1. Correction: Deletion of Nkx2-5 in trabecular myocardium reveals the developmental origins of pathological heterogeneity associated with ventricular non-compaction cardiomyopathy
- Author
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Caroline Choquet, Thi Hong Minh Nguyen, Pierre Sicard, Emeline Buttigieg, Thi Thom Tran, Frank Kober, Isabelle Varlet, Rachel Sturny, Mauro W. Costa, Richard P. Harvey, Catherine Nguyen, Pascal Rihet, Sylvain Richard, Monique Bernard, Robert G. Kelly, Nathalie Lalevée, and Lucile Miquerol
- Subjects
Cancer Research ,Immunofluorescence ,Severity of Illness Index ,Diagnostic Radiology ,Mice ,Electrocardiography ,Morphogenesis ,Medicine and Health Sciences ,Genetics (clinical) ,Sequence Deletion ,Mice, Knockout ,Isolated Noncompaction of the Ventricular Myocardium ,Radiology and Imaging ,Gene Expression Regulation, Developmental ,Heart ,Animal Models ,Magnetic Resonance Imaging ,Up-Regulation ,Bioassays and Physiological Analysis ,Experimental Organism Systems ,Homeobox Protein Nkx-2.5 ,cardiovascular system ,Female ,Anatomy ,Research Article ,lcsh:QH426-470 ,Imaging Techniques ,Cardiac Ventricles ,Heart Ventricles ,Mouse Models ,Research and Analysis Methods ,Purkinje Fibers ,Model Organisms ,Diagnostic Medicine ,Genetics ,Animals ,Humans ,Immunoassays ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Heart Failure ,Homeodomain Proteins ,Gene Expression Profiling ,Myocardium ,Electrophysiological Techniques ,Correction ,Biology and Life Sciences ,Fibrosis ,Disease Models, Animal ,lcsh:Genetics ,Cardiovascular Anatomy ,Immunologic Techniques ,Cardiac Electrophysiology ,Developmental Biology - Abstract
Left ventricular non-compaction (LVNC) is a rare cardiomyopathy associated with a hypertrabeculated phenotype and a large spectrum of symptoms. It is still unclear whether LVNC results from a defect of ventricular trabeculae development and the mechanistic basis that underlies the varying severity of this pathology is unknown. To investigate these issues, we inactivated the cardiac transcription factor Nkx2-5 in trabecular myocardium at different stages of trabecular morphogenesis using an inducible Cx40-creERT2 allele. Conditional deletion of Nkx2-5 at embryonic stages, during trabecular formation, provokes a severe hypertrabeculated phenotype associated with subendocardial fibrosis and Purkinje fiber hypoplasia. A milder phenotype was observed after Nkx2-5 deletion at fetal stages, during trabecular compaction. A longitudinal study of cardiac function in adult Nkx2-5 conditional mutant mice demonstrates that excessive trabeculation is associated with complex ventricular conduction defects, progressively leading to strain defects, and, in 50% of mutant mice, to heart failure. Progressive impaired cardiac function correlates with conduction and strain defects independently of the degree of hypertrabeculation. Transcriptomic analysis of molecular pathways reflects myocardial remodeling with a larger number of differentially expressed genes in the severe versus mild phenotype and identifies Six1 as being upregulated in hypertrabeculated hearts. Our results provide insights into the etiology of LVNC and link its pathogenicity with compromised trabecular development including compaction defects and ventricular conduction system hypoplasia., Author summary During fetal heart morphogenesis, formation of the mature ventricular wall requires coordinated compaction of the inner trabecular layer and growth of the outer layer of myocardium. Arrested trabecular development has been implicated in the pathogenesis of hypertrabeculation associated with ventricular non-compaction cardiomyopathy. However much uncertainty still exists among clinicians concerning the physiopathology of ventricular non-compaction cardiomyopathy, including its clinical characteristics, prognosis, classification and even the definition of hypertrabeculation. In particular, distinguishing between pathological and non-pathological subtypes of non-compaction is currently a major issue. Here we show that deletion of the gene encoding the transcription factor Nkx2-5 at critical steps during trabecular development recapitulates pathological features of hypertrabeculation, providing the first model of ventricular non-compaction cardiomyopathy in adult mice. We demonstrate that excessive trabeculation due to failure of trabecular compaction during fetal development is associated with Purkinje fiber hypoplasia and subendocardial fibrosis. Longitudinal functional studies reveal that these mice present all the clinical signs of symptomatic left ventricular non-compaction cardiomyopathy, including conduction defects, strain defects and progressive heart failure. Our results, including transcriptomic analysis, suggest that pathological features of non-compaction are primarily developmental defects. This study clarifies the origin of the pathological outcomes associated with LVNC and may provide helpful information for clinicians concerning the etiology of this rare cardiomyopathy.
- Published
- 2018