30 years of repeat expansion disorders: What have we learned and what are the remaining challenges?
Open accessAbstract
Tandem repeats represent one of the most abundant class of variations in human genomes, which are polymorphic by nature and become highly unstable in a length-dependent manner. The expansion of repeat length across generations is a well-established process that results in human disorders mainly affecting the central nervous system. At least 50 disorders associated with expansion loci have been described to date, with half recognized only in the last ten years, as prior methodological difficulties limited their identification. These limitations still apply to the current widely used molecular diagnostic methods (exome or gene panels) and thus result in missed diagnosis detrimental to affected individuals and their families, especially for disorders that are very rare and/or clinically not recognizable. Most of these disorders have been identified through family-driven approaches and many others likely remain to be identified. The recent development of long-read technologies provides a unique opportunity to systematically investigate the contribution of tandem repeats and repeat expansions to the genetic architecture of human disorders. In this review, we summarize the current and most recent knowledge about the genetics of repeat expansion disorders and the diversity of their pathophysiological mechanisms and outline the perspectives of developing personalized treatments in the future.
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Comprehensive genome analysis and variant detection at scale using DRAGEN
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Analysis and benchmarking of small and large genomic variants across tandem repeats
English, A. C., Dolzhenko, E., Ziaei Jam, H., McKenzie, S. K., Olson, N. D., De Coster, W., Park, J., Gu, B., Wagner, J., Eberle, M. A., et al. (2025) · Nature Biotechnology · doi:10.1038/s41587-024-02225-z · Cited by 68 · see citing works
Fragile sites, chromosomal lesions, tandem repeats, and disease
Mirceta, M., Shum, N., Schmidt, M. H. M., & Pearson, C. E. (2022) · Frontiers in Genetics · doi:10.3389/fgene.2022.985975 · Cited by 30 · see citing works
Wendt, F. R., Pathak, G. A., & Polimanti, R. (2022) · Nature Communications · doi:10.1038/s41467-022-35423-x · Cited by 12 · see citing works
The genetic architecture of pentanucleotide repeat variation and disease association
Xu, I. R. L., Pellerin, D., Van De Vondel, L., Weisburd, B., Dolzhenko, E., Danzi, M. C., & Zuchner, S. (2026) · The American Journal of Human Genetics · doi:10.1016/j.ajhg.2026.09.017
- Authors
- Depienne, C., & Mandel, J.-L.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Depienne, Christel
- Mandel, Jean-Louis
- Venue
- The American Journal of Human Genetics
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 108
- Issue
- 5
- Pages
- 764-785
- ISSN
- 0002-9297 (ISSN-L)
- PMC
- PMC8205997
- OpenAlex
- W3147352572
- Semantic Scholar
- 4667c3b1f49cabfbd5b88fc61fd1198249cd3318
- Cited by
- 429
- References
- 167
- Citations by year
- 2026: 64 · 2025: 108 · 2024: 125 · 2023: 62 · 2022: 59 · 2021: 10 · 2013: 1
- FWCI
- 9.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The American Journal of Human Genetics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Funders
- Deutsche Stiftung Neurologie
- Deutsche Forschungsgemeinschaft
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Genetic Neurodegenerative Diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
- Keywords
- repeat expansion disorders, tandem repeats, trinucleotide repeat instability, central nervous system disorders, molecular diagnosis, long-read sequencing, pathophysiological mechanisms, personalized treatment, rare genetic disorders
- MeSH terms
- Genes, Dominant, Genes, Recessive, Humans, Time Factors, Genome, Human, Founder Effect, Trinucleotide Repeat Expansion, Anticipation, Genetic, Biomedical Research
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