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Recent data suggest that the toxic species of protein in these diseases may be soluble mutant conformers, and that the protein context of expanded polyglutamine is critical to understand

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Huntington’s disease: revisiting the aggregation

hypothesis in polyglutamine neurodegenerative diseases Ray Truant, Randy Singh Atwal, Carly Desmond, Lise Munsie and Thu Tran

Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada

The toxic aggregate hypothesis in

polyglutamine diseases

With the identification of expanded CAG repeats of

the X-linked spinal and bulbar muscular atrophy

(SBMA or Kennedy’s disease) gene at the androgen

receptor in 1991 [1], followed by the Huntington’s

disease (HD) gene in 1993 [2], and the cloning of the

spinocerebellar ataxia type 1 gene [3], the expanded

polyglutamine tract as the result of a CAG DNA

expansion became the focus of intense interest to

investigators in these diseases Two seminal papers

appeared near that time that presented hypotheses

concerning the pathogenic mechanism of

polygluta-mine expansion One was from Nobel laureate Max

Perutz, demonstrating the concept of polyglutamine

‘polar zipper’ interactions with the side groups of

glutamine residues [4] Perutz focused on the fact that the genetics of some (but not all) polyglutamine dis-eases demonstrated that the minimal length of polyglu-tamine expansion required for disease was 37 repeats, and that a repeat length beyond 37 led to earlier dis-ease onset That paper demonstrated that polygluta-mine alone was toxic to Escherichia coli and Chinese hamster ovary cells, and concluded that polyglutamine had the ability to adopt a pleated b-sheet structure that could cause a displacement of water molecules and hence render the protein insoluble This theory was consistent with the genetic gain-of-function seen with mutant proteins in HD, in the ataxin-1 protein in spinocerebellar ataxia (SCA) type 1, and other poly-glutamine diseases Polar zippers were predicted to form tighter interactions with increasing polyglutamine length, thus potentially affecting the severity of disease

Keywords

huntingtin; Huntington’s disease;

polyglutamine; protein aggregation; protein

misfolding; Spinocerebellar ataxia

Correspondence

R Truant, Department of Biochemistry and

Biomedical Sciences, McMaster University,

1200 Main Street West, HSC 4H24A,

Hamilton, Ontario L8N3Z5, Canada

Fax: +1 905 522 9033

Tel: +1 905 525 9140 ext 22450

E-mail: truantr@mcmaster.ca

Website: http://www.RayTruantLab.ca

(Received 1 March 2008, revised 21 April

2008, accepted 12 May 2008)

doi:10.1111/j.1742-4658.2008.06561.x

After the successful cloning of the first gene for a polyglutamine disease in

1991, the expanded polyglutamine tract in the nine polyglutamine disease proteins became an obvious therapeutic target Early hypotheses were that misfolded, precipitated protein could be a universal pathogenic mechanism However, new data are accumulating on Huntington’s disease and other polyglutamine diseases that appear to contradict the toxic aggregate hypothesis Recent data suggest that the toxic species of protein in these diseases may be soluble mutant conformers, and that the protein context of expanded polyglutamine is critical to understanding disease specificity Here we discuss recent publications that define other important therapeutic targets for polyglutamine-mediated neurodegeneration related to the con-text of the expanded polyglutamine tract in the disease protein

Abbreviations

AR, androgen receptor; FRAP, fluorescence recovery after photobleaching; FRET, fluorescence resonant energy transfer; GFP, green fluorescent protein; HD, Huntington’s disease; NLS, nuclear localization signal; SCA, spinocerebellar ataxia; SMBA, spinal and bulbar muscular atrophy; YAC, yeast artificial chromosome.

