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Copyright De Langhe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Formation and Differentiation of Multiple Mesenchymal Lineages during Lung Development Is Regulated by β-catenin Signaling 1Developmental Biology Program, Department of Surgery, Saban Research Institute of Childrens Hospital Los Angeles, Los Angeles, California, United States of America 2Department of Pediatrics, Women's and Children's Hospital, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America 3Center for Craniofacial Molecular Biology, School of Dentistry, University of Southern California, Los Angeles, California, United States of America 4School of Biological Sciences, University of East Anglia (UEA), Norwich, Norfolk, United Kingdom 5Laboratoire de Génétique Moléculaire, Institut de Recherches Cliniques de Montréal (IRCM), Montréal, Québec, Canada Thomas Zwaka, Academic Editor Baylor College of Medicine, United States of America * To whom correspondence should be addressed. E-mail: SBellusci/at/chla.usc.edu Conceived and designed the experiments: SB SD MH VK. Performed the experiments: SD GC DT VK. Analyzed the data: SB SD MH GC DT PM VK. Contributed reagents/materials/analysis tools: YC SD JD GC DT CL XX PM. Wrote the paper: SB SD MH. ¤Current address: Division of Cell Biology, Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado, United States of America Received November 6, 2007; Accepted December 27, 2007. This article has been cited by other articles in PMC.Abstract Background The role of ß-catenin signaling in mesodermal lineage formation and differentiation has been elusive. Methodology To define the role of ß-catenin signaling in these processes, we used a Dermo1(Twist2)Cre/+ line to target a floxed β-catenin allele, throughout the embryonic mesenchyme. Strikingly, the Dermo1Cre/+; β-cateninf/− conditional Knock Out embryos largely phenocopy Pitx1−/−/Pitx2−/− double knockout embryos, suggesting that ß-catenin signaling in the mesenchyme depends mostly on the PITX family of transcription factors. We have dissected this relationship further in the developing lungs and find that mesenchymal deletion of β-catenin differentially affects two major mesenchymal lineages. The amplification but not differentiation of Fgf10-expressing parabronchial smooth muscle progenitor cells is drastically reduced. In the angioblast-endothelial lineage, however, only differentiation into mature endothelial cells is impaired. Conclusion Taken together these findings reveal a hierarchy of gene activity involving ß-catenin and PITX, as important regulators of mesenchymal cell proliferation and differentiation. Introduction During development and in adult tissues, mesenchymal cells serve as precursors to diverse cell lineages, including smooth muscle cells (SMCs), endothelial cells, pericytes, lipocytes and stromal fibroblasts. The proper generation of these cell types likely relies on the controlled amplification of lineage-restricted and non-restricted mesenchymal precursors followed by their timely differentiation into the appropriate progeny. The developing lung provides a good system for studying the regulators of epithelial and mesenchymal cell lineage formation [1] and thus regulators of epithelial progenitor fates have been elucidated. For example, hyperactive β-catenin signaling leads to aberrant amplification of distal lung progenitor cells, partly through the regulation of N-myc expression [2], [3], [4], while targeted disruption of N-myc results in premature differentiation and reduced epithelial cell proliferation [2], [3]. ß-catenin signaling also regulates the levels of Bmp4 and Fgfr2b expression in distal lung epithelium [4]. FGFR2b signaling in turn, is critical for maintenance and expansion of the pool of epithelial progenitor cells, not only in lungs, but also in developing pancreas, tooth and skin [5], [6], [7]. We