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Ruiz de Sabando A, Ciosi M, Galbete A, Cumming SA, Monckton DG, Ramos-Arroyo MA. Somatic CAG repeat instability in intermediate alleles of the HTT gene and its potential association with a clinical phenotype. Eur J Hum Genet 2024; 32:770-778. [PMID: 38433266 PMCID: PMC11220145 DOI: 10.1038/s41431-024-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024] Open
Abstract
Huntington disease (HD) is a neurodegenerative disorder caused by ≥36 CAGs in the HTT gene. Intermediate alleles (IAs) (27-35 CAGs) are not considered HD-causing, but their potential association with neurocognitive symptoms remains controversial. As HTT somatic CAG expansion influences HD onset, we hypothesised that IAs are somatically unstable, and that somatic CAG expansion may drive phenotypic presentation in some IA carriers. We quantified HTT somatic CAG expansions by MiSeq sequencing in the blood DNA of 164 HD subjects and 191 IA (symptomatic and control) carriers, and in the brain DNA of a symptomatic 33 CAG carrier. We also performed genotype-phenotype analysis. The phenotype of symptomatic IA carriers was characterised by motor (85%), cognitive (27%) and/or behavioural (29%) signs, with a late (58.7 ± 18.6 years), but not CAG-dependent, age at onset. IAs displayed somatic expansion that were CAG and age-dependent in blood DNA, with 0.4% and 0.01% of DNA molecules expanding by CAG and year, respectively. Somatic expansions of +1 and +2 CAGs were detected in the brain of the individual with 33 CAGs, with the highest expansion frequency in the putamen (10.3%) and the lowest in the cerebellum (4.8%). Somatic expansion in blood DNA was not different in symptomatic vs. control IA carriers. In conclusion, we show that HTT IAs are somatically unstable, but we found no association with HD-like phenotypes. It is plausible, however, that some IAs, close to the HD pathological threshold and with a predisposing genetic background, could manifest with neurocognitive symptoms.
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Affiliation(s)
- Ainara Ruiz de Sabando
- Department of Medical Genetics, Hospital Universitario de Navarra, IdiSNA, 31008, Pamplona, Spain
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, 31008, Pamplona, Spain
- Fundación Miguel Servet-Navarrabiomed, IdiSNA, 31008, Pamplona, Spain
| | - Marc Ciosi
- School of Molecular Biosciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Arkaitz Galbete
- Department of Statistics, Informatics and Mathematics, Universidad Pública de Navarra, IdiSNA, 31006, Pamplona, Spain
| | - Sarah A Cumming
- School of Molecular Biosciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Darren G Monckton
- School of Molecular Biosciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Maria A Ramos-Arroyo
- Department of Medical Genetics, Hospital Universitario de Navarra, IdiSNA, 31008, Pamplona, Spain.
- Fundación Miguel Servet-Navarrabiomed, IdiSNA, 31008, Pamplona, Spain.
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Yedke NG, Kumar P. The Neuroprotective Role of BCG Vaccine in Movement Disorders: A Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:30-38. [PMID: 36567299 DOI: 10.2174/1871527322666221223142813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 12/27/2022]
Abstract
Bacillus Calmette-Guérin (BCG) is the first developed vaccine to prevent tuberculosis (TB) and is the world's most widely used vaccine. It has a reconcilable defense in opposition to tuberculosis, meningitis, and miliary disease in children but changeable protection against pulmonary TB. Immune activation is responsible for regulating neural development by activating it. The effect of the BCG vaccine on neuronal disorders due to subordinate immune provocation is useful. BCG vaccine can prevent neuronal degeneration in different neurological disorders by provoking auto-reactive T-cells. In the case of TB, CD4+ T-cells effectively protect the immune response by protecting the central defense. Because of the preceding fact, BCG induces protection by creating precise T-cells like CD4+ T-cells and CD8+ T-cells. Hence, vaccination-induced protection generates specific T-cells and CD4+ T-cells, and CD8+ T-cells. The BCG vaccine may have an essential effect on motor disorders and play a crucial role in neuroprotective management. The present review describes how the BCG vaccine might be interrelated with motor disorders and play a key role in such diseases.
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Affiliation(s)
- Narhari Gangaram Yedke
- Department of Pharmaceutical Sciences and Technology Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, India
| | - Puneet Kumar
- Department of Pharmacology Central University of Punjab, Bathinda, Punjab, India
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Yedke NG, Arthur R, Kumar P. Bacillus calmette gaurine vaccine ameliorates the neurotoxicity of quinolinic acid in rats via the modulation of antioxidant, inflammatory and apoptotic markers. J Chem Neuroanat 2023; 131:102287. [PMID: 37172828 DOI: 10.1016/j.jchemneu.2023.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
A mutation in the Huntingtin gene causes 'Huntington's disease, which presents as a motor and behavioral impairment. Due to the limited drug therapy for this disease, scientists are constantly searching for newer and alternative drugs that may either retard or prevent the progress of the disease. This study aims to explore the neuroprotective potential of Bacillus Calmette Gaurine (BCG) vaccine against quinolinic acid-induced (QA) neurotoxicity in rats. QA (200 nmol/2 µl, i.s) was injected bilaterally into the rat striatum, after which a single dose of BCG (2 × 10^7, cfu) was given to the rats. Animals were assessed for behavioral parameters on the 14th and 21st days. On the 22nd day, animals were sacrificed, brains were harvested, and striatum was separated to evaluate biochemical, inflammatory, and apoptotic mediators. Histopathological studies were performed using Hematoxyline and Eosin staining to assess neuronal morphology. BCG treatment reversed motor abnormalities, reduced oxidative stress and neuroinflammatory markers, apoptotic mediators and striatal lesions induced by QA treatment. In conclusion, treat' 'ing rats with BCG vaccine (2 × 10^7, cfu) mitigated the quinolinic acid-induced Huntington's disease-like symptoms. Hence, BCG vaccine (2 ×10^7, cfu) could be used as an adjuvant in managing HD.
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Affiliation(s)
- Narhari Gangaram Yedke
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda 151001, Punjab, India; Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Richmond Arthur
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Puneet Kumar
- Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India.
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Lee CY, Ro JS, Jung H, Kim M, Jeon B, Lee JY. Increased 10-Year Prevalence of Huntington's Disease in South Korea: An Analysis of Medical Expenditure Through the National Healthcare System. J Clin Neurol 2023; 19:147-155. [PMID: 36700478 PMCID: PMC9982180 DOI: 10.3988/jcn.2022.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the updated 10-year prevalence of Huntington's disease (HD) in South Korea and the medical and economic burdens across the duration of the disease. METHODS Data from the National Health Insurance database during 2010-2019 were analyzed. We identified HD cases using predefined criteria. Information on age at diagnosis, sex, and common nonneurological comorbidities were collected. We analyzed individual patterns of the use of medical services and yearly medical expenditure. Incidence rates, 10-year prevalence rates, and longitudinal medical expenditure changes were assessed. RESULTS New patients with HD (average=152.10) were detected every year, with an annual incidence of 0.29 per 100,000. The estimated 10-year prevalence of HD was 2.2 per 100,000. The most common ages at the time of diagnosis were 50-59 years (23.3%). In 2019, 56.4% of patients with HD were followed-up at referral or general hospitals, and 32.2% were managed at long-term-care hospitals. The annual medical cost for an individual was KRW 6,569,341±895,097 (mean±SD) (mean≈USD 5,653). Medical expenditure was the highest in those aged 60-79 years, and lowest in those younger than 30 years. However, in all age groups, the annual medical expenditure was highest during the 9 years following a diagnosis. CONCLUSIONS This study found that the actual prevalence of HD in South Korea was higher than previously thought and that patients are in a situation with high medical expenditure that persists over time.
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Affiliation(s)
- Chan Young Lee
- Department of Neurology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jun-soo Ro
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Hyemin Jung
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Neurology, Neuroscience & Dementia Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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D’Egidio F, Castelli V, Cimini A, d’Angelo M. Cell Rearrangement and Oxidant/Antioxidant Imbalance in Huntington's Disease. Antioxidants (Basel) 2023; 12:571. [PMID: 36978821 PMCID: PMC10045781 DOI: 10.3390/antiox12030571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Huntington's Disease (HD) is a hereditary neurodegenerative disorder caused by the expansion of a CAG triplet repeat in the HTT gene, resulting in the production of an aberrant huntingtin (Htt) protein. The mutant protein accumulation is responsible for neuronal dysfunction and cell death. This is due to the involvement of oxidative damage, excitotoxicity, inflammation, and mitochondrial impairment. Neurons naturally adapt to bioenergetic alteration and oxidative stress in physiological conditions. However, this dynamic system is compromised when a neurodegenerative disorder occurs, resulting in changes in metabolism, alteration in calcium signaling, and impaired substrates transport. Thus, the aim of this review is to provide an overview of the cell's answer to the stress induced by HD, focusing on the role of oxidative stress and its balance with the antioxidant system.
