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Besides affecting the hypothalamus and other brain areas related to reproduction, ovarian steroids have widespread effects throughout the brain, on serotonin pathways, catecholaminergic neurons, and the basal forebrain cholinergic system as well as the hippocampal formation, a brain region involved in spatial and declarative memory. Thus, ovarian steroids have measurable effects on affective state as well as cognition, with implications for dementia. Two actions are discussed in this review; both appear to involve a combination of genomic and nongenomic actions of ovarian hormones. First, regulation of the serotonergic system appears to be linked to the presence of estrogen- and progestin-sensitive neurons in the midbrain raphe as well as possibly nongenomic actions in brain areas to which serotonin neurons project their axons. Second, ovarian hormones regulate synapse turnover in the CA1 region of the hippocampus during the 4- to 5-day estrous cycle of the female rat. Formation of new excitatory synapses is induced by estradiol and involves N-methyl-D-aspartate (NMDA) receptors, whereas downregulation of these synapses involves intracellular progestin receptors. A new, rapid method of radioimmunocytochemistry has made possible the demonstration of synapse formation by labeling and quantifying the specific synaptic and dendritic molecules involved. Although NMDA receptor activation is required for synapse formation, inhibitory interneurons may play a pivotal role as they express nuclear estrogen receptor-alpha (ERa). It is also likely that estrogens may locally regulate events at the sites of synaptic contact in the excitatory pyramidal neurons where the synapses form. Indeed, recent ultrastructural data reveal extranuclear ERalpha immunoreactivity within select dendritic spines on hippocampal principal cells, axons, axon terminals, and glial processes. In particular, the presence of ER in dendrites is consistent with a model for synapse formation in which filopodia from dendrites grow out to find new synaptic contacts and estrogens regulate local, post-transcriptional events via second messenger systems.
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Estrogen Actions Throughout the Brain
BRUCE MCEWEN
Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology,
The Rockefeller University, New York, New York 10021
ABSTRACT
Besides affecting the hypothalamus and other brain areas related to reproduction, ovarian
steroids have widespread effects throughout the brain, on serotonin pathways, catecholaminergic
neurons, and the basal forebrain cholinergic system as well as the hippocampal formation, a brain
region involved in spatial and declarative memory. Thus, ovarian steroids have measurable effects on
affective state as well as cognition, with implications for dementia. Two actions are discussed in this
review; both appear to involve a combination of genomic and nongenomic actions of ovarian
hormones. First, regulation of the serotonergic system appears to be linked to the presence of
estrogen- and progestin-sensitive neurons in the midbrain raphe as well as possibly nongenomic
actions in brain areas to which serotonin neurons project their axons. Second, ovarian hormones
regulate synapse turnover in the CA1 region of the hippocampus during the 4- to 5-day estrous cycle
of the female rat. Formation of new excitatory synapses is induced by estradiol and involves
N-methyl-D-aspartate (NMDA) receptors, whereas downregulation of these synapses involves
intracellular progestin receptors. A new, rapid method of radioimmunocytochemistry has made
possible the demonstration of synapse formation by labeling and quantifying the specific synaptic and
dendritic molecules involved. Although NMDA receptor activation is required for synapse formation,
inhibitory interneurons may play a pivotal role as they express nuclear estrogen receptor-alpha (ER
).
It is also likely that estrogens may locally regulate events at the sites of synaptic contact in the
excitatory pyramidal neurons where the synapses form. Indeed, recent ultrastructural data reveal
extranuclear ER
immunoreactivity within select dendritic spines on hippocampal principal cells,
axons, axon terminals, and glial processes. In particular, the presence of ER in dendrites is consistent
with a model for synapse formation in which filopodia from dendrites grow out to find new synaptic
contacts and estrogens regulate local, post-transcriptional events via second messenger systems.
I. Introduction
Most studies of estrogen action in brain have focused on reproduction. The
majority of these studies have dealt with animal models in which evidence
accumulating over more than 30 years has shown that estrogens target the brain
of experimental animals (Pfaff, 1980). Now, medical science has recognized that
the brain is one of the organs of the body that suffers from the loss of estrogen
after surgical or natural menopause and that damage from stroke and neurode-
generation in dementia may be retarded by estrogen actions. Indeed, with
357
Copyright © 2002 by The Endocrine Society
All rights of reproduction in any form reserved.
increasing life expectancy during the 20th century, women are likely to live a
substantial part of their lives in a state of estrogen deciency. Although hot
ushes are, for many women, the most-dramatic and noticeable consequence of
loss of ovarian hormones, some women experience, at surgical or natural
menopause, difculties in remembering names and other information important
for daily life as well as decits in ne motor coordination and reaction times and
feelings of depression and anxiety (McEwen and Alves, 1999). Loss of bone
calcium and osteoporosis are other consequences that have led many women to
take estrogen replacement therapy (ERT) at the menopause. Likewise, the loss of
protection of the coronary arteries, leading postmenopausal women to increased
risk for cardiovascular disease, is another result of estrogen deciency that has
reinforced the value of ERT. Thus, the somewhat-delayed recognition of the
brain as an important estrogen target provides another compelling reason to
investigate the value of ERT for states of estrogen deciency.
Although most of the animal studies cited above focused on estrogen actions on
the hypothalamus affecting ovulation and reproductive behavior, it is now apparent
in animal models and clinical studies that estrogens exert many actions outside of
reproductive function, including actions on brain areas that are important for learning
and memory and for emotions and affective state as well as motor coordination and
pain sensitivity. These effects reect the actions of estrogens on a large number of
brain areas outside of the hypothalamus, such as the midbrain and brain stem neurons
that produce serotonin and catecholamines, spinal cord, cerebral cortex, and hip-
pocampus. The problem in these brain regions has been to recognize the receptors
and mechanisms by which estrogens produce their effects.
This review will focus on two aspects. First, the cellular and molecular
mechanisms by which estrogens produce their diverse effects on the brain. Second,
the brain regions and cell types in which estrogens produce their effects, emphasizing
new knowledge regarding estrogen actions outside of the hypothalamus and pituitary
gland. The serotonin system will be discussed as an example as well as the
hippocampus. We will discuss the actions of estrogens in regulating synapse
formation in hippocampus because they reect a novel, nonreproductive action of
estrogens related to cognitive function that is relevant for postmenopausal changes.
Furthermore, these actions also illustrate the emerging evidence that estrogens act via
mechanisms other than the classical cell nuclear estrogen receptors (ERs).
II. Intracellular Mechanisms of Estrogen Action in the
Central Nervous System
A. INTRACELLULAR ESTROGEN RECEPTORS
In the early 1960s, ERs were identied that bind to DNA and regulate gene
expression (Jensen and Jacobson, 1962). Radioactive estrogens were used to
358 BRUCE MCEWEN
identify ERs inside of the cell nuclei. The identication and mapping of cells that
contain ERs were extended from the uterus and mammary glands to the brain and
pituitary gland (Pfaff, 1980). At rst, only ERs in the hypothalamus and pituitary
gland were studied because they were the most obvious and also the most
obviously related to estrogen actions on reproduction. Eventually, however,
nerve cells containing ERs were recognized in brain regions like the hippocam-
pus, cerebral cortex, midbrain, and brainstem. We are now aware of two types of
intracellular ER, ER
and ER
(see McEwen and Alves, 1999, for summary).
Measurements of mRNA for ER
and ER
reveal distributions in the body
that differ quite markedly from each other, with moderate to high expression of
ER
in pituitary, kidney, epididymus, and adrenal; moderate to high expression
of ER
in prostate, lung, bladder, and brain; and overlapping high expression in
ovary, testis, and uterus (Kuiper et al., 1998). Isoforms of ER
are now being
identied (see McEwen and Alves, 1999, for summary). The best characterized
of these splice variants is ER
2, as opposed to the originally identied isoform,
ER
1. ER
2 appears to have a lower afnity for estrogens than ER
1, presum-
ably due to an 18 amino acid insertion in the ligand-binding domain (Maruyama
et al., 1998). There are other splice variants of ER
with differential expression
in brain and other tissues, including a variant missing Exon 4 that does not bind
estradiol in hippocampus (Price et al., 2000).