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Consistent with this hypothesis, aggregates of protein

are not seen in proteins expressing polyasparagine, an

amino acid that differs from glutamine by only one

methyl group [5] Although what exactly polyglutamine

aggregates were doing to trigger toxicity was not

hypothesized by the authors, they did conclude that

this toxic property was universal to all cell types and

species

The second seminal paper concerning the prediction

of aggregation of polyglutamine disease proteins was

the report on the first HD model mouse using

trans-genic insertion technology [6] For this study, the

authors expressed the first exon of mutant human

hun-tingtin as a transgene in the mouse, thus expressing the

expanded polyglutamine tract The resultant ‘R6⁄ 2’

mouse lines developed severe disease in as little as

3 weeks, and obvious movement disorders that

resem-bled the chorea seen in HD, as well as some brain mass

loss and total body weight loss Brain slice imaging

from these mice revealed the abundance of

ubiquitin-rich inclusions of huntingtin fragments in many areas

of the brain, suggesting that these inclusions may be

the toxic trigger of cell death and dysfunction leading

to the HD-like phenotype in these mice

As a result of these two papers, HD research was

focused on what the gain-of-function was of the

poly-glutamine aggregates Published work on this small

fragment of huntingtin has implicated its role in

seques-tering important proteins in aggregates [7,8], blocking

cell vesicle trafficking [9], inhibiting proper proteasome

function [10], and toxic titration of chaperones away

from the rest of the cell [11] The important distinction

of this work is that they define mutant huntingtin

aggregates as static, misfolded, precipitated proteins

that the cell clearance machinery has a problem in

deal-ing with The central theme is that the toxic nature of

huntingtin depends upon the formation of protein

‘aggregates’ Although these ubiquitin-rich inclusions

are evident in the huntingtin exon 1 mouse models and

other small-fragment HD models [12,13], they can

become cleared in conditional expression models

cor-recting the disease phenotype to normal, for both

huntingtin exon 1 [13] and SCA1 [14] models The

conditional expression models are the most promising

for treatment of these diseases, implying that even at

the point of severe phenotypic manifestation, the toxic

effects can be reversed by stopping production of the

mutant protein, either by the alleviation of dysfunction

in neurons, or through the brain’s inherent plasticity

Protein aggregation in neurodegenerative disease is

not unique to polyglutamine diseases, and is a

com-mon theme with other amyloid diseases, including

transmitted spongiform encephalopathies, Parkinson’s

disease, and Alzheimer’s disease [15] Polyglutamine diseases have often been historically considered as amyloid diseases

New models, new insights

One problem with huntingtin exon 1 mouse models is that these models express only a fragment of mutant huntingtin protein that comprises roughly 3% of the total protein, and controls for observations in this mouse model are difficult, as a wild-type exon 1 trans-genic mouse is not typically used, and controls related

to the positional effects of transgene insertion in geno-mic DNA are difficult to construct More genetically accurate huntingtin mouse models now exist that express the polyglutamine expansion in a full-length (3144 amino acid) context, with control wild-type length strains, using a wide variety of technologies, including: yeast artificial chromosomes (YACs) [16]; human CAG expansion knock-in to the mouse huntingtin allele [17]; conditional mutant huntingtin knock-outs [18,19]; and expanded polyglutamine knock-in to the mouse huntingtin allele [20] The phe-notypes of these mice are generally much more attenu-ated, with little impact on animal longevity at 3 years The incidence of visible aggregates is much lower, and aggregates cannot be detected in the early stages of disease in the mouse when there are measurable phenotypic changes as compared to wild-type mice In the absence of any early biomarkers for HD to date, the huntingtin exon 1 model is still the mouse model

in use for drug development, due to the relatively fast and severe phenotype

In full-length huntingtin HD genetic mouse models, aspects of the disease phenotype seem more similar to the human disease, with the exception of specific stria-tal cell loss These models caused a rethinking of aggregates in polyglutamine disease, raising the possi-bility that whereas they can be seen in induced disease models and HD brains, they may not be the patho-genic trigger of disease One of the conceptual prob-lems regarding the pathology of aggregates in exon 1 models is that the pathogenic mechanisms implied do not explain disease specificity in certain neuronal pop-ulations Many of the polyglutamine disease proteins are expressed in many cell types, even outside the brain, but pathology is typically restricted to specific cell loss in a few brain areas The most striking exam-ple of this is in SCA17, where the affected protein is the TATA box-binding protein, which is ubiquitously expressed and required for RNA polymerase II transcription initiation at most promoters, but only manifests as ataxia when expanded beyond 60 repeats

