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Solís-Añez E, Salles PA, Rojas N, Benavides O, Chaná-Cuevas P. Huntington's Disease in Chile: Epidemiological and Genetic Aspects. Neuroepidemiology 2023; 57:176-184. [PMID: 37121230 DOI: 10.1159/000528961] [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: 05/31/2022] [Accepted: 12/20/2022] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Huntington's disease (HD) is a neurodegenerative, autosomal dominant disabling condition due to an expansion of the CAG trinucleotide in the HTT gene. Motor, psychiatric, and cognitive disorders characterize it. Chilean reports on HD in the era of molecular diagnosis were wanted. METHODS This is a retrospective analysis of a prospective cohort of patients with HD seen at the Center for Movement Disorders (CETRAM) in Chile between 2013 and 2019. Sociodemographic, genotype, and neuropsychiatric features were investigated. RESULTS One hundred three probands with HD were identified. The majority (63.1%) were born in the metropolitan region, followed by the VIII and V regions with 8.73% and 7.76%, respectively. When pedigrees were analyzed, ninety unrelated families encompassing 1,007 individuals were identified; among relatives, other 35 manifested HD, and 106 died of HD. Besides, five hundred seventy-nine individuals were at genetic risk. The minimum estimated prevalence of HD in Chile in 2019 was 0.72 × 100,000 inhabitants. The mean CAG repeats (CAGR) of 47.2 ± 10.74 for the expanded allele and 17.93 ± 2.05 for the normal allele. The mean age of onset was 41.39 ± 13.47 years. Juvenile cases represented 7.8% of this cohort, and 4.9% had a late onset. There was a negative correlation between the age of onset and the CAGR of the expanded allele (r =-0.84 p < 0.0001). Besides, 79.6% had a family history of HD. CONCLUSIONS This is the first report characterizing genetics, motor, and neuropsychiatric features in patients with HD in Chile. The mean length of CAGR expansion of the abnormal allele was similar to previous reports in North America (i.e., Mexico and Canada) and higher than that reported in the neighboring country of Argentina. According to previous estimations, the minimal prevalence of HD in Chile may be lower than expected.
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Affiliation(s)
| | - Philippe A Salles
- Center for Movement Disorders CETRAM, University of Santiago de Chile, Santiago, Chile,
| | - Natalia Rojas
- Center for Movement Disorders CETRAM, University of Santiago de Chile, Santiago, Chile
| | - Olga Benavides
- Neurology Department, Dr. Eloisa Díaz La Florida Metropolitan Hospital, Santiago, Chile
| | - Pedro Chaná-Cuevas
- Center for Movement Disorders CETRAM, University of Santiago de Chile, Santiago, Chile
- Faculty of Medical Sciences, University of Santiago de Chile, Santiago, Chile
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Vishnevetsky A, Cornejo‐Olivas M, Sarapura‐Castro E, Inca‐Martinez M, Rabinowitz D, Milla‐Neyra K, Mazzetti P, Bird T. Juvenile-Onset Huntington's Disease in Peru: A Case Series of 32 Patients. Mov Disord Clin Pract 2023; 10:238-247. [PMID: 36825038 PMCID: PMC9941913 DOI: 10.1002/mdc3.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/06/2022] [Accepted: 11/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Juvenile-onset Huntington's Disease (JoHD) or Huntington's disease (HD) with age of onset ≤20 years, is a rare clinical entity that often differs phenotypically from adult HD and represents only 1-15% of total HD cases. Objective To characterize the genetic and clinical characteristics of 32 JoHD patients seen in a Peruvian Neurogenetics clinic from 2000-2018. Methods This study is a retrospective clinical and genetic review. The clinical database in Lima, Peru was searched for HD patients seen in clinic between 2000 and 2018. Inclusion criteria were: (1) genetically confirmed disease; and (2) HD age of onset ≤20 years, according to the documented medical history. Results Among 475 patients with genetically confirmed HD in the database, 32 patients (6.7%) had symptom onset at ≤20 years. Among JoHD patients with a known transmitting parent (30 of 32), paternal transmission accounted for 77% of cases. Anticipation was higher with paternal transmission compared to maternal transmission (27.5 ± 11.5 vs. 11.3 ± 7.1 years). Overall expanded CAG repeat length ranged from 44 to 110, with a mean length of 65.6 ± 15.4, and 14 (44%) cases had repeat length under 60. Of the 32 patients included in the study, 25 had detailed clinical symptomatology available, and many patients had unique clinical features such as prominent sleep disturbance (60% of patients), or parkinsonism (73%). Conclusions This large case series of JoHD patients characterizes the Peruvian JoHD population, reports on unique familial relationships in JoHD, and highlights the varied symptomatic presentation of this rare disease.
