Response of tardive and L-dopa-induced dyskinesias to antidepressants

We report two patients with dyskinesia responding to antidepressants. The first is a 70-year-old man with depression, Parkinsonism and neuroleptic-induced tardive dyskinesia who presented with hysterical mutism. After recovery from the mutism, he was started on desipramine for depression. One week later the dyskinesia improved markedly. The second patient is a 61-year-old man with Parkinson's disease, dementia, depression and L-dopa-induced oro-lingual-facial dyskinesias. He was taking levodopa, trihexyphenydil and bromocriptine. The depression was treated first with desipramine and later with trazodone. The dyskinesia improved significantly on both drugs. The response of the dyskinesias to antidepressant medication may be due to the fact that antidepressants decrease beta-adrenoreceptor sensitivity and density which in turn may result in a diminished release of dopamine since beta-adrenoceptors mediate the noradrenaline-stimulated release of dopamine.

The absolute density of neurotransmitter receptors in the brain. Example for dopamine receptors

Since the absolute density of dopamine receptors can vary in disease, it is essential to establish the normal values for the absolute densities of D1 and D2 receptors in the brain. Absolute densities are most conveniently reported in units of picomoles per gram of original tissue, readily permitting their comparison to data obtained by positron emission tomography in patients. The density of D1 receptors is approximately 120 pmol/g in the rat striatum and 19 pmol/g in the human striatum. The density of D2 receptors is about 32 pmol/g in the rat striatum and 14 pmol/g in the human striatum, these values being determined by Teflon-glass homogenization and the centrifugation method. The customary Polytron-homogenization procedure results in a loss of about 9% of the D2 receptors in rat tissue and about 28% in human tissues; filtration results in a further loss of about 12%. There is general agreement between the in vitro and in vivo densities, but only if the receptors are measured by the amount of radioisotope specifically displaced.

Dopamine agonist high-affinity state in solubilized D2 receptors in striatum, but not in anterior pituitary

To determine whether brain and pituitary dopamine D2 receptors have similar characteristics on solubilization, canine striatal and bovine anterior pituitary tissues were solubilized with digitonin, and their D2 dopamine receptors were characterized by competition studies and by high pressure liquid chromatography. Solubilized striatal membranes retained the ability to bind agonists with high affinity and retained sensitivity to guanine nucleotides. In contrast, however, solubilized pituitary membranes no longer revealed high-affinity binding of agonists and sensitivity to guanine nucleotide unless they had been solubilized in the presence of agonist. Agonist-pre-labelled pituitary receptors were of larger apparent molecular weight than antagonist-pre-labelled receptors. However, striatal receptors pre-labelled by agonist or antagonist were of similar apparent molecular weight. Thus, unlike the pituitary, striatal receptors probably remain associated with a guanine nucleotide binding protein (N) upon solubilization.

Dopamine receptors and the dopamine hypothesis of schizophrenia

The discovery of neuroleptic drugs in 1952 provided a new strategy for seeking a biological basis of schizophrenia. This entailed a search for a primary site of neuroleptic action. The Parkinsonian effects caused by neuroleptics suggested that dopamine transmission may be disrupted by these drugs. In 1963 it was proposed that neuroleptics blocked "monoamine receptors" or impeded the release of monoamine metabolites. The neuroleptic concentration in plasma water or cerebrospinal fluid was of the order of 2 nM for haloperidol in clinical therapy. A systematic research was made between 1963 and 1974 for a primary site of neuroleptic action which would be sensitive to 2 nM haloperidol and stereoselective for (+)-butaclamol. Direct evidence that neuroleptics selectively blocked dopamine receptors occurred in 1974 with the finding that nanomolar concentrations of these drugs stereoselectively inhibited the binding of [3H]-dopamine or [3H]-haloperidol. These binding sites, now termed D2 dopamine receptors (which inhibit adenylate cyclase), are blocked by neuroleptics in direct relation to the antipsychotic potencies of the neuroleptics. No such correlation exists for D1 receptors (which stimulate adenylate cyclase). Based on the fact that dopamine-mimetic drugs elicited hallucinations, and that neuroleptics caused rigidity, Van Rossum in 1966 had suggested a hypothesis that dopamine pathways may be overactive in schizophrenia. The D2-selective blockade by all neuroleptics (except the monoamine-depleting reserpine) provided strong support for the dopamine hypothesis. Further support now comes from postmortem data and in vivo positron tomographic data, both of which indicate that the density of D2 receptors are elevated in the schizophrenic brain. The postmortem data indicate a bimodal pattern with half the schizophrenics having striatal D2 densities of 14 pmol/g (control is 13 pmol/g) and the other half having 26 pmol/g. Current positron tomographic data indicate D2 densities of 14 pmol/g in control subjects, but values of 34 pmol/g in drug-naive schizophrenics. Future tests of the dopamine hypothesis of schizophrenia may entail an examination of the amino acid composition and genes for D2 receptors in schizophrenic tissue, an examination of the ability of the D2 receptor to become phosphorylated and to desensitize into the low-affinity state, and an examination of the interaction of D2 receptors with D1 receptors or other neurotransmitters.

