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(Circulation. 2009;119:3062-3069.)
© 2009 American Heart Association, Inc.

Congenital Heart Disease

Dominant-Negative ALK2 Allele Associates With Congenital Heart Defects

Kelly A. Smith, PhD^*; Irene C. Joziasse, MD^*; Sonja Chocron, BSc; Maarten van Dinther, BSc; Victor Guryev, PhD; Manon C. Verhoeven, MS; Holger Rehmann, PhD; Jasper J. van der Smagt, MD; Pieter A. Doevendans, MD, PhD; Edwin Cuppen, PhD; Barbara J. Mulder, MD, PhD; Peter ten Dijke, PhD; Jeroen Bakkers, PhD

From the Hubrecht Institute-KNAW and University Medical Center Utrecht (K.A.S., S.C., V.G., M.C.V., E.C., J.B.) and Interuniversity Cardiology Institute of the Netherlands (K.A.S., P.A.D., B.J.M., J.B.), Utrecht; Departments of Cardiology (I.C.J., J.J.v.d.S., P.A.D.) and Physiological Chemistry (H.R.), University Medical Center Utrecht, Utrecht; Department of Molecular Cell Biology, Leiden University Medical Center, Leiden (M.v.D., P.t.D.); Centre for Biomedical Genetics, Leiden (P.t.D.); and Amsterdam Medical Center, Amsterdam (B.J.M.), the Netherlands.

Correspondence to Jeroen Bakkers, PhD, Associate Professor, Cardiac Development and Genetics Group, Hubrecht Institute for Developmental Biology and Stem Cell Research, Uppsalalaan 8, 3584 CT Utrecht, Netherlands. E-mail j.bakkers{at}niob.knaw.nl

Received December 15, 2008; accepted April 15, 2009.

Background— Serious congenital heart defects occur as a result of improper atrioventricular septum (AVS) development during embryogenesis. Despite extensive knowledge of the genetic control of AVS development, few genetic lesions have been identified that are responsible for AVS-associated congenital heart defects.

Methods and Results— We sequenced 32 genes known to be important in AVS development in patients with AVS defects and identified 11 novel coding single-nucleotide polymorphisms that are predicted to impair protein function. We focused on variants identified in the bone morphogenetic protein receptor, ALK2, and subjected 2 identified variants to functional analysis. The coding single-nucleotide polymorphisms R307L and L343P are heterozygous missense substitutions and were each identified in single individuals. The L343P allele had impaired functional activity as measured by in vitro kinase and bone morphogenetic protein-specific transcriptional response assays and dominant-interfering activity in vivo. In vivo analysis of zebrafish embryos injected with ALK2 L343P RNA revealed improper atrioventricular canal formation.

Conclusion— These data identify the dominant-negative allele ALK2 L343P in a patient with AVS defects.

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