At Therapeutics Conference, landmark study of young gene carriers highlights how Huntington’s disease researchers seek to solve critical puzzles

Armed with ever more impressive data and a deeper understanding of Huntington’s disease, scientists and drug hunters convened at the 15th Annual HD Therapeutics Conference this week, facing the complex puzzles that still hinder the quest for treatments for this deadly neurological disorder.

One of those puzzles: how to not only treat symptoms, but to prevent them, especially in young presymptomatic carriers of the HD gene, so that they don’t have to spend their lives fearing the currently inevitable onset of this devastating disease.

On February 26, Sarah Tabrizi, FRCP, Ph.D., of University College London, answered key questions about what kinds of health consequences young presymptomatic gene carriers suffer decades before they’re likely to develop the disease in midlife.

Previous studies have demonstrated that brain shrinkage can occur as early as 15 to 18 years before predicted age of onset. Ranging in age from 18-40, the 64 gene carriers in Dr. Tabrizi’s HD Young Adult Study went through state-of-the art brain scans and cognitive testing, and also provided samples of blood and cerebrospinal fluid (CSF) for analysis. These at-risk volunteers are, on average, 24 years from estimated onset.

This study, in line with “The Path to Prevention” (one of five major themes of the 2020 conference), is aimed at helping identify the optimal time to treat gene carriers to slow or prevent their neurological decline.

“Comprehensive cognitive testing was normal,” as compared to 67 non-HD-affected individuals, reported Dr. Tabrizi in her presentation to the conference. “There were no significant psychiatric differences, which I found very interesting, because I would have predicted they would’ve been big differences.”

Dr. Tabrizi said that "there’s always been a thought that carrying the HD gene hard-wired you for psychiatric burden,” but the Young Adult Study suggests that such symptoms become more prominent closer to onset.

“I think that was – and I don’t say this lightly – a landmark presentation,” Robert Pacifici, Ph.D., the chief scientific officer for CHDI Foundation, Inc., the conference sponsor, told me today, adding that Dr. Tabrizi’s team carried out the study with “a high degree of rigor and granularity.”

“The participants seem to be remarkably well,” Dr. Pacifici observed. The absence of many of the neurological and other problems typical of HD is an encouraging prospect for developing safe and well-tolerated treatments that could “not just reverse, but actually prevent” HD, he said.

Dr. Pacifici lauded the study volunteers for their "unbelievably selfless participation," including submitting to the study's "incredibly rigorous battery."

Above, Dr. Sarah Tabrizi presenting her talk on the HD Young Adult Study at the 2020 HD Therapeutics Conference, February 26, 2020, and, below, a closeup of Dr. Tabrizi (photos by Gene Veritas, aka Kenneth P. Serbin)

Overall, ‘good news’ for young gene carriers

The young gene carriers in the study did appear to go through a small change in the area of the forebrain known as the striatum, consisting primarily of the putamen and the caudate, the deep brain regions that are most affected by HD. The striatum helps to control our movements and rewards system.

The study found a significant reduction in the size of the putamen, but an insignificant reduction in the caudate. Nevertheless, Dr. Tabrizi explained that, based on this study, these differences (in comparison with the normal subjects) were “not associated with predicted years to onset.”

“So what we now know, based on the data, is that the striatum never appears to be the same size as the control group,” she explained. 

The “very slightly smaller” striatum may suggest a “neurodevelopmental effect” (the way the brain develops) that is “well compensated for,” Dr. Tabrizi said, meaning that the brain adjusts without clear damage. She added that it “might be why the striatum is vulnerable later in life, because it has a double hit.” As mentioned by Dr. Tabrizi, this interpretation resonates with the research of Peg Nopoulos, M.D., who has studied the compromised development of the brains of people affected by juvenile HD.

Alternatively, neurodegeneration early on could be “too subtle and variable” to associate with predicated age of onset, Dr. Tabrizi noted.

Other imaging results showed no decrease in the white matter (the tissue in the brain made of nerve fibers and possibly involved in cognitive problems in HD) or any other aspect of the brain measured in the study, indicating that the subjects were still “very far from onset,” Dr. Tabrizi continued.

“This is really good news,” Dr. Tabrizi stated.

Douglas Langbehn, M.D., Ph.D., a psychiatrist and biostatistician at the University of Iowa who did the statistical analysis for the HD Young Adult Study, listens to Dr. Tabrizi at the Therapeutics Conference (photo by Gene Veritas).

The ongoing search for reliable biomarkers

The study also involved the ongoing search for reliable biomarkers (signs of disease and drug efficacy).

The study detected mutant huntingtin protein in the subjects’ cerebrospinal fluid. “CSF mutant huntingtin was higher in those closer to [predicted] onset, suggesting that some injury is releasing mutant huntingtin [from the brain], but very subtle,” Dr. Tabrizi said.

Several other biomarkers were elevated in the subjects’ CSF, again indicating an early, subtle injury, but most of those subjects had readings showing levels very close to those of the unaffected control subjects, Dr. Tabrizi continued. Furthermore, six other biomarkers were normal, she added.

