Neurotoxic effects of androgens in spinal and bulbar muscular atrophy

Expansion of polyglutamine tracts in nine different genes causes selective neuronal degeneration through unknown mechanisms. Expansion of polyglutamine in the androgen receptor is responsible for spinal and bulbar muscular atrophy (SBMA), a neuromuscular disorder characterized by the loss of lower motor neurons in the brainstem and spinal cord. A unique feature of SBMA in the family of polyglutamine diseases is sex specificity. SBMA fully manifests only in males. SBMA is a disease triggered by the binding of polyglutamine androgen receptor to its natural ligand testosterone. Recent evidence has emerged showing that the expanded polyglutamine tract itself is not the only determinant of disease pathogenesis. There is evidence that both the native structure and function of the disease protein strongly influence the pathogenicity of mutant protein. Here, we review recent progress in the understanding of disease pathogenesis and advancements towards development of potential therapeutic strategies for SBMA.