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      The Voltage-Sensor S4 Rises to the Occasion in KCNQ2 Channel Activation

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      , MD, PhD
      Epilepsy Currents
      SAGE Publications

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          Abstract

          Distinctive Mechanisms of Epilepsy-Causing Mutants Discovered by Measuring S4 Movement in KCNQ2 Channels

          Edmond MA, Hinojo-Perez A, Wu X, Perez Rodriguez ME, Barro-Soria R. Elife. 2022;11:e77030. doi: 10.7554/eLife.77030

          Neuronal KCNQ channels mediate the M-current, a key regulator of membrane excitability in the central and peripheral nervous systems. Mutations in KCNQ2 channels cause severe neurodevelopmental disorders, including epileptic encephalopathies. However, the impact that different mutations have on channel function remains poorly defined, largely because of our limited understanding of the voltage-sensing mechanisms that trigger channel gating. Here, we define the parameters of voltage sensor movements in wt-KCNQ2 and channels bearing epilepsy-associated mutations using cysteine accessibility and voltage clamp fluorometry (VCF). Cysteine modification reveals that a stretch of eight to nine amino acids in the S4 becomes exposed upon voltage sensing domain activation of KCNQ2 channels. VCF shows that the voltage dependence and the time course of S4 movement and channel opening/closing closely correlate. VCF reveals different mechanisms by which different epilepsy-associated mutations affect KCNQ2 channel voltage-dependent gating. This study provides insight into KCNQ2 channel function, which will aid in uncovering the mechanisms underlying channelopathies.

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          Most cited references10

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          Muscarinic suppression of a novel voltage-sensitive K+ current in a vertebrate neurone.

          Cholinergic excitation of vertebrate neurones is frequently mediated through the action of acetylcholine on muscarinic (atropine-sensitve) receptors. This type of excitation differs substantially from the better known nicotinic excitation. One difference is that, instead of an increased membrane conductance, a decreased conductance (to K+ ions) frequently accompanies muscarinic depolarisation. This has been detected in sympathetic, cortical and hippocampal neurones. Using voltage-clamped frog sympathetic neurones we have now identified a distinctive voltage-sensitive K+-current, separate from the delayed rectifier current, as the prime target for muscarinic agonists. We have termed this current the M-current, IM.
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            KCNQ2 encephalopathy: emerging phenotype of a neonatal epileptic encephalopathy.

            KCNQ2 and KCNQ3 mutations are known to be responsible for benign familial neonatal seizures (BFNS). A few reports on patients with a KCNQ2 mutation with a more severe outcome exist, but a definite relationship has not been established. In this study we investigated whether KCNQ2/3 mutations are a frequent cause of epileptic encephalopathies with an early onset and whether a recognizable phenotype exists. We analyzed 80 patients with unexplained neonatal or early-infantile seizures and associated psychomotor retardation for KCNQ2 and KCNQ3 mutations. Clinical and imaging data were reviewed in detail. We found 7 different heterozygous KCNQ2 mutations in 8 patients (8/80; 10%); 6 mutations arose de novo. One parent with a milder phenotype was mosaic for the mutation. No KCNQ3 mutations were found. The 8 patients had onset of intractable seizures in the first week of life with a prominent tonic component. Seizures generally resolved by age 3 years but the children had profound, or less frequently severe, intellectual disability with motor impairment. Electroencephalography (EEG) at onset showed a burst-suppression pattern or multifocal epileptiform activity. Early magnetic resonance imaging (MRI) of the brain showed characteristic hyperintensities in the basal ganglia and thalamus that later resolved. KCNQ2 mutations are found in a substantial proportion of patients with a neonatal epileptic encephalopathy with a potentially recognizable electroclinical and radiological phenotype. This suggests that KCNQ2 screening should be included in the diagnostic workup of refractory neonatal seizures of unknown origin. Copyright © 2011 American Neurological Association.
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              Infantile spasms and encephalopathy without preceding neonatal seizures caused byKCNQ2R198Q, a gain-of-function variant

              Variants in KCNQ2 encoding for Kv7.2 neuronal K + channel subunits lead to a spectrum of neonatal-onset epilepsies ranging from self-limiting forms to severe epileptic encephalopathy. Most KCNQ2 pathogenic variants cause loss-of-function, whereas few increase channel activity (gain-of-function). We herein provide evidence for a new phenotypic and functional profile in KCNQ2 related epilepsy: infantile spasms without prior neonatal seizures associated to a gain-of-function gene variant. Via an international registry, we identified four unrelated patients with de novo heterozygous KCNQ2 c.593G>A, p.R198Q variants. All were born at term and discharged home without seizures or concern of encephalopathy, but developed infantile spasms with hypsarrhythmia (or modified hypsarrhythmia) between the ages of 4-6 months. At last follow up (ages 3-11 years), all patients were seizure-free and had severe developmental delay. In vitro experiments showed that Kv7.2 R198Q subunits shifted current activation gating to hyperpolarized potentials, indicative of gain-of-function; in neurons, Kv7.2 and Kv7.2 R198Q subunits similarly populated the axon initial segment, suggesting that gating changes rather than altered sub-cellular distribution contribute to disease molecular pathogenesis. We conclude that KCNQ2 R198Q is a model for a new subclass of KCNQ2 variants causing infantile spasms and encephalopathy, without preceding neonatal seizures.
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                Author and article information

                Contributors
                Journal
                Epilepsy Curr
                Epilepsy Curr
                EPI
                spepi
                Epilepsy Currents
                SAGE Publications (Sage CA: Los Angeles, CA )
                1535-7597
                1535-7511
                1 November 2022
                Jan-Feb 2023
                : 23
                : 1
                : 47-49
                Affiliations
                [1-15357597221132972]Division of Pediatric Neurology, Johns Hopkins University School of Medicine
                Author information
                https://orcid.org/0000-0002-4432-2453
                Article
                10.1177_15357597221132972
                10.1177/15357597221132972
                10009119
                36923340
                db99b756-2437-4c9e-a906-75739cc2d674
                © The Author(s) 2022

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Current Literature in Basic Science
                Custom metadata
                ts3
                January–February 2023

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