The Young Adult Study points to the one CSF biomarker in particular, neurofilament light, a marker of brain damage, as potentially helpful in measuring disease progression and treatment response in people decades from onset, Dr. Tabrizi concluded.

A drug that kept neurofilament light at very low levels could prevent degeneration of the brain, she added.

You can watch Dr. Tabrizi’s presentation in the video below.

A moving keynote address

With a record attendance of 380, the conference opened on February 24 with a moving keynote speech by Amy Merkel, a 45-year-old nurse from Wisconsin and the founder of Starfish Yoga.

A small company, Starfish focuses on encouraging constructive coping skills, primarily for people affected by past imprisonment, sexual abuse, and neurological disorders, including HD.

Amy, who titled her talk “Life is Good,” belongs to a family deeply affected by HD. She recounted her extended family’s decades-long struggles with HD. Amy received a standing ovation.

Stay tuned to this blog for additional reporting on the conference, including an overview provided in my interview with Dr. Pacifici.

Above, HD advocate Amy Merkel addresses the 15th Annual Therapeutics Conference, and, below, poses with researchers Dr. Sarah Tabrizi (far left), Leslie Thompson, Ph.D. (second from right), and Gillian Bates, Ph.D. (photos by Gene Veritas).

Pope Francis I to meet with victims of Huntington’s disease, a first for a world leader

In an unprecedented encounter, the first for any pope or world leader, Pope Francis I on May 18 will meet with Huntington’s disease sufferers at the Vatican, bringing new attention to this affliction.

The key papal guests will hail from Latin America, the pope’s home region, the area with the world’s most Catholics, and a key locus of the quest for the HD gene from the 1970s to the 1990s.

Several HD-affected HD individuals (with both juvenile and adult onset), three at-risk relatives, and other relatives and caregivers – a total of 16 people – will travel to Rome from Colombia, Venezuela, and Argentina, the pope’s birthplace.

The news was announced today via e-mail by an international coalition of patient advocates and organizations: "save the date for the largest global gathering of the Huntington's disease community!"

The coalition includes Elena Cattaneo, Ph.D., a prominent HD scientist and senator-for-life in Italy; Factor-H, a humanitarian project founded by HD researchers Claudia Perandones, M.D., Ph.D., and Ignacio Muñoz-Sanjuan, Ph.D.; global HD advocate Charles Sabine; and the Huntington’s Disease Society of America (HDSA).

Many physicians in Latin America laid the groundwork for the event through their long-term dedication to local HD communities and assistance in selecting the families.

The announcement comes, coincidentally, on the fourth anniversary of Francis’s election as the first pope from the Americas.

“What I want him to say, in some way, is that the disease should not be hidden anymore,” Sabine, an HD gene carrier, told me. “That’s the theme of the event: that people should not feel any shame or stigma about the disease.”

“This is a dream which has come true,” Dr. Perandones affirmed in a written response to questions about the event. “After working for nearly 20 years in Latin America in order to try to improve the quality of life of patients, and feeling so alone in this endeavor so many times, it seems unbelievable that the pope will receive us.”

Pope Francis I (above, photo by Argentine Presidency/Wikimedia) and the Soto family of Barranquitas, Venezuela, after receiving the invitation to the papal audience in Rome (below, photo courtesy of Dr. Ernesto Solis)

Putting HD on the global stage

The South American HD families will be joined by three dozen advocates and HD family members from other countries, including HDSA CEO Louise Vetter and leading American HD advocate Katie Moser, the 2010 HDSA Person of the Year. Latin American Catholic leaders will also take part.

“As a global leader, Pope Francis has the power to elevate the conversation about HD to an international stage with a call for compassion – and action,” Vetter said.

I was also invited to meet with the pope, because of my interlocking connections with the Catholic Church, Latin America, and HD advocacy. My mother died of HD, and I carry the genetic defect.

I am thrilled! I consider it a privilege and a responsibility to attend, and expect to bring my wife Regina and teenage daughter Bianca. We will represent the HD community in both the U.S. and Brazil, Regina’s homeland. At least three HD-affected individuals will attend from Brazil, according to advocates there.

(Portuguese speakers can watch my report in that language in the video at the end of this article.)

Help desperately needed

Scientists and advocates began discussing an appeal for the Church to help – and then a papal audience – in 2015.

Dr. Perandones, a clinical geneticist with the National Administration of Laboratories and Institutes of Health in Argentina, and Dr. Muñoz-Sanjuan, of Spain, a vice president at CHDI Foundation, Inc., the nonprofit virtual biotech dedicated solely to the development of HD treatments, first raised the idea of seeking Church support for Venezuela’s isolated HD people during a February 2015 CHDI conference. Talking with Sabine and Senator Cattaneo, Drs. Perandones and Muñoz-Sanjuan said that those families desperately needed help.

