Topotecan is a topoisomerase 1 (TOP1) inhibitor that is used to treat various forms of cancer. We recently found that topotecan reduces the expression of multiple long genes, including many neuronal genes linked to synapses and autism. However, whether topotecan alters synaptic protein levels and synapse function is currently unknown. Here we report that in primary cortical neurons, topotecan depleted synaptic proteins that are encoded by extremely long genes, including Neurexin-1, Neuroligin-1, Cntnap2, and GABA A β3. Topotecan also suppressed spontaneous network activity without affecting resting membrane potential, action potential threshold, or neuron health. Topotecan strongly suppressed inhibitory neurotransmission via pre-and postsynaptic mechanisms and reduced excitatory neurotransmission. The effects on synaptic protein levels and inhibitory neurotransmission were fully reversible upon drug washout. Collectively, our findings suggest that TOP1 controls the levels of multiple synaptic proteins and is required for normal excitatory and inhibitory synaptic transmission.synapse | topoisomerase | transcription T opoisomerase inhibitors such as topotecan (Hycamtin) are widely used to treat multiple forms of cancer, including brain metastases, ovarian cancer, and small cell lung cancer (1). Topoisomerases resolve DNA supercoiling during cell division and during gene transcription (2). Type I topoisomerases, encoded by Top1, Top3a, and Top3b in mammals, resolve supercoiling by cleaving a single strand of DNA, whereas type II topoisomerases, encoded by Top2a and Top2b, cleave both DNA strands (2). Recently, both types of topoisomerases were associated with neurodevelopment (3-5). For instance, topoisomerase 1 (TOP1) and topoisomerase 2 (TOP2) inhibitors transcriptionally up-regulate the paternal copy of Ubiquitin-protein ligase E3A (Ube3a) (5), a gene that affects synaptic activity and that is deleted or duplicated in distinct neurodevelopmental disorders (Angelman syndrome and autism, respectively) (6, 7). Moreover, a de novo mutation in Top1 and de novo mutations in genes that interact with Top1 and Top3b were identified recently in patients with autism (8, 9), whereas deletion of Top3b increases the risk for schizophrenia and intellectual disability (10, 11). Top2b is also required for axon outgrowth in different regions of the nervous system and for the survival of postmitotic neurons (12-15).TOP1 is localized primarily in the nucleus of postmitotic neurons and is expressed throughout the developing and adult brain (16), suggesting a nuclear function. Indeed, we recently found that topotecan, a selective TOP1 inhibitor, reduced the expression of extremely long genes (>200 kb) in postmitotic neurons by impairing transcription elongation (17). Topotecan and related camptothecin analogs inhibit TOP1 by covalently trapping the enzyme on DNA (2). TOP1 inhibitors also reduce the expression of long genes in cancer cell lines (17-19), revealing a gene length-dependent component to transcription that is common to sev...