Subcortical T1-Rho MRI Abnormalities in Juvenile-Onset Huntington's Disease

A Practical Guide for Diagnostic Investigations and Special Considerations in Patients With Huntington's Disease in Korea

This review provides a comprehensive framework for the diagnostic approach and management of Huntington's disease (HD) tailored to the Korean population. Key topics include genetic counseling, predictive testing, and reproductive options like preimplantation genetic testing. Strategies for assessing disease progression in premanifest HD through laboratory investigations, biofluid, and imaging biomarkers are highlighted. Special considerations for juvenile and late-onset HD, along with associated comorbidities like diabetes mellitus, hypertension, and cardiovascular abnormalities, are discussed. The guide emphasizes personalized symptom management, including pharmacotherapy, physical therapy, and nutritional support, while exploring emerging disease-modifying treatments. A multidisciplinary care model is advocated to improve outcomes for HD patients and caregivers in Korea.

Repeatability of quantitative T1rho magnetic resonance imaging in normal brain tissues at 3.0T

PURPOSE

T1rho imaging is a promising MRI technique for imaging of brain disease. This study aimed to assess the repeatability of quantitative T1rho imaging in the normal brain grey and white matter.

METHODS

The study prospectively recruited 30 healthy volunteers without a history of neurological diseases or brain injury, and T1rho was performed and quantified from three imaging sessions. Repeat measures analysis of variance (ANOVA) and within-subject coefficients of variation (wCoV) was used to detect differences in T1rho values between the three scans.

RESULTS

The results showed low wCoVs of less than 4.3% (range 0.92-4.27%) across all the brain structures. No significant differences were observed in T1rho measurement between the three scans (p > 0.05). The amygdala and hippocampus showed the highest T1rho values of 91.79 ± 2.55 msec and 91.07 ± 2.11 msec respectively, and the palladium and putamen had the lowest values of 67.60 ± 1.84 msec and 71.83 ± 1.85 msec respectively.

CONCLUSION

T1rho shows high test-retest repeatability for whole brain imaging in serial imaging sessions, indicating it to be a reliable sequence for quantitative brain imaging.

Longitudinal Clinical and Biological Characteristics in Juvenile-Onset Huntington's Disease

BACKGROUND

Juvenile-onset Huntington's disease (JOHD) is a rare form of Huntington's disease (HD) characterized by symptom onset before the age of 21 years. Observational data in this cohort is lacking.

OBJECTIVES

Quantify measures of disease progression for use in clinical trials of patients with JOHD.

METHODS

Participants who received a motor diagnosis of HD before the age of 21 were included in the Kids-JOHD study. The comparator group consisted of children and young adults who were at-risk for inheriting the genetic mutation that causes HD, but who were found to have a CAG repeat in the non-expanded range (gene non-expanded [GNE]).

RESULTS

Data were obtained between March 17, 2006, and February 13, 2020. There were 26 JOHD participants and 78 GNE participants who were comparable on age (16.03 vs. 14.43, respectively) and sex (53.8% female vs. 57.7% female, respectively). The mean annualized decrease in striatal volume in the JOHD group was -3.99% compared to -0.06% in the GNE (mean difference [MD], -3.93%; 95% confidence intervals [CI], [-4.98 to -2.80], FDR < 0.0001). The mean increase in the Unified Huntington's Disease Rating Scale Total Motor Score per year in the JOHD group was 7.29 points compared to a mean decrease of -0.21 point in the GNE (MD, 7.5; 95% CI, [5.71-9.28], FDR < 0·0001).

CONCLUSIONS

These findings demonstrate that structural brain imaging and clinical measures in JOHD may be potential biomarkers of disease progression for use in clinical trials. Collaborative efforts are required to validate these results in a larger cohort of patients with JOHD. © 2022 International Parkinson and Movement Disorder Society.

Dysregulation of Human Juvenile Huntington's Disease Brain Proteomes in Cortex and Putamen Involves Mitochondrial and Neuropeptide Systems

BACKGROUND

Huntington's disease (HD) is a genetic neurodegenerative disease caused by trinucleotide repeat CAG expansions in the human HTT gene. Early onset juvenile HD (JHD) in children is the most severe form of the disease caused by high CAG repeat numbers of the HTT gene.

OBJECTIVE

To gain understanding of human HD mechanisms hypothesized to involve dysregulated proteomes of brain regions that regulate motor and cognitive functions, this study analyzed the proteomes of human JHD cortex and putamen brain regions compared to age-matched controls.

METHODS

JHD and age-matched control brain tissues were assessed for CAG repeat numbers of HTT by PCR. Human brain JHD brain cortex regions of BA4 and BA6 with the putamen region (n = 5) were analyzed by global proteomics, compared to age-matched controls (n = 7). Protein interaction pathways were assessed by gene ontology (GO), STRING-db, and KEGG bioinformatics.

RESULTS

JHD brain tissues were heterozygous for one mutant HTT allele containing 60 to 120 CAG repeats, and one normal HTT allele with 10 to 19 CAG repeats. Proteomics data for JHD brain regions showed dysregulated mitochondrial energy pathways and changes in synaptic systems including peptide neurotransmitters. JHD compared to control proteomes of cortex and putamen displayed (a) proteins present only in JHD, (b) proteins absent in JHD, and (c) proteins that were downregulated or upregulated.

CONCLUSIONS

Human JHD brain cortex and putamen regions display significant dysregulation of proteomes representing deficits in mitochondrial and synaptic neurotransmission functions. These findings advance understanding of JHD brain molecular mechanisms associated with HD disabilities.

Special Issue: Juvenile Onset Huntington's Disease

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