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左旋多巴诱导的异动症的分子机制。

Molecular mechanisms underlying levodopa-induced dyskinesia.

作者信息

Calabresi Paolo, Di Filippo Massimiliano, Ghiglieri Veronica, Picconi Barbara

机构信息

Clinica Neurologica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.

出版信息

Mov Disord. 2008;23 Suppl 3:S570-9. doi: 10.1002/mds.22019.

Abstract

Although levodopa remains the most effective drug for the symptomatic treatment of Parkinson's disease, chronic therapy with this pharmacological compound initiates a complex cascade of cellular and molecular downstream effects resulting in the development of abnormal involuntary movements. The precise mechanisms underlying the development of levodopa induced dyskinesia, however, are far from being completely elucidated. In the present review, we will describe changes in long-term synaptic excitability following dopamine (DA) denervation and long-term levodopa treatment leading to abnormal involuntary movements. In particular, we will address the role of both DA D1 receptors and NMDA glutamate receptors in the induction and maintenance of dyskinesia and abnormal synaptic plasticity. We will also describe the possible interaction between these two receptors in the pathophysiology of dyskinesia taking the advantage of the existing knowledge concerning the mechanisms underlying drug abuse. This latter pathophysiological condition, in fact, seems to share several biochemical transduction pathways with those implicated in levodopa-induced dyskinesia. Finally, we will briefly discuss the possible implication of A2A adenosine receptors in long-term motor complications of levodopa therapy and focus on the interaction between A2A and D2 receptors. Future studies are required to understand how the interaction between these various biochemical steps converge to produce a long-term change in neuronal excitability within the basal ganglia leading to abnormal involuntary movements following levodopa treatment in the DA-denervated state.

摘要

尽管左旋多巴仍然是帕金森病症状治疗最有效的药物,但使用这种药理化合物进行长期治疗会引发一系列复杂的细胞和分子下游效应,导致异常不自主运动的发生。然而,左旋多巴诱发异动症发生的确切机制远未完全阐明。在本综述中,我们将描述多巴胺(DA)去神经支配和长期左旋多巴治疗后导致异常不自主运动的长期突触兴奋性变化。特别是,我们将探讨DA D1受体和NMDA谷氨酸受体在异动症的诱导和维持以及异常突触可塑性中的作用。我们还将利用关于药物滥用潜在机制的现有知识,描述这两种受体在异动症病理生理学中的可能相互作用。事实上,后一种病理生理状况似乎与左旋多巴诱发异动症涉及的那些状况共享若干生化转导途径。最后,我们将简要讨论A2A腺苷受体在左旋多巴治疗长期运动并发症中的可能影响,并聚焦于A2A和D2受体之间的相互作用。需要未来的研究来了解这些不同生化步骤之间的相互作用如何汇聚,从而在基底神经节内产生神经元兴奋性的长期变化,导致在DA去神经支配状态下左旋多巴治疗后出现异常不自主运动。

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