In brain, the distribution of ER
is fairly well established but there is less
certainty surrounding the localization of ER
. Autoradiographic maps of
3
H
estradiol uptake and retention in brain (Stumpf and Sar, 1976; Pfaff, 1980) are
presumed to reect binding to all forms of the ER, particularly the ER
and
ER
1 isoforms, which have similar, high afnities for 17
estradiol (Kuiper et
al., 1998). In situ hybridization data indicate widespread distribution of ER
mRNA throughout much of the brain, including olfactory bulbs, cerebellum, and
cerebral cortex (Kuiper et al., 1997,1998). Results from immunocytochemical
studies for ER
indicate a more-restricted localization of detectable protein,
although the antisera that are currently available do not always provide specic
signals in some brain areas (see McEwen and Alves, 1999, for discussion).
Recent evidence shows good agreement between ER
mRNA levels and ER
immunoreactivity with a polyclonal antibody to the C terminus of ER
(Shugh-
rue and Merchenthaler, 2001). In particular, colocalization of ER
mRNA with
cell nuclear ER
immunoreactivity was demonstrated in the rat cerebral cortex,
paraventricular nuclei of the hypothalamus, and hypothalamic preoptic area
(Shughrue and Merchenthaler, 2001). Other brain regions remain to be studied
for such co-localization.
The introduction of
125
I estrogen to label ER with a higher specic radio-
activity has revealed the presence of binding sites not previously detected using
3
H estradiol (Shughrue et al., 1999; Shughrue and Merchenthaler, 2000). In
hippocampus, labeling was evident in the interneurons previously seen to contain
359ESTROGEN ACTIONS THROUGHOUT THE BRAIN
ER
by other methods, with higher concentrations in ventral hippocampus
(Shughrue and Merchenthaler, 2000). However, the most important difference
from
125
I estrogen labeling of ER was the detection of label in pyramidal cells of
CA1CA3 in the ventral hippocampus. In parallel studies of ER
and -
mRNA,
there was a similar dorsal-to-ventral gradient as that seen for
125
I estrogen
binding and the ER
signal appeared to be stronger than that for ER
(Shughrue
and Merchenthaler, 2000). Thus, the greater sensitivity of
125
I estrogen labeling
of ER reveals sites that may indicate locations of estrogen actions in hippocampal
pyramidal cells, particularly in pyramidal cell nuclei of the ventral hippocampus.
ER
and ER
are similar not only in afnity for a number of estrogens and
estrogen antagonists (Kuiper et al., 1998) but also in their ability to regulate
genes in which the estrogen response element (ERE) is the primary site of
interaction (Paech et al., 1997). The major differences between ER
and ER
concern their ability to regulate transcription via the AP-1 response element.
With AP-1, estradiol 17
activated transcription with ER
, whereas it failed to
activate transcription with ER
and was able to cause inhibition. In contrast, with
AP-1, nonsteroidal estrogen antagonists such as tamoxifen activated transcription
with ER
and did so to a lesser extent with ER
(Paech et al., 1997).
ER
and ER
can form heterodimers when expressed in the same cells, thus
giving rise to additional possible variants as far as gene regulation (Pettersson et
al., 1997). Thus far, endogenous colocalization of ER
and ER
has been
demonstrated in the hypothalamic preoptic area, bed nucleus of the stria termi-
nalis, and medial amygdaloid nucleus (Hrabovszky et al., 1998) and probably
exists in other brain regions, including midbrain raphe (see below).
Nonsteroidal estrogen antagonists exert agonist-like effects on some neuro-
chemical or functional endpoints in the rat brain and antagonistic effects on
others. Antagonistic effects for CI-628, a tamoxifen-like estrogen antagonist,
were seen in terms of blockade of estrogen-induced progestin receptor induction
and lordosis behavior (Roy et al., 1979; Meisel et al., 1987). Agonist-like effects
of CI-628 were seen for induction of choline acetyltransferase in basal forebrain
and repression of monoamine oxidase A in amygdala (Luine and McEwen,
1977). Recently, CI-628 was shown to block estrogen-induced synapse formation
in the hippocampus without having any agonist-like effects (McEwen et al.,
1999b; Brake et al., 2001).
One important implication of these ndings concerning the mixed agonist
and antagonist role of some estrogen antagonists is that nonsteroidal anti-
estrogens, like CI-628 and possibly also tamoxifen and raloxifene, will not have
uniformly agonistic or antagonistic effects on the diversity of actions that
estrogens normally produce in the brain. This has implications for the therapeutic
applications of such agents and requires a separate study of the actions of these
agents on each endpoint of estrogen action.
360 BRUCE MCEWEN
Unfortunately, the molecular basis of these effects is not clear. Although
anti-estrogens function as antagonists for ER
and ER
via the ERE, these same
anti-estrogens worked through the AP-1 response element to activate transcrip-
tion via ER
also, to a lesser extent, via ER
(Paech et al., 1997). Yet, with
AP-1, estradiol 17
activated transcription with ER
, whereas it failed to
activate transcription with ER
and was able to cause inhibition (Paech et al.,
1997). Thus, to account for parallel agonist-like actions of estrogen antagonists,
such as we have demonstrated for choline acetyltransferase and monoamine
oxidase, it is necessary to postulate that ER
is the receptor involved and that it
uses the AP-1 response element where both estradiol and CI-628 can have
agonistic-like actions.
B. NOVEL ESTROGEN ACTIONS VIA NON-NUCLEAR RECEPTORS
Rapid estrogen effects on neuronal excitability (Kelly et al., 1977; Nabekura
et al., 1986) have been known for a number of years. Yet, only recently has this
topic emerged in full force as an alternative aspect of estrogen action that
involves interactions of ERs with second messenger systems and potentially
novel types of ERs (Kelly and Wagner, 1999; Brinton, 2001; Kelly and Levin,
2001; Lee and McEwen, 2001).
The variety of nongenomic estrogen effects includes 1) rapid actions on
excitability of neuronal and pituitary cells; 2) the activation by estrogens of
cyclic AMP and mitogen-activated protein kinase (MAP kinase) pathways that
affect activity of such targets as kainate and insulin-like growth factor-1 (IGF-1)
receptors; 3) estrogen actions that involve modulation of G protein coupling and
affect calcium currents and gonadotropin-releasing hormone (GnRH) release; 4)
effects on calcium channels and calcium ion entry; and 5) protection of neurons
from damage by excitotoxins and free radicals (Kelly and Wagner, 1999;
Brinton, 2001; Kelly and Levin, 2001; Lee and McEwen, 2001).
For estrogen actions on some aspects of calcium homeostasis, certain
aspects of second messenger systems, and some features of neuroprotection,
a novel receptor mechanism is implicated in which stereospecicity for 17
over 17
estradiol is replaced by a broader specicity for the 3 hydroxyl
group on the A ring ( McEwen and Alves, 1999; Lee and McEwen, 2001). On
the other hand, there is also evidence that ER
and ER
are capable of
participating in second messenger cascades involving second messenger
activation and G protein coupling (Razandi et al., 1999; Kelly and Levin,
2001). Besides ER
and ER
, membrane ERs have been reported on
pituitary, uterine, ovarian granulosa cell, spermatozoa, testes, and liver cell
membranes. However, these have been only partially characterized in binding
studies and only in a few cases have been shown to be linked to signal
361ESTROGEN ACTIONS THROUGHOUT THE BRAIN
transduction mechanisms (for a review, see McEwen and Alves, 1999; Kelly
and Levin, 2001; Lee and McEwen, 2001).
Finally, estrogenic compounds protect nerve cells from damage by excito-
toxins and free radicals in novel ways (McEwen and Alves, 1999; Lee and
McEwen, 2001). In this realm are neuroprotective effects that appear to be
mediated via classical genomic receptors, based upon the fact that they can be
blocked by estrogen antagonists. But other actions are not blocked by these
antagonists and appear to involve a novel mechanism in which estradiol 17
is
as potent as estradiol 17
(Green et al., 1997; Lee and McEwen, 2001). These
actions of estrogens, albeit in 100-nM to micromolar concentrations, reduce the
production of or actions of free radicals in causing cell damage and promoting
cell death through apoptosis. Mitochondria are major targets of estrogen action.
Estrogen effects stabilize mitochondrial membrane potentials, prevent adenosine
triphosphate (ATP) depletion, and reduce the generation of oxygen free radicals
(Mattson et al., 1997; Wang et al., 2001).
