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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Neurosci.</journal-id>
<journal-title>Frontiers in Cellular Neuroscience</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Neurosci.</abbrev-journal-title>
<issn pub-type="epub">1662-5102</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fncel.2016.00263</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Neuroscience</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>A Subset of Autism-Associated Genes Regulate the Structural Stability of Neurons</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Lin</surname> <given-names>Yu-Chih</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/361307/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Frei</surname> <given-names>Jeannine A.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/377631/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Kilander</surname> <given-names>Michaela B. C.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/377698/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Shen</surname> <given-names>Wenjuan</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/379403/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Blatt</surname> <given-names>Gene J.</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/239418/overview"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Laboratory of Neuronal Connectivity, Program in Neuroscience, Hussman Institute for Autism, Baltimore</institution> <country>MD, USA</country></aff>
<aff id="aff2"><sup>2</sup><institution>Laboratory of Autism Neurocircuitry, Program in Neuroscience, Hussman Institute for Autism, Baltimore</institution> <country>MD, USA</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: <italic>Hansen Wang, University of Toronto, Canada</italic></p></fn>
<fn fn-type="edited-by"><p>Reviewed by: <italic>Elva Diaz, University of California, Davis, USA; Annalisa Scimemi, University at Albany, SUNY, USA; Nicoletta Landsberger, University of Milan, Italy</italic></p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x002A;Correspondence: <italic>Yu-Chih Lin, <email>yclin@hussmanautism.org</email></italic></p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>17</day>
<month>11</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection">
<year>2016</year>
</pub-date>
<volume>10</volume>
<elocation-id>263</elocation-id>
<history>
<date date-type="received">
<day>19</day>
<month>07</month>
<year>2016</year>
</date>
<date date-type="accepted">
<day>28</day>
<month>10</month>
<year>2016</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2016 Lin, Frei, Kilander, Shen and Blatt.</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Lin, Frei, Kilander, Shen and Blatt</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>Autism spectrum disorder (ASD) comprises a range of neurological conditions that affect individuals&#x2019; ability to communicate and interact with others. People with ASD often exhibit marked qualitative difficulties in social interaction, communication, and behavior. Alterations in neurite arborization and dendritic spine morphology, including size, shape, and number, are hallmarks of almost all neurological conditions, including ASD. As experimental evidence emerges in recent years, it becomes clear that although there is broad heterogeneity of identified autism risk genes, many of them converge into similar cellular pathways, including those regulating neurite outgrowth, synapse formation and spine stability, and synaptic plasticity. These mechanisms together regulate the structural stability of neurons and are vulnerable targets in ASD. In this review, we discuss the current understanding of those autism risk genes that affect the structural connectivity of neurons. We sub-categorize them into (1) cytoskeletal regulators, e.g., motors and small RhoGTPase regulators; (2) adhesion molecules, e.g., cadherins, NCAM, and neurexin superfamily; (3) cell surface receptors, e.g., glutamatergic receptors and receptor tyrosine kinases; (4) signaling molecules, e.g., protein kinases and phosphatases; and (5) synaptic proteins, e.g., vesicle and scaffolding proteins. Although the roles of some of these genes in maintaining neuronal structural stability are well studied, how mutations contribute to the autism phenotype is still largely unknown. Investigating whether and how the neuronal structure and function are affected when these genes are mutated will provide insights toward developing effective interventions aimed at improving the lives of people with autism and their families.</p>
</abstract>
<kwd-group>
<kwd>autism-risk genes</kwd>
<kwd>neurite outgrowth</kwd>
<kwd>dendrite</kwd>
<kwd>dendritic spine</kwd>
<kwd>synapse formation</kwd>
<kwd>actin</kwd>
<kwd>adhesion molecule</kwd>
</kwd-group>
<counts>
<fig-count count="2"/>
<table-count count="5"/>
<equation-count count="0"/>
<ref-count count="688"/>
<page-count count="35"/>
<word-count count="0"/>
</counts>
</article-meta>
</front>
<body>
<sec><title>Introduction</title>
<p>Autism spectrum disorder (ASD) is a neurodevelopmental clinical condition currently diagnosed based on the American Psychiatric Association&#x2019;s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria reflecting symptoms, possibly of varying severity, in social interaction, communication and behavior (<xref ref-type="bibr" rid="B9">American Psychiatric Association, 2013</xref>; <xref ref-type="bibr" rid="B365">Lord and Jones, 2013</xref>). ASD occurs in 1:68 individuals in the United States (<xref ref-type="bibr" rid="B29">Baio, 2014</xref>) and complex genetic interactions appear responsible for a high degree of heterogeneity of the clinical symptoms in ASD. Individuals with ASD often co-express other comorbidities including epilepsy which often complicates diagnosis and treatment. Alterations in neuronal structures in different brain regions have been reported in ASD individuals, including increased dendritic spine density in cortical pyramidal neurons (<xref ref-type="bibr" rid="B271">Hutsler and Zhang, 2010</xref>; <xref ref-type="bibr" rid="B575">Tang et al., 2014</xref>) as well as stunting of dendritic branching in the hippocampus (<xref ref-type="bibr" rid="B492">Raymond et al., 1996</xref>; <xref ref-type="bibr" rid="B40">Bauman and Kemper, 2005</xref>). In addition, subcortical band heterotopia, representing alterations in cell migration has also been found in a child with ASD (<xref ref-type="bibr" rid="B43">Beaudoin et al., 2007</xref>). These brain regions are often characterized with neuroanatomical irregularities in ASD (<xref ref-type="bibr" rid="B168">Donovan and Basson, 2016</xref>). The defective regulation for structural stability of neurons may be one of the underlying mechanisms that contribute to the anatomical changes in ASD.</p>
<p>Autism spectrum disorder is typically diagnosed during the first 3 years of life, a period of extensive neurite formation, synaptogenesis and refinement (<xref ref-type="bibr" rid="B272">Huttenlocher and Dabholkar, 1997</xref>; <xref ref-type="bibr" rid="B688">Zoghbi and Bear, 2012</xref>; <xref ref-type="bibr" rid="B555">Stamou et al., 2013</xref>; <xref ref-type="bibr" rid="B387">McGee et al., 2014</xref>). Indeed, brain imaging studies from individuals with ASD and anatomical measurements of neuronal structure in post-mortem tissues exhibit differences in neuronal connectivity derived from the disruption of neurite outgrowth, synapse formation and stabilization (<xref ref-type="bibr" rid="B492">Raymond et al., 1996</xref>; <xref ref-type="bibr" rid="B271">Hutsler and Zhang, 2010</xref>; <xref ref-type="bibr" rid="B463">Penzes et al., 2011</xref>). Studies of human induced pluripotent stem cells (iPSCs) derived from people with ASD also have identified defects of neuronal structure (<xref ref-type="bibr" rid="B233">Habela et al., 2015</xref>; <xref ref-type="bibr" rid="B424">Nestor et al., 2015</xref>). Genome-wide association studies on individuals with ASD and their families revealed several risk genes that may be the common molecular targets in autism (<xref ref-type="bibr" rid="B76">Bucan et al., 2009</xref>; <xref ref-type="bibr" rid="B219">Glessner et al., 2009</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B440">O&#x2019;Roak et al., 2011</xref>, <xref ref-type="bibr" rid="B442">2012a</xref>; <xref ref-type="bibr" rid="B85">Buxbaum et al., 2012</xref>, <xref ref-type="bibr" rid="B83">2014</xref>; <xref ref-type="bibr" rid="B520">Sanders et al., 2012</xref>; <xref ref-type="bibr" rid="B540">Shi et al., 2013</xref>; <xref ref-type="bibr" rid="B555">Stamou et al., 2013</xref>; <xref ref-type="bibr" rid="B676">Yu et al., 2013</xref>; <xref ref-type="bibr" rid="B13">An et al., 2014</xref>; <xref ref-type="bibr" rid="B72">Brett et al., 2014</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B279">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B387">McGee et al., 2014</xref>; <xref ref-type="bibr" rid="B473">Pinto et al., 2014</xref>; <xref ref-type="bibr" rid="B500">Ronemus et al., 2014</xref>; <xref ref-type="bibr" rid="B587">Toma et al., 2014</xref>; <xref ref-type="bibr" rid="B677">Yuen et al., 2015</xref>). Animal studies of these genes further identify several specific cellular pathways during brain development that are vulnerable in ASD, including the disruption of neurite outgrowth, dendritic spine formation, and synaptic function (<bold>Figure <xref ref-type="fig" rid="F1">1</xref></bold>) (<xref ref-type="bibr" rid="B630">Walsh et al., 2008</xref>; <xref ref-type="bibr" rid="B68">Bourgeron, 2009</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B463">Penzes et al., 2011</xref>; <xref ref-type="bibr" rid="B688">Zoghbi and Bear, 2012</xref>; <xref ref-type="bibr" rid="B175">Ebert and Greenberg, 2013</xref>; <xref ref-type="bibr" rid="B555">Stamou et al., 2013</xref>; <xref ref-type="bibr" rid="B54">Bernardinelli et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B473">Pinto et al., 2014</xref>; <xref ref-type="bibr" rid="B470">Phillips and Pozzo-Miller, 2015</xref>). Differences in environment as well as the presence of multiple gene mutations occurring in the same individual with autism complicate studies of the relationship between each gene and the phenotype observed. However, because similar cellular pathways (e.g., neurite outgrowth) are altered in different affected individuals, we can potentially develop therapeutic interventions to help mitigate the autism phenotypes.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p><bold>Diagram of autism-risk genes implicated in regulating the structural stability of neurons.</bold> Each circle represents a cellular pathway to regulate the structural stability of neurons, including neurite outgrowth (red), dendritic spine or synapse formation (blue), and synaptic plasticity (gold). Experimental evidence shows that many autism-risk genes regulate at least one cellular pathway to maintain the integrity of neuronal structures. Genes that regulate only one pathway are labeled in light gray. Genes that regulate two pathways are labeled in dark gray. Genes that regulate three pathways are labeled in black. The summaries of autism-risk genes that affect each cellular pathway can be found in <bold>Tables <xref ref-type="table" rid="T1">1</xref></bold>&#x2013;<bold><xref ref-type="table" rid="T3">3</xref></bold>.</p></caption>
<graphic xlink:href="fncel-10-00263-g001.tif"/>
</fig>
<p>During development, neurite outgrowth and synapse formation are dynamic processes and their maturation is mutually dependent on proper guidance. Neurites initially exhibit frequent branch additions and retractions. Once dendrite arbors are established, productive synapse formation later in life and the accompanying activation of post-synaptic signaling machinery promotes arbor stability (<xref ref-type="bibr" rid="B147">Dailey and Smith, 1996</xref>; <xref ref-type="bibr" rid="B652">Wu and Cline, 1998</xref>; <xref ref-type="bibr" rid="B490">Rajan et al., 1999</xref>; <xref ref-type="bibr" rid="B651">Wong et al., 2000</xref>; <xref ref-type="bibr" rid="B122">Cline, 2001</xref>; <xref ref-type="bibr" rid="B429">Niell et al., 2004</xref>). Conversely, a loss of synaptic inputs leads to dendritic loss (<xref ref-type="bibr" rid="B294">Jones and Thomas, 1962</xref>; <xref ref-type="bibr" rid="B382">Matthews and Powell, 1962</xref>; <xref ref-type="bibr" rid="B127">Coleman and Riesen, 1968</xref>; <xref ref-type="bibr" rid="B534">Sfakianos et al., 2007</xref>). This reciprocal regulation contributes to the refinement of dendrites and synapses as the neurons mature (<xref ref-type="bibr" rid="B653">Wu et al., 1999</xref>; <xref ref-type="bibr" rid="B589">Trachtenberg et al., 2002</xref>; <xref ref-type="bibr" rid="B258">Holtmaat et al., 2005</xref>; <xref ref-type="bibr" rid="B320">Koleske, 2013</xref>). Thus, maintaining the structural stability of neurons and synapses is critical for proper brain function. Alterations in these processes likely underlie the disruption of normal dendrite and dendritic spine structure in neurological disorders, including neurodevelopmental conditions, psychiatric disorders, and neurodegenerative diseases (<xref ref-type="bibr" rid="B190">Fiala et al., 2002</xref>; <xref ref-type="bibr" rid="B357">Lin and Koleske</xref> <xref ref-type="bibr" rid="B357">2010</xref>; <xref ref-type="bibr" rid="B463">Penzes et al., 2011</xref>; <xref ref-type="bibr" rid="B328">Kulkarni and Firestein, 2012</xref>; <xref ref-type="bibr" rid="B688">Zoghbi and Bear, 2012</xref>; <xref ref-type="bibr" rid="B320">Koleske, 2013</xref>; <xref ref-type="bibr" rid="B54">Bernardinelli et al., 2014</xref>).</p>
<p>It is well-accepted that ASD is not a monogenetic disorder, instead, it is often a neurological condition resulted from multiple mutations of several different genes. Although knockout, knockin, or transgenic approaches of autism-risk genes in animal models have demonstrated some of the autistic-like behaviors (<xref ref-type="bibr" rid="B301">Kazdoba et al., 2016</xref>), the limitation of the number of genes being manipulated in animals makes it difficult to recapitulate the human condition experimentally. Furthermore, ASD is a common comorbid condition in individuals with other neurodevelopmental disorders. The similar representation of the symptoms but different contribution of genetic mutations often complicates the diagnosis and the treatment. The complex profile of gene mutations makes it difficult to call a gene &#x201C;the autism gene.&#x201D; However, the list of autism-risk genes provides us a direction to understand the potentially vulnerable pathways in neurons that may be therapeutic targets to develop more efficient interventions for ASD. Indeed, in addition to the structural stability of neurons, several cellular pathways including transcriptional regulation (<xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B517">Sanders, 2015</xref>), excitatory/inhibitory (E/I) balance (<xref ref-type="bibr" rid="B60">Blatt et al., 2001</xref>; <xref ref-type="bibr" rid="B269">Hussman, 2001</xref>; <xref ref-type="bibr" rid="B505">Rubenstein and Merzenich, 2003</xref>; <xref ref-type="bibr" rid="B206">Gao and Penzes, 2015</xref>; <xref ref-type="bibr" rid="B421">Nelson and Valakh, 2015</xref>), cerebellar development (<xref ref-type="bibr" rid="B640">Wang et al., 2014</xref>; <xref ref-type="bibr" rid="B239">Hampson and Blatt, 2015</xref>), and autoregulatory feedback loops (<xref ref-type="bibr" rid="B406">Mullins et al., 2016</xref>) have been proposed to be vulnerable in autism. In this review, we focus on recent identified autism-risk genes that have been shown to regulate neuronal structures and circuit formation, including aspects of neurite outgrowth (<bold>Table <xref ref-type="table" rid="T1">1</xref></bold>), synapse formation and spine stability (<bold>Table <xref ref-type="table" rid="T2">2</xref></bold>), and synaptic plasticity (<bold>Table <xref ref-type="table" rid="T3">3</xref></bold>). We will discuss the known biological function of those individual autism-risk genes in neurons and how they converge into common pathways. We have categorized these genes into cytoskeletal regulators, adhesion molecules, cell surface receptors, signaling molecules, as well as synaptic proteins (<bold>Figure <xref ref-type="fig" rid="F2">2</xref></bold>). In addition, we include genes causing syndromic disorders in the discussion to highlight the importance of maintaining the neuronal structures for proper brain function.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Summary of autism-associated genes that regulate neurite outgrowth.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Functional category</th>
<th valign="top" align="left">Gene</th>
