Key result
The novel SCN2A M1879T variant caused gain-of-function channel disturbances that were partially normalized by carbamazepine, correlating with the clinical drug response.
Why the study?
A novel de novo SCN2A variant (M1879T) associated with infantile-onset epilepsy responded dramatically to sodium channel blockers, prompting functional and pharmacological analysis to establish pathogenicity and correlate genotype with clinical drug response.
Does carbamazepine normalize the electrophysiological disturbances caused by the SCN2A M1879T variant in vitro?
Does carbamazepine normalize the electrophysiological disturbances caused by the SCN2A M1879T variant in vitro?
In vitro functional analysis of the SCN2A M1879T variant confirms its gain-of-function pathogenicity and provides a mechanistic basis for the clinical responsiveness to sodium channel blockers like carbamazepine.
Answers are grounded in this paper and cite their sources.
May guide SCN2A variant-specific therapy; extends functional validation but leaves broader use open pending larger studies.
OBJECTIVE: We identified a novel de novo SCN2A variant (M1879T) associated with infantile-onset epilepsy that responded dramatically to sodium channel blocker antiepileptic drugs. We analyzed the functional and pharmacological consequences of this variant to establish pathogenicity, and to correlate genotype with phenotype and clinical drug response. METHODS: 1.2 channels. We performed whole-cell patch clamp recording to determine the functional consequences and response to carbamazepine. RESULTS: The M1879T variant caused disturbances in channel inactivation including substantially depolarized voltage dependence of inactivation, slower time course of inactivation, and enhanced resurgent current that collectively represent a gain-of-function. Carbamazepine partially normalized the voltage dependence of inactivation and produced use-dependent block of the variant channel at high pulsing frequencies. Carbamazepine also suppresses resurgent current conducted by M1879T channels, but this effect was explained primarily by reducing the peak transient current. Molecular modeling suggests that the M1879T variant disrupts contacts with nearby residues in the C-terminal domain of the channel. INTERPRETATION: Our study demonstrates the value of conducting functional analyses of SCN2A variants of unknown significance to establish pathogenicity and genotype-phenotype correlations. We also show concordance of in vitro pharmacology using heterologous cells with the drug response observed clinically in a case of SCN2A-associated epilepsy.
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Adney et al. (2020) studied infantile-onset epilepsy (n=1). Carbamazepine was evaluated on Functional consequences and response to carbamazepine. The novel SCN2A M1879T variant caused gain-of-function channel disturbances that were partially normalized by carbamazepine, correlating with the clinical drug response.
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