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! "# $ % & % ' % !' ' "# ' '% $$(' Improving Therapeutics for Parkinson Disease A dissertation submitted to The Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the Degree of Doctor of Philosophy in the Neuroscience Graduate Program and Physician Scientist Training Program at the University of Cincinnati College of Medicine by Jennifer A. O’Malley BS Case Western Reserve University 2002; BA Case Western Reserve University 2002 July 2009 Thesis Advisor/Chair: Dr. Kathy Steece-Collier, Ph.D. Committee Members: Dr. Caryl E. Sortwell, Ph.D. Dr. Michael Behbehani, Ph.D. Dr. John Bissler, M.D. Dr. Timothy Collier, Ph.D. Dr. David Richards, Ph.D. Dr. Kim Seroogy, Ph.D Abstract The following results are from studies designed with the overall goal of elucidating means for improving therapeutics for Parkinson’s disease. There is still much to be understood regarding the cellular and molecular mechanisms underlying the development of side effects to therapies for Parkinson’s disease such as levodopa- induced dyskinesias. Additionally, therapeutic intervention is further complicated when one considers the role of the functionally waning host environment, especially in the context of its responsivity to therapeutic agents. The work in this thesis was designed to focus on two aspects of Parkinson’s disease therapeutics, (1) improving graft efficacy by contributing additional information on how the host environment in regards to age impacts graft function in Parkinson’s disease, and (2) determining whether specific morphological changes of the nigral target neurons within the striatum impact development or severity of levodopa-induced dyskinesias. The first study demonstrates that while the aging striatum can, under specific conditions, support the survival of large numbers of grafted embryonic dopamine neurons, there is limited functional benefit even with robust cell survival. This realization is an important contribution to the field as it newly suggests the aged striatum is capable of supporting grafted dopamine neurons, but the limited efficacy of these grafts demonstrates the importance of the intricate balance between grafted cells and the aged host environment. The second study demonstrate that maintaining appropriate synaptic contacts that are presumably maintained when striatal medium spiny neuron cytoarchitecture is preserved, resulting in reduced drug-induced side-effects in parkinsonian rats. Future experiments are Page | xx needed to explore the specific requirements of the aging striatum for functional recovery and how to implement synaptic stability of medium spiny neurons in clinical practice to potentially decrease side-effects of dopamine replacement pharmacotherapy. Page | xxi The scientist is not a person who gives the right answers, he's one who asks the right questions. Claude Lévi-Strauss, Le Cru et le cuit, 1964 Page | iii Table of Contents ABBREVIATIONS XI LIST OF FIGURES AND TABLES XVI ABSTRACT XX DEDICATION XXII ACKNOWLEDGEMENTS XXIII CHAPTER 1: INTRODUCTION 1 1.1 HISTORY OF PARKINSON DISEASE 2 1.2 HISTOLOGICAL CHANGES IN PD 6 1.3 THE BASAL GANGLIA 11 1.3.1 NEUROANATOMY OF THE BASAL GANGLIA: 11 1.3.1.1 THE STRIATUM 14 1.3.1.2 THE SUBSTANTIA NIGRA AND VENTRAL TEGMENTAL AREA 18 1.3.1.3 THE SUB-THALAMIC NUCLEUS 18 1.3.1.4 THE GLOBUS PALLIDUS 19 1.3.1.5 THE