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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Mol. Neurosci.</journal-id>
<journal-title>Frontiers in Molecular Neuroscience</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Mol. Neurosci.</abbrev-journal-title>
<issn pub-type="epub">1662-5099</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fnmol.2022.886729</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Neuroscience</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Loss, Gain and Altered Function of GlyR &#x03B1;2 Subunit Mutations in Neurodevelopmental Disorders</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Chen</surname> <given-names>Xiumin</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wilson</surname> <given-names>Katie A.</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1731460/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Schaefer</surname> <given-names>Natascha</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/66156/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>De Hayr</surname> <given-names>Lachlan</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1747377/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Windsor</surname> <given-names>Mark</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/532989/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Scalais</surname> <given-names>Emmanuel</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>van Rijckevorsel</surname> <given-names>Germaine</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Stouffs</surname> <given-names>Katrien</given-names></name>
<xref ref-type="aff" rid="aff7"><sup>7</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/692034/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Villmann</surname> <given-names>Carmen</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/41168/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>O&#x2019;Mara</surname> <given-names>Megan L.</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff8"><sup>8</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/639941/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Lynch</surname> <given-names>Joseph W.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/2084/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Harvey</surname> <given-names>Robert J.</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1139/overview"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Queensland Brain Institute, The University of Queensland</institution>, <addr-line>Brisbane, QLD</addr-line>, <country>Australia</country></aff>
<aff id="aff2"><sup>2</sup><institution>Research School of Chemistry, The Australian National University</institution>, <addr-line>Canberra, ACT</addr-line>, <country>Australia</country></aff>
<aff id="aff3"><sup>3</sup><institution>Institute of Clinical Neurobiology, University Hospital, Julius-Maximilians-University W&#x00FC;rzburg</institution>, <addr-line>W&#x00FC;rzburg</addr-line>, <country>Germany</country></aff>
<aff id="aff4"><sup>4</sup><institution>School of Health and Behavioural Sciences, University of the Sunshine Coast</institution>, <addr-line>Maroochydore, QLD</addr-line>, <country>Australia</country></aff>
<aff id="aff5"><sup>5</sup><institution>Sunshine Coast Health Institute</institution>, <addr-line>Birtinya, QLD</addr-line>, <country>Australia</country></aff>
<aff id="aff6"><sup>6</sup><institution>Neurologie P&#x00E9;diatrique, Centre Hospitalier de Luxembourg</institution>, <addr-line>Luxembourg</addr-line>, <country>Luxembourg</country></aff>
<aff id="aff7"><sup>7</sup><institution>Center for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel</institution>, <addr-line>Brussels</addr-line>, <country>Belgium</country></aff>
<aff id="aff8"><sup>8</sup><institution>Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland</institution>, <addr-line>Brisbane, QLD</addr-line>, <country>Australia</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Daniel F. Gilbert, Bruker Daltonics GmbH &#x0026; Co. KG, Germany</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Han Chow Chua, University of Copenhagen, Denmark; Qiang Shan, Shantou University, China; Ariel &#x00C1;vila, Universidad Cat&#x00F3;lica de la Sant&#x00ED;sima Concepci&#x00F3;n, Chile</p></fn>
<corresp id="c001">&#x002A;Correspondence: Robert J. Harvey, <email>rharvey2@usc.edu.au</email></corresp>
<fn fn-type="other" id="fn004"><p>This article was submitted to Molecular Signalling and Pathways, a section of the journal Frontiers in Molecular Neuroscience</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>29</day>
<month>04</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>15</volume>
<elocation-id>886729</elocation-id>
<history>
<date date-type="received">
<day>28</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>07</day>
<month>04</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2022 Chen, Wilson, Schaefer, De Hayr, Windsor, Scalais, van Rijckevorsel, Stouffs, Villmann, O&#x2019;Mara, Lynch and Harvey.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Chen, Wilson, Schaefer, De Hayr, Windsor, Scalais, van Rijckevorsel, Stouffs, Villmann, O&#x2019;Mara, Lynch and Harvey</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) and the copyright owner(s) 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>Glycine receptors (GlyRs) containing the &#x03B1;2 subunit govern cell fate, neuronal migration and synaptogenesis in the developing cortex and spinal cord. Rare missense variants and microdeletions in the X-linked GlyR &#x03B1;2 subunit gene (<italic>GLRA2</italic>) have been associated with human autism spectrum disorder (ASD), where they typically cause a <italic>loss-of-function</italic> via protein truncation, reduced cell-surface trafficking and/or reduced glycine sensitivity (e.g., <italic>GLRA2</italic>&#x0394;ex8-9 and extracellular domain variants p.N109S and p.R126Q). However, the GlyR &#x03B1;2 missense variant p.R323L in the intracellular M3-M4 domain results in a <italic>gain-of-function</italic> characterized by slower synaptic decay times, longer duration active periods and increases in channel conductance. This study reports the functional characterization of four missense variants in <italic>GLRA2</italic> associated with ASD or developmental disorders (p.V-22L, p.N38K, p.K213E, p.T269M) using a combination of bioinformatics, molecular dynamics simulations, cellular models of GlyR trafficking and electrophysiology in artificial synapses. The GlyR &#x03B1;2<sup>V&#x2013;22L</sup> variant resulted in altered predicted signal peptide cleavage and a reduction in cell-surface expression, suggestive of a <italic>partial loss-of-function</italic>. Similarly, GlyR &#x03B1;2<sup>N38K</sup> homomers showed reduced cell-surface expression, a reduced affinity for glycine and a reduced magnitude of IPSCs in artificial synapses. By contrast, GlyR &#x03B1;2<sup>K213E</sup> homomers showed a slight reduction in cell-surface expression, but IPSCs were larger, with faster rise/decay times, suggesting a <italic>gain-of-function</italic>. Lastly, GlyR &#x03B1;2<sup>T269M</sup> homomers exhibited a high glycine sensitivity accompanied by a substantial leak current, suggestive of an <italic>altered function</italic> that could dramatically enhance glycinergic signaling. These results may explain the heterogeneity of clinical phenotypes associated with <italic>GLRA2</italic> mutations and reveal that missense variants can result in a loss, gain or alteration of GlyR &#x03B1;2 function. In turn, these GlyR &#x03B1;2 missense variants are likely to either negatively or positively deregulate cortical progenitor homeostasis and neuronal migration in the developing brain, leading to changes in cognition, learning, and memory.</p>
</abstract>
<kwd-group>
<kwd>autism spectrum disorder</kwd>
<kwd>developmental disorders</kwd>
<kwd>epilepsy</kwd>
<kwd>glycine receptor (GlyR)</kwd>
<kwd><italic>GLRA2</italic></kwd>
<kwd>GlyR &#x03B1;2 subunit</kwd>
</kwd-group>
<contract-num rid="cn001">APP1156673</contract-num>
<contract-num rid="cn001">APP1058542</contract-num>
<contract-sponsor id="cn001">National Health and Medical Research Council<named-content content-type="fundref-id">10.13039/501100000925</named-content></contract-sponsor>
<counts>
<fig-count count="7"/>
<table-count count="3"/>
<equation-count count="0"/>
<ref-count count="75"/>
<page-count count="15"/>
<word-count count="11285"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="intro">
<title>Introduction</title>
<p>Glycine receptors (GlyRs) are key mediators of synaptic inhibition in the retina, inner ear, and throughout the developing brain, brainstem, and spinal cord (<xref ref-type="bibr" rid="B36">Malosio et al., 1991</xref>; <xref ref-type="bibr" rid="B67">W&#x00E4;ssle et al., 2009</xref>; <xref ref-type="bibr" rid="B9">Buerbank et al., 2011</xref>). GlyRs form part of a superfamily of ligand-gated ion channels that includes inhibitory GABA<sub>A</sub>, GABA<sub>C</sub> and excitatory nAChR and 5HT<sub>3</sub> receptors. These ion channels have a common pentameric receptor configuration and for GlyRs can be formed from either homomeric &#x03B1; or heteromeric &#x03B1;&#x03B2; subunit conformations (<xref ref-type="bibr" rid="B35">Lynch, 2004</xref>). Although the exact subunit stoichiometry of heteromeric GlyRs has been a matter of extensive debate, recent cryo-electron microscopy studies of native GlyRs have strongly suggested a 4&#x03B1;:1&#x03B2; arrangement, with inclusion of multiple &#x03B2; subunits rendering the receptor non-conductive (<xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>; <xref ref-type="bibr" rid="B75">Zhu and Gouaux, 2021</xref>). Each GlyR subunit has an N-terminal signal peptide (SP), a large N-terminal domain (NTD) that mediates subunit assembly and ligand-binding (<xref ref-type="bibr" rid="B16">Du et al., 2015</xref>; <xref ref-type="bibr" rid="B22">Huang et al., 2015</xref>; <xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>; <xref ref-type="bibr" rid="B75">Zhu and Gouaux, 2021</xref>) and four membrane-spanning domains (M1&#x2013;M4), followed by a short extracellular C-terminus. The M3&#x2013;M4 intracellular loop differs among GlyR subunits and provides sites for interactions with accessory proteins such as collybistin (<xref ref-type="bibr" rid="B8">Breitinger et al., 2020</xref>), gephyrin (<xref ref-type="bibr" rid="B64">Sola et al., 2004</xref>; <xref ref-type="bibr" rid="B28">Kim et al., 2006</xref>), and syndapin-1 (<xref ref-type="bibr" rid="B32">Langlhofer et al., 2020</xref>), as well as opportunities for subunit-specific modulation by G-protein-coupled receptor-mediated signaling pathways linked to GlyR phosphorylation (<xref ref-type="bibr" rid="B20">Harvey et al., 2004</xref>; <xref ref-type="bibr" rid="B38">Manzke et al., 2010</xref>).</p>