III. Estrogen Actions Throughout the Central Nervous System
We now know that ovarian steroids have numerous effects on the brain
throughout the lifespan, beginning during gestation and continuing on into
senescence. Estrogens participate in the sexual differentiation of the brain during
early embryonic or neonatal life. These effects undoubtedly involve the classical
intracellular ERs (McEwen, 1983; Auger et al., 2000). The process of sexual
differentiation involves the secretion of testosterone in fetal or early neonatal life
and the actions of testosterone either through androgen receptors or via aroma-
tization to estrogen in the defeminization and masculinization of brain structures
and function (Goy and McEwen, 1980; Naftolin, 1994). Although initially
believed to be conned to the hypothalamus, structural and functional sex
differences have been found in higher cognitive centers and in sensory and
autonomic ganglia as well as structures of the limbic system of the brain and the
midbrain, brainstem, and basal forebrain structures (for a review, see McEwen
and Alves, 1999).
Estrogens affect areas of the brain that are not primarily involved in
reproduction, such as the basal forebrain cholinergic system, the hippocampus
and cerebral cortex, the caudate-putamen, midbrain raphe and brainstem locus
coeruleus, and the spinal cord. These systems are involved in a variety of
estrogen actions on mood, locomotor activity, pain sensitivity, vulnerability to
epilepsy, and attentional mechanisms and cognition (for a review, see McEwen
and Alves, 1999).
Functional or structural sex differences exist in a number of these brain
regions (Fischette et al., 1984; Kimura, 1992; Bazzett and Becker, 1994;
Witelson et al., 1995). For example, developmentally programmed sex
362 BRUCE MCEWEN
differences in hippocampal structure may help explain differences in the
strategies that male and female rats use to solve spatial navigation problems
(Williams and Meck, 1991). A similar sex difference in spatial problemsolv-
ing is reported in humans (Kimura, 1992). During the period of development
when testosterone is elevated in the male, aromatase activity and ERs are
transiently expressed in hippocampus. Recent data on behavior and synapse
induction strongly suggest that this pathway is involved in the masculiniza-
tion or defeminization of hippocampal structure and function.
In spite of the paucity of ER
outside the hypothalamus, hypothalamic
preoptic region, and amygdala, estrogens have effects on many other brain
regions and neurochemical systems involved in a host of nonreproductive
brain functions. The expression of ER
mRNA in many of these brain regions
has raised the possibility of functional ERs in these brain areas. At the same
time, the presence of a few ER
-containing nerve cells has led to the
discovery, for example in the hippocampus, that these few nerve cells can
have powerful trans-synaptic effects on neighboring neurons. As will be
discussed in detail below, treatment of ovariectomized rats with estradiol 17
induces certain hippocampal neurons to form new synaptic connections with
other nerve cells. These estrogen effects appear to be attributable, at least in
part, to intracellular ER
in inhibitory interneurons (see below). In addition,
the rapidity and structure-activity prole of some of these effects have raised
questions about the possible nontraditionaland even nongenomic actions of
estrogens in some brain regions. For example, actions of estrogens on
dopaminergic activity in the corpus striatum and nucleus accumbens appear
to be mediated by membrane actions in the absence of any documented
expression of either ER
or ER
in cell nuclei of these brain regions (Maus
et al., 1990; Mermelstein et al., 1996).
Estrogen actions upon cholinergic, noradrenergic, serotonergic, and hypo-
thalamic dopaminergic systems, on the other hand, are likely to be mediated by
known nuclear intracellular ER
or ER
(see McEwen and Alves, 1999, for
summary). This will be decribed for the serotonin system. The spinal cord also
has intracellular ER
and ER
but the reported effects on nociception and
analgesia do not directly relate to those receptor sites in enkephalin-expressing
spinal neurons. Moreover, endothelial cells and at least some glial cells must be
considered as targets for estrogen action that affect glucose uptake and mecha-
nisms that support the replenishment of cell membranes and possibly also
synaptogenesis and other forms of structural plasticity (see McEwen and Alves,
1999; McEwen et al., 2001, for summary). We now will examine two systems
involving actions of estrogens on brain areas that are involved in many functions
beyond those specically concerned with reproduction, namely, the midbrain
serotonin system and the hippocampus.
363ESTROGEN ACTIONS THROUGHOUT THE BRAIN
IV. Estrogen Actions on Midbrain Raphe and Serotonin Receptors
in Forebrain
The serotonin system projects widely to many brain regions and is concerned
with the regulation of many aspects of brain function, ranging from autonomic
nervous system reactivity to mood, aggression, and cognitive function (Jacobs,
1994; Higley and Linnoila, 1997; Rubinow et al., 1998; Bethea et al., 1999).
Ovarian steroids regulate the serotonin system of rodents and primates (Alves et
al., 1998; Bethea et al., 1999), but important differences exist in the relationship
between detectable intracellular ERs and the serotonergic neurons.
In primates, both ER
and ER
are found in midbrain 5HT neurons and
estrogens regulate tryptophan hydroxylase as well as progestin receptor expres-
sion (Bethea et al., 1999). In rats, ER
is found in non-5HT neurons, where
estrogen regulates expression of progestin receptors (Alves et al., 1998) but not
expression of tryptophan hydroxylase (S.E. Alves, unpublished data). Sex dif-
ferences are found in the ability of estrogen treatment to induce progestin
receptors (Alves et al., 1998). In mice, both ER
and ER
are present and
functional in the midbrain. ER
is expressed in 5HT neurons that also express
progestin receptors (Alves et al., 2000). Yet, the
ERKO mouse also shows
estrogen induction of progestin receptors in midbrain raphe, implying that
another ER, most likely ER
, is involved (Alves et al., 2000) (Figure 1).
FIG. 1. Number of progestin receptor (PR) immunoreactive cells counted in the dorsal raphenucleus
(A) and median raphe nucleus (B) of wild-type (WT) and
ERKO mice of both sexes. Estradiol benzoate
(EB) treatment induces PR in both sexes of both genotypes. Although EB induces PR in both genotypes,
the signicant interaction between treatment and genotype in both dorsal (F (1,16) 4.73, p .045) and
median (F (1,16) 9.33, p .008) raphe nuclei indicates that the magnitude of PR induction by EB over
baseline levels was less in the
ERKO animals. No signicant gender differences were found. We
conclude that another ER besides ER
, most likely ER
, mediates the effects of EB in the raphe nuclei.
[Reprinted with permission from Alves SE, McEwen BS, Hayashi S, Korach KS, Pfaff DW, Ogawa S
2000 Estrogen-regulated progestin receptors are found in the midbrain raphe but not hippocampus of
estrogen receptor alpha (ER
) gene-disrupted mice. J Comp Neurol 427:185195. Copyright Wiley-Liss,
Inc., a subsidiary of John Wiley & Sons, Inc.]
364 BRUCE M
CEWEN
Estrogens also regulate other components of the serotonin system besides
tryptophan hydroxylase. In midbrain raphe of primates, estrogen treatment
decreased serotonin transporter mRNA expression (Bethea et al., 1999). In
macaque hypothalamus, estrogen treatment decreased expression of the 5HT2C
receptor in a number of hypothalamic nuclei (Gundlah et al., 1999). In rat brain,
32-hour estrogen treatment increased levels of 5HT2A mRNA in dorsal raphe
and 5HT2A receptor binding in frontal, cingulate, and primary olfactory cortex
as well as in nucleus accumbens (Sumner and Fink, 1998) (Figure 2). There were
no sex differences in this induction (Sumner and Fink, 1998). Another study on
rats reported that a 24-hour estrogen treatment increased 5HT2A mRNA levels
in amygdala, hippocampus, accumbens, and a number of cortical areas, while
FIG. 2. Serotonin 5HT2A receptor binding in the cingulate cortex and nucleus accumbens of
male and female rats after gonadectomy and treatment with either oil vehicle, estradiol benzoate
(EB), testosterone propionate (TP), or dihydrotestosterone (DHT). These two brain areas are not
normally considered to be estrogen or androgen target areas but the post-synaptic 5HT2A receptor
levels are elevated in both males and females by EB (p .005) and in males by TP (# p .05 for
cingulate; p .005 for accumbens) but not by DHT. There is a signicant effect of gonadectomy
in males (p .05). This suggests that estrogens work equally in both sexes and the aromatase
pathway may be involved in the TP effects, although the nature of the ERs that mediate these effects
remains uncertain. [Redrawn from Sumner BEH, Fink G 1998 Testosterone as well as estrogen
increases serotonin
2A
receptor mRNA and binding site densities in the male rat brain. Mol Brain Res
59:205214.]