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Affiliation(s)
| | | | | | - Michele d’Angelo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Zhang S, Shen L, Jiao B. Cognitive Dysfunction in Repeat Expansion Diseases: A Review. Front Aging Neurosci 2022; 14:841711. [PMID: 35478698 PMCID: PMC9036481 DOI: 10.3389/fnagi.2022.841711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
With the development of the sequencing technique, more than 40 repeat expansion diseases (REDs) have been identified during the past two decades. Moreover, the clinical features of these diseases show some commonality, and the nervous system, especially the cognitive function was affected in part by these diseases. However, the specific cognitive domains impaired in different diseases were inconsistent. Here, we survey literature on the cognitive consequences of the following disorders presenting cognitive dysfunction and summarizing the pathogenic genes, epidemiology, and different domains affected by these diseases. We found that the cognitive domains affected in neuronal intranuclear inclusion disease (NIID) were widespread including the executive function, memory, information processing speed, attention, visuospatial function, and language. Patients with C9ORF72-frontotemporal dementia (FTD) showed impairment in executive function, memory, language, and visuospatial function. While in Huntington's disease (HD), the executive function, memory, and information processing speed were affected, in the fragile X-associated tremor/ataxia syndrome (FXTAS), executive function, memory, information processing speed, and attention were impaired. Moreover, the spinocerebellar ataxias showed broad damage in almost all the cognitive domains except for the relatively intact language ability. Some other diseases with relatively rare clinical data also indicated cognitive dysfunction, such as myotonic dystrophy type 1 (DM1), progressive myoclonus epilepsy (PME), Friedreich ataxia (FRDA), Huntington disease like-2 (HDL2), and cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS). We drew a cognitive function landscape of the related REDs that might provide an aspect for differential diagnosis through cognitive domains and effective non-specific interventions for these diseases.
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Affiliation(s)
- Sizhe Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China
- Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
- *Correspondence: Bin Jiao
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Abstract
OBJECTIVE This study aims to systematically review evidence of the accuracy of the Montreal Cognitive Assessment (MoCA) for evaluating the presence of cognitive impairment in patients with Huntington's disease (HD) and to outline the quality and quantity of research evidence available about the use of the MoCA in this population. METHODS We conducted a systematic literature review, searching four databases from inception until April 2020. RESULTS We identified 26 studies that met the inclusion criteria: two case-control studies comparing the MoCA to a battery of tests, three studies comparing MoCA to Mini-Mental State Examination, two studies estimating the prevalence of cognitive impairment in individuals with HD and 19 studies or clinical trials in which the MoCA was used as an instrument for the cognitive assessment of participants with HD. We found no cross-sectional studies in which participants received the index test (MoCA) and a reference standard diagnostic assessment composed of an extensive neuropsychological battery. The publication period ranged from 2010 to 2020. CONCLUSIONS In patients with HD, the MoCA provides information about disturbances in general cognitive function. Even if the MoCA demonstrated good sensitivity and specificity when used at the recommended threshold score of 26, further cross-sectional studies are required to examine the optimum cutoff score for detecting cognitive impairments in patients with HD. Moreover, more studies are necessary to determine whether the MoCA adequately assesses cognitive status in individuals with HD.
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Crowell V, Houghton R, Tomar A, Fernandes T, Squitieri F. Modeling Manifest Huntington's Disease Prevalence Using Diagnosed Incidence and Survival Time. Neuroepidemiology 2021; 55:361-368. [PMID: 34350853 DOI: 10.1159/000516767] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Understanding the epidemiology of Huntington's disease (HD) is key to assessing disease burden and the healthcare resources required to meet patients' needs. We aimed to develop and validate a model to estimate the diagnosed prevalence of manifest HD by the Shoulson-Fahn stage. METHODS A literature review identified epidemiological data from Brazil, Canada, France, Germany, Italy, Spain, the UK, and the USA. Data on staging distribution at diagnosis, progression, and mortality were derived from Enroll-HD. Newly diagnosed patients with manifest HD were simulated by applying annual diagnosed incidence rates to the total population in each country, each year from 1950 onwards. The number of diagnosed prevalent patients from the previous year who remained in each stage was estimated in line with the probability of death or progression. Diagnosed prevalence in 2020 was estimated as the sum of simulated patients, from all the incident cohorts, still alive. RESULTS The model estimates that in 2020, there were 66,787 individuals diagnosed with HD in the 8 included countries, of whom 62-63% were in Shoulson-Fahn stages 1 and 2 (with less severely limited functional capacity than those in stages 3-5). Diagnosed prevalence is estimated to be 8.2-9.0 per 100,000 in the USA, Canada, and the 5 included European countries and 3.5 per 100,000 in Brazil. CONCLUSION The modeled estimates generally accord with the previously published data. This analysis contributes to better understanding of the epidemiology of HD and highlights areas of uncertainty.
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Affiliation(s)
- Valerie Crowell
- Access Insights & Metrics, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Houghton
- Product Development Personalized Healthcare, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
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Muroni A, Murru MR, Ulgheri L, Sechi M, Ercoli T, Marrosu F, Scaglione CL, Bentivoglio AR, Petracca M, Soliveri P, Cocco E, Cuccu S, Deriu M, Zuccato C, Defazio G. Geographic differences in the incidence of Huntington's disease in Sardinia, Italy. Neurol Sci 2021; 42:5177-5181. [PMID: 33792825 DOI: 10.1007/s10072-021-05217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The frequency of Huntington's disease (HD) may vary considerably, with higher estimates in non-Asian populations. We have recently examined the prevalence of HD in the southern part of Sardinia, a large Italian Mediterranean island that is considered a genetic isolate. We observed regional microgeographic differences in the prevalence of HD across the study area similar to those recently reported in other studies conducted in European countries. To explore the basis for this variability, we undertook a study of the incidence of HD in Sardinia over a 10-year period, 2009 to 2018. METHODS Our research was conducted in the 5 administrative areas of Sardinia island. Case patients were ascertained through multiple sources in Sardinia and Italy. RESULTS During the incidence period 53 individuals were diagnosed with clinically manifested HD. The average annual incidence rate 2009-2018 was 2.92 per 106 persons-year (95% CI, 2.2 to 3.9). The highest incidence rate was observed in South Sardinia (6.3; 95% CI, 4.2-9.5). This rate was significantly higher (p<0.01) than the rates from Cagliari, Oristano, and Sassari provinces but did not significantly differ (p = 0.38) from the Nuoro rate. CONCLUSIONS The overall incidence of HD in Sardinia is close to the correspondent estimates in Mediterranean countries. Our findings highlight also the possibility of local microgeographic variations in the epidemiology of HD that might reflect several factors, including a possible founder effect in the rural areas of South Sardinia and Nuoro.
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Affiliation(s)
- Antonella Muroni
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, 09124, Cagliari, Italy.
