Lethal digenic mutations in the K⁺ channels Kir4.1 (<i>KCNJ10</i>) and SLACK (<i>KCNT1</i>) associated with severe-disabling seizures and neurodevelopmental delay

Abstract

A 2-yr-old boy presented profound developmental delay, failure to thrive, ataxia, hypotonia, and tonic-clonic seizures that caused the death of the patient. Targeted and whole exome sequencing revealed two heterozygous missense variants: a novel mutation in the <i>KCNJ10</i> gene that encodes for the inward-rectifying K⁺ channel Kir4.1 and another previously characterized mutation in <i>KCNT1</i> that encodes for the Na⁺-activated K⁺ channel known as Slo2.2 or SLACK. The objectives of this study were to perform the clinical and genetic characterization of the proband and his family and to examine the functional consequence of the Kir4.1 mutation. The mutant and wild-type <i>KCNJ10</i> constructs were generated and heterologously expressed in <i>Xenopus laevis</i> oocytes, and whole cell K⁺ currents were measured using the two-electrode voltage-clamp technique. The <i>KCNJ10</i> mutation c.652C>T resulted in a p.L218F substitution at a highly conserved residue site. Wild-type <i>KCNJ10</i> expression yielded robust Kir current, whereas currents from oocytes expressing the mutation were reduced, remarkably. Western Blot analysis revealed reduced protein expression by the mutation. Kir5.1 subunits display selective heteromultimerization with Kir4.1 constituting channels with unique kinetics. The effect of the mutation on Kir4.1/5.1 channel activity was twofold: a reduction in current amplitudes and an increase in the pH-dependent inhibition. We thus report a novel loss-of-function mutation in Kir4.1 found in a patient with a coexisting mutation in SLACK channels that results in a fatal disease.<b>NEW & NOTEWORTHY</b> We present and characterize a novel mutation in <i>KCNJ10</i> Unlike previously reported EAST/SeSAME patients, our patient was heterozygous, and contrary to previous studies, mimicking the heterozygous state by coexpression resulted in loss of channel function. We report in the same patient co-occurrence of a <i>KCNT1</i> mutation resulting in a more severe phenotype. This study provides new insights into the phenotypic spectrum and to the genotype-phenotype correlations associated with EAST/SeSAME and MMFSI.