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Defining circadian disruption in neurodegenerative disorders
Christopher S. Colwell
Christopher S. Colwell
Published October 1, 2021
Citation Information: J Clin Invest. 2021;131(19):e148288. https://doi.org/10.1172/JCI148288.
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Review Series

Defining circadian disruption in neurodegenerative disorders

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Abstract

Neurodegenerative diseases encompass a large group of conditions that are clinically and pathologically diverse yet are linked by a shared pathology of misfolded proteins. The accumulation of insoluble aggregates is accompanied by a progressive loss of vulnerable neurons. For some patients, the symptoms are motor focused (ataxias), while others experience cognitive and psychiatric symptoms (dementias). Among the shared symptoms of neurodegenerative diseases is a disruption of the sleep/wake cycle that occurs early in the trajectory of the disease and may be a risk factor for disease development. In many cases, the disruption in the timing of sleep and other rhythmic physiological markers immediately raises the possibility of neurodegeneration-driven disruption of the circadian timing system. The aim of this Review is to summarize the evidence supporting the hypothesis that circadian disruption is a core symptom within neurodegenerative diseases, including Alzheimer’s disease, Huntington’s disease, and Parkinson’s disease, and to discuss the latest progress in this field. The Review discusses evidence that neurodegenerative processes may disrupt the structure and function of the circadian system and describes circadian-based interventions as well as timed drug treatments that may improve a wide range of symptoms associated with neurodegenerative disorders. It also identifies key gaps in our knowledge.

Authors

Christopher S. Colwell

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Figure 3

Circadian-regulated pathways essential to NDDs.

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Circadian-regulated pathways essential to NDDs.
At the beginning of the ...
At the beginning of the cycle, CLOCK and BMAL1 protein complexes bind DNA at specific promoter regions (E-box) to activate the transcription of a family of genes including the Period (Per1, Per2, and Per3) and Cryptochrome (Cry1 and Cry2) genes. The levels of the transcripts for Per and Cry reach their peak during mid- to late day, while the PER and CRY proteins peak in the early night. The PERs, CRYs, and other proteins form complexes that translocate back into the nucleus and turn off the transcriptional activity driven by CLOCK-BMAL1 with a delay (due to transcription, translation, dimerization, and nuclear entry). The proteins would be degraded by ubiquitination, allowing the cycle to begin again. Many cells contain this molecular feedback loop that regulates the rhythmic transcription of a number of genes. Other feedback loops within the cells serve to contribute to the precision and robustness of the core oscillation. Of particular importance, a rhythm in the transcription of BMAL1 is driven by a secondary feedback loop involving the activator retinoic acid receptor–related orphan receptor (ROR) and the repressor REV-ERBα/β. Mechanistically, this circadian clockwork drives a number of processes implicated in NDD. For example, the circadian clock regulates a number of pathways involved in proteostasis, including molecular chaperones as well as autophagy. In addition, many of the genes involved in control of excitability and secretion are rhythmically regulated by this molecular feedback loop. While the precise mechanisms involved in the transmission of misfolded proteins are not known, they are likely impacted by circadian disruption. Finally, it has long been appreciated that there is a close relationship between the circadian clock and the immune system, and disruptions of the circadian timing system drive neuroinflammation, mediated by glial cells. CCGs, circadian clock genes; RORE, ROR response element.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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