Our data show that
miR-218 is part of a regulatory circuit through which Tbx5 controls heart morphogenesis. Previous studies in mice identified
slit2, which encodes
miR-218-1 within one of its introns, as one of the genes highly sensitive to Tbx5 dosage
[8]. Moreover, the coordinate expression of
miR-218-1 and its host genes has been largely documented both in physiological (mouse development
[19]) and pathological (cancer progression
[39],
[40]) conditions. We showed a functional relation between Tbx5, Slit2 and
miR-218 in P19CL6 cells in which a progressive increase of Tbx5, Slit2 and
miR-218 expression was observed during cardiomyocyte differentiation. Moreover, we showed that Tbx5 deregulation affects
miR-218 expression. Tbx5 might regulate
slit2 expression directly or indirectly. However the presence of T-box consensus sequences upstream of both mouse and fish
slit2 transcription start site, as identified by the Transfac program (
http://www.biobase-international.com; not shown), supports the hypothesis that Tbx5 might directly bind to and activate the
slit2 promoter. To demonstrate that the Tbx5/
miR-218 regulatory circuit is also functional during development, we used the zebrafish as a model system. Through functional assays in zebrafish, we showed that either over-expression or down-regulation of Tbx5 affects heart morphogenesis. In line with the hypothesis that
miR-218 might be a Tbx5 effector, we demonstrated that
miR-218a deregulation generates cardiac defects (). As in zebrafish the expression level of
miR-218a is extremely low during the first stages of development (our observation is supported also by the data of Fish et al.
[16] and by data regarding miRNA microarray of Thatcher et al.
[29], the introduction of very low amounts of
miR-218a mimic into embryos at the one- or two-cell stage generated a severe cardiac phenotype.
miR-218a over-expressing hearts were not able to complete the looping process, showed marked alteration of the cardiac chamber morphology and mis-expression of a marker of valve cardiac tissues. A large pericardial edema was visible after 48 hpf. The frequency and severity of all these cardiac phenotypes were dose-dependent ( and ). Our data suggest that at least part of these morphological anomalies may be due to a reduced migration rate of myocardial cells (). Conversely,
miR-218a down regulation, even through injection of high doses of two different morpholinos, did not affect heart development.
Since Tbx5 and Slit2 are both expressed in myocardial cells
[16] we hypothesized that early Tbx5 over-expression might cause heart malformation through early activation of
miR-218a and silencing of the target genes of this miRNA. This hypothesis is supported by the observation that
miR-218 down-regulation by MO-218a injection rescues the effects of Tbx5 over-expression ().
robo1 has been identified as a target of
miR-218 in many different organs and tissues
[19],
[39],
[41]. Fish et al
[16] showed that
robo1 is a
miR-218a direct target and that early
robo1 down-regulation by morpholino injection in zebrafish embryos induces severe pericardial edema and heart defects caused by reduced migration rate of endocardial cells. Thus,
robo1 is a candidate gene through which Tbx5 and
miR-218a early over-expression affects heart development. Fish et al
[16]reported that
miR-218a down regulation, performed by the microinjection of one of the two morpholinos that we used in our study, causes severe cardiac defects and cardiac edema through reduced migration of endocardial and myocardial cells. This is inconsistent with both our data and with the results of Fish et al.
[16] who observed that Robo1 knock-down generates the same phenotype, because the same authors also showed that Robo1 is targeted by
miR-218. In fact, an effect of
miR-218a on the migration of endocardial and myocardial cells is not expected, as
miR-218a seems not to be substantially expressed before 24 hpf
[16],
[29], when the fusion of migrating cardiac cells is about to be completed. We speculate that the timing of
miR-218a upregulation during heart development is crucial for heart morphogenesis.
miR-218 and Robo1 are supposed to be upregulated and downregulated, respectively, when myocardial cell migration is about to end. In this view, Tbx5 mis-expression by mRNA microinjection at the one-cell stage might speed up the up-regulation of
miR-218 and reduce the migration of myocardial cells precociously, which in turn might affect heart morphogenesis by impairing the correct interaction between myocardial and endocardial cells.
A negative role of
miR-218 on cell migration has been highlighted in different biological contexts. In mice, it has been shown that
miR-218 regulates vascular patterning by modulating Slit-Robo signaling
[19]. The authors showed that
miR-218-driven repression of Robo1/2 and of heparan sulfate proteoglycans (HSPGs), which are proteins essential for Slit/Robo signaling, negatively affects endothelial cell (EC) migration.
miR-218 has also been shown to affect cancer progression by inhibiting tumor cell migration and metastasis via the repression of the Slit2/Robo1 pathway in gastric
[40] and in nasopharyngeal
[39] tumors, respectively. Therefore our data showing a migration delay of
cmlc2-positive cardiac precursors in embryos over-expressing
miR-218 (), but not in embryos in which
miR-218 was down-regulated by MO-218 injection (), are in line with these findings.
