Trisomy 21 impairs synchronized activity and connectivity in developing human down syndrome cortical excitatory neuron networks

  1. Manuel Peter
  2. Raquel Real
  3. Alessio Strano
  4. Hugh P. C. Robinson
  5. Mark A. Smith
  6. Samuel J. Barnes
  7. Vincenzo de Paola
  8. Frederick J. Livesey

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Abstract

Down syndrome (DS) is the most common genetic cause of intellectual disability, affecting one in 700 live births worldwide, and is caused by trisomy of the human chromosome 21 (Hsa21). Here, we investigated whether trisomy 21 alters the development of human excitatory cortical neuronal networks, and whether that could contribute to the neurodevelopmental phenotypes of DS. By recapitulating cerebral cortex development in vitro with Trisomy 21 and control isogenic and non-isogenic human induced pluripotent stem cells (hiPSC), we assessed the impact of Hsa21 triplication on activity and connectivity in developing excitatory cortical neural networks. Our analysis revealed a significant decrease in neuronal activity in TS21 neurons early in development. Unlike euploid cortical excitatory neurons, TS21 neurons failed to develop synchronised bursting activity in vitro and in vivo following transplantation into the mouse forebrain. Viral transynaptic tracing identified significant reduction of neuronal connectivity in TS21 neuronal networks in vitro , suggesting that reduced network connectivity contributes to the reduction of synchronised bursting. Furthermore, TS21 neurons displayed significantly reduced expression of voltage-gated potassium channels, with single-neuron recordings confirming the absence of hyperpolarization-activated currents. This points to a functional loss of the potassium/sodium hyperpolarization-activated cyclic nucleotide-gated channel 1 (HCN1) in TS21 neurons. Together, these findings indicate that Hsa21 trisomy leads to alterations in ion channel composition, spontaneous synchronised activity, and neuronal connectivity in cortical excitatory neuron networks, which likely contribute to the neurodevelopmental features of DS.

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    Reviewer #1 (Evidence, reproducibility and clarity (Required)):

    SECTION A - Evidence, Reproducibility, and Clarity Summary The study investigates the neurodevelopmental impact of trisomy 21 on human cortical excitatory neurons derived from induced pluripotent stem cells (hiPSCs). Key findings include a modest reduction in spontaneous firing, a marked deficit in synchronized bursting, decreased neuronal connectivity, and altered ion channel expression-particularly a downregulation of voltage‐gated potassium channels and HCN1. These conclusions are supported by a combination of in vitro calcium imaging, electrophysiological recordings, viral monosynaptic tracing, RNA sequencing, and in vivo transplantation with two‐photon imaging.

    Major Comments • Convincing Nature of Key Conclusions: The study's conclusions are generally well supported by a diverse set of experimental approaches. However, certain claims regarding the intrinsic properties of the excitatory network would benefit from further qualification. In particular, the assertion that reduced synchronization is solely attributable to altered ion channel expression might be considered somewhat preliminary without additional corroborative experiments.

    1.1) We agree with the reviewer and now write in the abstract: 'Together, these findings demonstrate long-lasting impairments in human cortical excitatory neuron network function associated with Trisomy 21 .' And in the Introduction: 'Collectively, the observed changes in ion channel expression, neuronal connectivity, and network activity synchronization may contribute to functional differences relevant to the cognitive and intellectual features associated with Down syndrome.'

    One major limitation of the current experimental design is the reliance on predominantly excitatory neuronal cultures derived from hiPSCs. Although the authors convincingly demonstrate differences in network synchronization and connectivity between trisomic (TS21) and control neurons, the almost exclusive focus on excitatory cells limits the physiological relevance of the in vitro network. In the developing cortex, interneurons and astrocytes play crucial roles in modulating network excitability, synaptogenesis, and plasticity. Therefore, incorporating these cell types-either through co-culture systems or through directed differentiation protocols that yield a more heterogeneous neuronal population-could help to determine whether the observed deficits are intrinsic to excitatory neurons or are compounded by a lack of proper inhibitory regulation and glial support. 1.2) Thank you for this thoughtful comment. We agree that interneurons and astrocytes are crucial for network function. To clarify, astrocytes are generated in this culture system, as we previously reported in our characterisation of the timecourse of network development using this approach (Kirwan et al., Development 2025). However, our primary goal was to first isolate and define the cell-autonomous defects intrinsic to TS21 excitatory neurons, minimizing the complexity introduced by additional neuronal types. This focused approach was chosen also because engineering a stable co-culture system with reproducible excitatory/inhibitory (E/I) proportions is a significant undertaking that extends beyond the scope of this initial investigation, and has proven challenging to date for the field. By establishing this foundational phenotype, our work complements prior studies on interneuron and glial contributions. Future studies building on this work will be essential to dissect the more complex, non-cell-autonomous effects within a heterogeneous network. Importantly, since our initial submission, two highly relevant preprints have emerged-including a notable study from the Geschwind laboratory at UCLA (Vuong et al., bioRxiv, 2025; Risgaard et al., bioRxiv, 2025), as well as our own complementary study Lattke et al, under revision, that highlight widespread transcriptional changes in excitatory cells of the human fetal DS cortex, providing strong validation for our central findings. This convergence of results from multiple groups underscores the timeliness and importance of our work.

    Furthermore, the assessment of neuronal connectivity via pseudotyped rabies virus tracing, while innovative, has inherent limitations. The quantification of connectivity as a ratio of red-to-green fluorescence pixels may be influenced by differential viral infection efficiencies, variations in the expression levels of the TVA receptor, or even by the lower basal activity levels observed in TS21 cultures. Complementary approaches-such as electron microscopy for synaptic density analysis or functional connectivity measurements using multi-electrode arrays (MEAs)-could provide additional structural and functional insights that would validate the rabies tracing data. 1.3) Thank you for this constructive feedback. While we cannot formally exclude that TS21 cells might express the TVA receptor at lower levels due to generalized gene dysregulation, we infected all WT and TS21 cultures in parallel using identical virus preparations and titers to minimize technical variability. Crucially, we also addressed the potential confound of differential basal activity by performing the rabies tracing under TTX incubation (see Suppl. Fig. 7), which blocks network activity and ensures that viral spread reflects structural connectivity alone.

    While complementary methods like EM or MEA could provide additional insight, they fall outside the scope of the current study. We are confident that our rigorous controls validate our use of the rabies tracing method to assess structural connectivity.

    Qualification of Claims: Some conclusions, particularly those linking specific ion channel dysregulation (e.g., HCN1 loss) directly to network deficits, might be better presented as preliminary. The authors could temper their language to indicate that while the evidence is suggestive, the mechanistic link remains to be fully established. 1.4) We have revised the text to more clearly indicate that the link between HCN1 dysregulation and network deficits is correlative and remains to be fully established. While our ex vivo recordings suggest altered Ih-like currents consistent with reduced HCN1 expression, we now present these findings as preliminary and hypothesis-generating, pending further functional validation. We write in the discussion: However, further targeted functional validation will be needed to confirm a causal link.

    Need for Additional Experiments: Additional experiments that could further consolidate the current findings include: o Inclusion of Inhibitory Neurons or Co-culture Systems: Incorporating interneurons or astrocytes would help determine whether the observed deficits are solely intrinsic to excitatory neurons. See 1.2 o Alternative Connectivity Assessments: Complementing the rabies virus tracing with electron microscopy or multi-electrode array (MEA) recordings would add structural and functional validation of the connectivity differences. See 1.3 o Extended Temporal Profiling: Monitoring network activity over a longer developmental window would clarify whether the observed deficits represent a delay or a permanent alteration in network maturation. 1.5) In vivo we were able to track the cells for up to five months post-transplantation supporting the interpretation of a permanent alteration.

    Reproducibility and Statistical Rigor: The methods and data presentation are largely clear, with adequate replication and appropriate statistical analyses. Nonetheless, a more detailed description of the experimental replicates, particularly regarding the viral tracing and in vivo transplantation studies, would enhance reproducibility. The availability of raw data and scripts for calcium imaging analysis would also further support independent verification. We thank the reviewer for these suggestions and we now provide a more detailed description of replicates. We also add the raw data.

    Minor Comments • Experimental Details: Minor revisions could include clarifying the infection efficiency and expression levels of the viral constructs used in connectivity assays to rule out technical variability.

    See 1.3

    Literature Context: The authors reference prior studies appropriately; however, integrating a brief discussion comparing their findings with alternative DS models (e.g., organoids or other hiPSC-derived systems) would improve contextual clarity. We thank the reviewer for this helpful suggestion. We have now added a brief discussion comparing our findings with those reported in alternative Down syndrome models, including brain organoids and other hiPSC-derived systems. This addition helps to contextualize our results within the broader field and highlights the unique strengths and limitations of our in vitro and in vivo xenograft approach. We write: 'Our findings align with and extend previous studies using alternative Down syndrome models, such as brain organoids and other hiPSC-derived systems. Organoid models have provided valuable insights into early neurodevelopmental phenotypes in DS, including altered interneuron proportions (Xu et al Cell Stem Cell 2019) but also suggest that variability across isogenic lines can overshadow subtle trisomy 21 neurodevelopmental phenotypes (Czerminski et al Front in Neurosci 2023). However, these systems often lack the structural complexity, vascularization, and long-term maturation achievable in vivo. By using a xenotransplantation model, we were able to assess the maturation and functional properties of human neurons within a physiologically relevant environment over extended time frames, offering complementary insights into DS-associated circuit dysfunction (Huo et al Stem Cell Reports 2018; Real et al., 2018).