and others have studied the sequential development of several lung mesenchymal lineages. The distal lung contains two distinct mesenchymal cell populations: sub-epithelial; sub-mesothelial. Sub-epithelial cells express Ptch and respond to epithelially-derived SHH, while transient fate analysis studies using an Fgf10-LacZ reporter line (here after termed Fgf10LacZ/+), show that the sub-mesothelial cells express high levels of Fgf10 and serve as progenitors to parabronchial smooth muscle cells (PSMCs). The PSMC progenitor status is maintained by mesothelialy-derived FGF9 [8]. With time, the PSMC progenitors relocate around the bronchi, and under the influence of an epithelially-derived signal, BMP4, differentiate into PSMCs [9]. The myogenic program is then completed along the proximal airways, where the progenitors encounter Laminin-2 and Fibronectin in the epithelial basement membrane [10], [11], [12]. Hints that ß-catenin signaling is important for the development of the mesenchyme, in addition to the epithelium, have emerged from expression pattern studies and the analysis of TOPGAL and BATGAL reporter mice. TOPGAL and BATGAL alleles serve as LEF1/TCF mediated ß-catenin signaling reporters only [13], [14] and their observed activity is restricted to the late/differentiated mesenchymal derivatives, such as the smooth muscle cells surrounding the proximal airways and in the mesenchyme around the trachea [2], [4], [11]. Furthermore, overexpression of Wnt5a has been shown to either directly or indirectly regulate Fgf10 expression in the mesenchyme [15] while Wnt7b has been demonstrated to act on lung vascular SMCs through Frizzled 1 and LRP5 [16]. Besides LEF1/TCF mediated ß-catenin signaling, ß-catenin can also act through the PITX family of transcription factors [17], which are abundantly expressed in developing mesenchymal tissues [18]. Yet, the precise role and contribution of ß-catenin-PITX signaling axis in the early development and specification of mesenchymal lineages has not been studied in detail. We have carried out a Dermo1Cre/+-mediated conditional inactivation (CKO) of β-catenin to study the role of ß-catenin signaling in mouse embryonic mesodermal lineages. In these mutants, we find multiple mesenchymally-related defects that are remarkably reminiscent of a double knock out of Pitx1 and Pitx2 genes [19]. By focusing on the lungs of the conditional mutant embryos and combining fate analysis and global gene expression pattern studies, we show for the first time that mesenchymal ß-catenin signaling has a dual, lineage-dependant function. It regulates the formation and amplification of Fgf10-expressing PSMC progenitor cells but does not affect their differentiation. Yet, it is required for proper differentiation of endothelial cells. These findings reveal a critical requirement for ß-catenin signaling in the development of multiple mesenchymal lineages. Results and Discussion Phenotypic similarities between Dermo1Cre/+-mediated inactivation of β-catenin and complete loss of Pitx1/2 Analysis of 327 embryos from F1 intercrosses revealed that the Dermo1Cre/+; β-cateninf/- conditional knockout (here on abbreviated to CKO) is lethal at embryonic day E13.5-E14.5 due to the severe cardiac (supplemental figure) and vasculogenesis-related defects. CKO embryos show a set of phenotypes that are remarkably reminiscent of Pitx2 null embryos. These include: an arrest in turning of the body axis and defective body wall closure; partial right pulmonary isomerism; altered cardiac position with major cardiac outflow tract abnormalities classified as double outlet right ventricle (DORV) (90%) and Pulmonary truncus arteriosus (PTA) (10%) (n = 20); defective development of the mandibular and maxillary facial prominences and regression of the stomodeum (supplemental Fig. S1) [17], [18], [20], [21], [22]. Furthermore, CKO embryos exhibit minor forelimb and severe