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Medium spiny neuron

Medium spiny neurons (MSNs), also known as spiny projection neurons, are the principal neurons of the , comprising approximately 90–95% of its neuronal population and serving as the primary interface between cortical inputs, thalamic signals, and modulation in the . These neurons are defined by their medium-sized ovoid cell bodies (14–20 μm in diameter) and extensive dendritic trees featuring numerous spines that receive excitatory and inhibitory synapses. With a hyperpolarized resting of around −80 mV and no spontaneous firing in acute slices, MSNs integrate diverse inputs to regulate , reward processing, and decision-making. MSNs exhibit significant anatomical and molecular diversity, particularly along the dorsal-ventral axis of the , which includes the dorsal (caudate-putamen) and ventral (nucleus accumbens and olfactory tubercle). Single-nucleus sequencing has revealed at least nine transcriptional subtypes, including distinct D1 receptor-expressing (D1-MSNs) and D2 receptor-expressing (D2-MSNs) populations, as well as hybrid and region-specific variants marked by genes like PP1R1B and BCL11B. D1-MSNs form the direct pathway, projecting to the internal (GPi) and pars reticulata (SNr) while co-expressing and facilitating thalamo-cortical output for movement initiation. In contrast, D2-MSNs constitute the indirect pathway, targeting the external (GPe) and expressing to inhibit unwanted movements and refine motor selection. Functionally, MSNs receive convergent inputs from the and on their spines, modulated by from the , which differentially affects D1 and D2 subtypes to balance excitation and inhibition. Their output connections include strong GABAergic projections to other MSNs (63% connectivity) and tonically active interneurons in the , as well as to pallidal and nigral targets, with presynaptic modulation by influencing synaptic strength. This circuitry underlies habit formation, motivated behavior, and emotional responses, with disruptions implicated in disorders such as , , and .

Anatomy and Morphology

Location in the Brain

Medium spiny neurons (MSNs) are the predominant neuronal population within the , comprising 90-95% of all neurons in this structure, which serves as the largest nucleus of the . The is anatomically divided into the dorsal , encompassing the and , and the ventral , primarily the nucleus accumbens.01369-5) These regions position MSNs at the interface of cortical, thalamic, and subcortical inputs, enabling their role in integrating sensory, motor, and reward-related signals within circuits. MSNs in the striatum, located in the caudate and , are primarily involved in and habit formation, receiving targeted projections that support selection and execution. In contrast, MSNs in the ventral striatum, such as those in the , contribute to limbic functions, including motivation, reward processing, and emotional regulation, reflecting their integration with limbic structures. This dorsoventral organization underscores the functional specialization of MSNs across striatal subregions, with populations emphasizing procedural learning and ventral ones focusing on goal-directed behaviors. As the principal output neurons of the , MSNs project inhibitory axons to key targets, including the globus pallidus interna (GPi), pars reticulata (SNr), and globus pallidus externa (GPe). These projections form the core of the direct and indirect pathways, modulating output to influence motor and cognitive functions. In terms of afferents, MSNs receive convergent glutamatergic inputs from the and , which provide excitatory drive for synaptic integration, alongside modulation from the pars compacta that fine-tunes and signaling. This rich connectivity positions MSNs as central hubs for coordinating activity across diverse brain networks.

Cellular Structure and Dendritic Features

Medium spiny neurons possess a medium-sized , typically measuring 12-20 μm in , with a smooth, aspiny surface devoid of protrusions. These neurons feature a highly branched dendritic tree that extends up to 200 μm from the , forming an intricate densely studded with spines. Each medium spiny neuron bears approximately 10,000-20,000 dendritic spines, which accommodate about 90% of the excitatory synaptic inputs onto the cell. The spines display morphological diversity, including thin spines with elongated necks and small heads, stubby spines that are short and wide, and mushroom-shaped spines characterized by large bulbous heads; these structures undergo dynamic remodeling in response to neuronal activity. Axonal arborization in medium spiny neurons includes extensive local collaterals that ramify within the to form inhibitory connections with neighboring neurons, alongside long projections that exit the to target regions such as the external segment of the and the pars reticulata. At the ultrastructural level, the dendrites exhibit a high density of and D2 dopamine distributed along their length, facilitating modulation. Components of the , including CB1 receptors, are also present on these dendrites and associated synaptic terminals.

