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Disease-causing variants in STXBP1 are among the most common genetic causes of neurodevelopmental disorders. However, the phenotypic spectrum in STXBP1-related disorders is wide and clear correlations between variant type and clinical features have not been observed so far. Here, we harmonized clinical data across 534 individuals with STXBP1-related disorders and analysed 19 973 derived phenotypic terms, including phenotypes of 253 individuals previously unreported in the scientific literature. The overall phenotypic landscape in STXBP1-related disorders is characterized by neurodevelopmental abnormalities in 95% and seizures in 89% of individuals, including focal-onset seizures as the most common seizure type (47%). More than 88% of individuals with STXBP1-related disorders have seizure onset in the first year of life, including neonatal seizure onset in 47%. Individuals with protein-truncating variants and deletions in STXBP1 (n = 261) were almost twice as likely to present with West syndrome and were more phenotypically similar than expected by chance. Five genetic hotspots with recurrent variants were identified in more than 10 individuals, including p.Arg406Cys/His (n = 40), p.Arg292Cys/His/Leu/Pro (n = 30), p.Arg551Cys/Gly/His/Leu (n = 24), p.Pro139Leu (n = 12), and p.Arg190Trp (n = 11). None of the recurrent variants were significantly associated with distinct electroclinical syndromes, single phenotypic features, or showed overall clinical similarity, indicating that the baseline variability in STXBP1-related disorders is too high for discrete phenotypic subgroups to emerge. We then reconstructed the seizure history in 62 individuals with STXBP1-related disorders in detail, retrospectively assigning seizure type and seizure frequency monthly across 4433 time intervals, and retrieved 251 anti-seizure medication prescriptions from the electronic medical records. We demonstrate a dynamic pattern of seizure control and complex interplay with response to specific medications particularly in the first year of life when seizures in STXBP1-related disorders are the most prominent. Adrenocorticotropic hormone and phenobarbital were more likely to initially reduce seizure frequency in infantile spasms and focal seizures compared to other treatment options, while the ketogenic diet was most effective in maintaining seizure freedom. In summary, we demonstrate how the multidimensional spectrum of phenotypic features in STXBP1-related disorders can be assessed using a computational phenotype framework to facilitate the development of future precision-medicine approaches.

Author(s): Chadwick, KD; Brodrick, PG; Grant, K; Goulden, T; Henderson, A; Falco, N; Wainwright, H; Williams, KH; Bill, M; Breckheimer, I; Brodie, EL; Steltzer, H; Williams, CFR; Blonder, B; Chen, J; Dafflon, B; Damerow, J; Hancher, M; Khurram, A; Lamb, J; Lawrence, CR; McCormick, M; Musinsky, J; Pierce, S; Polussa, A; Hastings Porro, M; Scott, A; Singh, HW; Sorensen, PO; Varadharajan, C; Whitney, B; Maher, K | Abstract: In recent years, the availability of airborne imaging spectroscopy (hyperspectral) data has expanded dramatically. The high spatial and spectral resolution of these data uniquely enable spatially explicit ecological studies including species mapping, assessment of drought mortality and foliar trait distributions. However, we have barely begun to unlock the potential of these data to use direct mapping of vegetation characteristics to infer subsurface properties of the critical zone. To assess their utility for Earth systems research, imaging spectroscopy data acquisitions require integration with large, coincident ground-based datasets collected by experts in ecology and environmental and Earth science. Without coordinated, well-planned field campaigns, potential knowledge leveraged from advanced airborne data collections could be lost. Despite the growing importance of this field, documented methods to couple such a wide variety of disciplines remain sparse. We coordinated the first National Ecological Observatory Network Airborne Observation Platform (AOP) survey performed outside of their core sites, which took place in the Upper East River watershed, Colorado. Extensive planning for sample tracking and organization allowed field and flight teams to update the ground-based sampling strategy daily. This enabled collection of an extensive set of physical samples to support a wide range of ecological, microbiological, biogeochemical and hydrological studies. We present a framework for integrating airborne and field campaigns to obtain high-quality data for foliar trait prediction and document an archive of coincident physical samples collected to support a systems approach to ecological research in the critical zone. This detailed methodological account provides an example of how a multi-disciplinary and multi-institutional team can coordinate to maximize knowledge gained from an airborne survey, an approach that could be extended to other studies. The coordination of imaging spectroscopy surveys with appropriately timed and extensive field surveys, along with high-quality processing of these data, presents a unique opportunity to reveal new insights into the structure and dynamics of the critical zone. To our knowledge, this level of co-aligned sampling has never been undertaken in tandem with AOP surveys and subsequent studies utilizing this archive will shed considerable light on the breadth of applications for which imaging spectroscopy data can be leveraged.

In this article I respond to the obligation to institute the policy of decoupled crop subsidies as is provided in Pilchman’s article “Money for Nothing: Are decoupled Crop Subsidies Just?” With growing problems of poor nutrition in the United States there have been two different but related phenomenon that have appeared. First, the obesity epidemic that has ravaged the nation and left an increasing number of people very unhealthy; and second, the phenomenon of food deserts where individuals are unable to access fresh fruits and vegetables. A possible solution to this problem, as has been proposed by some, is to institute a decoupled crop subsidy that would increase the production of fruits and vegetables in the United States. In this paper I explore the possible unintended consequences of this policy and how it may violate liberal international conceptions of justice. I conclude that there must be further empirical research before anyone can call decoupled crop subsidies an obligation to justice.