Rescue of behavioral and electrophysiological phenotypes in a Pitt-Hopkins syndrome mouse model by genetic restoration of <i>Tcf4</i> expression.

Abstract

Pitt-Hopkins syndrome (PTHS) is a neurodevelopmental disorder caused by monoallelic mutation or deletion in the <i>transcription factor 4</i> (<i>TCF4</i>) gene. Individuals with PTHS typically present in the first year of life with developmental delay and exhibit intellectual disability, lack of speech, and motor incoordination. There are no effective treatments available for PTHS, but the root cause of the disorder, <i>TCF4</i> haploinsufficiency, suggests that it could be treated by normalizing <i>TCF4</i> gene expression. Here, we performed proof-of-concept viral gene therapy experiments using a conditional <i>Tcf4</i> mouse model of PTHS and found that postnatally reinstating <i>Tcf4</i> expression in neurons improved anxiety-like behavior, activity levels, innate behaviors, and memory. Postnatal reinstatement also partially corrected EEG abnormalities, which we characterized here for the first time, and the expression of key TCF4-regulated genes. Our results support a genetic normalization approach as a treatment strategy for PTHS, and possibly other TCF4-linked disorders.