Electrophysiology and Signaling

Membrane Properties and Firing Patterns

Medium spiny neurons (MSNs) exhibit a characteristic biphasic , alternating between depolarized up-states and hyperpolarized down-states. The up-state typically reaches potentials around -70 mV and lasts 100-500 ms, while the down-state stabilizes near -80 to -85 mV. This arises from intrinsic and is a hallmark of MSN . MSNs display low intrinsic excitability, with a resting around -85 mV in the down-state, rendering them largely silent without external drive. They require strong depolarizing inputs to overcome this hyperpolarization and initiate firing, reflecting their role as integrators rather than pacemakers. In vivo, the down-state predominates, occupying most of the neuron's activity cycle, with transitions to up-states triggered by convergent excitatory inputs from cortical and thalamic sources. Firing patterns in MSNs are sparse, with spontaneous action potentials occurring at low rates of 0.1-1 Hz due to their high for . During up-states, brief bursts or single spikes may occur, often supported by plateau potentials generated via of L-type Ca²⁺ channels, which sustain and enable temporal summation of inputs. These plateaus contribute to the ’s to prolonged excitatory barrages without rapid fatigue. The bistable behavior is shaped by key ion channels, including inward-rectifying K⁺ channels (Kir2), which maintain the hyperpolarized down-state by stabilizing the membrane near the K⁺ equilibrium potential. Ca²⁺ channels and persistent Na⁺ currents further influence excitability, promoting rebound and sustaining up-states by counteracting repolarizing forces. Together, these conductances ensure the pronounced state-dependent fluctuations that define MSN signaling.

Synaptic Inputs and Plasticity

Medium spiny neurons (MSNs) in the receive convergent excitatory inputs primarily from layer V pyramidal cells in the and relay neurons in the , forming synapses on dendritic spines that express and NMDA receptors. Corticostriatal inputs from ipsilateral primary somatosensory (S1) and motor () cortices elicit strong excitatory postsynaptic potentials (EPSPs) in both direct-pathway D1-MSNs (approximately 4.5 mV from S1) and indirect-pathway D2-MSNs (approximately 3.2-4.6 mV), with inputs from the parafascicular nucleus producing somewhat smaller but reliable EPSPs (2.3 mV in D1-MSNs, 3.5 mV in D2-MSNs). These synapses exhibit a higher NMDA/ ratio compared to cortical inputs, which are predominantly -mediated, enabling distinct integration of sensory-motor signals. Differential innervation patterns ensure that direct- and indirect-pathway MSNs receive balanced yet specialized cortical projections, supporting pathway-specific processing. Inhibitory inputs to MSNs arise from local GABAergic sources, including collateral connections from other MSNs and direct synapses from fast-spiking parvalbumin-positive . MSN-to-MSN collaterals provide weak but widespread and inhibition, with unitary IPSCs having peak amplitudes around 50 pA (range 10-90 pA), helping to synchronize striatal output and prevent excessive excitation. Fast-spiking deliver powerful perisomatic inhibition, where a single spike can generate IPSCs sufficient to delay or block action potentials in multiple MSNs (amplitudes around 270 pA, range ~50-500 pA), exerting precise control over MSN firing thresholds. These inputs, often clustered near the , contrast with the distal excitatory synapses on spines, allowing to gate MSN excitability during behavioral states. Neuromodulatory inputs further refine MSN responses, with dopamine released from substantia nigra pars compacta (SNc) neurons acting via volume transmission to influence synaptic efficacy without direct synaptic contacts onto MSNs. from tonically active cholinergic interneurons provides diffuse modulation, projecting broadly to MSNs and altering excitability through muscarinic receptors that suppress excitatory transmission and promote pauses in MSN activity. These neuromodulators interact with glutamatergic and GABAergic synapses to contextualize inputs, such as dopamine enhancing LTP in direct-pathway MSNs during reward . Synaptic plasticity in MSNs follows spike-timing-dependent rules at corticostriatal synapses, embodying Hebbian principles where the relative timing of pre- and postsynaptic spikes determines strengthening or weakening. (LTP) is induced when presynaptic cortical spikes precede MSN postsynaptic spikes by 10-20 ms, requiring activation and occurring in about 80% of MSNs with minimal pairings (e.g., 100 at 1 Hz), thereby amplifying relevant sensorimotor associations. Conversely, long-term depression () at these synapses, triggered by post-before-pre timing or moderate-frequency stimulation (10-20 Hz), depends on postsynaptic endocannabinoid release acting retrogradely on presynaptic CB1 receptors to suppress glutamate release. This eCB-mediated is prominent in both direct- and indirect-pathway MSNs and correlates with structural remodeling, including shrinkage that reduces synaptic surface area and efficacy.