<th valign="top" align="left">Representative references</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" colspan="3"><bold>Cytoskeletal regulator</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>MYO16</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B456">Patel et al., 2001</xref>; <xref ref-type="bibr" rid="B670">Yokoyama et al., 2011</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CTTNBP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B542">Shih et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>ELMO1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B194">Franke et al., 2012</xref>; <xref ref-type="bibr" rid="B332">Lanoue et al., 2013</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Adhesion molecule</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDHs</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B179">Esch et al., 2000</xref>; <xref ref-type="bibr" rid="B44">Bekirov et al., 2008</xref>; <xref ref-type="bibr" rid="B574">Tan et al., 2010</xref>; <xref ref-type="bibr" rid="B197">Friedman et al., 2015b</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PCDH</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B596">Uemura et al., 2007</xref>; <xref ref-type="bibr" rid="B404">Morrow et al., 2008</xref>; <xref ref-type="bibr" rid="B302">Keeler et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NRXN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B218">Gjorlund et al., 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NLGN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B218">Gjorlund et al., 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CNTNAP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B14">Anderson et al., 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CNTN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B666">Ye et al., 2008</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NCAM2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B536">Sheng et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Surface receptor</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>GRIN2B</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B184">Ewald et al., 2008</xref>; <xref ref-type="bibr" rid="B180">Espinosa et al., 2009</xref>; <xref ref-type="bibr" rid="B532">Sepulveda et al., 2010</xref>; <xref ref-type="bibr" rid="B80">Bustos et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NTRK</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B295">Joo et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Signaling molecule</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>DYRK1A</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B238">Hammerle et al., 2003</xref>; <xref ref-type="bibr" rid="B47">Benavides-Piccione et al., 2005</xref>; <xref ref-type="bibr" rid="B220">Gockler et al., 2009</xref>; <xref ref-type="bibr" rid="B341">Lepagnol-Bestel et al., 2009</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDKL5</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B106">Chen et al., 2010b</xref>; <xref ref-type="bibr" rid="B8">Amendola et al., 2014</xref>; <xref ref-type="bibr" rid="B200">Fuchs et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PTEN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B286">Jaworski et al., 2005</xref>; <xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>; <xref ref-type="bibr" rid="B685">Zhou et al., 2009</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Synaptic protein</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>STXBP5</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B512">Sakisaka et al., 2004</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PRICKLE1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B358">Liu et al., 2013a</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Syndromic disorder related gene</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>FMR1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B204">Galvez et al., 2003</xref>; <xref ref-type="bibr" rid="B17">Antar et al., 2006</xref>; <xref ref-type="bibr" rid="B594">Tucker et al., 2006</xref>; <xref ref-type="bibr" rid="B53">Berman et al., 2012</xref>; <xref ref-type="bibr" rid="B11">Amiri et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>MECP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B202">Fukuda et al., 2005</xref>; <xref ref-type="bibr" rid="B296">Jugloff et al., 2005</xref>; <xref ref-type="bibr" rid="B686">Zhou et al., 2006</xref>; <xref ref-type="bibr" rid="B32">Ballas et al., 2009</xref>; <xref ref-type="bibr" rid="B45">Belichenko et al., 2009</xref>; <xref ref-type="bibr" rid="B315">Kishi and Macklis, 2010</xref>; <xref ref-type="bibr" rid="B126">Cohen et al., 2011</xref>; <xref ref-type="bibr" rid="B379">Marshak et al., 2012</xref>; <xref ref-type="bibr" rid="B426">Nguyen et al., 2012</xref>; <xref ref-type="bibr" rid="B559">Stuss et al., 2012</xref>; <xref ref-type="bibr" rid="B288">Jiang et al., 2013a</xref>; <xref ref-type="bibr" rid="B30">Baj et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>UBE3A</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B166">Dindot et al., 2008</xref>; <xref ref-type="bibr" rid="B394">Miao et al., 2013</xref>; <xref ref-type="bibr" rid="B601">Valluy et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>TSC1/2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B191">Floricel et al., 2007</xref>; <xref ref-type="bibr" rid="B116">Choi et al., 2008</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption><p>Summary of autism-associated genes that regulate synapse/spine formation.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Functional category</th>
<th valign="top" align="left">Gene</th>
<th valign="top" align="left">Representative references</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" colspan="3"><bold>Cytoskeletal regulator</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>ADNP</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B446">Oz et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CTTNBP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B108">Chen and Hsueh, 2012</xref>; <xref ref-type="bibr" rid="B107">Chen et al., 2012</xref>; <xref ref-type="bibr" rid="B262">Hsueh, 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>SYNGAP1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B103">Chen et al., 1998</xref>; <xref ref-type="bibr" rid="B325">Krapivinsky et al., 2004</xref>; <xref ref-type="bibr" rid="B435">Oh et al., 2004</xref>; <xref ref-type="bibr" rid="B506">Rumbaugh et al., 2006</xref>; <xref ref-type="bibr" rid="B120">Clement et al., 2012</xref>; <xref ref-type="bibr" rid="B1">Aceti et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>ELMO1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B311">Kim et al., 2011a</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Adhesion molecule</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDHs</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B50">Benson and Tanaka, 1998</xref>; <xref ref-type="bibr" rid="B268">Huntley and Benson, 1999</xref>; <xref ref-type="bibr" rid="B69">Bozdagi et al., 2000</xref>; <xref ref-type="bibr" rid="B585">Togashi et al., 2002</xref>; <xref ref-type="bibr" rid="B454">Paradis et al., 2007</xref>; <xref ref-type="bibr" rid="B561">Suzuki et al., 2007</xref>; <xref ref-type="bibr" rid="B44">Bekirov et al., 2008</xref>; <xref ref-type="bibr" rid="B646">Williams et al., 2011</xref>; <xref ref-type="bibr" rid="B197">Friedman et al., 2015b</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PCDH</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B591">Tsai et al., 2012a</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NRXN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B155">de Wit et al., 2009</xref>; <xref ref-type="bibr" rid="B318">Ko et al., 2009</xref>; <xref ref-type="bibr" rid="B222">Gokce and Sudhof, 2013</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NLGN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B527">Scheiffele et al., 2000</xref>; <xref ref-type="bibr" rid="B482">Prange et al., 2004</xref>; <xref ref-type="bibr" rid="B113">Chih et al., 2005</xref>; <xref ref-type="bibr" rid="B346">Levinson et al., 2005</xref>; <xref ref-type="bibr" rid="B615">Varoqueaux et al., 2006</xref>; <xref ref-type="bibr" rid="B330">Kwon et al., 2012</xref>;</td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CNTNAP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B14">Anderson et al., 2012</xref>; <xref ref-type="bibr" rid="B212">Gdalyahu et al., 2015</xref>; <xref ref-type="bibr" rid="B613">Varea et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CNTN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B347">Li et al., 2003</xref>; <xref ref-type="bibr" rid="B569">Takeda et al., 2003</xref>; <xref ref-type="bibr" rid="B514">Sakurai et al., 2009</xref>, <xref ref-type="bibr" rid="B513">2010</xref>; <xref ref-type="bibr" rid="B588">Toyoshima et al. 2009</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Surface receptor</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>GRIN2B</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B2">Akashi et al., 2009</xref>; <xref ref-type="bibr" rid="B180">Espinosa et al., 2009</xref>; <xref ref-type="bibr" rid="B73">Brigman et al., 2010</xref>; <xref ref-type="bibr" rid="B436">Ohno et al., 2010</xref>; <xref ref-type="bibr" rid="B304">Kelsch et al., 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>GRIK2/4</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B264">Huettner, 2003</xref>; <xref ref-type="bibr" rid="B331">Lanore et al., 2012</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NTRK</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B393">Menn et al., 2000</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Signaling molecule</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>DYRK1A</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B47">Benavides-Piccione et al., 2005</xref>; <xref ref-type="bibr" rid="B455">Park et al., 2012</xref>; <xref ref-type="bibr" rid="B582">Thomazeau et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDKL5</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B687">Zhu et al., 2013</xref>; <xref ref-type="bibr" rid="B159">Della Sala et al., 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PTEN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>; <xref ref-type="bibr" rid="B195">Fraser et al., 2008</xref>; <xref ref-type="bibr" rid="B366">Luikart et al., 2011</xref>; <xref ref-type="bibr" rid="B485">Pun et al., 2012</xref>; <xref ref-type="bibr" rid="B681">Zhang et al., 2012</xref>; <xref ref-type="bibr" rid="B243">Haws et al., 2014</xref>; <xref ref-type="bibr" rid="B144">Cupolillo et al., 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Synaptic protein</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>SHANK3</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B515">Sala et al., 2001</xref>; <xref ref-type="bibr" rid="B504">Roussignol et al., 2005</xref>; <xref ref-type="bibr" rid="B267">Hung et al., 2008</xref>; <xref ref-type="bibr" rid="B458">Pe&#x00E7;a et al., 2011</xref>; <xref ref-type="bibr" rid="B622">Verpelli et al., 2011</xref>; <xref ref-type="bibr" rid="B635">Wang et al., 2011b</xref>; <xref ref-type="bibr" rid="B459">Peixoto et al., 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>DLGAP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B291">Jiang-Xie et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left" colspan="3"><bold>Syndromic disorder related gene</bold></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>FMR1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B131">Comery et al., 1997</xref>; <xref ref-type="bibr" rid="B642">Weiler and Greenough, 1999</xref>; <xref ref-type="bibr" rid="B71">Braun and Segal, 2000</xref>; <xref ref-type="bibr" rid="B282">Irwin et al., 2000</xref>; <xref ref-type="bibr" rid="B430">Nimchinsky et al., 2001</xref>; <xref ref-type="bibr" rid="B530">Segal et al., 2003</xref>; <xref ref-type="bibr" rid="B205">Galvez and Greenough, 2005</xref>; <xref ref-type="bibr" rid="B319">Koekkoek et al., 2005</xref>; <xref ref-type="bibr" rid="B388">McKinney et al., 2005</xref>; <xref ref-type="bibr" rid="B17">Antar et al., 2006</xref>; <xref ref-type="bibr" rid="B229">Grossman et al., 2006</xref>, <xref ref-type="bibr" rid="B228">2010</xref>; <xref ref-type="bibr" rid="B163">Dictenberg et al., 2008</xref>; <xref ref-type="bibr" rid="B141">Cruz-Martin et al., 2010</xref>; <xref ref-type="bibr" rid="B452">Pan et al., 2010</xref>; <xref ref-type="bibr" rid="B344">Levenga et al., 2011a</xref>; <xref ref-type="bibr" rid="B486">Qin et al., 2011</xref>; <xref ref-type="bibr" rid="B53">Berman et al., 2012</xref>; <xref ref-type="bibr" rid="B248">He and Portera-Cailliau, 2013</xref>; <xref ref-type="bibr" rid="B11">Amiri et al., 2014</xref>; <xref ref-type="bibr" rid="B645">Wijetunge et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>MECP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B202">Fukuda et al., 2005</xref>; <xref ref-type="bibr" rid="B686">Zhou et al., 2006</xref>; <xref ref-type="bibr" rid="B97">Chapleau et al., 2009</xref>; <xref ref-type="bibr" rid="B426">Nguyen et al., 2012</xref>; <xref ref-type="bibr" rid="B559">Stuss et al., 2012</xref>; <xref ref-type="bibr" rid="B288">Jiang et al., 2013a</xref>; <xref ref-type="bibr" rid="B30">Baj et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>UBE3A</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B166">Dindot et al., 2008</xref>; <xref ref-type="bibr" rid="B225">Greer et al., 2010</xref>; <xref ref-type="bibr" rid="B667">Yi et al., 2015</xref>; <xref ref-type="bibr" rid="B308">Kim et al., 2016</xref>; <xref ref-type="bibr" rid="B601">Valluy et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>TSC1/2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B581">Tavazoie et al., 2005</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap position="float" id="T3">
<label>Table 3</label>
<caption><p>Summary of autism-associated genes that regulate synaptic plasticity.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Functional category</th>
<th valign="top" align="left">Gene</th>
<th valign="top" align="left">Representative references</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><bold>Cytoskeletal regulator</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>SYNGAP1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B618">Vazquez et al., 2004</xref>; <xref ref-type="bibr" rid="B506">Rumbaugh et al., 2006</xref>; <xref ref-type="bibr" rid="B89">Carlisle et al., 2008</xref>; <xref ref-type="bibr" rid="B120">Clement et al., 2012</xref>, <xref ref-type="bibr" rid="B121">2013</xref>; <xref ref-type="bibr" rid="B448">Ozkan et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Adhesion molecule</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDHs</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B69">Bozdagi et al., 2000</xref>; <xref ref-type="bibr" rid="B371">Manabe et al., 2000</xref>; <xref ref-type="bibr" rid="B585">Togashi et al., 2002</xref>; <xref ref-type="bibr" rid="B70">Bozdagi et al., 2010</xref>; <xref ref-type="bibr" rid="B392">Mendez et al., 2010</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NRXN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B346">Levinson et al., 2005</xref>; <xref ref-type="bibr" rid="B182">Etherton et al., 2009</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>NLGN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B113">Chih et al., 2005</xref>; <xref ref-type="bibr" rid="B615">Varoqueaux et al., 2006</xref>; <xref ref-type="bibr" rid="B118">Chubykin et al., 2007</xref>; <xref ref-type="bibr" rid="B566">Tabuchi et al., 2007</xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Surface receptor</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>GRIN2B</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B73">Brigman et al., 2010</xref>; <xref ref-type="bibr" rid="B436">Ohno et al., 2010</xref>; <xref ref-type="bibr" rid="B634">Wang et al., 2011a</xref>; <xref ref-type="bibr" rid="B662">Yang et al., 2012a</xref>; <xref ref-type="bibr" rid="B509">Ryan et al., 2013</xref>; <xref ref-type="bibr" rid="B173">Dupuis et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>GRIK2/4</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B134">Contractor et al., 2001</xref>; <xref ref-type="bibr" rid="B264">Huettner, 2003</xref>; <xref ref-type="bibr" rid="B673">Youn and Randic, 2004</xref>; <xref ref-type="bibr" rid="B331">Lanore et al., 2012</xref>; <xref ref-type="bibr" rid="B6">Aller et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Signaling molecule</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>CDKL5</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B159">Della Sala et al., 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>PTEN</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B195">Fraser et al., 2008</xref>; <xref ref-type="bibr" rid="B366">Luikart et al., 2011</xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Synaptic protein</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>SHANK3</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B33">Bangash et al., 2011</xref>; <xref ref-type="bibr" rid="B458">Pe&#x00E7;a et al., 2011</xref>; <xref ref-type="bibr" rid="B635">Wang et al., 2011b</xref>; <xref ref-type="bibr" rid="B459">Peixoto et al., 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>DLGAP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B291">Jiang-Xie et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>STXBP5</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B34">Barak et al., 2013</xref>; <xref ref-type="bibr" rid="B49">Ben-Simon et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"><bold>Syndromic disorder related gene</bold></td>
<td valign="top" align="left"></td>
<td valign="top" align="left"></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>FMR1</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B530">Segal et al., 2003</xref>; <xref ref-type="bibr" rid="B319">Koekkoek et al., 2005</xref>; <xref ref-type="bibr" rid="B78">Bureau et al., 2008</xref>; <xref ref-type="bibr" rid="B24">Auerbach and Bear, 2010</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>MECP2</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B130">Collins et al., 2004</xref>; <xref ref-type="bibr" rid="B148">Dani et al., 2005</xref>; <xref ref-type="bibr" rid="B22">Asaka et al., 2006</xref>; <xref ref-type="bibr" rid="B403">Moretti et al., 2006</xref>; <xref ref-type="bibr" rid="B96">Chao et al., 2007</xref>; <xref ref-type="bibr" rid="B680">Zhang et al., 2008</xref>; <xref ref-type="bibr" rid="B126">Cohen et al., 2011</xref>; <xref ref-type="bibr" rid="B348">Li et al., 2011</xref>; <xref ref-type="bibr" rid="B432">Noutel et al., 2011</xref>; <xref ref-type="bibr" rid="B58">Blackman et al., 2012</xref>; <xref ref-type="bibr" rid="B408">Na et al., 2012</xref>; <xref ref-type="bibr" rid="B487">Qiu et al., 2012</xref>; <xref ref-type="bibr" rid="B684">Zhong et al., 2012</xref>; <xref ref-type="bibr" rid="B409">Na et al., 2013</xref>; <xref ref-type="bibr" rid="B158">Della Sala and Pizzorusso, 2014</xref>; <xref ref-type="bibr" rid="B160">Deng et al., 2014</xref>; <xref ref-type="bibr" rid="B151">De Filippis et al., 2015</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left"><italic>UBE3A</italic></td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B665">Yashiro et al., 2009</xref>; <xref ref-type="bibr" rid="B523">Sato and Stryker, 2010</xref>; <xref ref-type="bibr" rid="B550">Smith et al., 2011</xref>; <xref ref-type="bibr" rid="B246">Hayrapetyan et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"></td>
