Integrative transcriptomics and electrophysiological profiling of hiPSC-derived neurons identifies novel druggable pathways in Koolen-de Vries Syndrome

Koolen-de Vries Syndrome (KdVS) is a neurodevelopmental disorder (NDD) caused by KANSL1 haploinsufficiency with no treatment options. To investigate neuronal network activity in KdVS, human induced pluripotent stem cell (hiPSC)-derived neurons from KdVS patients and controls were cultured on microelectrode arrays (MEAs). KdVS networks exhibited reduced burst rates and increased variability in burst rhythmicity. To bridge molecular and functional aspects of the syndrome, we applied MEA-seq, integrating electrophysiological recordings with high-throughput transcriptome profiling. This analysis revealed a negative correlation between the NDD-associated gene CLCN4 and network burst rate. Knockdown of CLCN4 in KdVS neurons restored network bursting toward control levels, highlighting how transcriptome profiling can identify mediators linking genetic defects to relevant physiological phenotypes. We also identified significant correlations between mitochondrial gene expression and network activity and consequently confirmed impaired mitochondrial function in KdVS hiPSC-derived neurons. Using the KdVS transcriptomic signature for computational screening against the LINCS drug perturbation database, we predicted compounds capable of reversing dysregulated gene expression. Ten candidates were prioritized for experimental validation, focusing on mitochondrial function. Among these, the antioxidant phloretin improved multiple aspects of the KdVS-related network activity phenotype, reduced reactive oxygen species, and rescued synaptic density across patient lines, revealing its potential as a therapeutic candidate. Together, these findings demonstrate that integrative MEA-seq profiling can connect molecular and electrophysiological alterations in KdVS, providing a robust framework for identifying novel drugs and druggable pathways for KdVS and potentially other neurodevelopmental disorders.