Huntington's Disease: Pathogenesis, Therapies, and Emerging Technologies
Abstract
Huntington’s Disease (HD) is a hereditary neurodegenerative disorder that is primarily manifested by motor, cognitive, and behavioral symptoms due to an expanded CAG trinucleotide repeat in the HTT gene. Currently, most of the therapeutic strategies in HD are largely centered on the pharmacological management of the symptoms. These treatments are linked to some disadvantages such as being partially effective, having adverse effects, and their inability to alter the natural course of the disease. Recent developments in HD research are exploring the use of novel pharmacological agents, nanoparticles, cell therapies, gene therapies, and RNA-based therapies, which have shown promise in preclinical and clinical studies. This literature review explores various aspects of HD, from its pathogenesis and etiology to emerging novel approaches for its treatment.
Keywords: Huntington's Disease, HTT Gene, Nanotechnology, Neurodegeneration, Emerging Therapies, Mutant Huntingtin Protein
Keywords:
Huntington's Disease, HTT Gene, Nanotechnology, Neurodegeneration, Emerging Therapies, Mutant Huntingtin ProteinDOI
https://doi.org/10.22270/jddt.v14i10.6828References
McColgan P, Tabrizi SJ. "Huntington’s disease: a clinical review". Eur J Neurol. 2018;25(1):24–34. https://doi.org/10.1111/ene.13413 PMID:28817209.
Tong H, Yang T, Xu S, Li X, Liu L, Zhou G, Yang S, Yin S, Li XJ, Li S. "Huntington’s Disease: Complex Pathogenesis and Therapeutic Strategies". Int J Mol Sci. 2024;25(7). https://doi.org/10.3390/ijms25073845 PMID:38612657.
Novak MJU, Tabrizi SJ. Huntington’s disease: Clinical presentation and treatment. Int Rev Neurobiol, vol. 98, Academic Press Inc.; 2011, p. 297–323. https://doi.org/10.1016/B978-0-12-381328-2.00013-4 .
Richards M. "Predictive testing for Huntington’s disease [3]". Lancet. 2001;357(9259):883. https://doi.org/10.1016/S0140-6736(05)71813-4 PMID:11265978.
Jiang A, Handley RR, Lehnert K, Snell RG. "From Pathogenesis to Therapeutics: A Review of 150 Years of Huntington’s Disease Research". Int J Mol Sci. 2023;24(16). https://doi.org/10.3390/ijms241613021 PMID:37629202.
Qureshi FH, Qureshi SH, Zia T, Khawaja F. "Huntington’S Disease (Hd): a Brief Review". European Journal of Public Health Studies. 2022;5(1). https://doi.org/10.46827/ejphs.v5i1.115 .
Frank S. "Treatment of Huntington’s Disease". Neurotherapeutics. 2014;11(1):153–60. https://doi.org/10.1007/s13311-013-0244-z PMID:24366610.
Dash D, Mestre TA. "Therapeutic Update on Huntington’s Disease: Symptomatic Treatments and Emerging Disease-Modifying Therapies". Neurotherapeutics. 2020;17(4):1645–59. https://doi.org/10.1007/s13311-020-00891-w PMID:32705582.
De Souza RAG, Leavitt BR. "Neurobiology of Huntington’s disease". Curr Top Behav Neurosci. 2014;22:81–100. https://doi.org/10.1007/7854_2014_353 PMID:25205327.
Payal B Kshirsagar, Hemant S Kanhere, Pallavi C Bansinge, Sawan K Rathod, Vrushali S Khandare, Ranjita K Das. "Huntington’s disease: Pathophysiology and therapeutic intervention". GSC Biological and Pharmaceutical Sciences. 2021;15(2):171–84. https://doi.org/10.30574/gscbps.2021.15.2.0140 .
Testa CM, Jankovic J. "Huntington disease: A quarter century of progress since the gene discovery". J Neurol Sci. 2019;396:52–68. https://doi.org/10.1016/j.jns.2018.09.022 PMID:30419368.
Nasrullah Md. "HUNTINGTON’S DISEASE: UNDERSTANDING THE PATHOPHYSIOLOGY THROUGH THE HUNTINGTIN GENE". INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES. 2018;05(01). https://doi.org/10.5281/zenodo.1162268 .