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[21] SCA17 challenges many aspects of the hypotheses

concerning polyglutamine toxicity, as TATA

box-bind-ing protein has normal polymorphic polyglutamine

tract lengths that can exceed 40 repeats with no

dis-ease, and is a normal nuclear protein The

manifesta-tion of the nine specific human diseases challenges the

concept that expanded polyglutamine expression alone

is toxic to all cells

Unfortunately, to the nonexpert, understanding the

field of polyglutamine diseases can be hampered by

inconsistent and inaccurate terminology Huntingtin

exon 1 model system studies often conclude that effects

are observed solely due to polyglutamine, and imply

similar mechanisms in other polyglutamine diseases,

but are rarely actually tested ‘Polyglutamine’ is often

mislabeled mutant exon 1 huntingtin, and the term

‘aggregates’ can actually refer to any puncta of

inclu-sions of polyglutamine-containing protein, whether

proven to be misfolded or not This is an important

distinction, given the role of huntingtin in vesicular

interactions [22,23] Even the term ‘huntingtin’ is often

inaccurately used when only the exon 1 fragment has

been tested, leading to the assumption that all

proper-ties of exon 1 huntingtin can be attributed to full-length

huntingtin in HD One conceptual milestone that

inves-tigators will have to deal with is whether all the related

pathology in HD can be recapitulated with only the first

exon fragment of this protein, and that the remaining

97% of the protein may not be relevant to this disease

Polyglutamine and protein context

One of the first groups to design elegant,

proof-of-principle experiments in the mouse to test the

uni-versal toxicity of expanded polyglutamine was the

long-term collaboration of the Orr and Zoghbi

labora-tories on SCA1 mouse models In both HD and

SCA1, inclusions of polyglutamine-expanded protein

can be seen within nuclei Orr’s group defined the

nuclear localization signal (NLS) in ataxin-1 protein,

inactivated it by point mutation, and expressed this

NLS mutant (Q84) ataxin-1 in the mouse [24] The

mice did not develop any disease, despite high

expres-sion of NLS mutant (Q84) ataxin-1 in the cerebellum

Thus, two important conclusions could be drawn from

this model: that expression of expanded polyglutamine

in the mouse brain was in itself not sufficient for

degeneration; and that the normal function of the

polyglutamine disease protein probably contributed to

the disease pathology This work was extended further

by the definition of a phosphoserine near the NLS

in ataxin-1 at position 776 that, when mutated to

alanine, also did not lead to disease, but still allowed

nuclear entry of polyglutamine-expanded ataxin-1 [25] Thus, nuclear localization of polyglutamine is not in itself sufficient to cause disease, and, perhaps of great-est intergreat-est to the polyglutamine diseases community,

a serine kinase signaling pathway could modulate the toxicity of SCA1, defining another, potentially better drug target for a polyglutamine disease outside of the polyglutamine tract This single serine mutant also affected the ability of ataxin-1 to form nuclear inclu-sions, suggesting that functions in the host protein could affect the inclusion or aggregation ability of that protein

The concept of targeting protein function for a poly-glutamine disease is best illustrated with SBMA or Kennedy’s disease and the polyglutamine-expanded protein androgen receptor (AR) [26] Males with SBMA typically exhibit more severe disease than sibling females, owing to higher levels of circulating testosterone, leading to increased nuclear signaling of the AR Male mice treated with the gonadotropin-releasing hormone antagonist leuprorelin showed reduced levels of circulating testosterone and a dra-matic decrease in the SBMA-like phenotype, a result that has now directly translated to the clinic with treat-ment of SBMA patients [27] Thus, SBMA represents

a success story for the therapeutic development of treatment that does not target polyglutamine and aggregation, but targets the well-described known function of the AR SCA1 and SBMA are two striking examples of the importance of the protein context of polyglutamine mediating its toxic effects