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Affiliation(s)
- Anastasia Vishnevetsky
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
- Northern Pacific Fogarty Global Health ScholarNIH Fogarty International CenterBethesdaUnited States
- Division of Neuroimmunology and Neuroinfectious DiseasesBostonMassachusettsUSA
| | - Mario Cornejo‐Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
- School of MedicineUniversidad Nacional Mayor de San MarcosLimaPeru
- Universidad Científica del SurLimaPeru
| | - Elison Sarapura‐Castro
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
- Northern Pacific Fogarty Global Health ScholarNIH Fogarty International CenterBethesdaUnited States
| | - Miguel Inca‐Martinez
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Danielle Rabinowitz
- Harvard Medical SchoolBostonMassachusettsUSA
- Boston Children's HospitalBostonMassachusettsUSA
| | - Karina Milla‐Neyra
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
- Boston Children's HospitalBostonMassachusettsUSA
| | - Thomas Bird
- Departments of Neurology and MedicineUniversity of WashingtonSeattleWashingtonUSA
- Geriatrics ResearchVA Puget Sound Health Care SystemSeattleWashingtonUSA
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Vega OM, Cepeda C. Converging evidence in support of omega-3 polyunsaturated fatty acids as a potential therapy for Huntington's disease symptoms. Rev Neurosci 2021; 32:871-886. [PMID: 33818039 PMCID: PMC10017201 DOI: 10.1515/revneuro-2021-0013] [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: 01/24/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Huntington's disease (HD) is a genetic, inexorably fatal neurodegenerative disease. Patient average survivability is up to 20 years after the onset of symptoms. Those who suffer from the disease manifest motor, cognitive, and psychiatric impairments. There is indirect evidence suggesting that omega-3 polyunsaturated fatty acids (ω-3 PUFA) could have alleviating effects on most of HD symptoms. These include beneficial effects against cachexia and weight loss, decrease of cognitive impairment over time, and improvement of psychiatric symptoms such as depression and irritability. Furthermore, there is a positive correlation between consumption of ω-3 PUFAs in diets and prevalence of HD, as well as direct effects on the disease via release of serotonin. Unfortunately, to date, very few studies have examined the effects of ω-3 PUFAs in HD, both on the symptoms and on disease progression. This paper reviews evidence in the literature suggesting that ω-3 PUFAs can be used in neurodegenerative disorders. This information can be extrapolated to support further research of ω-3 PUFAs and their potential use for HD treatment.