<p>Five genes encoding distinct GlyR subunits have been characterized in rodents and humans: <italic>GLRA1</italic>-<italic>GLRA4</italic> and <italic>GLRB</italic>, encoding the GlyR &#x03B1;1-4 and &#x03B2; subunits, respectively. GlyRs containing the &#x03B1;1 subunit are pivotal in spinal motoneuron inhibition, and consistent with this role, dominant and recessive mutations in the GlyR &#x03B1;1 and &#x03B2; subunit genes are associated with a rare neurological disorder known as startle disease/hyperekplexia (OMIM 149400; 614618; 614619; <xref ref-type="bibr" rid="B62">Shiang et al., 1993</xref>; <xref ref-type="bibr" rid="B51">Rees et al., 2002</xref>; <xref ref-type="bibr" rid="B11">Chung et al., 2010</xref>, <xref ref-type="bibr" rid="B10">2013</xref>; <xref ref-type="bibr" rid="B7">Bode et al., 2013</xref>; <xref ref-type="bibr" rid="B25">James et al., 2013</xref>; <xref ref-type="bibr" rid="B49">Piro et al., 2021</xref>). This disorder affects newborn humans, dogs, horses, and cattle (<xref ref-type="bibr" rid="B21">Harvey et al., 2008</xref>) and is characterized by an exaggerated startle response and muscle hypertonia in response to unexpected acoustic, tactile or visual stimuli. In humans, dominant missense mutations in the GlyR &#x03B1;1 subunit typically disrupt the transduction pathway linking ligand-binding to ion-channel gating, while recessive mutations in the GlyR &#x03B1;1 and &#x03B2; subunits result in ligand-binding or protein trafficking deficits (<xref ref-type="bibr" rid="B66">Villmann et al., 2009</xref>; <xref ref-type="bibr" rid="B11">Chung et al., 2010</xref>; <xref ref-type="bibr" rid="B7">Bode et al., 2013</xref>; <xref ref-type="bibr" rid="B25">James et al., 2013</xref>; <xref ref-type="bibr" rid="B56">Schaefer et al., 2015</xref>; <xref ref-type="bibr" rid="B49">Piro et al., 2021</xref>). Although these dominant and recessive mutations result in an overall loss of GlyR function, other more complex disease pathomechanisms also exist. For example, the GlyR &#x03B1;1<sup>P366L</sup> mutant disrupts interactions with syndapin 1, an F-BAR domain protein involved in membrane remodeling (<xref ref-type="bibr" rid="B32">Langlhofer et al., 2020</xref>). Moreover, a subset of GlyR &#x03B1;1 and &#x03B2; subunit mutations result in a gain or alteration of function (<xref ref-type="bibr" rid="B11">Chung et al., 2010</xref>, <xref ref-type="bibr" rid="B10">2013</xref>; <xref ref-type="bibr" rid="B7">Bode et al., 2013</xref>; <xref ref-type="bibr" rid="B25">James et al., 2013</xref>; <xref ref-type="bibr" rid="B73">Zhang et al., 2016</xref>; <xref ref-type="bibr" rid="B49">Piro et al., 2021</xref>). For example, some missense mutations increase the sensitivity to glycine (&#x03B1;1<sup>I43F</sup>), prolong the decay rate of inhibitory postsynaptic currents (IPSCs; &#x03B1;1<sup>I43F</sup>, &#x03B1;1<sup>W170S</sup>, &#x03B1;1<sup>Q266E</sup>, &#x03B1;1<sup>V280M</sup>, &#x03B1;1<sup>R414H</sup>), or induce spontaneous GlyR channel opening (&#x03B1;1<sup>I43F</sup>, &#x03B1;1<sup>Y128C</sup>, &#x03B1;1<sup>W170S</sup>, &#x03B1;1<sup>Q226E</sup>, &#x03B1;1<sup>V280M</sup>, &#x03B1;1<sup>R414H</sup>, &#x03B2;<sup>L285R</sup>). GlyRs containing the &#x03B1;3 and &#x03B1;4 subunits have not yet been linked to human disease, but studies using knockout and knockin mice have implicated GlyR &#x03B1;3 in central pain sensitization (<xref ref-type="bibr" rid="B20">Harvey et al., 2004</xref>; <xref ref-type="bibr" rid="B68">Werynska et al., 2021</xref>), rhythmic breathing (<xref ref-type="bibr" rid="B38">Manzke et al., 2010</xref>), and ethanol-mediated behaviors (<xref ref-type="bibr" rid="B6">Blednov et al., 2015</xref>; <xref ref-type="bibr" rid="B54">San Martin et al., 2021</xref>). GlyR &#x03B1;4 is a pseudogene in humans but contributes to touch-evoked escape behaviors in zebrafish (<xref ref-type="bibr" rid="B33">Leacock et al., 2018</xref>) and impacts embryonic development and litter sizes in rodents (<xref ref-type="bibr" rid="B42">Nishizono et al., 2020</xref>).</p>
<p>Glycine receptors containing the &#x03B1;2 subtype were initially assigned key roles in synaptogenesis, with GlyR activation resulting in membrane depolarization, triggering local opening of L-type Ca<sup>2+</sup> channels that resulted in clustering of gephyrin and GlyR at developing postsynaptic sites (<xref ref-type="bibr" rid="B29">Kirsch and Betz, 1998</xref>; <xref ref-type="bibr" rid="B34">L&#x00E9;vi et al., 1998</xref>). However, it rapidly became apparent that the kinetic properties of GlyR &#x03B1;2 are inconsistent with a synaptic function, since GlyR &#x03B1;2 exhibits slow activation kinetics (<xref ref-type="bibr" rid="B37">Mangin et al., 2003</xref>) and activates for longer durations than other GlyR subtypes (<xref ref-type="bibr" rid="B30">Krashia et al., 2011</xref>). Consistent with this, non-synaptic taurine or glycine release onto GlyRs was found to be vital for neocortical and spinal cord development (<xref ref-type="bibr" rid="B17">Flint et al., 1998</xref>; <xref ref-type="bibr" rid="B55">Scain et al., 2010</xref>). Studies using <italic>Glra2</italic> knockout mice have since revealed pivotal roles for GlyR &#x03B1;2 in retinal photoreceptor development (<xref ref-type="bibr" rid="B69">Young and Cepko, 2004</xref>) and the control of receptive field surrounds in retinal ganglion cells (<xref ref-type="bibr" rid="B43">Nobles et al., 2012</xref>; <xref ref-type="bibr" rid="B71">Zhang et al., 2015a</xref>), as well as modulation of ethanol intake, aversion and preference (<xref ref-type="bibr" rid="B6">Blednov et al., 2015</xref>; <xref ref-type="bibr" rid="B53">San Martin et al., 2020</xref>; <xref ref-type="bibr" rid="B3">Araya et al., 2021</xref>). However, a major role for GlyR &#x03B1;2 has been identified in dorsal cortical progenitor homeostasis and cortical interneuron migration (<xref ref-type="bibr" rid="B4">Avila et al., 2013</xref>, <xref ref-type="bibr" rid="B5">2014</xref>). Extrasynaptic activation of GlyR &#x03B1;2 in cortical interneurons by endogenous glycine activates voltage-gated Ca<sup>2+</sup> channels, which modulates actomyosin contractions to fine-tune nuclear translocation during interneuron migration (<xref ref-type="bibr" rid="B4">Avila et al., 2013</xref>). Knockout of GlyR &#x03B1;2 disrupts cortical progenitor homeostasis, impairing the capacity of apical progenitors to generate basal progenitors resulting in an overall reduction of projection neurons in upper or deep layers of the cerebral cortex (<xref ref-type="bibr" rid="B5">Avila et al., 2014</xref>). As a result, moderate microcephaly was observed in newborn mice (<xref ref-type="bibr" rid="B5">Avila et al., 2014</xref>). Further studies of <italic>Glra2</italic> knockout mice revealed permanent effects on the mature cortical networks: somatosensory cortical neurons had more dendritic branches with an overall increase in total spine number, resulting in an overall increase network excitability and enhanced susceptibility to epileptic seizures after pentylenetetrazol (PTZ) injections (<xref ref-type="bibr" rid="B41">Morelli et al., 2017</xref>). <italic>Glra2</italic> knockout mice also exhibited defects in long-term potentiation in the prefrontal cortex and object recognition memory (<xref ref-type="bibr" rid="B47">Pilorge et al., 2016</xref>) and impaired motor memory consolidation (<xref ref-type="bibr" rid="B40">Molchanova et al., 2018</xref>).</p>
<p>These findings led to the exploration of the X-linked human GlyR &#x03B1;2 subunit gene (<italic>GLRA2</italic>) as a candidate gene for childhood neurological disorders associated with cortical or cognitive defects. <italic>GLRA2</italic> defects were indeed reported in individuals with autism spectrum disorder (ASD; <xref ref-type="bibr" rid="B48">Pinto et al., 2010</xref>; <xref ref-type="bibr" rid="B50">Piton et al., 2011</xref>; <xref ref-type="bibr" rid="B24">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B47">Pilorge et al., 2016</xref>), although additional clinical symptoms were reported in some cases, including delay/loss of acquired language and seizures (<xref ref-type="bibr" rid="B50">Piton et al., 2011</xref>; <xref ref-type="bibr" rid="B47">Pilorge et al., 2016</xref>). For example, a microdeletion (<italic>GLRA2</italic>&#x0394;ex8-9) and two <italic>de novo</italic> missense mutations p.N109S and p.R126Q (p.N136S and p.R153Q in the GlyR &#x03B1;2 subunit with signal peptide) were found in the hemizygous (XY) state in males (<xref ref-type="bibr" rid="B47">Pilorge et al., 2016</xref>). The microdeletion <italic>GLRA2</italic>&#x0394;ex8-9 produced a truncated GlyR &#x03B1;2 subunit protein lacking M3, the cytoplasmic M3&#x2013;M4 intracellular loop and M4 that was not expressed at the cell surface. By contrast, two missense mutations, GlyR &#x03B1;2<sup>N109S</sup> and &#x03B1;2<sup>R126Q</sup>, caused reduced cell-surface expression and loss of glycine sensitivity (<xref ref-type="bibr" rid="B47">Pilorge et al., 2016</xref>). A third missense variant in <italic>GLRA2</italic> (p.R323L), associated with autism, macrocephaly, seizures and hypothyroidism in a female proband (<xref ref-type="bibr" rid="B50">Piton et al., 2011</xref>), was found to result in a gain of function (<xref ref-type="bibr" rid="B74">Zhang et al., 2017</xref>). Electrophysiological analysis of GlyR &#x03B1;2<sup>R323L</sup> revealed slower synaptic decay times, longer duration of active periods and an increase in conductance of &#x03B1;2<sup>R323L</sup> and &#x03B1;2<sup>R323L</sup>&#x03B2; channels (<xref ref-type="bibr" rid="B74">Zhang et al., 2017</xref>). In this study, we provide insights into the functional properties of four novel missense variants in <italic>GLRA2</italic> associated with ASD and developmental disorders (p.V-22L, p.N38K, p.K213E, p.T269M) using a multidisciplinary approach, encompassing cellular models of GlyR trafficking, molecular modeling, and electrophysiology using artificial glycinergic synapses. These variants cause either loss, gain or altered function of GlyR &#x03B1;2, explaining the range of clinical presentations associated with <italic>GLRA2</italic> variants.</p>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="S2.SS1">
<title>Molecular Biology, Bioinformatics and Molecular Modeling</title>
