Epigenetic insights into GABAergic development in Dravet Syndrome iPSC and therapeutic implications

Joint Public Review:

This study used ATAC-Seq to characterize chromatin accessibility during stages of GABAergic neuron development in induced pluripotent stem cells (iPSCs) derived from both Dravet Syndrome (DS) patients and healthy donors. The authors report accelerated GABAergic maturation to a point, followed by further differentiation into a perturbed chromatin profile, in the cells from patients. In a preliminary analysis, valproic acid, an anti-seizure medication commonly used in patients with DS, increased open chromatin in both patient and control iPSCs in a nonspecific manner, and to different degrees in cultures derived from different patients. These findings provide new information about DS-associated changes in chromatin, and provide further evidence for developmental abnormalities in interneurons with DS.

Strengths:

This is a novel study that aims to investigate the epigenetic changes that occur in a sodium channel model of epilepsy; these changes are often ignored but may be an interesting area for future therapeutics. In general, the flow of the paper is good, and the figures are well-designed.

Weaknesses:

The most substantial weakness relates to the observation that DS is often viewed as a monogenic form of epilepsy. It is directly linked to SCN1A gene haploinsufficiency (Yu et al, 2006; Ogiwara et al, 2007). The gene product is Nav1.1, the alpha subunit of voltage-gated sodium channel type I that regulates neuronal excitability. Yet, analysis was conducted at time points of GABAergic interneuron differentiation in which SCN1A is likely not expressed. The paper would be strengthened if SCN1A expression and Nav1.1 protein were examined across the experimental time course. If SCN1A is not yet expressed, this would complicate any explanation of how the observed epigenetic changes might arise. It also seems counterintuitive that the absence of a sodium channel can accelerate differentiation, when, a priori, one might expect the opposite (a 'less neuronal' signal).

Related to this, another important limitation of the study is that the controls are cells derived from healthy individuals and not from isogenic lines. The usage of isogenic lines is extremely relevant for every study in which iPSC-derived somatic cells are used to model a disease, but specifically in diseases like DS, in which the genetic background has an ascertained impact on disease phenotype (Cetica et al, 2017 and others). This serious limitation should be considered. In addition, the authors should provide data on variability across cell lines and differentiations to help convince the reader that the results can be attributed to genetic defects, rather than variability across individuals.

Additionally, the authors acknowledge the variability of the differentiations and cell lines, which is commendable, and they attribute this to "possibly reflecting cell line specific and endogenous differences reported previously", but could also have to do with cell death. This is a large confounding factor for ATAC-seq. Certainly, Sup Fig 1C shows lower FrIP scores, consistent with cell death, and there seems to be a lot of death in the representative images. Moreover, the iGABA neurons are very difficult to keep alive, especially to 65 days, without co-culturing with glia and/or glutamatergic neurons. The authors should comment on how much these factors may have influenced their results.

Finally, changes in gene expression are only inferred, as no RNA levels were measured. If RNA-seq was not possible it would have been good to see at least some of the key genes/findings corroborated with RNA/protein levels vs chromatin accessibility alone, particularly given that these molecular readouts do not always correlate.

Additional Points:

1. Representative images for cell-identity markers for only D65 are shown, and not D0, D19, and D35 though it is stated in the text that this was performed. At a minimum, these representative images should be shown for all lines.
2. What QC was performed on iPSC lines, i.e. karyotype/CNV analysis and confirmation of genotypes?
3. Were all experiments performed on a single differentiation? Or multiples? Were the differentiations performed with the same type? If not, was batch considered in the analysis? I also assume that technical replicates were merged, and then all three biological replicates were kept for each analysis and outliers were not removed, e.g. Control_D19_8F seems like an example of an outlier.
4. In Figure 1C, it is intriguing that the ATACseq signal gets stronger in imN. One might expect it to be strongest in the iPSCs which are undifferentiated and have the highest levels of open chromatin. Is this a function of sequencing depth, or are all the Y-axes normalized across all time points?
5. In Figure 1F, are these all enriched terms, or were they prioritized somehow?
6. In Figure 1G (also the same plots in Fig 2/3), are all these images normalized i.e. there is no scale bar for each track, and do they represent and aggregate BAM/bigwig? It would be good to show in supplement the variability across cell lines/diffs - particularly given the variability in the heatmap/PCA - and demonstrate the rigor/reproducibility of these results. This comment applies to all these plots across the 3 figures, particularly as in some instances the samples appear to cluster by individual first and then time point (Sup Fig 3B). How confident are the authors that these effects are driven by genotype and not a single cell line? In the Fig 3D representation of NANOG, it is very difficult to see any difference between patient and control.
7. For the changes in occupancy annotation (UTR/exon/intron etc), are these differences still significant after correcting for variability from cell line to cell line at each time point? I.e. rather than average across all three samples, what is the range?
8. The VPA timepoint is not well-justified. Given that VPA would be administered in patients with fully mature inhibitory neurons, it is difficult to determine the biological relevance. I appreciate that this is a limitation of the model, but this should at least be addressed in the manuscript.