The primate striatum is composed of limbic, cognitive, and sensorimotor functional domains. Although the effects of cocaine have generally been associated with the ventral striatum, or limbic domain, recent evidence in rodents suggests the involvement of the dorsal striatum (cognitive and sensorimotor domains) in cocaine self-administration. The goals of the present studies were to map the topography of the functional response to cocaine throughout the entire extent of the striatum of monkeys self-administering cocaine and determine whether this response is modified by chronic exposure to cocaine. Rhesus monkeys were trained to self-administer 0.3 mg/kg per injection cocaine for 5 d (initial stages; n ϭ 4) or 100 d (chronic stages; n ϭ 4) and compared with monkeys trained to respond under an identical schedule of food reinforcement (n ϭ 6). Monkeys received 30 reinforcers per session, and metabolic mapping was conducted at the end of the 5th or 100th self-administration session. In the initial phases of cocaine exposure, self-administration significantly decreased functional activity in the ventral striatum, but only in very restricted portions of the dorsal striatum. With chronic cocaine self-administration, however, the effects of cocaine intensified and spread dorsally to include most aspects of both caudate and putamen. Early experiences with cocaine, then, involve mainly the limbic domain, an area that mediates motivational and affective functions. In contrast, as exposure to cocaine continues, the impact of cocaine impinges progressively on the processing of sensorimotor and cognitive information, as well as the affective and motivational information processed in the ventral striatum.

The present study examined the time course of alterations in levels of dopamine transporter (DAT) binding sites that accompany cocaine self-administration using quantitative in vitro receptor autoradiography with [ 3 H]WIN 35,428. The density of dopamine transporter binding sites in the striatum of rhesus monkeys with 5 d, 3.3 months, or 1.5 years of cocaine selfadministration experience was compared with DAT levels in cocaine-naïve control monkeys. Animals in the long-term (1.5 years) exposure group self-administered cocaine at 0.03 mg/kg per injection, whereas the initial (5 d) and chronic (3.3 months) treatment groups were each divided into lower dose (0.03 mg/kg per injection) and higher dose (0.3 mg/kg per injection) groups. Initial cocaine exposure led to moderate decreases in [ 3 H]WIN 35,428 binding sites, with significant changes in the dorsolateral caudate (Ϫ25%) and central putamen (Ϫ19%) at the lower dose. Longer exposure, in contrast, resulted in elevated levels of striatal binding sites. The increases were most pronounced in the ventral striatum at the level of the nucleus accumbens shell. At the lower dose of the chronic phase, for example, significant increases of 21-42% were measured at the caudal level of the ventral caudate, ventral putamen, olfactory tubercle, and accumbens core and shell. Systematic variation of cocaine dose and drug exposure time demonstrated the importance of these factors in determining the intensity of increased DAT levels. With self-administration of higher doses especially, increases were more intense and included dorsal portions of the striatum so that every region at the caudal level exhibited a significant increase in DAT binding sites (20-54%). The similarity of these findings to previous studies in human cocaine addicts strongly suggest that the increased density of dopamine transporters observed in studies of human drug abusers are the result of the neurobiological effects of cocaine, ruling out confounds such as polydrug abuse, preexisting differences in DAT levels, or comorbid psychiatric conditions.

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Repeated exposure to psychostimulant drugs such as cocaine has been shown in numerous studies to produce significant neuroadaptations in both structure and function throughout the brain. Nonhuman primate models provide a way to systematically evaluate these adaptations engendered by cocaine self-administration and simulate the progressive nature of cocaine addiction in humans. Functional activity, measured using the 2-[ 14 C]deoxyglucose method, was evaluated at selected critical time points over the course of chronic cocaine self-administration in rhesus monkeys. The effects of cocaine exposure in the initial stages of self-administration resulted in changes in functional activity in a highly restricted network of interconnected brain regions when compared to activity in food-reinforced controls. This pattern of changes was confined mainly to ventromedial prefrontal cortex and ventral striatum. Following chronic exposure to cocaine self-administration, however, the spatial extent and intensity of significant alterations in functional activity expanded considerably. The shift in topography of these changes was orderly, originating ventromedially in the prefrontal cortical-ventral striatal network and expanding dorsally to encompass the dorsal striatum. A strikingly similar progression occurred within the cortical areas that project to each of these striatal regions. Preliminary studies suggest that this pattern is maintained despite periods of abstinence from cocaine. The shifting patterns of cerebral metabolic function that accompany longer durations of cocaine self-administration may underlie many of the characteristics of chronic drug exposure, and may provide transitional mechanisms to more compulsive cocaine use.

