Abstract
Congenital heart defects (CHD) affect approximately 1% of all live births, and often require complex surgeries at birth. We have previously demonstrated abnormal placental vascularization in human placentas from fetuses diagnosed with CHD. Hand1 has roles in both heart and placental development and is implicated in CHD development. We utilized two conditionally activated Hand1A126fs/+ murine mutant models to investigate the importance of cell-specific Hand1 on placental development in early (Nkx2-5Cre) and late (Cdh5Cre) pregnancy. Embryonic lethality occurred in Nkx2-5Cre/Hand1A126fs/+ embryos with marked fetal demise occurring after E10.5 due to a failure in placental labyrinth formation and therefore the inability to switch to hemotrophic nutrition or maintain sufficient oxygen transfer to the fetus. Labyrinthine vessels failed to develop appropriately and vessel density was significantly lower by day E12.5. In late pregnancy, the occurrence of Cdh5Cre+;Hand1A126fs/+ fetuses was reduced from 29% at E12.5 to 20% at E18.5 and remaining fetuses exhibited reduced fetal and placental weights, labyrinth vessel density and placenta angiogenic factor mRNA expression. Our results demonstrate for the first time the necessity of Hand1 in both establishment and remodeling of the exchange area beyond early pregnancy and in patterning vascularization of the placental labyrinth crucial for maintaining pregnancy and successful fetal growth.
Highlights
Congenital heart disease (CHD) is the most common birth defect, affecting ~1% of all live births [1]
Population studies have demonstrated that pregnancies complicated by CHD carry a higher risk of developing pathologies associated with abnormal placental development and function including growth disturbances [3,4,5], preeclampsia [6,7,8,9], preterm birth [10,11], and stillbirth [12]
While relatively recently demonstrated, that placental development is often affected in pregnancies with CHD as both the heart and placenta are vascular organs that develop concurrently very early in gestation, and shared pathways direct the development of both [14]
Summary
Congenital heart disease (CHD) is the most common birth defect, affecting ~1% of all live births [1]. The placenta serves as the mediator between mother and developing fetus to provide nutrition and gas exchange, remove fetal wastes, and prevents mixing of maternal and fetal blood [13]. It is unsurprising, while relatively recently demonstrated, that placental development is often affected in pregnancies with CHD as both the heart and placenta are vascular organs that develop concurrently very early in gestation, and shared pathways direct the development of both [14]. Placentas of fetuses with CHD often exhibit changes that disrupt the proper patterning and function of the maternal/fetal exchange area including underdeveloped vasculature and impaired nutrient transport [15,16]
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