(This article belongs to lớn the Special Issue Transcriptional Regulation of Cardiac Development và Disease)
Nearly three decades ago, the Wilms’ tumor suppressor Wt1 was identified as a crucial regulator of heart development. Wt1 is a zinc finger transcription factor with multiple biological functions, implicated in the development of several organ systems, among them cardiovascular structures. This nhận xét summarizes the results from many research groups which allowed to establish a relevant function for Wt1 in cardiac development & disease. During development, Wt1 is involved in fundamental processes as the formation of the epicardium, epicardial epithelial-mesenchymal transition, coronary vessel development, valve formation, organization of the cardiac autonomous nervous system, và formation of the cardiac ventricles. Wt1 is further implicated in cardiac disease và repair in adult life. We summarize here the current knowledge about expression & function of Wt1 in heart development and disease and point out controversies to lớn further stimulate additional research in the areas of cardiac development and pathophysiology. As re-activation of developmental programs is considered as paradigm for regeneration in response khổng lồ injury, understanding of these processes & the molecules involved therein is essential for the development of therapeutic strategies, which we discuss on the example of WT1.
Wilms’ tumor suppressor 1 (Wt1); heart; cardiac development; coronary vessel formation; transcriptional regulation; cardiac malformation; epicardium; epicardial derived cells (EPDCs); epithelial mesenchymal transition (EMT); cardiac cell fate; regeneration
The Wilms’ tumor 1 (WT1) gen was originally identified based on its mutational inactivation in Wilms’ tumor (nephroblastoma) <1,2,3>. This first discovery of WT1 as the responsible ren in an autosomal-recessive condition classified it as a tumor-suppressor gene. Mutations of WT1 were associated with the development of kidney tumors & urogenital defects. However, later it became clear that mutations of WT1 only occur in a low frequency in nephroblastoma <4> & that most nephroblastomas <5> express high levels of WT1. Based on the overexpression of WT1 in leukemia và most solid cancers (reviewed in <6,7> and its cancer-promoting functions in the tumor stroma <8>, WT1 is nowadays considered as an oncogene và attractive candidate for cancer therapy.
WT1 encodes a zinc finger transcription factor and RNA-binding protein <9,10,11,12>. As a transcriptional regulator, it can either activate or repress various target genes. Thus, WT1 influences cellular differentiation, growth, apoptosis, and metabolism. WT1 exists in multiple isoforms. Alternative splicing of exon 5 & exon 9 gives rise lớn major isoforms. Splicing of exon 9 generates the KTS isoforms, which either include or exclude three amino acids lysin, threonine, and serin (KTS) between zinc fingers 3 and 4 of the protein <13>. Although the majority of WT1 proteins are in the nucleus, some are present in the cytoplasm, located on actively translating polysomes. WT1 isoforms shuttle between the nucleus và cytoplasm <14>. The complexity of WT1 is further enhanced by post-translational modifications và a plethora of binding partners. WT1 directs the development of several organs và tissues, among them the heart.
The heart develops mostly from embryonic mesodermal germ layer cells and to some extent from ectoderm-derived cardiac neuronal crest (cushions of the outflow tract). The cardiogenic mesoderm differentiates into proepicardial, endocardial, & myocardial cells. The epicardium is formed from a subset of the proepicardial cells. Proepicardial cells also contribute subepicardial cells, interstitial fibroblast, pericytes, & a subset of the endothelial cells of the coronary vessels. The inner lining of the heart tube is formed by endocardial cells. The vertebrate heart forms as two concentric epithelial cylinders of myocardium và endocardium separated by an extended basement membrane matrix commonly referred lớn as cardiac jelly. The primitive heart tube is formed at embryonic day 8.5 (E8.5) in the mouse <15>. The primitive tube elongates and undergoes rightward looping. Further remodeling of the heart involves formation và expansion of the chambers, and formation of valves and septa, resulting in a heart with two atria và two ventricles <16>. The heart is the first organ to develop và is already functional at an early stage of fetal development, in line with its essential role for the distribution of oxygen và nutrients & removal of waste products và carbon dioxide. Several excellent đánh giá have already described cardiac development in detail <17,18,19,20,21,22>. Thus, we focus here only on the role of Wt1. Wt1 expression was first observed in a transitory cluster of cells—the proepicardium and the coelomic epithelium at E9.5. Wt1-expressing proepicardial cells liên hệ the dorsal wall of the heart from which the proepicardial cell migrate over the myocardium of the heart tube to khung the epicardial layer by E12.5 <23,24>. This view has been challenged recently by the detection of a common progenitor cell population of epicardium and myocardium using single-cell RNA sequencing <25>. How these common progenitors might migrate during cardiac development is currently an mở cửa question.
A proportion of epicardial cells undergoes epithelial-to-mesenchymal transition (EMT), which induces the formation of epicardial-derived cells (EPDCs), a population of multipotent mesenchymal cardiac progenitor cells, which might differentiate into cardiomyocytes, fibroblasts, smooth muscle, and endothelial cells <26,27,28>, which is discussed in detail later. First indications for the indispensable role of Wt1 in heart homeostasis came from the observations made in Wt1 knockout embryonic mice which died at mid-gestation due lớn cardiac malformations <29>.
Here, we review the history of investigations characterizing the role of WT1 (i) in cardiac development, (ii) in cardiac disease và regeneration, and (iii) in different cardiac cell types & transcriptional regulatory mechanisms. We indicate emerging notions and point out problems & promises in the field of development of therapeutic strategies for cardiac repair.
Nearly thirty years ago, Armstrong và colleagues, using in situ mRNA hybridization, observed Wt1 expression in the differentiating heart mesothelium of the mouse embryo at embryonic day 9 <23>. In the same year, the group of Jaenisch introduced a mutation into the murine Wt1 ren by gene targeting in embryonic stem cells. The embryos homozygous for this mutation died between days 13 và 15 of gestation. Besides the lack of kidney và gonad formation in Wt1 mutant mice, the authors observed a severe heart hypoplasia with thinned right ventricular walls, a rounded apex, and a reduction of kích thước of the left ventricles, signs of congestive heart failure, suggesting that cardiac malfunction was the cause of early embryonic death <29>. As Wt1 has been described before only khổng lồ be expressed in the epicardium, but has not yet been observed in the myocardium, it remained unclear whether these features of cardiac malformation were due to lớn primary defects in the myocardial tissue or a consequence of disturbed development in other tissues. A more detailed view on Wt1 expression during murine heart development was achieved using a lacZ reporter gene inserted into a YAC (yeast artificial chromosome) construct which demonstrated Wt1 expression in the early proepicardium, the epicardium, and subepicardial mesenchymal cells (SEMCs) throughout development. In Wt1-deficient animals, the epicardium did not size correctly, which results in disruption in the formation of the coronary vasculature, leading khổng lồ pericardial bleeding và midgestational death of the embryo. Complementation of Wt1 null embryos with a human WT1 transgene rescued both embryonic heart defects & midgestational death, confirming that indeed heart failure causes the death of Wt1-deficient embryos <24>.
Wt1-expressing cell types during heart development in different species are summarized in Table 1 và further described below. Of note, expression of Wt1 is limited to a subset of the identified cells. Functional differences between Wt1-expressing cells and the Wt1-negative counterparts remain mostly unknown at present.
Studies in birds confirmed the expression of Wt1 in epicardium- & epicardial-derived cells (EPDCs) during embryonic development <31>. Using normal avian and quail-to-chick chimeric embryos, the origin and fate of Wt1-expressing EPDCs were later described and the effects of epicardial ablation on cardiac development investigated <28>. Wt1-expressing EPDCs were found khổng lồ populate the subepicardial space và to invade the ventricular myocardium. Upon differentiation in smooth muscle & endothelial cells, Wt1 expression decreased in EPDCs. Undifferentiated EPDCs continued to express Wt1 và invaded the ventricular myocardium & the atrio-ventricular (AV) valves. Disruption of normal epicardial development either by proepicardial ablation or block reduced the number of invasive Wt1-positive EPDCs, và provoked anomalies in the coronary vessels, the ventricular myocardium, và the AV cushions. In addition lớn Wt1, EPDCs express retinaldehyde-dehydrogenase (Raldh) 2 <38,39>. It had been demonstrated that in humans WT1 transcriptionally regulates the retinoic acid receptor alpha (RAR-α) gene <40>. Transcriptional target genes of WT1 with relevance in the heart are summarized in Table 2 và discussed below.