</tr>
</tbody>
</table>
</table-wrap>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p><bold>Schematic illustration of how autism-risk genes regulate neuronal structure and their sites of action.</bold> An illustration of a dendritic segment containing a dendrite and a dendritic spine is enlarged from the box region on the left and shown on the right. Microtubules (green) and actin filaments (blue) are two major cytoskeletons found in dendrites and dendritic spines, respectively. Autism-risk genes (in bold font) are categorized by their main function and color coded accordingly. (1) Cytoskeletal proteins (gray rounded rectangular box): MYO16, CTTNBP2, and ADNP, directly regulate actin and microtubule function to control dendritic spine and neurite stability. ELMO1 and SYNGAP1 regulate actin dynamics to control spine stability via small RhoGTPases. (2) Adhesion molecules (colored rectangular box): Cadherins (CDHs), protocadherins (PCDHs), and neurexin (NRXN)-neuroligin (NLGN) complex, as well as surface receptors, NTRK, GRIK, and NMDAR, act at synapses to regulate synaptic function. NCAM2 and CNTNAP2, also have functions in regulating neurite outgrowth. (3) Signaling molecules (blue ellipse shape): CDKL5, DYRK1A, and PTEN regulate several signaling pathways to maintain the stability of dendritic structures. (4) Scaffolding proteins (yellow polygon): SHANK3 and DLGAP2, locate at post-synaptic density and tightly associate with PSD95 and other signaling molecules to regulate spine stability and synaptic plasticity. (5) Synaptic proteins (pink ellipse shape): STXBP5 and PRICKLE1 not only regulate synaptic vesicle release, but also play a role in regulating neurite outgrowth. (6) Syndromic molecules (clear rectangular box): FMRP and UBE3A regulate the structural stability of neurons via the regulation of protein synthesis or binding with other molecules in dendritic spines. MECP2 mainly functions in the nucleus and regulates transcription of many genes to in turn affecting the structural stability of neurons. TSC1/2 regulates the mTOR pathway and cytoskeletal machinery to maintain dendritic stability.</p></caption>
<graphic xlink:href="fncel-10-00263-g002.tif"/>
</fig>
</sec>
<sec><title>Cytoskeletal Regulation Is Key to the Maintenance of Proper Stability and Plasticity of Neurons</title>
<p>The actin and microtubule cytoskeletons are the major components of dendritic spine and neurite structure, respectively (<xref ref-type="bibr" rid="B259">Hoogenraad and Akhmanova, 2010</xref>; <xref ref-type="bibr" rid="B260">Hotulainen and Hoogenraad, 2010</xref>; <xref ref-type="bibr" rid="B161">Dent et al., 2011</xref>; <xref ref-type="bibr" rid="B546">Shirao and Gonzalez-Billault, 2013</xref>). Precise regulation of these actin and microtubule networks is thus central to guide the proper development, plasticity, and long-term stability of these structures (<xref ref-type="bibr" rid="B383">Matus, 2000</xref>; <xref ref-type="bibr" rid="B384">Matus et al., 2000</xref>; <xref ref-type="bibr" rid="B368">Luo, 2002</xref>; <xref ref-type="bibr" rid="B356">Lin and Webb, 2009</xref>; <xref ref-type="bibr" rid="B322">Korobova and Svitkina, 2010</xref>; <xref ref-type="bibr" rid="B357">Lin and Koleske, 2010</xref>; <xref ref-type="bibr" rid="B563">Svitkina et al., 2010</xref>; <xref ref-type="bibr" rid="B161">Dent et al., 2011</xref>; <xref ref-type="bibr" rid="B428">Nicholson et al., 2012</xref>; <xref ref-type="bibr" rid="B462">Penzes and Cahill, 2012</xref>; <xref ref-type="bibr" rid="B464">Penzes and Rafalovich, 2012</xref>; <xref ref-type="bibr" rid="B521">Saneyoshi and Hayashi, 2012</xref>).</p>
<sec><title>Actin and Microtubule Regulators Are Associated with Autism</title>
<p>Myosins are motors that utilize ATPase activity to provide motility of actin or cargo transport on actin filaments (<xref ref-type="bibr" rid="B476">Pollard and Korn, 1973</xref>; <xref ref-type="bibr" rid="B439">Oliver et al., 1999</xref>; <xref ref-type="bibr" rid="B595">Tyska and Warshaw, 2002</xref>). Several myosin isoforms play central roles in regulating neurite outgrowth, as well as dendritic spine structural plasticity (<xref ref-type="bibr" rid="B656">Wylie et al., 1998</xref>; <xref ref-type="bibr" rid="B655">Wylie and Chantler, 2003</xref>; <xref ref-type="bibr" rid="B510">Ryu et al., 2006</xref>; <xref ref-type="bibr" rid="B237">Hammer and Wagner, 2013</xref>; <xref ref-type="bibr" rid="B317">Kneussel and Wagner, 2013</xref>; <xref ref-type="bibr" rid="B672">Yoshii et al., 2013</xref>; <xref ref-type="bibr" rid="B324">Koskinen et al., 2014</xref>; <xref ref-type="bibr" rid="B597">Ultanir et al., 2014</xref>). Among all isoforms, <italic>MYO16</italic> (Myr8 or NYAP3) was recently implicated in ASD (<xref ref-type="bibr" rid="B637">Wang et al., 2009</xref>; <xref ref-type="bibr" rid="B132">Connolly et al., 2013</xref>; <xref ref-type="bibr" rid="B305">Kenny et al., 2014</xref>; <xref ref-type="bibr" rid="B498">Roberts et al., 2014</xref>; <xref ref-type="bibr" rid="B362">Liu et al., 2015b</xref>). MYO16 is expressed predominantly in the cortex and cerebellum. Levels and phosphorylation of MYO16 protein peak during early developmental stages, consistent with a role in regulating neuronal migration and neurite extension (<xref ref-type="bibr" rid="B456">Patel et al., 2001</xref>; <xref ref-type="bibr" rid="B670">Yokoyama et al., 2011</xref>). In addition to binding directly to filamentous- (F-)actin, MYO16 also physically interacts with PI3K and WAVE complex to regulate stress fiber remodeling in fibroblasts as well as the adhesion-dependent neurite outgrowth in neurons (<xref ref-type="bibr" rid="B670">Yokoyama et al., 2011</xref>).</p>
<p><italic>CTTNBP2</italic> encodes cortactin-binding protein 2 that interacts with cortactin, a nucleation-promoting factor of actin (<xref ref-type="bibr" rid="B437">Ohoka and Takai, 1998</xref>). CTTNBP2 is highly expressed in dendritic spines where it locally interacts with cortactin, striatin, a calcium binding protein, and PP2A, a serine/threonine protein phosphatase 2A, to control the formation and the maintenance of dendritic spines (<xref ref-type="bibr" rid="B107">Chen et al., 2012</xref>; <xref ref-type="bibr" rid="B108">Chen and Hsueh, 2012</xref>; <xref ref-type="bibr" rid="B262">Hsueh, 2012</xref>). In addition, oligomerization of CTTNBP2 induces microtubule bundling to promote dendrite arborization (<xref ref-type="bibr" rid="B542">Shih et al., 2014</xref>). Several mutations of <italic>CTTNBP2</italic> have been reported in ASD cases, further indicating the importance of neurite outgrowth and dendritic spine formation for proper brain function (<xref ref-type="bibr" rid="B111">Cheung et al., 2001</xref>; <xref ref-type="bibr" rid="B280">Iossifov et al., 2012</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>).</p>
<p>Activity-dependent neuroprotective protein (ADNP) is a homeobox-containing protein secreted from glia and neurons (<xref ref-type="bibr" rid="B38">Bassan et al., 1999</xref>; <xref ref-type="bibr" rid="B678">Zamostiano et al., 2001</xref>; <xref ref-type="bibr" rid="B203">Furman et al., 2004</xref>; <xref ref-type="bibr" rid="B374">Mandel et al., 2008</xref>; <xref ref-type="bibr" rid="B411">Nakamachi et al., 2008</xref>). Through its interaction with the chromatin remodeling complex SWI/SNF, ADNP regulates hundreds of genes to modulate brain function (<xref ref-type="bibr" rid="B472">Pinhasov et al., 2003</xref>; <xref ref-type="bibr" rid="B372">Mandel and Gozes, 2007</xref>; <xref ref-type="bibr" rid="B373">Mandel et al., 2007</xref>). In addition to its traditional role in regulating transcription, ADNP has also been suggested to have function in regulating dendritic spines through interactions with microtubule end binding proteins (<xref ref-type="bibr" rid="B446">Oz et al., 2014</xref>). Mutations in or the alteration of the protein expression of <italic>ADNP</italic> have been associated with several neurological disorders, including schizophrenia and Alzheimer&#x2019;s Disease (<xref ref-type="bibr" rid="B627">Vulih-Shultzman et al., 2007</xref>; <xref ref-type="bibr" rid="B189">Fernandez-Montesinos et al., 2010</xref>; <xref ref-type="bibr" rid="B170">Dresner et al., 2011</xref>; <xref ref-type="bibr" rid="B663">Yang et al., 2012b</xref>). Intriguingly, the association of mutations in <italic>ADNP</italic> and ASD is further emphasizing that the cytoskeletal integrity of neurons is vulnerable in ASD (<xref ref-type="bibr" rid="B442">O&#x2019;Roak et al., 2012a</xref>,<xref ref-type="bibr" rid="B443">b</xref>; <xref ref-type="bibr" rid="B48">Ben-David and Shifman, 2013</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B251">Helsmoortel et al., 2014</xref>; <xref ref-type="bibr" rid="B611">Vandeweyer et al., 2014</xref>; <xref ref-type="bibr" rid="B164">D&#x2019;Gama et al., 2015</xref>).</p>
</sec>
<sec><title>Small RhoGTPase Regulation Is a Key Mechanism in Controlling Neurite and Spine Stability</title>
<p>Small RhoGTPases including Rho, Rac, and Cdc42 are central cytoskeletal regulators that control cell motility and morphology (<xref ref-type="bibr" rid="B223">Govek et al., 2005</xref>; <xref ref-type="bibr" rid="B425">Newey et al., 2005</xref>; <xref ref-type="bibr" rid="B357">Lin and Koleske, 2010</xref>; <xref ref-type="bibr" rid="B586">Tolias et al., 2011</xref>). Genetic mutations or dysregulation of the small RhoGTPase regulators, including guanine-exchange factors (GEFs) and GTPase-activating proteins (GAPs), have been implicated in several neurological conditions, including ASD (<xref ref-type="bibr" rid="B425">Newey et al., 2005</xref>; <xref ref-type="bibr" rid="B357">Lin and Koleske, 2010</xref>; <xref ref-type="bibr" rid="B18">Antoine-Bertrand et al., 2011</xref>; <xref ref-type="bibr" rid="B556">Stankiewicz and Linseman, 2014</xref>). Here, we will highlight those that regulate the morphological stability of neurons.</p>
<p>Engulfment and cell motility 1 (ELMO1) was first identified in a complex with a RacGEF, DOCK180, to activate Rac1 activity, which is essential for cell migration and phagocytosis (<xref ref-type="bibr" rid="B231">Gumienny et al., 2001</xref>; <xref ref-type="bibr" rid="B75">Brugnera et al., 2002</xref>; <xref ref-type="bibr" rid="B226">Grimsley et al., 2004</xref>). In hippocampal neurons, ELMO1 and DOCK180 colocalize at synaptic sites and together are required for spine formation (<xref ref-type="bibr" rid="B311">Kim et al., 2011a</xref>). Loss of <italic>Elmo1</italic> shows a reduction in spine number but increased filopodia, suggesting a role in formation and/or maintenance of mature spines (<xref ref-type="bibr" rid="B311">Kim et al., 2011a</xref>). In addition, ELMO1 has been shown to regulate axonal and dendritic branching via Rac1 activation in response to different upstream signals (<xref ref-type="bibr" rid="B194">Franke et al., 2012</xref>; <xref ref-type="bibr" rid="B332">Lanoue et al., 2013</xref>).</p>
<p><italic>SYNGAP1</italic> encodes a synaptic-specific Ras/Rap GAP that associates with PSD-95 and specifically localizes to synaptic sites (<xref ref-type="bibr" rid="B310">Kim et al., 1998</xref>; <xref ref-type="bibr" rid="B325">Krapivinsky et al., 2004</xref>). The role of SYNGAP1 in regulating spine morphology and synaptic function has been well described. In response to CaMKII phosphorylation, SYNGAP1 directly regulates Ras/Rap activity to modulate MAPK signaling to maintain the stability of dendritic spines (<xref ref-type="bibr" rid="B103">Chen et al., 1998</xref>; <xref ref-type="bibr" rid="B325">Krapivinsky et al., 2004</xref>; <xref ref-type="bibr" rid="B435">Oh et al., 2004</xref>; <xref ref-type="bibr" rid="B506">Rumbaugh et al., 2006</xref>). Overexpression of SYNGAP1 decreases AMPAR-mediated currents and surface expression (<xref ref-type="bibr" rid="B506">Rumbaugh et al., 2006</xref>; <xref ref-type="bibr" rid="B633">Wang et al., 2013</xref>). Deletion or reduction of SYNGAP1 results in an elevated synaptic strength and an increase of mushroom spines (<xref ref-type="bibr" rid="B618">Vazquez et al., 2004</xref>; <xref ref-type="bibr" rid="B506">Rumbaugh et al., 2006</xref>; <xref ref-type="bibr" rid="B89">Carlisle et al., 2008</xref>). Mice with <italic>Syngap1</italic> haploinsufficiency show accelerated maturation of dendritic spines followed by disruptions of synaptic transmission and cognitive function (<xref ref-type="bibr" rid="B120">Clement et al., 2012</xref>, <xref ref-type="bibr" rid="B121">2013</xref>; <xref ref-type="bibr" rid="B448">Ozkan et al., 2014</xref>; <xref ref-type="bibr" rid="B1">Aceti et al., 2015</xref>). Coincidentally, haploinsufficiency in <italic>SYNGAP1</italic> has been found in individuals with autism, intellectual disability, and a specific form of epilepsy (<xref ref-type="bibr" rid="B55">Berryer et al., 2013</xref>). Several other <italic>de novo</italic> mutations of <italic>SYNGAP1</italic> also have been identified in different cases of ASD (<xref ref-type="bibr" rid="B474">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B135">Cook, 2011</xref>; <xref ref-type="bibr" rid="B236">Hamdan et al., 2011</xref>; <xref ref-type="bibr" rid="B55">Berryer et al., 2013</xref>; <xref ref-type="bibr" rid="B647">Willsey et al., 2013</xref>; <xref ref-type="bibr" rid="B72">Brett et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B441">O&#x2019;Roak et al., 2014</xref>).</p>
<p>Since the actin and microtubule cytoskeletons are the major components of neuronal processes, it is not surprising that manipulating the cytoskeletal machinery dramatically affects neuronal structures. A small imbalance of cytoskeletal dynamics will create a huge impact on the structural stability of neurons, which in turn alters the formation of neuronal circuitry. Interestingly, most autism-associated cytoskeletal regulators control neurite outgrowth and synapse/spine formation thereby affecting the structural stability of neurons. These two processes are also the initial steps to establish correct neuronal connections during development. Failure to regulate these processes properly may result in significantly altered wiring of brain circuitries that is often found in ASD. The next research focus should investigate early in development to connect the dysregulatory effects of mutations in cytoskeletal genes.</p>
</sec>
</sec>
<sec><title><italic>Trans</italic>-Synaptic Adhesion Molecules Play Important Roles in the Regulation of Neuronal Stability</title>
<p>Cell adhesion molecules (CAMs) play crucial roles in many aspects of neural circuit formation and, thus, it comes as no surprise that these molecules are found as top hits in lists of autism risk genes (<xref ref-type="bibr" rid="B56">Betancur et al., 2009</xref>; <xref ref-type="bibr" rid="B474">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B104">Chen et al., 2014b</xref>). Here, we discuss the current understanding of how CAMs that belong to the cadherin-, the neurexin/neuroligin- and the immunoglobulin-superfamily regulate neuronal stability.</p>
<sec><title>Cadherin Superfamily Members Are Prominent Hits in Autism Risk Gene Lists</title>
<p>The genetic association of cadherins with autism strongly supports their central roles in the development of the nervous system including synaptogenesis, dendrite arborization and dendritic spine regulation (<xref ref-type="bibr" rid="B20">Arikkath and Reichardt, 2008</xref>; <xref ref-type="bibr" rid="B562">Suzuki and Takeichi, 2008</xref>; <xref ref-type="bibr" rid="B39">Basu et al., 2015</xref>; <xref ref-type="bibr" rid="B196">Friedman et al., 2015a</xref>; <xref ref-type="bibr" rid="B531">Seong et al., 2015</xref>). The cadherin superfamily is comprised of more than a hundred different genes, subdivided into several classes including classical cadherins, protocadherins and atypical cadherins (<xref ref-type="bibr" rid="B266">Hulpiau and van Roy, 2009</xref>; <xref ref-type="bibr" rid="B252">Hirano and Takeichi, 2012</xref>). Several copy number variations (CNVs) and single nucleotide polymorphisms (SNPs) are found in classical cadherins: <italic>CDH2. CDH5. CDH8. CDH9, CDH10, CDH11</italic>, and <italic>CDH13</italic> (<xref ref-type="bibr" rid="B638">Wang et al., 2010</xref>; <xref ref-type="bibr" rid="B98">Chapman et al., 2011</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B450">Pagnamenta et al., 2011</xref>; <xref ref-type="bibr" rid="B518">Sanders et al., 2011</xref>; <xref ref-type="bibr" rid="B443">O&#x2019;Roak et al., 2012b</xref>; <xref ref-type="bibr" rid="B481">Prandini et al., 2012</xref>; <xref ref-type="bibr" rid="B132">Connolly et al., 2013</xref>; <xref ref-type="bibr" rid="B629">Walker and Scherer, 2013</xref>; <xref ref-type="bibr" rid="B139">Crepel et al., 2014</xref>; <xref ref-type="bibr" rid="B327">Krumm et al., 2015</xref>); non-clustered protocadherins: <italic>PCDH9, PCDH10</italic>, and <italic>PCDH19</italic> (<xref ref-type="bibr" rid="B404">Morrow et al., 2008</xref>; <xref ref-type="bibr" rid="B162">Depienne et al., 2009</xref>; <xref ref-type="bibr" rid="B86">Camacho et al., 2012</xref>; <xref ref-type="bibr" rid="B443">O&#x2019;Roak et al., 2012b</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B216">Girirajan et al., 2013</xref>; <xref ref-type="bibr" rid="B607">van Harssel et al., 2013</xref>)<italic>;</italic> and an atypical cadherin, <italic>FAT1</italic> (<xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B420">Neale et al., 2012</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B305">Kenny et al., 2014</xref>). In general, the extracellular domain of cadherins contains five cadherin repeats/EC motifs that mediate Ca<sup>2+</sup>-dependent homophilic adhesion (<xref ref-type="bibr" rid="B576">Tanihara et al., 1994</xref>). However, heterophilic interactions between different sub-classes of classical cadherins create more combinations of interaction and function (<xref ref-type="bibr" rid="B544">Shimoyama et al., 2000</xref>). The cytosolic tail binds to catenins leading to the anchoring of the cadherin-catenin complex to the cytoskeleton (via &#x03B2;-catenin and &#x03B1;-catenin) and the clustering of cadherins in the plasma membrane (via p120-catenin) (<xref ref-type="bibr" rid="B664">Yap et al., 1998</xref>; <xref ref-type="bibr" rid="B422">Nelson, 2008</xref>; <xref ref-type="bibr" rid="B386">McCrea and Gu, 2010</xref>). The cadherin superfamily contains numerous cadherin members which impact neuronal structure and function from early neurite extension to the maintenance of mature synaptic networks (<xref ref-type="bibr" rid="B39">Basu et al., 2015</xref>; <xref ref-type="bibr" rid="B196">Friedman et al., 2015a</xref>). However, the pathways underlying disrupted cadherin signaling still requires further investigation. Here, we focus our discussion on the autism-associated cadherins shown to regulate neurite outgrowth and synapse morphogenesis.</p>
