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Huntington’s Disease
By Dennis
Sulkouski
Objectives
• To explore Huntington’s disease as a
neurological disorder.
• Describe the genetics of the disorder.
• Describe testing and treatment options.
What is Huntington’s Disease
• Huntington’s disease is a progressive neurodegenerative
disorder that exhibits a dominant pattern of inheritance
(50%).
• It is most prevalent in people of Western European descent
(more than 15 incidences per 100,000 people).
• It usually strikes affected individuals during the fourth decade
of life (40 years).
• It is characterized by abnormal movement, cognitive
impairment, mood disorders, and behavioral changes. The
disorder ultimately leads to death (usually 15-18
years after onset of symptoms).
Genetics and Pathology of
Huntington’s Disease
• Huntington’s disease is an autosomal dominant
disease with a 100% phenotypic penetrance.
• It is a result of a mutation of the HTT gene on chromosome
4, which codes for a protein that is important during the early
neuronal development of the human fetus.
• The product of the HTT gene is called huntingtin.
• Though the exact role is still unknown, within cells, the gene
and its associated product are known to be involved in
chemical signaling, transporting materials, attaching to
proteins, and protecting the cell from self-destruction.
CHROMOSOME 4
Genetics and Pathology Continued
• Remember the 4 base nucleotides??? (A, G, T, C)
• Huntington's disease is a “trinucleotide repeat
mutation disorder”.
• Under normal conditions, HTT gene has a
certain number of CAG repeats.
• Under abnormal conditions, the number of CAG
repeats is increased significantly.
Genetics and Pathology Continued
• Normal Number of Repeats: fewer than 26
• Intermediate Num. of Repeats: 27-35 (Meiotic
ally Unstable in Males)
• HD-causing : 36 and more (can go as high up
as 120 repeats!!!)
Pathology and Genetics Continued
• The extra repeats result in the gene abnormality,
which in turn results in a misshapen version of
the huntingtin protein in the area of Exon 1.
• The elongated protein is cut into smaller, toxic
fragments that bind together and accumulate in
neurons, disrupting their normal functions.
• This process particularly affects regions of the
brain that help coordinate movement and
control thinking and emotions (the striatum,
Globus pallidum and cerebral cortex).
Testing for HD
• Initial symptoms of HD resemble symptoms of
many other neurological diseases.
• Careful family history and a close neurological
examination are done first.
• Direct testing of chromosome 4 provides definitive
diagnosis.
• Pre-natal testing is recommended for the at risk
population.
Treatment of HD
• No cure is available to this day.
• The aim of the therapy is to mask the symptoms of disease
progression.
• The abnormal movements (chorea) can be controlled with
antipsychotic agents (Haloperidol) and muscle relaxants
(benzodiazepines).
• Anti-Parkinsonian agents (levodopa & carbidopa) can be
used to reduce muscle stiffness and rigidity.
• Supportive care will be needed at some point in the person’s
life
Treatments of the Future
• Studies are continuous and many promising leads are
found.
• Such pharmacologic agents as apoptosis inhibitors,
huntingtin proteolysis, huntingtin phosphorylation
inhibitors.
• Another approach is gene therapy. Silencing abnormal
genetic repeats in a targeted fashion by using
interference RNA (RNAi) and antisense-
oligonucleotides.
• Lastly, direct neural transplantation is being
investigated. However, recent studies in mice have
revealed a troublesome discovery. Mutant huntingtin is
capable of spreading into the transplanted tissue.
Works Cited
• Warby, Simon. Huntington Disease. U.S.
National Library of Medicine, 11 Dec. 2014. Web.
22 Aug. 2015.
http://www.ncbi.nlm.nih.gov/books/NBK1305/.
• Myers, Richard. "Huntington’s Disease
Genetics." NeuroRx. The American Society for
Experimental NeuroTherapeutics, Inc., 1 Apr.
2004. Web. 22 Aug. 2015.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC
534940/.
• “HTT Gene." Genetics Home Reference. U.S.
National Library of Medicine, 18 Aug. 2015. Web.