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Affiliation(s)
- Owen M Vega
- Intellectual and Developmental Disabilities Research Center, Jane and Terry Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center, Jane and Terry Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA
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Huntington's disease among immigrant groups and Swedish-born individuals: a cohort study of all adults 18 years of age and older in Sweden. Neurol Sci 2021; 42:3851-3856. [PMID: 33515337 PMCID: PMC8413185 DOI: 10.1007/s10072-021-05085-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/21/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is a lack of studies of Huntington's disease (HD) in immigrants. OBJECTIVE To study the association between country of birth and incident HD in first-generation immigrants versus Swedish-born individuals and in second-generation immigrants versus Swedish-born individuals with Swedish-born parents. METHODS Study populations included all adults aged 18 years and older in Sweden, i.e., in the first-generation study 6,042,891 individuals with 1034 HD cases and in the second-generation study 4,860,469 individuals with 1001 cases. HD was defined as having at least one registered diagnosis of HD in the National Patient Register. The incidence of HD in different first-generation immigrant groups versus Swedish-born individuals was assessed by Cox regression, expressed as hazard ratios (HRs) and 95% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighborhood socioeconomic status. RESULTS Mean age-standardized incidence rates per 100,000 person-years were for all Swedish-born 0.82 and for all foreign born 0.53 and for all men 0.73 and for all women 0.81, with the highest incidence rates for the group 80-84 years of age. After adjusting for potential confounders, the HRs were lower in women in the first- and second-generation, i.e., 0.49 (95% CI 0.36-0.67) and 0.63 (95% 0.45-0.87), respectively, and also among women from Finland or with parents from Finland. SIGNIFICANCE In general, the risk of HD was lower in first-generation and second-generation immigrant women but not among male immigrants.
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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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Rosseto SM, Alarcon TA, Rocha DMC, Ribeiro FM, Ferguson SSG, Martins-Silva C, Muniz MR, Costa PF, Guimarães DA, Pires RGW. DYNLT1 gene expression is downregulated in whole blood of patients at different Huntington's disease stages. Neurol Sci 2020; 42:1963-1967. [PMID: 32995988 DOI: 10.1007/s10072-020-04772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
Huntington's disease (HD) is a neurodegenerative disorder caused by a CAG nucleotide expansion, which encodes the amino acid glutamine, in the huntingtin gene. HD is characterized by motor, cognitive, and psychiatric dysfunctions. In a previous study, we showed by qPCR that some genes altered in an HD mouse model were also altered in blood of HD patients. These alterations were mainly with respect to the dynein family. Therefore, this study aimed to investigate whether dynein light chain Tctex type 1 (DYNLT1) is altered in HD patients and if there is a correlation between DYNLT1 gene expression changes and disease progression. We assessed the DYNLT1 gene expression in the blood of 19 HD patients and 20 healthy age-matched controls. Also, in 6 of these patients, we analyzed the DYNLT1 expression at two time points, 3 years apart. The DYNLT1 gene expression in the whole blood of HD patients was significantly downregulated and this difference was widened in later stages. These data suggest that DYNLT1 could emerge as a peripheral prognostic indicator in HD and, also, might be a target for potential intervention in the future.
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Affiliation(s)
- S M Rosseto
- Graduate Program in Biochemistry and Pharmacology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - T A Alarcon
- Laboratory of Molecular and Behavioral Neurobiology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - D M C Rocha
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, 29043-900, Brazil
| | - F M Ribeiro
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - S S G Ferguson
- Department of Cellular and Molecular Medicine, Brain and Mind Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - C Martins-Silva
- Graduate Program in Biochemistry and Pharmacology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil.,Laboratory of Molecular and Behavioral Neurobiology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - M R Muniz
- Department of Clinical Medicine, Health Science Center, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - P F Costa
- Department of Physiotherapy, School of Sciences, Santa Casa de Misericordia de Vitoria, Vitória, ES, Brazil
| | - D A Guimarães
- Graduate Program in Biochemistry and Pharmacology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil.,Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, 29043-900, Brazil
| | - Rita G W Pires
- Graduate Program in Biochemistry and Pharmacology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil. .,Laboratory of Molecular and Behavioral Neurobiology, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil. .,Department of Physiological Sciences, Health Sciences Center, Federal University of Espirito Santo, Vitória, ES, 29043-910, Brazil.