    Presentation and Clarity: Figures are generally clear,.But the manuscript contains a minor labeling error. On page 13, the figure is erroneously labeled as "Fig6A", whereas, based on the context and corresponding data, it should be "Fig5A". I recommend that the authors correct this mistake to ensure consistency and avoid potential confusion for readers. Thank you for pointing this out. This has been corrected in the revised manuscript.

    Reviewer #1 (Significance (Required)):

    SECTION B - Significance • Nature and Significance of the Advance: The work offers a substantial conceptual advance by providing a mechanistic link between trisomy 21 and impaired neuronal network synchronization. Technically, the study integrates state-of-the-art imaging, electrophysiology, and transcriptomic profiling, thereby offering a multifaceted view of DS-related neural dysfunction. Clinically, the findings have the potential to inform future therapeutic strategies targeting network connectivity and ion channel function in Down syndrome.

    We thank the reviewer for this very supportive comment.

    • Context in the Existing Literature: The study builds on previous observations of altered network activity in DS patients and DS mouse models (e.g., altered EEG synchronization and reduced synaptic connectivity). It extends these findings to human-derived neuronal models, thus bridging a gap between clinical observations and molecular/cellular mechanisms. Relevant literature includes studies on DS neurodevelopment and the role of ion channels in synaptic maturation. • Target Audience: The reported findings will be of interest to researchers in neurodevelopmental disorders, Down syndrome, and ion channel physiology. Additionally, the study may attract the attention of those working on hiPSC-derived models of neurological diseases, as well as clinicians interested in the pathophysiology of DS. • Keywords and Field Contextualization: Keywords: Down syndrome, trisomy 21, neuronal connectivity, synchronized network activity, hiPSC-derived cortical neurons, ion channel dysregulation.

    Reviewer #2 (Evidence, reproducibility and clarity (Required)):

    Summary The manuscript by Peter et al., reports on the neuronal activity and connectivity of iPSC-derived human cortical neurons from Down syndrome (DS) that is caused by caused by trisomy of the human chromosome 21 (TS21). Major points: Although the manuscript is potentially interesting, the results appear somehow preliminary and need to be corroborated by control experiments and quantifications of effects to fully sustain the conclusions. (1) The authors have not assessed the percentage of WT and TS21 cells that acquire a neuronal or glia identity in their cultures. Indeed, the origin of alterations in network activity and connectivity observed in TS21 neurons could simply derive from reduced number of neurons arising from TS21 iPSC. Alternatively, the same alteration in network activity and connectivity could derive from a multitude of other factors including deficits in neuronal development, neurite extension, or intrinsic electrophysiological properties. In the current version of the manuscript, none of these has been investigated. 2.1) We thank the reviewer for this thoughtful comment. In response, we included an in vivo characterization of cell-type proportions at the same time points where we observed network activity defects using in vivo calcium imaging (see Supplementary Fig. 6).

    Previous work has identified several cellular and molecular phenotypes in human cells, postmortem tissue, and mouse models-including those mentioned by the reviewer. In this study, our focus was on investigating neural network activity, intrinsic electrophysiological properties both in vitro and in vivo, and preliminary bulk RNA sequencing. We have also independently measured cell proportions in the human fetal cortex and conducted a more extensive transcriptomic analysis of Ts21 versus control cells in a separate study (Lattke et al., under revision). We observed a reduction of RORB/FOXP1-expressing Layer 4 neurons in the human fetal cortex at midgestation, as well as increased GFAP+ cells, reduced progenitors and a non significant reduction of Cux2+ cells in late stage DS human cell transplants, along with a gene network dysregulation specifically affecting excitatory neurons (Lattke et al., under revision). Here, we provide complementary findings, demonstrating reduced excitatory neuron network connectivity in vitro and decreased neural network synchronised activity in both in vitro and in vivo models (see also 2.8). We agree with the reviewer that this could be for a number of reasons, both cell autonomous (channel expression and/or function) or non-autonomous (connectivity and/or network composition - as reflected in differences in proportions of SATB2+ neurons generated in TS21 cortical differentiations).

    (2) Electrophysiological properties of TS21 and WT neurons at day 53/54 in vitro indicate an extremely immature stage of development (i.e. RMP between -36 and -27 mV with most of the cells firing a single action potential after current injection) in the utilized culture conditions: This is far from ideal for in vitro neuronal-network studies. Finally, reduced activity of HCN1 channels should be confirmed by specific recordings isolating or blocking the related current.

    2.2) Thank you for this thoughtful comment. We have also conducted ex vivo electrophysiological recordings and found that the neurons exhibit relatively immature properties, consistent with the known slow developmental trajectory of human neuron cultures. In light of this and the absence of direct confirmatory evidence, we now refer to the observed reduction in HCN1 as preliminary.

    Main points highlighting the preliminary character of the study.

    1. In Figure 1 immunofluorescence images of the neuronal differentiation markers (Tbr1, Ctip2 and Tuj1) are showed. However, no quantification of the percentage of cells expressing these markers for WT and TS21 neurons is reported. On the other hand, simple inspection of the representative images clearly seams to indicate a difference between the two genotypes, with TS21 cultures showing lower number of cells expressing neuronal markers. This quantification should be corroborated by a similar staining for an astrocyte marker (GFAP, but not S100b since is triplicated in DS). This is an extremely important point since it is obvious that any change in the percentage of neurons (or the neuron/astrocyte ratio) in the cultures will strongly affect the resulting network activity (shown in Figure 2) and the connectivity (showed in Figure 4). Possibly, the quantification should be done at the same time points of the calcium imaging experiments.

    2.3) See 2.1. We included an in vivo characterization of cell-type proportions at the same time points where we observed network activity defects using in vivo calcium imaging. (see Supplementary Fig. 6).

    1. In Figure 2 the authors show some calcium imaging traces of WT and TS21 cultures at different time points. However, they again do not show any quantification of neuronal activity. A power spectra analysis is shown in Supplementary Figure 2, but only for WT cultures, while in Supplementary Figure 3 a comparison between WT and Ts21 power spectra is done, but only at the 50 day time point, while difference in synchrony are assessed at 60 days. At minimum, the author should include in main Figure 2 the quantification of the mean calcium event rate and mean event amplitude at the different time points and the power spectra analysis for both WT and TS21 cultures at the same timepoints.

    2.4) We thank the reviewer for this comment. We now add the power spectra analysis in the main Figure 2 and quantification of the mean calcium burst rate and mean event amplitude in SuppFig. 4.

    Of note, the synchronized neuronal activity is present in WT cultures at day 60, but totally lost at subsequent time-points (70 and 80 days). The results of this later time points are different from previous data from the same lab (Kirwan et al., 2015). How might these data be explained? It would be important to rule out any potential issues with the health of the culture that could explain the loss of neuronal activity.It would be beneficial to check cell viability at the different time points to exclude possible confounding factors ? A propidium staining or a MTT assay would strongly improve the soundness of the calcium data.

    2.5) We thank the reviewer for this important observation. The difference from the findings reported in Kirwan et al., 2015 is due to the use of a different neuronal differentiation medium in the current study (BrainPhys versus N2B27). BrainPhys medium supports robust early network activity compared to N2B27 (onset before day 60 in BrainPhys, post-day 60 in N2B27), resulting in an earlier decline in synchrony at later stages (day 70-80 in BrainPhys, compared with day 90-100 in N2B27). Importantly, in our in vivo xenograft model, burst activity is sustained up to at least 5 months post-transplantation (mpt), indicating that the neurons retain the capacity for network activity over extended periods in a more physiological environment. We adapted the text accordingly.

    1. In Figure 3 there is no quantification of the number and/or density of transplanted neurons for WT and TS21, but only representative images. As above, inspection of the representative images seems to show a decrease in cells labeled by the Tbr1 neuronal marker for TS21 cells. Moreover, the in vivo calcium imaging of transplanted WT and TS21 cells lacks most of the quantification normally done in calcium imaging experiments. Are the event rate and event amplitude different between WT and TS21 neurons ? The measure of neuronal synchrony by mean pixel correlation is not well explained, but it looks somehow simplistic. Neuronal synchrony can be more precisely measured by cross-correlation analysis or spike time tiling coefficients on the traces from single-neuron ROI rather than on all pixels in the field of view, as apparently was done here.

    2.6) We thank the reviewer for these valuable points. We now include quantification of the number and density of transplanted neurons for both WT and Ts21 grafts in Extended Data Figure 5 (see 2.1).

    Regarding the in vivo calcium imaging, we appreciate the reviewer's suggestion to include additional standard metrics. We have quantified the event rate in Real et al 2018. These analyses reveal that Ts21 neurons show a reduction in event rate.

    We agree that our initial description of the synchrony analysis using mean pixel correlation was not sufficiently detailed. We have now clarified this in the Methods and Results, and we acknowledge its limitations. Importantly, we note that the reduced synchronisation is a highly consistent phenotype, observed across at least six independent donor pairs, different differentiation protocols, and both in vitro (and in two independent labs) and in vivo settings. As suggested, future studies using ROI-based approaches-such as cross-correlation or spike-time tiling coefficients-would provide a more refined characterization of synchrony at the single-neuron level (Sintes et al, in preparation). We now include this point in the discussion.

    1. The results on reduced neuronal connectivity in Figure 3 look very striking. However, these results should be accompanied by control experiments to verify the number of neuronal cells and neurite extension in WT and Ts21 cultures. These two parameters could indeed strongly influence the results. As the cultures appear to grow in clusters, bright-field images and TuJ1 staining of the cultures will also greatly help to understand the degree of morphological interconnection between the clusters.

    We now add Tuj1 staining in Supplementary figure 10.

