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Original Research

Frontiers in Neuroscience ·

Volume 20 - 2026 | https://doi.org/10.3389/fnins.2026.1954412

Identification of microglia-associated hub genes and a CX3CR1/P2RY12 two-gene diagnostic model for cross-subtype epilepsy-associated cortical malformations: integrated transcriptomic analysis with external validation

  • Hongliang Zeng1*corresponding author
  • Bin Li1
  1. Ganzhou Hospital-Nanfang Hospital, Southern Medical University (Ganzhou People’s Hospital), Ganzhou, China
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Abstract

Focal cortical dysplasia (FCD) and tuberous sclerosis complex (TSC) are major causes of drug-resistant epilepsy, yet shared molecular mechanisms across these structurally distinct malformations remain poorly characterized. We performed an integrated transcriptomic analysis of RNA-seq data from GSE256068 [85 samples: 64 cortical (FCD2a, FCD2b, TSC, controls) and 21 hippocampal (TLE-HS, controls)]. Differential expression analysis with limma identified 865, 1,915, 2,772, and 3,749 DEGs in FCD2a, FCD2b, TSC, and TLE-HS versus controls, respectively, with 49 shared DEGs across all four subtypes. Weighted gene co-expression network analysis (WGCNA) identified the brown and red modules as key disease-associated modules. By intersecting WGCNA hub genes (|GS| > 0.5, |MM| > 0.8) with shared DEGs, we identified 15 hub genes, all functionally associated with microglia/myeloid lineage, including IRF8, TLR7, CX3CR1, P2RY12, C3AR1, and CCR1. Gene set enrichment analysis (GSEA) revealed 15 KEGG pathways consistently enriched across all subtypes, converging on Toll-like receptor, NF-kB, chemokine, and complement signaling. Immune deconvolution using MCP-counter and xCell confirmed elevated monocytic lineage and T cell infiltration in disease cortex, with monocytic scores showing a positive trend with seizure frequency. A two-gene logistic regression model (CX3CR1 + P2RY12), selected by LASSO and random forest, achieved a training AUC of 0.979 and a nested five-fold cross-validation AUC of 0.862 (95% CI: 0.693–1.000), with an external validation AUC of 0.865 (95% CI: 0.681–1.000) in GSE213488. Drug repurposing via Enrichr identified vorinostat (HDAC inhibitor) as a top candidate, and IRF8 was predicted as the master transcriptional regulator. In vitro , mTOR activation with MHY1485 preserved P2ry12 expression in BV-2 microglia, whereas LPS stimulation induced its loss, supporting a distinct microglia/myeloid-associated program driven by mTOR hyperactivity. These findings demonstrate that cross-subtype transcriptomic convergence on microglial innate immune activation represents a unifying molecular mechanism in FCD and TSC, and that CX3CR1 and P2RY12 together constitute a two-gene diagnostic classifier with encouraging but preliminary performance with potential clinical utility.

Keywords

1 Introduction

Epilepsy affects approximately 50 million people worldwide, with approximately 30% of patients developing resistance to anti-seizure medications despite optimal pharmacotherapy (Thijs et al., 2019). Focal cortical dysplasia (FCD) and tuberous sclerosis complex (TSC) represent the most common structural etiologies encountered in epilepsy surgery series (Blumcke et al., 2017; Najm et al., 2022). FCD is classified histopathologically into types I, IIa, IIb, and III, characterized by cortical dyslamination, dysmorphic neurons, and balloon cells (Blumcke et al., 2017). TSC, caused by loss-of-function mutations in TSC1 or TSC2, produces cortical tubers that share histological features with FCD type IIb (Curatolo et al., 2015). Despite distinct genetic etiologies, the clinical and histopathological overlap suggests shared downstream molecular mechanisms.

Neuroinflammation – particularly microglial activation – is increasingly recognized as a contributor to epilepsy pathogenesis (Eyo et al., 2017; Vezzani et al., 2019). Activated microglia have been demonstrated in surgical specimens from FCD and TSC patients, and TSPO-PET imaging has revealed microglial activation in epileptogenic foci (Gershen et al., 2015). Pro-inflammatory cytokines including IL-1beta, TNF-alpha, and IL-6 are elevated in cerebrospinal fluid and brain tissue from epilepsy patients (Vezzani et al., 2019). However, the transcriptome-wide molecular programs driving microglial activation across different epilepsy subtypes remain incompletely characterized.

Systems biology approaches, including weighted gene co-expression network analysis (WGCNA) and machine learning-based feature selection, offer powerful frameworks for identifying disease-associated gene modules and diagnostic biomarkers from high-dimensional transcriptomic data (Friedman et al., 2010; Langfelder and Horvath, 2008). Gene set enrichment analysis (GSEA) provides complementary information to traditional over-representation analysis by considering the rank order of all genes, enabling detection of coordinated pathway-level changes (Wu et al., 2021). Immune cell deconvolution methods such as MCP-counter and xCell enable characterization of the tissue immune microenvironment from bulk RNA-seq data (Aran et al., 2017; Becht et al., 2016).

In this study, we primarily focused on FCD and TSC as the most common cortical malformations, while also including TLE-HS as a comparator epileptogenic lesion to identify broader shared molecular signatures. Specific aims were: (1) identify shared DEGs across all four subtypes; (2) construct WGCNA co-expression networks and identify cross-subtype hub genes; (3) build and externally validate a multi-gene diagnostic classifier using LASSO and random forest; (4) characterize immune microenvironment alterations using multi-method deconvolution; and (5) perform GSEA, drug repurposing, and transcription factor prediction. In addition, we performed in vitro validation experiments to confirm the protein-level expression patterns of key hub genes under disease-relevant stimulatory conditions.