365ESTROGEN ACTIONS THROUGHOUT THE BRAIN
decreasing 5HT1A mRNA levels in many of the same brain regions of several
strains of rats differing in anxiety-related behaviors (Osterlund et al., 1999).
Chronic (2-week) estrogen treatment also decreased 5HT1A receptor binding in
amygdala, hippocampus, and cerebral cortex (Osterlund et al., 2000). Yet, in this
study, the effects of estrogen on 5HT1A mRNA levels, evident after acute
estrogen treatment, disappeared with the chronic treatment that decreased
5HT1A receptor binding.
The actions of estrogen on the 5HT1A receptor system illustrate the
complexities of distinguishing between traditional genomic effects of estrogens
and those involving a non-nuclear action. Estrogen treatment causes a rapid
decrease in coupling to G proteins that reduces the inhibitory effect of 5HT1A
agonists on lordosis behavior, hyperphagia, and oxytocin and corticotropin
(ACTH) responses (Raap et al., 2000; Mize et al., 2001). The rapid, estrogen-
induced decrease in 5HT1A efcacy has been assessed by measuring radio-
labeled GTP
S binding (Mize et al., 2001) after treatment with estrogen in
homogenates of hippocampus and frontal cortex. Estradiol 17
(EC50 25 nM)
showed a dose-dependent ability to decrease GTP
S binding. This effect was
mimicked by diethylstilbestrol but not by the less-potent estrogens, estradiol 17
and estriol, and was blocked by the estrogen antagonist, ICI 182780 (Mize et al.,
2001). These results are consistent with the involvement of a non-nuclear form
of ER
or ER
, as discussed above.
V. Estrogen Actions in Hippocampus re: Cognitive Function and
Memory Processes
The hippocampus is a brain region that is involved in episodic, declarative,
contextual, and spatial learning and memory as well as serving as a component
in the control of autonomic and vegetative functions such as ACTH secretion
(Jacobson and Sapolsky, 1991; Eichenbaum and Otto, 1992; Phillips and
LeDoux, 1992). The hippocampus is also vulnerable to damage by stroke and
head trauma and susceptible to damage during aging and repeated stress (Sapol-
sky, 1992). Among the most novel and fascinating effects of estrogen are those
on cognitive function. Estrogen effects on memory have been reported in animal
models and in studies on humans (McEwen and Alves, 1999). The memories
affected are ones in which the hippocampus plays a role along with the basal
forebrain cholinergic system and other neurochemical systems. Rather than one
estrogen-regulated process, many types of estrogen actions on a number of
neurochemical and neuroanatomical substrates and a number of molecular
mechanisms are likely to underlie the actions of estrogens on cognition and other
aspects of behavior such as mood, pain perception, and nociception.
One of the processes regulated by ovarian hormones is the cyclic formation
and breakdown of excitatory synapses in the hippocampus (Woolley et al., 1990).
366 BRUCE MCEWEN
This nding was surprising because the hippocampus is a brain region in which
cell nuclear ERs are present in scattered inhibitory interneurons but not in
principal neurons where synapse formation occurs (Weiland et al., 1997). Yet,
the effects of ovarian hormones on synaptic turnover were as impressive in the
hippocampus as those in the ventromedial hypothalamus (Carrer and Aoki, 1982;
Frankfurt et al., 1990; Calizo and Flanagan-Cato, 2000), a classic estrogen target
area of the brain for female sexual behavior (Pfaff, 1980).
A. MECHANISM OF EXCITATORY SYNAPSE FORMATION IN
THE HIPPOCAMPUS
Estrogen treatment increases dendritic spine density on CA1 pyramidal
neurons. As observed by electron microscopy, treatment of ovariectomized adult
rats with estrogen also induces new synapses on spines and not on dendritic
shafts of CA1 neurons (Woolley and McEwen, 1992). Estrogen did not effect
dendritic length or branching (Gould et al., 1990; Woolley et al., 1990; Woolley
and McEwen, 1992). Progesterone treatment acutely enhances spine formation.
But, over a 12- to 24-hour period, progesterone caused the downregulation of
estrogen-induced synapses (Gould et al., 1990; Woolley and McEwen, 1993).
Estrogens do not act alone and, in fact, ongoing excitatory neurotransmission
is required for synapse induction, as shown by the nding that antagonists of
NMDA receptors block estrogen-induced synaptogenesis on dendritic spines in
ovariectomized female rats (Woolley and McEwen, 1994). Because estrogen
treatment increases the density of NMDA receptors in the CA1 region of the
hippocampus (Weiland, 1992; Woolley et al., 1997), the activation of NMDA
receptors by glutamate is an essential factor in causing new excitatory synapses
to develop.
Spines are occupied by asymmetric, excitatory synapses and are sites of
Ca
2
ion accumulation and contain NMDA receptors (Horner, 1993). NMDA
receptors are expressed in large amounts in CA1 pyramidal neurons and can be
imaged by conventional immunocytochemistry as well as by confocal imaging,
in which individual dendrites and spines can be studied for co-localization with
other markers (Gazzaley et al., 1996). Confocal microscopic imaging showed
that estrogen treatment upregulates immunoreactivity for the largest NMDA
receptor subunit, NR1, on dendrites and cell bodies of CA1 pyramidal neurons,
whereas NR1 mRNA levels did not change after estrogen treatment that induces
new synapses (Gazzaley et al., 1996). This suggests the possibility that NR1
expression is regulated post-transcriptionally by estrogen.
Recent evidence indicates that in young female rats, estrogen induction of
NR1 is proportional to the induction of new spines, so that NMDA receptor
density per spine is not increased; however, in the aging female rat, there is NR1
induction without an increase in dendritic spines (Adams et al., 2001) (Figure 3).
367ESTROGEN ACTIONS THROUGHOUT THE BRAIN
This might make the aging hippocampus more vulnerable to excitotoxic damage,
for example, by stroke or seizures.
B. CELLULAR AND MOLECULAR EVENTS ASSOCIATED WITH
SYNAPSE FORMATION
The estrogen-induced increase in dendritic spines on CA1 neurons parallels
an increase in synapse density on spines without any decrease in shaft synapses
(Woolley and McEwen, 1992), implying that new spine synapses are formed.
Whereas synapse formation during development is considered to be a collabo-
rative process involving in-growth of a presynaptic element on a site where a
postsynaptic spine is either present or ready to form (Horner, 1993), the story for
estrogen-regulated hippocampal synaptogenesis is somewhat different. Estrogens
induce increased numbers of synapses on multiple synaptic boutons between
neurons not previously connected (Yankova et al., 2001) (Figure 4). This is
FIG. 3. Young adult female rats show upregulation of both NMDA receptors and dendritic
spines on CA1 pyramidal neurons in hippocampus, with a proportional increase of NMDA receptors
and spines. In contrast, the aging rat hippocampus responds to estrogen by upregulating NMDA
receptor R1 subunit expression but not by increasing the number of spine synapses. [Redrawn from
Adams MM, Shah RA, Janssen WGM, Morrison JH 2001 Different modes of hippocampal plasticity
in response to estrogen in young and aged female rats. Proc Natl Acad Sci USA 98:80718076.
Copyright 2001 National Academy of Sciences, USA.]
368 BRUCE MCEWEN
reminiscent of the nding in cultured hippocampal cells studied by time-lapse
photography that lopodia extend from dendrites and reach out to establish
contact with nearby axons (Ziv and Smith, 1996). This implies an active role for
the dendrite in forming synaptic contacts.
Gene products characterizing dendritic spines include spinophilin, a protein
that helps to bundle actin laments in the dendritic spine and regulates many of
the properties of spines (Allen et al., 1997; Feng et al., 2000). As reviewed in
McEwen et al. (2001), the calcium-calmodulin kinase II (CaMKII) is a major
protein of the postsynaptic density that plays an important role in long-term
potentiation (LTP) and synaptic differentiation. Recent evidence indicates that
CaMKII plays a key role in the formation of synapses and localization of
receptors in synapses. Glutamatergic synapses contain other key proteins in the
postsynaptic density besides CaMKII; these include PSD-95, densin-180, and
citron, a rac/rho effector protein. PSD-95 plays a key role in anchoring the
NMDA receptor within the synapse. The NMDA R1 (NR1) receptor subunit is
one of those proteins that may be translated from mRNA located in the dendrites
(Gazzaley et al., 1997).