hind limb defects (supplemental Fig. S1), the latter being characteristic of the Pitx1/2 double KO [19].Several studies have suggested that the ß-catenin signaling pathway can induce Pitx2 expression, and that direct binding of β-catenin to PITX2, converts PITX2 into a transcriptional activator [17]. Our in vivo findings provide the strongest genetic evidence yet for involvement of a ß-catenin-PITX axis in the formation and/or differentiation of multiple mesenchymal lineages. Here on, we study the lung mesenchyme of CKO embryos to dissect these interactions and decipher their precise role in mesenchymal cell lineage differentiation. CKO of β-catenin in lung mesenchyme alters the growth and patterning of mesenchymal and epithelial cells To monitor the onset and pattern of Cre activity in Dermo1Cre/+ lungs, we crossed the Dermo1Cre/+ mice [23] with Rosa26R reporter mice [24] and found a strong Cre-activity detectable in the mesenchyme surrounding the trachea and primary bronchi illustrated at E11.5 (Fig. 1a
To validate the specific inactivation of β-catenin in the mesenchyme, we compared the pattern and levels of β-catenin expression in CKO versus wild type lungs by immunofluorescence staining. Except for occasionally a few patches, we could not detect β-catenin expression in the mesenchyme of E14.5 CKO lungs and consistent with the restriction of Cre expression to Dermo1Cre/+ mesenchyme, epithelial β-catenin expression appeared unperturbed. Persistence of β-catenin in some small patches of lung mesenchyme is indicative of a mosaic deletion (Fig. 1l,k Analysis at E12.5 and E14.5 showed that the ß-catenin CKO lungs have shortened trachea and reduced branching as well as perturbation of normal stereotypic branching patterns observed in WT lungs. Moreover, the peripheral mesenchyme was reduced. The CKO lungs also exhibit partial isomerism such that the left lobes contained inter-lobular septations – characteristic of the right side of WT lungs, but lacked an accessory lobe (Fig. 1f,h The branching defect in CKO lungs is more severe than just the right isomerization initially described in Pitx2 hypomorph embryos and resembles more the phenotype of lungs from mice with a complete inactivation of Pitx2 [25]. We therefore examined the impact of CKO on PITX2 expression and asked whether its homologues, PITX1 and PITX3, are affected by loss of β-catenin. Immunostaining studies showed that PITX1 is present in both WT and CKO distal lung epithelium (Fig. 2a,b
Loss of β-catenin signaling affects the sub-mesothelial but not sub-epithelial mesenchyme and diminishes FGF signaling We analyzed the expression of a set of lineage and cell type-specific marker genes to examine whether all or just a subset of mesenchymal cells are affected by the loss of β-catenin signaling. In the developing lungs, Fgf10 is expressed by the PSMC progenitors, which are sub-mesothelial in origin [26]. Localized expression of Fgf10 in the distal mesenchyme also drives the stereotypic branching observed during early lung development [27]. Except for a few patches in the right lobes, levels of Fgf10 were greatly reduced in E13.5 CKO lungs (Fig. 3a,b
We then examined whether the sub-epithelial distal mesenchymal domain, was similarly affected. Expression of Shh (Fig. 3e,f We have previously shown that mesenchymal FGF signaling is important for the expression of Fgf10 within, and for the ensuing survival and proliferation of distal PSMC mesenchymal progenitors [28]. Mesenchymal FGF signaling induced by FGF9 is also important for preventing the differentiation of PSMC progenitors [8], [28]. Spry4, expressed in the distal mesenchyme is a faithful reflector of levels of FGF signaling in this tissue compartment [28]. Interestingly, we found that levels of Spry4 were also reduced in CKO lungs suggestive of reduced levels of mesenchymal FGF signaling (Fig. 3i,j We then compared the expression of Bmp4 