2 Materials and methods

2.1 Data acquisition and preprocessing

Transcriptomic data were obtained from the Gene Expression Omnibus (GEO)1. The training dataset GSE256068 comprised RNA-seq data from 85 samples in total, including 64 cortical samples (FCD2a, n = 18; FCD2b, n = 18; TSC, n = 14; ControlCortex, n = 14) and 21 hippocampal samples (TLE-HS, n = 8; ControlHippocampus, n = 13), profiled on the Illumina HiSeq platform. Clinical metadata included tissue region, sex, age, and seizure frequency (Supplementary Table 1). The external validation dataset GSE213488 included RNA-seq count data from cortical gray matter samples (FCD2a, n = 7; FCD2b, n = 6; Control, n = 4). Raw count matrices were normalized to log2(CPM+1) values prior to analysis. No ethical approval was required as all data were obtained from publicly available repositories. Principal component analysis of cortical samples is shown in Supplementary Figure 7.

2.2 Differential expression analysis

Differential expression analysis was performed using the limma package (v3.60) in R (v4.5.1) (Ritchie et al., 2015). For cortical samples, the linear model included group (ControlCortex, FCD2a, FCD2b, TSC) and tissue region (temporal, frontal, occipital, parietal) as covariates. For hippocampal samples, the model was ∼ group. Contrasts were constructed for FCD2a vs. ControlCortex, FCD2b vs. ControlCortex, TSC vs. ControlCortex, and TLE-HS vs. ControlHippocampus. DEGs were defined by |log2 fold change| > 1 and Benjamini-Hochberg adjusted P-value < 0.05. Gene IDs were mapped to HGNC symbols using org.Hs.eg.db (v3.19). Intersection analysis was performed using UpSetR and ggVennDiagram (Gao et al., 2021), and volcano plots were generated. As a sensitivity analysis, a three-way intersection restricted to cortical samples (FCD2a, FCD2b, and TSC), excluding hippocampal TLE-HS, was additionally performed (Supplementary Figure 6), which identified 564 shared DEGs across the three cortical groups. All 49 four-way shared DEGs remained shared among the three cortical groups, and all 15 hub genes and all 15 KEGG pathways were retained, confirming that the core immune-related signature is robust to the exclusion of TLE-HS.

2.3 Weighted gene co-expression network analysis

Weighted gene co-expression network analysis was performed using the WGCNA package (v1.72) (Langfelder and Horvath, 2008). The top 5,000 most variable genes (by median absolute deviation) from cortical samples were used to construct a signed co-expression network with soft-thresholding power beta = 4 (scale-free R-squared > 0.85). Modules were identified using dynamic tree cutting (deepSplit = 2, minModuleSize = 30) and merged at a cut height of 0.25. Module eigengenes were correlated with clinical traits. The complete module gene assignments are provided in Supplementary Table 3. Module membership (MM) and gene significance for TSC (GS.TSC) were calculated using TSC as a representative disease phenotype because TSC is driven by a well-defined monogenic pathway (TSC1/TSC2-mTORC1) and showed the strongest association with the brown module. Importantly, this choice does not bias the final gene set toward TSC-specific genes: hub gene candidates were additionally required to overlap with the 49 DEGs shared across all four subtypes, ensuring cross-subtype differential expression. Gene significance for FCD2a and FCD2b was also computed for the 15 hub genes (Supplementary Table 4). Hub genes were defined by: (1) |GS.TSC| > 0.5; (2) |MM| > 0.8 in brown or red modules; (3) membership in the 49 shared DEGs. In silico node deletion analysis (also termed virtual knockout) was performed by computing mean connectivity of the brown module TOM before and after removing each gene.

2.4 Functional enrichment analysis

Over-representation analysis (ORA) of Gene Ontology (GO) and KEGG pathways was performed using clusterProfiler (v4.16) with Benjamini-Hochberg correction (adjusted P < 0.05) (Wu et al., 2021). Gene set enrichment analysis (GSEA) was performed using clusterProfiler::gseKEGG and gseGO with gene lists ranked by log2 fold change for each comparison. KEGG pathways significantly enriched (adjusted P < 0.05) in all four comparisons were identified as cross-subtype common pathways (Supplementary Tables 5, 6).

2.5 Protein-protein interaction network

A protein-protein interaction (PPI) network was constructed using the STRING database (v12.0) with a minimum interaction score of 0.4 (Szklarczyk et al., 2023).

2.6 Immune cell infiltration analysis

Immune cell infiltration was assessed using MCP-counter (Becht et al., 2016) and independently cross-validated using xCell (Aran et al., 2017). Differences across groups were assessed by Kruskal-Wallis tests, and associations with clinical variables were evaluated by Spearman correlation and partial correlation analysis (ppcor package).

2.7 Diagnostic model construction and validation

The 15 identified hub genes were used as the input feature set for machine learning-based feature selection. LASSO logistic regression (glmnet v4.1, lambda.min, 5-fold CV) (Friedman et al., 2010) and random forest (randomForest v4.7, 500 trees) (Breiman, 2001) were applied to identify the most discriminative features. For random forest, variable importance was assessed by mean decrease in Gini impurity with ntree = 500 and default mtry (square root of the number of features). Genes selected by both algorithms were used to construct a multi-gene logistic regression model. Performance was assessed by ROC-AUC (pROC v1.19) (Robin et al., 2011). To avoid information leakage, feature selection was performed within each cross-validation fold using a nested approach: within each training fold, LASSO and random forest were applied to select features, and the resulting model was evaluated on the held-out fold. Across the five folds, CX3CR1 was selected in all five folds and P2RY12 in four of five folds, supporting their robustness as diagnostic features. The model was subsequently evaluated by internal 5-fold cross-validation and external validation on GSE213488. For cross-platform validation, expression values in both datasets were log2(CPM+1)-transformed to ensure comparability. No explicit batch correction was applied, and this is acknowledged as a limitation.