The phenotype of the WT1-deficient mice further resembled that of retinoic acid (RA)-depleted mice. Depletion of RA from the diet is known to lớn severely disturb heart development, causing hypoplasia of the ventricles <41>. The authors suggested therefore that Wt1 maintains the EPDCs in an undifferentiated, RA-producing state khổng lồ contribute to ventricular myocardium compaction in the development of the myocardial wall <28>. Availability of retinoic acid during cardiac development is mediated by Raldh2. It has been shown that Wt1 transcriptionally activates Raldh2 <42>. Pericardium and sinus horn formation are coupled & are based on the expansion & exact temporal release of pleuropericardial membranes (PPM) from the underlying subcoelomic mesenchyme. Wt1-deficient mouse embryos displayed a failure to khung myocardialized sinus horns & a loss of Raldh2 expression in the subcoelomic mesenchyme, pointing khổng lồ a crucial role of Wt1 & downstream Raldh2/RA signaling in sinus horn development <43>. Furthermore, Wt1-mutant mice were shown lớn display unilateral partial PPM absence in the dorsomedial region. Failure of PPM release affects the closure of the remaining communication area between pericardial và pleural cavities, the bilateral pericardioperitoneal canals (PPCs), which is disturbed in Wt1-deficient embryos, leading khổng lồ pleuropericardial communication và lateralization of the cardinal veins <44>. The group of Muñoz -Chapuli suggests that the proepicardium is an evolutionary derivative of the primordium of an ancient external pronephric glomerulus, initially based on the epicardial development in lampreys (Petromyzon), the most primitive living lineage of vertebrates <45>. Employing chick proepicardium, they propound that Wt1 could repress the nephrogenic potential of the proepicardium, while at the same time promote nephrogenesis in the intermediate mesoderm. This paradoxical function could be explained by the dual role of Wt1, which promotes mesenchymal khổng lồ epithelial transition (MET) in the kidney & EMT in the epicardium <46>, through a mechanism known as chromatin flip–flop <47>. Promotion of EMT in the developing epicardium & MET in the growing kidney is not only reflected by morphological cellular changes, but also differential expression of podocyte markers. In their study, the authors focused on podocalyxin, known khổng lồ be transcriptionally regulated by Wt1, and to be activated by Wt1 in kidney podocytes <48>, which they found in contrast to be upregulated in Wt1-deficient epicardium <46>. To lớn further strengthen this theory it appears interesting to lớn investigate the expression of other Wt1 transcriptional targets in kidney MET và epicardial EMT, such as nephrin <49>, nestin <50>, & podocin <51>.
In addition, the relation between Wt1-expressing epicardial derivatives and the development of compact ventricular myocardium has been investigated. The differences in myocardial architecture specifically between the right ventricle (RV) và the left ventricle (LV) in association to epicardial formation and distribution of Wt1-expressing cells were studied. The authors demonstrated that the RV is less densely and later covered by the epicardium than the LV. They also observed that compact myocardial layer formation occurred in parallel with the presence of Wt1-expressing cells & was more pronounced in the LV than in the RV, và within the RV more accentuated in the postero-lateral wall than in the anterior wall, which might explain the lateralized differences in ventricular morphology of the heart <52>. The same group was able khổng lồ identify a function of the epicardium in cardiac autonomic nervous system modulation, essential for proper cardiac activity by altering heart rate, conduction velocity, và force of contraction. They revealed expression of neuronal markers in the epicardium during early cardiac development, notably of tubulin beta-3 chain (Tubb3), which was colocalized with Wt1 in epicardium and the nervous system, neural cell adhesion molecule (Ncam), and the β2 adrenergic receptor (β2AR). Adrenaline (epinephrine), a catecholamine, is known to modulate heart rate, velocity of conduction, & contraction strength in the heart through its binding khổng lồ β2AR. Inhibition of the outgrowth of the epicardium abolished the response to lớn adrenaline administration, indicating that the epicardium is necessary for a normal response of the heart lớn adrenaline during early cardiac development <53>. This report further confirmed a role of Wt1 in neural function, as suggested by several studies <23,54,55,56,57,58,59>.
In zebrafish, two orthologues of wt1 have been described: wt1a <60,61> & wt1b <62>. Both of them were found khổng lồ be expressed in adult zebrafish hearts, but exhibited a differential expression màn chơi in other organs, as well as a differing temporal patterning during development, suggesting distinctive functions during zebrafish development <62>. During zebrafish cardiac development, Wt1 is required for the proper development of the proepicardial organ and epicardial lineage <30>. A later study proposed that Wt1-interacting protein (Wtip), a protein identified as a Wt1-interacting partner by a yeast two-hybrid screen <63>, signals in conjunction with WT1 for proepicardial organ specification and cardiac left/right asymmetry in the zebrafish heart <64>. Two main cardiac cell types were suggested khổng lồ be involved in zebrafish heart regeneration using ex vivo cultures: epicardial cells, displaying a larger, prismatic morphology & Wt1/Gata4 (Gata-binding protein 4) expression, và endocardial small, rounded cells, positive for Nfat2 (nuclear factor of activated T-cells 2) and Gata4 <65>.
Already in 1994, Wt1 transcripts were detected by Northern blot in adult rat heart tissues <94>. Whether modifications in Wt1 expression occur under pathophysiological conditions and which cell types express the protein remained open questions. Our group was the first khổng lồ demonstrate that Wt1 is a useful early marker of myocardial infarction <95>, a finding later confirmed by others <96,97,98>. We focused on the de novo Wt1 expression in the coronary vasculature of the ischemic myocardium. As Wt1 is essential for normal growth of the heart during development, we originally reasoned that it might also play a role in adult cardiac hypertrophy. To thử nghiệm this hypothesis, we analyzed the expression of Wt1 in normal hearts & in the hypertrophied left ventricles of spontaneously hypertensive rats (SHRs), with activation of the renin–angiotensin system by transgenic (over) expression of human renin và angiotensinogen genes, và with postinfarct remodeling of the heart after ligation of the left coronary artery (LAD). Interestingly, we detected an over two-fold increase of cardiac Wt1 mRNA expression after LAD ligation, but no differences for the two hypertrophy models compared lớn controls. Further experiments using LAD ligation demonstrated a rapid increase of cardiac Wt1 levels already 24 h after LAD ligation, which remained elevated for nine weeks following the ischemic injury. Strikingly, in addition to lớn its expression in the epicardium, we observed Wt1 localized to the coronary vessels in proximity lớn the infarcted tissue. Coronary vessels of non-infarcted animals did not express Wt1. Wt1 was expressed in endothelial as well as in vascular smooth muscle cells in the border zone of infarcted tissues. We confirmed this finding also in human cardiac ischemic tissues (unpublished results). Interestingly, WT1 expression could also be detected in healthy adult human myocardium by others <99>. Colocalization of Wt1 with proliferating cell nuclear antigen (PCNA) và vascular endothelial growth factor (VEGF) suggests a role of Wt1 in the proliferative response of the coronary vasculature lớn cardiac hypoxia <95>. In a following study, we were the first to lớn demonstrate that Wt1 expression is indeed triggered by hypoxia, which involves transcriptional activation of the Wt1 promoter by the hypoxia inducible factor 1 (HIF-1) <100>. Later studies confirmed our finding that Wt1 is a hypoxia-regulated gene <83,101>. Interestingly, it had been demonstrated that ischemia in vivo (through myocardial infarction in mice) or in vitro (hypoxia exposition of epicardial human explants) induced an embryonic reprogramming of the epicardial compartment, involving migration of epicardial-derived stem cell marker c-Kit expressing Wt1-positive cells which contributed khổng lồ re-vascularization và cardiac remodeling <102>. As we identified c-Kit as a transcriptional target of Wt1 in the context of vascular formation <8>, it seems conceivable that mobilization of c-Kit precursor cells represents one mechanism of Wt1-mediated cardiac neovascularization after ischemia. We further identified the telomere repeat-binding factor (Trf) 2 to lớn be regulated by Wt1 <92>. Down-regulation of Trf2 has been demonstrated lớn provoke cardiomyocyte telomere erosion & apoptosis, linking telomere dysfunction to lớn heart failure <103>.
Thymosin β4 (Tβ4), a 43-amino-acid G-actin-sequestering peptide which is expressed in the embryonic heart & implicated in coronary vessel development in mice <104>, has been shown khổng lồ activate cardiac regeneration through stimulation of the expression of embryonic developmental genes in the adult epicardium, leading khổng lồ de novo coronary vessel formation after myocardial infarction. However, a significant increase could only be reported for Vegf, Vegfr2, và TGFβ levels, whereas Wt1 levels were not significantly altered 24 h after mi compared to lớn vehicle-treated animals <105>. A later study additionally revealed that adult Wt1+ GFP+ EPDCs cells obtained through Tβ4 priming và myocardial infarction are a heterogeneous population expressing cardiac progenitor và mesenchymal stem markers that can restore an embryonic gene program, but bởi not revert entirely lớn adopt an embryonic phenotype <106>.
