1
|
Nikitina M, Bragina E, Nazarenko M, Alifirova V. The role of alleles with an intermediate number of trinucleotide repeats in Parkinson’s disease and other neurodegenerative disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:42-50. [DOI: 10.17116/jnevro202212207142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
2
|
Clever F, Cho IK, Yang J, Chan AWS. Progressive Polyglutamine Repeat Expansion in Peripheral Blood Cells and Sperm of Transgenic Huntington's Disease Monkeys. J Huntingtons Dis 2020; 8:443-448. [PMID: 31561381 PMCID: PMC6839466 DOI: 10.3233/jhd-190359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The expanded CAG repeat results in somatic mosaicism and genetic anticipation in Huntington’s disease (HD). Here we report a longitudinal study examining CAG repeat instability in lymphocytes and sperm of three HD monkeys throughout their whole life-span that encompass the prodromal to symptomatic stages of HD. We demonstrate a progressive increase in CAG repeat length in lymphocytes and sperm as the animals aged. We also examined the impact of CAG repeat length on expansion rate, which showed a clear linear correlation up to 62Q, and high instability after. Our findings stress the importance of further investigation in CAG instability in peripheral blood cells longitudinally.
Collapse
Affiliation(s)
- Faye Clever
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - In Ki Cho
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jingjing Yang
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony W S Chan
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
3
|
Sundblom J, Niemelä V, Ghazarian M, Strand AS, Bergdahl IA, Jansson JH, Söderberg S, Stattin EL. High frequency of intermediary alleles in the HTT gene in Northern Sweden - The Swedish Huntingtin Alleles and Phenotype (SHAPE) study. Sci Rep 2020; 10:9853. [PMID: 32555394 PMCID: PMC7299994 DOI: 10.1038/s41598-020-66643-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/20/2020] [Indexed: 11/08/2022] Open
Abstract
Trinucleotide (CAG) repeat expansions longer than 39 in the huntingtin (HTT) gene cause Huntington's disease (HD). The frequency of intermediate alleles (IA) with a length of 27-35 in the general population is not fully known, but studied in specific materials connected to the incidence of HD. The Swedish Huntingtin Alleles and Phenotype (SHAPE) study aims to assess the frequency of trinucleotide repeat expansions in the HTT gene in north Sweden. 8260 individuals unselected for HD from the counties of Norr- and Västerbotten in the north of Sweden were included. DNA samples were obtained and analysis of the HTT gene was performed, yielding data on HTT gene expansion length in 7379 individuals. A high frequency of intermediate alleles, 6.8%, was seen. Also, individuals with repeat numbers lower than ever previously reported (<5) were found. These results suggest a high frequency of HD in the norther parts of Sweden. Subsequent analyses may elucidate the influence of IA:s on traits other than HD.
Collapse
Affiliation(s)
- Jimmy Sundblom
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.
| | - Valter Niemelä
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Maria Ghazarian
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Ann-Sofi Strand
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | - Eva-Lena Stattin
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Jevtic SD, Provias JP. Case report and literature review of Huntington disease with intermediate CAG expansion. BMJ Neurol Open 2020; 2:e000027. [PMID: 33681777 PMCID: PMC7871728 DOI: 10.1136/bmjno-2019-000027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Huntington disease (HD) is a genetically inherited neurodegenerative disorder that classically involves a trinucleotide CAG repeat expansion on chromosome 4, with 36 repeats or greater being disease identifying. It generally presents between the age of 30 and 40 years old and is characterised by severe caudate/striatum degeneration with huntingtin protein aggregation. We present here the case of a patient in her early 80s who presented with 5-year history of worsening chorea and family history of HD but an intermediate length CAG expansion. Methods Genetic testing of CAG repeats on chromosome 4. Postmortem brain tissue was obtained and stained using immunohistochemistry for amyloid-beta, tau and glial fibrillary acidic protein (GFAP). Sections from the caudate/putamen were also analysed by p62 immunofluorescence. All sections were reviewed by trained neuropathologists. Results On genetic testing the patient was found to have a 28 CAG repeat on the longest expansion. Microscopic analysis revealed significant neuronal atrophy in the caudate and putamen with gliosis. Immunofluorescent staining demonstrated minimal intranuclear p62 inclusions suggesting little huntingtin aggregation present. Furthermore, there was significant amyloid-beta pathology (Thal-IV stage) and tau involvement in the medial temporal lobe (Braak stage II). Conclusion This case provides clinical and pathological evidence to support an emerging clinical entity involving HD presentation in late age with an intermediate CAG repeat.