2.8 Drug repurposing and transcription factor prediction

Drug repurposing and transcription factor enrichment were performed using Enrichr (Chen et al., 2013) with the 15 hub genes as input, querying the DSigDB, DrugMatrix, ChEA_2022, and TRRUST databases. miRNA target prediction was performed using TargetScan and miRTarBase. Terms with adjusted P < 0.05 were considered significant.

2.9 Statistical analysis

All analyses were performed in R v4.5.1 with Bioconductor 3.20. Multiple testing was corrected using the Benjamini-Hochberg method. Group comparisons used Kruskal-Wallis or Wilcoxon rank-sum tests. Correlations were assessed using Spearman’s rho. Partial correlation controlled for age, sex, and disease subtype. P < 0.05 was considered significant.

For in vitro experiments, comparisons among the three groups (Control, LPS, MHY1485) were performed using one-way ANOVA followed by Tukey post-hoc test. Data are presented as mean ± SEM from three independent experiments. P < 0.05 was considered statistically significant.

2.10 Cell culture and in vitro validation

BV-2 murine microglial cells were cultured in DMEM supplemented with 10% fetal bovine serum at 37 °C with 5% CO2. Cells were divided into three groups (n = 3 per group): (1) Control group, treated with phosphate-buffered saline (PBS); (2) LPS group, stimulated with lipopolysaccharide (100 ng/mL, 24 h) to induce classical neuroinflammation; and (3) MHY1485 group, treated with MHY1485 (10 μM, 24 h), a potent mTORC1 activator (Laplante and Sabatini, 2012), to mimic the mTOR pathway hyperactivation characteristic of FCD and TSC (Weichhart et al., 2008).

TABLE 1. Top 20 differentially expressed genes per comparison.