With aiding those people in mind, Sabine, a native of England, and Senator Cattaneo came up with idea for a papal audience in fall 2015 after Sabine saw a man with Parkinson’s disease have his picture taken with Francis and also learned the poignant story of an HD-affected teen from Buenos Aires. Sabine and the senator found no “reference anywhere by any pope to Huntington’s disease,” he explained.

Thanks to Cattaneo’s connections and the Vatican’s receptivity, they were able to schedule the papal audience. Now, Sabine says of the upcoming meeting, “It is perhaps one of the most historic moments in the history of the HD community.”

According to Sabine, it will mark the first time that any world leader, including a U.S. president, will meet with HD families.

Charles Sabine (above, photo by Gene Veritas, aka Kenneth P. Serbin) and Senator Elena Cattaneo (below, photo from Cattaneo Lab)

A major opportunity to overcome shame, stigma

Sabine, a former foreign correspondent for NBC News, has pursued activism since the mid-1990s, without being yet symptomatic. His father died of HD, and an older brother has the disease.

“I had spent a lot of time working for NBC at the Vatican,” he said. “I know that the pope is the hardest person on the planet to get to – much harder than the American president.”

By blessing and speaking to HD-afflicted families publicly, Francis can make a “profound difference” in combatting the shame and stigma surrounding HD, Sabine added.

“We want as much press on this as possible,” he continued. “We want to engage as many people as possible around the world, not just Catholics, to make this into a larger sum than the parts.”

“Furthermore, we hope this will lead to action, both by the Catholic Church, with its strong presence in Latin America, as well as from local and national institutions,” Dr. Muñoz-Sanjuan wrote in an e-mail.

The public event will take place in a 7,000-seat auditorium, where attendees can observe the pope’s interaction with the South American families and HD advocates. Event organizers want as many representatives as possible from the HD community to attend.

“Anyone can go,” Sabine emphasized. “They don’t even need to be HD-affected. They might just care about HD."

The announcement made today by the international HD coalition; click on image to view larger (photo courtesy of HDSA).

A humanitarian endeavor

The organizers also hope the meeting galvanizes the HD community worldwide. Members of groups such as the global Huntington’s Disease Youth Organization could meet beforehand and go to the event together, Sabine suggested. Other events in Rome will celebrate the unity of the HD movement and solidarity with the plight of Latin American HD communities.

All attendees are required to register on the event’s official website, HDdennomore.com, by May 5. The URL means “HD Hidden No More,” a theme of the papal event linked to Sabine’s previous awareness campaign in the UK Parliament.

The site will provide information on hotels, accommodations for special needs of the affected, and more.

Noting the “immense pressure” on Francis I from ultra-conservative Catholics because of his purported liberal stance, Sabine said that Senator Cattaneo and her staff have stressed the non-political nature of the HD event.

“It’s a humanitarian one,” he said. “It’s a pastoral event. This is about regarding people with compassion and humanity. This pope has shown humanitarian credentials unlike any other.”

South America’s HD-affected: deep struggles

The papal event builds on work by Factor-H, a small nonprofit organization, to improve the living conditions in the Lake Maracaibo region of Venezuela, and other sites where poor HD families cluster. Many HD families in the region live in dire conditions. In some clusters, many generations of intermarriage mean many families have passed on the genetic disease.

Maracaibo has played a key role in HD science. Columbia University scientist Nancy Wexler, Ph.D., started the search for the HD gene among Maracaibo HD families in the 1970s. In 1993, the HD gene was discovered. It was one of the first disease genes to be identified. This research

helped stimulate the Human Genome Project of the 1990s. Dr. Wexler also was invited to meet the pope, Sabine said.

“Poverty and disease are a terrible combination,” wrote Dr. Muñoz-Sanjuan, who has taken aid to Maracaibo and other communities. “Not everyone in Latin America with HD is poor. However, the main clusters in Venezuela and Colombia are very poor, and neglected. That’s why we are focusing on these clusters.”

“These are people living maybe in families of 16 in a space the size of an American garage on stilts on a lake,” Sabine observed. “No electricity. No running water. Nothing. It was so clear that there were so many people like the people at Lake Maracaibo who are affected by the disease and who have never had any kind of recognition from their respective governments or churches.”

Sabine said he hoped the Vatican event will empower Catholic HD families everywhere to seek assistance from their local clergy in raising awareness about HD and alleviating the social burden of the disease.

Dr. Ignacio Muñoz-Sanjuan (seated) with Colombian children at risk for HD (personal photo)

Preparing the logistics

Every HD family knows the extremely difficult challenge of travel for affected individuals, whose symptoms include constant involuntary movements, loss of balance, and cognitive decline. Many require wheelchairs.

To underwrite the cost of the enormously complex task of transporting the HD families to Rome, Sabine raised $100,000 from Israel-based Teva Pharmaceutical Industries Ltd. and $50,000 from the U.S.-based, HD-related Griffin Foundation.

Almost all of the South American travelers must get their first-ever passports, and in some cases even birth certificates.

