![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 98:8071-8076. Copyright 2001 National Academy of Sciences, USA.]](https://www.researchgate.net/profile/Bruce-Mcewen-2/publication/11353348/figure/fig4/AS:668339949031433@1536356069922/Young-adult-female-rats-show-upregulation-of-both-NMDA-receptors-and-dendritic-spines-on_Q320.jpg)
![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.]](https://www.researchgate.net/profile/Bruce-Mcewen-2/publication/11353348/figure/fig3/AS:282252434001924@1444305632610/Because-of-the-prominent-presence-of-ER-in-some-of-the-inhibitory-interneurons-in-the_Q320.jpg)
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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 deficiency. Although hot
flushes are, for many women, the most-dramatic and noticeable consequence of
loss of ovarian hormones, some women experience, at surgical or natural
menopause, difficulties in remembering names and other information important
for daily life as well as deficits in fine 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 deficiency 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 deficiency.
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 reflect 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 reflect 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 identified 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 identification and mapping of cells that
contain ERs were extended from the uterus and mammary glands to the brain and
pituitary gland (Pfaff, 1980). At first, 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
identified (see McEwen and Alves, 1999, for summary). The best characterized
of these splice variants is ER

2, as opposed to the originally identified isoform,
ER

1. ER

2 appears to have a lower affinity 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 reflect binding to all forms of the ER, particularly the ER
␣
and
ER

1 isoforms, which have similar, high affinities 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 specific
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 specific 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
CA1–CA3 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 affinity 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 findings 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 stereospecificity for 17