But what of universal polyglutamine toxicity? A major aspect of polyglutamine-mediated toxicity that was not considered in early biochemical work, and in typical longer-term cell overexpression models in HEK293, CHO, or Cos7 cell lines, is the level of huntingtin exon 1 fragment required to see effects, typically in these cell lines orders of magnitude in molar-ity above the levels of endogenous huntingtin This is particularly evident in biochemical studies in vitro In tissue culture cell models with typical very strong cyto-megalovirus-promoted expression vectors and relatively large amounts of protein expressed (relative to endoge-nous huntingtin), quantifiable in vivo by green fluores-cent protein (GFP) fusions, the incidence of visible aggregates of mutant huntingtin fragments decreases dramatically with the increased length of huntingtin protein the expanded polyglutamine tract is expressed within Whereas visible aggregates are very frequent with huntingtin 1–81 or 1–171 fragment expression, they do not appear in the context of larger huntingtin fragments, regardless of expression levels (J Xia, McMaster University, unpublished observations)

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What are the spots in polyglutamine

diseases?

If polyglutamine-expanded proteins form insoluble,

static and precipitated protein, then quantitative

bio-physical methods such as fluorescence recovery after

photobleaching (FRAP) in living cells could establish

that once polyglutamine-expanded protein enters an

inclusion, it does not exit, consistent with the original

aggregate hypothesis Three groups, including ours,

have independently used FRAP in the context of

mutant huntingtin exon 1, ataxin-1 and ataxin-3

pro-teins Some polyglutamine-expanded proteins in puncta

can exchange back to the soluble phase, others appear

to be static and sequester soluble protein, and some

can move from inclusion to inclusion [7,28,29] Thus,

the effect of polyglutamine expansion on protein

dynamics is not universal for all proteins This suggests

that a third species of soluble, mutant protein can

exist, and that this protein can exist in both the soluble

and insoluble states and move between those two

states (Fig 1) FRAP studies also confirm that fusions

of GFP to polyglutamine disease proteins are not

misfolded when in inclusions, as they continue to

fluo-resce quantitatively as protein is localized to the

inclu-sions, even when in excess of 5 lm in diameter In the

case of ataxin-1, normal ataxin-1 function dictates the

formation of nuclear ataxin bodies, which exist even in

the complete absence of the polyglutamine tract [28]

Ataxin-1 inclusion formation is dictated by signaling

and post-translational phosphorylation of a single serine in ataxin-1 at position 776, regardless of poly-glutamine tract length [25] These live cell dynamic observations and mouse model data obtained with ataxin-1 are inconsistent with the hypothesis that poly-glutamine has a universal effect on protein misfolding and insolubility, rendering all proteins ‘amyloid’ Another inconsistency with the amyloid hypothesis for HD is in a YAC mouse model of HD that resulted from a cloning artefact that was carefully character-ized The ‘shortstop’ mouse expressed only 120 amino acids of huntingtin on a YAC, or roughly 35 amino acids beyond exon 1 in a polyglutamine-expanded con-text, and displayed large visible aggregates throughout the brain, but this mouse had no measurable disease [30] The corresponding full-length mutant huntingtin YAC construct does show a slow, progressive HD-like phenotype, but without large visible aggregates [16] These models demonstrate that with HD, as with SCA1, other sequences within the polyglutamine dis-ease protein may be able to modulate toxicity, but that the formation of aggregates is not necessarily corre-lated with disease

Correlation between aggregates and toxicity

The connection between visible protein aggregates and polyglutamine diseases has been largely circumstantial

In human brains, the incidence of aggregates is

impos-Ataxin-1 Q82-GFP

Loss

Gain

A

Bleach area

B

Fig 1 Polyglutamine-expanded protein can exist in two reversible states FRAP experiment with overexpressed ataxin-1–GFP All of the protein is bleached except for one mutant ataxin-1 body in the nucleus Gain of fluorescence is first seen in the same inclusions bleached prior to recovery closest to the unbleached inclusion; the corresponding loss of fluorescence over time is seen in the unbleached inclusion Thus, polyglutamine-expanded mutant ataxin-1 can move from one inclusion of highly concentrated protein to another through a soluble phase.

