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The DRD2 gene on chromosome 11q22-23 comprises 8 exons and 7 introns. Encoding a 415 amino acid protein may be split into two primary isoforms: the long form (D2L) and the short form (D2S). These isoforms fulfill diverse purposes and are expressed in various brain areas. Mostly located in the striatum, nucleus accumbens, and olfactory bulb, D2L is a postsynaptic receptor. It is related to postsynaptic signal modulation. Conversely, D2S controls the release of dopamine from neurons in the ventral tegmental region and the substantia nigra pars compacta by functioning as a presynaptic autoreceptor. The DRD2 receptor's capacity to control dopamine release and activity in different areas of the brain sets it as a major target for antipsychotic medications and Parkinson's disease therapies.
Figure 1. The D2 Dopamine Receptor and Its Signaling Pathways. (Bibb JA, 2005)
DRD2 mostly links with the Gαi component of G-proteins, which inhibits adenylyl cyclase (AC) function, therefore lowering the cAMP levels in the cell. This drop in cAMP then reduces the activity of protein kinase A (PKA), a fundamental control mechanism of numerous downstream signaling processes. Through this route, DRD2 alters many ion channels, including those of potassium and calcium, therefore influencing the release of neurotransmitters. For motor control, especially in the basal ganglia where dopamine is essential in controlling movement, this modulation of ion channels has important consequences.
Furthermore, by use of Gβγ subunits, DRD2 may activate the phospholipase C (PLC) pathway. Inositol trisphosphate (IP3) and diacylglycerol (DAG) produced from this activation cause calcium release from intracellular storage and, respectively, activate protein kinase C (PKC). Synaptic plasticity depends on the higher intracellular calcium and activated PKC, which shapes memory and learning processes.
Driven by DRD2, another important mechanism is G-protein inwardly rectifying potassium (GIRK). Once triggered, DRD2 increases GIRK activity, which results in hyperpolarisation of the neuron and decreased neuronal excitability. Maintaining homeostasis in dopaminergic neurons, this mechanism functions as a feedback loop controlling dopamine output.
Apart from conventional G-protein mediated pathways, DRD2 also contributes to G-protein independent signaling. One interesting route is the interaction between DRD2 and arrestins, which function as scaffolding for different signaling complexes. For example, DRD2 may control the AKT/Glycogen synthase kinase 3β (GSK-3β) pathway, which has been linked to mental diseases like bipolar illness and schizophrenia. Under this route, DRD2 reduces AKT activity, thereby activating GSK-3β, a kinase that controls many cellular processes including cell differentiation, metabolism, and death. Hyperactivity seen in certain mental diseases has been connected to disturbance of this circuit.
Additionally, DRD2 has been shown to interact with the Na+/K+ ATPase pump, a necessary control of neuronal resting membrane potential. By changing the excitability of neurons, inhibiting Na+/K+ ATPase emphasizes, even more, the various functions DRD2 performs in neural signaling outside of conventional G-protein processes.
The D2S isoform's significance in the development of schizophrenia has lately been highlighted by studies. Although both isoforms are expressed in the brain, the short isoform seems to be more important in the illness. Researchers at Johns Hopkins University found in 2022 that greater schizophrenia risk is linked to varying expression of the D2S isoform but not D2L. This result implies that the function of a presynaptic autoreceptor in the D2S isoform might help to explain the dysregulation of dopamine signaling seen in the condition.
In healthy people, DRD2 helps to control dopamine release, therefore preserving a balance in the dopaminergic system. But in those with schizophrenia, the D2S isoform's malfunction causes inappropriate control of dopamine release, which results in an excess of the neurotransmitter.
Linked to schizophrenia, DRD2 is also a key component in Parkinson's disease, a neurodegenerative condition that kills substantia nigra dopamine-generating neurons. Dopaminergic neuron loss in Parkinson's disease compromises dopamine signaling in motor control circuits. Dopamine agonists and other DRD2-targeting medications help Parkinson's disease sufferers restore dopaminergic signaling and reduce bradykinesia, tremors, and stiffness. Addiction mechanisms relate to DRD2. Abuse of cocaine and amphetamine increases brain reward circuit dopamine, hence enhancing DRD2 receptors. Strong stimulation over time may desensitize and downregulate receptors, leading to tolerance and addiction.
Studies have shown that DRD2 can trigger a form of programmed cell death known as ferroptosis in breast cancer cells. Through its interaction with β-arrestin2, DRD2 downregulates critical proteins such as DDX5 and Eef1a2, ultimately inhibiting the NF-κB signaling pathway, a key player in cancer cell survival. This novel role of DRD2 in promoting cancer cell death has opened up new avenues for research into dopamine receptor agonists as potential adjuvants in cancer therapy.
Apart from breast cancer, first-line therapy for prolactinomas, a kind of pituitary tumor, is already bromocriptine and cabergoline, dopamine receptor agonists. Targeting DRD2 helps these medications lower prolactin production and stop tumor development. Researchers are now looking at whether other cancer types, including breast and colorectal cancer, may benefit from the same tactics.
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