CRISPR-mediated Stxbp1 gene activation ameliorates epileptic and aggressive phenotypes in Stxbp1-haploinsufficient mice

Mutations in the syntaxin-binding protein 1 (STXBP1) gene, which encodes the presynaptic protein Munc18-1, cause a spectrum of severe epileptic encephalopathies and neurodevelopmental disorders, including Ohtahara syndrome, for which no curative treatment is currently available. Because the disease pathomechanism is thought to be driven by haploinsufficiency, restoring expression of the wild-type allele to physiological levels could provide therapeutic benefit. Here, we evaluated CRISPR-mediated transcriptional activation (CRISPR-ON), based on a dCas9-VPR transcriptional activator, as a strategy to upregulate endogenous Stxbp1 expression in a Stxbp1-haploinsufficient (Stxbp1+/-) mouse model. Screening of guide RNAs (gRNAs) targeting the Stxbp1 promoter in Neuro2A cells identified a multiplexed four-gRNA cassette that elevated Stxbp1 mRNA approximately six-fold. AAV-PHP.eB vectors co-expressing this 4xgRNA cassette and Cre recombinase under the EF1a promoter were administered intracerebroventricularly to neonatal Stxbp1+/-/dCas9-VPRfl/+ mice. CRISPR-ON treatment restored not only brain Stxbp1 mRNA but also Munc18-1 protein levels to those of wild-type controls. Electrocorticographic recordings revealed an approximately 50% reduction in the frequency of spike-wave discharges in CRISPR-ON-treated Stxbp1+/- mice compared with untreated Stxbp1+/- controls, and aggressive behavior in the resident-intruder test was also partially attenuated. In contrast, locomotor activity remained unaffected, indicating that CRISPR-ON treatment achieves selective rescue of disease-related phenotypes without inducing motor side effects. Together, these findings demonstrate that CRISPR-ON-mediated activation of endogenous Stxbp1 is a promising therapeutic strategy for STXBP1-related encephalopathies and support endogenous gene activation as a broadly applicable platform for haploinsufficiency disorders.