Histological and Morphological Characterization of Developing Dermal Lymphatic Vessels

Lyve1-Driven NrasQ61R Causes Edema, Enlarged Lymphatic Vessels, and Hepatic Vascular Defects in Embryonic Mice

BACKGROUND

Kaposiform lymphangiomatosis (KLA) is a complex lymphatic anomaly associated with a somatic activating NRAS p.Q61R (NRASQ61R) mutation. KLA is characterized by malformed lymphatic vessels that can lead to effusions and coagulopathy. The goal of this study was to generate an in vivo mouse model to determine if prenatal expression of the NrasQ61R mutation in lymphatic endothelial cells induces disease characteristics found in KLA patients.

PROCEDURE

A Cre-loxP system was used to conditionally express NrasQ61R in cells expressing lymphatic vessel endothelial hyaluronan receptor 1 (Lyve1), a marker of lymphatic and other types of endothelial cells that starts being expressed at embryonic day (E) 7.5. Because pups did not survive birth, embryos were collected at E14.5, E15.5, and E18.5 for gross analysis, histology and immunostaining, and organ whole-mounts.

RESULTS

Staining for NRASQ61R demonstrated robust recombination in the NrasQ61R mutant embryos and localization of NrasQ61R at sites of vascular abnormalities. NrasQ61R mutant embryos had significant edema and dysmorphic jugular lymph sacs with abnormal Lyve1-positive cellular masses. The lymphatic vessel network in the back skin of the NrasQ61R mutant embryos had fewer branch points and increased vessel diameter. NrasQ61R mutant embryos had severe hepatic defects characterized by disordered and enlarged vessels. By E18.5, NrasQ61R mutant embryos were dead.

CONCLUSIONS

Conditional expression of NrasQ61R in Lyve1-positive cells caused edema, abnormal lymphatic development, and hepatic vascular defects in mouse embryos. These findings further support the role of NRASQ61R as a driver of the lymphatic overgrowth, vessel enlargement, and dysfunction in the pathophysiology of KLA.

Pathogenic variants in MDFIC cause recessive central conducting lymphatic anomaly with lymphedema

Central conducting lymphatic anomaly (CCLA), characterized by the dysfunction of core collecting lymphatic vessels including the thoracic duct and cisterna chyli, and presenting as chylothorax, pleural effusions, chylous ascites, and lymphedema, is a severe disorder often resulting in fetal or perinatal demise. Although pathogenic variants in RAS/mitogen activated protein kinase (MAPK) signaling pathway components have been documented in some patients with CCLA, the genetic etiology of the disorder remains uncharacterized in most cases. Here, we identified biallelic pathogenic variants in MDFIC, encoding the MyoD family inhibitor domain containing protein, in seven individuals with CCLA from six independent families. Clinical manifestations of affected fetuses and children included nonimmune hydrops fetalis (NIHF), pleural and pericardial effusions, and lymphedema. Generation of a mouse model of human MDFIC truncation variants revealed that homozygous mutant mice died perinatally exhibiting chylothorax. The lymphatic vasculature of homozygous Mdfic mutant mice was profoundly mispatterned and exhibited major defects in lymphatic vessel valve development. Mechanistically, we determined that MDFIC controls collective cell migration, an important early event during the formation of lymphatic vessel valves, by regulating integrin β₁ activation and the interaction between lymphatic endothelial cells and their surrounding extracellular matrix. Our work identifies MDFIC variants underlying human lymphatic disease and reveals a crucial, previously unrecognized role for MDFIC in the lymphatic vasculature. Ultimately, understanding the genetic and mechanistic basis of CCLA will facilitate the development and implementation of new therapeutic approaches to effectively treat this complex disease.

Characterization of Lymphatic Vasculature Using Whole-Mount Immunostaining of Mouse Embryonic Dorsal Skin

Understanding the development of the lymphatic vasculature is essential to the understanding of how these vessels function in health and disease. High-resolution imaging of histological techniques such as immunostaining of sectioned tissue provides a snapshot into lymphatic vessel morphogenesis, patterning, and organization. Whole-mount staining of embryonic dermal vasculature allows for a deeper analysis and characterization of the developing lymphatic vascular network.

Whole-mount Immunohistochemistry to Visualize Mouse Embryonic Dermal Lymphatic Vasculature

Lymphatic vessels are abundant in the skin where they regulate interstitial fluid uptake and immune surveillance. Defects in dermal lymphatic vessels, such as fewer vessels and abnormal lymphatic vessel coverage with mural cells, are frequently associated with lymphedema and other lymphatic disorders. Whole-mount immunohistochemistry allows the visualization of dermal lymphatic vessels and identifies morphogenetic defects. Most dermal lymphatic vessels start growing during embryogenesis from lymph sacs that are located close to the axilla towards the dorsal and ventral midlines. Here, we present an approach that we have developed to permeabilize, immunolabel, clear, and visualize the lymphatic vessels. These simple and inexpensive techniques reproducibly generate images of dermal lymphatic vessels with great clarity.

Maternal iron deficiency perturbs embryonic cardiovascular development in mice

Congenital heart disease (CHD) is the most common class of human birth defects, with a prevalence of 0.9% of births. However, two-thirds of cases have an unknown cause, and many of these are thought to be caused by in utero exposure to environmental teratogens. Here we identify a potential teratogen causing CHD in mice: maternal iron deficiency (ID). We show that maternal ID in mice causes severe cardiovascular defects in the offspring. These defects likely arise from increased retinoic acid signalling in ID embryos. The defects can be prevented by iron administration in early pregnancy. It has also been proposed that teratogen exposure may potentiate the effects of genetic predisposition to CHD through gene-environment interaction. Here we show that maternal ID increases the severity of heart and craniofacial defects in a mouse model of Down syndrome. It will be important to understand if the effects of maternal ID seen here in mice may have clinical implications for women.

Atypical cadherin FAT4 orchestrates lymphatic endothelial cell polarity in response to flow

The atypical cadherin FAT4 has established roles in the regulation of planar cell polarity and Hippo pathway signaling that are cell context dependent. The recent identification of FAT4 mutations in Hennekam syndrome, features of which include lymphedema, lymphangiectasia, and mental retardation, uncovered an important role for FAT4 in the lymphatic vasculature. Hennekam syndrome is also caused by mutations in collagen and calcium binding EGF domains 1 (CCBE1) and ADAM metallopeptidase with thrombospondin type 1 motif 3 (ADAMTS3), encoding a matrix protein and protease, respectively, that regulate activity of the key prolymphangiogenic VEGF-C/VEGFR3 signaling axis by facilitating the proteolytic cleavage and activation of VEGF-C. The fact that FAT4, CCBE1, and ADAMTS3 mutations underlie Hennekam syndrome suggested that all 3 genes might function in a common pathway. We identified FAT4 as a target gene of GATA-binding protein 2 (GATA2), a key transcriptional regulator of lymphatic vascular development and, in particular, lymphatic vessel valve development. Here, we demonstrate that FAT4 functions in a lymphatic endothelial cell-autonomous manner to control cell polarity in response to flow and is required for lymphatic vessel morphogenesis throughout development. Our data reveal a crucial role for FAT4 in lymphangiogenesis and shed light on the mechanistic basis by which FAT4 mutations underlie a human lymphedema syndrome.