Jurcau A. "Molecular Pathophysiological Mechanisms in Huntington’s Disease". Biomedicines. 2022;10(6). https://doi.org/10.3390/biomedicines10061432 .
McGarry A, Biglan K, Marshall F. Huntington’s disease: Clinical features, disease mechanisms, and management. Rosenberg’s Molecular and Genetic Basis of Neurological and Psychiatric Disease: Volume 2, Elsevier; 2020, p. 135–45. https://doi.org/10.1016/B978-0-12-813866-3.00009-6 .
Jimenez-Sanchez M, Licitra F, Underwood BR, Rubinsztein DC. "Huntington’s disease: Mechanisms of pathogenesis and therapeutic strategies". Cold Spring Harb Perspect Med. 2017;7(7):1–22. https://doi.org/10.1101/cshperspect.a024240 PMID:27940602.
Ignácio ZM, Quevedo J, Réus GZ. Pathophysiological mechanisms of huntington’s disease. Pathology, Prevention and Therapeutics of Neurodegenerative Disease, Springer Singapore; 2018, p. 49–60. https://doi.org/10.1007/978-981-13-0944-1_5
Sharma A, Sharma V. "HUNTINGTON’S DISEASE: A REVIEW". World J Pharm Pharm Sci. 2019;8(9):446–76. https://doi.org/10.20959/wjpps20199-14689 .
Papoutsi M, Labuschagne I, Tabrizi SJ, Stout JC. "The cognitive burden in Huntington’s disease: Pathology, phenotype, and mechanisms of compensation". Movement Disorders. 2014;29(5):673–83. https://doi.org/10.1002/mds.25864 PMID:24757115.
Martí-Martínez S, Valor LM. "A Glimpse of Molecular Biomarkers in Huntington’s Disease". Int J Mol Sci. 2022;23(10). https://doi.org/10.3390/ijms23105411 PMID:35628221.
Song W, Chen J, Petrilli A, Liot G, Klinglmayr E, Zhou Y, Poquiz P, Tjong J, Pouladi MA, Hayden MR, Masliah E, Ellisman M, Rouiller I, Schwarzenbacher R, Bossy B, Perkins G, Bossy-Wetzel E. "Mutant huntingtin binds the mitochondrial fission GTPase dynamin-related protein-1 and increases its enzymatic activity". Nat Med. 2011;17(3):377–83. https://doi.org/10.1038/nm.2313 PMID:21336284 .
Sari Y. "Huntington’s Disease: From Mutant Huntingtin Protein to Neurotrophic Factor Therapy.". Int J Biomed Sci. 2011;7(2):89–100 PMID:21841917 .
Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ, Tabrizi SJ. "Huntington disease". Nat Rev Dis Primers. 2015;1. https://doi.org/10.1038/nrdp.2015.5 PMID:27188817.
Dhingra H, Gaidhane SA. "Huntington’s Disease: Understanding Its Novel Drugs and Treatments". Cureus. 2023; https://doi.org/10.7759/cureus.47526 .
Bhat SA, Ahamad S, Dar NJ, Siddique YH, Nazir A. "The Emerging Landscape of Natural Small-molecule Therapeutics for Huntington’s Disease". Curr Neuropharmacol. 2023;21(4):867–89. https://doi.org/10.2174/1570159x21666230216104621 PMID:36797612.
Killoran A, Biglan KM. "Therapeutics in Huntington’s disease". Curr Treat Options Neurol. 2012;14(2):137–49. https://doi.org/10.1007/s11940-012-0165-x .
Palaiogeorgou AM, Papakonstantinou E, Golfinopoulou R, Sigala M, Mitsis T, Papageorgiou L, Diakou I, Pierouli K, Dragoumani K, Spandidos DA, Bacopoulou F, Chrousos GP, Eliopoulos E, Vlachakis D. "Recent approaches on Huntington’s disease (Review)". Biomed Rep. 2023;18(1). https://doi.org/10.3892/br.2022.1587 .