<p><italic>N</italic>-cadherin, also known as cadherin 2 (CDH2), is the best studied classical cadherin. <italic>N</italic>-cadherin functions throughout the development of the nervous system, including neurite outgrowth, axon guidance, synaptogenesis and synaptic plasticity (<xref ref-type="bibr" rid="B570">Takeichi and Abe, 2005</xref>; <xref ref-type="bibr" rid="B20">Arikkath and Reichardt, 2008</xref>; <xref ref-type="bibr" rid="B252">Hirano and Takeichi, 2012</xref>; <xref ref-type="bibr" rid="B196">Friedman et al., 2015a</xref>). <italic>N</italic>-cadherin promotes dendritic outgrowth during development and is also required for activity-dependent dendrite expansion (<xref ref-type="bibr" rid="B179">Esch et al., 2000</xref>; <xref ref-type="bibr" rid="B574">Tan et al., 2010</xref>). <italic>N</italic>-cadherin is also required for the establishment of initial contacts between axons and filopodia followed by clustering at contact points to stabilize early synapses (<xref ref-type="bibr" rid="B50">Benson and Tanaka, 1998</xref>; <xref ref-type="bibr" rid="B268">Huntley and Benson, 1999</xref>; <xref ref-type="bibr" rid="B585">Togashi et al., 2002</xref>). Blocking <italic>N</italic>-cadherin adhesion in hippocampal neurons perturbs synapse formation and abolishes long-term potentiation (LTP)-induced stabilization of dendritic spines (<xref ref-type="bibr" rid="B585">Togashi et al., 2002</xref>; <xref ref-type="bibr" rid="B392">Mendez et al., 2010</xref>). Neural activity increases <italic>N</italic>-cadherin protein levels and dimerization leading to increased synapse number (<xref ref-type="bibr" rid="B69">Bozdagi et al., 2000</xref>). In mature synapses, <italic>N</italic>-cadherin is required for the persistence of dendritic spine enlargement and LTP (<xref ref-type="bibr" rid="B69">Bozdagi et al., 2000</xref>, <xref ref-type="bibr" rid="B70">2010</xref>). Together with <italic>N</italic>-cadherin, CDH8 regulates the development of the hippocampal mossy fiber pathway (<xref ref-type="bibr" rid="B44">Bekirov et al., 2008</xref>). CDH8 also mediates assembly and maturation of corticostriatal synapses (<xref ref-type="bibr" rid="B44">Bekirov et al., 2008</xref>; <xref ref-type="bibr" rid="B197">Friedman et al., 2015b</xref>), whereas CDH9-mediated adhesion is involved in the formation and differentiation of dentate gyrus synapses on CA3 cells where it regulates synapse density, presynaptic bouton complexity and postsynaptic morphology (<xref ref-type="bibr" rid="B646">Williams et al., 2011</xref>). In contrast to CDH8 and CDH9, an RNAi screen for molecules required for synapse development identified CDH11 and CDH13 as positive regulators of glutamatergic synapse development (<xref ref-type="bibr" rid="B454">Paradis et al., 2007</xref>). Interestingly, <italic>Cdh11</italic>-deficient mice revealed enhanced LTP in the CA1 region of the hippocampus and mice show reduced fear- or anxiety-related behavior suggesting that CDH11 might restrict synaptic plasticity and efficacy (<xref ref-type="bibr" rid="B371">Manabe et al., 2000</xref>).</p>
<p>Protocadherins are the largest subgroup within the cadherin superfamily and are further subtyped into clustered (&#x03B1;-, &#x03B2;- and &#x03B3;-PCDH) and non-clustered protocadherins (&#x03B4;1- and &#x03B4;2-PCDH) (<xref ref-type="bibr" rid="B193">Frank and Kemler, 2002</xref>). They share a similar structure to classical cadherins, but with six to seven cadherin domains/EC motifs. However, the cytosolic tails of protocadherins and cadherins do not show significant homology suggesting that they likely engage distinct intracellular signaling pathways. Protocadherins are highly expressed in the nervous system and localize to synapses. Based on their spatial and temporal expression pattern in the brain and on recent reports, protocadherins have roles in dendritic development and synaptic connections (<xref ref-type="bibr" rid="B253">Hirano et al., 1999</xref>; <xref ref-type="bibr" rid="B193">Frank and Kemler, 2002</xref>; <xref ref-type="bibr" rid="B312">Kim et al., 2007</xref>, <xref ref-type="bibr" rid="B313">2011b</xref>; <xref ref-type="bibr" rid="B302">Keeler et al., 2015</xref>). For example, PCDH10 expression is regulated by neuronal activity and its function is crucial for forebrain axon outgrowth and the proper patterning of thalamocorticial projections (<xref ref-type="bibr" rid="B596">Uemura et al., 2007</xref>; <xref ref-type="bibr" rid="B404">Morrow et al., 2008</xref>). In addition, PCDH10 mediates synapse elimination by promoting proteasomal degradation of PSD-95 (<xref ref-type="bibr" rid="B591">Tsai et al., 2012a</xref>).</p>
<p>FAT atypical cadherin 1 (FAT1) belongs to the atypical cadherin family and consists of a huge extracellular domain comprising 34 cadherin domains/EC motifs (<xref ref-type="bibr" rid="B578">Tanoue and Takeichi, 2005</xref>; <xref ref-type="bibr" rid="B511">Sadeqzadeh et al., 2014</xref>). FAT1 expression is enriched during embryonic neurodevelopment and severe nervous system defects are found in FAT1-deficient mice (<xref ref-type="bibr" rid="B119">Ciani et al., 2003</xref>; <xref ref-type="bibr" rid="B511">Sadeqzadeh et al., 2014</xref>). At the cellular level, FAT1 localizes to cell&#x2013;cell contacts as well as to the leading edge of lamellipodia and tips of filopodia to regulate cell polarity, cell migration, and cell-cell adhesion (<xref ref-type="bibr" rid="B399">Moeller et al., 2004</xref>; <xref ref-type="bibr" rid="B577">Tanoue and Takeichi, 2004</xref>). These functions are likely mediated through intracellular signaling via Ena/VASP proteins to regulate actin assembly and dynamics (<xref ref-type="bibr" rid="B399">Moeller et al., 2004</xref>; <xref ref-type="bibr" rid="B577">Tanoue and Takeichi, 2004</xref>). Other intracellular binding partners of FAT1 include the classical cadherin binding partner &#x03B2;-catenin as well as the synaptic scaffolding molecules Homer-1 and 3 (<xref ref-type="bibr" rid="B261">Hou et al., 2006</xref>; <xref ref-type="bibr" rid="B528">Schreiner et al., 2006</xref>).</p>
</sec>
<sec><title>The Neurexin-Neuroligin Complex Is One of the Most Studied <italic>Trans</italic>-synaptic Adhesion Pairs in Autism</title>
<p>Neurexins are encoded by three genes (<italic>NRXN1-3</italic>) while the neuroligin family consists of four isoforms in mice (<italic>Nlgn1-4</italic>) and five isoforms in humans (<italic>NLGN1-4X and 4Y</italic>) (<xref ref-type="bibr" rid="B560">S&#x00FC;dhof, 2008</xref>). Neurexins localize to presynaptic terminals and form heterophilic interactions with neuroligins, which are localized to the postsynaptic compartment (<xref ref-type="bibr" rid="B275">Ichtchenko et al., 1995</xref>, <xref ref-type="bibr" rid="B276">1996</xref>; <xref ref-type="bibr" rid="B427">Nguyen and Sudhof, 1997</xref>). Presynaptic neurexins link synaptic adhesion with the synaptic vesicle release machinery via binding to PDZ-domain containing proteins (<xref ref-type="bibr" rid="B241">Hata et al., 1996</xref>; <xref ref-type="bibr" rid="B82">Butz et al., 1998</xref>; <xref ref-type="bibr" rid="B156">Dean et al., 2003</xref>; <xref ref-type="bibr" rid="B398">Missler et al., 2003</xref>). At the postsynaptic site, the neurexin-neuroligin complex induces clustering of scaffolding proteins, such as PSD-95, and recruits NMDA- and AMPA-receptors (<xref ref-type="bibr" rid="B281">Irie et al., 1997</xref>; <xref ref-type="bibr" rid="B113">Chih et al., 2005</xref>; <xref ref-type="bibr" rid="B413">Nam and Chen, 2005</xref>; <xref ref-type="bibr" rid="B249">Heine et al., 2008</xref>; <xref ref-type="bibr" rid="B36">Barrow et al., 2009</xref>; <xref ref-type="bibr" rid="B402">Mondin et al., 2011</xref>). Distinct neurexin-neuroligin complexes play discrete roles during synaptogenesis with neuroligin-1 regulating excitatory synapse formation and maturation, while neuroligin-2 and 3 mediate inhibitory synapse formation (<xref ref-type="bibr" rid="B551">Song et al., 1999</xref>; <xref ref-type="bibr" rid="B527">Scheiffele et al., 2000</xref>; <xref ref-type="bibr" rid="B482">Prange et al., 2004</xref>; <xref ref-type="bibr" rid="B616">Varoqueaux et al., 2004</xref>, <xref ref-type="bibr" rid="B615">2006</xref>; <xref ref-type="bibr" rid="B113">Chih et al., 2005</xref>; <xref ref-type="bibr" rid="B346">Levinson et al., 2005</xref>; <xref ref-type="bibr" rid="B36">Barrow et al., 2009</xref>; <xref ref-type="bibr" rid="B330">Kwon et al., 2012</xref>; <xref ref-type="bibr" rid="B222">Gokce and Sudhof, 2013</xref>). Intriguingly, neurexin-1 can also bind to leucine-rich repeat transmembrane protein 2 (LRRTM2) and promote synapse formation (<xref ref-type="bibr" rid="B155">de Wit et al., 2009</xref>; <xref ref-type="bibr" rid="B318">Ko et al., 2009</xref>; <xref ref-type="bibr" rid="B222">Gokce and Sudhof, 2013</xref>). In addition to their synaptic roles, interaction of neurexin-1 and neuroligin-1 regulates neurite outgrowth (<xref ref-type="bibr" rid="B218">Gjorlund et al., 2012</xref>). Several mutations and CNVs in <italic>NRXN1-3</italic> have been found to be associated with ASD with the prevalence highest for mutations in <italic>NRXN1</italic> (<xref ref-type="bibr" rid="B187">Feng et al., 2006</xref>; <xref ref-type="bibr" rid="B25">Autism Genome Project Consortium et al., 2007</xref>; <xref ref-type="bibr" rid="B309">Kim et al., 2008</xref>; <xref ref-type="bibr" rid="B660">Yan et al., 2008</xref>; <xref ref-type="bibr" rid="B114">Ching et al., 2010</xref>; <xref ref-type="bibr" rid="B474">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B650">Wisniowiecka-Kowalnik et al., 2010</xref>; <xref ref-type="bibr" rid="B210">Gauthier et al., 2011</xref>; <xref ref-type="bibr" rid="B626">Voineskos et al., 2011</xref>; <xref ref-type="bibr" rid="B87">Camacho-Garcia et al., 2012</xref>; <xref ref-type="bibr" rid="B172">Duong et al., 2012</xref>; <xref ref-type="bibr" rid="B280">Iossifov et al., 2012</xref>; <xref ref-type="bibr" rid="B321">Kong et al., 2012</xref>; <xref ref-type="bibr" rid="B361">Liu et al., 2012</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B525">Schaaf et al., 2012</xref>; <xref ref-type="bibr" rid="B599">Vaags et al., 2012</xref>; <xref ref-type="bibr" rid="B46">Bena et al., 2013</xref>; <xref ref-type="bibr" rid="B146">Dabell et al., 2013</xref>; <xref ref-type="bibr" rid="B216">Girirajan et al., 2013</xref>; <xref ref-type="bibr" rid="B290">Jiang et al., 2013b</xref>; <xref ref-type="bibr" rid="B323">Koshimizu et al., 2013</xref>; <xref ref-type="bibr" rid="B629">Walker and Scherer, 2013</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B176">Egger et al., 2014</xref>; <xref ref-type="bibr" rid="B278">Imitola et al., 2014</xref>; <xref ref-type="bibr" rid="B623">Vinas-Jornet et al., 2014</xref>; <xref ref-type="bibr" rid="B573">Tammimies et al., 2015</xref>). Similarly, <italic>NLGN1-4</italic> genes have been implicated in the pathogenesis of ASD with <italic>NLGN3</italic> and <italic>4</italic> being the most prevalent (<xref ref-type="bibr" rid="B285">Jamain et al., 2003</xref>; <xref ref-type="bibr" rid="B335">Laumonnier et al., 2004</xref>; <xref ref-type="bibr" rid="B669">Ylisaukko-oja et al., 2005</xref>; <xref ref-type="bibr" rid="B337">Lawson-Yuen et al., 2008</xref>; <xref ref-type="bibr" rid="B219">Glessner et al., 2009</xref>; <xref ref-type="bibr" rid="B675">Yu et al., 2011</xref>, <xref ref-type="bibr" rid="B676">2013</xref>; <xref ref-type="bibr" rid="B338">Leblond et al., 2012</xref>; <xref ref-type="bibr" rid="B443">O&#x2019;Roak et al., 2012b</xref>; <xref ref-type="bibr" rid="B558">Steinberg et al., 2012</xref>; <xref ref-type="bibr" rid="B661">Yanagi et al., 2012</xref>; <xref ref-type="bibr" rid="B216">Girirajan et al., 2013</xref>; <xref ref-type="bibr" rid="B290">Jiang et al., 2013b</xref>; <xref ref-type="bibr" rid="B279">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B305">Kenny et al., 2014</xref>; <xref ref-type="bibr" rid="B349">Li et al., 2014a</xref>; <xref ref-type="bibr" rid="B327">Krumm et al., 2015</xref>; <xref ref-type="bibr" rid="B519">Sanders et al., 2015</xref>; <xref ref-type="bibr" rid="B677">Yuen et al., 2015</xref>). However, several reports also indicate the negative association of <italic>NLGN3</italic> and <italic>4</italic> with autism (<xref ref-type="bibr" rid="B624">Vincent et al., 2004</xref>; <xref ref-type="bibr" rid="B209">Gauthier et al., 2005</xref>; <xref ref-type="bibr" rid="B59">Blasi et al., 2006</xref>; <xref ref-type="bibr" rid="B643">Wermter et al., 2008</xref>; <xref ref-type="bibr" rid="B26">Avdjieva-Tzavella et al., 2012</xref>; <xref ref-type="bibr" rid="B359">Liu et al., 2013b</xref>; <xref ref-type="bibr" rid="B657">Xu et al., 2014</xref>). Further investigation is required to clarify this controversy.</p>
<p>Mutations in another member of the neurexin superfamily, contactin-associated protein-like 2 (<italic>CNTNAP2/CASPR2</italic>), have also been identified in individuals with autism (<xref ref-type="bibr" rid="B4">Alarc&#x00F3;n et al., 2008</xref>; <xref ref-type="bibr" rid="B21">Arking et al., 2008</xref>; <xref ref-type="bibr" rid="B31">Bakkaloglu et al., 2008</xref>; <xref ref-type="bibr" rid="B621">Vernes et al., 2008</xref>; <xref ref-type="bibr" rid="B353">Li et al., 2010</xref>; <xref ref-type="bibr" rid="B469">Petrin et al., 2010</xref>; <xref ref-type="bibr" rid="B478">Poot et al., 2010</xref>; <xref ref-type="bibr" rid="B431">Nord et al., 2011</xref>; <xref ref-type="bibr" rid="B440">O&#x2019;Roak et al., 2011</xref>; <xref ref-type="bibr" rid="B461">Pe&#x00F1;agarikano et al., 2011</xref>; <xref ref-type="bibr" rid="B644">Whitehouse et al., 2011</xref>; <xref ref-type="bibr" rid="B15">Anney et al., 2012</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B216">Girirajan et al., 2013</xref>; <xref ref-type="bibr" rid="B516">Sampath et al., 2013</xref>; <xref ref-type="bibr" rid="B176">Egger et al., 2014</xref>; <xref ref-type="bibr" rid="B477">Poot, 2014</xref>; <xref ref-type="bibr" rid="B115">Chiocchetti et al., 2015</xref>). CNTNAP2 is required for dendrite arborization and dendritic spine development and maintenance (<xref ref-type="bibr" rid="B14">Anderson et al., 2012</xref>; <xref ref-type="bibr" rid="B212">Gdalyahu et al., 2015</xref>). Mice deficient for <italic>Cntnap2</italic> show defects in spine stabilization and synaptic function resulting in several core ASD-like behaviors such as deficits in communication and social interaction, as well as repetitive behaviors (<xref ref-type="bibr" rid="B461">Pe&#x00F1;agarikano et al., 2011</xref>; <xref ref-type="bibr" rid="B212">Gdalyahu et al., 2015</xref>; <xref ref-type="bibr" rid="B613">Varea et al., 2015</xref>).</p>
</sec>
<sec><title>Immunoglobulin Superfamily of Cell Adhesion Molecules Participate Largely in Neuronal Circuit Formation</title>
<p>The immunoglobulin superfamily of CAMs (IgSF-CAMs), including contactin, L1CAM, NCAM or SynCAM, make up a third large group of <italic>trans</italic>-synaptic CAMs. IgSF-CAMs have been implicated in various processes during neural circuit formation, from neurite outgrowth and axonal navigation to synapse formation and plasticity (<xref ref-type="bibr" rid="B503">Rougon and Hobert, 2003</xref>).</p>
<p>The contactin (CNTN) subfamily consists of six members (CNTN1-6), each of which contain six Ig-like and four fibronectin III-like domains that are linked to the cell membrane via a glycosylphosphatidylinositol (GPI)-anchoring domain (<xref ref-type="bibr" rid="B543">Shimoda and Watanabe, 2009</xref>). While CNTN1 and 2 have been extensively studied in the context of neurite outgrowth, fasciculation, and axon guidance, less is known about the function of CNTN3-6 (<xref ref-type="bibr" rid="B299">Karagogeos, 2003</xref>; <xref ref-type="bibr" rid="B543">Shimoda and Watanabe, 2009</xref>; <xref ref-type="bibr" rid="B401">Mohebiany et al., 2014</xref>). However, <italic>CNTN3-6</italic> have been implicated as risk genes in ASD (<xref ref-type="bibr" rid="B188">Fernandez et al., 2004</xref>; <xref ref-type="bibr" rid="B117">Christian et al., 2008</xref>; <xref ref-type="bibr" rid="B404">Morrow et al., 2008</xref>; <xref ref-type="bibr" rid="B219">Glessner et al., 2009</xref>; <xref ref-type="bibr" rid="B502">Roohi et al., 2009</xref>; <xref ref-type="bibr" rid="B138">Cottrell et al., 2011</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B604">van Daalen et al., 2011</xref>; <xref ref-type="bibr" rid="B338">Leblond et al., 2012</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B599">Vaags et al., 2012</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B300">Kashevarova et al., 2014</xref>; <xref ref-type="bibr" rid="B418">Nava et al., 2014</xref>; <xref ref-type="bibr" rid="B477">Poot, 2014</xref>; <xref ref-type="bibr" rid="B263">Hu et al., 2015</xref>; <xref ref-type="bibr" rid="B360">Liu et al., 2015a</xref>). CNTN4 is strongly expressed in a subset of olfactory sensory neurons where it guides proper targeting of axon terminals to the corresponding glomeruli for the formation of olfactory circuits (<xref ref-type="bibr" rid="B297">Kaneko-Goto et al., 2008</xref>). The <italic>Cntn5</italic> knockout mice display reduced fiber density and glutamatergic synapses in the auditory brainstem (<xref ref-type="bibr" rid="B347">Li et al., 2003</xref>; <xref ref-type="bibr" rid="B588">Toyoshima et al., 2009</xref>). CNTN6 is highly expressed in the postnatal cerebellum and plays an important role in the formation of synapses between parallel fibers and Purkinje cells (<xref ref-type="bibr" rid="B569">Takeda et al., 2003</xref>; <xref ref-type="bibr" rid="B514">Sakurai et al., 2009</xref>). Similarly, CNTN6 regulates the formation of glutamatergic synapses in the hippocampus and the orientation of apical dendrites of layer V pyramidal neurons in the visual cortex (<xref ref-type="bibr" rid="B666">Ye et al., 2008</xref>; <xref ref-type="bibr" rid="B513">Sakurai et al., 2010</xref>).</p>
