Blood flows through a well-organized network of vessels (arteries, veins, and capillaries) to allow proper nutrient
and oxygen exchange throughout the body. In Hereditary Hemorrhagic Telangiectasia (HHT), blood vessel
organization becomes disrupted, resulting in the formation of localized, enlarged direct connections between
arteries and veins (arteriovenous malformations, AVMs) that bypass the normal capillary bed in major organs or
entangled vessels (telangiectasias) at the skin and mucosa. These malformations can rupture and bleed into the
surrounding area, and people with HHT often experience nosebleeds, anemia, stroke, and even death. HHT
occurs in individuals with pathogenic variants of three major components of Transforming growth factor beta
(TGF-β) signaling - Smad-related protein 4 (SMAD4, JP-HHT), Endoglin (ENG, HHT1), or Activin receptor-like
kinase-1 (ALK1, HHT2). While these germline-inactivating mutations are systemic, AVM formation is localized
to major organs such as the brain, lungs, and liver. This leads us to wonder whether focal second hits, such as
random somatic mutations or wounds, could lead to complete loss of function (loss of heterozygosity, LOH) and
initiate AVM formation in a certain area. It was recently shown that some telangiectasias in HHT patients consist
of cells with both mono-allelic and bi-allelic loss, which supports this idea of LOH. This project aims to develop
an HHT mouse model of Smad4 LOH, compare it to previous Smad4 homozygous inducible knockout models,
and explore the role of LOH in AVM formation in HHT. My central hypothesis is that i) the LOH model will
offer a better alternative for studying the impact of second hits on HHT pathology and ii) localized,
mosaic loss of function mutations lead to LOH-ECs influencing surrounding non-LOH ECs to initiate
AVM formation. I will test this through two major aims that: 1) fully compare the Smad4 LOH model to the
previous model and 2) evaluate the influence of Smad4 LOH on nearby cells and overall AVM formation.
Exploring the role of LOH is a novel approach in HHT, as previous studies have focused solely on heterozygous
or complete knockout but were lacking uniform heterozygosity coupled with localized complete loss of function.
This project offers the potential to better represent HHT patients and further explore the pathobiology of this rare
disease. Through this project, I will grow into a more independent scientist by developing my research
communication, collaboration, and problem-solving skills. I will learn how to effectively design experiments,
trouble shoot, and incorporate new, cutting-edge techniques such as spatial transcriptomics. From this training,
I will develop the skills necessary to fulfill my immediate goal of working as a post doctorate in a neurovascular
lab and long-term goal of obtaining a tenure-track position at an academic research institute.