in the epithelium of WT and CKO lungs as BMP4 engages the Fgf10 expressing progenitors into the smooth muscle cell lineage [9], [29]. However, no difference in Bmp4 expression between WT and CKO lungs was observed (data not shown) suggesting that the differentiation of the PSMC progenitors could occur normally in CKO lungs. Mesenchymal defects in CKO lungs do involve a gradual loss of PITX Next, we used an imported TOPGAL reporter allele to examine the level and distribution of LEF1/TCF-mediated β-catenin signaling. At E13.5, TOPGAL activity was restricted to epithelium, in both WT and CKO lungs, with no discernable difference in levels (Fig. 3k,l As the ß-catenin-PITX2 pathway has previously been shown to regulate Pitx2 expression itself, both at the level of transcription [17] and mRNA stability [30], we compared the levels of Pitx2 expression in CKO and WT lungs by in situ hybridization. Using a riboprobe that detects all three isoforms of Pitx2, we found that at E13.5, CKO lungs show an absence of Pitx2 expression (Fig. 3m,n Remarkably, at E11.5, CKO embryos already exhibit a Pitx1/2 KO-like phenotype even though Pitx2 expression is not fully extinguished at this stage (Fig. 3o,p Fgfr2 is a downstream target of β-catenin signaling in the mesenchyme The observed reduction in Fgf10 and Spry4 expression, indicative of reduced FGFR2C signaling in CKO lung mesenchyme, led us to investigate its mechanism. Shu et al., (2005) reported that inactivation of β-catenin in the distal lung epithelium, leads to a down-regulation of Fgfr2 receptor in the epithelium. By inactivating β-catenin in the lung mesenchyme, we might expect to observe a similar down-regulation of Fgfr2 in the mesenchyme. Using immunohistochemistry, we found that indeed FGFR2 expression is reduced in the mesenchyme but not epithelium of CKO lungs (Fig. 4a,b = 3, P = 0.03) compared to scrambled led to a corresponding downregulation in Fgfr2 expression of 40%±4 (n = 3, P = 0.003) (Fig 4l = 3, P = 0.01) compared to scrambled led to a corresponding downregulation in Fgfr2 expression of 40%±6 (n = 3, P = 0.009) (Fig. 4l
Next, we set out to investigate if this relationship is reflected in functional assays. We quantified the distribution of P-ERK positive cells and found much fewer P-ERK positive cells in the mesenchyme of CKO lungs wherever β-catenin was deleted (0.1±0.1% vs. 1±0.2%, n = 3, P = 0.03) (Fig. 4d,c = 3, P = 0.03). There was also a clear reduction in the number of mitotic cells, as determined by Phospho-Histone H3 (PH3) staining, in mesenchyme (0.2±0.1% vs. 1.1±0.1%, n = 3, P = 0.02) (Fig. 4f,e = 3, P = 0.03) of CKO, when compared to WT.Interestingly, no significant differences in P-ERK or PH3 could be found in areas of CKO lung mesenchyme that lacked recombination (P-ERK 1.3±0.1% vs. 1.1±0.2% P = 0.2) (PH3 1.5±0.2% vs. 1.1±0.1%, n = 3, P = 0.2), demonstrating that the effect of β-catenin deletion in CKO lungs on mesenchymal proliferation and ERK phosphorylation is cell autonomous.We also tested the response of CKO and WT lung explants to FGF9 treatment, which in a normal scenario would stimulate the proliferation of sub-mesothelial mesenchyme and cause dilation of the epithelium, effects that are brought about by FGFR2 signaling [8], [35] (Fig. 4i,g In this system, we also found that PITX2 expression is decreased in CKO lung mesenchyme. Finally, a set of immunoprecipitation studies indicated that PITX2 is not only a downstream target of β-catenin signaling in the lung but also binds to β-catenin (Fig. 4k Taken together these results support the notion that Fgfr2 is a specific downstream target gene in the β-catenin/PITX2 pathway of the mesenchyme. Conditional deletion of β-catenin in the lung mesenchyme results in the functional inactivation of the FGFR2c signaling pathway. In turn, this affects the sub-mesothelial mesenchymal domain containing the PSMC progenitor cells, which is known to depend on mesenchymal FGF signaling for its maintenance and proliferation [8], [28]. Reduction of PSCM cells correlates with loss of c-Myc expression The loss of proliferation noted in CKO lungs led us to measure the levels of c-Myc expression, which is known to be a ß-catenin/PITX2 signaling target gene [17] and key regulator of cell proliferation [36]. As shown in Fig. 5a, c