There are a number of presynaptic molecular markers of mature synapses
that can be used in studies of synapse formation (McEwen et al., 2001). GAP43
is a marker of the growth cone and has been shown to increase in the
FIG. 4. Estrogen treatment of young adult female rats increases the number of dendritic spines
on CA1 pyramidal neurons that are associated with multiple synaptic boutons (MSB), (i.e., more than
one spine contacting a presynaptic terminal). Two examples are shown. On the left is a same cell
bouton receiving two spines from the same cell that had been lled with dye to make it electron dense
in the electron micrograph. On the right is a different cell bouton, where two different cells send
spines to contact the same presynaptic terminal. Estrogen treatment increases preferentially the
number of different cell MSBs. [Reprinted with permission from Yankova M, Hart SA, Woolley CS
2001 Estrogen increases synaptic connectivity between single presynaptic inputs and multiple
postsynaptic CA1 pyramidal cells: a serial electron-microscopic study. Proc Natl Acad Sci USA
98:35253530. Copyright 2001 National Academy of Sciences, USA.]
369ESTROGEN ACTIONS THROUGHOUT THE BRAIN
hypothalamus after estrogen treatment; however, no studies of this type have
been done on the hippocampus. SNAP-25 is a marker of synaptic vesicles, as are
syntaxin, synaptotagmins, synaptoporin, synaptophysin, and the synapsins. Al-
though mRNAs for these proteins are most likely found in neuron cell bodies,
growth cones of hippocampal neurons in culture have been reported to have
mRNAs for proteins such as GAP43 and Arc and perhaps other presynaptic
proteins; these can be translated in the growth cone (Crino and Eberwine, 1996).
C. APPLICATION OF RADIOIMMUNOCYTOCHEMISTRY TO
STUDY SYNAPSE FORMATION AND MATURATION
The methods used to assess synapse formation (i.e., Golgi staining, dye lling of
cells, electron microscopy) are all labor intensive and time consuming and do not
provide information about the underlying molecular events. Radioimmunocytochem-
istry is a method for assessing the locally expressed levels of synaptic and spine
proteins using a primary antibody and a radioactive secondary antibody, then
assessing levels of radioactivity using quantitative autoradiography. This procedure
has not only conrmed the anatomical methods for assessing spine synapse forma-
tion but has also added a new dimension by providing insights into estrogen-induced
increases in proteins that characterize presynaptic terminals and spines.
Figure 5 shows the results of the rst study, using synaptophysin and
syntaxin as presynaptic markers and spinophilin as a spine marker (Brake et al.,
2001). Estrogen treatment was conducted exactly as in previous studies using the
Golgi method and the estrogen antagonist, CI 628, was used to block estrogen
actions (McEwen et al., 1999a). Estrogen treatment induced both pre- and
postsynaptic markers in the stratum oriens and stratum radiatum of the CA1
region, location of the spine synapses (Brake et al., 2001). The magnitude of the
increases corresponded very well to the magnitude of the changes in spine
density seen with the Golgi method (Woolley et al., 1997; McEwen et al.,
1999a). These effects were blocked by CI-628, which had no agonist effects by
itself, and this nding agreed with the Golgi results (McEwen et al., 1999a). One
unique nding with radioimmunocytochemistry is the estrogen-induced increase
in spinophilin immunoreactivity in the hilus of the dentate gyrus and in the
stratum lucidum of CA3, neither of which is accompanied by increases in the
presynaptic markers, synaptophysin, and syntaxin (Brake et al., 2001). This
suggests that there may be a process of synapse maturation taking place that
reects expression of spinophilin in the absence of any estrogen-induced changes
in presynaptic proteins. Further studies are needed to conrm this interpretation.
D. CELL NUCLEAR ESTROGEN RECEPTORS IN THE HIPPOCAMPUS
Adult CA1 pyramidal cells of the dorsal hippocampus do not express
detectable cell nuclear ER by tritium autoradiography and light microscopic
370 BRUCE MCEWEN
FIG. 5. Radioimmunocytochemistry for two presynaptic (synaptophysin and syntaxin) and one
spine-specic (spinophilin) marker reveals the same magnitude of up-regulation by estrogen treat-
ment as has been shown by morphological techniques for dendritic spines on CA1 neurons of the
female rat hippocampus. A
35
S-labeled secondary antibody was used for quantitative autoradiography
of the distribution and intensity of labeling of synaptic proteins by specic primary antibodies.
Treatment with the nonsteroidal estrogen antagonist, CI 628, blocks the estrogen effect and does not
produce an agonist-like effect of its own. These ndings are very similar to a study using the Golgi
method to reveal dendritic spines (McEwen et al., 1999a). [Reprinted with permission from Brake
WG, Alves SE, Dunlop JC, Lee SJ, Bulloch K, Allen PB, Greengard P, McEwen BS 2001 Novel
target sites for estrogen action in the dorsal hippocampus: an examination of synaptic proteins.
Endocrinology 142:12841289. Copyright The Endocrine Society.]
371ESTROGEN ACTIONS THROUGHOUT THE BRAIN
immunocytochemistry (Weiland et al., 1997), whereas they express low levels of
ER
and ER
mRNA by in situ hybridization (Shughrue and Merchenthaler,
2000; McEwen et al., 2001). Instead, immunocytochemistry for ER
showed cell
nuclear ER in sparsely distributed interneurons in the CA1 region as well as other
regions of Ammons horn and dentate gyrus, with greater density in the ventral
than dorsal hippocampus (McEwen and Alves, 1999). As far as ER
immuno-
reactivity, an antibody generated at the C-terminal end of the receptor revealed
only weak labeling of cell nuclei, particularly in the ventral hippocampus, and
some staining of dendrites of pyramidal cells (Shughrue and Merchenthaler,
2001).
Autoradiography with
125
I estrogen to label ER with a higher-specic
radioactivity showed binding sites not previously detected in hippocampus using
3
H estradiol (Shughrue and Merchenthaler, 2000). Besides the interneurons
previously seen to contain ER
by other methods, labeling with
125
I estrogen was
found in CA1CA3 pyramidal cell nuclei in ventral hippocampus. A similar
dorsal-to-ventral gradient was seen for ER
and ER
mRNA and
125
I estrogen
binding. The ER
signal appeared to be stronger than that for ER
(Shughrue
and Merchenthaler, 2000). Thus, the greater sensitivity of
125
I estrogen labeling
of ER reveals sites that may indicate locations of estrogen actions in hippocampal
pyramidal cells, particularly in the ventral hippocampus. A recent developmental
study of ER
in the rat hippocampus is consistent with this and suggests that,
early in development, more pyramidal cells may have nuclear ER
than in the
adult (Solum and Handa, 2001). Recent data with radioimmunocytochemistry
have shown much stronger estrogen effects on synapse and spine protein levels
in ventral, compared to dorsal hippocampus (Bulloch et al., 2000).
E. CELL-CULTURE MODEL OF SYNAPSE FORMATION
It has been possible to study estrogen-induced synapse formation in cell
cultures of hippocampal neurons. In this model, estrogen induces spines on
dendrites of dissociated hippocampal neurons in cell culture by a process that is
blocked by an NMDA receptor antagonist and not by an AMPA (alpha-amino-
3-hydroxy-5-methylisoxasole proprionic acid)/kainate receptor blocker (Murphy
and Segal, 1996). Furthermore, estrogen treatment was found to increase expres-
sion of phosphorylated cyclic AMP response binding protein (CREB). A specic
antisense to CREB prevented both the formation of dendritic spines and the
elevation in phosphoCREB immunoreactivity (IR) (Murphy and Segal, 1997).
The cellular location of ER
in the cultures, resembling the in vivo
localization, was in putative inhibitory interneurons (i.e., glutamic acid decar-
boxylase (GAD)-immunoreactive cells) that constituted around 20% of total
neuronal population. Estrogen treatment caused decreases in GAD content and
the number of neurons expressing GAD. Mimicking this decrease with an
372 BRUCE MCEWEN
inhibitor of gamma aminobutyric acid (GABA) synthesis, mercaptopropionic
acid, caused an upregulation of dendritic spine density, paralleling the effects of
estrogen (Murphy et al., 1998a). Thus, estrogen-induced synapse formation may
involve the suppression of GABA inhibitory input to the pyramidal neurons
where the synapses are being generated (Figure 6).