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sible to follow with disease in any one individual,

although increased aggregates are noted in more severe

stages or grades of HD [31,32] In order to directly

follow the fate of individual neurons expressing a

small fragment of polyglutamine-expanded huntingtin,

Arrasate and colleagues transfected huntingtin exon 1–

GFP expression plasmids in primary neuronal cultures,

and used robotic 4D fluorescent microscopy to track

the fate of single cultured neurons over time, imaging

them repeatedly [33] From this work, they observed

an inverse correlation between huntingtin exon 1

frag-ment inclusion size and cell death; that is, the larger

the aggregate, the more likely the neuron was to

survive longer than a neuron expressing mutant

huntingtin without any visible aggregates This work

took advantage of recent technology and trends in cell

biology towards quantitative measurement of effects

This data thus indicated that large aggregates of

hun-tingtin fragments may constitute a cellular protective

mechanism to localize the toxic soluble mutant protein

to insoluble and inactive protein reservoirs (Fig 2) This localization to large inclusions may also contrib-ute to the loss-of-function seen in HD [34], whereas the soluble mutant protein can participate in normal protein functions with an additional gain-of-function

We know that mutant huntingtin protein can assume the functions of wild-type protein, as it can lead to normal development in mutant homozygous mice and humans [17]

The concept of neuroprotection of aggregates of polyglutamine disease proteins is not limited to HD

In SCA7, two groups independently showed an inverse correlation of aggregate formation of ataxin-7 with toxicity, both in cultured neurons and in a mouse model [35,36] Ataxin-7 has a known role as a compo-nent of the transcription mediator complex known as STAGA, and when polyglutamine-expanded, can affect the proper recruitment and composition of this complex [37] Therefore, with ataxin-7, it is likely that the toxic version of the protein is not that found in

<36 Repeats

No structure

No structure

Gain of structure

Biological or chemical modulators

Biological or chemical modulators

Toxic

Very toxic

Inert?

Loss-of-function?

Inert?

Fig 2 Polyglutamine expansion lengths may disrupt the equilibria between toxic and healthy protein and between toxic soluble species and inert insoluble species Polyglutamine lengths beyond 37 repeats in HD are predicted to form a structure leading to gain of toxic function Mutant protein can exist in three states: soluble and without structure (healthy); soluble with a structure leading to gain of toxic function; and insoluble with a structure leading to loss of normal function Longer expansion lengths can skew this equilibrium to essentially two con-formers, either loss-of-function or gain-of-function, both contributing to the manifestation of disease Biological or chemical modulators are able to skew equilibria in vivo, suggesting that the optimal modulator may be a molecule that can push all mutant protein into the insoluble, unstructured and hence inert state This modulator may not necessarily need to interact with polyglutamine, and may be different for different protein contexts related to biological functions.

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aggregates, but rather the soluble mutant protein that

is able to participate in complexes with STAGA to

exert dominant effects over wild-type protein In

SCA2, although aggregates can be seen in a small

number of neurons, they are not seen within the

nucleus, as they are in HD or SCA1 [38] In

SCA3⁄ Machado–Joseph disease, as in HD and SCA7,

an inverse correlation is seen between nuclear

inclu-sions of ataxin-3 protein and cell death, both by

exam-ination of brain slices [39,40] and in tissue culture

models [41]

