Abstract
Spinocerebellar ataxias (SCAs) are rare types of cerebellar ataxia with a dominant mode of inheritance. To date, 47 SCA subtypes have been identified, and the number of genes implicated in SCAs is continually increasing. Polyglutamine (polyQ) expansion diseases ( ATXN1/SCA1, ATXN2/SCA2, ATXN3/SCA3, CACNA1A/SCA6, ATXN7/SCA7, TBP/SCA17, and ATN1/DRPLA) are the most common group of SCAs. No preventive or curative treatments are currently available, but various therapeutic approaches, including RNA-targeting treatments, such as antisense oligonucleotides (ASOs), are being developed. Clinical trials of ASOs in SCA patients are already planned. There is, therefore, a need to identify valid outcome measures for such studies. In this review, we describe recent advances towards identifying appropriate biomarkers, which are essential for monitoring disease progression and treatment efficacy. Neuroimaging biomarkers are the most powerful markers identified to date, making it possible to reduce sample sizes for clinical trials. Changes on brain MRI are already evident at the premanifest stage in SCA1 and SCA2 carriers and are correlated with CAG repeat size. Other potential biomarkers have also been developed, based on neurological examination, oculomotor study, cognitive assessment, and blood and cerebrospinal fluid analysis. Longitudinal studies based on multimodal approaches are required to establish the relationships between parameters and to validate the biomarkers identified.
Highlights
Spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases displaying autosomal dominant inheritance
This review provides an overview of findings for biomarkers, recent results of clinical trials in spinocerebellar ataxia (SCA) patients, and future perspectives for treatment
In a recent study focusing on cognitive dysfunction in SCA6 patients, mild impairments of executive functions, mental flexibility, and visuospatial skills were found to be correlated with decreased resting-state connectivity in the frontoparietal network[63]
Summary
Spinocerebellar ataxias (SCAs) are rare types of cerebellar ataxia with a dominant mode of inheritance. Clinical trials of ASOs in SCA patients are already planned. We describe recent advances towards identifying appropriate biomarkers, which are essential for monitoring disease progression and treatment efficacy. Neuroimaging biomarkers are the most powerful markers identified to date, making it possible to reduce sample sizes for clinical trials. Longitudinal studies based on multimodal approaches are required to establish the relationships between parameters and to validate the biomarkers identified. Biomarkers, antisense oligonucleotides, clinical trials, neuroimaging version 1 published 12 Nov 2018. F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. Any comments on the article can be found at the end of the article
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