PEDUNCULOPONTINE TEGMENTAL NUCLEUS 19 1.3.1.6 THE NUCLEUS ACCUMBENS 20 1.3.1.7 THE NUCLEUS BASALIS (BASAL NUCLEUS OF MEYNERT) 21 1.3.2 GENERAL CIRCUITRY IN THE NORMAL BASAL GANGLIA 21 Page | iv 1.4 BASAL GANGLIA CIRCUITRY IN THE PARKINSONIAN BRAIN 24 1.5 RISK FACTORS FOR PARKINSON DISEASE 28 1.6 THE ROLE OF AGE IN PARKINSON DISEASE 32 1.7 SYMPTOMS OF PARKINSON DISEASE 36 1.8 SYMPTOMATIC TREATMENT OF PARKINSON DISEASE 40 1.8.1 PHARMACOTHERAPY: 40 1.8.2 THERAPEUTIC SURGICAL OPTIONS 46 1.8.2.1 GENE THERAPY 46 1.8.2.2 PALLIDOTOMY 48 1.8.2.3 DEEP BRAIN STIMULATION 49 1.8.2.4 TRANSPLANTATION 53 1.8.2.4.1 PRECLINICAL ANIMAL STUDIES 53 1.8.2.4.2 TRANSPLANTATION: CLINICAL TRIALS 61 1.9 LEVODOPA- AND GRAFT-INDUCED DYSKINESIAS 67 1.10 POTENTIAL MECHANISMS UNDERLYING DYSKINESIA IN THE PARKINSONIAN STRIATUM 71 1.10.1 FACTORS UNDERLYING INDUCTION OF LIDS 72 1.10.2 THE AGING STRIATUM AND DYSKINESIAS 76 1.10.3 STRIATAL PLASTICITY AND DYSKINESIAS 77 1.10.3.1 SYNAPTIC PLASTICITY IN THE STRIATUM 77 1.10.3.2 CHANGES IN STRIATAL PLASTICITY WITH 6-OHDA DA-DEPLETION; POTENTIAL ROLE IN LIDS 79 1.10.4 DENDRITE MORPHOLOGY AND LIDS 80 Page | v 1.10.4.1 DENDRITIC SPINES 81 1.10.4.2 ROLE OF DENDRITIC MORPHOLOGY IN NEURONAL COMMUNICATION IN THE STRIATUM 85 1.10.4.3 ROLE OF DENDRITE AND SYNAPSE PATHOLOGY IN LIDS 88 1.11 CELLULAR TARGETS INVOLVED IN DEVELOPMENT AND MAINTENANCE OF DYSKINESIAS 89 1.11.1 PARALLELS BETWEEN DYSKINESIA INDUCTION & COCAINE SENSITIZATION 90 1.11.2 STRIATAL DOPAMINE RECEPTORS AND ASSOCIATED PATHWAYS 93 1.11.3 STRIATAL GLUTAMATERGIC RECEPTORS & ASSOCIATED PATHWAYS 96 1.11.4 THE ROLE OF SEROTONIN IN LIDS 99 1.12 MODELING PARKINSON’S DISEASE: THE RAT MODEL OF PD AND LIDS 101 CHAPTER 2; INTRODUCTION TO THE SPECIFIC AIMS 108 2.1 AIM 1: IMPROVING EFFICACY OF DA TERMINAL REPLACEMENT STRATEGIES: IMPACT OF AGE ON GRAFT FUNCTION 109 2.2 AIM 2: UNDERSTANDING MECHANISMS OF LEVODOPA-INDUCED DYSKINESIAS: THE ROLE OF STRIATAL PATHOLOGY ON LEVODOPA-INDUCED DYSKINESIAS 111 Page | vi CHAPTER 3; MATERIALS AND METHODS 113 3.1 AIM 1- IMPACT OF AGE ON GRAFT FUNCTION 114 3.1.1 BRIEF SUMMARY OF THE EXPERIMENTAL DESIGN 114 3.1.2 NIGROSTRIATAL DOPAMINE LESION 116 3.1.3 AMPHETAMINE-INDUCED ROTATIONAL ASYMMETRY 116 3.1.4 LATERAL FOREPAW STEP ADJUSTMENT TESTING 117 3.1.5 LEVODOPA PRIMING 117 3.1.6 PREPARATION OF TISSUE FOR TRANSPLANTATION 117 3.1.7 DOPAMINE NEURON TRANSPLANTATION 118 3.1.8 DYSKINESIA RATING 119 3.1.9 NECROPSY AND PREPARATION OF TISSUE 120 3.1.10 IMMUNOHISTOCHEMISTRY 121 3.1.11 STEREOLOGICAL QUANTIFICATION OF GRAFT CELL NUMBER 122 3.1.12 GRAFT VOLUME QUANTIFICATION 123 3.1.13 STRIATAL INTEGRITY 123 3.1.14 DENSITOMETRY ANALYSIS OF FOSB/ΔFOSB-IR CELLS 124 3.1.15 QUANTIFICATION OF NEURITE OUTGROWTH VIA DENSITOMETRY 125 3.1.16 QUANTIFICATION OF THIR FIBER DENSITY IN THE STRIATUM 128 3.1.17 STATISTICAL ANALYSIS 129 3.2 AIM 2- UNDERSTANDING MECHANISMS OF LEVODOPA-INDUCED DYSKINESIAS: THE ROLE OF STRIATAL PATHOLOGY ON LEVODOPA-INDUCED DYSKINESIAS 130 Page | vii 3.2.1 PILOT STUDY EXPERIMENTAL DESIGN 130 3.2.2 FOLLOW-UP STUDY DATA: EXPERIMENTAL DESIGN AND TIMELINE 133 3.2.3 EXPERIMENTAL SUBJECTS AND DOPAMINE DENERVATING LESION 136 3.2.4 NIMODIPINE ADMINISTRATION 136 3.2.5 LEVODOPA TREATMENT AND LID RATING 137 3.2.6 SENSORI-MOTOR INTEGRATION (VIBRISSAE) TEST 138 3.2.7 DENDRITIC SPINE DENSITY QUANTIFICATION USING A MODIFIED GOLGI- COX IMPREGNATION