EpiPred: A gene-specific machine learning model for classifying missense variants in the epilepsy-related gene STXBP1

Missense variants in the STXBP1 gene are a frequent cause of early-onset developmental and epileptic encephalopathies and related neurodevelopmental disorders, but the clinical interpretation of these variants remains a major challenge. Most reported STXBP1 missense variants are classified as variants of uncertain significance (VUS), complicating diagnosis, counseling, and patient eligibility for precision therapies. Here, we developed EpiPred, a gene-specific machine learning classifier that predicts the pathogenicity of STXBP1 missense variants by integrating computational features with empirical evidence from cellular assays. Trained on a curated set of pathogenic and benign variants, EpiPred outperformed leading global prediction tools in accuracy, sensitivity, and specificity. We validated the models predictions using functional assays that measure protein abundance, solubility, stability, and interaction with the SNARE complex partner syntaxin 1. These biochemical readouts aligned closely with model outputs and enabled reclassification of several likely misdiagnosed variants. We deployed EpiPred in an interactive web application that allows clinicians, researchers, and patients to explore predictions for all possible missense variants in STXBP1. Our approach illustrates the power of gene-specific predictive modeling combined with experimental validation to improve variant interpretation and diagnostic resolution. By identifying likely pathogenic STXBP1 variants, including those that may respond to emerging therapies such as molecular chaperones, EpiPred supports more precise genetic diagnoses and offers a generalizable framework for other clinically relevant genes in neurological disease. ONE SENTENCE SUMMARYEpiPred improves STXBP1 variant interpretation, enabling precision genetic diagnoses and promoting access to targeted precision therapies