Neurotransmitter Systems

Dopamine Receptor Expression

Medium spiny neurons (MSNs) in the striatum predominantly express dopamine receptors from the D1-like (D1 and D5) and D2-like (D2, D3, and D4) families, with D1 receptors primarily found in direct pathway MSNs and D2 receptors in indirect pathway MSNs. D1 receptors are Gs-coupled, stimulating adenylyl cyclase to increase cyclic AMP (cAMP) levels, which enhances neuronal excitability. In contrast, D2 receptors are Gi-coupled, inhibiting adenylyl cyclase and thereby reducing cAMP production, which decreases MSN excitability. Approximately 50-55% of MSNs express primarily receptors, 40-50% express primarily D2 receptors, and 2-15% co-express both, with co-expression being lower (~2%) in the and higher in ventral regions; the extent of co-expression varies by striatal subregion and species. These expression patterns contribute to the functional segregation of MSNs into direct and indirect pathways within the circuitry. Upon activation, receptors trigger () signaling, which phosphorylates DARPP-32 at 34, thereby inhibiting 1 (PP1) and promoting of downstream targets that facilitate . receptors counteract this by lowering levels, reducing activity and leading to of DARPP-32, which activates PP1 and dampens excitability. Recent studies from 2023 indicate that the /D2 balance in striatal shifts with aging, with aged mice exhibiting a more counterbalanced ratio of transcriptionally active - and D2-expressing compared to the -dominant state in young mice. This shift may underlie age-related declines in motor and . Tonic release maintains baseline modulation of excitability through sustained receptor activation, while phasic transients, associated with reward prediction errors, elicit stronger, transient responses in to promote action selection and in D2 to suppress competing actions.

Other Receptor Types and Modulation

Medium spiny neurons (MSNs) in the express group I metabotropic glutamate receptors, primarily mGluR1 and mGluR5, which are localized on and play key roles in modulating signaling. These receptors couple to proteins, activating (PLC) to produce (IP3) and diacylglycerol, which in turn mobilize intracellular calcium and enhance function. Specifically, mGluR5 activation potentiates NMDA-mediated currents in MSNs, facilitating through downstream PKC signaling. mGluR1 and mGluR5 exhibit cooperative interactions, where their heterodimerization amplifies responses to glutamate, as demonstrated in striatal neurons. While mGluR5 is more abundantly expressed in MSNs compared to mGluR1, both contribute to spine morphology regulation, with opposing effects on density upon selective activation. GABAergic modulation of MSNs occurs via both ionotropic GABAA and metabotropic GABAB receptors, primarily from inputs by local and collateral connections among MSNs. GABAA receptors, which are ligand-gated channels, mediate fast inhibitory postsynaptic currents through Cl⁻ influx, contributing to phasic and inhibition that shapes synaptic integration in MSNs. In contrast, GABAB receptors couple to Gi/o proteins, activating G protein-gated inward rectifier potassium (GIRK) channels to hyperpolarize the membrane and suppress neurotransmitter release presynaptically. These receptors are differentially distributed across D1- and D2-expressing MSNs, with GABAA α1 and α2 subunits prominent in the , influencing inhibitory formation during development. Acetylcholine acts on MSNs predominantly through muscarinic M1 and M4 receptors, which are highly expressed in these projection neurons and mediate opposing effects on excitability. receptors, coupled to /PLC, increase MSN intrinsic excitability via IP3-mediated calcium release and enhancement of persistent sodium currents, promoting long-lasting . Conversely, M4 receptors, linked to Gi/o proteins, inhibit and activate potassium conductances, reducing excitability and modulating release from MSNs onto interneurons. M4 receptors are notably colocalized with dopamine receptors in a subset of MSNs, allowing acetylcholine to fine-tune direct pathway activity. Opioid and systems provide additional modulation of MSN circuits, with mu-opioid receptors (MORs) expressed on axonal collaterals of D2 MSNs to facilitate . Activation of MORs inhibits release from presynaptic terminals, thereby enhancing excitability of target MSNs and contributing to reward processing, as seen in divergent roles for versus reinforcement. Similarly, CB1 receptors, localized presynaptically on and terminals synapsing onto MSNs, mediate endocannabinoid to suppress transmitter release. This depolarization-induced suppression of inhibition (DSI) or excitation (DSE) refines synaptic balance in striatal circuits, with CB1 knockout impairing long-term depression at corticostriatal synapses. Adenosine A2A receptors are selectively co-expressed with D2 in indirect pathway MSNs, where they enhance signaling through Gs-coupled activation, opposing D2-mediated inhibition and promoting indirect pathway output. Recent research highlights A2A-D2 heteromerization in these neurons, which modulates NMDA excitation and contributes to effort-related behaviors in the core. In 2024 studies, A2A receptor interactions with D2 were shown to regulate central and cognitive functions, underscoring their role in striatal modulation.

