CANVAS RFC1

Sensory disturbances, imbalance, oscillopsia, chronic dry cough, dysarthria and dysphagia¹; Late-onset ataxia, sensory neuropathy, vestibular areflexia syndrome². This expansion has been implicated in the genetic etiology of Parkinson's disease³.

Prevalence

Carrier frequency in European is 0.7-4% and in Chinese Han population is 2.24%; estimated prevalence of 1/20,000 to 1/625⁴. Many cases are likely not diagnosed due to heterogeneous presentation⁵. Observed in multiple ethnicities¹; patients diagnosed with European, Chinese Han, and Maori ancestry, as well as found in Japan, Canada, Brazil, the UK, Italy, Germany, and Australia⁴.

Age of Onset Details

Typical: 36-52; Range: 19-76⁴.

Locus

hg19

chr4:39350044-39350103

hg38

chr4:39348424-39348483

t2t

chr4:39318077-39318136

Details

Disease is caused by an insertion of a pathogenic motif, although motif presence is variable and can expand up to 200 repeats without apparently causing a phenotype⁴. Pathogenic expansions (ranging from 400-2750 pathogenic motifs) may be flanked by other motifs⁴. For example, (AAAGG)10-25(AAGGG)exp(AAAGG)4-6⁶. Motif heterogeneity is common in unaffected individuals⁴, and motif associations are described by Delforge et al⁷. The pathogenic size threshold appears to differ for the AAAGG motif: AAAGG expansions >= 600 repeats have been observed in CANVAS patients (vs 400 with established pathogenic motif AAGGG), while ~100-380 AAAGG repeats were found in unaffected controls⁸. Length appears to impact age of onset and disease severity, with particular impact from the smaller allele⁹. Phenotypic spectrum may include Parkinsonism¹⁰and chronic cough¹¹.

Mechanism

LoF

LoF; exact mechanism unknown¹².

Year

2019¹³

Location in Gene

Intron 2

Gene Strand

Alleles

Ref. Motif

AAAAG

Benign (ref.)

AAAAG, AAAGG, AAGAG, AAAGGG

Benign (gene)

CTTTT, CCTTT, CTCTT, CCCTTT

Pathogenic (ref.)

AAGGG, ACAGG, AGGGC, AAGGC, AGAGG

Pathogenic (gene)

CCCTT, CCTGT, CCCTG, CCTTG, CCTCT

Unknown (ref.)

AAAAA, AAAAC, AACGG, AAGAC, AAGGT, AGAAC, AGGGG, GAAAC, GGGAC, GTGAG, AAAAGA, AAAGGA, GGAAAG

Unknown (gene)

TTTTT, GTTTT, CCGTT, CTTGT, ACCTT, CTGTT, CCCCT, CGTTT, CCCGT, ACCTC, CTTTTT, CCTTTT, CCCTTT

gnomAD

References

Direct supporting references for info on this page.

Neurological disorders caused by novel non-coding repeat expansions: clinical features and differential diagnosis.

Elisa,Vegezzi, Hiroyuki,Ishiura, D Cristopher,Bragg, David,Pellerin, Francesca,Magrinelli, Riccardo,Currò, Stefano,Facchini, Arianna,Tucci, John,Hardy, Nutan,Sharma, Matt C,Danzi, Stephan,Zuchner, Bernard,Brais, Mary M,Reilly, Shoji,Tsuji, Henry,Houlden, Andrea,Cortese

The Lancet. Neurology · 2024-07-01

pmid:38876750

Repeat expansion disorders.

Zhongbo,Chen, Huw R,Morris, James,Polke, Nicholas W,Wood, Sonia,Gandhi, Mina,Ryten, Henry,Houlden, Arianna,Tucci

Practical neurology · 2025-05-15

pmid:39349043

Biallelic RFC1 Expansions Are a Rare Cause of Early-Onset and Familial Parkinson's Disease.

Anja,Kovanda, Lara,Šušmelj, Helena,Jaklič, Tadeja,Lukežič, Aleš,Maver, Igor,Petrovic, Natasa Dragasevic,Miskovic, Marina,Svetel, Valentino,Rački, Vladimira,Vuletič, Ivana,Novakovic, Borut,Peterlin

Clinical genetics · 2025-11-02

pmid:41177915

RFC1 CANVAS / Spectrum Disorder

Andrea,Cortese, Mary M.,Reilly, Henry,Houlden

GeneReviews® · 1993-01-01

genereviews:NBK564656

Pseudodominance in RFC1-Spectrum Disorder.

Grazia Maria Igea,Falcone, Alessandra,Tessa, Ignazio Giuseppe,Arena, Melissa,Barghigiani, Alba,Migliorato, Alex,Incensi, Carmelo,Rodolico, Vincenzo,Donadio, Filippo Maria,Santorelli, Olimpia,Musumeci

Cerebellum (London, England) · 2024-09-04

pmid:39230846

A Māori specific RFC1 pathogenic repeat configuration in CANVAS, likely due to a founder allele.

