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New Avenues for the Treatment of Huntington’s Disease
Amy Kim, Kathryn Lalonde, Aaron Truesdell and 4 more
International Journal of Molecular Sciences · 2021 · Review · CC BY
Abstract
Huntington’s disease (HD) is a neurodegenerative disorder caused by a CAG expansion in the HD gene. The disease is characterized by neurodegeneration, particularly in the striatum and cortex. The first symptoms usually appear in mid-life and include cognitive deficits and motor disturbances that progress over time. Despite being a genetic disorder with a known cause, several mechanisms are thought to contribute to neurodegeneration in HD, and numerous pre-clinical and clinical studies have been conducted and are currently underway to test the efficacy of therapeutic approaches targeting some of these mechanisms with varying degrees of success. Although current clinical trials may lead to the identification or refinement of treatments that are likely to improve the quality of life of those living with HD, major efforts continue to be invested at the pre-clinical level, with numerous studies testing novel approaches that show promise as disease-modifying strategies. This review offers a detailed overview of the currently approved treatment options for HD and the clinical trials for this neurodegenerative disorder that are underway and concludes by discussing potential disease-modifying treatments that have shown promise in pre-clinical studies, including increasing neurotropic support, modulating autophagy, epigenetic and genetic manipulations, and the use of nanocarriers and stem cells.
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Corey-Bloom J., Aikin A.M., Gutierrez A.M., Nadhem J.S., Howell T.L., Thomas E.A. Beneficial effects of glatiramer acetate in Huntington’s disease mouse models: Evidence for BDNF-elevating and immunomodulatory mechanisms. Brain Res. 2017;1673:102-110.
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Skaper S.D., Selak I., Manthorpe M., Varon S. Chemically defined requirements for the survival of cultured 8-day chick embryo ciliary ganglion neurons. Brain Res. 1984;302:281-290.
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Emerich D.F., Winn S.R., Hantraye P.M., Peschanski M., Chen E.Y., Chu Y., McDermott P., Baetge E.E., Kordower J.H. Protective effect of encapsulated cells producing neurotrophic factor CNTF in a monkey model of Huntington’s disease. Nature. 1997;386:395-399.
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Duarte A.I., Petit G.H., Ranganathan S., Li J.Y., Oliveira C.R., Brundin P., Björkqvist M., Rego A.C. IGF-1 protects against diabetic features in an in vivo model of Huntington’s disease. Exp. Neurol. 2011;231:314-319.
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Lopes C., Ribeiro M., Duarte A.I., Humbert S., Saudou F., Pereira De Almeida L., Hayden M., Rego A.C. IGF-1 intranasal administration rescues Huntington’s disease phenotypes in YAC128 mice. Mol. Neurobiol. 2014;49:1126-1142.
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McCloskey D.P., Hintz T.M., Scharfman H.E. Modulation of vascular endothelial growth factor (VEGF) expression in motor neurons and its electrophysiological effects. Brain Res. Bull. 2008;76:36-44.
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Ellison S.M., Trabalza A., Tisato V., Pazarentzos E., Lee S., Papadaki V., Goniotaki D., Morgan S., Mirzaei N., Mazarakis N.D. Dose-dependent neuroprotection of VEGF165 in Huntington’s disease striatum. Mol. Ther. 2013;21:1862-1875.
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Ji C.H., Kwon Y.T. Crosstalk and Interplay between the Ubiquitin-Proteasome System and Autophagy. Mol. Cells. 2017;40:441-449.
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Pohl C., Dikic I. Cellular quality control by the ubiquitin-proteasome system and autophagy. Science. 2019;366:818-822.
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Wang Y., Le W.-D. Autophagy and Ubiquitin-Proteasome System. Advances in Experimental Medicine and Biology. 2019;Volume 1206:527-550.
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Safren N., El Ayadi A., Chang L., Terrillion C.E., Gould T.D., Boehning D.F., Monteiro M.J. Ubiquilin-1 overexpression increases the lifespan and delays accumulation of huntingtin aggregates in the R6/2 mouse model of huntington’s disease. PLoS ONE. 2014;9:e87513.