ENSEMBLSymbollogFCAveExprP-valueadj.P valComparison
ENSG00000232810TNF4.279914−0.720456.44E-139.19E-09FCD2a_vs_Control
ENSG00000273409LINC027122.536294−0.317456.48E-139.19E-09FCD2a_vs_Control
ENSG00000110876SELPLG2.4441574.2845531.58E-121.49E-08FCD2a_vs_Control
ENSG00000166428PLD42.4985123.6605073.13E-122.22E-08FCD2a_vs_Control
ENSG00000265206MIR142HG3.284463−0.860745.69E-122.85E-08FCD2a_vs_Control
ENSG00000132744ACY33.6599571.9631717.00E-122.85E-08FCD2a_vs_Control
ENSG00000073737DHRS93.2322712.0742827.04E-122.85E-08FCD2a_vs_Control
ENSG00000168329CX3CR13.2654245.3759531.89E-116.72E-08FCD2a_vs_Control
ENSG00000181631P2RY132.9578833.1641252.81E-118.87E-08FCD2a_vs_Control
ENSG00000161911TREML12.6491090.0653194.98E-111.41E-07FCD2a_vs_Control
ENSG00000169313P2RY122.505755.3979871.82E-104.43E-07FCD2a_vs_Control
ENSG00000261795NA2.877052−0.044761.87E-104.43E-07FCD2a_vs_Control
ENSG00000183160TMEM1192.2241813.6163542.18E-104.76E-07FCD2a_vs_Control
ENSG00000159958TNFRSF13C1.8302691.666372.81E-105.69E-07FCD2a_vs_Control
ENSG00000227039ITGB2-AS12.5204110.9132366.83E-101.27E-06FCD2a_vs_Control
ENSG00000130300PLVAP1.7961151.7066697.14E-101.27E-06FCD2a_vs_Control
ENSG00000168334XIRP14.292975−0.546097.95E-101.33E-06FCD2a_vs_Control
ENSG00000198019NA2.3892861.9649979.28E-101.46E-06FCD2a_vs_Control
ENSG00000182557SPNS32.423581−0.297911.24E-091.86E-06FCD2a_vs_Control
ENSG00000184574LPAR51.9350752.5807291.52E-092.16E-06FCD2a_vs_Control
ENSG00000110876SELPLG2.8080674.2845532.18E-174.23E-13FCD2b_vs_Control
ENSG00000265206MIR142HG3.870079−0.860743.39E-174.23E-13FCD2b_vs_Control
ENSG00000232810TNF4.713434−0.720455.37E-174.23E-13FCD2b_vs_Control
ENSG00000166428PLD42.8624173.6605075.97E-174.23E-13FCD2b_vs_Control
ENSG00000132744ACY34.2656041.9631717.46E-174.23E-13FCD2b_vs_Control
ENSG00000181631P2RY133.2488373.1641256.37E-153.01E-11FCD2b_vs_Control
ENSG00000159958TNFRSF13C2.1329351.666379.67E-153.92E-11FCD2b_vs_Control
ENSG00000168329CX3CR13.4697695.3759531.62E-145.74E-11FCD2b_vs_Control
ENSG00000273409LINC027122.443809−0.317452.13E-146.72E-11FCD2b_vs_Control
ENSG00000233695NA2.8423430.788312.57E-147.30E-11FCD2b_vs_Control
ENSG00000161911TREML12.8391950.0653193.65E-149.40E-11FCD2b_vs_Control
ENSG00000157303SUSD32.4735741.1045249.32E-142.06E-10FCD2b_vs_Control
ENSG00000213316LTC4S1.8256370.8300659.42E-142.06E-10FCD2b_vs_Control
ENSG00000073737DHRS93.1589362.0742821.63E-133.30E-10FCD2b_vs_Control
ENSG00000183160TMEM1192.3957073.6163541.82E-133.45E-10FCD2b_vs_Control
ENSG00000227502MROCKI2.1354941.4788943.08E-135.46E-10FCD2b_vs_Control
ENSG00000182578CSF1R2.1148955.8592038.40E-131.36E-09FCD2b_vs_Control
ENSG00000169313P2RY122.5776695.3979878.90E-131.36E-09FCD2b_vs_Control
ENSG00000164691TAGAP2.1105111.9430329.44E-131.36E-09FCD2b_vs_Control
ENSG00000105122RASAL32.3462582.1303359.55E-131.36E-09FCD2b_vs_Control
ENSG00000166428PLD43.294393.6605072.35E-186.61E-14TSC_vs_Control
ENSG00000110876SELPLG3.120954.2845534.66E-186.61E-14TSC_vs_Control
ENSG00000232810TNF5.182844−0.720451.97E-171.86E-13TSC_vs_Control
ENSG00000168329CX3CR14.2238915.3759536.64E-174.71E-13TSC_vs_Control
ENSG00000204472AIF12.4918743.5248091.27E-166.66E-13TSC_vs_Control
ENSG00000182578CSF1R2.7845655.8592031.64E-166.66E-13TSC_vs_Control
ENSG00000183160TMEM1193.0336683.6163541.64E-166.66E-13TSC_vs_Control
ENSG00000164691TAGAP2.7382961.9430323.70E-161.20E-12TSC_vs_Control
ENSG00000077420APBB1IP2.6926463.5726233.79E-161.20E-12TSC_vs_Control
ENSG00000169313P2RY123.3114235.3979875.42E-161.54E-12TSC_vs_Control
ENSG00000273409LINC027122.840534−0.317457.57E-161.95E-12TSC_vs_Control
ENSG00000184574LPAR52.7007862.5807299.82E-162.32E-12TSC_vs_Control
ENSG00000181631P2RY133.6420493.1641251.08E-152.35E-12TSC_vs_Control
ENSG00000157303SUSD32.9403841.1045241.37E-152.77E-12TSC_vs_Control
ENSG00000140749IGSF62.3697432.6124571.69E-153.19E-12TSC_vs_Control
ENSG00000073737DHRS93.7813612.0742821.85E-153.29E-12TSC_vs_Control
ENSG00000247774PCED1B-AS12.5679511.272872.01E-153.35E-12TSC_vs_Control
ENSG00000162511LAPTM52.4203095.8558492.65E-154.17E-12TSC_vs_Control
ENSG00000233695NA3.215730.788313.07E-154.43E-12TSC_vs_Control
ENSG00000132744ACY34.2305941.9631713.12E-154.43E-12TSC_vs_Control
ENSG00000166428PLD42.324994.0829515.34E-239.59E-19TLE_HS_vs_Control
ENSG00000215417MIR17HG3.606882−1.213939.65E-239.59E-19TLE_HS_vs_Control
ENSG00000132744ACY34.0266432.3438941.01E-229.59E-19TLE_HS_vs_Control
ENSG00000273409LINC027122.2920450.0561962.95E-222.09E-18TLE_HS_vs_Control
ENSG00000110876SELPLG2.167194.9535976.45E-223.52E-18TLE_HS_vs_Control
ENSG00000277632CCL36.3194974.4866877.44E-223.52E-18TLE_HS_vs_Control
ENSG00000267559NA−1.661950.2611241.10E-214.44E-18TLE_HS_vs_Control
ENSG00000181631P2RY132.6616253.8203264.09E-211.45E-17TLE_HS_vs_Control
ENSG00000114120SLC25A360.8324056.4398068.55E-212.69E-17TLE_HS_vs_Control
ENSG00000101335MYL9−2.029013.8072871.11E-203.16E-17TLE_HS_vs_Control
ENSG00000119608PROX23.229791−1.252991.51E-203.89E-17TLE_HS_vs_Control
ENSG00000280234NA−2.210183.5291012.00E-204.72E-17TLE_HS_vs_Control
ENSG00000232810TNF6.5463651.6380462.29E-204.99E-17TLE_HS_vs_Control
ENSG00000083642PDS5B−1.445796.4868452.51E-205.10E-17TLE_HS_vs_Control
ENSG00000235613NSRP1P1−3.67445−0.439953.49E-206.59E-17TLE_HS_vs_Control
ENSG00000287258LOC124901391−2.510222.069011.04E-191.78E-16TLE_HS_vs_Control
ENSG00000196659IFT70B1.0710862.1764781.13E-191.78E-16TLE_HS_vs_Control
ENSG00000260691ANKRD20A1−2.960292.6900981.14E-191.78E-16TLE_HS_vs_Control
ENSG00000230606NA−1.97914.7243421.19E-191.78E-16TLE_HS_vs_Control
ENSG00000198467TPM2−1.887884.6620632.06E-192.92E-16TLE_HS_vs_Control

Total RNA was extracted using TRIzol reagent (Invitrogen) and reverse-transcribed into cDNA using the PrimeScript RT reagent kit (TaKaRa). Quantitative real-time PCR (qPCR) was performed using SYBR Green Master Mix (TaKaRa) on an Applied Biosystems QuantStudio 6 Flex system. Primer sequences, sourced from PrimerBank and published literature, were as follows: Irf8 (Forward: 5′-CAGGTGGGCAAGATCCAGAA-3′, Reverse: 5′-TGGTGAGGAAGTTGGCGATA-3′), Cx3cr1 (Forward: 5′-CCATCTGCTCAGGACCTCAC-3′, Reverse: 5′-CA CCAGACACTCGCCATTTCT-3′), P2ry12 (Forward: 5′-TGCCAT CTGTACCTGCCTTC-3′, Reverse: 5′-CGTCCCTTTTCCCCAT CCAA-3′), Tlr7 (Forward: 5′-GGAAATTGCCCTCGATGTTA-3′, Reverse: 5′-CAAAAATTTGGCCTCCTCAA-3′), and Gapdh (Forward: 5′-AGGTCGGTGTGAACGGATTTG-3′, Reverse: 5′-TGTAGACCATGTAGTTGAGGTCA-3′). Relative mRNA expression was calculated using the 2 to the power of negative delta Ct method with Gapdh as the internal reference.

