT1A and 1B, in humans and rodents. Here we investigate the heritable components of 5-HT regulation of aggressiveness in chickens, utilizing 3 distinct genetic strains. In this study, we used 2 divergently selected strains (high and low group productivity and survivability, respectively; HGPS and LGPS) and a third strain, Dekalb XL (DXL), an aggressive out-group. Hens were paired within the same strain. At 24 wk of age, the subordinate of each pair received a daily i.p. injection of NAN-190 (0.5 mg/kg, a 5-HT1A antagonist), GR-127935 (0.5 mg/kg, a 5-HT1B antagonist), or saline (control) for 5 consecutive days. Frequency of aggressive behaviors was increased in the hens of DXL and LGPS treated with 5-HT1A antagonist and in the HGPS hens treated with 5-HT1B antagonist. The 5-HT1B antagonist-treated HGPS hens and 5-HT1A antagonist-treated LGPS hens also displayed increased feather pecking, but neither antagonist had an effect on feather pecking of DXL hens. This may suggest that multiple mediating factors alter feather pecking behaviors. Among the controls, LGPS hens have higher epinephrine levels than HGPS or DXL hens, indicative of the inferior stress-coping ability of LGPS hens. Treatment with 5-HT1B antagonist reduced epinephrine in LGPS hens but not in DXL or HGPS hens, suggesting a role of 5-HT1B in stress regulation in LGPS hens. The results provide evidence for different heritable serotonergic mediation of aggressive behaviors and stress coping in chickens. [PubMed Citation] [Order full text from Infotrieve]


2) Nakamura K, Kikusui T, Takeuchi Y, Mori Y
Changes in social instigation- and food restriction-induced aggressive behaviors and hippocampal 5HT1B mRNA receptor expression in male mice from early weaning.
Behav Brain Res. 2008 Mar 5;187(2):442-8.
The time of weaning has numerous effects on neurobehavioral development. Previous findings suggest that the early weaning influences development of aggressive behaviors. Behavioral and neuroendocrine responsiveness to stressors in the adulthood are also influenced by maternal care received early in life, and early-weaned male mice and rats show higher responsiveness to acute stresses than do normally weaned males. Therefore, it is conceivable that early weaning influences stress-related aggressive behaviors. We investigated the effects of early weaning on aggressive behaviors under two stress conditions: social stress (social instigation) and ecological stress (food restriction), both of which augment aggression. Male ICR mice were divided into two groups based on weaning period. Normally weaned mice (weaned PD21) showed twice the baseline level of attack bites after 5 min of social instigation, whereas early-weaned animals (weaned PD14) were not more aggressive following social instigation. However, the early-weaned mice were more aggressive after food restriction stress than were the normally weaned mice, suggesting lower threshold for aggressive behavior after food shortage. We also measured 5HT1A and 5HT1B receptor mRNA expression in the hippocampus which involved in aggression using real-time PCR. Early-weaned mice had lower 5HT1B expression levels than did normally weaned mice; no effect was found for 5HT1A expression. These results suggest that manipulation of weaning time modulates adult aggressive behavior depending on the stressors imposed and that this change may involve the 5HT1B receptor system in the hippocampus. [PubMed Citation] [Order full text from Infotrieve]


