Locus Coeruleus and Noradrenergic Pharmacology in Neurodegenerative Disease

• Published in: Handbook of experimental pharmacology Vol. 285; p. 555
• Main Authors: Matt, Rachel A, Martin, Renee S, Evans, Andrew K, Gever, Joel R, Vargas, Gabriel A, Shamloo, Mehrdad, Ford, Anthony P
• Format: Journal Article
• Language: English
• Published: Germany 2024
• Subjects: Animals; Cognition - drug effects; Humans; Locus Coeruleus - drug effects; Locus Coeruleus - metabolism; Locus Coeruleus - physiopathology; Neurodegenerative Diseases - drug therapy; Neurodegenerative Diseases - metabolism; Neurodegenerative Diseases - physiopathology; Norepinephrine - metabolism; Receptors, Adrenergic - drug effects; Receptors, Adrenergic - metabolism; G protein-coupled receptors; Alzheimer’s disease; Neuroinflammation; Tauopathy; Neurodegenerative disorders; Adrenergic reuptake inhibitors; Alpha-synucleinopathies; Alpha adrenergic receptor; Cerebral blood flow; Aerobic glycolysis; Beta adrenergic receptor; Norepinephrine; Noradrenaline; Locus coeruleus; Parkinson’s disease; Dementia; Neurovascular coupling
• ISSN: 0171-2004
• DOI: 10.1007/164_2023_677

Adrenoceptors (ARs) throughout the brain are stimulated by noradrenaline originating mostly from neurons of the locus coeruleus, a brainstem nucleus that is ostensibly the earliest to show detectable pathology in neurodegenerative diseases such as Alzheimer's and Parkinson's diseases. The α
-AR, α
-AR, and β-AR subtypes expressed in target brain regions and on a range of cell populations define the physiological responses to noradrenaline, which includes activation of cognitive function in addition to modulation of neurometabolism, cerebral blood flow, and neuroinflammation. As these heterocellular functions are critical for maintaining brain homeostasis and neuronal health, combating the loss of noradrenergic tone from locus coeruleus degeneration may therefore be an effective treatment for both cognitive symptoms and disease modification in neurodegenerative indications. Two pharmacologic approaches are receiving attention in recent clinical studies: preserving noradrenaline levels (e.g., via reuptake inhibition) and direct activation of target adrenoceptors. Here, we review the expression and role of adrenoceptors in the brain, the preclinical studies which demonstrate that adrenergic stimulation can support cognitive function and cerebral health by reversing the effects of noradrenaline depletion, and the human data provided by pharmacoepidemiologic analyses and clinical trials which together identify adrenoceptors as promising targets for the treatment of neurodegenerative disease.