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Synaptic Dysfunction in Complex Psychiatric Disorders: from Genetics to Mechanisms Xinyuan Wang1,2, Kimberly M

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Synaptic Dysfunction in Complex Psychiatric Disorders: from Genetics to Mechanisms Xinyuan Wang1,2, Kimberly M Wang et al. Genome Medicine (2018) 10:9 DOI 10.1186/s13073-018-0518-5 COMMENT Open Access Synaptic dysfunction in complex psychiatric disorders: from genetics to mechanisms Xinyuan Wang1,2, Kimberly M. Christian1, Hongjun Song1,3,4,5 and Guo-li Ming1,3,4,6* mechanistic studies that provide novel insights into Editorial summary synaptic dysfunction in complex psychiatric disorders. Breakthroughs on many fronts have provided strong evidence to support synaptic dysfunction as a causal factor for neuropsychiatric diseases. Genetic studies Genetics of synaptic dysfunction in psychiatric have identified variants implicated in novel biological disorders and synaptic pathways, and animal and patient-derived Despite different endophenotypes and ages of onset, SCZ, induced pluripotent stem cell-based models have ASD, and several other complex psychiatric disorders have allowed mechanistic investigations of synaptic a developmental origin and strong genetic contributions. dysfunction in pathological processes. Large consortium efforts have made substantial progress in identifying genetic risk factors and in describing the genetic architecture for these disorders, which suggest a Synaptic function and dysfunction in the brain convergence in molecular pathophysiology through synap- Synapses are structural elements that allow electrical or tic dysregulation. A large genome-wide association study chemical signals to flow from one neuron (presynaptic (GWAS) identified 128 independent single-nucleotide cell) to the next (postsynaptic cell). Synapses can undergo polymorphisms (SNPs) spanning 108 distinct genetic loci dynamic modifications in the form of synaptic plasticity, that are associated with SCZ [1]. Results from this study which supports essential brain functions such as learning provided strong evidence to support a polygenic contribu- and memory. Dysregulated synaptic development, proper- tion to SCZ and identified multiple risk genes that are ties, and plasticity have been hypothesized to underlie directly involved in synaptic transmission and plasticity. altered neuronal function in complex neuropsychiatric Another striking finding was the strong association of the disorders, such as schizophrenia (SCZ) and autism major histocompatibility complex (MHC) region with spectrum disorder (ASD). For example, adhesion mole- SCZ. The MHC region encodes proteins that are part of cules, such as neurexin (NRXN) at the presynaptic site the immune system but its relation to SCZ was unclear. and its ligand, neuroligin (NLGN), at the postsynaptic site, The answer came from the study of the complement com- are central organizing proteins for synapse formation and ponent 4 (C4) gene within the MHC region that controls maintenance. Mutations of NRXN, NLGN,andSHANK, the expression of various C4 alleles. C4A is expressed in which encodes the stabilizer scaffolding protein SHANK proportion to the allelic risk association with SCZ, and C4 at the postsynaptic site, are risk factors for both ASD and regulates synapse elimination, or ‘pruning,’ during postna- SCZ. Immune system components, such as microglia and tal neurodevelopment in an animal model [2]. Synaptic complement factor C4, also regulate synapse numbers, pruning fine tunes the number of synapses during and mutations in these pathways are linked to both ASD development and early adulthood. In humans, the number and SCZ. Here, we focus on recent genetic and of synapses in the prefrontal cortex peaks at 15 months of age, and then is gradually reduced via synaptic pruning through late adolescence or adulthood [3]. Children with * Correspondence: [email protected] ASD are thought to have excess synapses due to deficits in 1Department of Neuroscience and Mahoney Institute for Neurosciences, pruning, whereas patients with SCZ have fewer synapses Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA overall. Intriguingly, the window for synaptic pruning 19104, USA 3Department of Cell and Developmental Biology, Perelman School of roughly begins with the age of onset for ASD and ends at Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA the age of onset for SCZ, which suggests that dysregulation Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Wang et al. Genome Medicine (2018) 10:9 Page 2 of 3 of synaptic pruning may be