3) Veiga CP, Miczek KA, Lucion AB, Almeida RM
Effect of 5-HT1B receptor agonists injected into the prefrontal cortex on maternal aggression in rats.
Braz J Med Biol Res. 2007 Jun;40(6):825-30.
Serotonin (5-HT1B) receptors play an essential role in the inhibition of aggressive behavior in rodents. CP-94,253, a 5-HT1B receptor agonist, can reduce aggression in male mice when administered directly into the ventro-orbitofrontal (VO) prefrontal cortex (PFC). The objective of the current study was to assess the effects of two selective 5-HT1B receptor agonists (CP-94,253 and CP-93,129), microinjected into the VO PFC, on maternal aggressive behavior after social instigation in rats. CP-94,253 (0.56 microg/0.2 microL, N = 8, and 1.0 microg/0.2 microL, N = 8) or CP-93,129 (1.0 microg/0.2 microL, N = 9) was microinjected into the VO PFC of Wistar rats on the 9th day postpartum and 15 min thereafter the aggressive behavior by the resident female against a male intruder was recorded for 10 min. The frequency and duration of aggressive and non-aggressive behaviors were analyzed using ANOVA and post hoc tests. CP-93,129 significantly decreased maternal aggression. The frequency of lateral attacks, bites and pinnings was reduced compared to control, while the non-aggressive behaviors and maternal care were largely unaffected by this treatment. CP-94,253 had no significant effects on aggressive or non-aggressive behaviors when microinjected into the same area of female rats. CP-93,129, a specific 5-HT1B receptor agonist, administered into the VO PFC reduced maternal aggressive behavior, while the CP-94,253 agonist did not significantly affect this behavior after social instigation in female rats. We conclude that only the 5-HT1B receptor agonist CP-93,129 administered into the VO PFC decreased aggression in female rats postpartum after social instigation. [Free Full Text] [PubMed Citation] [Order full text from Infotrieve]


4) Zouk H, McGirr A, Lebel V, Benkelfat C, Rouleau G, Turecki G
The effect of genetic variation of the serotonin 1B receptor gene on impulsive aggressive behavior and suicide.
Am J Med Genet B Neuropsychiatr Genet. 2007 Dec 5;144B(8):996-1002.
Impulsive-aggressive behaviors (IABs) are regarded as possible suicide intermediate phenotypes, mediating the relationship between genes and suicide outcome. In this study, we aimed to investigate the putative relationship between genetic variation at the 5-HT1B receptor gene, which in animal models is involved in impulse-aggression control, IABs, and suicide risk. We investigated the relationship of variation at five 5-HT1B loci and IAB measures in a sample of 696 subjects, including 338 individuals who died by suicide and 358 normal epidemiological controls. We found that variation at the 5-HT1B promoter A-161T locus had a significant effect on levels of IABs, as measured by the Buss-Durkee Hostility Inventory (BDHI). Suicides also differed from controls in distribution of variants at this locus. The A-161T locus, which seems to impact 5-HT1B transcription, could play a role in suicide predisposition by means of mediating impulsive-aggressive behaviors. [PubMed Citation] [Order full text from Infotrieve]


5) Bannai M, Fish EW, Faccidomo S, Miczek KA
Anti-aggressive effects of agonists at 5-HT1B receptors in the dorsal raphe nucleus of mice.
Psychopharmacology (Berl). 2007 Aug;193(2):295-304.
RATIONALE: In rodents, serotonin 1B (5-HT(1B)) agonists specifically reduce aggressive behaviors, including several forms of escalated aggression. One form of escalated aggression is seen in mice that seek the opportunity to attack another mouse by accelerating their responding during a fixed interval (FI) schedule. Responses preceding the opportunity to attack may reflect aggressive motivation. OBJECTIVE: This study investigated the effects of two 5-HT(1B) receptor agonists on the motivation to fight and the performance of heightened aggression. MATERIALS AND METHODS: Male mice were housed as "residents" and performed nose-poke responses on an FI 10-min schedule with the opportunity to briefly attack an "intruder" serving as the reinforcer. In the first experiment, the 5-HT(1B) receptor agonist, CP-94,253 (0-10 mg/kg, IP), was given 30 min before the FI 10 schedule. To confirm that CP-94,253 achieved its effects via 5-HT(1B) receptors, the 5HT(1B/1D) receptor antagonist, GR 127,935 (10 mg/kg, IP) was administrated before the agonist injection. In the second experiment, the 5-HT(1B) agonist CP-93,129 (0-1.0 microg) was microinjected into the dorsal raphe 10 min before the FI 10 schedule. RESULTS: The agonists had similar effects on all behaviors. CP-94,253 and CP-93,129 significantly reduced the escalated aggression towards the intruder at doses lower than those required to affect operant responding. The highest doses of CP-94,253 (10 mg/kg) and CP-93,129 (1.0 microg) decreased the rate and accelerating pattern of responding during the FI 10 schedule; lower doses were less effective. GR 127,935 antagonized CP-94,253's effects on all other behaviors, except response rate. CONCLUSIONS: These data extend the anti-aggressive effects of 5-HT(1B) agonists to a type of escalated aggression that is rewarding and further suggest that these effects are associated with actions at 5-HT(1B) receptors in the dorsal raphe. [PubMed Citation] [Order full text from Infotrieve]