<p>The majority of the GlyR &#x03B1;2 variants studied were sourced from published sources (<xref ref-type="bibr" rid="B24">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B31">Krumm et al., 2015</xref>; <xref ref-type="bibr" rid="B13">Deciphering Developmental Disorders Study, 2017</xref>. GlyR &#x03B1;2 p.K213E was identified by ES, GvR, and KS in diagnostic exome sequencing. Site-directed mutagenesis of the human GlyR &#x03B1;2 subunit cDNA in the expression vector pRK5 (<xref ref-type="bibr" rid="B74">Zhang et al., 2017</xref>) was performed using the QuikChange kit (Agilent, Santa Clara, CA, United States). The successful incorporation of mutations was confirmed by Sanger DNA sequencing, performed by DNA Sequencing and Services (MRC PPU, School of Life Sciences, University of Dundee, United Kingdom) and analysis using Sequencher software (Gene Codes, Ann Arbor, MI, United States). Plasmid DNAs were prepared using a HiSpeed Plasmid Maxi Kit (QIAGEN, Hilden, Germany). The damaging effects of human GlyR &#x03B1;2 subunit variants were assessed using Sorting Intolerant From Tolerant (SIFT; <xref ref-type="bibr" rid="B63">Sim et al., 2012</xref>), PolyPhen-2 (<xref ref-type="bibr" rid="B2">Adzhubei et al., 2013</xref>), and CADD scores (<xref ref-type="bibr" rid="B52">Rentzsch et al., 2019</xref>). Mutation position in the GlyR &#x03B1;2 subunit is indicated using mature subunit numbering (i.e., after signal peptide cleavage). The effects of the V-22L variant on signal peptide cleavage were assessed using SignalP 4.0 (<xref ref-type="bibr" rid="B45">Petersen et al., 2011</xref>). Molecular modeling of the p.N38K and p.K213E variants was accomplished using the recently resolved structures of the GlyR &#x03B1;2&#x03B2; pentamer in the closed (RCSB: 7L31) and glycine-bound open state (RCSB: 5BKF) (<xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>). GlyR structures were visualized using the UCSF ChimeraX molecular visualization program (<xref ref-type="bibr" rid="B46">Pettersen et al., 2021</xref>). Amino acid substitutions were modeled using the swapaa command, taking into account the highest rotamer prevalence (Dunbrack backbone-dependent rotamer library, <xref ref-type="bibr" rid="B61">Shapovalov and Dunbrack, 2011</xref>), the highest number of H-bonds and the lowest clash score.</p>
</sec>
<sec id="S2.SS2">
<title>Molecular Dynamics Simulations</title>
<p>A homology model of the GlyR &#x03B1;2 homopentamer was also constructed using the Phyre2 web server (<xref ref-type="bibr" rid="B27">Kelley et al., 2015</xref>). GlyR &#x03B1;2 monomers were overlaid onto the GlyR &#x03B1;1 homopentamer (PDB ID: 3JAE; <xref ref-type="bibr" rid="B16">Du et al., 2015</xref>) to create the GlyR &#x03B1;2 homopentamer. The GlyR &#x03B1;2<sup>T269M</sup> variant was created by introducing M269 into the GlyR &#x03B1;2 homopentamer using PyMOL (<xref ref-type="bibr" rid="B14">DeLano, 2002</xref>). Wild-type and GlyR &#x03B1;2<sup>M269</sup> homopentamer systems were embedded into a model membrane composed of 80% POPC and 20% CHOL. Each system was solvated with SPC water, neutralized with Na<sup>+</sup> and NaCl was added to a concentration of 0.15 M. This led to an overall system consisting of the GlyR &#x03B1;2 homopentamer, in a membrane containing 80 mol% POPC and 20 mol% CHOL, surrounded by &#x223C;155,000 water molecules and 0.15 M NaCl. Simulations were conducted in the apo state, in the absence of the ligand glycine. All systems were simulated using GROMACS 2019.4 molecular dynamics engine (<xref ref-type="bibr" rid="B1">Abraham et al., 2015</xref>) in conjunction with the GROMOS 54a7 force field (<xref ref-type="bibr" rid="B59">Schmid et al., 2011</xref>). The system was energy minimized using the steepest descent algorithm and equilibrated in five sequential 1 ns simulations with decreasing restraints on the protein (1000 kJ mol<sup>&#x2013;1</sup> nm<sup>&#x2013;1</sup>, 500 kJ mol<sup>&#x2013;1</sup> nm<sup>&#x2013;1</sup>, 100 kJ mol<sup>&#x2013;1</sup> nm<sup>&#x2013;1</sup>, 50 kJ mol<sup>&#x2013;1</sup> nm<sup>&#x2013;1</sup>, and 10 kJ mol<sup>&#x2013;1</sup> nm<sup>&#x2013;1</sup>). Each unrestrained system was then simulated in triplicate for 500 ns. In all simulations, a 2 fs timestep was used. The pressure was maintained at 1 bar using semi-isotropic pressure coupling using the Berendsen barostat (&#x03C4;<sub>P</sub> = 0.5 ps and isothermal compressibility = 4.5 &#x00D7; 10<sup>&#x2013;5</sup> bar), and the temperature was maintained at 300 K using the Bussi-Donadio-Parrinello velocity rescale thermostat (&#x03C4;<sub>T</sub> = 0.1 ps). Periodic boundary conditions were implemented. SETTLE was used to constrain the geometry of water molecules and LINCS was used to constrain the covalent bond lengths of the solute. Analysis was performed using the GROMACS tools and the trj_cavity package on the entire 1.5 &#x03BC;s of combined production simulation for each system. The Visual Molecular Dynamics (VMD) program was used for visualization of the simulations (<xref ref-type="bibr" rid="B23">Humphrey et al., 1996</xref>; <xref ref-type="bibr" rid="B44">Paramo et al., 2014</xref>).</p>
</sec>
<sec id="S2.SS3">
<title>Cell-Surface Trafficking Assays</title>
<p>HEK293 cells (CRL-1573; ATCC &#x2013; Global Biosource Center, Manassas, VA, United States) were transfected with GlyR constructs using the Ca<sup>2+</sup> phosphate-DNA co-precipitation method as previously described (<xref ref-type="bibr" rid="B65">Sontheimer et al., 1989</xref>). Cells were washed 6 h post- transfection and used for biotinylation assays (New England Biolabs, Ipswich, MA, United States) 48 h after transfection. Biotin labeling and subsequent binding to streptavidin was used to discriminate between whole-cell and cell-surface protein. Surface proteins were labeled by incubating the cells for 30 min with 1 mg/ml EZ-Link Sulfo-NHS-LC-Biotin [sulfosuccinimidyl-6-(biotinamido)hexanoate (Pierce Biotechnologies, Rockford, IL, United States)]. Following a quenching step (192 mM glycine, 25 mM Tris in PBS, pH 8.0 for 10 min), cells were detached by using ice-cold PBS buffer. After centrifugation for 10 min at 1,000 &#x00D7; <italic>g</italic>, cells were lysed with TBS (Tris-buffer saline with 1% Triton-X100 and protease inhibitor mixture tablet, Roche Diagnostics, Mannheim, Germany). After centrifugation for 1 min at 13,000 &#x00D7; <italic>g</italic>, the supernatant (whole protein fraction) was incubated with 50 &#x03BC;l of streptavidin-agarose beads (Pierce Biotechnologies, Rockford, IL, United States) for 2 h at 4&#x00B0;C. Beads were washed three times in TBS buffer. Biotinylated proteins (surface fraction) were eluted by boiling with 50 &#x03BC;l of 2 &#x00D7; SDS buffer for 5 min at 95&#x00B0;C. Whole cell (WC) and cell surface (SF) fractions were separated by SDS-PAGE and Western blotting on nitrocellulose membranes (GE Healthcare, Little Chalfont, United Kingdom). Membranes were blocked for 1 h with 5% BSA in TBS-T (TBS with 1% Tween 20). GlyR &#x03B1;2 subunits were detected with the antibody mAb4A (cat. no. 146011, 1:1,000, Synaptic Systems, G&#x00F6;ttingen, Germany). Pan-cadherin (Cell Signaling Technology, Danvers, MA, United States, 4068, 1:1000) served as a loading control for the whole-cell fraction and cell-membrane protein fractions. Signals were detected using the ECL plus system (GE Healthcare, Little Chalfont, United Kingdom). Image quantification was performed using ImageJ (1.51)/Fiji2 (<xref ref-type="bibr" rid="B57">Schindelin et al., 2012</xref>, <xref ref-type="bibr" rid="B58">2015</xref>; <xref ref-type="bibr" rid="B60">Schneider et al., 2012</xref>). Data were analyzed using Student&#x2019;s <italic>t</italic>-test. For all tests, the number of asterisks corresponds to the level of statistical significance: &#x002A;<italic>p</italic> &#x003C; 0.05; <sup>&#x002A;&#x002A;</sup><italic>p</italic> &#x003C; 0.01; <sup>&#x002A;&#x002A;&#x002A;</sup><italic>p</italic> &#x003C; 0.001. Values are displayed as means &#x00B1; standard error of the mean (&#x00B1;SEM) unless otherwise noted.</p>
</sec>
<sec id="S2.SS4">
<title>Primary Culture of Spinal Neurons</title>
<p>Spinal neurons were prepared using methods as previously described (<xref ref-type="bibr" rid="B15">Dixon et al., 2015</xref>; <xref ref-type="bibr" rid="B72">Zhang et al., 2015b</xref>,<xref ref-type="bibr" rid="B74">2017</xref>; <xref ref-type="bibr" rid="B33">Leacock et al., 2018</xref>). Briefly, E15 timed-pregnant rats were euthanized via CO<sub>2</sub> inhalation in accordance with procedures approved by The University of Queensland Animal Ethics Committee (Approval number: QBI/142/16/NHMRC/ARC). The spinal cords were rapidly removed, triturated and plated onto poly-D-lysine-coated coverslips in a 4-well plate at a density of 8&#x2013;10 &#x00D7; 10<sup>4</sup> cells/well, and cultured for 3&#x2013;4 weeks until spontaneous inhibitory postsynaptic currents (IPSCs) could be detected. The cells were initially cultured in Dulbecco&#x2019;s Modified Eagle&#x2019;s Medium (DMEM) supplemented with 10% fetal bovine serum (DMEM-FBS). After 24 h, the entire DMEM-FBS medium was replaced with Neurobasal medium including 2% B27 and 1% GlutaMAX supplements. A second and final feed 1 week later replaced half of this medium with fresh Neurobasal medium. Neurons were used in co-culture experiments between 1 and 4 weeks later.</p>
</sec>
<sec id="S2.SS5">
<title>HEK293 Cell and Artificial Synapse Preparations</title>
<p>Artificial synapses were generated as previously described (<xref ref-type="bibr" rid="B15">Dixon et al., 2015</xref>; <xref ref-type="bibr" rid="B72">Zhang et al., 2015b</xref>,<xref ref-type="bibr" rid="B74">2017</xref>; <xref ref-type="bibr" rid="B33">Leacock et al., 2018</xref>). Briefly, HEK293 cells were cultured in DMEM-FBS until &#x223C;90% confluent. One day prior to transfection, cells were trypsinized and plated onto glass coverslips in 35 mm culture dishes at a density of 5 &#x00D7; 10<sup>3</sup> cells/dish. Each dish was transfected with 0.3 &#x03BC;g of GlyR &#x03B1;2 subunit DNA, plus 0.1 &#x03BC;g EGFP (pEGFP) was used as a transfection marker. For artificial synapses, 0.3 &#x03BC;g of mouse neuroligin 2A (pNice) and 0.3 &#x03BC;g of rat gephyrin (pCIS) were also added. Transfection was performed via a Ca<sup>2+</sup> phosphate-DNA co-precipitation method for 15&#x2013;20 h in a 3% CO<sub>2</sub> incubator and terminated by washing cells twice with divalent cation-free phosphate buffered saline. Cells were trypsinized the next day, centrifuged and re-suspended in Neurobasal medium (including 2% B27 and 1% GlutaMAX supplements) then seeded onto neurons. One 35 mm dish of HEK293 cells was typically sufficient to seed four coverslips of neurons. Once seeded with HEK293 cells, the co-cultures were returned to the incubator overnight to allow artificial synapses to form between neurons and transfected HEK293 cells. Cells were used for patch-clamp recording over the following 2&#x2013;3 days.</p>
