Sex-dependent, lateralized engagement of anterior insular cortex inputs to the dorsolateral striatum in binge alcohol drinking

Reviewer #1 (Public Review):

Summary:

This paper uses a model of binge alcohol consumption in mice to examine how the behaviour and its control by a pathway between the anterior insular cortex (AIC) to the dorsolateral striatum (DLS) may differ between males and females. Photometry is used to measure the activity of AIC terminals in the DLS when animals are drinking and this activity seems to correspond to drink bouts in males but not females. The effects appear to be lateralized with inputs to the left DLS being of particular interest.

Strengths:

Increasing alcohol intake in females is of concern and the consequences for substance use disorder and brain health are not fully understood, so this is an area that needs further study. The attempt to link fine-grained drinking behaviour with neural activity has the potential to enrich our understanding of the neural basis of behaviour, beyond what can be gleaned from coarser measures of volumes consumed etc.

Weaknesses:

The introduction to the drinking in the dark (DID) paradigm is rather narrow in scope (starting line 47). This would be improved if the authors framed this in the context of other common intermittent access paradigms and gave due credit to important studies and authors that were responsible for the innovation in this area (particularly studies by Wise, 1973 and returned to popular use by Simms et al 2010 and related papers; e.g., Wise RA (1973). Voluntary ethanol intake in rats following exposure to ethanol on various schedules. Psychopharmacologia 29: 203-210; Simms, J., Bito-Onon, J., Chatterjee, S. et al. Long-Evans Rats Acquire Operant Self-Administration of 20% Ethanol Without Sucrose Fading. Neuropsychopharmacol 35, 1453-1463 (2010).) The original drinking in the dark demonstrations should also be referenced (Rhodes et al., 2005). Line 154 Theile & Navarro 2014 is a review and not the original demonstration.

When sex differences in alcohol intake are described, more care should be taken to be clear about whether this is in terms of volume (e.g. ml) or blood alcohol levels (BAC, or at least g/kg as a proxy measure). This distinction was often lost when lick responses were being considered. If licking is similar (assuming a single lick from a male and female brings in a similar volume?), this might mean males and females consume similar volumes, but females due to their smaller size would become more intoxicated so the implications of these details need far closer consideration. What is described as identical in one measure, is not in another.

No conclusions regarding the photometry results can be drawn based on the histology provided. Localization and quantification of viral expression are required at a minimum to verify the efficacy of the dual virus approach (the panel in Supplementary Figure 1 is very small and doesn't allow terminals to be seen, and there is no quantification). Whether these might differ by sex is also necessary before we can be confident about any sex differences in neural activity.

While the authors have some previous data on the AIC to DLS pathway, there are many brain regions and pathways impacted by alcohol and so the focus on this one in particular was not strongly justified. Since photometry is really an observational method, it's important to note that no causal link between activity in the pathway and drinking has been established here.

It would be helpful if the authors could further explain whether their modified lickometers actually measure individual licks. While in some systems contact with the tongue closes a circuit which is recorded, the interruption of a photobeam was used here. It's not clear to me whether the nose close to the spout would be sufficient to interrupt that beam, or whether a tongue protrusion is required. This detail is important for understanding how the photometry data is linked to behaviour. The temporal resolution of the GCaMP signal is likely not good enough to capture individual links but I think more caution or detail in the discussion of the correspondence of these events is required.

Even if the pattern of drinking differs between males and females, the use of the word "strategy" implies a cognitive process that was never described or measured.

Reviewer #2 (Public Review):

Summary:

This study looks at sex differences in alcohol drinking behaviour in a well-validated model of binge drinking. They provide a comprehensive analysis of drinking behaviour within and between sessions for males and females, as well as looking at the calcium dynamics in neurons projecting from the anterior insula cortex to the dorsolateral striatum.

Strengths:

Examining specific sex differences in drinking behaviour is important. This research question is currently a major focus for preclinical researchers looking at substance use. Although we have made a lot of progress over the last few years, there is still a lot that is not understood about sex-differences in alcohol consumption and the clinical implications of this.

Identifying the lateralisation of activity is novel, and has fundamental importance for researchers investigating functional anatomy underlying alcohol-driven behaviour (and other reward-driven behaviours).

Weaknesses:

Very small and unequal sample sizes, especially females (9 males, 5 females). This is probably ok for the calcium imaging, especially with the G-power figures provided, however, I would be cautious with the outcomes of the drinking behaviour, which can be quite variable.

For female drinking behaviour, rather than this being labelled "more efficient", could this just be that female mice (being substantially smaller than male mice) just don't need to consume as much liquid to reach the same g/kg. In which case, the interpretation might not be so much that females are more efficient, as that mice are very good at titrating their intake to achieve the desired dose of alcohol.

I may be mistaken, but is ANCOVA, with sex as the covariate, the appropriate way to test for sex differences? My understanding was that with an ANCOVA, the covariate is a continuous variable that you are controlling for, not looking for differences in. In that regard, given that sex is not continuous, can it be used as a covariate? I note that in the results, sex is defined as the "grouping variable" rather than the covariate. The analysis strategy should be clarified.

Reviewer #3 (Public Review):

Summary:

In this manuscript by Haggerty and Atwood, the authors use a repeated binge drinking paradigm to assess how water and ethanol intake changes in male in female mice as well as measure changes in anterior insular cortex to dorsolateral striatum terminal activity using fiber photometry. They find that overall, males and females have similar overall water and ethanol intake, but females appear to be more efficient alcohol drinkers. Using fiber photometry, they show that the anterior insular cortex (AIC) to dorsolateral striatum projections (DLS) projections have sex, fluid, and lateralization differences. The male left circuit was most robust when aligned to ethanol drinking, and water was somewhat less robust. Male right, and female and left and right, had essentially no change in photometry activity. To some degree, the changes in terminal activity appear to be related to fluid exposure over time, as well as within-session differences in trial-by-trial intake. Overall, the authors provide an exhaustive analysis of the behavioral and photometric data, thus providing the scientific community with a rich information set to continue to study this interesting circuit. However, although the analysis is impressive, there are a few inconsistencies regarding specific measures (e.g., AUC, duration of licking) that do not quite fit together across analytic domains. This does not reduce the rigor of the work, but it does somewhat limit the interpretability of the data, at least within the scope of this single manuscript.

Strengths:

- The authors use high-resolution licking data to characterize ingestive behaviors.
- The authors account for a variety of important variables, such as fluid type, brain lateralization, and sex.
- The authors provide a nice discussion on how this data fits with other data, both from their laboratory and others'.
- The lateralization discovery is particularly novel.

Weaknesses:

- The volume of data and number of variables provided makes it difficult to find a cohesive link between data sets. This limits interpretability.
- The authors describe a clear sex difference in the photometry circuit activity. However, I am curious about whether female mice that drink more similarly to males (e.g., less efficiently?) also show increased activity in the left circuit, similar to males. Oppositely, do very efficient males show weaker calcium activity in the circuit? Ultimately, I am curious about how the circuit activity maps to the behaviors described in Figures 1 and 2.
- What does the change in water-drinking calcium imaging across time in males mean? Especially considering that alcohol-related signals do not seem to change much over time, I am not sure what it means to have water drinking change.