| | - Maria R Murru
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lucia Ulgheri
- S.S.D. di Genetica e Biologia dello Sviluppo, University Hospital, Sassari, Italy
| | - Margherita Sechi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Marrosu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cesa L Scaglione
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Martina Petracca
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Soliveri
- Unit of Neurology I, Parkinson and Movement Disorders Unit, Fondazione IRCSS Istituto Neurologico Carlo Basta, Milan, Italy.,Parkinson Institute - CTO, Milan, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Stefania Cuccu
- Multiple Sclerosis Centre, Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Marcello Deriu
- Neurology Service, Nostra Signora della Mercede Hospital, ATS Sardegna, San Gavino Monreale, Italy
| | - Chiara Zuccato
- Department of Biosciences, University of Milan, Milan, Italy.,Istituto Nazionale di Genetica Molecolare "Romeo ed Enrica Invernizzi", Milan, Italy
| | - Giovanni Defazio
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, 09124, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Vicente E, Ruiz de Sabando A, García F, Gastón I, Ardanaz E, Ramos-Arroyo MA. Validation of diagnostic codes and epidemiologic trends of Huntington disease: a population-based study in Navarre, Spain. Orphanet J Rare Dis 2021; 16:77. [PMID: 33568143 PMCID: PMC7877055 DOI: 10.1186/s13023-021-01699-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is great heterogeneity on geographic and temporary Huntington disease (HD) epidemiological estimates. Most research studies of rare diseases, including HD, use health information systems (HIS) as data sources. This study investigates the validity and accuracy of national and international diagnostic codes for HD in multiple HIS and analyses the epidemiologic trends of HD in the Autonomous Community of Navarre (Spain). METHODS HD cases were ascertained by the Rare Diseases Registry and the reference Medical Genetics Centre of Navarre. Positive predictive values (PPV) and sensitivity with 95% confidence intervals (95% CI) were estimated. Overall and 9-year periods (1991-2017) HD prevalence, incidence and mortality rates were calculated, and trends were assessed by Joinpoint regression. RESULTS Overall PPV and sensitivity of combined HIS were 71.8% (95% CI: 59.7, 81.6) and 82.2% (95% CI: 70.1, 90.4), respectively. Primary care data was a more valuable resource for HD ascertainment than hospital discharge records, with 66% versus 50% sensitivity, respectively. It also had the highest number of "unique to source" cases. Thirty-five per cent of HD patients were identified by a single database and only 4% by all explored sources. Point prevalence was 4.94 (95% CI: 3.23, 6.65) per 100,000 in December 2017, and showed an annual 6.1% increase from 1991 to 1999. Incidence and mortality trends remained stable since 1995-96, with mean annual rates per 100,000 of 0.36 (95% CI: 0.27, 0.47) and 0.23 (95% CI: 0.16, 0.32), respectively. Late-onset HD patients (23.1%), mean age at onset (49.6 years), age at death (66.6 years) and duration of disease (16.7 years) were slightly higher than previously reported. CONCLUSION HD did not experience true temporary variations in prevalence, incidence or mortality over 23 years of post-molecular testing in our population. Ascertainment bias may largely explain the worldwide heterogeneity in results of HD epidemiological estimates. Population-based rare diseases registries are valuable instruments for epidemiological studies on low prevalence genetic diseases, like HD, as long as they include validated data from multiple HIS and genetic/family information.
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Affiliation(s)
- Esther Vicente
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain.
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain.
| | - Ainara Ruiz de Sabando
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
- Fundación Miguel Servet-Navarrabiomed, IdiSNA, Pamplona, Spain
| | - Fermín García
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Itziar Gastón
- Department of Neurology, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Eva Ardanaz
- Community Health Observatory Section, Instituto de Salud Pública y Laboral de Navarra, IdiSNA (Navarre Institute for Health Research), Pamplona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María A Ramos-Arroyo
- Department of Health Sciences, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Medical Genetics, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
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Sienes Bailo P, Lahoz R, Sánchez Marín JP, Izquierdo Álvarez S. Incidence of Huntington disease in a northeastern Spanish region: a 13-year retrospective study at tertiary care centre. BMC MEDICAL GENETICS 2020; 21:233. [PMID: 33228555 PMCID: PMC7684714 DOI: 10.1186/s12881-020-01174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/12/2020] [Indexed: 11/15/2022]
Abstract
Background Despite the progress in the knowledge of Huntington disease (HD) in recent years, the epidemiology continues uncertain, so the study of incidence becomes relevant. This is important since various factors (type of population, diagnostic criteria, disease-modifying factors, etc.) make these data highly variable. Therefore, the genetic diagnosis of these patients is important, since it unequivocally allows the detection of new cases. Methods Descriptive retrospective study with 179 individuals. Incidence of HD was calculated from the ratio of number of symptomatic cases newly diagnosed per 100,000 inhabitants per year during the period 2007–2019 in Aragon (Spain). Results 50 (27.9%) incident cases of HD (CAG repeat length ≥ 36) were identified from a total of 179 persons studied. The remaining 129/179 (72.1%) were HD negative (CAG repeat length < 36). 29 (58.0%) females and 21 (42.0%) males were confirmed as HD cases. The overall incidence was 0.648 per 100,000 patient-years. 11/50 positive HD cases (22.0%) were identified by performing a predictive test, without clinical symptoms. The minimum number of CAG repeats found was 9 and the most common CAG length among HD negative individuals was 16. Conclusions Our incidence lied within the range reported for other Caucasian populations. Implementation of new techniques has allowed to determine the exact number of CAG repeats, which is especially important in patients with triplet expansions in an HD intermediate and/or incomplete penetrance allele, both in diagnostic, predictive and prenatal tests. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01174-z.
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Affiliation(s)
- Paula Sienes Bailo
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Raquel Lahoz
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain.
| | - Juan Pelegrín Sánchez Marín
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
| | - Silvia Izquierdo Álvarez
- Departamento de Genética. Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet. C/ Padre Arrupe, s/n. Consultas Externas. Planta 3ª. 50009, Zaragoza, Spain
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12
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Oosterloo M, Bijlsma EK, van Kuijk SM, Minkels F, de Die-Smulders CE. Clinical and genetic characteristics of late-onset Huntington's disease. Parkinsonism Relat Disord 2019; 61:101-105. [PMID: 30528461 DOI: 10.1016/j.parkreldis.2018.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/10/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. OBJECTIVE Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. METHODS Participants with late- and common-onset (30-50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. RESULTS Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P < .001). Overall motor and cognitive performance (P < .001) were worse, however only disease motor progression was slower (coefficient, -0.58; SE 0.16; P < .001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P < .001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P < .001). CONCLUSIONS Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients.
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Affiliation(s)
- Mayke Oosterloo
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Floor Minkels
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Christine Em de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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13
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Abstract
Background: Although the typical age of onset for Huntington’s disease (HD) is in the fourth decade, between 4.4–11.5% of individuals with HD have a late onset (over 60 years of age). Diagnosis of Late onset HD (LoHD) can be missed, due to the perceived low likelihood of HD in the over 60-year-olds. Objective: To review the epidemiology, genotype and phenotype of LoHD. Methods: We systematically searched MEDLINE, EMBASE and Web of Science (inception-November 2016). Web of Science was then used to search for papers citing identified studies. Content experts were consulted for any additional studies. We included all studies reporting the clinical phenotype of LoHD for more than one participant. Results: 20 studies were identified from a potential list of 1243. Among Caucasian HD cohorts, 4.4–11.5% of individuals have LoHD, and this proportion may be increasing. Proportion of LoHD without a positive family history ranges from 3–68%. 94.4% of reported cases of LoHD had CAG repeat lengths of ≤44. Motor manifestations are the commonest initial presentation, although 29.2% presented with non-motor manifestations as the first clinical feature in one case series. Individuals with LoHD may have slower progression of illness. Cognitive impairment rather than chorea may be the major source of disability in this group. Conclusions: LoHD represents a substantial proportion of new diagnoses of HD and has some unique features. Further characterization of this population will aid clinicians in diagnosis.
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Affiliation(s)
- Sai S Chaganti
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Elizabeth A McCusker
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia.,The Garvan Institute of Medical Research, Sydney, Australia
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14
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Demetriou CA, Heraclides A, Salafori C, Tanteles GA, Christodoulou K, Christou Y, Zamba-Papanicolaou E. Epidemiology of Huntington disease in Cyprus: A 20-year retrospective study. Clin Genet 2018; 93:656-664. [PMID: 29105741 DOI: 10.1111/cge.13168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
Abstract
Huntington disease (HD) is most prevalent among populations of western European descent and isolated populations where founder effects may operate. The aim of this study was to examine the epidemiology of HD in Cyprus, an island in southern Europe with extensive western European colonization in the past. All registered HD patients in the Cyprus, since 1994, were included. Detailed pedigrees and clinical information were recorded and maps, showing the geographic distribution of HD, were constructed. Requests for genetic testing were also examined. The project identified 58 clinically manifested cases of HD belonging to 19 families. The 16 families of Cypriot origin were concentrated in a confined geographical cluster in southeast Cyprus. In 2015, prevalence of symptomatic HD was 4.64/100 000 population, while incidence was 0.12/100 000 person-years. Prevalence displayed a marked increase during the past 20 years. Disease characteristics of HD patients were similar to those reported in western European populations. Lastly, the uptake of predictive and/or prenatal testing was limited. HD disease characteristics, incidence and prevalence in Cyprus were comparable to western European populations. Together with the geographical clustering observed, these results support the possibility for a relatively recent founder effect of HD in Cyprus, potentially of western European origin.