The Vatican is helping to speed the acquisition of travel documents and to prepare special accommodations for the families, including lodging at a monastery near the Vatican instead of a hotel.

“We felt they would be more comfortable staying all together in a quiet and peaceful place,” Dr. Muñoz-Sanjuan noted. “We assumed that they will experience some culture shock and wanted for them to be at ease during their stay and make the experience more personable.”

Physicians will accompany the families.

A lonely HD teen in Buenos Aires

On January 6, the Feast of the Epiphany on the Catholic calendar (the day the Christ child was visited by three kings, according to the Bible), each of the South Americans received a red envelope from the Vatican with the invitation to meet with Francis. (Video recordings of these moments will become available at HDdennomore.com.)

One was 15-year-old Brenda, who lives in the greater Buenos Aires area, where Francis served as archbishop. She has juvenile HD, which has severely hampered her ability to speak and learn. She communicates mainly by texting on her cell phone.

“The children don’t play with her, so she’s very lonely,” Sabine said. “She has no friends, because they’re afraid of catching HD. The local school wouldn’t give her access to a laptop, because they said there’s not much point, because she doesn’t have long to live.”

“Brenda is my patient and I have a great affection to her,” Dr. Perandones wrote. “She is very clever and sensitive. We have a great connection.”

According to Dr. Perandones, Brenda and her father - from whom she inherited HD - lived with his sister, Brenda’s aunt, whom she calls “mom.”

“A major concern for the aunt at the time was the fact that Brenda and her father shared the bedroom, and his movements during the night scared Brenda a lot,” Dr. Perandones recalled in an e-mail to supporters about Brenda’s reaction to the papal invitation.

To lift the family’s spirits and improve their living situation, Drs. Perandones and Muñoz-Sanjuan raised funds to make a heartfelt “Christmas for Brenda.” That resulted in the remodeling of the aunt’s home, including a new room for Brenda, a full bathroom, and a recreational area.

“Regrettably, Brenda’s father’s health gradually deteriorated and last year, on the day Brenda turned 15, he passed away,” Dr. Perandones wrote. (For girls turning 15 in Latin America, the quinceañera is typically a joyous passage to womanhood.)

Brenda and her aunt (personal photo)

A turning point for HD community

Sabine said “Brenda’s Christmas” helped inspire the idea of a papal audience.

Dr. Perandones, who describes herself as “totally Catholic,” met Francis (then Archbishop Jorge Bergoglio) before his papal election through her support of a group advocating for victims of human trafficking in Argentina. He “always supported” this effort, she recalled in her written response to my questions.

“Many indigent individuals living in the streets of Buenos Aires have neurological and mental health conditions, including Huntington’s disease,” she added. “Bergoglio was interested in this issue and gave his support to start a Homeless Rescue Program."

Dr. Perandones hopes the meeting will make HD move visible and attune others to HD families’ regular difficulties and challenges.

“I think that the meeting with the pope will be a turning point for the HD community globally and particularly in Latin America,” she stated.

In addition to Brenda and her aunt, the papal invitees include HD families from the towns of San Luís and Barranquitas in Venezuela’s Maracaibo region and from the city of Medellín and the small town of El Difícil in Colombia.

Brenda flanked by Dr. Claudia Perandones and Academy Award winner Eugenio Zanetti, a supporter of the HD cause, after Brenda received news of the papal invitation (personal photo).

A testament to the world

Rooted in Christian love and compassion, Pope Francis’s meeting with the HD-affected of South America should reflect the Church’s historic mission of aiding the sick and defenseless. With 1.27 billion Catholics and hundreds of thousands of priests, nuns, and other personnel, the Church runs an enormous, vital network of charitable and social-service entities that could have a significant impact on HD.

With the biomedical revolution, the Church has sought to both apply and adapt its 2,000-year-old moral and theological tradition to today’s bioethical challenges.

The Huntington’s disease community stands on the bioethical frontier. HD families contribute to advances in neurological and rare-disease research, and they have pioneered ways of dealing with the impact of disease such as discrimination, disability, decisions about genetic testing, family unity, caregiving, suicide, and end-of-life care.

The May 18 meeting with Pope Francis will allow the HD community to provide a testament to the world of human perseverance and solidarity and, ultimately, the need to alleviate and cure devastating diseases.

“Those suffering with HD and living in extreme poverty need urgent help to lead a life of dignity and hope,” Dr. Ignacio Muñoz-Sanjuan asserted.

I hope that Francis’s Pope’s humanitarian gesture serves as a message to the church and to world opinion leaders to address the critical need of ameliorating Huntington’s disease.

Janeth Mosquera, of the Colombian HD patient association and Factor-H, hugs an HD man in the town of Choco in the Colombian jungle, April 2016, after delivering assistance (personal photo).

Creating a Christmas memory for a Huntington’s family

As he slowly succumbs to Huntington’s disease, Dan Boyle of Bakersfield, CA, is building a legacy for his five-year-old at-risk son Colby to remember when the symptoms make impossible his greatest professional love: conducting music.