Ferguson MW, Kennedy CJ, Palpagama TH, Waldvogel HJ, Faull RLM, Kwakowsky A. "Current and Possible Future Therapeutic Options for Huntington’s Disease". J Cent Nerv Syst Dis. 2022;14. https://doi.org/10.1177/11795735221092517 PMID:35615642 .
Brett AC, Rosenstock TR, Rego AC. "Current therapeutic advances in patients and experimental models of Huntington’s disease.". Curr Drug Targets. 2014;15(3):313–34. https://doi.org/10.2174/1389450114666131124140704 PMID:24266585.
Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. "Symptomatic treatment options for Huntington’s disease (guidelines of the German Neurological Society)". Neurol Res Pract. 2023;5(1). https://doi.org/10.1186/s42466-023-00285-1 .
Dickey AS, La Spada AR. "Therapy development in Huntington disease: From current strategies to emerging opportunities". Am J Med Genet A. 2018;176(4):842–61. https://doi.org/10.1002/ajmg.a.38494 PMID:29218782.
Quinn N, Marsden CD. "A double blind trial of sulpiride in Huntington’s disease and tardive dyskinesia.". J Neurol Neurosurg Psychiatry. 1984;47(8):844–7. https://doi.org/10.1136/JNNP.47.8.844 PMID:6236286.
Unti E, Mazzucchi S, Palermo G, Bonuccelli U, Ceravolo R. "Antipsychotic drugs in Huntington’s disease". Expert Rev Neurother. 2017;17(3):227–37. https://doi.org/10.1080/14737175.2016.1226134 PMID:27534434.
Stewart JT. "Treatment of Huntington’s disease with clonazepam". South Med J. 1988;81(1):102. https://doi.org/10.1097/00007611-198801000-00029 PMID:2962291.
McGeeney BE. "Anticonvulsants". Cancer Pain: Pharmacological, Interventional, and Palliative Care Approaches. 2006;317–26. https://doi.org/10.1016/B978-0-7216-0261-5.50028-4 .
Winblad B. "Piracetam: A Review of Pharmacological Properties and Clinical Uses". CNS Drug Rev. 2005;11(2):169–82. https://doi.org/10.1111/J.1527-3458.2005.TB00268.X PMID:16007238.
Symington GR, Leonard DP, Shannon PJ, Vajda FJE. "Sodium valproate in Huntington’s disease.". Am J Psychiatry. 1978;135(3):352–4. https://doi.org/10.1176/AJP.135.3.352 PMID:147033.
O’Suilleabhain P, Dewey RB. "A randomized trial of amantadine in Huntington disease". Arch Neurol. 2003;60(7):996–8. https://doi.org/10.1001/ARCHNEUR.60.7.996 PMID:12873857.
Shoulson I, Odoroff C, Oakes D, Behr J, Goldblatt D, Caine E, Kennedy J, Miller C, Bamford K, Rubin A, Plumb S, Kurlan R. "A controlled clinical trial of baclofen as protective therapy in early huntington’s disease". Ann Neurol. 1989;25(3):252–9. https://doi.org/10.1002/ANA.410250308 PMID:2524992.
Loeb C, Roccatagliata G, La Medica G, Abbruzzese G, Albano C. "Levodopa and Huntington’s chorea". J Neurol Neurosurg Psychiatry. 1976;39(10):958–61. https://doi.org/10.1136/JNNP.39.10.958 PMID:137301.
Luis-Ravelo D, Estévez-Silva H, Barroso-Chinea P, Afonso-Oramas D, Salas-Hernández J, Rodríguez-Núñez J, Acevedo-Arozena A, Marcellino D, González-Hernández T. "Pramipexole reduces soluble mutant huntingtin and protects striatal neurons through dopamine D3 receptors in a genetic model of Huntington’s disease". Exp Neurol. 2018;299(Pt A):137–47. https://doi.org/10.1016/J.EXPNEUROL.2017.10.019 PMID:29056363.
de Boer JN, Vingerhoets C, Hirdes M, McAlonan GM, Amelsvoort T V., Zinkstok JR. "Efficacy and tolerability of riluzole in psychiatric disorders: A systematic review and preliminary meta-analysis". Psychiatry Res. 2019;278:294–302. https://doi.org/10.1016/J.PSYCHRES.2019.06.020 PMID:31254879.
