Access to the CNS: Biomarker Strategies for Dopaminergic Treatments

Cellular and neuronal mechanisms that underlie addiction - literature review

Introduction: Addictive substances act on a number of neurotransmitter systems, and the end result of this action is the activation of the reward system in the brain. The cellular and neuronal mechanisms that underlie addiction have long been searched for. One of such neurotransmitters is dopamine, a catecholamine synthesized in neurons located mainly in the midbrain.

Material and method: The available literature was reviewed on the Pubmed platform and from other sources. The analysis included original studies, reviews.

The aim of the study was to review the literature on the relationship between the DRD2 gene and the occurrence of substance addiction.

Discussion: This work presents several currently discussed biological mechanisms, especially at the molecular and genetic level, involved in the process of addiction to various psychoactive substances. They discovered the brain structures that are most at risk, as well as other neurotransmitter systems and receptor proteins through which they can exert their pathological effects. It has also been established that exposure to psychoactive substances causes significant changes in expression in over 100 genes (including genes for dopaminergic, serotonergic and signaling pathways). The DRD2 receptor (present, among others, in the nucleus accumbens) plays an important role in the reward system, in the transmission of information. The weakening of this conductivity is a significant risk factor for the onset of clinical features that are associated with reward system deficiency syndrome. The expression of the D2 receptor gene may take up to 2 isoforms: short D2S and long D2L.

Conclusions: Further research at the molecular level may result in the modification of psychotherapy and pharmacotherapy in terms of their personalization.

Abnormalities of Resting-State Electroencephalographic Microstate in Rapid Eye Movement Sleep Behavior Disorder

Objective: Rapid eye movement (REM) sleep behavior disorder (RBD) is a disease characterized by dream enacting behavior and is now commonly believed to be a harbinger to alpha-synucleinopathy diseases such as dementia with Lewy bodies, Parkinson's disease, and multiple system atrophy. The aim of this study was to explore the quasi-stable topological structure of the brain in RBD by analyzing resting-state electroencephalography (EEG) microstates.

Methods: We enrolled 22 participants with RBD and 46 healthy controls (HCs) with age and gender-matched. After the resting-state EEG recordings were acquired, EEG microstate features were analyzed to assess the functional networks of all participants.

Results: Significant differences in the brain topological structure and temporal characteristics of sub-second brain activity were identified between the RBD and HCs. The RBD group had a shorter average duration of microstate A and microstate D when compared with HCs, and microstate B contributed more, while microstate D contributed significantly less to the RBD group. Furthermore, the average duration and proportion of microstate D were negatively correlated with the RBD questionnaire Hong Kong (RBDQ-HK) score.

Conclusion: The result of this study indicates that the microstate dynamics is disturbed in RBD, which might jeopardize the flexibility and adaptability of the brain. Microstates are potential biomarkers to explore the early electrophysiological abnormality of alpha-synucleinopathy diseases.

Discovery of eight alkaloids with D1 and D2 antagonist activity in leaves of Nelumbo nucifera Gaertn. Using FLIPR assays

ETHNOPHARMACOLOGICAL RELEVANCE

Dopamine receptors are long-standing primary targets in the treatment of mental diseases and there is growing evidence that suggests relationships between obesity and the dopamine system, especially dopamine D1 and D2 receptors. Leaves of Nelumbo nucifera Gaertn. (lotus leaves) have been medically used for helping long-term maintenance of weight loss. Whether and how components of lotus leaves function through the dopamine receptors remains unclear.

AIM OF THE STUDY

This work aimed to discover dopamine receptor-active alkaloids isolated from the lotus leaves, to evaluate their potencies and to analyze their structure activity relationship.

MATERIALS AND METHODS

Dried lotus leaves were prepared and total extract was divided into alkaloids and flavones. Eight alkaloids were separated and characterized by a combination of high-performance liquid chromatography, quadrupole time-of-flight mass spectrometry and nuclear magnetic resonance, and assayed by a fluorometric imaging plate reader platform. Human embryonic kidney 239 cell lines expressing dopamine D1, D2 and serotonin 2A (5-HT2A) receptors, respectively, were cultured and used in the assay.

RESULTS

Alkaloids in the lotus leaves were the bioactive phytochemicals and inhibited dopamine from accessing the D1 and D2 receptors. All eight compounds functioned as D1-receptor antagonists and except N-nornuciferine, seven alkaloids functioned as D2-receptor antagonists. (S)-coclaurine and (R)-coclaurine are optical isomers and antagonized both D1 and D2 with equivalent potencies, suggesting that the optical rotation of the methylene linker in the monobenzyl isoquinoline backbone did not influence their activity. Among the eight alkaloids, O-nornuciferine was the potent antagonist to both receptors (the lowest IC₅₀ values, D1: 2.09 ± 0.65 μM and D2: 1.14 ± 0.10 μM) while N-nornuciferine was found to be the least potent as it moderately antagonized D1 and was inactive on D2. O-nornuciferine was also a 5-HT2A antagonist (IC₅₀~20 μM) while N-nornuciferine had no activity. These hinted the importance of a methyl group attached to the nitrogen atom in the aporphine backbone. Armepavine showed a nearly 10-fold selectivity to D2.