On the evening of December 19, with his musically inclined wife Audrey and Colby present, Dan, 45, will lead the Poway High School Band in a performance of “Russian Christmas Music,” the piece that inspired him to pursue a musical career when he played trumpet in the band in the mid-1980s.

“Every aspect of music is cool,” Dan said as we sat outside the Poway High band room this morning after he conducted a half-hour rehearsal of the song along with 175 band members. “I just want him to see this particular aspect. He can already pick up my trumpet and make a sound. He’s been to all our performances. The more avenues he can see, the better.”

A tradition more than three decades old, the annual Poway High Winter Band Concert involves band alumni in the performance. This year, because of Dan’s popularity and his struggle against HD, alumni from around the country and as far off as Japan will visit and play their instruments under his direction.

“He’s the last person in the world that deserves this, although we knew there was a possibility,” said Ron Schei, a childhood friend who lives near Toyko, referring to Dan’s diagnosis and his family’s history of HD. “It’s just a horrible, horrible thing.

“It’s a beautiful event. It’ll be important for Dan and for us. And if it leads to more awareness – most people don’t know about Huntington’s – and brings in some donations for the cure, it’ll have a positive effect.”

“They want to share that experience with him,” Sylvester Sybilski, the assistant band director, said of Dan’s friends. “That’s what I think is touching everyone’s heart: how he’s trying to create these moments for his son and videotape them so that eventually, when the disease gets the best of him, his son will have a record of all these events he’s going to be doing for the next five, ten years.”

Christmas this year has a special meaning for Dan. “Seeing how many friends are coming, it really makes you feel good,” he said.

Ron Schei (left) with friends Colby and Dan Boyle at Poway High School (photo by Gene Veritas)

The first symptoms

Over the years, Dan had garnered recognition for his musical talent and leadership. A native of Rancho Bernardo, CA, he was part of a world champion drum corps team at the University of California, Los Angeles, where he and Audrey met while both receiving degrees in music education. In Bakersfield, CA, where the couple worked as music educators, he was teacher of the year at Highland High School, and in Kern County he was named jazz educator of the year, orchestra educator of the year, and band director of the year.

However, Dan’s fate would include an encounter with HD. His mother, aunt, and grandmother all died of HD. He first noticed symptoms in himself in 2009 and received an official diagnosis in 2010.

After more than a decade of employment, he was no longer able to work. He receives a public school teacher’s pension and Social Security disability, while Audrey, 40, continues to work as a junior high school music instructor and band director.

In a typical progression of HD symptoms, Dan said that he can no longer multi-task, and his short-term memory is bad.

“Packing yesterday, there were three different times when I went to get the same item,” he said with a bit of a chuckle. “In the big realm of things, I would rather have short-term than long-term memory loss. Long-term is your real memories. Short-term is convenience.”

Fear of falling

HD is also affecting him physically. He has a still mild version of the involuntary movements experienced by most HD patients. His eyes move irregularly or sometimes seem to stare into space, and his face freezes up. He also has some difficulty in speaking.

“I used to hike and ski,” Dan said. “I was never very fast, but I hiked the Grand Canyon rim to rim back in 2005.

“I just started to feel weaker. I hadn’t gone skiing since Colby was born, and last winter we went. Before I was diagnosed, I could do the intermediate slopes. (This time) I was on the easiest slope there was, and I fell like ten times.”

He adds, chuckling, “I have no sense of balance! I think I know when to say when.”

Falling presents the biggest threat to Dan’s health. He recently needed to receive staples for a gash he suffered on his head. During our conversation, he turned his head to show me a very large, red bump on the back of his head from another fall just yesterday.

He plans to start using a motorized wheelchair soon.

Dan also suffers from diabetes caused by another genetic condition, hemochromatosis.

“I won the lottery, I guess,” he said with a laugh.

The conductor’s passion

However, HD’s onslaught has not stopped Dan from conducting again for the first time in several years. In today’s rehearsal of “Russian Christmas Music,” he sat in a conductor’s chair and will do so again at the concert.

“I conducted ever day, five hours a day,” Dan recalled. “When you teach music, you stand all day. It would never bother me, even a little bit.

“Over the last six to eight months, I have noticed an extreme shrinking of the time that I can stand without pain.”

Sylvester and band director Mike Cook are “bending over backwards” to make it possible for him to conduct, Dan said. He happily complied with Mike’s request for a taped audition.

Poway High School band director Mike Cook (left) and assistant director Sylvester Sybilski (photo by Gene Veritas)

“You can easily ruin a performance as a conductor, and because the score is an advanced score, he just wanted to make sure I could still do it,” Dan said.

Although Dan experienced some HD movements during the rehearsal, he successfully finished the piece along with the students.

“’Russian Christmas Music’ is a very challenging piece of music,” said Sylvester. “So, even for someone in perfect health, it would be a challenge. I think it went very well.”

“His mind seems pretty clear,” noted Mike, adding that Dan has “an extremely bright wit” and an “obviously still strong” sense of humor.

