The Role of MPTP in Research Probably the most significant advance in the research of Parkinson's disease since its connection to striatal dopamine loss in 1960 is the discovery of the parkinson-like effects caused by 1-methyl-4-phenyl- 1,2,3,6-tetra-hydropyridine (MPTP). MPTP was implicated for research after many young narcotic drug abusers in northern California exhibited parkinson-like symptoms in the 1980s. An illicit supply of meperidine was tainted with MPTP, a by-product of the narcotic drug's synthesis. Immediate research into the mechanism of MPTP's neurotoxicity produced results that shed much light onto the study of idiopathic parkinsonism. MPTP is a lipophilic molecule that easily crosses the blood-brain barrier. Once inside the brain's neurons it is rapidly bound by monoamine oxidase (MAO) receptors in mitochondrial outer membranes. MAO, the normal role of which is to break down monoamines such as dopamine, converts MPTP to 1-methyl-4-phenylpyridinium ion (MPP+- see Figure 1, below) but MPTP does not seem to significantly interfere with the normal role of MAO. Figure 1- The Action of MAO on MPTP For unknown reasons MPP+ tends to preferentially accumulate in the substantia nigra. MPP+ -induced neuronal death is believed to be caused by inhibition of oxidative phosphorylation at complex I of the mitochondrial respiratory chain (and therefore inhibition of ATP synthesis) (Beal et al. 1993) or by production of free radicals which cause lipid breakdown or DNA damage. A majority of what is currently known about the pathology of Parkinson's disease is the result of studying MPTP-induced parkinsonism. In order to draw conclusions about Parkinson's disease from MPTP studies it is important to know the similarities and differences between Parkinson's disease and MPTP induced-parkinsonism. Most pathological and clinical aspects of the two diseases are the same but MPTP patients (meperidine drug abusers) generally have more cognitive and emotional instabilities. They also have more difficulty with excess salivation and gait instabilities. However, MPTP patients usually experience less tremor. After the effects of MPTP were discovered, other similar causative agents were sought. Another molecule, 6-hydroxydopamine (OHDA), was found to produce similar clinical characteristics in monkeys. Though both MPTP and OHDA cause lesions of nigral dopamine neurons, few studies were carried out on OHDA because it cannot readily cross the blood-brain barrier. It has to be directly injected into the brain, and direct physical manipulation of the brain often causes injuries to tissue. Because MPTP easily crosses the blood-brain barrier this problem can be averted by administering MPTP systemically. Neuroanatomy of the Extrapyramidal System The functional neuroanatomy involved in Parkinson's disease is centered on the extrapyramidal system. The extrapyramidal tracts control and coordinate the postural, static, supporting and locomotor mechanisms. They are also responsible for causing contractions of muscle groups in sequence or simultaneously. The principle structures are the striatum, globus pallidus, substantia nigra, subthalamic nucleus and the thalamus (see Figure 2). Two anatomically contiguous nuclei, the putamen and the caudate nucleus, comprise the striatum. The caudate nucleus is involved in manifestation or driving locomotion whereas the putamen is involved in regulation of tonus in contralateral proximal muscles (Yoshida 1993). The globus pallidus is divided into two segments, the external and internal nuclei. Figure 2- Anatomy of the Extrapyramidal System Medial to the globus pallidus is the thalamus. The subthalamic nucleus, which is inferior to the thalamus, is referred to as the gatekeeper of the thalamocortical motor circuit. A ventral midbrain nucleus called the substantia nigra is divided into three functionally distinct units: the pars reticulata, pars compacta , and pars lateralis. Although they are parts of the same anatomical nucleus, they do not all have the same role. The pars reticulata, along with the internal globus pallidus, is called the output nucleus. The pars compacta however, which is made up primarily of dopaminergic melanin-containing neurons, is the primary input nucleus. Though believed to be functionally similar to the pars compacta, the exact function of the pars lateralis remains unclear. Dopaminergic neuronal degeneration of the pars compacta defines Parkinson's disease. There are approximately 7,000 ipsilaterally projecting dopaminergic neurons in the substantia nigra, and each neuron gives rise to approximately 250,000 termini (Yurek and Sladek 1990). Dopaminergic neurons impinge on three different types of neurons: striatal interneurons, corticostriatal terminals, and striatal efferents. Striatal interneurons, which