<p>Neural cell adhesion molecule 2 (NCAM2) belongs to the NCAM family and is a paralog of NCAM1. Similar to other members of the Ig-superfamily, NCAMs contain five Ig- and two FN3-domains in the extracellular region and are differentially spliced to produce both transmembrane and GPI-anchored variants (<xref ref-type="bibr" rid="B649">Winther et al., 2012</xref>). NCAM2 is predominantly expressed in the brain and required for the formation and maintenance of axonal and dendritic compartmentalization in the olfactory glomeruli (<xref ref-type="bibr" rid="B632">Walz et al., 2006</xref>; <xref ref-type="bibr" rid="B67">Borisovska et al., 2011</xref>). In addition, NCAM2 regulates filopodia formation and neurite branching of cortical neurons via a CaMKII-dependent signaling pathway (<xref ref-type="bibr" rid="B536">Sheng et al., 2015</xref>). SNP and chromosomal deletion including <italic>NCAM2</italic> has been reported in individuals with autism (<xref ref-type="bibr" rid="B235">Haldeman-Englert et al., 2010</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B467">Petit et al., 2015</xref>).</p>
<p>Adhesion molecules are a huge group of proteins that display many similarities in molecular structure and in signaling property. Depending on the cellular localization, functions of adhesion molecules range from neurite outgrowth and synapse/spine formation, to neuronal plasticity, further highlighting their importance in regulating the structural stability of neurons. However, whether these molecules function to compensate each other or are developmentally regulated is still not clear. The interesting question is whether the temporal and spatial expression patterns of these autism-associated adhesion molecules correlate with the affected developmental time frame and affected brain regions in ASD.</p>
</sec>
</sec>
<sec><title>Surface Receptors Signal Through Intracellular Signaling Pathways to Regulate Neuronal Stability</title>
<p>Establishment of synaptic connections and modification of their strength and stability is intimately related to the receptor populations in the plasma membranes of pre- and postsynaptic cell compartments. Thus, several ASD risk genes code for cell surface receptor proteins including the ionotropic glutamate receptors (iGluR) and the receptor tyrosine kinases (RTK).</p>
<sec><title>Glutamate Receptors: GRIN2B and the GRIK Genes</title>
<p>Glutamate-mediated ionotropic signaling occurs via activation of the glutamate-gated ion channel family which is divided into three subfamilies; the &#x03B1;-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs), the <italic>N</italic>-methyl-<sc>D</sc>-aspartate receptors (NMDARs) and the kainate-type receptors (KARs) (<xref ref-type="bibr" rid="B129">Collingridge et al., 2009</xref>). The main function of these receptors focuses on the regulation of synaptic activity and plasticity, which in turn affect the structural stability of neurons. In particular, the genetic association of the <italic>GRIN2B</italic> gene, which encodes the GluN2B subunit of NMDARs, and the <italic>GRIK2/4</italic> genes that encodes the GluK2 and 4 subunits of KARs with autism has been established (<xref ref-type="bibr" rid="B284">Jamain et al., 2002</xref>; <xref ref-type="bibr" rid="B547">Shuang et al., 2004</xref>; <xref ref-type="bibr" rid="B257">Holt et al., 2010</xref>; <xref ref-type="bibr" rid="B407">Myers et al., 2011</xref>; <xref ref-type="bibr" rid="B440">O&#x2019;Roak et al., 2011</xref>, <xref ref-type="bibr" rid="B442">2012a</xref>; <xref ref-type="bibr" rid="B579">Tarabeux et al., 2011</xref>; <xref ref-type="bibr" rid="B152">de Ligt et al., 2012</xref>; <xref ref-type="bibr" rid="B227">Griswold et al., 2012</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B572">Talkowski et al., 2012</xref>; <xref ref-type="bibr" rid="B671">Yoo et al., 2012</xref>; <xref ref-type="bibr" rid="B165">Dimassi et al., 2013</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B305">Kenny et al., 2014</xref>; <xref ref-type="bibr" rid="B349">Li et al., 2014a</xref>; <xref ref-type="bibr" rid="B414">Namjou et al., 2014</xref>; <xref ref-type="bibr" rid="B477">Poot, 2014</xref>; <xref ref-type="bibr" rid="B6">Aller et al., 2015</xref>; <xref ref-type="bibr" rid="B453">Pan et al., 2015</xref>).</p>
<p>NMDARs are composed of an obligatory GluN1 subunit and one or more GluN2 (GluN2A-GluN2D) subunits with the majority of the composition being GluN1/2A/2B (<xref ref-type="bibr" rid="B77">Buller et al., 1994</xref>; <xref ref-type="bibr" rid="B468">Petralia et al., 1994</xref>; <xref ref-type="bibr" rid="B367">Luo et al., 1997</xref>). The composition of GluN2 subunits are developmentally regulated and critically determine the synaptic properties (<xref ref-type="bibr" rid="B336">Laurie and Seeburg, 1994</xref>; <xref ref-type="bibr" rid="B537">Sheng et al., 1994</xref>; <xref ref-type="bibr" rid="B351">Li et al., 1998</xref>). The GluN2B subunit expresses early during development gradually being replaced by GluN2A indicating its role in the formation of neuronal circuitry (<xref ref-type="bibr" rid="B537">Sheng et al., 1994</xref>; <xref ref-type="bibr" rid="B351">Li et al., 1998</xref>; <xref ref-type="bibr" rid="B80">Bustos et al., 2014</xref>). Overexpression or knockdown of GluN2B alters dendrite arborization in neurons both <italic>in vivo</italic> and <italic>in vitro</italic> (<xref ref-type="bibr" rid="B184">Ewald et al., 2008</xref>; <xref ref-type="bibr" rid="B180">Espinosa et al., 2009</xref>; <xref ref-type="bibr" rid="B532">Sepulveda et al., 2010</xref>; <xref ref-type="bibr" rid="B80">Bustos et al., 2014</xref>). GluN2B is also required for the formation of dendritic spines, maturation of synapses, and the proper molecular compositions of several postsynaptic proteins (<xref ref-type="bibr" rid="B2">Akashi et al., 2009</xref>; <xref ref-type="bibr" rid="B180">Espinosa et al., 2009</xref>; <xref ref-type="bibr" rid="B73">Brigman et al., 2010</xref>; <xref ref-type="bibr" rid="B304">Kelsch et al., 2012</xref>). In turn, GluN2B is crucial for maintaining proper synaptic plasticity (<xref ref-type="bibr" rid="B73">Brigman et al., 2010</xref>; <xref ref-type="bibr" rid="B436">Ohno et al., 2010</xref>; <xref ref-type="bibr" rid="B634">Wang et al., 2011a</xref>; <xref ref-type="bibr" rid="B662">Yang et al., 2012a</xref>; <xref ref-type="bibr" rid="B509">Ryan et al., 2013</xref>; <xref ref-type="bibr" rid="B173">Dupuis et al., 2014</xref>). <italic>GRIN2B</italic>, an autism-risk gene, further suggests that pathways involved in early circuitry formation may be vulnerable targets in autism. Selective inhibition of GluN2B function has been shown to restore dendritic spine loss and associated behavior alterations in several experimental conditions providing insights to the potential therapeutic targets to correct some ASD phenotypes (<xref ref-type="bibr" rid="B101">Chen et al., 2011</xref>; <xref ref-type="bibr" rid="B273">Iafrati et al., 2014</xref>; <xref ref-type="bibr" rid="B232">Gupta et al., 2015</xref>).</p>
<p>Kainate-type receptors regulate axonal filopodia motility of hippocampal mossy fibers in response to neuronal stimulation during synaptogenesis (<xref ref-type="bibr" rid="B580">Tashiro et al., 2003</xref>). KAR subunits, in particular GluK2, interacts with structural elements of the synapse; such as the PSD-95 and SAP-102 scaffolding molecules, as well as the <italic>N</italic>-cadherin and &#x03B2;-catenin adhesion molecules (<xref ref-type="bibr" rid="B92">Carta et al., 2014</xref>; <xref ref-type="bibr" rid="B451">Pahl et al., 2014</xref>), indicating that <italic>Grik</italic> genes are involved in processes that regulate synapse architecture and stability. Indeed, GluK2 regulates hippocampal synapse maturation and stability (<xref ref-type="bibr" rid="B264">Huettner, 2003</xref>; <xref ref-type="bibr" rid="B133">Contractor et al., 2011</xref>; <xref ref-type="bibr" rid="B331">Lanore et al., 2012</xref>; <xref ref-type="bibr" rid="B342">Lerma and Marques, 2013</xref>). Animals with deficient GluK2 proteins exhibit a delay in the postnatal maturation of synaptic contacts between MF-CA3 in the hippocampus, suggesting that the expression of the GluK2 is important for the establishment of normal morphology and function of synaptic networks in the hippocampus (<xref ref-type="bibr" rid="B134">Contractor et al., 2001</xref>; <xref ref-type="bibr" rid="B331">Lanore et al., 2012</xref>). Expression of the GluK4 is mainly restricted to mossy fiber synapses in the hippocampal CA3 region where it co-assembles with GluK2 in functional pre- and postsynaptic GluK2/4 receptor complexes (<xref ref-type="bibr" rid="B149">Darstein et al., 2003</xref>). Mice with forebrain GluK4 overexpression exhibit altered synaptic transmission and display several autistic-like behaviors including social impairment, enhanced anxiety, and depressive states, coinciding with the finding of <italic>GRIK4</italic> duplications in individuals with ASD (<xref ref-type="bibr" rid="B227">Griswold et al., 2012</xref>; <xref ref-type="bibr" rid="B6">Aller et al., 2015</xref>). Even though the phenotypes resulting from <italic>Grik</italic> gene dysfunction in mice are in the same general categories with symptoms of ASD, further investigation about the molecular consequences of impairments in GluK proteins in ASD is required for developing future therapeutic interventions.</p>
</sec>
<sec><title>Receptor Tyrosine Kinases: The NTRK Genes</title>
<p>Tyrosine receptor kinases (Trks) mediate neurotrophic growth factor-induced signaling via dimerization and trans-autophosphorylation of Tyr residues on the intracellular domains of the receptor and subsequent activation of intracellular signaling pathways (<xref ref-type="bibr" rid="B157">Deinhardt and Chao, 2014</xref>). This results in a number of neurogenic events, such as synaptic plasticity, maturation and stability, dendritic and axonal growth and differentiation as well as cell survival and maintenance (<xref ref-type="bibr" rid="B381">Martinez et al., 1998</xref>; <xref ref-type="bibr" rid="B157">Deinhardt and Chao, 2014</xref>). The Trk family consists of three proteins; TrkA, B and C, which are expressed by the neurotrophic tyrosine receptor kinase genes (<italic>NTRK. 1. 2</italic> and <italic>3</italic>, respectively. Each Trk receptor interacts selectively with a different neurotrophin resulting in preferential interaction pairs: TrkA is activated by NGF, TrkB by BDNF, and TrkC by NT-3 (<xref ref-type="bibr" rid="B157">Deinhardt and Chao, 2014</xref>). Considering its well-documented function in synaptophysiology (<xref ref-type="bibr" rid="B397">Minichiello, 2009</xref>), it would be reasonable to suspect a correlation between genetic variations in <italic>NTRK2</italic> and ASD. However, to date, only one study has reported a weak association between <italic>NTRK2</italic> mutations and ASD (<xref ref-type="bibr" rid="B137">Correia et al., 2010</xref>), while other studies were unable to confirm that link (<xref ref-type="bibr" rid="B95">Chakrabarti et al., 2009</xref>). Alternatively, a growing body of evidence generated from genetic evaluation of ASD risk genes has identified <italic>NTRK3</italic>, the gene coding for TrkC, as a plausible candidate in autism (<xref ref-type="bibr" rid="B95">Chakrabarti et al., 2009</xref>; <xref ref-type="bibr" rid="B270">Hussman et al., 2011</xref>; <xref ref-type="bibr" rid="B612">Vardarajan et al., 2013</xref>).</p>
<p>In the mammalian brain, TrkC (as well as other neurotrophic receptors) is present both as full length catalytically active receptor, as well as a splice variant that lacks the Tyr kinase domain and is catalytically inactive (<xref ref-type="bibr" rid="B274">Ichinose and Snider, 2000</xref>). Interestingly, knockout of the non-catalytic TrkC isoform in mice yields a more severe phenotype than does the depletion of the kinase-active receptor, indicating that TrkC has important functions beyond the ability to convey classical RTK signaling (<xref ref-type="bibr" rid="B185">Faux et al., 2007</xref>; <xref ref-type="bibr" rid="B157">Deinhardt and Chao, 2014</xref>). Indeed, recent studies have begun to elucidate the function assigned to non-catalytic isoforms by demonstrating a role for TrkC in synaptic adhesion complexes (<xref ref-type="bibr" rid="B568">Takahashi and Craig, 2013</xref>). Postsynaptic TrkC interacts across the presynaptic cleft with protein tyrosine phosphatase (PTP) &#x03C3; to form an adhesion complex crucial for development and stability of excitatory, but not inhibitory, synapses (<xref ref-type="bibr" rid="B567">Takahashi et al., 2011</xref>; <xref ref-type="bibr" rid="B128">Coles et al., 2014</xref>). Formation of this adhesion complex is enhanced by the presence of the TrkC ligand, NT-3, which facilitates glutamatergic presynaptic assembly and function (<xref ref-type="bibr" rid="B12">Ammendrup-Johnsen et al., 2015</xref>). NT-3 binding to kinase domain-truncated TrkC isoforms has also been shown to induce cytoskeletal changes via recruitment of the scaffold protein tamalin, leading to activation of Arf6 and induction of Rac1-GTP (<xref ref-type="bibr" rid="B181">Esteban et al., 2006</xref>). Interestingly, the expression of non-catalytic TrkC relative to the kinase active isoform is upregulated during the second and third postnatal weeks, the most intense period of synaptogenesis, indicating that expression of the different <italic>Ntrk3</italic> gene products is temporally associated with synapse formation (<xref ref-type="bibr" rid="B600">Valenzuela et al., 1993</xref>; <xref ref-type="bibr" rid="B393">Menn et al., 2000</xref>). Recent studies also found that NT-3-TrkC signaling between presynaptic granule neurons and postsynaptic Purkinje cells controls dendrite morphogenesis in cerebellum (<xref ref-type="bibr" rid="B295">Joo et al., 2014</xref>). Although no studies have evaluated the ratio of non-catalytic to catalytic TrkC receptors in individuals with ASD, it might be speculated that certain genetic variants could cause imbalances in the expression patterns of <italic>NTRK3</italic> isoforms.</p>
<p>Surface receptors respond to extracellular signals such as neurotransmitters and trophic factors to activate downstream signaling pathways to diversify the cellular responses. Each receptor may have a unique signaling pathway associated with it and therefore, the mutations on selective receptors provide us with clues about which signaling pathways may be more susceptible to perturbations in ASD. Thus, identifying the downstream effectors and signaling pathways that are affected by these autism-associated receptor mutants should be an important direction of future investigation.</p>
</sec>
</sec>
<sec><title>Signaling Molecules Actively Regulate Dendritic Spine and Dendrite Morphology</title>
<sec><title>Protein Kinases</title>
<p>The dual-specificity tyrosine-(<italic>Y</italic>)-phosphorylation-regulated kinase 1a (DYRK1A) is one of the isoforms in DYRK family and is a human homolog of the <italic>Drosophila</italic> kinase minibrain (MNB) (<xref ref-type="bibr" rid="B545">Shindoh et al., 1996</xref>). <italic>DYRK1A</italic> was first described as a cadidate gene for intellectual disability in Down syndrome because of its location on the &#x201C;Down syndrome critical region&#x201D; of chromosome 21 (<xref ref-type="bibr" rid="B603">van Bon et al., 1993</xref>; <xref ref-type="bibr" rid="B545">Shindoh et al., 1996</xref>; <xref ref-type="bibr" rid="B238">Hammerle et al., 2003</xref>). Interestingly, recent genetic analyses suggest that <italic>DYRK1A</italic> is also a risk gene in ASD (<xref ref-type="bibr" rid="B280">Iossifov et al., 2012</xref>; <xref ref-type="bibr" rid="B442">O&#x2019;Roak et al., 2012a</xref>,<xref ref-type="bibr" rid="B443">b</xref>; <xref ref-type="bibr" rid="B102">Chen et al., 2014a</xref>; <xref ref-type="bibr" rid="B326">Krumm et al., 2014</xref>; <xref ref-type="bibr" rid="B494">Redin et al., 2014</xref>; <xref ref-type="bibr" rid="B74">Bronicki et al., 2015</xref>; <xref ref-type="bibr" rid="B602">van Bon et al., 2016</xref>). Expression of <italic>Dyrk1a</italic> in mouse brain is limited to early developmental periods and can promote neurite formation (<xref ref-type="bibr" rid="B438">Okui et al., 1999</xref>; <xref ref-type="bibr" rid="B238">Hammerle et al., 2003</xref>; <xref ref-type="bibr" rid="B220">Gockler et al., 2009</xref>). In addition, DYRK1A phosphorylates N-WASP, a cytoskeletal protein, to inhibit spine formation in primary hippocampal neurons (<xref ref-type="bibr" rid="B455">Park et al., 2012</xref>). Pyramidal neurons in <italic>Dyrk1a<sup>+/-</sup></italic> mouse cortex have reduced dendritic branches and dendritic spine density, which potentially causes the reduced brain size in these mice (<xref ref-type="bibr" rid="B192">Fotaki et al., 2002</xref>; <xref ref-type="bibr" rid="B47">Benavides-Piccione et al., 2005</xref>). On the other hand, overexpression of DYRK1A in mice causes increased spine density in cortical pyramidal neurons, and these animals show prefrontal deficits including significant impairment of spatial learning and cognitive flexbitiliy (<xref ref-type="bibr" rid="B7">Altafaj et al., 2001</xref>; <xref ref-type="bibr" rid="B582">Thomazeau et al., 2014</xref>). However, overexpressing DYRK1A in primary cortical mouse neurons significantly reduces dendrite complexity through disruption of REST/NRSF levels and REST/NRSF-SWI/SNF chromatin remodeling complex (<xref ref-type="bibr" rid="B341">Lepagnol-Bestel et al., 2009</xref>).</p>