First suspicions for a role of Wt1 in human cardiac pathologies originated in 2004, with a case report from an adult XY karyotype patient with a N-terminal WT1 missense mutation presenting a very unusual phenotype: ambiguous genitalia, but normal testosterone levels, absence of kidney disease, & an associated congenital heart defect <107>. Later, a role for WT1 in some cases of congenital diaphragmatic hernia associated with the Meacham syndrome phenotype had been suggested <108>. Meacham syndrome is a rare sporadically occurring multiple malformation syndrome characterized by male pseudo-hermaphroditism with abnormal internal female genitalia, complex congenital heart defects, including hypoplastic left hearts, and diaphragmatic abnormalities <109>. In a number of Meacham syndrome patients, heterozygous missense mutations in the C–terminal zinc finger domains of WT1 could be identified, suggesting that at least some cases displaying phenotypes of Meacham syndrome are caused by mutations at the WT1 locus <108>. We reported the case of a 4-month-old girl, who presented with end-stage renal disease, nephroblastomatosis, thrombopenia, anemia, pericarditis, & cardiac hypertrophy accompanied by severe hypertension. Sequence analysis identified a heterozygous nonsense mutation in exon 9 of WT1, which leads khổng lồ a truncation of the WT1 protein at the beginning of zinc finger 3 <110>. WT1 is a transcriptional regulator of erythropoietin, which might explain the persistent anemia in this patient <80>. Evolution over time showed severe & resistant high blood pressure, despite multi-drug therapy và bilateral nephrectomy, which did not result in the normalization of the blood pressure values. Acute episodes of high blood pressure were associated with cardiogenic shock & anemia. The little patient showed a severe concentric myocardial hypertrophy, with moderate signs of heart failure và intermittent pericarditis <110>. Still awaiting kidney transplantation, the child died due lớn myocardial infarction at the age of five years. Later, another case of cardiac pathology in a patient with a WT1 mutation was reported: A 46, XY phenotypic male patient with isolated nephrotic syndrome, end-stage renal disease, & hypertension, presented at the age of 6.3 years. A mutation in exon 8 of the WT1 ren was identified. After starting hemodialysis, manifestations of hypertension and renal failure improved, but he died at 6.8 years of age as a result of heart và respiratory failure <111>. Monozygotic twins with congenital nephrotic syndrome caused by a WT1 mutation have been reported to have died due khổng lồ sepsis and extensive thrombosis of central venous system & sepsis và sudden heart failure at ages 23 weeks/13.5 months, respectively <112>. WT1 misexpression has been reported in autopsy findings from two human fetuses, displaying congenital pulmonary airway malformation, bilateral renal agenesis, & congenital heart defects <113>. Shortly after, re-evaluation of autopsy data from fourteen additional fetuses with combined renal agenesis and cardiac anomalies revealed abnormalities of Wt1 expression, mostly in liver mesenchymal cells. As WT1 is widely expressed in mesothelium, it had been suggested that the defects could be caused by abnormal function of mesenchyme derived from mesothelial cells <114>. WT1 is further expressed in cardiac angiosarcomas, which is the most common malignant neoplasm of the heart in adults. As other primary cardiac malignancies such as synovial sarcoma, leiomyosarcoma, và unclassified sarcomas are frequently negative for WT1, this finding might be helpful for differential diagnosis. It further confirms the implication of WT1 in vascular formation <115>.
Interestingly, it has been shown recently using patient biopsies that the thickening of the epicardium và migration of Wt1-positive EPDCs contributes lớn atrial fibro-fatty infiltration, a source of atrial fibrillation. Employing Wt1 genetic lineage mouse lines, the authors showed that adult EPDCs maintain an adipogenic potential in the epicardial layer and can shift to lớn a fibrotic phenotype in response khổng lồ distinct stimuli, identifying the epicardium as a central regulator of the balance between fat & fibrosis accumulation <116>. Additionally, the expression of TGFβ1 and FGFs (fibroblast growth factors) by EPDCs has been suggested to lớn contribute to lớn the pathogenesis of myocardial fibrosis, apoptosis, arrhythmias, and cardiac dysfunction in a mouse mã sản phẩm of arrhythmogenic cardiomyopathy (ACM) <117>.
Table 3 summarizes WT1-expressing cell types in the adult heart. Reported functions & regulatory mechanisms are discussed below.
Although a relationship between Wt1 và myocardial blood vessel development had already been suggested <24,28>, it remained unclear whether Wt1 is indeed necessary for normal vascularization of the heart. Coronary vessel formation is organized through a series of tightly regulated events. The epicardial cells undergo an epithelial-to-mesenchymal transition <122,123,124> to become subepicardial mesenchymal cells. The subepicardial mesenchymal cells then migrate into the myocardium, where they differentiate into endothelial cells, smooth muscle cells, & perivascular fibroblasts of the coronary vessels <124,125>. Further steps in coronary vessel formation include stabilization of the newly formed vessels & remodeling lớn connect the vessels to lớn the main coronary arteries, originating from the aorta (reviewed in <126>). In contrast lớn this classical view, mostly lineage tracing experiments suggested an important contribution of sinus venosus-derived endothelial cells <127,128> or the endocardium <129> for cardiac vessel endothelial cells, which has been questioned later <130> (reviewed in <131,132>).
In addition khổng lồ the epicardium, we clearly observed nuclear Wt1 protein expression in the coronary vessels of mouse embryos at E12.5, E15.5, & E18.5. Notably, we detected endogenous Wt1 protein but not reporter gene activity. Wt1-deficient embryos (E12.5) failed to size subepicardial coronary vessels. To identify candidate target genes of Wt1 in the process of coronary vessel formation, we performed a transcriptome analysis of differentially expressed genes from hearts of wild-type and Wt1-deficient mice. One of the genes found khổng lồ be differentially expressed was Ntrk2, the gene encoding for the tyrosine kinase type B receptor (TrkB) <32>. TrkB is a tyrosine kinase receptor with high affinity for brain-derived neurotrophic factor (BDNF) & neurotrophin 4/5 (NT4/5) (reviewed in <133>). A role for BDNF signaling in coronary blood vessel formation had emerged based on the observation that BDNF-deficient mice displayed abnormal myocardial vessel formation due khổng lồ endothelial cell apoptosis <134>. TrkB and Wt1 co-localized in the epicardium and the coronary vessels of mouse embryonic hearts at E12.5. TrkB expression was absent from Wt1-deficient embryonic hearts. TrkB-deficient mouse embryos revealed a reduction of coronary vessel formation along with enhanced apoptosis. In addition khổng lồ these lines of evidence which suggested that Ntrk2, the gen encoding the TrkB neurotrophin receptor, represents a target of Wt1 in the process of myocardial vascularization, molecular approaches employing transient transfections, Dnase1 footprint analyses, and electrophoretic mobility shift assays helped lớn identify a binding site for Wt1 in the Ntrk2 promoter. This binding site was necessary for transgenic expression of a lacZ reporter in the developing myocardial vasculature and other known sites of Wt1 expression as the gonads và the coelomic epithelium. Activation of TrkB expression by Wt1 appears therefore khổng lồ be a critical step for the proper development of the coronary vessels <32>. Another protein that is expressed by newly forming vessels is the intermediate filament protein nestin <135>. We could demonstrate the regulation of nestin by Wt1; nestin further colocalized with Wt1 in the epicardium and the forming coronary vessels, và was undetectable in Wt1 knockout hearts <50>. Nestin has been found lớn be highly expressed in proangiogenic capillaries after myocardial infarction & has been proposed to play a role in remodeling the cytoskeleton of cells in the human postinfarcted myocardium <136>. Moreover, the transmembrane cell adhesion molecule α4 integrin has been identified to be a transcriptional target of Wt1 in cardiac development <81>. α4-integrin-deficient mouse embryos display epicardial and coronary vessel formation defects, similar khổng lồ those observed in Wt1 knockout embryos <137>. The transcriptional activation of the α4 integrin gen by Wt1 could therefore be an additional regulatory mechanism for the formation of the epicardium. We further identified the major podocyte protein nephrin as a transcriptional target of Wt1 <49>. Nephrin is not only required for kidney podocyte function <138>, but also is crucial for cardiac vessel formation during development. We found nephrin to be expressed during human and mouse cardiac development. Nephrin-deficient mice displayed epicardial defects, a disturbed coronary vessel formation, & an increased apoptosis predominantly in the developing epicardium. Direct interaction of nephrin with the low affinity neurotrophin receptor p75NTR và subsidiary upregulation of p75NTR are critically involved in the cardiac phenotype of nephrin-deficient embryos <139>. Cardiac abnormalities have been reported in FinMajor nephrin mutation patients, which presented mainly with mild cardiac hypertrophy <140,141,142>. Another protein critically involved in cardiac vessel formation, which is transcriptionally regulated by Wt1, is the transcription factor Ets-1 <84>. Lượt thích Wt1, Ets-1 deficiency results in a failure of epicardial differentiation, a disturbed coronary vessel formation, & myocardial defects <143>. Recently, extracardiac septum transversum/proepicardium (ST/PE)-derived endothelial cells have been shown to be required for proper coronary vascular morphogenesis. Conditional deletion of Wt1 from both, the ST/PE and the endothelium disrupted embryonic coronary transmural patterning, leading khổng lồ embryonic death. The ST/PE contributes a significant fraction of cells (≈20%) lớn the coronary endothelium during embryogenesis required for proper coronary vascular development <144>.