“It’s a pretty cool feeling to get to control all that sound at once and have it respond to you,” Dan said of the work of conducting. “I couldn’t believe I didn’t really have any good videos of me conducting. I have lots of me playing, but not of my conducting. I’m glad they gave me the opportunity to do this.”

You can watch the rehearsal in the video below.

'Russian Christmas Music' Conducted by Huntington's Disease Patient Dan Boyd from Gene Veritas on Vimeo.

Planning a future for Colby

Dan is also writing an autobiography he wants Colby to read someday. It will include fatherly advice for a young man. It will also address the family’s experience with HD.

During our interview, Colby sat next to Dan. Engrossed in a hand-held video game, Colby raised five fingers when asked to tell his age.

Like many HD families, the Boyles faced difficult decisions. Colby was born not long before Dan’s symptoms began. Even though the couple knew of Dan’s risk for HD, he had not been tested. Nor did they resort to methods for avoiding the transmission of the mutation. They preferred to let life take its natural course.

“Obviously I worried about passing it on,” said Dan. “I just figure there’s always hope for the cure. He could get hit by a bus tomorrow. I could, too. I got a scholarship to UCLA. I played trumpet in 40 of the 50 states. I’ve travelled. I’ve done a lot of good things. Hopefully he’ll be able to experience those things before whatever.”

However, Dan and Audrey are proactive about his HD. They keep informed about the latest developments in HD research. They attended the annual convention of the Huntington’s Disease Society of America in Jacksonville this year and in Las Vegas in 2012. Dan is also participating in a clinical trial to examine the efficacy of the supplement creatine. He plans to enter any other trial for which he qualifies in the future.

“I just want to make sure, whether Colby has it or not, that I’ve done everything possible to help the cause of research,” Dan said. “That’s one of my big responsibilities. When I was a kid they said, ‘Oh, you don’t really have to worry about it, because by the time you’re old enough, they’ll have it cured.’ I remember hearing that time and time again. But that didn’t happen.”

It’s never too late

For now, Dan is taking advantage of every moment.

He uses music, especially playing the trumpet, to try to stave off the impact of HD on his brain.

“There’s so many decisions every second in music,” he said. “It's unbelievable how active your brain is while you’re playing.”

He, Audrey, and Colby will spend Christmas at home in Bakersfield – preceded, of course, by Dan putting out milk and cookies for Colby and Santa Claus.

Audrey didn’t believe people still did that. “She found out the hard way,” Dan said.

“One of the silver linings of this is, because I am home for Colby, I feed him every day, I give him his bath, I wash his clothes, I do his homework with him, I read to him,” Dan said. “We have a really close relationship.”

Dan has a simple message for the HD community, one he will put into practice on December 19: “It’s easy to withdraw and just go into a shell, but it’s never too late to do some of the things that you’ve always done.”

(The winter concert, which will take place in the Poway High School gymnasium, starts at 7. The event is open to the public. Admission is $5. The band directors recommend arriving early to obtain seating. The school is located at 15500 Espola Road.)

Reaching out to the ‘HD family’ at the World Congress on Huntington’s Disease

As I returned on the plane from Brazil and the sixth World Congress on Huntington’s Disease, held September 15-18 in Rio de Janeiro, I was thrilled about my fortified connections to the emerging global movement to defeat HD.

I greatly expanded my contacts within the Brazilian HD community, which had the largest representation of HD family members, with more than 60 attendees.

After months of frequent contact via e-mail, phone, and Skype, I was delighted to meet in person Taíse Cadore, the president of the Associação Brasil Huntington (ABH), and neurologist Francisco Cardoso, M.D., Ph.D., two key organizers of the event. Along with Dr. Mônica Santoro Haddad, Cadore, Cardoso, and I have worked to raise the profile of HD in Brazil and to involve the government in improving the care provided to patients.

ABH volunteers helped put on the congress, staffed an information table, and attended many of the scientific and HD-family-oriented activities. Along with the organizing committee and many other Brazilians contributing to the event, the ABH volunteers made the congress a success.

In the coming days, I will prepare a comprehensive report on the congress, including a video of my presentation on coping strategies for living with the HD gene, plus many of the other presentations.

Taíse Cadore (photo by Gene Veritas)

Gene Veritas with (from left to right) ABH volunteers Carmen Faccio, Maria Eni Souza, Carmen Varalta, Majida, and Tereza Portigliotti and Zulay Final Romero of the Venezuelan HD association. The t-shirts say "embrace this cause." 

Cramming in activities

For now, I am focusing on the transition from the cultural environment of Brazil – my “other home” – back to my life in San Diego.

International journeys require intense, detailed preparation. This one proved especially demanding.

After a 25-year stretch in which I visited Brazil annually, including long periods living there, I declined to travel there in 2011 and 2012. Those years my time was taken up by my increasingly public HD advocacy and my added focus on the history of science, technology, and medicine in the context of the Huntington’s movement. The trip felt like a whirlwind: it included the congress, four presentations, other Brazil-related research, and visits with relatives and friends crammed into just ten days.

