Differential activation states of direct pathway striatal output neurons associated with the development of L-DOPA-induced dyskinesia

L-DOPA-induced dyskinesia (LID) is a debilitating motor side effect arising from chronic dopamine replacement therapy with L-DOPA for the treatment of Parkinson disease (PD). The emergence of LID is linked to heightened sensitivity of striatal dopaminergic signaling and driven by abnormal fluctuations in synaptic dopamine levels following each administration of L- DOPA. This maladaptive plasticity narrows the therapeutic window for L-DOPA treatment, even as the progressive worsening of PD symptoms demands escalating doses. The heterogeneous composition of the striatum, including diverse subpopulations of medium spiny output neurons (MSNs), interneurons, and supporting cells, has complicated the precise identification of the cell(s) underlying LID development and persistence. To elucidate the cellular and molecular mechanisms of LID, we used single nucleus RNA-sequencing (snRNA-seq) to establish a comprehensive striatal transcriptional profile during the development and maintenance of LID in an animal model. Hemiparkinsonian mice were treated with vehicle or L-DOPA for progressive durations (1, 5, or 10 d) and nuclei from the striata were processed for snRNA-seq. Our analysis found that a limited population of dopamine D1 receptor-expressing MSNs (D1-MSNs), arising from both the patch and matrix compartments, formed three subclusters in response to L-DOPA treatment that expressed cellular markers of activation. These activated D1-MSN subpopulations display many of the transcriptional changes previously associated with LID; however, the prevalence and transcriptional behavior of activated D1-MSNs was differentially influenced by the extent of L-DOPA experience. The differentially expressed genes found in these D1-MSNs indicated that acute L-DOPA induced upregulation of multiple plasticity-related transcription factors and regulators of MAPK signaling, while repeated L-DOPA exposure induced numerous genes associated with synaptic remodeling, learning and memory, and transforming growth factor-ß (TGFß) signaling. Notably, repeated L-DOPA led to a sensitization in the expression of Inhba, a member of the activin/TGFß superfamily, in activated D1-MSNs. We tested pharmacological inhibition of its receptor, ALK4, and found that it impaired LID development. Collectively, these data suggest that distinct subsets of D1-MSNs become differentially responsive to L-DOPA due to the aberrant induction of the molecular mechanisms necessary for neuronal entrainment, similar to those processes underlying hippocampal learning and memory formation. Our data further suggests that activin/TGFß signaling may play an essential role in LID development in this subpopulation of D1-MSNs.