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Avecillas-Chasin JM, Honey CR. Modulation of Nigrofugal and Pallidofugal Pathways in Deep Brain Stimulation for Parkinson Disease. Neurosurgery 2020; 86:E387-E397. [PMID: 31832650 DOI: 10.1093/neuros/nyz544] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical therapy for patients with Parkinson disease (PD). OBJECTIVE To define the role of adjacent white matter stimulation in the effectiveness of STN-DBS. METHODS We retrospectively evaluated 43 patients with PD who received bilateral STN-DBS. The volumes of activated tissue were analyzed to obtain significant stimulation clusters predictive of 4 clinical outcomes: improvements in bradykinesia, rigidity, tremor, and reduction of dopaminergic medication. Tractography of the nigrofugal and pallidofugal pathways was performed. The significant clusters were used to calculate the involvement of the nigrofugal and pallidofugal pathways and the STN. RESULTS The clusters predictive of rigidity and tremor improvement were dorsal to the STN with most of the clusters outside of the STN. These clusters preferentially involved the pallidofugal pathways. The cluster predictive of bradykinesia improvement was located in the central part of the STN with an extension outside of the STN. The cluster predictive of dopaminergic medication reduction was located ventrolateral and caudal to the STN. These clusters preferentially involved the nigrofugal pathways. CONCLUSION Improvements in rigidity and tremor mainly involved the pallidofugal pathways dorsal to the STN. Improvement in bradykinesia mainly involved the central part of the STN and the nigrofugal pathways ventrolateral to the STN. Maximal reduction in dopaminergic medication following STN-DBS was associated with an exclusive involvement of the nigrofugal pathways.
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Affiliation(s)
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, Canada
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Rat subthalamic stimulation: Evaluating stimulation-induced dyskinesias, choosing stimulation currents and evaluating the anti-akinetic effect in the cylinder test. MethodsX 2019; 6:2384-2395. [PMID: 31681539 PMCID: PMC6818350 DOI: 10.1016/j.mex.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/10/2019] [Indexed: 12/01/2022] Open
Abstract
In experimental deep brain stimulation of the subthalamic nucleus (STN HFS), stimulation currents just below the appearance threshold of stimulation-induced dyskinesias has often been used. The behavioral effect of STN HFS can be measured by the reversal of forelimb use asymmetry produced by hemiparkinsonism can be measured with the cylinder test among other tests. We used 18 Wistar rats with 6-hydroxydopamine induced hemiparkinsonism to test a customized scale to rate the severity of stimulation-induced dyskinesia; we then used these ratings to choose low and high stimulation currents. Subsequent cylinder tests showed that stimulation at the higher current, inducing mild and short-lived dyskinesias, was required for robust improvement in forelimb use, contradicting the use of currents below stimulation-induced dyskinesia threshold. It was also beneficial to separately count both all touches and first touches with the cylinder wall; this provided additional sensitivity and robustness to our results. Scoring stimulation-induced dyskinesias can be used as a quantitative measure of dyskinesias and to choose stimulation currents. Cylinder test scoring separately for both first and all touches can improve both sensitivity and reliability. STN HFS at a current producing short-lived dyskinesias was required for robust improvement in forelimb use asymmetry.
