Hongda Li, Stephanie L. Bielas, Maha S

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Biallelic Mutations in Citron Kinase Link Mitotic Cytokinesis to Human Primary Microcephaly Hongda Li, Stephanie L. Bielas, Maha S. Zaki, Samira Ismail, Dorit Farfara, Kyongmi Um, Rasim O. Rosti, Eric C. Scott, Shu Tu, Neil C. Chi, Stacey Gabriel, Emine Z. Erson-Omay, A. Gulhan Ercan-Sencicek, Katsuhito Yasuno, Ahmet Okay Çağlayan, Hande Kaymakçalan, Barış Ekici, Kaya Bilguvar, Murat Gunel, Joseph G. Gleeson The American Journal of Human Genetics Volume 99, Issue 2, Pages 501-510 (August 2016) DOI: 10.1016/j.ajhg.2016.07.004 Copyright © 2016 American Society of Human Genetics Terms and Conditions

Figure 1 Mutations in CIT Cause Primary Microcephaly (A) Pedigrees of consanguineous families 718, 1379, and 1924. Symbols are as follows: filled, affected; empty, unaffected; circle, female; square, male; hash, deceased; B, branch. (B) Faces (top) and axial MRI (bottom) of representative affected individuals from each family show reduced brain volume and a simplified gyral pattern, consistent with a diagnosis of MCPH. (C) Exonic structure of CIT and the location of the identified mutations. The shorter CIT-N isoform, encoded by GenBank: NM_007174.2, lacks the N-terminal kinase domain. The longer CIT-K isoform, encoded by GenBank: NM_001206999.1, encodes the kinase domain where the CIT variants localize. (D) Identified missense variants cluster within the kinase domain of full length CIT-K. (E) Defective activity of the kinase domain with CIT variants. P[32] incorporation was detected in the wild-type only for histone H1 and FLAG-CIT autophosphorylation. The American Journal of Human Genetics 2016 99, 501-510DOI: (10.1016/j.ajhg.2016.07.004) Copyright © 2016 American Society of Human Genetics Terms and Conditions

Figure 2 Cell-Division Defects in NPCs Derived from Individuals with CIT Variants (A) Representative phase-contrast time-lapse images of NPCs from unaffected and affected individuals. 718-III-1 is a healthy father (black typeface), and 718-IV-1 is an affected member (red typeface). Asterisks mark the dividing cells analyzed in each series. Note that unaffected cells completed division within 28 min. Affected cells (top row) showed blebbing at 16 min and then incomplete cytokinesis with binucleated derivatives at 28 min. Affected cells (bottom row) showed minimal blebbing and then division by 48 min. Arrows mark cortical blebbing. (B) Quantification of the length of cytokinesis (n = 15 cells per group). (C and D) Representative images and quantification of the percentage of multipolar cells in NPCs from unaffected (C) and affected (D) individuals. Arrowheads mark multipolar cells (n = 7 cultures per group). Bar graphs show the mean ± SEM. ∗∗p < 0.01 (Student’s t test). Scale bar represents 10 μm. The American Journal of Human Genetics 2016 99, 501-510DOI: (10.1016/j.ajhg.2016.07.004) Copyright © 2016 American Society of Human Genetics Terms and Conditions

Figure 3 Correcting the CIT Variant Rescues Cellular NPC Phenotypes in Cells from Affected Individuals (A) Schematic of gene-editing strategy for correcting the CIT variant in iPSCs. WT exon 4 and the floxed puromycin cassette were recombined at the mutant locus after Cas9 cleavage. Cre-mediated removal of the LoxP-Puro-LoxP cassette left only the single LoxP site. (B) Representative differential interference contrast (DIC) time-lapse images from unaffected (black), affected (red), and mutation-corrected (gray) NPCs during cytokinesis. Scale bar represents 10 μm. (C) Quantification of the length of cytokinesis (n = 15 cells for each group). (D and E) Representative images and quantification of the percentage of multipolar cells in unaffected, affected, and mutation-corrected (COR) NPCs. Arrowheads mark multipolar cells (n = 4 cultures per group). Scale bar represents 10 μm. (F and G) Representative images (F) and quantification (G) of active caspase-3 immunoreactivity in unaffected, affected, and mutation-corrected neurospheres (n = 6 cultures per group). Note the dramatically increased amount of cleaved caspase-3 in mutant cells (718-IV-1) prior to correction (F, arrow). Scale bar represents 150 μm. (C, E, and G) One-way ANOVA was followed by Tukey’s multiple-comparison test. Bar graphs show the mean ± SEM. ∗∗p < 0.01. The American Journal of Human Genetics 2016 99, 501-510DOI: (10.1016/j.ajhg.2016.07.004) Copyright © 2016 American Society of Human Genetics Terms and Conditions