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Affiliation(s)
- C A Demetriou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - A Heraclides
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - C Salafori
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - G A Tanteles
- Clinical Genetics Clinic, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - K Christodoulou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Y Christou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - E Zamba-Papanicolaou
- Neurology Clinic D, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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15
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Sipilä JOT, Kauko T, Päivärinta M, Majamaa K. Comparison of mid-age-onset and late-onset Huntington’s disease in Finnish patients. J Neurol 2017; 264:2095-2100. [DOI: 10.1007/s00415-017-8600-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
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16
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Ramaswamy S, Shannon KM, Kordower JH. Huntington's Disease: Pathological Mechanisms and Therapeutic Strategies. Cell Transplant 2017; 16:301-12. [PMID: 17503740 DOI: 10.3727/000000007783464687] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Huntington's disease (HD) is a devastating neurodegenerative disorder that occurs in patients with a mutation in the huntingtin or IT15 gene. Patients are plagued by early cognitive signs, motor deficits, and psychiatric disturbances. Symptoms are attributed to cell death in the striatum and disruption of cortical–striatal circuitry. Mechanisms of cell death are unclear, but processes involving mitochondrial abnormalities, excitotoxicity, and abnormal protein degradation have been implicated. Many factors likely contribute to neuron death and dysfunction, and this has made it difficult to systematically address the pathology in HD. Pharmaceutical therapies are commonly used in patients to treat disease symptoms. These have limited benefit and do not address the inexorable disease progression. Several neuroprotective therapies are being evaluated in animal models of HD as well as in clinical trials. Similarly, cell replacement strategies such as fetal transplantation have been used in the clinic with minimal success, making future cell replacement strategies such as stem cell therapy uncertain. This review describes the disease pathology in HD and addresses many of the past and emerging therapeutic strategies.
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Affiliation(s)
- Shilpa Ramaswamy
- Department of Neuroscience, Rush University Medical Center, Chicago, IL 60612, USA
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17
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Kay C, Hayden MR, Leavitt BR. Epidemiology of Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 144:31-46. [DOI: 10.1016/b978-0-12-801893-4.00003-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Tell-Marti G, Puig-Butille JA, Gimenez-Xavier P, Segu-Roig A, Potrony M, Badenas C, Alvarez V, Millán JM, Trujillo-Tiebas MJ, Ramos-Arroyo MA, Milà M, Puig S. The p. R151C Polymorphism in MC1R Gene Modifies the Age of Onset in Spanish Huntington's Disease Patients. Mol Neurobiol 2016; 54:3906-3910. [PMID: 27924526 DOI: 10.1007/s12035-016-0305-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/16/2016] [Indexed: 11/26/2022]
Abstract
The expansion of CAG repeats (≥36 CAG) in the HTT gene is the only known genetic cause of Huntington's disease (HD) and the main determinant of the course of the disease. The length of the expanded CAG repeats correlates inversely with the age of onset (AOO) but does not completely determine it. We investigated the role of the melanocortin 1 receptor (MC1R) gene as a modifier factor of AOO in 600 HD patients from Spain. We sequenced the entire region of the MC1R gene and analyzed all the nonsynonymous MC1R genetic variants with a minor allele frequency of at least 0.01 in HD patients. The variability in AOO attributable to the CAG repeats and MC1R polymorphisms was evaluated using a multiple linear regression model. We found that the loss-of-function p. R151C MC1R polymorphism has a significant influence on the AOO (P = 0.004; Bonferroni-corrected P = 0.032) which explains 1.42% of the variance in AOO that cannot be accounted for by the expanded CAG repeat. Our results suggest that the MC1R gene could modify the AOO in Spanish HD patients and encourage the evaluation of loss-of-function MC1R polymorphisms in other HD populations with a higher frequency of these MC1R polymorphisms.
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Affiliation(s)
- Gemma Tell-Marti
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Joan Anton Puig-Butille
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
- Biochemical and Molecular Genetics Service, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Pol Gimenez-Xavier
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Ariadna Segu-Roig
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Miriam Potrony
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Celia Badenas
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
- Biochemical and Molecular Genetics Service, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Victoria Alvarez
- Laboratorio de Genética. AGC Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José M Millán
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Fe, IIS-La Fe, Valencia, Spain
| | - María José Trujillo-Tiebas
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
- Department of Genetics, Health Research Institute-Jimenez Diaz Foundation University Hospital (IIS-FJD), Madrid, Spain
| | - María A Ramos-Arroyo
- Medical Genetics Department, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, Irunlarrea 4, 31008, Pamplona, Navarra, Spain
| | - Montserrat Milà
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
- Biochemical and Molecular Genetics Service, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.
- Medicine Department, Universitat de Barcelona, Barcelona, Spain.
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19
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Sipilä JOT, Posti JP, Majamaa K. Chronic subdural hematomas in Finnish patients with Huntington's disease. Acta Neurochir (Wien) 2016; 158:1487-90. [PMID: 27272892 DOI: 10.1007/s00701-016-2845-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many features of Huntington's disease (HD) make these patients susceptible to subdural hematomas (SDH), but there are no previous reports on the epidemiology of SDH in this population. We investigated the incidence and risk factors of chronic SDH. METHODS A national cohort of 192 Finnish patients with HD was investigated. Information was gathered from medical records and administrative registries. RESULTS The incidence rate of SDH was 68.3/100,000 person-years among the 192 patients. Seven patients were identified with a chronic SDH at or after the diagnosis of HD. Their age was 58.5 ± 15.0 years (mean ± SD) at the time of diagnosis of HD and 60.9 ± 14.1 years at the time of diagnosis of SDH. The incidence rate of chronic SDH after the diagnosis of HD was 4.7/1000 person-years and by 8.3 years of follow-up the cumulative risk was 5.4 %. Review of the patient charts revealed only a few of the common risk factors for chronic SDH, but the rate of reoperations was high. CONCLUSIONS The incidence of chronic SDH was higher in patients with HD than that in the general population. Incidence of chronic SDH began to increase at the time of expected motor onset of HD. Common risk factors of SDH were scarce aside from fall-related head injuries.
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20
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Yang J, Chen K, Wei Q, Chen Y, Cao B, Burgunder JM, Shang HF. Clinical and genetic characteristics in patients with Huntington’s disease from China. Neurol Res 2016; 38:916-20. [PMID: 27483361 DOI: 10.1080/01616412.2016.1214555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jean-Marc Burgunder
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, University of Bern, Bern, Switzerland
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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21
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Baig SS, Strong M, Quarrell OW. The global prevalence of Huntington's disease: a systematic review and discussion. Neurodegener Dis Manag 2016; 6:331-43. [PMID: 27507223 DOI: 10.2217/nmt-2016-0008] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The ascertained prevalence of Huntington's disease (HD) increased significantly following the provision of diagnostic testing. A systematic review was conducted to estimate the prevalence of HD in the post-diagnostic testing era. 22 studies with original data pertaining to the prevalence of HD (1993-2015) were included and analyzed. A global meta-analysis was not performed due to heterogeneity in study methods and geographical variation. The prevalence of HD is significantly lower in Asian populations compared with western Europe, North America and Australia. The global variation in HD prevalence is partly explained by the average CAG repeat lengths and frequency of different HTT gene haplotypes in the general population. Understanding the prevalence of HD has significant implications for healthcare resource planning.
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Affiliation(s)
| | - Mark Strong
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Oliver Wj Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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22
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Sipilä JOT, Majamaa K. Epidemiology of stroke in Finnish patients with Huntington's disease. Acta Neurol Scand 2016; 134:61-6. [PMID: 26403692 DOI: 10.1111/ane.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Diabetes mellitus and hypercholesterolemia are known risk factors of stroke, and altered glucose and cholesterol metabolism has been reported in patients with Huntington's disease (HD). We investigated the incidence and risk factors of stroke in this population. MATERIALS AND METHODS National registries were used to identify a cohort of 192 patients with HD. Data on stroke, silent cerebral infarcts and risk factors were obtained from the patient records. RESULTS Five patients with an ischemic stroke (IS) were found suggesting a crude incidence of 42/100,000 person years. Silent brain infarcts were found in 13 patients and a hemorrhagic stroke in two patients, while none were found with a transient ischemic attack (TIA). The cumulative incidence of IS was 2.7% and that of silent cerebral infarct 6.7% by age of 65 years. The CAG age product (CAP) score, an estimate of genetic burden, was 495 ± 117 for the patients with IS or silent cerebral infarct and 568 ± 126 for the patients without ischemic events (P = 0.025 for difference). The frequency of diagnoses of stroke risk factors was at least twofold higher among the patients with IS or silent infarcts than among those without. CONCLUSION Cerebrovascular disease is as common in patients with HD as in the general population, but minor cerebrovascular events and vascular risk factors may remain unrecognized. Genetic burden of the HTT mutation does not appear to increase the risk of stroke.
