Abstract Virtually all neuropsychiatric disorders display sex differences in prevalence, age of onset, and/or clinical symptomology. In sex-biased disorders, one sex is often suggested to harbor protective mechanisms, rendering them resilient to genetic and/or environmental risk factors. Here, we demonstrate sex-biased molecular, pharmacological and behavioral effects induced by the dopamine (DA) transporter (DAT) coding variant Ala559Val, previously identified in subjects diagnosed with the male-biased disorders attention-deficit/hyperactivity disorder and autism spectrum spectrum disorder. In DAT Val559 mice, we identified sex differences in response to psychostimulants, social behavior, and cognitive traits. We reveal a sex by circuit dissociation in D2-type autoreceptor (D2AR) regulation of DAT wherein D2AR-dependent DAT phosphorylation and trafficking, detectable in the male dorsal striatum, does not occur in females but rather is a property of the ventral striatum, predicting sex-specific changes in behavior. Consequently, we found that a subset of altered behaviors can be normalized using the D2R antagonist sulpiride in DAT Val559 mice. Our studies provide a cogent example of how sex shapes the behavioral trajectory of DA signaling perturbations and identify the sex-dependent, locality-selective capacity for D2AR regulation of DAT as an unrecognized determinant of this trajectory. Rather than identifying one sex as resilient, we find that sex can drive alterative behavioral patterns from shared signaling perturbations that may result in females being underreported. Our work underscores the utility of model systems to study the functional intrusions of rare genetic variation to gain insights into pathways underlying normal and perturbed trait domains associated with common neuropsychiatric conditions.

Sex and Circuit Specific Dopamine Transporter Regulation Underlies Unique Behavioral Trajectories of Functional SLC6A3 Coding Variation