Second-hit DEPDC5 mutation is limited to dysmorphic neurons in cortical dysplasia type IIA

Wei Shern Lee1,2, Sarah E M Stephenson1,2, Katherine B Howell1,2,3,4

  • 1Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Insights

Focal cortical dysplasia (FCD), a cause of drug-resistant epilepsy, may involve a two-hit genetic model. A second DEPDC5 variant in dysmorphic neurons correlated with epilepsy severity, supporting this hypothesis.

Area of Science:

  • Neuroscience
  • Genetics
  • Epilepsy Research

Background:

  • Focal cortical dysplasia (FCD) is a leading cause of intractable epilepsy, often linked to genetic mutations within the mTOR signaling pathway.
  • The precise mechanism by which germline variants lead to focal brain lesions in FCD remains incompletely understood, with a "two-hit" germline-plus-somatic model being a prominent hypothesis.

Observation:

  • A study examined a male patient presenting with drug-resistant epilepsy and FCD, who carried a germline pathogenic variant in the DEPDC5 gene.
  • Investigated the presence and distribution of a potential second somatic DEPDC5 variant within the affected brain tissue.

Findings:

  • A second, somatic DEPDC5 pathogenic variant was identified, specifically localized to dysmorphic neurons within the FCD lesion.
  • The burden of this somatic mutation load demonstrated a direct correlation with both the density of dysmorphic neurons and the extent of the epileptogenic zone.

Implications:

  • These findings provide critical molecular and cellular insights into the pathogenesis of FCD and its role in driving drug-resistant epilepsy.
  • The study refines the conceptual understanding of the epileptogenic zone, highlighting the contribution of somatic mosaicism in specific neuronal populations.
  • Supports the hypothesized germline-plus-somatic "two-hit" model for FCD development, particularly involving DEPDC5 variants.

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