PRRT2 as an auxiliary regulator of Nav channel slow inactivation

Reviewer #1 (Public review):

Summary:

The manuscript by Lu and colleagues demonstrates convincingly that PRRT2 interacts with brain voltage-gated sodium channels to enhance slow inactivation in vitro and in vivo. The work is interesting and rigorously conducted. The relevance to normal physiology and disease pathophysiology (e.g., PRRT2-related genetic neurodevelopmental disorders) seems high. Some simple additional experiments could elevate the impact and make the study more complete.

Strengths:

Experiments are conducted rigorously, including experimenter blinding and appropriate controls. Data presentation is excellent and logical. The paper is well written for a general scientific audience.

Weaknesses:

There are a few missing experiments and one place where data are over-interpreted.

(1) An in vitro study of Nav1.6 is conspicuously absent. In addition to being a major brain Na channel, Nav1.6 is predominant in cerebellar Purkinje neurons, which the authors note lack PRRT2 expression. They speculate that the absence of PRRT2 in these neurons facilitates the high firing rate. This hypothesis would be strengthened if PRRT2 also enhanced slow inactivation of Nav1.6. If a stable Nav1.6 cell were not available, then simple transient co-transfection experiments would suffice.

(2) To further demonstrate the physiological impact of enhanced slow inactivation, the authors should consider a simple experiment in the stable cell line experiments (Figure 1) to test pulse frequency dependence of peak Na current. One would predict that PRRT2 expression will potentiate 'run down' of the channels, and this finding would be complementary to the biophysical data.

(3) The study of one K channel is limited, and the conclusion from these experiments represents an over-interpretation. I suggest removing these data unless many more K channels (ideally with measurable proxies for slow inactivation) were tested. These data do not contribute much to the story.

(4) In Figure 2, the authors should confirm that protein is indeed expressed in cells expressing each truncated PRRT2 construct. Absent expression should be ruled out as an explanation for absent enhancement of slow inactivation.

Reviewer #2 (Public review):

Summary:

As a member of DspB subfamily, PRRT2 is primarily expressed in the nervous system and has been associated with various paroxysmal neurological disorders. Previous studies have shown that PRRT2 directly interacts with Nav1.2 and Nav1.6, modulating channel properties and neuronal excitability.

In this study, Lu et al. reported that PRRT2 is a physiological regulator of Nav channel slow inactivation, promoting the development of Nav slow inactivation and impeding the recovery from slow inactivation. This effect can be replicated by the C-terminal region (256-346) of PRRT2, and is highly conserved across species from zebrafish, mouse, to human PRRT2. TRARG1 and TMEM233, the other two DspB family members, showed similar effects on Nav1.2 slow inactivation. Co-IP data confirms the interaction between Nav channels and PRRT2. Prrt2-mutant mice, which lack PRRT2 expression, require lower stimulation thresholds for evoking after-discharges when compared to WT mice.

Strengths:

(1) This study is well designed, and data support the conclusion that PRRT2 is a potent regulator of slow inactivation of Nav channels.

(2) This study reveals similar effects on Nav1.2 slow inactivation by PRRT2, TMEM233, and TRARG1, indicating a common regulation of Nav channels by DspB family members (Supplemental Figure 2). A recent study has shown that TMEM233 is essential for ExTxA (a plant toxin)-mediated inhibition on fast inactivation of Nav channels; and PRRT2 and TRARG1 could replicate this effect (Jami S, et al. Nat Commun 2023). It is possible that all three DspB members regulate Nav channel properties through the same mechanism, and exploring molecules that target PRRT2/TRARG1/TMEM233 might be a novel strategy for developing new treatments of DspB-related neurological diseases.

Weaknesses:

(1) Previously, the authors have reported that PRRT2 reduces Nav1.2 current density and alters biophysical properties of both Nav1.2 and Nav1.6 channels, including enhanced steady-state inactivation, slower recovery, and stronger use-dependent inhibition (Lu B, et al. Cell Rep 2021, Fig 3 & S5). All those changes are expected to alter neuronal excitability and should be discussed.

(2) In this study, the fast inactivation kinetics was examined by a single stimulus at 0 mV, which may not be sufficient for the conclusion. Inactivation kinetics at more voltage potentials should be added.