Using Wt1GFPCre và inducible Wt1CreERT2 mouse lines, the group of William Pu suggested in 2008 that Wt1-expressing epicardial cells contribute to lớn the cardiomyocyte lineage during normal heart development. Wt1 epicardial cells located on the heart at E10.5–E11.5 differentiated in vivo into fully functional cardiomyocytes, as evidenced ex vivo by spontaneous contractility và calcium oscillations with kinetics, amplitude, & frequency characteristic of cardiomyocytes <26>. Moreover, in 2008, Cai và colleagues reported the identification of a cardiac myocyte lineage that derives from the proepicardial organ. These T-box transcription factor (Tbx) 18-expressing progenitor cells migrated onto the outer cardiac surface to form the epicardium, and then contributed to lớn myocytes in the ventricular septum và the atrial & ventricular walls <145>. Shortly after, Christoffels et al. Showed that Tbx18 is expressed in left ventricular and interventricular septum cardiomyocytes independent of a epicardial contribution <146>. Both groups used independent Tbx18 Cre knock-in lines, which differed considerably in sensitivity and specificity. The results of the Tbx18 reporter system used by Christoffels et al. Correspond to lớn endogenous Tbx18 expression data reported earlier <147>. Studying in detail the migration và differentiation of epicardium-derived cells, the group of Poelman already observed in 1998 that EPDCs migrated to lớn the subendocardium, myocardium, và atrioventricular cushions. The functional role of these novel EPDCs remained however unclear <148>. Employing chick proepicardial explant cultures, it had further been demonstrated that proepicardial cells were able khổng lồ differentiate into cardiac muscle cells in vitro, reflecting the pluripotency of the pericardial mesoderm <149>. In 2011, a reactivation of Wt1 expression after myocardial infarction resulting in cardiomyocyte restitution has been proposed. Using Wt1CreEGFP & inducible Wt1CreERT2 lines, the authors observed only a mild increase in Wt1 expression upon cardiac injury & no initiation of cardiac vessel formation, which is in contrast lớn our previous findings <95>. Only by using thymosin β4 (Tβ4) priming which had before been reported to lớn initiate expression of embryonic developmental genes in the epicardium <105>, a significant reactivation of Wt1 expression after myocardial infarction was achieved resulting in the appearance of some Wt1-positive cardiomyocytes in the border zone of the infarcted area. These findings suggest a contribution of Wt1-positive EPDCs lớn the myocardium after myocardial infarction in the artificial setting of thymosin β4 priming before infarction <119>. However, co-authors from this study showed one year later, using the epicardium genetic lineage tracing line Wt1CreERT2/+ và double reporter line Rosa26mTmG/+, that epicardial cells vì chưng not differentiate into cardiomyocytes following myocardial infarction & Tβ4 treatment. Their study clearly raises cautions regarding a potential clinical use of Tβ4 with the goal to lớn increase cardiac repair <150>. An additional Wt1 Cre using a BAC clone has been described, which again gave different results. Without using Tβ4, the authors observed a significant increase of Wt1 expression và proliferation in the epicardium shortly after myocardial infarction, leading lớn the formation of a Wt1-lineage-positive subepicardial mesenchyme until two weeks post-infarction. These mesenchymal cells were shown khổng lồ contribute khổng lồ the fibroblast population, myofibroblasts, and coronary endothelium in the infarct zone, a few of them later also differentiated into cardiomyocytes <118>. C. Rudat and A. Kispert undertook a substantial effort lớn identify Wt1-expressing cardiac cell types & to clarify the contribution of Wt1-expressing progenitor cells khổng lồ differentiated cardiac cells. Using in situ hybridization & immunofluorescence, they revealed expression of Wt1 mRNA & protein not before E9.5 in the (pro)epicardium and endothelial cells throughout development. They further determined that neither Wt1CreEGFP nor Wt1CreERT2 lineage tracing systems are reliable epicardial fate-defining approaches due khổng lồ ectopic recombination & poor recombination efficiency. Endogenous expression of Wt1 in the endothelium and eventually the myocardium in the developing heart eliminates Wt1-based Cre lines to trace the epicardial contribution khổng lồ myocardial, and endothelial cells in the murine heart. The proposed epicardial origin of myocardial and endothelial cells in the heart using Wt1-based Cre/loxP lines appears therefore not justified <35>. Accordingly, Wt1 had already been excluded from epicardial cell fate mapping approaches in zebrafish due to its non-epicardial expression in the fish hearts <151>. A population of adult cardiac resident colony forming unit fibroblasts (cCFUs), most likely originating from the proepicardium/epicardium has been identified, giving rise mainly to lớn cellular components of the coronary vasculature. A differentiation into cardiomyocytes in vivo could, however, not be supported <152>. Our group found Wt1 to lớn be expressed in cardiomyocytes during development (first time point studied E10.5) và throughout lifespan. The number of Wt1-positive cardiomyocytes as well as the individual cellular intranuclear Wt1 expression decreased during development & was very low in adulthood, but we propose that low levels of Wt1 expression are sufficient lớn maintain a cardiac progenitor subset from terminal differentiation. Myocardial infarction strongly up-regulated Wt1-expressing cardiomyocytes, as well as individual nuclear Wt1 expression in cardiomyocytes. Interestingly, in contrast to the expression pattern in epicardial cells, Wt1 was expressed in a speckled manner in cardiomyocytes <37>, suggesting the presence of the Wt1 + KTS variant <153>. We detected Wt1+ cardiomyocytes already 48 h after myocardial infarction. Given the distance khổng lồ the epicardium & the differing expression pattern of Wt1, speckled in the nucleus in cardiomyocytes versus diffuse nuclear expression in epicardial cells, it is unlikely that these cardiomyocytes are epicardium-derived <37>. It has been shown that de novo cardiomyocytes arise in adjacent areas of a myocardial infarction <154,155>. This could tư vấn cardiac tissue regeneration by Wt1 reactivation in response to stimuli as hypoxia/inflammation, inducing progenitor cell proliferation & cell survival. We observed that upon cardiac differentiation of mouse embryonic stem cells (mESCs), Wt1 expression increased. Overexpression of Wt1 in mESCs reduced phenotypic cardiomyocyte differentiation in vitro keeping the cells in a more progenitor-like stage <37>. Recently, a common progenitor pool of the epicardium và myocardium has been identified by single cell transcriptomic analyses. Most of the clusters expressed Wt1, which explains expression in some cardiomyocytes và epicardium later in life <25>, suggesting that these few cells with low màn chơi Wt1 expression are sufficient lớn maintain a cardiac progenitor subset from terminal differentiation, which becomes reactivated in cardiac repair.
Nearly three decades ago, the Wilms’ tumor suppressor Wt1 was identified as a crucial regulator of heart development. Wt1 is a zinc finger transcription factor with multiple biological functions, implicated in the development of several organ systems, among them cardiovascular structures. This nhận xét summarizes the results from many research groups which allowed to establish a relevant function for Wt1 in cardiac development & disease. During development, Wt1 is involved in fundamental processes as the formation of the epicardium, epicardial epithelial-mesenchymal transition, coronary vessel development, valve formation, organization of the cardiac autonomous nervous system, và formation of the cardiac ventricles. Wt1 is further implicated in cardiac disease và repair in adult life. We summarize here the current knowledge about expression & function of Wt1 in heart development and disease and point out controversies to lớn further stimulate additional research in the areas of cardiac development and pathophysiology. As re-activation of developmental programs is considered as paradigm for regeneration in response khổng lồ injury, understanding of these processes & the molecules involved therein is essential for the development of therapeutic strategies, which we discuss on the example of WT1.
