Precision therapy for a new disorder of AMPA receptor recycling due to mutations in .

OBJECTIVE: encodes Thorase, a mediator of α-amino-3-hydroxy-5-methylisoxazole-4-proprionate (AMPA) receptor recycling; in this work, we characterized the phenotype resulting from mutations and developed a targeted therapy in both mice and humans.

METHODS: Using exome sequencing, we identified a novel mutation (p.E276X) as the etiology of a devastating neurologic disorder characterized by hypertonia, seizures, and death in a consanguineous family. We postulated that pathogenesis was a result of excessive AMPA receptor activity and designed a targeted therapeutic approach using perampanel, an AMPA-receptor antagonist.

RESULTS: Perampanel therapy in knockout mice reversed behavioral defects, normalized brain MRI abnormalities, prevented seizures, and prolonged survival. The patients treated with perampanel showed improvement in hypertonicity and resolution of seizures.

CONCLUSIONS: This work demonstrates that identification of novel monogenic neurologic disorders and observation of response to targeted therapeutics can provide important insights into human nervous system functioning.