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Trinucleotide repeat disorders

Trinucleotide repeat disorders (also known as trinucleotide repeat expansion disorders, triplet repeat expansion disorders or codon reiteration disorders) are due to stretches of DNA in a gene that contain the same trinucleotide sequence repeated many times. These repeats are a subset of unstable microsatellite repeats that occur throughout all genomic sequences. If the repeat is present in a gene, an expansion of the repeat results in a defective gene product and often disease.

Trinucleotide repeat disorders are classified as a type of Non-Mendelian inheritance.[1]



Since the early 90’s, a new class of molecular disease has been characterized based upon the presence of unstable and abnormal expansions of DNA-triplets (trinucleotides). The first triplet disease to be identified was fragile X syndrome that has since been mapped to the long arm of the X chromosome. At this point, there are from 230 to 4000 CGG repeats in the gene that causes fragile X syndrome in these patients, as compared with 60 to 230 repeats in carriers and 5 to 54 repeats in normal persons. The chromosomal instability resulting from this trinucleotide expansion presents clinically as mental retardation, distinctive facial features, and macroorchidism in males. The second, related DNA-triplet repeat disease, fragile X-E syndrome, was also identified on the X chromosome, but was found to be the result of an expanded GCC repeat. Identifying trinucleotide repeats as the basis of disease has brought clarity to our understanding of a complex set of inherited neurologic diseases.

As more repeat expansion diseases have been discovered, several categories have been established to group them based upon similar characteristics. Category 1 includes Huntington’s disease (HD) and the spinocerebellar ataxias that are caused by a CAG repeat expansion in a protein-coding portion of specific genes. Category 2 expansions tend to be more phenotypically diverse with heterogeneous expansions that are generally small in magnitude, but also found in the exons of genes. Category 3 includes fragile X syndrome, myotonic dystrophy, two of the spinocerebellar ataxias, juvenile myoclonic epilepsy, and Friedreich’s ataxia. These diseases are characterized by typically much larger repeat expansions than the first two groups, and the repeats are located outside of the protein-coding regions of the genes.

Currently, ten neurologic disorders are known to be caused by an increased number of CAG repeats that encode an expanded series of glutamine residues in otherwise unrelated proteins. During protein synthesis, the expanded CAG repeats are translated into a series of uninterrupted glutamine residues forming what is known as a polyglutamine tract. These disorders are characterized by autosomal dominant mode of inheritance (with the exception of spino-bulbar muscular atrophy which shows X-linked inheritance), midlife onset, a progressive course, and a correlation of the number of CAG repeats with the severity of disease and the age at onset. Family studies have also suggested that these diseases are associated with anticipation, the tendency for progressively earlier or more severe expression of the disease in successive generations. Although the causative genes are widely expressed in all of the known polyglutamine diseases, each disease displays an extremely selective pattern of neurodegeneration.


Anita Harding was the first to identify the correlation between trinucleotide repeat expansion and diseases causing neurological dysfunction. At present there are 14 documented trinucleotide repeat disorders that affect humans.


A common symptom of Polyq diseases is characterized by a progressive degeneration of nerve cells usually affecting people later in life. Although these diseases share the same repeated codon (CAG) and some symptoms, the repeats for the different polyglutamine diseases occur on different chromosomes.

The non-Polyq diseases do not share any specific symptoms and are unlike the Polyq diseases.


Trinucleotide repeat disorders generally show genetic anticipation, where their severity increases with each successive generation that inherits them.

Trinucleotide repeat disorders are the result of extensive duplication of a single codon. In fact, the cause is trinucleotide expansion up to a repeat number above a certain threshold level.

Why three nucleotides?

An interesting question is why three nucleotides are expanded, rather than two or four or some other number. Dinucleotide repeats are a common feature of the genome in general, as are larger repeats (e.g. VNTRs - Variable Number Tandem Repeats). One possibility is that repeats that are not a multiple of three would not be viable. Trinucleotide repeat expansions tend to be near coding regions of the genome, and therefore repeats that are not multiples of three could cause frameshift mutations that would be deadly.