Collapse
Affiliation(s)
- Stefan D Jevtic
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John P Provias
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Laboratory Medicine and Pathology - Neuropathology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Palpagama TH, Waldvogel HJ, Faull RLM, Kwakowsky A. The Role of Microglia and Astrocytes in Huntington's Disease. Front Mol Neurosci 2019; 12:258. [PMID: 31708741 PMCID: PMC6824292 DOI: 10.3389/fnmol.2019.00258] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
Huntington's disease (HD) is an autosomal dominant neurodegenerative disease. HD patients present with movement disorders, behavioral and psychiatric symptoms and cognitive decline. This review summarizes the contribution of microglia and astrocytes to HD pathophysiology. Neuroinflammation in the HD brain is characterized by a reactive morphology in these glial cells. Microglia and astrocytes are critical in regulating neuronal activity and maintaining an optimal milieu for neuronal function. Previous studies provide evidence that activated microglia and reactive astrocytes contribute to HD pathology through transcriptional activation of pro-inflammatory genes to perpetuate a chronic inflammatory state. Reactive astrocytes also display functional changes in glutamate and ion homeostasis and energy metabolism. Astrocytic and microglial changes may further contribute to the neuronal death observed with the progression of HD. Importantly, the degree to which these neuroinflammatory changes are detrimental to neurons and contribute to the progression of HD pathology is not well understood. Furthermore, recent observations provide compelling evidence that activated microglia and astrocytes exert a variety of beneficial functions that are essential for limiting tissue damage and preserving neuronal function in the HD brain. Therefore, a better understanding of the neuroinflammatory environment in the brain in HD may lead to the development of targeted and innovative therapeutic opportunities.
Collapse
Affiliation(s)
- Thulani H Palpagama
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Henry J Waldvogel
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard L M Faull
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea Kwakowsky
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Parkinsonism with a Hint of Huntington's from 29 CAG Repeats in HTT. Brain Sci 2019; 9:brainsci9100245. [PMID: 31546689 PMCID: PMC6826852 DOI: 10.3390/brainsci9100245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
Huntington's disease is caused by at least 36 cytosine-adenine-guanine (CAG) repeats in an HTT gene allele, but repeat tracts in the intermediate range (27-35 repeats) also display a subtle phenotype. This patient had a slightly elongated CAG repeat tract (29 repeats), a prominent family history of Parkinson's disease (PD), and a clinical phenotype mostly consistent with PD, but early dystonia and poor levodopa response. Neurophysiological test results were more consistent with Huntington's disease (HD) than PD. It is suggested that the intermediate allele modulated the clinical phenotype of PD in this patient.
Collapse
|
7
|
Migliore S, Jankovic J, Squitieri F. Genetic Counseling in Huntington's Disease: Potential New Challenges on Horizon? Front Neurol 2019; 10:453. [PMID: 31114543 PMCID: PMC6503085 DOI: 10.3389/fneur.2019.00453] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Huntington's disease (HD) is a rare, hereditary, neurodegenerative and dominantly transmitted disorder affecting about 10 out of 100,000 people in Western Countries. The genetic cause is a CAG repeat expansion in the huntingtin gene (HTT), which is unstable and may further increase its length in subsequent generations, so called anticipation. Mutation repeat length coupled with other gene modifiers and environmental factors contribute to the age at onset in the offspring. Considering the unpredictability of age at onset and of clinical prognosis in HD, the accurate interpretation, a proper psychological support and a scientifically sound and compassionate communication of the genetic test result are crucial in the context of Good Clinical Practice and when considering further potential disease-modifying therapies. We discuss various genetic test scenarios that require a particularly careful attention in psychological and genetic counseling and expect that the counseling procedures will require a constant update.
