Glycine receptors (GlyRs) mediate fast inhibitory neurotransmission in the spinal cord and brainstem. Four GlyR subunits (α1 -3, β) have been identified in humans, and their differential anatomical distributions result in a diversity of synaptic isoforms with unique physiological and pharmacological properties. However, despite their importance in controlling neuronal function, little is known about these properties. To address this, we developed an 'artificial' synapse system which allows to control over the synaptic GlyR subunit composition. We induced the formation of recombinant synapses between cultured spinal neurons and HEK293 cells expressing GlyR subunits of interest plus the synapse-promoting molecule, neuroligin-2A. In the heterosynapses thus formed, recombinant α1β and α3β GlyRs mediated fast decaying inhibitory postsynaptic currents (IPSCs) whereas α2β GlyRs mediated slow decaying IPSCs. These results are consistent with the fragmentary information available from native synapses and single channel kinetic studies. As β subunit incorporation is considered essential for localizing GlyRs at the synapse, we were surprised that α1 -3 homomers supported robust IPSCs with β subunit incorporation accelerating IPSC rise and decay times in α2β and α3β heteromers only. Finally, heterosynapses incorporating α1 D80A β and α1 A52S β GlyRs exhibited accelerated IPSC decay rates closely resembling those recorded in native synapses from mutant mice homozygous for these mutations, providing an additional validation of our technique. As our model system successfully recapitulates the effects of known GlyR disease mutations, we employed it to investigate the effects of new GlyR disease mutations.Hyperekplexia is a human neuromotor disorder caused by mutations that impair glycinergic neurotransmission. We investigated the mechanism by which gain-of-function GlyR mutations cause hyperekplexia. We identified two new gain-of-function mutations (I43F, W170S) and characterised these along with the known gain-of-function mutations (Q226E, V280M, R414H) to identify how they cause hyperekplexia. Using 'artificial' synapses, we show that all mutations prolong the decay of IPSCs and induce spontaneous activation. As these effects may deplete the chloride electrochemical gradient, hyperekplexia could potentially result from reduced glycinergic inhibitory efficacy. However, we consider this unlikely as it should also lead to pain sensitization and a hyperekplexia phenotype that correlates with mutation severity, neither of which is observed in patients. We also rule out small increases in IPSC decay times (as caused by W170S and R414H)as a possible mechanism given that the clinically-important drug, tropisetron, increases glycinergic IPSC decay times without causing motor side effects. A recent study concluded that an elevated intracellular chloride concentration late during development ablates α1β glycinergic synapses but iii spares GABAergic synapses. As this mechanism satisfies all our considerations, we propose it is pr...