6) Jacobs C, Van Den Broeck W, Simoens P
Neurons expressing serotonin-1B receptor in the basolateral nuclear group of the amygdala in normally behaving and aggressive dogs.
Brain Res. 2007 Mar 9;1136(1):102-9.
The present study aimed to quantify neurons expressing the serotonin-1B receptor and evaluate numerical differences in normally behaving and pathologically aggressive dogs in order to assess whether the serotonin-1B receptor is involved in pathological canine aggression. Because previous studies have reported structural alterations in the basolateral nuclear group (BNG) of the amygdaloid body of aggressive dogs, this structure was selected as region of interest in the present study. Indirect immunohistochemistry was applied to visualise the serotonin-1B-receptor-positive neurons. Immunoreactivity was located predominantly within the neuronal cell bodies and adjacent neuronal processes. In the aggressive dogs the BNGs contained a significantly higher number of serotonin-1B-receptor-positive neurons compared to the normally behaving dogs. This number was strongly correlated with the total number of neurons per BNG, which was also significantly increased in aggressive dogs compared to normal dogs. The percentage of neurons expressing the serotonin-1B receptor did not differ significantly between both groups. No significant asymmetries were observed for the number and percentage of serotonin-1B-receptor-positive neurons. Potential relationships between the present findings and the etiology of aggressive behaviour, the neuroprotective role of the serotonin-1B receptor and receptor dysfunction are discussed. [PubMed Citation] [Order full text from Infotrieve]


7) van den Bergh FS, Bloemarts E, Groenink L, Olivier B, Oosting RS
Delay aversion: effects of 7-OH-DPAT, 5-HT1A/1B-receptor stimulation and D-cycloserine.
Pharmacol Biochem Behav. 2006 Dec;85(4):736-43.
Impulsive individuals often display an aversion to waiting for rewards. Delay aversion can be quantified in rats in a delayed reward task, in which animals choose between an immediately available, small reward, and a large reward available after a delay. In previous research conducted at our laboratory and in literature, positive correlations between delay aversion and aggression, substance abuse and persistence during extinction of conditioned responses were found. The correlations suggest a possible shared pharmacology. Therefore, we tested drugs with known effects on these behaviors for possible effects on delay aversion: the dopamine D(3)-receptor agonist 7-OH-DPAT, the 5-HT(1A)-receptor agonist flesinoxan, the 5HT(1A/1B)-receptor agonist eltoprazine, and the NMDA-receptor agonist d-cycloserine. The results show that 7-OH-DPAT slightly decreased choice for the large reward. Flesinoxan disrupted task execution by lowering choice for the large reward even at a delay of 0 s. Eltoprazine slightly increased choice for the large reward, but the 5-HT(1B)-antagonist GR127935 had no effect. Administration of D-cycloserine also had no effect on choice behavior. The data suggest the dopamine D(3)-receptor and the 5-HT(1B)-receptor are interesting targets for treating delay aversion impulsivity. These targets were correctly predicted by the positive correlation between delay aversion and aggressive behavior and the intimate links between delay aversion and substance abuse disorders. [PubMed Citation] [Order full text from Infotrieve]


8) Grimes JM, Melloni RH
Prolonged alterations in the serotonin neural system following the cessation of adolescent anabolic-androgenic steroid exposure in hamsters (Mesocricetus auratus).
Behav Neurosci. 2006 Dec;120(6):1242-51.
In hamsters (Mesocricetus auratus), anabolic-androgenic steroid (AAS) exposure during adolescence facilitates offensive aggression that is modulated, in part, by serotonin (5-HT) signaling and development and by signaling and expression of 5-HT1B receptors. To examine whether these effects are persistent or reversible, the authors administered AAS to hamsters, then examined them for aggression at 1, 4, 11, 18, or 25 days following cessation of AAS treatment. Then, 1 day later, hamsters were killed by transcardial perfusion and examined for 5-HT afferents to and 5-HT1B receptor-containing neuronal puncta and somata in areas of the brain altered by AAS, namely, the anterior hypothalamus, ventrolateral hypothalamus, and medial amygdala. Although aggression resulting from AAS exposure returned to control, nonaggressive levels by 18 days following cessation of AAS treatment, alterations in 5-HT afferent innervation and 5-HT1B receptor localization were observed throughout the extended time period examined. These data suggest that adolescent AAS exposure may have long-term, irreversible effects on 5-HT neural systems and that return to nonaggressive behavioral phenotypes following adolescent AAS exposure may not be a function of plasticity in central 5-HT systems. [PubMed Citation] [Order full text from Infotrieve]


