In normal
dopamine and
serotonin (5-HT) neurotransmitter synthesis, AADC is not the
rate-limiting step in either reaction. However, AADC becomes the rate-limiting step of dopamine synthesis in patients treated with (such as in
Parkinson's disease), and the rate-limiting step of serotonin synthesis in people treated with
5-HTP (such as in mild
depression or
dysthymia). AADC is inhibited by
carbidopa outside of the
blood brain barrier to inhibit the premature conversion of L-DOPA to
dopamine in the treatment of
Parkinson's. In humans, AADC is also the
rate-limiting enzyme in the formation of
trace amines.
Aromatic L-amino acid decarboxylase deficiency is associated with various symptoms as severe developmental delay,
oculogyric crises and autonomic dysfunction. The molecular and clinical spectrum of AAAC deficiency is heterogeneous. The first case of AADC deficiency was described in twin brothers 1990. Patients can be treated with
dopamine agonists,
MAO inhibitors, and
pyridoxine (
vitamin B6). Clinical phenotype and response to treatment is variable and the long-term and functional outcome is unknown. To provide a basis for improving the understanding of the epidemiology, genotype–phenotype correlation and outcome of these diseases their impact on the quality of life of patients, and for evaluating diagnostic and therapeutic strategies a patient registry was established by the noncommercial
International Working Group on Neurotransmitter Related Disorders (iNTD).
Immunohistochemical studies have revealed that AADC is expressed in various
neuronal cell types such as
serotonergic and
catecholaminergic neurons. Neurons that express AADC but are not considered classical
monoaminergic cell neurons are termed D cells. Cells that are
immunoreactive for AADC have also been found in the human
brainstem. These cells include
melanin-pigmented cells that are typically designated as catecholaminergic and may also be serotonergic. Significant localization of dopaminergic cells that are also immunoreactive for AADC is reported in the
substantia nigra,
ventral tegmental area, and the
mesencephalic reticular formation. Unlike previous reports on animal models, nonaminergic (D cells) are unlikely to be observed in the human brain. == Genetics ==