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Updated: Jul 16, 2026

Fractionation for Resolution of Soluble and Insoluble Huntingtin Species
Published on: February 27, 2018
Interaction of normal and expanded CAG repeat sizes influences age at onset of Huntington disease
L Djoussé1, B Knowlton, M Hayden
1Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Insights
The size of the normal Huntington allele may influence Huntington disease (HD) onset. Larger normal repeats might mitigate disease severity in individuals with expanded CAG repeats.
Area of Science:
- Genetics
- Neuroscience
- Molecular Biology
Background:
- Huntington disease (HD) is a neurodegenerative disorder linked to CAG repeat expansion in the HD gene.
- CAG repeat size is known to inversely correlate with age at onset (AO) in HD patients.
Purpose of the Study:
- To investigate if the normal Huntington allele size interacts with the expanded CAG repeat size to influence the age at onset (AO) of Huntington disease (HD).
Main Methods:
- Analysis of data from two independent cohorts: the New England Huntington Disease Center Without Walls (NEHD) and HD-MAPS.
- Statistical analysis to assess the interaction between normal and expanded CAG repeat sizes and their effect on AO.
Main Results:
- Evidence of an interaction between expanded and unexpanded CAG repeat sizes influencing AO was found in both cohorts (P = 0.08 and 0.07).
- This interaction was statistically significant when both cohorts were combined (P = 0.012).
- The estimated heritability of AO residuals, after accounting for repeats and their interaction, was 0.56.
Conclusions:
- An increase in normal allele size may potentially mitigate disease expression in HD patients with large expanded CAG repeats.
- These findings highlight a potential modifier role for the normal Huntington allele in HD pathogenesis.
Abstract:
Huntington disease (HD) is a neurodegenerative disorder caused by the abnormal expansion of CAG repeats in the HD gene on chromosome 4p16.3. Past studies have shown that the size of expanded CAG repeat is inversely associated with age at onset (AO) of HD. It is not known whether the normal Huntington allele size influences the relation between the expanded repeat and AO of HD. Data collected from two independent cohorts were used to test the hypothesis that the unexpanded CAG repeat interacts with the expanded CAG repeat to influence AO of HD. In the New England Huntington Disease Center Without Walls (NEHD) cohort of 221 HD affected persons and in the HD-MAPS cohort of 533 HD affected persons, we found evidence supporting an interaction between the expanded and unexpanded CAG repeat sizes which influences AO of HD (P = 0.08 and 0.07, respectively). The association was statistically significant when both cohorts were combined (P = 0.012). The estimated heritability of the AO residual was 0.56 after adjustment for normal and expanded repeats and their interaction. An analysis of tertiles of repeats sizes revealed that the effect of the normal allele is seen among persons with large HD repeat sizes (47-83). These findings suggest that an increase in the size of the normal repeat may mitigate the expression of the disease among HD affected persons with large expanded CAG repeats.
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