Huntington disease (HD) is characterized by the loss of striatal projection neurons, which constitute the vast majority of striatal neurons. To determine whether there is differential loss among different populations of striatal projection neurons, the integrity of the axon terminal plexuses arising from the different populations of substance P-containing and enkephalin-containing striatal projection neurons was studied in striatal target areas by immunohistochemistry. Analysis of 17 HD specimens indicated that in early and middle stages of HD, enkephalin-containing neurons projecting to the external segment of the globus pallidus were much more affected than substance P-containing neurons projecting to the internal pallidal segment. Furthermore, substance P-containing neurons projecting to the substantia nigra pars reticulata were more affected than those projecting to the substantia nigra pars compacta. At the most advanced stages of the disease, projections to all striatal target areas were depleted, with the exception of some apparent sparing of the striatal projection to the substantia nigra pars compacta. These findings may explain some of the clinical manifestations and pharmacology of HD. They also may aid in identifying the neural defect underlying HD and provide additional data with which to evaluate current models of HD pathogenesis.Huntington disease (HD) is an autosomal dominant neurodegenerative disorder characterized by choreiform movements, cognitive decline, and personality disturbance (1). The underlying genetic defect in HD is unknown, but the gene has been localized to the short arm of chromosome 4 (2). The histopathology of HD reveals cell loss and astrogliosis in several brain areas, with the most prominent alterations occurring in the striatum (3-5). Although the pathogenetic mechanism of this process is unknown, endogenous "excitotoxins" have been proposed as the mechanism of cell death (6-8). Recent findings indicate that striatal neurons are not uniformly affected in HD and that somatostatin-neuropeptide Y-containing interneurons and cholinergic interneurons are relatively spared (8, 9). Striatal interneurons, however, constitute only a small fraction of the total number of striatal neurons, and it has not been possible to correlate the preservation of interneuron populations with the clinical features of HD.The great majority of striatal neurons are projection neurons, which are heterogeneous in terms of their projection targets and in terms of the neuropeptides they contain (10, 11). These neurons show the earliest evidence of abnormality and are progressively depleted in HD (4, 12). Previous studies, however, have not resolved whether all populations of striatal projection neurons are equally affected in HD. The identification ofthe putative populations of striatal projection neurons that are earliest and most severely affected in HD, however, could provide valuable clues regarding the basis of striatal cell death in HD. To determine whether some populations of striatal proje...