In Search for Animal Models of Female Sexual Dysfunction Uitnodiging

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In Search for Animal Models of Female Sexual Dysfunction Uitnodiging In search for animal models of female sexual dysfunction Snoeren Eelke Uitnodiging In search for animal models of Voor het bijwonen van de openbare verdediging female sexual dysfunction van mijn proefschrift Woensdag 1 december 2010 om 16:15 uur in de senaatzaal van het Academiegebouw Domplein 29 te Utrecht Na afl oop van de promotie is er een receptie in het Academiegebouw Eelke Snoeren Faustdreef 365 3561 LL Utrecht 06-19006960 [email protected] Paranimfen Paul Adriaansen Eelke Snoeren Ruud Disco Omslag_Snoeren1.indd 1 19-10-10 11:13 In search for animal models of female sexual dysfunction In search for animal models of female sexual dysfunction Snoeren, Eelke Mirthe Simone Thesis, Utrecht University, with a summary in Dutch Lay-out R. Heijkoop Cover art A.J.M. Snoeren Cover design Ridderprint Printed by Ridderprint ISBN: 978-90-5335-342-4 All rights reserved. No part of this publication may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or informationstorage and retrieval) without the prior written permission of the author. ©2010, Eelke Snoeren, Utrecht, the Netherlands In search for animal models of female sexual dysfunction Op zoek naar diermodellen voor vrouwelijke seksuele disfunctie (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. J.C. Stoof, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op woensdag 1 december 2010 des middags te 4.15 uur door Eelke Mirthe Simone Snoeren geboren op 24 juli 1983 te Oirschot Promotoren: Prof.dr. B. Olivier Prof.dr. M.D. Waldinger Copromotor: Dr. R.S. Oosting Dit proefschrift werd (mede) mogelijk gemaakt met financiële steun van: Emotional Brain BV Turing Institute Almere Table of Contents Chapter 1 General introduction 9 Chapter 2 Serotonin 1A receptors, ligands and sexual 15 behavior: a review Chapter 3 A new female rat animal model for hypoactive 51 sexual desire disorder; behavioral and pharmacological evidence Chapter 4 Combination of testosterone and vardenafil 71 increases female sexual functioning in sub-primed rats Chapter 5 Serotonin transporter null mutation and 89 sexual behavior in female rats: 5-HT1A receptor desensitization Chapter 6 Chronic paroxetine treatment does not affect 107 sexual behavior in hormonally sub-primed female rats despite 5-HT1A receptor desensitization Chapter 7 General discussion 125 Chapter 8 Samenvatting in het Nederlands 137 List of abbreviations Dankwoord About the author List of publications General introduction 1 Eelke Snoeren Chapter 1 Introduction This thesis focuses on the development of an animal model for female sexual dys- function (FSD). FSD is a disorder that affects between 33-48% of the population in the USA and in Europe.1-3 According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV),4 FSD can be divided in four main categories: low sexual desire, low arousal, orgasmic disorders, and sexual pain. Each is defined as “persistent or recurrent” and causes “marked distress or interpersonal difficulty”. The majority of sexual dysfunction surveys identify low sexual desire/interest and sexual arousal disorder as the most common problems in women.5, 6 These sexual disturbances can have multiple causes, like low hormonal levels,7, 8 different disea- ses (anxiety, depression), but also medication. Antidepressants (SSRIs), for instance, can cause sexual dysfunctions in men and women.9-11 Although a large population of women suffers from FSD, the disorder is not well studied, in particular in compari- son with male sexual dysfunction. Research with patients can have ethical and practical limitations, and therefore, animal models are required for neuromolecular, neuroanatomical and psycho- pharmacological research into female sexual behavior and its pathology. Method Throughout this thesis female sexual behavior was measured in a paced mating set- up. The test was performed in a cage with two compartments divided by a sheet 10 with three little holes (4 cm diameter). One compartment was empty and one room contained a sexually active male rat. The female could choose between the com- partments because of her smaller size than the male. The most important factor in this paced mating sex test is the possibility of the female rat to control her sexual behavior. In female sexual behavior research, it is important to use a paced mating set up, because non-paced mating is not rewarding.12, 13 As soon as the female is able to pace her interactions, conditioned place preference is shown.12 What the exact component of paced mating is that is rewarding is unclear. By creating the right environment for a female rat to have rewarding sexual