Role in Basal Ganglia Pathways

Direct Pathway Contributions

Medium spiny neurons (MSNs) expressing dopamine receptors form the core of the in the , originating primarily in the and providing monosynaptic inhibitory projections to the internal segment of the (GPi) and the pars reticulata (SNr). These projections utilize () as the primary , along with co-release of , to suppress the tonic inhibitory output of the GPi and SNr. This anatomical arrangement positions MSNs as key facilitators within the striatonigral pathway, distinct from other striatal efferents. Functionally, activation of direct pathway MSNs promotes movement initiation by inhibiting the GPi/SNr, which in turn disinhibits thalamocortical projections from the ventral anterior and ventrolateral thalamic nuclei to the , enhancing cortical output for "go" signals. This process requires convergent glutamatergic excitation from the cortex, which depolarizes the MSNs, coupled with dopamine-mediated enhancement via receptors that amplify excitability and synaptic efficacy. Selective or optogenetic inhibition of these MSNs impairs action selection, leading to deficits in motor vigor and the ability to initiate goal-directed behaviors. In the broader context of basal ganglia circuitry, direct pathway MSNs integrate with parallel pathways to enable balanced control of movement, where their activation contributes to net facilitation of desired actions through coordinated thalamic release.

Indirect Pathway Contributions

Medium spiny neurons (MSNs) expressing dopamine D2 receptors constitute the primary output of the indirect pathway in the , projecting inhibitory axons to the external segment of the (GPe). These neurons also co-release enkephalins, which contribute to modulating pallidal activity. From the GPe, inhibitory projections target the subthalamic nucleus (STN), which in turn sends excitatory glutamatergic inputs to the internal segment of the (GPi) and pars reticulata (SNr). The GPi and SNr then provide inhibitory outputs to the ventral anterior and ventrolateral thalamic nuclei, ultimately influencing thalamocortical circuits. Functionally, the indirect pathway mediated by D2-expressing MSNs suppresses unwanted movements by enhancing basal ganglia output, leading to thalamic inhibition and reduced cortical motor activation. This pathway forms a critical loop with the STN, where GPe inhibition of the STN disinhibits GPi/SNr excitability, amplifying the suppression of thalamic activity to facilitate action selection and inhibit competing motor programs. acting on D2 receptors inhibits these MSNs, thereby reducing indirect pathway activity and promoting a balance with the direct pathway to enable desired movements. Indirect pathway MSNs exhibit distinct intrinsic properties, including differences in dendritic integration compared to direct pathway neurons, which influence their responsiveness to synaptic inputs. Dysfunction in this pathway, such as selective degeneration of D2 MSNs, underlies hyperkinetic disorders like , where impaired suppression leads to excessive involuntary movements.

