Huntington disease (HD) is an autosomal dominant neurodegenerative disease with complete penetrance. Although the understanding of the cellular mechanisms that drive neurodegeneration in HD and account for the characteristic pattern of neuronal vulnerability is incomplete, defects in energy metabolism, particularly mitochondrial function, represent a common thread in studies of HD pathogenesis in humans and animal models. Here we review the clinical, biochemical, and molecular evidence of an energy deficit in HD and discuss the mechanisms underlying mitochondrial and related alterations.
IntroductionHuntington disease (HD) is an autosomal dominant neurodegenerative disease with age-dependent complete penetrance. HD is caused by a CAG repeat expansion in the first exon of the HTT gene that encodes huntingtin (Htt) (1, 2). Individuals who have 36 CAG repeats or more may develop the clinical symptoms and signs of HD, including neuropsychiatric, motor, and cognitive abnormalities that cause a progressive loss of functional capacity and shortened life span. The clinical features of HD typically emerge in adulthood between 30 and 50 years of age, after which the disease progresses relentlessly over the next 15-20 years (3). Presymptomatic testing - preceded by genetic counseling according to internationally accepted guidelines - allows an at-risk person to assess their genetic status and thus predict whether a carrier will develop HD before he or she shows clinical symptoms and signs. Of importance, the presymptomatic phase in HD provides a unique window for therapeutic intervention and neuroprotection.γ-Aminobutyric acid (GABAergic) medium spiny neurons of the striatum that contain enkephalin or substance P and project to the globus pallidus and substantia nigra are particularly vulnerable in HD and are key to the characteristic involuntary movements in this disease (4). The basis of the selective vulnerability of these neurons in HD remains elusive but may involve the reduced phosphorylation of Htt at serine 421 in the striatum (5), the specific localization of Rhes (Ras homolog enriched in striatum; a small guanine nucleotidebinding protein partner of Htt) to the striatum (6), and/or the preferential vulnerability of the striatum to mitochondrial dysfunction (7). However, the neuropathology is ultimately more widespread, affecting cortical neurons as well as the globus pallidus, substantia nigra, and brainstem. Understanding of the cellular mechanisms that drive neurodegeneration in HD and account for the characteristic pattern of neuronal vulnerability remains incomplete, but defects in energy metabolism, particularly mitochondrial function, represent a common thread in studies of HD pathogenesis in humans and animal models (7,8). Here we provide an overview of clinical, biochemical, and molecular evidence of an energy deficit in HD, in both the brain and the peripheral organs. We also discuss the mechanisms underlying mitochondrial and related alterations in the context of both a