an essential part of the patho- Patient iPSC-based 3D human brain organoids have physiology in these disorders. provided additional insight into the biological basis of Whole-exome sequencing and targeted sequencing of neuropsychiatric diseases. Consistent with macrocephaly candidate genes, in deeply phenotyped cohorts, isolated reported in clinical MRI studies of ASD patients, brain populations, or family studies, have also revealed rare organoids derived from idiopathic ASD patient iPSCs ex- variants associated with psychiatric disorders. For hibited a transient increase in size and faster neural pro- example, a deleterious variant of CX3CR1, which encodes genitor proliferation when compared with controls [8]. a G protein-coupled receptor that binds the chemokine GABAergic neuron production was also increased in a CX3CL1, was found to be associated with increased risk FOXG1-dependent fashion. Another study focused on for both SCZ and ASD [4]. As CX3CR1 is expressed in two well-known SCZ risk genes and demonstrated that microglia only, this provides additional support for the specific interruption of the DISC1–Ndel1/Nde1 inter- role of immune components in psychiatric disorders. action leads to cell-cycle progression defects in radial glial Genetic convergence has also begun to emerge from ana- cells, both in embryonic mouse cortex and human fore- lyses of multiple psychiatric disorders. In addition to the brain organoids [9]. The same phenotype is also observed genes mentioned above, mutations of large genetic loci, in patient iPSC-derived organoids with a DISC1 mutation, which include 2p16.3/NRXN1, 15q13.3, and 22q11.21, are which disrupts DISC1–Ndel1/Nde1 interaction. These also associated with both SCZ and ASD. Genes in these loci studies suggest that early developmental events, such as have been implicated in neural developmental processes as neuronal proliferation and differentiation, which precede well as in synapse formation and plasticity. Together, synaptic development, might also contribute to ASD and genomic profiling studies have provided novel insights into SCZ. Considering that each neuron forms many synapses, psychiatric disorders, such as molecular pathways that these early neurogenic events may have a larger net im- directly or indirectly affect synaptic function and plasticity. pact on neuronal circuitry. As SCZ and ASD are complex disorders involving multiple Several recent studies have shed light on the role of brain regions, a central question remains as to how genetic microglia in regulating brain function by synaptic pruning. mutations affect specific neural circuits and contribute to In mice, loss of PGRN (progranulin), a key regulator of divergent clinical phenotypes. inflammation, leads to increased complement activation and excessive microglia-mediated pruning of inhibitory synapses in the ventral thalamus, which in turn resulted in How do genetic lesions impact synaptic function hyperexcitability in thalamocortical circuits and abnormal and lead to manifestation of psychiatric disorders? grooming behaviors [10]. Autophagy appears to be essential Identification of meaningful phenotypes and the use of for microglia-mediated synaptic pruning. Deletion of Atg7 appropriate functional assays are important challenges in (an autophagy essential gene) specifically in microglia understanding complex psychiatric diseases. In the past abolishes its ability to prune synapses, resulting in increased decade, with the development of human induced pluripo- synapse numbers, altered brain region connectivity, and tent stem cell (iPSC) technology and advanced 2D or 3D ASD-like repetitive behaviors and social behavior defects differentiation protocols, psychiatric disorders now can be [11]. Together with genetic findings that implicate immune modeled in a dish with disease-relevant cell populations. components in the risk for psychiatric disorders, these The most common 2D models rely on cortical or hippo- studies provide a mechanistic hypothesis for how dysregu- campal neurons differentiated from patient-specific iPSCs. lated microglia activation leads to synaptic dysfunction. Using distinct differentiation protocols to generate cortical neurons from idiopathic SCZ patients [5]orfrompatients Conclusions and future directions with a defined mutation at the DISC1 locus [6], results from Human genetic studies of psychiatric disorders are picking two independent studies showed synaptic defects in patient up pace with increasing cohort sizes and the use of whole- iPSC-derived glutamatergic neurons. Moreover, in
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