Heart valve development proceeds through coordinated steps by which endocardial cushions (ECs) form thin, elongated, and stratified valves. Wnt signaling and its canonical effector β-catenin are proposed to contribute to endocardial-to-mesenchymal transformation (EMT) through postnatal steps of valvulogenesis. However, genetic redundancy and lethality have made it challenging to define specific roles of the canonical Wnt pathway at different stages of valve formation. We developed a transgenic mouse system that provides spatiotemporal inhibition of Wnt/β-catenin signaling by chemically-inducible overexpression of Dkk1. Unexpectedly, this approach indicates canonical Wnt signaling is required for EMT in the proximal outflow tract (pOFT) but not atrioventricular canal (AVC) cushions. Further, Wnt indirectly promotes pOFT EMT through its earlier activity in neighboring myocardial cells or their progenitors. Subsequently, Wnt/β-catenin signaling is activated in cushion mesenchymal cells where it supports FGF-driven expansion of ECs and then AVC valve extracellular matrix patterning. Mice lacking Axin2, a negative Wnt regulator, have larger valves, suggesting that accumulating Axin2 in maturing valves represents negative feedback that restrains tissue overgrowth rather than simply reporting Wnt activity. Disruption of these Wnt/β-catenin signaling roles that enable developmental transitions during valvulogenesis could account for common congenital valve defects. This work suggests that Wnt/β-catenin maintains a subpopulation of valve mesenchyme in a less-differentiated, progenitor-like state that allows these cells to respond to mitogens and morphogens. The coordinated interplay of signals with distinct effects on a “progenitor cell” pool is a common logic mechanism for balanced tissue growth and differentiation in many biological contexts. Inspired by epithelial organ homeostasis processes, we identified specific and dynamic expression of the well-established quiescent stem cell marker Lrig1 in the developing valves. Endocardial Lrig1 likely moderates ErbB2 levels and thereby signaling output to prevent excessive EMT and resulting pathologically enlarged valves. Finally, we use Cre-mediated lineage labeling to show that the cusps of the semilunar valves have differential mesenchymal origins and that the localization of said distinct mesenchyme may account for the discretely patterned extracellular matrix of mature valves. This dissertation includes previously published and unpublished coauthored material. / 10000-01-01

Venous valves (VVs) are critical for unidirectional blood flow from superficial and deep veins towards the heart. Congenital valve aplasia or agenesis may, in some cases, be a direct cause of vascular disease, motivating an understanding of the molecular mechanisms underlying the development and maintenance of VVs. Three gap junction proteins (Connexins), Cx37, Cx43, and Cx47, are specifically expressed at VVs in a highly polarized fashion. VVs are absent from adult mice lacking Cx37; however it is not known if Cx37 is required for the initial formation of valves. In addition, the requirement of Cx43 and Cx47 for VV development has not been studied. Here, we provide a detailed description of Cx37, Cx43, and Cx47 expression during mouse vein development and show by gene knockout that each Cx is necessary for normal valve development. The valve phenotypes in the knockout lines exhibit Cx-specific differences, however, including whether peripheral or central VVs are affected by gene inactivation. In addition, we show that a Cx47 null mutation impairs peripheral VV development but does not affect lymphatic valve formation, a finding of significance for understanding how some CX47 mutations cause inherited lymphedema in humans. Finally, we demonstrate a striking segregation of Foxc2 and NFATc1 transcription factor expression between the downstream and upstream faces, respectively, of developing VV leaflets and show that this segregation is closely associated with the highly polarized expression of Cx37, Cx43, and Cx47. The partition of Foxc2 and NFATc1 expression at VV leaflets makes it unlikely that these factors directly cooperate during the leaflet elongation stage of VV development. (C) 2016 Elsevier Inc. All rights reserved.

Lymphatic valves (LVs) are cusped luminal structures that permit the movement of lymph in only one direction and are therefore critical for proper lymphatic vessel function. Congenital valve aplasia or agenesis can, in some cases, be a direct cause of lymphatic disease. Knowledge about the molecular mechanisms operating during the development and maintenance of LVs may thus aid in the establishment of novel therapeutic approaches to treat lymphatic disorders. In this study, we examined the role of Connexin43 (Cx43), a gap junction protein expressed in lymphatic endothelial cells (LECs), during valve development. Mouse embryos with a null mutation in Cx43 (Gja1) were previously shown to completely lack mesenteric LVs at embryonic day 18. However, interpreting the phenotype of Cx43(-/-) mice was complicated by the fact that global deletion of Cx43 causes perinatal death due to heart defects during embryogenesis. We have now generated a mouse model (Cx43(∆LEC)) with a lymphatic-specific ablation of Cx43 and show that the absence of Cx43 in LECs causes a delay (rather than a complete block) in LV initiation, an increase in immature valves with incomplete leaflet elongation, a reduction in the total number of valves, and altered lymphatic capillary patterning. The physiological consequences of these lymphatic changes were leaky valves, insufficient lymph transport and reflux, and a high incidence of lethal chylothorax. These results demonstrate that the expression of Cx43 is specifically required in LECs for normal development of LVs.