An additional factor in the formation of dendritic spines in the in vitro cell
culture model is the neurotrophin, brain-derived neurotrophic factor (BDNF)
(Murphy et al., 1998b). Besides downregulating GABA expression in inhibitory
interneurons, estrogen treatment also reduced BDNF by 60% within 24 hours
(Murphy et al., 1998b). Exogenous BDNF blocked estrogen induction of den-
dritic spines; furthermore, BDNF depletion either with an antisense or blockade
with BDNF antibodies mimicked estrogen in inducing spine density. Thus,
BDNF is also an important player in regulating dendritic spines in hippocampal
neurons (Murphy et al., 1998b). In this connection, neurotrophins such as BDNF
and neurotrophin-3 (NT-3) also increase the function of inhibitory and excitatory
Fig. 6. Because of the prominent presence of ER
in some of the inhibitory interneurons in the
hippocampus and the presence of similar ER
-positive GABA cells in hippocampal cell culture,
Murphy and Segal proposed a model of the control of spine synapse formation in which estrogen
treatment suppresses the inhibitory tone upon CA1 pyramidal neurons and creates an environment
conducive to the formation of new excitatory spine synapses. Blocking GABA inhibition and
immunoneutralizing the neurotrophin, BDNF increased spine synapse formation in cell culture. [See
text for details and references.]
373ESTROGEN ACTIONS THROUGHOUT THE BRAIN
synapses in hippocampal cell cultures; moreover, BDNF causes an increase in
axonal branching and length of GABAergic interneurons (Vicario-Abejon et al.,
1998). Hence, BDNF appears to favor the growth of inhibitory interneurons and
the functional activation of synaptic transmission in excitatory and inhibitory
cells, while suppressing the formation of the type of excitatory synaptic connec-
tions induced by estradiol (Figure 6).
F. NON-NUCLEAR ESTROGEN RECEPTORS
As compelling as the role of estrogen-regulated GABA input appears to be
to the mechanism of synapse formation, we were not satised that there was no
additional role for estrogen actions in the pyramidal neurons themselves. Given
the increasing evidence for such a mechanism, it seemed plausible that, besides
the indirect, trans-synaptic mechanism described above, local signaling by
estrogen might be involved. This hypothesis was stimulated by a seminal study
that ER
and ER
into Chinese hamster ovarian cells found that both ERs are
expressed in a form that couples to second messenger systems that are stimulated
by estrogen and blocked at least partially by nonsteroidal estrogen antagonists
(Razandi et al., 1999). Previous studies had indicated that non-nuclear ERs can
be seen at the light microscopic level in cultured cells (Clarke et al., 2000) and
also at the electron microscopic (EM) level in hypothalamus (Blaustein et al.,
1992). The proliferation of articles on non-nuclear actions of estrogen via
membrane ER and membrane-associated ER (Kelly and Levin, 2001) has
reinforced the importance of investigating non-nuclear actions of estrogens in the
hippocampus.
Electron microscopy was used to examine ER
localization in rat hippocam-
pal formation (Milner et al., 2001) utilizing four antibodies to different parts of
the ER
structure, two polyclonal and two monoclonal. The specicity of these
antibodies was determined by preabsorption with the full-length ER protein,
which abolished labeling in all sites examined, both nuclear and non-nuclear. We
were able to see at the EM level the cell nuclear labeling seen by light
microscopy in some GABA interneurons. In addition, some pyramidal and
granule neuron perikarya have small amounts of ER
IR in the nuclear mem-
brane, which is consistent with a recent report that
125
I estradiol labels a small
number of estrogen-binding sites in cell nuclei of hippocampal principal cells
(Shughrue and Merchenthaler, 2000).
In stratum radiatum of CA1, around 50% of the ER
-IR proles were found
in unmyelinated axons and axon terminals containing small synaptic vesicles.
This is of potential functional relevance, given ndings that estrogen can
inuence neurotransmitter release (see McEwen et al., 2001, for references). The
synaptic ER
-IR was found in terminals that formed both asymmetric and
symmetric synapses on dendritic shafts and spines, suggesting that both excita-
374 BRUCE MCEWEN
tory and inhibitory transmitter systems are associated with ER
(Milner et al.,
2001).
Around 25% of the ER
IR was found in dendritic spines of principal cells,
where it often was associated with spine apparati and/or post-synaptic densities,
suggesting that estrogen might act locally to regulate calcium availability,
phosphorylation, or protein synthesis. Finally, the remaining 25% of ER
IR was
found in astrocytic proles, often located near the spines of principal cells.
While these ndings corroborate existing evidence for an indirect GABA-
ergic mediation of estrogen actions (Murphy et al., 1998a; Rudick and Woolley,
2000), the close association between the ER
-IR and dendritic spines supports a
possible local, nongenomic role for this ER in regulation of dendritic spine
density via second messenger systems. Initial in vivo and in vitro studies in
hippocampus of one second messenger pathway, the phosphorylation of CREB,
have indicated that estrogen has rapid effects that are evident within as little as
15 minutes to increase phosphoCREB immunoreactivity in cell nuclei of
hippocampal pyramidal neurons (S. Lee, S. Alves, B. McEwen, unpublished
data). One pathway by which CREB phosphorylation may occur involves the
phosphoinositol-3 (PI3) kinase, or Akt, system (Datta et al., 1999). Studies are
underway to try to connect these events together in the early actions of estrogen
on hippocampal neurons that precede the induction of synapse formation. We
next consider some of the cellular and molecular events associated with the
formation of synapses in which estrogen actions may be involved.
G. DENDRITIC
MRNA TRANSPORT AND PROTEIN SYNTHESIS
The nding of non-nuclear ER
in dendritic spines compelled us to consider
sites and mechanisms whereby estrogens could regulate the process of synapse
formation via post-transcriptional mechanisms. Protein synthesis is likely to be
an essential component of de novo synapse formation. Neurons have at least three
strategies for activity-dependent regulation of protein synthesis and targeting of
those proteins to pre- and postsynaptic sites (Tiedge et al., 2001). First, there is
translation of mRNA in the cell soma and trafcking of proteins to tagged
synapses. Second is transport of mRNA into the dendrites or growth cones and
local translation into protein on polyribosomal clusters such as are found at the
base of spines. The third strategy is local regulation of the translation of
transported mRNAs (Tiedge et al., 2001).
Dendrites contain transported mRNAs for gene products such as MAP-2,
CaMKII, NMDA R1 subunit, Arc, GAP-43, and BC1 (Gao, 1998). One feature
of the regulation of translation is that the dendritic mRNAs are decient in poly
A; therefore, the regulation of polyadenylation by cytoplasmic polyadenylation
element binding protein (CPEP) is able to rapidly activate translation (Wells et
al., 2000). Moreover, other regulatory points such as the initiation of the
375ESTROGEN ACTIONS THROUGHOUT THE BRAIN
translation process via regulatory factors are subject to second messenger-
stimulated phosphorylation (Gingras et al., 1999). These are currently under
investigation in our laboratory as far as possible regulation by estrogen.
H. A MODEL OF ESTROGEN ACTION INVOLVING GENOMIC AND
NONGENOMIC ERs
The results summarized above have led us to propose a testable, working
model (Figure 7) that delineates possible sites of estrogen action in relation to the
location of nuclear and non-nuclear ERs. Although this model pertains to ER
because we know more about its distribution, further studies of ER
may reveal
that it is present in non-nuclear as well as cell nuclear sites within the hippocam-
pus and may participate in some of the processes outlined in Figure 7. According
to our model, ER in the dendritic spine may be associated with the activation of
mRNA translation from polyribosomes (Tiedge et al., 2001) or endomembrane
structures found in spines (Pierce et al., 2000). In addition, other second
messenger signaling effects might include the phosphorylation of neurotransmit-
ter receptors or ion channels. ERs in certain presynaptic terminals might mod-
ulate neurotransmitter release or reuptake (see McEwen et al., 2001, for refer-
ences). Moreover, ER-mediated activation of second messenger systems in
dendritic spines and presynaptic endings might lead to retrograde signal trans-
duction back to the cell nucleus, perhaps via Akt or CREB, providing another
pathway through which estrogen could regulate gene expression. As indicated at
the bottom right of Figure 7, we consider that these postulated actions of estrogen
operate synergistically with the actions of estrogen via nuclear receptors in
interneurons that modulate the inhibitory tone upon the CA1 pyramidal neurons
where synapse formation occurs.