    1. The authors performed RNA-seq experiments on day 50 cultures. Why the authors do not show the complete differential gene expression analysis, but only a small subset of genes? A comprehensive volcano plot and the complete list of identified genes with logFC and FDR values would be helpful. If possible, comparison of the present data (particularly on KCN and HCN expression changes) with published and publicly available expression datasets of other human or human Down syndrome iPSC-derived neurons or human Down syndrome brains will greatly increase the soundness of the present findings. In addition, the gene ontology (GO) results are mentioned in the text, but are not presented. Showing the complete GO analysis for both up and downregulated genes will help the reader to better understand the RNA-seq results. Notably, the results shown in Supplementary Figure on GRIN2A and GRIN2B expression (with values of 300-700 counts versus 2000-4000 counts, respectively) clearly indicate that in both WT and TS21 cultures the NMDA developmental switch has not occurred yet at the 50 days timepoint.

    We now show volcano plots in Supplementary Fig. 11.

    1. The measure of hyperpolarization-activated currents shown in Figure 5 lack proper control experiments. First, the hyperpolarizing current in TS21 cells do not reach a steady-state as the controls. The two curves are therefore hard to compare. To exclude possible difference in kinetic activation, the authors should have prolonged the current injection period (1-2 seconds). Second, to ultimately prove that such currents are mediated by HCN channels in WT cells the authors should perform some control experiments with a specific HCN blocker. A good example of a suitable protocol, with also current blockers to exclude all other possible current contributions, is the one reported in Matt et al Cell. Mol. Life Sci. 68, 125-137 (2011).

    2.7) We thank the reviewer for this detailed and helpful comment. We agree that to definitively identify the recorded currents as Ih, it would be necessary to isolate them pharmacologically using specific HCN channel blockers and appropriate controls, such as those described in Matt et al., Cell. Mol. Life Sci. Unfortunately, due to current constraints, we no longer have access to the animals used in this study and cannot allocate the necessary time or resources, we are unable to perform the additional experiments at this stage.

    However, our goal here was to use electrophysiological recordings as an indication of altered HCN channel activity, which we then support with molecular evidence. We now emphasize this point more clearly in the revised manuscript.

    1. The manuscript lacks information on the statistical analysis used. Also, the numerosity of samples is not clear. Were the dots shown in some graph technical replicates from a single neuronal induction or were all independent neuronal inductions or a mix of the two ? Please clarify.

    We now clarify the numbers in the Figure legend.

    1. The method section lacks important information to guarantee reproducibility. Just a few examples: • Only electrophysiology methods for slice are reported, but not for in vitro culture.

    We now clarify these details in the methods.

    Details on Laminin coating is lacking. What concentration was used ? Was poly-ornithine or poly-lysine used before Laminin coating ? We now clarify these details in the methods.

    How long cells were switched to BrainPhys medium before calcium imaging ? We now clarify these details in the methods.

    Minor point/typos etc.

    Introduction • Page 4 line 6: in the line "Trisomy 21 in humans commonly results in a range in developmental and morphological changes in the forebrain ..." "in" could be replaced by "of". We have fixed this. • Page 5 line 2: please remove "an" before the word "another". We have fixed this. • Page 5 line 2: please replace "ecitatory" with "excitatory". We have fixed this typo.

    Results • Page 10 line 25: The concept of "pixel-wise" appears for the first time in this section and could be better introduced to facilitate the understanding of the experiment. • In the "results" section, page 11 line 1 and 4, references are made to "Figure 4D" and "4F," but these figures do not appear to be present in the figure section. Upon reviewing the rest of the section, the data seem to refer to "Figure 3D" and "3E." We have fixed this. Discussion • Page 15 line 20: please replace "synchronised" with "synchronized". We have fixed this typo. • Page 16 line 11: please replace "T21" with "TS21". We have fixed this typo. Methods • Page 19 line 12: "Pens/Strep" has to be replaced by Pen/Strep. We have fixed this typo. • Page 20 line 20: "Tocris Biocience" has to be replaced by "Tocris Bioscience". We have fixed this typo. • Page 21 line 2: "Addegene" has to be replaced by "Addgene". We have fixed this typo. Figures • Figure 3: the schematic experimental design (Fig. 3A) could be enlarged to match the width of the images/graphs below. We have fixed this. • Figure 5: the reviewer suggests resizing/repositioning the graphs in Fig. 1A so that they match the width of those below. We have fixed this. • Figure S1D: In all the figures of the paper, the respective controls for the TS21 1 and TS21 2 lines are labelled as "WT1/WT2," while in these graphs, they are called "Ctrl1" and "Ctrl2." To ensure consistency throughout the paper, it is suggested to change the names in these graphs. We have fixed this. • Figure S4L: The graph is not very clear, especially regarding the significance reported at -50 pA, please modify the graphical visualization and/or add a legend in the caption. We have fixed this.

    Reviewer #2 (Significance (Required)):

    Nature and significance of the advance for the field. The results presented in the manuscript are potentially interesting and useful, but not completely novel (currents deregulation has already been highlighted in mouse models of Down Syndrome).

    2.8) We thank the reviewer for this comment. While we agree that current deregulation has been observed in mouse models of Down syndrome, the novelty and significance of our study lie in demonstrating these alterations directly in human neurons using both in vitro and in vivo xenograft models.

    This is a critical advance because the human cortex has distinct developmental and functional properties not fully recapitulated in mice. In fact, three recent studies have already highlighted significant defects mainly in excitatory neurons within the fetal human DS cortex (Vuong et al., bioRxiv, 2025; Risgaard et al., bioRxiv, 2025; Lattke et al, under revision). Our work builds directly on these observations by providing, for the first time, an electrophysiological and network-level characterization of these human-specific deficits.

    Our findings thus provide translationally relevant insight that is not merely confirmatory but extends previous work by grounding it in a human cellular context.

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    Referee #2

    Evidence, reproducibility and clarity

    Summary

    The manuscript by Peter et al., reports on the neuronal activity and connectivity of iPSC-derived human cortical neurons from Down syndrome (DS) that is caused by caused by trisomy of the human chromosome 21 (TS21).

    Major points:

    Although the manuscript is potentially interesting, the results appear somehow preliminary and need to be corroborated by control experiments and quantifications of effects to fully sustain the conclusions.

    (1) The authors have not assessed the percentage of WT and TS21 cells that acquire a neuronal or glia identity in their cultures. Indeed, the origin of alterations in network activity and connectivity observed in TS21 neurons could simply derive from reduced number of neurons arising from TS21 iPSC. Alternatively, the same alteration in network activity and connectivity could derive from a multitude of other factors including deficits in neuronal development, neurite extension, or intrinsic electrophysiological properties. In the current version of the manuscript, none of these has been investigated.

    (2) Electrophysiological properties of TS21 and WT neurons at day 53/54 in vitro indicate an extremely immature stage of development (i.e. RMP between -36 and -27 mV with most of the cells firing a single action potential after current injection) in the utilized culture conditions: This is far from ideal for in vitro neuronal-network studies. Finally, reduced activity of HCN1 channels should be confirmed by specific recordings isolating or blocking the related current.

    Main points highlighting the preliminary character of the study.

    1. In Figure 1 immunofluorescence images of the neuronal differentiation markers (Tbr1, Ctip2 and Tuj1) are showed. However, no quantification of the percentage of cells expressing these markers for WT and TS21 neurons is reported. On the other hand, simple inspection of the representative images clearly seams to indicate a difference between the two genotypes, with TS21 cultures showing lower number of cells expressing neuronal markers. This quantification should be corroborated by a similar staining for an astrocyte marker (GFAP, but not S100b since is triplicated in DS). This is an extremely important point since it is obvious that any change in the percentage of neurons (or the neuron/astrocyte ratio) in the cultures will strongly affect the resulting network activity (shown in Figure 2) and the connectivity (showed in Figure 4). Possibly, the quantification should be done at the same time points of the calcium imaging experiments.

    2. In Figure 2 the authors show some calcium imaging traces of WT and TS21 cultures at different time points. However, they again do not show any quantification of neuronal activity. A power spectra analysis is shown in Supplementary Figure 2, but only for WT cultures, while in Supplementary Figure 3 a comparison between WT and Ts21 power spectra is done, but only at the 50 day time point, while difference in synchrony are assessed at 60 days. At minimum, the author should include in main Figure 2 the quantification of the mean calcium event rate and mean event amplitude at the different time points and the power spectra analysis for both WT and TS21 cultures at the same timepoints.

    Of note, the synchronized neuronal activity is present in WT cultures at day 60, but totally lost at subsequent time-points (70 and 80 days). The results of this later time points are different from previous data from the same lab (Kirwan et al., 2015). How might these data be explained? It would be important to rule out any potential issues with the health of the culture that could explain the loss of neuronal activity.It would be beneficial to check cell viability at the different time points to exclude possible confounding factors ? A propidium staining or a MTT assay would strongly improve the soundness of the calcium data.

    1. In Figure 3 there is no quantification of the number and/or density of transplanted neurons for WT and TS21, but only representative images. As above, inspection of the representative images seems to show a decrease in cells labeled by the Tbr1 neuronal marker for TS21 cells. Moreover, the in vivo calcium imaging of transplanted WT and TS21 cells lacks most of the quantification normally done in calcium imaging experiments. Are the event rate and event amplitude different between WT and TS21 neurons ? The measure of neuronal synchrony by mean pixel correlation is not well explained, but it looks somehow simplistic. Neuronal synchrony can be more precisely measured by cross-correlation analysis or spike time tiling coefficients on the traces from single-neuron ROI rather than on all pixels in the field of view, as apparently was done here.

    2. The results on reduced neuronal connectivity in Figure 3 look very striking. However, these results should be accompanied by control experiments to verify the number of neuronal cells and neurite extension in WT and Ts21 cultures. These two parameters could indeed strongly influence the results. As the cultures appear to grow in clusters, bright-field images and TuJ1 staining of the cultures will also greatly help to understand the degree of morphological interconnection between the clusters.

