Clinical features and molecular genetics of autosomal recessive spinocerebellar degenerations]

The number of patients with spinocerebellar degeneration (SCD) has recently exceeds 20,000 in Japan. Among them, sporadic form is the most common form (67.2%). Among the hereditary forms of SCD, autosomal dominant (AD) form comprises 27.0%, while autosomal recessive (AR) form is rare (1.8%). Because of the rare occurrence of AR-SCD, the molecular genetic studies have been difficult to conduct. Recent progresses in molecular genetics, however, have enabled identification of causative genes for the majority of AR-SCD. Although Friedreich's ataxia is the most representative form of AR-SCD, patients with molecular diagnosis of Friedreich's ataxia have not been described in the Japanese population. Among the various forms of AR-SCD, early-onset ataxia with ocular motor apraxia and hypoalbuminemia (EAOH) seems to be the most common form in the Japanese population. Aprataxin, the causative gene for EAOH, has been suggested to play a role in the single strand DNA break repair. Interestingly, abnormalities in DNA break repair processes have been implicated in several forms of AR-SCD including AOA2, SCAN1 and ataxia telangiectasia. In this group of AR-SCD, cerebellar atrophy is more marked compared to that observed in Friedreich's ataxia. Taken together, abnormalities in DNA break repair processes may play an essential role in cerebellar degeneration in this group of AR-SCD.