<p>The Cyclin-dependent kinase-like 5 (CDKL5) is a serine/threonine kinase, also known as serine/threonine kinase 9 (STK9). Mutations of <italic>CDKL5</italic> have been associated with several X-linked neurodevelopmental disorders, as well as ASD (<xref ref-type="bibr" rid="B641">Weaving et al., 2004</xref>; <xref ref-type="bibr" rid="B524">Scala et al., 2005</xref>; <xref ref-type="bibr" rid="B19">Archer et al., 2006</xref>; <xref ref-type="bibr" rid="B508">Russo et al., 2009</xref>; <xref ref-type="bibr" rid="B553">Sprovieri et al., 2009</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B28">Bahi-Buisson and Bienvenu, 2012</xref>; <xref ref-type="bibr" rid="B37">Bartnik et al., 2012</xref>; <xref ref-type="bibr" rid="B375">Maortua et al., 2012</xref>; <xref ref-type="bibr" rid="B93">Carvill et al., 2013</xref>; <xref ref-type="bibr" rid="B178">Epi et al., 2013</xref>; <xref ref-type="bibr" rid="B475">Piton et al., 2013</xref>; <xref ref-type="bibr" rid="B682">Zhao et al., 2014</xref>; <xref ref-type="bibr" rid="B124">Codina-Sola et al., 2015</xref>; <xref ref-type="bibr" rid="B565">Szafranski et al., 2015</xref>). Expression of CDKL5 is enriched in the brain and increases gradually following development (<xref ref-type="bibr" rid="B355">Lin et al., 2005</xref>; <xref ref-type="bibr" rid="B507">Rusconi et al., 2008</xref>). In addition to a catalytic domain, CDKL5 contains nuclear localization and export signals and can shuttle between the cytoplasm and nucleus. In the nucleus, CDKL5 phosphorylates methyl-CpG-binding protein 2 (MECP2), a causative gene for Rett syndrome (see below), providing a suggestive molecular mechanism associated with the condition (<xref ref-type="bibr" rid="B378">Mari et al., 2005</xref>). In the cytosol, CDKL5 postively regulates neurite outgrowth and dendritic arborization via binding with Rac1 (<xref ref-type="bibr" rid="B106">Chen et al., 2010b</xref>). With this broad influence on neuronal function, <italic>Cdkl5</italic> null mice have several defects ranging from neuronal survival, dendritie maturation, spine stability, synaptic plasticity, and behaviors (<xref ref-type="bibr" rid="B8">Amendola et al., 2014</xref>; <xref ref-type="bibr" rid="B200">Fuchs et al., 2014</xref>; <xref ref-type="bibr" rid="B159">Della Sala et al., 2016</xref>). Treatment of <italic>Cdkl5</italic> null mice with insulin-like growth factor 1 (IGF-1) or the glycogen synthase kinase 3&#x03B2; (GSK3&#x03B2;) inhibitor can rescue these defective phenotypes (<xref ref-type="bibr" rid="B159">Della Sala et al., 2016</xref>; <xref ref-type="bibr" rid="B199">Fuchs et al., 2015</xref>). Furthermore, CDKL5 has been shown to bind to palmitoylated-PSD-95 and this interaction is important for synaptic targeting of CDKL5 and spine formation (<xref ref-type="bibr" rid="B687">Zhu et al., 2013</xref>).</p>
</sec>
<sec><title>Phosphatase: PTEN</title>
<p>Phosphatase and tensin homolog (PTEN) is a dual-specificity lipid/protein tyrosine phosphatase that negatively regulates the phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of the rapamycin (mTOR) pathway to control cellular function (<xref ref-type="bibr" rid="B369">Maehama and Dixon, 1998</xref>, <xref ref-type="bibr" rid="B370">1999</xref>; <xref ref-type="bibr" rid="B554">Stambolic et al., 1998</xref>; <xref ref-type="bibr" rid="B617">Vazquez and Sellers, 2000</xref>; <xref ref-type="bibr" rid="B169">Downes et al., 2001</xref>; <xref ref-type="bibr" rid="B343">Leslie and Downes, 2002</xref>; <xref ref-type="bibr" rid="B255">Hoeffer and Klann, 2010</xref>). PTEN was first identified as a tumor suppressor (<xref ref-type="bibr" rid="B350">Li et al., 1997</xref>) but later also found to be associated with neurodevelopmental conditions such as epilepsy, macrocephaly, and autism (<xref ref-type="bibr" rid="B221">Goffin et al., 2001</xref>; <xref ref-type="bibr" rid="B81">Butler et al., 2005</xref>; <xref ref-type="bibr" rid="B84">Buxbaum et al., 2007</xref>; <xref ref-type="bibr" rid="B444">Orrico et al., 2009</xref>; <xref ref-type="bibr" rid="B614">Varga et al., 2009</xref>; <xref ref-type="bibr" rid="B385">McBride et al., 2010</xref>; <xref ref-type="bibr" rid="B493">Redfern et al., 2010</xref>; <xref ref-type="bibr" rid="B557">Stein et al., 2010</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B443">O&#x2019;Roak et al., 2012b</xref>; <xref ref-type="bibr" rid="B79">Busa et al., 2013</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B254">Hobert et al., 2014</xref>; <xref ref-type="bibr" rid="B376">Marchese et al., 2014</xref>; <xref ref-type="bibr" rid="B610">Vanderver et al., 2014</xref>; <xref ref-type="bibr" rid="B124">Codina-Sola et al., 2015</xref>; <xref ref-type="bibr" rid="B164">D&#x2019;Gama et al., 2015</xref>; <xref ref-type="bibr" rid="B293">Johnston and Raines, 2015</xref>; <xref ref-type="bibr" rid="B327">Krumm et al., 2015</xref>; <xref ref-type="bibr" rid="B552">Spinelli et al., 2015</xref>; <xref ref-type="bibr" rid="B573">Tammimies et al., 2015</xref>; <xref ref-type="bibr" rid="B144">Cupolillo et al., 2016</xref>; <xref ref-type="bibr" rid="B529">Schwerd et al., 2016</xref>; <xref ref-type="bibr" rid="B583">Tilot et al., 2016</xref>). PTEN expression in the brain is positively correlated with the developmental stages of neuronal dendrite formation and synaptogenesis suggesting a role in regulating neuronal function (<xref ref-type="bibr" rid="B465">Perandones et al., 2004</xref>). PTEN plays a critical role in regulating the stability of dendritic spines and synaptic activity. PTEN overexpression in hippocampal CA1 pyramidal neurons results in a decrease in spine density (<xref ref-type="bibr" rid="B681">Zhang et al., 2012</xref>). Deleting PTEN in cortical and hippocampal neurons causes loss of neuronal polarity and general neuronal hypertrophy, including increases in dendrite arborization and spine density (<xref ref-type="bibr" rid="B286">Jaworski et al., 2005</xref>; <xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>; <xref ref-type="bibr" rid="B195">Fraser et al., 2008</xref>; <xref ref-type="bibr" rid="B685">Zhou et al., 2009</xref>). Selective deletion of PTEN in dentate granule neurons results in increased spine density and synaptic activity, as well as increased mossy fiber sprouting (<xref ref-type="bibr" rid="B366">Luikart et al., 2011</xref>; <xref ref-type="bibr" rid="B485">Pun et al., 2012</xref>). Knockdown of PTEN in basaolateral amygdala and dentate gyrus, however, does not affect spine density, but spine morphology is dramatically altered with an increase of mature mushroom-shaped spines (<xref ref-type="bibr" rid="B243">Haws et al., 2014</xref>). The <italic>Pten</italic> knockout in cerebellum also results in significant alterations in neuronal morphology of Purkinje cells including swelling of dendrites, and an increase of axonal bouton and dendritic spine size (<xref ref-type="bibr" rid="B144">Cupolillo et al., 2016</xref>). The impact of PTEN on spine stability is dependent on the phosphorylation status of its serine/threonin residues and the PDZ-binding motif in its C-terminus (<xref ref-type="bibr" rid="B681">Zhang et al., 2012</xref>). The phenotypes observed following PTEN deletion result from hyperactivation of the PI3K/AKT/mTOR pathway and inhibition of this molecular pathway is sufficient to rescue these phenotypes (<xref ref-type="bibr" rid="B286">Jaworski et al., 2005</xref>; <xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>; <xref ref-type="bibr" rid="B685">Zhou et al., 2009</xref>; <xref ref-type="bibr" rid="B485">Pun et al., 2012</xref>).</p>
<p>The identification of the vulnerable intracellular signaling pathways will aid us in the pursuit to find new therapeutic drug targets in patients with ASD. Interestingly, a variety of gene mutations result in disruption of the mechanistic pathways that these signaling molecules participate in. Therefore, several of the experimental pharmacological agents currently proposed as possible treatment strategies for autistic phenotypes are targeting these signaling molecules (see &#x201C;Perspectives&#x201D;).</p>
</sec>
</sec>
<sec><title>Synaptic Proteins Regulate Synaptic Function to Maintain Neuronal Stability</title>
<sec><title>Scaffolding Proteins Provide Supporting Roles to Connect Structural and Signaling Molecules</title>
<p>Synaptic signaling processes are key to proper neural function. Some pivotal components of synapses are postsynaptic scaffolding proteins, which cluster neurotransmitter receptors, cell adhesion proteins, ion channels and cytoskeletal molecules to a confined postsynaptic region (<xref ref-type="bibr" rid="B307">Kim and Sheng, 2004</xref>; <xref ref-type="bibr" rid="B538">Sheng and Hoogenraad, 2007</xref>). Dysfunction in scaffolding proteins often has a huge impact on neuronal function, including neuronal morphology and synaptic plasticity (<xref ref-type="bibr" rid="B584">Ting et al., 2012</xref>). Emerging evidence has recently linked ASD with mutations of several genes encoding scaffolding proteins as described below.</p>
<p><italic>SHANK</italic> genes encode three large scaffolding proteins, SHANK1-3, that contain ankyrin repeats, the SH3 domain, the PDZ domain, the proline-rich domain, and the SAM domain (<xref ref-type="bibr" rid="B410">Naisbitt et al., 1999</xref>; <xref ref-type="bibr" rid="B539">Sheng and Kim, 2000</xref>; <xref ref-type="bibr" rid="B35">Baron et al., 2006</xref>). These multiple putative protein interaction domains enable shank proteins to function as a bridge linking inotropic glutamate receptors, PSD-95, SAPAPS (<xref ref-type="bibr" rid="B410">Naisbitt et al., 1999</xref>), Homers (<xref ref-type="bibr" rid="B593">Tu et al., 1999</xref>; <xref ref-type="bibr" rid="B244">Hayashi et al., 2009</xref>) and the cytoskeleton (<xref ref-type="bibr" rid="B62">B&#x00F6;ckers et al., 2001</xref>; <xref ref-type="bibr" rid="B488">Qualmann et al., 2004</xref>). Altered function of all three <italic>SHANK</italic> genes have been implicated in autism, with <italic>SHANK3</italic> showing the highest prevalence (<xref ref-type="bibr" rid="B400">Moessner et al., 2007</xref>; <xref ref-type="bibr" rid="B211">Gauthier et al., 2009</xref>; <xref ref-type="bibr" rid="B27">Awadalla et al., 2010</xref>; <xref ref-type="bibr" rid="B51">Berkel et al., 2010</xref>, <xref ref-type="bibr" rid="B52">2012</xref>; <xref ref-type="bibr" rid="B474">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B628">Waga et al., 2011</xref>; <xref ref-type="bibr" rid="B338">Leblond et al., 2012</xref>, <xref ref-type="bibr" rid="B339">2014</xref>; <xref ref-type="bibr" rid="B483">Prasad et al., 2012</xref>; <xref ref-type="bibr" rid="B520">Sanders et al., 2012</xref>; <xref ref-type="bibr" rid="B522">Sato et al., 2012</xref>; <xref ref-type="bibr" rid="B61">Boccuto et al., 2013</xref>; <xref ref-type="bibr" rid="B323">Koshimizu et al., 2013</xref>; <xref ref-type="bibr" rid="B125">Coe et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>; <xref ref-type="bibr" rid="B230">Guilmatre et al., 2014</xref>; <xref ref-type="bibr" rid="B349">Li et al., 2014a</xref>; <xref ref-type="bibr" rid="B123">Cochoy et al., 2015</xref>; <xref ref-type="bibr" rid="B327">Krumm et al., 2015</xref>; <xref ref-type="bibr" rid="B423">Nemirovsky et al., 2015</xref>; <xref ref-type="bibr" rid="B677">Yuen et al., 2015</xref>). In general, SHANK2 and 3 promote dendritic spine formation, whereas SHANK1 promotes dendritic spine head size enlargement (<xref ref-type="bibr" rid="B515">Sala et al., 2001</xref>; <xref ref-type="bibr" rid="B504">Roussignol et al., 2005</xref>; <xref ref-type="bibr" rid="B267">Hung et al., 2008</xref>; <xref ref-type="bibr" rid="B622">Verpelli et al., 2011</xref>). SHANK3 also binds to a synaptic scaffold, Densin-180, to inhibit the Densin-180-induced dendrite arborization (<xref ref-type="bibr" rid="B489">Quitsch et al., 2005</xref>). Disruption of the <italic>SHANK3</italic> gene is associated with the 22q13.3 deletion syndrome, characterized by severe expressive-language delay and mild cognitive challenges (<xref ref-type="bibr" rid="B65">Bonaglia et al., 2001</xref>). Several genetically manipulated <italic>Shank3</italic> mutant mouse models were developed to study the role of <italic>SHANK3</italic> mutations in ASD (<xref ref-type="bibr" rid="B33">Bangash et al., 2011</xref>; <xref ref-type="bibr" rid="B458">Pe&#x00E7;a et al., 2011</xref>; <xref ref-type="bibr" rid="B635">Wang et al., 2011b</xref>; <xref ref-type="bibr" rid="B289">Jiang and Ehlers, 2013</xref>; <xref ref-type="bibr" rid="B459">Peixoto et al., 2016</xref>). Neurons in these mice have morphological alterations in dendritic spines resulting in LTP deficiency and defects at striatal synapses. Furthermore, these animals display several behavioral deficits including abnormal vocalization, dyadic social interaction, and compulsive-repetitive behaviors. Intriguingly, re-expressing <italic>Shank3</italic> in adulthood is sufficient to restore parts of the autism-related phenotypes in mice (<xref ref-type="bibr" rid="B390">Mei et al., 2016</xref>). This study sheds light on the application of gene therapy for individuals with <italic>SHANK3</italic> mutations. Mechanistically, several actin regulators including Abp1, cortactin, cofilin, and Rac1, have altered expression or activity associated with <italic>Shank3</italic> deficiency or autism-related mutations that contribute to dendritic spine reduction and synaptic dystrophy (<xref ref-type="bibr" rid="B234">Haeckel et al., 2008</xref>; <xref ref-type="bibr" rid="B174">Durand et al., 2012</xref>; <xref ref-type="bibr" rid="B171">Duffney et al., 2015</xref>).</p>
<p>Disks large-associated protein 2 (DLGAP2), also known as synapse-associated protein 90/postsynaptic density-95-associated proteins (SAPAP2), is a postsynaptic adapter protein in mammalian brains (<xref ref-type="bibr" rid="B314">Kindler et al., 2004</xref>). DLGAP2 directly interacts with DLG4 (also known as PSD-95) and Shank proteins to form the Dlg4-Dlgap-Shanks complex important for maintaining the PSD structure (<xref ref-type="bibr" rid="B306">Kim et al., 1997</xref>; <xref ref-type="bibr" rid="B571">Takeuchi et al., 1997</xref>; <xref ref-type="bibr" rid="B63">Boeckers et al., 1999</xref>). The <italic>Dlgap2<sup>-/-</sup></italic> mice have reduced spine density in the orbitofrontal cortex accompanied with downregulation of synaptic proteins, Homer1 and &#x03B1;CaMKII, as well as receptors, NR1 and GluR1, and exhibit exacerbated aggressive behaviors (<xref ref-type="bibr" rid="B291">Jiang-Xie et al., 2014</xref>). Molecular and genetic studies have demonstrated that alterations in <italic>DLGAP2</italic> are involved the pathophysiology of various psychiatric conditions, including schizophrenia, Alzheimer&#x2019;s disease, post-tramautic syndrome, and pediatric obsessive-compulsive disorder (<xref ref-type="bibr" rid="B110">Chertkow-Deutsher et al., 2010</xref>; <xref ref-type="bibr" rid="B654">Wu et al., 2013</xref>; <xref ref-type="bibr" rid="B352">Li et al., 2014b</xref>; <xref ref-type="bibr" rid="B100">Chaudhry et al., 2015</xref>). Rare <italic>de novo</italic> CNVs, deletions, and duplications of <italic>DLGAP2</italic> have been reported in individuals with ASD, but how mutations of <italic>DLGAP2</italic> contribute to autism is still largely unknown (<xref ref-type="bibr" rid="B380">Marshall et al., 2008</xref>; <xref ref-type="bibr" rid="B447">Ozgen et al., 2009</xref>; <xref ref-type="bibr" rid="B112">Chien et al., 2010</xref>; <xref ref-type="bibr" rid="B474">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>).</p>
</sec>
<sec><title>Molecules Regulating Synaptic Vesicles Are Implicated in the Regulation of Neurite Outgrowth</title>
<p>Neurotransmitter release is regulated by the cycling of synaptic vesicles at the axonal terminal. The regulation of synaptic vesicles contains several steps and requires precise interaction of several specialized proteins, including SNARE complex for membrane fusion and syntaxin for vesicle docking. <italic>STXBP5</italic> encodes a syntaxin-binding protein, tomosyn that negatively regulates neurotransmitter release by forming a syntaxin-SNAP25-tomosyn complex (<xref ref-type="bibr" rid="B201">Fujita et al., 1998</xref>; <xref ref-type="bibr" rid="B512">Sakisaka et al., 2004</xref>; <xref ref-type="bibr" rid="B668">Yizhar et al., 2004</xref>; <xref ref-type="bibr" rid="B658">Yamamoto et al., 2009</xref>, <xref ref-type="bibr" rid="B659">2010</xref>; <xref ref-type="bibr" rid="B57">Bielopolski et al., 2014</xref>). Neuron-specific tomosyn deletion in mouse hippocampal dentate gyrus impairs spatial learning and memory, whereas tomosyn knockdown in dentate gyrus decreases synaptic plasticity of mossy fibers (<xref ref-type="bibr" rid="B34">Barak et al., 2013</xref>; <xref ref-type="bibr" rid="B49">Ben-Simon et al., 2015</xref>). Tomosyn also regulates SNARE complexes via ROCK phosphorylation of syntaxin-1 to control neurite outgrowth (<xref ref-type="bibr" rid="B512">Sakisaka et al., 2004</xref>). Recent genetic studies have identified the association of <italic>STXBP5</italic> and ASD (<xref ref-type="bibr" rid="B150">Davis et al., 2009</xref>; <xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B153">De Rubeis et al., 2014</xref>).</p>