Because most human studies of the neurobiological substrates of the effects of cocaine have been performed with drug-dependent subjects, little information is available about the effects of cocaine in the initial phases of drug use before neuroadaptations to chronic exposure have developed. The purpose of the present study, therefore, was to define the substrates that mediate the initial effects of cocaine in a nonhuman primate model of cocaine self-administration using the 2-[14C]deoxyglucose method. Rhesus monkeys were trained to self-administer 0.03 mg/kg per injection (N = 4) or 0.3 mg/kg per injection (N = 4) cocaine and compared with monkeys trained to respond under an identical schedule of food reinforcement (N = 4). Monkeys received 30 reinforcers per session, and metabolic mapping was conducted at the end of the fifth self-administration session. Cocaine self-administration reduced glucose utilization in the mesolimbic system, including the ventral tegmental area, ventral striatum, and medial prefrontal cortex. In addition, metabolic activity was increased in the dorsolateral and dorsomedial prefrontal cortex, as well as in the mediodorsal nucleus of the thalamus. These latter effects are distinctly different from those seen after the noncontingent administration of cocaine, suggesting that self-administration engages circuits beyond those engaged merely by the pharmacological actions of cocaine. The involvement of cortical areas subserving working memory suggests that strong associations between cocaine and the internal and external environment are formed from the very outset of cocaine self-administration. The assessment of the effects of cocaine at a time not readily evaluated in humans provides a baseline from which the effects of chronic cocaine exposure can be investigated.

OBJECTIVE -Patients with diabetes commonly have a greater degree of anemia for their level of renal impairment than those presenting with other causes of renal failure. To clarify the contribution and differing roles of diabetes and nephropathy in the development of anemia in diabetic patients, we examined the hematologic and hematinic parameters of diabetic patients without nephropathy.RESEARCH DESIGN AND METHODS -The study group was comprised of 62 patients with type 2 diabetes who had been followed for a median of 7 years. For the study, these patients had additional samples taken during their annual routine blood testing for the measurement of extra parameters, including serum ferritin, serum erythropoietin (Epo) levels, and the percentage of reticulocytes. These measurements were combined with the routine parameters Hb, hematocrit, HbA 1c , and glomerular filtration rate.RESULTS -In all, 8 of the 45 male patients (17.8%) and 2 of the 17 female patients (11.8%) were classified as anemic (Hb Ͻ13g/dl and Ͻ11.5g/dl, respectively). Although only a small number of the patients had anemia as defined by normal values, a retrospective analysis of individual patients over time revealed a sustained though small decrease in Hb from initial presentation. A statistically significant difference in Epo levels (P ϭ 0.016 by Kruskal-Wallis test) was observed from the group with the lowest (Hb Յ11.5) to that with the highest (Hb Ն14.5) Hb values, with a median Epo value of 37 (interquartile range 24 -42) vs. 13 (9 -15) IU/l, respectively. In contrast, there was no evidence of an increased reticulocyte response to higher levels of Epo (r ϭ 0.134 [Pearsons], P ϭ 0.36). Reticulocyte counts ranged from 44 (38 -57) to 76.5 (56 -83) in the lowest and highest Hb groups, respectively.CONCLUSIONS -Although only a small number of subjects in the group were overtly anemic, all subjects had an ongoing, small but significant decrease in Hb since presentation. This study of diabetic patients without nephropathy shows an expected increase in Epo production in response to lowering levels of Hb but without the expected reticulocyte response. Diabetes Care 28:1118 -1123, 2005I n the U.K., as in the rest of the Western world, diabetes is the most prevalent cause of renal failure. Over the next 10 years, the number of patients with diabetes and end-stage renal disease is expected to double, causing a significant increase in the burden of care for this patient population (1). Although the prognosis with diabetic nephropathy has improved since early reports (2,3), there remains an excess mortality of 70 -100 times that of an otherwise matched population (4). Survival rates on dialysis remain poor, with up to 33% of patients dying within a year of starting dialysis (4). Furthermore, for patients who require renal replacement therapy, morbidity as assessed by hospitalization is 2-3 times greater than for nondiabetic patients with end-stage renal failure (2). This excess of morbidity and mortality in part relates to the high incidence of cardiovascul...

The bed nucleus of the stria terminalis (BNST) is in a key position to influence the integration of motivational and visceral functions, receiving inputs from limbic regions, including the amygdala, and sending projections to areas central to reward processing, including the ventral tegmental area and nucleus accumbens. The BNST also possesses a high density of noradrenergic fibers. The purpose of the present studies was to characterize the effects of cocaine self-administration on the regulation of norepinephrine transporter (NET) distribution and functional activity in the BNST of rhesus monkeys in the initial (5 d) or chronic (100 d) phases of cocaine self-administration. NET binding site densities in the BNST were assessed with quantitative in vitro receptor autoradiography using [(3)H]nisoxetine, and rates of local cerebral glucose utilization in the BNST were measured in the same monkeys using the 2-[(14)C]deoxyglucose method. Chronic exposure to cocaine self-administration resulted in significantly higher NET binding site densities (up to 52% relative to controls) throughout the BNST. Furthermore, cerebral metabolism was depressed significantly in a time-dependent manner with larger decreases after 100 d of cocaine self-administration. These data represent the first report of significant changes in the regulation of the NET resulting from cocaine exposure in primates. Furthermore, given the role of the BNST in cocaine withdrawal and stress-related reinstatement of self-administration, the changes reported here may provide a substrate for these phenomena.

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