Nine of these disorders have the same repeated codon, CAG, that codes for glutamine (Q). These diseases are commonly referred to as polyglutamine ( or PolyQ) diseases. The other six disorders do not have similar repeats and are classified as non-polyglutamine diseases.

Polyglutamine (PolyQ) Diseases

Type Gene Normal/wildtype Pathogenic
DRPLA (Dentatorubropallidoluysian atrophy) ATN1 or DRPLA between 6 and 35 copies of CAG between 49 and 88 copies
HD (Huntington's disease) HD between 10 and 35 copies of CAG more than 35 copies
SBMA (Spinobulbar muscular atrophy or Kennedy disease) AR - Androgen receptor on the X chromosome. between 9 and 36 copies of CAG between 38 and 62 copies
SCA1 (Spinocerebellar ataxia Type 1) ATXN1 6-35 49-88 copies
SCA2 (Spinocerebellar ataxia Type 2) ATXN2 14-32 33-77 copies
SCA3 (Spinocerebellar ataxia Type 3 or Machado-Joseph disease) ATXN3 12-40 55-86 copies
SCA6 (Spinocerebellar ataxia Type 6) CACNA1A 4-18 21-30 copies
SCA7 (Spinocerebellar ataxia Type 7) ATXN7 7-17 38-120 copies
SCA17 (Spinocerebellar ataxia Type 17) TBP 25-42 47-63 copies

Non-Polyglutamine Diseases

Type Gene Normal/wildtype Pathogenic
FRAXA (Fragile X syndrome) FMR1, on the X-chromosome between 6 and 53 copies of CGG over 230 copies
FRAXE (Fragile XE mental retardation) AFF2 or FMR2, on the X-chromosome between 6 and 35 copies of GCC over 200 copies
FRDA (Friedreich's ataxia) FXN or X25, (frataxin) between 7 and 34 copies of GAA over 100 copies
DM (Myotonic dystrophy) DMPK between 5 and 37 copies of CTG, over 50 copies
SCA8 (Spinocerebellar ataxia Type 8) IOSCA or SCA8 between 16 and 37 copies of CTG between 110 and 250 copies
SCA12 (Spinocerebellar ataxia Type 12) PPP2R2B or SCA12 between 7 and 28 copies of CAG (in the 3' UTR and therefore does not translate to glutamine) between 66 and 78 copies

Trinucleotide repeat expansion

Trinucleotide repeat expansion, also known as triplet repeat expansion, is the DNA mutation responsible for causing any type of disorder categorized as a trinucleotide repeat disorder. Robert I. Richards and Grant R. Sutherland called these phenomena, in the framework of dynamical genetics, dynamic mutations.[2]

Triplet expansion is caused by slippage during DNA replication. Due to the repetitive nature of the DNA sequence in these regions, 'loop out' structures may form during DNA replication while maintaining complementary base paring between the parent strand and daughter strand being synthesized. If the loop out structure is formed from sequence on the daughter strand this will result in an increase in the number of repeats. However if the loop out structure is formed on the parent strand a decrease in the number of repeats occurs. It appears that expansion of these repeats is more common than reduction. Generally the larger the expansion the more likely they are to cause disease or increase the severity of disease. This property results in the characteristic of anticipation seen in trinucleotide repeat disorders. Anticipation describes the tendency of age of onset to decrease and severity of symptoms to increase through successive generations of an affected family due to the expansion of these repeats.


  1. ^ Lesson 1: Triplet Repeat Expansion. Retrieved on 2007-10-16.
  2. ^ Richards RI, Sutherland GR (1997). "Dynamic mutation: possible mechanisms and significance in human disease". Trends Biochem. Sci. 22 (11): 432–6. PMID 9397685.
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Trinucleotide_repeat_disorders". A list of authors is available in Wikipedia.
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