Next, we examined the consequence of this reduced cell proliferation on parabronchial smooth muscle formation around the bronchi, since sub-mesothelial mesenchymal progenitors contribute to these muscles. Immunofluorescent staining with SMA-specific antibodies revealed that the continuity of the PSMC layer around the bronchi of the CKO lungs is compromised (Fig. 5d,c We also tested the potential of CKO mesenchymal cells to differentiate into smooth muscle cells in vitro and found this unperturbed [37] because, like WT cells, cultured CKO cells readily differentiated into SMC (Fig. 5e,f = 3, P = 0.005) increase in P-ERK (Fig. 5k,i = 3, P = 0.001) increase in P-ERK levels (Fig. 5l,jMesenchymal β-catenin signaling is essential for the amplification of the Fgf10 expressing PSMC progenitors and differentiation of the angioblasts into mature endothelial cells So far, we have provided experimental evidence suggesting that CKO deletion of β-catenin in the lung mesenchyme perturbs the amplification but not the differentiation of the PSMC progenitors into smooth muscle cells. To directly visualize the fate of the Fgf10-expressing progenitors, we crossed our mutant mice with a previously published Fgf10LacZ enhancer-trap line [38]. Due to the stability of the LacZ protein, this line can be used to lineage trace transiently the Fgf10 expressing PSMC progenitors [9]. CKO lungs showed a marked reduction in Fgf10/LacZ expressing progenitors in the distal mesenchyme at E13.5 vs. WT lungs (Fig. 6b,a
Mesenchymal β-catenin signaling controls the amplification of PSMC progenitors in the sub-mesothelial mesenchyme Figure 7
As PSMC progenitors relocate around the bronchi, they are exposed to high levels of epithelial BMP4, and eventually stretch out on the epithelial basement membrane which engages them into the smooth muscle cell lineage [9], [11], and there appears to be a switch from PITX2 to PITX3 expression. Our data suggest that PITX2 and 3 have distinct effects on cell fate and seem to be differently affected by the deletion of β-catenin. We propose that mesenchymal β-catenin signaling in the sub-mesothelial mesenchyme acting at least in part via PITX2 is necessary for the amplification of the PSMC progenitors or at least the proliferation of the transient amplifying cells derived from the Fgf10 expressing PSMC progenitors. Use of the Fgf10LacZ reporter shows that single Fgf10/LacZ positive PSMC progenitors are present in the distal mesenchyme of CKO lungs. The presence of these cells may indicate that β-catenin signaling is required for asymmetrical division of these progenitors into PSMC precursor cells. Deletion of β-catenin in the progenitor cells leads to impaired formation of transient amplifying cells, revealing the single Fgf10/LacZ expressing PSMC progenitors in the CKO lungs. However, deletion of β-catenin in the progenitors or the transient amplifying cells does not inhibit their differentiation into smooth muscle cells, which coincides with a switch in expression from PITX2 to PITX3. On the contrary, FGF9 is no longer capable of maintaining the undifferentiated state of mesenchymal cells, effectively allowing them to differentiate prematurely. Paradoxically, ß-catenin signaling seems to play the opposite role in the other major mesodermally derived cell lineage, the endothelial cell lineage. In the whole CKO embryo and in the lung in particular, we observe an amplification of Flk1-positive angioblasts. We propose that absence of β-catenin prevents them from differentiating into