Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
Evox Therapeutics Limited, Oxford OX4 4HG, UK.
Brain. 2023 Nov 2;146(11):4766-4783. doi: 10.1093/brain/awad231.
KPTN-related disorder is an autosomal recessive disorder associated with germline variants in KPTN (previously known as kaptin), a component of the mTOR regulatory complex KICSTOR. To gain further insights into the pathogenesis of KPTN-related disorder, we analysed mouse knockout and human stem cell KPTN loss-of-function models. Kptn -/- mice display many of the key KPTN-related disorder phenotypes, including brain overgrowth, behavioural abnormalities, and cognitive deficits. By assessment of affected individuals, we have identified widespread cognitive deficits (n = 6) and postnatal onset of brain overgrowth (n = 19). By analysing head size data from their parents (n = 24), we have identified a previously unrecognized KPTN dosage-sensitivity, resulting in increased head circumference in heterozygous carriers of pathogenic KPTN variants. Molecular and structural analysis of Kptn-/- mice revealed pathological changes, including differences in brain size, shape and cell numbers primarily due to abnormal postnatal brain development. Both the mouse and differentiated induced pluripotent stem cell models of the disorder display transcriptional and biochemical evidence for altered mTOR pathway signalling, supporting the role of KPTN in regulating mTORC1. By treatment in our KPTN mouse model, we found that the increased mTOR signalling downstream of KPTN is rapamycin sensitive, highlighting possible therapeutic avenues with currently available mTOR inhibitors. These findings place KPTN-related disorder in the broader group of mTORC1-related disorders affecting brain structure, cognitive function and network integrity.
KPTN 相关疾病是一种常染色体隐性疾病,与 KPTN(以前称为 kaptin)种系变异相关,KPTN 是 mTOR 调节复合物 KICSTOR 的一个组成部分。为了深入了解 KPTN 相关疾病的发病机制,我们分析了小鼠敲除和人类干细胞 KPTN 功能丧失模型。Kptn -/- 小鼠表现出许多 KPTN 相关疾病的关键表型,包括大脑过度生长、行为异常和认知缺陷。通过对受影响个体的评估,我们发现了广泛的认知缺陷(n = 6)和出生后大脑过度生长的发病(n = 19)。通过分析其父母的头部大小数据(n = 24),我们发现了以前未被认识到的 KPTN 剂量敏感性,导致致病性 KPTN 变异杂合子携带者的头围增加。Kptn -/- 小鼠的分子和结构分析显示出病理变化,包括大脑大小、形状和细胞数量的差异,主要是由于异常的出生后大脑发育。该疾病的小鼠和分化诱导多能干细胞模型均显示出 mTOR 通路信号改变的转录和生化证据,支持 KPTN 在调节 mTORC1 中的作用。通过对我们的 KPTN 小鼠模型进行治疗,我们发现 KPTN 下游增加的 mTOR 信号对雷帕霉素敏感,突出了目前可用的 mTOR 抑制剂的可能治疗途径。这些发现将 KPTN 相关疾病置于影响大脑结构、认知功能和网络完整性的更广泛的 mTORC1 相关疾病组中。