over 17
␣
estradiol is replaced by a broader specificity 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 confined 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 profile of some of these effects have raised
questions about the possible “nontraditional” and 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 specifically 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 significant 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 significant 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 427:185–195. 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 significant 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
59:205–214.]
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 efficacy 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 finding 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 finding 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 98:8071–8076.
Copyright 2001 National Academy of Sciences, USA.]
368 BRUCE MCEWEN
reminiscent of the finding in cultured hippocampal cells studied by time-lapse
photography that filopodia 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 filaments 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 filled 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
98:3525–3530. 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 filling 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 confirmed 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 first 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 finding agreed with the Golgi results (McEwen et al., 1999a). One
unique finding 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
reflects expression of spinophilin in the absence of any estrogen-induced changes
in presynaptic proteins. Further studies are needed to confirm 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-specific (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 specific 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 findings 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 142:1284–1289. 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 Ammon’s 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-specific
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 CA1–CA3 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 specific
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 satisfied 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 specificity 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 profiles were found
in unmyelinated axons and axon terminals containing small synaptic vesicles.
This is of potential functional relevance, given findings that estrogen can
influence 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 profiles, often located near the spines of principal cells.
While these findings 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 finding 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 trafficking 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 deficient 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 significance 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 figure 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 figure) 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 (O’Neal 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 fibroids 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 influence 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 influence 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.
REFERENCES
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
98:8071–8076
Allen PB, Ouimet CC, Greengard P 1997 Spinophilin, a novel protein phosphatase 1 binding
protein localized to dendritic spines. Proc Natl Acad Sci USA 94:9956–9961
Alves S, Weiland NG, Hayashi S, McEwen B 1998 Immunocytochemical localization of nuclear
estrogen receptors and progestin receptors within the dorsal raphe nucleus. J Comp Neurol
391:322–334
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 427:185–195
Auger AP, Tetel MJ, McCarthy MM 2000 Steroid receptor coactivator-1 (SRC-1) mediates the
development of sex-specific brain morphology and behavior. Proc Natl Acad Sci USA
97:7551–7555
Bazzett TJ, Becker JB 1994 Sex differences in the rapid and acute effects of estrogen on striatal D
dopamine receptor binding. Brain Res 637:163–172
Bethea CL, Pecins-Thompson M, Schutzer WE, Gundlah CLZN 1999 Ovarian steroids and
serotonin neural function. Mol Neurobiol 18:87–123
Blaustein JD, Lehman MN, Turcotte JC, Greene G 1992 Estrogen receptors in dendrites and axon
terminals in guinea pig hypothalamus. Endocrinology 131:281–290
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 142:1284–1289
Brinton RD 2001 Cellular and molecular mechanisms of estrogen regulation of memory function and
neuroprotection against Alzheimer’s disease: Recent insights and remaining challenges. Learn
Memory 8:121–133
Bulloch K, Brake WG, Lee SJ, Patel A, Wolf OT, McEwen BS 2000 Estrogen increases synaptic
protein immunoreactivity in the dorsal and ventral hippocampus of ovariectomized rats. Abstr
Soc Neurosci 26(7.1):4 (Abstract)
Calizo LH, Flanagan-Cato LM 2000 Estrogen selectively regulates spine density within the
dendritic arbor of rat ventromedial hypothalamic neurons. J Neurosci 20:1589–1596
Carrer H, Aoki A 1982 Ultrastructural changes in the hypothalamic ventromedial nucleus of
ovariectomized rats after estrogen treatment. Brain Res 240:221–233
Clarke CH, Norfleet AM, Clarke MSF, Watson CS, Cunningham KA, Thomas ML 2000
Perimembrane localization of the estrogen receptor
␣
protein in neuronal processes of
cultured hippocampal neurons. Neuroendocrinology 71:34–42
Crino PB, Eberwine J 1996 Molecular characterization of the dendritic growth cone: regulated
mRNA transport and local protein synthesis. Neuron 17:1173–1187
Daniel JM, Roberts SL, Dohanich GP 1999 Effects of ovarian hormones and environment on radial
maze and water maze performance of female rats. Physiol Behav 66:11–20
Datta SR, Brunet A, Greenberg ME 1999 Cellular survival: a play in three Akts. Genes Dev
13:2905–2927
Eichenbaum H, Otto T 1992 The hippocampus – what does it do? Behav Neural Biol 57:2–36
379ESTROGEN ACTIONS THROUGHOUT THE BRAIN
Fader AJ, Hendricson AW, Dohanich GP 1998 Estrogen improves performance of reinforced
T-maze alternation and prevents the amnestic effects of scopolamine administered systemi-
cally or intrahippocampally. Neurobiol Learn Memory 69:225–240
Feng J, Yan Z, Ferreira A, Tomizawa K, Liauw JA, Zhuo M, Allen PB, Ouimet CC, Greengard
P 2000 Spinophilin regulates the formation and function of dendritic spines. Proc Natl Acad
Sci USA 97:9287–9292
Fischette C, Biegon A, McEwen BS 1984 Sex steroid modulation of the serotonin behavioral
syndrome. Life Sci 35:1197–1206
Foy MR, Xu J, Xie X, Brinton RD, Thompson RF, Berger TW 1999 17

-estradiol enhances
NMDA receptor-mediated EPSPs and long-term potentiation. J Neurophysiol 81:925–929
Frankfurt M, Gould E, Wolley C, McEwen BS 1990 Gonadal steroids modify dendritic spine
density in ventromedial hypothalamic neurons: a Golgi study in the adult rat. Neuroendocri-
nology 51:530–535
Gao F-B 1998 Messenger RNAs in dendrites: localization, stability, and implications for neuronal
function. BioEssays 20:70–78
Gazzaley AH, Weiland NG, McEwen BS, Morrison JH 1996 Differential regulation of NMDAR1
mRNA and protein by estradiol in the rat hippocampus. J Neurosci 16:6830–6838.
Gazzaley AH, Benson DL, Huntley GW, Morrison JH 1997 Differential subcellular regulation of
NMDAR1protein and mRNA in dendrites of dentate gyrus granule cells after perforant path
transection. J Neurosci 17:2006–2017
Gingras A-C, Raught B, Sonenberg N 1999 eIF4 initiation factors: Effectors of mRNA recruitment
to ribosomes and regulators of translation. Annu Rev Biochem 68:913–963
Gould E, Woolley C, Frankfurt M, McEwen BS 1990 Gonadal steroids regulate dendritic spine
density in hippocampal pyramidal cells in adulthood. J Neurosci 10:1286–1291
Goy R, McEwen BS 1980 Sexual Differentiation of the Brain. Cambridge: MIT Press
Green PS, Bishop J, Simpkins JW 1997 17