In the human heart, Tbx5 is expressed not only in the myocardium, but also throughout the embryonic epicardium and coronary vasculature. Using chick development as a model system, Hatcher et al.
[42] showed that,
in vivo, over-expression of biologically active Tbx5 inhibits proepicardial cell migration. Although we do not know whether the
slit2 is expressed in proepicardial cells, it is tempting to speculate that the up regulation of the Tbx5-
miR-218 circuit might also impact the proepicardial cell migration by targeting robo1 or other cell migration regulators such as Semaphorins, some members of this large class of molecules being predicted targets of
miR-218 (not shown).
Tbx5 over-expression affects heart development in different organisms. In humans,
tbx5 gene duplication produces cardiac abnormalities
[35],
[36]; in mice, persistent cardiac Tbx5 over-expression results in heart looping defects and abnormalities of early chamber development
[37]. In chicks, Tbx5 over-expression determines a significant decrease in heart size and a marked decrease in ventricular trabeculation
[5]. We also observed looping and cardiac chamber alterations in zebrafish after injection of
tbx5a mRNA in embryos at one-cell stage. Unexpectedly, the severity of cardiac morphology defects was paralleled by the severity of eye defects (). Tbx5 is expressed in optic primordia from zebrafish to humans
[43],
[44] and its mis-expression has been shown to affect eye morphogenesis and the visual projection in chicks
[45]. Moreover, ophthalmological examination of HOS patients revealed alteration of dorso-ventral polarity in developing eye vesicles
[46]. However, our Tbx5 over-expressing embryos showed particularly severe eye defects such as asymmetrically positioned eyes, fusion of eyes, and even unilateral anophthalmia (). Comparable eye defects are observed in Brg1 over-expressing zebrafish embryos
[47]. Recently the importance of the balance between Brg1, a member of the SWI/SNF chromatin-remodeling complex, and several cardiac transcription factors including Tbx5, has been demonstrated
[48]. Since Brg1 is maternally expressed
[47], the over-expression of Tbx5 might generate a strong imbalance between these two factors during the first hours of development, and this imbalance might be at the root of eye defects. At the moment we do not know how
miR-218 might also partially rescue eye defects. It is interesting to know that Pax2, that is negatively controlled by Tbx5
[45], is a predicted target of
miR-218. Overall, these observations suggest that Tbx5 over-expression affects heart and eye development and that this might be at least partially mediated by
miR-218. Our observation that MO-218 co-injection is able to ameliorate both heart and eye defects caused by Tbx5 injection is consistent with this model.
Our data suggest that the haplo-insufficiency of the Tbx5 gene, at the moment the most significant cause of HOS, does not impact heart and upper limb formation through
miR-218 misregulation. The simplest explanation for this might be that other key RNAs controlled by Tbx5 than
miR-218 might be necessary for heart morphogenesis by regulating mechanisms other than myocardial cell migration. This would still be consistent with the requirement of a tight
tbx5 gene dosage regulation in space and time for proper heart morphogenesis. More rarely, HOS has been associated with increased Tbx5 expression by partial chromosome duplication
[6],
[28] or mutation resulting in Tbx5 gain of function
[49]. However advances in DNA sequencing technology also highlighted the potential role of non-coding variants in congenital malformations. Recent studies in mice uncovered three enhancers that collectively recapitulate the endogenous expression pattern of
tbx5 but that singularly have specific and compartmentalized expression in the heart and forelimbs
[50]. Interestingly, a mutation in one of these enhancer sequences was identified in a cohort of non-syndromic patients and it has been shown to affect the enhancer activity in mice and zebrafish transgenic models. The population-wide frequency of this variant suggests that a significant number of congenital heart defects (CHD) associated with Tbx5 dysregulation might arise from non-coding mutations in Tbx5 heart enhancers effectively decoupling the heart and hand phenotypes of HOS syndrome. Therefore it is likely that modulation of Tbx5 in general, and over-expression of
miR-218 as a consequence of Tbx5 up-regulation in particular, might have a higher impact on CHD population than previously hypothesized.
Finally, our results highlight the potential advantage of using miRNAs as target molecules for heart disease therapies. Their potential to restore the expression of hundreds of dysregulated mRNAs to their pre-pathological level in one shot and, in so doing possibly reverse the disease, places miRNAs among the most exciting molecules for the development of new therapeutic strategies.