9) Heiser P, Dempfle A, Friedel S, Konrad K, Hinney A, Kiefl H, Walitza S, Bettecken T, Saar K, Linder M, Warnke A, Herpertz-Dahlmann B, Schäfer H, Remschmidt H, Hebebrand J
Family-based association study of serotonergic candidate genes and attention-deficit/hyperactivity disorder in a German sample.
J Neural Transm. 2007;114(4):513-21.
Alterations in the serotonergic pathway have been implicated in the pathogenesis of attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate seven genetic variants in three genes (serotonin transporter (5-HTT), serotonin receptor 1B (5-HTR1B) and serotonin receptor 2A (5-HTR2A)), which have previously been shown to be associated with ADHD. The polymorphisms under investigation were the 5-HTTLPR, the VNTR in intron 2 and the 3'UTR SNP in 5-HTT, the 5-HTR1B variations 861G>C and 102T>C, and the 5-HTR2A variations His452Tyr and 1438G>A. We genotyped these variants in a sample of 102 families with 229 children with ADHD according to DSM-IV criteria. Among the affected children, 69% fulfilled criteria for the combined type, 27% for the predominantly inattentive type, and 4% for the predominantly hyperactive-impulsive type. Associations were tested by the pedigree transmission disequilibrium test (PDT). All investigated polymorphisms in serotonergic candidate genes showed no association to ADHD in our sample. Earlier studies of these polymorphisms had also shown inconsistent results, with some studies reporting significant associations and others demonstrating no association. This discordance between studies may reflect variation in patient ascertainment criteria, genetic heterogeneity, too low statistical power for the expected effects or false positive results in the initial reports. We cannot rule out the possibility that other variations in the investigated genes contribute to the etiology of ADHD. [PubMed Citation] [Order full text from Infotrieve]


10) Ickowicz A, Feng Y, Wigg K, Quist J, Pathare T, Roberts W, Malone M, Schachar R, Tannock R, Kennedy JL, Barr CL
The serotonin receptor HTR1B: gene polymorphisms in attention deficit hyperactivity disorder.
Am J Med Genet B Neuropsychiatr Genet. 2007 Jan 5;144B(1):121-5.
Serotonin plays an essential role in cognition, locomotor activity, and the regulation of sleep, pain, mood, and aggression. Polymorphisms of the HTR1B gene have been implicated in a variety of psychiatric disorders including attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The objectives of this study were to: (i) expand our original investigation of the relationship between the HTR1B receptor gene and attention deficit/hyperactivity and; (ii) to investigate a possible association of obsessive behaviors/perfectionism and the HTR1B gene in a sample of 203 families with an ADHD proband. Six single nucleotide polymorphisms (SNPs) of the HTR1B receptor gene were genotyped using standard methods. Evidence for an association between the HTR1B gene and ADHD as a qualitative diagnosis, or the inattentive and hyperactive-impulsive quantitative traits was not supported by either TDT single marker analysis or haplotype analysis. In addition we did not find evidence to suggest an association between HTR1B and perfectionism in this sample of ADHD families. [PubMed Citation] [Order full text from Infotrieve]