mature endothelial cells. Interestingly c-Myc, which is down-regulated in the CKO lung mesenchyme, has also previously been shown to be essential for vasculogenesis and angiogenesis during development and tumor progression [44]. In conclusion, our data indicate that ß-catenin signaling in the undifferentiated lung mesenchyme is mediated by members of the PITX family of transcription factors and exhibits a duality in effect, being necessary for the amplification of the Fgf10-expressing PSMC progenitors on the one hand and the proper differentiation of angioblasts into mature endothelial cells on the other. Materials and Methods Transgenic embryos β-cateninf/f; CMV-Cre, Rosa26R, Flk1LacZ/+ and TOPGAL, mice were obtained from The Jackson Laboratory. Dermo1Cre/+ mice were a kind gift from Dr. David Ornitz [23], Fgf10LacZ/+ mice were a generous gift from Dr. Robert Kelly [38] and Pitx2−/− embryos were a kind gift of Dr. James Martin [21]. β-catenin heterozygotes were obtained by crossing floxed β-catenin mice with CMV-Cre mice. β-catenin+/− mice were crossed with Dermo1Cre/+ mice to obtain double heterozygous males, which were then crossed with β-cateninf/f females. Also β-cateninf/f/Rosa26R+/+; β-cateninf/f/TOPGAL+/+; β-cateninf/f/Flk1Lacz/+ and β-catenin/Fgf10LacZ/+ mice were created by intercrossing β-cateninf/f mice with the respective mouse reporter lines. β-galactosidase staining Tissues containing Rosa26R, Flk1LacZ, TOPGAL or Fgf10LacZ alleles were dissected and β-galactosidase staining was performed as previously described [11]. In situ hybridization WMISH was performed like previously described [28]. Paraffin sections of embryonic lungs were hybridized using a protocol adapted from [45]. The following mouse cDNAs were used as templates for the synthesis of digoxigenin-labeled riboprobes: a 1.5 kb full-length mouse Bmp-4, a 642 bp Shh, a 584 bp fragment of Fgf10, a 1.1 kb Spry4 probe, a 948 bp full-length mouse Spry2 cDNA, a 841 bp fragment of Ptch, a 559 bp fragment from Pitx2 present in all 3 Pitx2 isoforms (cloned by RT-PCR using primers Pitx2-F gcagaggactcatttcacta and Pitx2-R tataaacgtacggaggagtc) and a 201 fragment of c-Myc (cloned by RT-PCR using primers c-Myc-F accaacaggaactatgacctc and c-Myc-R aaggacgtagcgaccgcaac). Isolation of mesenchymal cells Mesenchymal cells from E13.5 WT and CKO lungs were isolated according to [46]. Immunochemistry E13.5 CKO and WT lung mesenchymal cells were grown on 8 well permanox Lab-Tek chamber slides in the presence of FGF9 (200 ng/ml) for 24 hours. The cells were fixed for 30 minutes with 4% paraformaldehyde and subsequently washed with PBS. Lungs were fixed in 4% PFA washed in PBS, dehydrated and paraffin embedded. Lung sections and slides were treated with a monoclonal anti α-smooth muscle actin antibody (Ab), clone 1A4, Cy3 conjugated (from Sigma®) at 1 200, anti-β-catenin Ab (BD biosciences) 1 200, anti-PH3 Ab (cell signaling) 1 100, anti-PERK Ab (cell signaling) 1 100, anti PECAM Ab (BD biosciences) 1 50, anti FGFR2 (Bek) Ab (Santa Cruz) 1 50, anti-Nkx2.1 Ab (TTF1) (Neomarkers), PITX1 and PITX3 were generated in Dr. Drouin's laboratory and were described previously [47], [48]. Ab against PITX2 were a kind gift of Dr. Hjalt [33]. Alternatively, PITX3 Ab from (Zymed) were also used. Dako cytomation CSAII signal amplification system was used for FGFR2 immunohistochemistry and slides were mounted using DPX. For immunofluorescence, FITC and CY3 conjugated F(ab')2 fragments were purchased from Jackson Immunoresearch and slides were mounted with DAPI containing Vectashield®.Western blot and immunoprecipitation Western blot and Immunoprecipitation studies using antibodies against P-ERK, total ERK, FGFR2 and PITX2 were carried out as previously described [9]. Cell lysates from primary culture of WT or CKO lung mesenchymal cells were immunoprecipitated with β-catenin antibodies and analyzed by western blot for