make up less than four percent of the striatal neurons, are of two morphological types: aspiny I inhibitory interneurons release the neurotransmitter gamma-aminobutyric acid (GABA) and the other type, composed of excitatory aspiny II interneurons, releases acetylcholine (ACh). A majority of dopamine cells target striatal efferents which send axons to the globus pallidus and substantia nigra. They are also composed of two morphologically distinct cell types; spiny I interneurons release the neurotransmitter GABA, and excitatory spiny II interneurons release substance P. A small fraction of dopamine neurons impinge on the termini of corticostriatal neurons. Mesostriatal Circuitry One of the difficulties in understanding the relationship between striatal dopamine loss and the clinical manifestations of parkinsonism is the complexity of the neurological circuits involved in the extrapyramidal system. There is some uncertainty about details of the circuitry but a general model for the basal ganglia thalamocortical motor circuit is widely accepted (see Figure 3). Wichmann et al. describe the circuit as a reentrant pathway for motor influences from the supplementary motor area, premotor cortex, and somatosensory cortex (1993). Motor stimuli emanating from the precentral and postcentral motor areas of the cerebral cortex, after being processed by the basal ganglia and thalamus, are returned to the precentral motor areas (Wichman et al. 1993). Input from the motor cortices is supplied to the striatum and then to the rest of the basal ganglia thalamocortical motor circuit (the details of which are explained later). After being processed the motor information is returned to the motor cortices. Basal ganglia thalamocortical motor activity is modulated by dopaminergic input from the pars compacta of the substantia nigra. Dopaminergic activity in this nigrostriatal pathway is drastically reduced or eliminated in parkinsonism. Within the striatum are at least two types of dopamine receptors, termed D1 and D2. D1 receptors, which are involved in the "direct" pathway, are stimulated by dopamine, but D2 receptors of the "indirect" pathway appear to be inhibited by dopamine (Albin et al. 1989). There are D1 receptors on striatal neurons of the "direct" pathway which release a combination of the neurotransmitters GABA and substance P in their monosynaptic inhibitory projections to motor portions of the internal globus pallidus and pars reticulata (output nucleus). Stimulation of D1 receptors causes direct inhibition of the output nucleus which prevents excessive inhibitory output to the ventrolateral thalamic nucleus. Other striatal neurons which belong to the "indirect pathway" have D2 receptors. In the absence of dopamine these neurons emit tonic inhibitory output to the external globus pallidus (which itself has tonic inhibitory projections to the subthalamic nucleus). However, when the D2 receptors bind dopamine these neurons are inhibited and their release of the neurotransmitters GABA and enkephalin to the external globus pallidus is decreased. Normal dopamine release prevents excessive inhibition of the external globus pallidus while allowing moderate tonic inhibition of the subthalamic nucleus. The subthalamic nucleus has stimulatory glutamatergic projections to the output nucleus which causes partial inhibition of the ventrolateral thalamic nucleus. Reciprocal inhibitory pathways between the output nucleus and the external globus pallidus act as a negative feedback mechanism to regulate inhibition of the ventrolateral thalamic nucleus (Wichmann and DeLong 1993). Moderate inhibition of the ventrolateral thalamic nucleus allows smooth motor control, but excessive inhibition of the ventrolateral thalamic nucleus greatly reduces its ability to stimulate the motor cortex (as in parkinsonism). However, excessive disinhibition of the ventrolateral thalamic nucleus causes hyperstimulation of the motor cortex, therefore a delicate balance of D1 and D2 activity is required for normal motor control. Striatal dopamine loss results in enhancement of the indirect D2 pathway and inhibition of the direct D1 pathway, so the direct pathway no longer keeps the indirect pathway in check (DeLong 1990). There is no consensus on the exact relationship between cerebral cortex hypostimulation and movement disorders. DeLong suggests that increased feedback by proprioceptors causes the basal ganglia to falsely perceive excessive movement or velocity and the basal ganglia then act to slow them down (1990). He also suggests that inhibition of tonic ventrolateral thalamic nuclear activity could decrease the responsiveness of precentral motor fields (1990). The complexities of the basal ganglia thalamocortical motor circuit make verification or refutation of these hypotheses very difficult.