Sarah J,Beecroft, Andrea,Cortese, Roisin,Sullivan, Wai Yan,Yau, Zoe,Dyer, Teddy Y,Wu, Eoin,Mulroy, Luciana,Pelosi, Miriam,Rodrigues, Rachael,Taylor, Stuart,Mossman, Ruth,Leadbetter, James,Cleland, Tim,Anderson, Gianina,Ravenscroft, Nigel G,Laing, Henry,Houlden, Mary M,Reilly, Richard H,Roxburgh

Brain : a journal of neurology · 2020-09-01

pmid:32851396

RFC1: Motifs and phenotypes.

V,Delforge, C,Tard, J-B,Davion, K,Dujardin, A,Wissocq, C-M,Dhaenens, E,Mutez, V,Huin

Revue neurologique · 2024-04-15

pmid:38627134

Normal and pathogenic variation of RFC1 repeat expansions: implications for clinical diagnosis.

Natalia,Dominik, Stefania,Magri, Riccardo,Currò, Elena,Abati, Stefano,Facchini, Marinella,Corbetta, Hannah,Macpherson, Daniela,Di Bella, Elisa,Sarto, Igor,Stevanovski, Sanjog R,Chintalaphani, Fulya,Akcimen, Arianna,Manini, Elisa,Vegezzi, Ilaria,Quartesan, Kylie-Ann,Montgomery, Valentina,Pirota, Emmanuele,Crespan, Cecilia,Perini, Glenda Paola,Grupelli, Pedro J,Tomaselli, Wilson,Marques, Joseph,Shaw, James,Polke, Ettore,Salsano, Silvia,Fenu, Davide,Pareyson, Chiara,Pisciotta, George K,Tofaris, Andrea H,Nemeth, John,Ealing, Aleksandar,Radunovic, Seamus,Kearney, Kishore R,Kumar, Steve,Vucic, Marina,Kennerson, Mary M,Reilly, Henry,Houlden, Ira,Deveson, Arianna,Tucci, Franco,Taroni, Andrea,Cortese

Brain : a journal of neurology · 2023-12-01

pmid:37450567

RFC1 CANVAS: genotype phenotype correlations

Curro,Riccardo, Natalia,Dominik, Stojkovic,Tanya, Miller,James, Gosal,David, Hadivassiliou,Marios, Giunti,Paola, Henry,Houlden, Reilly,Mary M, Cortese,Andrea

RFC1 CANVAS: genotype phenotype correlations · 2024-11-01

doi:10.1136/jnnp-2024-ABN.259

Long-read sequencing revealed complex biallelic pentanucleotide repeat expansions in RFC1-related Parkinson's disease.

Peng,Liu, Fan,Zhang, Xinhui,Chen, Xiaosheng,Zheng, Miao,Chen, Zhiru,Lin, Shuqi,Chen, Lebo,Wang, Xinchen,Wang, Nan,Jin, Chenxin,Ying, Fei,Xie, Bo,Wang, Sheng,Wu, Zhidong,Cen, Wei,Luo

NPJ Parkinson's disease · 2025-01-20

pmid:39833204

Repeat expansions in

Barnaby,Hirons, Peter S P,Cho, Katie,Rhatigan, Joe,Shaw, Riccardo,Curro, Bianca,Rugginini, Natalia,Dominik, Richard D,Turner, Ewan,Mackay, James H,Hull, Hisham,Abubakar-Waziri, Harini,Kesavan, Caroline J,Jolley, Robert D,Hadden, Andrea,Cortese, Surinder S,Birring

ERJ open research · 2025-01-13

pmid:39811557

Sequence composition changes in short tandem repeats: heterogeneity, detection, mechanisms and clinical implications.

Indhu-Shree,Rajan-Babu, Egor,Dolzhenko, Michael A,Eberle, Jan M,Friedman

Nature reviews. Genetics · 2024-03-11

pmid:38467784

Bioinformatics-Based Identification of Expanded Repeats: A Non-reference Intronic Pentamer Expansion in RFC1 Causes CANVAS.

Haloom,Rafehi, David J,Szmulewicz, Mark F,Bennett, Nara L M,Sobreira, Kate,Pope, Katherine R,Smith, Greta,Gillies, Peter,Diakumis, Egor,Dolzhenko, Michael A,Eberle, María García,Barcina, David P,Breen, Andrew M,Chancellor, Phillip D,Cremer, Martin B,Delatycki, Brent L,Fogel, Anna,Hackett, G Michael,Halmagyi, Solange,Kapetanovic, Anthony,Lang, Stuart,Mossman, Weiyi,Mu, Peter,Patrikios, Susan L,Perlman, Ian,Rosemergy, Elsdon,Storey, Shaun R D,Watson, Michael A,Wilson, David S,Zee, David,Valle, David J,Amor, Melanie,Bahlo, Paul J,Lockhart

American journal of human genetics · 2019-06-20

pmid:31230722

Additional Literature

Additional literature related to this locus.