-Estradiol exerts neuroprotective effects on SK-N-SH
cells. J Neurosci 17:511–515
Gu Q, Korach KS, Moss RL 1999 Rapid action of 17

-estradiol on kainate-induced currents in
hippocampal neurons lacking intracellular estrogen receptors. Endocrinology 140:660–666
Gundlah C, Pecins-Thompson M, Schutzer WE, Bethea CL 1999 Ovarian steroid effects on
serotonin 1A, 2A and 2C receptor mRNA in macaque hypothalamus. Mol Brain Res
63:325–339
Higley JD, Linnoila M 1997 Low central nervous system serotonergic activity is traitlike and
correlates with impulsive behavior. Ann NY Acad Sci 836:39–56
Horner CH 1993 Plasticity of the dendritic spine. Progr Neurobiol 41:281–321
Hrabovszky E, Kallo I, Hajszan T, Shughrue PJ, Merchenthaler I, Liposits Z 1998 Expression
of estrogen receptor-

messenger ribonucleic acid in oxytocin and vasopressin neurons of the
rat supraoptic and paraventricular nuclei. Endocrinology 139:2600–2604
Jacobs BL 1994 Serotonin, motor activity and depression-related disorders. Am Sci 82:456–463
Jacobson L, Sapolsky R 1991 The role of the hippocampus in feedback regulation of the
hypothalamic-pituitary-adrenocortical axis. Endocr Rev 12:118–134
Jensen E, Jacobson H 1962 Basic guides to the mechanism of estrogen action. Rec Progr Horm Res
18:387–408
Kelly MJ, Levin ER 2001 Rapid actions of plasma membrane estrogen receptors. Trends Endocrinol
Metab 12:152–156
Kelly MJ, Wagner EJ 1999 Estrogen modulation of G-protein-coupled receptors. Trends Endocrinol
Metab 10:369–374
Kelly M, Moss R, Dudley C 1977 The effects of microelectrophoretically applied estrogen, cortisol
and acetylcholine on medial preoptic-septal unit activity throughout the estrous cycle of the
female rat. Exp Brain Res 30:53–64
380 BRUCE M
CEWEN
Kimura D 1992 Sex differences in the brain. Sci Am 267:119–125
Kuiper GGJM, Carlsson B, Grandien K, Enmark E, Haggblad J, Nilsson S, Gustafsson J-A
1997 Comparison of the ligand binding specificity and transcript tissue distribution of
estrogen receptors
␣
and

. Endocrinology 138:863–870
Kuiper GGJM, Shughrue PJ, Merchenthaler I, Gustafsson J-A 1998 The estrogen receptor

subtype: a novel mediator of estrogen action in neuroendocrine systems. Front Neuroendo-
crinol 19:253–286
Lee SJ, McEwen BS 2001 Neurotrophic and neuroprotective actions of estrogens and their
therapeutic implications. Annu Rev Pharmacol Toxicol 41:569–591
Luine V, McEwen BS 1977 Effects of an estrogen antagonist on enzyme activities and 3H estradiol
nuclear binding in uterus, pituitary and brain. Endocrinology 100:903–910
Luine VN, Richards ST, Wu VY, Beck KD 1998 Estradiol enhances learning and memory in a
spatial memory task and effects levels of monoaminergic neurotransmitters. Horm Behav
34:149–162
Maruyama K, Endoh H, Sasaki-Iwaoka H, Kanou H, Shimaya E, Hashimoto S, Kato S,
Kawashima H 1998 A novel isoform of rat estrogen receptor beta with 18 amino acid
insertion in the ligand binding domain as a putative dominant negative regular of estrogen
action. Biochem Biophys Res Commun 246:142–147
Mattson MP, Robinson N, Guo Q 1997 Estrogens stabilize mitochondrial function and protect
neural cells against the pro-apoptotic action of mutant presenilin-1. NeuroReport 8:3817–
3821
Maus M, Homburger V, Bockaert J, Glowinski J, Premont J 1990 Pretreatment of mouse striatal
neurons in primary culture with 17