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Affiliation(s)
- J. O. T. Sipilä
- Division of Clinical Neurosciences; Turku University Hospital; Turku Finland
- Neurology; University of Turku; Turku Finland
| | - K. Majamaa
- Unit of Clinical Neuroscience; Neurology; University of Oulu; Oulu Finland
- Department of Neurology and Medical Research Center; Oulu University Hospital; Oulu Finland
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23
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Wexler NS, Collett L, Wexler AR, Rawlins MD, Tabrizi SJ, Douglas I, Smeeth L, Evans SJ. Incidence of adult Huntington's disease in the UK: a UK-based primary care study and a systematic review. BMJ Open 2016; 6:e009070. [PMID: 26908513 PMCID: PMC4769413 DOI: 10.1136/bmjopen-2015-009070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/24/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The prevalence of Huntington's disease (HD) recorded in the UK primary care records has increased twofold between 1990 and 2010. This investigation was undertaken to assess whether this might be due to an increased incidence. We have also undertaken a systematic review of published estimates of the incidence of HD. SETTING Incident patients with a new diagnosis of HD were identified from the primary care records of the Clinical Practice Research Datalink (CPRD). The systematic review included all published estimates of the incidence of HD in defined populations. PARTICIPANTS A total of 393 incident cases of HD were identified from the CPRD database between 1990 and 2010 from a total population of 9,282,126 persons. PRIMARY AND SECONDARY OUTCOME MEASURES The incidence of HD per million person-years was estimated. From the systematic review, the extent of heterogeneity of published estimates of the incidence of HD was examined using the I(2) statistic. RESULTS The data showed that the incidence of HD has remained constant between 1990 and 2010 with an overall rate of 7.2 (95% CI 6.5 to 7.9) per million person-years. The systematic review identified 14 independent estimates of incidence with substantial heterogeneity and consistently lower rates reported in studies from East Asia compared with those from Australia, North America and some--though not all--those from Europe. Differences in incidence estimates did not appear to be explained solely by differences in case ascertainment or diagnostic methods. CONCLUSIONS The rise in the prevalence of diagnosed HD in the UK, between 1990 and 2010, cannot be attributed to an increase in incidence. Globally, estimates of the incidence of HD show evidence of substantial heterogeneity with consistently lower rates in East Asia and parts of Europe. Modifiers may play an important role in determining the vulnerability of different populations to expansions of the HD allele.
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Affiliation(s)
- Nancy S Wexler
- Department of Neurology and Psychiatry, Columbia University, New York, New York, USA
- Hereditary Disease Foundation, New York, New York, USA
| | - Laura Collett
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine,London, UK
| | | | - Michael D Rawlins
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Sarah J Tabrizi
- Department of Neurodegenerative Diseases, Institute of Neurology, University College London,London, UK
| | - Ian Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine,London, UK
| | - Stephen J Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine,London, UK
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24
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Sipilä JOT, Päivärinta M. Why We Still Need More Research on the Epidemiology of Huntington's Disease. Neuroepidemiology 2016; 46:154-5. [PMID: 26836497 DOI: 10.1159/000444230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/27/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Joensuu, Finland
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25
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Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ, Tabrizi SJ. Huntington disease. Nat Rev Dis Primers 2015; 1:15005. [PMID: 27188817 DOI: 10.1038/nrdp.2015.5] [Citation(s) in RCA: 911] [Impact Index Per Article: 101.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Huntington disease is devastating to patients and their families - with autosomal dominant inheritance, onset typically in the prime of adult life, progressive course, and a combination of motor, cognitive and behavioural features. The disease is caused by an expanded CAG trinucleotide repeat (of variable length) in HTT, the gene that encodes the protein huntingtin. In mutation carriers, huntingtin is produced with abnormally long polyglutamine sequences that confer toxic gains of function and predispose the protein to fragmentation, resulting in neuronal dysfunction and death. In this Primer, we review the epidemiology of Huntington disease, noting that prevalence is higher than previously thought, geographically variable and increasing. We describe the relationship between CAG repeat length and clinical phenotype, as well as the concept of genetic modifiers of the disease. We discuss normal huntingtin protein function, evidence for differential toxicity of mutant huntingtin variants, theories of huntingtin aggregation and the many different mechanisms of Huntington disease pathogenesis. We describe the genetic and clinical diagnosis of the condition, its clinical assessment and the multidisciplinary management of symptoms, given the absence of effective disease-modifying therapies. We review past and present clinical trials and therapeutic strategies under investigation, including impending trials of targeted huntingtin-lowering drugs and the progress in development of biomarkers that will support the next generation of trials. For an illustrated summary of this Primer, visit: http://go.nature.com/hPMENh.
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Affiliation(s)
- Gillian P Bates
- Department of Medical and Molecular Genetics, King's College London, London, UK
| | - Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - James F Gusella
- Molecular Neurogenetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, and Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Kay
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minneapolis, Minnesota, USA; and Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Departments of Neurology, Pharmacology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachael I Scahill
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Ronald Wetzel
- Department of Structural Biology and Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Edward J Wild
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London WC1N 3BG, UK
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26
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Fan HC, Ho LI, Chi CS, Chen SJ, Peng GS, Chan TM, Lin SZ, Harn HJ. Polyglutamine (PolyQ) diseases: genetics to treatments. Cell Transplant 2015; 23:441-58. [PMID: 24816443 DOI: 10.3727/096368914x678454] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The polyglutamine (polyQ) diseases are a group of neurodegenerative disorders caused by expanded cytosine-adenine-guanine (CAG) repeats encoding a long polyQ tract in the respective proteins. To date, a total of nine polyQ disorders have been described: six spinocerebellar ataxias (SCA) types 1, 2, 6, 7, 17; Machado-Joseph disease (MJD/SCA3); Huntington's disease (HD); dentatorubral pallidoluysian atrophy (DRPLA); and spinal and bulbar muscular atrophy, X-linked 1 (SMAX1/SBMA). PolyQ diseases are characterized by the pathological expansion of CAG trinucleotide repeat in the translated region of unrelated genes. The translated polyQ is aggregated in the degenerated neurons leading to the dysfunction and degeneration of specific neuronal subpopulations. Although animal models of polyQ disease for understanding human pathology and accessing disease-modifying therapies in neurodegenerative diseases are available, there is neither a cure nor prevention for these diseases, and only symptomatic treatments for polyQ diseases currently exist. Long-term pharmacological treatment is so far disappointing, probably due to unwanted complications and decreasing drug efficacy. Cellular transplantation of stem cells may provide promising therapeutic avenues for restoration of the functions of degenerative and/or damaged neurons in polyQ diseases.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Epidemiology of Huntington's disease in Finland. Parkinsonism Relat Disord 2015; 21:46-9. [DOI: 10.1016/j.parkreldis.2014.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/22/2014] [Accepted: 10/27/2014] [Indexed: 11/24/2022]
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Poliakov E, Koonin EV, Rogozin IB. Impairment of translation in neurons as a putative causative factor for autism. Biol Direct 2014; 9:16. [PMID: 25011470 PMCID: PMC4099083 DOI: 10.1186/1745-6150-9-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A dramatic increase in the prevalence of autism and Autistic Spectrum Disorders (ASD) has been observed over the last two decades in USA, Europe and Asia. Given the accumulating data on the possible role of translation in the etiology of ASD, we analyzed potential effects of rare synonymous substitutions associated with ASD on mRNA stability, splicing enhancers and silencers, and codon usage. PRESENTATION OF THE HYPOTHESIS We hypothesize that subtle impairment of translation, resulting in dosage imbalance of neuron-specific proteins, contributes to the etiology of ASD synergistically with environmental neurotoxins. TESTING THE HYPOTHESIS A statistically significant shift from optimal to suboptimal codons caused by rare synonymous substitutions associated with ASD was detected whereas no effect on other analyzed characteristics of transcripts was identified. This result suggests that the impact of rare codons on the translation of genes involved in neuron development, even if slight in magnitude, could contribute to the pathogenesis of ASD in the presence of an aggressive chemical background. This hypothesis could be tested by further analysis of ASD-associated mutations, direct biochemical characterization of their effects, and assessment of in vivo effects on animal models. IMPLICATIONS OF THE HYPOTHESIS It seems likely that the synergistic action of environmental hazards with genetic variations that in themselves have limited or no deleterious effects but are potentiated by the environmental factors is a general principle that underlies the alarming increase in the ASD prevalence. REVIEWERS This article was reviewed by Andrey Rzhetsky, Neil R. Smalheiser, and Shamil R. Sunyaev.