    3. The authors performed RNA-seq experiments on day 50 cultures. Why the authors do not show the complete differential gene expression analysis, but only a small subset of genes? A comprehensive volcano plot and the complete list of identified genes with logFC and FDR values would be helpful. If possible, comparison of the present data (particularly on KCN and HCN expression changes) with published and publicly available expression datasets of other human or human Down syndrome iPSC-derived neurons or human Down syndrome brains will greatly increase the soundness of the present findings. In addition, the gene ontology (GO) results are mentioned in the text, but are not presented. Showing the complete GO analysis for both up and downregulated genes will help the reader to better understand the RNA-seq results. Notably, the results shown in Supplementary Figure on GRIN2A and GRIN2B expression (with values of 300-700 counts versus 2000-4000 counts, respectively) clearly indicate that in both WT and TS21 cultures the NMDA developmental switch has not occurred yet at the 50 days timepoint.

    4. The measure of hyperpolarization-activated currents shown in Figure 5 lack proper control experiments. First, the hyperpolarizing current in TS21 cells do not reach a steady-state as the controls. The two curves are therefore hard to compare. To exclude possible difference in kinetic activation, the authors should have prolonged the current injection period (1-2 seconds). Second, to ultimately prove that such currents are mediated by HCN channels in WT cells the authors should perform some control experiments with a specific HCN blocker. A good example of a suitable protocol, with also current blockers to exclude all other possible current contributions, is the one reported in Matt et al Cell. Mol. Life Sci. 68, 125-137 (2011).

    5. The manuscript lacks information on the statistical analysis used. Also, the numerosity of samples is not clear. Were the dots shown in some graph technical replicates from a single neuronal induction or were all independent neuronal inductions or a mix of the two ? Please clarify.

    6. The method section lacks important information to guarantee reproducibility. Just a few examples:

    • Only electrophysiology methods for slice are reported, but not for in vitro culture.
    • Details on Laminin coating is lacking. What concentration was used ? Was poly-ornithine or poly-lysine used before Laminin coating ?
    • How long cells were switched to BrainPhys medium before calcium imaging ?

    Minor point/typos etc.

    Introduction

    • Page 4 line 6: in the line "Trisomy 21 in humans commonly results in a range in developmental and morphological changes in the forebrain ..." "in" could be replaced by "of".
    • Page 5 line 2: please remove "an" before the word "another".
    • Page 5 line 2: please replace "ecitatory" with "excitatory"

    Results

    • Page 10 line 25: The concept of "pixel-wise" appears for the first time in this section and could be better introduced to facilitate the understanding of the experiment.
    • In the "results" section, page 11 line 1 and 4, references are made to "Figure 4D" and "4F," but these figures do not appear to be present in the figure section. Upon reviewing the rest of the section, the data seem to refer to "Figure 3D" and "3E."

    Discussion

    • Page 15 line 20: please replace "synchronised" with "synchronized".
    • Page 16 line 11: please replace "T21" with "TS21".

    Methods

    • Page 19 line 12: "Pens/Strep" has to be replaced by Pen/Strep.
    • Page 20 line 20: "Tocris Biocience" has to be replaced by "Tocris Bioscience".
    • Page 21 line 2: "Addegene" has to be replaced by "Addgene".

    Figures

    • Figure 3: the schematic experimental design (Fig. 3A) could be enlarged to match the width of the images/graphs below.
    • Figure 5: the reviewer suggests resizing/repositioning the graphs in Fig. 1A so that they match the width of those below.
    • Figure S1D: In all the figures of the paper, the respective controls for the TS21 1 and TS21 2 lines are labelled as "WT1/WT2," while in these graphs, they are called "Ctrl1" and "Ctrl2." To ensure consistency throughout the paper, it is suggested to change the names in these graphs.
    • Figure S4L: The graph is not very clear, especially regarding the significance reported at -50 pA, please modify the graphical visualization and/or add a legend in the caption.

    Significance

    Nature and significance of the advance for the field. The results presented in the manuscript are potentially interesting and useful, but not completely novel (currents deregulation has already been highlighted in mouse models of Down Syndrome).

    Work in the context of the existing literature. This work follows the line of evidence that characterizes Down Syndrome in human neurons (Huo, H.-Q. et al. Stem Cell Rep. 10, 1251-1266 (2018); Briggs, J. A. et al. Etiology. Stem Cells 31, 467-478 (2013)), both in vitro and in xenotransplanted mice, by corrborating some important findings already found in animal models (Stern, S., Segal, M. & Moses, E. EBioMedicine 2, 1048-1062 (2015); Cramer, N. P., Xu, X., F. Haydar, T. & Galdzicki, Z. Physiol. Rep. 3, e12655 (2015); Stern, S., Keren, R., Kim, Y. & Moses, E. http://biorxiv.org/lookup/doi/10.1101/467522 (2018) doi:10.1101/467522.

    Audience. Scientists in the field of pre-clinical biomedical research, especially those working on neurodevelopmental disorders and iPSC-based non-animal models.

    Field of expertise. In vitro electrophysiology, Neurodevelopmental disorders, Down Syndrome, ips cells.

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    Referee #1

    Evidence, reproducibility and clarity

    Summary

    The study investigates the neurodevelopmental impact of trisomy 21 on human cortical excitatory neurons derived from induced pluripotent stem cells (hiPSCs). Key findings include a modest reduction in spontaneous firing, a marked deficit in synchronized bursting, decreased neuronal connectivity, and altered ion channel expression-particularly a downregulation of voltage‐gated potassium channels and HCN1. These conclusions are supported by a combination of in vitro calcium imaging, electrophysiological recordings, viral monosynaptic tracing, RNA sequencing, and in vivo transplantation with two‐photon imaging.

    Major Comments

    • Convincing Nature of Key Conclusions: The study's conclusions are generally well supported by a diverse set of experimental approaches. However, certain claims regarding the intrinsic properties of the excitatory network would benefit from further qualification. In particular, the assertion that reduced synchronization is solely attributable to altered ion channel expression might be considered somewhat preliminary without additional corroborative experiments.
    • One major limitation of the current experimental design is the reliance on predominantly excitatory neuronal cultures derived from hiPSCs. Although the authors convincingly demonstrate differences in network synchronization and connectivity between trisomic (TS21) and control neurons, the almost exclusive focus on excitatory cells limits the physiological relevance of the in vitro network. In the developing cortex, interneurons and astrocytes play crucial roles in modulating network excitability, synaptogenesis, and plasticity. Therefore, incorporating these cell types-either through co-culture systems or through directed differentiation protocols that yield a more heterogeneous neuronal population-could help to determine whether the observed deficits are intrinsic to excitatory neurons or are compounded by a lack of proper inhibitory regulation and glial support.
    • Furthermore, the assessment of neuronal connectivity via pseudotyped rabies virus tracing, while innovative, has inherent limitations. The quantification of connectivity as a ratio of red-to-green fluorescence pixels may be influenced by differential viral infection efficiencies, variations in the expression levels of the TVA receptor, or even by the lower basal activity levels observed in TS21 cultures. Complementary approaches-such as electron microscopy for synaptic density analysis or functional connectivity measurements using multi-electrode arrays (MEAs)-could provide additional structural and functional insights that would validate the rabies tracing data.
    • Qualification of Claims: Some conclusions, particularly those linking specific ion channel dysregulation (e.g., HCN1 loss) directly to network deficits, might be better presented as preliminary. The authors could temper their language to indicate that while the evidence is suggestive, the mechanistic link remains to be fully established.
    • Need for Additional Experiments: Additional experiments that could further consolidate the current findings include:
      • Inclusion of Inhibitory Neurons or Co-culture Systems: Incorporating interneurons or astrocytes would help determine whether the observed deficits are solely intrinsic to excitatory neurons.
      • Alternative Connectivity Assessments: Complementing the rabies virus tracing with electron microscopy or multi-electrode array (MEA) recordings would add structural and functional validation of the connectivity differences.
      • Extended Temporal Profiling: Monitoring network activity over a longer developmental window would clarify whether the observed deficits represent a delay or a permanent alteration in network maturation.
    • Reproducibility and Statistical Rigor: The methods and data presentation are largely clear, with adequate replication and appropriate statistical analyses. Nonetheless, a more detailed description of the experimental replicates, particularly regarding the viral tracing and in vivo transplantation studies, would enhance reproducibility. The availability of raw data and scripts for calcium imaging analysis would also further support independent verification.

    Minor Comments

    • Experimental Details:

    Minor revisions could include clarifying the infection efficiency and expression levels of the viral constructs used in connectivity assays to rule out technical variability.

    • Literature Context:

    The authors reference prior studies appropriately; however, integrating a brief discussion comparing their findings with alternative DS models (e.g., organoids or other hiPSC-derived systems) would improve contextual clarity.

    • Presentation and Clarity:

    Figures are generally clear,.But the manuscript contains a minor labeling error. On page 13, the figure is erroneously labeled as "Fig6A", whereas, based on the context and corresponding data, it should be "Fig5A". I recommend that the authors correct this mistake to ensure consistency and avoid potential confusion for readers.

    Significance

    • Nature and Significance of the Advance:

    The work offers a substantial conceptual advance by providing a mechanistic link between trisomy 21 and impaired neuronal network synchronization. Technically, the study integrates state-of-the-art imaging, electrophysiology, and transcriptomic profiling, thereby offering a multifaceted view of DS-related neural dysfunction. Clinically, the findings have the potential to inform future therapeutic strategies targeting network connectivity and ion channel function in Down syndrome.

