Understanding Huntington's Disease: Epidemiology, Mechanisms, and Modeling Approaches

Huntington's disease (HD) is a monogenic, autosomal dominant neurodegenerative disorder. Huntington's disease is caused by a CAG trinucleotide repeat expansion in exon 1 of the huntingtin gene, which is located on the short arm of chromosome 4. Although HD has a well-defined genetic cause, the underlying molecular and cellular mechanisms remain complex and incompletely understood. This review examines the established functions of normal huntingtin protein and discusses the harmful consequences of CAG repeat expansions, which result in abnormally extended polyglutamine tracts. In this review, we offer a modern perspective on the molecular biology of HD, using it as a key example of polyglutamine disorders. We explore how mutations in the huntingtin protein disrupt its structure, leading to problems in how cells function and respond to stress, particularly in neurons that are already vulnerable. We highlight the main pathways that contribute to the disease, including issues with autophagy, mitochondrial production, lysosomal function, transport of proteins and organelles, inflammation, oxidative stress, and gene regulation by transcription factors. While much has been learned, some aspects of how the disease develops are still unclear. This concise overview summarizes what is currently known about the normal role of the huntingtin protein and the latest discoveries related to how Huntington's disease progresses at the molecular level.