experiences, the outcome of sex experiments will not be influenced anymore by aversive environmental cues, and thus it enables the measurement of the real fe- male’s sexual functioning. Aim of the thesis The goal of this thesis was the development of animal models of FSD. Pharmaco- logical studies were necessary to test the developed animal models for their usefulness in future research. In chapter 2, a review about the existing literature regarding the role of 5-HT1A receptors in sexual behavior is presented. The 5-HT1A receptor was chosen as central topic for this review because of its important role in the regulation of sexual beha- vior. Both, human and animal studies are discussed here to give a broad overview of male and female sexual behavior. General introduction In chapter 3, we have investigated whether stable differences (endophenotypes) in sexual behavior exist between individual female rats. Female rats with low sexual behavior may model women suffering from hyposexual desire or arousal disorders. In the same chapter, the effects of some drugs acting on the 5-HT system or the dopaminergic system are presented. In chapter 4, we used hormonally sub-primed rats as a model for FSD. Female rats were ovariectomized and manually primed with estradiol to develop a rat with lower levels of sexual functioning. To validate this model, the effects of testosterone and vardenafil (PDE-5 inhibitor) alone and in combination were tested. Chronic SSRIs (selective serotonin reuptake inhibitors) are used for the treatment of depression and their use may affect sexual functioning in women. However it is unclear whether the sexual complaint under SSRI users is the result of the drug use or one of the symptoms of depression. In chapter 5, we used the serotonin transporter (SERT) knockout rats to investigate the importance of the SERT in the female sexual behavior. Furthermore, we studied the function of 5-HT1A receptors in these females. Surprisingly, there was no effect of the absence of SERTs on sexual activity in female rats. Maybe, there are adaptive changes in these animals, such as desensitization of the 5-HT1A receptors, that prevents the development of sexual dysfunctions. Therefore, we tested, in chapter 6, the effects of chronic paroxetine (SSRI) treat- ment in ovariectomized female rats. We used both sub-primed and fully-primed females and injected the paroxetine for in total 56 days. After this period of chronic injections, we also screened the females for 5-HT1A receptor desensitization. 11 In the last part, chapter 7, all preceding chapters are summarized, integrated and discussed. Also the perspectives for future research are presented. Chapter 1 References 1. Bancroft J, Loftus J, Long JS. Distress about sex: a national survey of women in heterosexual relationships. Arch Sex Behav. 2003 Jun;32(3):193-208. 2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: preva- lence and predictors. Jama. 1999 Feb 10;281(6):537-44. 3. Dunn KM, Croft PR, Hackett GI. Sexual problems: a study of the prevalen- ce and need for health care in the general population. Fam Pract. 1998 Dec; 15(6):519-24. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-TR. American Psychiatric Association. 2000:493-522. 5. Brotto LA, Bitzer J, Laan E, Leiblum S, Luria M. Women’s sexual desire and arousal disorders. J Sex Med. 2010 Jan;7(1 Pt 2):586-614. 6. Frank E, Anderson C, Rubinstein D. Frequency of sexual dysfunction in “normal” couples. N Engl J Med. 1978 Jul 20;299(3):111-5. 7. Vermeulen A. The hormonal activity of the postmenopausal ovary. J Clin Endocrinol Metab. 1976 Feb;42(2):247-53. 8. Berman JR, Bassuk J. Physiology and pathophysiology of female sexual function and dysfunction. World J Urol. 2002 Jun;20(2):111-8. 9. Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, et al. Prevalence of sexual dysfunction among newer anti- 12 depressants. J Clin Psychiatry. 2002 Apr;63(4):357-66. 10. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psycho- tropic- Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 Suppl 3:10-21. 11. Rosen RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999 Feb;19(1):67-85. 12. Paredes RG, Alonso A. Sexual behavior regulated (paced) by the female induces conditioned place preference. Behav Neurosci. 1997 Feb;111(1):123-8. 13. Martinez I, Paredes RG. Only self-paced mating is rewarding in rats of both sexes. Horm Behav. 2001 Dec;40(4):510-7. Serotonin 1A receptors and sexual behavior: a review 2 Eelke Snoeren Johnny Chan Jan Veening Marcel Waldinger Berend Olivier Ronald Oosting Chapter 2 16 Abstract Serotonin plays an important role in both male and female sexual behavior. Many studies are performed on the role of 5-HT1A receptors in sexual behavior.
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