2. Academic Validation
  3. Maternal cholesterol deficiency predisposes congenital heart defects risk

Maternal cholesterol deficiency predisposes congenital heart defects risk

  • Signal Transduct Target Ther. 2025 Nov 12;10(1):366. doi: 10.1038/s41392-025-02463-w.
Yayun Gu # 1 2 3,  Jimiao Gao # 1 2,  Hong Lv # 1 2,  Yan Zhou # 1 2,  Tao Jiang # 1 2,  Jia Guo 1 2,  Wanting Ma 1 2,  Yiwei Cheng 1 2,  Xia Chi 4,  Qi Xi 5,  Kan Ye 6,  Jiangbo Du 1 2,  Jiong Li 1 2,  Cheng Wang 1 2,  Juncheng Dai 1 2,  Hongxia Ma 1 2,  Guangfu Jin 1 2,  Yuan Lin 1 2,  Hongbing Shen 1 2,  Zhibin Hu 7 8 9
Affiliations

Affiliations

  • 1 State Key Laboratory of Reproductive Medicine and offspring health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211100, China.
  • 2 State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, China.
  • 3 Jiangsu Province Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, Jiangsu, 210000, China.
  • 4 Department of Child Health Care, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, 210000, China.
  • 5 Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, Jiangsu, China.
  • 6 Department of Child Health Care, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, Jiangsu, China.
  • 7 State Key Laboratory of Reproductive Medicine and offspring health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211100, China. [email protected].
  • 8 State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, China. [email protected].
  • 9 Jiangsu Province Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing, Jiangsu, 210000, China. [email protected].
  • # Contributed equally.
PMID: 41219186 DOI: 10.1038/s41392-025-02463-w
Abstract

The relationship between maternal Cholesterol deficiency and the risk of congenital heart defects (CHDs) in offspring is not fully understood. In a birth cohort study of 5041 family trios, we found that low maternal Cholesterol levels were significantly associated with an increased risk of CHD, with RRs of 1.52 in the second trimester and 1.73 in the third trimester. To further investigate this link, we treated pregnant mice with cholesterol-lowering agents, namely, ezetimibe or atorvastatin. Both treatments led to a significant increase in the incidence of CHD in offspring. To identify a pathogenic variant that could provide genetic evidence linking Cholesterol synthesis to CHD occurrence and serve as a target for constructing a genetic mouse model, we performed whole-genome Sequencing (WGS) on 103 CHD cases from the birth cohort. We identified a recurrent functional variant in the CYP51A1 gene (c.1147 A > G, p.Ile383Val). We then developed a CYP51I383V knock-in mouse model. This variant disrupted Cholesterol synthesis, resulting in CHD through impaired Hedgehog (Hh) signaling. Most intriguingly, maternal dietary intervention to increase Cholesterol intake effectively reduced the risk of CHD in CYP51I383V mutant offspring. Our study suggests that low maternal Cholesterol during pregnancy increases the risk of CHD in offspring by inhibiting Hh signaling and that maternal Cholesterol supplementation during pregnancy may reduce the occurrence of CHD.

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