Structural analysis ofde novoSTXBP1 mutation in complex with syntaxin 1A reveals a major alteration in the interaction interface in a child with developmental delay and spasticity

STXBP1, also known as Munc-18, is a master regulator of neurotransmitter release and synaptic function in the human brain through its direct interaction with syntaxin 1A. STXBP1 related disorders are well characterized and cover a diverse range of neurological and neurodevelopmental conditions. Through exome sequencing of a child with developmental delay, hypotonia and spasticity, we found a novel de novo insertion mutation of three nucleotides in the STXBP1 coding region, resulting in an additional arginine after position 39 (R39dup). Inconclusive results from state-of-the-art variant prediction tools mandated a structure-based approach using molecular dynamics (MD) simulations of the STXBP1-syntaxin 1A complex. Comparison of the interaction interfaces of the wild type and the R39dup complexes revealed a reduced interaction surface area in the mutant, leading to destabilization of the interaction. We applied the same MD methodology to 7 additional previously reported STXBP1 mutations. We find that the stability of the STXBP1-syntaxin 1A interface correlates with the reported clinical phenotypes. We illustrate a direct link between a patient’s genetic variations and the observed clinical phenotype through protein structure, dynamics, and function.