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Morbus Huntington

Huntington’s disease

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Zusammenfassung

Hintergrund

Die Huntington-Erkrankung (Huntington’s disease, HD) ist eine progrediente neurodegenerative Erkrankung, die mit motorischen (Hyperkinesen), psychiatrischen (Depression, Psychose) und kognitiven Symptomen (frontale Demenz) einhergehen kann. In Deutschland sind etwa 8000 Patienten von ihr betroffen.

Fragestellung

Die vorliegende Arbeit präsentiert eine Literaturübersicht zu Symptomatik, Epidemiologie, Genetik, Differenzialdiagnostik, Pathophysiologie, symptomatischer Behandlung und aktuellen therapeutischen Ansätzen, die sich an Kliniker richtet.

Material und Methodik

Über Medline aufrufbare tierexperimentelle und klinische Studien sowie Reviews zu HD wurden ausgewertet.

Ergebnisse

Diagnostische Sicherheit kann nur durch eine genetische Testung erreicht werden. Die Zahl der CAG-Wiederholungen im mutierten Huntingtin-Gen hat entscheidenden Einfluss auf Manifestationsalter, Krankheitsverlauf und Lebenserwartung. Die durch das mutante Huntingtin-Eiweiß (mHTT) ausgelöste Pathophysiologie ist komplex und führt letztlich zum Neuronenuntergang, v. a. im Corpus striatum. In klinischen Studien wurden Antioxidanzien (z. B. Koenzym Q10), Selisistat, PBT2, Cysteamin, NMDA-Rezeptor-Antagonisten und Tyrosinkinase-B-Rezeptor-Agonisten bei HD geprüft.

Schlussfolgerungen

Eine krankheitsmodifizierende Therapie steht bei HD noch nicht zur Verfügung, aber durch „gene silencing“, z. B. mittels RNA-Interferenz, könnte in absehbarer Zeit eine wirkungsvolle Behandlungsoption verfügbar sein.

Summary

Background

Huntington’s disease (HD) is a progressive neurodegenerative disorder characterized by hyperkinetic movements, psychiatric (e.g. depression and psychosis) and cognitive symptoms (frontal lobe dementia). In Germany approximately 8000 patients suffer from HD.

Objectives

The paper reviews the clinical course, epidemiology, genetics, differential diagnoses, pathophysiology, symptomatics and causal treatment options.

Methods

Publications on animal and human HD studies and trials and reviews available in Medline have been taken into account.

Results

Only genetic testing allows diagnostic certainty. The CAG repeat length influences age of onset, disease course and life expectancy. The mechanism by which mutant huntingtin protein (mHTT) causes HD is complex and poorly understood but leads to cell death, in particular in striatal neurons. In clinical trials antioxidants (e.g. coenzyme Q10), selisistat, PBT2, cysteamine, N-methyl-D-aspartate (NMDA)-receptor antagonists and tyrosine kinase B receptor agonists have been studied in HD.

Conclusion

No disease-modifying therapy is currently available for HD; however, gene silencing, e.g. through RNA interference, is a promising technique which could lead to effective therapies in due course.

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  1. Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf gGmbH, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Greitstr. 18–28, 31840, Hessisch Oldendorf, Deutschland

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Rollnik, J. Morbus Huntington. Nervenarzt 86, 725–735 (2015). https://doi.org/10.1007/s00115-015-4306-9

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