<p><italic>PRICKLE1</italic> encodes PRICKLE1 protein, which has been traditionally thought to regulate the Wnt/beta-catenin signaling pathway to control epithelial planar cell polarity and cell migration during neural tube formation (<xref ref-type="bibr" rid="B250">Heitzler et al., 1993</xref>; <xref ref-type="bibr" rid="B91">Carreira-Barbosa et al., 2003</xref>; <xref ref-type="bibr" rid="B619">Veeman et al., 2003</xref>; <xref ref-type="bibr" rid="B287">Jenny et al., 2005</xref>). Intriguingly, the <italic>Prickle1<sup>+/-</sup></italic> mice exhibit autism-like behaviors, which may result from disrupted interaction with synapsin, a regulator of neurotransmitter release, suggesting that PRICKLE1 plays a critical role in synaptic vesicle regulation (<xref ref-type="bibr" rid="B449">Paemka et al., 2013</xref>). In addition, knockdown of PRICKLE1 in mice results in reduced axonal and dendrite formation in hippocampal neurons (<xref ref-type="bibr" rid="B358">Liu et al., 2013a</xref>). More recently, variants of <italic>PRICKLE1</italic> have been found in individuals with autism (<xref ref-type="bibr" rid="B142">Cukier et al., 2014</xref>; <xref ref-type="bibr" rid="B587">Toma et al., 2014</xref>).</p>
<p>Synaptic scaffolds are crucial not only to maintain the structural stability of dendritic spines and synapses but also to link the signaling molecules and receptors to efficiently act in response to certain extracellular stimuli. Mutations in these molecules may disrupt several different signaling pathways and result in wide range of cellular defects, which sometimes are not limited to ASD. In addition, couple autism-associated genes that have been shown to regulate synaptic vesicles also play roles in neurite outgrowth or synaptic plasticity thereby regulating the structural stability of neurons. An interesting direction of investigation is whether the regulation of synaptic vesicles represents one of the key vulnerable cellular pathway that contributes to the alteration of neuronal structures in ASD.</p>
</sec>
</sec>
<sec><title>Specific Syndromic Disorder Related Genes</title>
<p>Several autism-related neurodevelopmental disorders, such as Fragile X, Rett, Angelman syndromes (AS), and tuberous sclerosis are caused by a highly penetrable mutation of a single gene, e.g., <italic>FMR1</italic> in Fragile X (<xref ref-type="bibr" rid="B620">Verkerk et al., 1991</xref>; <xref ref-type="bibr" rid="B213">Gedeon et al., 1992</xref>), <italic>MECP2</italic> in Rett (<xref ref-type="bibr" rid="B10">Amir et al., 1999</xref>), <italic>UBE3A</italic> in AS (<xref ref-type="bibr" rid="B316">Kishino et al., 1997</xref>), and <italic>TSC1/2</italic> in tuberous sclerosis complex (TSC; <xref ref-type="bibr" rid="B480">Povey et al., 1994</xref>). In recent DMS-5 criteria, however, ASD condition has been separated out from these single gene related disorders. Interestingly, these molecules all have a major function in regulating gene expression or protein synthesis, which in turn widely affects the structural stability of neurons. Because of the comorbidity between ASD and these single gene related disorders, we also review the current understanding of these genes and discuss how alterations of these genes may impair the structural integrity of neurons.</p>
<sec><title>FMRP</title>
<p>FMRP is a RNA-binding protein encoded by <italic>FMR1</italic> gene (<xref ref-type="bibr" rid="B23">Ashley et al., 1993</xref>; <xref ref-type="bibr" rid="B548">Siomi et al., 1993</xref>). Mutations of the <italic>FMR1</italic> gene in humans result in CGG repeat polymorphisms or in the deletion of FMRP protein contributing to Fragile X syndrome, the most common inherited form of intellectual disability (<xref ref-type="bibr" rid="B620">Verkerk et al., 1991</xref>; <xref ref-type="bibr" rid="B213">Gedeon et al., 1992</xref>). Interestingly, people with Fragile X syndrome often exhibit autistic behaviors and mutations of <italic>FMR1</italic> genes are also found in several cases of ASD (<xref ref-type="bibr" rid="B625">Vincent et al., 1996</xref>; <xref ref-type="bibr" rid="B186">Feinstein and Reiss, 1998</xref>; <xref ref-type="bibr" rid="B499">Rogers et al., 2001</xref>; <xref ref-type="bibr" rid="B242">Hatton et al., 2006</xref>; <xref ref-type="bibr" rid="B99">Chaste et al., 2012</xref>; <xref ref-type="bibr" rid="B676">Yu et al., 2013</xref>). The absence of FMRP is associated with widespread morphological changes of dendrites and dendritic spines in different brain regions, including cortex (<xref ref-type="bibr" rid="B131">Comery et al., 1997</xref>; <xref ref-type="bibr" rid="B642">Weiler and Greenough, 1999</xref>; <xref ref-type="bibr" rid="B282">Irwin et al., 2000</xref>; <xref ref-type="bibr" rid="B224">Greenough et al., 2001</xref>; <xref ref-type="bibr" rid="B430">Nimchinsky et al., 2001</xref>; <xref ref-type="bibr" rid="B204">Galvez et al., 2003</xref>; <xref ref-type="bibr" rid="B205">Galvez and Greenough, 2005</xref>; <xref ref-type="bibr" rid="B388">McKinney et al., 2005</xref>; <xref ref-type="bibr" rid="B78">Bureau et al., 2008</xref>; <xref ref-type="bibr" rid="B141">Cruz-Martin et al., 2010</xref>; <xref ref-type="bibr" rid="B452">Pan et al., 2010</xref>; <xref ref-type="bibr" rid="B486">Qin et al., 2011</xref>; <xref ref-type="bibr" rid="B53">Berman et al., 2012</xref>; <xref ref-type="bibr" rid="B11">Amiri et al., 2014</xref>; <xref ref-type="bibr" rid="B645">Wijetunge et al., 2014</xref>), hippocampus (<xref ref-type="bibr" rid="B71">Braun and Segal, 2000</xref>; <xref ref-type="bibr" rid="B530">Segal et al., 2003</xref>; <xref ref-type="bibr" rid="B17">Antar et al., 2006</xref>; <xref ref-type="bibr" rid="B228">Grossman et al., 2010</xref>; <xref ref-type="bibr" rid="B344">Levenga et al., 2011a</xref>; <xref ref-type="bibr" rid="B11">Amiri et al., 2014</xref>), and cerebellum (<xref ref-type="bibr" rid="B319">Koekkoek et al., 2005</xref>).</p>
<p>Upon mGluR-activation, the local translation of <italic>Fmr1</italic> in dendrite and dendritic spines is crucial for maintaining dendritic structure (<xref ref-type="bibr" rid="B16">Antar et al., 2004</xref>; <xref ref-type="bibr" rid="B42">Bear et al., 2004</xref>; <xref ref-type="bibr" rid="B594">Tucker et al., 2006</xref>; <xref ref-type="bibr" rid="B445">Osterweil et al., 2010</xref>; <xref ref-type="bibr" rid="B479">Pop et al., 2014</xref>). The hyperactivation of mGluR5 signaling, as well as the neuronal and behavioral deficits resulting from FMRP deficiency can be corrected by application of a mGluR5 antagonists (<xref ref-type="bibr" rid="B42">Bear et al., 2004</xref>; <xref ref-type="bibr" rid="B41">Bear, 2005</xref>; <xref ref-type="bibr" rid="B594">Tucker et al., 2006</xref>; <xref ref-type="bibr" rid="B167">Dolen et al., 2007</xref>; <xref ref-type="bibr" rid="B484">Price et al., 2007</xref>; <xref ref-type="bibr" rid="B648">Wilson and Cox, 2007</xref>; <xref ref-type="bibr" rid="B24">Auerbach and Bear, 2010</xref>; <xref ref-type="bibr" rid="B445">Osterweil et al., 2010</xref>; <xref ref-type="bibr" rid="B345">Levenga et al., 2011b</xref>; <xref ref-type="bibr" rid="B396">Michalon et al., 2012</xref>, <xref ref-type="bibr" rid="B395">2014</xref>; <xref ref-type="bibr" rid="B501">Ronesi et al., 2012</xref>; <xref ref-type="bibr" rid="B363">Lohith et al., 2013</xref>; <xref ref-type="bibr" rid="B479">Pop et al., 2014</xref>). The activation of FMRP subsequently regulates the local synthesis of several other synaptic proteins, including AMPAR, CaMKII, and PSD95, which in turn modulates the activity-dependent dynamics and plasticity of dendritic spines (<xref ref-type="bibr" rid="B405">Muddashetty et al., 2007</xref>; <xref ref-type="bibr" rid="B412">Nakamoto et al., 2007</xref>; <xref ref-type="bibr" rid="B298">Kao et al., 2010</xref>; <xref ref-type="bibr" rid="B277">Ifrim et al., 2015</xref>). In addition, the Rac-PAK pathway is upregulated and coincides with the disruptive dendritic phenotype in the absence of FMRP (<xref ref-type="bibr" rid="B340">Lee et al., 2003</xref>; <xref ref-type="bibr" rid="B245">Hayashi et al., 2007</xref>; <xref ref-type="bibr" rid="B105">Chen et al., 2010a</xref>; <xref ref-type="bibr" rid="B66">Bongmba et al., 2011</xref>). A rare deletion and several variants of cytoplasmic FMR1 interacting protein 1 (<italic>CYFIP1</italic>) are also found in cases of ASD further suggesting genes involved in the FMRP signaling pathway are prevalent risk factors (<xref ref-type="bibr" rid="B606">van der Zwaag et al., 2010</xref>; <xref ref-type="bibr" rid="B338">Leblond et al., 2012</xref>; <xref ref-type="bibr" rid="B587">Toma et al., 2014</xref>; <xref ref-type="bibr" rid="B631">Waltes et al., 2014</xref>; <xref ref-type="bibr" rid="B636">Wang et al., 2015</xref>). Interestingly, CYFIP1 mediates FMRP-dependent protein translation to regulate the dendritic complexity and the stability of dendritic spines (<xref ref-type="bibr" rid="B417">Napoli et al., 2008</xref>; <xref ref-type="bibr" rid="B154">De Rubeis et al., 2013</xref>; <xref ref-type="bibr" rid="B457">Pathania et al., 2014</xref>). Overexpression of CYFIP1 results in an increase of dendritic branching and dendritic spine density (<xref ref-type="bibr" rid="B434">Oguro-Ando et al., 2015</xref>). Thus, the understanding of the molecular mechanisms regulated by FMRP provides insights into how mutations of <italic>FMR1</italic> in ASD may affect neuronal function and contribute to autistic behaviors.</p>
</sec>
<sec><title>MECP2</title>
<p>Methyl-CpG binding protein 2 (MECP2) is a transcriptional factor that has multiple functions in gene regulation (<xref ref-type="bibr" rid="B389">Meehan et al., 1989</xref>; <xref ref-type="bibr" rid="B415">Nan et al., 1997</xref>, <xref ref-type="bibr" rid="B416">1998</xref>; <xref ref-type="bibr" rid="B674">Young et al., 2005</xref>; <xref ref-type="bibr" rid="B94">Chahrour et al., 2008</xref>; <xref ref-type="bibr" rid="B109">Cheng et al., 2014</xref>). Mutations of <italic>MECP2</italic> gene contribute to 90% of cases with Rett syndrome, which is a severe developmental disorder exhibiting autistic phenotypes (<xref ref-type="bibr" rid="B10">Amir et al., 1999</xref>; <xref ref-type="bibr" rid="B535">Shahbazian and Zoghbi, 2001</xref>; <xref ref-type="bibr" rid="B605">Van den Veyver and Zoghbi, 2001</xref>). Interestingly, the <italic>MECP2</italic> duplication syndrome also exhibit phenotypes that resemble those with ASD (<xref ref-type="bibr" rid="B491">Ramocki et al., 2009</xref>; <xref ref-type="bibr" rid="B466">Peters et al., 2013</xref>; <xref ref-type="bibr" rid="B364">Lombardi et al., 2015</xref>). Mutations and CNVs of <italic>MECP2</italic>, including duplication of the gene, have been identified in people with ASD without the diagnoses of either Rett or <italic>MECP2</italic> duplication syndromes (<xref ref-type="bibr" rid="B90">Carney et al., 2003</xref>; <xref ref-type="bibr" rid="B679">Zappella et al., 2003</xref>; <xref ref-type="bibr" rid="B541">Shibayama et al., 2004</xref>; <xref ref-type="bibr" rid="B564">Swanberg et al., 2009</xref>; <xref ref-type="bibr" rid="B88">Campos et al., 2011</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B143">Cukier et al., 2012</xref>; <xref ref-type="bibr" rid="B240">Hanchard et al., 2012</xref>; <xref ref-type="bibr" rid="B354">Lim et al., 2013</xref>; <xref ref-type="bibr" rid="B676">Yu et al., 2013</xref>). Most studies on MECP2 function focus on the understanding of the etiology of Rett syndrome and the <italic>MECP2</italic> duplication syndrome. Upregulation or downregulation of MECP2 dramatically alters the dendritic and axonal architecture of neurons and significantly disrupts the connectivity of neuronal networks (<xref ref-type="bibr" rid="B202">Fukuda et al., 2005</xref>; <xref ref-type="bibr" rid="B296">Jugloff et al., 2005</xref>; <xref ref-type="bibr" rid="B32">Ballas et al., 2009</xref>; <xref ref-type="bibr" rid="B45">Belichenko et al., 2009</xref>; <xref ref-type="bibr" rid="B97">Chapleau et al., 2009</xref>; <xref ref-type="bibr" rid="B315">Kishi and Macklis, 2010</xref>; <xref ref-type="bibr" rid="B126">Cohen et al., 2011</xref>; <xref ref-type="bibr" rid="B379">Marshak et al., 2012</xref>; <xref ref-type="bibr" rid="B426">Nguyen et al., 2012</xref>; <xref ref-type="bibr" rid="B559">Stuss et al., 2012</xref>; <xref ref-type="bibr" rid="B288">Jiang et al., 2013a</xref>; <xref ref-type="bibr" rid="B30">Baj et al., 2014</xref>). Overexpression of BDNF appears to restore the dendritic defects in <italic>Mecp2</italic>-null condition suggesting a molecular mechanism regulated by MECP2 to maintain the structural stability of neurons (<xref ref-type="bibr" rid="B686">Zhou et al., 2006</xref>; <xref ref-type="bibr" rid="B333">Larimore et al., 2009</xref>; <xref ref-type="bibr" rid="B208">Gao et al., 2015</xref>). Synaptic plasticity is also regulated by the expression or the phosphorylation of MECP2 (<xref ref-type="bibr" rid="B130">Collins et al., 2004</xref>; <xref ref-type="bibr" rid="B148">Dani et al., 2005</xref>; <xref ref-type="bibr" rid="B22">Asaka et al., 2006</xref>; <xref ref-type="bibr" rid="B403">Moretti et al., 2006</xref>; <xref ref-type="bibr" rid="B96">Chao et al., 2007</xref>; <xref ref-type="bibr" rid="B680">Zhang et al., 2008</xref>; <xref ref-type="bibr" rid="B348">Li et al., 2011</xref>; <xref ref-type="bibr" rid="B432">Noutel et al., 2011</xref>; <xref ref-type="bibr" rid="B58">Blackman et al., 2012</xref>; <xref ref-type="bibr" rid="B408">Na et al., 2012</xref>, <xref ref-type="bibr" rid="B409">2013</xref>; <xref ref-type="bibr" rid="B487">Qiu et al., 2012</xref>; <xref ref-type="bibr" rid="B684">Zhong et al., 2012</xref>; <xref ref-type="bibr" rid="B158">Della Sala and Pizzorusso, 2014</xref>; <xref ref-type="bibr" rid="B160">Deng et al., 2014</xref>; <xref ref-type="bibr" rid="B151">De Filippis et al., 2015</xref>). Whether a similar mechanism to Rett or <italic>MECP2</italic> duplication syndromes is altered in ASD individuals with <italic>MECP2</italic> mutations needs to be further evaluated.</p>
</sec>
<sec><title>UBE3A</title>
<p><italic>UBE3A</italic> gene is a paternally imprinted gene located at human chromosome 15 and encodes a member of the E3 ubiquitin ligase proteins (<xref ref-type="bibr" rid="B265">Huibregtse et al., 1993</xref>; <xref ref-type="bibr" rid="B5">Albrecht et al., 1997</xref>). Because <italic>UBE3A</italic> is selectively imprinted in mature neurons, epigenetic regulation of <italic>UBE3A</italic> has been associated with several neurodevelopmental disorders (<xref ref-type="bibr" rid="B5">Albrecht et al., 1997</xref>; <xref ref-type="bibr" rid="B334">LaSalle et al., 2015</xref>). Mutations resulting in loss-of-function in the maternally expressed copy of <italic>UBE3A</italic> causes AS, a severe developmental disorder characterized by delayed development, intellectual disability, severe speech impairment, and ataxia (<xref ref-type="bibr" rid="B316">Kishino et al., 1997</xref>). Maternal duplication of <italic>UBE3A</italic> results in Dup15q syndrome, a developmental disorder that has many similarities with AS but also exhibits several autistic traits (<xref ref-type="bibr" rid="B136">Cook et al., 1997</xref>; <xref ref-type="bibr" rid="B639">Wang et al., 2008</xref>; <xref ref-type="bibr" rid="B256">Hogart et al., 2010</xref>; <xref ref-type="bibr" rid="B550">Smith et al., 2011</xref>; <xref ref-type="bibr" rid="B598">Urraca et al., 2013</xref>; <xref ref-type="bibr" rid="B3">Al Ageeli et al., 2014</xref>; <xref ref-type="bibr" rid="B214">Germain et al., 2014</xref>). Coincidently, several genome-wide studies from individuals with autism identify <italic>UBE3A</italic> as an autism-risk gene (<xref ref-type="bibr" rid="B433">Nurmi et al., 2001</xref>; <xref ref-type="bibr" rid="B219">Glessner et al., 2009</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B303">Kelleher et al., 2012</xref>; <xref ref-type="bibr" rid="B93">Carvill et al., 2013</xref>; <xref ref-type="bibr" rid="B279">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B677">Yuen et al., 2015</xref>). In addition to its function of ubiquitin ligase to catalyze the protein degradation step, UBE3A also can act as a transcriptional coactivator for the nuclear hormone receptor superfamily of transcription factors (<xref ref-type="bibr" rid="B419">Nawaz et al., 1999</xref>). UBE3A localizes both in the nucleus and cytosol, including dendrite and pre- and post-synaptic compartments in neurons to regulate dendrite and dendritic spine morphology (<xref ref-type="bibr" rid="B166">Dindot et al., 2008</xref>; <xref ref-type="bibr" rid="B601">Valluy et al., 2015</xref>). Although maternal deletion of <italic>Ube3a</italic> does not affect dendrite arborization in mouse brains, knockdown of UBE3A in cultured neurons results in defects of dendrite polarization in pyramidal neurons (<xref ref-type="bibr" rid="B166">Dindot et al., 2008</xref>; <xref ref-type="bibr" rid="B394">Miao et al., 2013</xref>). Maternal-deficiency of <italic>Ube3a</italic> in mouse brain, however, shows defects in dendritic spine development in the cortex, hippocampus, and cerebellum (<xref ref-type="bibr" rid="B166">Dindot et al., 2008</xref>; <xref ref-type="bibr" rid="B308">Kim et al., 2016</xref>). Furthermore, several neuronal substrates for UBE3A have been identified, including Arc (<xref ref-type="bibr" rid="B225">Greer et al., 2010</xref>), the Rho-GEF Pbl/ECT2 (<xref ref-type="bibr" rid="B495">Reiter et al., 2006</xref>), Ephexin5 (<xref ref-type="bibr" rid="B377">Margolis et al., 2010</xref>), and TSC2 (<xref ref-type="bibr" rid="B683">Zheng et al., 2008</xref>). Their regulation by UBE3A provides molecular mechanisms to explain how synaptic integrity is maintained and how alteration of this interaction contributes in part to neuronal phenotypes in neurodevelopmental disorders. In addition, a recent study demonstrates that a PKA phosphorylation-defective mutation on <italic>UBE3A</italic> found in an individual with autism resulted in an increase of dendritic spine density (<xref ref-type="bibr" rid="B667">Yi et al., 2015</xref>).</p>
</sec>
<sec><title>TSC1/TSC2</title>