(3) It is a little surprising that there is no difference in Nav1.2 current density in axon-blebs between WT and Prrt2-mutant mice (Figure 7B). PRRT2 significantly shifts steady-state slow inactivation curve to hyperpolarizing direction, at -70 mV, nearly 70% of Nav1.2 channels are inactivated by slow inactivation in cells expressing PRRT2 when compared to less than 10% in cells expressing GFP (Figure supplement 1B); with a holding potential of -70 mV, I would expect that most of Nav channels are inactivated in axon-blebs from WT mice but not in axon-blebs from Prrt2-mutant mice, and therefore sodium current density should be different in Figure 7B, which was not. Any explanation?

(3) Besides Nav channels, PRRT2 has been shown to act on Cav2.1 channels as well as molecules involved in neurotransmitter release, which may also contribute to abnormal neuronal activity in Prrt2-mutant mice. These should be mentioned when discussing PRRT2's role in neuronal resilience.

Reviewer #3 (Public review):

This paper reveals that the neuronal protein PRRT2, previously known for its association with paroxysmal dyskinesia and infantile seizures, modulates the slow inactivation of voltage-gated sodium ion (Nav) channels, a gating process that limits excitability during prolonged activity. Using electrophysiology, molecular biology, and mouse models, the authors show that PRRT2 accelerates entry of Nav channels into the slow-inactivated state and slows their recovery, effectively dampening excessive excitability. The effect seems evolutionarily conserved, requires the C-terminal region of PRRT2, and is recapitulated in cortical neurons, where PRRT2 deficiency leads to hyper-responsiveness and reduced cortical resilience in vivo. These findings extend the functional repertoire of PRRT2, identifying it as a physiological brake on neuronal excitability. The work provides a mechanistic link between PRRT2 mutations and episodic neurological phenotypes.

Comments:

(1) The precise structural interface and the molecular basis of gating modulation remain inferred rather than demonstrated.

(2) The in vivo phenotype reflects a complex circuit outcome and does not isolate slow-inactivation defects per se.

(3) Expression of PRRT2 in muscle or heart is low, so the cross isoform claims are likely of limited physiological significance.

(4) The mechanistic separation between the trafficking of PRRT2 and its gating effects is not clearly resolved.

(5) Additional studies with Nav1.6 should be carried out.

Author response:

Public Reviews:

Reviewer #1 (Public review):

Summary:

The manuscript by Lu and colleagues demonstrates convincingly that PRRT2 interacts with brain voltage-gated sodium channels to enhance slow inactivation in vitro and in vivo. The work is interesting and rigorously conducted. The relevance to normal physiology and disease pathophysiology (e.g., PRRT2-related genetic neurodevelopmental disorders) seems high. Some simple additional experiments could elevate the impact and make the study more complete.

Strengths:

Experiments are conducted rigorously, including experimenter blinding and appropriate controls. Data presentation is excellent and logical. The paper is well written for a general scientific audience.

Weaknesses:

There are a few missing experiments and one place where data are over-interpreted.

(1) An in vitro study of Nav1.6 is conspicuously absent. In addition to being a major brain Na channel, Nav1.6 is predominant in cerebellar Purkinje neurons, which the authors note lack PRRT2 expression. They speculate that the absence of PRRT2 in these neurons facilitates the high firing rate. This hypothesis would be strengthened if PRRT2 also enhanced slow inactivation of Nav1.6. If a stable Nav1.6 cell were not available, then simple transient co-transfection experiments would suffice.

We thank the reviewer for this suggestion. In the revised manuscript, we will examine whether PRRT2 modulates slow inactivation of Nav1.6 channels using heterologous co-expression experiments.

(2) To further demonstrate the physiological impact of enhanced slow inactivation, the authors should consider a simple experiment in the stable cell line experiments (Figure 1) to test pulse frequency dependence of peak Na current. One would predict that PRRT2 expression will potentiate 'run down' of the channels, and this finding would be complementary to the biophysical data.

We agree that examining pulse frequency-dependent changes in peak sodium current would provide a functional readout linking PRRT2-mediated enhancement of slow inactivation to use-dependent channel availability. In the revision, we will include a pulse-train protocol to quantify use-dependent attenuation (“run-down”) of peak sodium current across stimulation trains and will compare this adaptation between control and PRRT2-expressing conditions.

(3) The study of one K channel is limited, and the conclusion from these experiments represents an over-interpretation. I suggest removing these data unless many more K channels (ideally with measurable proxies for slow inactivation) were tested. These data do not contribute much to the story.