</sec>
<sec id="S2.SS6">
<title>Electrophysiology</title>
<p>Whole-cell patch clamp recordings were performed at room temperature (22 &#x00B1; 1&#x00B0;C). Glycine concentration-response relationships were performed at &#x2212;40 mV, whereas artificial synapse recordings were performed at &#x2212;70 mV, both using a MultiClamp 700B amplifier and pCLAMP 10 software (Molecular Devices). Signals were filtered at 4 kHz and sampled at 10 kHz. Patch pipettes (4&#x2013;8 M&#x03A9; resistance) were fabricated from borosilicate glass (GC150F-7.5, Harvard Apparatus) and filled with an internal solution comprising (in mM): 145 CsCl, 2 CaCl<sub>2</sub>, 2 MgCl<sub>2</sub>, 10 HEPES, and 10 EGTA, adjusted to pH 7.4 with CsOH. The extracellular solution comprised (in mM) 140 NaCl, 5 KCl, 2 CaCl<sub>2</sub>, 1 MgCl<sub>2</sub>, 10 HEPES, and 10 <sc>D</sc>-glucose, adjusted to pH 7.4 with NaOH.</p>
</sec>
<sec id="S2.SS7">
<title>Electrophysiology Data Analysis</title>
<p>Analyses of IPSC amplitudes, 10&#x2013;90% rise times, and decay time constants were performed using AxoGraph X (AxoGraph Scientific). Only cells with a stable series resistance of &#x003C;25 M&#x03A9; throughout the recording period were selected for analysis. IPSCs were detected using a semi-automated sliding template. Each detected event was visually inspected and only those with no inflections in the rising or decay phases were included. All selected events from a single cell were digitally averaged. Parameters derived from these digitally averaged waveforms were then pooled with those from other cells to obtain group data. To calculate macroscopic current decay time constants, digitally averaged macroscopic recordings were fitted with double-exponential functions in AxoGraph X, and a weighted time constant was calculated from individual time constants (&#x03C4;1, &#x03C4;2) and their relative amplitude (A1, A2) as follows: &#x03C4;<sub>weighted</sub> = (&#x03C4;1 &#x00D7; A1 + &#x03C4;2 &#x00D7; A2)/(A1 + A2). Displayed averaged data represent group means &#x00B1; SEMs. The Hill equation was used to calculate the saturating current magnitude (I<sub>max</sub>), half-maximal concentration (EC<sub>50</sub>), and Hill coefficient (n<sub>H</sub>) values for glycine activation. Individual concentration-response relationships were fitted using a non-linear least squares algorithm (SigmaPlot 11.0; Jandel Scientific, San Rafael, CA, United States). Statistical analysis and graphing were performed with SigmaPlot 11.0. Data were first tested for normality using both the Shapiro&#x2013;Wilk and Kolmogorov&#x2013;Smirnov tests. Via either test, all data proved normally distributed using an alpha value of 0.05. Statistical analysis was then performed using a one-way ANOVA for multiple comparisons followed by Tukey&#x2019;s <italic>post hoc</italic> test. <italic>P</italic> values of &#x003C;0.05 were taken to be statistically significant.</p>
</sec>
</sec>
<sec id="S3" sec-type="results">
<title>Results</title>
<sec id="S3.SS1">
<title>Identification of Candidate <italic>GLRA2</italic> Variants and Bioinformatic Analysis</title>
<p>Candidate GlyR &#x03B1;2 subunit mutations were identified from exome sequencing studies in ASD and/or developmental disorders (<xref ref-type="bibr" rid="B24">Iossifov et al., 2014</xref>; <xref ref-type="bibr" rid="B31">Krumm et al., 2015</xref>; <xref ref-type="bibr" rid="B13">Deciphering Developmental Disorders Study, 2017</xref>; <xref ref-type="fig" rid="F1">Figure 1A</xref> and <xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>) and include p.V-22L (signal peptide), p.N38K (extracellular domain, ECD), p.K213E (ECD), and p.T269M (M2). These correspond to substitutions p.V6L, p.N65K, p.K240E, and p.T296M in the human GlyR &#x03B1;2 subunit precursor prior to signal peptide cleavage. The damaging effects of the human GlyR &#x03B1;2 subunit variants were assessed using SIFT (<xref ref-type="bibr" rid="B63">Sim et al., 2012</xref>), PolyPhen-2 (<xref ref-type="bibr" rid="B2">Adzhubei et al., 2013</xref>), and CADD scores (<xref ref-type="bibr" rid="B52">Rentzsch et al., 2019</xref>; <xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>). All variants were found to be possibly/probably damaging with PolyPhen-2 and all had high CADD scores: p.V-22L, 15.78; p.N38K, 20.4, p.K213E, 24.3 and p.T269M 25.4, consistent with previously reported GlyR &#x03B1;2 subunit variants associated with ASD (p.N109S, p.R126Q, p.R323L; <xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>). All variants were absent from gnomAD database (<xref ref-type="bibr" rid="B26">Karczewski et al., 2020</xref>) with the exception of p.K213E, which occurs with a low frequency of 4/177,746 alleles. However, given the high CADD score for p.K213E (24.3), we proceeded with structure/function analysis. The variant p.V-22L would not normally be expected to affect GlyR &#x03B1;2 subunit function, since it is located in the cleavable signal peptide found at the N-terminus of the protein. However, on analysis with SignalP 4.0 (<xref ref-type="bibr" rid="B45">Petersen et al., 2011</xref>) we noted that p.V-22L subtly alters the predicted signal peptide cleavage site for GlyR &#x03B1;2. While the wild-type protein was predicted to be cleaved between amino acids 27 and 28 AFC-KD, the GlyR &#x03B1;2<sup>V&#x2013;22L</sup> missense variant was predicted to be cleaved between amino acids 21 and 22: TNH-FR (<xref ref-type="fig" rid="F1">Figure 1A</xref>), which could influence the efficiency of signal peptide cleavage and cell-surface expression. By contrast, GlyR &#x03B1;2<sup>N38K</sup> and GlyR &#x03B1;2<sup>K213E</sup> lie within the ligand-binding ECD (<xref ref-type="fig" rid="F1">Figure 1A</xref>), while GlyR &#x03B1;2<sup>T269M</sup> affects a highly conserved residue within the pore-forming M2 domain (<xref ref-type="fig" rid="F1">Figure 1B</xref>). Interestingly, substitutions at the equivalent residues to GlyR &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> have not been observed in the GlyR &#x03B1;1 subunit in startle disease (<xref ref-type="bibr" rid="B11">Chung et al., 2010</xref>; <xref ref-type="bibr" rid="B7">Bode et al., 2013</xref>; <xref ref-type="bibr" rid="B73">Zhang et al., 2016</xref>; <xref ref-type="fig" rid="F1">Figure 1</xref>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>Human GlyR &#x03B1;2 subunit variants associated with ASD and neurodevelopmental disorders. <bold>(A)</bold> Human GlyR &#x03B1;2 subunit missense variants p.V-22L (signal peptide), p.N38K (ECD), p.K213E (ECD), and p.T269M (M2) were identified in individuals with autism spectrum disorder (ASD) or developmental disorders (DD). Amino acid sequence of the human GlyR &#x03B1;2 subunit indicating the positions of putative membrane-spanning domains (gray shaded boxes), amino-acid residues affected by missense changes associated with ASD or DD (green), key glycine-binding residues (blue), and glycosylation sites (boxes). <bold>(B)</bold> Alignment of the human GlyR &#x03B1;1 and &#x03B1;2 subunits showing pore-lining residues (black dots) and different types of pathogenic mutations found in the GlyR &#x03B1;1 subunit in human startle disease. Red, dominant; blue, recessive; green, spontaneously opening channels (leakage current). Note that GlyR &#x03B1;2<sup>T269M</sup> does not affect predicted pore-lining residue, nor does it correspond to a position of a known GlyR &#x03B1;1 subunit startle disease mutation.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g001.tif"/>
</fig>
<p>Initial analysis of the potential effects of GlyR &#x03B1;2<sup>N38K</sup> and GlyR &#x03B1;2<sup>K213E</sup> variants was conducted using the GlyR &#x03B1;2&#x03B2; pentamer in the closed (RCSB: 7L31) and glycine-bound open state (RCSB: 5BKF) (<xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>). GlyR structures were visualized using the UCSF ChimeraX molecular visualization program (<xref ref-type="bibr" rid="B46">Pettersen et al., 2021</xref>). The GlyR &#x03B1;2<sup>N38K</sup> variant introduces a larger charged side-chain that is predicted to result in clashes with the glycan attached to residue N45 in both closed and open states (<xref ref-type="fig" rid="F2">Figures 2A,B</xref>; <xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>). Artificial mutations of the corresponding consensus glycosylation site in GlyR &#x03B1;1 (N-X-T), encompassing N38 and S40, have been found to be essential for GlyR homo-oligomerization and receptor biogenesis (<xref ref-type="bibr" rid="B19">Griffon et al., 1999</xref>). However, GlyR &#x03B1;2 is now known to be glycosylated at two sites, N45 and N76 (<xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>; <xref ref-type="fig" rid="F1">Figure 1</xref>), with the second site being specific to GlyR &#x03B1;2. We therefore predict that while GlyR &#x03B1;2<sup>N38K</sup> may not interfere with N-linked glycosylation at N76, it could negatively impact GlyR homo-oligomerization and cell-surface trafficking by interfering with glycosylation at N45. GlyR &#x03B1;2<sup>K213</sup> is located in the second dicysteine loop in the ECD and is flanked by key ligand-binding residues including GlyR &#x03B1;2 Y209, T211 and F214 (<xref ref-type="fig" rid="F1">Figure 1</xref>, blue lettering; <xref ref-type="fig" rid="F2">Figures 2C,D</xref>). GlyR &#x03B1;2<sup>K213E</sup> introduces charge swap to the region and some loss of flexibility in the side chain. In the closed state, we found an obvious clash with H208 (<xref ref-type="fig" rid="F2">Figure 2E</xref>), but in the open state, the glutamic acid side chain was free of clashes and made additional contacts with Y209 (<xref ref-type="fig" rid="F2">Figure 2F</xref>). These changes suggest that for GlyR &#x03B1;2<sup>K213E</sup>, the open state may be favored, resulting in prolonged opening of the ion channel.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p>Molecular modeling of the impacts of GlyR &#x03B1;2<sup>N38K</sup> and &#x03B1;2<sup>K213E</sup> variants. The potential effects of GlyR &#x03B1;2<sup>N38K</sup> and GlyR &#x03B1;2<sup>K213E</sup> variants were visualized using the GlyR &#x03B1;2&#x03B2; pentamer in the strychnine-bound closed state (RCSB: 7L31) and glycine-bound open state (RCSB: 5BKF) (<xref ref-type="bibr" rid="B70">Yu et al., 2021</xref>). In the closed state <bold>(A)</bold>, GlyR &#x03B1;2 N38 makes contacts (green lines) with neighboring residues R36 and P42, while mutant GlyR &#x03B1;2<sup>N38K</sup> <bold>(B)</bold> is predicted to maintain the original contacts but results in clashes (purple lines) with the glycan at residue N45. In the closed state <bold>(C)</bold>, GlyR &#x03B1;2<sup>K213</sup> makes numerous contacts with neighboring residues (green lines), stabilizing the cysteine loop structure formed by C205 and C216. However, in the open state <bold>(D)</bold>, GlyR &#x03B1;2<sup>K213</sup> forms stabilizing contacts with the loop and the ligand-binding residue F214 (green lines). In the closed state <bold>(E)</bold>, mutant GlyR &#x03B1;2<sup>K213E</sup> is predicted to clash with H208 on the opposing side of the cysteine loop (purple lines). Interestingly, in the open state <bold>(F)</bold> the GlyR &#x03B1;2<sup>K213E</sup> variant increases the number of contacts with neighboring residues, but does not show a clash with H208, suggesting that the open state may be favored for &#x03B1;2<sup>K213E</sup>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g002.tif"/>
