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Insights into KIF11 pathogenesis in microcephaly-lymphedema-chorioretinopathy syndrome from a lymphatic perspective
Kazim Ogmen, Sara E. Dobbins, Rose Yinghan Behncke, Ines Martinez-Corral, Ryan C.S. Brown, Michelle Meier, Sascha Ulferts, Nils Rouven Hansmeier, Ege Sackey, Ahlam Alqahtani, Christina Karapouliou, Dionysios Grigoriadis, Juan C. Del Rey Jimenez, Michael Oberlin, Denise Williams, Arzu Ekici, Kadri Karaer, Steve Jeffery, Peter Mortimer, Kristiana Gordon, Kazuhide S. Okuda, Benjamin M. Hogan, Taija Mäkinen, René Hägerling, Sahar Mansour, Silvia Martin-Almedina, Pia Ostergaard
Kazim Ogmen, Sara E. Dobbins, Rose Yinghan Behncke, Ines Martinez-Corral, Ryan C.S. Brown, Michelle Meier, Sascha Ulferts, Nils Rouven Hansmeier, Ege Sackey, Ahlam Alqahtani, Christina Karapouliou, Dionysios Grigoriadis, Juan C. Del Rey Jimenez, Michael Oberlin, Denise Williams, Arzu Ekici, Kadri Karaer, Steve Jeffery, Peter Mortimer, Kristiana Gordon, Kazuhide S. Okuda, Benjamin M. Hogan, Taija Mäkinen, René Hägerling, Sahar Mansour, Silvia Martin-Almedina, Pia Ostergaard
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Research Article Clinical Research Genetics Vascular biology

Insights into KIF11 pathogenesis in microcephaly-lymphedema-chorioretinopathy syndrome from a lymphatic perspective

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Abstract

Pathogenic variants in kinesin KIF11 underlie microcephaly-lymphedema-chorioretinopathy (MLC) syndrome. Although well known for regulating spindle dynamics ensuring successful cell division, the association of KIF11 (encoding EG5) with development of the lymphatic system and how KIF11 pathogenic variants lead to lymphatic dysfunction and lymphedema remain unknown. Using patient-derived lymphoblastoid cells, we demonstrated that patients with MLC carrying pathogenic stop-gain variants in KIF11 have reduced mRNA and protein levels. Lymphoscintigraphy showed reduced tracer absorption, and intestinal lymphangiectasia was detected in one patient, pointing to impairment of lymphatic function caused by KIF11 haploinsufficiency. We revealed that KIF11 is expressed in early human and mouse development with the lymphatic markers VEGFR3, podoplanin, and PROX1. In zebrafish, single-cell RNA-Seq identified kif11 specifically expressed in endothelial precursors. In human lymphatic endothelial cells, EG5 inhibition with ispinesib reduced VEGFC-driven AKT phosphorylation, migration, and spheroid sprouting. KIF11 knockdown reduced PROX1 and VEGFR3 expression, providing for the first time to our knowledge a link between KIF11 and drivers of lymphangiogenesis and lymphatic identity.

Authors

Kazim Ogmen, Sara E. Dobbins, Rose Yinghan Behncke, Ines Martinez-Corral, Ryan C.S. Brown, Michelle Meier, Sascha Ulferts, Nils Rouven Hansmeier, Ege Sackey, Ahlam Alqahtani, Christina Karapouliou, Dionysios Grigoriadis, Juan C. Del Rey Jimenez, Michael Oberlin, Denise Williams, Arzu Ekici, Kadri Karaer, Steve Jeffery, Peter Mortimer, Kristiana Gordon, Kazuhide S. Okuda, Benjamin M. Hogan, Taija Mäkinen, René Hägerling, Sahar Mansour, Silvia Martin-Almedina, Pia Ostergaard

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Figure 1

Patients with MLC show lymphatic abnormalities.

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Patients with MLC show lymphatic abnormalities.
(A) Photography of lower...
(A) Photography of lower limbs of patients F3-II.1 and F3-II.2 showing asymmetrical lower limb lymphedema. (B–E) Lower limb lymphoscintigraphy 2 hours after injection of radionuclide (technetium-99) was used to image the lymphatic system (anterior view shown here). (B) Bilateral functional aplasia evidenced by no lymphatic drainage in either leg. (C) Significantly reduced function with rerouting in the right limb and functional aplasia of the left. (D) Functional aplasia of the right limb and abnormal tortuous tracts with patchy superficial rerouting on the left. (E) Unaffected patient with symmetrical transport of radionuclide tracer from injection sites in the feet up to the inguinal lymph nodes via main lymphatic vessels. (F) Intestinal biopsy of patient F4-II.1 with KIF11 variant c.2922G>A; p.939_974del. H&E staining shows aberrant morphology of the lacteals; podoplanin (PDPN) detected slightly enlarged lymphatic vessels (arrows). (G) Human duodenum sections derived from same patient as in F and an unaffected control were subjected to immunofluorescence staining. Selected magnifications (framed areas) depict staining for Hoechst (brown; right column, second and fourth images), E-cadherin (yellow; middle column, first and third images), PDPN (magenta; right column, first and third images), CD31 (cyan; middle column, second and fourth images). Scale bars: 100 μm. Immunofluorescence staining revealed significantly reduced lymphatic vessel density compared with healthy control samples based on PDPN-positive area per mm2 tissue area. Two-tailed Student’s t test; **P < 0.01. E is a historical standard taken from authors’ archive: “Methods of Imaging the Lymphatic System” by City St George’s University of London licensed under CC BY-SA-4.0 (59).

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