11) Videtic A, Pungercic G, Pajnic IZ, Zupanc T, Balazic J, Tomori M, Komel R
Association study of seven polymorphisms in four serotonin receptor genes on suicide victims.
Am J Med Genet B Neuropsychiatr Genet. 2006 Sep 5;141B(6):669-72.
A number of molecular genetic studies have investigated if serotonin (5-HT) receptor subtypes are involved in the pathogenesis of depression, suicidal behavior, aggression, and impulsive behavior. Existence of many receptor subtypes for a single transmitter permits a great diversity of signaling raising the possibility that they may serve as genetic markers for suicidal behavior. Most previous studies of suicide have analyzed polymorphisms of the receptors 5-HT1A, 5-HT1B, 5-HT2A, fewer have examined 5-HT1F. We report a study of possible association between the polymorphisms in the 5-HT receptor genes (1A, 1B, 1F, and 2A) and suicidal behavior on a sample of 226 suicide victims and 225 healthy control subjects. No significant differences in genotype frequency distributions between the suicide victims and healthy control subjects were observed for four polymorphisms; three were not polymorphic. A single polymorphism, C-1420T in gene 5-HT2A, showed a slight association with suicide (chi2= 4.94, df = 2, P = 0.067), but the correlation was not statistically significant. None of the tested genetic variants of serotonin receptors appears to be associated with suicidal behavior in the Slovenian population which has a relatively high suicide rate. [PubMed Citation] [Order full text from Infotrieve]


12) Popova NK
From genes to aggressive behavior: the role of serotonergic system.
Bioessays. 2006 May;28(5):495-503.
Recent investigations in neurogenomics have opened up new lines of research into a crucial genetic problem-the pathway from genes to behavior. This paper concentrates on the involvement of protein elements in the brain neurotransmitter serotonin (5-HT) system in the genetic control of aggressive behavior. Specifically, it describes: (1) the effect of the knockout of MAO A, the principal enzyme in 5-HT degradation, (2) the association of intermale aggression with the polymorphism in the Tph2 gene encoding the key enzyme in 5-HT synthesis in the brain, tryptophan hydroxylase (TPH), and (3) the effect of selective breeding for nonaggressive behavior on 5-HT metabolism, TPH activity and 5-HT(1A) receptors in the brain. The review provides converging lines of evidence that: (1) brain 5-HT contributes to a critical mechanism underlying genetically defined individual differences in aggressiveness, and (2) genes encoding pivotal enzymes in 5-HT metabolism (TPH and MAO A), 5-HT-transporter, 5-HT(1A) and 5-HT(1B) receptors belong to a group of genes that modulate aggressive behavior. [PubMed Citation] [Order full text from Infotrieve]


13) De Almeida RM, Rosa MM, Santos DM, Saft DM, Benini Q, Miczek KA
5-HT(1B) receptors, ventral orbitofrontal cortex, and aggressive behavior in mice.
Psychopharmacology (Berl). 2006 May;185(4):441-50.
RATIONALE: Systemic injections of 5-HT(1B) receptor agonists have been shown to have specific anti-aggressive effects in aggressive individuals. One site of action for these drugs is the 5-HT(1B) receptors in the ventral orbitofrontal cortex (VO PFC), an area that has been implicated in the inhibitory control of behavior and is a terminal region for 5-HT projections. OBJECTIVE: To assess the anti-aggressive effects of the 5-HT(1B) receptor agonist CP-94,253 when microinjected into the VO PFC (0.1, 0.56, and 1.0 microg/0.2 microl) or into the infralimbic prefrontal cortex (IL PFC; 1.0 microg/0.2 microl) in separate groups of aggressive resident male mice. To confirm the 5-HT(1B) receptor as the critical site of action for the anti-aggressive effects, the 5-HT(1B/D) antagonist GR-127,935 was microinjected at 10.0 microg/0.2 microl into the VO PFC. After recovery from surgery, the anti-aggressive effects of microinjected CP-94,253 were studied during 5-min resident-intruder confrontations that were recorded and analyzed. RESULTS: Microinjections of CP-94,253 (0.56 and 1.0 microg/0.2 microl) dose-dependently reduced the frequency of attack bites and sideways threats. This effect was behaviorally specific because non-aggressive motor activities were not significantly altered by the drug. In the IL vmPFC or in an area lateral to the VO PFC, CP-94,253 (1.0 microg/0.2 microl) did not have significant behavioral effects. CONCLUSIONS: The results highlight the 5-HT(1B) receptors in the VO PFC as a particularly important site for the inhibition of species-typical aggressive behavior in male mice. [PubMed Citation] [Order full text from Infotrieve]