the presence of a PITX2/β-catenin or PITX3/β-catenin complexes. Primary cultures were grown in the presence of 10 mM LiCl to study the interaction of ß-catenin and PITX2 or were serum starved to study the interaction of ß-catenin with PITX3. siRNA transfection Pre-validated siRNA pools targeting mouse β-catenin and Pitx2 Dharmacon (ON-TARGETplus SMARTpool) were used. β-catenin and Pitx2 siRNA or scrambled siRNA were transfected into primary cultures of lung mesenchymal cells using Lipofectamine LTX (Invitrogen) according to the manufacturer's instructions. Mesenchymal cells at a density of 1×104 cells per well in 12-well plates were transfected in triplicate with 50 µM siRNA. The percentage of silencing of β-catenin and Pitx2 and the effect on Fgfr2c expression were detected by real-time PCR as previous described [28]. Proliferation and PERK study Organ culture Lung explants isolated from E12.5 WT and CKO embryos were cultured and treated with 200 ng/ml FGF9 (R&D systems) as previously described [8]. Intracardiac ink injections India ink was injected intracardially with custom made glass pipettes (12 µm opening) at E13.5. After injections, embryos were fixed in 4% formaldehyde for 12 hours, dehydrated and cleared in benzyl benzoate:benzyl alcohol (2 1).Figure S1 Inactivation of β-catenin in the mesenchyme resembles the phenotype of Pitx2 null embryos. (a) Frontal images of control and CKO embryos at E13.5. (b-c) Ectopic hearts and visceral organs in CKO's vs. WT with leftward displacement of ventricles (pseudo-colored in green). (d,e) β-galactosidase staining of WT or CKO embryos containing the Fgf10LacZ allele. CKO embryos display severe hind limb defects with no detectable LacZ/Fgf10 expression (inset in e). (f,g) Defective development of the mandibular and maxillary facial prominences and regression of the stomodeum. (h, i) Altered cardiac position with major cardiac outflow tract abnormalities in CKO heart (i) compared to WT (h). In WT, the pulmonary trunk (PT) rises from the right ventricle (rv) and is separated from the aorta (Ao), which rises from the left ventricle, by the aortic-pulmonary septum (rv and PT pseudo-colored in blue, lv and Ao in yellow). (j-r) Histology of control (j-l) and mutant (m-r) at E13.5 (transverse sections on comparable axial levels from rostral to caudal). Most mutants display double outlet right ventricle or DORV (m, n), i.e., both the aorta and pulmonary trunk originate from the right ventricle. A subset of mutants demonstrates a single outflow tract rising from the right ventricle, i.e., they display Pulmonary truncus arteriosus or PTA (p-r). Leftward orientation of the heart is evident in all mutants; moreover the right ventricle is largely located above the left ventricle (m-r). (4.86 MB TIF) Click here for additional data file.(4.6M, tif) Figure S2 Comparative analysis of the Pitx2−/− phenotype. (a-b) Images of control and Pitx2−/− embryos at E12.5. (c-d) Immunohistochemistry. Reduced expression for FGFR2 in E12.5 Pitx2−/− lung mesenchyme and epithelium (d) compared to WT lungs (c). (e-f) Section RISH for c-Myc on E12.5 WT and Pitx2−/− lungs. Expression of c-Myc is reduced in Pitx2−/− lung mesenchyme (f) compared to WT lung mesenchyme (e). (g-h) Intracardiac India ink injection of E12.5 WT and Pitx2−/− embryos. Pitx2−/− embryos show defects in vasculogenesis and leakage of India ink from premature blood vessels is apparent (g) compared to WT embryos (h). (10.05 MB TIF) Click here for additional data file.(9.5M, tif) Footnotes Competing Interests: The authors have declared that no competing interests exist. Funding: SDL acknowledges the support of ALA Senior Research Training Fellowship and CHLA Career Development Fellowship. This work was funded by AHA and an NIH RO1 HL074832 (to SB), HL056590 and 073471 (to PM) and HL074862 (VK). References 1. Cardoso WV, Lu J. 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