Collapse
Affiliation(s)
- Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| |
Collapse
|
8
|
Espinoza FA, Liu J, Ciarochi J, Turner JA, Vergara VM, Caprihan A, Misiura M, Johnson HJ, Long JD, Bockholt JH, Paulsen JS, Calhoun VD. Dynamic functional network connectivity in Huntington's disease and its associations with motor and cognitive measures. Hum Brain Mapp 2019; 40:1955-1968. [PMID: 30618191 PMCID: PMC6865767 DOI: 10.1002/hbm.24504] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 02/03/2023] Open
Abstract
Dynamic functional network connectivity (dFNC) is an expansion of traditional, static FNC that measures connectivity variation among brain networks throughout scan duration. We used a large resting-state fMRI (rs-fMRI) sample from the PREDICT-HD study (N = 183 Huntington disease gene mutation carriers [HDgmc] and N = 78 healthy control [HC] participants) to examine whole-brain dFNC and its associations with CAG repeat length as well as the product of scaled CAG length and age, a variable representing disease burden. We also tested for relationships between functional connectivity and motor and cognitive measurements. Group independent component analysis was applied to rs-fMRI data to obtain whole-brain resting state networks. FNC was defined as the correlation between RSN time-courses. Dynamic FNC behavior was captured using a sliding time window approach, and FNC results from each window were assigned to four clusters representing FNC states, using a k-means clustering algorithm. HDgmc individuals spent significantly more time in State-1 (the state with the weakest FNC pattern) compared to HC. However, overall HC individuals showed more FNC dynamism than HDgmc. Significant associations between FNC states and genetic and clinical variables were also identified. In FNC State-4 (the one that most resembled static FNC), HDgmc exhibited significantly decreased connectivity between the putamen and medial prefrontal cortex compared to HC, and this was significantly associated with cognitive performance. In FNC State-1, disease burden in HDgmc participants was significantly associated with connectivity between the postcentral gyrus and posterior cingulate cortex, as well as between the inferior occipital gyrus and posterior parietal cortex.
Collapse
Affiliation(s)
- Flor A. Espinoza
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Jingyu Liu
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Jennifer Ciarochi
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Jessica A. Turner
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Victor M. Vergara
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Arvind Caprihan
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | - Maria Misiura
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
| | - Hans J. Johnson
- Department of Electrical and Computer EngineeringUniversity of IowaIowa CityIowa
- Department of PsychiatryUniversity of IowaIowa CityIowa
| | - Jeffrey D. Long
- Department of PsychiatryUniversity of IowaIowa CityIowa
- Department of BiostatisticsUniversity of IowaIowa CityIowa
| | - Jeremy H. Bockholt
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
| | | | - Vince D. Calhoun
- Department of Translational Neuroscience, The Mind Research NetworkAlbuquerqueNew Mexico
- Department of Psychology and NeuroscienceGeorgia State UniversityAtlantaGeorgia
- Department of Electrical and Computer EngineeringUniversity of New MexicoAlbuquerqueNew Mexico
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Downing NR, Lourens S, De Soriano I, Long JD, Paulsen JS. Phenotype Characterization of HD Intermediate Alleles in PREDICT-HD. J Huntingtons Dis 2017; 5:357-368. [PMID: 27983559 DOI: 10.3233/jhd-160185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Huntington disease (HD) is a neurodegenerative disease caused by a CAG repeat expansion on chromosome 4. Pathology is associated with CAG repeat length. Prior studies examining people in the intermediate allele (IA) range found subtle differences in motor, cognitive, and behavioral domains compared to controls. OBJECTIVE The purpose of this study was to examine baseline and longitudinal differences in motor, cognitive, behavioral, functional, and imaging outcomes between persons with CAG repeats in three ranges: normal (≤26), intermediate (27-35), and reduced penetrance (36-39). METHODS We examined longitudinal data from 389 participants in three allele groups: 280 normal controls (NC), 21 intermediate allele [IA], and 88 reduced penetrance [RP]. We used linear mixed models to identify differences in baseline and longitudinal outcomes between groups. Three models were tested: 1) no baseline or longitudinal differences; 2) baseline differences but no longitudinal differences; and 3) baseline and longitudinal differences. RESULTS Model 1 was the best fitting model for most outcome variables. Models 2 and 3 were best fitting for some of the variables. We found baseline and longitudinal trends of declining performance across increasing CAG repeat length groups, but no significant differences between the NC and IA groups. CONCLUSION We did not find evidence to support differences in the IA group compared to the NC group. These findings are limited by a small IA sample size.