V. Possible Functional Significance
The functional signicance of estrogen actions in the hippocampal CA1
region is evident from electrophysiological studies indicating that estrogen
treatment of ovariectomized rats produces a delayed facilitation of synaptic
transmission in CA1 neurons that is NMDA mediated and leads to an enhance-
ment of voltage-gated Ca
2
currents (Wong and Moss, 1992). Using biocytin
injection after recording from CA1 pyramidal neurons in order to visualize
estrogen induction of dendritic spines, Woolley and coworkers (1997) found that
spine density correlated negatively with input resistance. Input/output curves
showed an increased slope under conditions where NMDA receptor-mediated
currents predominated, whereas there was no increased slope where AMPA
receptor currents predominated. Other studies have shown that LTP sensitivity
peaks on the afternoon of proestrus in intact female rats at exactly the time when
376 BRUCE MCEWEN
FIG. 7. Schematic depiction of an overall model of estrogen (E) regulation of spine synapse formation, based upon the model shown in Figure 6,
combined with ER localization in non-nuclear sites in CA1 pyramidal neurons that respond to E with synapse formation. As summarized in the text, ER
immunoreactivity is found in dendrites, presynaptic terminals, glia, and the nuclear envelope of some principal cells as well as in cell nuclei of inhibitory
interneurons (Milner et al., 2001). Glia may be involved in synapse formation and/or removal. The left side of the gure highlights the fact that dendrites
are sites of protein synthesis on polyribosomes and at endomembrane structures using RNAs transported from the cell body (see text). Non-nuclear ER may
be involved in other E effects linked to second messenger activation on processes such as neurotransmitter release (top of gure) and phosphorylation of
neurotransmitter receptors and ion channels. Second messenger activation by E in nerve terminals, dendrites, and glial cell processes may result in retrograde
second messenger signals, such as P-CREB and P-Akt, that return to signal the genome. These actions synergize with the transient decrease in
GABA-inhibitory tone produced by estrogen actions on ER
-containing inhibitory interneurons based upon the model in Figure 6.
377ESTROGEN ACTIONS THROUGHOUT THE BRAIN
excitatory synapse density has reached its peak (Warren et al., 1995). Proestrus
is also the time of the estrous cycle when seizure thresholds in dorsal hippocam-
pus are the lowest (Terasawa and Timiras, 1968).
Besides affecting neuronal activity in hippocampus, estrogen treatment
affects hippocampal-dependent learning and memory. In the natural estrous cycle
of the female rat, a recent study has utilized a delayed matching-to-place task in
female rats to show a close parallel between the temporal conditions by which
estrogen improves memory and the conditions for it to induce new excitatory
synaptic connections in the hippocampus (McEwen et al., 2001). Moreover,
estrogen treatment of ovariectomized female rats has been reported to improve
acquisition on a radial maze task as well as in a reinforced T-maze alternation
task (Fader et al., 1998; Daniel et al., 1999). Furthermore, sustained treatment is
reported to improve performance in a working memory task (ONeal et al., 1996)
as well as in the radial-arm maze (Luine et al., 1998; Daniel et al., 1999). Finally,
the effects of estrogen replacement in rats are reminiscent of the effects of
treatment in women whose estrogen levels have been suppressed by a gonado-
trophin-releasing hormone agonist used to shrink the size of broids prior to
surgery (Sherwin and Tulandi, 1996).
In addition to the delayed effects of estrogens in hippocampus, estrogens and
some form of ER are involved in local signaling within neurons. Among the
possible targets of local signaling is the translation of RNAs found in dendrites
of hippocampal and other neurons. There are at least three other targets for local
signaling by estrogens. They are 1) the rapid activation of kainate-induced ion
currents via a G protein-coupled ER that is present in
ERKO mice and is
insensitive to nonsteroidal estrogen antagonists (Gu et al., 1999); 2) the suppres-
sion of calcium ion currents that is mimicked by a nonsteroidal estrogen
antagonist (Mermelstein et al., 1996); and 3) rapid actions of estradiol on NMDA
receptor activity and LTP (Teyler et al., 1980; Foy et al., 1999).
VI. Conclusions
It is abundantly clear that estrogen actions in brain and other tissues involve
an array of cellular and molecular mechanisms and that estrogens inuence many
behavioral and physiological processes that go beyond their traditional role in
reproduction. Brain regions such as the hippocampus are affected by estrogens,
even though they have a paucity of cell nuclear ERs. These actions may be
explained by the powerful trans-synaptic inuence of a small number of ER-
containing cells upon other neurons (e.g., GABA inhibitory neurons depicted in
Figure 6) or by non-nuclear ERs and second messenger activation, or a combi-
nation of both. Elsewhere in the nervous system, cell nuclear ER
may well help
explain estrogen actions in other brain areas that do not express ER
. What all
of this means is that, besides the classical genomic actions of estradiol that have
378 BRUCE MCEWEN
been studied for over 40 years, the molecular mechanisms of estrogen action are
likely to involve many pathways not ordinarily considered, in which indirect
genomic activation may occur as a consequence of second messenger activation.
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... A limited number of non-clinical studies have been conducted to address the impairing effect of tamoxifen on memory consolidation and retrieval (Chen et al., 2017;Tajik et al., 2016). Tamoxifen, as a selective estrogen receptor modulator (SERM) or an estrogen antagonist, has diverse effects on the brain's estrogen receptors (McEwen, 2002). Estrogen facilitates cognitive performance (Genazzani et al., 2007) through acting on estrogen receptors alpha (ERα) and beta (ERβ). ...
... In addition, our results indicate that successful memory recall after exposure to the passive avoidance task provokes an increase in cFos expression in all targeted sites of the control/vehicle groups. Considering the modulatory role of tamoxifen on estrogen receptors, the diverse effects can be predicted on the brain estrogen receptors (McEwen, 2002). ...
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Tamoxifen-induced cognitive dysfunction may lead to fluoxetine consumption in patients with breast cancer. Since the brain mechanisms are unclear in tamoxifen/fluoxetine therapy, the blockade effect of hippocampal/amygdala/prefrontal cortical NMDA receptors was examined in fluoxetine/tamoxifen-induced memory retrieval. We also assessed the corticolimbic signaling pathways in memory retrieval under the drug treatment in adult male Wistar rats. Using the Western blot technique, the expression levels of the cAMP response element-binding protein (CREB), brain-derived neurotrophic factor (BDNF), and cFos were evaluated in the corticolimbic regions. The results showed that pre-test administration of fluoxetine (3 and 5 mg/kg, i.p.) improved tamoxifen-induced memory impairment in the passive avoidance learning task. Pre-test bilateral microinjection of D-AP5, a selective NMDA receptor antagonist, into the dorsal hippocampal CA1 regions and the central amygdala (CeA), but not the medial prefrontal cortex (mPFC), inhibited the improving effect of fluoxetine on tamoxifen response. It is important to note that the microinjection of D-AP5 into the different sites by itself did not affect memory retrieval. Memory retrieval increased the signaling pathway of pCREB/CREB/BDNF/cFos in the corticolimbic regions. Tamoxifen-induced memory impairment decreased the hippocampal/PFC BDNF level and the amygdala level of pCREB/CREB/cFos. The improving effect of fluoxetine on tamoxifen significantly increased the hippocampal/PFC expression levels of BDNF, the PFC/amygdala expression levels of cFos, and the ratio of pCREB/CREB in all targeted areas. Thus, NMDA receptors’ activity in the different corticolimbic regions mediates fluoxetine/tamoxifen memory retrieval. The corticolimbic synaptic plasticity changes likely accompany the improving effect of fluoxetine on tamoxifen response.
... To date, many studies have focused on single cognitive domains such as verbal memory as the brain areas that serve this function are disproportionately rich in estrogen receptors (McEwen, 2002), with conflicting findings (Meyer et al., 2003;Fuh et al., 2006;Greendale et al., 2009Greendale et al., , 2010Epperson et al., 2013;Weber et al., 2013). Variations in study design and size may have led to these inconsistencies. ...