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Brito DV, Della Coletta MV, Takano SA, Ferreira GBM, Fantin C. Genetic analysis of Huntington's disease in a population from the Brazilian Amazon. Parkinsonism Relat Disord 2020; 78:94-95. [PMID: 32771600 DOI: 10.1016/j.parkreldis.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Diana V Brito
- Laboratório de Biologia Molecular, Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, AM, Brazil.
| | - Marcus V Della Coletta
- Departamento de Neurologia, Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, AM, Brazil
| | - Satiko Andrezza Takano
- Ambulatório Araújo Lima, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus 69020-160, AM, Brazil
| | - Giselle B M Ferreira
- Ambulatório Araújo Lima, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus 69020-160, AM, Brazil
| | - Cleiton Fantin
- Laboratório de Biologia Molecular, Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, AM, Brazil
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Silva-Paredes G, Urbanos-Garrido RM, Inca-Martinez M, Rabinowitz D, Cornejo-Olivas MR. Economic burden of Huntington's disease in Peru. BMC Health Serv Res 2019; 19:1017. [PMID: 31888613 PMCID: PMC6937635 DOI: 10.1186/s12913-019-4806-6] [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: 01/17/2019] [Accepted: 12/03/2019] [Indexed: 01/26/2023] Open
Abstract
Background Huntington’s disease (HD) is a devastating and fatal neurodegenerative disorder that leads to progressive disability, and over time to total dependence. The economic impact of HD on patients living in developing countries like Peru is still unknown. This study aims to estimate the economic burden by estimating direct and indirect costs of Huntington’s disease in Peru, as well as the proportion of direct costs borne by patients and their families. Methods Disease-cost cross-sectional study where 97 participants and their primary caregivers were interviewed using a common questionnaire. Prevalence and human capital approaches were used to estimate direct and indirect costs, respectively. Results The average annual cost of HD reached USD 8120 per patient in 2015. Direct non-healthcare costs represented 78.3% of total cost, indirect costs 14.4% and direct healthcare costs the remaining 7.3%. The mean cost of HD increased with the degree of patient dependency: from USD 6572 for Barthel 4 & 5 (slight dependency and total independency, respectively) to USD 23,251 for Barthel 1 (total dependency). Direct costs were primarily financed by patients and their families. Conclusions The estimated annual cost of HD for Peruvian society reached USD 1.2 million in 2015. The cost impact of HD on patients and their families is very high, becoming catastrophic for most dependent patients, and thus making it essential to prioritize full coverage by the State.
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Affiliation(s)
- Gustavo Silva-Paredes
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, 15003, Lima, Peru.
| | | | - Miguel Inca-Martinez
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, 15003, Lima, Peru.,Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Mario R Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, 1271 Ancash St, 15003, Lima, Peru.,Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Castilhos RMD, Santos JAD, Augustin MC, Pedroso JL, Barsottini O, Saba R, Ferraz HB, Godeiro Junior C, Vargas FR, Salarini DZ, Furtado GV, Polese-Bonatto M, Rodrigues LP, Sena LS, Saraiva-Pereira ML, Jardim LB. Minimal prevalence of Huntington's disease in the South of Brazil and instability of the expanded CAG tract during intergenerational transmissions. Genet Mol Biol 2019; 42:329-336. [PMID: 31259362 PMCID: PMC6726154 DOI: 10.1590/1678-4685-gmb-2018-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022] Open
Abstract
Huntington’s disease (HD) is due to dominant expansions of the CAG repeat of the
HTT gene. Meiotic instability of the (CAG)n
might impact the disorder frequency. We report on HD minimal prevalence in Rio
Grande do Sul (RS) state, Brazil, and on intergenerational instability of the
(CAG)n in HD families. Symptomatic and at-risk subjects from 179
HD families were ascertained between 2013 and 2016. Clinical, molecular and
family history data were obtained. Expanded (CAG)n length differences
between parent and child (delta-expanded-(CAG)n) were calculated.
Effect of parental age on the (CAG)n instability upon transmission
was inferred by correlating delta-expanded-(CAG)n between siblings to
their age differences. HD minimal prevalence in RS state was estimated as
1.85:100,000 inhabitants. Alleles with (CAG)27-35 were found on
21/384 non-disease associated chromosomes (5.5%); among 253 expanded alleles,
four (1.6%) were within reduced penetrance range with (CAG)36-39. In
32 direct transmissions, mean instability was larger among paternal than
maternal transmissions. In direct transmissions and in 51 sibling pairs,
parental age at the time of child birth were not correlated with
delta-expanded-(CAG)n. Briefly, HD prevalence in RS state was
lower than those reported for European populations. Expanded (CAG)n
transmissions were unstable and not associated to parental age.