Collapse
Affiliation(s)
| | - Spencer Lourens
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Isabella De Soriano
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jeffrey D Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jane S Paulsen
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.,Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | |
Collapse
|
11
|
Epping EA, Kim JI, Craufurd D, Brashers-Krug TM, Anderson KE, McCusker E, Luther J, Long JD, Paulsen JS. Longitudinal Psychiatric Symptoms in Prodromal Huntington's Disease: A Decade of Data. Am J Psychiatry 2016; 173:184-92. [PMID: 26472629 PMCID: PMC5465431 DOI: 10.1176/appi.ajp.2015.14121551] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Psychiatric symptoms are a significant aspect of Huntington's disease, an inherited neurodegenerative illness. The presentation of these symptoms is highly variable, and their course does not fully correlate with motor or cognitive disease progression. The authors sought to better understand the development and longitudinal course of psychiatric manifestations in individuals who carry the Huntington's disease mutation, starting from the prodromal period prior to motor diagnosis. METHOD Longitudinal measures for up to 10 years of psychiatric symptoms from the Symptom Checklist-90-Revised were obtained from 1,305 participants (1,007 carrying the Huntington's disease mutation and 298 without [classified as controls]) and 1,235 companions enrolled in the Neurobiological Predictors of Huntington's Disease (PREDICT-HD) study. Participants with the mutation were stratified into three groups according to probability of motor diagnosis within 5 years. Using linear mixed-effects regression models, differences in psychiatric symptoms at baseline and over time between the mutation-positive groups and the controls were compared, as well as between ratings by mutation-positive participants and their companions. RESULTS Nineteen of 24 psychiatric measures (12 participant ratings and 12 companion ratings) were significantly higher at baseline and showed significant increases longitudinally in the individuals with the Huntington's disease mutation compared with controls. The differences were greatest in comparisons of symptom reports from companions compared with self-reports, especially in participants who were closest to motor diagnosis. CONCLUSIONS The results indicate that psychiatric manifestations develop more often than previously thought in the Huntington's disease prodrome. Symptoms also increase with progression of disease severity. Greater symptom ratings by companions than by mutation-positive participants suggest decreasing awareness in those affected.
