CART peptide and the mesolimbic dopamine system.

Over the past decade, CART peptide has been commonly associated with the rewarding and reinforcing properties of drugs of abuse and natural rewards such as food. The mesolimbic dopamine system is the predominant pathway involved in mediating reward and reinforcement. Many behavioral and neuroanatomical studies have been conducted in order to further elucidate the importance of CART-containing neurons within the mesolimbic dopamine system. This chapter will review the current knowledge of the localization, synaptic connectivity and neurochemical content of CART peptidecontaining neurons in nuclei of the mesolimbic reward pathway. These nuclei include the nucleus accumbens (NA), ventral midbrain, and the lateral hypothalamus (LH). In conclusion, an interconnected CART-containing loop between the NA, ventral midbrain and LH has evolved from these neuroanatomical studies that may have functional implications for CART peptide's involvement in reward and reinforcement.

Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial.

750 mg per day of acetazolamide in the prevention of acute mountain sickness (AMS), as recommended in the meta-analysis published in 2000 in the British Medical Journal, may be excessive and is controversial. To determine if the efficacy of low-dose acetazolamide 125 mg bd (250 mg), as currently used in the Himalayas, is significantly different from 375 mg bd (750 mg) of acetazolamide in the prevention of AMS, we designed a prospective, double-blind, randomized, placebo-controlled trial. The participants were sampled from a diverse population of (non-Nepali) trekkers at Namche Bazaar (3440 m) in Nepal on the Everest trekking route as they ascended to study midpoints (4280 m/4358 m) and the endpoint, Lobuje (4928 m), where data were collected. Participants were randomly assigned to receive 375 mg bd of acetazolamide (82 participants), 125 mg bd of acetazolamide (74 participants), or a placebo (66 participants), beginning at 3440 m for up to 6 days as they ascended to 4928 m. The results revealed that composite AMS incidence for 125 mg bd was similar to the incidence for 375 mg bd (24% vs. 21%, 95% confidence interval, -12.6%, 19.8%), in contrast to significantly greater AMS (51%) observed in the placebo group (95% confidence interval for differences: 8%, 46%; 12%, 49% for low and high comparisons, respectively). Both doses of acetazolamide improved oxygenation equally (82.9% for 250 mg daily and 82.8% for 750 mg daily), while placebo endpoint oxygen saturation was significantly less at 80.7% (95% confidence interval for differences: 0.5%, 3.9% and 0.4%, 3.7% for low and high comparisons, respectively). There was also more paresthesia in the 375-mg bd group (p < 0.02). We conclude that 125 mg bd of acetazolamide is not significantly different from 375 mg bd in the prevention of AMS; 125 mg bd should be considered the preferred dosage when indicated for persons ascending to altitudes above 2500 m.

Cocaine- and amphetamine-regulated transcript peptides play a role in drug abuse and are potential therapeutic targets.

Cocaine- and amphetamine-regulated transcript (CART) peptides (55 to 102 and 62 to 102) are neurotransmitters with important roles in a number of physiologic processes. They have a role in drug abuse by virtue of the fact that they are modulators of mesolimbic function. Key findings supporting a role in drug abuse are as follows. First, high densities of CART-containing nerve terminals are localized in mesolimbic areas. Second, CART 55 to 102 blunts some of the behavioral effects of cocaine and dopamine (DA). This functional antagonism suggests that CART peptides be considered as targets for medications development. Third, CREB in the nucleus accumbens has been shown to have an opposing effect on cocaine self-administration. CREB may activate CART expression in that region, and, if so, CART may mediate at least some of the effects of CREB. Fourth, in addition to the effects of CART on DA, DA can influence CART in the accumbens. Thus a complex interacting circuitry likely exists. Fifth, in humans, CART is altered in the ventral tegmental area of cocaine overdose victims, and a mutation in the CART gene associates with alcoholism. Overall, it is clear that there are functional interactions among CART, DA, and cocaine and that plausible cellular mechanisms exist to explain some of these actions. Future studies will clarify and extend these findings.