It didn’t help matters that my connection to Rio was delayed some 13 hours, obliging me to spend the early morning of September 13 sleeping on a cot in the Dallas-Fort Worth airport. The trip to Rio wound up taking 30 hours!

A life-affirming quest

This was not just another of my expeditions to Brazil.

Once again, I was on a mission to help defeat Huntington’s disease, the condition that, unless a treatment comes soon, will relentlessly attack my brain. In addition to helping with advocacy in Brazil and planning a bit of the congress, I spent more than 30 hours preparing the speeches I would deliver in Brazil.

The day before I left the U.S., I gave a 90-minute Skype interview to journalist Marcelo Leite, who published an article in the Folha de S. Paulo titled “‘It’s necessary to pass laws against genetic discrimination,’ says historian.”

The ABH circulated copies of the article at the congress. A radio reporter who had seen the article interviewed me and others. Senator Aloysio Nunes Ferreira, one of three senators representing the state of São Paulo, Brazil’s most populous and economically powerful state, wrote me a personal e-mail pledging to push for passage of such legislation in Brazil’s Congresso Nacional.

I felt a deeply visceral satisfaction meeting with so many of the HD movement’s advocates. It was emotionally wrenching to see people with HD and hear the affected, gene carriers, at-risk, and caregivers tell their stories.

Hugging my fellow “HD family” members from far-off lands or shaking their hands joined us in a lifelong, life-affirming quest.

Gene Veritas with actress and ABH volunteer Luiza Portigliotti 

Gene Veritas with Carlos and Eliezé Adriani of Campinas, Brazil

Stark challenges, seeking advice

One woman, a middle-aged dentist from Rio in the early stages of HD but still completely lucid, wanted to know about supplements and other remedies that I take.

The mother of Priscila, a 31-year-old Rio woman with pronounced chorea, the involuntary, dance-like movements produced by HD, asked how she might get her daughter into a clinical trial for the HD “vaccine” they heard was in development in California. The newspaper O Estado de S. Paulo featured Priscila and her family in an article about the world congress and HD.

Priscila's mom was referring to the gene-silencing approach at Carlsbad-headquartered Isis Pharmaceuticals, Inc., which, along with pharmaceutical giant Roche, hopes to start Phase I of the trial by the end of 2014. I explained that Isis and Roche had not yet announced the trial sites and suggested that she and her family should keep abreast of news on the project.

Others shared with me their stories of testing positive for the gene, the stark challenges of family planning, and learning that a potential future mate is at risk.

Priscila, a 31-year old Rio resident who suffers from HD (photo courtesy of O Estado de S. Paulo)

Priscila on the beach in Rio (photo courtesy of O Estado de S. Paulo)

In sync with the movement

During this trip, I reached many milestones.

I felt fully in sync with the HD movement, its values, and its supporters, as I took 13 congress participants and leading HD researchers to my favorite Rio steakhouse and bar; for the first time met Nancy Wexler, the dean of HD scientists; and delivered my speech on HD and bioethics and engaging with the emotion-charged audience at a college in São Paulo on September 21.

As waiter serves steak, Gene Veritas (right) converses with HD specialist Dr. Ed Wild, global HD advocate Charles Sabine, and HD drug-hunter Dr. Doug Macdonald at Café Lamas in Rio de Janeiro (photo by Alice Wexler).

I felt vindicated in my decision to go fully public about HD late last year and meld my professional and personal lives with my advocacy.

I smiled and got a warm feeling inside as I spoke of this big transition in my life with a long-time Brazilian friend and professional colleague.

As she observed, I was doing the right thing.

Gene Veritas (aka Kenneth P. Serbin) in Rio (photo by Tim Power)

The incredible lightness – and responsibility – of exiting the Huntington’s closet

A month after definitively exiting the Huntington’s closet by publishing my story in the mainstream media, I feel an immense relief.

As one good friend predicted, I now feel lighter.

After learning of my mother’s diagnosis for HD on the day after Christmas 1995, I built a near-perfect firewall between my advocacy for the Huntington’s Disease Society of America (HDSA) and my career.

Nothing symbolized that firewall more than my e-mail management. On thousands of occasions I zealously guarded the firewall by sending messages from five different accounts and often triple-checking the sending address and especially the addressee.

Now I no longer worry! I relish communicating about Huntington’s disease on my main e-mail.

Speaking or writing openly about HD is an utterly new and liberating experience.

“I feel now that I can be more fully ‘me,’” I wrote to one work colleague, who first learned of my story with the publication of my article in The Chronicle of Higher Education on November 4.

I also feel closer to everybody – from my wife and daughter to all of the people at work I had kept in the dark about my risk for HD and my work as Gene Veritas.

Gene Veritas, aka Kenneth Serbin (photo by Bianca Serbin)

In my corner

The feeling of lightness grows when I think of the immense emotion and support my story stirred among friends and professional colleagues.

