Triplets and TADs

Neurologists have long been interested in triplet diseases — https://en.wikipedia.org/wiki/Trinucleotide_repeat_disorder.  The triplet is made of a string of 3 nucleotides.  Example —  cytosine adenosine guanosine or CAG — which accounts for a lot of them.  We have lots of places in our genome where such repeats normally occur, with the triplets repeated up to 42 times.  However in diseases like Huntington’s chorea the repeats get to be as many as 250 CAGs in a row.  You normally are quite fine as long as you have under 36 of them, and no one has fewer than 6 at this particular location.

Subsequently, expansions of 4, 5, and 6 nucleotide repeats have also been shown to cause disease, bring the total of repeat expansion diseases to over 40.  Why more than half of them should affect the nervous system entirely or for the most part is a mystery.  Needless to say there are plenty of theories.

This leads to three questions (1) there are repeats all over the genome, why do only 40 or so of them expand (2) since we all have repeats in front of the genes where they cause disease why don’t we all have the diseases (3) why do the number of repeats expand with each succeeding generation — the phenomenon is called anticipation.  I saw one such example where a father brought his son to my muscular dystrophy clinic.  The boy had moderately severe myotonic dystrophy.  When I shook the father’s hand, it was clear that he had mild myotonia, which had in no way impaired his life (he was a successful banker).

A recent paper in Cell may help answer the first question and has a hint about the second [ Cell vol. 175 pp. 38 – 40, 224 – 238 ’18 ].  21 of 27 disease associated short tandem repeats (daSTRs) localize to something called a topologically associated domain (TAD) or subdomain (subTAD) boundary. These are defined as contiguous intervals in the genome in which every pair has an elevated interaction frequency compared to loci out side the domain.  TADs and subTADs are measured using chromosome conformation capture assays (acronyms for them include 3C, CCC, 4C, 5C, Hi-C).

Briefly they are performed as follows.  Intact nuclei are isolate from live cel cultures.  These are subjected to paraformaldehye crosslinking to fix segment of genome in close physical proximity. The crosslinked genomic DNA is digested with a restriction endonuclease, and the products expanded by PCR using primers in all possible combinations.  Then having a complete genome sequence in hand, you see what regions of the genome got close enough together to show up in the assay.

This may help explain question one, and the paper gives some speculation about question two — we don’t all have these diseases, because unlike the unfortunates with them, we don’t have problems in our genes for DNA replication, repair and recombination.  There is some evidence for this;  studies in model organisms with these mutations do have short tandem repeat instability.

Unfortunately the paper doesn’t discuss anticipation, because no clinicians appear to be among the authors, even though they’re from Penn which 50+ years ago was very strong in clinical neurology.

None of this work discusses the fascinating questions of how the expanded repeats cause disease, or why so many of them affect the nervous system.

The Kavanaugh Ford confrontation will be to this decade what the Patty Hearst kidnapping was to a previous one  — https://en.wikipedia.org/wiki/Patty_Hearst.  Since I suffered 4 episodes of physical (not sexual) abuse as a kid, and dealt with this extensively as a neurologist, I’m trying to decide whether to write about it.  Emotions are high and there are a lot of nuts out there on the net. There is even a reasonable possibility that both Ford and Kavanaugh are right and not lying.

18 at one blow said the molecular biologist

With apologies to the brothers Grimm, molecular biologists may have found a way to treat 18 genetic diseases at one blow [ Cell vol. 170 pp. 899 – 912 ’17 ]. They use adeno-associated virus (AAV) packing a modified enzyme and an RNA to remove repeat expansions from RNA.   The paper give a list of the 18, all but one of which are neurologic.  They include such horrors as Huntington’s chorea, the most common form of familial ALS, 3 forms of spinocerebellar ataxia and 6 forms of spinocerebellar atrophy.

They use Cas9 from Streptococcus Pyogenes, part of the CRISPR system (https://en.wikipedia.org/wiki/CRISPR)  bacteria use to defend themselves against viruses, with a single guide RNA.  Even more interestingly, Cas9 is an enzyme which breaks up RNA, but the Cas9 they used is catalytically dead.  They think that just binding to the aggregated RNA containing the repeats is enough to break up the aggregate.  This is the way antiSense oligoNucleotides are thought to work.

The problem with getting a bacterial enzyme into a human cell is avoided here by using a virus to infect them (AAV).  It did get rid of RNA aggregates in patients’ cells from 4 of the diseases (two myotonic dystrophies, and the familial ALS).

It is almost too fantastic to be true.

Why almost all of these repeat expansion diseases affect the nervous system is anyone’s guess.  As you can image theories abound.  So all we have to do is figure out how to get the therapy into the brain (hardly a small task).