Counter-balancing X-linked Mecp2 hypofunction by hyperfunction ameliorates disease features in a model of Rett syndrome: implications for genetic therapies

Treating monogenic neurodevelopmental disorders remains challenging and mostly symptomatic. X-linked disorders affecting women such as the postnatal neurodevelopmental disorder Rett syndrome (caused by mutations in the gene MECP2) have additional challenges due to dosage sensitivity and to cellular mosaicism caused by random X-chromosome inactivation. An approach to augment MECP2 expression from wild-type cells in RTT may be feasible and simpler than gene replacement but has never been tested due to known toxicity of MECP2 over-expression, as evidenced by the distinct neurological condition known as MECP2 Duplication Syndrome. Here, using genetic techniques, we find that "counter-balancing" Mecp2-null cells in female Mecp2-null/+ mice by a complementary population of cells harboring an X-linked transgene associated with 3X normal levels of MECP2 leads to normalization of multiple whole animal phenotypic outcomes without noticeable toxicity. In addition, in vivo LFP recordings demonstrate that counter-balancing Mecp2 loss-of-function improves select within-region and between-region abnormalities. By comparing the counter-balance approach with an approach based on cell autonomous restoration of MeCP2 using an autosomal transgene expressing 2X normal levels of MECP2 in all cells (mimicking gene replacement), we identify neurobehavioral and electrographic features best suited for preclinical biomarkers of a therapeutic response to cell autonomous versus non-cell autonomous correction. Notably, these proof-of-concept findings demonstrate how non-cell autonomous suppression of MeCP2 deficiency by boosting overall wild-type MeCP2 levels may be a viable disease-modifying therapy for RTT, with potential implications for genetic-based therapies of monogenic X-linked disorders. One Sentence SummaryIn a mouse model of Rett syndrome, counterbalancing mosaic LOF with complementary mosaic GOF improves phenotypic outcome.