Kieburtz K, Feigin A, McDermott M, Como P, Abwender D, Zimmerman C, Hickey C, Orme C, Claude K, Sotack J, Greenamyre JT, Dunn C, Shoulson I. "A controlled trial of remacemide hydrochloride in Huntington’s disease". Movement Disorders. 1996;11(3):273–7. https://doi.org/10.1002/MDS.870110310 PMID:8723144.
Ogilvie AC, Schultz JL. "Memantine Use and Cognitive Decline in Huntington’s Disease: An Enroll-HD Study". Mov Disord Clin Pract. 2023;10(7):1120–5. https://doi.org/10.1002/MDC3.13763 .
Shen YC. "Lamotrigine in motor and mood symptoms of Huntington’s disease". The World Journal of Biological Psychiatry. 2008;9(2):147–9. https://doi.org/10.1080/15622970701332520 PMID:17853293.
Devadiga SJ, Bharate SS. "Recent developments in the management of Huntington’s disease". Bioorg Chem. 2022;120. https://doi.org/10.1016/j.bioorg.2022.105642 PMID:35121553.
Pan L, Feigin A. "Huntington’s Disease: New Frontiers in Therapeutics". Curr Neurol Neurosci Rep. 2021;21(3):10. https://doi.org/10.1007/s11910-021-01093-3 .
Kumar A, Kumar V, Singh K, Kumar S, Kim YS, Lee YM, Kim JJ. "Therapeutic advances for huntington’s disease". Brain Sci. 2020;10(1). https://doi.org/10.3390/brainsci10010043 PMID:31940909.
Mestre TA. "Recent advances in the therapeutic development for Huntington disease". Parkinsonism Relat Disord. 2019;59:125–30. https://doi.org/10.1016/j.parkreldis.2018.12.003 PMID:30616867.
Deb A, Frank S, Testa CM. New symptomatic therapies for Huntington disease. Handb Clin Neurol, vol. 144, Elsevier B.V.; 2017, p. 199–207. https://doi.org/10.1016/B978-0-12-801893-4.00017-1 PMID:28947118.
Zhang J. "Huntington’s Disease-Emerging Therapeutic Methods and Potential Utilisation of Bacteriophage to Overcome Current Challenges". Int J Res Appl Sci Eng Technol. 2024;12(2):1459–66. https://doi.org/10.22214/ijraset.2024.58581 .
Wasser CI, Mercieca EC, Kong G, Hannan AJ, Allford B, McKeown SJ, Stout JC, Glikmann-Johnston Y. "A Randomized Controlled Trial of Probiotics Targeting Gut Dysbiosis in Huntington’s Disease". J Huntingtons Dis. 2023;12(1):43–55. https://doi.org/10.3233/JHD-220556 PMID:37005888.
Eje OE, Ogbonna CV, Onoyima CS, Nduka FO. "Huntington Disease: Mechanism of Pathogenesis and Recent Developments in Its Therapeutic Strategies-A Short Review". Journal of Chemical Reviews. 2023;5(2). https://doi.org/10.22034/jcr.2023.362508.1194 .
Rosser AE, Busse ME, Gray WP, Badin RA, Perrier AL, Wheelock V, Cozzi E, Martin UP, Salado-Manzano C, Mills LJ, Drew C, Goldman SA, Canals JM, Thompson LM. "Translating cell therapies for neurodegenerative diseases: Huntington’s disease as a model disorder". Brain. 2022;145(5):1584–97. https://doi.org/10.1093/brain/awac086 PMID:35262656.
Jurcau A, Jurcau MC. "Therapeutic Strategies in Huntington’s Disease: From Genetic Defect to Gene Therapy". Biomedicines. 2022;10(8). https://doi.org/10.3390/biomedicines10081895 .
Kieburtz K, Reilmann R, Olanow CW. "Huntington’s disease: Current and future therapeutic prospects". Movement Disorders. 2018;33(7):1033–41. https://doi.org/10.1002/mds.27363 PMID:29737569.
Killoran A, Biglan KM. "Current therapeutic options for Huntington’s disease: Good clinical practice versus evidence-based approaches?". Movement Disorders. 2014;29(11):1404–13. https://doi.org/10.1002/mds.26014 PMID:25164707.