</fig>
</sec>
<sec id="S3.SS2">
<title>Molecular Dynamics Simulations of the GlyR &#x03B1;2<sup>T269M</sup> Variant</title>
<p>For the GlyR &#x03B1;2<sup>T269M</sup> variant, we used molecular dynamics simulations to examine the potential effects of this substitution in the M2 domain. Wild-type GlyR &#x03B1;2<sup>T269</sup> and mutant &#x03B1;2<sup>M269</sup> GlyR homopentamers were stable over the triplicate 500 ns simulations (<xref ref-type="fig" rid="F3">Figures 3A&#x2013;D</xref>). The ion channel for the GlyR &#x03B1;2 homopentamer is closed around T272, giving a physical occlusion to the channel pore (<xref ref-type="fig" rid="F3">Figures 3A,C,E</xref>). By contrast, the M269 ion channel is open and allows movement between the extracellular and intracellular solutions (<xref ref-type="fig" rid="F3">Figures 3B,D,E</xref>). This opening of the channel leads to an increase in the channel volume for the GlyR &#x03B1;2<sup>M269</sup> vs. wild-type GlyR &#x03B1;2<sup>T269</sup> and a corresponding increase in the number of water molecules within the channel. An average of 56 water molecules was found within the channel for wild-type GlyR &#x03B1;2<sup>T269</sup> across each 500 ns replicate simulation, compared to an average of 130 water molecules for the GlyR &#x03B1;2<sup>M269</sup> variant. The changes in ion channel volume and water occupancy were also coupled with an increase in Cl<sup>&#x2013;</sup> ion presence in the channel for GlyR &#x03B1;2<sup>M269</sup>, compared to wild-type GlyR &#x03B1;2<sup>T269</sup>. Here, one or more Cl<sup>&#x2013;</sup> ions are found in the channel for 27% of the total 1,500 ns of combined simulation time for &#x03B1;2<sup>M269</sup>, compared to only 5% of the total combined simulation time of the wild-type &#x03B1;2<sup>T269</sup> system. The changes in ion channel properties between the wild-type &#x03B1;2<sup>T269</sup> and &#x03B1;2<sup>M269</sup> systems are due to altered inter-residue interactions in this region of the channel (<xref ref-type="fig" rid="F4">Figures 4A,B</xref>). Specifically, in the wild-type GlyR &#x03B1;2, T269 is stabilized by hydrogen bonds with the adjacent polar residues T265 and Q273 located on the same M2 domain in an arrangement where the side chains are stacked (<xref ref-type="fig" rid="F4">Figure 4A</xref>). Conversely, while the larger, non-polar mutant M269 also interacts with T265 and Q273, the longer side chain forms an additional interaction with T271 in the M2 domain of the adjacent GlyR &#x03B1;2 monomer (<xref ref-type="fig" rid="F4">Figure 4B</xref>). When T271 interacts with the mutated M269, T271 is no longer able to stabilize the closed conformation of the L268 gating residue. In the GlyR &#x03B1;2<sup>M269</sup> system, the backbone of L268 forms hydrogen bonds with the sidechain of T272. Collectively, these changes in hydrogen bonding in the region surrounding M269 and L268 predict an opening of the channel for GlyR &#x03B1;2<sup>M269</sup> compared to wild-type &#x03B1;2<sup>T269</sup>, increasing both the water and Cl<sup>&#x2013;</sup> occupancy of the channel.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>Molecular dynamic simulations of wild-type GlyR &#x03B1;2 and GlyR &#x03B1;2<sup>T269M</sup> variants. Mean internal cavity surface detected for GlyR &#x03B1;2 homomers in a model membrane (headgroups shown in gray) for: <bold>(A)</bold> wild-type GlyR &#x03B1;2<sup>T269</sup> and <bold>(B)</bold> the GlyR &#x03B1;2<sup>T269M</sup> variant over the 1.5 &#x03BC;s of combined production simulation. The site of the M269 mutation is shown in gold. The channel radius (&#x00C5;) of the wild-type GlyR &#x03B1;2 is compared to the GlyR &#x03B1;2<sup>T269M</sup> variant over the 1.5 &#x03BC;s of combined production simulation. <bold>(C,D)</bold> The red surfaces show the solvent volume within wild-type GlyR &#x03B1;2<sup>T269</sup> and GlyR &#x03B1;2<sup>T269M</sup> channels. Wild-type GlyR is occluded to water at the level of T272, while water permeates the length of the GlyR &#x03B1;2<sup>T269M</sup> variant. <bold>(E)</bold> The radius of the channel (&#x00C5;) along the transmembrane region of the longitudinal channel axis is given in the right panel. Selected residues along the channel have been noted for reference and to enable calibration of the distance along the <italic>z</italic>-axis (in Angstroms) with a residue number. blue indicates GlyR&#x03B1;2<italic><sup>T269</sup></italic>, yellow indicates GlyR&#x03B1;2<italic><sup>T269M</sup></italic>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g003.tif"/>
</fig>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption><p>Hydrogen bonding interactions for wild-type GlyR &#x03B1;2 and GlyR &#x03B1;2<sup>T269M</sup> variants. Two adjacent M2 helices are shown and surrounding amino acids showing interactions between adjacent M2 domains. <bold>(A)</bold> In the wild-type GlyR &#x03B1;2, T269 is stabilized by hydrogen bonds with the adjacent polar residues T265 and Q273 located in the same M2 domain in an arrangement where the side chains are stacked. <bold>(B)</bold> Conversely, while the larger, non-polar mutant M269 also interacts with T265 and Q273, the longer side-chain forms an additional interaction with T271 in the M2 domain of the adjacent GlyR &#x03B1;2 monomer.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g004.tif"/>
</fig>
</sec>
<sec id="S3.SS3">
<title>GlyR &#x03B1;2<sup>V&#x2013;22L</sup>, &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> Variants Exhibit Impaired Cell-Surface Trafficking</title>
<p>To examine the effects of these GlyR &#x03B1;2 variants on cell-surface expression, we measured whole-cell versus surface GlyR expression levels by labeling of surface proteins with biotin followed by cell lysis and precipitation of biotin-labeled proteins using streptavidin beads (<xref ref-type="fig" rid="F5">Figures 5A&#x2013;D</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). Samples from the lysate refer to the whole-cell protein pool (<xref ref-type="fig" rid="F5">Figures 5A,B</xref>), samples of biotinylated proteins refer to the surface-expressed receptor protein (<xref ref-type="fig" rid="F5">Figures 5C,D</xref>). Whole-cell and surface-expressed protein levels were first normalized to the expression levels of cadherin, and then relative to wild-type GlyR &#x03B1;2 levels which were designated as 100%. While whole-cell expression of the signal peptide variant GlyR &#x03B1;2<sup>V&#x2013;22L</sup> was not significantly reduced compared to wild-type GlyR &#x03B1;2, cell-surface expression was significantly reduced (&#x03B1;2<sup>V&#x2013;22L</sup> 52 &#x00B1; 12% of control values, &#x002A;<italic>p</italic> &#x003C; 0.05). By contrast, for GlyR &#x03B1;2<sup>N38K</sup>, predicted to interfere with N-linked glycosylation, both whole-cell and cell-surface expression levels were significantly reduced (&#x03B1;2<sup>N38K</sup> whole-cell 26 &#x00B1; 6%<sup>&#x002A;&#x002A;</sup>; cell surface 11 &#x00B1; 7%<sup>&#x002A;&#x002A;</sup>; <sup>&#x002A;&#x002A;</sup><italic>p</italic> &#x003C; 0.01, <xref ref-type="fig" rid="F5">Figures 5A&#x2013;D</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). For the remaining two GlyR &#x03B1;2 variants &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> whole-cell expression levels were indistinguishable from wild-type GlyR &#x03B1;2 (&#x03B1;2<sup>K213E</sup> 68 &#x00B1; 25% and &#x03B1;2<sup>T269M</sup> 86 &#x00B1; 15% of wild-type values), while both showed diminished cell-surface expression (&#x03B1;2<sup>K213E</sup>: 42 &#x00B1; 8%&#x002A;; &#x03B1;2<sup>T269M</sup>: 30 &#x00B1; 9%&#x002A;; &#x002A;<italic>p</italic> &#x003C; 0.05, <xref ref-type="fig" rid="F5">Figures 5A&#x2013;D</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). Hence, all GlyR &#x03B1;2 missense variants affected cell-surface expression to varying degrees, but none were completely retained in the endoplasmic reticulum or other subcellular compartments.</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption><p>Whole-cell protein and cell-surface expression of GlyR &#x03B1;2 subunit variants. <bold>(A,C)</bold> Whole-cell protein and cell-surface protein fractions from HEK293 cells transfected with either wild-type GlyR &#x03B1;2 or GlyR &#x03B1;2 variants &#x03B1;2<sup>V&#x2013;22L</sup>, &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup>, or &#x03B1;2<sup>T269M</sup> were immunostained for GlyR &#x03B1;2 using the pan-GlyR &#x03B1; subunit antibody mAb4a (48 kDa). For cell-surface biotinylation assays, cells were also transfected with EGFP as an internal control to ensure that only cell-surface proteins (30 kDa) were isolated. Cadherin served as housekeeping protein for both whole-cell and cell-surface expression and was detected by a pan-cadherin (pan-CAD) antibody (130 kDa). <bold>(B,D)</bold> Quantification of whole-cell and cell-surface protein fractions, normalized to pan-cadherin. The expression of wild-type GlyR &#x03B1;2 subunit was set to 1 (reflecting 100%). We noted a significant reduction of cell-surface protein for all GlyR &#x03B1;2 variants compared to the wild-type GlyR &#x03B1;2 control; significance values are &#x002A;<italic>p</italic> &#x003C; 0.05, &#x002A;&#x002A;<italic>p</italic> &#x003C; 0.01. All results are detailed in <xref ref-type="table" rid="T1">Table 1</xref>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g005.tif"/>