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Affiliation(s)
- Eugenia Poliakov
- Laboratory of Retinal Cell & Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eugene V Koonin
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Igor B Rogozin
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
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29
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Genetics of Huntington's disease and related disorders. Drug Discov Today 2014; 19:985-9. [PMID: 24657309 DOI: 10.1016/j.drudis.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/07/2014] [Indexed: 02/05/2023]
Abstract
Huntington's disease is the most frequent form of the hereditary choreas and has a multifaceted phenotype including cognitive and psychiatric impairment. The disorder is due to a dynamic mutation, which also influences the onset age of the disorder. Other genetic modifiers of the HD phenotypes have been suggested but often not confirmed by independent studies. Several syndromes with similar presentation have different genetic backgrounds, including the neuroacanthocytoses, mainly choreoacanthocytosis and MacLeod syndrome as a result of mutations in chorein and Kell protein, respectively, but also benign hereditary chorea, owing to mutations in NKX-2-1, and paroxysmal kinesigenic dyskinesia, as a result of recently found mutations in the proline-rich transmembrane protein 2, PRRT2. Chorea can also be a major feature in other neurogenetic disorders, including the spinocerebellar ataxias and also in neurometabolic disorders.
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Pulkes T, Papsing C, Wattanapokayakit S, Mahasirimongkol S. CAG-Expansion Haplotype Analysis in a Population with a Low Prevalence of Huntington's Disease. J Clin Neurol 2014; 10:32-6. [PMID: 24465260 PMCID: PMC3896646 DOI: 10.3988/jcn.2014.10.1.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose The prevalence of Huntington's disease (HD) among East Asians is less than one-tenth of that among Caucasians. Such a low prevalence may be attributable to a lack of carriers of specific predisposing haplogroups associated with the high instability of the Huntingtin gene (HTT). The aim of this study was to evaluate the association between specific HTT haplogroups and the occurrence of HD in a Thai population. Methods CAG-repeat sizes and HTT haplotypes were analyzed in 18 Thai HD patients and 215 control subjects. Twenty-two tagging single-nucleotide polymorphisms (tSNPs) were genotyped. Results Only 18 patients from 15 unrelated families were identified over the last 17 years. Pathological CAG-repeat alleles ranged from 39 to 48 repeats (43.5±3.0, mean±SD), and normal alleles ranged from 9 to 24 repeats (16.49±1.74). Only two of the chromosomes studied comprised intermediate alleles. Unlike the Caucasian data, all but 1 of the 22 tSNPs were not associated with the occurrence of HD. The predisposing haplogroups for Caucasian HD (haplogroups A1 and A2) are very rare in Thai patients (<4%). Both HD and normal chromosomes are commonly haplogroups A5 and C, in contrast to the case for Chinese and Japanese patients, in whom only haplogroup C was common in HD chromosomes. The frequency of CAG-repeat sizes of haplogroup A5 and C were also similarly distributed. Conclusions HD chromosomes of Thai patients may arise randomly from each haplogroup, with a similar mutation rate. This rate is much lower than the CAG expansions from Caucasian HD haplogroups. These data suggest that the different mechanisms underlie CAG expansion in Thai and Caucasian patients.
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Affiliation(s)
- Teeratorn Pulkes
- Department of Neurology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutima Papsing
- Department of Neurology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sukanya Wattanapokayakit
- Department of Medical Sciences, Medical Genetic Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Surakameth Mahasirimongkol
- Department of Medical Sciences, Medical Genetic Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
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Vázquez-Mojena Y, Laguna-Salvia L, Laffita-Mesa JM, González-Zaldívar Y, Almaguer-Mederos LE, Rodríguez-Labrada R, Almaguer-Gotay D, Zayas-Feria P, Velázquez-Pérez L. Genetic features of Huntington disease in Cuban population: Implications for phenotype, epidemiology and predictive testing. J Neurol Sci 2013; 335:101-4. [DOI: 10.1016/j.jns.2013.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/22/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Analysis of gait and balance through a single triaxial accelerometer in presymptomatic and symptomatic Huntington's disease. Gait Posture 2013; 37:49-54. [PMID: 22819009 DOI: 10.1016/j.gaitpost.2012.05.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 05/23/2012] [Accepted: 05/30/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the capacity of a single triaxial accelerometer sensor in detecting gait and balance impairments in pre-manifest and manifest Huntington's disease (HD) subjects. METHODS Fourteen manifest HD (MHD) (age: 51.83±14.8), ten pre-manifest HD (PHD) (age: 44.8±11.7) and ten healthy subjects (HLY) (age: 56.4±10.9) were recruited. The sensor was attached to the upper sternum as subjects completed gait and Romberg balance tests. An inverted pendulum model of the body's centre of mass and an unbiased autocorrelation procedure were employed to derive gait parameters from the triaxial accelerometer signal. The accuracy of the gait measurements was compared to those recorded by a computerized walkway. RESULTS Strong agreement was seen between the sensor and the walkway; cadence (ICC=0.95, CI=[0.75, 0.97]), velocity (ICC=0.94, CI=[0.75, 0.97]) and step length (ICC=0.89, CI=[0.77, 0.95]). Sensor derived velocity was significantly higher in HLY (p<0.001) and PHD (p<0.005) when compared to MHD. Step and stride length was significantly longer in HLY (p<0.05) and PHD (p<0.001) when compared to MHD. Significant differences between subject groups across all four balance tasks (p<0.001) were found. CONCLUSION An accelerometer based sensor may be an effective means of differentiating between pre-manifest and manifest Huntington's disease subjects.
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Semaka A, Balneaves LG, Hayden MR. "Grasping the grey": patient understanding and interpretation of an intermediate allele predictive test result for Huntington disease. J Genet Couns 2012; 22:200-17. [PMID: 22903792 DOI: 10.1007/s10897-012-9533-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
Since the discovery of the genetic mutation underlying Huntington disease (HD) and the development of predictive testing, the genetics of HD has generally been described as straightforward; an individual receives either mutation-positive or negative predictive test results. However, in actuality, the genetics of HD is complex and a small proportion of individuals receive an unusual predictive test result called an intermediate allele (IA). Unlike mutation-positive or negative results, IAs confer uncertain clinical implications. While individuals with an IA will usually not develop HD, there remains an unknown risk for their children and future generations to develop the disorder. The purpose of this study was to explore how individuals understood and interpreted their IA result. Interviews were conducted with 29 individuals who received an IA result and 8 medical genetics service providers. Interviews were analyzed using the constant comparative method and the coding procedures of grounded theory. Many participants had difficulty "Grasping the Grey" (i.e. understanding and interpreting their IA results) and their family experience, beliefs, expectations, and genetic counseling influenced the degree of this struggle. The theoretical model developed informs clinical practice regarding IAs, ensuring that this unique subset of patients received appropriate education, support, and counseling.
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Affiliation(s)
- A Semaka
- Department of Medical Genetics, Centre for Molecular Medicine & Therapeutics, University of British Columbia, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.
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Quarrell O, O'Donovan KL, Bandmann O, Strong M. The Prevalence of Juvenile Huntington's Disease: A Review of the Literature and Meta-Analysis. PLOS CURRENTS 2012; 4:e4f8606b742ef3. [PMID: 22953238 PMCID: PMC3426104 DOI: 10.1371/4f8606b742ef3] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Juvenile Huntington's disease (JHD) is usually defined as Huntington's disease with an onset ≤ 20 years. The proportion of JHD cases reported in studies of Huntington's disease (HD) varies. A review of the literature found 62 studies that reported the proportion of JHD cases amongst all HD cases. The proportion of JHD cases in these studies ranged from 1% to 15%, and in a meta-analysis the pooled proportion of JHD cases was 4.92% (95% confidence interval of 4.07% to 5.84%). Limiting the analysis to the 25 studies which used multiple methods of ascertainment resulted in a similar pooled proportion of 5.32%, (95% confidence interval 4.18% to 6.60%). A small difference was observed when the meta-analysis was restricted to studies from countries defined by the World Bank as high income, that used multiple methods of ascertainment, and that were conducted since 1980 (4.81%, 95% confidence interval 3.31% to 6.58%, n=11). This contrasts with the pooled result from three post 1980 studies using multiple methods of ascertainment from South Africa and Venezuela, defined by the World Bank as upper middle income, where the estimated mean proportion was 9.95%, (95% confidence interval 6.37% to 14.22%). These results, which are expected to be more robust than those from a single study alone, may be helpful in estimating the proportion of JHD cases in a given population. Key Words: Juvenile Huntington's disease, prevalence, epidemiology.