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Wilms’ tumor suppressor 1 (Wt1); heart; cardiac development; coronary vessel formation; transcriptional regulation; cardiac malformation; epicardium; epicardial derived cells (EPDCs); epithelial mesenchymal transition (EMT); cardiac cell fate; regeneration
The Wilms’ tumor 1 (WT1) gen was originally identified based on its mutational inactivation in Wilms’ tumor (nephroblastoma) <1,2,3>. This first discovery of WT1 as the responsible ren in an autosomal-recessive condition classified it as a tumor-suppressor gene. Mutations of WT1 were associated with the development of kidney tumors & urogenital defects. However, later it became clear that mutations of WT1 only occur in a low frequency in nephroblastoma <4> & that most nephroblastomas <5> express high levels of WT1. Based on the overexpression of WT1 in leukemia và most solid cancers (reviewed in <6,7> and its cancer-promoting functions in the tumor stroma <8>, WT1 is nowadays considered as an oncogene và attractive candidate for cancer therapy.
WT1 encodes a zinc finger transcription factor and RNA-binding protein <9,10,11,12>. As a transcriptional regulator, it can either activate or repress various target genes. Thus, WT1 influences cellular differentiation, growth, apoptosis, and metabolism. WT1 exists in multiple isoforms. Alternative splicing of exon 5 & exon 9 gives rise lớn major isoforms. Splicing of exon 9 generates the KTS isoforms, which either include or exclude three amino acids lysin, threonine, and serin (KTS) between zinc fingers 3 and 4 of the protein <13>. Although the majority of WT1 proteins are in the nucleus, some are present in the cytoplasm, located on actively translating polysomes. WT1 isoforms shuttle between the nucleus và cytoplasm <14>. The complexity of WT1 is further enhanced by post-translational modifications và a plethora of binding partners. WT1 directs the development of several organs và tissues, among them the heart.
The heart develops mostly from embryonic mesodermal germ layer cells and to some extent from ectoderm-derived cardiac neuronal crest (cushions of the outflow tract). The cardiogenic mesoderm differentiates into proepicardial, endocardial, & myocardial cells. The epicardium is formed from a subset of the proepicardial cells. Proepicardial cells also contribute subepicardial cells, interstitial fibroblast, pericytes, & a subset of the endothelial cells of the coronary vessels. The inner lining of the heart tube is formed by endocardial cells. The vertebrate heart forms as two concentric epithelial cylinders of myocardium và endocardium separated by an extended basement membrane matrix commonly referred lớn as cardiac jelly. The primitive heart tube is formed at embryonic day 8.5 (E8.5) in the mouse <15>. The primitive tube elongates and undergoes rightward looping. Further remodeling of the heart involves formation và expansion of the chambers, and formation of valves and septa, resulting in a heart with two atria và two ventricles <16>. The heart is the first organ to develop và is already functional at an early stage of fetal development, in line with its essential role for the distribution of oxygen và nutrients & removal of waste products và carbon dioxide. Several excellent đánh giá have already described cardiac development in detail <17,18,19,20,21,22>. Thus, we focus here only on the role of Wt1. Wt1 expression was first observed in a transitory cluster of cells—the proepicardium and the coelomic epithelium at E9.5. Wt1-expressing proepicardial cells liên hệ the dorsal wall of the heart from which the proepicardial cell migrate over the myocardium of the heart tube to khung the epicardial layer by E12.5 <23,24>. This view has been challenged recently by the detection of a common progenitor cell population of epicardium and myocardium using single-cell RNA sequencing <25>. How these common progenitors might migrate during cardiac development is currently an mở cửa question.
A proportion of epicardial cells undergoes epithelial-to-mesenchymal transition (EMT), which induces the formation of epicardial-derived cells (EPDCs), a population of multipotent mesenchymal cardiac progenitor cells, which might differentiate into cardiomyocytes, fibroblasts, smooth muscle, and endothelial cells <26,27,28>, which is discussed in detail later. First indications for the indispensable role of Wt1 in heart homeostasis came from the observations made in Wt1 knockout embryonic mice which died at mid-gestation due lớn cardiac malformations <29>.
Here, we review the history of investigations characterizing the role of WT1 (i) in cardiac development, (ii) in cardiac disease và regeneration, and (iii) in different cardiac cell types & transcriptional regulatory mechanisms. We indicate emerging notions and point out problems & promises in the field of development of therapeutic strategies for cardiac repair.
Nearly thirty years ago, Armstrong và colleagues, using in situ mRNA hybridization, observed Wt1 expression in the differentiating heart mesothelium of the mouse embryo at embryonic day 9 <23>. In the same year, the group of Jaenisch introduced a mutation into the murine Wt1 ren by gene targeting in embryonic stem cells. The embryos homozygous for this mutation died between days 13 và 15 of gestation. Besides the lack of kidney và gonad formation in Wt1 mutant mice, the authors observed a severe heart hypoplasia with thinned right ventricular walls, a rounded apex, and a reduction of kích thước of the left ventricles, signs of congestive heart failure, suggesting that cardiac malfunction was the cause of early embryonic death <29>. As Wt1 has been described before only khổng lồ be expressed in the epicardium, but has not yet been observed in the myocardium, it remained unclear whether these features of cardiac malformation were due to lớn primary defects in the myocardial tissue or a consequence of disturbed development in other tissues. A more detailed view on Wt1 expression during murine heart development was achieved using a lacZ reporter gene inserted into a YAC (yeast artificial chromosome) construct which demonstrated Wt1 expression in the early proepicardium, the epicardium, and subepicardial mesenchymal cells (SEMCs) throughout development. In Wt1-deficient animals, the epicardium did not size correctly, which results in disruption in the formation of the coronary vasculature, leading khổng lồ pericardial bleeding và midgestational death of the embryo. Complementation of Wt1 null embryos with a human WT1 transgene rescued both embryonic heart defects & midgestational death, confirming that indeed heart failure causes the death of Wt1-deficient embryos <24>.
Wt1-expressing cell types during heart development in different species are summarized in Table 1 và further described below. Of note, expression of Wt1 is limited to a subset of the identified cells. Functional differences between Wt1-expressing cells and the Wt1-negative counterparts remain mostly unknown at present.
Studies in birds confirmed the expression of Wt1 in epicardium- & epicardial-derived cells (EPDCs) during embryonic development <31>. Using normal avian and quail-to-chick chimeric embryos, the origin and fate of Wt1-expressing EPDCs were later described and the effects of epicardial ablation on cardiac development investigated <28>. Wt1-expressing EPDCs were found khổng lồ populate the subepicardial space và to invade the ventricular myocardium. Upon differentiation in smooth muscle & endothelial cells, Wt1 expression decreased in EPDCs. Undifferentiated EPDCs continued to express Wt1 và invaded the ventricular myocardium & the atrio-ventricular (AV) valves. Disruption of normal epicardial development either by proepicardial ablation or block reduced the number of invasive Wt1-positive EPDCs, và provoked anomalies in the coronary vessels, the ventricular myocardium, và the AV cushions. In addition lớn Wt1, EPDCs express retinaldehyde-dehydrogenase (Raldh) 2 <38,39>. It had been demonstrated that in humans WT1 transcriptionally regulates the retinoic acid receptor alpha (RAR-α) gene <40>. Transcriptional target genes of WT1 with relevance in the heart are summarized in Table 2 và discussed below.
The phenotype of the WT1-deficient mice further resembled that of retinoic acid (RA)-depleted mice. Depletion of RA from the diet is known to lớn severely disturb heart development, causing hypoplasia of the ventricles <41>. The authors suggested therefore that Wt1 maintains the EPDCs in an undifferentiated, RA-producing state khổng lồ contribute to ventricular myocardium compaction in the development of the myocardial wall <28>. Availability of retinoic acid during cardiac development is mediated by Raldh2. It has been shown that Wt1 transcriptionally activates Raldh2 <42>. Pericardium and sinus horn formation are coupled & are based on the expansion & exact temporal release of pleuropericardial membranes (PPM) from the underlying subcoelomic mesenchyme. Wt1-deficient mouse embryos displayed a failure to khung myocardialized sinus horns & a loss of Raldh2 expression in the subcoelomic mesenchyme, pointing khổng lồ a crucial role of Wt1 & downstream Raldh2/RA signaling in sinus horn development <43>. Furthermore, Wt1-mutant mice were shown lớn display unilateral partial PPM absence in the dorsomedial region. Failure of PPM release affects the closure of the remaining communication area between pericardial và pleural cavities, the bilateral pericardioperitoneal canals (PPCs), which is disturbed in Wt1-deficient embryos, leading khổng lồ pleuropericardial communication và lateralization of the cardinal veins <44>. The group of Muñoz -Chapuli suggests that the proepicardium is an evolutionary derivative of the primordium of an ancient external pronephric glomerulus, initially based on the epicardial development in lampreys (Petromyzon), the most primitive living lineage of vertebrates <45>. Employing chick proepicardium, they propound that Wt1 could repress the nephrogenic potential of the proepicardium, while at the same time promote nephrogenesis in the intermediate mesoderm. This paradoxical function could be explained by the dual role of Wt1, which promotes mesenchymal khổng lồ epithelial transition (MET) in the kidney & EMT in the epicardium <46>, through a mechanism known as chromatin flip–flop <47>. Promotion of EMT in the developing epicardium & MET in the growing kidney is not only reflected by morphological cellular changes, but also differential expression of podocyte markers. In their study, the authors focused on podocalyxin, known khổng lồ be transcriptionally regulated by Wt1, and to be activated by Wt1 in kidney podocytes <48>, which they found in contrast to be upregulated in Wt1-deficient epicardium <46>. To lớn further strengthen this theory it appears interesting to lớn investigate the expression of other Wt1 transcriptional targets in kidney MET và epicardial EMT, such as nephrin <49>, nestin <50>, & podocin <51>.
