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Published on: January 19, 2009
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.
Abstract:
Focal cortical dysplasia (FCD) causes drug-resistant epilepsy and is associated with pathogenic variants in mTOR pathway genes. How germline variants cause these focal lesions is unclear, however a germline + somatic "2-hit" model is hypothesized. In a boy with drug-resistant epilepsy, FCD, and a germline DEPDC5 pathogenic variant, we show that a second-hit DEPDC5 variant is limited to dysmorphic neurons, and the somatic mutation load correlates with both dysmorphic neuron density and the epileptogenic zone. These findings provide new insights into the molecular and cellular correlates of FCD determining drug-resistant epilepsy and refine conceptualization of the epileptogenic zone.
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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