Cause or compensation?—Altered neuronal Ca 2+ handling in Huntington's disease

Summary Huntington's disease ( HD ) is a hereditary neurodegenerative disorder of typically middle‐aged onset for which there is no disease‐modifying treatment. Caudate and putamen medium‐sized spiny projection neurons ( SPN s) most severely degenerate in HD . However, it is unclear why mutant huntingtin protein ( mHTT ) is preferentially toxic to these neurons or why symptoms manifest only relatively late in life. mHTT interacts with numerous neuronal proteins. Likewise, multiple SPN cellular processes have been described as altered in various HD models. Among these, altered neuronal Ca 2+ influx and intracellular Ca 2+ handling feature prominently and are addressed here. Specifically, we focus on extrasynaptic NMDA ‐type glutamate receptors, endoplasmic reticulum IP 3 receptors, and mitochondria. As mHTT is expressed throughout development, compensatory processes will likely be mounted to mitigate any deleterious effects. Although some compensations can lessen mHTT 's disruptive effects, others—such as upregulation of the ER ‐refilling store‐operated Ca 2+ channel response—contribute to pathogenesis. A causation‐based approach is therefore necessary to decipher the complex sequence of events linking mHTT to neurodegeneration, and to design rational therapeutic interventions. With this in mind, we highlight evidence, or lack thereof, that the above alterations in Ca 2+ handling occur early in the disease process, clearly interact with mHTT , and show disease‐modifying potential when reversed in animals.