Regional Specializations

Dorsal Striatal MSNs

Medium spiny neurons (MSNs) in the dorsal striatum, comprising the and , exhibit a high density that supports their central role in sensorimotor integration. These neurons constitute the vast majority of cells in the caudate-putamen complex, enabling efficient processing of sensory and motor signals essential for coordinated movement and behavioral adaptation. The balance between direct and indirect pathway MSNs in the dorsal is finely tuned to facilitate habit formation and procedural learning. Direct pathway MSNs, expressing dopamine receptors, promote action execution, while indirect pathway MSNs, expressing D2 receptors, inhibit competing actions, allowing a shift from goal-directed to habitual behaviors over repeated training. This antagonistic interplay is particularly pronounced in the dorsolateral , where in MSN circuits strengthens stimulus-response associations critical for skill acquisition. Dorsal striatal MSNs receive stronger excitatory inputs from cortical sensorimotor areas, such as the primary motor and somatosensory cortices, compared to limbic regions, which topographically organizes their role in . These inputs converge on MSN spines, integrating sensory with motor planning. In turn, dorsal MSNs project through the basal ganglia's direct and indirect pathways to modulate activity in the motor , disinhibiting thalamocortical loops to refine movement selection and execution. Functionally, striatal MSNs play a greater role in action selection by integrating signals to bias toward rewarded or habitual responses, suppressing irrelevant motor programs. During , these neurons undergo spine remodeling, including selective pruning of immature spines to stabilize persistent connections, which enhances circuit efficiency for automated behaviors.

Ventral Striatal MSNs

Medium spiny neurons (MSNs) in the ventral striatum, primarily located within the () and , constitute the predominant neuronal population and are subdivided into those in the core and shell subregions of the NAc. The NAc core occupies a more central position and shares structural similarities with the dorsal striatum, while the shell forms a more peripheral, ventromedial layer with distinct cytoarchitectonic features that facilitate its role in limbic processing. MSNs in the , integrated with inputs, contribute to odor-reward associations and emotional processing. Unlike the dorsal striatum, where MSNs predominantly express either D1 or D2 in a segregated manner, ventral striatal MSNs exhibit higher levels of D1-D2 co-expression, with densities of co-expressing neurons significantly elevated in the NAc compared to dorsal regions across species. This co-expression pattern, often manifesting as D1-D2 receptor heteromers, may enable more integrated signaling in reward-related contexts. Ventral striatal MSNs receive convergent inputs from limbic and cortical areas, including the , limbic structures, and , which convey emotional and motivational information to modulate striatal output. These afferents onto MSN dendrites, allowing integration of valence-specific signals that influence behavioral selection. Outputs from ventral MSNs project primarily to the (VP), forming part of the striatopallidal pathway that translates limbic inputs into motivated actions. In motivational processing, direct-pathway MSNs (D1-expressing) promote approach behaviors toward rewards by facilitating and positive , whereas indirect-pathway MSNs (D2-expressing) contribute to aversion avoidance by suppressing responses to negative stimuli. This dichotomy supports the ventral striatum's role in balancing appetitive and defensive motivations. Functional adaptations in ventral striatal MSNs emphasize enhanced linked to reward prediction errors (RPEs), where inputs from the drive or depression at corticostriatal synapses to refine value representations. modulation is particularly prominent here, with mu-opioid receptors on MSN terminals and gating excitatory inputs and amplifying hedonic responses through disinhibition. Recent studies indicate that MSNs in the medial shell contribute to hedonic "liking" reactions during palatable reward consumption, with modulation amplifying affective signals in hotspot regions.