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35
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Pringsheim T, Wiltshire K, Day L, Dykeman J, Steeves T, Jette N. The incidence and prevalence of Huntington's disease: a systematic review and meta-analysis. Mov Disord 2012; 27:1083-91. [PMID: 22692795 DOI: 10.1002/mds.25075] [Citation(s) in RCA: 350] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/20/2012] [Accepted: 05/09/2012] [Indexed: 01/21/2023] Open
Abstract
Huntington's disease (HD) is a rare, neurodegenerative disorder characterized by chorea, behavioral manifestations, and dementia. The aim of this study was to estimate the incidence and prevalence of HD through a systematic review of the literature. Medline and Embase databases were searched using terms specific to HD as well as studies of incidence, prevalence, and epidemiology. All studies reporting the incidence and/or prevalence of HD were included. Twenty original research articles were included. Eight studies examined incidence, and 17 studies examined prevalence. Meta-analysis of data from four incidence studies revealed an incidence of 0.38 per 100,000 per year (95% confidence interval [CI]: 0.16, 0.94). Lower incidence was reported in the Asian studies (n = 2), compared to the studies performed in Europe, North America, and Australia (n = 6). The worldwide service-based prevalence of HD, based on a meta-analysis (n = 13 studies), was 2.71 per 100,000 (95% CI: 1.55-4.72). Eleven studies were conducted in Europe, North American, and Australia, with an overall prevalence of 5.70 per 100,000 (95% CI: 4.42-7.35). Three studies were conducted in Asia, with an overall prevalence of 0.40 per 100,000 (95% CI: 0.26-0.61). Metaregression revealed a significantly lower prevalence of HD in Asia, compared to European, North American, and Australian populations. HD is a devastating neurodegenerative disorder with a higher prevalence in Europe, North America, and Australia than in Asia. The difference in prevalence of this genetic disorder can be largely explained by huntingtin gene haplotypes.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Ramaswamy S, Kordower JH. Gene therapy for Huntington's disease. Neurobiol Dis 2011; 48:243-54. [PMID: 22222669 DOI: 10.1016/j.nbd.2011.12.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/01/2011] [Accepted: 12/14/2011] [Indexed: 12/30/2022] Open
Abstract
Huntington's disease (HD) is a neurodegenerative disease for which there is no cure. Therapies that are efficacious in animal models have to date shown benefit for humans. One potential powerful approach is gene therapy. The ideal method of administration of gene therapy has been hotly debated and viral vectors have provided one method of long-term and wide-spread delivery to the brain. Trophic factors to protect cells from degeneration and RNAi to reduce mutant huntingtin (mHtt) protein expression are 2 main classes of compounds that demonstrate benefit in animal models. This review will examine some commonly used adeno-associated viral (AAV) vectors and discuss some therapies that hold promise for HD.
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Affiliation(s)
- Shilpa Ramaswamy
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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37
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Ramos Arroyo MA, Trujillo-Tiebas MJ, Milá M. [Recommendations of good practices for molecular diagnosis of Huntington disease]. Med Clin (Barc) 2011; 138:584-8. [PMID: 21524764 DOI: 10.1016/j.medcli.2011.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/10/2011] [Accepted: 03/10/2011] [Indexed: 11/16/2022]
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Shannon KM. Huntington's disease - clinical signs, symptoms, presymptomatic diagnosis, and diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2011; 100:3-13. [PMID: 21496568 DOI: 10.1016/b978-0-444-52014-2.00001-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
HD is a complex illness, with a broad clinical picture that begins years before clear motor onset and evolves over decades to a terminal state of extreme disability. It challenges the resources of families and communities and the skills of medical and ancillary health care providers. A broader understanding of the phenotypes, progression, and genetic basis of HD may elevate the standard of care for these deserving patients.
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Affiliation(s)
- Kathleen M Shannon
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA.
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Panas M, Karadima G, Vassos E, Kalfakis N, Kladi A, Christodoulou K, Vassilopoulos D. Huntington's disease in Greece: the experience of 14 years. Clin Genet 2010; 80:586-90. [PMID: 21166788 DOI: 10.1111/j.1399-0004.2010.01603.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A large scale genetic and epidemiological study of Huntington's disease (HD) was carried out in Greece from January 1995 to December 2008. Diagnostic testing was carried out in 461 symptomatic individuals, while 256 were tested for presymptomatic purposes. The diagnosis of HD with a CAG expansion ≥ 36 was confirmed in 278 symptomatic individuals. The prevalence of HD in Greece was estimated at approximately 2.5 to 5.4:100,000, while the mean minimum incidence was estimated at 2.2 to 4.4 per million per year. The molecular diagnosis of HD was confirmed in the majority of patients (84.4%) sent for confirmation. The false-positive cases 15.6% were characterized by the absence of a family history of HD and the presence of an atypical clinical picture. The uptake of predictive testing for HD was 8.6%. A prenatal test was requested in six pregnancies. The findings of our study do not differ significantly from those of similar studies from other European countries despite the relative genetic isolation of Greece. Of interest is the identification of clusters of HD in Greece. The presence or absence of a family history of HD should be interpreted cautiously, during the diagnostic process.
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Affiliation(s)
- M Panas
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece.
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40
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Semaka A, Collins JA, Hayden MR. Unstable familial transmissions of Huntington disease alleles with 27-35 CAG repeats (intermediate alleles). Am J Med Genet B Neuropsychiatr Genet 2010; 153B:314-20. [PMID: 19455596 DOI: 10.1002/ajmg.b.30970] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are inconsistent reports regarding the likelihood of repeat instability for alleles with 27-35 CAG repeats in the Huntington disease (HD) gene. We have examined the intergenerational stability of such intermediate alleles in 51 families from the University of British Columbia's DNA and Tissue Bank for Huntington Disease Research (UBC-HD Databank). A total of 181 transmissions were identified, with 30% (n = 54/181) of the alleles being unstable upon transmission. The unstable transmissions included both expansions (n = 37) and contractions (n = 17) of CAG size. Of the expanded alleles, 68% (n = 25/37) expanded into the HD range (>36 CAG). Therefore, 14% (n = 25/181) of the 27-35 CAG allele transmissions examined expanded into the disease-associated range resulting in a new mutation for HD. Significantly, of these new mutations, 40% (n = 10/25) originated from an allele with 35 CAG repeats with CAG repeat expansions ranging from +1 CAG to +23 CAG. The proportion of new mutations in the UBC-HD Databank is consistent with the most recent new mutation rate for HD, estimated to be at least 10%. The observed difference in the stability of HD intermediate allele transmissions in this data set and in other studies may be a reflection of a small sample size. Alternately, these inconsistencies may indicate an underlying difference in genetic factors which influence repeat instability between the different populations examined. Additional studies determining the frequency and magnitude of repeat instability in this CAG repeat range and factors that influence instability are urgently needed. Until we understand the clinical implications of HD alleles with 27-35 CAG repeats and establish reliable risks of instability, we should exercise caution when translating these results to the clinic.
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Affiliation(s)
- A Semaka
- Centre for Molecular Medicine and Therapeutics, Vancouver, Canada
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Al Mutairy A, Al Kadasah S, Elfaki I, Arshaduddin M, Malik D, Al Moutaery K, Tariq M. Trolox ameliorates 3-nitropropionic acid-induced neurotoxicity in rats. Neurotoxicol Teratol 2009; 32:226-33. [PMID: 19755148 DOI: 10.1016/j.ntt.2009.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 09/06/2009] [Accepted: 09/08/2009] [Indexed: 12/16/2022]
Abstract
3-nitropropionic acid (3-NPA) is a naturally occurring neurotoxin produced by legumes of the genus Astragalus and Arthrium fungi. Acute exposure to 3-NPA results in striatal astrocytic death and variety of behavior dysfunction in rats. Oxidative stress has been reported to play an important role in 3-NPA-induced neurotoxicity. Trolox is a potent free radical chain breaking antioxidant which has been shown to restore structure and function of the nervous system following oxidative stress. This rapid and efficient antioxidant property of trolox was attributed to its enhanced water solubility as compared with alpha-tocopherol. This investigation was aimed to study the effect of trolox against 3-NPA-induced neurotoxicity in female Wistar rats. The animals received trolox (0, 40 mg, 80 mg and 160 mg/kg, orally) daily for 7 days. 3-NPA (25mg/kg, i.p.) was administered daily 30 min after trolox for the same duration. One additional group of rats served as control (vehicle only). On day 8, the animals were observed for neurobehavioral performance. Immediately after behavioral studies, the animal's brains were dissected out for histological studies. Lesions in the striatal dopaminergic neurons were assessed by immunohistochemical method using tyrosine hydroxylase immunostaining. Administration of 3-NPA alone caused significant depletion of striatal dopamine and glutathione, whereas, the levels of thiobarbituric acid reactive substance (TBARS) and nitric oxide (NO) were significantly increased suggesting an elevated level of oxidative stress. Trolox significantly and dose-dependently protected animals against 3-NPA-induced neurobehavioral, neurochemical and structural abnormalities. These results clearly suggest that protective effect of trolox against 3-NPA-induced neurotoxicity is mediated through its free radical scavenging activity.
