Left pulmonary artery in 22q11.2 deletion syndrome. Echocardiographic evaluation in patients without cardiac defects and role of Tbx1 in mice

• Published in: PloS one 2019-04, Vol.14 (4), p.e0211170-e0211170
• Main Authors: Mastromoro, Gioia, Calcagni, Giulio, Versacci, Paolo, Putotto, Carolina, Chinali, Marcello, Lambiase, Caterina, Unolt, Marta, Pelliccione, Elena, Anaclerio, Silvia, Caprio, Cinzia, Cioffi, Sara, Bilio, Marchesa, Baban, Anwar, Drago, Fabrizio, Digilio, Maria Cristina, Marino, Bruno, Baldini, Antonio
• Format: Article
• Language: English
• Subjects: Adolescent; Animals; Arteries; Biology and Life Sciences; Biophysics; Cardiology; Cell fate; Child; Child, Preschool; Children; Clonal deletion; Coronary vessels; Defects; DiGeorge Syndrome - diagnostic imaging; DiGeorge Syndrome - genetics; DiGeorge Syndrome - pathology; Disease Models, Animal; Echocardiography; Embryos; Fate maps; Female; Fetuses; Gene expression; Gene mapping; Genetic counseling; Genetic research; Genetics; Haploinsufficiency; Health aspects; Heart; Heart surgery; Humans; Infant; Male; Mapping; Medicine and Health Sciences; Mice; Mice, Knockout; Morphogenesis; Mutants; Patients; Pediatrics; People and Places; Phenotypes; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - pathology; Research and Analysis Methods; T-Box Domain Proteins - genetics; T-Box Domain Proteins - metabolism; Tbx1 protein; Veins & arteries; Ventricle; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0211170

Patients with 22q11 deletion syndrome (22q11.2DS) present, in about 75% of cases, typical patterns of cardiac defects, with a particular involvement on the ventricular outflow tract and great arteries. However, in this genetic condition the dimensions of the pulmonary arteries (PAs) never were specifically evaluated. We measured both PAs diameter in patients with 22q11.2DS without cardiac defects, comparing these data to a normal control group. Moreover, we measured the PAs diameter in Tbx1 mutant mice. Finally, a cell fate mapping in Tbx1 mutants was used to study the expression of this gene in the morphogenesis of PAs. We evaluated 58 patients with 22q11.2DS without cardiac defects. The control group consisted of 54 healthy subjects, matched for age and sex. All cases underwent a complete transthoracic echocardiography. Moreover, we crossed Tbx1+/- mice and harvested fetuses. We examined the cardiovascular phenotype of 8 wild type (WT), 37 heterozygous (Tbx1+/-) and 6 null fetuses (Tbx1-/-). Finally, we crossed Tbx1Cre/+mice with R26RmT-mG Cre reporter mice to study Tbx1 expression in the pulmonary arteries. The echocardiographic study showed that the mean of the LPA/RPA ratio in 22q11.2DS was smaller (0.80 ± 0.12) than in controls (0.97 ± 0.08; p < 0.0001). Mouse studies resulted in similar data as the size of LPA and RPA was not significantly different in WT embryos, but in Tbx1+/- and Tbx1-/- embryos the LPA was significantly smaller than the RPA in both mutants (P = 0.0016 and 0.0043, respectively). We found that Tbx1 is expressed near the origin of the PAs and in their adventitia. Children with 22q11.2DS without cardiac defects show smaller LPA compared with healthy subjects. Mouse studies suggest that this anomaly is due to haploinsufficiency of Tbx1. These data may be useful in the clinical management of children with 22q11.2DS and should guide further experimental studies as to the mechanisms underlying PAs development.