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Huntington's Disease Research Paper

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Perspective: The Therapeutic Potential of Deep Brain Stimulation in Huntington's Disease

AUTHORS:
Sean J. Nagel, Andre G. Machado, John Gale, Darlene A. Lobel, Mayur Pandya

ABSTRACT

Huntington’s Disease (HD) is an incurable neurodegenerative disease characterized by the triad of chorea, cognitive dysfunction and psychiatric disturbances. Since the discovery of the HD gene in 1993, the pathogenesis has been outlined, but to date a cure has not been found. Disease modifying therapies are needed desperately to improve function, alleviate suffering, and provide hope for symptomatic patients. Deep brain stimulation (DBS), a proven therapy for managing the symptoms of some neurodegenerative movement disorders, including Parkinson’s …show more content…
In those who inherit the mutation, a cytosine-adenosine-guanine (CAG) repeat expansion is added to the IT15 huntington (HTT) gene on the short arm of chromosome 4 (Raymond, 2011). Affected individuals with the mutated form have between 36 and 121 CAG repeats in the coding region that translate into a polyglutamine expansion. The age of onset of motor symptoms inversely correlates with the number of repeated sequences (Ross, 2014). In healthy persons, HTT encodes a protein (huntingtin) responsible for synaptic vesicular transit and other cellular functions that when absent leads to in utero death (Cepeda, 2007). For example, wild type huntingtin contributes to the cortical production of brain derived neurotrophic factor (BDNF) before the latter’s downstream support of striatal neurons (Zuccato,2010). In those with the mutation, glutamine residues accumulate and the mutant HTT protein disrupts cellular signals and homeostasis decades before symptoms …show more content…
In mouse models of HD, widespread electrophysiologic dysfunction at the neuronal level is observed. The MSNs demonstrate a depolarized resting membrane potential. This induces hyper-excitability of the depolarization dependent NMDA receptor in response to glutamate. The overactive cells create an energy sink that may lead to cellular death (Rebec, 2006). Similar findings are noted in cortical pyramidal cells. As the disease progresses, the overactive cortico-striatal pathway eventually becomes less active and cortical synaptic inputs are lost (Cepeda,

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