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Xia Y, Chen L, Lu J, Ma J, Zhang Y. The comprehensive study on the role of POSTN in fetal congenital heart disease and clinical applications. J Transl Med 2023; 21:901. [PMID: 38082393 PMCID: PMC10714640 DOI: 10.1186/s12967-023-04529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Congenital heart defect (CHD) is the most common congenital abnormality, and it has long been a clinical and public health concern. Our previous findings have found Periostin (POSTN) and Pappalysin-1 (PAPPA) as potential biomarkers for fetal CHD. We aim to further elucidate POSTN's role in fetal heart development and explore the clinical applicability of POSTN and PAPPA as diagnostic marker for fetal CHD. This study is poised to establish a theoretical framework for mitigating the incidence of CHD and advance a novel approach for prenatal screening of fetal CHD. METHODS We verified differential expression of POSTN and PAPPA in gravida serum and fetal amniotic fluid based on our previous research. We established the Postn knockout mouse by CRISPR/Cas9 to investigate whether Postn deletion leads to cardiac abnormalities in mice. Besides, we explored the mechanism of POSTN on heart development through Postn knockout mouse model and cell experiments. Finally, we established the logistic regression model and decision curve analysis to evaluate the clinical utility of POSTN and PAPPA in fetal CHD. RESULTS We observed a significant decrease in POSTN and increase in PAPPA in the CHD group. Atrial septal defects occurred in Postn-/- and Postn± C57BL/6 fetal heart, while ventricular septal defects with aortic saddle were observed in Postn± C57BL/6 fetal heart. Disruption of the extracellular matrix (ECM) in cardiomyocytes and multiple abnormalities in cellular sub-organelles were observed in Postn knockout mice. POSTN may positively regulate cell behaviors and unsettle ECM via the TGFβ-Smad2/3 signaling pathway. The combination of serum biomarkers POSTN and PAPPA with Echocardiogram can enhance the diagnostic accuracy of CHD. Furthermore, the comprehensive model including POSTN, PAPPA, and two clinical indicators (NT and age) exhibits significantly higher predictive ability than the diagnosis group without the use of serum biomarkers or clinical indicators. CONCLUSIONS It is the first evidence that Postn deletion leads to cardiac developmental abnormalities in fetal mice. This may involve the regulation of the TGFβ signaling pathway. Importantly, POSTN and PAPPA possess clinical utility as noninvasive prenatal promising screening indicators of CHD.
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Affiliation(s)
- Yi Xia
- Department of Obstetrics, Women's and Children's Hospital, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Liang Chen
- Department of Obstetrics, Women's and Children's Hospital, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - JinWen Lu
- Department of Ultrasound, Wuhan University Zhongnan Hospital, Wuhan, 430071, Hubei, China
| | - Jianhong Ma
- Department of Obstetrics, Women's and Children's Hospital, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
- Clinical Research Center for Prenatal Diagnosis and Birth Health of Hubei Province, Wuhan, Hubei, China
- Clinical Research Center for Reproductive Science and Birth Health of Wuhan, Wuhan, Hubei, China
| | - Yuanzhen Zhang
- Department of Obstetrics, Women's and Children's Hospital, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
- Clinical Research Center for Prenatal Diagnosis and Birth Health of Hubei Province, Wuhan, Hubei, China.
- Clinical Research Center for Reproductive Science and Birth Health of Wuhan, Wuhan, Hubei, China.
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