Tardive dyskinesia (TD), a movement disorder produced by long-term treatment with a classical antipsychotic drug, is generally considered to be a disorder of dopamine (DA) systems, since classical antipsychotics are potent DA D2 receptor blockers. Also, acute DA D1 agonist treatment of rats is known to produce vacuous chewing movements (VCMs), a behavioral feature resembling the oral dyskinesia that is so prominent in most instances of TD. In this paper we outline a series of studies in a new animal model of TD in which DA D1 receptor supersensitivity was produced by neonatal 6-hydroxydopamine (6-OHDA)-induced destruction of nigrostriatal DA fibers. In rats so-lesioned 5-HT receptor supersensitivity is additionally produced, and in fact 5-HT receptor antagonists attenuate enhanced DA D16-lesioned rats treated with haloperidol for one year, there is a 2-fold increase in numbers of VCMs (versus intact rats treated with haloperidol); and this high frequency of VCMs persists for more than 6 months after discontinuing haloperidol treatment. During this stage, 5-HT2 receptor antagonists, but not DA D1 receptor antagonists, attenuate the incidence of VCMs. This series of findings implicates the 5-HT neuronal phenotype in TD, and promotes 5-HT2 receptor antagonists, more specifically 5-HT2C receptor antagonists, as a rational treatment approach for TD in humans.

Tardive dyskinesia (TD), first appearing in humans after introduction of the phenothiazine class of antipsychotics in the 1950s, is now recognized as an abnormality resulting predominately by long-term block of dopamine (DA) D2 receptors (R). TD is thus reproduced in primates and rodents by chronic administration of D2-R antagonists. Through a series of studies predominately since the 1980s, it has been shown in rodent modeling of TD that when haloperidol or other D2-R antagonist is added to drinking water, rats develop spontaneous oral dyskinesias, vacuous chewing movements (VCMs), after ~3 months, and this TD is associated with an increase in the number of striatal D2-R. This TD persists for the duration of haloperidol administration and another ~2 months after haloperidol withdrawal. By neonatally lesioning dopaminergic nerves in brain in neonatal rats with 6-hydroxydopamine (6-OHDA), it has been found that TD develops sooner, at ~2 months, and also is accompanied by a much higher number of VCMs in these haloperidol-treated lesioned rats, and the TD persists lifelong after haloperidol withdrawal, but is not associated with an increased D2-R number in the haloperidol-withdrawn phase. TD apparently is related in part to supersensitization of both D1-R and serotoninergic 5-HT2-R, which is also a typical outcome of neonatal 6-OHDA (n6-OHDA) lesioning. Testing during the haloperidol-withdrawn phase in n6-OHDA rats displaying TD reveals that receptor agonists and antagonists of a host of neuronal phenotypic classes have virtually no effect on spontaneous VCM number, except for 5-HT2-R antagonists which acutely abate the incidence of VCMs in part. Extrapolating to human TD, it appears that (1)5-HT2-R supersensitization is the crucial alteration accounting for persistence of TD, (2) dopaminergic-perhaps age-related partial denervation-is a risk factor for the development of TD, and (3) 5-HT2-R antagonists have the therapeutic potential to alleviate TD, particularly if/when an antipsychotic D2-R blocker is withdrawn.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Considering the hypothesis that GABA and oxidative stress are involved in the development of oral movements associated with important neuropathologies, the present study investigated the possible ability of V. officinalis in the prevention of vacuous chewing movements (VCMs) induced by reserpine in rats. Adult male rats were treated with reserpine (1 mg/kg, s.c.) and/or with V. officinalis (in the drinking water). VCMs, locomotor activity and oxidative stress measurements were evaluated. The neuroprotective effect of V. officinalis against iron-induced cell toxicity was investigated in brain cortical slices. Furthermore, we carried out the identification of valeric acid and gallic acid by HPLC in the V. officinalis tincture. Our findings demonstrate that reserpine caused a marked increase on VCMs and the co-treatment with V. officinalis was able to reduce the intensity of VCM. Reserpine did not induce oxidative stress in cerebral structures (cortex, hippocampus, striatum and substantia nigra). However, a significant positive correlation between DCF-oxidation (an estimation of oxidative stress) in the cortex and VCMs (p<0.05) was observed. Moreover, a tendency for a negative correlation between Na+K+- ATPase activity in substantia nigra and the number of VCMs was observed (p= 0.06). In vitro, V. officinalis protected brain cortical slices viability against Fe(II)-induced neurotoxicity. In conclusion, V. officinalis had in vitro and in vivo neuroprotective effects in rats, i.e., reduced Fe(II) neurotoxicity and reserpine-induced VCMs, probably via modulation of oxidative stress in specific brain nucleus and its GABA-mimetic action. However, the mechanisms involved in this protective activity needs to further investigated to better understand the action of V. officinalis. / Considerando as hipóteses do papel da neurotransmissão gabaérgica e do estresse oxidativo no desenvolvimento de movimentos orais associados a neuropatologias importantes, o presente estudo investigou a possível habilidade da tintura de V. officinalis na prevenção dos movimentos de mascar no vazio (MMV) induzidos por reserpina em ratos. Os animais foram tratados com reserpina (1 mg/Kg, s.c.) e/ou com V. officinalis (na água de beber). MMV, atividade locomotora e medidas de estresse oxidativo foram avaliadas. O efeito neuroprotetor da V. officinalis contra a toxicidade celular induzida por ferro foi investigada em fatias de córtex cerebral. Além disso, fez-se a identificação do ácido valérico e do ácido gálico por HPLC na tintura de V. officinalis. Os resultados demonstram que a reserpina causou um aumento nos MMV quando comparado com o seu veículo e o co-tratamento com V. officinalis foi capaz de reduzir a intensidade dos MMV. A reserpina não alterou de forma significativa alguns parâmetros de estresse oxidativo analisados nas estruturas do cérebro (córtex, hipocampo, estriado e substantia nigra). Porém, uma correlação positiva entre os níveis de oxidação da DCF (uma estimativa do estresse oxidativo) no cortex e o número de MMV (p<0.05) foi observada. Além disso, foi observada uma tendência a haver uma correlação negativa entre a atividade da Na+/K+- ATPase na substantia nigra e o número de MMV (p= 0.055). In vitro, V. officinalis protegeu as fatias de córtex cerebral contra a neurotoxicidade induzida por ferro. Desta forma, pode-se concluir que a V. officinalis apresentou efeitos neuroprotetores em ratos tanto in vitro quanto in vivo, ou seja, reduziu a neurotoxicidade induzida por ferro e os MMV induzidos por reserpina, provavelmente via modulação do estresse oxidativo em núcleos específicos do cérebro e sua ação gabamimética. Porém, os mecanismos envolvidos nesta atividade protetora necessitam de mais investigações para melhor entender a ação da V. officinalis.