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In addition, the relation between Wt1-expressing epicardial derivatives and the development of compact ventricular myocardium has been investigated. The differences in myocardial architecture specifically between the right ventricle (RV) và the left ventricle (LV) in association to epicardial formation and distribution of Wt1-expressing cells were studied. The authors demonstrated that the RV is less densely and later covered by the epicardium than the LV. They also observed that compact myocardial layer formation occurred in parallel with the presence of Wt1-expressing cells & was more pronounced in the LV than in the RV, và within the RV more accentuated in the postero-lateral wall than in the anterior wall, which might explain the lateralized differences in ventricular morphology of the heart <52>. The same group was able khổng lồ identify a function of the epicardium in cardiac autonomic nervous system modulation, essential for proper cardiac activity by altering heart rate, conduction velocity, và force of contraction. They revealed expression of neuronal markers in the epicardium during early cardiac development, notably of tubulin beta-3 chain (Tubb3), which was colocalized with Wt1 in epicardium and the nervous system, neural cell adhesion molecule (Ncam), and the β2 adrenergic receptor (β2AR). Adrenaline (epinephrine), a catecholamine, is known to modulate heart rate, velocity of conduction, & contraction strength in the heart through its binding khổng lồ β2AR. Inhibition of the outgrowth of the epicardium abolished the response to lớn adrenaline administration, indicating that the epicardium is necessary for a normal response of the heart lớn adrenaline during early cardiac development <53>. This report further confirmed a role of Wt1 in neural function, as suggested by several studies <23,54,55,56,57,58,59>.
In zebrafish, two orthologues of wt1 have been described: wt1a <60,61> & wt1b <62>. Both of them were found khổng lồ be expressed in adult zebrafish hearts, but exhibited a differential expression màn chơi in other organs, as well as a differing temporal patterning during development, suggesting distinctive functions during zebrafish development <62>. During zebrafish cardiac development, Wt1 is required for the proper development of the proepicardial organ and epicardial lineage <30>. A later study proposed that Wt1-interacting protein (Wtip), a protein identified as a Wt1-interacting partner by a yeast two-hybrid screen <63>, signals in conjunction with WT1 for proepicardial organ specification and cardiac left/right asymmetry in the zebrafish heart <64>. Two main cardiac cell types were suggested khổng lồ be involved in zebrafish heart regeneration using ex vivo cultures: epicardial cells, displaying a larger, prismatic morphology & Wt1/Gata4 (Gata-binding protein 4) expression, và endocardial small, rounded cells, positive for Nfat2 (nuclear factor of activated T-cells 2) and Gata4 <65>.
| Insulin lượt thích growth factor 1 receptor (IGF-1-R) | <66> |
| Epidermal growth factor receptor (EGFR) | <67> |
| Retinoic acid receptor alpha (RAR- α) | <40> |
| Retinaldehyde-dehydrogenase (Raldh) 2 | <42> |
| Insulin receptor (IR) | <68> |
| Paired box gen 2 (Pax2) | <69> |
| Platelet-derived growth factor A (PDGFA) | <70,71> |
| Early growth response protein 1 (EGR-1) | <72> |
| Insulin lượt thích growth factor 2 (IGF-2) | <73> |
| Transforming growth factor beta (TGF-β) | <74> |
| Colony-stimulating factor-1 (CSF-1) | <75> |
| Syndecan 1 | <76> |
| Midkine | <77> |
| Vitamin D receptor (Vdr) | <78,79> |
| Podocalyxin | <48> |
| Nephrin (Nphs1) | <49> |
| Podocin (Nphs2) | <51> |
| Tyrosinkinase receptor (Trk)B | <32> |
| Nestin | <50> |
| Erythropoietin (EPO) | <80> |
| α4 Integrin | <81> |
| Vascular endothelial growth factor (VEGF) | <82,83> |
| Vascular endothelial growth factor receptor (Vegfr) 2 | <84,85> |
| ETS proto-oncogene (ETS)-1 | <84> |
| Snail (Snai1) | <86> |
| Slug (Snai2) | <87> |
| E-Cadherin | <86,88> |
| VE-Cadherin | <89> |
| Coronin1B | <90> |
| Cxcl10 (C-X-C Motif Chemokine Ligand 10) | <91> |
| Ccl5 (C-C Motif Chemokine Ligand 5) | <91> |
| Interferon regulatory factor (Irf)7 | <91> |
| c-Kit (tyrosine-protein kinase KIT) | <8> |
| Pecam-1 (platelet & endothelial cell adhesion molecule 1) | <8> |
| Telomere repeat binding factor (Trf) 2 | <92> |
| Bone morphogenetic protein (Bmp) 4 | <93> |
Already in 1994, Wt1 transcripts were detected by Northern blot in adult rat heart tissues <94>. Whether modifications in Wt1 expression occur under pathophysiological conditions and which cell types express the protein remained open questions. Our group was the first khổng lồ demonstrate that Wt1 is a useful early marker of myocardial infarction <95>, a finding later confirmed by others <96,97,98>. We focused on the de novo Wt1 expression in the coronary vasculature of the ischemic myocardium. As Wt1 is essential for normal growth of the heart during development, we originally reasoned that it might also play a role in adult cardiac hypertrophy. To thử nghiệm this hypothesis, we analyzed the expression of Wt1 in normal hearts & in the hypertrophied left ventricles of spontaneously hypertensive rats (SHRs), with activation of the renin–angiotensin system by transgenic (over) expression of human renin và angiotensinogen genes, và with postinfarct remodeling of the heart after ligation of the left coronary artery (LAD). Interestingly, we detected an over two-fold increase of cardiac Wt1 mRNA expression after LAD ligation, but no differences for the two hypertrophy models compared lớn controls. Further experiments using LAD ligation demonstrated a rapid increase of cardiac Wt1 levels already 24 h after LAD ligation, which remained elevated for nine weeks following the ischemic injury. Strikingly, in addition to lớn its expression in the epicardium, we observed Wt1 localized to the coronary vessels in proximity lớn the infarcted tissue. Coronary vessels of non-infarcted animals did not express Wt1. Wt1 was expressed in endothelial as well as in vascular smooth muscle cells in the border zone of infarcted tissues. We confirmed this finding also in human cardiac ischemic tissues (unpublished results). Interestingly, WT1 expression could also be detected in healthy adult human myocardium by others <99>. Colocalization of Wt1 with proliferating cell nuclear antigen (PCNA) và vascular endothelial growth factor (VEGF) suggests a role of Wt1 in the proliferative response of the coronary vasculature lớn cardiac hypoxia <95>. In a following study, we were the first to lớn demonstrate that Wt1 expression is indeed triggered by hypoxia, which involves transcriptional activation of the Wt1 promoter by the hypoxia inducible factor 1 (HIF-1) <100>. Later studies confirmed our finding that Wt1 is a hypoxia-regulated gene <83,101>. Interestingly, it had been demonstrated that ischemia in vivo (through myocardial infarction in mice) or in vitro (hypoxia exposition of epicardial human explants) induced an embryonic reprogramming of the epicardial compartment, involving migration of epicardial-derived stem cell marker c-Kit expressing Wt1-positive cells which contributed khổng lồ re-vascularization và cardiac remodeling <102>. As we identified c-Kit as a transcriptional target of Wt1 in the context of vascular formation <8>, it seems conceivable that mobilization of c-Kit precursor cells represents one mechanism of Wt1-mediated cardiac neovascularization after ischemia. We further identified the telomere repeat-binding factor (Trf) 2 to lớn be regulated by Wt1 <92>. Down-regulation of Trf2 has been demonstrated lớn provoke cardiomyocyte telomere erosion & apoptosis, linking telomere dysfunction to lớn heart failure <103>.