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Superviseur : Dr. Piet Van Vliet Collaborateurs: Dr. Alexandre Dubrac, Dr. Martin Smith / Résumé INTRODUCTION : Les maladies valvulaires du cœur surviennent dans 2% de la population, impliquant souvent un reflux sanguin dû au rétrécissement de la valve. Nous avons récemment identifié deux familles non apparentées étant atteintes par une sténose aortique. Le séquençage exomique des familles a révélé une mutation entrainant une perte de fonction homozygote pour le gène ADAMTS19. La relation entre la perturbation du gène ADAMTS19 et la sténose a été reproduite et donc confirmée grâce à une souris ADAMTS19-LACZ KO/KO. Cette souris montre également que ADAMTS19 est spécifiquement exprimé dans les cellules valvulaires interstitielles (VICs) dans les valves. Le rôle d’ADAMTS19 durant le développement des valves reste inconnu. Pour analyser le patron d’expression d’ADAMTS19 pendant le développement du cœur, nous avons obtenu un modèle de souris transgénique contenant une CRE-tamoxifen inductible (Cre-ERT2) qui est exprimé sous l’influence du promoteur humain ADAMTS19. HYPOTHESE/OBJECTIF : Nous émettons l’hypothèse que le promoteur humain d’ADAMTS19 inséré dans la souris ADAMTS19-Cre-ERT2 contient toutes les séquences régulatrices permettant d’exprimer le gène ADAMTS19 et que ADAMTS19 est principalement exprimé au niveau des cellules valvulaires interstitielles dans les valves. L’objectif est de caractériser le patron d’expression d’ADAMTS19 en analysant sa distribution durant le développement grâce à une souris reportrice tdTomato. Comme ADAMTS19 est spécifiquement exprimé dans les VICs, cet outil transgénique permettrait d’étudier ces cellules durant le développement. METHODE/RESULTAT : Suite à une étude in silico le promoteur ADAMTS19 est apparu comme extrêmement conservé. Par conséquent, pour analyser l’expression d’ADAMTS19 nous avons obtenu une souris BAC ADAMTS19-Cre-ERT2 contenant la séquence conservée que nous avons croisé avec une souris reportrice tdTomato. Le Tamoxifen est administré aux femelles gestantes par gavage aux jours embryonnaires E9,5, E11,5 ainsi que E13,5, et les cœurs sont extrait a E16,5. Des coupes de cœurs embryonnaires vont permettre d’identifier la localisation et la morphologie des cellules marquées. L’expression d’ADMATS19 dans les cellules valvulaires interstitielles est consistant avec le fait qu’ADAMTS19 est connu pour affecter les valves durant le développent et dans le cas de maladie valvulaire. Cependant, le patron des valves n’est pas reproductible au travers des générations. De plus, nous observons qu’ADAMTS19 est marqué dans des cellules des oreillettes et ventricule dans une lignée et dans une sous population de cellules de l’artère pulmonaire dans une autre. CONCLUSION : L’analyse des séquences de chaque lignée par séquençage permettre d’investiguer la raison de ses différents patrons et de mettre en évidence des régulateurs spécifiques. / BACKGROUND: Valvular heart disease (VHD) occurs in ~2% of the general population, often resulting in reduced or disturbed blood flow. We recently identified two unrelated families with recessive inheritance patterns of progressive polyvalvular heart disease in absence of any clear syndromic phenotype. Exome sequencing revealed homozygous, rare, loss of function (LOF) alleles in both families for the gene ADAMTS19. The relation between ADAMTS19 mutation and aortic stenosis were confirm via an ADAMTS19-LacZ KO/KO mouse model. This model also shows that ADAMTS19 is specific of VICs during valve development. The ADAMTS protein family includes 19 proteases that are involved in matrix remodeling, and tissue homeostasis in development and disease. However, the role of ADAMTS19 specifically during valve development remains unknown. We aim to characterize ADAMTS19 expression using a BAC transgenic ADMTS19-CRERT2 mouse. HYPOTHESE/OBJECTIVE We hypothesize that the BAC used to make the ADMTS19-CRERT2 mouse contains all the regulatory elements to express it and also that its expression will be specific to the VICs. The objective is to establish the ADAMTS19- CREERT2 and therefore to create a new tool to study VICs in vivo. METHODS/RESULTS: In silico analysis of the human and mouse ADAMTS19 genomic regions showed a high level of conservation. Thus, to analyze ADAMTS19 expression patterns during mouse development, we obtained a BAC transgenic mouse model containing a tamoxifen inducible Cre (CreERT2) that is expressed under the influence of the human ADAMTS19 promoter and surrounding genomic region. We crossed males from several lines created in parallel with Rosa-tdTomato reporter females to generate offspring in which expression of the fluorescent tdTomato reporter is activated in ADAMTS19-expressing cells upon tamoxifen administration. Surprisingly, whole mount imaging of embryos induced at E13.5 and isolated at E16.5 revealed strong, but distinct labelling patterns in offspring from different ADAMTS19CreERT2 sublines. Whereas one line exclusively labelled VICs, consistent with ADAMTS19 in situ RNA expression data from the Eurexpress database, another line specifically labelled cells in atrial and ventricular, but not VICs. A third line seems to label only a subset of cells in the pulmonary artery. Labeling of ADAMTS19-positive VICs is consistent with ADAMTS19 affecting valve development and VHD. In addition, we observed exclusive ADAMTS19-dependent labelling in atrial and ventricular cells or in a subset of pulmonary artery cells in two different sublines. CONCLUSION: The distinct expression patterns in offspring from different ADAMTS19-Cre-ERT2 lines indicates that although regulation of ADAMTS19 is conserved between human and mouse, expression in VICs versus other cells may be dependent on mutually exclusive regulatory mechanisms.