CONCLUSIONS

In this work, eight alkaloids were isolated from the leaves of Nelumbo nucifera Gaertn. and assayed on the D1 and D2 receptors. They were D1/D2 antagonists with IC₅₀ values in the mid- to low-micromolar range and O-nornuciferine was the most potent alkaloid among the eight. This family of alkaloids was biochemically evaluated on the dopamine receptors by the same platform for the first time.

Mechanisms Underlying the Comorbidity of Schizophrenia and Type 2 Diabetes Mellitus

The mortality rate of patients with schizophrenia is high, and life expectancy is shorter by 10 to 20 years. Metabolic abnormalities including type 2 diabetes mellitus (T2DM) are among the main reasons. The prevalence of T2DM in patients with schizophrenia may be epidemiologically frequent because antipsychotics induce weight gain as a side effect and the cognitive dysfunction of patients with schizophrenia relates to a disordered lifestyle, poor diet, and low socioeconomic status. Apart from these common risk factors and risk factors unique to schizophrenia, accumulating evidence suggests the existence of common susceptibility genes between schizophrenia and T2DM. Functional proteins translated from common genetic susceptibility genes are known to regulate neuronal development in the brain and insulin in the pancreas through several common cascades. In this review, we discuss common susceptibility genes, functional cascades, and the relationship between schizophrenia and T2DM. Many genetic and epidemiological studies have reliably associated the comorbidity of schizophrenia and T2DM, and it is probably safe to think that common cascades and mechanisms suspected from common genes' functions are related to the onset of both schizophrenia and T2DM. On the other hand, even when genetic analyses are performed on a relatively large number of comorbid patients, the results are sometimes inconsistent, and susceptibility genes may carry only a low or moderate risk. We anticipate future directions in this field.

Spatiotemporal EEG microstate analysis in drug-free patients with Parkinson's disease

The clinical diagnosis of Parkinson's disease (PD) is very difficult, especially in the early stage of the disease, because there is no physiological indicator that can be referenced. Drug-free patients with early PD are characterized by clinical symptoms such as impaired motor function and cognitive decline, which was caused by the dysfunction of brain's dynamic activities. The indicators of brain dysfunction in patients with PD at an early unmedicated condition may provide a valuable basis for the diagnosis of early PD and later treatment. In order to find the spatiotemporal characteristic markers of brain dysfunction in PD, the resting-state EEG microstate analysis is used to explore the transient state of the whole brain of 23 drug-free patients with PD on the sub-second timescale compared to 23 healthy controls. EEG microstates reflect a transiently stable brain topological structure with spatiotemporal characteristics, and the spatial characteristic microstate classes and temporal parameters provide insight into the brain's functional activities in PD patients. The further exploration was to explore the relation between temporal microstate parameters and significant clinical symptoms to determine whether these parameters could be used as a basis for clinically assisted diagnosis. Therefore, we used a general linear model (GLM) to explore the relevance of microstate parameters to clinical scales and multiple patient attributes, and the Wilcoxon rank sum test was used to quantify the linear relation between influencing factors and microstate parameters. Results of microstate analysis revealed that there was an unique spatial microstate different from healthy controls in PD, and several other typical microstates had significant differences compared with the normal control group, and these differences were reflected in the microstate parameters, such as longer durations and more occurrences of one class of microstates in PD compared with healthy controls. Furthermore, correlation analysis showed that there was a significant correlation between multiple microstate classes' parameters and significant clinical symptoms, including impaired motor function and cognitive decline. These results indicate that we have found multiple quantifiable feature tags that reflect brain dysfunction in the early stage of PD. Importantly, such temporal dynamics in microstates are correlated with clinical scales which represent the motor function and recognize level. The obtained results may deepen our understanding of the brain dysfunction caused by PD, and obtain some quantifiable signatures to provide an auxiliary reference for the early diagnosis of PD.

EEG Microstates Change in Response to Increase in Dopaminergic Stimulation in Typical Parkinson's Disease Patients

Objectives: Characterizing pharmacological response in Parkinson's Disease (PD) patients may be a challenge in early stages but gives valuable clues for diagnosis. Neurotropic drugs may modulate Electroencephalography (EEG) microstates (MS). We investigated EEG-MS default-mode network changes in response to dopaminergic stimulation in PD. Methods: Fourteen PD subjects in HY stage III or less were included, and twenty-one healthy controls. All patients were receiving dopaminergic stimulation with levodopa or dopaminergic agonists. Resting EEG activity was recorded before the first daily PD medication dose and 1 h after drug intake resting EEG activity was again recorded. Time and frequency variables for each MS were calculated. Results: Parkinson's disease subjects MS A duration decreases after levodopa intake, MS B appears more often than before levodopa intake. MS E was not present, but MS G was. There were no significant differences between control subjects and patients after medication intake. Conclusion: Clinical response to dopaminergic drugs in PD is characterized by clear changes in MS profile. Significance: This work demonstrates that there are clear EEG MS markers of PD dopaminergic stimulation state. The characterization of the disease and its response to dopaminergic medication may be of help for early therapeutic diagnosis.