Human brain dopamine receptors in children and aging adults

Since spontaneous oral dyskinesias are more prevalent in the elderly, and since these movements may be controlled by the balance of brain dopamine D1 and D2 dopamine receptors, we measured the densities of these receptors in 247 postmortem brain striata. In childhood, the densities of D1 and D2 dopamine receptors in the brain striatum rise and fall together. After age 20 years, D1 receptors disappear at 3.2% per decade while D2 receptors disappear at about 2.2% per decade. Overall, therefore, the D1/D2 ratio falls with age. Since perioral motion in rats is dominated by a high D1/D2 ratio, the observed decline in the human D1/D2 ratio with age suggests that the perioral control mechanisms for humans and rats may be different.

Photoaffinity labelling of dopamine D2 receptors by [3H]azidomethylspiperone

We have characterized the dopamine D2 receptor photoaffinity probe, [3H]azido-N-methylspiperone ([3H]AMS). In the absence of light, [3H]AMS bound reversibly and with high affinity (Kd 70 pM) to sites in canine striatal membranes and was competitively inhibited by dopaminergic agonists and antagonists with an appropriate D2 receptor specificity. Upon photolysis, [3H]AMS covalently incorporated into a peptide of Mr 92,000 as assessed by fluorography following SDS-polyacrylamide gel electrophoresis. Labelling of this peptide was specifically and stereoselectively blocked by D2 antagonists and agonists. Minor specifically labelled peptides of Mr 70,000-55,000 were observed under some conditions and were the result of proteolytic degradation of the peptide at Mr 92,000.

Age-related changes of beta-adrenoceptors in spleen lymphocytes and cerebral cortex of NZB/BIN mice

The density (Bmax) of beta-adrenoceptors in splenic lymphocytes of NZB/BIN mice decreased up to an age of about 40 weeks and then levelled out. The Bmax in cerebral cortex, on the other hand, increased in the first half of life and then changed relatively little. The dissociation constant of the ligand (Kd) was larger in the cortex than the spleen and showed relatively little age-dependent change.

Age-related changes in beta-adrenoceptors of lymphocytes

The density of adrenoceptors (Bmax) is greater on B than on T splenocytes. It decreases more or less rapidly on membranes of both populations, as animals age. The exception, we have observed in this respect, is an increase in Bmax on B cells of SJL mice, between the 6th and 25th week of life.

Age-related changes of beta-adrenoceptors in aging inbred mice

The density (Bmax) and antagonist dissociation constant (KD) of beta-adrenoceptors were determined on spleen and brain of three different inbred strains of mice--BALB/cJ, C3H/HeJ, and C57BL/6J. Receptor densities (Bmax) differed with strain and declined in both spleen and cortical receptor populations as mice became older. Age-related changes in KD were found on spleen cells of BALB/cJ and in the cortex of C3H/HeJ and C57BL/6J. Bmax and KD in different organs of the same strain changed at different rates. changed at different rates.

Dopamine D1 receptors characterized with [3H]SCH 23390. Solubilization of a guanine nucleotide-sensitive form of the receptor