14) Olivier B, van Oorschot R
5-HT1B receptors and aggression: a review.
Eur J Pharmacol. 2005 Dec 5;526(1-3):207-17.
The serotonergic (5-HT) system in the brain is involved in the modulation of offensive aggressive behavior. The dogma that activity of the 5-HT system is inversely related to aggression is obsolete now. Research on the status of the 5-HT system before, during and after the execution of aggression is ongoing but has not yet led to a clear picture about the actual functional role of the 5-HT system, the more because state versus trait aggression seems to play a pivotal role in the outcome. Pharmacological challenges pinpoint 5-HT(1A) and 5-HT(1B) receptors as key players in the modulation of offensive aggression. This review emphasizes in particular the role of postsynaptic 5-HT(1B) (hetero) receptors as a premier site to modulate offensive aggression. Modulation of the firing and 5-HT release of the serotonergic neuron, via presynaptic 5-HT(1A) (auto) receptors, presynaptic 5-HT(1B) (auto) receptors and serotonergic transporters, may also have striking influences on aggression under certain conditions. Therefore, it is hypothesized that postsynaptic 5-HT(1B) (hetero) receptors directly influence the executive, consummatory phases of agonistic behavior, whereas presynaptic serotonergic feedback systems are particularly useful in the introductory (appetitive) phases of the agonistic behavioral complex. [PubMed Citation] [Order full text from Infotrieve]


15) de Boer SF, Koolhaas JM
5-HT1A and 5-HT1B receptor agonists and aggression: a pharmacological challenge of the serotonin deficiency hypothesis.
Eur J Pharmacol. 2005 Dec 5;526(1-3):125-39.
More than any other brain neurotransmitter system, the indolamine serotonin (5-HT) has been linked to aggression in a wide and diverse range of species, including humans. The nature of this linkage, however, is not simple and it has proven difficult to unravel the precise role of this amine in the predisposition for and execution of aggressive behavior. The dogmatic view that 5-HT inhibits aggression has dominated both pharmacological research strategies to develop specific and effective novel drug treatments that reduce aggressive behavior and the pharmacological mechanistic interpretation of putative serenic drug effects. Our studies on brain serotonin and aggression in feral wild-type rats using the resident-intruder paradigm have challenged this so-called serotonin deficiency hypothesis of aggressive behavior. The well-known fact that certain 5-HT(1A/1B) receptor agonists potently and specifically reduce aggressive behavior without motor slowing and sedative effects is only consistent with this hypothesis under the assumption that the agonist mainly acts on the postsynaptic 5-HT(1A/1B) receptor sites. However, systemic injections of anti-aggressive doses of 5-HT(1A) and (1B) agonists robustly decrease brain 5-HT release due to their inhibitory actions at somatodendritic and terminal autoreceptors, respectively. The availability of the novel benzodioxopiperazine compound S-15535, which acts in vivo as a preferential agonist of the somatodendritic 5-HT(1A) auto-receptor and as an antagonist (weak partial agonist) at postsynaptic 5-HT(1A) receptors, allows for a pharmacological analysis of the exact site of action of this anti-aggressive effect. It was found that, similar to other prototypical full and partial 5-HT(1A) and/or 5-HT(1B) receptor agonists like repinotan, 8-OHDPAT, ipsapirone, buspirone, alnespirone, eltoprazine, CGS-12066B and CP-93129, also S-15535 very effectively reduced offensive aggressive behavior. Unlike the other ligands, however, a remarkable degree of behavioral specificity was observed after treatment with S-15535, in that the anti-aggressive effects were not accompanied by inhibiting (like other 5-HT(1A) receptor agonist with moderate to high efficacy at postsynaptic 5-HT(1A) receptors) or enhancing (like agonists with activity at 5-HT(1B) receptors and alnespirone) non-aggressive motor behaviors (e.g., social exploration, ambulation, rearing, and grooming) beyond the range of undrugged animals with corresponding levels of aggression. The involvement of 5-HT(1A) and/or 5-HT(1B) receptors in the anti-aggressive actions of these drugs was convincingly confirmed by showing that the selective 5-HT(1A) receptor antagonist WAY-100635 and/or the 5-HT(1B) receptor antagonist GR-127935, while inactive when given alone, effectively attenuated/prevented these actions. Furthermore, combined administration of S-15535 with either alnespirone or CGS-42066B elicited a clear additive effect, indicated by a left-ward shift in their dose-effect curves, providing further support for presynaptic sites of action (i.e., inhibitory somatodendritic 5-HT(1A) and terminal 5-HT(1B) autoreceptors). These findings strongly suggest that the specific anti-aggressive effects of 5-HT(1A) and 5-HT(1B) receptor agonists are predominantly based on reduction rather than enhancement of 5-HT neurotransmission during the combative social interaction. Apparently, normal display of offensive aggressive behavior is positively related to brief spikes in serotonergic activity, whereas an inverse relationship probably exists between tonic 5-HT activity and abnormal forms of aggression only. [PubMed Citation] [Order full text from Infotrieve]