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Affiliation(s)
- Raphael Machado de Castilhos
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, RS, Brazil
| | - José Augusto Dos Santos
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Marina Coutinho Augustin
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - José Luiz Pedroso
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Orlando Barsottini
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Roberta Saba
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Henrique Ballalai Ferraz
- Disciplina de Neurologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Clécio Godeiro Junior
- Departamento de Medicina Integrada, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Fernando Regla Vargas
- Hospital Graffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.,Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Gabriel Vasata Furtado
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Marcia Polese-Bonatto
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Luiza Paulsen Rodrigues
- Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Lucas Schenatto Sena
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Luiza Saraiva-Pereira
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Laura Bannach Jardim
- Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Identificação Genética, Centro de Pesquisa Experimental, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, RS, Brazil
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- Rede Neurogenética, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Walker RH, Gatto EM, Bustamante ML, Bernal-Pacheco O, Cardoso F, Castilhos RM, Chana-Cuevas P, Cornejo-Olivas M, Estrada-Bellmann I, Jardim LB, López-Castellanos R, López-Contreras R, Maia DP, Mazzetti P, Miranda M, Rodríguez-Violante M, Teive H, Tumas V. Huntington's disease-like disorders in Latin America and the Caribbean. Parkinsonism Relat Disord 2018; 53:10-20. [PMID: 29853295 DOI: 10.1016/j.parkreldis.2018.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/24/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
Abstract
Diseases with a choreic phenotype can be due to a variety of genetic etiologies. As testing for Huntington's disease (HD) becomes more available in previously resource-limited regions, it is becoming apparent that there are patients in these areas with other rare genetic conditions which cause an HD-like phenotype. Documentation of the presence of these conditions is important in order to provide appropriate diagnostic and clinical care for these populations. Information for this article was gathered in two ways; the literature was surveyed for publications reporting a variety of genetic choreic disorders, and movement disorders specialists from countries in Latin America and the Caribbean were contacted regarding their experiences with chorea of genetic etiology. Here we discuss the availability of molecular diagnostics for HD and for other choreic disorders, along with a summary of the published reports of affected subjects, and authors' personal experiences from the regions. While rare, patients affected by non-HD genetic choreas are evidently present in Latin America and the Caribbean. HD-like 2 is particularly prevalent in countries where the population has African ancestry. The incidence of other conditions is likely determined by other variations in ethnic background and settlement patterns. As genetic resources and awareness of these disorders improve, more patients are likely to be identified, and have the potential to benefit from education, support, and ultimately molecular therapies.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Mount Sinai School of Medicine, New York, NY, USA.
| | - Emilia M Gatto
- Sanatorio Trinidad Mitre, INEBA, Buenos Aires, Argentina
| | - M Leonor Bustamante
- Human Genetics Program, Biomedical Sciences Institute, and Department of Psychiatry North Division, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | | | - Raphael M Castilhos
- Neurology Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Chana-Cuevas
- Facultad de Ciencias Medicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | | | - Laura B Jardim
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Brazil
| | - Ricardo López-Castellanos
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Debora P Maia
- The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Marcelo Miranda
- Department of Neurology, Clinica Las Condes, Santiago, Chile