    • Context in the Existing Literature:

    The study builds on previous observations of altered network activity in DS patients and DS mouse models (e.g., altered EEG synchronization and reduced synaptic connectivity). It extends these findings to human-derived neuronal models, thus bridging a gap between clinical observations and molecular/cellular mechanisms. Relevant literature includes studies on DS neurodevelopment and the role of ion channels in synaptic maturation.

    • Target Audience:

    The reported findings will be of interest to researchers in neurodevelopmental disorders, Down syndrome, and ion channel physiology. Additionally, the study may attract the attention of those working on hiPSC-derived models of neurological diseases, as well as clinicians interested in the pathophysiology of DS.

    • Keywords and Field Contextualization:

    Keywords: Down syndrome, trisomy 21, neuronal connectivity, synchronized network activity, hiPSC-derived cortical neurons, ion channel dysregulation.

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    Reply to the reviewers

    Reviewer #1 (Evidence, reproducibility and clarity (Required)):

    SECTION A - Evidence, Reproducibility, and Clarity Summary The study investigates the neurodevelopmental impact of trisomy 21 on human cortical excitatory neurons derived from induced pluripotent stem cells (hiPSCs). Key findings include a modest reduction in spontaneous firing, a marked deficit in synchronized bursting, decreased neuronal connectivity, and altered ion channel expression-particularly a downregulation of voltage‐gated potassium channels and HCN1. These conclusions are supported by a combination of in vitro calcium imaging, electrophysiological recordings, viral monosynaptic tracing, RNA sequencing, and in vivo transplantation with two‐photon imaging.

    Major Comments • Convincing Nature of Key Conclusions: The study's conclusions are generally well supported by a diverse set of experimental approaches. However, certain claims regarding the intrinsic properties of the excitatory network would benefit from further qualification. In particular, the assertion that reduced synchronization is solely attributable to altered ion channel expression might be considered somewhat preliminary without additional corroborative experiments.

    1.1) We agree with the reviewer and now write in the abstract: 'Together, these findings demonstrate long-lasting impairments in human cortical excitatory neuron network function associated with Trisomy 21 .' And in the Introduction: 'Collectively, the observed changes in ion channel expression, neuronal connectivity, and network activity synchronization may contribute to functional differences relevant to the cognitive and intellectual features associated with Down syndrome.'

    One major limitation of the current experimental design is the reliance on predominantly excitatory neuronal cultures derived from hiPSCs. Although the authors convincingly demonstrate differences in network synchronization and connectivity between trisomic (TS21) and control neurons, the almost exclusive focus on excitatory cells limits the physiological relevance of the in vitro network. In the developing cortex, interneurons and astrocytes play crucial roles in modulating network excitability, synaptogenesis, and plasticity. Therefore, incorporating these cell types-either through co-culture systems or through directed differentiation protocols that yield a more heterogeneous neuronal population-could help to determine whether the observed deficits are intrinsic to excitatory neurons or are compounded by a lack of proper inhibitory regulation and glial support. 1.2) Thank you for this thoughtful comment. We agree that interneurons and astrocytes are crucial for network function. To clarify, astrocytes are generated in this culture system, as we previously reported in our characterisation of the timecourse of network development using this approach (Kirwan et al., Development 2025). However, our primary goal was to first isolate and define the cell-autonomous defects intrinsic to TS21 excitatory neurons, minimizing the complexity introduced by additional neuronal types. This focused approach was chosen also because engineering a stable co-culture system with reproducible excitatory/inhibitory (E/I) proportions is a significant undertaking that extends beyond the scope of this initial investigation, and has proven challenging to date for the field. By establishing this foundational phenotype, our work complements prior studies on interneuron and glial contributions. Future studies building on this work will be essential to dissect the more complex, non-cell-autonomous effects within a heterogeneous network. Importantly, since our initial submission, two highly relevant preprints have emerged-including a notable study from the Geschwind laboratory at UCLA (Vuong et al., bioRxiv, 2025; Risgaard et al., bioRxiv, 2025), as well as our own complementary study Lattke et al, under revision, that highlight widespread transcriptional changes in excitatory cells of the human fetal DS cortex, providing strong validation for our central findings. This convergence of results from multiple groups underscores the timeliness and importance of our work.

    Furthermore, the assessment of neuronal connectivity via pseudotyped rabies virus tracing, while innovative, has inherent limitations. The quantification of connectivity as a ratio of red-to-green fluorescence pixels may be influenced by differential viral infection efficiencies, variations in the expression levels of the TVA receptor, or even by the lower basal activity levels observed in TS21 cultures. Complementary approaches-such as electron microscopy for synaptic density analysis or functional connectivity measurements using multi-electrode arrays (MEAs)-could provide additional structural and functional insights that would validate the rabies tracing data. 1.3) Thank you for this constructive feedback. While we cannot formally exclude that TS21 cells might express the TVA receptor at lower levels due to generalized gene dysregulation, we infected all WT and TS21 cultures in parallel using identical virus preparations and titers to minimize technical variability. Crucially, we also addressed the potential confound of differential basal activity by performing the rabies tracing under TTX incubation (see Suppl. Fig. 7), which blocks network activity and ensures that viral spread reflects structural connectivity alone.

    While complementary methods like EM or MEA could provide additional insight, they fall outside the scope of the current study. We are confident that our rigorous controls validate our use of the rabies tracing method to assess structural connectivity.

    Qualification of Claims: Some conclusions, particularly those linking specific ion channel dysregulation (e.g., HCN1 loss) directly to network deficits, might be better presented as preliminary. The authors could temper their language to indicate that while the evidence is suggestive, the mechanistic link remains to be fully established. 1.4) We have revised the text to more clearly indicate that the link between HCN1 dysregulation and network deficits is correlative and remains to be fully established. While our ex vivo recordings suggest altered Ih-like currents consistent with reduced HCN1 expression, we now present these findings as preliminary and hypothesis-generating, pending further functional validation. We write in the discussion: However, further targeted functional validation will be needed to confirm a causal link.

    Need for Additional Experiments: Additional experiments that could further consolidate the current findings include: o Inclusion of Inhibitory Neurons or Co-culture Systems: Incorporating interneurons or astrocytes would help determine whether the observed deficits are solely intrinsic to excitatory neurons. See 1.2 o Alternative Connectivity Assessments: Complementing the rabies virus tracing with electron microscopy or multi-electrode array (MEA) recordings would add structural and functional validation of the connectivity differences. See 1.3 o Extended Temporal Profiling: Monitoring network activity over a longer developmental window would clarify whether the observed deficits represent a delay or a permanent alteration in network maturation. 1.5) In vivo we were able to track the cells for up to five months post-transplantation supporting the interpretation of a permanent alteration.

    Reproducibility and Statistical Rigor: The methods and data presentation are largely clear, with adequate replication and appropriate statistical analyses. Nonetheless, a more detailed description of the experimental replicates, particularly regarding the viral tracing and in vivo transplantation studies, would enhance reproducibility. The availability of raw data and scripts for calcium imaging analysis would also further support independent verification. We thank the reviewer for these suggestions and we now provide a more detailed description of replicates. We also add the raw data.

    Minor Comments • Experimental Details: Minor revisions could include clarifying the infection efficiency and expression levels of the viral constructs used in connectivity assays to rule out technical variability.

    See 1.3

    Literature Context: The authors reference prior studies appropriately; however, integrating a brief discussion comparing their findings with alternative DS models (e.g., organoids or other hiPSC-derived systems) would improve contextual clarity. We thank the reviewer for this helpful suggestion. We have now added a brief discussion comparing our findings with those reported in alternative Down syndrome models, including brain organoids and other hiPSC-derived systems. This addition helps to contextualize our results within the broader field and highlights the unique strengths and limitations of our in vitro and in vivo xenograft approach. We write: 'Our findings align with and extend previous studies using alternative Down syndrome models, such as brain organoids and other hiPSC-derived systems. Organoid models have provided valuable insights into early neurodevelopmental phenotypes in DS, including altered interneuron proportions (Xu et al Cell Stem Cell 2019) but also suggest that variability across isogenic lines can overshadow subtle trisomy 21 neurodevelopmental phenotypes (Czerminski et al Front in Neurosci 2023). However, these systems often lack the structural complexity, vascularization, and long-term maturation achievable in vivo. By using a xenotransplantation model, we were able to assess the maturation and functional properties of human neurons within a physiologically relevant environment over extended time frames, offering complementary insights into DS-associated circuit dysfunction (Huo et al Stem Cell Reports 2018; Real et al., 2018).

    Presentation and Clarity: Figures are generally clear,.But the manuscript contains a minor labeling error. On page 13, the figure is erroneously labeled as "Fig6A", whereas, based on the context and corresponding data, it should be "Fig5A". I recommend that the authors correct this mistake to ensure consistency and avoid potential confusion for readers. Thank you for pointing this out. This has been corrected in the revised manuscript.

    Reviewer #1 (Significance (Required)):

    SECTION B - Significance • Nature and Significance of the Advance: The work offers a substantial conceptual advance by providing a mechanistic link between trisomy 21 and impaired neuronal network synchronization. Technically, the study integrates state-of-the-art imaging, electrophysiology, and transcriptomic profiling, thereby offering a multifaceted view of DS-related neural dysfunction. Clinically, the findings have the potential to inform future therapeutic strategies targeting network connectivity and ion channel function in Down syndrome.

    We thank the reviewer for this very supportive comment.

