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ATP6AP2 variant impairs CNS development and neuronal survival to cause fulminant neurodegeneration
Takuo Hirose, Alfredo Cabrera-Socorro, David Chitayat, Thomas Lemonnier, Olivier Féraud, Carmen Cifuentes-Diaz, Nicolas Gervasi, Cedric Mombereau, Tanay Ghosh, Loredana Stoica, Jeanne d’Arc Al Bacha, Hiroshi Yamada, Marcel A. Lauterbach, Marc Guillon, Kiriko Kaneko, Joy W. Norris, Komudi Siriwardena, Susan Blasér, Jérémie Teillon, Roberto Mendoza-Londono, Marion Russeau, Julien Hadoux, Sadayoshi Ito, Pierre Corvol, Maria G. Matheus, Kenton R. Holden, Kohji Takei, Valentina Emiliani, Annelise Bennaceur-Griscelli, Charles E. Schwartz, Genevieve Nguyen, Matthias Groszer
Takuo Hirose, Alfredo Cabrera-Socorro, David Chitayat, Thomas Lemonnier, Olivier Féraud, Carmen Cifuentes-Diaz, Nicolas Gervasi, Cedric Mombereau, Tanay Ghosh, Loredana Stoica, Jeanne d’Arc Al Bacha, Hiroshi Yamada, Marcel A. Lauterbach, Marc Guillon, Kiriko Kaneko, Joy W. Norris, Komudi Siriwardena, Susan Blasér, Jérémie Teillon, Roberto Mendoza-Londono, Marion Russeau, Julien Hadoux, Sadayoshi Ito, Pierre Corvol, Maria G. Matheus, Kenton R. Holden, Kohji Takei, Valentina Emiliani, Annelise Bennaceur-Griscelli, Charles E. Schwartz, Genevieve Nguyen, Matthias Groszer
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Research Article Genetics Neuroscience

ATP6AP2 variant impairs CNS development and neuronal survival to cause fulminant neurodegeneration

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Abstract

Vacuolar H+-ATPase–dependent (V-ATPase–dependent) functions are critical for neural proteostasis and are involved in neurodegeneration and brain tumorigenesis. We identified a patient with fulminant neurodegeneration of the developing brain carrying a de novo splice site variant in ATP6AP2 encoding an accessory protein of the V-ATPase. Functional studies of induced pluripotent stem cell–derived (iPSC-derived) neurons from this patient revealed reduced spontaneous activity and severe deficiency in lysosomal acidification and protein degradation leading to neuronal cell death. These deficiencies could be rescued by expression of full-length ATP6AP2. Conditional deletion of Atp6ap2 in developing mouse brain impaired V-ATPase–dependent functions, causing impaired neural stem cell self-renewal, premature neuronal differentiation, and apoptosis resulting in degeneration of nearly the entire cortex. In vitro studies revealed that ATP6AP2 deficiency decreases V-ATPase membrane assembly and increases endosomal-lysosomal fusion. We conclude that ATP6AP2 is a key mediator of V-ATPase–dependent signaling and protein degradation in the developing human central nervous system.

Authors

Takuo Hirose, Alfredo Cabrera-Socorro, David Chitayat, Thomas Lemonnier, Olivier Féraud, Carmen Cifuentes-Diaz, Nicolas Gervasi, Cedric Mombereau, Tanay Ghosh, Loredana Stoica, Jeanne d’Arc Al Bacha, Hiroshi Yamada, Marcel A. Lauterbach, Marc Guillon, Kiriko Kaneko, Joy W. Norris, Komudi Siriwardena, Susan Blasér, Jérémie Teillon, Roberto Mendoza-Londono, Marion Russeau, Julien Hadoux, Sadayoshi Ito, Pierre Corvol, Maria G. Matheus, Kenton R. Holden, Kohji Takei, Valentina Emiliani, Annelise Bennaceur-Griscelli, Charles E. Schwartz, Genevieve Nguyen, Matthias Groszer

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Figure 2

Cerebral atrophy in a patient carrying the ATP6AP2 c.321C>T (p.D107D) variant.

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Cerebral atrophy in a patient carrying the ATP6AP2 c.321C>T (p.D107D)...
(A–H) Brain MRI of the 15-year-old male patient carrying the c.321C>T variant in exon 4 (OMIM 300423) and of an age-matched normal subject. Patient axial T2-weighted MR brain images (A and B) and normal subject brain images (E and F) for comparison. Patient coronal T2-weighted MR image (C) and normal subject (G). Patient MR images (A–C) exhibit diffuse parenchymal volume loss of gray and white matter. This is observed in the white matter tracts that travel adjacent to the prominently enlarged lateral ventricles (white arrows), as well as the prominent sulci (white arrowheads) in the cerebral hemispheres and cerebellum. Supratentorial and infratentorial parenchymal volume loss involves the cerebral hemispheres and cerebellum symmetrically. Sagittal T1-weighted MR brain image (D) compared with normal subject (H) demonstrates significantly reduced white matter volume of the corpus callosum (curved white arrows). There is also significant white matter volume loss in the patient cerebellum (D) with increased cerebrospinal fluid (asterisk) in the prominent posterior fossa mega cisterna magna. (I) ATP6AP2 genomic locus and positions of variant c.321C>T (p.D107D). (J and K) Schematics of ATP6AP2 and ATP6AP2Δe4.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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