Development and Plasticity

Embryonic Origins and Maturation

Medium spiny neurons (MSNs) originate from progenitor cells in the lateral ganglionic eminence (LGE) of the embryonic telencephalon, a subpallial structure that gives rise to the . These progenitors express the transcription factors Dlx1 and Dlx2, which are essential for specifying the neuronal fate and regulating downstream genes like Meis2 to promote MSN . In , such as mice, MSN neurogenesis primarily occurs between embryonic day 12.5 (E12.5) and E17.5, with the majority generated during E12-E15 from the LGE . Postmitotic MSN precursors migrate from the LGE to the developing through a combination of tangential and radial migration pathways, beginning around E13 and largely completing by E18 in mice. Upon arrival in the striatal , these neurons differentiate into the two major MSN subtypes: D1 receptor-expressing MSNs of the direct pathway and D2 receptor-expressing MSNs of the indirect pathway. Fate determination for D1 and D2 MSNs occurs postmitotically, with lineage commitment established between E18 and postnatal day 0 (P0), influenced by differential expression of transcription factors such as Sp8/9 for D2 bias and combinatorial signaling from progenitors. afferents from the (SNc) arrive in the in the late embryonic stage, around E14-E16 in mice, coinciding with early MSN clustering into patches and compartments and refining nascent striatal circuits through trophic support and modulation of . Postnatal maturation of MSNs involves dendritic elaboration and , with spine density on MSN dendrites increasing rapidly from low levels at birth to a peak around P21 in mice, after which it stabilizes into adulthood to support mature excitatory input integration. This process is regulated by key transcription factors, including Gsh2 (also known as Gsx2), which maintains LGE progenitor identity from E9.5 and upregulates Dlx1/2 and Ascl1 to drive early MSN production, particularly neurons; its loss leads to depleted DARPP-32-positive MSNs by E18.5. Ascl1, a basic helix-loop-helix factor, promotes in LGE progenitors and cooperates with Dlx1/2 for later stages, with double mutants showing severe LGE defects. Epigenetic modulation via MeCP2 further shapes maturation, as it binds methylated DNA to regulate activity-dependent transcription of genes like Bdnf, supporting dendritic growth and stabilization in striatal neurons during postnatal development. In humans, MSN generation parallels timelines but occurs earlier in , with peak production in the LGE during gestational weeks 8-12 post-conception, as evidenced by upregulated striatal markers like FoxP1 in fetal tissue from this period. This window corresponds to the expansion of the and initial striatal patterning, setting the foundation for circuitry.

Activity-Dependent Changes

Medium spiny neurons (MSNs) in the exhibit structural in response to and neural activity during adulthood, particularly through changes in and arborization. In the ventral , repeated exposure induces proliferation of on MSNs, enhancing synaptic and contributing to addictive behaviors. This effect is observed in both D1- and D2-expressing MSNs within the , persisting for weeks after and linked to altered inputs. Conversely, in the , motor training such as response learning or intensive exercise promotes increased density and arborization in MSNs, supporting acquisition and motor refinement. These adaptations reflect region-specific responses to behavioral demands, with ventral changes tied to reward processing and modifications to formation. Molecular mechanisms underlying these structural changes involve key signaling pathways that regulate spine dynamics in adult MSNs. (BDNF) signaling through its receptor TrkB drives spine growth and stabilization, particularly in response to or environmental stimuli, by promoting remodeling and synaptic protein synthesis. In striatal MSNs, BDNF-TrkB activation enhances dendritic complexity and spine density, countering atrophy in dopamine-depleted states. Additionally, the Arc contributes to the consolidation of , including long-term depression (), by localizing to dendritic spines in MSNs following activity and modulating endocytosis to sustain circuit adaptations. At the circuit level, activity-dependent long-term potentiation (LTP) and LTD in corticostriatal synapses remodel the balance between direct and indirect pathways over days to weeks, influencing basal ganglia output. LTP preferentially strengthens direct pathway MSNs (D1-expressing), facilitating movement initiation, while LTD predominates in indirect pathway MSNs (D2-expressing), refining inhibitory control. Chronic manipulations, such as in Parkinson's models, shift this equilibrium, with aberrant LTP in direct MSNs and LTD in indirect ones altering motor circuit dynamics. Recent studies highlight how chronic stress induces hypertrophy and spine density increases specifically in D2 MSNs of the nucleus accumbens, exacerbating avoidance behaviors, an effect reversed by environmental enrichment that restores baseline morphology via GSK3 pathway modulation. In aging, MSNs undergo progressive spine loss, reducing synaptic efficacy and contributing to motor decline. These findings underscore the potential of activity-based interventions to preserve MSN function across the lifespan.