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Deep Brain Stimulation of Hemiparkinsonian Rats with Unipolar and Bipolar Electrodes for up to 6 Weeks: Behavioral Testing of Freely Moving Animals. PARKINSONS DISEASE 2017; 2017:5693589. [PMID: 28758044 PMCID: PMC5512044 DOI: 10.1155/2017/5693589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 12/15/2022]
Abstract
Although the clinical use of deep brain stimulation (DBS) is increasing, its basic mechanisms of action are still poorly understood. Platinum/iridium electrodes were inserted into the subthalamic nucleus of rats with unilateral 6-OHDA-induced lesions of the medial forebrain bundle. Six behavioral parameters were compared with respect to their potential to detect DBS effects. Locomotor function was quantified by (i) apomorphine-induced rotation, (ii) initiation time, (iii) the number of adjusting steps in the stepping test, and (iv) the total migration distance in the open field test. Sensorimotor neglect and anxiety were quantified by (v) the retrieval bias in the corridor test and (vi) the ratio of migration distance in the center versus in the periphery in the open field test, respectively. In our setup, unipolar stimulation was found to be more efficient than bipolar stimulation for achieving beneficial long-term DBS effects. Performance in the apomorphine-induced rotation test showed no improvement after 6 weeks. DBS reduced the initiation time of the contralateral paw in the stepping test after 3 weeks of DBS followed by 3 weeks without DBS. Similarly, sensorimotor neglect was improved. The latter two parameters were found to be most appropriate for judging therapeutic DBS effects.
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Carcenac C, Favier M, Vachez Y, Lacombe E, Carnicella S, Savasta M, Boulet S. Subthalamic deep brain stimulation differently alters striatal dopaminergic receptor levels in rats. Mov Disord 2015; 30:1739-49. [DOI: 10.1002/mds.26146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/02/2014] [Accepted: 12/05/2014] [Indexed: 01/11/2023] Open
Affiliation(s)
- Carole Carcenac
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
| | - Mathieu Favier
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
| | - Yvan Vachez
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
| | - Emilie Lacombe
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
| | - Sébastien Carnicella
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
| | - Marc Savasta
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
- Centre Hospitalier Universitaire de Grenoble; Grenoble France
| | - Sabrina Boulet
- Institut National de la Santé et de la Recherche Médicale, Grenoble Institut des Neurosciences; Dynamique et Physiopathologie des Ganglions de la Base Grenoble France
- Grenoble University; Grenoble France
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Petri D, Pum M, Vesper J, Huston JP, Schnitzler A. GABAA-receptor activation in the subthalamic nucleus compensates behavioral asymmetries in the hemiparkinsonian rat. Behav Brain Res 2013; 252:58-67. [PMID: 23727148 DOI: 10.1016/j.bbr.2013.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 01/22/2023]
Abstract
The subthalamic nucleus (STN) has a pivotal role in the pathophysiology of Parkinson's disease (PD). Modulation of STN activity (by lesions, pharmacological or electrical stimulation) has been shown to improve motor parameters in PD patients and in animal models of PD. In an attempt to characterize the neurochemical bases for such antiparkinsonian action, we address specific neurotransmitter systems via local pharmacological manipulation of the STN in hemiparkinsonian rats. Here, we have focused on the GABAergic and glutamatergic receptors in the STN. In animals with unilateral 6-hydroxydopamine lesions of the nigro-striatal tract, we administered either the selective GABAA-agonist muscimol (0.5 μg and 1.0 μg), the non-competitive N-methyl-d-aspartate (NMDA)-antagonist MK-801 (dizocilpine; 2.5 μg), or vehicle (0.25 μl) into the STN. The effects of GABAergic and glutamatergic modulation of the STN on motor parameters were assessed by gauging rotational behavior and locomotion. Application of muscimol ipsilateral to the side of dopamine-depletion influenced turning behavior in a dose-dependent fashion, with the low dose re-adjusting turning behavior to a non-biased distribution, and the high dose evoking contraversive turning. The administration of MK-801 did not have such effects. These findings give evidence for the involvement of GABAergic activation in the STN in the compensation of motor asymmetries in the hemiparkinsonian rat, whereas N-methyl-d-aspartate (NMDA)-antagonism was ineffective in this model of PD.