Thymosin β4 (Tβ4), a 43-amino-acid G-actin-sequestering peptide which is expressed in the embryonic heart & implicated in coronary vessel development in mice <104>, has been shown khổng lồ activate cardiac regeneration through stimulation of the expression of embryonic developmental genes in the adult epicardium, leading khổng lồ de novo coronary vessel formation after myocardial infarction. However, a significant increase could only be reported for Vegf, Vegfr2, và TGFβ levels, whereas Wt1 levels were not significantly altered 24 h after mi compared to lớn vehicle-treated animals <105>. A later study additionally revealed that adult Wt1+ GFP+ EPDCs cells obtained through Tβ4 priming và myocardial infarction are a heterogeneous population expressing cardiac progenitor và mesenchymal stem markers that can restore an embryonic gene program, but bởi not revert entirely lớn adopt an embryonic phenotype <106>.
First suspicions for a role of Wt1 in human cardiac pathologies originated in 2004, with a case report from an adult XY karyotype patient with a N-terminal WT1 missense mutation presenting a very unusual phenotype: ambiguous genitalia, but normal testosterone levels, absence of kidney disease, & an associated congenital heart defect <107>. Later, a role for WT1 in some cases of congenital diaphragmatic hernia associated with the Meacham syndrome phenotype had been suggested <108>. Meacham syndrome is a rare sporadically occurring multiple malformation syndrome characterized by male pseudo-hermaphroditism with abnormal internal female genitalia, complex congenital heart defects, including hypoplastic left hearts, and diaphragmatic abnormalities <109>. In a number of Meacham syndrome patients, heterozygous missense mutations in the C–terminal zinc finger domains of WT1 could be identified, suggesting that at least some cases displaying phenotypes of Meacham syndrome are caused by mutations at the WT1 locus <108>. We reported the case of a 4-month-old girl, who presented with end-stage renal disease, nephroblastomatosis, thrombopenia, anemia, pericarditis, & cardiac hypertrophy accompanied by severe hypertension. Sequence analysis identified a heterozygous nonsense mutation in exon 9 of WT1, which leads khổng lồ a truncation of the WT1 protein at the beginning of zinc finger 3 <110>. WT1 is a transcriptional regulator of erythropoietin, which might explain the persistent anemia in this patient <80>. Evolution over time showed severe & resistant high blood pressure, despite multi-drug therapy và bilateral nephrectomy, which did not result in the normalization of the blood pressure values. Acute episodes of high blood pressure were associated with cardiogenic shock & anemia. The little patient showed a severe concentric myocardial hypertrophy, with moderate signs of heart failure và intermittent pericarditis <110>. Still awaiting kidney transplantation, the child died due lớn myocardial infarction at the age of five years. Later, another case of cardiac pathology in a patient with a WT1 mutation was reported: A 46, XY phenotypic male patient with isolated nephrotic syndrome, end-stage renal disease, & hypertension, presented at the age of 6.3 years. A mutation in exon 8 of the WT1 ren was identified. After starting hemodialysis, manifestations of hypertension and renal failure improved, but he died at 6.8 years of age as a result of heart và respiratory failure <111>. Monozygotic twins with congenital nephrotic syndrome caused by a WT1 mutation have been reported to have died due khổng lồ sepsis and extensive thrombosis of central venous system & sepsis và sudden heart failure at ages 23 weeks/13.5 months, respectively <112>. WT1 misexpression has been reported in autopsy findings from two human fetuses, displaying congenital pulmonary airway malformation, bilateral renal agenesis, & congenital heart defects <113>. Shortly after, re-evaluation of autopsy data from fourteen additional fetuses with combined renal agenesis and cardiac anomalies revealed abnormalities of Wt1 expression, mostly in liver mesenchymal cells. As WT1 is widely expressed in mesothelium, it had been suggested that the defects could be caused by abnormal function of mesenchyme derived from mesothelial cells <114>. WT1 is further expressed in cardiac angiosarcomas, which is the most common malignant neoplasm of the heart in adults. As other primary cardiac malignancies such as synovial sarcoma, leiomyosarcoma, và unclassified sarcomas are frequently negative for WT1, this finding might be helpful for differential diagnosis. It further confirms the implication of WT1 in vascular formation <115>.
Interestingly, it has been shown recently using patient biopsies that the thickening of the epicardium và migration of Wt1-positive EPDCs contributes lớn atrial fibro-fatty infiltration, a source of atrial fibrillation. Employing Wt1 genetic lineage mouse lines, the authors showed that adult EPDCs maintain an adipogenic potential in the epicardial layer and can shift to lớn a fibrotic phenotype in response khổng lồ distinct stimuli, identifying the epicardium as a central regulator of the balance between fat & fibrosis accumulation <116>. Additionally, the expression of TGFβ1 and FGFs (fibroblast growth factors) by EPDCs has been suggested to lớn contribute to lớn the pathogenesis of myocardial fibrosis, apoptosis, arrhythmias, and cardiac dysfunction in a mouse mã sản phẩm of arrhythmogenic cardiomyopathy (ACM) <117>.
Table 3 summarizes WT1-expressing cell types in the adult heart. Reported functions & regulatory mechanisms are discussed below.
Although a relationship between Wt1 và myocardial blood vessel development had already been suggested <24,28>, it remained unclear whether Wt1 is indeed necessary for normal vascularization of the heart. Coronary vessel formation is organized through a series of tightly regulated events. The epicardial cells undergo an epithelial-to-mesenchymal transition <122,123,124> to become subepicardial mesenchymal cells. The subepicardial mesenchymal cells then migrate into the myocardium, where they differentiate into endothelial cells, smooth muscle cells, & perivascular fibroblasts of the coronary vessels <124,125>. Further steps in coronary vessel formation include stabilization of the newly formed vessels & remodeling lớn connect the vessels to lớn the main coronary arteries, originating from the aorta (reviewed in <126>). In contrast lớn this classical view, mostly lineage tracing experiments suggested an important contribution of sinus venosus-derived endothelial cells <127,128> or the endocardium <129> for cardiac vessel endothelial cells, which has been questioned later <130> (reviewed in <131,132>).
In addition khổng lồ the epicardium, we clearly observed nuclear Wt1 protein expression in the coronary vessels of mouse embryos at E12.5, E15.5, & E18.5. Notably, we detected endogenous Wt1 protein but not reporter gene activity. Wt1-deficient embryos (E12.5) failed to size subepicardial coronary vessels. To identify candidate target genes of Wt1 in the process of coronary vessel formation, we performed a transcriptome analysis of differentially expressed genes from hearts of wild-type and Wt1-deficient mice. One of the genes found khổng lồ be differentially expressed was Ntrk2, the gene encoding for the tyrosine kinase type B receptor (TrkB) <32>. TrkB is a tyrosine kinase receptor with high affinity for brain-derived neurotrophic factor (BDNF) & neurotrophin 4/5 (NT4/5) (reviewed in <133>). A role for BDNF signaling in coronary blood vessel formation had emerged based on the observation that BDNF-deficient mice displayed abnormal myocardial vessel formation due khổng lồ endothelial cell apoptosis <134>. TrkB and Wt1 co-localized in the epicardium and the coronary vessels of mouse embryonic hearts at E12.5. TrkB expression was absent from Wt1-deficient embryonic hearts. TrkB-deficient mouse embryos revealed a reduction of coronary vessel formation along with enhanced apoptosis. In addition khổng lồ these lines of evidence which suggested that Ntrk2, the gen encoding the TrkB neurotrophin receptor, represents a target of Wt1 in the process of myocardial vascularization, molecular approaches employing transient transfections, Dnase1 footprint analyses, and electrophoretic mobility shift assays helped lớn identify a binding site for Wt1 in the Ntrk2 promoter. This binding site was necessary for transgenic expression of a lacZ reporter in the developing myocardial vasculature and other known sites of Wt1 expression as the gonads và the coelomic epithelium. Activation of TrkB expression by Wt1 appears therefore khổng lồ be a critical step for the proper development of the coronary vessels <32>. Another protein that is expressed by newly forming vessels is the intermediate filament protein nestin <135>. We could demonstrate the regulation of nestin by Wt1; nestin further colocalized with Wt1 in the epicardium and the forming coronary vessels, và was undetectable in Wt1 knockout hearts <50>. Nestin has been found lớn be highly expressed in proangiogenic capillaries after myocardial infarction & has been proposed to play a role in remodeling the cytoskeleton of cells in the human postinfarcted myocardium <136>. Moreover, the transmembrane cell adhesion molecule α4 integrin has been identified to be a transcriptional target of Wt1 in cardiac development <81>. α4-integrin-deficient mouse embryos display epicardial and coronary vessel formation defects, similar khổng lồ those observed in Wt1 knockout embryos <137>. The transcriptional activation of the α4 integrin gen by Wt1 could therefore be an additional regulatory mechanism for the formation of the epicardium. We further identified the major podocyte protein nephrin as a transcriptional target of Wt1 <49>. Nephrin is not only required for kidney podocyte function <138>, but also is crucial for cardiac vessel formation during development. We found nephrin to be expressed during human and mouse cardiac development. Nephrin-deficient mice displayed epicardial defects, a disturbed coronary vessel formation, & an increased apoptosis predominantly in the developing epicardium. Direct interaction of nephrin with the low affinity neurotrophin receptor p75NTR và subsidiary upregulation of p75NTR are critically involved in the cardiac phenotype of nephrin-deficient embryos <139>. Cardiac abnormalities have been reported in FinMajor nephrin mutation patients, which presented mainly with mild cardiac hypertrophy <140,141,142>. Another protein critically involved in cardiac vessel formation, which is transcriptionally regulated by Wt1, is the transcription factor Ets-1 <84>. Lượt thích Wt1, Ets-1 deficiency results in a failure of epicardial differentiation, a disturbed coronary vessel formation, & myocardial defects <143>. Recently, extracardiac septum transversum/proepicardium (ST/PE)-derived endothelial cells have been shown to be required for proper coronary vascular morphogenesis. Conditional deletion of Wt1 from both, the ST/PE and the endothelium disrupted embryonic coronary transmural patterning, leading khổng lồ embryonic death. The ST/PE contributes a significant fraction of cells (≈20%) lớn the coronary endothelium during embryogenesis required for proper coronary vascular development <144>.