<p><italic>TSC1</italic> and <italic>TSC2</italic> genes encode protein harmartin and tuberin, respectively, and they bind and function together (<xref ref-type="bibr" rid="B183">European Chromosome 16 Tuberous Sclerosis Consortium, 1993</xref>; <xref ref-type="bibr" rid="B608">van Slegtenhorst et al., 1997</xref>; <xref ref-type="bibr" rid="B609">van Slegtenhorst et al., 1998</xref>). Mutations of <italic>TSC1</italic> or <italic>TSC2</italic> genes cause an autosomal dominant disorder TSC, which is characterized by hamartomas in various organs (<xref ref-type="bibr" rid="B480">Povey et al., 1994</xref>; <xref ref-type="bibr" rid="B140">Crino et al., 2006</xref>). Some patients with TSC exhibit several neurological problems including autism (<xref ref-type="bibr" rid="B549">Smalley, 1998</xref>; <xref ref-type="bibr" rid="B64">Bolton, 2004</xref>). Similarly, mutations of <italic>TSC1</italic> or <italic>TSC2</italic> are also found in several ASD cases (<xref ref-type="bibr" rid="B549">Smalley, 1998</xref>; <xref ref-type="bibr" rid="B533">Serajee et al., 2003</xref>; <xref ref-type="bibr" rid="B526">Schaaf et al., 2011</xref>; <xref ref-type="bibr" rid="B303">Kelleher et al., 2012</xref>; <xref ref-type="bibr" rid="B443">O&#x2019;Roak et al., 2012b</xref>; <xref ref-type="bibr" rid="B323">Koshimizu et al., 2013</xref>; <xref ref-type="bibr" rid="B72">Brett et al., 2014</xref>; <xref ref-type="bibr" rid="B587">Toma et al., 2014</xref>; <xref ref-type="bibr" rid="B327">Krumm et al., 2015</xref>). TSC1/2 act upstream as to suppress the mammalian target of rapamycin (mTOR) pathway and mTOR inhibitors have been promising therapeutic agents to ameliorate some symptoms in TSC (<xref ref-type="bibr" rid="B207">Gao et al., 2002</xref>; <xref ref-type="bibr" rid="B391">Meikle et al., 2008</xref>; <xref ref-type="bibr" rid="B145">Curatolo et al., 2016</xref>). One of the mTOR inhibitors, rapamycin, has also been shown to correct the autistic-like synaptic pruning deficits in <italic>Tsc2<sup>+/-</sup></italic> mice (<xref ref-type="bibr" rid="B575">Tang et al., 2014</xref>). In addition to the mTOR pathway being the key downstream target for TSC1/2, LIMK-cofilin pathway is altered upon deletion of TSC1 or TSC2 and enlargement of somas and dendritic spines are observed (<xref ref-type="bibr" rid="B581">Tavazoie et al., 2005</xref>). The <italic>Tsc2</italic> mutations result in a loss of Purkinje cells and <italic>Tsc1</italic> mutant mice have increased dendritic spine density, which correlates with cerebellar dysfunction and several autistic-like behaviors in animals (<xref ref-type="bibr" rid="B592">Tsai et al., 2012b</xref>; <xref ref-type="bibr" rid="B496">Reith et al., 2013</xref>). TSC1/2 also negatively regulates neurite and axonal outgrowth (<xref ref-type="bibr" rid="B191">Floricel et al., 2007</xref>; <xref ref-type="bibr" rid="B116">Choi et al., 2008</xref>). It has yet to be determined whether <italic>TSC1/2</italic> mutations in ASD correlate with perturbations of neuronal structures.</p>
</sec>
</sec>
<sec><title>Perspectives</title>
<p>Diagnosis of ASD cases has risen dramatically in recent years. The increased awareness of the symptoms and the broader definition of the spectrum may be major contributing factors for the rising number of ASD cases. Thus, there is an increased interest on understanding the etiologies of ASD. It is widely accepted that the genetic component plays a major role in ASD, however, except for the direct inheritance of some syndromic conditions, it is difficult to identify risk factors for autism. It is possible due to the low sample size and the high heterogeneity of genetic variances to have sufficient statistical power to make conclusive correlations (<xref ref-type="bibr" rid="B215">Geschwind and State, 2015</xref>). Among those autism-risk genes identified to date, some of the autism associations are due to <italic>de novo</italic> mutations, and some are familial variants (<bold>Table <xref ref-type="table" rid="T4">4</xref></bold>). Whether the inheritance pattern exhibits a risk factor is still not clear, however, the diverse gene mutations found in different individuals with autism suggest that instead of focusing on the genes <italic>per se</italic>, identifying the vulnerable pathways that these genes regulate may provide better clues toward understanding the contributing cellular and molecular changes that reserve in the autism phenotypes. The cellular defects resulting from different combinations of gene mutations contribute to the diverse phenotypes observed in autism. The heterogeneity of symptoms in ASD further complicates the diagnosis and treatment. However, understanding how autism-associated genes function in the regulation of key cellular pathways will provide insights to how therapeutic intervention can be more targeted and efficient to treat affected individuals.</p>
<table-wrap position="float" id="T4">
<label>Table 4</label>
<caption><p>Inheritance pattern of autism-risk genes that regulate the structural stability of neurons.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Functional category</th>
<th valign="top" align="left"><italic>De novo</italic> variants</th>
<th valign="top" align="left">Familial variants</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Cytoskeletal regulator</td>
<td valign="top" align="left"><italic>CTTNBP2, <underline>ADNP</underline>, <underline>SYNGAP1</underline></italic></td>
<td valign="top" align="left"><italic><underline>CTTNBP2</underline>, ADNP, SYNGAP1</italic></td>
</tr>
<tr>
<td valign="top" align="left">Adhesion molecule</td>
<td valign="top" align="left"><bold><italic>CDH10</italic></bold>, <italic>CDH11, PCDH10, PCDH19, FAT1, CTNNA3, NRXN1-3, NLGN1</italic>, <bold><italic>NLGN2</italic></bold>, <italic>NLGN3, CNTNAP2, CNTN4-6</italic></td>
<td valign="top" align="left"><bold><italic>CDH2, CDH8</italic></bold>, <bold><italic>CDH9</italic></bold>, <italic>CDH11</italic>, <bold><italic>PCDH9</italic></bold>, <italic>PCDH10, PCDH19, FAT1, <underline>CTNNA3</underline>, NRXN1, <underline>NRXN2</underline>, NRXN3, NLGN1, NLGN3, <underline>CNTNAP2</underline></italic>, <bold><italic>CNTN3</italic></bold>, <italic><underline>CNTN4</underline>, CNTN5-6</italic></td>
</tr>
<tr>
<td valign="top" align="left">Surface receptor</td>
<td valign="top" align="left"><bold><italic>GRIK4</italic></bold>, <italic>NTRK3, <underline>GRIN2B</underline></italic></td>
<td valign="top" align="left"><bold><italic>GRIK2</italic></bold>, <italic>NTRK3, GRIN2B</italic></td>
</tr>
<tr>
<td valign="top" align="left">Signaling molecule</td>
<td valign="top" align="left"><italic><underline>DYRK1A</underline>, <underline>CDKL5</underline>, PTEN</italic></td>
<td valign="top" align="left"><italic>DYRK1A, CDKL5, PTEN</italic></td>
</tr>
<tr>
<td valign="top" align="left">Synaptic molecule</td>
<td valign="top" align="left"><italic>SHANK1-3, DLGAP2, STXBP5</italic></td>
<td valign="top" align="left"><italic><underline>SHANK1</underline>, SHANK2-3, <underline>DLGAP2</underline>, <underline>STXBP5</underline></italic>, <bold><italic>PRICKLE1, CYFIP1</italic></bold></td>
</tr>
<tr>
<td valign="top" align="left">Syndromic molecule</td>
<td valign="top" align="left"><italic>FMR1, MECP2, UBE3A, TSC2</italic></td>
<td valign="top" align="left"><italic>FMR1, MECP2, UBE3A</italic>, <bold><italic>TSC1</italic></bold><italic>,TSC2</italic></td>
</tr>
<tr>
<td valign="top" align="left"></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<attrib><italic>This table shows whether autism-risk variants found in these genes are <italic>de novo</italic> mutations or familial variants. Most genes have <italic>de novo</italic> and familial variants, however, some of genes show a preferential inheritance pattern (underlined; label in bold if only one pattern is found).</italic></attrib>
</table-wrap-foot>
</table-wrap>
<p>Neuroanatomical studies of individuals with autism suggest a common disruption of neuronal structures with a decrease of dendrite arborization but an increase of dendritic spine density in select brain regions (<xref ref-type="bibr" rid="B492">Raymond et al., 1996</xref>; <xref ref-type="bibr" rid="B40">Bauman and Kemper, 2005</xref>; <xref ref-type="bibr" rid="B271">Hutsler and Zhang, 2010</xref>; <xref ref-type="bibr" rid="B575">Tang et al., 2014</xref>). This feature is distinct from other neurodevelopmental disorders, such as Rett or Fragile X syndromes, where the dendrite arbors and dendritic spine density are both downregulated (<xref ref-type="bibr" rid="B328">Kulkarni and Firestein, 2012</xref>). Intriguingly, dendrite arborization completes prior to dendritic spine formation during development. Although it has been proposed that the pruning mechanism of dendritic spines is defective in ASD (<xref ref-type="bibr" rid="B198">Frith, 2003</xref>), it is also plausible that the increase of dendritic spine density may be a compensation to re-establish the sufficient quantity of connections with fewer dendrite arbors. However, the precise spatial arborization of dendrites is critical for correct pre- and post-synaptic innervation when establishing the brain circuitry. The local increase of dendritic spine density may not be sufficient to compensate the effect from the loss of dendrite arbors, and may instead result in abnormal synaptic activity to disrupt normal neuronal function. This further emphasizes the importance of the establishment of structural integrity for neurons in order to provide proper brain function. In addition, the mechanisms of action of many current pharmacological agents for treating ASD affect normal neuronal function including the structural stability of neurons. With the early onset of ASD, the treatment often occurs at a very young age when the brain is still undergoing the period of development and maturation. As these pharmacological treatments may be beneficial to ameliorate some symptoms in ASD, the general brain development of these individuals may also be affected (<xref ref-type="bibr" rid="B460">Penagarikano, 2015</xref>). Thus, more precise circuitry-specific therapeutic intervention is needed to reduce the unwanted effect to the developing brain. Understanding the genetic and cellular pathways affected in ASD should provide more selective candidates for developing targeted intervention.</p>
<p>Although the list of autism-associated genes that regulate neuronal structures is extensive, it stands out that several genes actually function in the same signaling pathways (<bold>Table <xref ref-type="table" rid="T5">5</xref></bold>). For example, the mGluR5 pathway is disrupted when <italic>Shank3</italic> (<xref ref-type="bibr" rid="B622">Verpelli et al., 2011</xref>), <italic>Fmr1</italic> (<xref ref-type="bibr" rid="B217">Giuffrida et al., 2005</xref>; <xref ref-type="bibr" rid="B167">Dolen et al., 2007</xref>; <xref ref-type="bibr" rid="B484">Price et al., 2007</xref>; <xref ref-type="bibr" rid="B648">Wilson and Cox, 2007</xref>; <xref ref-type="bibr" rid="B247">Hays et al., 2011</xref>; <xref ref-type="bibr" rid="B501">Ronesi et al., 2012</xref>), <italic>Ube3a</italic> (<xref ref-type="bibr" rid="B471">Pignatelli et al., 2014</xref>), or <italic>Mecp2</italic> (<xref ref-type="bibr" rid="B684">Zhong et al., 2012</xref>) gene is altered. Application of mGluR5 antagonists has been shown to be promising to restore some phenotypes experimentally in neurons or animals with <italic>Fmr1</italic> mutants (<xref ref-type="bibr" rid="B484">Price et al., 2007</xref>; <xref ref-type="bibr" rid="B648">Wilson and Cox, 2007</xref>; <xref ref-type="bibr" rid="B345">Levenga et al., 2011b</xref>; <xref ref-type="bibr" rid="B396">Michalon et al., 2012</xref>, <xref ref-type="bibr" rid="B395">2014</xref>; <xref ref-type="bibr" rid="B501">Ronesi et al., 2012</xref>; <xref ref-type="bibr" rid="B479">Pop et al., 2014</xref>). Whether targeting mGluR5 pathway can be clinically effective for ASD with mutations beyond <italic>FMR1</italic> will require further investigation. The mTOR pathway is defective when <italic>Pten</italic> (<xref ref-type="bibr" rid="B286">Jaworski et al., 2005</xref>; <xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>; <xref ref-type="bibr" rid="B685">Zhou et al., 2009</xref>; <xref ref-type="bibr" rid="B485">Pun et al., 2012</xref>), <italic>Tsc1/2</italic> (<xref ref-type="bibr" rid="B207">Gao et al., 2002</xref>; <xref ref-type="bibr" rid="B391">Meikle et al., 2008</xref>; <xref ref-type="bibr" rid="B145">Curatolo et al., 2016</xref>), or <italic>Mecp2</italic> (<xref ref-type="bibr" rid="B497">Ricciardi et al., 2011</xref>) gene is mutated. However, the mTOR pathway is upregulated in mice carrying defective gene products of <italic>Pten. Tsc1/2</italic>, or <italic>Fmr1</italic>, but downregulated in <italic>Mecp2</italic>-null mice. The mTOR inhibitor, rapamycin, has been shown to be effective to rescue some phenotypes caused by these mutations and has been used as a therapeutic agent to treat some of the autism symptoms (<xref ref-type="bibr" rid="B391">Meikle et al., 2008</xref>; <xref ref-type="bibr" rid="B177">Ehninger and Silva, 2011</xref>; <xref ref-type="bibr" rid="B145">Curatolo et al., 2016</xref>). The alteration of IGF-1/GSK3&#x03B2; pathway is implicated in <italic>Pten</italic> (<xref ref-type="bibr" rid="B329">Kwon et al., 2006</xref>), <italic>Cdk5l</italic> (<xref ref-type="bibr" rid="B200">Fuchs et al., 2014</xref>) or <italic>Mecp2</italic> (<xref ref-type="bibr" rid="B283">Itoh et al., 2007</xref>) mutant animals. Inhibition of GSK3&#x03B2; or application of IGF-1 can rescue the dendritic phenotype in <italic>Cdk5l</italic> and <italic>Mecp2</italic> mutant mice (<xref ref-type="bibr" rid="B590">Tropea et al., 2009</xref>; <xref ref-type="bibr" rid="B199">Fuchs et al., 2015</xref>; <xref ref-type="bibr" rid="B159">Della Sala et al., 2016</xref>). The mTOR pathway and the GSK3&#x03B2; pathway can be further linked together as they are both regulated by AKT. In addition, Rac1 activity is altered when <italic>Elmo1</italic> (<xref ref-type="bibr" rid="B226">Grimsley et al., 2004</xref>), <italic>Cdk5l</italic> (<xref ref-type="bibr" rid="B106">Chen et al., 2010b</xref>), <italic>Shank3</italic> (<xref ref-type="bibr" rid="B171">Duffney et al., 2015</xref>), or <italic>Fmr1</italic> (<xref ref-type="bibr" rid="B340">Lee et al., 2003</xref>; <xref ref-type="bibr" rid="B105">Chen et al., 2010a</xref>; <xref ref-type="bibr" rid="B66">Bongmba et al., 2011</xref>) is mutated suggesting its crucial role to maintain the stability of neurons. The potential therapeutic approach targeting the Rac1 pathway to rescue the neuronal and behavioral phenotype in mutant animals is actively under investigation (<xref ref-type="bibr" rid="B245">Hayashi et al., 2007</xref>; <xref ref-type="bibr" rid="B171">Duffney et al., 2015</xref>).</p>
<table-wrap position="float" id="T5">
<label>Table 5</label>
<caption><p>The common signaling pathways that are altered by mutations of autism-risk genes.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Altered signaling pathway</th>
<th valign="top" align="left">Autism-risk gene involved</th>
<th valign="top" align="left">Available pharmacological agent</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">mGluR5</td>
<td valign="top" align="left"><italic>SHANK3, FMR1, UBE3A, MECP2</italic></td>
<td valign="top" align="left">mGluR5 antagonists (e.g., fenobam, mavoglurant, CTEP, MPEP)</td>
</tr>
<tr>
<td valign="top" align="left">PI3K/Akt/mTOR</td>
<td valign="top" align="left"><italic>PTEN, MECP2, TSC1/2</italic></td>
<td valign="top" align="left">mTOR inhibitor (e.g., rapamycin)</td>
</tr>
<tr>
<td valign="top" align="left">IGF-1/GSK3&#x03B2;</td>
<td valign="top" align="left"><italic>PTEN, CDK5L, MECP2</italic></td>
<td valign="top" align="left">IGF-1, GSK3&#x03B2; inhibitor (e.g., SB216763)</td>
</tr>
<tr>
<td valign="top" align="left">Rac1</td>
<td valign="top" align="left"><italic>ELMO1, CDK5L, SHANK3, FMR1</italic></td>
<td valign="top" align="left">N/A</td>
</tr>
<tr>
<td valign="top" align="left"></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<attrib><italic>Several pharmacological agents targeting these pathways are available and have successfully rescued the neuronal phenotype and function experimentally. References can be found in the text.</italic></attrib>
</table-wrap-foot>
</table-wrap>
<p>To date, several animal studies have tried to model the behavior phenotypes in autism, however, there remains a debate as to whether rodents can sufficiently recapitulate the complexities of the condition in human. The heterogeneity of genetic components also make it difficult to establish reliable animal models to describe the cellular and molecular mechanistic alterations in specific pathways. However, the studies on rodents can suggest which brain circuitry should be the area of interest for the corresponding behavior. iPSCs derived from ASD individuals appear to be an attractive model systems that allow researchers to directly investigate the interaction between the genetic contribution and the autism-relevant phenotypes. However, what is lacking in this system is a physiological relevant environment to correlate the behavior and the cellular phenotype. A recent emerging genetic editing technique, CRISPR/Cas9 (<xref ref-type="bibr" rid="B292">Jinek et al., 2012</xref>), is a powerful tool to study the mechanistic questions and identify the potential therapeutic interventions. Unlike the traditional knock-in or knock-out technique, CRISPR/Cas9 can introduce genomic editing of several genes at once. Using CRISPR/Cas9 in iPSCs can potentially determine the genetic contribution to the cellular phenotypes and provide a mechanism to correct them. However, there is still room for improvement of the efficiency and precision before this technique can be reliably used in clinical applications. Combining animal studies, iPSC models, and gene editing techniques, it is now possible to perform more comprehensive translational research in order to better understand the etiologies of ASD and design more efficient and effective therapeutic interventions.</p>
</sec>
<sec><title>Author Contributions</title>
<p>All authors listed, have made substantial, direct and intellectual contribution to the work, and approved it for publication.</p>
</sec>
<sec><title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="financial-disclosure">
<p><bold>Funding.</bold> This work is supported by Hussman Foundation grant HIAS15003 to Y-CL.</p>
</fn>
</fn-group>
<ack>
<p>We thank Dr. Anthony Koleske from Yale University and Dr. John Hussman for critical evaluation of the manuscript.</p>
</ack>
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