ZNF717 or PABPC1 Gene Variants Contribute to Congenital Esophageal Atresia by Interfering with Normal Esophageal Growth

Congenital esophageal atresia (EA) is an abnormality induced by the incomplete differentiation of the foregut in infants, and is frequently accompanied by tracheoesophageal fistula (TEF). Our understanding of the pathogenesis of EA-TEF is limited, additionally, there is still a lack of standard animal or cell models for in vitro EA-TEF investigation. Therefore, we analyzed esophageal tissue samples from 10 children with EA-TEF via Exome sequencing (ES) to identify gene variants. And esophageal organoid units (EOUs) were established as an in vitro model of EA by culturing esophageal tissues from Adriamycin-challenged rats. The ES results indicated 11 mutated genes, including the frameshift variants of ZNF717 and PABPC1. The EA organoids expressed the esophageal marker proteins CK13 and CK4 and showed a significantly slower rate of growth and dysplasia of cell development. In EA organoids, the transcription of SOX2, ZNF717, and PABPC1 was downregulated at varying levels, while NOGGIN transcription was markedly upregulated. Furthermore, when siRNA-ZNF717 or siRNA-PABPC1 was transfected into normal esophageal organoids, the proliferation of esophageal cells was significantly decreased. In conclusion, we found that normal ZNF717 and PABPC1 expressions are essential to the esophageal development, whereas the variant or deficiency of these genes might lead to EA-TEF.