-estradiol enhances the pertussis toxin-catalyzed ADP-
ribosylation of G
␣
o,i
protein subunits. J Neurochem 55:1244–1251
McEwen BS 1983 Gonadal steroid influences on brain development and sexual differentiation. In:
Greep R, ed. Reproductive Physiology IV. University Park, MD: University Park Press;
99–145
McEwen BS, Alves SH 1999 Estrogen actions in the central nervous system. Endocr Rev 20:279–
307
McEwen BS, Tanapat P, Weiland NG 1999a Inhibition of dendritic spine induction on hippocam-
pal CA1 pyramidal neurons by a non-steroidal estrogen antagonist in female rats. Endocri-
nology 140:1044–1047
McEwen BS, Tanapat P, Weiland NG 1999b Inhibition of dendritic spine induction on hippocam-
pal CA1 pyramidal neurons by a nonsteroidal estrogen antagonist in female rats. Endocri-
nology 140:1044–1047
McEwen BS, Akama K, Alves S, Brake WG, Bulloch K, Lee S, Li C, Yuen G, Milner TA 2001
Tracking the estrogen receptor in neurons: Implications for estrogen-induced synapse forma-
tion. Proc Natl Acad Sci USA 98:7093–7100
Meisel R, Dohanich G, McEwen BS, Pfaff DW 1987 Antagonism of sexual behavior in female rats
by ventromedial hypothalamic implants of antiestrogen. Neuroendocrinology 45:201–207
Mermelstein PG, Becker JB, Surmeier DJ 1996 Estradiol reduces calcium currents in rat
neostriatal neurons via a membrane receptor. J Neurosci 16:595–604
Milner TA, McEwen BS, Hayashi S, Li CJ, Reagen L, Alves SE 2001 Ultrastructural evidence that
hippocampal alpha estrogen receptors are located at extranuclear sites. J Comp Neurol
429:355–371
Mize AL, Poisner AM, Alper RH 2001 Estrogens act in rat hippocampus and frontal cortex to
produce rapid, receptor-mediated decreases in serotonin 5-HT
1A
receptor function. Neuroen-
docrinology 73:166–174
Murphy DD, Segal M 1996 Regulation of dendritic spine density in cultured rat hippocampal
neurons by steroid hormones. J Neurosci 16:4059–4068
381ESTROGEN ACTIONS THROUGHOUT THE BRAIN
Murphy DD, Segal M 1997 Morphological plasticity of dendritic spines in central neurons is
mediated by activation of cAMP response element binding protein. Proc Natl Acad Sci USA
94:1482–1487
Murphy DD, Cole NB, Greenberger V, Segal M 1998a Estradiol increases dendritic spine density
by reducing GABA neurotransmission in hippocampal neurons. J Neurosci 18:2550–2559
Murphy DD, Cole NB, Segal M 1998b Brain-derived neurotrophic factor mediates estradiol-induced
dendritic spine formation in hippocampal neurons. Proc Natl Acad Sci USA 95:11412–11417
Nabekura J, Oomura Y, Minami T, Mizuno Y, Fukuda A 1986 Mechanism of the rapid effect of
17

-estradiol on medial amygdala neurons. Science 233:226–228
Naftolin F 1994 Brain aromatization of androgens. J Reprod Med 39:257–261
O’Neal MF, Means LW, Poole MC, Hamm RJ 1996 Estrogen affects performance of ovariecto-
mized rats in a two-choice water-escape working memory task. Psychoneuroendocrinology
21:51–65
Osterlund MK, Overstreet DH, Hurd YL 1999 The flinders sensitive line rats, a genetic model of
depression, show abnormal serotonin receptor mRNA expression in the brain that is reversed
by 17