    • Context in the Existing Literature: The study builds on previous observations of altered network activity in DS patients and DS mouse models (e.g., altered EEG synchronization and reduced synaptic connectivity). It extends these findings to human-derived neuronal models, thus bridging a gap between clinical observations and molecular/cellular mechanisms. Relevant literature includes studies on DS neurodevelopment and the role of ion channels in synaptic maturation. • Target Audience: The reported findings will be of interest to researchers in neurodevelopmental disorders, Down syndrome, and ion channel physiology. Additionally, the study may attract the attention of those working on hiPSC-derived models of neurological diseases, as well as clinicians interested in the pathophysiology of DS. • Keywords and Field Contextualization: Keywords: Down syndrome, trisomy 21, neuronal connectivity, synchronized network activity, hiPSC-derived cortical neurons, ion channel dysregulation.

    Reviewer #2 (Evidence, reproducibility and clarity (Required)):

    Summary The manuscript by Peter et al., reports on the neuronal activity and connectivity of iPSC-derived human cortical neurons from Down syndrome (DS) that is caused by caused by trisomy of the human chromosome 21 (TS21). Major points: Although the manuscript is potentially interesting, the results appear somehow preliminary and need to be corroborated by control experiments and quantifications of effects to fully sustain the conclusions. (1) The authors have not assessed the percentage of WT and TS21 cells that acquire a neuronal or glia identity in their cultures. Indeed, the origin of alterations in network activity and connectivity observed in TS21 neurons could simply derive from reduced number of neurons arising from TS21 iPSC. Alternatively, the same alteration in network activity and connectivity could derive from a multitude of other factors including deficits in neuronal development, neurite extension, or intrinsic electrophysiological properties. In the current version of the manuscript, none of these has been investigated. 2.1) We thank the reviewer for this thoughtful comment. In response, we included an in vivo characterization of cell-type proportions at the same time points where we observed network activity defects using in vivo calcium imaging (see Supplementary Fig. 6).

    Previous work has identified several cellular and molecular phenotypes in human cells, postmortem tissue, and mouse models-including those mentioned by the reviewer. In this study, our focus was on investigating neural network activity, intrinsic electrophysiological properties both in vitro and in vivo, and preliminary bulk RNA sequencing. We have also independently measured cell proportions in the human fetal cortex and conducted a more extensive transcriptomic analysis of Ts21 versus control cells in a separate study (Lattke et al., under revision). We observed a reduction of RORB/FOXP1-expressing Layer 4 neurons in the human fetal cortex at midgestation, as well as increased GFAP+ cells, reduced progenitors and a non significant reduction of Cux2+ cells in late stage DS human cell transplants, along with a gene network dysregulation specifically affecting excitatory neurons (Lattke et al., under revision). Here, we provide complementary findings, demonstrating reduced excitatory neuron network connectivity in vitro and decreased neural network synchronised activity in both in vitro and in vivo models (see also 2.8). We agree with the reviewer that this could be for a number of reasons, both cell autonomous (channel expression and/or function) or non-autonomous (connectivity and/or network composition - as reflected in differences in proportions of SATB2+ neurons generated in TS21 cortical differentiations).

    (2) Electrophysiological properties of TS21 and WT neurons at day 53/54 in vitro indicate an extremely immature stage of development (i.e. RMP between -36 and -27 mV with most of the cells firing a single action potential after current injection) in the utilized culture conditions: This is far from ideal for in vitro neuronal-network studies. Finally, reduced activity of HCN1 channels should be confirmed by specific recordings isolating or blocking the related current.

    2.2) Thank you for this thoughtful comment. We have also conducted ex vivo electrophysiological recordings and found that the neurons exhibit relatively immature properties, consistent with the known slow developmental trajectory of human neuron cultures. In light of this and the absence of direct confirmatory evidence, we now refer to the observed reduction in HCN1 as preliminary.

    Main points highlighting the preliminary character of the study.

    1. In Figure 1 immunofluorescence images of the neuronal differentiation markers (Tbr1, Ctip2 and Tuj1) are showed. However, no quantification of the percentage of cells expressing these markers for WT and TS21 neurons is reported. On the other hand, simple inspection of the representative images clearly seams to indicate a difference between the two genotypes, with TS21 cultures showing lower number of cells expressing neuronal markers. This quantification should be corroborated by a similar staining for an astrocyte marker (GFAP, but not S100b since is triplicated in DS). This is an extremely important point since it is obvious that any change in the percentage of neurons (or the neuron/astrocyte ratio) in the cultures will strongly affect the resulting network activity (shown in Figure 2) and the connectivity (showed in Figure 4). Possibly, the quantification should be done at the same time points of the calcium imaging experiments.

    2.3) See 2.1. We included an in vivo characterization of cell-type proportions at the same time points where we observed network activity defects using in vivo calcium imaging. (see Supplementary Fig. 6).

    1. In Figure 2 the authors show some calcium imaging traces of WT and TS21 cultures at different time points. However, they again do not show any quantification of neuronal activity. A power spectra analysis is shown in Supplementary Figure 2, but only for WT cultures, while in Supplementary Figure 3 a comparison between WT and Ts21 power spectra is done, but only at the 50 day time point, while difference in synchrony are assessed at 60 days. At minimum, the author should include in main Figure 2 the quantification of the mean calcium event rate and mean event amplitude at the different time points and the power spectra analysis for both WT and TS21 cultures at the same timepoints.

    2.4) We thank the reviewer for this comment. We now add the power spectra analysis in the main Figure 2 and quantification of the mean calcium burst rate and mean event amplitude in SuppFig. 4.

    Of note, the synchronized neuronal activity is present in WT cultures at day 60, but totally lost at subsequent time-points (70 and 80 days). The results of this later time points are different from previous data from the same lab (Kirwan et al., 2015). How might these data be explained? It would be important to rule out any potential issues with the health of the culture that could explain the loss of neuronal activity.It would be beneficial to check cell viability at the different time points to exclude possible confounding factors ? A propidium staining or a MTT assay would strongly improve the soundness of the calcium data.

    2.5) We thank the reviewer for this important observation. The difference from the findings reported in Kirwan et al., 2015 is due to the use of a different neuronal differentiation medium in the current study (BrainPhys versus N2B27). BrainPhys medium supports robust early network activity compared to N2B27 (onset before day 60 in BrainPhys, post-day 60 in N2B27), resulting in an earlier decline in synchrony at later stages (day 70-80 in BrainPhys, compared with day 90-100 in N2B27). Importantly, in our in vivo xenograft model, burst activity is sustained up to at least 5 months post-transplantation (mpt), indicating that the neurons retain the capacity for network activity over extended periods in a more physiological environment. We adapted the text accordingly.

    1. In Figure 3 there is no quantification of the number and/or density of transplanted neurons for WT and TS21, but only representative images. As above, inspection of the representative images seems to show a decrease in cells labeled by the Tbr1 neuronal marker for TS21 cells. Moreover, the in vivo calcium imaging of transplanted WT and TS21 cells lacks most of the quantification normally done in calcium imaging experiments. Are the event rate and event amplitude different between WT and TS21 neurons ? The measure of neuronal synchrony by mean pixel correlation is not well explained, but it looks somehow simplistic. Neuronal synchrony can be more precisely measured by cross-correlation analysis or spike time tiling coefficients on the traces from single-neuron ROI rather than on all pixels in the field of view, as apparently was done here.

    2.6) We thank the reviewer for these valuable points. We now include quantification of the number and density of transplanted neurons for both WT and Ts21 grafts in Extended Data Figure 5 (see 2.1).

    Regarding the in vivo calcium imaging, we appreciate the reviewer's suggestion to include additional standard metrics. We have quantified the event rate in Real et al 2018. These analyses reveal that Ts21 neurons show a reduction in event rate.

    We agree that our initial description of the synchrony analysis using mean pixel correlation was not sufficiently detailed. We have now clarified this in the Methods and Results, and we acknowledge its limitations. Importantly, we note that the reduced synchronisation is a highly consistent phenotype, observed across at least six independent donor pairs, different differentiation protocols, and both in vitro (and in two independent labs) and in vivo settings. As suggested, future studies using ROI-based approaches-such as cross-correlation or spike-time tiling coefficients-would provide a more refined characterization of synchrony at the single-neuron level (Sintes et al, in preparation). We now include this point in the discussion.

    1. The results on reduced neuronal connectivity in Figure 3 look very striking. However, these results should be accompanied by control experiments to verify the number of neuronal cells and neurite extension in WT and Ts21 cultures. These two parameters could indeed strongly influence the results. As the cultures appear to grow in clusters, bright-field images and TuJ1 staining of the cultures will also greatly help to understand the degree of morphological interconnection between the clusters.

    We now add Tuj1 staining in Supplementary figure 10.

    1. The authors performed RNA-seq experiments on day 50 cultures. Why the authors do not show the complete differential gene expression analysis, but only a small subset of genes? A comprehensive volcano plot and the complete list of identified genes with logFC and FDR values would be helpful. If possible, comparison of the present data (particularly on KCN and HCN expression changes) with published and publicly available expression datasets of other human or human Down syndrome iPSC-derived neurons or human Down syndrome brains will greatly increase the soundness of the present findings. In addition, the gene ontology (GO) results are mentioned in the text, but are not presented. Showing the complete GO analysis for both up and downregulated genes will help the reader to better understand the RNA-seq results. Notably, the results shown in Supplementary Figure on GRIN2A and GRIN2B expression (with values of 300-700 counts versus 2000-4000 counts, respectively) clearly indicate that in both WT and TS21 cultures the NMDA developmental switch has not occurred yet at the 50 days timepoint.

    We now show volcano plots in Supplementary Fig. 11.