For Western blot analysis, total protein was extracted using RIPA lysis buffer (Beyotime) containing protease and phosphatase inhibitors, separated by 10% SDS-PAGE, and transferred to PVDF membranes (Millipore). Membranes were blocked with 5% non-fat milk and incubated overnight at 4 °C with the following primary antibodies: anti-IRF8 (1:1000, Proteintech, 18977-1-AP), anti-CX3CR1 (1:500, Proteintech, 29819-1-AP), anti-P2RY12 (1:500, Proteintech, 11976-1-AP), anti-phospho-S6 (Ser240/244) (1:1000, Proteintech, 29220-1-AP), and anti-GAPDH (1:5000, Proteintech, 60004-1-Ig). After washing, membranes were incubated with HRP-conjugated secondary antibodies (1:5000, Proteintech) for 1 h at room temperature. Protein bands were visualized by enhanced chemiluminescence (ECL, Beyotime) and quantified using ImageJ. All experiments were performed using three independent biological replicates (n = 3), each with technical duplicates.

3 Results

3.1 Forty-nine shared DEGs across four epilepsy subtypes

Differential expression analysis identified substantial transcriptomic alterations: 865 DEGs (FCD2a vs. Control), 1,915 DEGs (FCD2b vs. Control), 2,772 DEGs (TSC vs. Control), and 3,749 DEGs (TLE-HS vs. Control) (Figures 1A–D, Supplementary Figure 1, and Table 1). The majority of DEGs were upregulated. Four-way intersection analysis revealed 49 shared DEGs across all subtypes (Figures 1E, F and Supplementary Table 2), all consistently upregulated, indicating a conserved activation signature.

Differential expression analysis across epilepsy subtypes. **(A–D)** Volcano plots for FCD2a, FCD2b, TSC vs. Control, and TLE-HS vs. Control. Red: upregulated; blue: downregulated (|log2FC| > 1, adjusted *P* < 0.05). **(E)** UpSet plot of four-way DEG intersection. **(F)** Venn diagram of shared DEGs.
Figure 1. Differential expression analysis across epilepsy subtypes. (A–D) Volcano plots for FCD2a, FCD2b, TSC vs. Control, and TLE-HS vs. Control. Red: upregulated; blue: downregulated (|log2FC| > 1, adjusted P < 0.05). (E) UpSet plot of four-way DEG intersection. (F) Venn diagram of shared DEGs.

3.2 WGCNA reveals disease-associated immune modules

Weighted gene co-expression network analysis of cortical samples (beta = 4, signed network) identified the brown module (MEbrown) and red module (MEred) as the modules most significantly associated with disease status (Figure 2 and Supplementary Figure 3). Gene Ontology enrichment of brown module genes revealed predominant involvement in immune system processes, inflammatory response, and myeloid leukocyte activation.

Weighted gene co-expression network analysis (WGCNA) module identification. **(A)** Scale-free topology fit and mean connectivity across soft-thresholding powers (selected beta = 4). **(B)** Sample dendrogram with clinical trait heatmap. **(C)** Module-trait correlation heatmap.
Figure 2. Weighted gene co-expression network analysis (WGCNA) module identification. (A) Scale-free topology fit and mean connectivity across soft-thresholding powers (selected beta = 4). (B) Sample dendrogram with clinical trait heatmap. (C) Module-trait correlation heatmap.

3.3 Fifteen hub genes converge on microglial identity

Hub gene screening by GS, MM, and DEG overlap identified 15 hub genes, all functionally associated with microglia/myeloid lineage: IRF8, CLEC7A, CYBB, TLR7, CX3CR1, CCR1, C3AR1, P2RY12, IRF5, CD300C, GPR34, MPEG1, RGS18, LILRA2, and CD84 (Figure 3A–C; Table 2). CX3CR1 and P2RY12 are canonical homeostatic microglial markers (Hickman et al., 2013). IRF8 is a master transcription factor for microglial development (Kierdorf et al., 2013). TLR7 functions as an endosomal innate immune sensor. C3AR1 mediates complement C3a signaling (Stevens et al., 2007). IRF5 and CYBB drive inflammatory effector functions (Takaoka et al., 2005). This highly non-random functional convergence implicates a conserved microglia/myeloid-associated program in epileptic cortex.

Hub gene identification and characterization. **(A)** Three-way intersection (WGCNA hub × shared DEGs × |GS|/|MM| filtering). **(B)** Expression heatmap of 15 hub genes. **(C)** Boxplots of top hub genes across subtypes.
Figure 3. Hub gene identification and characterization. (A) Three-way intersection (WGCNA hub × shared DEGs × |GS|/|MM| filtering). (B) Expression heatmap of 15 hub genes. (C) Boxplots of top hub genes across subtypes.

TABLE 2. Fifteen hub genes identified by WGCNA and three-way DEG overlap.