16) Grimes JM, Melloni RH
Serotonin-1B receptor activity and expression modulate the aggression-stimulating effects of adolescent anabolic steroid exposure in hamsters.
Behav Neurosci. 2005 Oct;119(5):1184-94.
Repeated high dose (5.0 mg/kg) anabolic-androgenic steroid (AAS) exposure during adolescence stimulates offensive aggression in male Syrian hamsters. These studies examined whether AAS-induced aggression was regulated by the activity of serotonin (5HT) type-1B receptors and correlated with altered 5HT1B expression. AAS-treated hamsters were tested for offensive aggression following the administration of the 5HT1B agonist anpirtoline (0.125-0.5 mg/kg). Anpirtoline dose-dependently reduced select components of the AAS-induced aggressive response, with significant reductions observed at 0.25 mg/kg. Aggressive, AAS-treated hamsters showed significant decreases in the area covered by 5HT1B-containing neuronal puncta and increases in the number of 5HT1B-containing neuronal somata in select brain regions implicated in aggression control. Together, these data support a role for site-specific alterations in 5HT1B signaling and expression in adolescent AAS-induced aggression. [PubMed Citation] [Order full text from Infotrieve]


17) Olivier B
Serotonergic mechanisms in aggression.
Novartis Found Symp. 2005;268:171-83; discussion 183-9, 242-53.
The serotonergic system in the CNS has complex interactions with many, if not all other neurotransmitter systems in the brain. Its localization, distribution and amazing receptor diversity makes it an appealing system for modulatory aspects in many basic behaviours, including food and water intake, sexual behaviour and aggression. Notwithstanding decades of research into the putative role of the serotonergic system in aggression, no clear picture about its specific role has emerged. It seems, dependent on state or trait, to be involved in either the performance or the termination of aggressive behaviours. The present technology appears not developed enough to give answers to these questions. Application of drugs and particular selective ligands for certain subtype receptors seems a more promising approach to unravelling the role of 5-HT in aggression. The (postsynaptic) 5-HT1B and to a lesser extent, the 5-HT1A receptor seems to play a prominent role, at least in rodents, in the modulation of (offensive) aggression. [PubMed Citation] [Order full text from Infotrieve]


18) Lesch KP
Serotonergic gene inactivation in mice: models for anxiety and aggression?
Novartis Found Symp. 2005;268:111-40; discussion 140-6, 167-70.
Variation in genes coding for proteins that control serotonin (5-HT) system development, plasticity and function have been implicated in various aspects of complex behaviour including anxiety and aggression. Based on the remarkable progress in technologies that allow the alteration or elimination of individual genes to create transgenic animal models, gene knockout strategies further increase our knowledge about which serotonergic gene products are involved in behavioural traits. This overview selects anxiety and aggression as paradigmatic traits and behaviours, and focuses on mouse models which have been modified by deletion of genes coding for key players of serotonergic neurotransmission. In particular, phenotypic changes in mice bearing inactivation mutations of 5-HT1A and 5-HT1B receptors, 5-HT transporter, 5-HT neuron-specific transcription factor Pet1, monoamine oxidase A and genes related to 5-HT signalling will be discussed and major findings highlighted. However, because a missing gene might affect many developmental processes throughout ontogeny and compensatory mechanisms may be activated in knockouts, behavioural data from mice with targeted gene deletions should be interpreted with caution. The development of conditional knockout mice, in which a specific gene can be inactivated neurocircuit-specifically at any time, is therefore likely to avert the deficiencies associated with behavioural data from classical constitutive knockouts. [PubMed Citation] [Order full text from Infotrieve]