    1. The measure of hyperpolarization-activated currents shown in Figure 5 lack proper control experiments. First, the hyperpolarizing current in TS21 cells do not reach a steady-state as the controls. The two curves are therefore hard to compare. To exclude possible difference in kinetic activation, the authors should have prolonged the current injection period (1-2 seconds). Second, to ultimately prove that such currents are mediated by HCN channels in WT cells the authors should perform some control experiments with a specific HCN blocker. A good example of a suitable protocol, with also current blockers to exclude all other possible current contributions, is the one reported in Matt et al Cell. Mol. Life Sci. 68, 125-137 (2011).

    2.7) We thank the reviewer for this detailed and helpful comment. We agree that to definitively identify the recorded currents as Ih, it would be necessary to isolate them pharmacologically using specific HCN channel blockers and appropriate controls, such as those described in Matt et al., Cell. Mol. Life Sci. Unfortunately, due to current constraints, we no longer have access to the animals used in this study and cannot allocate the necessary time or resources, we are unable to perform the additional experiments at this stage.

    However, our goal here was to use electrophysiological recordings as an indication of altered HCN channel activity, which we then support with molecular evidence. We now emphasize this point more clearly in the revised manuscript.

    1. The manuscript lacks information on the statistical analysis used. Also, the numerosity of samples is not clear. Were the dots shown in some graph technical replicates from a single neuronal induction or were all independent neuronal inductions or a mix of the two ? Please clarify.

    We now clarify the numbers in the Figure legend.

    1. The method section lacks important information to guarantee reproducibility. Just a few examples: • Only electrophysiology methods for slice are reported, but not for in vitro culture.

    We now clarify these details in the methods.

    Details on Laminin coating is lacking. What concentration was used ? Was poly-ornithine or poly-lysine used before Laminin coating ? We now clarify these details in the methods.

    How long cells were switched to BrainPhys medium before calcium imaging ? We now clarify these details in the methods.

    Minor point/typos etc.

    Introduction • Page 4 line 6: in the line "Trisomy 21 in humans commonly results in a range in developmental and morphological changes in the forebrain ..." "in" could be replaced by "of". We have fixed this. • Page 5 line 2: please remove "an" before the word "another". We have fixed this. • Page 5 line 2: please replace "ecitatory" with "excitatory". We have fixed this typo.

    Results • Page 10 line 25: The concept of "pixel-wise" appears for the first time in this section and could be better introduced to facilitate the understanding of the experiment. • In the "results" section, page 11 line 1 and 4, references are made to "Figure 4D" and "4F," but these figures do not appear to be present in the figure section. Upon reviewing the rest of the section, the data seem to refer to "Figure 3D" and "3E." We have fixed this. Discussion • Page 15 line 20: please replace "synchronised" with "synchronized". We have fixed this typo. • Page 16 line 11: please replace "T21" with "TS21". We have fixed this typo. Methods • Page 19 line 12: "Pens/Strep" has to be replaced by Pen/Strep. We have fixed this typo. • Page 20 line 20: "Tocris Biocience" has to be replaced by "Tocris Bioscience". We have fixed this typo. • Page 21 line 2: "Addegene" has to be replaced by "Addgene". We have fixed this typo. Figures • Figure 3: the schematic experimental design (Fig. 3A) could be enlarged to match the width of the images/graphs below. We have fixed this. • Figure 5: the reviewer suggests resizing/repositioning the graphs in Fig. 1A so that they match the width of those below. We have fixed this. • Figure S1D: In all the figures of the paper, the respective controls for the TS21 1 and TS21 2 lines are labelled as "WT1/WT2," while in these graphs, they are called "Ctrl1" and "Ctrl2." To ensure consistency throughout the paper, it is suggested to change the names in these graphs. We have fixed this. • Figure S4L: The graph is not very clear, especially regarding the significance reported at -50 pA, please modify the graphical visualization and/or add a legend in the caption. We have fixed this.

    Reviewer #2 (Significance (Required)):

    Nature and significance of the advance for the field. The results presented in the manuscript are potentially interesting and useful, but not completely novel (currents deregulation has already been highlighted in mouse models of Down Syndrome).

    2.8) We thank the reviewer for this comment. While we agree that current deregulation has been observed in mouse models of Down syndrome, the novelty and significance of our study lie in demonstrating these alterations directly in human neurons using both in vitro and in vivo xenograft models.

    This is a critical advance because the human cortex has distinct developmental and functional properties not fully recapitulated in mice. In fact, three recent studies have already highlighted significant defects mainly in excitatory neurons within the fetal human DS cortex (Vuong et al., bioRxiv, 2025; Risgaard et al., bioRxiv, 2025; Lattke et al, under revision). Our work builds directly on these observations by providing, for the first time, an electrophysiological and network-level characterization of these human-specific deficits.

    Our findings thus provide translationally relevant insight that is not merely confirmatory but extends previous work by grounding it in a human cellular context.

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    Referee #2

    Evidence, reproducibility and clarity

    Summary

    The manuscript by Peter et al., reports on the neuronal activity and connectivity of iPSC-derived human cortical neurons from Down syndrome (DS) that is caused by caused by trisomy of the human chromosome 21 (TS21).

    Major points:

    Although the manuscript is potentially interesting, the results appear somehow preliminary and need to be corroborated by control experiments and quantifications of effects to fully sustain the conclusions.

    (1) The authors have not assessed the percentage of WT and TS21 cells that acquire a neuronal or glia identity in their cultures. Indeed, the origin of alterations in network activity and connectivity observed in TS21 neurons could simply derive from reduced number of neurons arising from TS21 iPSC. Alternatively, the same alteration in network activity and connectivity could derive from a multitude of other factors including deficits in neuronal development, neurite extension, or intrinsic electrophysiological properties. In the current version of the manuscript, none of these has been investigated.

    (2) Electrophysiological properties of TS21 and WT neurons at day 53/54 in vitro indicate an extremely immature stage of development (i.e. RMP between -36 and -27 mV with most of the cells firing a single action potential after current injection) in the utilized culture conditions: This is far from ideal for in vitro neuronal-network studies. Finally, reduced activity of HCN1 channels should be confirmed by specific recordings isolating or blocking the related current.

    Main points highlighting the preliminary character of the study.

    1. In Figure 1 immunofluorescence images of the neuronal differentiation markers (Tbr1, Ctip2 and Tuj1) are showed. However, no quantification of the percentage of cells expressing these markers for WT and TS21 neurons is reported. On the other hand, simple inspection of the representative images clearly seams to indicate a difference between the two genotypes, with TS21 cultures showing lower number of cells expressing neuronal markers. This quantification should be corroborated by a similar staining for an astrocyte marker (GFAP, but not S100b since is triplicated in DS). This is an extremely important point since it is obvious that any change in the percentage of neurons (or the neuron/astrocyte ratio) in the cultures will strongly affect the resulting network activity (shown in Figure 2) and the connectivity (showed in Figure 4). Possibly, the quantification should be done at the same time points of the calcium imaging experiments.

    2. In Figure 2 the authors show some calcium imaging traces of WT and TS21 cultures at different time points. However, they again do not show any quantification of neuronal activity. A power spectra analysis is shown in Supplementary Figure 2, but only for WT cultures, while in Supplementary Figure 3 a comparison between WT and Ts21 power spectra is done, but only at the 50 day time point, while difference in synchrony are assessed at 60 days. At minimum, the author should include in main Figure 2 the quantification of the mean calcium event rate and mean event amplitude at the different time points and the power spectra analysis for both WT and TS21 cultures at the same timepoints.

    Of note, the synchronized neuronal activity is present in WT cultures at day 60, but totally lost at subsequent time-points (70 and 80 days). The results of this later time points are different from previous data from the same lab (Kirwan et al., 2015). How might these data be explained? It would be important to rule out any potential issues with the health of the culture that could explain the loss of neuronal activity.It would be beneficial to check cell viability at the different time points to exclude possible confounding factors ? A propidium staining or a MTT assay would strongly improve the soundness of the calcium data.

    1. In Figure 3 there is no quantification of the number and/or density of transplanted neurons for WT and TS21, but only representative images. As above, inspection of the representative images seems to show a decrease in cells labeled by the Tbr1 neuronal marker for TS21 cells. Moreover, the in vivo calcium imaging of transplanted WT and TS21 cells lacks most of the quantification normally done in calcium imaging experiments. Are the event rate and event amplitude different between WT and TS21 neurons ? The measure of neuronal synchrony by mean pixel correlation is not well explained, but it looks somehow simplistic. Neuronal synchrony can be more precisely measured by cross-correlation analysis or spike time tiling coefficients on the traces from single-neuron ROI rather than on all pixels in the field of view, as apparently was done here.

    2. The results on reduced neuronal connectivity in Figure 3 look very striking. However, these results should be accompanied by control experiments to verify the number of neuronal cells and neurite extension in WT and Ts21 cultures. These two parameters could indeed strongly influence the results. As the cultures appear to grow in clusters, bright-field images and TuJ1 staining of the cultures will also greatly help to understand the degree of morphological interconnection between the clusters.

    3. The authors performed RNA-seq experiments on day 50 cultures. Why the authors do not show the complete differential gene expression analysis, but only a small subset of genes? A comprehensive volcano plot and the complete list of identified genes with logFC and FDR values would be helpful. If possible, comparison of the present data (particularly on KCN and HCN expression changes) with published and publicly available expression datasets of other human or human Down syndrome iPSC-derived neurons or human Down syndrome brains will greatly increase the soundness of the present findings. In addition, the gene ontology (GO) results are mentioned in the text, but are not presented. Showing the complete GO analysis for both up and downregulated genes will help the reader to better understand the RNA-seq results. Notably, the results shown in Supplementary Figure on GRIN2A and GRIN2B expression (with values of 300-700 counts versus 2000-4000 counts, respectively) clearly indicate that in both WT and TS21 cultures the NMDA developmental switch has not occurred yet at the 50 days timepoint.

