The biochemical background to tardive dyskinesia

Localization of multiple dopamine receptor subtype mRNAs in human and monkey motor cortex and striatum

Dopamine plays a critical role in motor and cognitive function through actions mediated by specific receptors, multiple subtypes of which have recently been identified. The distribution of mRNAs encoding D1, D2 and D5 receptors in the motor cortex of humans and in the motor cortex and striatum of macaque monkeys was examined using in situ hybridization. In motor cortices from both primate species, hybridization to each receptor probe resulted in numerous labeled cells throughout layers II-VI. In contrast to neocortex, in monkey striatum only the D1 and D2 receptor probes showed significant hybridization. Thus, not only does primate neocortex possess a broader representation of the dopamine receptor subtype mRNAs examined in comparison with striatum, but the unexpected presence and widespread distribution of D2 and D5 receptor mRNAs in cortex suggests that, along with D1 receptors, D2 and D5 receptors play a crucial role in the dopaminergic modulation of cognition and motor behavior, and in dopamine dysfunction associated with neuropsychiatric disorders.

Muscarinic and dopaminergic receptor subtypes on striatal cholinergic interneurons

Unilateral stereotaxic injection of small amounts of the cholinotoxin, AF64A, caused minimal nonselective tissue damage and resulted in a significant loss of the presynaptic cholinergic markers [3H]hemicholinium-3 (45% reduction) and choline acetyltransferase (27% reduction). No significant change from control was observed in tyrosine hydroxylase or tryptophan hydroxylase activity; presynaptic neuronal markers for dopamine- and serotonin-containing neurons, respectively. The AF64A lesion resulted in a significant reduction of dopamine D2 receptors as evidenced by a decrease in [3H]sulpiride binding (42% reduction) and decrease of muscarinic non-M1 receptors as shown by a reduction in [3H]QNB binding in the presence of 100 nM pirenzepine (36% reduction). Saturation studies revealed that the change in [3H]sulpiride and [3H]QNB binding was due to a change in Bmax not Kd. Intrastriatal injection of AF64A failed to alter dopamine D1 or muscarinic M1 receptors labeled with [3H]SCH23390 and [3H]pirenzepine, respectively. In addition, no change in [3H]forskolin-labeled adenylate cyclase was observed. These results demonstrate that a subpopulation of muscarinic receptors (non-M1) are presynaptic on cholinergic interneurons (hence, autoreceptors), and a subpopulation of dopamine D2 receptors are postsynaptic on cholinergic interneurons. Furthermore, dopamine D1, muscarinic M1 and [3H]forskolin-labeled adenylate cyclase are not localized to striatal cholinergic interneurons.

Progressive pathology of the caudate nucleus, the substantia nigra pars reticulata and the deeper layers of the colliculus superior: acute behavioural and metabolic effects of intrastriatal kainic acid

The acute behavioural and metabolic consequences of functional changes following unilateral intracaudate kainic acid at the level of the feline caudate nucleus, the substantia nigra pars reticulata and the deeper layers of the colliculus superior were investigated. The present study became possible since it was previously found that unilateral changes in neurotransmission processes in these structures all result in behavioural alterations that can be distinguished from each other. During the first 17 min after kainic acid, all animals displayed contralateral forced staccato head turning; these movements are characteristic for an activation of dopamine receptors and/or inhibition of GABA receptors in the rostromedial caudate nucleus. Between 15 and 50 min, all animals displayed fast, uninterrupted contralateral forced head, torso or body turning; these movements are characteristic for an activation of nigral GABA receptors. From about 48 min, all animals displayed sequences of short contralateral forced ear, head, torso and body turnings; these movements are characteristic for an inhibition of collicular GABA receptors. Furthermore, most cats displayed ipsilateral orofacial dyskinetic movements during the whole 180 min observation period. Metabolism was analysed in three cats that received [14C]2-D-deoxyglucose immediately before, 5 min after, or 70 min after kainic acid. Metabolism was increased in the ipsilateral caudate nucleus; this effect was most pronounced in the cat that received deoxyglucose immediately before kainic acid. Metabolic activity was increased in the ipsilateral substantia nigra pars reticulata; this effect was most pronounced in the cat treated with deoxyglucose 5 min after kainic acid. Metabolism was increased in the ipsilateral deeper layers of the colliculus superior in the cat that received deoxyglucose 70 min after kainic acid. The present behavioural and metabolic data suggest that kainic acid produces an increasing pathology resulting successively in functional changes in the caudate nucleus, its output-station the substantia nigra pars reticulata and the nigral output-station the deeper layers of the colliculus superior. It is suggested that the successive appearance of the latter effects is inherent in the hierarchical order of the brain structures under study. The occurrence of orofacial dyskinetic movements during the whole observation period suggests that the former movements were not mediated via the striato-nigro-collicular pathway. Finally, apomorphine injected in the ipsilateral caudate nucleus 1 week after kainic acid was significantly less effective compared to apomorphine injected 1 week before kainic acid. The c

