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      FGF14‐related episodic ataxia: delineating the phenotype of Episodic Ataxia type 9

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          Abstract

          We report four patients from two families who presented attacks of childhood‐onset episodic ataxia associated with pathogenic mutations in the FGF14 gene. Attacks were triggered by fever, lasted several days, and had variable frequencies. Nystagmus and/or postural tremor and/or learning disabilities were noticed in individuals harboring FGF14 mutation with or without episodic ataxia. These cases and literature data delineate the FGF14‐mutation‐related episodic ataxia phenotype: wide range of age at onset (from childhood to adulthood), variable durations and frequencies, triggering factors including fever, and association to chronic symptoms. We propose to add FGF14‐related episodic ataxia to the list of primary episodic ataxia as Episodic Ataxia type 9.

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          Genetic Variants Associated with Episodic Ataxia in Korea

          Episodic ataxia (EA) is a rare neurological condition characterized by recurrent spells of truncal ataxia and incoordination. Five genes (KCNA1, CACNA1A, CACNB4, SLC1A3, and UBR4) have been linked to EA. Despite extensive efforts to genetically diagnose EA, many patients remain still undiagnosed. Whole-exome sequencing was carried out in 39 Korean patients with EA to identify pathogenic mutations of the five known EA genes. We also evaluated 40 candidate genes that cause EA as a secondary phenotype or cerebellar ataxia. Eighteen patients (46%) revealed genetic information useful for establishing a molecular diagnosis of EA. In 11 patients, 16 pathogenic mutations were detected in three EA genes. These included nine mutations in CACNA1A, three in SLC1A3, and four in UBR4. Three patients had mutations in two genes, either CACNA1A and SLC1A3 or CACNA1A and UBR4, suggesting that SLC1A3 and UBR4 may act as genetic modifiers with synergic effects on the abnormal presynaptic activity caused by CACNA1A mutations. In seven patients with negative results for screening of EA genes, potential pathogenic mutations were identified in the candidate genes ATP1A2, SCN1A, TTBK2, TGM6, FGF14, and KCND3. This study demonstrates the genetic heterogeneity of Korean EA, and indicates that whole-exome sequencing may be useful for molecular genetic diagnosis of EA.
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            Intracellular Fibroblast Growth Factor 14: Emerging Risk Factor for Brain Disorders

            The finely tuned regulation of neuronal firing relies on the integrity of ion channel macromolecular complexes. Minimal disturbances of these tightly regulated networks can lead to persistent maladaptive plasticity of brain circuitry. The intracellular fibroblast growth factor 14 (FGF14) belongs to the nexus of proteins interacting with voltage-gated Na+ (Nav) channels at the axonal initial segment. Through isoform-specific interactions with the intracellular C-terminal tail of neuronal Nav channels (Nav1.1, Nav1.2, Nav1.6), FGF14 controls channel gating, axonal targeting and phosphorylation in neurons effecting excitability. FGF14 has been also involved in synaptic transmission, plasticity and neurogenesis in the cortico-mesolimbic circuit with cognitive and affective behavioral outcomes. In translational studies, interest in FGF14 continues to rise with a growing list of associative links to diseases of the cognitive and affective domains such as neurodegeneration, depression, anxiety, addictive behaviors and recently schizophrenia, suggesting its role as a converging node in the etiology of complex brain disorders. Yet, a full understanding of FGF14 function in neurons is far from being complete and likely to involve other functions unrelated to the direct regulation of Nav channels. The goal of this Mini Review article is to provide a summary of studies on the emerging role of FGF14 in complex brain disorders.
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              FGF14 regulates presynaptic Ca2+ channels and synaptic transmission.

              Fibroblast growth factor homologous factors (FHFs) are not growth factors, but instead bind to voltage-gated Na+ channels (NaV) and regulate their function. Mutations in FGF14, an FHF that is the locus for spinocerebellar ataxia 27 (SCA27), are believed to be pathogenic because of a dominant-negative reduction of NaV currents in cerebellar granule cells. Here, we demonstrate that FGF14 also regulates members of the presynaptic CaV2 Ca2+ channel family. Knockdown of FGF14 in granule cells reduced Ca2+ currents and diminished vesicular recycling, a marker for presynaptic Ca2+ influx. As a consequence, excitatory postsynaptic currents (EPSCs) at the granule cell to Purkinje cell synapse were markedly diminished. Expression of the SCA27-causing FGF14 mutant in granule cells exerted a dominant-negative reduction in Ca2+ currents, vesicular recycling, and the resultant EPSCs in Purkinje cells. Thus, FHFs are multimodal, regulating several discrete neuronal signaling events. SCA27 most likely results at least in part from dysregulation of Ca2+ channel function. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                a-roubertie@chu-montpellier.fr
                Journal
                Ann Clin Transl Neurol
                Ann Clin Transl Neurol
                10.1002/(ISSN)2328-9503
                ACN3
                Annals of Clinical and Translational Neurology
                John Wiley and Sons Inc. (Hoboken )
                2328-9503
                12 March 2020
                April 2020
                : 7
                : 4 ( doiID: 10.1002/acn3.v7.4 )
                : 565-572
                Affiliations
                [ 1 ] Département de Neuropédiatrie CHU Gui de Chauliac Montpellier France
                [ 2 ] Service de Génétique Moléculaire Neurovasculaire Groupe hospitalier Saint‐Louis ‐ Lariboisière ‐ Fernand Widal AP‐HP Paris France
                [ 3 ] Service de Médecine Psychologique Enfants et Adolescents CHU Saint Eloi Montpellier France
                [ 4 ] Service de néonatologie CHU Estaing Clermont‐Ferrand France
                [ 5 ] Service de Génétique Clinique Département de Génétique Médicale Maladies Rares et Médecine Personnalisée Hôpital Arnaud de Villeneuve CHU de Montpellier Montpellier France
                [ 6 ] PhyMedExp U1046 INSERM UMR9214 CNRS Montpellier France
                [ 7 ] INSERM U 1051 Institut des Neurosciences de Montpellier Montpellier France
                Author notes
                [*] [* ] Correspondence

                Agathe Roubertie, Département de Neuropédiatrie, CHU Gui de Chauliac, 80 Avenue Fliche, 34295 Montpellier, France. Tel: 33 4 67 33 01 82; Fax: 33 4 67 33 01 83; E‐mail: a-roubertie@ 123456chu-montpellier.fr

                [†]

                These authors contributed equally to the manuscript.

                Author information
                https://orcid.org/0000-0002-8180-4857
                Article
                ACN351005
                10.1002/acn3.51005
                7187715
                32162847
                ce4733cc-daa8-4df7-9118-e093187b897e
                © 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 December 2019
                : 12 February 2020
                : 14 February 2020
                Page count
                Figures: 1, Tables: 3, Pages: 8, Words: 3993
                Funding
                Funded by: Clinical Research Hospital Program from the French Ministry of Health
                Award ID: 14‐12
                This work was funded by Clinical Research Hospital Program from the French Ministry of Health grant 14‐12.
                Categories
                Brief Communication
                Brief Communications
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:28.04.2020

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