Dopamine D1 receptors were solubilized from canine and bovine striatal membranes with the detergent digitonin. The receptors retained the pharmacological characteristics of membrane-bound D1 receptors, as assessed by the binding of the selective antagonist [3H]SCH 23390. The binding of [3H]SCH 23390 to solubilized receptor preparations was specific, saturable, and reversible, with a dissociation constant of 5 nM. Dopaminergic antagonists and agonists inhibited [3H]SCH 23390 binding in a stereoselective and concentration-dependent manner with an appropriate rank order of potency for D1 receptors. Moreover, agonist high affinity binding to D1 receptors and its sensitivity to guanine nucleotides was preserved following solubilization, with agonist dissociation constants virtually identical to those observed with membrane-bound receptors. To ascertain the molecular basis for the existence of an agonist-high affinity receptor complex, D1 receptors labeled with [3H] dopamine (agonist) or [3H]SCH 23390 (antagonist) prior to, or following, solubilization were subjected to high pressure liquid steric-exclusion chromatography. All agonist- and antagonist-labeled receptor species elute as the same apparent molecular size. Treatment of brain membranes with the guanine nucleotide guanyl-5'-yl imidodiphosphate prior to solubilization prevented the retention of [3H]dopamine but not [3H]SCH 23390-labeled soluble receptors. This suggests that the same guanine nucleotide-dopamine D1 receptor complex formed in membranes is stable to solubilization and confers agonist high affinity binding in soluble preparations. These results contrast with those reported on the digitonin-solubilized dopamine D2 receptor, and the molecular mechanism responsible for this difference remains to be elucidated.

Dopamine D2 receptor density remains constant in treated Parkinson's disease

D2 dopamine receptor densities were measured in postmortem samples of the caudate nucleus and putamen from 36 parkinsonian patients. The relationship between the age of the patient, duration of the disease, and duration of L-dopa therapy versus density of brain D2 dopamine receptors was examined using [3H]spiperone. Receptor density in parkinsonian tissues was constant over the age range of 56 to 90 years, as was the case for control tissues. Density did not change with duration of disease up to 24 years. Treatment with L-dopa did not cause progressive reduction in receptor density. The diminished clinical response in the final stages of Parkinson's disease is not due to receptor dropout, and must depend on other factors.

[3H]-domperidone labels only a single population of receptors which convert from high to low affinity for dopamine in rat brain

Dopamine recognized and competed for a single population of [3H]-domperidone-binding sites in rat striatum and olfactory tubercle when tested in the presence of sodium ions and guanine nucleotide [Gpp(NH)p]. In the absence of Na+ and Gpp(NH)p, however, dopamine recognized two components of [3H]-domperidone binding. Thus, [3H]-domperidone labelled only a single population of dopamine receptors (type D2) which fully converted from high to low affinity for dopamine. These results agree with those found previously using [3H]-spiperone and [3H]-YM-09151-2.

Regulation of anterior pituitary D2 dopamine receptors by magnesium and sodium ions

At D2 3,4-dihydroxyphenylethylamine (dopamine) receptors in anterior pituitary tissue, magnesium ions shifted receptors to agonist high-affinity states, but decreased the affinity of the antagonist [3H]spiperone. Conversely, sodium ions shifted the receptors to agonist low-affinity states, but increased the affinity of [3H]spiperone. Magnesium is proposed to stabilize the hormone-receptor-guanine nucleotide regulatory protein complex, whereas sodium appears to destabilize this ternary complex. Thus, magnesium and sodium appear to mediate their regulatory effects via a common component at the D2 dopamine-receptor ternary complex.

Dopamine D2 receptor binding sites for agonists. A tetrahedral model

In order to develop a model for the putative binding sites between the D2 dopamine receptor and many of its agonists, we obtained the dissociation constants of many dopaminergic agonists at the high affinity state, D2high, as well as at the low affinity state, D2low, of the receptor. [3H]Spiperone was used to label the D2 dopamine receptors in porcine anterior pituitary tissue. Agonists without any hydroxyl groups, such as 2-aminotetralin, effectively inhibited the binding of [3H]spiperone; the addition of a hydroxyl group corresponding to the "meta" position in dopamine, however, enhanced the potency (in four series of agonists) by an order of magnitude. The R-(-)-enantiomers of the aporphines and 5,6,-dihydroxy-2-dipropylaminotetralin were more potent than the S-(+)-enantiomers. Although the 4-methoxy-2-dipropylaminoindans were potent, the R-(-)-11-methoxyaporphines were not. A tetrahedral model is proposed; this has two sites for agonist attachment, the extremities of the sites being separated by 8 A, and their functional groups directed between 15 degrees and 30 degrees off the orthogonal from the receptor surface. Several steric obstacles are required to account for the inactivity of several congeners.

Synthesis and radioreceptor binding activity of N-0437, a new, extremely potent and selective D2 dopamine receptor agonist

The synthesis of a new, potent and selective D2 dopamine receptor agonist, N-0437, of the 2-aminotetralin group is described. The results of a radioreceptor binding assay using a homogenate of porcine anterior pituitary as a tissue source for D2 dopamine receptors and 3H-spiperone as radioligand demonstrate that this compound is one of the most potent compounds so far evaluated in this test system.