Tardive dyskinesia with inflated neurons of the cerebellar dentate nucleus. Case reports and morphometric study

Four autopsied cases of tardive dyskinesia manifesting oral hyperkinesia revealed markedly inflated neurons in the cerebellar dentate nucleus (DN), which had not been described previously. The inflation of the neurons was proved to be statistically significant (P less than 0.01) by morphometric study. The nuclei were usually situated in the central portion of the cytoplasm. This inflated change was different from both central chromatolysis and grumose degeneration of the DN, typically observed in progressive supranuclear palsy and dentatorubropallidolysian atrophy, and seemed to be easy to miss without careful observation, since neuronal loss and gliosis were very mild in the DN. Among a few autopsied cases of tardive dyskinesia reported previously, degeneration of the DN was described in only two. It is believed, however, that the inflated neurons of the DN may not be so rare and may be related to the occurrence of some involuntary hyperkinesia, especially oral hyperkinesia following some neurotoxic disorders and/or neuroleptic medications.

Behavioural and biochemical alterations following haloperidol treatment and withdrawal: the animal model of tardive dyskinesia reexamined

Behavioural and biochemical studies were carried out in rats given a single daily dose (1 mg/kg, i.p.) of haloperidol for 30 days and subsequently withdrawn for 7 days. Long-term administration of haloperidol resulted in supersensitivity of dopamine receptors. This was manifested by enhanced stereotypic biting, rearing, locomotor and floor activity of haloperidol withdrawn rats when challenged to a low dose of apomorphine (0.5 mg/kg, s.c.) on the 8th day. Chronic haloperidol treatment significantly decreased dopamine synthesis and release as evidenced by low activity of tyrosine hydroxylase and low level of homovanillic acid in striatum. Dopamine levels did not change in the frontal cortex, striatum and midbrain. Haloperidol treatment significantly increased striatal gamma-aminobutyric acid content and glutamic acid decarboxylase activity by 17% and 16% respectively. The decreased tyrosine hydroxylase activity and homovanillic acid level in corpus striatum might, in part, be due to an inhibitory effect of GABAergic neurons on dopaminergic system. Rats withdrawn from chronic haloperidol treatment showed significant increases in GABA level and glutamic acid decarboxylase activity. This probably resulted in further inhibition of dopamine release as evidenced by marked accumulation of dopamine in the corpus striatum and midbrain. No significant alterations in the endogenous levels of norepinephrine, 5-hydroxytryptamine and 5-hydroxyindoleacetic acid were observed in haloperidol-treated and subsequently withdrawn rats. These data suggest that chronic haloperidol treatment and subsequent withdrawal results in the development of behavioural dopamine supersensitivity as well as biochemical alterations in dopaminergic and GABAergic system. The changes in these two neuronal systems seem to be interrelated.

Differential sensitivity to amphetamine following long-term treatment with clozapine or haloperidol

When rats were pretreated for 8 consecutive days with 2.0 mg/kg haloperidol, injection of 2.5 or 5.0 mg/kg d-amphetamine 2 or 6 days later resulted in a larger increase in oral behaviors and a more prolonged period of focused sterotypy than in saline-pretreated controls. This increased sensitivity to amphetamine is consistent with the effects of a chronic haloperidol-induced increase in dopamine receptor sensitivity. In contrast, long-term treatment with either d-amphetamine or clozapine produced complex changes in the multiphasic behavioral response to amphetamine, which cannot be explained solely by a shift in the sensitivity of dopamine receptors.