| | | | - Helio Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Vitor Tumas
- Department of Neuroscience and Behavior Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
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12
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Population-specific genetic modification of Huntington's disease in Venezuela. PLoS Genet 2018; 14:e1007274. [PMID: 29750799 PMCID: PMC5965898 DOI: 10.1371/journal.pgen.1007274] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/23/2018] [Accepted: 02/23/2018] [Indexed: 12/21/2022] Open
Abstract
Modifiers of Mendelian disorders can provide insights into disease mechanisms and guide therapeutic strategies. A recent genome-wide association (GWA) study discovered genetic modifiers of Huntington's disease (HD) onset in Europeans. Here, we performed whole genome sequencing and GWA analysis of a Venezuelan HD cluster whose families were crucial for the original mapping of the HD gene defect. The Venezuelan HD subjects develop motor symptoms earlier than their European counterparts, implying the potential for population-specific modifiers. The main Venezuelan HD family inherits HTT haplotype hap.03, which differs subtly at the sequence level from European HD hap.03, suggesting a different ancestral origin but not explaining the earlier age at onset in these Venezuelans. GWA analysis of the Venezuelan HD cluster suggests both population-specific and population-shared genetic modifiers. Genome-wide significant signals at 7p21.2-21.1 and suggestive association signals at 4p14 and 17q21.2 are evident only in Venezuelan HD, but genome-wide significant association signals at the established European chromosome 15 modifier locus are improved when Venezuelan HD data are included in the meta-analysis. Venezuelan-specific association signals on chromosome 7 center on SOSTDC1, which encodes a bone morphogenetic protein antagonist. The corresponding SNPs are associated with reduced expression of SOSTDC1 in non-Venezuelan tissue samples, suggesting that interaction of reduced SOSTDC1 expression with a population-specific genetic or environmental factor may be responsible for modification of HD onset in Venezuela. Detection of population-specific modification in Venezuelan HD supports the value of distinct disease populations in revealing novel aspects of a disease and population-relevant therapeutic strategies.
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13
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Kay C, Collins JA, Wright GEB, Baine F, Miedzybrodzka Z, Aminkeng F, Semaka AJ, McDonald C, Davidson M, Madore SJ, Gordon ES, Gerry NP, Cornejo-Olivas M, Squitieri F, Tishkoff S, Greenberg JL, Krause A, Hayden MR. The molecular epidemiology of Huntington disease is related to intermediate allele frequency and haplotype in the general population. Am J Med Genet B Neuropsychiatr Genet 2018; 177:346-357. [PMID: 29460498 DOI: 10.1002/ajmg.b.32618] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023]
Abstract
Huntington disease (HD) is the most common monogenic neurodegenerative disorder in populations of European ancestry, but occurs at lower prevalence in populations of East Asian or black African descent. New mutations for HD result from CAG repeat expansions of intermediate alleles (IAs), usually of paternal origin. The differing prevalence of HD may be related to the rate of new mutations in a population, but no comparative estimates of IA frequency or the HD new mutation rate are available. In this study, we characterize IA frequency and the CAG repeat distribution in fifteen populations of diverse ethnic origin. We estimate the HD new mutation rate in a series of populations using molecular IA expansion rates. The frequency of IAs was highest in Hispanic Americans and Northern Europeans, and lowest in black Africans and East Asians. The prevalence of HD correlated with the frequency of IAs by population and with the proportion of IAs found on the HD-associated A1 haplotype. The HD new mutation rate was estimated to be highest in populations with the highest frequency of IAs. In European ancestry populations, one in 5,372 individuals from the general population and 7.1% of individuals with an expanded CAG repeat in the HD range are estimated to have a molecular new mutation. Our data suggest that the new mutation rate for HD varies substantially between populations, and that IA frequency and haplotype are closely linked to observed epidemiological differences in the prevalence of HD across major ancestry groups in different countries.
