PURPOSE: SLC4A10 encodes a plasma membrane-bound transporter, which mediates Na+-dependent HCO3- import thus mediating net acid extrusion. Slc4a10 knockout (KO) mice show collapsed brain ventricles, an increased seizure threshold, mild behavioral abnormalities, impaired vision, and deafness. METHODS: Utilizing exome/genome sequencing in families with undiagnosed neurodevelopmental disorders (NDD) and international data sharing, 11 patients from 6 independent families with biallelic variants in SLC4A10 were identified. Clinico-radiological and dysmorphology assessments were conducted. A minigene assay, localization studies, intracellular pH recordings, and protein modelling were performed to study the possible functional consequences of the variant alleles. RESULTS: The families harbour 8 segregating ultra-rare biallelic SLC4A10 variants (7 missense and 1 splicing). Patients phenotypically exhibit global developmental delay/intellectual disability and central hypotonia associated with variable speech delay, microcephaly, cerebellar ataxia, epilepsy, and facial dysmorphism. Neuroimaging features range from some non-specific to distinct neuroradiological findings, including slit ventricles and a peculiar form of bilateral curvilinear nodular heterotopia. In-silico analyses showed 6/7 missense variants affect evolutionarily conserved residues. Functional analyses supported the pathogenicity of 4/7 missense variants. CONCLUSION: We provide evidence that pathogenic biallelic SLC4A10 variants can lead to NDD characterized by variable abnormalities of the central nervous system including altered brain ventricles thus resembling several features observed in KO mice.
Grants Alzheimer's Research UK (ARUK) Sparks GOSH Charity Rosetrees Trust, Ataxia UK BBSRC, The Fidelity Trust National Institute for Health Research University College London Hospitals Biomedical Research Centre MSA Trust MRC Wellcome Trust CureDRPLA German Research Foundation (DFG) Deutsche Forschungsgemeinschaft (DFG) European Research Council (ERC) United States National Institutes of Health Deutsche Forschungsgemeinschaft (DFG, German Research Founda-tion) NIHR University College London Hospitals Biomedical Research Centre