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The novel sodium channel modulator GS ‐458967 ( GS 967) is an effective treatment in a mouse model of SCN 8A encephalopathy

2018; Wiley; Volume: 59; Issue: 6 Linguagem: Inglês

10.1111/epi.14196

1528-1167

Erin M. Baker, Christopher H. Thompson, Nicole A. Hawkins, Jacy L. Wagnon, Eric R. Wengert, Manoj K. Patel, Alfred L. George, Miriam H. Meisler, Jennifer A. Kearney,

Ion channel regulation and function

Summary Objective De novo mutations of SCN 8A , encoding the voltage‐gated sodium channel Na V 1.6, have been associated with a severe infant onset epileptic encephalopathy. Individuals with SCN 8A encephalopathy have a mean age of seizure onset of 4‐5 months, with multiple seizure types that are often refractory to treatment with available drugs. Anecdotal reports suggest that high‐dose phenytoin is effective for some patients, but there are associated adverse effects and potential for toxicity. Functional characterization of several SCN 8A encephalopathy variants has shown that elevated persistent sodium current is one of several common biophysical defects. Therefore, specifically targeting elevated persistent current may be a useful therapeutic strategy in some cases. Methods The novel sodium channel modulator GS 967 has greater preference for persistent as opposed to peak current and nearly 10‐fold greater potency than phenytoin. We evaluated the therapeutic effect of GS 967 in the Scn8a N1768D/+ mouse model carrying an SCN 8A patient mutation that results in elevated persistent sodium current. We also performed patch clamp recordings to assess the effect of GS 967 on peak and persistent sodium current and excitability in hippocampal neurons from Scn8a N1768D/+ mice. Results GS 967 potently blocked persistent sodium current without affecting peak current, normalized action potential morphology, and attenuated excitability in neurons from heterozygous Scn8a N1768D/+ mice. Acute treatment with GS 967 provided dose‐dependent protection against maximal electroshock–induced seizures in Scn8a N1768D/+ and wild‐type mice. Chronic treatment of Scn8a N1768D/+ mice with GS 967 resulted in lower seizure burden and complete protection from seizure‐associated lethality observed in untreated Scn8a N1768D/+ mice. Protection was achieved at a chronic dose that did not cause overt behavioral toxicity or sedation. Significance Persistent sodium current modulators like GS 967 may be an effective precision targeting strategy for SCN 8A encephalopathy and other functionally similar channelopathies when elevated persistent sodium current is the primary dysfunction.