Hereditary Sensory and Autonomic Neuropathies (HSANs) compose a heterogeneous group
of genetic disorders characterized by sensory and autonomic dysfunctions. Familial
Dysautonomia (FD), also known as HSAN III, is an autosomal recessive disorder that
affects 1/3,600 live births in the Ashkenazi Jewish population. The major features of
the disease are already present at birth and are attributed to abnormal development
and progressive degeneration of the sensory and autonomic nervous systems. Despite
clinical interventions, the disease is inevitably fatal. FD is caused by a point
mutation in intron 20 of the IKBKAP gene that results in severe
reduction in expression of IKAP, its encoded protein. In vitro and
in vivo studies have shown that IKAP is involved in multiple
intracellular processes, and suggest that failed target innervation and/or impaired
neurotrophic retrograde transport are the primary causes of neuronal cell death in
FD. However, FD is far more complex, and appears to affect several other organs and
systems in addition to the peripheral nervous system. With the recent generation of
mouse models that recapitulate the molecular and pathological features of the
disease, it is now possible to further investigate the mechanisms underlying
different aspects of the disorder, and to test novel therapeutic strategies.