Mutations in the GDAP1 gene cause different forms of Charcot-Marie-Tooth (CMT) disease, and the primary clinical expression of this disease is markedly variable in the dominant inheritance form (CMT type 2K; CMT2K), in which carriers of the GDAP1 p.R120W mutation can display a wide range of clinical severity. Here, the authors investigated the junctophilin-1 (JPH1) gene as a genetic modifier of clinical expression variability because JPH1 is a good positional and functional candidate. They demonstrated that the JPH1-GDAP1 cluster forms a paralogon and is conserved in vertebrates. Moreover, both proteins play a role in Ca2+ homeostasis; JPH1 is able to restore the store-operated Ca2+ entry (SOCE) activity in GDAP1-silenced cells. After the mutational screening of JPH1 in a series of 24 CMT2K subjects who harbour the GDAP1 p.R120W mutation, the authors characterized the JPH1 p.R213P mutation in one patient with a more severe clinical picture. JPH1p.R213P cannot rescue the SOCE response in GDAP1-silenced cells. They observed that JPH1 colocalizes with STIM1, which is the activator of SOCE, in endoplasmic reticulum-plasma membrane puncta structures during Ca2+ release in a GDAP1-dependent manner. However, when GDAP1p.R120W is expressed, JPH1 seems to be retained in mitochondria. They also established that the combination of GDAP1p.R120W and JPH1p.R213P dramatically reduces SOCE activity, mimicking the effect observed in GDAP1 knock-down cells. In summary, JPH1 and GDAP1 share a common pathway and depend on each other; therefore, JPH1 can contribute to the phenotypical consequences of GDAP1 mutations.