</fig>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>Cellular expression profiles of GlyR &#x03B1;2 ASD/DD variants expressed in HEK293 cells.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="center" colspan="2">Whole cell<hr/></td>
<td valign="top" align="center" colspan="2">Cell-surface<hr/></td>
</tr>
<tr>
<td valign="top" align="left">Construct</td>
<td valign="top" align="center">Relative expression</td>
<td valign="top" align="center">Normalized expression (%)</td>
<td valign="top" align="center">Relative expression</td>
<td valign="top" align="center">Normalized expression (%)</td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2 wild-type</td>
<td valign="top" align="center">0.54 &#x00B1; 0.03</td>
<td valign="top" align="center">100 &#x00B1; 5</td>
<td valign="top" align="center">0.63 &#x00B1; 0.08</td>
<td valign="top" align="center">100 &#x00B1; 12</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>V&#x2013;22L</sup></td>
<td valign="top" align="center">0.49 &#x00B1; 0.19</td>
<td valign="top" align="center">92 &#x00B1; 36</td>
<td valign="top" align="center">0.32 &#x00B1; 0.07</td>
<td valign="top" align="center">52 &#x00B1; 12<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>N38K</sup></td>
<td valign="top" align="center">0.14 &#x00B1; 0.03</td>
<td valign="top" align="center">26 &#x00B1; 6<xref ref-type="table-fn" rid="t1fns1">&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.07 &#x00B1; 0.04</td>
<td valign="top" align="center">11 &#x00B1; 7<xref ref-type="table-fn" rid="t1fns1">&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>K213E</sup></td>
<td valign="top" align="center">0.37 &#x00B1; 0.13</td>
<td valign="top" align="center">68 &#x00B1; 25</td>
<td valign="top" align="center">0.26 &#x00B1; 0.05</td>
<td valign="top" align="center">42 &#x00B1; 8<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>T269M</sup></td>
<td valign="top" align="center">0.46 &#x00B1; 0.08</td>
<td valign="top" align="center">86 &#x00B1; 15</td>
<td valign="top" align="center">0.19 &#x00B1; 0.06</td>
<td valign="top" align="center">30 &#x00B1; 9<xref ref-type="table-fn" rid="t1fns1">&#x002A;</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t1fns1"><p><italic>Relative expression reflects the expression values obtained for the GlyR variants in relation to levels of the control protein pan-cadherin. For normalized expression, expression of GlyR &#x03B1;2 variants is shown as a percentage of wild-type GlyR &#x03B1;2 subunit values (100%). p-values were calculated relative to wild-type GlyR &#x03B1;2 homomers using Student&#x2019;s t-test (analysis of variance) and values below &#x002A;p &#x003C; 0.05 were considered significant, &#x002A;&#x002A;p &#x003C; 0.01. Values are displayed as means &#x00B1; standard error of the mean (&#x00B1;SEM).</italic></p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S3.SS4">
<title>Electrophysiological Properties of GlyR &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> Homomers</title>
<p>Consistent with cell-surface trafficking data, GlyR &#x03B1;2<sup>N38K</sup> subunit homomers expressed in HEK293 cells exhibited a significantly reduced mean I<sub>max</sub> value (&#x03B1;2<sup>N38K</sup> 3.3 &#x00B1; 0.7 vs. wild-type 8.9 &#x00B1; 1.6 nA; <italic>n</italic> = 7 cells each; <italic>p</italic> &#x003C; 0.01) and a significantly increased glycine EC<sub>50</sub> value (&#x03B1;2<sup>N38K</sup> 243 &#x00B1; 12 vs. wild-type 141 &#x00B1; 14 &#x03BC;M; <italic>n</italic> = 7 cells each; <italic>p</italic> &#x003C; 0.001) compared to wild-type GlyR &#x03B1;2 subunit homomers (<xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>). Again, this is consistent with a <italic>loss-of-function</italic> for GlyR &#x03B1;2<sup>N38K</sup>. By contrast, despite the reduced expression levels observed in cell-surface biotinylation experiments, GlyR &#x03B1;2<sup>K213E</sup> subunit homomers exhibited no significant change in either I<sub>max</sub> or EC<sub>50</sub> relative to the wild-type GlyR &#x03B1;2 subunit homomers (<xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>), suggesting that this missense change has a more subtle effect on GlyR function, as predicted by molecular modeling. However, as suggested by the location of p.T269M substitution in the ion-channel pore, and molecular dynamics simulations, GlyR &#x03B1;2<sup>T269M</sup> subunit homomers exhibited a dramatic phenotype (<xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>). GlyR &#x03B1;2<sup>T269M</sup> homomers not only displayed robust glycine-gated currents but also exhibited a significant leakage current, as revealed by the block of the baseline current by 100 &#x03BC;M picrotoxin, an inhibitor of homomeric GlyRs. Averaged from five cells, the mean magnitude of the picrotoxin-blocked current was 240 &#x00B1; 35 pA, and the relative magnitude of leak current to saturating whole-cell current in individual cells was 18.7 &#x00B1; 3.8% (<italic>n</italic> = 5 cells). By contrast, we did not observe any upward deflection in the baseline current when 100 &#x03BC;M picrotoxin was applied to cells expressing wild-type GlyR &#x03B1;2, &#x03B1;2<sup>N38K</sup> or &#x03B1;2<sup>K213E</sup> (data not shown).</p>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption><p>Functional analysis of human GlyR &#x03B1;2 variants using whole-cell patch-clamp electrophysiology. <bold>(A)</bold> Glycine dose-response sample traces for wild-type GlyR &#x03B1;2 and &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> variants. Note that the GlyR &#x03B1;2<sup>V&#x2013;22L</sup> variant was not studied, since this change is in the signal peptide, and is not located in the mature GlyR &#x03B1;2 subunit polypeptide. Horizontal bars indicate the applied glycine concentration in micromolar. The effect of applying 100 &#x03BC;M picrotoxin on baseline current is also shown for the GlyR &#x03B1;2<sup>T269M</sup> variant. Note that this results in an apparent outward current, reflecting a significant leakage current caused by spontaneous GlyR activity. <bold>(B)</bold> Normalized, averaged glycine dose-response results for wild-type GlyR &#x03B1;2 and &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> variants. Note that GlyR &#x03B1;2<sup>T269M</sup> also exhibits a significantly reduced glycine EC<sub>50</sub> value, which results in GlyR &#x03B1;2<sup>T269M</sup> activation at low micromolar glycine concentrations. Parameters of best fit to the Hill equation are summarized in <xref ref-type="table" rid="T2">Table 2</xref>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g006.tif"/>
</fig>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>Properties of wild-type and mutant GlyRs measured using whole-cell patch-clamp electrophysiology in HEK293 cells.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Construct</td>
<td valign="top" align="center">I<sub>max</sub> (nA)</td>
<td valign="top" align="center">n<italic><sub><italic>H</italic></sub></italic></td>
<td valign="top" align="center">EC<sub>50</sub> (&#x03BC;M)</td>
<td valign="top" align="center"><italic>n</italic></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2 wild-type</td>
<td valign="top" align="center">8.9 &#x00B1; 1.6</td>
<td valign="top" align="center">2.1 &#x00B1; 0.1</td>
<td valign="top" align="center">141 &#x00B1; 14</td>
<td valign="top" align="center">7</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>N38K</sup></td>
<td valign="top" align="center">3.3 &#x00B1; 0.7<xref ref-type="table-fn" rid="t2fns1">&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">2.8 &#x00B1; 0.1</td>
<td valign="top" align="center">243 &#x00B1; 12<xref ref-type="table-fn" rid="t2fns1">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">7</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>K213E</sup></td>
<td valign="top" align="center">5.2 &#x00B1; 0.7</td>
<td valign="top" align="center">2.3 &#x00B1; 0.3</td>
<td valign="top" align="center">177 &#x00B1; 9</td>
<td valign="top" align="center">7</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>T269M</sup></td>
<td valign="top" align="center">2.1 &#x00B1; 0.4<xref ref-type="table-fn" rid="t2fns1">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">1.4 &#x00B1; 0.2</td>
<td valign="top" align="center">4.5 &#x00B1; 1.7<xref ref-type="table-fn" rid="t2fns1">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">7</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t2fns1"><p><italic>The averaged maximal currents (I<sub>max</sub>), Hill coefficients (n<sub>H</sub>), and EC<sub>50</sub> values in response to glycine activation are shown. p-values were calculated relative to wild-type GlyR &#x03B1;2 homomers using one-way ANOVA followed by Tukey&#x2019;s post hoc test: &#x002A;&#x002A;p &#x003C; 0.01, &#x002A;&#x002A;&#x002A;p &#x003C; 0.001.</italic></p></fn>
</table-wrap-foot>
</table-wrap>
<p>Relative to wild-type GlyR &#x03B1;2 subunit homomers, GlyRs containing the &#x03B1;2<sup>T269M</sup> subunit also exhibited a significantly reduced mean glycine-activated I<sub>max</sub> current (2.1 &#x00B1; 0.4 vs. 8.9 &#x00B1; 1.6 nA; <italic>n</italic> = 7 cells; <italic>p</italic> &#x003C; 0.001, <xref ref-type="table" rid="T2">Table 2</xref>) but this was counterbalanced by a significantly reduced glycine EC<sub>50</sub> value (&#x03B1;2<sup>T269M</sup> 4.5 &#x00B1; 1.7 vs. wild-type 141 &#x00B1; 14 &#x03BC;M; <italic>n</italic> = 7 cells; <italic>p</italic> &#x003C; 0.001, <xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>). Thus, despite a reduction in cell surface-trafficking, the leak current and the high glycine sensitivity of GlyR &#x03B1;2<sup>T269M</sup> subunit homomers are suggestive of a <italic>gain-of-function</italic> that is predicted to increase glycinergic signaling at synapses. It should be noted that tonic leak currents that impair cell viability have been previously observed for &#x201C;leaky&#x201D; GlyR &#x03B1;1 subunit mutants (<xref ref-type="bibr" rid="B7">Bode et al., 2013</xref>; <xref ref-type="bibr" rid="B73">Zhang et al., 2016</xref>). The degree of degradation in viability may well have been proportional to the functional expression level of the GlyR &#x03B1;2<sup>T269M</sup> construct in individual cells. Thus, by selecting relatively healthy cells for analysis, we may have biased cell selection toward weakly expressing cells with smaller than average whole-cell current magnitudes.</p>
</sec>
<sec id="S3.SS5">