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Affiliation(s)
- David Petri
- Center for Behavioral Neuroscience, Heinrich-Heine-University, D-40225 Düsseldorf, Germany
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Sgambato-Faure V, Cenci MA. Glutamatergic mechanisms in the dyskinesias induced by pharmacological dopamine replacement and deep brain stimulation for the treatment of Parkinson's disease. Prog Neurobiol 2012; 96:69-86. [DOI: 10.1016/j.pneurobio.2011.10.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 10/25/2011] [Accepted: 10/27/2011] [Indexed: 12/13/2022]
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Oxytocin directly administered into the nucleus accumbens core or subthalamic nucleus attenuates methamphetamine-induced conditioned place preference. Behav Brain Res 2011; 228:185-93. [PMID: 22155611 DOI: 10.1016/j.bbr.2011.11.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/24/2011] [Accepted: 11/28/2011] [Indexed: 11/22/2022]
Abstract
Accumulating evidence indicates that the neuropeptide oxytocin (OXY) may modulate reward-related behavioural responses to methamphetamine (METH) administration. Limited research has examined the effect of OXY on METH-induced conditioned place preference (CPP) and little is known about the neural mechanisms involved. A Fos immunohistochemistry study recently demonstrated that peripheral OXY administration reduced METH-induced Fos expression within the nucleus accumbens (NAc) core and subthalamic nucleus (STh) in rats. The current study aimed to (i) investigate the effect of systemically administered OXY on METH-induced CPP, (ii) determine the effectiveness of a single-trial CPP procedure with METH, in order to (iii) evaluate whether pretreatment with OXY injected directly into the NAc core or the STh attenuates METH-induced CPP. Results showed that male Sprague Dawley rats learned to associate unique compartmental cues with METH (1 mg/kg, i.p.) such that they spent more time in the METH-paired compartment and less time in the saline-paired compartment. Pretreatment with systemic OXY (0.6 mg, i.p.), or OXY (0.6 ng, i.c.) microinjected into the NAc core or the STh prior to METH administration attenuated the formation of a CPP to METH. This provides further evidence that OXY acts within either the NAc core or the STh to reduce the rewarding effects of METH administration.
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Winter C, Harnack D, Kupsch A. [Deep brain stimulation for neurological and psychiatric diseases: animal experiments on effect and mechanisms]. DER NERVENARZT 2010; 81:711-8. [PMID: 20502860 DOI: 10.1007/s00115-010-2936-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation at high frequencies has emerged as a powerful therapeutic strategy in the treatment of basal ganglia-related movement disorders. Attempts have also been made to establish this for the treatment of therapy-resistant psychiatric disorders. To date the mechanisms underlying the clinical efficacy of high frequency stimulation remain largely unknown. Their detailed description, however, is essential for promoting the extended application of high frequency stimulation as a therapeutic alternative and may simultaneously allow conclusions to be drawn on the pathophysiological mechanisms underlying the diseases benefiting from deep brain stimulation. This review demonstrates how animal models contribute to i) further understand the mechanisms underlying deep brain stimulation at high frequencies and ii) promote the establishment of high frequency stimulation for the treatment of therapy-resistant psychiatric disorders.
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Affiliation(s)
- C Winter
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, Dresden, Germany.
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Carson DS, Hunt GE, Guastella AJ, Barber L, Cornish JL, Arnold JC, Boucher AA, McGregor IS. Systemically administered oxytocin decreases methamphetamine activation of the subthalamic nucleus and accumbens core and stimulates oxytocinergic neurons in the hypothalamus. Addict Biol 2010; 15:448-63. [PMID: 20731630 DOI: 10.1111/j.1369-1600.2010.00247.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recent preclinical evidence indicates that the neuropeptide oxytocin may have potential in the treatment of drug dependence and drug withdrawal. Oxytocin reduces methamphetamine self-administration, conditioned place preference and hyperactivity in rodents. However, it is unclear how oxytocin acts in the brain to produce such effects. The present study examined how patterns of neural activation produced by methamphetamine were modified by co-administered oxytocin. Male Sprague-Dawley rats were pretreated with either 2 mg/kg oxytocin (IP) or saline and then injected with either 2 mg/kg methamphetamine (IP) or saline. After injection, locomotor activity was measured for 80 minutes prior to perfusion. As in previous studies, co-administered oxytocin significantly reduced methamphetamine-induced behaviors. Strikingly, oxytocin significantly reduced methamphetamine-induced Fos expression in two regions of the basal ganglia: the subthalamic nucleus and the nucleus accumbens core. The subthalamic nucleus is of particular interest given emerging evidence for this structure in compulsive, addiction-relevant behaviors. When administered alone, oxytocin increased Fos expression in several regions, most notably in the oxytocin-synthesizing neurons of the supraoptic nucleus and paraventricular nucleus of the hypothalamus. This provides new evidence for central actions of peripheral oxytocin and suggests a self-stimulation effect of exogenous oxytocin on its own hypothalamic circuitry. Overall, these results give further insight into the way in which oxytocin might moderate compulsive behaviors and demonstrate the capacity of peripherally administered oxytocin to induce widespread central effects.