We agree with the reviewer’s assessment. To avoid over-interpretation and to maintain focus on PRRT2-dependent regulation of Nav channel slow inactivation, we will remove potassium channel dataset and the associated conclusions from the revised manuscript.

(4) In Figure 2, the authors should confirm that protein is indeed expressed in cells expressing each truncated PRRT2 construct. Absent expression should be ruled out as an explanation for the enhancement of slow inactivation.

We appreciate the reviewer’s concern regarding expression of the truncated PRRT2 constructs in the Nav1.2 stable cell line, particularly PRRT2(1-266), which shows little effect on slow inactivation of Nav1.2 channels. In the revision, we will include expression controls for each truncation construct in the Nav1.2-expressing cells to rule out lack of expression as an explanation for the observed functional differences.

Reviewer #2 (Public review):

Summary:

As a member of DspB subfamily, PRRT2 is primarily expressed in the nervous system and has been associated with various paroxysmal neurological disorders. Previous studies have shown that PRRT2 directly interacts with Nav1.2 and Nav1.6, modulating channel properties and neuronal excitability.

In this study, Lu et al. reported that PRRT2 is a physiological regulator of Nav channel slow inactivation, promoting the development of Nav slow inactivation and impeding the recovery from slow inactivation. This effect can be replicated by the C-terminal region (256-346) of PRRT2, and is highly conserved across species from zebrafish, mouse, to human PRRT2. TRARG1 and TMEM233, the other two DspB family members, showed similar effects on Nav1.2 slow inactivation. Co-IP data confirms the interaction between Nav channels and PRRT2. Prrt2-mutant mice, which lack PRRT2 expression, require lower stimulation thresholds for evoking after-discharges when compared to WT mice.

Strengths:

(1) This study is well designed, and data support the conclusion that PRRT2 is a potent regulator of slow inactivation of Nav channels.

(2) This study reveals similar effects on Nav1.2 slow inactivation by PRRT2, TMEM233, and TRARG1, indicating a common regulation of Nav channels by DspB family members (Supplemental Figure 2). A recent study has shown that TMEM233 is essential for ExTxA (a plant toxin)-mediated inhibition on fast inactivation of Nav channels; and PRRT2 and TRARG1 could replicate this effect (Jami S, et al. Nat Commun 2023). It is possible that all three DspB members regulate Nav channel properties through the same mechanism, and exploring molecules that target PRRT2/TRARG1/TMEM233 might be a novel strategy for developing new treatments of DspB-related neurological diseases.

Weaknesses:

(1) Previously, the authors have reported that PRRT2 reduces Nav1.2 current density and alters biophysical properties of both Nav1.2 and Nav1.6 channels, including enhanced steady-state inactivation, slower recovery, and stronger use-dependent inhibition (Lu B, et al. Cell Rep 2021, Fig 3 & S5). All those changes are expected to alter neuronal excitability and should be discussed.

We agree that PRRT2 has been reported to exert multiple effects on Nav channels which are all expected to influence neuronal excitability (Fruscione et al., 2018; Lu et al., 2021; Valente et al., 2023). In the revised manuscript, we will expand the Discussion to integrate these prior findings and to clarify how these PRRT2-dependent changes may interact with (and potentially converge on) modulation of slow inactivation to shape neuronal excitability.

(2) In this study, the fast inactivation kinetics was examined by a single stimulus at 0 mV, which may not be sufficient for the conclusion. Inactivation kinetics at more voltage potentials should be added.

We thank the reviewer for this suggestion. In the revision, we will extend our analysis of Nav1.2 fast-inactivation kinetics across a range of test potentials (e.g., -20, -10, 0, +10 and +20 mV) in the presence and absence of PRRT2.

(3) It is a little surprising that there is no difference in Nav1.2 current density in axon-blebs between WT and Prrt2-mutant mice (Figure 7B). PRRT2 significantly shifts steady-state slow inactivation curve to hyperpolarizing direction, at -70 mV, nearly 70% of Nav1.2 channels are inactivated by slow inactivation in cells expressing PRRT2 when compared to less than 10% in cells expressing GFP (Figure supplement 1B); with a holding potential of -70 mV, I would expect that most of Nav channels are inactivated in axon-blebs from WT mice but not in axon-blebs from Prrt2-mutant mice, and therefore sodium current density should be different in Figure 7B, which was not. Any explanation?

