Liu Xiaoqin, Yagi Hisato, Saeed Shazina, Bais Abha S, Gabriel George C, Chen Zhaohan, Peterson Kevin A, Li You, Schwartz Molly C, Reynolds William T, Saydmohammed Manush, Gibbs Brian, Wu Yijen, Devine William, Chatterjee Bishwanath, Klena Nikolai T, Kostka Dennis, de Mesy Bentley Karen L, Ganapathiraju Madhavi K, Dexheimer Phillip, Leatherbury Linda, Khalifa Omar, Bhagat Anchit, Zahid Maliha, Pu William, Watkins Simon, Grossfeld Paul, Murray Stephen A, Porter George A, Tsang Michael, Martin Lisa J, Benson D Woodrow, Aronow Bruce J, Lo Cecilia W
Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
The Jackson Laboratory, Bar Harbor, Maine, USA.
Nat Genet. 2017 Jul;49(7):1152-1159. doi: 10.1038/ng.3870. Epub 2017 May 22.
Congenital heart disease (CHD) affects up to 1% of live births. Although a genetic etiology is indicated by an increased recurrence risk, sporadic occurrence suggests that CHD genetics is complex. Here, we show that hypoplastic left heart syndrome (HLHS), a severe CHD, is multigenic and genetically heterogeneous. Using mouse forward genetics, we report what is, to our knowledge, the first isolation of HLHS mutant mice and identification of genes causing HLHS. Mutations from seven HLHS mouse lines showed multigenic enrichment in ten human chromosome regions linked to HLHS. Mutations in Sap130 and Pcdha9, genes not previously associated with CHD, were validated by CRISPR-Cas9 genome editing in mice as being digenic causes of HLHS. We also identified one subject with HLHS with SAP130 and PCDHA13 mutations. Mouse and zebrafish modeling showed that Sap130 mediates left ventricular hypoplasia, whereas Pcdha9 increases penetrance of aortic valve abnormalities, both signature HLHS defects. These findings show that HLHS can arise genetically in a combinatorial fashion, thus providing a new paradigm for the complex genetics of CHD.
先天性心脏病(CHD)在活产婴儿中的发病率高达1%。尽管复发风险增加表明存在遗传病因,但散发性病例表明CHD的遗传学机制很复杂。在此,我们表明,严重的先天性心脏病——左心发育不全综合征(HLHS)具有多基因性且基因异质性。利用小鼠正向遗传学方法,据我们所知,我们首次分离出HLHS突变小鼠并鉴定出导致HLHS的基因。来自七个HLHS小鼠品系的突变在与HLHS相关的十个人类染色体区域显示出多基因富集。Sap130和Pcdha9基因的突变此前未与CHD相关联,通过小鼠体内的CRISPR-Cas9基因组编辑验证,这两个基因是HLHS的双基因病因。我们还鉴定出一名患有HLHS且携带SAP130和PCDHA13突变的患者。小鼠和斑马鱼模型显示,Sap130介导左心室发育不全,而Pcdha9增加主动脉瓣异常的外显率,这两者都是典型的HLHS缺陷。这些发现表明,HLHS可能以组合方式通过遗传产生,从而为CHD复杂的遗传学机制提供了一种新的范例。