These newer data can therefore allow us to revisit

the early brain pathology data obtained with HD

patients from another perspective One of the

hall-marks of HD in humans, but not as much in mouse

models, is the striking loss of the striatum, and up to

30% of total brain mass, prior to death [31] In the

neurons that remain to be seen post mortem,

aggre-gates of huntingtin N-terminal fragments can be seen

[32] One hypothesis was that these aggregates may be

the cause of cell death, and when they were visualized,

they were in neurons en route to death However, from

a revisionist perspective, one can also hypothesize that

these neurons may have survived longer than the

missing striatal neurons, due to the presence of the

aggregates The consideration of aggregates in HD

fol-lows many of the conundrums seen with polyglutamine

diseases and the struggle to understand what is cause

and what is effect in these diseases

Hunting the elusive toxic

polyglutamine conformer

A thorough search of crystallographic databases

reveals that polyglutamine tracts seen in a variety of

normal cellular proteins are either annotated as

‘unstructured’ or have to be removed to facilitate

crys-tallization Obtaining structural information on

poly-glutamine in proteins is technically difficult, as even

wild-type polyglutamine lengths can tend to be

insolu-ble at the high concentrations required for

crystallo-graphic or NMR studies Wetzel’s group has focused

on the identification of the toxic structure of

poly-glutamine Led by the antiparallel b-sheet model

originally proposed by Perutz [4], they inserted

proline–glycine substitutions in pure polyglutamine

tracts to induce a b-strand structure, and found that

even short lengths of polyglutamine could form

aggre-gates similar to pure Q45 lengths when b-strands and

b-turns were induced [42] The group of Ross then

showed that these structured constructs were similarly

toxic in primary cultured neurons and tissue culture

models [43] This work led to the concept that the

genetic gain-of-function of polyglutamine could be tied to a gain of structure [44], but that this structural gain did not necessarily have to exert toxicity by the formation of aggregates Recently, Onodera’s group confirmed the parallel b-sheet model or cylindrical b-sheet of polyglutamine in atrophin-1 by the use of fluorescence resonant energy transfer (FRET) studies

in vivo This FRET-based ‘spectroscopic ruler’ tool allowed the investigators to distinguish between solu-ble expanded polyglutamine oligomers, solusolu-ble mono-mer and inclusion bodies in live cells In neuronal cell culture toxicity assays, they demonstrated that the toxic species appeared to be soluble oligomers, and not the protein in aggregates [45] The caveat of this work is that the authors assume that polyglutamine in the context of atrophin-1 fragments has the same structure in all polyglutamine disease proteins, but given the importance of flanking sequences to polyglu-tamine structure, this model needs to be tested in other polyglutamine disease contexts Biophotonic methods such as FRET and fluorescence correlation spectroscopy have led, and will probably continue to lead, to major biochemical insights into polyglutamine folding in vivo [46]

With small huntingtin fragments, many groups, including ours, have independently reported the impor-tance of flanking sequences next to the polyglutamine tract in huntingtin exon 1 as modulators of toxicity In the yeast toxicity model, the positioning of flag-tags on the expression constructs modulated toxicity and the nature of aggregated protein, with tight, compact aggregates being benign, but amorphous aggregates being much more toxic [47] Another group observed modulation of polyglutamine aggregation by the use of structured chimeras with the cellular retinoic-acid binding protein in E coli [48] Again revisiting the seminal Perutz paper [4], investigators have shown that the glutathione S-transferase fusion to polyglutamine does affect the aggregation dynamics, and may not be

an innocuous purification tag, as it was once cons-idered to be Aggregation may occur through forma-tion of a reservoir of soluble intermediates whose populations and stabilities increase with polyglutamine length [49] However, these sequences were exogenous

to huntingtin exon 1, and toxicity was not assayed in mammalian cells Deletion of the proline-rich region in huntingtin exon 1 greatly increases the toxicity of exon 1 fragments in yeast, which are otherwise inno-cuous [50] Therefore, the proline-rich region appears

to be protective against the effects of expanded polyglutamine The effects of polyproline in cis, in vitro can be seen to affect the structure of expanded polyglutamine [51]

