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New research suggests that nicotine or nicotine agonists may play an important 
role in the future of Parkinson's disease therapy.

Dopaminergic neurons of the striatum also bear so-called nicotinic 
acetylcholine receptors (nAchRs). Each nAchR is composed of five subunits, 
drawn from multiple possible types of alpha and beta subunits. Recent work by 
Drenan et al. demonstrate that one such subunit, alpha-6, appears to play a 
special role in the striatum. 

--They showed in mice that specific stimulation of the alpha-6 subunit 
prompted dopamine release from striatal dopamine neurons, indicating the 
importance of nAchRs containing alpha-6 as modulators of dopaminergic 
signaling. 

--Results of stimulation suggested that alpha-6 containing nAchRs do not occur 
on striatal GABA neurons, even though nAchRs of other subunit concentration 
do. This finding suggests that alpha-6-specific stimulation may be able to 
avoid off-target effects of less specific nicotinic receptor agonists. 

--Repeated stimulation did not induce tolerance or sensitization, suggesting 
drugs targeting alpha-6 might have less potential for abuse, and "might avoid 
well known use-dependent side effects [of direct dopamine stimulation] such 
as dyskinesias," the authors say.

In vivo activation of midbrain dopamine neurons via sensitive, high-affinity 
alpha-6* nicotinic acetylcholine receptors
RM Drenan, SR Grady, P Whiteaker, et al.
Neuron, 2008;60:123-136

The potential of nicotinic stimulation for PD therapy was also recently 
highlighted in a review by Quik et al. They outline the case for nicotine 
stimulation as follows:

--Nicotinic receptors are found presynaptically on nigrostriatal dopaminergic 
neurons, as well as on GABAergic and cholinergic neurons in the striatum, and 
nicotinic stimulation affects motor function in animals with nigrostriatal 
damage. 

--alpha-6-containing dopaminergic neurons are more susceptible to damage in PD 
than neurons with other subtypes predominating. These receptors, 
therefore, "may represent promising pharmacologic targets for Parkinson's 
disease for neuroprotection and/or symptomatic improvement.

--Epidemiologic studies consistently show that smokers have a lower risk of 
developing PD. The effect is dose-dependent and wanes after smoking 
cessation, "consistent with a true biologic protective effect of tobacco 
use."

--Nicotine stimulation is neuroprotective in animal models of PD and cell 
culture systems. 

--Nicotinic stimulation improves motor symptoms in animal models. Variable 
outcomes have been reported in humans from case studies and small trials.

--Nicotine reduces dyskinesias in animal models.

"These combined data indicate that nicotine or nicotinic agonists may be 
useful for Parkinson's disease therapy," potentially including 
neuroprotection, symptomatic improvement, and alleviation or prevention of 
dyskinesias, the authors conclude.

Nicotine and Parkinson's disease: Implications for therapy
M Quik, K O'Leary, CM Tanner
Movement Disorders 2008;23:1641-1652

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