Mason SL, Barker RA. "Advancing pharmacotherapy for treating Huntingtons disease: A review of the existing literature". Expert Opin Pharmacother. 2016;17(1):41–52. https://doi.org/10.1517/14656566.2016.1109630 PMID:26536068.
Bachoud-Lévi AC, Massart R, Rosser A. "Cell therapy in Huntington’s disease: Taking stock of past studies to move the field forward". Stem Cells. 2021;39(2):144–55. https://doi.org/10.1002/stem.3300 PMID:33176057.
Shannon KM. "Recent Advances in the Treatment of Huntington’s Disease: Targeting DNA and RNA". CNS Drugs. 2020;34(3):219–28. https://doi.org/10.1007/s40263-019-00695-3 PMID:31933283.
Bashir H. "Emerging therapies in Huntington’s disease". Expert Rev Neurother. 2019;19(10):983–95. https://doi.org/10.1080/14737175.2019.1631161 PMID:31181964.
Jarosińska OD, Rüdiger SGD. "Molecular Strategies to Target Protein Aggregation in Huntington’s Disease". Front Mol Biosci. 2021;8. https://doi.org/10.3389/fmolb.2021.769184 .
Tabrizi SJ, Estevez-Fraga C, Flower MD. "Therapeutic strategies for Huntington’s disease". Curr Opin Neurol. 2020;33(4):508–18. https://doi.org/https://doi.org/10.1097/WCO.0000000000000835 .
Kumar D, Hasan GM, Islam A, Hassan MI. "Therapeutic targeting of Huntington’s disease: Molecular and clinical approaches". Biochem Biophys Res Commun. 2023;655:18–24. https://doi.org/10.1016/j.bbrc.2023.02.075 PMID:36913762.
Aguiar S, van der Gaag B, Cortese FAB. "RNAi mechanisms in Huntington’s disease therapy: SiRNA versus shRNA". Transl Neurodegener. 2017;6(1). https://doi.org/10.1186/s40035-017-0101-9 PMID:29209494.
Conroy F, Miller R, Alterman JF, Hassler MR, Echeverria D, Godinho BMDC, Knox EG, Sapp E, Sousa J, Yamada K, Mahmood F, Boudi A, Kegel-Gleason K, DiFiglia M, Aronin N, Khvorova A, Pfister EL. "Chemical engineering of therapeutic siRNAs for allele-specific gene silencing in Huntington’s disease models". Nat Commun. 2022;13(1). https://doi.org/10.1038/s41467-022-33061-x PMID:36192390.
Kotowska-Zimmer A, Pewinska M, Olejniczak M. "Artificial miRNAs as therapeutic tools: Challenges and opportunities". Wiley Interdiscip Rev RNA. 2021;12(4). https://doi.org/10.1002/wrna.1640 PMID:33386705.
Malankhanova TB, Malakhova AA, Medvedev SP, Zakian SM. "Modern Genome Editing Technologies in Huntington’s Disease Research". J Huntingtons Dis. 2017;6(1):19–31. https://doi.org/10.3233/JHD-160222 PMID:28128770.
Williams L, Larsen J. "Nanoparticle-mediated delivery of non-viral gene editing technology to the brain". Prog Neurobiol. 2024;232. https://doi.org/10.1016/j.pneurobio.2023.102547 PMID:38042249.
Mukherjee S, Madamsetty VS, Bhattacharya D, Roy Chowdhury S, Paul MK, Mukherjee A. "Recent Advancements of Nanomedicine in Neurodegenerative Disorders Theranostics". Adv Funct Mater. 2020;30(35). https://doi.org/10.1002/adfm.202003054 .
Valadão KMG, Luizeti BO, Yamaguchi MU, Issy AC, Bernuci MP. "Nanotechnology in Improving the Treatment of Huntington’s Disease: a Systematic Review". Neurotox Res. 2022;40(2):636–45. https://doi.org/10.1007/s12640-021-00468-1 PMID:35060083.
