Genetic variants disrupting activity-dependent CELF2 shuttling cause neuronal hyperexcitability, learning deficits, and seizures

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Abstract De novo heterozygous variants in the CELF2 gene have recently been associated with a rare neurodevelopmental disorder. However, the mechanisms linking specific variants to distinct clinical phenotypes remain poorly understood. Here, we report a new cohort of 14 individuals with de novo CELF2 variants, providing evidence that variants causing CELF2 cytoplasmic mislocalization, but not its loss-of-function, are associated with seizures. Using proband induced pluripotent stem cell-derived neurons and transgenic mouse models, we show that CELF2 undergoes activity-dependent nucleocytoplasmic shuttling in excitatory neurons, and its cytoplasmic retention causes neuronal hyperexcitability, leading to learning and memory deficits. In the cytoplasm, CELF2 regulates mRNAs critical for synaptic functions and neuronal excitability implicated in epileptic seizures and intellectual disability. Through drug screening, we identify AKT signaling as a key regulator of CELF2 shuttling and a target for treating CELF2-associated hyperexcitability. Our findings expand the clinical and genetic spectrum of CELF2-related neurodevelopmental disorders and reveal variant-specific mechanisms that link CELF2 mislocalization to neuronal hyperexcitability, learning deficits, and epileptic seizures. One Sentence Summary CELF2 variants link protein mislocalization to neuronal hyperexcitability, learning deficits, and epileptic seizures.

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