19) Kirilly E, Benko A, Ferrington L, Ando RD, Kelly PA, Bagdy G
Acute and long-term effects of a single dose of MDMA on aggression in Dark Agouti rats.
Int J Neuropsychopharmacol. 2006 Feb;9(1):63-76.
MDMA causes selective depletion of serotonergic terminals in experimental animals and the consequent decrease in synaptic 5-HT may, inter alia, increase impulsivity. To study the effects of MDMA upon brain function, the behaviour of male Dark Agouti rats exposed to MDMA (15 mg/kg i.p.), two 5-HT1B agonists (CGS-12066A and CP-94,253, both 5 mg/kg i.p.) or saline were investigated in the resident-intruder test. Studies were performed in drug-naive rats and also in rats exposed to MDMA (15 mg/kg i.p.) 21 d earlier. In parallel experiments the functional neuroanatomy of MDMA effects were assessed using 2-deoxyglucose imaging of local cerebral metabolic rate of glucose utilization (LCMRGlu) and neurotoxicity was assessed by measuring [3H]paroxetine binding. There was no significant difference in aggressive behaviour (biting, boxing, wrestling and their latencies) between drug-naive rats and rats previously exposed to MDMA 21 d earlier, despite reduced social behaviour, decreased LCMRGlu in several brain areas involved in aggression, and reductions in paroxetine binding by 30-60% in the forebrain. CGS-12066A, CP-94,253 and acute MDMA produced marked decreases in aggressive behaviours, especially in biting, boxing and kicking found in drug-naive rats. In animals previously exposed to the drug, acute anti-aggressive effects of MDMA were, in general, preserved as were MDMA-induced increases in LCMRGlu. Our studies provide evidence that in the resident-intruder test, where social isolation is a requirement, aggressive behaviour and acute anti-aggressive effects of MDMA and 5-HT1B receptor agonists remain intact 3 wk after a single dose of the drug despite significant damage to the serotonergic system. [PubMed Citation] [Order full text from Infotrieve]


20) Gorwood P, Lanfumey L, Hamon M
[Alcohol dependence and polymorphisms of serotonin-related genes]
Med Sci (Paris). 2004 Dec;20(12):1132-8.
Genetic factors have a non-specific but significant impact on the risk of alcohol-dependence. Molecular genetic analyses are now less devoted to the genes involved in the metabolism of ethanol, focusing on core concepts of addiction, such as arousal, pleasure, reward, craving, and impulsivity. Indeed, the neuro-cognitive functions, temperament traits and psycho-behavioral specificities of patients with alcohol abuse or dependence led to select new sets of candidate genes. One of them are related to serotonin transmission, as serotonin modulates dopaminergic pathways, and is also stimulated by many addictive susbtances. The genetic analyses of serotonin in alcohol-dependence are mainly focused on the serotonin transporter gene (5-HTT), as one polymorphism within the promoter has a functional impact. From the 16 case-control association studies yet performed, many are positive, and one family-based study showed a large excess of transmission of the short allele. We performed a meta-analysis of the case-control studies showing that the S allele could be a risk factor for a phenotype related to alcohol-dependence (OR=1.31), with still unknown boundaries. Other genes coding for serotonin receptors were analysed with mainly negative results, for example the 5-HT2A, 5-HT2C, 5-HT5A and 5-HT7 receptors. The 5-HT1B could be more interesting as being located in a locus linked to alcohol preference in rodents, and associated with antisocial alcoholism in two human studies. Genetics may thus provide new insights about the different mechanisms which explain why some subjects are more at risk for the development of alcohol abuse or dependence. Genes involved in the transmission, reuptake and metabolism of serotonin constitute a set of candidate genes that could be involved in core aspects of alcoholism, such as the tendency to prefer immediate reward, despite negative consequences. [Free Full Text] [PubMed Citation] [Order full text from Infotrieve]