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Affiliation(s)
- Dean S Carson
- Brain & Mind Research Institute, University of Sydney, NSW, Australia
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Baunez C, Gubellini P. Effects of GPi and STN inactivation on physiological, motor, cognitive and motivational processes in animal models of Parkinson’s disease. PROGRESS IN BRAIN RESEARCH 2010; 183:235-58. [DOI: 10.1016/s0079-6123(10)83012-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gubellini P, Salin P, Kerkerian-Le Goff L, Baunez C. Deep brain stimulation in neurological diseases and experimental models: From molecule to complex behavior. Prog Neurobiol 2009; 89:79-123. [DOI: 10.1016/j.pneurobio.2009.06.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 04/28/2009] [Accepted: 06/18/2009] [Indexed: 11/30/2022]
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12
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Hesse S, Strecker K, Winkler D, Luthardt J, Scherfler C, Reupert A, Oehlwein C, Barthel H, Schneider JP, Wegner F, Meyer P, Meixensberger J, Sabri O, Schwarz J. Effects of subthalamic nucleus stimulation on striatal dopaminergic transmission in patients with Parkinson’s disease within one-year follow-up. J Neurol 2008; 255:1059-66. [PMID: 18446306 DOI: 10.1007/s00415-008-0849-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/30/2007] [Accepted: 12/18/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Swen Hesse
- Dept. of Nuclear Medicine, University of Leipzig, Stephanstrasse 11, 04103 Leipzig, Germany.
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Jabre M, Nohra G, Damier P, Bejjani BP. Does dopamine still have a leading role in advanced Parkinson's disease after subthalamic stimulation? Stereotact Funct Neurosurg 2008; 86:184-6. [PMID: 18421247 DOI: 10.1159/000126941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of endogenous dopamine in severe Parkinson's disease is often underestimated. We report on a case of acute general motor worsening induced by the ingestion of fluphenazine in a parkinsonian patient successfully treated with STN DBS. Other etiologies were ruled out. Clinical improvement was gradual and fully reversible 4 days after discontinuation of the antidopaminergic drug. We suggest that residual striatal and extrastriatal dopaminergic pathways still play a paramount role in mediating central neurotrasmissions that may take part in STN DBS's mechanism of action.
