PURPOSE: Variants in IQSEC2, escaping X inactivation, cause X-linked intellectual disability with frequent epilepsy in males and females. We aimed to investigate sex-specific differences. METHODS: We collected the data of 37 unpublished patients (18 males and 19 females) with IQSEC2 pathogenic variants and 5 individuals with variants of unknown significance and reviewed published variants. We compared variant types and phenotypes in males and females and performed an analysis of IQSEC2 isoforms. RESULTS: IQSEC2 pathogenic variants mainly led to premature truncation and were scattered throughout the longest brain-specific isoform, encoding the synaptic IQSEC2/BRAG1 protein. Variants occurred de novo in females but were either de novo (2/3) or inherited (1/3) in males, with missense variants being predominantly inherited. Developmental delay and intellectual disability were overall more severe in males than in females. Likewise, seizures were more frequently observed and intractable, and started earlier in males than in females. No correlation was observed between the age at seizure onset and severity of intellectual disability or resistance to antiepileptic treatments. CONCLUSION: This study provides a comprehensive overview of IQSEC2-related encephalopathy in males and females, and suggests that an accurate dosage of IQSEC2 at the synapse is crucial during normal brain development.

• Klíčová slova
• IQSEC2, X-linked inheritance, epilepsy, intellectual disability, isoforms,
• MeSH
• fenotyp MeSH
• kojenec MeSH
• lidé MeSH
• mentální retardace epidemiologie   genetika   patofyziologie   MeSH
• mozek růst a vývoj   metabolismus   MeSH
• mutace MeSH
• nemoci mozku epidemiologie   genetika   patofyziologie   MeSH
• novorozenec MeSH
• pohlavní dimorfismus MeSH
• protein - isoformy genetika   MeSH
• rodokmen MeSH
• výměnné faktory guaninnukleotidů genetika   MeSH
• záchvaty epidemiologie   genetika   patofyziologie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• IQSEC2 protein, human MeSH Prohlížeč
• protein - isoformy MeSH
• výměnné faktory guaninnukleotidů MeSH

Christianson syndrome (CS) is an X-linked neurodevelopmental and neurological disorder characterized in males by core symptoms that include non-verbal status, intellectual disability, epilepsy, truncal ataxia, postnatal microcephaly and hyperkinesis. CS is caused by mutations in the SLC9A6 gene, which encodes a multipass transmembrane sodium (potassium)-hydrogen exchanger 6 (NHE6) protein, functional in early recycling endosomes. The extent and variability of the CS phenotype in female heterozygotes, who presumably express the wild-type and mutant SLC9A6 alleles mosaically as a result of X-chromosome inactivation (XCI), have not yet been systematically characterized. Slc9a6 knockout mice (Slc9a6 KO) were generated by insertion of the bacterial lacZ/β-galactosidase (β-Gal) reporter into exon 6 of the X-linked gene. Mutant Slc9a6 KO male mice have been shown to develop late endosomal/lysosomal dysfunction associated with glycolipid accumulation in selected neuronal populations and patterned degeneration of Purkinje cells (PCs). In heterozygous female Slc9a6 KO mice, β-Gal serves as a transcriptional/XCI reporter and thus facilitates testing of effects of mosaic expression of the mutant allele on penetrance of the abnormal phenotype. Using β-Gal, we demonstrated mosaic expression of the mutant Slc9a6 allele and mosaically distributed lysosomal glycolipid accumulation and PC pathology in the brains of heterozygous Slc9a6 KO female mice. At the behavioral level, we showed that heterozygous female mice suffer from visuospatial memory and motor coordination deficits similar to but less severe than those observed in X-chromosome hemizygous mutant males. Our studies in heterozygous Slc9a6 KO female mice provide important clues for understanding the likely phenotypic range of Christianson syndrome among females heterozygous for SLC9A6 mutations and might improve diagnostic practice and genetic counseling by helping to characterize this presumably underappreciated patient/carrier group.

• Klíčová slova
• Christianson syndrome, Female heterozygotes, Mosaicism, NHE6 protein, Slc9a6, X-chromosome inactivation,
• MeSH
• alely MeSH
• ataxie genetika   MeSH
• chování zvířat MeSH
• epilepsie genetika   MeSH
• fenotyp MeSH
• G(M2) gangliosid imunologie   MeSH
• genetické nemoci vázané na chromozom X genetika   MeSH
• genotyp MeSH
• heterozygot MeSH
• kognitivní poruchy genetika   MeSH
• mentální retardace genetika   MeSH
• mikrocefalie genetika   MeSH
• modely nemocí na zvířatech MeSH
• mozaicismus * MeSH
• mutace MeSH
• myši knockoutované MeSH
• myši MeSH
• Na(+)-H(+) antiport genetika   fyziologie   MeSH
• poruchy hybnosti oka genetika   MeSH
• Purkyňovy buňky cytologie   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• G(M2) gangliosid MeSH
• Na(+)-H(+) antiport MeSH
• NHE6 protein, mouse MeSH Prohlížeč