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Affiliation(s)
- Chris Kay
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer A Collins
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Galen E B Wright
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Fiona Baine
- Division of Human Genetics, Department of Pathology, University of Cape Town, South Africa.,Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zosia Miedzybrodzka
- Medical Genetics Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Folefac Aminkeng
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Alicia J Semaka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Cassandra McDonald
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Davidson
- Medical Genetics Group, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Steven J Madore
- Molecular Biology Group, Coriell Institute for Medical Research, Camden, New Jersey
| | - Erynn S Gordon
- Molecular Biology Group, Coriell Institute for Medical Research, Camden, New Jersey
| | - Norman P Gerry
- Molecular Biology Group, Coriell Institute for Medical Research, Camden, New Jersey
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Ferdinando Squitieri
- IRCCS Casa Sollievo della Sofferenza Hospital, Huntington and Rare Diseases Unit (CSS-Mendel Rome), San Giovanni Rotondo, Italy
| | - Sarah Tishkoff
- Department of Genetics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacquie L Greenberg
- Division of Human Genetics, Department of Pathology, University of Cape Town, South Africa
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael R Hayden
- Centre for Molecular Medicine Therapeutics, University of British Columbia, Vancouver, BC, Canada
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14
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Vermund SH. The Vital Case for Global Health Investments by the US Government. Clin Infect Dis 2017; 64:707-710. [PMID: 28158519 PMCID: PMC10941300 DOI: 10.1093/cid/cix048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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15
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García AM, Bocanegra Y, Herrera E, Pino M, Muñoz E, Sedeño L, Ibáñez A. Action-semantic and syntactic deficits in subjects at risk for Huntington's disease. J Neuropsychol 2017; 12:389-408. [PMID: 28296213 DOI: 10.1111/jnp.12120] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/23/2017] [Indexed: 12/21/2022]
Abstract
Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre-clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients' children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above-mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first-degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects' overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.
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Affiliation(s)
- Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Yamile Bocanegra
- Neuroscience Group, Faculty of Medicine, University of Antioquia (UDEA), Medellín, Colombia.,Group of Neuropsychology and Conduct (GRUNECO), Faculty of Medicine, University of Antioquia (UDEA), Medellín, Colombia
| | - Eduar Herrera
- Psychological Studies Department, Icesi University, Cali, Colombia
| | - Mariana Pino
- Autonomous University of the Caribbean, Barranquilla, Colombia
| | - Edinson Muñoz
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Chile
| | - Lucas Sedeño
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Autonomous University of the Caribbean, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Sydney, New South Wales, Australia
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16
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Kay C, Tirado-Hurtado I, Cornejo-Olivas M, Collins JA, Wright G, Inca-Martinez M, Veliz-Otani D, Ketelaar ME, Slama RA, Ross CJ, Mazzetti P, Hayden MR. The targetable A1 Huntington disease haplotype has distinct Amerindian and European origins in Latin America. Eur J Hum Genet 2016; 25:332-340. [PMID: 28000697 DOI: 10.1038/ejhg.2016.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/09/2022] Open
Abstract
Huntington disease (HD) is a dominant neurodegenerative disorder caused by a CAG repeat expansion in the Huntingtin (HTT) gene. HD occurs worldwide, but the causative mutation is found on different HTT haplotypes in distinct ethnic groups. In Latin America, HD is thought to have European origins, but indigenous Amerindian ancestry has not been investigated. Here, we report dense HTT haplotypes in 62 mestizo Peruvian HD families, 17 HD families from across Latin America, and 42 controls of defined Peruvian Amerindian ethnicity to determine the origin of HD in populations of admixed Amerindian and European descent. HD in Peru occurs most frequently on the A1 HTT haplotype (73%), as in Europe, but on an unexpected indigenous variant also found in Amerindian controls. This Amerindian A1 HTT haplotype predominates over the European A1 variant among geographically disparate Latin American controls and in HD families from across Latin America, supporting an indigenous origin of the HD mutation in mestizo American populations. We also show that a proportion of HD mutations in Peru occur on a C1 HTT haplotype of putative Amerindian origin (14%). The majority of HD mutations in Latin America may therefore occur on haplotypes of Amerindian ancestry rather than on haplotypes resulting from European admixture. Despite the distinct ethnic ancestry of Amerindian and European A1 HTT, alleles on the parent A1 HTT haplotype allow for development of identical antisense molecules to selectively silence the HD mutation in the greatest proportion of patients in both Latin American and European populations.
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Affiliation(s)
- Chris Kay
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Indira Tirado-Hurtado
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Jennifer A Collins
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Galen Wright
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Miguel Inca-Martinez
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Diego Veliz-Otani
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Maria E Ketelaar
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Ramy A Slama
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Colin J Ross
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | - Michael R Hayden
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, V5Z 4H4 Canada
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