METHOD 139 3.2.8 IMMUNOHISTOCHEMISTRY 143 3.2.9 DENSITOMETRY ANALYSIS OF FOSB/DELTAFOSB-IR CELLS 144 3.2.10 AREA UNDER THE CURVE CALCULATIONS 145 3.2.11 MEDIAL TERMINAL NUCLEUS (MTN) GUIDED CONFIRMATION OF DA- DEPLETION 146 3.2.12 STATISTICAL ANALYSES 146 CHAPTER 4; EXPERIMENTAL RESULTS & DISCUSSION FOR SPECIFIC AIMS 148 4.1 AIM 1: IMPACT OF AGE ON GRAFT FUNCTION 149 4.1.1 RESULTS 149 4.1.2 GRAFTED CELL SURVIVAL AND TOTAL GRAFT VOLUME ACROSS AGES 151 4.1.3 CONFIRMATION OF NEURONAL INTEGRITY IN THE GRAFTED STRIATUM 154 Page | viii 4.1.4 NEURITE OUTGROWTH OF GRAFTS IN YOUNG, MIDDLE, AND AGED RATS 156 4.1.5 PRE- AND POST-GRAFT LIDS ACROSS AGES 170 4.1.6 EVALUATION OF PARKINSONIAN MOTOR BEHAVIORS; PRE- AND POST- GRAFT 175 4.1.7 FOSB/DELTAFOSB IMMUNOREACTIVITY IS REDUCED WITH GRAFTING ACROSS ALL AGES 177 4.1.8 DISCUSSION OF RESULTS FOR AIM 1 179 4.2 AIM 2: UNDERSTANDING MECHANISMS OF LEVODOPA-INDUCED DYSKINESIAS: THE ROLE OF STRIATAL PATHOLOGY ON LEVODOPA-INDUCED DYSKINESIAS 187 4.2.1 RESULTS 187 4.2.2 CONFIRMATION OF DENDRITIC SPINE LOSS WITH DA-DEPLETION, AND SPINE PRESERVATION WITH NIMODIPINE 188 4.2.3 IMPACT OF NIMODIPINE-MEDIATED SPINE PRESERVATION IN DA- DEPLETED RATS ON PARKINSONIAN MOTOR BEHAVIORS 194 4.2.4 ACUTELY ADMINISTERED NIMODIPINE DOES NOT ALTER THE EXPRESSION OF LIDS 200 4.2.5 PILOT STUDY DATA: IMPACT OF NIMODIPINE-MEDIATED SPINE PRESERVATION IN DA-DEPLETED RATS ON LIDS: 203 Page | ix 4.2.6 CONFIRMATION OF DA-DENERVATION AND IMPACT OF NIMODIPINE- MEDIATED SPINE PRESERVATION IN DA-DEPLETED RATS ON PARKINSONIAN MOTOR BEHAVIORS 208 4.2.7 FOLLOW-UP STUDY DATA: IMPACT OF NIMODIPINE-MEDIATED SPINE PRESERVATION IN DA-DEPLETED RATS ON LIDS 211 4.2.8 FOLLOW-UP STUDY DATA: IMPACT OF NIMODIPINE-MEDIATED SPINE PRESERVATION IN DA-DEPLETED RATS ON FOSB EXPRESSION 221 4.2.9 DISCUSSION FOR AIM 2 223 CHAPTER 5; DISCUSSION 229 5.1 SUMMARY OF THE RESULTS OF THE SPECIFIC AIMS 230 5.2 OPTIMIZING GRAFT EFFICACY 238 5.3 EFFICACY OF GRAFTING IN THE AGING PARKINSONIAN PATIENT 243 5.4 THOUGHTS ON HOW SPINE PRESERVATION MIGHT REDUCE LEVODOPA- INDUCED DYSKINESIAS 252 5.5 THE ROLE OF CALCIUM SIGNALING IN THE PARKINSONIAN STRIATUM; MODELING AN EXPLANATION FOR LIDS AND REDUCED GRAFT EFFICACY 259 5.6 FUTURE DIRECTIONS 268 CHAPTER 6; REFERENCES 270 Page | x Abbreviations 6-OHDA 6-hydroxydopamine A2A adenosine-2A AADC aromatic amino acid decarboxylase ACC anterior cingulate cortex ad autosomal dominant AMPA α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate ar autosomal recessive bFGF basic fibroblast growth factor C caudal CamKII calcium/calmodulin-dependent protein kinase II CB carotid body CeM central medial thalamic nuclei CL central lateral thalamic nuclei cm centimeter CNS central nervous system COMT catechol-0-methyl transferase Page | xi CREB cAMP response element binding D1R dopamine receptor 1 D2R dopamine receptor 2 DA Dopamine DARPP-32 dopamine and cAMP-regulated phospho-protein DBS deep brain stimulation dPL dorsal prelimbic cortices DR3 dopamine receptor 3 Erk1/ Erk2 extracellular signal-related kinase 1 / 2 FFD facial-forelimb dyskinesias FosB FBJ murine osteosarcoma viral oncogene homolog B GABA gamma-aminobutyric acid GID(s) graft-induced dyskinesias Glut glutamate GP globus pallidus GPe globus pallidus, externa GPi globus pallidus, interna HD Huntington’s disease Page | xii hESC (human) embyonic stem cell Hz Hertz i.m.