-estradiol. Mol Brain Res 74:158–166
Osterlund MK, Halldin C, Hurd YL 2000 Effects of chronic 17

-estradiol treatment on the
serotonin 5-HT
1A
receptor mRNA and binding levels in the rat brain. Synapse 35:39–44
Paech K, Webb P, Kuiper GGJM, Nilsson S, Gustafsson J-A, Kushner PJ, Scanlan TS 1997
Differential ligand activation of estrogen receptors ER
␣
and ER

at AP1 sites. Science
277:1508–1510
Pettersson K, Grandien K, Kuiper GGJM, Gustafsson J-A 1997 Mouse estrogen receptor

forms
estrogen response element-binding heterodimers with estrogen receptor
␣
. Mol Endocrinol
11:1486–1496
Pfaff DW 1980 Estrogens and Brain Function. New York: Springer-Verlag
Phillips RG, LeDoux JE 1992 Differential contribution of amygdala and hippocampus to cued and
contextual fear conditioning. Behav Neurosci 106:274–285
Pierce JP, van Leyen K, McCarthy JB 2000 Translocation machinery for synthesis of integral
membrane and secretory proteins in dendritic spines. Nature Neurosci 3:311–313
Price RH Jr, Lorenzon N, Handa RJ 2000 Differential expression of estrogen receptor beta splice
variants in rat brain: identification and characterization of a novel variant missing exon 4
1
.
Mol Brain Res 80:260–268
Raap DK, DonCarlos L, Garcia F, Muma NA, Wolf WA, Battaglia G, Van de Kar LD 2000
Estrogen desensitizes 5-HT
1A
receptors and reduces levels of G
z
,G
i1
and G
i3
proteins in the
hypothalamus. Neuropharmacology 39:1823–1832
Razandi M, Pedram A, Greene GL, Levin ER 1999 Cell membrane and nuclear estrogen receptors
(ERs) originate from a single transcript: studies of ER
␣
and ER

