Dopamine (DA) deficiency has been implicated in Lesch-Nyhan disease (LND), a genetic disorder that is characterized by hyperuricemia, choreoathetosis, dystonia, and compulsive self-injury. To Several neurodevelopmental disorders are thought to involve the neuropathology of the basal ganglia. Among them, the best known are Lesch-Nyhan disease (LND) and Rett syndrome. In both of these conditions, there is evidence for the dysfunction of the dopaminergic neurotransmission.LND is an X-chromosome-linked disease with infantile onset characterized by hyperuricemia, choreoathetosis, dystonia, and compulsive self-injury (1). The underlying defect is a near absence of hypoxanthine-guanine phosphoribosyl transferase (HPRT) (2), an enzyme that is normally present in the brain in greater amounts than in other organs. Three lines of evidence suggest that HPRT deficiency is linked to abnormal dopamine (DA) function in LND: (i) an autopsy study of three LND subjects demonstrated a marked reduction in the DA content and in the activity of DA-synthesizing enzymes in the caudate and putamen (3); (ii) when neonatal rats are depleted of DA with the neurotoxin 6-hydroxydopamine, self-injurious behavior (similar to that seen in LND) occurs when the rats are challenged with 3,4-dihydroxyphenylalanine (L-dopa) as adults (4, 5); and (iii) in an HPRT-deficient mutant mouse strain, there is a reduction of striatal tyrosine hydroxylase and in the number of striatal dopamine transporters measured with 3H-N-[1-(2-benzo(,B)thiophenyl) cyclohexyl]piperidine (3H-BTCP) (6). The pertinence of the loss of brain DA in LND has been questioned due to the limited scope of the autopsy study and the fact that the HPRT-deficient mouse study showed only a modest reduction of DA with no self-injury, or other clinical symptoms of LND (6). Therefore the question of dopamine reduction in vivo remains unresolved.The availability of positron emission tomography (PET) ligands that bind to pre-or postsynaptic DA sites has made it possible to study the DA system in vivo in patients affected with disorders that involve the basal ganglia. For example, the DA transporter probe ,3-carbomethoxy-3,3-4-fluorophenyl-tropane (CFT; WIN-35,428) (7-11) has been used to detect the degeneration of DA nerve terminals in adult humans (12,13). It has also been used to measure the degeneration of nerve terminals in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated primates and in idiopathic Parkinson disease (14-16). In addition, 428 is suitable for evaluating the integrity of DAcontaining neurons in neurodevelopmental disorders.In the present investigation, the hypothesis-that HPRT deficiency in LND is associated with impaired development of dopaminergic projections to the striatum-was tested by determining the number of DA transporters in vivo by using PET with the radiolabeled DA transporter ligand 428. The measurement of the presynaptic DA sites of 428 using PET provides a relevant assessment of the degree of dopaminergic deficiency in LND.The binding of [1...