It has been estimated that about 1% of live births carry severe congenital heart defects and 20-30% among them have valve malformations. Despite its medical importance the underlying cause of many valvular diseases remains undiscovered. Thus, it is important to identify genes that play a crucial role in cardiac valve formation and maturation.
A temporal RNA expression analysis of heart development suggested that the extracellular matrix protein Nephronectin might be a novel regulator of valve development and/or trabeculation. Nephronectin is transiently expressed during rat heart development at the time of heart valve morphogenesis and trabeculation. Moreover, the extracellular matrix is known to be crucial for organogenesis. It is a complex, dynamic and critical component that regulates cell behavior by modulating the activity, bioavailability, or presentation of growth factors to cell surface receptors.
In order to verify the hypothesis that Nephronectin is a novel regulator of valve formation and/or trabeculation the zebrafish was chosen as model system. Females are able to spawn at intervals of 5 days laying hundreds of eggs in each clutch. Development progresses rapidly with precursors to all major organs appearing within 36 hours post fertilization. Zebrafish embryos develop externally, are translucent and continue to grow for several days despite developing severely malformed, non functional hearts. In addition, gene expression can be easily modulated. During the present study it has been shown that Nephronectin expression is correlated to valve development and trabeculation. Morpholinomediated knockdown of Nephronectin in zebrafish caused failure of valve formation and trabeculation resulting in > 85% lethality at 7 days post fertilization.
Cardiac valve formation is initiated at the junction of atrium and ventricle and is characterized by extracellular matrix deposition and endocardial cell differentiation. In accordance with the above-described phenotype the earliest observed abnormality in Nephronectin morphants was an extended tube like structure at the atrio-ventricular boundary. In addition, the expression of myocardial genes involved in cardiac valve formation (cspg2, fibulin1, tbx2b, bmp4) was expanded and endocardial cells along the extended tube like structure exhibited characteristics of atrio-ventricular cells (has2, notch1b and Alcam expression, cuboidal cell shape). Inhibition of has2 in Nephronectin morphants rescued the endocardial but not the myocardial expansion. In contrast, diminishment of BMP signaling in npnt morphants resulted in reduced ectopic expression of myocardial and endocardial atrio-ventricular markers. Taken together, these results identify Nephronectin as a novel upstream regulator of BMP4-HAS2 signaling playing a crucial role in atrio-ventricular canal differentiation.