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Weber J.J., Pereira Sena P., Singer E., Nguyen H.P. Killing Two Angry Birds with One Stone: Autophagy Activation by Inhibiting Calpains in Neurodegenerative Diseases and Beyond. Biomed. Res. Int. 2019;2019:1-13.
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Menzies F.M., Garcia-Arencibia M., Imarisio S., O’Sullivan N.C., Ricketts T., Kent B.A., Rao M.V., Lam W., Green-Thompson Z.W., Nixon R.A., et al. Calpain inhibition mediates autophagy-dependent protection against polyglutamine toxicity. Cell Death Differ. 2015;22:433-444.
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Cortes C.J., La Spada A.R. TFEB dysregulation as a driver of autophagy dysfunction in neurodegenerative disease: Molecular mechanisms, cellular processes, and emerging therapeutic opportunities. Neurobiol. Dis. 2019;122:83-93.
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Vodicka P., Chase K., Iuliano M., Tousley A., Valentine D.T., Sapp E., Kegel-Gleason K.B., Sena-Esteves M., Aronin N., Difiglia M. Autophagy Activation by Transcription Factor EB (TFEB) in Striatum of HD Q175/Q7 Mice. J. Huntingtons. Dis. 2016;5:249-260.
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Tanaka M., Machida Y., Niu S., Ikeda T., Jana N.R., Doi H., Kurosawa M., Nekooki M., Nukina N. Trehalose alleviates polyglutamine-mediated pathology in a mouse model of Huntington disease. Nat. Med. 2004;10:148-154.
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Rose C., Menzies F.M., Renna M., Acevedo-Arozena A., Corrochano S., Sadiq O., Brown S.D., Rubinsztein D.C. Rilmenidine attenuates toxicity of polyglutamine expansions in a mouse model of Huntington’s disease. Hum. Mol. Genet. 2010;19:2144-2153.
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Underwood B.R., Green-Thompson Z.W., Pugh P.J., Lazic S.E., Mason S.L., Griffin J., Jones P.S., Rowe J.B., Rubinsztein D.C., Barker R.A. An open-label study to assess the feasibility and tolerability of rilmenidine for the treatment of Huntington’s disease. J. Neurol. 2017;264:2457-2463.
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Jiang W., Wei W., Gaertig M.A., Li S., Li X.J. Therapeutic effect of berberine on Huntington’s disease transgenic mouse model. PLoS ONE. 2015;10:e0134142.
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Zhang T., Dong K., Liang W., Xu D., Xia H., Geng J., Najafov A., Liu M., Li Y., Han X., et al. G-protein Coupled Receptors Regulate Autophagy by ZBTB16-mediated Ubiquitination and Proteasomal Degradation of Adaptor Protein Atg14L. Elife. 2015;2015:e06734.
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Jeon J., Kim W., Jang J., Isacson O., Seo H. Gene therapy by proteasome activator, PA28γ, improves motor coordination and proteasome function in Huntington’s disease YAC128 mice. Neuroscience. 2016;324:20-28.
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Valionyte E., Yang Y., Roberts S.L., Kelly J., Lu B., Luo S. Lowering Mutant Huntingtin Levels and Toxicity: Autophagy-Endolysosome Pathways in Huntington’s Disease. J. Mol. Biol. 2020;432:2673-2691.
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Neo S.H., Tang B.L. Sirtuins as Modifiers of Huntington’s Disease (HD) Pathology. Progress in Molecular Biology and Translational Science. 2018;Volume 154:105-145.
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Duan W. Targeting Sirtuin-1 in Huntington’s Disease: Rationale and Current Status. CNS Drugs. 2013;27:345-352.
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Jeong H., Cohen D.E., Cui L., Supinski A., Savas J.N., Mazzulli J.R., Yates J.R., Bordone L., Guarente L., Krainc D. Sirt1 mediates neuroprotection from mutant huntingtin by activation of the TORC1 and CREB transcriptional pathway. Nat. Med. 2012;18:159-165.
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