Collapse
Affiliation(s)
- Eric A. Epping
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Ji-In Kim
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - David Craufurd
- Institute of Human Development, The University of Manchester, Manchester, England, UK
| | - Thomas M. Brashers-Krug
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Karen E. Anderson
- Huntington Disease Care, Education, and Research Center, MedStar Georgetown University Hospital, Washington, DC, USA,Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC, USA,Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Elizabeth McCusker
- Department of Neurology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolene Luther
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jeffrey D. Long
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Biostatistics, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Jane S. Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA,Department of Psychology, The University of Iowa, Iowa City, IA, USA,Correspondence to Jane S. Paulsen, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Psychiatry Research, 1–305 Medical Education Building, Iowa City, IA USA 52242-1000. Tele: 319-353-4551; Fax: 319-353-3003;
| | | |
Collapse
|
12
|
Panegyres PK, Shu CC, Chen HY, Paulsen JS. Factors influencing the clinical expression of intermediate CAG repeat length mutations of the Huntington's disease gene. J Neurol 2014; 262:277-84. [PMID: 25380582 DOI: 10.1007/s00415-014-7559-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 02/07/2023]
Abstract
Our aim is to elucidate the clinical variables associated with the development of manifest HD in patients with intermediate CAG repeat lengths. 2,167 participants were seen throughout 44 research sites in the United States, Canada or Australia over a five-year natural history observational study (2006-2011) (Trial # NCT00313495). The Chi-square test and a generalised linear model were used to examine the differences in demographics and cognitive tests among three groups of CAG repeat length. The mixed model was then used to examine the time effect on cognitive assessments by CAG groups. No patient with CAG repeat length 27-35 developed manifest HD, whereas three patients with 36-39 did. Total motor score, maximal chorea score and maximal dystonia score were significantly different at baseline (p < 0.001) for each measure between those patients with a repeat length 27-35 versus those 36-39; as were total functional assessment, independence scale and total functional capacity (p < 0.001). Being aged 65 years or more (OR 5.81, 95 % CI 0.37-90.58, p = 0.02) and smoking (OR 13.99, 95 % CI 2.03-96.44, p = 0.007) were related to manifest HD in patients with CAG 36-39; those with an associated university degree or higher education were less frequently diagnosed as manifest HD (OR 0.10, 95 % CI 0.02-0.54, p = 0.007). Age, smoking and lower education achievement were found to be significantly associated with higher odds of manifest HD in patients with intermediate CAG repeat length mutations.
Collapse
Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, 6005, West Perth, WA, Australia,
| | | | | | | |
Collapse
|
13
|
Chandra A, Johri A, Beal MF. Prospects for neuroprotective therapies in prodromal Huntington's disease. Mov Disord 2014; 29:285-93. [PMID: 24573776 DOI: 10.1002/mds.25835] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 12/13/2022] Open
Abstract
Huntington's disease (HD) is a prototypical dominantly inherited neurodegenerative disorder characterized by progressive cognitive deterioration, psychiatric disturbances, and a movement disorder. The genetic cause of the illness is a CAG repeat expansion in the huntingtin gene, which leads to a polyglutamine expansion in the huntingtin protein. The exact mechanism by which mutant huntingtin causes HD is unknown, but it causes abnormalities in gene transcription as well as both mitochondrial dysfunction and oxidative damage. Because the penetrance of HD is complete with CAG repeats greater than 39, patients can be diagnosed well before disease onset with genetic testing. Longitudinal studies of HD patients before disease onset have shown that subtle cognitive and motor deficits occur as much as 10 years before onset, as do reductions in glucose utilization and striatal atrophy. An increase in inflammation, as shown by elevated interleukin-6, occurs approximately 15 years before onset. Detection of these abnormalities may be useful in defining an optimal time for disease intervention to try to slow or halt the degenerative process. Although reducing gene expression with small interfering RNA or short hairpin RNA is an attractive approach, other approaches targeting energy metabolism, inflammation, and oxidative damage may be more easily and rapidly moved into the clinic. The recent PREQUEL study of coenzyme Q10 in presymptomatic gene carriers showed the feasibility of carrying out clinical trials to slow or halt onset of HD. We review both the earliest detectable clinical and laboratory manifestations of HD, as well as potential neuroprotective therapies that could be utilized in presymptomatic HD.