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Aims Female sex is associated with an increased prevalence of dementia. Menopause may have a role to play in explaining sex differences in cognition, and possibly the risk of future dementia. We aimed to determine if the rate of cognitive decline differed between stages of the menopausal transition. Materials and methods Women with data on menopause and longitudinal cognitive function from the UK Biobank study were stratified into three groups: premenopausal, perimenopausal and postmenopausal. We studied associations of these menopause groups with rate of change in reaction time, verbal-numeric reasoning, prospective memory, visual memory and attention/working memory, adjusted for age, education, ethnicity and APOEε4 genotype. We also explored the effect of menopausal hormonal therapy (MHT) use and cross-sectional brain magnetic resonance imaging (MRI) volumes on these models. Results We included 15,486 women (baseline mean age 52 years) over a mean duration of 8 years. An interaction between menopausal group status and time was found for reaction time ( p < 0.01). Compared with premenopausal women, the rate of increase (worsening) in reaction time was least in postmenopausal women (β = −1.07, p for interaction = 0.02). In general, compared with premenopausal women, perimenopausal and postmenopausal women had overall poorer performance in fluid intelligence and memory over the study duration, with no difference in rates of change. The models were unaffected by MHT use and brain volume measures. Conclusions Perimenopause and post-menopause are associated with cognitive changes. Psychomotor speed appears to be most sensitive to the menopause transition, whereas other cognitive functions may be less susceptible. More sensitive structural or functional brain imaging may be required to understand the underlying neural basis for these findings.
... NOS1 is the first gene encoding a neurotransmitter-synthesizing enzyme to be implicated in CHH. The increase in Nos1-dependent NO production in the hypothalamus and hippocampus of infantile female mice appears to depend on hormones secreted by the maturing gonads, likely estrogens (47)(48)(49), which promotes the establishment of neuronal circuits in several other brain areas (50)(51)(52). Furthermore, sildenafil, used to treat erectile dysfunction in men, increases serum testosterone (53), and in 10 to 20% of patients with CHH, hormone therapy to normalize their sex steroid milieu reverses their condition (54). ...
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... Older women showed lesser PPT scores than younger women on dominant and non-dominant hand respectively (Ranganathan et al., 2001;Soyupek et al., 2006). Older women who experienced symptoms of hormonal deficiency and aging progress may facilitate deficits in motor dexterity and processing speed of cognitive function (Greendale et al., 2009;McEwen, 2001McEwen, , 2002. Taken together, age-related deficits in motor control and drastic hormonal change may impair dexterity at dominant hand in older women. ...
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... In this mini-review, we will use the abbreviation E2 to refer to 17b-estradiol and will focus predominantly on this form as this is the most abundant and most of the research has been largely focused on studying this molecule. In addition to its role in reproductive functions, E2 has a profound influence on the central nervous system (1,2). This has contributed to the interest generated around the impact of E2 on neuronal function in health and disease. ...
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... In parallel, tumor-bearing rodent models display impaired cognitive function [13] and increased affective-like behaviors, [14,15] which may be driven by in ammation [16][17][18]. Estrogens are not only essential in regulating reproductive functioning but are also potent neuroprotective steroids that promote cognitive function and balance mood [19,20]. The bene cial effects of estrogens on the brain are hypothesized to be due, in part, to their anti-in ammatory and neuroprotective properties [21]. ...
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... Indeed, pretreatment concentrations of circulating inflammatory markers are elevated in patients with cancer and rodent tumor models (12)(13)(14) and are correlated with the neurobehavioral deficits (9,(14)(15)(16)(17), implying that inflammation may be a key mechanistic pathway involved (18)(19)(20). Estrogens are not only essential in regulating reproductive functioning but are also potent neuroprotective steroids that promote cognitive function and balance mood (21,22). The beneficial effects of estrogens on the brain are hypothesized to be due, in part, to their anti-inflammatory and neuroprotective properties (23). ...
Article
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Chapter
The human brain continues to develop and change throughout life. Structural and functional studies research helps us to understand that the brain matures through gestation, infancy, childhood, adolescence and into young adulthood up until the mid to late twenties (Kolb and Whishaw, 2015). Healthy brain maturation during childhood and adolescence supports learning through these years and is considered essential for normative cognitive, social, and emotional development, setting the scene for a healthy, positive adulthood. Puberty is a key stage in development involving a complex cascade of hormonal changes, particularly those identified as sex hormones (androgens and estrogens) and the hypothalamic and pituitary hormones that control their release. Although most often researched in relation to puberty, the effect of sex hormones on our bodies and brains begins in utero and continue throughout our life. Despite the clear overlap in timing of brain development and the fluctuation of hormones throughout the first 20 years of our life, research investigating the association between the two from a developmental point of view is much less well developed than might be expected. This chapter will provide a brief review of brain development including in utero maturation through to adolescence and discuss the simultaneously occurring sex hormone changes occurring throughout this period. Following this, we present a review and critique of the literature investigating the role of sex hormones on brain development and functioning across both animal and human studies and examine how this links with adolescent brain development and the associated changes in neurocognitive functioning. Finally, we use provided case study that illustrates the potential relevance of these findings to modern clinical practice.
Article
Different effects of estrogen on synaptic plasticity has been reported. Here, we summarise effects of low, gonad-derived serum estrogen concentrations, of intermediate concentrations, provided by hippocampal cells, and of pharmacological doses of estrogen on synapses and spines and on the expression of synaptic proteins. No effects of low concentrations were found. To study the effects of hippocampus-derived estradiol, we inhibited hippocampal estrogen synthesis by treatment of hippocampal cell cultures with letrozole, an aromatase inhibitor. Alternatively, we used siRNA against Steroidogenic acute regulatory protein (StAR). Spines, synapses, and synaptic proteins were significantly downregulated in response to letrozole and in siRNA-StAR transfected cells. Application of high pharmacological doses of estradiol promoted only synaptophysin expression, a presynaptic protein, but did not increase the number of boutons. Our results point to an essential role of endogenous hippocampal estrogen in hippocampal synaptic plasticity rather than to a direct influence of estrogens derived from peripheral sources, such as the gonads.
Chapter
Research examining the menstrual cycle and mental health has received increased interest in recent decades. In the current article, we describe the history of menstrual cycle and ovarian hormone research in psychological science and provide an overview of work examining the menstrual cycle in mood and anxiety. Although the study of the menstrual cycle in mood and anxiety has a troubled history, research in recent decades has largely aimed to understand this association for the benefit of women's health and wellbeing. However, extant findings suggest it is unclear how and for whom the menstrual cycle and ovarian hormones play a role in mood and anxiety. We provide several critical future directions that could improve our understanding of mixed findings to strengthen research quality, including establishing and consistently using methodological best practices and increasing attention to societal factors. Scientists examining the menstrual cycle and ovarian hormones in mental health must continue to grapple with how societal beliefs and context influence this work, so that research can truly be to the benefit of all females.
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Previously our laboratory has shown that 17β-estradiol in vivo rapidly decreases R(&plus;)-8-OH-DPAT-stimulated [35S]GTPγS binding (a measure of the initial biochemical event in the intracellular signaling pathway associated with 5-HT1A receptors) in the hippocampus, frontal cortex and amygdala. Studies were designed to determine if 17β-estradiol also acts in vitro on estrogen receptors in the hippocampus and frontal cortex to decrease -HT1A receptor function. Hippocampus and frontal cortex were dissected from ovariectomized rats and incubated for up to 3 h with various estrogens and antiestrogens; membrane homogenates were prepared for R(&plus;)-8-OH-DPAT-stimulated [35S]GTPγS binding assays. 17β-Estradiol (10–6 M) decreased the maximal response in the R(&plus;)-8-OH-DPAT-stimulated [35S]GTPγS binding assay in a time-dependent manner (observed at 30, 60 and 120 min) in both hippocampus and frontal cortex. The hormone, however, did not alter the EC50 of R(&plus;)-8-OH-DPAT. When hippocampus and frontal cortex were incubated in graded concentrations of 17β-estradiol for 1 h, the calculated EC50 was approximately 2.5 × 10–8 M in both brain regions. The nonestradiol estrogen diethylstilbestrol also decreased -HT1A receptor function while the less potent estrogens 17α-estradiol and estriol were inactive at 5 × 10–8 M. The estrogen receptor antagonist ICI 182,780 potently and completely blocked the effects of 17β-estradiol on -HT1A receptor function with an apparent KB of approximately 10–9 M. These data demonstrate clearly that estrogens can act on estrogen receptors located in hippocampus and frontal cortex of ovariectomized rats to produce rapid heterologous decreases in -HT1A receptor function.
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