Alqahtani, A. | bioRxiv Science

bioRxiv2025

Remodelling of supernumerary leaflet primordia leads to bicuspid aortic valve (BAV) caused by loss of primary cilia

AimsBicuspid aortic valve (BAV), where two valve leaflets are found instead of the usual three, affects 1-2% of the general population and is associated with significant morbidity and mortality. Despite its frequency, the majority of cases remain unexplained. This is, at least in part, because there are two types of valve leaflet primordia: endocardial cushions and intercalated valve swellings (ICVS). Moreover, multiple progenitors make distinct contribution to the formation of these primordia. Genomic studies in mouse and human have suggested a correlation between BAV and malfunctional primary cilia. However, the precise requirement for cilia during early embryonic valvulogenesis remains unknown. Methods and resultsHere, we disrupted primary cilia by deleting the ciliary gene Ift88 in the main progenitor cells forming the aortic valve using specific Cre drivers: Wnt1-Cre for neural crest cells, Isl1-Cre for second heart field cells (SHF); Tie2-Cre for endocardial-derived cells and Tnnt2-Cre for direct-differentiating SHF in the ICVS. Loss of Ift88, and thus primary cilia, from neural crest cells and endocardium did not impact aortic valve formation. However, primary cilia are essential in SHF cells for aortic valve leaflet formation, with over half of Ift88f/f;Isl1-Cre mutants presenting with BAV. As the valve leaflets are forming, 50% of the Ift88f/f;Isl1-Cre mutants have two small leaflets in the position of the usual posterior leaflet, meaning that at this stage the aortic valve is quadricuspid, which then remodels to BAV by E15.5. Mechanistic studies demonstrate premature differentiation of SHF cells as the ICVS form, leading to the formation of a broadened ICVS that forms two posterior leaflet precursors. This abnormality in the formation of the ICVS is associated with disruption of Notch-Jag1 signalling pathway, with Jag1f/f;Isl1-Cre mutants presenting with a similar phenotype. ConclusionsThese data show that primary cilia, via the Notch-Jag1 signalling pathway, regulate differentiation of SHF cells in the aortic valve primordia. Additionally, we identify a mechanistic link between the developmental basis of quadricuspid and bicuspid arterial valve leaflets. Translational PerspectiveSeveral genomic studies in human and mouse have suggested that disruption of cilia-related genes may be a significant cause of CHD. Although there is limited data from animal models to suggest a link between cilia and bicuspid aortic valve (BAV), the mechanisms underpinning BAV formation during early valvulogenesis have not been described. Here, we established a potential mechanism underpinning BAV formation, highlighting a role for primary cilia in a subset of valve interstitial cells (VIC) derived from second heart field progenitors. Loss of cilia altered VIC differentiation and valvulogenesis. This study confirms that disruption of cilial formation and/or function can lead to arterial valve defects and could pave the way to finding therapies for patient benefit.

developmental biology↗

bioRxiv2024

Zebrafish arterial valve development occurs through direct differentiation of second heart field progenitors

AimsBicuspid Aortic Valve (BAV) is the most common congenital heart defect, affecting at least 2% of the population. The embryonic origins of BAV remain poorly understood, limiting the identification of assays for validating patient variants and ultimately causative genes for BAV. In both human and mouse, the left and right leaflets of the arterial valves arise from the outflow tract cushions, with interstitial cells originating from neural crest cells and endocardial-to-mesenchymal transition (EndoMT). In contrast, an EndoMT-independent mechanism of direct differentiation by cardiac progenitors from the second heart field (SHF) is responsible for the formation of the anterior and posterior leaflets. Defects in either of these developmental mechanisms can result in BAV. Although zebrafish have been suggested as a model for human variant testing, their naturally bicuspid arterial valve has not been considered suitable for understanding human arterial valve development. Here, we have set out to investigate to what extent the processes involved in arterial valve development are conserved in zebrafish and ultimately, whether functional testing of BAV variants could be carried out in zebrafish. Methods and ResultsUsing a combination of live imaging, immunohistochemistry and Cre-mediated lineage tracing, we show that the zebrafish arterial valve primordia develop directly from undifferentiated SHF progenitors with no contribution from EndoMT or neural crest, in keeping with the human and mouse anterior and posterior leaflets. Moreover, once formed, these primordia share common subsequent developmental events with all three mammalian arterial valve leaflets. ConclusionsOur work highlights a conserved ancestral mechanism of arterial leaflet formation from the SHF and identifies that development of the zebrafish arterial valve is distinct from that of the atrioventricular valve. Crucially, this confirms the utility of zebrafish for understanding the development of specific BAV subtypes and arterial valve dysplasia, offering potential for high-throughput variant testing. Translational PerspectiveLarge genomic studies of patients with Bicuspid Aortic Valve (BAV) have identified numerous variants predicted to be causative, yet due to a lack of suitable, in vivo functional assays, advancement of genetic testing, discussion of risk to family members and accurate prognosis is not yet widely possible. Here, we show that zebrafish demonstrate a high level of conservation in arterial valve development with the intercalated leaflets in human, establishing zebrafish as a suitable in vivo model that can begin to overcome the disconnect between clinical genetics and developmental biology.

developmental biology↗