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Affiliation(s)
- Ahmed Al Mutairy
- Department of Biochemistry, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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Peterlin B, Kobal J, Teran N, Flisar D, Lovrecić L. Epidemiology of Huntington's disease in Slovenia. Acta Neurol Scand 2009; 119:371-5. [PMID: 18976322 DOI: 10.1111/j.1600-0404.2008.01110.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the prevalence of Huntington's disease (HD) in Slovenia using direct mutation analysis. MATERIALS AND METHODS Symptomatic patients and presymptomatic individuals at risk for HD referred to the Institute of Medical Genetics between 1997 and 2007 were included in the study. The patients were ascertained through multiple sources. The prevalence was estimated on 31 December 2006. RESULTS A total of 116 and 68 individuals with CAG repeat number >36 were symptomatic and presymptomatic, respectively. The prevalence of HD in Slovenia was estimated at 5.16/10(5) (95% confidence interval 4.16-6.16). CONCLUSIONS This is the first report on the epidemiology and prevalence of HD in Slovenia. The prevalence of HD is comparable with previously reported data in other European countries. In Slovenia, a higher proportion of individuals at risk for HD decide on predictive mutational testing as compared with the estimated numbers for Europe, United States, Canada and Australia.
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Affiliation(s)
- B Peterlin
- Institute of Medical Genetics, Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.
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44
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Phillips W, Shannon KM, Barker RA. The current clinical management of Huntington's disease. Mov Disord 2009; 23:1491-504. [PMID: 18581443 DOI: 10.1002/mds.21971] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Huntington's disease is a neurodegenerative condition, characterized by movement disorders, cognitive decline, and psychiatric disturbance. We review the pharmacological management of the various movement disorders associated with the disease, the cognitive decline and the commonly encountered behavioral disturbances. We discuss the nonclassical features of the disease, important in the management of these patients. Nonpharmacological support including genetic counseling and therapy and the importance of palliative care are also addressed. Finally, experimental approaches that may soon impact upon clinical practice are discussed.
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Affiliation(s)
- Wendy Phillips
- Cambridge Centre for Brain Repair, E.D. Adrian Building, Forvie Site, Cambridge, United Kingdom
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45
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Youssov K, Bachoud-Lévi AC. Malattia di Huntington: aspetti diagnostici attuali e applicazioni pratiche. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Eskenazi BR, Wilson-Rich NS, Starks PT. A Darwinian approach to Huntington's disease: subtle health benefits of a neurological disorder. Med Hypotheses 2007; 69:1183-9. [PMID: 17689877 DOI: 10.1016/j.mehy.2007.02.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 02/22/2007] [Indexed: 01/04/2023]
Abstract
Huntington's disease (HD) is a neurodegenerative disorder that, unlike most autosomal dominant disorders, is not being selected against. One explanation for the maintenance of the mutant HD allele is that it is transparent to natural selection because disease symptoms typically occur subsequent to an individual's peak reproductive years. While true, this observation does not explain the population-level increase in HD. The increase in HD is at least partly the result of enhanced fitness: HD+ individuals have more offspring than unaffected relatives. This phenomenon has previously been explained as the result of elevated promiscuity of HD+ individuals. For this to be true, disease symptoms must be expressed during the otherwise asymptomatic peak reproductive years and promiscuity must increase offspring production; however, neither prediction is supported by data. Instead, new data suggest that the mutant HD allele bestows health benefits on its carriers. HD+ individuals show elevated levels of the tumor suppressor protein p53 and experience significantly less cancer than unaffected siblings. We hypothesize that the mutant HD allele elevates carriers' immune activity and thus HD+ individuals are, on average, healthier than HD- individuals during reproductive years. As health and reproductive output are positively related, data suggest a counterintuitive relationship: health benefits may lead to an increased prevalence of Huntington's disease.
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Kenney C, Powell S, Jankovic J. Autopsy-proven Huntington's disease with 29 trinucleotide repeats. Mov Disord 2007; 22:127-30. [PMID: 17115386 DOI: 10.1002/mds.21195] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Huntington's disease (HD) is a neurodegenerative disorder associated with expansion of CAG trinucleotide repeats in the huntingtin gene. A minimum of 36 CAG repeats is usually reported in patients with clinical features of HD; 30 to 35 repeats represent an intermediate range. Here we report a 65-year-old male with autopsy-proven HD and 29 CAG repeats.
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Affiliation(s)
- Christopher Kenney
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
Worldwide, predictive testing for Huntington's disease has become an accepted clinical application that has allowed many individuals from HD-families to proceed with their life without the uncertainty of being at risk. International guidelines have extensively contributed to establishing counselling programmes of high quality, and have served as a model for other genetic disorders. Psychological follow-up studies have increased the insight into the far-reaching impact of test results for all individuals involved. Although the guidelines have served as a useful frame of reference, clinical experience has shown the importance of a case-by-case approach to do justice to the specific needs of the individual test candidate. Issues such as ambiguous test results, lack of awareness in a test candidate of early signs of the disease, non-compliance to the test protocol, or the test candidate's need for information on the relationship between age at onset and CAG-repeat require careful consideration. Receiving a test result is only one of the transition points in the life of an individual at risk; such result needs to be valued from a life-cycle perspective.
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Affiliation(s)
- Aad Tibben
- Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.
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Ramaswamy S, McBride JL, Herzog CD, Brandon E, Gasmi M, Bartus RT, Kordower JH. Neurturin gene therapy improves motor function and prevents death of striatal neurons in a 3-nitropropionic acid rat model of Huntington's disease. Neurobiol Dis 2007; 26:375-84. [PMID: 17336076 DOI: 10.1016/j.nbd.2007.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 01/10/2007] [Accepted: 01/14/2007] [Indexed: 11/21/2022] Open
Abstract
Huntington's disease (HD) is a devastating neurodegenerative disease characterized by the selective loss of neurons in the striatum and cerebral cortex. This study tested the hypothesis that an adenoassociated viral (AAV2) vector encoding for the trophic factor neurturin (NTN) could provide neuroprotection in the rat 3-nitropropionic acid (3NP) model of HD. Rats received AAV2-NTN (CERE-120), AAV2-eGFP or Vehicle, followed 4 weeks later by the mitochondrial toxin 3NP. 3NP induced motor impairments were observed on the rotarod test, the platform test, and a clinical rating scale in all groups. However, each of these deficits was attenuated by AAV2-NTN (CERE-120). Stereological counts revealed a significant protection of NeuN-ir striatal neurons from 3NP toxicity by AAV2-NTN. These data support the concept that AAV2-NTN might be a valuable treatment for patients with Huntington's disease.
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Affiliation(s)
- Shilpa Ramaswamy
- Department of Neuroscience, Rush University Medical Center, 1735 West Harrison Street, Suite 300, Chicago, IL 60612, USA
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Abstract
Chorea is one of the major types of involuntary movement disorders originating from dysfunctional neuronal networks interconnecting the basal ganglia and frontal cortical motor areas. The syndrome is characterised by a continuous flow of random, brief, involuntary muscle contractions and can result from a wide variety of causes. Diagnostic work-up can be straightforward in patients with a positive family history of Huntington's disease or acute-onset hemichorea in patients with lacunar stroke, but it can be a challenging and complex task in rare autoimmune or genetic choreas. Principles of management focus on establishing an aetiological classification and, if possible, removal of the cause. Preventive strategies may be possible in Huntington's disease where genetic counselling plays a major part. In this review we summarise the current understanding of the neuroanatomy and pathophysiology of chorea, its major aetiological classes, and principles of diagnostic work-up and management.
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