expressed in Chinese
hamster ovary cells. Mol Endocrinol 13:307–319
Roy E, MacLusky N, McEwen BS 1979 Antiestrogen inhibits the induction of progestin receptors
by estradiol in the hypothalamus, pituitary and uterus. Endocrinology 104:1333–1336
Rubinow DR, Schmidt PJ, Roca CA 1998 Estrogen-serotonin interactions: Implications for
affective regulation. Biol Psychiat 44:839–850
Rudick CN, Woolley CS 2000 Estradiol induces a phasic Fos response in the hippocampal CA1 and
CA3 regions of adult female rats. Hippocampus 10:274–283
Sapolsky R 1992 Stress, the aging brain and the mechanisms of neuron death. Cambridge: MIT
Press; 1–423
Sherwin BB, Tulandi T 1996 “Add-back” estrogen reverses cognitive deficits induced by a
gonadotropin-releasing hormone agonist in women with leiomyomata uteri. J Clin Endocrinol
Metab 81:2545–2549
382 BRUCE M
CEWEN
Shughrue PJ, Merchenthaler I 2000 Evidence for novel estrogen binding sites in the rat hippocam-
pus. Neuroscience 99:605–612
Shughrue PJ, Merchenthaler I 2001 Distribution of estrogen receptor
␣
immunoreactivity in the rat
central nervous system. J Comp Neurol 43:64–81
Shughrue PJ, Lane MV, Merchenthaler I 1999 Biologically active estrogen receptor-
␣
: evidence
from in vivo autoradiographic studies with estrogen receptor
␣
-knockout mice. Endocrinology
140:2613–2620
Solum DT, Handa RJ 2001 Localization of estrogen receptor alpha (ER
␣
) in pyramidal neurons of
the developing rat hippocampus. Devel Brain Res 128:165–175
Stumpf WE, Sar M 1976 Steroid hormone target sites in the brain: the differential distribution of
estrogen, progestin, androgen and glucocorticosteroid. J Steroid Biochem 7:1163–1170
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 59:205–214
Terasawa E, Timiras P 1968 Electrical activity during the estrous cycle of the rat: cyclic changes
in limbic structures. Endocrinology 83:207–216
Teyler T, Vardaris R, Lewis D, Rawitch A 1980 Gonadal steroids: effects on excitability of
hippocampal pyramidal cells. Science 209:1017–1019
Tiedge H, Bloom FE, Richter D 2001 Colloquium: molecular kinesis in cellular function and
plasticity. Proc Natl Acad Sci USA 98:6997–7106
Vicario-Abejon C, Collin C, McKay RDG, Segal M 1998 Neurotrophins induce formation of
functional excitatory and inhibitory synapses between cultured hippocampal neurons. J Neu-
rosci 18:7256–7271
Wang J, Green PS, Simpkins JW 2001 Estradiol protects against ATP depletion, mitochondrial
membrane potential decline and the generation of reactive oxygen species induced by
3-nitroproprionic acid in SK-N-SH human neuroblastoma cells. J Neurochem 77:804–811
Warren SG, Humphreys AG, Juraska JM, Greenough WT 1995 LTP varies across the estrous
cycle: enhanced synaptic plasticity in proestrus rats. Brain Res 703:26–30
Weiland NG 1992 Estradiol selectively regulates agonist binding sites on the N-methyl-D-aspartate
receptor complex in the CA1 region of the hippocampus. Endocrinology 131:662–668
Weiland NG, Orikasa C, Hayashi S, McEwen BS 1997 Distribution and hormone regulation of
estrogen receptor immunoreactive cells in the hippocampus of male and female rats. J Comp
Neurol 388:603–612
Wells DG, Richter JD, Fallon JR 2000 Molecular mechanisms for activity-regulated protein
synthesis in the synapto-dendritic compartment. Curr Opin Neurobiol 10:132–137
Williams CL, Meck WH 1991 The organizational effects of gonadal steroids on sexually dimorphic
spatial ability. Psychoneuroendocrinology 16:155–176
Witelson SF, Glezer II, Kigar DL 1995 Women have greater density of neurons in posterior
temporal cortex. J Neurosci 15:3418–3428
Wong M, Moss RL 1992 Long-term and short-term electrophysiological effects of estrogen on the
synaptic properties of hippocampal CA1 neurons. J Neurosci 12:3217–3225
Woolley C, McEwen BS 1992 Estradiol mediates fluctuation in hippocampal synapse density during
the estrous cycle in the adult rat. J Neurosci 12:2549–2554
Woolley C, McEwen BS 1993 Roles of estradiol and progesterone in regulation of hippocampal
dendritic spine density during the estrous cycle in the rat. J Comp Neurol 336:293–306
Woolley C, McEwen BS 1994 Estradiol regulates hippocampal dendritic spine density via an
N-methyl-D-aspartate receptor dependent mechanism. J Neurosci 14:7680–7687
Woolley C, Gould E, Frankfurt M, McEwen BS 1990 Naturally occurring fluctuation in dendritic
spine density on adult hippocampal pyramidal neurons. J Neurosci 10:4035–4039
383ESTROGEN ACTIONS THROUGHOUT THE BRAIN
Woolley CS, Weiland NG, McEwen BS, Schwartzkroin PA 1997 Estradiol increases the sensi-
tivity of hippocampal CA1 pyramidal cells to NMDA receptor-mediated synaptic input:
correlation with dendritic spine density. J Neurosci 17:1848–1859
Yankova M, Hart SA, Woolley CS 2001 Estrogen increases synaptic connectivity between single
presynaptic inputs and multiple postsynaptic CA1 pyramidal cells: a serial electron-micro-
scopic study. Proc Natl Acad Sci USA 98:3525–3530
Ziv NE, Smith SJ 1996 Evidence for a role of dendritic filopodia in synaptogenesis and spine
formation. Neuron 17:91–102
384 BRUCE M
CEWEN