SymbolENSEMBLGS_TSCGS_pvalueMMMM_pvalueModule
IRF5ENSG0000012860400.427Brown
CYBBENSG0000016516800.228Brown
CCR1ENSG0000016382300.333Brown
CD84ENSG0000006629400.367Brown
IRF8ENSG0000014096800.337Brown
TLR7ENSG0000019666400.344Brown
GPR34ENSG0000017165900.313Brown
C3AR1ENSG0000017186000.452Brown
P2RY12ENSG0000016931300.219Brown
RGS18ENSG0000015068100.324Brown
CX3CR1ENSG0000016832900.347Brown
MPEG1ENSG0000019762900.247Brown
LILRA2ENSG0000023999800.492Brown
CD300CENSG0000016785000.329Brown
CLEC7AENSG0000017224300.475Brown

3.4 GSEA reveals convergent innate immune pathway enrichment

GSEA identified 15 KEGG pathways significantly enriched across all four comparisons (Figure 4, Table 3, and Supplementary Figures 2, 4, 5). The shared pathways clustered into six biological themes: (1) innate immune sensing (Toll-like receptor, NOD-like receptor, C-type lectin receptor signaling); (2) inflammatory signal transduction (NF-kB, JAK-STAT, TNF signaling); (3) immune cell communication (cytokine-cytokine receptor interaction, chemokine signaling); (4) phagocytosis (phagosome, Fc-gamma-R-mediated phagocytosis); (5) complement and coagulation cascades; and (6) hematopoietic/immune cell biology (hematopoietic cell lineage, osteoclast differentiation, Th17 differentiation). Notably, three hub genes directly participate in these pathways: TLR7 in TLR signaling, IRF5/IRF8 in NF-kB signaling, and CCR1/CX3CR1 in chemokine signaling.

Bubble plot of 15 KEGG pathways significantly enriched across all four comparisons. Size: −log10(adjusted P); color: NES.
Figure 4. Bubble plot of 15 KEGG pathways significantly enriched across all four comparisons. Size: −log10(adjusted P); color: NES.

TABLE 3. Fifteen common KEGG pathways significantly enriched across all four comparisons (NES and adjusted P-value).

Pathway IDPathway descriptionFCD2a NESFCD2b NESTSC NESTLE-HS NES
hsa03010Ribosome−2.46***−1.85***−1.37*−2.46***
hsa05323Rheumatoid arthritis2.27***2.32***2.44***2.15***
hsa04740Olfactory transduction−2.18***−1.96***−1.95***−2.02***
hsa04940Type I diabetes mellitus2.31***2.33***2.35***2.04**
hsa04380Osteoclast differentiation2.07***2.06***2.29***1.75**
hsa05140Leishmaniasis2.21***2.39***2.40***1.97**
hsa05332Graft-versus-host disease2.19***2.28***2.35***1.91**
hsa04060Cytokine-cytokine receptor interaction1.82***1.84***2.09***1.78***
hsa04620Toll-like receptor signaling pathway2.01***2.09***2.19***2.27***
hsa04640Hematopoietic cell lineage1.98***2.35***2.33***1.68*
hsa05142Chagas disease1.92***1.90***2.06***2.00***
hsa04064NF-kappa B signaling pathway1.89***1.94***2.07***1.86**
hsa05321Inflammatory bowel disease1.97***2.36***2.37***1.70*
hsa04062Chemokine signaling pathway1.75**1.59**1.70***1.67**
hsa04061Viral protein interaction with cytokine and cytokine receptor1.85**1.99***2.10***1.87**

NES, normalized enrichment score from gene set enrichment analysis. *P < 0.05, **P < 0.01, ***P < 0.001 (adjusted P-value, Benjamini-Hochberg method). Negative NES values indicate downregulation in the disease group.

TABLE 4. Per-gene AUC values across training comparisons and external validation.

GeneFCD2a_vs_ControlFCD2b_vs_ControlTSC_vs_ControlGSE213488
IRF80.873950.8528140.9455780.519
CLEC7A0.8655460.9069260.9285710.731
CYBB0.8151260.8116880.9081630.587
TLR70.873950.8766230.9455780.567
CX3CR10.9789920.976190.9795920.673
CCR10.8361340.8398270.9421770.538
C3AR10.8529410.8831170.9523810.433
P2RY120.9705880.9588740.9795920.846
IRF50.8277310.9350650.976190.471
CD300C0.9159660.8874460.9285710.731
GPR340.9201680.9047620.9625850.731
MPEG10.8529410.9112550.9319730.808
RGS180.7268910.7575760.874150.596
LILRA20.7773110.870130.9319730.596
CD840.9159660.9112550.976190.798

3.5 Myeloid and T-cell infiltration correlates with clinical features

MCP-counter analysis revealed significantly elevated Monocytic lineage and T cell scores in FCD2a, FCD2b, and TSC compared to ControlCortex (Figure 5A). xCell independently confirmed monocyte/macrophage and dendritic cell expansion (Figure 5D). Full xCell immune scores are provided in Supplementary Table 7. Exploratory analyses showed that monocytic lineage scores showed a non-significant positive trend with seizure frequency in FCD2a (Spearman rho = 0.478, P = 0.052; Figure 5B). No correction for multiple comparisons was applied to these exploratory immune-cell/clinical-variable correlation analyses, and T cell scores showed a significant negative correlation with patient age (Spearman rho = −0.373, P = 1.34e-3; Figure 5C).

Immune cell infiltration. **(A)** MCP-counter cell scores. **(B)** Monocytic lineage vs. seizure frequency in FCD2a. **(C)** T cells vs. patient age. **(D)** xCell immune scores.
Figure 5. Immune cell infiltration. (A) MCP-counter cell scores. (B) Monocytic lineage vs. seizure frequency in FCD2a. (C) T cells vs. patient age. (D) xCell immune scores.

3.6 PPI network and virtual knockout analysis

STRING analysis revealed a dense PPI network centered on an IRF8-TLR7-CX3CR1 axis (Figure 6A). While the PPI network highlights the central connectivity of the IRF8-TLR7-CX3CR1 axis, in silico node deletion analysis additionally identified CLEC7A, LILRA2, and IRF5 (followed by C3AR1 and CD84) as the hub genes whose removal caused the largest decreases in brown module connectivity (Figure 6B), providing independent evidence of their structural importance.

