SynTEF1 restores the functional disease phenotype of SCA27B in an hiPSC-derived neuronal model

Spinocerebellar Ataxia 27B (SCA27B), caused by a deep-intronic GAA repeat expansion in the first intron of the FGF14 gene, is one of the most frequent genetic ataxias. Its underlying disease mechanisms remain largely unknown, and disease-modifying therapies targeting upstream processes are lacking. Here we hypothesized that (i) SCA27B is driven by transcriptional repression of FGF14, which encodes a protein regulating ion channels at the axon initial segment (AIS), resulting in reduced Na+ channel availability and neuronal excitability, and that (ii) these defects can be restored by a synthetic elongation transcription factor (Syn-TEF1). We assessed FGF14 mRNA levels by qPCR and neuronal function by whole-cell patch-clamp recordings in iPSC-derived neurons from two SCA27B patients and two healthy controls. Patients carried GAA repeat expansions that were either monoallelic (391/16 repeats) or biallelic (315/290 repeats), exceeding the common pathogenicity threshold of >250 repeats. FGF14 mRNA levels were reduced approximately to 60% and 70% of control levels in monoallelic and biallelic SCA27B neurons, respectively. This was accompanied by impaired excitability, with cumulative action potential (AP) firing reduced to 38% and 45% of control levels in monoallelic and biallelic lines, respectively, and peak Na current density reduced to 46% and 41%, while voltage-dependent gating of Na channels remained unchanged. Treatment with Syn-TEF1 significantly increased FGF14 mRNA expression and restored cumulative AP firing to 83% and 135% of control levels in monoallelic and biallelic neurons, respectively, and Na peak current density to 95% and 138%. These findings strongly suggest that the pathophysiological cascade in SCA27B - from FGF14 repression to impaired Na+ currents and decreased neuronal excitability - can be reversed by an elongation transcription factor. Our results thus provide a rationale for further exploring Syn-TEF1 as a first gene-targeted, disease-modifying therapeutic approach for SCA27B.