SCN1A gain of function causes interneuron hyperexcitability and network instability through inhibitory synaptic plasticity in early infantile encephalopathy.

Abstract

SCN1A gain-of-function variants are associated with early infantile and neonatal-onset developmental and epileptic encephalopathies (DEE). It is unclear how SCN1A gain-of-function may predispose to cortical hyper-excitability and seizures. We studied the biophysical properties of four pathogenic Nav1.1 variants associated with neonatal-onset (T162I, I236V) or early infantile (P1345S, R1636Q) DEE. In voltage clamp experiments, the activation curves of the variants were either unchanged (T236V), or exhibited hyperpolarized shifts (T162I, P1345S, R1636Q), corresponding to gain-of-function through enhanced window currents. Inactivation curves were unchanged (I236V, P1345S), depolarized, suggesting gain-of-function (R1636Q), or hyperpolarized, suggesting loss-of-function (T162I). Dynamic action potential clamp experiments supported a gain of function mechanism for all variants. Model neurons incorporating Nav1.1. channels with properties of I236V, P1345S, or R1636Q variants exhibited higher and sustained firing relative to wild type, whereas T162I exhibited enhanced early action potential firing and depolarization block. T162I and R1636Q produced a hyperpolarized threshold and reduced neuronal rheobase. To explore the impact of SCN1A variants upon cortical excitability, we used a cortical network model containing excitatory pyramidal cells, PV interneurons and realistic synaptic connectivity. SCN1A gain-of-function was modelled by enhancing PV excitability and incorporating a simple form of homeostatic adaptation: inhibitory synaptic plasticity. Although both wild-type and gain-of-function networks possessed similar basal pyramidal cell firing rates, the gain-of-function network was more sensitive to external perturbation and exhibited synchronous epileptiform-like activity. Further analysis revealed that reduced synaptic strength results in a deficit of feedback inhibition and an increased excitatory-inhibitory ratio in the gain-of-function network. Overall, our findings support the role of SCN1A gain-of-function in early onset DEE. We propose a mechanism through which homeostatic adaptations in neuronal networks can predispose to enhanced excitatory activity and seizures.