Polyglutamine Repeats in Neurodegenerative Diseases

Andrew P. Lieberman, Vikram G. Shakkottai, Roger L. Albin

Research output: Contribution to journalReview articlepeer-review

Abstract

Among the age-dependent protein aggregation disorders, nine neurodegenerative diseases are caused by expansions of CAG repeats encoding polyglutamine (polyQ) tracts. We review the clinical, pathological, and biological features of these inherited disorders. We discuss insights into pathogenesis gleaned from studies of model systems and patients, highlighting work that informs efforts to develop effective therapies. An important conclusion from these analyses is that expanded CAG/polyQ domains are the primary drivers of neurodegeneration, with the biology of carrier proteins influencing disease-specific manifestations. Additionally, it has become apparent that CAG/polyQ repeat expansions produce neurodegeneration via multiple downstream mechanisms, involving both gain- and loss-of-function effects. This conclusion indicates that the likelihood of developing effective therapies targeting single nodes is reduced. The evaluation of treatments for premanifest disease will likely require new investigational approaches. We highlight the opportunities and challenges underlying ongoing work and provide recommendations related to the development of symptomatic and disease-modifying therapies and biomarkers that could inform future research.

Original languageEnglish (US)
Pages (from-to)1-27
Number of pages27
JournalAnnual Review of Pathology: Mechanisms of Disease
Volume14
DOIs
StatePublished - 2019
Externally publishedYes

Keywords

  • polyglutamine, neurodegeneration, trinucleotide repeat disorders, Huntington's disease, spinal and bulbar muscular atrophy, spinocerebellar ataxia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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