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Nkx2-5 mutation causes anatomic hypoplasia of the cardiac conduction system
Patrick Y. Jay, Brett S. Harris, Colin T. Maguire, Antje Buerger, Hiroko Wakimoto, Makoto Tanaka, Sabina Kupershmidt, Dan M. Roden, Thomas M. Schultheiss, Terrence X. O’Brien, Robert G. Gourdie, Charles I. Berul, Seigo Izumo
Patrick Y. Jay, Brett S. Harris, Colin T. Maguire, Antje Buerger, Hiroko Wakimoto, Makoto Tanaka, Sabina Kupershmidt, Dan M. Roden, Thomas M. Schultheiss, Terrence X. O’Brien, Robert G. Gourdie, Charles I. Berul, Seigo Izumo
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Article Cardiology

Nkx2-5 mutation causes anatomic hypoplasia of the cardiac conduction system

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Abstract

Heterozygous mutations of the cardiac transcription factor Nkx2-5 cause atrioventricular conduction defects in humans by unknown mechanisms. We show in KO mice that the number of cells in the cardiac conduction system is directly related to Nkx2-5 gene dosage. Null mutant embryos appear to lack the primordium of the atrioventricular node. In Nkx2-5 haploinsufficiency, the conduction system has half the normal number of cells. In addition, an entire population of connexin40–/connexin45+ cells is missing in the atrioventricular node of Nkx2-5 heterozygous KO mice. Specific functional defects associated with Nkx2-5 loss of function can be attributed to hypoplastic development of the relevant structures in the conduction system. Surprisingly, the cellular expression of connexin40, the major gap junction isoform of Purkinje fibers and a putative Nkx2-5 target, is unaffected, consistent with normal conduction times through the His-Purkinje system measured in vivo. Postnatal conduction defects in Nkx2-5 mutation may result at least in part from a defect in the genetic program that governs the recruitment or retention of embryonic cardiac myocytes in the conduction system.

Authors

Patrick Y. Jay, Brett S. Harris, Colin T. Maguire, Antje Buerger, Hiroko Wakimoto, Makoto Tanaka, Sabina Kupershmidt, Dan M. Roden, Thomas M. Schultheiss, Terrence X. O’Brien, Robert G. Gourdie, Charles I. Berul, Seigo Izumo

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Figure 3

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Hypoplasia of the peripheral conduction system in Nkx2-5neo/+ mice revea...
Hypoplasia of the peripheral conduction system in Nkx2-5neo/+ mice revealed by minK-lacZ expression. (A) In E14.5 hearts minK-lacZ enzymatic activity is proportional to minK-lacZ (copy numbers 0, 1, or 2) and Nkx2-5 gene dosage. Whole-mount images of minK-lacZ–stained neonatal hearts contrast the dense Purkinje fiber network in WT (B and D) compared with the hypocellular system in Nkx2-5+/neo mice (C and E). Sections show that the prominent blue X-gal stain shown in the whole mount is the peripheral conduction system at the interventricular septum (D and E). The hearts shown were from minK-lacZ homozygotes; heterozygotes yield similar results. The images shown are representative of at least three hearts. P < 0.05.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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