The functional state of the dopamine receptor in the anterior pituitary is in the high affinity form

In order to determine whether the high affinity state or the low affinity state of the dopamine receptor mediated the inhibition of release of PRL by dopamine agonists, a large number of dopaminergic agonists (n = 31) and antagonists (n = 24) were tested for their potencies to inhibit the binding of [3H] spiperone to porcine anterior pituitary tissue, and for their potencies to affect the release of PRL from rat anterior pituitary cells in culture. All agonists (except bromocriptine, ergocryptine, and dihydroergocryptine) inhibited [3H]spiperone binding in two phases: one phase occurred at nanomolar or subnanomolar concentrations (representing the high affinity state of the dopamine receptor) and the other phase occurred at much higher concentrations of agonist (the low affinity state of the dopamine receptor). The dissociation constants (K) for each drug at each state were derived by computer, with the program LIGAND. It was observed that the agonist K values for the high affinity state were virtually identical with those agonist concentrations inhibiting PRL release; the K values for the low affinity state were about 2 orders higher. These data suggest that the high affinity state of the D2 dopamine receptor is the functional state which mediates the inhibition of PRL release.

Dependence of dopamine receptor conversion from agonist high- to low-affinity state on temperature and sodium ions

Previous workers found that the anterior pituitary dopamine receptors were inconsistent in converting from their high-affinity state (D2 high) into their low-affinity state (D2 low) for dopamine. We tested, therefore, whether temperature or sodium ion concentration could be factors accounting for such inconsistencies. We found that the proportion of sites which converted depended on the temperature of incubation. No conversion occurred at 4 degrees, despite the presence of guanine nucleotide and sodium ions. At room temperature (20 degrees) guanine nucleotide consistently induced complete conversion in the presence of sodium ions, but gave inconsistent conversion in the absence of sodium ions. At body temperature (37 degrees) guanine nucleotide consistently resulted in complete conversion without requiring sodium ions.

L-dopa reverses the elevated density of D2 dopamine receptors in Parkinson's diseased striatum

Striatal dopamine receptors were studied using [3H]-spiperone in postmortem tissues of thirty-six patients with Parkinson's Disease. Each tissue was analyzed by the receptor saturation method. In non-treated patients, the D2 dopamine receptor density was elevated in the caudate nucleus and putamen compared to controls. The dissociation constant for [3H]-spiperone was similar in all groups. The elevated density of D2 receptors in non-treated patients may indicate dopaminergic supersensitivity in this disease. The elevated density was reversed with dopamine agonist therapy, but the density was not lower than control tissues.

Complete conversion of brain D2 dopamine receptors from the high- to the low-affinity state for dopamine agonists, using sodium ions and guanine nucleotide

Since previous work had shown that brain D2 3,4-dihydroxyphenylethylamine (dopamine) receptors were only partly converted from their high-affinity state to their low-affinity state, we here tested whether it was possible to obtain a complete 100% conversion of these receptors into their low-affinity state. It was first essential to resolve the components of [3H]spiperone binding to dopaminergic sites and nondopaminergic sites in rat striatal homogenates. In the presence of 50 microM S-sulpiride (to occlude the dopaminergic sites), therefore, we first determined that the residual binding of [3H]spiperone (approximately 20%) was inhibited by serotonergic agonists much more effectively than dopamine or noradrenaline, thus identifying the serotonergic component of [3H]spiperone binding. Thus, dopamine (or ADTN) inhibited the binding of [3H]spiperone at a high-affinity site (with dissociation constant of 10 nM dopamine), at a low-affinity site (with dissociation constant of 2,000 nM dopamine), and at the serotonergic site (with dissociation constant of 50,000 nM dopamine). In the absence of sodium ions, the high-affinity site was about 50% occupied by [3H]spiperone, and guanine nucleotide had no effect on this proportion. In the presence of 120 mM NaCl, however, the high-affinity site was reduced to 15% and guanine nucleotide completely eliminated this high-affinity site, 100% of the sites having been completely converted to their low-affinity state. Using [3H]N-propyl-norapomorphine to label the high-affinity state of the dopamine receptor, 50% conversion into the low-affinity state occurred at 45 mM LiCl, 69 mM NaCl, and 202 mM KCl. We conclude that it is possible to convert brain D2 dopamine receptors completely into their low-affinity state, in the presence of NaCl and a guanine nucleotide, providing that appropriate allowance is made for the serotonergic component of [3H]spiperone binding.