A Rare Mutation in MESP1 Increases the Risk of Congenital Heart Disease

Objective: In this study, we aim to screen MESP1 variants in congenital heart disease (CHD), and explore the biological functions of these variants. Methods: Targeted sequencing was used to screen MESP1 variants in a cohort of patients with CHD and healthy controls from Shandong Province, China, and confirm the variants with Sanger sequencing. Dual-luciferase reporter assay was used to assess the effects of MESP1 variants on the expression of downstream target genes in HEK293T and H9C2 cells. Binding affinity with NKX2-5 between variants and wild-type MESP1 was detected in HEK293T cells using an electrophoretic gel mobility shift assay (EMSA). The teratogenic effects of the MESP1 variants compared to the wild-type were explored with zebrafish embryo microinjection. Results: We identified two rare mutations, namely c.359T>C (p.L120P) and c.526A>T (p.T176S), in MESP1 . The impact of these mutations was investigated using dual-luciferase reporter assay. Our findings demonstrate that compared to the wild-type, the mutation c.359T>C (p.L120P) significantly inhibits the expression of downstream target genes, whereas the mutation c.526A>T (p.T176S) does not exhibit altered activity. Further insights from EMSA revealed that the mutation c.359T>C (p.L120P) displays a reduced binding affinity with NKX2-5 . Notably, our investigation involving zebrafish embryo microinjection unveiled a significant increase in the rate of malformation associated with the mutation c.359T>C (p.L120P). Conclusions: Two rare mutations in MESP1 were identified in the CHD cohort. Our in vitro and in vivo studies showed that MESP1 c.359T>C (p.L120P) is a loss-of-function mutation that may increase the risk of CHD.