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Mesenchymal folliculin is required for alveolar development: implications for cystic lung disease in Birt-Hogg-Dubé syndrome
  1. Ling Chu1,2,
  2. Yongfeng Luo2,
  3. Hui Chen2,
  4. Qing Miao2,
  5. Larry Wang2,
  6. Rex Moats2,
  7. Tiansheng Wang1,
  8. John C Kennedy3,
  9. Elizabeth P Henske3,
  10. Wei Shi2
  1. 1 The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  2. 2 The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  3. 3 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Wei Shi, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA; WShi{at}


Background Pulmonary cysts and spontaneous pneumothorax are presented in most patients with Birt-Hogg-Dubé (BHD) syndrome, which is caused by loss of function mutations in the folliculin (FLCN) gene. The pathogenic mechanisms underlying the cystic lung disease in BHD are poorly understood.

Methods Mesenchymal Flcn was specifically deleted in mice or in cultured lung mesenchymal progenitor cells using a Cre/loxP approach. Dynamic changes in lung structure, cellular and molecular phenotypes and signalling were measured by histology, immunofluorescence staining and immunoblotting.

Results Deletion of Flcn in mesoderm-derived mesenchymal cells results in significant reduction of postnatal alveolar growth and subsequent alveolar destruction, leading to cystic lesions. Cell proliferation and alveolar myofibroblast differentiation are inhibited in the Flcn knockout lungs, and expression of the extracellular matrix proteins Col3a1 and elastin are downregulated. Signalling pathways including mTORC1, AMP-activated protein kinase, ERK1/2 and Wnt-β-catenin are differentially affected at different developmental stages. All the above changes have statistical significance (p<0.05).

Conclusions Mesenchymal Flcn is an essential regulator during alveolar development and maintenance, through multiple cellular and molecular mechanisms. The mesenchymal Flcn knockout mouse model provides the first in vivo disease model that may recapitulate the stages of cyst development in human BHD. These findings elucidate the developmental origins and mechanisms of lung disease in BHD.

  • rare lung diseases
  • paediatric lung disaese
  • lung physiology

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  • EPH and WS are joint senior authors.

  • Contributors Concept and design, LC, EPH and WS; acquisition of data: LC, YL, HC, QM, TW, RM and WS; analysis and interpretation: LC, JCK, LW, EPH and WS; drafting of the manuscript: LC, JCK, EPH and WS.

  • Funding The work is funded by National Institute of Health/National Heart, Lung, and Blood Institute grant R01 HL141352-01 (WS).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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