Huntington disease is an autosomal dominant neurodegenerative disorder caused by a toxic expansion in the CAG repeat region of the huntingtin gene. Oligonucleotide approaches based on RNAi and antisense oligonucleotides provide promising new therapeutic strategies for direct intervention through reduced production of the causative mutant protein. Allele-specific and simultaneous mutant and wild-type allele–lowering strategies are being pursued with local delivery to the brain, each with relative merits. Delivery remains a key challenge for translational success, especially with chronic therapy. The potential of disease-modifying oligonucleotide approaches for Huntington disease will be revealed as they progress into clinical trials.
Dinah W.Y. Sah, Neil Aronin
Multiple pathogenic mechanisms of mutant huntingtin include loss of BDNF neurotrophic support for striatal neurons, impaired axonal transport, altered vesicle recycling, mitochondrial dysfunction, increased autophagy, protein aggregation, and transcriptional dysregulation.