22 Aug. 2015. http://ghr.nlm.nih.gov/gene/HTT.

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Huntington’s Disease

  • 1.
  • 3. Objectives • To explore Huntington’s disease as a neurological disorder. • Describe the genetics of the disorder. • Describe testing and treatment options.
  • 4. What is Huntington’s Disease • Huntington’s disease is a progressive neurodegenerative disorder that exhibits a dominant pattern of inheritance (50%). • It is most prevalent in people of Western European descent (more than 15 incidences per 100,000 people). • It usually strikes affected individuals during the fourth decade of life (40 years). • It is characterized by abnormal movement, cognitive impairment, mood disorders, and behavioral changes. The disorder ultimately leads to death (usually 15-18 years after onset of symptoms).
  • 5. Genetics and Pathology of Huntington’s Disease • Huntington’s disease is an autosomal dominant disease with a 100% phenotypic penetrance. • It is a result of a mutation of the HTT gene on chromosome 4, which codes for a protein that is important during the early neuronal development of the human fetus. • The product of the HTT gene is called huntingtin. • Though the exact role is still unknown, within cells, the gene and its associated product are known to be involved in chemical signaling, transporting materials, attaching to proteins, and protecting the cell from self-destruction.
  • 7. Genetics and Pathology Continued • Remember the 4 base nucleotides??? (A, G, T, C) • Huntington's disease is a “trinucleotide repeat mutation disorder”. • Under normal conditions, HTT gene has a certain number of CAG repeats. • Under abnormal conditions, the number of CAG repeats is increased significantly.
  • 8. Genetics and Pathology Continued • Normal Number of Repeats: fewer than 26 • Intermediate Num. of Repeats: 27-35 (Meiotic ally Unstable in Males) • HD-causing : 36 and more (can go as high up as 120 repeats!!!)
  • 9. Pathology and Genetics Continued • The extra repeats result in the gene abnormality, which in turn results in a misshapen version of the huntingtin protein in the area of Exon 1. • The elongated protein is cut into smaller, toxic fragments that bind together and accumulate in neurons, disrupting their normal functions. • This process particularly affects regions of the brain that help coordinate movement and control thinking and emotions (the striatum, Globus pallidum and cerebral cortex).
  • 10. Testing for HD • Initial symptoms of HD resemble symptoms of many other neurological diseases. • Careful family history and a close neurological examination are done first. • Direct testing of chromosome 4 provides definitive diagnosis. • Pre-natal testing is recommended for the at risk population.
  • 11.
  • 12. Treatment of HD • No cure is available to this day. • The aim of the therapy is to mask the symptoms of disease progression. • The abnormal movements (chorea) can be controlled with antipsychotic agents (Haloperidol) and muscle relaxants (benzodiazepines). • Anti-Parkinsonian agents (levodopa & carbidopa) can be used to reduce muscle stiffness and rigidity. • Supportive care will be needed at some point in the person’s life
  • 13. Treatments of the Future • Studies are continuous and many promising leads are found. • Such pharmacologic agents as apoptosis inhibitors, huntingtin proteolysis, huntingtin phosphorylation inhibitors. • Another approach is gene therapy. Silencing abnormal genetic repeats in a targeted fashion by using interference RNA (RNAi) and antisense- oligonucleotides. • Lastly, direct neural transplantation is being investigated. However, recent studies in mice have revealed a troublesome discovery. Mutant huntingtin is capable of spreading into the transplanted tissue.
  • 14. Works Cited • Warby, Simon. Huntington Disease. U.S. National Library of Medicine, 11 Dec. 2014. Web. 22 Aug. 2015. http://www.ncbi.nlm.nih.gov/books/NBK1305/. • Myers, Richard. "Huntington’s Disease Genetics." NeuroRx. The American Society for Experimental NeuroTherapeutics, Inc., 1 Apr. 2004. Web. 22 Aug. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 534940/. • “HTT Gene." Genetics Home Reference. U.S. National Library of Medicine, 18 Aug. 2015. Web. 22 Aug. 2015. http://ghr.nlm.nih.gov/gene/HTT.