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The first 17 amino acids of huntingtin, prior to the

polyglutamine tract, are highly conserved (100%

simi-larity) in all vertebrate species, and were originally

annotated as unstructured [4] However, by exhaustive

mutational analysis in vivo and CD spectroscopy

in vitro with peptides, our group has determined the

first 17 amino acids to be an amphipathic a-helix, with

membrane-associating properties with regard to the

endoplasmic reticulum [23] Like the proline-rich tract,

this region of huntingtin, present in all mouse models

of HD, was shown to modulate the toxicity of Q138

huntingtin 1–171 in a structure-dependent manner A

single point mutant in the middle of the helix, shown

to disrupt the a-helical structure, resulted in three

surprising phenotypes: constitutive nuclear entry of

full-length huntingtin, or any huntingtin small

N-ter-minal fragments; the complete abrogation of any

visible aggregates of polyglutamine-expanded

hun-tingtin 1–171, even in the context of 250 repeats; and a

corresponding increase of toxicity of this fragment of

huntingtin in a polyglutamine-dependent manner of

close to four-fold over Q138 huntingtin 1–171 Thus,

loss of structure in regions adjoining the polyglutamine

tract on either side of the tract can lead to increased

huntingtin toxicity, with an inverse correlation with

aggregation These results predict that regions on

either side of the polyglutamine tract in huntingtin

may interact with each other, with a critical

compo-nent of normal interaction being the flexible region of

at least four glutamine residues seen in all vertebrate

huntingtin proteins Huntingtin 1–17 and the

proline-rich region adjacent to the polyglutamine tracts are

both involved in targeting vesicular populations

[23,52] In HD, the gain-of-structure may perturb

huntingtin functions in vesicular trafficking by a ‘rusty

hinge’ model, where important on–off interactions may

be stuck on or off by the structure gained as a result

of polyglutamine expansion (Fig 3) Similar models

may apply to other polyglutamine disease proteins,

with different consequences

Basic residues in the ataxin-3 protein form an

inter-action motif with VCP⁄ p97 protein, and this

inter-action can modulate ataxin-3 aggregation and toxicity

in Drosophila models [53] Serine mutations in the

N-terminus of the AR can modulate

polyglutamine-expanded AR’s ability to aggregate, with increased

aggregation but less toxicity being seen in a Drosophila

model [54] Thus, many different sequences flanking

polyglutamine tracts can affect polyglutamine

tract-mediated toxicity and the potential to form aggregates

The importance of the structure on either side of an

expanded polyglutamine tract may be due to

imp-rinting of structure on polyglutamine by adjoining

sequences that interact with the flexible polyglutamine tract in cis This is consistent with peptides or small molecules in trans that are able to mediate the aggrega-tion potential of polyglutamine tracts and skew the equilibrium distribution of polyglutamine-expanded protein towards soluble or insoluble Some of the factors that may be able to affect this equilibrium may include normal interacting proteins, such as chaper-ones, or the HYPK protein interaction with hunting-tin’s N-terminus modulating its ability to form aggregates [55,56]

Modifiers of polyglutamine structure and toxicity

Even if large visible ‘aggregates’ are not the actual targets of therapeutic development in HD and other polyglutamine diseases, proteins, small molecules or other factors that affect polyglutamine-dependent aggregation may have important effects on the toxic soluble species of polyglutamine-expanded proteins Early high-throughput (biochemical) assays used filter-trapped aggregates as the readout for screening

of small molecules Benzothiazole compounds were

Fig 3 The ‘rusty hinge’ hypothesis of gain of structure leading to toxic function in HD We speculate that there is an overall superhe-lical structure of huntingtin, owing to the large number of HEAT repeats throughout the entire 3144 amino acid protein The normal polyglutamine tract, present in all vertebrates with least four gluta-mines, provides an important flexible region in the huntingtin scaf-fold for factors that can interact with the first 17 amino acids and downstream regions With increasing polyglutamine lengths, the pool of total mutant protein is skewed towards b-sheet structured polyglutamine, leading to a loss of flexibility and the ability of hun-tingtin 1–17 to interact with the rest of hunhun-tingtin via factors or complexes Normal interactions that should switch on or off will then be stuck in either the on or off position or pools of either posi-tion, both of which may be toxic Normal interaction between the proline-rich region and huntingtin 1–17 influences the structure of expanded polyglutamine in cis, leading to increased toxicity if the normal structures of these regions are disrupted.

