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Stereoselective, sex-dependent 5-HT2A receptor modulation of cortical plasticity by MDMA in mice

Year: 2026

Type: article

Abstract: The psychoactive entactogen 3,4-methylenedioxymethamphetamine (MDMA), widely known as a recreational drug, is gaining renewed attention as a potential psychotherapeutic adjunct for treatment-resistant psychiatric disorders, yet its neurobiological mechanisms – particularly those related to its stereoisomers and sex-specific effects – remain poorly understood. Here, we report stereoselective and sex-dependent actions of MDMA on serotonin (or 5-hydroxytryptamine) 2A receptor (5-HT 2A R)-mediated signaling and dendritic structural plasticity in mouse frontal cortex. Using both in vitro and in vivo approaches, we found that racemic MDMA and S (+)-MDMA exhibit weak partial agonism at 5-HT 2A R in HEK293 cells, whereas R (–)-MDMA shows negligible functional activity despite higher specific binding affinity. In vivo, S (+)-MDMA elicited a dose-dependent head-twitch response (HTR) in both sexes, while R (–)-MDMA-induced HTR only in females. Correspondingly, S (+)-MDMA increased inositol monophosphate (IP 1 ) accumulation in the frontal cortex of male and female mice, whereas R (–)-MDMA showed minimal effects. Structurally, S (+)-MDMA enhanced dendritic spine density in male frontal cortex in a partially 5-HT 2A R-dependent manner, while no spine remodeling was observed in females or with R (–)-MDMA. Pharmacological blockade of the serotonin transporter (SERT) with fluoxetine fully prevented S (+)-MDMA-induced HTR and IP 1 signaling, without affecting responses to the direct 5-HT 2A R agonist DOI. These findings indicate that MDMA engages 5-HT 2A R signaling indirectly via serotonin efflux and that this effect is both stereoselective and sex-dependent in mice, uncovering a previously unrecognized interaction between sex, MDMA stereochemistry, and 5-HT 2A R-mediated cortical plasticity, with important implications for the rational design of MDMA-based therapeutics.

Source: Neuropsychopharmacology

DOI: 10.1038/s41386-025-02313-x