    4. The measure of hyperpolarization-activated currents shown in Figure 5 lack proper control experiments. First, the hyperpolarizing current in TS21 cells do not reach a steady-state as the controls. The two curves are therefore hard to compare. To exclude possible difference in kinetic activation, the authors should have prolonged the current injection period (1-2 seconds). Second, to ultimately prove that such currents are mediated by HCN channels in WT cells the authors should perform some control experiments with a specific HCN blocker. A good example of a suitable protocol, with also current blockers to exclude all other possible current contributions, is the one reported in Matt et al Cell. Mol. Life Sci. 68, 125-137 (2011).

    5. The manuscript lacks information on the statistical analysis used. Also, the numerosity of samples is not clear. Were the dots shown in some graph technical replicates from a single neuronal induction or were all independent neuronal inductions or a mix of the two ? Please clarify.

    6. The method section lacks important information to guarantee reproducibility. Just a few examples:

    • Only electrophysiology methods for slice are reported, but not for in vitro culture.
    • Details on Laminin coating is lacking. What concentration was used ? Was poly-ornithine or poly-lysine used before Laminin coating ?
    • How long cells were switched to BrainPhys medium before calcium imaging ?

    Minor point/typos etc.

    Introduction

    • Page 4 line 6: in the line "Trisomy 21 in humans commonly results in a range in developmental and morphological changes in the forebrain ..." "in" could be replaced by "of".
    • Page 5 line 2: please remove "an" before the word "another".
    • Page 5 line 2: please replace "ecitatory" with "excitatory"

    Results

    • Page 10 line 25: The concept of "pixel-wise" appears for the first time in this section and could be better introduced to facilitate the understanding of the experiment.
    • In the "results" section, page 11 line 1 and 4, references are made to "Figure 4D" and "4F," but these figures do not appear to be present in the figure section. Upon reviewing the rest of the section, the data seem to refer to "Figure 3D" and "3E."

    Discussion

    • Page 15 line 20: please replace "synchronised" with "synchronized".
    • Page 16 line 11: please replace "T21" with "TS21".

    Methods

    • Page 19 line 12: "Pens/Strep" has to be replaced by Pen/Strep.
    • Page 20 line 20: "Tocris Biocience" has to be replaced by "Tocris Bioscience".
    • Page 21 line 2: "Addegene" has to be replaced by "Addgene".

    Figures

    • Figure 3: the schematic experimental design (Fig. 3A) could be enlarged to match the width of the images/graphs below.
    • Figure 5: the reviewer suggests resizing/repositioning the graphs in Fig. 1A so that they match the width of those below.
    • Figure S1D: In all the figures of the paper, the respective controls for the TS21 1 and TS21 2 lines are labelled as "WT1/WT2," while in these graphs, they are called "Ctrl1" and "Ctrl2." To ensure consistency throughout the paper, it is suggested to change the names in these graphs.
    • Figure S4L: The graph is not very clear, especially regarding the significance reported at -50 pA, please modify the graphical visualization and/or add a legend in the caption.

    Significance

    Nature and significance of the advance for the field. The results presented in the manuscript are potentially interesting and useful, but not completely novel (currents deregulation has already been highlighted in mouse models of Down Syndrome).

    Work in the context of the existing literature. This work follows the line of evidence that characterizes Down Syndrome in human neurons (Huo, H.-Q. et al. Stem Cell Rep. 10, 1251-1266 (2018); Briggs, J. A. et al. Etiology. Stem Cells 31, 467-478 (2013)), both in vitro and in xenotransplanted mice, by corrborating some important findings already found in animal models (Stern, S., Segal, M. & Moses, E. EBioMedicine 2, 1048-1062 (2015); Cramer, N. P., Xu, X., F. Haydar, T. & Galdzicki, Z. Physiol. Rep. 3, e12655 (2015); Stern, S., Keren, R., Kim, Y. & Moses, E. http://biorxiv.org/lookup/doi/10.1101/467522 (2018) doi:10.1101/467522.

    Audience. Scientists in the field of pre-clinical biomedical research, especially those working on neurodevelopmental disorders and iPSC-based non-animal models.

    Field of expertise. In vitro electrophysiology, Neurodevelopmental disorders, Down Syndrome, ips cells.

  6. Review Commons

    Note: This preprint has been reviewed by subject experts for Review Commons. Content has not been altered except for formatting.

    Learn more at Review Commons

    Referee #1

    Evidence, reproducibility and clarity

    Summary

    The study investigates the neurodevelopmental impact of trisomy 21 on human cortical excitatory neurons derived from induced pluripotent stem cells (hiPSCs). Key findings include a modest reduction in spontaneous firing, a marked deficit in synchronized bursting, decreased neuronal connectivity, and altered ion channel expression-particularly a downregulation of voltage‐gated potassium channels and HCN1. These conclusions are supported by a combination of in vitro calcium imaging, electrophysiological recordings, viral monosynaptic tracing, RNA sequencing, and in vivo transplantation with two‐photon imaging.

    Major Comments

    • Convincing Nature of Key Conclusions: The study's conclusions are generally well supported by a diverse set of experimental approaches. However, certain claims regarding the intrinsic properties of the excitatory network would benefit from further qualification. In particular, the assertion that reduced synchronization is solely attributable to altered ion channel expression might be considered somewhat preliminary without additional corroborative experiments.
    • One major limitation of the current experimental design is the reliance on predominantly excitatory neuronal cultures derived from hiPSCs. Although the authors convincingly demonstrate differences in network synchronization and connectivity between trisomic (TS21) and control neurons, the almost exclusive focus on excitatory cells limits the physiological relevance of the in vitro network. In the developing cortex, interneurons and astrocytes play crucial roles in modulating network excitability, synaptogenesis, and plasticity. Therefore, incorporating these cell types-either through co-culture systems or through directed differentiation protocols that yield a more heterogeneous neuronal population-could help to determine whether the observed deficits are intrinsic to excitatory neurons or are compounded by a lack of proper inhibitory regulation and glial support.
    • Furthermore, the assessment of neuronal connectivity via pseudotyped rabies virus tracing, while innovative, has inherent limitations. The quantification of connectivity as a ratio of red-to-green fluorescence pixels may be influenced by differential viral infection efficiencies, variations in the expression levels of the TVA receptor, or even by the lower basal activity levels observed in TS21 cultures. Complementary approaches-such as electron microscopy for synaptic density analysis or functional connectivity measurements using multi-electrode arrays (MEAs)-could provide additional structural and functional insights that would validate the rabies tracing data.
    • Qualification of Claims: Some conclusions, particularly those linking specific ion channel dysregulation (e.g., HCN1 loss) directly to network deficits, might be better presented as preliminary. The authors could temper their language to indicate that while the evidence is suggestive, the mechanistic link remains to be fully established.
    • Need for Additional Experiments: Additional experiments that could further consolidate the current findings include:
      • Inclusion of Inhibitory Neurons or Co-culture Systems: Incorporating interneurons or astrocytes would help determine whether the observed deficits are solely intrinsic to excitatory neurons.
      • Alternative Connectivity Assessments: Complementing the rabies virus tracing with electron microscopy or multi-electrode array (MEA) recordings would add structural and functional validation of the connectivity differences.
      • Extended Temporal Profiling: Monitoring network activity over a longer developmental window would clarify whether the observed deficits represent a delay or a permanent alteration in network maturation.
    • Reproducibility and Statistical Rigor: The methods and data presentation are largely clear, with adequate replication and appropriate statistical analyses. Nonetheless, a more detailed description of the experimental replicates, particularly regarding the viral tracing and in vivo transplantation studies, would enhance reproducibility. The availability of raw data and scripts for calcium imaging analysis would also further support independent verification.

    Minor Comments

    • Experimental Details:

    Minor revisions could include clarifying the infection efficiency and expression levels of the viral constructs used in connectivity assays to rule out technical variability.

    • Literature Context:

    The authors reference prior studies appropriately; however, integrating a brief discussion comparing their findings with alternative DS models (e.g., organoids or other hiPSC-derived systems) would improve contextual clarity.

    • Presentation and Clarity:

    Figures are generally clear,.But the manuscript contains a minor labeling error. On page 13, the figure is erroneously labeled as "Fig6A", whereas, based on the context and corresponding data, it should be "Fig5A". I recommend that the authors correct this mistake to ensure consistency and avoid potential confusion for readers.

    Significance

    • Nature and Significance of the Advance:

    The work offers a substantial conceptual advance by providing a mechanistic link between trisomy 21 and impaired neuronal network synchronization. Technically, the study integrates state-of-the-art imaging, electrophysiology, and transcriptomic profiling, thereby offering a multifaceted view of DS-related neural dysfunction. Clinically, the findings have the potential to inform future therapeutic strategies targeting network connectivity and ion channel function in Down syndrome.

    • Context in the Existing Literature:

    The study builds on previous observations of altered network activity in DS patients and DS mouse models (e.g., altered EEG synchronization and reduced synaptic connectivity). It extends these findings to human-derived neuronal models, thus bridging a gap between clinical observations and molecular/cellular mechanisms. Relevant literature includes studies on DS neurodevelopment and the role of ion channels in synaptic maturation.

    • Target Audience:

    The reported findings will be of interest to researchers in neurodevelopmental disorders, Down syndrome, and ion channel physiology. Additionally, the study may attract the attention of those working on hiPSC-derived models of neurological diseases, as well as clinicians interested in the pathophysiology of DS.

    • Keywords and Field Contextualization:

    Keywords: Down syndrome, trisomy 21, neuronal connectivity, synchronized network activity, hiPSC-derived cortical neurons, ion channel dysregulation.

  7. Version published to 10.1101/2024.12.27.630530 on bioRxiv