Using Wt1GFPCre và inducible Wt1CreERT2 mouse lines, the group of William Pu suggested in 2008 that Wt1-expressing epicardial cells contribute to lớn the cardiomyocyte lineage during normal heart development. Wt1 epicardial cells located on the heart at E10.5–E11.5 differentiated in vivo into fully functional cardiomyocytes, as evidenced ex vivo by spontaneous contractility và calcium oscillations with kinetics, amplitude, & frequency characteristic of cardiomyocytes <26>. Moreover, in 2008, Cai và colleagues reported the identification of a cardiac myocyte lineage that derives from the proepicardial organ. These T-box transcription factor (Tbx) 18-expressing progenitor cells migrated onto the outer cardiac surface to form the epicardium, and then contributed to lớn myocytes in the ventricular septum và the atrial & ventricular walls <145>. Shortly after, Christoffels et al. Showed that Tbx18 is expressed in left ventricular and interventricular septum cardiomyocytes independent of a epicardial contribution <146>. Both groups used independent Tbx18 Cre knock-in lines, which differed considerably in sensitivity and specificity. The results of the Tbx18 reporter system used by Christoffels et al. Correspond to lớn endogenous Tbx18 expression data reported earlier <147>. Studying in detail the migration và differentiation of epicardium-derived cells, the group of Poelman already observed in 1998 that EPDCs migrated to lớn the subendocardium, myocardium, và atrioventricular cushions. The functional role of these novel EPDCs remained however unclear <148>. Employing chick proepicardial explant cultures, it had further been demonstrated that proepicardial cells were able khổng lồ differentiate into cardiac muscle cells in vitro, reflecting the pluripotency of the pericardial mesoderm <149>. In 2011, a reactivation of Wt1 expression after myocardial infarction resulting in cardiomyocyte restitution has been proposed. Using Wt1CreEGFP & inducible Wt1CreERT2 lines, the authors observed only a mild increase in Wt1 expression upon cardiac injury & no initiation of cardiac vessel formation, which is in contrast lớn our previous findings <95>. Only by using thymosin β4 (Tβ4) priming which had before been reported to lớn initiate expression of embryonic developmental genes in the epicardium <105>, a significant reactivation of Wt1 expression after myocardial infarction was achieved resulting in the appearance of some Wt1-positive cardiomyocytes in the border zone of the infarcted area. These findings suggest a contribution of Wt1-positive EPDCs lớn the myocardium after myocardial infarction in the artificial setting of thymosin β4 priming before infarction <119>. However, co-authors from this study showed one year later, using the epicardium genetic lineage tracing line Wt1CreERT2/+ và double reporter line Rosa26mTmG/+, that epicardial cells vì chưng not differentiate into cardiomyocytes following myocardial infarction & Tβ4 treatment. Their study clearly raises cautions regarding a potential clinical use of Tβ4 with the goal to lớn increase cardiac repair <150>. An additional Wt1 Cre using a BAC clone has been described, which again gave different results. Without using Tβ4, the authors observed a significant increase of Wt1 expression và proliferation in the epicardium shortly after myocardial infarction, leading lớn the formation of a Wt1-lineage-positive subepicardial mesenchyme until two weeks post-infarction. These mesenchymal cells were shown khổng lồ contribute khổng lồ the fibroblast population, myofibroblasts, and coronary endothelium in the infarct zone, a few of them later also differentiated into cardiomyocytes <118>. C. Rudat and A. Kispert undertook a substantial effort lớn identify Wt1-expressing cardiac cell types & to clarify the contribution of Wt1-expressing progenitor cells khổng lồ differentiated cardiac cells. Using in situ hybridization & immunofluorescence, they revealed expression of Wt1 mRNA & protein not before E9.5 in the (pro)epicardium and endothelial cells throughout development. They further determined that neither Wt1CreEGFP nor Wt1CreERT2 lineage tracing systems are reliable epicardial fate-defining approaches due khổng lồ ectopic recombination & poor recombination efficiency. Endogenous expression of Wt1 in the endothelium and eventually the myocardium in the developing heart eliminates Wt1-based Cre lines to trace the epicardial contribution khổng lồ myocardial, and endothelial cells in the murine heart. The proposed epicardial origin of myocardial and endothelial cells in the heart using Wt1-based Cre/loxP lines appears therefore not justified <35>. Accordingly, Wt1 had already been excluded from epicardial cell fate mapping approaches in zebrafish due to its non-epicardial expression in the fish hearts <151>. A population of adult cardiac resident colony forming unit fibroblasts (cCFUs), most likely originating from the proepicardium/epicardium has been identified, giving rise mainly to lớn cellular components of the coronary vasculature. A differentiation into cardiomyocytes in vivo could, however, not be supported <152>. Our group found Wt1 to lớn be expressed in cardiomyocytes during development (first time point studied E10.5) và throughout lifespan. The number of Wt1-positive cardiomyocytes as well as the individual cellular intranuclear Wt1 expression decreased during development & was very low in adulthood, but we propose that low levels of Wt1 expression are sufficient lớn maintain a cardiac progenitor subset from terminal differentiation. Myocardial infarction strongly up-regulated Wt1-expressing cardiomyocytes, as well as individual nuclear Wt1 expression in cardiomyocytes. Interestingly, in contrast to the expression pattern in epicardial cells, Wt1 was expressed in a speckled manner in cardiomyocytes <37>, suggesting the presence of the Wt1 + KTS variant <153>. We detected Wt1+ cardiomyocytes already 48 h after myocardial infarction. Given the distance khổng lồ the epicardium & the differing expression pattern of Wt1, speckled in the nucleus in cardiomyocytes versus diffuse nuclear expression in epicardial cells, it is unlikely that these cardiomyocytes are epicardium-derived <37>. It has been shown that de novo cardiomyocytes arise in adjacent areas of a myocardial infarction <154,155>. This could tư vấn cardiac tissue regeneration by Wt1 reactivation in response to stimuli as hypoxia/inflammation, inducing progenitor cell proliferation & cell survival. We observed that upon cardiac differentiation of mouse embryonic stem cells (mESCs), Wt1 expression increased. Overexpression of Wt1 in mESCs reduced phenotypic cardiomyocyte differentiation in vitro keeping the cells in a more progenitor-like stage <37>. Recently, a common progenitor pool of the epicardium và myocardium has been identified by single cell transcriptomic analyses. Most of the clusters expressed Wt1, which explains expression in some cardiomyocytes và epicardium later in life <25>, suggesting that these few cells with low màn chơi Wt1 expression are sufficient lớn maintain a cardiac progenitor subset from terminal differentiation, which becomes reactivated in cardiac repair.