Raw PubMed search results
(All PubMed results returned by searching for this gene, tandem repeats, and disease, in medline format)

Pentanucleotide guanine-rich WGGGW repeats, including CANVAS AGGGA repeats, form a variety of noncanonical structures.

Jiawei,Wang, Dehui,Qiu, Jun,Zhou, Jean-Louis,Mergny, Patrizia,Alberti

Nucleic acids research · 2026-01-22

pmid:41614301

RFC1 Repeat Expansion in Chronic Cough: Findings From the Korean Chronic Cough Registry.

Kyung Eun,Park, Jiwon,Lee, Jun-Pyo,Choi, Ji-Yoon,Oh, Ha-Kyeong,Won, Hwa Young,Lee, Surinder S,Birring, Heung-Woo,Park, Sang Heon,Cho, Woo-Jung,Song

Allergy, asthma & immunology research · 2026-01-01

pmid:41592538

Efficacy of morphine on cough in patients with repeat expansions of

Laurent,Guilleminault, Pauline,Chazelas, Corinne,Magdelaine, Thomas,Villeneuve, Anne-Sophie,Lia, Laurent,Magy

ERJ open research · 2026-01-12

pmid:41532091

The role of disease-associated short tandem repeats in amyotrophic lateral sclerosis.

Joke J F A,van Vugt, Ramona A J,Zwamborn, Egor,Dolzhenko, Michael A,Eberle, Ben,Weisburd, Erwin,Bekema, Maarten,Kooyman, Bi-Nan,Wang, Erik-Jan,Kamsteeg, Monique,Losekoot, Frank,Baas, Camilla,Novy, Helle,Høyer, Ruben P A,van Eijk, Michael A,van Es, Wouter,van Rheenen, Ammar,Al-Chalabi, Leonard H,van den Berg, Jan H,Veldink

Brain communications · 2025-12-09

pmid:41426430

Long-read sequencing identifies FGF14 repeat expansions in Parkinson's disease.

Fulya,Akçimen, Kensuke,Daida, Lara M,Lange, Abraham,Moller, Abigail,Miano-Burkhardt, Laksh,Malik, Kimberly,Paquette, Pilar,Alvarez Jerez, Jackson,Mingle, Breeana,Baker, Melissa,Meredith, Cedric,Kouam, Paige,Jarreau, Androo,Markham, Jessica,Anderson, Miten,Jain, Mark,Chaisson, Mark,Cookson, Bradford,Casey, Hirotaka,Iwaki, Sara,Bandres-Ciga, Paula,Saffie-Awad, Mike,Nalls, Zih-Hua,Fang, Andrew B,Singleton, Cornelis,Blauwendraat, Kimberley J,Billingsley

Brain : a journal of neurology · 2025-12-02

pmid:41327893

Nerve ultrasound, neuronopathy and cough predict sensory neuropathy patients with

Anthony,Garvey, I Zay,Melville, Carolin K,Scriba, Vivien,Yong, Miriam,Rodrigues, Justin,Kao, Melanie,Glenn, Shilpan,Patel, Thomas,Chang, James,Caldwell, Caitlyn,Ren, Nigel G,Laing, Gianina,Ravenscroft, Luciana,Pelosi, Rachael L,Taylor, Richard,Roxburgh

Brain communications · 2025-11-03

pmid:41322202

Long-read sequencing reveals extensive

Anna,Dischler, Akshay,Avvaru, Susana,Lopez-Ignacio, Cristina,Lau, Martin W,Breuss, Verónica Martínez,Cerdeño, Harriet,Dashnow, Caroline M,Dias

bioRxiv : the preprint server for biology · 2025-10-09

pmid:41278766

Comprehensive phenotyping of RFC1-related disorder: integrating electrophysiological, brain imaging, and otoneurological data in deep phenotyping.

André Aires,Fernandes, Pedro L,Alexandre, Sofia,Vedor, Rita,Figueiredo, Pedro,Marques, Luís,Braz

Arquivos de neuro-psiquiatria · 2025-10-27

pmid:41145152

First Report of Co-Occurring FGF14 (SCA27B) and RFC1 (CANVAS) Repeat Expansions in Two of Three Siblings with Late-Onset Cerebellar Ataxia.

Tasos,Tsokkos, Kyproula,Christodoulou, Christina,Votsi, Anthi,Georghiou, Andrea,Christofides, Astero,Constantinou, Eleni,Zamba-Papanicolaou

Cerebellum (London, England) · 2025-10-21

pmid:41118032