<title>Properties of GlyR &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>T269M</sup> Variants in Artificial Synapses</title>
<p>For functional studies in artificial synapses, we utilized homomeric &#x03B1;2 subunit GlyRs, as these extrasynaptic GlyRs represent the predominant prenatal isoform that is critical for interneuron migration in the developing cortex (<xref ref-type="bibr" rid="B4">Avila et al., 2013</xref>, <xref ref-type="bibr" rid="B5">2014</xref>). In the artificial synapse system, homomeric &#x03B1;2 GlyRs exhibit slow decay time constants, and are thought to be perisynaptic in location due to slow 10&#x2013;90% rise times (<xref ref-type="table" rid="T3">Table 3</xref>), implying that they are located a substantial distance from presynaptic terminals (<xref ref-type="bibr" rid="B71">Zhang et al., 2015a</xref>). Whole-cell recordings from transfected HEK293 cells in co-culture with spinal neurons exhibited robust, spontaneous IPSCs with amplitudes up to 1000 pA. Sample recordings at low and high temporal resolution for wild-type GlyR &#x03B1;2 and each variant are shown in <xref ref-type="fig" rid="F7">Figures 7A&#x2013;D</xref>, left and center panels. After each recording, we normalized and digitally averaged all well-separated IPSCs to produce a single globally averaged waveform. We thereby obtained a single averaged 10&#x2013;90% rise time, decay time constant and amplitude for each cell. <xref ref-type="table" rid="T3">Table 3</xref> summarizes the mean values obtained for each of the three parameters. These values were averaged from 9 to 46 cells as indicated. IPSCs mediated by wild-type GlyR &#x03B1;2 exhibited a mean amplitude of 60.6 &#x00B1; 9.7 pA, a 10&#x2013;90% rise time of 6.76 &#x00B1; 0.98 ms and a mean decay time constant of 105.3 &#x00B1; 11.4 ms (<italic>n</italic> = 22 cells). These values are very similar to those recorded previously from wild-type GlyR &#x03B1;2 expressed in artificial synapses (<xref ref-type="bibr" rid="B72">Zhang et al., 2015b</xref>). Relative to wild-type GlyR &#x03B1;2 values, IPSCs mediated by GlyR &#x03B1;2<sup>N38K</sup> exhibited significantly reduced amplitudes (23.4 &#x00B1; 3.0 pA; <italic>p</italic> &#x003C; 0.001, <italic>n</italic> = 46 cells) although IPSC rise and decay times were unchanged (<xref ref-type="table" rid="T3">Table 3</xref>). Notably, GlyR &#x03B1;2<sup>K213E</sup>-mediated IPSCs were dramatically different from wild-type GlyR &#x03B1;2 values, with significantly larger amplitudes (&#x03B1;2<sup>K213E</sup> 271.9 &#x00B1; 104.2 vs. wild-type 60.6 &#x00B1; 9.7 pA; <italic>n</italic> = 22 and 46 cells, respectively; <italic>p</italic> &#x003C; 0.001), significantly faster rise times (&#x03B1;2<sup>K213E</sup> 4.58 &#x00B1; 0.35 vs. wild-type 6.76 &#x00B1; 0.98 ms; <italic>n</italic> = 22 and 46 cells, respectively; <italic>p</italic> &#x003C; 0.05), and significantly slower decay times (&#x03B1;2<sup>K213E</sup> 240.4 &#x00B1; 55.4 vs. wild-type 105.3 &#x00B1; 11.4 ms; <italic>n</italic> = 22 and 46 cells, respectively; <italic>p</italic> &#x003C; 0.05). Thus, although this variant appeared to have little functional effect in patch-clamp experiments, in artificial synapses GlyR &#x03B1;2<sup>K213E</sup> dramatically enhanced glycinergic signaling suggesting that it causes a <italic>gain-of-function.</italic> Unfortunately, HEK293 cells expressing GlyR &#x03B1;2<sup>T269M</sup> were unhealthy when maintained in co-culture for several days and this permitted only short-lasting, unstable recordings. We were able to obtain an estimate of the mean IPSC amplitude (23.2 &#x00B1; 5.8 pA) from <italic>n</italic> = 9 cells despite attempted recordings from &#x003E;200 cells. Moreover, due to the extraordinarily long IPSC decay times (e.g., <xref ref-type="fig" rid="F7">Figure 7D</xref>, bottom center panel), it was not possible to isolate individual events, and thus we could not quantify mean IPSC rise and decay times. However, these results are consistent with the leak currents and gain-of-function observed in simple patch-clamp experiments.</p>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Properties of IPSCs mediated wild-type and mutant GlyRs in artificial synapses.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left">Construct</td>
<td valign="top" align="center">Amplitude (pA)</td>
<td valign="top" align="center">Rise time (ms)</td>
<td valign="top" align="center">Decay time (ms)</td>
<td valign="top" align="center"><italic>n</italic></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2 wild-type</td>
<td valign="top" align="center">60.6 &#x00B1; 9.7</td>
<td valign="top" align="center">6.76 &#x00B1; 0.98</td>
<td valign="top" align="center">105.3 &#x00B1; 11.4</td>
<td valign="top" align="center">22</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>N38K</sup></td>
<td valign="top" align="center">23.4 &#x00B1; 3.0<xref ref-type="table-fn" rid="t3fns1">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">4.58 &#x00B1; 0.35</td>
<td valign="top" align="center">91.3 &#x00B1; 6.7</td>
<td valign="top" align="center">46</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>K213E</sup></td>
<td valign="top" align="center">271.9 &#x00B1; 104.2<xref ref-type="table-fn" rid="t3fns1">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">2.97 &#x00B1; 0.18<xref ref-type="table-fn" rid="t3fns1">&#x002A;</xref></td>
<td valign="top" align="center">240.4 &#x00B1; 55.4<xref ref-type="table-fn" rid="t3fns1">&#x002A;</xref></td>
<td valign="top" align="center">23</td>
</tr>
<tr>
<td valign="top" align="left">GlyR &#x03B1;2<sup>T269M</sup></td>
<td valign="top" align="center">23.2 &#x00B1; 5.8</td>
<td valign="top" align="center">N.D.</td>
<td valign="top" align="center">N.D.</td>
<td valign="top" align="center">9</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t3fns1"><p><italic>The averaged IPSC peak amplitudes, rise times and decay time constants are shown. p-values were calculated relative to wild-type GlyR &#x03B1;2 homomers using one-way ANOVA followed by Tukey&#x2019;s post hoc test: &#x002A;p &#x003C; 0.05, &#x002A;&#x002A;&#x002A;p &#x003C; 0.001. N.D., not determined.</italic></p></fn>
</table-wrap-foot>
</table-wrap>
<fig id="F7" position="float">
<label>FIGURE 7</label>
<caption><p>Properties of spontaneous inhibitory postsynaptic currents (IPSCs) recorded from artificial synapses incorporating human GlyR &#x03B1;2 ASD variants. <bold>(A)</bold> Representative recordings of IPSCs from HEK293 cells expressing wild-type GlyR &#x03B1;2 and &#x03B1;2<sup>N38K</sup>, &#x03B1;2<sup>K213E</sup>, and &#x03B1;2<sup>T269M</sup> variants at two temporal scales. <bold>(B&#x2013;D)</bold> Mean 10&#x2013;90% rise times, IPSC decay time constants and amplitudes. Each data point represents the global average of all well-isolated events recorded from a single cell. Means were tested for significance relative to WT using one-way ANOVA followed by Tukey&#x2019;s <italic>post hoc</italic> test: &#x002A;<italic>p</italic> &#x003C; 0.05, &#x002A;&#x002A;&#x002A;<italic>p</italic> &#x003C; 0.001. All results are tabulated in <xref ref-type="table" rid="T3">Table 3</xref>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fnmol-15-886729-g007.tif"/>
</fig>
</sec>
</sec>
<sec id="S4" sec-type="discussion">
<title>Discussion</title>
<p>In this article, we identified functional alterations for four missense variants in <italic>GLRA2</italic>, encoding the GlyR &#x03B1;2 subunit that had previously been associated with human ASD and developmental disorders, using a combination of bioinformatics, molecular dynamics simulations, cellular models of GlyR trafficking and electrophysiology using artificial synapses. The GlyR &#x03B1;2<sup>V&#x2013;22L</sup> variant resulted in altered predicted signal peptide cleavage and a reduction in cell-surface expression, suggestive of a partial loss-of-function. GlyR &#x03B1;2<sup>V&#x2013;22L</sup> was reported in a female proband with ASD and a verbal IQ of 63 (<xref ref-type="bibr" rid="B24">Iossifov et al., 2014</xref>; <xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>). Given the alteration in predicted signal cleavage, coupled with a significant reduction in cell-surface expression (52 &#x00B1; 12% of control values, <xref ref-type="fig" rid="F5">Figure 5</xref> and <xref ref-type="table" rid="T1">Table 1</xref>) we suggest that this variant should be classified as <italic>potentially pathogenic</italic>. By contrast, molecular modeling of the GlyR &#x03B1;2<sup>N38K</sup> variant (<xref ref-type="fig" rid="F2">Figures 2A,B</xref>) revealed that the GlyR &#x03B1;2<sup>N38K</sup> variant introduces a larger, charged side-chain that is predicted to form contacts with GlyR &#x03B1;2<sup>N45</sup>, which is predicted to be glycosylated <italic>in vivo</italic>. Glycosylation has long been known to be an essential determinant of GlyR maturation and homo-oligomerization (<xref ref-type="bibr" rid="B19">Griffon et al., 1999</xref>) and hence GlyR &#x03B1;2<sup>N38K</sup> is predicted to interfere with N-linked glycosylation, GlyR homo-oligomerization and/or cell-surface trafficking. The latter was demonstrated biochemically by measuring whole-cell and cell-surface expression of GlyR &#x03B1;2<sup>N38K</sup>, revealing a dramatic reduction in both parameters (<xref ref-type="fig" rid="F5">Figure 5</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). GlyR &#x03B1;2<sup>N38K</sup> also showed a reduced mean I<sub>max</sub> value (&#x03B1;2<sup>N38K</sup> 3.3 &#x00B1; 0.7 nA vs. wild-type 8.9 &#x00B1; 1.6 nA) and a significantly increased glycine EC<sub>50</sub> value (&#x03B1;2<sup>N38K</sup> 243 &#x00B1; 12 &#x03BC;M vs. wild-type 141 &#x00B1; 14 &#x03BC;M) versus wild-type GlyR &#x03B1;2, again consistent with a <italic>loss-of-function</italic> (<xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>). In artificial synapses, this was reflected in significantly reduced amplitudes of IPSCs mediated by GlyR &#x03B1;2<sup>N38K</sup> (23.4 &#x00B1; 3.0 pA vs. 60.6 &#x00B1; 9.7 pA for wild-type GlyR &#x03B1;2, <xref ref-type="fig" rid="F7">Figure 7</xref> and <xref ref-type="table" rid="T3">Table 3</xref>). Curiously, GlyR &#x03B1;2<sup>N38K</sup> was reported as a <italic>de novo</italic> variant in a male and assigned as a &#x201C;designated unaffected sibling&#x201D; to an affected case (<xref ref-type="bibr" rid="B31">Krumm et al., 2015</xref>; <xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>). However, given our bioinformatic and functional findings, suggesting that this variant is highly deleterious to GlyR &#x03B1;2 function, we would definitely classify the GlyR &#x03B1;2<sup>N38K</sup> variant as <italic>pathogenic</italic> and would advise the referring clinicians to revisit this case/family.</p>