Species differences in brain distribution of CART mRNA and CART peptide between prairie and meadow voles.

Reward mechanisms are involved in pair bond formation in monogamous prairie voles. Given the potential role of CART (cocaine- and amphetamine-regulated transcript) in reward, and its possible role as a third neurohypophysial hormone, we examined the brain distribution of CART mRNA and peptide in monogamous prairie voles compared to congener promiscuous meadow voles. Large species differences in CART mRNA distribution were apparent in the nucleus accumbens, bed nucleus of the stria terminalis, hippocampus, and cortex. CART peptide distribution largely mirrored, but did not exactly match, CART mRNA distribution. Dramatic species differences also existed in CART peptide distribution, including the medial preoptic area, nucleus accumbens, central amygdala, lateral septum, and cortex. In contrast, several brain regions were highly conserved between prairie and meadow voles, including many subnuclei examined within the hypothalamus and olfactory tubercle. Taken together, these data suggest a potential role for CART in the regulation of pair bond formation between monogamous mates and suggest potential brain regions involved in its neural circuitry. Our findings also point to novel avenues of investigation regarding the brain mechanisms for the evolution of diverse social organization.

CART peptide diurnal rhythm in brain and effect of fasting.

We have recently shown that CART peptides exhibit a diurnal rhythm in blood that is affected by food intake and glucocorticoids. In the present study, we extend our observations by demonstrating that CART peptides also exhibit a diurnal rhythm in several brain regions, notably the nucleus accumbens, hypothalamus and amygdala, but not in the midbrain. To examine whether the CART peptide rhythm was dependent on food intake, animals were food-deprived for 24 h. In regular-fed animals, CART peptide levels were lower in the morning compared to evening hours. However, this diurnal variation of CART peptide was not apparent in fasted animals, and CART peptide levels were reduced. The diurnal variation of CART mRNA in the nucleus accumbens paralleled the variation of CART peptide in this region. Similar to the peptide, the mRNA did not change in midbrain. These results show that CART peptide levels and gene expression undergo a diurnal variation in some brain regions, and the variation is altered by fasting. These findings suggest a variety of regulatory mechanisms for CART and additional considerations for CART's role in brain.

CART in feeding and obesity.

CART (cocaine- and amphetamine-regulated transcript) peptides are neurotransmitters that have received much attention as mediators of feeding behavior and body-weight regulation in mammals. CART peptides and their mRNAs are found in many brain regions and in peripheral tissues that are involved in feeding, and many animal studies implicate CART as an inhibitor of feeding. Animal studies also demonstrate that CART expression is regulated by both leptin and glucocorticoids, two hormones known to be associated with the regulation of body weight. A recent study also links a mutation in the CART gene to obesity in humans. These peptides might become targets for drug development in the area of obesity.

Intra-accumbal injection of CART (cocaine-amphetamine regulated transcript) peptide reduces cocaine-induced locomotor activity.

Evidence suggests that CART (cocaine-amphetamine regulated transcript) peptides are mediators or modulators of the actions of psychostimulant drugs. In this study, the effects of intra-accumbal injections of rat long form (rl) CART 55-102 were examined. Injection of the peptide alone had no effect, but pretreatment with the peptide blunted or reduced the locomotor-inducing effects of cocaine after an i.p. injection. This effect was dose related and time limited, as expected. rlCART 1-27, a CART peptide fragment not active in other studies, was without effect on cocaine-induced locomotor activity. Because the actions of cocaine involve dopamine, the effect of rlCART 55-102 on dopamine-induced locomotor activity was examined. Intraaccumbal injection of dopamine produced a dose-related and time-limited increase in locomotor activity, as expected. Coinjection of rlCART 55-102 with dopamine blunted the effect. In summary, these data suggest that CART peptides in the nucleus accumbens would tend to oppose the actions of cocaine.