We appreciate the reviewer for raising this point. In our axonal bleb recordings, although the holding potential was -70 mV, sodium current density was measured after a hyperpolarizing pre-pulse (-110 mV) to relieve inactivation immediately prior to the test depolarization (as described in the Methods). Thus, the current density measurement in Figure 7B reflects the maximal available current following this recovery step, rather than the steady-state availability at -70 mV. In the revision, we will state this explicitly in the Results and/or figure legend to avoid confusion.

(4) Besides Nav channels, PRRT2 has been shown to act on Cav2.1 channels as well as molecules involved in neurotransmitter release, which may also contribute to abnormal neuronal activity in Prrt2-mutant mice. These should be mentioned when discussing PRRT2's role in neuronal resilience.

We agree with the reviewer. In the revised manuscript, we will broaden the Discussion to acknowledge PRRT2 functions beyond Nav channels, including reported roles in Cav2.1 regulation and neurotransmitter release. We will frame the in vivo phenotypes in Prrt2-mutant mice as likely arising from convergent mechanisms—altered intrinsic excitability together with changes in synaptic transmission.

Reviewer #3 (Public review):

This paper reveals that the neuronal protein PRRT2, previously known for its association with paroxysmal dyskinesia and infantile seizures, modulates the slow inactivation of voltage-gated sodium ion (Nav) channels, a gating process that limits excitability during prolonged activity. Using electrophysiology, molecular biology, and mouse models, the authors show that PRRT2 accelerates entry of Nav channels into the slow-inactivated state and slows their recovery, effectively dampening excessive excitability. The effect seems evolutionarily conserved, requires the C-terminal region of PRRT2, and is recapitulated in cortical neurons, where PRRT2 deficiency leads to hyper-responsiveness and reduced cortical resilience in vivo. These findings extend the functional repertoire of PRRT2, identifying it as a physiological brake on neuronal excitability. The work provides a mechanistic link between PRRT2 mutations and episodic neurological phenotypes.

Comments:

(1) The precise structural interface and the molecular basis of gating modulation remain inferred rather than demonstrated.

We thank the reviewer for this comment. In the revision, we will make it explicit that our structural modeling are based on prediction rather than evidential. We will also expand the Limitations section to highlight that direct structural and biochemical mapping of the PRRT2-Nav interface (e.g., through targeted mutagenesis, crosslinking, and/or structural determination) will be required to define the binding interface and establish the molecular basis of gating modulation.

(2) The in vivo phenotype reflects a complex circuit outcome and does not isolate slow-inactivation defects per se.

We agree with the reviewer. In the revision, we will refine the Discussion to avoid over-attributing the in vivo phenotype to slow-inactivation defects alone and to explicitly state that impaired slow inactivation in Prrt2-mutant mice represents one plausible contributing mechanism to reduced cortical resilience, alongside other PRRT2-dependent process.

(3) Expression of PRRT2 in muscle or heart is low, so the cross-isoform claims are likely of limited physiological significance.

We thank the review for your comment about physiological relevance. In the revised manuscript, we will clarify that our Nav isoform panel was designed to assess mechanistic generality at the channel level rather than to imply broad in vivo relevance across tissues. We will also expand the Discussion to emphasize that any therapeutic strategy involving PRRT2 delivery should consider its consistent effect on slow inactivation across multiple Nav isoforms.

(4) The mechanistic separation between the trafficking effect of PRRT2 and its gating effects is not clearly resolved.

We appreciate the reviewer for raising this important point. In the revision, we will expand the Discussion to clarify why we interpret the effect of PRRT2 on slow inactivation as a gating modulation rather than a secondary consequence of altered channel abundance or localization. First, our slow inactivation measurements are expressed as the fraction of available channels after depolarization conditioning relative to baseline availability within the same cell (post-/pre-conditioning), which minimizes confounding by differences in initial surface expression. Second, the slow inactivation of Nav channel occurs on a rapid, activity-dependent timescale (seconds), whereas remarkable changes in trafficking and surface abundance generally develop over longer intervals (minutes to hours).

(5) Additional studies with Nav1.6 should be carried out.

We thank the reviewer’s suggestion. We will include Nav1.6 slow inactivation experiments in the revised manuscript.