D1 receptor antagonists in schizophrenia

Aberrant behavioral effects of a dopamine D1 receptor antagonist and agonist in monkeys: evidence of uncharted dopamine D1 receptor actions

BACKGROUND

Basic research indicates a role for dopamine (DA) D1 antagonism in the treatment of schizophrenia. Clinical trials have not confirmed any role. Besides the defining second messenger (adenylyl cyclase [AC]), DA D1 receptors are linked to other effectors (e.g., phospholipase C [PLC]). Differing actions of DA D1 antagonists upon differing effectors could explain conflicting results between the lab/clinic.

METHODS

In a monkey model in which behavioral effects of DA D1 antagonists/agonists have been well characterized we examined: 1) SKF 83959, biochemically, a DA D1 antagonist, behaviorally a DA D1 agonist, and 2) SKF 83822, biochemically, a DA D1 agonist, which, unlike all previously tested DA D1 agonists, does not also stimulate PLC. SKF 83959 and SKF 83822 were given alone and combined with DA D1 and D2 agonists, antagonists, and dextroamphetamine (AMP).

RESULTS

SKF 83959 acted as a DA D1 agonist (induced oral dyskinesia given alone, counteracted DA D1 antagonist [NNC 756], induced dystonia, and did not inhibit AMP induced behaviors). SKF 83822, unlike previously studied DA D1 agonists, did not induce dyskinesia, but resulted in a state of extreme arousal and locomotor activation without stereotypy, effectively counteracted by NNC 756, but not by SKF 83959 nor raclopride (DA D2 antagonist).

CONCLUSIONS

It is hypothesized that: 1) dyskinesia is linked to PLC stimulation; 2) DA D1 agonism can play a role in the induction of psychosis, via a mechanism linked neither to AC nor PLC, and 3) DA D1 antagonists differ in antipsychotic potential, possibly via this unidentified mechanism.

Discriminative stimulus properties of antipsychotics

Drug discrimination methodology has been used in a number of ways to analyze the actions of novel and putative novel antipsychotics in vivo. Recent studies suggest (a) in contrast to earlier theorizing, antagonism of the low-dose d-amphetamine stimulus in rats may not be an effective screen for novel antipsychotics; (b) dopamine D2-like agonists and antagonists, some of which are putative antipsychotics, can be studied in vivo as discriminative cues, although there is a pressing need for more selective drugs that differentiate the various members of the D2 family. (c) antagonism of the cue induced by the noncompetitive NMDA antagonist MK-801, which has been proposed as a possible screen for clozapine-like compounds, may be an unreliable assay; and (d) the clozapine stimulus is probably a compound cue (a drug "mixture"), which can be used to screen for novel clozapine-like antipsychotics, although the precise receptor mechanisms involved in mediating the clozapine stimulus, and its direct relevance to the antipsychotic action of clozapine remains to be proven conclusively.

Behavioral effects of clozapine and dopamine receptor subtypes

The atypical neuroleptic clozapine (CLZ) is an extremely effective antipsychotic that produces relatively few motoric side effects. However, CLZ displays limited antagonism at the dopamine (DA) D2 receptor, the receptor commonly thought to mediate the antipsychotic activity of neuroleptics. The mechanism of action behind the efficacy of CLZ remains to be determined. Miller, Wickens and Beninger [Progr. Neurobiol., 34, 143-184 (1990)] propose a "D1 hypothesis of antipsychotic action" that may explain the antipsychotic effects of CLZ. This hypothesis is built on the interactions between D2, cholinergic and D1 mechanisms in the striatum. These authors assert that although typical neuroleptics block D2 receptors, it is through an indirect action on D1 receptors that their antipsychotic action is manifest. The extra-pyramidal side effects produced by typical neuroleptics are hypothesized to be due to an indirect action on cholinergic receptors. It is argued that the anticholinergic properties of CLZ negate the D2 (motor side effects) action of CLZ, allowing CLZ to diminish psychotic symptoms through a direct action on D1 receptors. Thus, CLZ may function as a D1 receptor antagonist in behavioral paradigms. The current paper reviews and compares the behavioral profile of CLZ to those produced by D2- and D1-selective antagonists with specific reference to unconditioned and conditioned behaviors in order to more fully evaluate the "D1 hypothesis of CLZ action". Although the actions of CLZ remain unique, they do share some striking similarities with D1 receptor antagonists especially in tests of unconditioned behavior, possibly implicating the D1 receptor in the action of this antipsychotic drug.

The advantage of using positron emission tomography in drug research

A large problem in drug discovery is to find relevant in vitro or in vivo animal models and to be able to extrapolate the results obtained to humans. Drug research now benefits from the fast development of imaging technologies that trace radiolabelled molecules directly in the human brain. Positron emission tomography (PET) and allied techniques use molecules that are labelled with short-lived radioisotopes and injected intravenously. The most straightforward approach is to radiolabel a new potential drug and then to trace its anatomical distribution and binding in the brain. An indirect approach is to study how the unlabelled drug inhibits specific radioligand binding. The demonstration of quantitative relationships between drug binding in vivo and drug effects in patients is used to validate targets for drug action and to optimize clinical treatment.