Pathophysiological Implications

Involvement in Movement Disorders

Medium spiny neurons (MSNs) play a central role in the pathophysiology of Parkinson's disease (PD), a hypokinetic movement disorder characterized by bradykinesia, rigidity, and tremor, primarily due to the progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta. The resulting dopamine depletion in the dorsal striatum disrupts the balance between the direct and indirect basal ganglia pathways, where MSNs predominate. Specifically, loss of dopamine leads to hypoactivity in the direct pathway, mediated by D1 receptor-expressing MSNs that project to the substantia nigra pars reticulata and entopeduncular nucleus, while causing overactivity in the indirect pathway, driven by D2 receptor-expressing MSNs that project to the globus pallidus externus. This imbalance results in excessive inhibition of thalamocortical motor circuits, contributing to the motor deficits observed in PD. Anatomical alterations in MSNs further exacerbate these functional disruptions. denervation induces a significant loss of dendritic s on dorsal striatal MSNs, with reductions of 30-50% reported in postmortem analyses of the and in advanced cases. These spine losses are closely tied to the extent of striatal depletion and occur early in the disease process, impairing synaptic integration from cortical and thalamic inputs. Additionally, aggregates, a hallmark of , accumulate in MSNs and disrupt and D2 receptor signaling, further altering excitability and synaptic transmission in both pathway subtypes. In , a Parkinsonian , patient-derived MSNs exhibit elevated release and hypoexcitability, mirroring these pathological changes. Therapeutic interventions targeting MSN dysfunction aim to restore pathway balance but can introduce complications. Levodopa (), the standard dopamine replacement therapy, partially ameliorates by enhancing pathway MSN activity and suppressing indirect pathway overdrive, yet chronic use often leads to L-DOPA-induced through aberrant corticostriatal in MSNs. This maladaptive manifests as exaggerated synaptic strengthening in pathway MSNs, promoting hyperkinetic side effects. (DBS) of the internus (GPi), a key downstream target of MSN outputs, modulates indirect pathway hyperactivity and has shown sustained efficacy in reducing motor symptoms in patients, with 2024 meta-analyses confirming long-term benefits comparable to subthalamic stimulation. Genetic models, such as Pitx3-deficient mice, recapitulate PD-like loss and MSN morphological changes, exhibiting bradykinesia and altered striatal excitability that respond to L-DOPA, providing insights into disease mechanisms. In contrast to the hypokinetic features of , involves progressive loss in the leading to hyperkinetic , highlighting divergent pathological impacts on populations across .

Role in Addiction and Reward Processing

Medium spiny neurons () in the ventral , particularly within the (), play a pivotal role in the neural mechanisms underlying by integrating reward signals and facilitating compulsive behaviors. Chronic exposure to drugs of abuse induces the accumulation of ΔFosB, a , predominantly in receptor-expressing MSNs (-MSNs), which promotes structural and functional adaptations that enhance sensitivity to drug-related cues and drive compulsive drug seeking. This ΔFosB-mediated transcriptional reprogramming in -MSNs alters gene expression to favor reward pathway activation, contributing to the persistence of even after prolonged abstinence. Concurrently, hyperactivity in the ventral direct pathway, comprising -MSN projections from the to downstream targets like the , amplifies reward processing and motivational drive, shifting normal hedonic responses toward pathological reinforcement. Structural plasticity in NAc MSNs further underlies addiction vulnerability, with drugs such as inducing spinogenesis—the formation of new dendritic —on both D1- and D2-MSNs, thereby increasing synaptic connectivity and strengthening reward-associated circuits. These serve as primary sites for excitatory inputs, enhancing the efficacy of synapses that encode drug cues. However, during withdrawal, alterations in occur, particularly in the NAc , such as reduced head diameter without changes in , that sustain craving and relapse propensity by destabilizing normal reward . This biphasic reflects the transition from acute to chronic dependence, with protracted withdrawal exacerbating negative affective states that motivate drug-seeking. Circuit-level dynamics in MSN networks are driven by phasic surges from the , which selectively induce (LTP) at reward-predictive corticostriatal synapses onto D1-MSNs, reinforcing associative learning and habit formation. These transient bursts, timed to unexpected rewards or cues, amplify MSN excitability and synaptic strength, embedding maladaptive memories central to . Recent rodent studies using have demonstrated that activating D2-MSNs in the suppresses cocaine reward and seeking, counteracting excessive direct pathway activity to mitigate . In humans, (fMRI) reveals heightened activity, attributable to MSN ensembles, correlating with subjective craving intensity during cue exposure, underscoring translational relevance. Beyond substance use, MSNs contribute to non-drug addictions like and through analogous reward encoding mechanisms in the ventral striatum, where dysregulated D1-MSN signaling promotes overconsumption or risk-taking by amplifying incentive salience for high-calorie foods or uncertain gains. This shared circuitry explains comorbid vulnerabilities, with MSN similarly driving persistent motivational biases across reward domains.

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