11 The human DRPLA gene spans approximately 20 kbp and consists of 10 exons, with the CAG repeats located in exon 5.12 The number of CAG repeats in normal chromosomes and DRPLA patients range from 6 to 35 and from 54 to 79, respectively.13 It is characteristic that there is anticipation in DRPLA.9,10,14 Paternal transmission results in more

prominent anticipation (26–29 years/generation) than does maternal transmission (14–15 years/generation). There is an inverse correlation between the size of expanded CAG repeats and age at onset, and also a correlation between clinical features and the repeat selleckchem size.13 DRPLA patients with longer CAG repeats show a more early onset and severer phenotypes. The physiological functions of DRPLA protein remain to this website be elucidated. It is generally accepted that mutant

DRPLA proteins with expanded polyglutamine stretches are toxic to neuronal cells (“gain of toxic functions”). The discovery of neuronal intranuclear inclusions (NIIs) in transgenic mice for Huntington’s disease15 triggered new development of neuropathology in polyglutamine diseases, including DRPLA. NIIs are eosinophilic round structures, and easily detectable by ubiquitin immunohistochemistry (Fig. 3c). In DRPLA, they are also immunoreactive for expanded polyglutamine stretches (Fig. 3d) as well as for atrophin-1, the DRPLA gene product.16,17 Ultrastructurally, NIIs are non-membrane bound, heterogeneous in composition, and contain a mixture of granular and filamentous structures,

approximately 10–20 nm in diameter. NIIs were initially thought to be toxic structures responsible for neuronal cell death in affected brain regions; however, subsequent Tryptophan synthase investigations raised the possibility that NII formation itself might be a cellular reaction designed to reduce the acute toxic effect of the mutant proteins.18–20 In DRPLA, NIIs were detectable in multiple brain regions far beyond the dentatorubral and pallidoluysian systems, suggesting that neurons are affected much more widely than was recognized previously, although the incidences of NIIs were very low even in the affected regions.21 In 2001, it became apparent that diffuse intranuclear accumulation of the mutant DRPLA protein affects many neurons in wide area of the CNS, including the cerebral cortex (Fig. 3e–g), and that the prevalence of this pathology changes dynamically in relation to CAG repeat size. The results suggest that the novel lesion distribution revealed by the diffuse nuclear labeling may be responsible for a variety of clinical features, such as dementia and epilepsy in DRPLA.22 In addition to NIIs, skein-like inclusions were also detectable in DRPLA brains, although their appearances were restricted in the cerebellar dentate nucleus (Fig. 3h).23 To elucidate the molecular mechanisms of neuronal degeneration in DRPLA, transgenic mice harboring a single copy of a full-length human mutant DRPLA gene with 76 or 129 CAG repeats have been generated.