Center for Gene Therapy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pharmacology and Warren Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, TN 37232, USA.
Neurotherapeutics. 2024 Sep;21(5):e00376. doi: 10.1016/j.neurot.2024.e00376. Epub 2024 Jun 14.
The neurodevelopmental disorder Pitt Hopkins syndrome (PTHS) causes clinical symptoms similar to Rett syndrome (RTT) patients. However, RTT is caused by MECP2 mutations whereas mutations in the TCF4 gene lead to PTHS. The mechanistic commonalities underling these two disorders are unknown, but their shared symptomology suggest that convergent pathway-level disruption likely exists. We reprogrammed patient skin derived fibroblasts into induced neuronal progenitor cells. Interestingly, we discovered that MeCP2 levels were decreased in PTHS patient iNPCs relative to healthy controls and that both iNPCs and iAstrocytes displayed defects in function and differentiation in a mutation-specific manner. When Tcf4 mice were genetically crossed with mice overexpressing MeCP2, molecular and phenotypic defects were significantly ameliorated, underlining and important role of MeCP2 in PTHS pathology. Importantly, post-natal intracerebroventricular gene replacement therapy with adeno-associated viral vector serotype 9 (AAV9)-expressing MeCP2 (AAV9.P546.MeCP2) significantly improved iNPC and iAstrocyte function and effectively ameliorated histological and behavioral defects in Tcf4 mice. Combined, our data suggest a previously unknown role of MeCP2 in PTHS pathology and common pathways that might be affected in multiple neurodevelopmental disorders. Our work highlights potential novel therapeutic targets for PTHS, including upregulation of MeCP2 expression or its downstream targets or, potentially, MeCP2-based gene therapy.
神经发育障碍皮特霍普金斯综合征(PTHS)引起的临床症状与雷特综合征(RTT)患者相似。然而,RTT 是由 MECP2 突变引起的,而 TCF4 基因突变导致 PTHS。这两种疾病的机制共同点尚不清楚,但它们共同的症状表明可能存在趋同的通路水平破坏。我们将患者皮肤衍生的成纤维细胞重新编程为诱导性神经祖细胞。有趣的是,我们发现 PTHS 患者的 iNPCs 中 MeCP2 水平相对于健康对照组降低,并且 iNPCs 和 iAstrocytes 以突变特异性方式表现出功能和分化缺陷。当 Tcf4 小鼠与过表达 MeCP2 的小鼠进行基因杂交时,分子和表型缺陷显著改善,这强调了 MeCP2 在 PTHS 病理学中的重要作用。重要的是,用腺相关病毒血清型 9(AAV9)表达 MeCP2(AAV9.P546.MeCP2)的脑室内基因替代治疗在产后显著改善了 iNPC 和 iAstrocyte 的功能,并有效地改善了 Tcf4 小鼠的组织学和行为缺陷。综上所述,我们的数据表明 MeCP2 在 PTHS 病理学中的一个以前未知的作用以及可能在多种神经发育障碍中受到影响的共同途径。我们的工作强调了 PTHS 的潜在新治疗靶点,包括上调 MeCP2 表达或其下游靶标,或者可能基于 MeCP2 的基因治疗。