“Only now do I believe the social and political climate in America have evolved to the point where I can reveal my journey living with the gene for Huntington’s disease,” I wrote in an e-mail notifying my work colleagues about the article. “Please know that what will most certainly come as a shock to you is something that I have come to terms with over the past 17 years. I am also happy to report that I received a clean bill of neurological health at my most recent checkup on October 30.” 

Most were stunned to learn that I had tested positive for HD and, together with my wife Regina, faced the travails of leading a double life, testing our daughter Bianca for HD in the womb, and witnessing my mother’s demise.

The very first comment, and perhaps the most significant, came from the person whose reaction I worried about the most, my dean (and, essentially, boss) at the University of San Diego, Dr. Mary Boyd.

I was immensely relieved and deeply moved to read her e-mail: “Thank you for your courage in sharing your story. You are a true inspiration and I am so proud that you are my colleague.”

“Thanks for your kind words of support,” I responded. “It means the world to me that you are in my corner.”

Dr. Boyd, who sent news of my article to her Twitter followers, later asked if I would grant an interview for a feature article on the university website. On November 20, I gave the interview and did a photo shoot with Regina and Bianca. The article and a video will appear soon.

Sources of strength

Several colleagues were, not surprisingly, a bit hurt that I hadn’t confided in them sooner. Still, they understood when I explained that I couldn’t risk harming my career and by extension my family.

A number of colleagues had never heard of HD or had little knowledge of it. One actually knows a local family facing the disease and promised to put them in touch with me. Along with her husband, another responded immediately by donating to HDSA.

Others recalled their own families’ struggles with neurological disorders. One colleague at risk for Parkinson’s revealed how her father had died of a combination of Parkinson’s and Lewy body disease.

Another, whose sister had just died after a long bout with cancer, began reading this blog after seeing the Chronicle article. “It’s a little hard for me hearing so many voices of people in pain given my recent loss,” he wrote, “but at the same time, I have to tell you, it has been therapeutic in spite of the fact that we are looking at different conditions, … because the family dynamics of people who have to go through this are so similar.”

More than a dozen people left comments on The Chronicle website. “I am also at-risk for HD, and I'm also a budding humanities scholar (recipe for disaster, eh?),” wrote one person. “Your article was very moving, and I am so relieved that your good works will make it easier for the rest of us to live with HD more openly. The stigma can be just as debilitating as the disease.  I’m also sending you an email, and I would love to help with advocacy and awareness.”

Such comments, e-mails, and my colleagues’ gestures, including some very special hugs, provided me with incalculable strength to carry on the fight against Huntington’s.

Doing our jobs

“Yes, I am feeling much lightness, one the one hand, but, on the other, an even greater responsibility and determination in carrying this fight forward,” I wrote one friend and former San Diego colleague.

To another fellow professor, I expanded on the idea of responsibility: “We all must be leaders – in our families, our jobs, our churches, our communities. I am simply doing the job that we are all cut out to do in life.”

People sensed that I don’t dwell on the negatives of my predicament. Like all of us, they proceeded with their own challenges. Hardly missing a beat, I maintained my own routine at home and at work.

However, I also renewed my commitment to defeat HD.

On Friday, November 16, I helped out at HDSA-San Diego’s 12^th annual Celebration of Hope Gala. Afterwards, I pulled an all-nighter to post an article about the gala and efforts by the honored company, Isis Pharmaceuticals, Inc., to set up a clinical trial of a potential drug for attacking HD at its genetic roots.

I arranged for a Portuguese translation of my Chronicle article to appear in one of Brazil’s most prestigious newspapers, the Folha de S. Paulo, later this month. (My academic specialty is Brazil, and I speak Portuguese.) In September 2013, Rio de Janeiro will host the World Congress on Huntington’s Disease, which I plan to attend. The Southern Alberta Chapter of the Huntington Society of Canada will also republish the article.

With the family holiday greetings cards I mailed last week, I included a slip of paper with the HDSA Snowflake of Hope and Help and a reminder to keep the organization in mind for year-end charitable giving.

I’m going to start wearing my blue HDSA “Care2Cure” bracelet, and I’m going to set up my e-mail program to include a tagline with information about HD and my advocacy in every message I send.

Gene Veritas – again

Each day I am reminded that people are suffering and dying from Huntington’s disease.

In exiting the Huntington’s closet, I want to combat the stigma and fear surrounding HD and galvanize increased support for brain research. This is my job as a public advocate.

However, I’ve also done something to and for my private self. By publicly sharing my gene-positive status, I am assuming it for myself fully for the first time.

All the years of anonymity allowed me to deny that I could get symptoms. As terrible and lonely as the HD closet was, I felt safe inside.

More than ever before, I am Gene Veritas, the truth in my undeniable genes, which include the debilitating and deadly mutation that causes Huntington’s disease. Gene Veritas is also Kenneth Serbin, professor, HD community advocate, husband, and father.

The responsibility is enormous: I must work, in concert with other advocates, to save myself and my family from the ravages of HD.