Collapse
Affiliation(s)
- Abhishek Chandra
- Brain and Mind Research Institute, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York, USA
| | | | | |
Collapse
|
14
|
Reiner A, Shelby E, Wang H, DeMarch Z, Deng Y, Guley NH, Hogg V, Roxburgh R, Tippett LJ, Waldvogel HJ, Faull RLM. Striatal parvalbuminergic neurons are lost in Huntington's disease: implications for dystonia. Mov Disord 2013; 28:1691-9. [PMID: 24014043 PMCID: PMC3812318 DOI: 10.1002/mds.25624] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 12/13/2022] Open
Abstract
Although dystonia represents a major source of motor disability in Huntington's disease (HD), its pathophysiology remains unknown. Because recent animal studies indicate that loss of parvalbuminergic (PARV+) striatal interneurons can cause dystonia, we investigated if loss of PARV+ striatal interneurons occurs during human HD progression, and thus might contribute to dystonia in HD. We used immunolabeling to detect PARV+ interneurons in fixed sections, and corrected for disease-related striatal atrophy by expressing PARV+ interneuron counts in ratio to interneurons co-containing somatostatin and neuropeptide Y (whose numbers are unaffected in HD). At all symptomatic HD grades, PARV+ interneurons were reduced to less than 26% of normal abundance in rostral caudate. In putamen rostral to the level of globus pallidus, loss of PARV+ interneurons was more gradual, not dropping off to less than 20% of control until grade 2. Loss of PARV+ interneurons was even more gradual in motor putamen at globus pallidus levels, with no loss at grade 1, and steady grade-wise decline thereafter. A large decrease in striatal PARV+ interneurons, thus, occurs in HD with advancing disease grade, with regional variation in the loss per grade. Given the findings of animal studies and the grade-wise loss of PARV+ striatal interneurons in motor striatum in parallel with the grade-wise appearance and worsening of dystonia, our results raise the possibility that loss of PARV+ striatal interneurons is a contributor to dystonia in HD.
Collapse
Affiliation(s)
- Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Evan Shelby
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Hongbing Wang
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Zena DeMarch
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Yunping Deng
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Natalie Hart Guley
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, Tennessee, USA
| | - Virginia Hogg
- Centre for Brain Research, University of AucklandAuckland, New Zealand
- Department of Psychology, University of AucklandAuckland, New Zealand
| | - Richard Roxburgh
- Centre for Brain Research, University of AucklandAuckland, New Zealand
- Department of Neurology, Auckland City HospitalAuckland, New Zealand
| | - Lynette J Tippett
- Centre for Brain Research, University of AucklandAuckland, New Zealand
- Department of Psychology, University of AucklandAuckland, New Zealand
| | - Henry J Waldvogel
- Centre for Brain Research, University of AucklandAuckland, New Zealand
- Department of Anatomy with Radiology, University of AucklandAuckland, New Zealand
| | - Richard LM Faull
- Centre for Brain Research, University of AucklandAuckland, New Zealand
- Department of Anatomy with Radiology, University of AucklandAuckland, New Zealand
| |
Collapse
|
15
|
Killoran A, Biglan KM, Jankovic J, Eberly S, Kayson E, Oakes D, Young AB, Shoulson I. Characterization of the Huntington intermediate CAG repeat expansion phenotype in PHAROS. Neurology 2013; 80:2022-7. [PMID: 23624566 DOI: 10.1212/wnl.0b013e318294b304] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to describe the clinical phenotype conferred by the intermediate-length huntingtin allele CAG repeat expansion in a population-based study. METHODS The Prospective Huntington At Risk Observational Study (PHAROS) enrolled adults at risk for Huntington disease (HD). They were assessed approximately every 9 months with the Unified Huntington's Disease Rating Scale (UHDRS) by investigators unaware of participants' gene status. UHDRS scores were compared according to the Huntingtin gene CAG repeat number: expanded >36, intermediate 27-35, and nonexpanded controls <26. RESULTS Fifty (5.1%) of the 983 participants had an intermediate allele (IA). They were similar to controls on UHDRS motor, cognitive, and functional measures, but significantly worse behaviorally on apathy and suicidal ideation. On 5 of the 9 other behavioral items and on total behavior, the IA group's scores were worse than those of controls and expanded participants, who themselves scored significantly worse than controls on 6 behavioral measures. Retention rates at 4 years were 48% for the IA group compared to 58% and 60% for the expanded and control groups. CONCLUSIONS In a cohort at risk for HD, the IA was associated with significant behavioral abnormalities but normal motor and cognition. This behavioral phenotype may represent a prodromal stage of HD, with the potential for subsequent clinical manifestations, or be part of a distinct phenotype conferred by pathology independent of the CAG expansion length.
Collapse
|