title: Novel mutations in ATP1A3 associated with catastrophic early life epilepsy, episodic prolonged apnea, and postnatal microcephaly.
abstract: OBJECTIVE
  Mutations of ATP1A3 have been associated with rapid onset dystonia-parkinsonism and more recently with alternating hemiplegia of childhood. Here we report one child with catastrophic early life epilepsy and shortened survival, and another with epilepsy, episodic prolonged apnea, postnatal microcephaly, and severe developmental disability. Novel heterozygous mutations (p.Gly358Val and p.Ile363Asn) were identified in ATP1A3 in these children.
  
  
  METHODS
  Subjects underwent next-generation sequencing under a research protocol. Clinical data were collected retrospectively. The biochemical effects of the mutations on ATP1A3 protein function were investigated. Postmortem neuropathologic specimens from control and affected subjects were studied.
  
  
  RESULTS
  The mutations localized to the P domain of the Na,K-ATPase α3 protein, and resulted in significant reduction of Na,K-ATPase activity in vitro. We demonstrate in both control human brain tissue and that from the subject with the p.Gly358Val mutation that ATP1A3 immunofluorescence is prominently associated with interneurons in the cortex, which may provide some insight into the pathogenesis of the disease.
  
  
  CONCLUSIONS
  The findings indicate these mutations cause severe phenotypes of ATP1A3-related disorder spectrum that include catastrophic early life epilepsy, episodic apnea, and postnatal microcephaly.
authors: Departments of Neurology, Pediatrics, and Biomedical Genetics, University of Rochester Medical Center, Rochester, New York, U.S.A; Center for Neural Development and Disease, University of Rochester Medical Center, Rochester, New York, U.S.A.
authors: Alex R
authors: AR
authors: Paciorkowski
authors: Sharon S
authors: SS
authors: McDaniel
authors: Laura A
authors: LA
authors: Jansen
authors: Hannah
authors: H
authors: Tully
authors: Emily
authors: E
authors: Tuttle
authors: Dalia H
authors: DH
authors: Ghoneim
authors: Srinivasan
authors: S
authors: Tupal
authors: Sonya A
authors: SA
authors: Gunter
authors: Valeria
authors: V
authors: Vasta
authors: Qing
authors: Q
authors: Zhang
authors: Thao
authors: T
authors: Tran
authors: Yi B
authors: YB
authors: Liu
authors: Laurie J
authors: LJ
authors: Ozelius
authors: Allison
authors: A
authors: Brashear
authors: Kathleen J
authors: KJ
authors: Sweadner
authors: William B
authors: WB
authors: Dobyns
authors: Sihoun
authors: S
authors: Hahn
mesh_terms: D001921:Brain / Q000378:metabolism / Q000473:pathology; D002388:Catastrophic Illness; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004569:Electroencephalography; D004791:Enzyme Inhibitors / Q000494:pharmacology; D004827:Epilepsy / Q000150:complications / Q000235:genetics* / Q000473:pathology / Q000523:psychology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000378:metabolism; D057809:HEK293 Cells; D006801:Humans; D007223:Infant; D008297:Male; D008958:Models, Molecular; D009154:Mutation / Q000235:genetics*; D009422:Nervous System Diseases / Q000209:etiology; D010042:Ouabain / Q000494:pharmacology; D000254:Sodium-Potassium-Exchanging ATPase / Q000235:genetics*; D014162:Transfection
chemical_list: C488756:ATP1A3 protein, human; D004791:Enzyme Inhibitors; D010042:Ouabain; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2; D000254:Sodium-Potassium-Exchanging ATPase
keywords: ATP1A3; Apnea; Early life epilepsy; K-ATPase; Na; Next-generation sequencing; Postnatal microcephaly
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