Cooper E C
Department of Neurology, Northern California Comprehensive Epilepsy Center, University of California, San Francisco 94143-0725, USA.
Epilepsia. 2001;42 Suppl 5:49-54. doi: 10.1046/j.1528-1157.2001.0420s5049.x.
How can epilepsy gene hunting lead to better care for patients with epilepsy? Lessons may be learned from the progress made by identifying the mutated genes that cause Benign Familial Neonatal Convulsions (BFNC). In 1998, a decade of clinical and laboratory-based genetics work resulted in the cloning of the KCNQ2 potassium channel gene at the BFNC locus on chromosome 20. Subsequently, computer "mining" of public DNA databases allowed the rapid identification of three more brain KCNQ genes. Mutations in each of these additional genes were implicated as causes of human hereditary diseases: epilepsy (KCNQ3), deafness (KCNQ4), and, possibly, retinal degeneration (KCNQ5). Physiologists discovered that the KCNQ genes encoded subunits of the "M-channel," a type of potassium channel known to control repetitive neuronal discharges. Finally, pharmacologists discovered that retigabine, a novel anticonvulsant with a broad but distinctive efficacy profile in animal studies, was a potent KCNQ channel opener. These studies suggest that KCNQ channels may be an important new class of targets for anticonvulsant therapies. The efficacy of retigabine is currently being tested in multicenter clinical trials; identification of its molecular targets will allow it to be more efficiently exploited as a "lead compound." Cloned human KCNQ channels can now be expressed in cultured cells for "high-throughput" screening of drug candidates. Ongoing studies of the KCNQ channels in humans and animal models will refine our understanding of how M-channels control excitability at the cellular, network, and behavioral levels, and may reveal additional targets for therapeutic manipulation.
癫痫基因搜寻如何能为癫痫患者带来更好的治疗?我们可以从鉴定出导致良性家族性新生儿惊厥(BFNC)的突变基因所取得的进展中吸取经验教训。1998年,经过十年基于临床和实验室的遗传学研究工作,位于20号染色体上BFNC位点的KCNQ2钾通道基因被克隆出来。随后,通过对公共DNA数据库进行计算机“挖掘”,又迅速鉴定出另外三个脑KCNQ基因。这些额外基因中的每一个发生突变都被认为是人类遗传性疾病的病因:癫痫(KCNQ3)、耳聋(KCNQ4)以及可能的视网膜变性(KCNQ5)。生理学家发现,KCNQ基因编码“M通道”的亚基,M通道是一种已知可控制神经元重复放电的钾通道类型。最后,药理学家发现瑞替加滨,一种在动物研究中具有广泛但独特疗效的新型抗惊厥药,是一种强效的KCNQ通道开放剂。这些研究表明,KCNQ通道可能是抗惊厥治疗的一类重要新靶点。瑞替加滨的疗效目前正在多中心临床试验中进行测试;确定其分子靶点将使其能作为“先导化合物”得到更有效的利用。克隆的人类KCNQ通道现在可以在培养细胞中表达,用于对候选药物进行“高通量”筛选。正在进行的关于人类和动物模型中KCNQ通道的研究将深化我们对M通道如何在细胞、网络和行为水平上控制兴奋性的理解,并可能揭示更多可用于治疗操作的靶点。
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