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Affiliation(s)
- Mazen Jabre
- Parkinson, Memory and Movement Disorders Center, Notre Dame des Secours Hospital, Byblos/Jbail, Lebanon
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Continuous high-frequency stimulation in freely moving rats: Development of an implantable microstimulation system. J Neurosci Methods 2008; 167:278-91. [DOI: 10.1016/j.jneumeth.2007.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 08/23/2007] [Accepted: 08/23/2007] [Indexed: 11/21/2022]
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Sun B, Chen S, Zhan S, Le W, Krahl SE. Subthalamic nucleus stimulation for primary dystonia and tardive dystonia. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 97:207-14. [PMID: 17691306 DOI: 10.1007/978-3-211-33081-4_23] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
With the renaissance of stereotactic pallidotomy for Parkinson's disease in 1990s, pallidotomy has become increasingly used as an effective treatment for various manifestations of medically refractory dystonia. More recently, deep brain stimulation of globus pallidus internus (GPi) has been replacing pallidotomy. Although GPi DBS has great promise for treating dystonia, there are some disadvantages. We introduce our experiences in subthalamic nucleus (STN) DBS for primary dystonia and tardive dystonia in this chapter. We propose that STN DBS has the following advantages over GPi DBS: (1) symptomatic improvement is seen immediately after stimulation, allowing us to quickly select the most suitable stimulation parameters; (2) the stimulation parameters for the STN are lower than those used for the GPi, resulting in longer battery life; and (3) STN DBS results in better symptomatic control than GPi DBS in dystonia patients when our STN data is compared to that obtained by others with using the GPi as the target. We suggest that STN DBS may be the most appropriate surgical technique for dystonia.
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Affiliation(s)
- B Sun
- Center for Functional Neurosurgery, Shanghai Jiao Ton University Ruijin Hospital, Shanghai, PR China.
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Winter C, Mundt A, Jalali R, Joel D, Harnack D, Morgenstern R, Juckel G, Kupsch A. High frequency stimulation and temporary inactivation of the subthalamic nucleus reduce quinpirole-induced compulsive checking behavior in rats. Exp Neurol 2007; 210:217-28. [PMID: 18076877 DOI: 10.1016/j.expneurol.2007.10.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 10/29/2007] [Accepted: 10/31/2007] [Indexed: 11/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) represents a highly prevalent and impairing psychiatric disorder. Functional and structural imaging studies implicate the involvement of basal ganglia-thalamo-cortical circuits in the pathophysiology of this disorder. In patients remaining resistant to pharmaco- and behavioral therapy, modulation of these circuits may consequently reverse clinical symptoms. High frequency stimulation (HFS) of the subthalamic nucleus (STN), an important station of the basal ganglia-thalamo-cortical circuits, has been reported to reduce obsessive-compulsive symptoms in a few Parkinson's disease patients with comorbid OCD. The present study tested the effects of bilateral HFS of the STN and of bilateral pharmacological inactivation of the STN (via intracranial administration of the GABA agonist muscimol) on checking behavior in the quinpirole rat model of OCD. We demonstrate that both HFS and pharmacological inactivation of the STN reduce quinpirole-induced compulsive checking behavior. We conclude that functional inhibition of the STN can alleviate compulsive checking, and suggest the STN as a potential target structure for HFS in the treatment of OCD.
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Affiliation(s)
- Christine Winter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Germany; Department of Neurology, Charité Campus Mitte, Germany.
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Anderson L, Caldwell MA. Human neural progenitor cell transplants into the subthalamic nucleus lead to functional recovery in a rat model of Parkinson’s disease. Neurobiol Dis 2007; 27:133-40. [PMID: 17587588 DOI: 10.1016/j.nbd.2007.03.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 03/21/2007] [Accepted: 03/27/2007] [Indexed: 01/03/2023] Open
Abstract
Despite the success of foetal nigral transplantation for the treatment of Parkinson's disease, supply limitations of tissue means that alternative sources must be found. Transplantation of human neural progenitor cells (HNPCs) may offer a solution, however few studies have shown functional recovery in animal models of PD without cell modification. Here we show that unmodified HNPC grafted into the subthalamic nucleus (STN) show excellent survival of up to 5 months and induce significant functional recovery following amphetamine-induced rotations within 4 weeks. For the first time we also show that HNPCs, which remain in an immature nestin-positive state, produce VEGF in vivo allowing further modification of the host brain. This suggests that even in the absence of cell replacement strategies utilising immature progenitor cells could be of real therapeutic value.
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Affiliation(s)
- Lucy Anderson
- Centre for Brain Repair and Department of Clinical Neurosciences, University Forvie Site, Robinson Way, Cambridge, CB2 2PY, UK
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