<p>GlyR &#x03B1;2<sup>K213E</sup> was reported in a male individual with a refractory epilepsy, microcephaly, and severe developmental delay (<xref ref-type="supplementary-material" rid="TS1">Supplementary Table 1</xref>). GlyR &#x03B1;2<sup>K213E</sup> homomers showed a reduction in cell-surface expression (&#x03B1;2<sup>K213E</sup>: 42 &#x00B1; 8% of wild-type values, <xref ref-type="fig" rid="F5">Figure 5</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). However, in whole-cell patch clamp electrophysiology GlyR &#x03B1;2<sup>K213E</sup> subunit homomers exhibited no significant change in either I<sub>max</sub> or EC<sub>50</sub> relative to the wild-type GlyR &#x03B1;2 subunit homomers (<xref ref-type="fig" rid="F6">Figures 6A,B</xref> and <xref ref-type="table" rid="T2">Table 2</xref>). While this evidence would normally result in this variant being classified as non-pathogenic, high CADD scores, plus molecular modeling findings caused us to reconsider. In particular, GlyR &#x03B1;2<sup>K213E</sup> introduces change from a positive to a negatively charged side chain in the second dicysteine loop, which contains several ligand-binding residues (GlyR &#x03B1;2 Y209, T211, and F214, <xref ref-type="fig" rid="F1">Figure 1</xref>). In the closed state, we found an obvious clash with H208, but in the open state, we found that the &#x03B1;2<sup>K213E</sup> side chain was free of clashes and made additional contacts with Y209. These changes suggested that the open state may be favored for this mutant, resulting in prolonged channel opening. This theory was borne out in artificial synapse experiments, where we observed that IPSCs mediated by &#x03B1;2<sup>K213E</sup> had significantly larger amplitudes, faster rise times and significantly slower decay times than wild-type GlyR &#x03B1;2 (<xref ref-type="fig" rid="F7">Figure 7</xref> and <xref ref-type="table" rid="T3">Table 3</xref>). We therefore classify &#x03B1;2<sup>K213E</sup> as a <italic>pathogenic gain-of-function</italic> variant that is likely to enhance glycinergic signaling in the developing brain.</p>
<p>Lastly, GlyR &#x03B1;2<sup>T269M</sup> was reported in a female proband in the <xref ref-type="bibr" rid="B13">Deciphering Developmental Disorders Study (2017)</xref>. It has previously been suggested that GlyR &#x03B1;2 missense mutations in females cannot be associated with ASD since: (i) an intact copy of <italic>GLRA2</italic> is found on the other X chromosome and (ii) because <italic>GLRA2</italic> escapes X-inactivation in the vast majority of tissues including the brain (<xref ref-type="bibr" rid="B12">Cotton et al., 2015</xref>). However, this assumption is clearly incorrect as exemplified by our previous study of the GlyR &#x03B1;2<sup>R323L</sup> mutation found in a female proband (<xref ref-type="bibr" rid="B74">Zhang et al., 2017</xref>). GlyRs form either homomeric (5&#x03B1;) or heteromeric complexes (4&#x03B1;:1&#x03B2;) <italic>in vivo</italic>, so mutant GlyRs subunits can incorporate into GlyRs alongside wild-type subunits. GlyR &#x03B1;2<sup>T269M</sup> homomers showed diminished cell-surface expression (<xref ref-type="fig" rid="F5">Figure 5</xref> and <xref ref-type="table" rid="T1">Table 1</xref>). Consistent with this finding, in whole-cell recordings where glycine was applied under steady-state conditions, GlyRs containing the &#x03B1;2<sup>T269M</sup> subunit had a significantly decreased mean glycine-activated I<sub>max</sub> current (&#x03B1;2<sup>T269M</sup> 2.1 &#x00B1; 0.4 vs. wild-type 8.9 &#x00B1; 1.6 nA). However, this was counterbalanced by a significantly increased sensitivity to glycine (EC<sub>50</sub> values &#x03B1;2<sup>T269M</sup> 4.5 &#x00B1; 1.7 vs. wild-type 141 &#x00B1; 14 &#x03BC;M; <italic>n</italic> = 7 cells; <italic>p</italic> &#x003C; 0.001). As predicted from our molecular dynamics simulations (<xref ref-type="fig" rid="F3">Figures 3</xref>, <xref ref-type="fig" rid="F4">4</xref>), GlyR &#x03B1;2<sup>T269M</sup> homomers also exhibited a significant leakage current that could be revealed by blockade with 100 &#x03BC;M picrotoxin (<xref ref-type="fig" rid="F6">Figure 6A</xref>). Averaged from five cells, the mean magnitude of the picrotoxin-blocked current was 240 &#x00B1; 35 pA. This mutant was particularly difficult to study in artificial synapses, as HEK293 cells expressing GlyR &#x03B1;2<sup>T269M</sup> were unhealthy when maintained in co-culture. Despite this, an estimate of mean IPSC amplitude (23.2 &#x00B1; 5.8 pA) was obtained. It is also noteworthy that spontaneous IPSC decay rates were dramatically prolonged (<xref ref-type="fig" rid="F7">Figure 7</xref>) as previously observed with other GlyR mutants that reduce the glycine EC<sub>50</sub> (<xref ref-type="bibr" rid="B15">Dixon et al., 2015</xref>; <xref ref-type="bibr" rid="B73">Zhang et al., 2016</xref>). Based on these results, we classify &#x03B1;2<sup>T269M</sup> as a <italic>pathogenic alteration-of-function</italic> variant (given the reduced glycine EC<sub>50</sub> plus leak current) that is predicted to enhance glycinergic signaling in the developing brain. It is also noteworthy that the GlyR &#x03B1;2<sup>T269M</sup> mutation has recently been reported as a <italic>de novo</italic> mutation in six additional female subjects (<xref ref-type="bibr" rid="B39">Marcogliese et al., 2022</xref>), making it the first recurrent <italic>GLRA2</italic> pathogenic mutation. Using a novel <italic>Drosophila</italic>-based functional system for ASD mutations, <xref ref-type="bibr" rid="B39">Marcogliese et al. (2022)</xref> also classified GlyR &#x03B1;2<sup>T269M</sup> as a <italic>gain-of-function</italic> allele based on experiments overexpressing human GlyR &#x03B1;2<sup>T269M</sup> in pre-synaptic photoreceptors and postsynaptic neurons, reporting a significant increase in amplitudes of &#x201C;OFF&#x201D; transients for the GlyR &#x03B1;2<sup>T269M</sup> transgenic line. This artificial system has severe limitations for the study of GlyR &#x03B1;2 subunit mutants, since glycinergic neurons in <italic>Drosophila</italic> seem to be limited to small ventral lateral neurons (sLNvs) involved in circadian behavior (<xref ref-type="bibr" rid="B18">Frenkel et al., 2017</xref>). It is therefore unclear how glycine would be released onto exogenous GlyRs expressed in photoreceptors. However, our study has revealed a convincing explanation for the increase in &#x201C;OFF&#x201D; transient amplitudes observed by <xref ref-type="bibr" rid="B39">Marcogliese et al. (2022)</xref>. GlyR &#x03B1;2<sup>T269M</sup> forms spontaneously opening channels that do not require activation by endogenous glycine.</p>
<p>In summary, our study has revealed that GlyR &#x03B1;2 subunit mutations are a complex mix, or loss, gain and alteration of function, associated with a range of clinical phenotypes. For this reason, we predict that many more <italic>GLRA2</italic> mutations remain to be discovered in a spectrum of neurological disorders encompassing ASD, DD, epilepsy and neuronal migration disorders and that detailed functional characterization will be required to distinguish different mutational pathomechanisms. The comprehensive functional characterization of the GlyR &#x03B1;2<sup>K213E</sup> and &#x03B1;2<sup>R323L</sup> variants has also provided a solid basis for the production of knock-in mice that have GlyR &#x03B1;2 <italic>gain-of-function</italic> mutations to examine the effects of enhanced GlyR &#x03B1;2 function on cortical progenitor homeostasis, interneuron migration and other biological roles of this important GlyR subtype.</p>
</sec>
<sec id="S5" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="TS1">Supplementary Material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="S6">
<title>Ethics Statement</title>
<p>Ethical review/approval was not required for this study of de-identified genetic variants in accordance with local legislation and institutional requirements. Written informed consent to participate in the study was provided by the legal guardians for the individual with the GlyR a2p.E213K variant.</p>
</sec>
<sec id="S7">
<title>Author Contributions</title>
<p>RH conceived the study. ES, GR, and KS identified the p.K213E mutation in diagnostic exome sequencing. RH, MW, and LD performed the bioinformatic analysis, molecular modeling, and generated GlyR &#x03B1;2 subunit expression constructs and mutants. XC and JL conducted artificial synapse experiments and electrophysiology. NS and CV conducted cell-surface trafficking experiments. KW and MO&#x2019;M conducted molecular dynamics simulations. RH, CV, JL, and MO&#x2019;M drafted the manuscript. All authors were involved in revising the manuscript for important intellectual content and gave approval for the final version to be published.</p>
</sec>
<sec id="conf1" sec-type="COI-statement">
<title>Conflict of Interest</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>
<sec id="pudiscl1" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<sec id="S8" sec-type="funding-information">
<title>Funding</title>
<p>This work was supported by the National Health and Medical Research Council of Australia (APP1156673 to RH and APP1058542 to JL). CV was supported by the Deutsche Forschungsgemeinschaft (VI586). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</p>
</sec>
<ack><p>We thank DNA Sequencing and Services (MRC PPU, School of Life Sciences, University of Dundee, United Kingdom, <ext-link ext-link-type="uri" xlink:href="http://www.dnaseq.co.uk">www.dnaseq.co.uk</ext-link>) for DNA sequencing. Molecular graphics and analyses were performed with UCSF ChimeraX, developed by the Resource for Biocomputing, Visualization, and Informatics at the University of California, San Francisco, with support from National Institutes of Health R01-GM129325 and the Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases. The molecular dynamic simulations were performed with the assistance of resources and services from the National Computational Infrastructure (NCI), which is supported by the Australian Government.</p>
</ack>
<sec id="S10" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fnmol.2022.886729/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fnmol.2022.886729/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Table_1.XLSX" id="TS1" mimetype="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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