Pharmacogenetics in the Treatment of Huntington’s Disease: Review and Future Perspectives

Abstract

Huntington’s disease (HD) is an autosomal dominant progressive brain disorder, caused by a pathological expansion of a CAG repeat that encodes the huntingtin gene. This genetic neurodegenerative rare disease is characterized by cognitive, motor, and neuropsychiatric manifestations. The aim of the treatment is symptomatic and addresses the hyperkinetic disorders (chorea, dystonia, myoclonus, tics, etc.) and the behavioural and cognitive disturbances (depression, anxiety, psychosis, etc.) associated with the disease. HD is still a complex condition in need of innovative and efficient treatment. The long-term goal of pharmacogenetic studies is to use genotype data to predict the effective treatment response to a specific drug and, in turn, prevent potential undesirable effects of its administration. Chorea, depression, and psychotic symptoms have a substantial impact on HD patients’ quality of life and could be better controlled with the help of pharmacogenetic knowledge. We aimed to carry out a review of the available publications and evidence related to the pharmacogenetics of HD, with the objective of compiling all information that may be useful in optimizing drug administration. The impact of pharmacogenetic information on the response to antidepressants and antipsychotics is well documented in psychiatric patients, but this approach has not been investigated in HD patients. Future research should address several issues to ensure that pharmacogenetic clinical use is appropriately supported, feasible, and applicable.

Prevalence and Incidence of Huntington's Disease

“…However, this is exactly how the pooled estimates reported in a previous meta-analysis study 5 have been used. [6][7][8][9] This misinterpretation is made even more likely due to an error in the reporting of the key measures of study heterogeneity, Q (which follows a χ 2 distribution and therefore allows us to test the significance of the heterogeneity) and I 2 . The values of Q and I 2 reported in tables 1 and 2 of Medina et al 1 suggest that heterogeneity is very small or absent.…”