Mustafa G, Hassan D, Zeeshan M, Ruiz-Pulido G, Ebrahimi N, Mobashar A, Pourmadadi M, Rahdar A, Sargazi S, Fathi-karkan S, Medina DI, Díez-Pascual AM. "Advances in nanotechnology versus stem cell therapy for the theranostics of Huntington’s disease". J Drug Deliv Sci Technol. 2023;87. https://doi.org/10.1016/j.jddst.2023.104774 .
Oli AK, Jain A, Shivshetty N, Javaregowda PK, Chandrakanth. K. "Nano Based Approach for the Neurological Disorder Treatments-A Scenario (A-Review)". Oriental Journal Of Chemistry. 2023;39(2):263–75. https://doi.org/10.13005/ojc/390205 .
Guo ZH, Khattak S, Rauf MA, Ansari MA, Alomary MN, Razak S, Yang CY, Wu DD, Ji XY. "Role of Nanomedicine-Based Therapeutics in the Treatment of CNS Disorders". Molecules. 2023;28(3). https://doi.org/10.3390/molecules28031283 PMID:36770950.
Paul S, Ahmed T, Hasan S, Rahman Bhuiyan MdK, Kumar Das S, Symros N. "Formulation Development & Evaluation of Controlled Drug Delivery System: An Overview". Clinical Medicine And Health Research Journal. 2022;2(6):274–80. https://doi.org/10.18535/cmhrj.v2i6.117 .
Singh S, Hema, Sharma N, Sachdeva M, Behl T, Zahoor I, Fuloria NK, Sekar M, Fuloria S, Subramaniyan V, Alsubayiel AM, Dailah HG, Naved T, Bhatia S, Al-Harrasi A, Aleya L. "Focusing the pivotal role of nanotechnology in Huntington’s disease: an insight into the recent advancements". Environmental Science and Pollution Research. 2022;29(49):73809–27. https://doi.org/10.1007/s11356-022-22830-2 PMID:36100788.
Nayab DE, Din F ud, Ali H, Kausar WA, Urooj S, Zafar M, Khan I, Shabbir K, Khan GM. "Nano biomaterials based strategies for enhanced brain targeting in the treatment of neurodegenerative diseases: an up-to-date perspective". J Nanobiotechnology. 2023;21(1). https://doi.org/10.1186/s12951-023-02250-1 PMID:38087359.
Cong W, Bai R, Li YF, Wang L, Chen C. "Selenium Nanoparticles as an Efficient Nanomedicine for the Therapy of Huntington’s Disease". ACS Appl Mater Interfaces. 2019;11(38):34725–35. https://doi.org/10.1021/acsami.9b12319 PMID:31479233.
Ngowi EE, Wang YZ, Qian L, Helmy YASH, Anyomi B, Li T, Zheng M, Jiang ES, Duan SF, Wei JS, Wu DD, Ji XY. "The Application of Nanotechnology for the Diagnosis and Treatment of Brain Diseases and Disorders". Front Bioeng Biotechnol. 2021;9. https://doi.org/10.3389/fbioe.2021.629832 .
Adepu S, Ramakrishna S. "Controlled drug delivery systems: Current status and future directions". Molecules. 2021;26(19). https://doi.org/10.3390/molecules26195905 PMID:34641447.
Rhaman MM, Islam MR, Akash S, Mim M, Noor alam M, Nepovimova E, Valis M, Kuca K, Sharma R. "Exploring the role of nanomedicines for the therapeutic approach of central nervous system dysfunction: At a glance". Front Cell Dev Biol. 2022;10. https://doi.org/10.3389/fcell.2022.989471 .
Zhang C, Ötjengerdes RM, Roewe J, Mejias R, Marschall ALJ. "Applying Antibodies Inside Cells: Principles and Recent Advances in Neurobiology, Virology and Oncology". BioDrugs. 2020;34(4):435–62. https://doi.org/10.1007/s40259-020-00419-w PMID:32301049.
Komatsu H. "Innovative Therapeutic Approaches for Huntington’s Disease: From Nucleic Acids to GPCR-Targeting Small Molecules". Front Cell Neurosci. 2021;15. https://doi.org/10.3389/fncel.2021.785703
Published
Abstract Display: 740
PDF Downloads: 799
PDF Downloads: 125 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

.