an initial short term activation followed by long term activation. The short term activation is thought to proceed through kinase activation and subsequent phosphorylation of AADC, while the sensitivity of long term activation to protein translation inhibitors suggests regulation of mRNA transcription. Reactions AADC catalyzes several different decarboxylation reactions: L-DOPA to dopamine – a neurotransmitter L-Phenylalanine to phenethylamine – a trace amine which functions as a neuromodulator L-Tyrosine to tyramine – a trace amine neuromodulator L-Histidine to histamine – a neurotransmitter L-Tryptophan to tryptamine – a trace amine neuromodulator 5-HTP to serotonin (5-hydroxytryptamine) – a neurotransmitter However, some of these reactions do not seem to bear much or any biological significance. For example, histamine is biosynthesised strictly via the enzyme histidine decarboxylase in humans and other organisms. Clinical relevance 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 L-DOPA (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