Études de la subthalamotomie comme traitement des dyskinésies chez le primate parkinsonien

• Main Author: Jourdain, Vincent
• Other Authors: Di Paolo, Thérèse
• Format: Doctoral Thesis
• Language: French
• Published: Université Laval 2013
• Subjects: Dyskinésies > Traitement; Maladie de Parkinson > Traitement; Noyau subthalamique > Chirurgie
• Online Access: http://hdl.handle.net/20.500.11794/24505

La présente thèse comprend une étude des mécanismes neurochimiques d’une approche chirurgicale, la subthalamotomie, pour le traitement de la maladie de Parkinson et les dyskinésies induites à la L-DOPA. Nous avons cherché à identifier, à l’aide de quelques hypothèses de recherche, les changements biochimiques dans les ganglions de la base induits par la lésion du noyau sous-thalamique. Nous avons utilisé un modèle de singe parkinsonien traité à la L-DOPA et ayant reçu une subthalamotomie unilatérale. Nos résultats démontrent que la subthalamotomie potentialise la réponse à faible dose de L-DOPA et que cette potentialisation serait entre autre régulée par le récepteur dopaminergique D1 et les récepteurs glutamatergiques métabotropiques. Ces données apportent de nouveaux éléments aidant à mieux comprendre les mécanismes de cette chirurgie pour le traitement des dyskinésies induites à la L-DOPA. De telles connaissances ouvrent la porte à de nouvelles stratégies pour augmenter la réponse chirurgicale du patient. === Lesion of the subthalamic nucleus, also called subthalamotomy, is surgical therapy offered to parkinsonian patients refractory to L-DOPA or for whom L-DOPA-induced dyskinesias become disabling. Its mechanisms remain however largely unknown. In order to better understand the biochemical and cellular changes underlying subthalamotomy, we used an Parkinson’s disease animal model, the MPTP monkey. Chronic administration of L-DOPA in this animal model induces dyskinesias, as those seen in parkinsonian patients. The monkeys used in this study displayed such side effects and took part of different pharmacological trials to reduce these dyskinesias before undergoing surgery. Thus, we replicated the clinical situation where patients receive such surgery when all the other pharmacological treatments have failed. These monkeys received a unilateral subthalamotomy, the non-lesioned side served as an intra-animal control. Antiparkinsonian response to low dose of L-DOPA was potentiated by subthalamotomy. Then, we studied by autoradiography the D1 and D2 dopaminergic receptors, ionotropic NMDA (NR1/NR2B) and AMPA, metabotropic mGluR2/3 and mGluR5 glutamatergic receptors, and the dopaminergic transporter (DAT) using respectively the selective radioligands [3H]-SCH-23390, [3H]-Raclopride, [3H]-Ro 25-6981, [3H]-Ro 48-8587, [3H]-LY-341495, [3H]-ABP688 and [125I]-RTI-121. We measured by in situ hybridization the D1, D2 and preproenkephalin mRNAs using oligonucleotides as well as preprodynorphin mRNA using a riboprobe. We also assessed the dopamine and its metabolites by high-performance liquid chromatography. Finally, we measured the proteins ERK1 and ERK2, involved in intracellular signaling, and their respective phosphorylation state, as well as DARPP-32 by Western blot. Our results show that the dopamine D1 receptor, but not D2, as well as the metabotropic glutamate receptors are involved in the behavioral effects of subthalamotomy. This data suggest that the potentiation of response to L-DOPA after subthalamotomy would be due to changes in the direct pathway of the model of basal ganglia and in the subthalamic output. Our results open new and exciting pathways to explore on subthalamotomy, as well as other surgeries that are offered to disabled patients with movement disorders, whether these surgeries are lesional or with implantable stimulation devices.