Objective: To identify and characterize the molecular basis of a syndrome associated with myasthenia, cortical hyperexcitability, cerebellar ataxia, and intellectual disability.Methods: We performed in vitro microelectrode studies of neuromuscular transmission, performed exome and Sanger sequencing, and analyzed functional consequences of the identified mutation in expression studies.Results: Neuromuscular transmission at patient endplates was compromised by reduced evoked quantal release. Exome sequencing identified a dominant de novo variant, p.Ile67Asn, in SNAP25B, a SNARE protein essential for exocytosis of synaptic vesicles from nerve terminals and of dense-core vesicles from endocrine cells. Ca 21 -triggered exocytosis is initiated when synaptobrevin attached to synaptic vesicles (v-SNARE) assembles with SNAP25B and syntaxin anchored in the presynaptic membrane (t-SNAREs) into an a-helical coiled-coil held together by hydrophobic interactions. Pathogenicity of the Ile67Asn mutation was confirmed by 2 measures. First, the Ca 21 triggered fusion of liposomes incorporating v-SNARE with liposomes containing t-SNAREs was hindered when t-SNAREs harbored the mutant SNAP25B moiety. Second, depolarization of bovine chromaffin cells transfected with mutant SNAP25B or with mutant plus wildtype SNAP25B markedly reduced depolarization-evoked exocytosis compared with wild-type transfected cells.
Conclusion:Ile67Asn variant in SNAP25B is pathogenic because it inhibits synaptic vesicle exocytosis. We attribute the deleterious effects of the mutation to disruption of the hydrophobic a-helical coiled-coil structure of the SNARE complex by replacement of a highly hydrophobic isoleucine by a strongly hydrophilic asparagine. Neurology ® 2014;83:2247-2255 GLOSSARY AChR 5 acetylcholine receptor; cDNA 5 complementary DNA; CMS 5 congenital myasthenic syndrome; EP 5 endplate; MEPP 5 miniature endplate potential; SNAP25B 5 synaptosomal-associated protein, 25B; SNARE 5 soluble N-ethylmaleimide-sensitive factor attachment protein receptor; t-SNAREs 5 target membrane-attached SNAP25B and syntaxin; v-SNARE 5 synaptic vesicle-attached synaptobrevin.The SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptor) proteins are core components of the synaptic vesicle fusion machinery. Synaptobrevin attached to the synaptic vesicles is referred to as a v-SNARE, and SNAP25 (synaptosomal-associated protein of 25 kD) and syntaxin attached to the target plasma membrane are designated as t-SNAREs.1 The assembled complex is a coiled-coil in which a-helices are held together by strong hydrophobic interactions. The complex is stabilized by complexin, a small soluble neuronal protein.2 In the resting state, Munc18 binds to a closed form of syntaxin and blocks formation of the SNARE complex but assists the SNARE complex to effect exocytosis in the active state. 3 SNAP25 also participates in endocytosis at hippocampal synapses 4 and negatively modulates the neuronal voltage-gated calcium channel during intense activity.5 Also, ...