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identified as being able to prevent aggregation or

solu-bilize aggregates [57] The small molecule C2–8 was

identified from high-content screening (cell biological)

as an inhibitor of polyglutamine aggregate growth [58],

but its efficacy in mouse models was modest, despite it

crossing the blood–brain barrier effectively [59] One

surprising finding from a FRET-based high-content

screen of a kinase inhibitor library is that the Rho

kinase inhibitor, Y-27632, could prevent huntingtin

exon 1 fragment-mediated aggregation [60] What is

not known is what the mechanism of this inhibition is,

but Rho kinase inhibition suggests that other functions

of huntingtin exon 1 fragment, perhaps in actin

associ-ation, may be necessary for the formation of

aggre-gates These classes of small molecules that affect

huntingtin aggregation now allow cell biologists to use

these molecules as tools of ‘chemical biology’ in the

study of huntingtin function and mutant huntingtin

pathology

One of the strongest lines of evidence for a soluble

oligomeric or misfolded toxic species of polyglutamine,

and effects of peptides in trans, comes from the studies

of the polyglutamine-binding trytophan-rich peptide

QBP1 (WKWWPGIF) Although it was originally

described as a suppressor of polyglutamine-mediated

toxicity through the suppression of aggregation [61,62],

more detailed studies have shown that this peptide can

inhibit the transition of polyglutamine from an

unstructured state to the toxic soluble b-sheet

mono-mer structure [63], consistent with independent work

on the b-sheet structure of polyglutamine from many

other groups

Another look at the amyloid hypothesis

In the past, it has been tempting to place

polygluta-mine diseases into the category of amyloid diseases,

a family of neurodegenerative disorders caused by

misfolded proteins leading to large protein

ultrastruc-tures within or outside affected neurons However,

recent research evidence from Alzheimer’s and

Par-kinson’s diseases is starting to cast doubt on the

uni-versality of the amyloid hypothesis in those diseases

as well In Alzheimer’s disease, genetic mutations in

familial Alzheimer’s disease reveal that Alzheimer’s

disease in those cases may be caused by a redox

imbalance, leading to the effect of amyloid plaques

[64] In Parkinson’s disease, a-synuclein

accumula-tion, like mutant huntingtin aggregaaccumula-tion, can be seen

to be neuroprotective [65] Small molecules that

encourage aggregation appear to be effective in

toxic-ity assays for many amyloid diseases and HD

[66,67] Although it now appears that understanding

polyglutamine disease probably cannot be achieved without the disease protein context, important lessons have been learned from huntingtin small-fragment models and studies focusing on the toxic species of polyglutamine in different disease contexts Proof-of-concept successes with SCA1 pointing to serine kinase inhibition as a therapeutic strategy, and clini-cal success with the treatment of SBMA by leupro-relin, underscore the importance of analysis of huntingtin toxicity in the full protein context and the importance of elucidating the normal biological func-tion of huntingtin From that milestone, HD researchers can then have a new vantage point from which to consider alternative or coincident therapeu-tic strategies related to huntingtin function along with antiaggregation compounds The hallmark of any good drug is selective toxicity for its target, and thus expanded polyglutamine remains a valid target

in polyglutamine diseases, with the appeal that drug toxicity will be specific to the mutant, and not wild-type, protein

Acknowledgements

The Truant laboratory is supported by current and past grants from the Hereditary Disease Foundation, (HDF) USA, the Cure Huntington’s Disease Initiative (CHDI) USA, the Huntington’s disease Society of America (HDSA), the Huntington’s Society of Canada and the Canadian Institutes of Health Research (CIHR), Genetics and Mental Health and Addiction Institutes R Truant is Chair of the Huntington’s disease Society of Canada (HSC) scientific advisory board

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