Objective: Friedreich's ataxia patients are homozygous for expanded alleles of a GAA triplet-repeat sequence in the FXN gene. Patients develop progressive ataxia due to primary neurodegeneration involving the dorsal root ganglia (DRGs). The selective neurodegeneration is due to the sensitivity of DRGs to frataxin deficiency; however, the progressive nature of the disease remains unexplained. Our objective was to test whether the expanded GAA triplet-repeat sequence undergoes further expansion in DRGs as a possible mechanism underlying the progressive pathology seen in patients. Methods: Small-pool polymerase chain reaction analysis, a sensitive technique that allows the measurement of repeat length in individual FXN genes, was used to analyze somatic instability of the expanded GAA triplet-repeat sequence in multiple tissues obtained from six autopsies of Friedreich's ataxia patients. Results: DRGs showed a significantly greater frequency of large expansions ( p Ͻ 0.001) and a relative paucity of large contractions compared with all other tissues. There was a significant age-dependent increase in the frequency of large expansions in DRGs, which ranged from 0.5% at 17 years to 13.9% at 47 years (r ϭ 0.78; p ϭ 0.028). Interpretation: Progressive pathology involving the DRGs is likely due to age-dependent accumulation of large expansions of the GAA triplet-repeat sequence. Thus, somatic instability of the expanded GAA triplet-repeat sequence may contribute directly to disease pathogenesis and progression. Progressive repeat expansion in specific tissues is a common theme in the pathogenesis of triplet-repeat diseases.Ann Neurol 2007;61: [55][56][57][58][59][60] Friedreich's ataxia (FRDA) is characterized by progressive sensory ataxia with onset before 25 years of age, areflexia, loss of position and vibration senses, dysarthria, and extensor plantar responses. 1 Patients have primary degeneration of dorsal root ganglia (DRGs), associated with axonal degeneration of the posterior columns, spinocerebellar tracts, and corticospinal tracts, and large myelinated fibers in peripheral nerves. 2 In later stages, the cerebellum may be affected; however, other regions of the nervous system remain unaffected. Two-thirds of patients have cardiomyopathy. Although the rate of progression is variable, the mean age of loss of ambulation is 25 years, and patients often die prematurely. 1 FRDA is an autosomal recessive disease, and most patients are homozygous for expanded GAA tripletrepeat sequences (E alleles) in intron 1 of the FXN gene. 3 E alleles interfere with transcription in a lengthdependent manner, 4 resulting in deficiency of the mitochondrial protein frataxin. 5 E alleles contain 66 to 1,700 triplets, and the severity of disease and rate of progression correlate with repeat length. 6 -8 DRG neurons are hypersensitive to frataxin deficiency as seen in neuronal-specific, conditional, frataxin knock-out mice. 9 However, this mouse model did not accurately mimic the situation in FRDA, because the mice had normal levels th...