Human hyperekplexia is a neuromotor disorder caused by disturbances in inhibitory glycine-mediated neurotransmission. Mutations in genes encoding for glycine receptor subunits or associated proteins, such as GLRA1, GLRB, GPHN and ARHGEF9, have been detected in patients suffering from hyperekplexia. Classical symptoms are exaggerated startle attacks upon unexpected acoustic or tactile stimuli, massive tremor, loss of postural control during startle and apnoea. Usually patients are treated with clonazepam, this helps to dampen the severe symptoms most probably by up-regulating GABAergic responses. However, the mechanism is not completely understood. Similar neuromotor phenotypes have been observed in mouse models that carry glycine receptor mutations. These mouse models serve as excellent tools for analysing the underlying pathomechanisms. Yet, studies in mutant mice looking for postsynaptic compensation of glycinergic dysfunction via an up-regulation in GABAA receptor numbers have failed, as expression levels were similar to those in wild-type mice. However, presynaptic adaptation mechanisms with an unusual switch from mixed GABA/glycinergic to GABAergic presynaptic terminals have been observed. Whether this presynaptic adaptation explains the improvement in symptoms or other compensation mechanisms exist is still under investigation. With the help of spontaneous glycine receptor mouse mutants, knock-in and knock-out studies, it is possible to associate behavioural changes with pharmacological differences in glycinergic inhibition. This review focuses on the structural and functional characteristics of the various mouse models used to elucidate the underlying signal transduction pathways and adaptation processes and describes a novel route that uses gene-therapeutic modulation of mutated receptors to overcome loss of function mutations.
AbbreviationsCLR, cys-loop receptor; ECD, extracellular domain; GEFS+, generalized epilepsy with febrile seizures plus; Gly, glycine; M1-M4, transmembrane domains 1-4; PTX, picrotoxin
History of human hyperekplexiaThe ability of strychnine to influence inhibitory reflexes and to convert these into excitatory reflexes was originally shown by Owen and Sherrington (1911). Hyperekplexia (Startle disease, Stiff baby syndrome, STHE -startle disease or hyperekplexia, OMIM 149400) was first described by Kirstein and Silfverskiold (1958) long before recombinant systems became available. In 1966 Suhren et al. reported a family with 25 members through five generations that suffered from abnormal severe startle reactions. This family was clinically described as having an autosomal dominant inheritance with an abnormal startle reaction in affected patients, which was elicited by different stimuli that did not provoking similar reactions in healthy controls. With the help of electroencephalographic (EEG) observations, a subcortical origin, for example, some midline structure like the brainstem, was proposed as being the source for this abnormal startle reaction. Furthermore, the patients were c...