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CAG Repeat Not Polyglutamine Length Determines Timing of Huntington’s Disease Onset

2019; Cell Press; Volume: 178; Issue: 4 Linguagem: Inglês

10.1016/j.cell.2019.06.036

1097-4172

Jong‐Min Lee, Kevin Correia, Jacob M. Loupe, Kyung‐Hee Kim, Douglas Barker, Eun Pyo Hong, Michael J. Chao, Jeffrey D. Long, Diane Lucente, Jean Paul Vonsattel, Ricardo Mouro Pinto, Kawther Abu Elneel, Eliana Marisa Ramos, Jayalakshmi Srinidhi Mysore, Tammy Gillis, Vanessa C. Wheeler, Marcy E. MacDonald, James F. Gusella, Branduff McAllister, Thomas H. Massey, Christopher Medway, Timothy Stone, Lynsey S. Hall, Lesley Jones, Peter Holmans, Seung Kwak, Anka G Ehrhardt, Cristina Sampaio, Marc Ciosi, Alastair Maxwell, Afroditi Chatzi, Darren G. Monckton, Michael Orth, G. Bernhard Landwehrmeyer, Jane S. Paulsen, E. Ray Dorsey, Ira Shoulson, Richard H. Myers,

DNA Repair Mechanisms

Variable, glutamine-encoding, CAA interruptions indicate that a property of the uninterrupted HTT CAG repeat sequence, distinct from the length of huntingtin's polyglutamine segment, dictates the rate at which Huntington's disease (HD) develops. The timing of onset shows no significant association with HTT cis-eQTLs but is influenced, sometimes in a sex-specific manner, by polymorphic variation at multiple DNA maintenance genes, suggesting that the special onset-determining property of the uninterrupted CAG repeat is a propensity for length instability that leads to its somatic expansion. Additional naturally occurring genetic modifier loci, defined by GWAS, may influence HD pathogenesis through other mechanisms. These findings have profound implications for the pathogenesis of HD and other repeat diseases and question the fundamental premise that polyglutamine length determines the rate of pathogenesis in the "polyglutamine disorders."