Protein-protein interaction (PPI) network and virtual knockout. **(A)** STRING PPI network of 15 hub genes. **(B)** *In silico* node deletion effect on MEbrown connectivity.
Figure 6. Protein-protein interaction (PPI) network and virtual knockout. (A) STRING PPI network of 15 hub genes. (B) In silico node deletion effect on MEbrown connectivity.

3.7 CX3CR1 + P2RY12 two-gene diagnostic model

Individual per-gene ROC curves for all 15 hub genes are shown in Figure 7A. LASSO selected five genes (CX3CR1, C3AR1, P2RY12, IRF5, RGS18), and random forest ranked CX3CR1, P2RY12, GPR34, CD84, and CD300C as the top five features (Figures 7B, C). Algorithm intersection yielded CX3CR1 and P2RY12. A logistic regression model incorporating these two genes achieved an AUC of 0.979 (95% CI: 0.947–1.000) in the training set (Figure 7D). Nested five-fold cross-validation, with feature selection performed within each training fold, yielded an AUC of 0.862 (95% CI: 0.693–1.000), an accuracy of 94.12%, a sensitivity of 97.18%, and a specificity of 78.57%. Across folds, CX3CR1 was selected in all five folds and P2RY12 in four of five folds. External validation on GSE213488 demonstrated an AUC of 0.865 (95% CI: 0.681–1.000, DeLong method; Figure 7E). Per-gene AUC values are reported in Table 3.

Diagnostic model construction and validation. **(A)** Multi-gene ROC curves. **(B)** LASSO cross-validation. **(C)** Random forest variable importance. **(D)** CX3CR1 + P2RY12 model ROC (training). **(E)** External validation ROC (GSE213488).
Figure 7. Diagnostic model construction and validation. (A) Multi-gene ROC curves. (B) LASSO cross-validation. (C) Random forest variable importance. (D) CX3CR1 + P2RY12 model ROC (training). (E) External validation ROC (GSE213488).

3.8 Drug repurposing and transcription factor prediction

Enrichr analysis identified vorinostat (SAHA), an FDA-approved HDAC inhibitor with blood-brain barrier permeability, as a hypothesis-generating drug candidate (adjusted P = 0.042; Figure 8A). This finding is consistent with preclinical studies demonstrating that HDAC inhibition restores synaptic plasticity and seizure threshold in TSC models (Basu et al., 2019). Additional candidates included piperlongumine, emetine, tamibarotene, and ciclopirox. IRF8 was predicted as the top upstream transcription factor (adjusted P = 1.45E-7; Figure 8B), consistent with its dual role as hub gene and master regulator of monocyte/microglial differentiation (Kurotaki et al., 2013).

Drug repurposing and TF prediction. **(A)** Top drug candidates (DSigDB). **(B)** Top upstream transcription factors (ChEA_2022).
Figure 8. Drug repurposing and TF prediction. (A) Top drug candidates (DSigDB). (B) Top upstream transcription factors (ChEA_2022).

3.9 In vitro validation in LPS-stimulated and mTOR-activated BV-2 microglia

To experimentally validate the transcriptomic findings, we examined the expression of four key hub genes in BV-2 microglial cells under two distinct activation paradigms: classical TLR4-mediated inflammation (LPS) and mTOR-driven activation (MHY1485). qPCR analysis revealed that LPS stimulation significantly upregulated Irf8 and Tlr7 mRNA, consistent with their known roles in innate immune activation (Figure 9). Notably, P2ry12 mRNA expression was significantly downregulated in the LPS group compared to Control, whereas it was maintained or slightly upregulated in the MHY1485 group. Cx3cr1 showed a decrease under LPS stimulation but an increase under MHY1485 treatment, mirroring the divergent regulation observed for P2ry12.

*In vitro* qPCR validation in BV-2 microglia. Relative mRNA expression of Irf8, Tlr7, P2ry12, and Cx3cr1 in Control, LPS (100 ng/mL, 24 h), and MHY1485 (10 μM, 24 h) groups. Data are presented as mean ± SEM (*n* = 3). **P* < 0.05, ***P* < 0.01, ****P* < 0.001 vs. Control; #*P* < 0.05 LPS vs. MHY1485 (one-way ANOVA with Tukey *post-hoc* test).
Figure 9. In vitro qPCR validation in BV-2 microglia. Relative mRNA expression of Irf8, Tlr7, P2ry12, and Cx3cr1 in Control, LPS (100 ng/mL, 24 h), and MHY1485 (10 μM, 24 h) groups. Data are presented as mean ± SEM (n = 3). *P < 0.05, **P < 0.01, ***P < 0.001 vs. Control; #P < 0.05 LPS vs. MHY1485 (one-way ANOVA with Tukey post-hoc test).

Western blot analysis confirmed the qPCR findings at the protein level (Figure 10). Irf8 protein was markedly upregulated in both LPS and MHY1485 groups. P2ry12 protein showed divergent regulation: decreased in the LPS group but maintained in MHY1485-treated cells. Phospho-S6 (p-S6) levels were strongly elevated in the MHY1485 group, confirming successful mTORC1 activation, but remained unchanged in the LPS group. These results provide proof-of-concept evidence that mTOR-driven activation preserves P2ry12 expression, whereas classical TLR4-mediated inflammation triggers its loss, providing mechanistic evidence that the homeostatic-to-reactive microglial transition differs fundamentally between these two activation modes.

Western blot validation in BV-2 microglia. Representative Western blot images of Irf8, Cx3cr1, P2ry12, p-S6 (Ser240/244), and GAPDH across the three groups (left), and densitometric quantification of band intensities normalized to GAPDH (right). Data are presented as mean ± SEM (*n* = 3). **P* < 0.05, ***P* < 0.01, ****P* < 0.001 vs. Control.
Figure 10. Western blot validation in BV-2 microglia. Representative Western blot images of Irf8, Cx3cr1, P2ry12, p-S6 (Ser240/244), and GAPDH across the three groups (left), and densitometric quantification of band intensities normalized to GAPDH (right). Data are presented as mean ± SEM (n = 3). *P < 0.05, **P < 0.01, ***P < 0.001 vs. Control.

4 Discussion

In this study, we identified a conserved transcriptomic program of innate immune activation, predominantly microglia/myeloid-associated, across FCD2a, FCD2b, and TSC. The 15 hub genes, all microglia/myeloid-associated, represent a cross-subtype disease module. Several genes warrant focused discussion.

CX3CR1 and P2RY12 are canonical homeostatic microglial markers (Hickman et al., 2013). Although often described as homeostatic markers, both CX3CR1 and P2RY12 can remain highly expressed in certain activated human microglial states, and their marked upregulation in patient tissue likely reflects an expanded microglial population rather than simple per-cell downregulation. This interpretation is supported by our in vitro experiments, which demonstrated that P2ry12 expression was preserved or upregulated under mTOR-driven activation (MHY1485) but was markedly reduced under classical TLR4-mediated inflammation (LPS; Figures 9, 10). These findings are consistent with the established role of P2RY12 in regulating microglial activation states through purinergic signaling (Haynes et al., 2006), and suggest that mTOR pathway hyperactivation, a hallmark of FCD and TSC, drives a distinct microglia/myeloid-associated program that retains features of homeostatic identity. The IRF8-IRF5-TLR7 axis represents a compelling regulatory cascade: IRF8 as master TF (Kierdorf et al., 2013), TLR7 as endogenous RNA sensor (Kawai and Akira, 2010), and IRF5 as pro-inflammatory effector (Takaoka et al., 2005). C3AR1 and complement pathway enrichment implicate complement-mediated synaptic pruning in epileptic network reorganization (Stevens et al., 2007).

Limitations include: retrospective design with public datasets; limited external validation sample size; lack of batch effect correction between training and validation datasets; and the inherent inability of bulk RNA-seq to resolve microglial abundance, activation state, or infiltrating myeloid cells. Cross-region differences between hippocampal TLE-HS and cortical FCD/TSC samples may also contribute to the observed signature, although a three-cortical-group sensitivity analysis confirmed robustness. While in vitro validation using the BV-2 murine microglial cell line provided protein-level confirmation of key hub genes, these findings require further validation in human iPSC-derived microglia or primary human surgical specimens. Additionally, drug predictions remain purely computational and require experimental confirmation. Future directions include scRNA-seq validation, IHC confirmation in surgical specimens, and functional studies using conditional knockout models.

5 Conclusion

Focal cortical dysplasia and TSC share a conserved microglia/myeloid-associated innate immune transcriptomic program. Fifteen hub genes represent a cross-subtype disease module, and CX3CR1 + P2RY12 provide a two-gene diagnostic classifier with encouraging but preliminary performance (training AUC 0.979; nested CV AUC 0.862; external validation AUC 0.865). GSEA reveals convergent TLR, NF-kB, chemokine, and complement pathway enrichment. IRF8 is the predicted master transcriptional regulator, and vorinostat is a candidate therapeutic. These findings support microglia-targeted strategies as a trans-subtype therapeutic approach in drug-resistant epilepsy.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnins.2026.1954412/full#supplementary-material

Supplementary material Supplementary material at the source

Supplementary material Supplementary material at the source

Supplementary material Supplementary material at the source

Per-group multi-gene ROC curves. Supplementary material at the source

GO enrichment dotplots for 49 shared DEGs. Supplementary material at the source

WGCNA module eigengene dendrogram. Supplementary material at the source

Hub gene expression in GSE213488 validation cohort. Supplementary material at the source

GSEA GO BP dotplots for all comparisons. Supplementary material at the source

Cortical-only DEG overlap among FCD2a, FCD2b, and TSC (Venn diagram). Supplementary material at the source

Principal component analysis of cortical samples by disease group. Supplementary material at the source

Sample clinical characteristics (GSE256068). Supplementary material at the source

Full list of 49 shared DEGs. Supplementary material at the source

WGCNA module gene assignments (MEbrown and MEred). Supplementary material at the source

Gene significance (GS) of the 15 hub genes for TSC, FCD2a, and FCD2b. Supplementary material at the source

Complete GSEA KEGG results for the four comparisons. Supplementary material at the source

Complete GSEA GO BP results for the four comparisons. Supplementary material at the source

xCell immune scores. Supplementary material at the source

Footnotes

Edited by: Jihoon Nah, Chungbuk National University, Republic of Korea

Reviewed by: Paolo Milazzo, University of Pisa, Italy

Haifeng Ran, The Affiliated Hospital of Zunyi Medical University, China

Footnotes

https://www.ncbi.nlm.nih.gov/geo/

Statements

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Data availability

The data are publicly available in the GEO repository under accession numbers GSE213488 and GSE213488.

Author contributions

HZ: Conceptualization, Data curation, Formal analysis, Methodology, Software, Validation, Writing – original draft, Writing – review & editing. BL: Data curation, Software, Writing – review & editing.

Acknowledgements

We thank the investigators who deposited their data in the GEO public repository.

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Citation

Zeng, H. & Li, B. (2026). Identification of microglia-associated hub genes and a CX3CR1/P2RY12 two-gene diagnostic model for cross-subtype epilepsy-associated cortical malformations: integrated transcriptomic analysis with external validation. Frontiers in Neuroscience, Volume 20. https://doi.org/
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Copyright © 2026 Zeng and Li.

License: https://creativecommons.org/licenses/by/4.0/

*Correspondence: Hongliang Zeng

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